Defiance County Community Health Status Assessment 2018 Examining the Health of Defiance County FOREWORD Once again on behalf of the POWER Defiance County Coalition, I am pleased to present the 2018 Defiance County Community Health Assessment Report. This report is the fifth community health assessment conducted by various social service, business, and government organizations in Defiance County in an effort to collect data reporting the health and health behaviors of Defiance County residents. Data was collected for this assessment with the assistance of the Hospital Council of Northwest Ohio. Monitoring the health of local residents to identify community health problems is an essential public health service. This health status assessment should be used as a guide for strategic planning and decision making. It can help our communities identify new health concerns, measure the impact of current community improvement efforts, and guide the judicious use of local resources. However, this is only one planning tool. A true plan of action for community improvement will require taking a closer look at these survey results; seeking additional information from community residents, service providers, and others; identifying populations at risk for specific health conditions, and choosing effective strategies that will truly improve the health of Defiance County residents when put into action. This report would not have been possible without the help of members of the POWER Defiance County Coalition as well as the groups who contributed financially. Both are acknowledged on the following pages. It is vital that assessments such as this continue so that scarce resources are used in the most advantageous ways. All contributions whether financial or expertise is greatly appreciated. Addressing the needs of the Defiance County community will take further collaborations and partnerships of many individuals and agencies. The work of public health is more a system than a single agency. Working together we can achieve a healthier Defiance County. Sincerely, Jamie Gerken Health Commissioner Defiance County General Health District FOREWORD | 1 ACKNOWLEDGEMENTS This report has been funded by: Four County ADAMhs Board City of Defiance Community Memorial Hospital Defiance County Commissioners Defiance County General Health District Mercy Health Defiance ProMedica Defiance Regional Hospital United Way of Defiance County This report has been commissioned by POWER Defiance County: Promoting Overall Wellness and Empower Residents: Ayersville Local Schools City of Defiance Community Memorial Hospital Credit Adjustments Inc. Defiance Area Foundation Defiance Area YMCA Defiance City Schools Defiance County Commissioners Defiance County Drug Free Coalition Defiance County General Health District Defiance County Juvenile Court Defiance County Ohio State University Extension Office Defiance County Public Library System Defiance Development and Visitors Bureau Defiance 2100 Fairview School District Family and Children First Council Four County ADAMhs Board Hicksville Schools Hicksville Village Maumee Valley Guidance Center Mercy Health Defiance Ministerial Association Northeastern Local Schools Northwestern Ohio Community Action Commission ProMedica Defiance Regional Hospital Recovery Services of Northwest Ohio United Way of Defiance County Contact Information: Jamie Gerken Health Commissioner Defiance County General Health District 1300 E. Second St., Ste 100 Defiance, Ohio 43512 [email protected] (419)784-3818 ACKNOWLEDGEMENTS | 2 Project Management, Secondary Data, Data Collection, and Report Development Hospital Council of Northwest Ohio Britney L. Ward, MPH Margaret Wielinski, MPH Director of Community Health Improvement Assistant Director of Community Health Improvement Selena Coley, MPH Tessa Elliott, MPH Community Health Improvement Coordinator Community Health Improvement Coordinator Emily A. Golias, MPH, CHES Emily Stearns, MPH, CHES Community Health Improvement Coordinator Community Health Improvement Coordinator Alyssa Miller Carolynn McCartney Graduate Assistant Undergraduate Assistant Erin Rauschenberg Emily Soles Graduate Assistant Graduate Assistant Data Collection & Analysis Joseph A. Dake, Ph.D., MPH Professor and Chair School of Population Health University of Toledo Aaron J Diehr, PhD, CHES Consultant To see Defiance County data compared to other counties, please visit the Hospital Council of Northwest Ohio’s Data Link website at: http://www.hcno.org/community/data-indicator.html The 2018 Defiance County Health Assessment is available on the following websites: Defiance County General Health