Lynn Lifestyle Summary Adair County Tribal Health Assessment 2019 ©Cherokee Nation Health Services
Conducting this study, on request and at the direction of The Cherokee Nation, was The Lynn Institute, an Oklahoma City based nonprofit research institute seeking to improve the health of the communities we serve. Lynn believes in providing a comprehensive summary of an area, a disease condition, or a specific need and then supports the formation of a collaborative to achieve sustainable health and lifestyle changes. All inquiries regarding the contents of this study and the research methodology are welcomed.
Lynn Institute for Healthcare Research, Inc. 3555 Northwest 58th Street, Suite 800, Oklahoma City, OK, 73112, 405.602.3939, www.lynninstitute.org Principal Investigator Angela Cozby, Director of Research and Planning, [email protected] Lynn Lifestyle Summary Adair County Tribal Health Assessment 2019
Adair County Tribal Health Assessment 2019
Table of Contents
Section 1 - Executive Summary Page 1
Section 2 - Research Methodology Page 3
Section 3 - Introducing Adair County Page 7 • History, Assets, and Demographics
Section 4 - Cherokee Counties Quantitative Tables Page 15 • Health Outcomes, Health Behaviors, Economics, Education, Households, and Environment
Section 5 - Qualitative Outcomes Page 25 • General Health Related Public Opinions, Healthcare Accessibility, Individual Health Concerns, Nutrition and Exercise Trends, Individual and Family Well-being
Section 6 - Stilwell Life Expectancy Reporting Page 33 • September 2018 Report Overview, Public Opinion, Outcome Analysis and Clarification
Appendices
Appendix A - References Page 35
Appendix B - Complete Assets List Page 37
Appendix C - Qualitative Instruments Page 57
Appendix D - Tribal Jurisdictions Quantitative Comparisons Page 61
Appendix E - About Lynn Institute Page 95
Appendix F - About the Authors Page 97 ... Executive Summary
The purpose of the Adair County Tribal Assessment 2019 is to communicate the current health conditions and begin development and implementation of a plan to improve the lifestyle quality of Adair County. This assessment provides an objective overview of the health and well-being of Adair County and important findings regarding life expectancy for area residents. Adair County is a community steeped in Cherokee history and pride. Major industries today are manufacturing, healthcare, education, government, and ranching. Since 1949, the county has been affectionately known as “the Strawberry Capital of the World.” The work on this Assessment began in January 2019, included Cherokee Nation Institutional Review Board evaluation and approval, and will be presented fall 2019. The primary objectives of the Assessment are: 1. Review basic demographic factors within Adair County and how they differ from other counties comprising the Cherokee Nation, 2. Review basic lifestyle measurements of Adair County and how they compare to the other 13 counties of the Cherokee Nation, the state of Oklahoma, and other Native American Tribes, 3. Survey, record, and summarize the opinions and concerns of individuals and groups of influence regarding access to healthcare and lifestyle conditions in Adair County, 4. Analyze data to project potential solutions to improve the lifestyle quality of Adair County, and, 5. Determine what, if any, next steps are planned. This may include talking with representatives of the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, author(s) of the Study, and representative(s) of the publishing agency, the National Institute for Health Statistics. The report identified Stilwell, the County seat of Adair County, as having the shortest life expectancy in the United States, 56.3 years.
The Assessment focuses on three fundamental data sets: (1) History & Assets, (2) Quantitative Data, and (3) Qualitative Data. The History and Assets section includes a brief overview of Adair County in relation to the Cherokee Nation, and a comprehensive listing for Adair County. It defines a community rich in history and tradition founded by Cherokee leaders, many of whom weathered the heinous “Trail of Tears.” Among the county’s assets are eight sites listed on the National Register of Historical Sites, 197 businesses, 90 nonprofit organizations, and 33 churches.
The quantitative data measures Health Behaviors, Health Outcomes, Economics, Education, Crime, Households, and the Environment. The Cherokee Nation is invested in the well-being of the entire population, therefore data is presented by county and not by tribal jurisdiction. For all its physical grandeur and strength of its heritage, Adair County lifestyle quality is less than ideal. The most current statistics available (as of this publishing) from multiple government and private sources were utilized for the quantitative sections.
The data sets reveal concerning health and economic factors.
• Adair County yields higher rates than the state of Oklahoma in most adverse health behaviors presented and in all subsequent health outcomes presented, • Adair County diabetes rate is 44% higher than the state and 58% higher than the nation, • Adair County obesity rate is 29% higher than the state and 37% higher than the nation, • The teen birth rate is 50% higher than the state teen birth rate, • The infant mortality rate is 40% higher than the state, • Native children are living in poverty at a rate of 45%, and, • Persons living in poverty percentage is 42% higher than the state.
1 The qualitative data includes conducting and analyzing interviews with 41 influence leaders. Additionally, the qualitative research included a sampling of public opinion with more than 400 online survey participants. The qualitative participants were eager to share their thoughts with respect to the community and offer a positive outlook for a healthier future.
Significant comments from the qualitative research include: • In general, residents do not believe Adair County is a physically or mentally healthy community, • Poor health outcomes are attributed to poverty, substance abuse, poor food choices, lack of physical activity, and a general lack of resources across the county, • The population is most concerned with diabetes, cancer, and heart disease, • Cost and time constraints impede healthy eating habits, as does the abundance of unhealthy food choices, • Walking is the physical activity of choice among residents, • Families spend time together at sporting events and family events eating unhealthy foods, • Residents strongly support having a fitness center in the county, and • The delivery of quality care, wait times, and availability of healthcare professionals at local clinics are barriers to receiving acute and preventative health care.
The Adair County Tribal Assessment 2019 reflects a population who endures difficult health situations, and yet express optimism regarding their love of their community and the work of the Cherokee Nation. The data accurately suggests complexity in trying to resolve many of the health, behavioral, and lifestyle issues.
One of the most critical common denominators within Adair County is poverty. This overarching issue negatively affects all social determinants of health for residents and the economy across the county.
However, Adair County’s strong founding principles of hard work, bravery, and commitment to heritage, is ever present. It is the people of Adair County who should be considered the county’s greatest asset, and its key to improving the health of current and future generations.
It is Lynn's recommendation this Adair County Assessment 2019 be carefully studied and a commitment to a 10-year community health improvement plan, which includes measurable and evidenced based goals, objectives and action steps, be developed and implemented to achieve sustainable improvement in health and lifestyle quality.
The Lynn Institute is honored to have had the opportunity to prepare this assessment for the Cherokee Nation. The Cherokee Nation Public Health Team has been instrumental in facilitating this work and each member of the Public Health Team has demonstrated the highest level of professionalism and heartfelt concern for this deep-rooted and spirited community.
2 Research Methodology
LYNN HEALTHY COMMUNITY PLANS
The foundation of Lynn Lifestyle Summaries is comprehensive research designed to profile an overall situation through the compilation and evaluation of (1) Community assets, (2) Unique health/environmental conditions specific to particular groups, neighborhoods, or disease specific situations, and (3) Opinion and values explaining behaviors and lifestyle conditions.
QUALITATIVE RESEARCH DESIGN
The Lynn Institute prepared, conducted and analyzed all qualitative data for inclusion in this work. The qualitative data collected provided insight into the issues of the current target population, Adair County. In accordance with outcome specifications from Cherokee Nation Public Health Leadership, questions were developed from tested verbiage used in over 400 previous Lynn qualitative sessions, with a high majority of solicited responses yielding the information needed to explain community issues and ultimately create community health improvement plans. Adair County Tribal Assessment qualitative research segments were developed with specific objectives and goals in the areas of public health opinions, healthcare accessibility, individual health concerns, and family well-being. The objectives and goals of qualitative research are:
• Objective: Identify public perception regarding the health of the community.
• Goal: Understand and respond to health-related public opinion.
• Objective: Identify the accessibility of healthcare and health education.
• Goal: Ensure convenient/efficient access and usability of healthcare services and resources.
• Objective: Identify general health concerns and needs.
• Goal: Improve the overall health of the community by providing population specific support, services and education.
• Objective: Identify nutrition and exercise trends within the community.
• Goal: Develop programs to promote healthy lifestyles.
• Objective: Identify individual/family well-being concerns and needs.
• Goal: Improve family stability and individual well-being through support and services.
SAMPLING PROCEDURES
Researchers used non-probability sampling defined by the characteristics of the target population with participants selected in relation to the objectives of the research project. Interview participants were selected due to their expertise in health and/or general knowledge of residents and resources. Survey participants were chosen based on their Adair County residency. The privacy of all individual subjects has been protected. No records or data have been or will be reported which will identify qualitative research participants.
3 KEY INFORMANT SEMI-STRUCTURED INTERVIEWS
Lynn Researchers conducted semi-structured interviews with 41 Key Informants as identified by Cherokee Nation Public Health Leadership based upon the informant’s Adair County community involvement, community health knowledge, and/or affiliation with the Cherokee Nation. The majority of semi-structured interviews were held in-person and in a formal setting. Some participants were only available via phone and such collection procedures did not compromise the quality of the data. Responses were coded by common themes and then analyzed to yield a quantitative statement. Researchers accepted “I don’t know” responses because follow-up information regarding the questions could influence the respondents to answer according to their perception of the researcher’s desired result. Incomplete responses were a result of time constraints during sessions.
KEY INFORMANT DEMOGRAPHICS
Gender
Female Male Total Respondents 48.78% 51.22% 41
Age
18-24 25-34 35-44 45-54 55-64 Over 65 Total Respondents 0% 21.95% 17.07% 29.27% 17.07% 14.63% 41
Race
Native American Caucasian Total Respondents 53.66% 46.34% 41
Are you a member of the Cherokee Nation?
Yes No Total Respondents 43.90% 56.10% 41
Duration of residency/employment in the area
0-5 Years 5-10 Years 10-25 Years Over 25 Years Total Respondents 12.20% 2.44% 12.20% 85.37% 41
Home Zip Code
74135 74441 74457 74464 74467 74931 74960 74965 Total Respondents 2.44% 4.88% 2.44% 7.32% 2.44% 4.88% 53.66% 21.95% 41
Occupation
Elected Official/ Community Health Education Finance Faith Media Total Responses City Services Services 26.83% 19.51% 21.95% 7.32% 4.88% 17.07% 2.44% 41
4 ADAIR COUNTY RESIDENT SURVEYS
Adair County Resident Surveys were primarily collected online, with a portion conducted in-person at the 2019 Strawberry Festival by Cherokee Nation Public Health staff. Survey participants were randomly selected because of their involvement in Cherokee Nation services or their prospective need for social services provided by the Cherokee Nation. Adair County residents were recruited for participation in the online survey through various Cherokee communication channels including targeted social media postings. The Adair County Resident Survey has been interpreted through the online application with the quantitative statements verified by the Lynn principal investigator.
RESIDENT SURVEY DEMOGRAPHICS
Gender
Female Male Total Responses 78.21% 21.79% 491
Age
18-24 25-34 35-44 45-54 55-64 Over 65 Total Responses 5.91% 20.16% 26.68% 24.85% 16.50% 5.91% 491
Race
Native American Caucasian Other Total Responses 83.33% 15.04% 1.63% 492
Are you a member of the Cherokee Nation?
Yes No Total Responses 81.06% 18.94% 491
How long have you lived in the area?
0-5 Years 5-10 Years 10-25 Years Over 25 Years Total Responses 4.69% 3.27% 18.37% 73.67% 490
Home Zip Code
74960 74464 74965 74931 74457 Total Responses 73.70% 5.64% 16.28% 3.76% 0.63% 479
Occupation Self-employed/ Office Service Cherokee Nation Security Student Finance Professional Administration and Retail 3.74% 6.61% 11.01% 1.98% 1.10% 5.95% 2.86%
Stay at Family Production, Home Total Health Disabled Education Retired and Social Food Unemployed Factory, Care- Responses Services and Labor giver 17.84% 6.39% 16.96% 5.95% 4.19% 3.30% 3.08% 1.54% 7.49% 454
5 QUANTITATIVE COLLECTION
Lynn Quantitative Research highlights statistical data from secondary sources – such as city, county, and state health departments, the Centers for Disease Control and Prevention, and U.S. Census Bureau to provide the base of the quantitative demographic data and a consistent, comparable reference set. The process of determining reputable, accurate, academic level sources for Lynn Research involved detailed steps based on a literature search and subsequent tracking of over 1,000 references. Analysis is then conducted by comparing data to like geographic or demographic data elements, wherever data is available or where calculated. Differences were noted as positive or negative and the most telling data elements summarized. All quantitative data sources have been cited in this report. Where applicable, quantitative data will be further explicated with use of academic level publications from sources previously vetted by Lynn Researchers.
6 Introducing Adair County
Adair County is one of 14 counties comprising the Cherokee Nation lands in northeastern Oklahoma. It is 577 square miles, has a population of approximately 22,000, is bordered by US Highway 412 and the state of Arkansas to the east, to the north is Delaware County, and to the south is Sequoyah County. Oklahoma Highways 59, a north-south road, and 62, an east-west route, intersect at Westville. Other east-west routes include State Highways 51 and 100.1 Adair County has five zip codes: 74457, 74931, 74960, 74964, 74965.2 Primary industries of the county include manufacturing, healthcare, ranching, government, and education. The vocational interests are supported and grow through the efforts of many, including the Indian Capital Technology Center – Stilwell which awarded 82 degrees in 2016.3 The Stilwell Strawberry Festival, which began in 1948 and gives acclaim to Oklahoma Governor Roy Turner, who in 1949, heralded Stilwell as the Strawberry Capital of the World.4
The story of Adair County isn’t about land measurements, industry, the population counts or fruits and festivals. The story of Adair County is one of resiliency and the tenacity of a people steeped in pride and heritage who will “never give up.”5
Adair County is in the heart of Oklahoma’s Green Country, distinctively marked by rolling hills, rushing rivers, tall trees, and blue skies. Stilwell is the county seat and home to Adair Park, formerly Adair State Park, which is adjacent to the county fairgrounds. Adair County is part of the Ozark Plateau uplift, which comprises the tree-covered foothills of the Boston Mountains. The north and central portions of Adair County are drained by the Illinois River and by Baron Fork, Evansville and Caney creeks. The first whites to live in the region were Creole trapper/traders and white pioneers who moved into the into the area after 1812. In 1825, the Osage sold the land that is now Adair County to the United States, and by 1828, the Western Cherokee had arrived from Arkansas. The Eastern Cherokee were forcibly removed from Georgia, Tennessee, and North Carolina in the 1830s. By 1900, whites outnumbered Cherokees in their nation and by 1910, the white population doubled Native Americans in Adair County.6
In 1906, at the Oklahoma Constitutional Convention, Adair County was created from the Goingsnake and Flint districts of the Cherokee Nation. The county was named in honor of the influential Cherokee family founded by William Penn Adair. He was described as being magnetic, logical and frankly agreeable, the ablest and most brilliant of all Cherokees. Adair served the Cherokees in the Confederate Army as colonel, senator, justice of the Cherokee Supreme Court, delegate to Washington D.C. and an assistant principal chief. Admired by generations of Cherokees, there were many Cherokee men named after him in the late 19th century, including the celebrated Cherokee humorist William Penn Adair Rogers - better known as Will Rogers.7
The county’s population numbers over the last 100 years reflect the ups and downs and volatility of the state and national economy. The county’s original strength was tied to the growth of the railroad industry, specifically to the Kansas City Southern Railway, which established the town of Stilwell. Preliminary plans had envisioned a railroad from Kansas City, Missouri, through western Arkansas to the Gulf of Mexico. The difficulty of laying tracks across the Boston Mountains influenced railroad owner Arthur Stilwell to reroute his line through Indian Territory. As the importance of the railroad declined in America, the people of Adair County struggled to find an economic replacement.8
Source: World Pop. Review
7 The county seat for Adair County is Stilwell but that wasn’t always the case. For almost a decade, from 1897 to 1906, Westville and Stilwell fought over which would be the county seat and Westville won the battle. However, in 1910, the county seat was moved to Stilwell, reflecting the change in the railroad’s path as well as responding to political influences.9 Today, Adair County has 21 communities and 3 incorporated cities (asterisk indicates incorporated city):
Community Population Community Population Community Population
Bell 528 Lyons Switch 284 Salem 111
Bunch 1,183 Maryetta 105 Stilwell* 3,782
Cherry Tree 870 Mulberry 136 Titanic 351
Chewey 134 Old Green 296 Watts* 323
Christie 216 Peavine 417 Wauhillau 340
Elm Grove 195 Piney 113 West Peavine 217
Fairfield 570 Proctor 228 Westville* 1,634
Greasy 360 Rocky Mountain 413 Zion 41
Source: Hometown Locator
Adair County’s history mirrors the lives of the Cherokee Nation. In the early 1900s, Cherokees worked to rebuild their lives while still reeling from their grandparents’ and parents’ Trail of Tears march, as well as broken treaties, unkept promises, droughts, and poverty. Adair County was the site of multiple dramatic situations including a mass shooting on April 15, 1872. The Going Snake Massacre occurred during a trial in the Cherokee court system in which eight of the marshal’s posse and three Cherokee citizens died.10 As laws changed and formalized discrimination changed in America, the Cherokees built a new community and created a noble future for the next generation. Within the community, there are now eight structures, buildings, and historic sites which are listed on the National Register of Historic Sites: Source: Smithsonian Institution
1. Adair County Courthouse - constructed in 1930, a classically-inspired art deco building featuring sunbursts and scrolls.
2. Ballard Creek Roadbed - the remnant of a nineteenth century wagon road along Ballard Creek in far Eastern Adair County, associated with the arrival and resettlement of the Cherokees in Oklahoma at the end of their Trail of Tears (near Westville).
3. Breadtown - food was delivered here, intended to sustain the Cherokees their first year in Indian Territory after completing the Trail of Tears, located near the Ballard Creek Roadbed adjacent to Westville.
4. Buffington Hotel - a brick building estimated to be built around 1910 in Westville featuring an array of round-arch windows on the east and south facades.
8 5. Rev. Jesse Bushyhead Grave - Bushyhead was an important Cherokee religious and political leader of the early 19th Century. He led one of the detachments west to Indian Territory during Cherokee removal and later helped to bring opposing factions together to create the Cherokee Nation. His grave, the only surviving property directly associated with his productive life, is located in the Baptist Mission Cemetery and is marked by a fifteen-foot-tall marble obelisk crowned with an urn.
6. Golda’s Mill - constructed by Dr. Nicholas Bitting around 1882 and utilized until 1983. It featured an overshot water wheel, 20 feet in diameter. The original wooden wheel was replaced in 1908 by a steel wheel.
7. KCS Railway Depot - between 1890-97 Arthur E. Stilwell, owner of the Kansas City, Pittsburg and Gulf Railroad, built a rail line connecting Kansas City, Missouri and the Gulf of Mexico. The section that would be the Stilwell town site was completed between 1893-94. The town, named for the railroad’s owner, was incorporated January 2, 1897. The railroad was renamed the Kansas City Southern Railway in 1900. The present brick depot building was built in 1915 after fire destroyed buildings along Front Street, which faced the railroad.
8. Opera Block - a brick building located in Westville and built 1911-1912, it was used for multiple purposes through its existence including commercial, government, and entertainment functions. It once served as City Hall during which time the second floor was configured as an opera house auditorium.11
Ballard Creek Roadbed Golda’s Mill KCS Railway Depot Source: National Register Source: Oklahoma Historical Society Source: National Register of Historic Places State Historic Preservation Office of Historic Places
The list of notable Cherokees and those who have built Adair County are abundant. A few of these include: The two Principal Chiefs of the Cherokee Nation, one in Indian Territory serving from 1895-1899, Samuel Mayes, and the other, Wilma Mankiller, the Nation’s first female chief serving from 1985-1995. Mankiller was born in Tahlequah November 18, 1945 and died in Adair County in 2010. She remained an advocate for Native-American and women’s rights until her death.12
Adair County is built on a foundation of its ancestors who endured heinous atrocities and overcame them time and time again. It is a legacy of strong people made stronger by the challenges they faced. Today’s Adair County residents carry forward the strength and character exemplified by their ancestors. Just as their grandparents did, they enjoy the scenic environment, rich community relationships, access to a broad range of healthcare services, and comprehensive educational experiences through local schools.
However, the current population of Adair County endures chronic health issues, high percentages of diabetes and obesity, extreme poverty, and limited resources to support healthy lifestyles. As a result of these and many other factors, Stilwell, Oklahoma was identified in a 2018 research study as having the shortest life expectancy in the United States: 56.3 years. Source: USA Today
9 While there is strong reason to believe the data collection/assessment is concerning, the fact remains that the citizens of Adair County, in almost all health areas, remain below state and national averages.
Amidst concerning health trends, it is still the people who are the greatest assets of Adair county. From generation to generation they have overcome adversity, challenges and oppression with grit and tenacity.
The state’s largest newspaper described the Cherokee Nation this way, “Despite their hardships, the Cherokees hold a fierce grip to traditions that embrace and ensure the best of life’s possibilities - devotion to family, duty and friends, freedom from hunger and tyranny, enrichment of the mind through education, and of the soul through toil, maintaining and nourishing spirituality, and straight, honest dealings with others.”13
Perhaps the words of Wilma Mankiller best describe the resiliency of Adair County, “The secret of our success is that we never, never give up.”14
ADAIR COUNTY SUMMARY OF ASSETS Information was accessed July 10, 2019 from a marketing database. Total: 663 Asset No. Asset No.
