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Adair-Tribal-Assessment-121319.Pdf 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
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