District http://defiancecohealth.org/defiance-county-public-health/ Hospital Council of Northwest Ohio http://www.hcno.org/community/reports.html ACKNOWLEDGEMENTS | 3 TABLE OF CONTENTS EXECUTIVE SUMMARY Pages 6-30 Primary Data Collection Methods Pages 6-8 2016 Ohio State Health Assessment (SHA) Page 9 Data Summary Pages 10-23 Trend Summary Pages 24-30 ADULT HEALTH CARE ACCESS Health Care Coverage Pages 31-33 Access and Utilization Pages 34-35 Preventive Medicine Pages 36-38 Women’s Health Pages 39-41 Men’s Health Pages 42-45 Oral Health Pages 46-47 ADULT HEALTH BEHAVIORS Health Status Perceptions Pages 48-49 Weight Status Pages 50-52 Tobacco Use Pages 53-56 Alcohol Consumption Pages 57-60 Drug Use Pages 61-66 Sexual Behavior Pages 67-70 Mental Health Pages 71-73 ADULT CHRONIC DISEASE Cardiovascular Health Pages 74-78 Cancer Pages 79-82 Asthma Pages 83-84 Diabetes Page 85 Quality of Life Pages 86-87 SOCIAL CONDITIONS Social Determinants of Health Pages 88-92 Environmental Conditions Page 93 Parenting Page 94 YOUTH HEALTH Weight Status Pages 95-98 Tobacco Use Pages 99-101 Alcohol Consumption Pages 102-105 Drug Use Pages 106-108 Sexual Behavior Pages 109-112 Mental Health Pages 113-117 Social Determinants of Health Pages 118-119 Violence Pages 120-122 CHILD HEALTH Health and Functional Status Pages 123-126 Health Care Access Pages 127-129 Early Childhood (0-5 Years) Pages 130-131 Middle Childhood (6-11 Years) Pages 132-133 Family and Community Characteristics Pages 134-137 Parent Health Page 138 TABLE OF CONTENTS | 4 APPENDICES APPENDIX I — Health Assessment Information Sources Pages 139-141 APPENDIX II — Acronyms and Terms Pages 142-143 APPENDIX III — Weighting Methods Pages 144-145 APPENDIX IV — School Participation Page 146 APPENDIX V — Demographic Profile Pages 147-148 APPENDIX VI — Demographics and Household Information Pages 149-156 APPENDIX VII — County Health Rankings Pages 157-159 TABLE OF CONTENTS | 5 EXECUTIVE SUMMARY This executive summary provides an overview of health-related data for Defiance County adults (ages 19 and older), youth (ages 12 through 18), and children (ages 0 through 11) who participated in a county-wide health assessment survey from January through March 2018. The findings are based on self-administered surveys using a structured questionnaire. The questions were modeled after the survey instruments used by the Centers for Disease Control and Prevention for their national and state Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Surveillance System (YRBSS), and the National Survey of Children’s Health (NSCH) which was developed by the Child and Adolescent Health Measurement Initiative. The Hospital Council of Northwest Ohio (HCNO) collected the data, guided the health assessment process, and integrated sources of primary and secondary data into the final report. Primary Data Collection Methods DESIGN This community health assessment was cross-sectional in nature and included a written survey of adults, adolescents, and parents within Defiance County. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. INSTRUMENT DEVELOPMENT Three survey instruments were designed and pilot tested for this study: one for adults, one for adolescents in grades 6 through 12, and one for parents of children ages 0 through 11. As a first step in the design process, health education researchers from the University of Toledo and staff members from HCNO met to discuss potential sources of valid and reliable survey items that would be appropriate for assessing the health status and health needs of adults, adolescents, and children. The investigators decided to derive the majority of the adult survey items from the BRFSS, the majority of the adolescent survey items from the YRBSS, and the majority of the survey items for the parents of children 0 through 11 from the NSCH. This decision was based on being able to compare local data with state and national data. The project coordinator from the Hospital Council of Northwest Ohio conducted a series of meetings with POWER Defiance County. During these meetings, HCNO and the planning committee reviewed and discussed banks of potential survey questions from the BRFSS, YRBSS, and NSCH surveys. Based on input from POWER Defiance County, the project coordinator composed drafts of surveys containing 113 items for the adult survey, 76 items for the adolescent survey, and 83 items for the 0 through 11 survey. Health education researchers from the University of Toledo reviewed and approved the drafts. SAMPLING | Adult Survey The sampling frame for the adult survey consisted of adults ages 19 and over living in Defiance County. There