Animal Care & Services 3 Government 59 Businesses 197 Healthcare and Behavioral Health: Churches 32 64 • Doctors, Dentists, PAs, RNs, etc. 55 Education: Schools & Libraries 34 • Behavioral Health Counselors 9 Entertainment 1 and Clinics
Emergency Services 15 Miscellaneous 35 Childcare 4 Nonprofit 99 Food & Beverage: 47 Parks, Rec., Fitness 5 • Convenience & Gas Stations 18 Services, Shops, Stores 52 • Grocery Stores 3 Transportation 5 • Restaurants & Fast Food 22 • Alcohol & Tobacco 4 Medical Marijuana Dispensaries 11
Clinic Clinicians
Stilwell Memorial Hospital Physicians 13, APRN 5, CRNA 1, PAC, 1 Wilma P Mankiller Health Center Physicians 5, DDS 3, RNs 9, PAs 2, APRN 5 Brunk Optometry OD 1 Chad A Catron P C DDS 1 Family Dentistry DDS 1 Mathew L Freeman PAC 1 Dr. Jimmie Taylor MD 1 Late Night Chiropractic Chiro 1 Westville Family medical MD 2 Stillwell health Pharmacy RPh 2 Walmart Pharmacy Only Pharmacist ever at the store Westville Prescription Center RPh 1
10 DESCRIPTION OF ASSET TYPES
Asset Type Asset # of Entities Animal Care & Services
Veterinary Clinics 3 Stilwell
Businesses
Accountants 13 Stilwell
Attorneys 5 Stilwell
17 Automotive Dealers & Repair Services (1 Colcord, 10 Stilwell, 2 Watts, 4 Westville)
Bail Bonds 3 Stilwell
6 Banks & Credit Unions (4 Stilwell, 2 Westville)
Consultants 2 Stilwell
12 Construction Contractors (9 Stilwell, 1 Bunch, 2 Westville)
3 Electric Services (2 Stilwell, 1 Westville)
12 Farms & Farm Equipment (4 Stilwell, 2 Watts, 6 Westville)
Gas & Oil Services 6 Stilwell
3 Heating & Air (2 Stilwell, 1 Westville)
Insurance Services 9 Stilwell
Landscaping 2 Stilwell
19 Manufacturing (12 Stilwell, 4 Watts, 3 Westville)
4 Plumbing Contractors (2 Stilwell, 2 Westville)
55 Retail Businesses (41 Stilwell, 3 Watts, 11 Westville)
10 Wholesalers (5 Stilwell, 2 Watts, 3 Westville)
Wildlife Services 1 Stilwell
Churches
32 (24 Stilwell, 1 Bunch, 4 Watts, 4 Westville)
11 Education & Libraries 31 Schools (21 Stilwell, 3 Bunch, 3 Watts, 4 Westville) 2 Libraries (1 Stilwell, 1 Westville) Entertainment
Casinos 1 Watts
Emergency Services
15 Fire Departments, Police, Sheriff, (8 Fire Depts., 4 Police, Sheriff, Emergency Healthcare 3 EMS, Hospital Emergency)
Family & Child
Child Care Services: My Other Mother’s Daycare, United 4 Stilwell Keetoowah Band, Nanna’s Day Care, Tiny Tots Day Care
Food & Beverage 43 18 Convenience Stores and Gas Stations (12 Stilwell, 1 Oaks, 1 Watts, 5 Westville)
Grocery Store 3 Stilwell
22 Restaurants & Fast Food (15 Stilwell, 4 Watts, 3 Westville) Government
City, Village, Municipality, County, Native 21 American, State, Federal
Healthcare 62
Clinics, Practitioners, Hospitals 56
Mental Health Counselors 6
Miscellaneous
Abstractors & Title Companies 3 Stilwell
Apartments 10 Stilwell
Cemeteries 4 - 100 plus*
Non-Classified Establishments 17 Stilwell
Coin & Bill Services 1 Stilwell
Nonprofit Organizations Children & Youth, Homeless, Historical, 99** Social Services Parks, Rec., Fitness, Trails
Park, Fitness Center 4 Stilwell
12 Services, Shops, Stores 8 Beauty Services (6 Stilwell, 1 Watts, 1 Westville) 3 Carpet Cleaning Services (2 Stilwell, 1 Watts)
Coin star 1 Stilwell
Demolition & Excavation Services 1 Stilwell
Employment Services 2 Stilwell
8 Financial Services & Investment Services (7 Stilwell, 1 Watts)
3 Funeral Services (2 Stilwell, 1 Westville)
Hunting Services 3 Stilwell
Leather Dealers & Leather Repair 1 Westville
Pest Control Services 1 Watts
10 Repair Services (9 Stilwell, 1 Westville)
Sanitary & Landfill Services 1 Stilwell
Senior Citizen Services: Nursing Homes 5 Nutrition Centers, Residential Care (3 Stilwell, 1 Watts, 1 Westville)
4 Storage Facilities (2 Stilwell, 1 Watts, 1 Westville)
4 Alcohol & Tobacco (3 Stilwell, 1 Westville)
11 Medical Marijuana Dispensaries (5 Stilwell, 2 Watts, 4 Westville)
Transportation
5 Trucking Services (1 Stilwell, 2 Watts, 2 Westville)
* Chamber of Commerce and funeral directors confirmed that there were over 100 cemeteries in Adair County. However, only 4 are listed in public directories. ** The list of Nonprofits was obtained from www.taxexemptworld.com. Inquiries need to be made on a routine basis to determine if these nonprofits are still viable.
Adair County Demographics
Total Population: 22,082 Female: 50.1% Median Age: 37.2 Median Household Income: $33,366 25 or older high school graduates: 79.4% 25 or older bachelor’s degree or higher: 13.6%
13 Ages Adair
% Under 5 7.4
% Under 18 26.6
% Over 65 15.9
Adair County Adair
% Caucasian Alone 42.3
% African American 0.6
% Native American 45.7
% Two or More Races 10.6
% Hispanic or Latino 6.8
Family Type Owner-Occupied Housing Units Renter-Occupied Housing Units
% With Related Children of Householder Under 18 29.3 47.5
% With Own Children of Householder under 18 23.1 41
% No Own Children of Householder 6.2 6.5
% No Related Children of Householder 70.7 52.5
Family Household Owner-Occupied Housing Units Renter-Occupied Housing Units
% Married Couple Family 59.6 36.6
% Male Householder – No Wife 4.9 8.5
% Female Householder – No Husband 12.2 24.8
Occupations Civilians Employed Over Age 16
Management, Business, Science, and Arts 1,940
Service 1,427
Sales and Office 1,579
Natural Resources, Construction, and Maintenance 1,135
Production, Transportation, and Material Moving 2,049
Total 8,130
Source: U.S. Census Bureau Fact Finder & Quick Facts
14 Cherokee Counties Quantitative Tables
HEALTH OUTCOMES Chronic Disease Mortality As defined by the Centers for Disease Control, cardiovascular disease encompasses many heart conditions including heart attacks and coronary artery disease. Cardiovascular disease is the number one killer of Americans with a rate of 198.8 per 100,000. The Adair County rate is 336.3 per 100,000, much higher than the national average and the Oklahoma rate of 297.8 per 100,000.1 All counties exhibit rates higher than the national rate with Craig County being double the national rate at 421.5. Hypertension and diabetes are contributing factors to cardiovascular mortality. The Adair County hypertension percentage is 45.9%, 18% higher than the state average of 37.7%. The prevalence of diabetes in Adair County is higher than all comparison counties, the state, and the nation. Compared to all races, Native Americans are twice as likely to suffer from diabetes than non-Hispanic whites. Education level impacts the prevalence of adult diabetes. Those with less than a high school education are diagnosed at a rate of 12.6% versus 9.5% for those with a high school education and 7.2% for those who seek higher education.2 Chronic lower respiratory disease is the fourth leading cause of death among Americans and can be caused by smoking, second-hand smoke, genetics, and environmental issues.3 Adair County ranks third among the comparisons for COPD/emphysema/chronic bronchitis prevalence.
The cancer death rate in Rogers County is lower than all comparisons including the state. The Adair County cancer death rate ranks seventh among the 14 total Cherokee counties.
Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Cardiovascular Disease Age-Adjusted Death Rate per 336.3 312.5 421.5 293.2 320.6 417.8 401.1 265.7 413.8 337.4 328.7 305.8 257.1 312.5 297.8 100,000
Hypertension Prevalence % 45.9 39 48.9 47 36 47.3 40.4 44.4 37 36.7 49.5 35.6 41 46.1 37.7
Diabetes Prevalence % 22.5 18.4 12.2 15.5 11.1 13.1 13.8 16.5 17 12.8 19.5 12 14.1 14.9 12.7
COPD/Emphysema/Chronic 11.8 7.6 10.7 11.4 10.2 11 10.5 13.5 10.8 7.2 14.4 6.6 7.4 5.5 8.6 Bronchitis Prevalence %
Cancer Age-Adjusted Death 192.1 192.4 198.6 169.4 197.7 173.5 211.1 188.3 217.9 155.3 227.9 170.9 137.5 176.1 177.2 Rate per 100,000
Source: OK State Department of Health Wellness County Profile 2019
Unintentional Deaths The Adair County unintentional death rate is 14% higher than the rate of Oklahoma Sate. Unintentional injury deaths rank third among U.S. leading causes of death. The primary unintentional injuries are poisoning, transportation related, and unintentional falls.4 Unintentional injury is the leading cause of death for infants, children, and adolescents. Respectively, the primary cause of death for ages 0 to 1 is suffocation, the leading fatal injury for ages 1 to 4 is drowning, and motor vehicle accidents are the main cause of death for ages 5 to 19.5 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Unintentional Death Rate per 70.1 63.3 84.2 76.2 72 88.2 71.7 82.4 65.7 47.2 62.6 50.7 52.1 47.8 60.4 100,000 Population
Transportation Related Deaths 26.7 21 29.1 36 26.2 26.2 24.5 47.1 21 16.3 19.6 14.3 15 13.2 19.5
Source: OK State Department of Health State of the County 2017 15 HEALTH BEHAVIORS
Health behaviors are deliberate or unintentional activities that may positively or negatively impact an individual’s health. Examples of health behaviors include, physical activity, sleep, diet, and substance abuse. Health behaviors are “dynamic, varying over the lifespan, across cohorts, across settings, and over time.” Recent reports have shown that health behaviors are not simply an execution of free will but rather often times determined in concert with social determinants of health such as education, access to resources, and socioeconomic status.6
Mental Health Suicide mortality is highest in Cherokee County, while Adair County and Nowata County have the lowest incidences of suicide mortality. Native Americans exhibit the second highest suicide rate by race within Oklahoma.7 Since 2007, suicide rates in rural areas have steadily surpassed rates in urban areas. The highest rates in metropolitan areas belong to White Non-Hispanics and the highest suicide rates in rural areas belong to Native Americans. Rates are highest among males in both rural and urban settings and overall 60% of deaths occur by firearm. Contributing factors to suicide include history of mental illness, lack of social support, hopelessness, stressful events, and having access to a mortal method.8 Qualitative participants frequently discussed the need for increased mental health awareness and treatments within Adair County. Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Suicide Mortality / 6.9 24.2 20.3 23.4 23.7 21.5 18.7 6.9 23.7 17.7 19.6 19.2 19.1 17.3 18.5 100,000
Mental Illness Hospital Inpatient Cost 2014 $3.1 mil $3.1 mil $3.1 $2.1 mil $2.1 $48 mil $4.1 mil $4.1 $3.7 mil $3.7 $7.8 mil $7.8 $8.7 mil $8.7 $3.5 mil $3.8 mil $2.8 mil $2.8 mil $382 mil $449.141 $788,476.
Source: OK State Department of Health State of the County’s Health Report 2017
Obesity Adair County has the highest obesity rate of all comparisons. Obesity occurs when a person’s body weight due to extra body fat is greater than the defined healthy weight for a particular height. Many factors can contribute to weight gain including medical conditions, inactivity, genetics, eating habits, and access to environments that promote healthy lifestyles. Obesity is ultimately caused by consuming more calories from food and beverages than your body utilizes for daily physical activity. An estimated 1 in 3 adults are obese and an estimated 1 in 6 children. Obesity can lead to diabetes, heart disease, certain cancers, kidney disease, and ultimately reduces life.9 Not only is the condition life threatening, it creates an economic burden on communities. The direct costs of obesity are related to health services while the indirect costs are defined as resources forgone. Obese employees miss more days from work than their non-obese counterparts, costing the employee lost wages and the employer overall productivity. In addition, higher insurance premiums and higher workers’ compensation are paid for obese employees.10 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Obesity Prevalence % 51.3 38.5 38.5 41.6 38.9 40.1 44 42.5 40.5 35.5 36.2 34 36.8 40.1 36.5 Source: OK State Department of Health Wellness County Profile 2019
16 Physical Activity According to the U.S. Department of Health and Human Services, to achieve significant health benefits, adults ages 18-64 should engage in at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week. Adolescents and children should engage in at least 60 minutes of activity daily, most of which should be either moderate or vigorous-intensity.11 Physical activity not only reduces the risk of many of the chronic diseases exhibited by the population of Adair County, but physical activity has been proven to better overall mental health by reducing stress, depression, and anxiety while improving cognitive abilities and self-esteem.12 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Physical Activity Prevalence % 66.7 67.4 54.2 59.4 62.8 63 66.5 67.4 65.6 70.4 55.8 69.2 68.6 66.5 67.6 (any/last 30 days)
Source: OK State Department of Health Wellness County Profile 2019
Nutrition The recommended total amount of calories per day for adult women is 1,600-2,400 and 2,000-3,000 for adult men. Calorie levels should be maintained through healthy eating patterns consisting of vegetable varieties, fruit, grains, fat- free/low-fat dairy, protein, and oils. Depending on the calorie level of an individual’s eating pattern, the recommended serving of daily vegetables is 2-4 cups and 1.5-2.5 cups of fruit. Adair County has the highest population eating less than one serving of fruit per day of all the comparison counties and the state. A diet rich in nutrients can protect the body from chronic diseases such as type 2 diabetes. The 2015-2020 Dietary Guidelines for Americans states specific principles that can be individualized to satiate diverse tastes and different lifestyles such as: • Follow a healthy eating patterns across the lifespan, • Focus on variety, nutrient density and amount, • Limit calories from added sugars and saturated fats and reduce sodium intake, • Shift to healthier food and beverage choices, and • Support healthy eating patterns for all.
Everyone has a role in helping to create and support healthy eating patterns in their home, school, work, and communities.13 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Minimal Vegetable Consump- tion Prevalence % (less than 1 15.9 22.4 17.8 18 18.1 15.2 21.4 26 18.9 17.3 18.8 16.2 15 12.8 17.1 serving per day)
Minimal Fruit Consumption Prevalence % (less than 1 serv- 53.4 42.6 51.8 48.6 51.4 50.7 51 51.5 52.9 46.7 45.2 43.6 45.4 42.3 45.8 ing per day) Source: OK State Department of Health Wellness County Profile 2019
Smoking & Alcohol Abuse Tobacco use remains the leading cause of preventable death worldwide. The smoking habits among the Adair County population is slightly higher than the state percentage. Any segment of the population that smokes detrimentally impacts the overall health of the community. The life ending diseases caused by smoking include heart disease, stroke, COPD, cancer, and diabetes - all deadly chronic diseases already rampant among the study population. Smokers tend to die ten years earlier than people who do not smoke. Nowata has the highest percentage of smokers at 34.55%, a number more closely related to the US smoking rate in 1965 (42.4%) than the current US smoking rate of 14%.14 Native Americans exhibit the highest percentage, 16.7%, of women who smoke during pregnancy.15
17 The USDA recommends alcohol be consumed in moderation and specifically limited to one drink per day for women and up to two drinks per day for men.16 The CDC defines binge drinking as consumption that yields a blood alcohol concentration of .08% or higher. Binge drinking is associated with potentially deadly infant conditions, violence including homicide, chronic diseases, addiction, and unintentional injuries.17 McIntosh County has the highest percentage of adults that engage in binge drinking. Among Oklahoma high school students, 15% drank alcohol before the age of thirteen and this number was highest for Native Americans and Hispanic males.18 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Smoking Prevalence % 23 18.9 15.5 24.9 23.3 26.5 23.8 34.5 18.1 19.9 31.3 17.1 20.3 21.6 20.1
% of Adults that Binge Drink 9.8 11.1 9.3 8.8 9.4 16.6 11.7 8.9 9.1 10.9 11 13.9 10.8 11.3 11.6
Source: OK State Department of Health Wellness County Profile 2019 & OK State Department of Health State of the County’s Health Report 2017
Maternal & Child Health
The Adair County teen birth rate is nearly double the rate of Oklahoma and higher than all of the comparison counties. In 2017, the National Center for Health Statistics reported that among all races and ethnicities, the teen birth rate of Native Americans was the highest.19 Children of teenage mothers are more likely to: • Have a low birth rate, • Have a greater risk of perinatal death, • Live in poverty, • Experience abuse and neglect, • Exhibit lower academic achievement later on, and • Have a greater probability of starting a family at a young age.20
The low birth rate percentage for babies born in Adair County is lower than the state percentage and the national percentage of 8%.21 However, the infant mortality rate in Adair County surpasses all comparison counties, Oklahoma, and the US rate of 5.8 per 1,000 live births.22 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
2017 Teen Birth Rate per 1,000 72.1 24.2 26.1 39.9 35.4 40.6 37 49.7 42.9 20.7 48.9 33* 25* 30.6* 36.2* Ages 15-19
2017 Teen Birth Rate per 1,000 14.7 12.8 22.1 12.3 7 N/A 11.8 39 17.3 3.1 20.6 12 4.8 6.2 12.4 Ages 15-17
2016 Low Birthweight % Under 7 4.4 5.7 7 8.1 7.1 6.7 N/A 5.9 6.4 6.5 6.5 7.3 7.3 6.5 5 1/2 lbs.
Infant Mortality Rate / 1000 12.4 8.5 N/A* 4.8 8.4 10.4 7.7 N/A N/A 7.2 5.8 7.3 7.8 6 7.4 Live Births
Source: The Annie E. Casey Foundation & OK State Department of Health State of the County’s Health Report 2017 *2016 Data. NA - Could not be computed due to low number of infant deaths.
Adair County confirmed cases of child abuse and neglect is 20.3 per 1,000. Child welfare workers turn to family first for immediate emergency care of at-risk children and a growing number of children are living with grandparents. In Adair County, 9.1% of children are cared for by grandparents. Children being cared for by grandparents is typically a result of incarceration, substance abuse, abuse and neglect, death, or because the parent gave birth at a young age. The grandparents serving as full-time caregivers are more likely to have chronic and mental health issues, increased 18 stress, disabilities, and financial instability including severe poverty. Although there is immense need, grandparents are not eligible for many social services that would ultimately improve living conditions for both child and caregiver.23 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Rate per 1,000 Child Abuse & 20.3 23 23.7 9.3 25.2 20.5 22.5 21.8 17.8 12.1 24.3 16.6 4.8 14.9 15.9 Neglect 2017
% Children Cared by Grandpar- 9.1 6.4 7.6 8.9 7.2 6.3 6.9 8 7.1 4.1 7.5 3.6 6.1 3.4 5.3 ents 2012-2016
Rate per 1,000 Children 0 to 17 10.2 7.8 8.5 5.5 7.9 13 16.6 8.5 5.5 3.1 9 10.4 1.9 8.8 10.3 in Foster Care 2017
Source: The Annie E. Casey Foundation
SOCIAL DETERMINANTS OF HEALTH
Social determinants of health are defined as “conditions in which people are born, grow, live, work, and age that shape health.” More specifically, social determinants of health include employment, socioeconomic status, educa- tion, housing, healthcare availability and quality, physical environment, access to resources, and social support networks. Increasingly, healthcare officials are recognizing the importance of social determinants of health along with genetics and health behaviors in evaluating individual health and developing healthcare initiatives.24
Socioeconomic Status Research published in the Journal of the American Medical Association found that higher incomes are related to longer life expectancy with the difference in longevity increasing over time. The life expectancy gap between the poorest 1% and the richest 1% was reported as 10.1 years for women and 14.6 years for men. The states with the lowest life expectancies reported were Nevada, Indiana, and Oklahoma. New York, California, and Vermont yielded the highest life expectancies.25
Of the comparisons, Adair County has the lowest median income, lowest per capita income and the highest percentage of individuals living in poverty. A quarter of the population does not have health insurance and utilizes the Supplemental Nutrition Assistance Program. Of the comparison counties and state, Adair County has the highest percentage of child food insecurity. Numerous qualitative participants cited poverty has an overwhelming contributor to poor health behaviors and health outcomes in Adair County. Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Median Household Income $52,017 $37,455 $39,187 $41,329 $41,282 $38,163 $59,210 $61,320 $38,472 $49,767 $33,366 $38,234 $50,388 $45,302 $40,465
Per Capita Income in Past 12 Months $19,415 $22,175 $21,491 $27,337 $16,576 $19,253 $22,241 $22,575 $19,799 $29,797 $28,913 $21,800 $26,461 $29,824 $20,666
% Persons in Poverty 27.2 21.2 19.8 18.4 17.2 19.9 24.8 17 19.9 10.1 20.5 14.4 10 14.3 15.8
% Persons Without Health 24.5 24.4 19.3 23.9 19.5 20.7 19.1 20.6 19.5 13.5 20.3 15.4 15.6 16.4 16.6 Insurance, Under 65
% SNAP Use by Households 24.6 14.8 13.1 15.9 17.1 18.8 20.7 16.1 19.1 9.2 20.3 12.9 11.3 11.2 13.7
2016 Child Food Insecurity % 28.9 25.1 23.6 25.9 25.4 27.5 24.8 24.3 26.2 19.8 28.1 21.9 20.1 22.2 22.7
Source: US Census Bureau QuickFacts, Food Research & Action Center, The Annie E. Casey Foundation
19 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Unemployment rate, civilian 6.6 5.6 5.1 5.2 4.8 8.9 5.4 6 5.6 4.5 6.5 4.4 4.4 4.5 4.6 labor force
% With a Disability, Under 65 13.9 12 16.7 17.1 16.8 15.9 13.3 12.1 13.5 10.5 19.2 10 11.6 10.7 11.4 Years
Source: OK State Department of Health Wellness County Profile 2019 & US Census Bureau QuickFacts
Households The Adair County median value of owner-occupied housing units is lower than all comparisons with a persons per household rate higher than all comparisons with the exception of Cherokee County. Adair County households have the lowest percentage of computer access and broadband internet access which impairs individuals’ access to key community-based and general health information. Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
Median Value of Owner- occupied housing units $97,700 $81,200 $96,100 $81,600 $92,500 $95,300 $111,300 $84,300 $112,600 $110,000 $125,800 $145,800 $106,700 $150,900 $150,400
% of Housing Units Occupied 69.8 66.5 73.5 76 73.4 77.1 66.5 75.7 68.6 78.1 71.2 59.1 79.2 69.9 65.7 by Owners
Persons per Household 2.83 2.84 2.49 2.5 2.57 2.34 2.52 2.52 2.55 2.6 2.66 2.52 2.7 2.47 2.58
% Households with Computer 69.5 75.9 76.8 81.6 82.6 76.7 79.1 78.4 74.1 89.5 79.2 88 90.6 84.3 84.9
% Households with Broadband 49.1 58.9 60.4 65.9 68.8 56.2 62.5 58.7 59.3 75.5 63.4 78.8 82 73.8 72.8 Internet Subscription
Source: US Census Bureau QuickFacts
Education Education is a key indicator of health and life expectancy. Higher education builds pathways to healthy lifestyle resources, healthcare accessibility, safer environments, and ultimately results in lower rates of disability and illness. U.S. college graduates can be expected to live nine years longer than people without a high school diploma. A population with low education achievements creates higher medical costs and are less productive at work, directly impacting the local economy of a community.26 Individuals with college degrees had lower obesity prevalence compared to those with less education.27 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
High School Graduate or Higher, % of Persons Age 25+ 79.4 85.4 86 84.6 86.1 85.4 85.2 87 84.3 91.7 81.5 89 89.8 90.6 87.5
Bachelor’s Degree or Higher, % of Persons Age 25+ 13.6 24 14.7 16.5 15.4 13.6 18.9 11.5 14 23.5 13.8 30.9 22.7 27 24.8 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
2017 High School Drop Out % 8 7.7 5.8 6.4 10.2 11.5 8.5 9 7.5 7.6 10.7 10.5 5.7 5.3 9.2
20 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
2016 -2017 3rd Grade Reading Proficiency % 35 33 29 38 36 39 40 48 40 45 47 36 47 47 39 Craig Tulsa State Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Oklahoma Washington
2016-2017 8th Grade Math Proficiency % 18 23 11 23 28 17 22 20 15 25 14 23 21 29 23
Source: US Census Bureau QuickFacts & The Annie E. Casey Foundation
Environment Local environmental conditions such as indoor and outdoor air quality and water quality impact the health of a community. Such conditions have the greatest bearing on populations already at-risk for poor health outcomes. It is imperative for communities to be aware of air and water pollution issues. Air quality can cause long-term damage to cardiovascular and respiratory systems, possibly leading to certain cancers and premature death. Water quality has also been linked to various illness including certain cancers.28
As reported by the Environmental Working Group, a non-partisan nonprofit agency, assessments conducted in 2018 by the Environmental Protection Agency revealed that drinking water in the Adair County area was in compliance with federal health-based standards.29 Of the contaminants listed, only dichloroacetic and trichloroacetic acids were above state levels yet below EPA maximum contaminant level. Both acids are formed during disinfectant treatments. Nitrate and nitrite levels were the lowest of all contaminants, ranking below the recommended health guidelines. These contaminants enter water typically through fertilizer, septic tanks, and animal waste runoff.30
EPA Maximum Contaminant Level Goal EPA Maximum Drinking Water Contaminant Local Level State Nation (Federal Health Guideline) Contaminant Level
Bromodichloromethane 8.58 10.4 4.36 NA 80
Chlorite 137.3 327.1 302.5 800 1,000
Chloroform 33.9 29.3 11.4 70.0 80
Dibromochloromethane 1.58 6.16 2.99 60.0 80
Dichloroacetic acid 14.3 10.9 5.97 NA 60
Nitrate and nitrite 0.6 2.1 0.764 10 10
Total trihalomethanes 44 49 23.6 NA 80
Trichloroacetic acid 14.9 10 4.89 0.5 20
Source: The Environmental Working Group & The Environmental Protection Agency
According to the Oklahoma Department of Environmental Quality 2018 State of Oklahoma Public Water Supply Program Annual Compliance Report, Adair County violations were primarily related to monitoring and reporting. A monitoring and reporting violation is a failure to have water tested or a failure to correctly report test results to primary agents. Including the Westville Utility Authority, 195 systems in Oklahoma had Disinfectant Byproduct Maximum Containment Level Violations in which disinfectant agents react with residual organic matter.31 Adair County exhibited no maximum Contaminant Level Violations.
21 Violation System Zip Code
Disinfectant Byproducts Maximum Contaminant Level Westville Utility Authority 74965
Disinfectant Byproducts Monitoring & Reporting Adair County Rural Water District #4 74960
Disinfectant Byproducts Monitoring & Reporting Adair County Rural Water District #5 74457
Disinfectant Byproducts Monitoring & Reporting Watts 74964
Public Notification Monitoring & Reporting Adair County Rural Water District #5 74457
Surface Water Treatment Rule Monitoring and Reporting Adair County Rural Water District #5 74457
Surface Water Treatment Rule Monitoring and Reporting Watts 74964
Source: OK DEQ 2018 State of OK Public Water Supply Program Annual Compliance Report
Of the 14 Cherokee counties, Tulsa County and Mayes County have the highest number of facilities with reported emissions. Adair County and Cherokee County have the least number, five, of facilities with reported emissions. Air quality within a specific region can swing positively and negatively daily. The numerical measurement for air quality is 0 to 500 with levels over 300 presenting hazardous conditions. The air quality index for Adair County can be monitored in real time at www.airnow.gov. August 2019 air quality observations reveal levels fluctuating from “good 0 to 50” to “moderate 51 to 100.” Craig Tulsa Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Number of Facilities with Reported 5 5 6 6 29 23 21 6 10 43 10 150 15 15 Emissions
Source: The OK Department of Environmental Quality
Every year 3,000 nonsmokers die from radon exposure making it the second-leading cause of lung cancer after smoking. Radon is a naturally occurring gas originating from the natural decay of uranium found in nearly all soils. Radon exposure occurs within the home and home testing kits are available from a variety of sources. Adair County is listed in Radon Zone 2 by the Environmental Protection Agency. Definitions of zones are as follows:
Zone 1: Counties with predicted average indoor radon screening levels greater that 4 picocuries per liter (pCi/L)
Zone 2: Counties with predicted average indoor radon screening levels from 2 to 4 pCi/L
Zone 3: Counties with predicted average indoor radon screening levels less than 2 pCi/L
The Environmental Protection Agency recommends reducing exposure in your home if radon level is 4 picocuries per liter or higher.32
22 Crime Direct or indirect exposure to crime can negatively impact individual health in a variety of ways. Children exposed to violence are at risk for long-term behavioral problems, depression, anxiety, and post-traumatic stress disorder.33 Post-traumatic stress disorder rates are three times higher among Native American children compared to the general population.34 Female survivors of domestic partner violence have an increased risk of depression, suicidal ideation, and disordered eating.35 Violence against Native American women has been described as an epidemic with 4 out 5 women having experienced violence and 1 in 2 women experiencing sexual violence.36
Crime and the perceived safety of the local environment affects levels of physical activity and obesity within a population. If an individual defines their community as unsafe, they are more likely to have a higher body mass index and less likely to engage in physical activity compared to individuals who define their local environment as safe.37 Adair County has the highest incidences of homicide. The 11.2 rate per 100,000 is 55.6% higher than the Oklahoma rate. Craig Tulsa Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Arrests of Juveniles 2017 11 21 3 8 10 1 45 4 17 31 13 560 31 2
2017 Violent Crimes Reported 47 102 14 53 42 24 84 7 23 75 101 304 42 0
2017 Homicide Reported 0 2 0 0 0 0 0 0 0 3 2 1 2 0
2017 Rape Reported 3 5 5 7 4 1 7 0 6 22 5 29 5 0
2017 Aggravated Assault Reported 44 91 9 44 37 21 74 7 15 42 93 257 31 0
2017 Robbery Reported 0 4 0 2 1 2 3 0 2 8 1 17 4 0
Source: The Annie E. Casey Foundation & FBI Crime Reporting Program
23 24 Qualitative Outcomes
Resident survey (green) and semi-structured interview (gold) outcomes are presented together to show the commonalities and differences between the opinions of the general public (survey) and explicitly selected key informants (semi- structured interviews). As outlined in section 2 page 4 of this report, survey and interview participants have dissimilar characteristics as a result some qualitative outcomes varied among the two groups. Key informants were asked open- ended questions rather than offered choices such as with the online surveys. Open-ended questions yielded responses that are more complex and therefore when creating statistical statements, the spread among the percentages are more widely distributed. Participants had the option to submit comments outside of the suggested answers, but comments were not required in order to complete the survey.
Of important note, albeit not statistically significant, is that respondents from both assessment groups disclosed the impact of historical trauma on the health of Adair County inhabitants. Historical Trauma Theory explains the lasting health effects of experiencing horrific societal circumstances such as, but not limited to, colonialism, genocide, physical and emotional abuse. After an individual or group experiences the traumatic event, the effects of historical trauma manifests for generations resulting in acute feelings of hopelessness, predilection for addiction, and susceptibility to diseases. Historical trauma is transferred through generations environmentally, socially, and physiologically. Specifically for Native Americans, trauma from multiple periods of colonialism, racism, and violent oppression has been described as a “soul wound” resulting in detrimental health outcomes. Mental illnesses as a result of trauma may be passed to offspring of the first generation of trauma survivors. Dysfunctional behaviors are learned by secondary and following generations. Studies have shown that generations following the first traumatized group may experience vicarious traumatization through the retelling of past traumatic events. The populations advocate sharing the pain of their lineages resulting in unresolved grief adversely impacting individual self-esteem and relationships with others. Subsequent generations may experience their own primary trauma through diminishment of culture, injustice, poverty, and bigotry.1
Another statistically insignificant number of resident survey and key informant respondents alluded to environmental factors as root causes of health disparities in Adair County. Explicitly, participants cited industrial pollution for perceived high rates of various deadly cancers. Quantitative data, as cited on page 15 of this study, shows that compared to the other 13 counties in the Cherokee district, Adair County has the 7th highest frequency of cancer related deaths. Nitrate contamination of drinking water is considered to be the cause of over 12,000 U.S. cancer diagnosis yearly. The states with the highest cancer rates attributed to nitrate contamination are Arizona, Delaware, California and Iowa with over 10 cases per 100,000 people. The maximum number per 100,000 in Oklahoma is estimated to be 2.98.2 According to the National Cancer Institute, drinking water with nitrate contamination levels of five parts per million may increase the risk for certain cancers including kidney, colon, ovarian, and bladder cancer.3 Current water quality reports present a nitrate and nitrite level of .6 parts per million for the Adair County area. Environmental quantitative data is presented on page 20 of this report.
25 Outcome A Key informants and resident survey respondents described Adair County as, in general, physically and mentally unhealthy. An overwhelming 83% of 488 Adair County residents selected “no” when asked if they thought Adair County was physically healthy. Both assessment groups accredited poverty as one of the primary explanations for poor health outcomes in the region. In addition, key informants outlined the existence of generational poverty in terms of a mindset which residents lack the hope and education needed to improve the conditions of their lives. These conditions typically mirrored the respective childhood environment and the conditions of older generations. Most survey respondents selected more than one of the recommended options resulting in substance abuse, poverty, and lack of resources being the most frequently selected causes of poor health outcomes.
Objective: Identify public perception regarding the health of the community. Goal: Understand and respond to health-related public opinion. Outcome: Public perception is that Adair County is generally physically and mentally unhealthy because of poverty, access to resources, diet and exercise habits, and substance abuse.
Would you say that in general Adair County is physically and/or mentally healthy?
Physically Healthy Mentally Healthy Physically Healthy Mentally Healthy Mentally I Don’t Somewhat Physically Total Responses No No Yes Yes Know & Mentally Healthy
41.03% 37.17% 6.41% 7.69% 2.6% 5.13% 78
Source: Lynn Key Informant Semi-structured Interviews
Would you say that in general Adair County is physically healthy?
No Yes Total Responses
82.99% 17.01% 488
Source: Lynn Resident Survey
Would you say that in general Adair County is mentally healthy?
No Yes Total Responses
73.98% 26.02% 488
Source: Lynn Resident Survey
Data shows people in OK have more health-related issues than people in other states. Why do you think this is the case specifically in Adair County?
Lack of Or Poor Generational Poor Diet & Access to Substance Environmental Total Poverty Genetics Education Government Poverty Mindset Lack of Exercise Resources Abuse Contaminants Responses Interventions
18.35% 15% 14.68% 14.68% 11.93% 10.09% 6.42% 6.42% 2.75% 109
Source: Lynn Key Informant Semi-structured Interviews
Data shows people in OK have more health-related issues than people in other states. Why do you think this is the case specifically in Adair County? (Select all that apply)
Alcohol Lack of Cultural/Family Total Drug Abuse Poverty Education Other Abuse Resources Traditions Responses
87.04% 84.57% 79.01% 60.49% 51.85% 39.71% 11.93% 486 Source: Lynn Resident Survey
26 Environmental Tribal and Federal Poor Food Total Access Apathy Historical Trauma Contamination Political Issues Choices Responses
32.65% 20.4% 20.4% 12.24% 8.16% 6.12% 49
Source: Lynn Resident Survey – Additional Comments
Outcome B Cost and lack of insurance were the primary barriers to healthcare discussed among key informants. Finances were also a primary barrier to healthcare for resident survey respondents. Although, 67% of resident survey respondents selected “no” when asked if barriers to healthcare exist for them and/or their family. Survey respondents opting to submit comments cited quality of care and wait times at area clinics as barriers. Similarly, 66% of key informants stated there is a need for more physicians at area clinics, improved patient wait times, and increased access to specialists.
Objective: Identify the accessibility of healthcare and health education. Goal: Ensure convenient/efficient access and usability of healthcare services and resources. Outcome: Cost is the primary barrier to healthcare and more healthcare providers are needed at existing clinics in order to improve the overall quality of care.
What barriers prevent people from receiving healthcare?
Cost, Lack of Little to No Quality of Drug Abuse/Mental Total Education Transportation Apathy Access Time Insurance barriers Care Health Responses
24.73% 16.13% 13.98% 12.95% 11.83% 6.45% 5.38% 4.3% 4.3% 93
Source: Lynn Key Informant Semi-structured Interviews
Are there barriers preventing you and your family from receiving healthcare?
I don’t care to go I don’t know No Money Time Transportation Other Total Responses to the doctor where to go
67.08% 21.88% 12.50% 6.25% 2.92% 1.67% 8.54% 480
Source: Lynn Resident Survey
Lack of Primary Cost/Lack of Difficulty In Getting Difficulty In Getting Lack of Dental/ Total Poor Quality of Care Care Physicians Insurance Appointments Referrals Eye Care Responses
31.25% 20.83% 16.66% 10.41% 10.41% 10.41% 48
Source: Lynn Resident Survey – Additional Comments
Is there a need for more healthcare providers?
Yes No I Don’t Know Total Responses
65.85% 26.83% 7.32% 41
Source: Lynn Key Informant Semi-structured Interviews
Outcome C Varied outcomes among the two groups are presented because the two groups selected for this study exhibit different overall characteristics. The majority of key informants, 63%, believe the general population of Adair County does not have personal doctors and are not getting annual physicals. Yet, most resident survey respondents, 80%, stated that they in fact do have personal doctors and they do get annual physicals. Both assessment groups stated the reason some community members are not getting annual physicals is that they only seek medical care when they are sick which relates to general health education needs within the community. Cost and quality of care were also listed as reasons people are choosing not to get annual physicals.
27 According to key informants, the general population has some familiarity with Cherokee Nation Public Health Services, but additional communication efforts are needed to ensure the population as a whole is aware of the multifaceted offerings of the Cherokee Nation. In addition to population awareness of the vast resources available, easy to follow instructions on how to access are encouraged. Key informants discussed social media as the best way to inform the public, with Facebook being the most popular platform for adults. Twitter, Instagram, and Snapchat were named as online platforms to reach younger members of the population. Email and texting were the top forms of communication selected by residents.
Objective: Identify the accessibility of healthcare and health education. Goal: Ensure convenient/efficient access and usability of healthcare services and resources. Outcome: Successfully educating the public regarding the importance of preventative health and the availability of all resources entails a multipronged communication campaign with email, texting, and social media being the primary pathways to reach the public.
Do you think residents of Adair County have a personal doctor and get annual physicals? Why/Why Not?
No Some Have Doctors but Do Not Get Physicals I Don’t Know Total Responses
63.41% 24.39% 7.32% 4.88% 41
Only Go When Sick Cost Education Access Total Responses
31.91% 23.4% 23.4% 21.28% 47
Source: Lynn Key Informant Semi-structured Interviews
Do you have a personal doctor and get annual physicals?
No Yes Total Responses
20.83% 79.58% 480
Source: Lynn Resident Survey
If yes, where do you go?
W. P. Physician's Arkansas Private Indian Health Total Hastings Mankiller Clinic Based Clinics Physician Services Responses
62.35% 12.35% 10.95% 5.05% 3.65% 3.37% 348
Source: Lynn Resident Survey
If no, why not?
Can't Get Appointment/ Cost/Lack of Only Go When Don't Have a Dr. or Poor Quality Total I Just Don't Go Length of Wait Time Insurance Sick Know How to Get One of Care Responses
31.16% 22.07% 19.48% 12.98% 7.79% 6.49% 77
Source: Lynn Resident Survey
Do you think county residents are aware of available services?
Yes No Somewhat Total Responses
43.9% 36.59% 19.51% 41
Source: Lynn Key Informant Semi-structured Interviews
What is the best way to communicate/share information with the community?
Social Media Events & Word of Mouth Newspaper Church/School Fliers/Pamphlets/Signage US Mail Text Total Responses
35.71% 23.81% 19.05% 8.33% 7.14% 4.76% 1.19% 84
Source: Lynn Key Informant Semi-structured Interviews
28 What is the best way to communicate/share information with you and your family?
Email Text Social Media US Mail Phone Call Television Newspaper Radio Other Total Responses
58.35% 57.93% 46.09% 37.42% 32.56% 11.42% 12.05% 4.23% 2.11% 480
Source: Lynn Resident Survey
Outcome D Quantitative heath statistics illustrate what health issues are most prevalent within a community, yet it is important to understand the perceptions of individuals regarding what issues are of the utmost importance to them. Heart disease was the health condition of most concern to key informants and diabetes was listed of most concern by resident survey respondents. The majority of both assessment groups stated there have not been incidences of premature death in their families. For those responding yes to incidences of premature death, heart disease and cancer were the most reoccurring specific causes of premature death.
Objective: Identify general health concerns and needs. Goal: Improve the overall health of the community by providing population-specific support, services and education. Outcomes: Diabetes, heart disease, and cancer are primary health concerns of the community.
What health conditions are most important to you and your family?
Substance Heart Lifestyle Cancer Diabetes Mental Health Blood Pressure Obesity Stroke Abuse
24.14% 20.69% 17.24% 11.49% 5.75% 4.6% 3.45% 3.45% 3.45%
Cleanliness Dental/Eye Genetic Chronic Disease Total Response
2.3% 2.3% 1.14% 87
Source: Lynn Key Informant Semi-structured Interviews
What health concerns are most important to you and your family? (Select all that apply)
Heart D i e t / Mental Substance Total Diabetes Cancer Obesity Exercise Other Disease Nutrition Health Abuse Responses
71.24% 62.88% 59.01% 57.51% 55.79% 53.86% 42.49% 28.33% 4.08% 466
Source: Lynn Resident Survey
Have there been occurrences of premature death in your family?
No Yes Total Responses
58.54% 41.46% 41
Source: Lynn Key Informant Semi-structured Interviews
Have there been occurrences of premature death in your family?
No Yes Total Responses
63.01% 36.99% 465
Source: Lynn Key Informant Semi-structured Interviews
29 Please explain.
Substance Stroke/Brain Total Cancer Heart Disease Diabetes Accident Murder Abuse Disease Responses
38.98% 31.63% 9.03% 7.34% 6.21% 4.51% 2.25% 177
Source: Lynn Resident Survey
Outcome E Key informants do not believe residents of Adair County attempt to consume a healthy diet on a regular basis citing familial traditions, a lack of social support, and cost as the reasons. Key informants described the local community members’ affinity for unhealthy convenience foods. Resident survey respondents also listed cost as a factor in choosing between healthy and unhealthy foods. Some resident survey respondents are under the belief that healthy foods cannot and do not taste as good as the unhealthy cheaper food options. Moderate levels of physical activity were reported by assessment respondents. Resident survey respondents who do not exercise named motivation, time, and lack of access to an exercise facility as factors. It was often pointed out that a facility in the area was needed because community members were unable to pay membership dues to the one local gym nor are they able to drive, either due to time or access to transportation, to facilities in Tahlequah. Overwhelmingly, walking was mentioned as the activity that the population would enjoy the most. Assessment respondents discussed activity at local parks as typically being seasonal and specifically the WINGS program was mentioned as a positive effort to engage the population.
Objective: Identify nutrition and exercise trends within the community. Goal: Develop programs to promote healthy lifestyles. Outcomes: The population generally chooses low-cost, convenient and unhealthy foods. Walking is a widely popular activity and there is a strong desire for a local low-cost fitness facility.
Do you think residents of Adair County attempt to consume a healthy diet on a regular basis? If no, why?
No Somewhat I Don’t Know Total Responses
85.37% 12.2% 2.44% 41
Tradition/Social Support Cost Convenience Education Access Total Responses
28.38% 27.03% 20.27% 13.51% 10.81% 74
Source: Lynn Key Informant Semi-structured Interviews
Do you try to eat a healthy diet on a regular basis?
Yes No Sometimes Total Responses
38.91% 6.74% 54.35% 460
Source: Lynn Resident Survey
If no, why not?
We Eat Healthy I Like Unhealthy Total Cost Time Access Education or Try To Food Responses
40.57% 22.46% 18.84% 7.97% 6.52% 3.62% 138
Source: Lynn Resident Survey
How often do you think county residents engage in physical activity/exercise?
Never, 1-2 Days Small Percent 3 plus days a Seasonal Activity Average Amount Youth Are Active Total Responses per Week Actually Do week/ A Lot
37.7% 19.67% 14.75% 13.11% 8.2% 6.56% 61
Source: Lynn Key Informant Semi-structured interviews
30 How often do you engage in physical activity/exercise?
1-2 Times per Week 3-4 Times per Week 5-7 Times per Week Never Total Responses
46.09% 32.17% 12.83% 8.91% 460
Source: Lynn Resident Survey
Never, why not?
Physical Limitations/ Lack of Motivation/ Access Time Total Responses Disabled Laziness
31.70% 24.39% 24.39% 19.51% 41
Source: Lynn Resident Survey
What type of physical activity/exercise do you think residents would participate in and/or enjoy?
Outdoors Gym Activities/ Community & Walking/Run Sports Pool Biking Total Responses Activities Classes Family Events
30.77% 19.78% 16.48% 12.09% 8.79% 6.59% 5.49% 91
Source: Lynn Key Informant Semi-structured Interviews
What type of exercise would you enjoy? (Select all that apply)
Walking Swimming Jogging/Running Biking Basketball Softball Baseball Other Total Responses
86.30% 45.43% 28.91% 24.35% 20.00% 15.65% 5.87% 22.83% 460
Source: Lynn Resident Survey
Gym/Weight Lifting Outdoor Activities Games/Sports Yoga Dance Crossfit Total Responses
36.79% 26.41% 14.15% 9.43% 8.49% 4.71% 106
Source: Lynn Resident Survey – Additional Comments
Outcome F Key informants noted that families and groups predominantly spend time together at local sporting events. The youth population is highly engaged in school sponsored team events and families typically attend games and practices in support. “Watching kids play sports” was a high-ranking activity among resident survey respondents. However, the predominant activity among residents was special family gatherings and eating together. Commonly the foods served at gatherings are family recipes consisting of typical southern comfort food, often fried and not considered to be healthy.
Generally speaking, assessment respondents revered current and past efforts of the Cherokee Nation. The foremost criticism of the Cherokee Nation related to the quality of care at area clinics. Key informants discussed the importance of a strong leadership message from the Cherokee Nation, a message in which the community is inspired to enact positive lifestyle changes while simultaneously preserving ancestral traditions. In regard to strong and healthy families, resident survey respondents again expressed the need for a fitness facility in the county. Several respondents selected “A Fitness Facility Near Me” but also submitted comments to emphasize their initial selection. “Fitness classes” was the third top ranking choice for resident survey respondents with “jobs” ranking slightly higher.
Objective: Identify individual/family well-being concerns and needs. Goal: Improve family stability and individual well-being through support and services. Outcomes: Families/friends gather for special occasions to eat and gather to support local sports. The Cherokee Nation can improve family cohesiveness through meaningful messaging and offering opportunities for families to be active in an indoor environment.
31 What is your opinion of how families/groups in this community spend time together?
Special Family Outdoor School Activities Sports Events Eating Church & Community They Don’t At Home Total Responses Activities (not sports) Events
34.62% 15.38% 12.82% 11.54% 10.26% 7.69% 5.13% 2.56% 78
Source: Lynn Key Informant Semi-structured Interviews
How do your families/friends spend time together? (Select all that apply)
Outdoor Special Family Watching Activities Traditional Get-togethers E a ti n g Church School Playing Games/ Kids Play (Camping, Tribal Other Total Responses (Birthday, Together Activities Activities Sports Sports Fishing, Ceremonies Holiday) Hunting)
75.87% 73.70% 48.91% 44.13% 47.39% 40.43% 36.96% 10.87% 2.61% 460
Source: Lynn Resident Survey
What can the Cherokee Nation do to support a strong and healthy family unit?
Promote/ Substance Facilities and Wellness Leadership Keep it up Family Skills Abuse/Mental Events Study Education Total Responses Infrastructure Education Messaging Health
19% 16% 15% 15% 10% 9% 8% 5% 3% 100
Source: Lynn Key Informant Semi-structured Interviews
What can the Cherokee Nation do to support a strong and healthy family unit?
Fitness Substance Budget/Money Facility Fitness Counseling Walking Cooking Parenting Cultural Sport Total Jobs Abuse Management Other Near Classes Services Clubs Classes Classes Events Leagues Responses Treatment Classes Me
77.73% 62.23% 61.35% 57.64% 50.22% 49.56% 46.51% 42.14% 34.06% 34.93% 31.88% 11.35% 458
Source: Lynn Resident Survey
Fitness Facility Health and Wellness More Support for Jobs/Economic Community Gardens/ Total Responses Near Me Education Children and Elders Development Safe Public Spaces
36.95% 19.56% 19.56% 13.04% 10.86% 46
Source: Lynn Resident Survey – Additional Comments
32 STILWELL LIFE EXPECTANCY REPORTING
Stilwell Life Expectancy Reporting
SEPTEMBER 2018 CDC REPORT OVERVIEW Under the purview of the Centers for Disease Control and Prevention, the National Center for Health Statistics, in partnership with the Robert Wood Johnson Foundation and the National Association for Public Health Statistics & Information Systems, developed the U.S. Small-area Life Expectancy Estimates Project (USALEEP), an innovative methodology for calculating life expectancy for small populations. Prior to USALEEP, life expectancy, an important measure in identifying health disparities within a defined region, was limited to county specific reporting. In September of 2018, the publication of the USALEEP led to national, state, and local headlines pronouncing Stilwell, Oklahoma as having the lowest life expectancy in the nation, 56.3 years.
PUBLIC OPINION Residents of Adair County and specifically those who call Stilwell home responded to the reports with impassioned sentiments related not only to the data but the news affiliates responsible for headlines such as “The Tragedy of Stilwell” and “The Strawberry Capital of the World is the Early Death Capital of the U.S.” The majority of Adair County key informants stated they were shocked and distressed by the reports, utilizing descriptors such as “outraged, surprised, bogus, and fake news.” Despite describing the reports and data as somewhat fabricated, 39% of key informants stated that Stilwell and the surrounding communities display dangerous health behaviors, and an additional 27% of key informants responded that the life expectancy estimation was plausible.
Are you familiar with recent reports stating Stilwell, OK as having the lowest life expectancy in the U.S.? If yes - please tell me your thoughts about the reports.
Shocked/Upset but somewhat agree False Data/Reporting Makes Sense Total Responses 39.02% 34.15% 26.83% 41
OUTCOME ANALYSIS AND CLARIFICATION The 31-page report is teeming with technical terms and statistical equations. It acutely describes the methodology and subsequent results of the first set of abridged period life tables for the 2010-2015 census tracts. Although the lowest life expectancy number within the report is attributed to Stilwell, a definitive ranking of all U.S. small populations was not the intent of the authors and the new methodology has limitations that are detailed within the USALEEP report.
Small population life expectancy estimates require specific data including a minimum of six years of geocoded death records. The authors of USALEEP clearly affirm that Maine and Wisconsin were omitted from the study because each state had only five years of geocoded death records. Increasing the record years from five to six increases the reliability of the population estimates. The authors caution readers that “the methodology developed for this study addressed the issues of small populations and zero deaths as robustly as possible, although it is not without error.”1
Dr. Elizabeth Arias, Director of the U.S. Life Table Program for the National Center for Health Statistics/CDC, describes period life tables as providing “only a snapshot of a population’s mortality profile at a particular point or period in time. They are not estimates of the life expectancy of a real group of people.” Life tables are created through observed age-specific death rates and predicted death rates and are estimations based on assumptions with standard errors ranging from 1.46 years to 3.41 years. County level data is the smallest geographic data available in National Vital Statistics System mortality information. Statistical modeling was developed to substitute missing population estimates information.2 “(Mortality rates) do not remain static and this why we estimate life expectancy every year for the US population. Although it is not a perfect measure of mortality in a population, it is the best measure that summarized mortality levels in a population which is also comparable across different population, geographic areas, and time.” says Dr. Arias.
33 Quantitative data substantiates some of the claims concerning the health of Stilwell residents and Adair County as a whole. Within Oklahoma, Adair County has the highest percentages of diabetes and obesity - two major contributors of early deaths caused by heart failure. At an estimated 75.3 years, Oklahoma has one of the lowest life expectancies in the nation. Hawaii ranks number one at 81.5 years.3 Of the 77 counties in Oklahoma, Adair County is ranked 74th for health outcomes and ranked 77th for health factors that include smoking, obesity, substance abuse and poverty.4 During the past few years, life expectancy has declined throughout the U.S. “Life expectancy gives us a snapshot of the nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early, and too often, to conditions that are preventable,” said Dr. Robert R. Redfield, CDC Director.5 Tribal Assessment participants also agree that recent reports, albeit not completely founded in their opinion, are a critical call to action for community members to work together to improve the overall health of Adair County. Certain key informants stated the following in reaction to the media coverage of the USALEEP report.
“Feeling of what can we do to make it better.” “I was not happy and I want to change it.” “Not good, we have work to do.” “It has brought much attention to Stilwell of which could be used to its advantage in creating public health and not only infrastructure, but also a good platform to create a healthier community.”
34 Appendix A: References
Section 3 – Introducing Adair County
1. Adair County. (n.d.). Retrieved from https://www.okhistory.org/publications/enc/entry.php?entry=AD003
2. Adair County. (n.d.). Retrieved from https://www.okhistory.org/publications/enc/entry.php?entry=AD003
3. History of Stilwell. (n.d.) Retrieved from https://www.cityofstilwell.com/178/History-of-Stilwell
4. Swan, J. (1981). Off to the Strawberry Festival. Retrieved from https://oklahoman.com/article/2023966/off-to-the-stilwell-strawberry-festival
5. Statue Dedicated at Wilma P. Mankiller Health Center. (2016, February). Retrieved from https://www.cherokeephoenix.org?Article/index/10011
6. Adair County. (n.d.). Retrieved from https://www.okhistory.org/publications/enc/entry.php?entry=AD003
7. Blackburn, B., King, D., & Morton, N. (2018). The History of Survival, Self Determination, & Identity. Canada: Cherokee Nation.
8. Adair County. (n.d.). Retrieved from https://www.okhistory.org/publications/enc/entry.php?entry=AD003
9. Adair County, Oklahoma Population 2019. (2019) Retrieved from http://worldpopulationreview.com/us-counties/ok/adair-county-population/
10. Blackburn, B., King, D., & Morton, N. (2018). The History of Survival, Self Determination, & Identity. Canada: Cherokee Nation.
11. National Register of Historic Places. (n.d.). Retrieved from https://www.nps.gov/subjects/nationalregister/index.htm
12. Wilma Mankiller Biography (2019, June 27). Retrieved from https://oklahoman.com/article/2658630/cherokees-show-persistent-spirit-in-over- coming-obstacles
13. Jones, C., T. (1999). Cherokees Show Persistent Spirit in Overcoming Obstacles. Retrieved from https://oklahoman.com/article/2658630/ cherokees-show-persistent-spirit-in-overcoming-obstacles
14. Statue Dedicated at Wilma P. Mankiller Health Center. (2016, February). Retrieved from https://www.cherokeephoenix.org?Article/index/10011
Section 4 - Cherokee Nation Quantitative Tables
1. Heart Disease. (2017, January). Retrieved from https://www.cdc.gov/nchs/fastats/heart-disease.htm
2. National Diabetes Statistics Report, 2017. (2017). Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/ national-diabetes-statistics-report.pdf
3. Basics About COPD. (2019, July). Retrieved from https://www.cdc.gov/copd/basics-about.html
4. Accidents or Unintentional Injuries. (2017, January). Retrieved from https://www.cdc.gov/nchs/fastats/accidental-injury.htm
5. CDC Childhood Injury Report. (2008). Retrieved from https://www.cdc.gov/safechild/child_injury_data.html
6. Short, S. E., and Mollborn, S. (2015) Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511598/
7. America’s Health Rankings Annual Report. (2018). Retrieved from https://www.americashealthrankings.org/explore/annual/measure/Suicide/ state/OK
8. National Advisory Committee on Rural Health and Human Services Understanding the Impact of Suicide in Rural America. (2017). Retrieved from https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/rural/publications/2017-impact-of-suicide.pdf
9. Health Risks of Being Overweight. (n.d.). Retrieved from https://www.niddk.nih.gov/health-information/weight-management/ health-risks-overweight#problems
10. Economic Costs: Paying the Price for Those Extra Pounds. (n.d.). Retrieved from https://www.hsph.harvard.edu/obesity-prevention-source/obesi- ty-consequences/economic/
11. Dietary Guidelines for Americans 2015-2020. (2015) Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/
12. Sharma, A., Madaan, V., and Petty, F. (2006). Exercise for Mental Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1470658/
13. Dietary Guidelines for Americans 2015-2020. (2015). Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/
14. Smoking & Tobacco Use. (2019, February). Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm#featured
15. Births: Final Data for 2017. (2017). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf
16. Dietary Guidelines for Americans 2015-2020. (2015). Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/
17. Fact Sheets – Binge Drinking. (2018, October). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
35 18. State of the County’s Health Report. (2017). Retrieved from https://www.ok.gov/health/Community_Health/Community_Epidemiology/ County_Health_Profiles/index.html
19. Births: Final Data for 2017. (2017). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf
20. Teenage Births: Outcomes for Young Parents and Their (2008). Retrieved from https://www.scaany.org/documents/teen_pregnancy_dec08.pdf
21. Births: Final Data for 2017. (2017). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf
22. The World Factbook. (n.d.). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
23. When Grandparents Raise Their Grandchildren. (2017). Retrieved from https://www.psychologytoday.com/us/blog/ evidence-based-living/201709/when-grandparents-raise-their-grandchildren
24. Artiga, S., and Hinton, E. (2018, May). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Retrieved from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health- equity/
25. Chetty, R., et.al. (2016). The Association Between Income and Life expectancy in the United States, 2001-2014. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/
26. Education: It Matters More to Health than Ever Before. (2014). Retrieved from https://www.rwjf.org/en/library/research/2014/01/ education-it-matters-more-to-health-than-ever-before.html
27. Overweight & Obesity. (2018, August). Retrieved from https://www.cdc.gov/obesity/index.html
28. Environmental Health. (n.d.) Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health
29. The Environmental Working Group Tap Water Database. (n.d.). Retrieved from https://www.ewg.org/tapwater/search-results. php?zip5=74960&searchtype=zip
30. Schechinger, A. W., and Cox, C. (2018). America’s Nitrate Habit Is Costly and Dangerous. (2018) Retrieved from https://www.ewg.org/research/ nitratecost/
31. Oklahoma Department of Environmental Quality 2018 State of Oklahoma Public Water Supple Program Annual Compliance Report. (2018). Retrieved from https://www.deq.ok.gov/divisions/wqd/
32. Crime and Violence. (n.d.). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/ interventions-resources/crime-and-violence
33. Radon. (n.d.) Retrieved from https://www.epa.gov/radon
34. Ending Violence Against Native Women. (n.d.). Retrieved from https://indianlaw.org/issue/ending-violence-against-native-women
35. Crime and Violence. (n.d.). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/ interventions-resources/crime-and-violence
36. Ending Violence Against Native Women. (n.d.). Retrieved from https://indianlaw.org/issue/ending-violence-against-native-women
37. Brown, B., et. al. (2014) Physical Activity Mediates the Relationship Between Perceived Crime Safety and Obesity. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24963894
Section 5 – Qualitative Outcomes
1. Sotero, M. (2009). A Conceptual Model of Historical Trauma: Implications for Public Health Practice and Research. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1350062
2. Schechinger, A. W. and Cox, C. (2018). America’s Nitrate Habit Is Costly and Dange rous. Retrieved from https://www.ewg.org/research/nitratecost/
3. Nitrate. (2019, February). Retrieved from https://progressreport.cancer.gov/prevention/nitrate
Section 7 – Stilwell Life Expectancy Reporting
1. U.S. Small-area Life Expectancy Estimates Project – USALEEP. (2018, September). Retrieved from https://www.cdc.gov/nchs/nvss/usaleep/ usaleep.html#data
2. U.S. Small-area Life Expectancy Estimates Project – USALEEP. (2018, September). Retrieved from https://www.cdc.gov/nchs/nvss/usaleep/ usaleep.html#data
3. If You’re an Average American, You’ll Live to be 78.6 Years Old. (2018, December). Retrieved from https://www.nationalgeographic.com/ culture/2018/12/life-expectancy-united-states/
4. Oklahoma Rankings Data. (2019). Retrieved from https://www.countyhealthrankings.org/app/oklahoma/2019/downloads
5. CDC Director’s Media Statement on U.S. Life Expectancy. (2018, November). Retrieved from https://www.cdc.gov/media/releases/2018/ s1129-US-life-expectancy.html
36 Appendix B: Complete Assets List
Company Name Mailing Address Mailing City Mailing State Mailing Zip Code
ALCOHOL & TOBACCO
1 59 Liquor Hiway 59 Westville OK 74965
2 Old Time Liquor 309 W Locust St Stilwell OK 74960
3 Stillwell Spirits 829 S Highway 59 Stilwell OK 74960
4 Cherokee Tobacco Sales 1113 N 2nd St Stillwell OK 74960
ANIMAL CARE & SERVICES
1 Northside Animal Clinic 80489 Highway 59 Stilwell OK 74960
2 Patterson Animal Hospital 506 W Blackjack St Stilwell OK 74960
3 Kester Veterinary Svc LLC 83192 E 4737 Rd Stilwell OK 74960
BUSINESSES
ACCOUNTANTS
1 Green Michael CPA 827 W Locust St Stilwell OK 74960
2 H&R Block 712 S 2nd St Stilwell OK 74960
3 H&R Block 83981 Highway 59 Stilwell OK 74960
4 H&R Block 70656 Highway 59 # 3 Westville OK 74965
5 J & S Tax Svc 83731 S 4730 Road Stilwell OK 74960
6 Jackson Hewitt Tax Svc 84127 Highway 59 Stilwell OK 74960
7 Kris KIRK CPA PC 111 S Williams Ave Westville OK 74965
8 R & D Svc 115 W Division St Stilwell OK 74960
9 Roye, Ross J CPA 816 S 4th St Stilwell OK 74960
10 St Pierre, Robert CPA 1113 N 2nd St Stilwell OK 74960
11 White Tax & Accounting 101 W Division St Stilwell OK 74960
12 Wilhite’s Tax & Bkpg Bus Ctr 59n S Highway 59 # Hwy Stilwell OK 74960
13 World Acceptance 107 W Division St Stilwell OK 74960
ATTORNEYS
1 Adair Joe D & Assoc PC 400 W Division St Stilwell OK 74960
2 Harris Law Office PC 401 W Division St Stilwell OK 74960
3 Keen Law Office PC 205 W Division St Stilwell OK 74960
4 Morton Law Office 221 W Division St Stilwell OK 74960
5 Rex Earl Starr, Attorney-at-Law 108 North First St Stilwell OK 74960
AUTOMOTIVE DEALERS & REPAIR SERVICES
1 Adkins 4x4 24122 E 557 Rd Colcord OK 74338
37 2 Bill’s Auto Sales 713 N 2nd St Stilwell OK 74960
3 Bill’s Auto Sales 825 S Highway 59 Stilwell OK 74960
4 Black’s Auto 471376 E 590 Rd Watts OK 74964
5 Car-Mart 600 RR 6 Stilwell OK 74960
6 Country Cycle & Marine 465432 Highway 100 Stilwell OK 74960
7 Custom Auto & Rv 9006 S 200th East Ave Stilwell OK 74960
8 Eds Auto Parts 1020 N 2nd St Stilwell OK 74960
9 Guinn’s Automotive Highway 62 & Morris Rd Westville OK 74965
10 Jason Helm Auto 469509 E 790 Rd Stilwell OK 74960
11 Mission Mountain Collision Rpr RR 1 Box 5631 Westville OK 74965
12 Nix Body Shop 343 W Black Jack St Stilwell OK 74960
13 Northside Body Shop Hwy 51 W Stilwell OK 74960
14 O’Reilly Auto Parts 825 S Highway 59 Stilwell OK 74960
15 State Line Auto Salvage 475 S Highway 59 Watts OK 74964
16 Wilson’s Tire & Lube 71021 Highway 59 Westville OK 74965
17 Womack Auto Parts 214 S Williams Westville OK 74965
BAIL BONDS
1 Doherty Bailbonds 4 N 2nd St Stilwell OK 74960
2 Jeff Limore Bail Bonds 147 Rt 1 Stilwell OK 74690
3 Morton Bail Bonds 813 W Division St Stilwell OK 74690
BANKS & CREDIT UNIONS
1 Armstrong Bank 501 S 2nd St Stilwell OK 74960
2 Arvest Bank 514 W Locust St Stilwell OK 74960
3 Arvest Bank 901 US-59 Westville OK 74965
4 Bank Of Commerce 24 W Division St Stilwell OK 74960
5 Peoples Bank 121 S Williams St Westville OK 74965
6 Red River Credit 13 W Division St Stilwell OK 74960
CONSULTANTS
1 Cherokee Business Forms Inc 471688 Highway 51 Stilwell OK 74960
2 H & H Enterprises 468964 E 815 Rd Stilwell OK 74960
CONSTRUCTION CONTRACTORS
1 B & B Backhoe & Dozer Svc PO Box 938 Stilwell OK 74960
2 Baird’s Construction Rt 3 Box 825 Stilwell OK 74960
3 C & W Contractors LLC 715 S 3rd St Stilwell OK 74960
4 C & W Contractor 715 S 3rd St Stilwell OK 74960
5 Honeycutt Backhoe & Dozer LLC 4615323 East 959 Road Bunch OK 74931
6 John’s Construction 206 E Cherokee St Westville OK 74965
7 Phillips Construction 1199 S Locust Ave Westville OK 74965
38 8 Radtke Backhoe Svc E Highway 100 Stilwell OK 74960
9 Scott Construction 80393 Highway 59 Stilwell OK 74960
10 Stilwell Construction 470450 E 880 Rd Stilwell OK 74960
11 Triple V Pole Barns 77671 S 4660 Rd Stilwell OK 74960
12 Wilson Built Construction 86897 S 4750 Rd Stilwell OK 74960
ELECTRIC SERVICES
1 Ozarks Electric 470479 Hwy 51 Stilwell OK 74960
2 Ozarks Electric Co-Op 405 S Williams Ave Westville OK 74965
3 Wheeler Electric LLC 817 S 4th St Stilwell OK 74960
FARMS & FARM EQUIPMENT
1 Baird’s Farm 467210 E 810 Rd Stilwell OK 74960
2 Baird’s Stoney Point Machine 467357 E 810 Rd Stilwell OK 74960
3 Green Country Farms 467984 E 642 Rd Watts OK 74964
4 Green Country Farms Hwy 59 N Westville OK 74965
5 Green Country Farms Complex 3 RR 1 Box 549 Westville OK 74965
6 Green Country Farms Complex 5 472178 E 706 Rd Westville OK 74965
7 Janda Bend Farms 26436 E Mclemore Hollow Rd Stilwell OK 74960
8 Mcconnell Farms Range LLC 467790 E 648 Rd Watts OK 74964
9 R K5 Farms LLC RR 1 Box 536 Westville OK 74965
10 Tyson Foods Inc 67378 S 4744 Rd Westville OK 74965
11 Wick Dairy 82299 S 4784 Rd Stilwell OK 74960
12 Youngman Family Farm LLC 472654 E 700 Rd Westville OK 74965
GAS & OIL SERVICES
1 Chris Quick Lube Hwy 59 N Stilwell OK 74960
2 Conoco US Highway 59 5th St Stilwell OK 74960
3 Davis Oil Inc Highway 51 E Stilwell OK 74960
4 MFA Propane Hwy 59 N Stilwell OK 74960
5 Nopfa 81075 Highway 59 Stilwell OK 74960
6 Northeast Ok Pubc Facilities 601 W Doyle Ave Stilwell OK 74960
HEATING & AIR
1 H2 Heat & Air Inc 108 W Division Westville OK 74965
2 Ogden Heating & Air 82280 S 4745 Rd Stilwell OK 74960
3 Turner Refrigeration & A C 86400 S 4620 Rd Stilwell OK 74960
INSURANCE SERVICES
1 Adair County Farm Bureau 1310 N 2nd St Stilwell OK 74960
2 Davis Insurance 500 Highway 59 Westville OK 74965
3 Farm Bureau Insurance 1310 N 2nd St Stilwell OK 74960
4 Farmers Insurance 118 W Olive St Stilwell OK 74960
39 5 Larry Strauss-State Farm Ins 114 W Division St Stilwell OK 74960
6 Nancy Garrett Insurance Agency 118 W Olive St Stilwell OK 74960
7 Oklahoma Farm Bureau Insurance 70154 Hwy 59 Westville OK 74965
8 Peoples Insurance 102 W Division St Stilwell OK 74960
9 Shelter Insurance-Jake Cooper 116 N 2nd St Stilwell OK 74960
LANDSCAPING SERVICES
1 Northeast Landscaping LLC 82904 S 4670 Rd Stilwell OK 74960
2 Fourkiller Lawn Solutions LLC 79030 S 4697 Rd Stilwell OK 74960
MANUFACTURERS
1 ABB Inc 305 Ballman Rd Westville OK 74965
2 Automated Machining Co PO Box 326 Westville OK 74965
3 Bakery Feeds PO Box 209 Watts OK 74964
4 Bruner’s Used Equipment 466246 Highway 51 Stilwell OK 74960
5 Calman Foods Highway 59 S Watts OK 74964
6 Cherokee Nation Industries 470739 Highway 51 Stilwell OK 74960
7 Cnd LLC Hwy 51 W Stilwell OK 74960
8 Conner Distributors Inc 80955 Highway 59 Stilwell OK 74960
9 Conner Industries Inc 80955 Highway 59 Stilwell OK 74960
10 Facet International 470555 E 868 Rd Stilwell OK 74960
11 Graphic Excursions 1576 S Highway 59 Watts OK 74964
12 L & L Printing 117 W Division St Stilwell OK 74960
13 PECO Facet 3636 Stilwell Stilwell OK 74960
14 Sharron & Roberts Tractor Svc 471904 E 815 Rd Stilwell OK 74960
15 Stilwell Smoke Shop 119 W Cedar St # 1-2 Stilwell OK 74960
16 Sundowner Tractor 77423 S 4640 Rd Stilwell OK 74960
17 Tyson Foods Inc Highway 59 N Westville OK 74965
18 Tyson Foods Inc 82077 Highway 59 Stilwell OK 74960
19 Watts Water Technologies Inc PO Box 70 Watts OK 74964
PLUMBING CONTRACTORS
1 Gayle Mullin Plumbing LLC 74858 S 4760 Rd Westville OK 74965
2 Johnson Plumbing 605 W Johnson St Stilwell OK 74960
3 Mullin Plumbing Stilwell OK 74960
4 Mullin Plumbing 2624 C Westville OK 74965
RETAIL BUSINESSES
1 59 Liquor Highway 59 Westville OK 74965
2 Aaron’s 84059 Highway 59 Stilwell OK 74960
3 All Purpose Glass 66724 Highway 59 Westville OK 74965
4 Bargain Center 84059 Highway 59 Stilwell OK 74960
40 5 Bargain Center Inc 312 W Locust St Stilwell OK 74960
6 Bell Thrift Store 474620 E 850 Rd Stilwell OK 74960
7 Cherokee Tobacco Sales-Thlqh 1113 N 2nd St Stilwell OK 74960
8 Cherry Tree Grocery & Meals 87792 Highway 59 Stilwell OK 74960
9 Coco’s Tanning 316 W Locust St Stilwell OK 74960
10 Cv’s Family Food 610 N 2nd St Stilwell OK 74960
11 D & D Tire Shop 101 W Blackjack St Stilwell OK 74960
12 Dollar General 317 N 2nd St Stilwell OK 74960
13 Dollar General 189 S Highway 59 Watts OK 74964
14 Dollar General PO Box 810 Westville OK 74965
15 Elkhart Products 300 N Industrial Pkwy Westville OK 74965
16 Eubanks Claude Grocery 464207 Highway 100 Stilwell OK 74960
17 Everything Nice Flower Shop 320 S 2nd St Stilwell OK 74960
18 Felts Shoe Store 306 W Locust St Stilwell OK 74960
19 Fletcher Hardware PO Box 509 Stilwell OK 74960
20 Flower & Balloon Magic PO Box 381 Westville OK 74965
21 Fragrance & Flowers 323 S 2nd St Stilwell OK 74960
22 Front Porch Fabrics LLC 10 W Chestnut St Stilwell OK 74960
23 H & H Pawn Gun & Tool 470546 Highway 51 Stilwell OK 74960
24 Harps Food Store PO Box 750 Westville OK 74965
25 Kennith’s Overhead Door 474735 E 740 Rd Westville OK 74965
26 Market Square 419 N 2nd St Stilwell OK 74960
27 Means Furniture Co 82212 Highway 59 Stilwell OK 74960
28 Movie Town 805 S 2nd St Stilwell OK 74960
29 Old Time Liquor 309 W Locust St Stilwell OK 74960
30 Redbox 1895 US-59 N Stilwell OK 74960
31 Redbox 317 N 2nd St Stilwell OK 74960
32 Redbox 189 S Highway 59 Watts OK 74964
33 Redbox 915 Highway 62 Westville OK 74965
34 Reed Hardware 21 W Division St Stilwell OK 74960
35 Reed’s Grocery RR 5 Stilwell OK 74960
36 S B C Materials & Supply Rt 4 Box 1860 Stilwell OK 74960
37 Schwan’s Global Supply Chain 5 E Walnut St Stilwell OK 74960
38 Scott Materials 80393 Highway 59 Stilwell OK 74960
39 Shady Deals 1100 W Locust St Stilwell OK 74960
40 Spears Co LLC 464963 E 785 Rd Stilwell OK 74960
41 Stilwell Food Pantry Acrc 110 S 2nd St Stilwell OK 74960
42 Stilwell Hardware Inc 209 N 2nd St Stilwell OK 74960
41 43 Stilwell Spirits 829 S Highway 59 Stilwell OK 74960
44 Sunshine Store 208 N 2nd St Stilwell OK 74960
45 Surplus Sales 714 N 2nd St Stilwell OK 74960
46 Tajour Specialty Products LLC 65294 S 4710 Rd Westville OK 74965
47 Ted’s Stilwell Discount Lbr 309 S 2nd St Stilwell OK 74960
48 Tyson Foods Inc Westville OK 74965
49 Walmart Bakery 84127 Highway 59 Stilwell OK 74960
50 Walmart Photo Center 84127 Highway 59 Stilwell OK 74960
51 Walmart Photo Center RR 6 Stilwell OK 74960
52 Walmart Supercenter 84127 Highway 59 Stilwell OK 74960
53 West Siloam Pawn 3381 Highway 412 W Watts OK 74964
54 Westville Flowers & Gifts 124 S Williams Westville OK 74965
55 Winner’s Circle Trophies 475419 Highway 51 Stilwell OK 74960
WHOLESALERS
1 Advanced Environmental RR 1 Box 14152 Watts OK 74964
2 Anderson Gas & Propane Inc 1828 N 5th St Stilwell OK 74960
3 Cal-Maine Foods Inc 62947 Highway 59 Watts OK 74964
4 Farmers Coop 81473 Highway 59 Stilwell OK 74960
5 Feeders Supply 12 W Oak St Stilwell OK 74960
6 L & S Feed & Supply PO Box 329 Westville OK 74965
7 Langley Feeds Inc PO Box 485 Westville OK 74965
8 Laserry’s Propane 73882 Highway 59 Westville OK 74965
9 Mountain View Meat Co Inc 465561 Highway 100 Stilwell OK 74960
10 Stilwell Livestock Sales PO Box 1417 Stilwell OK 74960
WILDLIFE SERVICES
1 Untamed Ranch Wildlife Rescue 77423 S 4640 Rd Stilwell OK 74960
CHURCHES
1 Antioch Baptist Church 470527 E 778 Rd Stilwell OK 74960
2 Bethel United Methodist Church 3223 Highway 412 W Watts OK 74964
3 Bidding Creek Baptist Church 317 W Maple St Stilwell OK 74960
4 Bunch Baptist Church 84504 S 4660 Rd Stilwell OK 74960
5 Calvary Southern Baptist Chr 920 N 4th St Stilwell OK 74960
6 Central Baptist Church Stilwell OK 74960
7 Cherry Tree Baptist Church 2015 RR 1 Stilwell OK 74960
8 Christian Worship Ctr Highway 100 E Stilwell OK 74960
9 Church Of Christ Section Line Rd Stilwell OK 74960
10 Fairfield Baptist Church E0810 Rd Stilwell OK 74960
42 11 Faith Alive Church Stilwell OK
12 Faith Alive Church 668 S Highway 59 Watts OK 74964
13 Faith Alive Church Westville OK
14 Fellowship Baptist Church Highway 100 W Stilwell OK 74960
15 First Assembly Of God S 4641 Rd Bunch OK 74931
16 First Baptist Church of Proctor 801 W Hickory St Stilwell OK 74960
17 First Baptist Church of Westville 224 S Locust Ave Westville OK 74965
18 First Baptist Church of Watts 421 4th St Watts OK 74964
19 First Christian Church 306 N 2nd Stilwell OK 74960
20 First United Mthdst Chr-Stlwll 4 N 3rd St Stilwell OK 74960
21 Guiding Light Church RR 1 Stilwell OK 74960
22 Independent Baptist Church 800 S Highway 59 Watts OK 74964
23 Jaybird Church E 680 Rd Westville OK 74965
24 Jubilee Baptist Church 830 S 4750 Rd Westville OK 74965
25 Mulberry Tree Baptist Church PO Box 1337 Stilwell OK 74960
26 New Life Church RR 2 Stilwell OK 74960
27 New Testament Church Stilwell OK 74960
28 Rock Springs Baptist Church 473460 Highway 100 Stilwell OK 74960
29 Rocky Mountain Bible Church 462937 E 830 Rd Stilwell OK 74960
30 Salem Baptist Church PO Box 1212 Stilwell OK 74960
31 Stilwell Assembly Of God Chr 219 W Walnut St Stilwell OK 74960
32 Victory Southern Baptist Chr Highway 51 E Stilwell OK 74960
EDUCATION: SCHOOLS & LIBRARIES
1 Bell Elementary School N4740 Rd Stilwell OK 74960
2 Bell School 88963 S 4729 Rd Stilwell OK 74960
3 Cave Springs Public Schools 89660 S 4637 Rd Bunch OK 74931
4 Cookson Hills Christian School 60416 Highway 10 Kansas OK 74347
5 Dahlonegah School 468739 E 878 Rd Stilwell OK 74960
6 Greasy Public School 92009 S 4676 Rd Bunch OK 74931
7 Indian Capital Technology Ctr 470826 E 810 Rd Stilwell OK 74960
8 Maryetta Head Start RR 4 Stilwell OK 74960
9 Maryetta Pre-School 470819 E 810 Rd Stilwell OK 74960
10 Maryetta Public Schools 470819 E 810 Rd Stilwell OK 74960
11 Maryetta School District 22 470819 E 810 Rd Stilwell OK 74960
12 Peavine Elementary School 77943 Highway 59 N Stilwell OK 74960
13 Peavine School District Highway 59 N Stilwell OK 74960
14 Peavine School District Highway 59 N Stilwell OK 74960
43 15 Rocky Mountain School 463355 E 835 Rd Stilwell OK 74960
16 South Greasy School 92009 S 4676 Rd Bunch OK 74931
17 Stilwell Elementary School 10 S 6th St Stilwell OK 74960
18 Stilwell High School 1801 W Locust St Stilwell OK 74960
19 Stilwell Kindergarten Ctr 520 W Oak St Stilwell OK 74960
20 Stilwell Middle School 12 N 7th St Stilwell OK 74960
21 Stilwell Preschool 519 W Oak St Stilwell OK 74960
22 Stilwell Public Sch Bus Barn 704 W Oak St Stilwell OK 74960
23 Stilwell School District Supt 1801 W Locust St Stilwell OK 74960
24 Stilwell Special Education 10 S 6th St Stilwell OK 74960
25 Watts Elementary School 616 6th St Watts OK 74964
26 Watts High School 616 6th St Watts OK 74964
27 Watts School District Office 616 6th St Watts OK 74964
28 Westville Elementary School 500 Chincapin St Westville OK 74965
29 Westville Junior High School 410 S Park Highway 62 Westville OK 74965
30 Westville School District 500 Chincapin St Westville OK 74965
31 Westville Special Education Highway 62 & Park St Westville OK 74965
32 Zion School 470658 E 850 Rd Stilwell OK 74960
LIBRARIES
1 Eastern Ok District Library 5 N 6th St Stilwell OK 74960
2 John Henderson Public Library 116 N Williams St Westville OK 74965
ENTERTAINMENT
CASINOS
Cherokee Casino West Siloam 2416 Highway US-412 Watts OK 74964
EMERGENCY SERVICES
1 Adair County Health Center 1401 W. Locust Stilwell OK 74960
2 Adair County Sheriff 600 Paul Mead Rd Stilwell OK 74960
3 Adair County Tri-Community Fire Dept 476626 E 855 Rd Stilwell OK 74960
4 Bell Rural Fire Department 101 W Walnut St. Stilwell OK 74960
5 Chance Community Fire Dept RR 2 Westville OK 74965
6 Greasy Volunteer Fire Dept Route 1 Box 1216 Bunch OK 74931
7 Oaks Fire Department 928 N Hwy 412a Oaks OK 74359
8 Pafford EMS 20 1/2 W Walnut St. Stilwell OK 74960
9 Stilwell Fire Department 14 W. Walnut St. Stilwell OK 74960
10 Stilwell Memorial Hospital - Emergency Dept 1401 W. Locust Stilwell OK 74960
44 11 Stilwell Police Department 17 S Second Street Stilwell OK 74960
12 Watts Fire Department 210 2nd St. Watts OK 74964
13 Watts Police Department 220 E 2nd St Watts OK 74964
14 Westville Fire Dept 221 S Williams Westville OK 74965
15 Westville Police Department 221 S Williams Westville OK 74965
CHILD CARE SERVICES
1 My Other Mothers Daycare Ctr 112 S Williams Ave Westville OK 74965
2 Nanna’s Day Care Stilwell OK
3 Tiny Tots Day Care Stilwell OK
4 United Keetoowah Band RR 1 Box 31 Stilwell OK 74960
FOOD & BEVERAGE
CONVENIENCE STORES & GAS STATIONS
1 59 Fuel & Feed Highway 59 & N 5th St Stilwell OK 74960
2 Big B Food & Deli 910 S 2nd St Stilwell OK 74960
3 Casey’s General Store 800 Highway 59 Westville OK 74965
4 Circle H Country Store 464505 Highway 51 Stilwell OK 74960
5 Claude Eubanks Grocery OK-100 Stilwell OK 74960
6 Conoco / QuickStop 901 US-59 Westville OK 74965
7 E-Z Mart 110 N 2nd St Stilwell OK 74960
8 Hop-In Highway 59 N Stilwell OK 74960
9 KWIK Kountry Highway 59 N & Buffington Rd Westville OK 74965
10 Love’s Travel Stop 3033 Highway 412 W Watts OK 74964
11 Murphy USA - Walmart 84081 Highway 59 & Route 100 Stilwell OK 74960
12 Oaks 1 Stop 155 W Main Oaks OK 74359
13 Providence Retail Stilwell LLC 1025 W Locust St Stilwell OK 74960
14 Reed’s Grocery 1227 RR 6 Stilwell OK 74960
15 Shop ‘n Go Highway 62 E & Piney Rd Westville OK 74965
16 State Line Grocery 478463 Highway 100 Stilwell OK 74960
17 Sunshine Store/Super Stop Stilwell OK
18 Westville Quick Stop Highway 59 & Highway 62 Westville OK 74965
GROCERY STORES
1 Shoppers Value RR6, Box 1895 Stilwell OK 74960
2 Top Value Cost Plus Foods 419 N. 2nd St Stilwell OK 74690
3 Walmart Super Center N 2nd St Stilwell OK 74690
RESTAURANTS & FAST FOOD
1 Best Western 273 S Highway 59 Watts OK 74964
45 2 Charlie’s Chicken & Bar-B-Que 11 W Walnut St Stilwell OK 74960
3 Checkers Stilwell OK
4 Chester’s & Godfather’s 3033 Highway 412 W Watts OK 74964
5 Co Co’s Bistro & Everything’s Nice 320 S 2nd St Stilwell OK 74960
6 Daylight Donuts 314 W Locust St Stilwell OK 74960
7 Double R&P Gas & Grill E 660 Rd Watts OK 74964
8 East Park Diner Highway 51 E Stilwell OK 74960
9 Holiday Motel 714 S 2nd St Stilwell OK 74960
10 LA Cabana 411 S 2nd St Stilwell OK 74960
11 LA Hacienda De Los Reyes #2 3535 Highway 412 W Watts OK 74964
12 Mc Donald’s 201 W Locust St Stilwell OK 74960
13 Mr B’s Pizza 300 W Locust St Stilwell OK 74960
14 Okie Joes Bbq 210 S 2nd St Stilwell OK 74960
15 Pizza Hut 84031 Highway 59 Stilwell OK 74960
16 Regency Inn & Suites 471245 Hwy 100 Stilwell OK 74960
17 Simple Simon’s Pizza Highway 59 N Stilwell OK 74960
18 Simple Simon’s Pizza Highway 59 N Westville OK 74965
19 Sonic Drive-In 82152 Highway 59 Stilwell OK 74960
20 Sonic Drive-In 862 Highway 59 Westville OK 74965
21 SUBWAY 817 S Highway 59 Stilwell OK 74960
22 SUBWAY Highway 62 & Hwy 59 S Jct Westville OK 74965
GOVERNMENT
1 3li LLC P.O. Box 877 Stilwell OK 74960
2 Adair County Assessor 220 W Division St # 109 Stilwell OK 74960
3 Adair County Clerk 220 W Division St Stilwell OK 74960
4 Adair County Commissioner Dist 220 W Division St #102 Stilwell OK 74960
5 Adair County Conservation Dist 468670 Highway 100 Stilwell OK 74960
6 Adair County Court Clerk 220 W Division St Stilwell OK 74960
7 Adair County District Atty 220 W Division St # 201 Stilwell OK 74960
8 Adair County District Judge 220 W Division St Stilwell OK 74960
9 Adair County Election Board 220 W Division St # 2 Stilwell OK 74960
10 Adair County Emergency Mgmt 600 Paul Mead Rd Stilwell OK 74960
11 Adair County Health Ctr Inc 1401 W Locust St Stilwell OK 74960
12 Adair County Health Unit 600 W Hickory St Stilwell OK 74960
13 Adair County OSU Extension 220 W Division St # 1 Stilwell OK 74960
14 Adair County Rural Water 75155 S 4724 Rd Westville OK 74965
15 Adair County Rural Water Dist 1113 N 2nd St Stilwell OK 74960
46 16 Adair County RWD Highway 62 Westville OK 74965
17 Adair County Sheriff 600 Paul Mead Rd Stilwell OK 74960
18 Adair County Treasurer 220 W Division St # 101 Stilwell OK 74960
19 Adair State Park Highway 51 & 59 Stilwell OK 74960
20 Benton County Stone Co Inc 463917 Hwy 100 Stilwell OK 74960
21 Chamber Of Commerce 1 S Highway 59 Stilwell OK 74960
22 Cherokee Nation Natrl Rsrcs RR 2 Box 93 Stilwell OK 74960
23 Cherry Tree Rural Water Dist 308 W Locust St Stilwell OK 74960
24 City-Stilwell Sewer Department 2306 N 5466 Rd Stilwell OK 74960
25 City-Stilwell Sewer Dept 2301 N Cemetery Rd Stilwell OK 74960
26 Department Of Human Svc 83346 S 4700 Rd Stilwell OK 74960
27 District Shop Courthouse/PO Box 88 Stilwell OK 74960
28 Kibois Area Transit System 310 W Locust St Stilwell OK 74960
29 Langley Development Co 716 S 2nd St Stilwell OK 74960
30 Northeast Ok Pubc Facilities 81075 Highway 59 Stilwell OK 74960
31 Oklahoma Workforce 219 W Oak St Stilwell OK 74960
32 Stilwell Area Development Auth 925 W Hickory St Stilwell OK 74960
33 Stilwell City Clerk 503 W Division St Stilwell OK 74960
34 Stilwell City Hall 503 W Division St Stilwell OK 74960
35 Stilwell City Mayor’s Office 503 W Division St Stilwell OK 74960
36 Stilwell City Personnel Dept 503 W Division St Stilwell OK 74960
37 Stilwell City Police 17 S 2nd St Stilwell OK 74960
38 Stilwell Community Building 320 N 6th St Stilwell OK 74960
39 Stilwell Court Clerk 17 S 2nd St Stilwell OK 74960
40 Stilwell Filtration Plant 860 W Spray St Stilwell OK 74960
41 Stilwell Housing Authority 801 N 4th St Stilwell OK 74960
42 Stilwell Sanitation Dept 503 W Division St Stilwell OK 74960
43 Stilwell Tag Office 115 W Division St Stilwell OK 74960
44 Stilwell Utilities 925 W Hickory St Stilwell OK 74960
45 Stilwell Utilities RR 3 Stilwell OK 74960
46 Tag Agency 115 W Division St Stilwell OK 74960
47 Town Of Watts Police Dept 220 E 2nd St Watts OK 74964
48 Tribal Complex Office 217 W Oak St Stilwell OK 74960
49 US Adair County Indian Credit 17 N 1st St Stilwell OK 74960
50 US Agricultural Dept 468670 Highway 100 Stilwell OK 74960
51 US Post Office 3 E Main St Bunch OK 74931
52 US Post Office 16 S 2nd St Stilwell OK 74960
53 US Post Office 601 E 6th St Watts OK 74964
47 54 US Post Office 210 S Williams St Westville OK 74965
55 WIc Prgm Cherokee Nation-Ok 150 Goingsnake Dr Westville OK 74965
56 Watts Public Works Authority PO Box 70 Watts OK 74964
57 Westville City Office 221 S Williams St Westville OK 74965
58 Westville Tag Agency 218 S Williams Westville OK 74965
59 Westville Utility Authority 502 S North Williams St. Westville OK 74965
HEALTH & HUMAN SERVICES
1 Adan Sprankelle, MD 471688 Highway 51 Stilwell OK 74960
2 Asbill, Tracie J Np 471688 Highway 51 Stilwell OK 74960
3 Auffet, Lois Rn 471688 Highway 51 Stilwell OK 74960
4 Bottoms, Frances 470819 E 810 Rd Stilwell OK 74960
5 Brady, Racheal I 1401 W Locust St # 102 Stilwell OK 74960
6 Brunk Optometry 816 W Cedar St Stilwell OK 74960
7 Carrie Haney, APRN 471688 Highway 51 Stilwell OK 74960
8 Chad A Catron P C 19 N 2nd St Stilwell OK 74960
9 Cook, David D Do 100 S Bliss Ave Tahlequah OK 74464
10 Country Style Health Care 802 W Chincapin Westville OK 74965
11 Dansby, Donna Ann APRN 1401 W Locust St Stilwell OK 74960
12 Dargan, Patrick Pa 471688 Hwy 51 Stilwell OK 74960
13 Public Health 471688 Highway 51 Stilwell OK 74960
14 Deroussel, Anastasia D Np 1401 W Locust St Stilwell OK 74960
15 Dustin Oxford, PA 471688 Highway 51 Stilwell OK 74960
16 Edgmon, William D 471688 Highway 51 Stilwell OK 74960
17 Family Dentistry 704 S 2nd St Stilwell OK 74960
18 Freeman, Matthew L Pa RR 6 Box 840 Stilwell OK 74960
19 Harp, Emma Beth Do 100 S Bliss Ave Tahlequah OK 74464
20 Hopkins, Karalee Rn 471688 Highway 51 Stilwell OK 74960
21 Hudson, Mystery A 500 Chincapin St Westville OK 74965
22 Janel Johnson, DO 471688 Highway 51 Stilwell OK 74960
23 Jimmie W Taylor MD 735 W Locust St Stilwell OK 74960
24 John Orkwis, Do 471688 Highway 51 Stilwell OK 74960
25 Late Night Chiropractic 201 S 2nd St Stilwell OK 74960
26 Matthew Freeman, PA 471688 Highway 51 Stilwell OK 74960
27 Morgan, Jason R 1401 W Locust St Stilwell OK 74960
28 Murphey, Molly E 761 Buffington Rd Westville OK 74965
29 Pettit, Ruby Rn 471688 Highway 51 Stilwell OK 74960
30 Physician’s Clinic 1401 W Locust St # 102 Stilwell OK 74960
48 31 Physician’s Clinic 1401 W Locust St # 102 Stilwell OK 74960
32 Physician’s Clinic 1401 W Locust St # 102 Stilwell OK 74960
33 Physician’s Clinic 1401 W Locust St # 102 Stilwell OK 74960
34 Physicians Clinic 1401 W Locust St # 102 Stilwell OK 74960
35 Physicians Clinic 1401 W Locust St # 102 Stilwell OK 74960
36 Physicians Clinic 1401 W Locust St # 102 Stilwell OK 74960
37 Physicians’ Clinic 1401 W Locust St # 102 Stilwell OK 74960
38 Physicians’ Clinic 1401 W Locust St # 102 Stilwell OK 74960
39 Physicians’ Clinic 1401 W Locust St # 102 Stilwell OK 74960
40 Reece, Matthew G DDS 471688 Hwy 51 East Stilwell OK 74960
41 Reed, Augusta 471688 Highway 51 Stilwell OK 74960
42 Rockey, Meghan APRN 471688 Highway 51 Stilwell OK 74960
43 Smith, Joie 471688 Highway 51 Stilwell OK 74960
44 Stewart, Krystal L 1401 W Locust St Stilwell OK 74960
45 Stilwell Health Pharmacy 202 S 2nd St Stilwell OK 74960
46 Stilwell Memorial Hospital 1401 W Locust St Stilwell OK 74960
47 Stilwell Nursing Home 422 W Locust St Stilwell OK 74960
48 Stilwell Mem. Physicians’ Clinic 471688 Highway 51 Stilwell OK 74960
49 Talbot, Terrie Dawn 500 Chincapin St Westville OK 74965
50 TBS Behavioral Svc 202 S Main St Watts OK 74964
51 Unger, Adrian APRN 1401 W Locust St # 102 Stilwell OK 74960
52 Walmart Pharmacy RR 6 Box 1895 Stilwell OK 74960
53 West, Fredric A Pa 761 Buffington Rd Westville OK 74965
54 Westville Family Medical Ctr 761 Buffington Rd Westville OK 74965
55 Westville Prescription Ctr 301 S Williams St Westville OK 74965
56 Wilma P Mankiller Health Ctr 471688 Highway 51 Stilwell OK 74960
COUNSELORS
1 Cherokee Behavioral Health 471688 Highway 51 Stilwell OK 74960
2 Creoks 716 S. 2nd Street #1014 Stilwell OK 74960
3 Fundamentals Counseling Svc 747 Highway 59 Suite 4 Westville OK 74965
4 Grand Lake Mental Health 106 W Maple St Stilwell OK 74960
5 Phoenix Counseling Svc LLC 1418 W Hickory St Stilwell OK 74960
6 Worley Carla Ms Lpc 621 S 4th St Stilwell OK 74960
MISCELLANEOUS
ABSTRACTERS & TITLE COMPANIES
1 AAA Abstract Co 118 W Olive St Stilwell OK 74960
2 Adair County Abstract & Title 207 W Division St Stilwell OK 74960
3 Green Country Abstract & Title 10 N 2nd St Stilwell OK 74960
49 APARTMENTS
1 Bushyhead Apartments (Cherokee Housing)
2 Gardenwalk Of Stilwell 802 Skywood Dr Stilwell OK 74960
3 Gardenwalk of Westville 352 N 3rd St Westville OK 74965
4 Hickory Village Inc 1400 W Hickory St Stilwell OK 74960
5 Kimberly Apartments
6 Savannah Park Of Stilwell 1501 W Young Ave Stilwell OK 74960
7 Savannah Park Of Westville 1000 Buffington Rd Westville OK 74965
8 Stilwell Housing Authority
9 Stonebrook Park
10 Willow Apartments
CEMETARIES Over 100 in Adair County, Oklahoma per local funeral home and okcemetaries.net
1 Corntassel Cemetary D4710 Rd. Westville OK
2 Stilwell Cemetery 503 W Division St Stilwell OK 74960
3 Watts City Cemetary
4 Westville Cemetary
NON CLASSIFIED ESTABLISHMENTS
1 A & A Athletics Highway 59 Westville OK 74965
2 Burton Bullies 506 W Blackjack St Stilwell OK 74960
3 Butterfield At The Smith Est 299 Serenity Dr Watts OK 74964
4 Cedar Valley LLC 64365 S 4645 Rd Watts OK 74964
5 Cycle 911 LLC 66903 Stompground Rd Proctor OK 74457
6 Cymmetta LLC RR 1 Box 474 Westville OK 74965
7 Even Start 520 W Division St Stilwell OK 74960
8 Fern Hill LLC 102 W Division St Stilwell OK 74960
9 Healing Springs Suris PO Box 188 Westville OK 74965
10 J D H LLC 78626 S 4710 Rd Stilwell OK 74960
11 Littledeer Smokeshop LLC 1113 N 2nd St Stilwell OK 74960
12 My Elite Accessories PO Box 18 Stilwell OK 74960
13 Rocking J F LLC 102 W Division St Stilwell OK 74960
14 Stanley Truck Shop LLC 210 W Division Westville OK 74965
15 Stomping Grounds 83971 Highway 59 Stilwell OK 74960
16 Stonebrook Of Stilwell 1503 Stonebrook Dr Stilwell OK 74960
17 T M S LLC 102 W Division St Stilwell OK 74960
COIN & BILL SERVICES
1 Coinstar 84127 Highway 59 Stilwell OK 74960
50 NONPROFIT ORGANIZATIONS
1 4-H Clubs & Affiliated 4-H Organizations 220 W Division St Ste 1 Stilwell OK 74960-3007
2 Adair County Cattlemans Association 1202 Sassafras St Stilwell OK 74960-4711
3 Adair County Environment Health Initiative Inc Po Box 1362 Stilwell OK 74960-1362
4 Adair County Fair Association Inc 82701 S 4670 Rd Stilwell OK 74960-6097
Adair County Historical And 5 1 S Highway 59 Stilwell OK 74960-3041 Genealogical Assocaition
6 Adair County Reserve Coalition Incorporated 475164 E 750 Rd Westville OK 74965-5005
7 Adair County Resource Center Inc Po Box 547 Stilwell OK 74960-0547
8 Adair County Schools Boys and Girls Club Po Box 1362 Stilwell OK 74960-1362
9 Adair County Spring Livestock Show 2018 Inc 74498 S 4690 Rd Stilwell OK 74960-2499
10 Adair County Tri Community Vol Fire Dept Po Box 484 Stilwell OK 74960-0484
11 American Legion Route 1 Box 319 Westville OK 74965-0000
12 Ancient Free & Accepted Masons Of Oklahoma Po Box 483 Westville OK 74965-0483
13 Art Works Creative Center Inc Rr 6 Box 1715 Stilwell OK 74960-8716
14 Baron Community Improvement Corporation 75422 Highway 59 Westville OK 74965-7038
Cc Camp Community Organization 15 Po Box 305 Stilwell OK 74960-0305 Incorporated
16 Cherokee Children Inc 89109 S 4629 Rd Bunch OK 74931-5218
17 Cherry Tree Community Youth Services Inc Po Box 825 Stilwell OK 74960-0825
18 Child Enrichment Program Po Box 268 Stilwell OK 74960-0268
Cookson Hills Community Action 19 Po Box 880 Stilwell OK 74960-0880 Foundation Inc
Dairy Herd Improvement Association 20 Rr 1 Box 108 Westville OK 74965-9718 Heart Of America
Department Of Oklahoma 21 Po Box 236 Watts OK 74964-0236 Ladies Auxiliary To The Vfw Inc
22 Dry Creek Community Organization Inc 30402 S 584 Rd Bunch OK 74931-2046
23 E P E C Earth People Education Center Inc 321 S 2Nd St Stilwell OK 74960-3807
24 East Oklahoma K9 74639 Highway 59 Westville OK 74965-7198
25 Ecolaw Institute Inc Rr 1 Box 964 Watts OK 74964-9737
26 Equip Tutoring Center 300 S Williams St Stilwell OK 74960-3638
27 Everyday Heroes For Children Foundation Inc Rr 1 Box 1340 Stilwell OK 74960-9750
28 Fairfield Community Organization Inc 471573 E 810 Rd Stilwell OK 74960-6029
Farm Ag Assistance Representation 29 101 W Division St Stilwell OK 74960-3009 For Minority Services Inc
30 Foundation Of Peavine Elementary School Po Box 389 Stilwell OK 74960-0389
31 Fraternal Order Of Police Po Box 527 Stilwell OK 74960-0527
Friends Of The John F Henderson 32 Po Box 580 Westville OK 74965-0580 Public Library Inc
Future Farmers Of America State 33 59200 S 4689 Rd Watts OK 74964-6869 Associations & Local Chapter
51 34 Goingsnake District Heritage Association Po Box 180 Westville OK 74965-0180
35 Goingsnake Soccer Club Rr 2 Box 393 Westville OK 74965-9648
36 Goingsnake Youth Services Inc Po Box 40 Westville OK 74965-0040
37 Good News Evangelistic Fellowship Inc 74798 S 4710 Rd Westville OK 74965-7041
38 Greasy Community Fellowship Organization Inc 467367 E 923 Rd Bunch OK 74931-5179
39 Green Country Soccer Association Rr 1 Box 350 Stilwell OK 74960-9710
40 Heartland Youth Inc Po Box 40 Westville OK 74965-0040
41 Hi-Way 100 West Fire Protection Association Po Box 872 Stilwell OK 74960-0872
42 Hickory Village Inc Po Box 1218 Stilwell OK 74960-1218
43 Hill Descendants Incorporated Rr 1 Box 482 Westville OK 74965-9763
44 Hope Center Inc Po Box 602 Westville OK 74965-0602
45 Jaycees Horses For Healing Inc 72401 S 4647 Rd Westville OK 74965-5050
46 Jeremiah 29 Foundation 116 W Division St Stilwell OK 74960-3010
47 Jesus Outreach International Church Rt 1 Box 5A Cave Springs Hollow Bunch OK 74931-9801
48 Jubilee Baptist Church Po Box 195 Westville OK 74965-0195
49 Key Club International 1801 W Locust St Stilwell OK 74960-3259
50 Kiwanis International 1305 W Young Ave Stilwell OK 74960-3243
51 Matthew 25 Housse Inc Po Box 347 Westville OK 74965-0347
52 Mcintosh Home Foundation Rr 4 Box 2656 Stilwell OK 74960-9499
53 Mid County Community Organization 77536 S 4700 Rd Stilwell OK 74960-3647
54 Military Order Of The Purple Heart Of The Usa Rr 1 Box 1175 Stilwell OK 74960-9743
55 Mount Of God Ministries Inc 476315 E 855 Rd Stilwell OK 74960-4662
National Association Of 56 Po Box 622 Westville OK 74965-0622 Postmasters Of The United States
57 Native Health Matters Rr 1 Box 2244 Stilwell OK 74960-9102
58 New Vision Corporation Rr 1 Box 1162 Watts OK 74964-9757
59 Oklahoma Farm Bureau 1310 N 2Nd St Stilwell OK 74960-1814
Oklahoma Home And Community 60 220 W Division St Stilwell OK 74960-3039 Education Inc
61 Orchard Road Community Outreach Inc 83089 S 4730 Rd Stilwell OK 74960-2789
62 Order Of Eastern Star Of Oklahoma Po Box 142 Stilwell OK 74960-0142
63 Order Of Eastern Star Of Oklahoma Rr 1 Box 517 Westville OK 74965-9768
64 Paws And Hooves Rescue Foundation 506 W Blackjack St Stilwell OK 74960-1658
65 Proctor Community Center A Corporation Po Box 193 Proctor OK 74457-0193
66 Pta Oklahoma Congress 1801 W Locust St Stilwell OK 74960-3259
Rocky Mountain Cherokee Community 67 Rr 1 Box 783 Stilwell OK 74960-9783 Organization
68 Safe House Foundation 419 W Division St Stilwell OK 74960-2809
69 Shalem House Foundation 71479 S 4644 Rd Proctor OK 74457-5031
52 70 Soroptimist International Of The Americas Inc Po Box 1278 Stilwell OK 74960-1278
71 Stilwell Public Library Friendssociety 82499 S 4752 Rd Stilwell OK 74960-2849
72 Stilwell Public School Foundation Inc 1202 Sassafras St Stilwell OK 74960-4711
73 Stilwell Roundup Club Inc Po Box 41 Stilwell OK 74960-0041
74 Stilwell Youth League Inc 1113 N 2Nd St Stilwell OK 74960-1809
75 Tops Club Inc 464001 E 689 Rd Proctor OK 74457-5205
76 Tri-Community W-E-B Association 18612 S 585 Rd Stilwell OK 74960-2726
77 United Postmasters And Managers Of America Po Box 622 Westville OK 74965-0622
78 United Way Of Adair County Inc Po Box 5 Stilwell OK 74960-0005
79 Untamed Ranch Wildlife Rescue Ltd Rr 4 Box 2170 Stilwell OK 74960-9494
Veterans Of Foreign Wars Of The United States 80 Po Box 101 Stilwell OK 74960-0101 Dept Of Oklahoma
81 Vietnam Veterans Of America Inc 320 S 3Rd Street Stilwell OK 74960-3802
82 Vital-Care Systems Inc 01012000 Po Box 6 Westville OK 74965-0006
83 Watts Community Building Organization 218 E 2Nd St Watts OK 74964-4502
84 Westville Alumni Golfersassociation Inc Po Box 341 Westville OK 74965-0341
85 Westville Education Foundation Inc Po Box 63 Westville OK 74965-0063
86 Westville Little League Sports Association 473920 E 705 Rd Westville OK 74965-7180
87 Westville Ph Church 176 N College Westville OK 74965-9425
Woodrow Bowles Westville School Project 88 Po Box 311 Westville OK 74965-0311 Memorial Fund Inc
89 Jaycee’s Horses For Healing 72401 S 4647 Rd Westville OK 74965
90 Cookson Hills Christian School 60416 Highway 10 Kansas OK 74347
91 Boys & Girls Club 10 N 2nd St Stilwell OK 74960
92 Gracepoint Outreach Ctr 75099 Hwy 59 Stilwell OK 74960
93 East Oklahoma K9 74639 Highway 59 Westville OK 74965
94 Good News Evangelistic Fllwshp 74798 S 4710 Rd Westville OK 74965
95 Mountain Top Youth Ministry 87200 S 4778 Rd Stilwell OK 74960
96 People Inc 104 S 1st St Stilwell OK 74960
97 Boys & Girls Club Of America 470819 E 810 Rd Stilwell OK 74960
98 Boys-Girls Club-Adair Coun 421 W Pine St Stilwell OK 74960
99 People Inc Youth Svc 106 W Maple St Stilwell OK 74960
PARKS, RECREATION, FITNESS, TRAILS
1 Rolling Wheels 611 N 4th St Stilwell OK 74960
2 Adair Park
3 Fitness Innovations 320 S 2nd Stilwell OK 74960
4 Fast Lane Fitness 317 N 2nd Stilwell OK 74960
5 Edna M. Carson Community Park 1155 W. Hickory Stilwell OK 74960
53 SERVICES, SHOPS, STORES
BEAUTY SERVICES
1 Cut Ups 211. N 2nd St Stilwell OK 74960
2 Deb’s Hair Depot 24 N 1st St Stilwell OK 74960
3 Headquarters Hair-Tanning Salon 1202 W Locust St Stilwell OK 74960
4 Jagged Edge Hair-Tanning Salo 1202 W Locust St Stilwell OK 74960
5 Styling Room Highway 62 W Westville OK 74960
6 Tranquility Gardens Hair 82511 S 4759 Rd Stilwell OK 74960
7 Becky’s Beauty & Boutique 195 S Highway 59 Watts OK 74960
8 Vivi Nails 15 N 1st St Stilwell OK 74960
CARPET CLEANING SERVICES
1 On-Site Carpet Drapery & More 27272 E Mclemore Hollow Rd Stilwell OK 74960
2 Sooner Supply Warrantee Crpts 1019 W Locust St Stilwell OK 74960
3 Holland Carpet Svc Watts OK 74964
CELLULAR & INTERNET SERVICES
1 Internet Café & Boutique 118 W Division St Stilwell OK 74960
2 Russel Celluar-Verizon Auth 83979 Highwaaay 59 Stilwell OK 74960
DEMOLITION & EXCAVATION SERVICES
4b Land Svc LLC 78981 S 4665 Rd Stilwell OK 74960
EMPLOYMENT SERVICES
1 People Link Staffing Solutions 835 S Highway 59 Stilwell OK 74960
2 Cherokee Nation Industries Inc 83944 S 4700 Rd Stilwell OK 74960
FINANCIAL SERVICES
1 Bell Finance Loans Stilwell 1737 US-59 Stilwell OK 74960
2 Carson Loan & Investment Co PO Box 71 Stilwell OK 74960
3 Dixie Finance 3455 Highway 412 W Suite A Watts OK 74964
4 Empire Finance 217 W Division St Stilwell OK 74960
5 Freedom Finance 82212 Highway 59 Stilwell OK 74960
6 Speedy Loans 119 W Plum St Stilwell OK 74960
7 Stilwell Loans 83617 Highway 59 Stilwell OK 74960
FUNERAL SERVICES
1 Hart Funeral Home 1400 W Locust St Stilwell OK 74960
2 Roberts & Hart Funeral Home 404 S Williams St Westville OK 74965
3 Roberts Reed-Culver Funeral Hm 801 W Locust St Stilwell OK 74960
HUNTING SERVICES
1 Hunt Mill Hollow Ranch 899 E Road Stilwell OK 74960
INVESTMENT SERVICES
1 Eastern Workforce Invstmnt Brd 219 W Oak St Stilwell OK 74960
54 LEATHER DEALERS & LEATHER GOODS REPAIR
1 Woods Saddlery 70246 S 4760 Rd Westville OK 74965
MEDICAL MARIJUANA DISPENSARIES
1 Backstreet Bud 815 South 3rd Street Stilwell OK 74960
2 Good Vibes Dispensary 312 West Locust Street, Ste. B Stilwell OK 74960
3 Green Country Elite Management Stilwell OK 74960
4 Happy Trails Dispensary Stilwell OK 74960
5 The Healing Hemp 319 South 2nd Street Stilwell OK 74960
6 Becky's Beauty and Boutique 195 South Highway 59 Watts OK 74964
7 Green Horizons Watts OK 74960
8 Earthy Mist 747 US-59 #2 Westville OK 74965
9 Emerald Skye Westville OK 74965
10 Higher Path Medicinals 420 Shady Place Westville OK 74965
11 Leafy Peace 470798 East 723 Road Westville OK 74965
PEST CONTROL SERVICES
1 State Termite Pest Control 201 N 2nd St Watts OK 74964
REAL ESTATE SERVICES
1 Century 21 Wright Real Est 1100 N 2nd St Stilwell OK 74960
2 Stilwell Realty 724 S 2nd St Stilwell OK 74960
3 Code3 Properties LLC RR 3 Box 1364 Westville OK 74965
REPAIR SERVICES
1 Action Lube & Muffler PO Box 944 Stilwell OK 74960
2 Bruners Towing & Recovery LLC 313 N 2nd St Stilwell OK 74960
3 Jerry’s Muffler & Auto PO Box 613 Westville OK 74965
4 Muffler Shop PO Box 1438 Stilwell OK 74960
5 Ozarks Electric Co-Op 470479 Highway 51 Stilwell OK 74960
6 Ozarks Electric Co-Op Corp PO Box 28 Stilwell OK 74960
7 S & S Small Engine Repair 470519 Highway 51 Stilwell OK 74960
8 South Side Lift Station 9108 S Fletcher Rd Stilwell OK 74960
9 Steve Panter Repairs Stilwell OK 74960
10 Ted’s Auto Repair 19 W Cedar St Stilwell OK 74960
SANITARY & LANDFILL SERVICES
1 Cherokee Nation Landfill Highway 59 Stilwell OK 74960
SENIOR CITIZEN SERVICES
1 Lake Frances Residential Care 304 Walnut St Watts OK 74964
2 Stilwell Nursing Home 422 W Locust St Stilwell OK 74960
3 Stilwell Senior Housing 400 N 8th St Stilwell OK 74960
4 Stilwell Nutrition Ctr 320 N 6th St Stilwell OK 74960
55 5 Westville Senior Citizens Ctr 113 Buffington Rd Westville OK 74965
STORAGE FACILITIES
1 Cram-A-Lot-In 20 N 1st St Stilwell OK 74960
2 Henningsen Cold Storage 1000 Paul Mead Rd Stilwell OK 74960
3 Secure Ministorage Inc 273 S Highway 59 Watts OK 74964
4 We Stor Mini Storage 473333 Highway 62 Westville OK 74965
TRANSPORTATION
1 Larry Mitchell Trucking 1235 S Highway 59 Watts OK 74964
2 Lrs Transport LLC 464914 E 785 Rd Stilwell OK 74960
3 Thomsen Trucking LLC 62593 S 4741 Rd Watts OK 74964
4 Tyner Creek X Press LLC RR 1 Westville OK 74965
5 Holbird Dump Trucking Westville OK 74965
56 Apendix C: Qualitative Instruments Adair County Tribal Health Assessment Semi-structured Interview Questions All information is private and utilized strictly for the purpose of this study.
Respondent Demographics Name Gender Age Race Occupation Zip Code Duration of residence in the area: Are you a member of the Cherokee Nation?
Objective: Identify public perception regarding the health of the community. Goal: Understand and respond to health related public opinion. Outcome: Public perception is that Adair County is generally physically and mentally unhealthy because of poverty, access to resources, diet and exercise habits, and substance abuse.
1. Would you say that in general Adair County is physically and/or mentally healthy? 2. Are you familiar with recent reports stating Stilwell, OK as having the lowest life expectancy in the US? • If yes – Please tell me your thoughts about the reports. • If no – According to multiple news reports, residents of Stilwell have an average life expectancy of 56. What are your thoughts? 3. Data shows people in OK have more health-related issues than people in other states. Why do you think this is the case specifically in Adair County?
Objective: Identify the accessibility of healthcare and health education. Goal: Ensure convenient/efficient access and usability of healthcare services and resources. Outcome: Cost is the primary barrier to healthcare and more healthcare providers are needed at existing clinics in order to improve the overall quality of care.
4. What barriers prevent people from receiving health care? 5. Is there a need for more healthcare providers?
Objective: Identify the accessibility of healthcare and health education. Goal: Ensure convenient/efficient access and usability of healthcare services and resources. Outcome: Successfully educating the public regarding the importance of preventative health and the availability of all resources entails a multipronged communication campaign with email, texting, and social media being the primary pathways to reach the public.
6. Do you think residents of Adair County have a personal doctor and get annual physicals? Why/Why Not? 7. Do you think county residents are aware of available services? 8. What is the best way to communicate/share information with the community?
Objective: Identify general health concerns and needs. Goal: Improve the overall health of the community by providing population-specific support, services and education. Outcomes: Diabetes, heart disease, and cancer are primary health concerns of the community
9. What health conditions are most important to you and your family? 10. Have there been occurrences of premature death in your family? Please explain.
Objective: Identify nutrition and exercise trends within the community. Goal: Develop programs to promote healthy lifestyles. Outcomes: The population generally chooses low-cost, convenient and unhealthy foods. Walking is a widely popular activity and there is a strong desire for a local low-cost fitness facility.
11. Do you think residents of Adair County attempt to consume a healthy diet on a regular basis? If no, why? 12. How often do you think county residents engage in physical activity/exercise? 13. What type of physical activity/exercise do you think residents would participate in and/or enjoy?
Objective: Identify individual/family well-being concerns and needs. Goal: Improve family stability and individual well-being through support and services. Outcomes: Families/friends gather for special occasions to eat traditional family recipes and they gather to support local sports. The Cherokee Nation can improve family cohesiveness through meaningful messaging and offering opportunities for families to be active in an indoor environment.
14. What is your opinion of how families/groups in this community spend time together? 15. What can the Cherokee Nation do to support a strong and healthy family unit? 57 Adair County Tribal Health Assessment Adair County Resident Survey All information is private and utilized strictly for the purpose of this study.
Respondent Demographics Name Gender Age Race Occupation Zip Code Duration of residence in the area: Are you a member of the Cherokee Nation?
Please Circle All That Apply For Each Question.
Objective: Identify public perception regarding the health of the community. Goal: Understand and respond to health related public opinion. Outcome: Public perception is that Adair County is generally physically and mentally unhealthy because of poverty, access to resources, diet and exercise habits, and substance abuse.
1. Would you say that in general your community is physically healthy? Yes No 2. Would you say that in general your community is mentally healthy? Yes No 3. Data shows people in Oklahoma have more health-related issues than people in other states. Why do you think this is the case in Adair County? Poverty Education Cultural/Family Traditions Lack of resources Alcohol Abuse Drug Abuse Other -
Objective: Identify the accessibility of healthcare and health education. Goal: Ensure convenient/efficient access and usability of healthcare services and resources. Outcome: Cost is the primary barrier to healthcare and more healthcare providers are needed at existing clinics in order to improve the overall quality of care.
4. Are there any barriers preventing you and your family from receiving healthcare? No Yes – Please select all that apply Transportation Time Money I don’t know where to go. I don’t care to go to the doctor. Other -
Objective: Identify the accessibility of healthcare and health education. Goal: Ensure convenient/efficient access and usability of healthcare services and resources. Outcome: Successfully educating the public regarding the importance of preventative health and the availability of all resources entails a multipronged communication campaign with email, texting, and social media being the primary pathways to reach the public.
5. Do you have a personal doctor and get annual physicals? Yes – Where do you go? No – Why not? 6. What is the best way to communicate/share information with you and your family? Email US Mail Phone Call Text Social Media Television Newspaper Radio Other -
58 Objective: Identify general health concerns and needs. Goal: Improve the overall health of the community by providing population-specific support, services and education. Outcomes: Diabetes, heart disease, and cancer are primary health concerns of the community
7. What health concerns are most important to you and your family? Heart Disease Cancer Diabetes Obesity Substance Abuse Mental Health Exercise Diet/Nutrition Other - 8. Have there been occurrences of premature death in your family? No Yes - Please explain.
Objective: Identify nutrition and exercise trends within the community. Goal: Develop programs to promote healthy lifestyles. Outcomes: The population generally chooses low-cost, convenient and unhealthy foods. Walking is a widely popular activity and there is a strong desire for a local low-cost fitness facility.
9. Do you try to eat a healthy diet on a regular basis? Yes Sometimes, Why only Sometimes? No, Why not? 10. How often do you engage in physical activity/exercise? Never – Why not? 1-2 times per week 3-4 times per week 5-7 times per week 11. What type of physical exercise would you enjoy? Walking Jogging/Running Biking Softball Baseball Basketball Swimming Other -
Objective: Identify individual/family well-being concerns and needs. Goal: Improve family stability and individual well-being through support and services. Outcomes: Families/friends gather for special occasions to eat traditional family recipes and they gather to support local sports. The Cherokee Nation can improve family cohesiveness through meaningful messaging and offering opportunities for families to be active in an indoor environment.
12. How do you spend time with your family and friends? Playing Games/Sports Watching the kids play sports Church Activities School Activities Outdoor Activities (camping, fishing, hunting) Special family get togethers (birthdays, holidays) Eating Together Traditional Tribal Ceremonies Other - 13. What can the Cherokee Nation do to support a strong and healthy family units? Cultural Events Parenting Classes Walking Clubs Counseling Services Jobs Sport Leagues Fitness facility near me Budget/Money Management Classes Cooking Classes Substance Abuse Treatment Fitness Classes Other -
59 60 Appendix D: Tribal Jurisdictions Quantitative Comparisons
The purpose of the Tribal Comparison Tables are to provide a synopsis of the differences and similarities among the Oklahoma counties within Cherokee, Chickasaw, Choctaw, and Muscogee (Creek) jurisdiction. The quantitative data parameters are by county and not by the specific geographic boundaries of tribal jurisdictions. Some county information is applicable to more than one tribe. Where appropriate and feasible, a population-based average of all counties within a district was computed to show overall rankings by tribal affiliation. The data, including categorized rankings, is presented with limitations and should not be interpreted as definitive rankings of the respective tribes. The data does establish accurate rankings of individual counties.
The Oklahoma tribal districts of the Cherokee, Chickasaw, Choctaw, and Creek Nations are comprised of 39 counties. The 14 counties within the Cherokee Nation yield the highest total population, the highest population of children under age five, and the highest concentration of Native Americans, with Adair, Cherokee, and Delaware counties comprising the top three highest Native American populations of the 39 comparison counties.
Adair County has the highest prevalence of obesity and diabetes of all 39 counties. Concurrent comparisons of the data set groupings reveal that Chickasaw counties exhibit the highest combined obesity mean at 38.05%. Cherokee counties have the lowest combined diabetes mean with Creek counties having the highest collective percentage of diabetes.
In addition to leading in obesity and diabetes, Cherokee counties ranked within the top three of the following data sets:
Health Outcomes & Behaviors • Lowest Diabetes % - Mayes (2), Tulsa (3) • Highest Respiratory Disease % - Sequoyah (2) • Lowest Respiratory Disease % - Washington (1), Tulsa (2) • Highest Hypertension % - Sequoyah (3) • Lowest Hypertension % - Tulsa (2), Mayes (3) • Highest Cardiovascular Disease Death Rate - Craig (3) • Highest Cancer Death Rate - Sequoyah (3) • Lowest Cancer Death Rate - Wagoner (1), Rogers (2) • Highest Smoking % - Nowata (2) • Lowest Smoking % - Craig (1), Tulsa (3) • Highest Physical Activity % - Rogers (2) • Lowest Physical Activity % - Craig (3) • Highest Vegetable Consumption % - Nowata (1) • Lowest Vegetable Consumption - Washington (1) • Highest Minimal Fruit Consumption - Adair (3) • Lowest Minimal Fruit Consumption - Washington (2)
Maternal & Child Health • Highest Teen Birth Rate - Adair (1) • Lowest Teen Birth Rate - Rogers (1), Cherokee (2) • Lowest Low Birthweight % - Cherokee (1) • Lowest % of Children Cared by Grandparents - Washington (2), Tulsa (3) • Highest Rate of Children in Foster Care - Muskogee (3) • Lowest Rate of Children in Foster Care - Wagoner (1), Rogers (2) • Lowest Rate of Child Abuse - Wagoner (1)
61 Education • Highest High School Drop Out % - McIntosh (2), Sequoyah (3) • Highest 3rd Grade Reading Proficiency - Nowata (1), Washington (3), Wagoner (3), Sequoyah (3) • Lowest 3rd Grade Reading Proficiency - Craig (3) • Highest 8th Grade Math Proficiency - Washington (3) • Highest High School Graduate % - Rogers (1), Washington (2), Wagoner (3) • Lowest High School Graduate % - Adair (2) • Highest Bachelor’s Degree % - Tulsa (1) • Lowest Bachelor’s Degree % - Nowata (1)
Households • Highest Owner-Occupied Rate - Wagoner (1) • Lowest Owner-Occupied Rate - Tulsa (1) • Highest Median Value of Owner-Occupied Housing Units - Rogers (2), Wagoner (3) • Highest Person per Household - Cherokee (2), Adair (3) • Lowest Person per Household - Mcintosh (2) • Highest % Households with a Computer - Wagoner (1), Rogers (2) • Highest % with Broadband Internet Subscription - Wagoner (1), Tulsa (3) • Lowest % Households with Broadband Internet Subscription - Adair (1)
Economy • Highest Persons without Insurance - Adair (1), Cherokee (2), Delaware (3) • Lowest Persons Without Health Insurance % - Rogers (1) • Highest Household Income - Rogers (2), Wagoner (3) • Lowest Household Income - Adair (2) • Highest Per Capita Income - Rogers (1), Tulsa (2) • Lowest Per Capita Income - Adair (1) • Highest Persons in Poverty % - Adair (1) • Lowest Persons in Poverty % - Wagoner (1), Rogers (2) • Highest Native American Children Living in Poverty % - Adair (1) • Lowest Native American Children Living in Poverty % - Rogers (3) • Highest SNAP Use % - Adair (2) • Lowest SNAP Use % - Rogers (3) • Highest Child Food Insecurity % - Adair (2), Sequoyah (3) • Lowest Child Food Insecurity % - Rogers (2), Wagoner (3)
62 Quantitative Tribal Comparison Tables
Highest Population 1. Cherokee Counties 1,211,949 2. Muscogee (Creek) Counties 952,019 3. Chickasaw Counties 363,713 4. Choctaw Counties 304,387
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Nowata All Races Otttawa Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Population 31,175 41,179 41,107 19,815 10,218 80,110 51,843 91,984 42,733 14,306 48,675 68,362 22,082 648,360
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Population 6,123 5,520 27,811 55,551 47,192 10,134 48,177 13,953 38,247 10,949 16,806 43,265 39,985
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Population 11,179 5,520 10,231 47,192 13,335 13,838 12,668 14,668 43,877 38,247 32,703 10,949 49,980
Counties within Muscogee
(Creek) Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Population 19,815 13,335 80,110 12,098 38,335 71,604 68,362 648,360
Source: US Census Bureau QuickFacts
63 Highest Population % Under 5 1. Adair - Cherokee 2. Tulsa - Cherokee and Muscogee (Creek) 3. Coal - Chickasaw and Choctaw
Highest Population % Over 65 1. McIntosh - Cherokee and Muscogee (Creek) 2. Delaware - Cherokee 3. Marshall - Chickasaw
Ages Craig Tulsa Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% Under 5 7.4 5.7 5.7 5 5.9 5.6 6.5 5.9 6.4 5.8 6.3 7.1 5.9 6.3
% Over 65 15.9 16.7 19.6 25 18.4 25.3 16.7 19.2 18.3 16.4 18.9 14.4 16.3 19.5
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% Under 5 6.5 6.8 7 6.6 5.7 6.4 6.1 6.4 5.9 6 5.6 6.8 5.9
% Over 65 18 16.8 20.3 17.9 16.2 21.3 19.4 19.1 21.7 15.5 19.7 16.5 20
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% Under 5 6 6.5 6.7 7 6 6.1 6.1 5.9 6.4 6.9 5.9 6.8 6
% Over 65 19.8 18 20.7 20.3 20.3 18.8 19.4 22.2 18.1 18.2 20 16.5 23
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% Under 5 6.3 6.1 5.6 6 5.6 6.5 7.1 5.9
% Over 65 17.6 18.8 17.7 18.9 25.3 16.7 14.4 16.3
Source: US Census Bureau QuickFacts
64 Lowest Native American Population % per County 1. Grady - Chickasaw 2. Jefferson - Chickasaw, Tulsa - Cherokee and Muscogee (Creek) 3. McCliain - Chickasaw
Highest Native American Population % per County 1. Adair - Cherokee 2. Cherokee - Cherokee 3. Delaware - Cherokee
Race Craig Tulsa Adair Mayes Rogers Ottawa Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% Caucasian Alone 42.3 51.8 65.6 66.2 67.1 69.4 60 68.7 69 75.2 65.3 72.6 76.4 77.4
% African American 0.6 1.4 3.1 0.5 0.7 3 11 2.5 1.1 1.3 1.9 10.8 3.8 2.6
% Native American 45.7 36.3 21.3 23.9 22.1 18.8 19.6 19.4 20.2 13.5 22.2 6.8 10.5 10.7
% Two or More Races 10.6 9.6 9.2 8 9.6 8.1 8.7 9.2 8 8.4 9.9 6.1 7.5 6.9
% Hispanic or Latino 6.8 7.3 3.7 3.7 3.7 2.8 6.3 3.1 5.8 4.9 4.3 13 6.4 6.1
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% Caucasian Alone 75.1 75 70.7 82.3 85.9 86.3 73.2 83.9 80.4 85.9 77 68.8 86.2
% African American 1.9 6.9 0.8 2.4 2.3 1.5 2.7 2.6 2 1 1.7 2.5 2.1
% Native American 14.7 10 19.7 8.9 6.2 6.8 15.6 7.6 10.9 7 13.8 19.5 5.9
% Two or More Races 7.8 6.7 8.6 5.7 5 4.7 7.9 5.1 6.2 5.5 6.9 8.3 4.9
% Hispanic or Latino 6.1 7.6 4.5 9.2 5.9 10.7 5.6 15.5 18.1 8.2 7.2 5.4 8
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% Caucasian Alone 73.2 75.1 63.3 70.7 73.2 66.1 73.2 66.5 77 65.9 72.8 68.8 72.9
% African American 3.9 1.9 10.5 0.8 0.8 5.8 2.7 1.2 2.1 8.1 3.3 2.5 1.1
% Native American 14.3 14.7 18.3 19.7 17.6 20.2 15.6 23.1 13.9 17 15.4 19.5 19.2
% Two or More Races 7.8 7.8 7.4 8.6 7.4 7.5 7.9 8.6 6 7.2 7.9 8.3 6.4
% Hispanic or Latino 3.5 6.1 4.5 4.5 4.5 6 5.6 4 7.1 6 5.3 5.4 4.2
65 Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% Caucasian Alone 78.9 66.1 63.5 64.9 69.4 60 72.6 76.4
% African American 2.3 5.8 7.3 8.3 3 11 10.8 3.8
% Native American 10.9 20.2 21.9 17.4 18.8 19.6 6.8 10.5
% Two or More Races 7.2 7.5 6.9 8.9 8.1 8.7 6.1 7.5
% Hispanic or Latino 4.3 6 3.9 4.3 2.8 6.3 13 6.4
Source: US Census Bureau QuickFacts
Health Outcomes & Behaviors
Highest Obesity % 1. Adair - Cherokee 2. Marshall - Chickasaw 3. Murray - Chickasaw
Lowest Obesity % 1. Latimer - Choctaw 2. Pushmataha - Choctaw 3. Love - Chickasaw
Highest Obesity % Combined Counties 1. Chickasaw 38.05% 2. Choctaw 37.09% 3. Cherokee 36.74% 4. Muscogee (Creek) 36.05%
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Obesity Prevalence % 34 35.5 36.2 36.8 38.5 38.5 38.9 40.1 40.1 40.5 41.6 42.5 44 51.3
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Obesity Prevalence % 33.3 33.6 34 36.1 37.2 38.3 38.9 39.7 40 40.6 43 46.5 47.6
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Obesity Prevalence % 31.1 32.9 33.6 34 36.7 36.7 37.4 38.2 38.9 39.3 39.7 40 42.3
66 Counties within Muscogee
(Creek) Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Obesity Prevalence % 34 36.8 39.5 40.1 41.7 42.3 44 44.2
Source: OK State Department of Health Wellness County Profile 2019
Highest Diabetes % 1. Adair - Cherokee 2. Pushmataha - Choctaw 3. Hughes - Choctaw & Muscogee (Creek)
Lowest Diabetes % 1. McClain - Chickasaw 2. Mayes - Cherokee 3. Tulsa - Cherokee and Muscogee (Creek), Carter - Chickasaw
Highest Diabetes % Combined Counties 1. Muscogee (Creek) 18.88% 2. Choctaw 14.84% 3. Chickasaw 13.68% 4. Cherokee 13.40%
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Diabetes Prevalence % 11.1 12 12.2 12.8 13.1 13.8 14.1 14.9 15.5 16.5 17 18.4 19.5 22.5
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Diabetes Prevalence % 9.7 12 12.3 12.3 12.8 13.3 14.4 14.7 15.1 15.8 16.7 18.7 19.3
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Diabetes Prevalence % 12.3 13.3 13.7 14.5 14.7 14.7 15.2 15.9 16.6 16.7 17.5 19.5 20.8
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Diabetes Prevalence % 12 12.8 13.1 13.8 14.1 16.3 16.5 19.5
Source: OK State Department of Health Wellness County Profile 2019
67 Highest Respiratory Disease % 1. Murray - Chickasaw 2. Sequoyah - Cherokee 3. Atoka - Choctaw
Lowest Respiratory Disease % 1. Washington - Cherokee 2. Tulsa - Cherokee and Muscogee (Creek) 3. McClain - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
COPD/Emphysema/Chronic 5.5 6.6 7.2 7.4 7.6 10.2 10.5 10.7 10.8 11 11.4 11.8 13.5 14.4 Bronchitis %
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
COPD/Emphysema/Chronic 7.2 9.6 9.7 9.8 10.1 10.2 10.3 10.5 11.1 11.2 11.2 12.9 15.1 Bronchitis %
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
COPD/Emphysema/Chronic 9.3 9.6 10.2 10.4 10.5 10.6 10.9 11.2 11.2 12.5 13.6 13.7 14.3 Bronchitis %
Counties within Muscogee
(Creek) Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
COPD/Emphysema/Chronic 6.6 7.4 8.2 9.2 10.4 10.5 10.8 11 Bronchitis % Source: OK State Department of Health Wellness County Profile 2019
68 Highest Hypertension % 1. Latimer - Choctaw 2. Marshall - Chickasaw 3. Sequoyah - Cherokee
Lowest Hypertension % 1. Murray - Chickasaw 2. Tulsa - Cherokee and Muscogee (Creek) 3. Mayes - Cherokee
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Hypertension Prevalence % 35.6 36 36.7 37 39 40.4 41 44.4 45.9 46.1 47 47.3 48.9 49.5
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Hypertension Prevalence % 35 36.8 37.2 37.7 38 38.8 39.9 40.4 41.8 46.2 50.3 51.9 52.8
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Hypertension Prevalence % 36.8 38.7 40.4 40.8 41.8 41.8 46.2 49 50.3 51.4 51.8 54.7 55.2
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Hypertension Prevalence % 35.6 40.4 41 41.9 44 45.6 47.3 49
Source: OK State Department of Health Wellness County Profile 2019
69 Highest Cardiovascular Disease Death Rate 1. Coal - Chickasaw and Choctaw 2. Haskell - Choctaw 3. Jefferson - Chickasaw
Lowest Cardiovascular Disease Death Rate 1. Marshall - Chickasaw 2. Okfuskee - Muscogee (Creek) 3. Love - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Cardiovascular Disease Age-Adjusted Death Rate 257.1 265.7 293.2 305.8 312.5 312.5 320.6 328.7 336.3 337.4 401.1 413.8 417.8 421.5 per 100,000
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Cardiovascular Disease Age-Adjusted Death Rate 226.1 255.4 279 284.9 295.2 297.8 301.5 301.7 303.2 311 315.8 421.9 459.3 per 100,000
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Cardiovascular Disease Age-Adjusted Death Rate 281.2 295.2 303.2 315.8 316.4 323.6 333.3 346.2 359.5 365.8 384.6 437 459.3 per 100,000
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Cardiovascular Disease Age-Adjusted Death Rate 246.4 257.1 305.8 316.1 366.1 384.6 401.1 417.8 per 100,000
Source: OK State Department of Health Wellness County Profile 2019
70 Highest Cancer Death Rate 1. Love - Chickasaw 2. Murray - Chickasaw 3. Sequoyah - Cherokee
Lowest Cancer Death Rate 1. Wagoner - Cherokee and Muscogee (Creek) 2. Rogers - Cherokee 3. Stephens - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Cancer Age-Adjusted Death Rate 137.5 155.3 169.4 170.9 173.5 176.1 188.3 192.1 192.4 197.7 198.6 211.1 217.9 227.9 per 100,000
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Cancer Age-Adjusted Death Rate 163.1 163.7 164.2 167.6 171.9 187.3 193.3 199.2 203.4 203.9 209.7 234.6 260.3 per 100,000
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Cancer Age-Adjusted Death Rate 164.2 178.5 179.8 181.4 184.9 186.9 187.3 188.6 191.9 199.1 203.4 203.9 213.1 per 100,000
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Cancer Age-Adjusted Death Rate 137.5 170.9 173.5 187 188.6 193.4 211.1 223.4 per 100,000
Source: OK State Department of Health Wellness County Profile 2019
71 Highest Smoking % 1. Okfuskee - Muscogee (Creek) 2. Nowata - Cherokee 3. Atoka - Choctaw
Lowest Smoking % 1. Craig - Cherokee 2. McClain - Chickasaw 3. Tulsa - Cherokee and Muscogee (Creek)
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Smoking Prevalence % 15.5 17.1 18.1 18.9 19.9 20.3 21.6 23 23.3 23.8 24.9 26.5 31.3 34.5
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Smoking Prevalence % 15.6 19.1 21.4 22.1 22.5 22.6 22.9 24.5 24.8 25.6 25.8 28.5 29.2
Counties within Choctaw
Nation - All Races Coal Atoka Bryan Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Smoking Prevalence % 20.1 21.1 22.1 22.6 22.7 23.8 24.5 25.1 26.3 29.1 29.2 31.9 34.3
Counties within Muscogee
(Creek) Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Smoking Prevalence % 17.1 20.3 21.1 23.8 24.9 25.8 26.5 38.9
Source: OK State Department of Health Wellness County Profile 2019
72 Highest Physical Activity % 1. Grady - Chickasaw 2. Rogers - Cherokee 3. McClain - Chickasaw
Lowest Physical Activity % 1. Haskell - Choctaw 2. Coal - Chickasaw and Choctaw 3. Craig - Cherokee
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Physical Activity Prevalence % 54.2 55.8 59.4 62.8 63 65.6 66.5 66.5 66.7 67.4 67.4 68.6 69.2 70.4
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Physical Activity Prevalence % 51.7 58.3 59.5 61.2 63.3 63.3 64.4 64.8 65 65.6 66.2 69.6 72.4
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Physical Activity Prevalence % 51.4 51.7 55.6 56.1 58.2 61.2 61.2 62.4 62.8 65 65.6 67 68.5
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Physical Activity Prevalence % 56.1 63 63.4 65.9 66.5 67.3 68.6 69.2
Source: OK State Department of Health Wellness County Profile
73 Highest Vegetable Consumption % 1. Nowata - Cherokee 2. Pushmataha - Choctaw 3. Bryan - Chickasaw and Choctaw
Lowest Vegetable Consumption % 1. Washington - Cherokee 2. Okmulgee - Muscogee (Creek) 3. Marshall - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Minimal Vegetable Consumption 12.8 15 15.2 15.9 16.2 17.3 17.8 18 18.1 18.8 18.9 21.4 22.4 26 Prevalence %
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Minimal Vegetable Consumption 14.9 16.4 16.5 16.8 17.1 17.3 17.8 18 18.7 20.3 20.9 21.7 23.8 Prevalence %
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Minimal Vegetable Consumption 15.7 15.9 16.3 17.8 18.2 18.7 21 21.1 21.2 21.7 22.3 23.8 24.7 Prevalence %
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Minimal Vegetable Consumption 13.1 15 15 15.2 16.2 18.7 21 21.4 Prevalence %
Source: OK State Department of Health Wellness County Profile 2019
74 Highest Minimal Fruit Consumption % 1. Bryan – Chickasaw and Choctaw 2. McCurtain - Choctaw 3. Okfuskee - Muscogee (Creek), Adair - Cherokee
Lowest Minimal Fruit Consumption % 1. Stephens - Chickasaw 2. McClain - Chickasaw 3. Carter - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Minimal Fruit Consumption Preva- 42.3 42.6 43.6 45.2 45.4 46.7 48.6 50.7 51 51.4 51.5 51.8 52.9 53.4 lence %
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Minimal Fruit Consumption Preva- 40 40.9 41.7 44.3 49.6 49.6 50.5 50.5 50.8 50.8 51.6 51.8 55.6 lence %
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Minimal Fruit Consumption Preva- 44.3 46.6 50.6 51.4 51.4 51.6 51.7 51.8 51.9 52.2 52.7 54.2 55.6 lence %
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Minimal Fruit Consumption Preva- 42.8 43.6 45.4 48.5 50.7 51 52.2 53.4 lence %
Source: OK State Department of Health Wellness County Profile 2019
75 Maternal & Child Health
Highest Teen Birth Rate 1. Adair - Cherokee 2. Hughes - Choctaw and Muscogee (Creek) 3. Atoka - Choctaw
Lowest Teen Birth Rate 1. Rogers - Cherokee 2. Cherokee - Cherokee 3. McClain - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
2017 Teen Birth Rate per 1,000 20.7 24.2 26.1 25* 30.6* 33* 35.4 37 39.9 40.6 42.9 48.9 49.7 72.1 Ages 15-19
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
2017 Teen Birth Rate per 1,000 24.6 25.6 26.2 29.4 33.8 35.9 36.2 42.2 44.5 47.1* 49.6 50* 53.9 Ages 15-19
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
2017 Teen Birth Rate per 1,000 26.2 30.7 33.8 39.1 41.8 42.2 44 44.5 44.6 47.4 50* 63.8 70.8 Ages 15-19
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
2017 Teen Birth Rate per 1,000 25* 29.5 31.4 33* 37 40.6 46.9 70.8 Ages 15-19
Source: The Annie E. Casey Foundation *2016 Data
76 Highest Low Birthweight % 1. Atoka - Choctaw 2. Love - Chickasaw 3. Johnston - Chickasaw and Choctaw
Lowest Low Birthweight % 1. Cherokee - Cherokee 2. Okmulgee - Muscogee (Creek) 3. Pittsburg - Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
2016 Low Birthweight % 4.4 5.7 5.9 6.4 6.5 6.5 6.7 7 7 7.1 7.3 7.3 8.1 N/A Under 5 1/2 lbs.
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
2016 Low Birthweight % 5.7 5.7 6 6.2 7.2 7.2 7.7 8.1 9.2 10.1 10.2 N/A N/A Under 5 1/2 lbs.
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
2016 Low Birthweight % 5.1 5.7 6 6.4 6.5 6.7 7.6 7.8 8.5 9 10.1 11.1 N/A Under 5 1/2 lbs.
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
2016 Low Birthweight % 4.6 5.6 5.6 6.5 6.7 6.7 7.1 7.3 Under 5 1/2 lbs.
Source: The Annie E. Casey Foundation
77 Highest % Children Cared by Grandparents 1. McCurtain - Choctaw 2. Choctaw - Choctaw 3. Johnston - Chickasaw
Lowest % of Children Cared by Grandparents 1. McClain - Chickasaw 2. Washington - Cherokee 3. Tulsa - Cherokee and Muscogee (Creek)
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% Children Cared by Grandparents 3.4 3.6 4.1 6.1 6.3 6.4 6.9 7.1 7.2 7.5 7.6 8 8.9 9.1 2012-2016
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% Children Cared by Grandparents 3.3 5.1 5.5 5.6 5.9 6.8 6.8 7 7.1 7.8 7.8 9 10.7 2012-2016
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% Children Cared by Grandparents 5.5 5.9 6.7 7 7.4 7.8 8.1 8.2 8.9 9 10.7 11.7 12 2012-2016
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% Children Cared by Grandparents 3.6 6.1 6.3 6.4 6.9 7.2 8.9 9.8 2012-2016
Source: The Annie E. Casey Foundation
78 Highest Rate of Children in Foster Care 1. Hughes - Choctaw and Muscogee (Creek) 2. Carter - Chickasaw 3. Muskogee - Cherokee and Muscogee (Creek)
Lowest Rate of Children in Foster Care 1. Wagoner - Cherokee and Muscogee (Creek) 2. Rogers - Cherokee 3. Murray - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Rate per 1,000 Children 0 to 17 1.9 3.1 5.5 5.5 7.8 7.9 8.5 8.5 8.8 9 10.2 10.4 13 16.6 in Foster Care 2017
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Rate per 1,000 Children 0 to 17 4.3 5.8 5.9 6.5 6.7 7.3 7.6 8.3 11.3 12.9 15 15.7 16.7 in Foster Care 2017
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Rate per 1,000 Children 0 to 17 6.5 6.7 7.8 8.1 8.7 10.7 10.9 11 11.1 14.2 15 15.7 27 in Foster Care 2017
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Rate per 1,000 Children 0 to 17 1.9 8.2 9 10.4 13 15.6 16.6 27 in Foster Care 2017
Source: The Annie E. Casey Foundation
79 Highest Rate of Child Abuse 1. Carter - Chickasaw 2. Choctaw - Choctaw 3. McCurtain - Choctaw
Lowest Rate of Child Abuse 1. Wagoner - Cherokee and Muscogee (Creek) 2. Delaware - Cherokee 3. McClain - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Rate per 1,000 Child Abuse & 4.8 9.3 12.1 14.9 16.6 17.8 20.3 20.5 21.8 22.5 23 23.7 24.3 25.2 Neglect 2017
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Rate per 1,000 Child Abuse & 11.1 11.2 11.4 12.7 13.1 14 18.7 18.9 19.4 20 20.3 23.7 27.3 Neglect 2017
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Rate per 1,000 Child Abuse & 11.2 15.7 17.1 18.8 18.9 19.4 21.3 23.3 23.7 23.8 24.9 25.4 26.8 Neglect 2017
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Rate per 1,000 Child Abuse & 4.8 11.6 12.1 16.6 20.4 20.5 22.5 23.8 Neglect 2017
Source: The Annie E. Casey Foundation
80 Education
Highest High School Drop Out % 1. Okfuskee - Muscogee (Creek) 2. McIntosh - Cherokee and Muscogee (Creek), Pittsburg - Choctaw, McCurtain - Choctaw 3. Sequoyah - Cherokee
Lowest High School Drop Out % 1. Latimer - Choctaw 2. Coal - Chickasaw & Choctaw 3. Haskell - Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
2017 High School Drop Out % 5.3 5.7 5.8 6.4 7.5 7.6 7.7 8 8.5 9 10.2 10.5 10.7 11.5
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
2017 High School Drop Out % 2.7 3.1 3.5 4.3 4.4 4.9 5.3 5.3 5.4 6.4 7 9.4 10.4
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
2017 High School Drop Out % 1.7 2.7 2.7 4 4.3 6.4 6.4 8 8.6 9 10.4 11.5 11.5
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
2017 High School Drop Out % 4 4.6 5.7 8.5 9 10.5 11.5 12
Source: The Annie E. Casey Foundation
81 Highest 3rd Grade Reading Proficiency 1. Nowata - Cherokee 2. Marshall - Chickasaw 3. Washington - Cherokee, Wagoner - Cherokee and Muscogee (Creek), Sequoyah - Cherokee
Lowest 3rd Grade Reading Proficiency 1. Love - Chickasaw 2. Choctaw - Choctaw 3. Craig - Cherokee
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
2016 -2017 3rd Grade Reading 29 33 35 36 36 38 39 40 40 45 47 47 47 48 Proficiency %
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
2016-2017 3rd Grade Reading 26 34 36 36 37 40 40 40 42 44 45 46 48 Proficiency %
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
2016-2017 3rd Grade Reading 28 32 34 34 35 36 39 40 40 44 45 46 46 Proficiency %
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
2016-2017 3rd Grade Reading 36 39 39 39 40 41 44 47 Proficiency %
Source: The Annie E. Casey Foundation
82 Highest 8th Grade Math Proficiency 1. Atoka - Choctaw 2. Latimer - Choctaw 3. Washington - Cherokee
Lowest 8th Grade Math Proficiency 1. Jefferson - Chickasaw, Choctaw - Choctaw 2. Okfuskee - Muscogee (Creek) 3. Hughes - Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
2016-2017 8th Grade Math 11 14 15 17 18 20 21 22 23 23 23 25 28 29 Proficiency %
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
2016-2017 8th Grade Math 4 16 17 20 22 23 23 23 24 24 24 26 27 Proficiency %
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
2016-2017 8th Grade Math 4 9 15 17 17 20 21 21 21 23 24 32 34 Proficiency %
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
2016-2017 8th Grade Math 6 9 12 17 21 22 23 25 Proficiency %
Source: The Annie E. Casey Foundation
83 Highest High School Graduate % Highest Bachelor’s Degree % 1. Rogers - Cherokee 1. Tulsa - Cherokee and Muscogee (Creek) 2. Washington - Cherokee 2. Pontotoc - Chickasaw and Choctaw 3. Wagoner - Cherokee and Muscogee (Creek) 3. McClain - Chickasaw
Lowest High School Graduate % Lowest Bachelor’s Degree % 1. Okfuskee - Muscogee (Creek) 1. Nowata - Cherokee 2. Adair - Cherokee 2. Okfuskee - Muscogee (Creek) 3. Hughes - Choctaw and Creek 3. Hughes - Choctaw and Creek
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
High School Graduate or Higher, 79.4 85.4 86 84.6 86.1 85.4 85.2 87 84.3 91.7 81.5 89 89.8 90.6 % of Persons Age 25+
Bachelor’s Degree or Higher, 13.6 24 14.7 16.5 15.4 13.6 18.9 11.5 14 23.5 13.8 30.9 22.7 27 % of Persons Age 25+
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
High School Graduate or Higher, 86.2 86.8 83.6 85.3 88.4 82.2 83.7 83.1 81.4 88.5 82.7 88.7 86.6 % of Persons Age 25+
Bachelor’s Degree or Higher, 22.5 20.4 16.6 15.5 18.9 12.5 16.6 14.8 14.6 24.1 19.8 28.1 17.4 % of Persons Age 25+
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
High School Graduate or Higher, 82.8 86.2 80.9 83.6 81.9 80.6 83.7 85.9 82.2 81.1 86.5 88.7 82.9 % of Persons Age 25+
Bachelor’s Degree or Higher, 14.6 22.5 12.5 16.6 12.9 12.4 16.6 16.3 14.9 13.5 16.3 28.1 15.2 % of Persons Age 25+
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
High School Graduate or Higher, 86.7 80.6 78.8 86.8 85.4 85.2 89 89.8 % of Persons Age 25+
Bachelor’s Degree or Higher, 15.6 12.4 12.1 14.6 13.6 18.9 30.9 22.7 % of Persons Age 25+
Source: US Census Bureau QuickFacts
84 Households
Highest Owner-Occupied Rate 1. Wagoner - Cherokee and Muscogee (Creek) 2. Love - Chickasaw 3. McClain - Chickasaw
Lowest Owner-Occupied Rate 1. Tulsa - Cherokee and Muscogee (Creek) 2. Bryan - Chickasaw and Choctaw 3. Pontotoc - Chickasaw and Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% of Housing Units Occupied 59.1 66.5 66.5 68.6 69.8 69.9 71.2 73.4 73.5 75.7 76 77.1 78.1 79.2 by Owners
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% of Housing Units Occupied 63 64 67.6 67.8 69.2 71.2 71.4 71.9 71.9 75.5 77.3 78.2 78.4 by Owners
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% of Housing Units Occupied 63 64 68.1 68.6 69.7 71.2 71.9 72.7 73.2 73.2 73.8 74.6 74.8 by Owners
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% of Housing Units Occupied 59.1 66.5 70.7 72.8 74.1 74.8 77.1 79.2 by Owners
Source: US Census Bureau QuickFacts
85 Highest Median Value of Owner Occupied Housing Units 1. McClain - Chickasaw 2. Rogers - Cherokee 3. Wagoner - Cherokee and Muscogee (Creek)
Lowest Median Value of Owner Occupied Housing Units 1. Jefferson - Chickasaw 2. Hughes - Choctaw and Muscogee (Creek) 3. Pushmataha - Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Median Value of Owner-occupied housing units $97,700 $81,200 $96,100 $81,600 $92,500 $95,300 $111,300 $84,300 $112,600 $110,000 $145,800 $106,700 $150,900 $150,400
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Median Value of Owner-Occupied Housing Units $87,800 $59,700 $79,500 $117,200 $93,400 $98,900 $86,600 $94,600 $107,100 $120,300 $166,400 $109,000 $104,000
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Median Value of Owner-Occupied Housing Units $81,100 $87,500 $87,200 $87,800 $79,500 $73,400 $78,000 $88,800 $98,900 $69,400 $98,400 $98,400 $120,300
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Median Value of Owner-Occupied Housing Units $97,700 $79,100 $95,300 $112,100 $80,300 $69,400 $145,800 $150,400
Source: US Census Bureau QuickFacts
86 Highest Persons per Household 1. Love - Chickasaw 2. Cherokee - Cherokee 3. Adair - Cherokee
Lowest Persons per Household 1. Atoka - Choctaw 2. McIntosh - Cherokee and Muscogee (Creek) 3. Pittsburg - Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Persons per Household 2.34 2.47 2.49 2.5 2.52 2.52 2.52 2.55 2.57 2.6 2.66 2.7 2.83 2.84
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Persons per Household 2.5 2.53 2.53 2.54 2.54 2.56 2.56 2.6 2.6 2.62 2.72 2.72 3.13
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Persons per Household 2.32 2.38 2.42 2.48 2.5 2.51 2.53 2.54 2.55 2.6 2.61 2.64 2.77
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Persons per Household 2.34 2.52 2.52 2.54 2.65 2.7 2.71 2.77
Source: US Census Bureau QuickFacts
87 Highest % Households with a Computer Lowest % Households with a Computer 1. Wagoner - Cherokee and Muscogee (Creek) 1. Choctaw - Choctaw 2. Rogers - Cherokee 2. McCurtain - Choctaw 3. McClain - Chickasaw 3. Hughes - Choctaw and Muscogee (Creek)
Highest % Households with Broadband Lowest % Households with Broadband Internet Subscription Internet Subscription 1. Wagoner - Cherokee and Muscogee (Creek) 1. Adair - Cherokee 2. McClain - Chickasaw 2. Hughes - Choctaw and Muscogee (Creek) 3. Tulsa - Cherokee and Muscogee (Creek) 3. Choctaw - Choctaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% Households with a Computer 69.5 75.9 76.8 81.6 82.6 76.7 79.1 78.4 74.1 89.5 79.2 88 90.6 84.3
% Households with Broadband 49.1 58.9 60.4 65.9 68.8 56.2 62.5 58.7 59.3 75.5 63.4 78.8 82 73.8 Internet Subscription
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% Households with a Computer 82.3 81.6 72.5 79.5 84 72.1 75.4 81.7 81.6 88.8 84.4 79.6 81.8
% Households with Broadband 65.7 60.7 60.2 66.8 64.5 54.9 58.2 61.4 57 79.3 64.2 64 67.2 Internet Subscription
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell LeFlore Hughes Latimer Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% Households with a Computer 77.6 82.3 65.1 72.5 74.5 66.1 75.4 75.8 73.3 65.5 79.4 79.6 71.7
% Households with Broadband 64.2 65.7 53 60.2 60.2 51.2 58.2 59 61.8 53.7 67.1 64 59.8 Internet Subscription
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% Households with a Computer 80.2 66.1 71.9 77.3 76.7 79.1 88 90.6
% Households with Broadband 72.1 51.2 57.8 61.7 56.2 62.5 78.8 82 Internet Subscription
Source: US Census Bureau QuickFacts
88 Economy
Highest Persons without Health Insurance % 1. Adair - Cherokee 2. Cherokee - Cherokee 3. Delaware - Cherokee
Lowest Persons without Health Insurance % 1. Rogers - Cherokee 2. Grady - Chickasaw 3. McClain - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% Persons Without Health 13.5 15.4 15.6 16.4 19.1 19.3 19.5 19.5 20.3 20.6 20.7 23.9 24.4 24.5 Insurance, Under 65
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% Persons Without Health 14.6 14.7 16.4 17.4 17.5 17.7 17.8 18.7 19.6 19.9 20 21.3 22.9 Insurance, Under 65
Counties within Choctaw
Nation - All Races Coal Atoka Bryan Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% Persons Without Health 17.7 19.5 19.6 19.8 19.9 20.2 20.4 20.7 21 21 21 21.3 21.3 Insurance, Under 65
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% Persons Without Health Insur- 15.4 15.6 16.2 16.5 19.1 19.8 20.4 20.7 ance, Under 65
Source: US Census Bureau QuickFacts
89 Highest Household Income Lowest Per Capita Income 1. McClain - Chickasaw 1. Adair - Cherokee 2. Rogers - Cherokee 2. Okfuskee - Muscogee (Creek) 3. Wagoner - Cherokee and Muscogee (Creek) 3. Hughes - Choctaw and Muscogee (Creek)
Lowest Household Income Highest Persons in Poverty % 1. Choctaw - Choctaw 1. Adair - Cherokee 2. Adair - Cherokee 2. Choctaw - Choctaw 3. Jefferson - Chickasaw 3. Muskogee - Cherokee and Muscogee (Creek)
Highest Per Capita Income Lowest Persons in Poverty % 1. Rogers - Cherokee 1. Wagoner - Cherokee 2. Tulsa - Cherokee and Muscogee (Creek) 2. Rogers - Cherokee 3. McClain - Chickasaw 3. McClain - Chickasaw
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
Median Household Income $52,017 $37,455 $39,187 $41,329 $41,282 $38,163 $59,210 $61,320 $38,472 $33,366 $38,234 $50,388 $45,302 $40,465
Per Capita Income in Past 12 Months $19,415 $22,175 $21,491 $27,337 $16,576 $19,253 $22,241 $22,575 $28,913 $19,799 $29,797 $21,800 $29,824 $20,666
% Persons in Poverty 27.2 21.2 19.8 18.4 17.2 19.9 24.8 17 19.9 10.1 20.5 14.4 10 14.3
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
Median Household Income $41,197 $45,671 $55,527 $39,931 $47,754 $51,844 $42,567 $35,933 $62,081 $38,636 $46,689 $44,805 $49,409
Per Capita Income in Past 12 Months $22,171 $25,177 $19,130 $22,431 $27,334 $21,022 $28,353 $22,433 $23,862 $24,965 $20,965 $24,804 $24,004
% Persons in Poverty 18.2 17 22.1 17.1 13.2 23 18 13.4 15.8 10.4 15.5 17.9 15
90 Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
Median Household Income $41,197 $37,106 $39,931 $38,017 $35,414 $39,253 $44,941 $38,425 $38,636 $34,250 $40,539 $30,298 $46,689
Per Capita Income in Past 12 Months $22,171 $21,022 $19,439 $19,446 $24,233 $23,862 $22,596 $18,004 $19,040 $20,264 $24,408 $20,009 $24,004
% Persons in Poverty 19.1 18.2 26.3 22.1 20.4 23.6 18 17.4 22.4 26 17.7 17.9 20
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
Median Household Income $47,147 $52,017 $41,329 $38,163 $59,210 $39,567 $38,425 $38,346
Per Capita Income in Past 12 Months $17,656 $27,337 $22,241 $21,436 $29,797 $21,800 $18,004 $24,056
% Persons in Poverty 16.3 23.6 24.2 18.1 19.9 24.8 14.4 10
Source: US Census Bureau QuickFacts
91 Highest Native American Children living in Poverty % 1. Adair - Cherokee 2. Murray - Chickasaw 3. McCurtain - Choctaw
Lowest Native American Children Living in Poverty % 1. Grady - Chickasaw 2. Love - Chickasaw 3. Rogers - Cherokee
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% Native American Children Living 16.2 22.3 26.1 26.2 26.5 27.4 27.4 29.7 31.5 31.8 33.1 36.6 37.2 44.5 in Poverty 2012-2016
% Caucasian Children Living in 12 11.1 17 29 18.6 25.9 18.5 21.6 25.1 34.1 30.5 26.4 36.7 40.9 Poverty 2012-2016
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% Native American Children Living 9.6 10.6 17.8 21.6 23.4 24.1 24.9 25 28.7 29.3 31.4 33.9 44.3 in Poverty 2012-2016
% Caucasian Children Living in 18.5 22.5 19.9 26 9 27.6 21.6 22.2 26.7 23.8 31.8 18.6 16.1 Poverty 2012-2016
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% Native American Children Living 23.4 24.1 24.8 24.9 25 26 29.8 30 30 31.4 33.7 35.6 39 in Poverty 2012-2016
% Caucasian Children Living in 29.3 27.6 30.2 21.6 22.2 34.4 20.2 17.6 27.7 31.8 32.1 28.1 24.3 Poverty 2012-2016
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
% Native American Children Living 22.3 26.1 27 27.4 27.8 31.5 36.7 35.6 in Poverty 2012-2016
% Caucasian Children Living in 11.1 17 18.8 25.9 23.9 25.1 29.6 28.1 Poverty 2012-2016
Source: The Annie E. Casey Foundation
92 Highest SNAP Use % 1. Choctaw - Choctaw 2. Adair - Cherokee 3. McCurtain – Choctaw
Lowest SNAP Use % 1. Love - Chickasaw 2. McClain - Chickasaw 3. Rogers - Cherokee
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
% SNAP Use by Households 9.2 11.2 11.3 12.9 13.1 14.8 15.9 16.1 17.1 18.8 19.1 20.3 20.7 24.6
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
% SNAP Use by Households 6.5 8.4 11.8 12.1 12.5 12.9 13.3 13.6 14 14.5 16.8 17.8 20.5
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
% SNAP Use by Households 14 14.5 15.3 15.4 17.2 17.8 19.7 20.3 20.4 20.5 21.1 21.6 26.4
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner McIntosh Okmulgee Muskogee Okfuskgee
% SNAP Use by Households 11.3 12.9 13.1 15.3 18.8 18.8 19.8 20.7
Source: Food Research & Action Center
93 Highest Child Food Insecurity % 1. Choctaw - Choctaw 2. Adair - Cherokee 3. Sequoyah - Cherokee
Lowest Child Food Insecurity % 1. McClain - Chickasaw 2. Rogers - Cherokee, Love - Chickasaw 3. Wagoner - Cherokee and Muscogee (Creek)
Counties within Cherokee Nation Reservation - Craig Tulsa Adair Mayes Rogers Ottawa All Races Nowata Wagoner McIntosh Cherokee Delaware Sequoyah Muskogee Washington
2016 Child Food Insecurity % 19.8 20.1 21.9 22.2 23.6 24.3 24.8 25.1 25.4 25.9 26.2 27.5 28.1 28.9
Counties within Chickasaw Coal Nation - All Races Love Bryan Grady Carter Garvin Murray McClain Marshall Jefferson Johnston Pontotoc Stephens
2016 Child Food Insecurity % 18.2 19.8 21.1 21.3 22 22.2 22.4 22.5 23.2 25.3 25.5 25.8 26.8
Counties within Choctaw
Nation - All Races Coal Bryan Atoka Haskell Hughes Latimer Le Flore Choctaw Pittsburg Johnston Pontotoc McCurtain Pushmataha
2016 Child Food Insecurity % 22.4 22.5 24.1 25.3 26.1 26.3 26.6 26.7 26.8 27.1 27.1 27.4 29.1
Counties within Muscogee (Creek)
Nation - All Races Tulsa Creek Hughes Wagoner Okfuskee McIntosh Okmulgee Muskogee
2016 Child Food Insecurity % 20.1 21.9 23 24.8 26.3 26.5 26.6 27.5
Source: The Annie E. Casey Foundation
94 Appendix E: About the Lynn Institute
Mission: To measurably improve the health of the communities we serve. Vision: LIHR will make significant improvements in health.
The Lynn Institute developed through a partnership with the Integris Baptist Medical Center Research Department in Oklahoma City. In 1997, the Lynn Institute separated from Integris Baptist Medical Center and was established as Lynn Institute for Healthcare Research Inc. (LIHR), an independent, nonprofit entity. For many years, the nonprofit conducted basic medical research and sleep studies. In 2012, LIHR transitioned to a new mission and began focusing on community health research.
The Lynn Institute for Healthcare Research, a 501(c)(3), now focuses on developing Lynn Healthy Community plans for neighborhoods, special groups, and disease specific situations. The four-step process includes identifying the at- risk population, defining the unique health risk through in-depth qualitative and quantitative data, publishing findings, and assembling or guiding the creation of a collaborative to adopt a sustainable plan to improve the health of the community. Lynn Healthy Community Initiative–Northeast Oklahoma City launched in 2014 with a 10-year plan to achieve measurable health goals within a community that leads Oklahoma, and in some cases the nation, in morbidity from preventable disease, infant mortality, obesity, diabetes and suicide. In 2016, Lynn published the Lynn Lifestyle Summary-Crossing Mission and Outreach Ministries Zip Code Study, a detailed analysis of the neighborhoods surrounding the Crossings Community Clinic in Northwest Oklahoma City. Lynn will launch the Oklahoma Inventory of Children’s Services in the fall of 2019, a user-friendly online tool to provide valuable resource information to multiple audiences helping Oklahoma families.
Board of Directors Chair Marc Edwards, J.D. | Attorney, Partner | Phillips Murrah
Wade Brawley | President | Land Information Services, Inc.
Robert Foreman, Ph.D. | George Lynn Cross Research Professor Dept. of Physiology | OU College of Medicine
Betsy Guthrie-Brunsteter | Principal Healthcare Planner | ADG
Leslie Lynn | Realtor | Churchill-Brown
Valerie McMurry | Director of Community Outreach | Metro Technology Centers
Laura Pitman, Ph.D. | Director of Population, Programs and Strategic Planning | OK Dept. of Corrections
Jerry Tubb, J.D. | Attorney, Partner | Fuller, Tubb, Bickford and Krahl
Karen Vinyard Waddell | President/CEO | Lynn Institute
95 96 Appendix E: About the Authors
President and Chief Executive Officer for The Lynn Institutes Karen Vinyard Waddell has more than 30 years of hospital administration and healthcare leadership, specializing in organizational strategic planning and taking companies to their next level of greatness. Prior to joining Lynn in 2011, Ms. Waddell’s administrative leadership included having served as Senior Vice President of Community Hospitals of Central California (Fresno, CA) and President, Community Hospitals Foundation; Regional Group Vice President for Hospital Corporation of America, Oklahoma-Texas-Arkansas, and Vice President of Presbyterian Hospital, Oklahoma City, and as Associate Vice President and Executive Director, the University of Oklahoma Health Sciences Center. She also served as President/Chief Executive Officer of Eckerd Youth Alternatives, a $110 million corporation helping at-risk kids, based in Clearwater, Florida and serving children and families in eleven states. She is a recognized and honored community leader in her home state of Oklahoma, having been appointed in 2013 by Governor Mary Fallin to chair the State Children’s Panel for the Oklahoma Department of Human Services and in 2012 as a Commissioner to the Oklahoma Department of Human Services Commission. She was a member and report author for the Special Review Committee studying deaths of children in foster care in 2011- 12, and chairs the collaborative she founded, “Count Me In 4 Kids”, a clearing house matching needs with providers and donors to help Oklahoma children. She is a graduate of the University of Oklahoma, a member of Leadership Oklahoma Class I, Leadership Oklahoma City Class II, SALLT Class I, Esther Women, and a member of the Ardmore Institutes of Health Board of Directors. She has been a finalist for Business Woman of the Year both in Tampa, Florida, and in Oklahoma City and is currently being honored as the 2019 Oklahoma Institute for Child Advocacy Children’s Advocate of the Year.
Principal Investigator, Director of Research and Planning Angela Cozby received a B.S. in Liberal Arts from the University of Central Oklahoma and earned an MBA from Oklahoma City University. Cozby began her career curating exhibits at the Oklahoma State Capitol while managing the prominent Oklahoma State Art Collection. In 2008, she accepted the position of Festival of the Arts Director at the Arts Council of Oklahoma City where she was responsible for planning and implementing all aspects of the community event which attracts over 750,000 people annually. As the Director of Research and Planning for the Lynn Institute for Healthcare Research, her role entails gathering and analyzing in-depth qualitative and quantitative data for creating dissertation level summaries outlining barriers and supports for health improvement of at-risk populations. She has extensive experience with project management, fundraising, program development, marketing, volunteer management, collaborating, data analysis, and creating fiscally responsible budgets. Cozby is certified in Human Subjects Research, Social and Behavioral Responsible Conduct of Research, and Health Information Privacy and Security through the Collaborative Institutional Training Initiative. She is a member of Leadership Oklahoma City LOYAL Class IV, Leadership Oklahoma City Signature Class 38 and was recognized as “Forty under 40” by both OKCBIZ 2009 and Oklahoma Magazine 2010. She was chair of the 2016 and 2017 Plaza District Festivals and currently serves on the Plaza District Association Board of Directors and Northeast OKC Renaissance, Inc. Board of Directors.
97 Director of Publications, Branding, and Marketing Steve Hanes is a graduate of the University of Central Oklahoma with a degree in Creative Studies and Graphic Design. With more than 25 years of creative professional experience, both in large and small companies, local and international, he is an accomplished graphic designer, highly proficient in Adobe Creative Suite and who has a repertoire of work that attests to his talent. He has worked with such clients as The State of Oklahoma, The World Wrestling Federation, PGA Online, American Institute of Architects (AIA), First National Bank & Trust Co., and Bob Moore Auto Group to name just a few.
CONTENT EDITORS
Jeaneen Pointer – Vice President and Chief Strategy Officer
Chandler Petty – Coordinator of Community Engagement and Digital Media
Stephen D. Petty – Vice President and Chief Community Engagement Officer
98 Conducting this study, on request and at the direction of The Cherokee Nation, was The Lynn Institute, an Oklahoma City based nonprofit research institute seeking to improve the health of the communities we serve. Lynn believes in providing a comprehensive summary of an area, a disease condition, or a specific need and then supports the formation of a collaborative to achieve sustainable health and lifestyle changes. All inquiries regarding the contents of this study and the research methodology are welcomed.
Lynn Institute for Healthcare Research, Inc. 3555 Northwest 58th Street, Suite 800, Oklahoma City, OK, 73112, 405.602.3939, www.lynninstitute.org Principal Investigator Angela Cozby, Director of Research and Planning, [email protected]
99 100