Seneca County Health Assessment Project 2013 COMMUNITY FOREWORD The members of the Seneca County Health Alliance are pleased to present the 2013 Health Assessment of our community. This comprehensive Community Health Assessment is the result of a strong commitment by dedicated community partners. This health assessment gives us the opportunity to glance into our community, state and nation to compare and analyze our strengths and weaknesses in order to take action to improve the health and well-being of residents of Seneca County. The data presented in this report will provide valuable information to develop strategies that focus on wellness, access to care, and unmet community needs. It will provide additional insight into our community structure in the areas of health and well-being. This assessment is counted reliable through scientific method. Although comparisons can be made related to previous health assessments, one must be cautious in comparing previous data to this current assessment. This assessment will prove invaluable to you as an agency or a community member. As we review the results of this assessment, we will continue to work collaboratively to coordinate resources, identify unmet needs in our community, and strive to initiate quality programs to improve the health of our residents. We encourage new membership into the Seneca County Health Alliance and look forward to new members bringing new ideas and resources to the Alliance and our community. 1 ACKNOWLEDGEMENTS Funding for the Seneca County Health Assessment Provided by: Community Hospice Care Firelands Counseling and Recovery Services Fostoria City Schools Fostoria Community Hospital – ProMedica Mental Health and Recovery Services Board of Seneca, Sandusky and Wyandot Counties Mercy Hospital of Tiffin Seneca County Family and Children First Council Seneca County General Health District Seneca County Department of Job and Family Services Tiffin City Schools Printing of the report made possible by the Mental Health and Recovery Services levy funds. Commissioned by: Seneca County Health Alliance Jenifer Bayer Director of Nursing Becky Gosche Seneca County General Health District Assistant Director Heidelberg University Laura Bogard Community Health Nurse Sue Hampshire Seneca County General Health District Executive Director Allen Eiry Senior Center Brenda Carper Project Director Mircea Handru Commission On Aging Deputy Director Mental Health and Recovery Services Martha Cobb Board of Seneca, Sandusky and Wyandot Counties Salvation Army Fostoria Lewis Hurst Nancy Cochran Superintendent Executive Director School of Opportunity Mental Health and Recovery Services Board of Seneca, Sandusky and Wyandot Counties Aaron Montz Don Coletta Mayor City of Tiffin Superintendent Tiffin City Schools Allyson Murray Christine Courtney Dir. Of Public Safety and Service Fostoria Mayor Office Program Coordinator First Call for Help Lori Myers Scott Daniel Manager of Outpatient Services and Specialty Clinics Mercy Hospital of Tiffin Director of Operations Tiffin City Schools Kathy Oliver Pat DeMonte Director Seneca County Department of Job and Family Services Director Seneca United Way Robin Reaves Bernie Dickson Site Director Firelands Counseling and Recovery Services Pastor Fostoria Ministerial Rebecca Shank Bill Eckelberry Executive Director Sheriff Community Hospice Care Seneca County Sheriff Sheryl St. Clair, RN, BSN Bev Funkhouser School Nurse Fostoria City Schools Wellness Specialist Fostoria Community Hospital – ProMedica Angi Todd Sharon George Health Advocate Executive Director WSOS Seneca County Family & Children First Council Angel Torrez Social Services Coordinator 2 Ann Golden PK Management Educator for Youth Development OSU Extension Project Management, Secondary Data, Data Collection, and Report Development Healthy Communities Foundation Britney L. Ward, MPH Hospital Council of Northwest Ohio Assistant Director of Health Planning Margaret Wielinski, MPH Michelle Von Lehmden Health Improvement Data Specialist Health Assessment Coordinator Amy Nagle Graduate Assistant Data Collection & Analysis James H. Price, Ph.D., MPH Joseph A. Dake, Ph.D., MPH Professor Emeritus of Health Education Professor and Chair of Health Education University of Toledo University of Toledo Timothy R. Jordan, Ph.D., M.Ed. Professor of Health Education University of Toledo Contact Information Nancy A. Cochran Mental Health & Recovery Services Board of Seneca, Sandusky, and Wyandot Counties 600 North River Road Tiffin, Ohio 44883 Phone: 419-448-0640 Email: [email protected] 3 TABLE OF CONTENTS EXECUTIVE SUMMARY PAGES 5-16 TREND SUMMARY PAGES 17-20 Adult Health (Ages 19 and Over) HEALTH STATUS PERCEPTIONS PAGES 21-23 HEALTH CARE COVERAGE PAGES 24-27 HEALTH CARE ACCESS AND UTILIZATION PAGES 28-29 CARDIOVASCULAR HEALTH PAGES 30-34 CANCER PAGES 35-39 DIABETES PAGES 40-42 ARTHRITIS PAGES 43-45 ASTHMA AND OTHER RESPIRATORY DISEASE PAGES 46-48 WEIGHT STATUS PAGES 49-51 TOBACCO USE PAGES 52-56 ALCOHOL CONSUMPTION PAGES 57-61 MARIJUANA AND OTHER DRUG USE PAGES 62-64 WOMEN’S HEALTH PAGES 65-70 MEN’S HEALTH PAGES 71-75 PREVENTIVE MEDICINE AND HEALTH SCREENINGS PAGES 76-78 EMERGENCY PREPAREDNESS PAGES 79-80 SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES PAGES 81-87 QUALITY OF LIFE PAGES 88-89 SOCIAL CONTEXT AND SAFETY PAGES 90-92 MENTAL HEALTH AND SUICIDE PAGES 93-95 ORAL HEALTH PAGES 96-98 PARENTING PAGES 99-100 Youth Health (Ages 12-18) WEIGHT CONTROL PAGES 101-104 TOBACCO USE PAGES 105-107 ALCOHOL CONSUMPTION PAGES 108-111 MARIJUANA AND OTHER DRUG USE PAGES 112-114 SEXUAL BEHAVIOR AND TEEN PREGNANCY OUTCOMES PAGES 115-118 MENTAL HEALTH AND SUICIDE PAGES 119-121 YOUTH SAFETY PAGES 122-124 YOUTH VIOLENCE ISSUES PAGES 125-127 Appendices HEALTH ASSESSMENT INFORMATION SOURCES APPENDIX I PAGES 128-132 LIST OF ACRONYMS AND TERMS APPENDIX II PAGES 133-134 WEIGHTING METHODS APPENDIX III PAGES 135-137 SCHOOL PARTICIPATION APPENDIX IV PAGE 138 DEMOGRAPHIC PROFILE APPENDIX V PAGE 139 DEMOGRAPHICS AND HOUSEHOLD INFORMATION APPENDIX VI PAGES 140-147 4 EXECUTIVE SUMMARY This executive summary provides an overview of health-related data for Seneca County adults (19 years of age and older) and youth (ages 12 through 18), who participated in a county-wide health assessment survey during 2013. 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) and Youth Risk Behavior Surveillance System (YRBSS). The Hospital Council of Northwest Ohio collected the data, guided the health assessment process and integrated sources of primary and secondary data into the final report. Primary Data Collection Methods DESIGN This community health assessment was cross-sectional in nature and included a written survey of adults and adolescents within Seneca County. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. INSTRUMENT DEVELOPMENT Two survey instruments were designed and pilot tested for this study: one for adults and one for adolescents. As a first step in the design process, health education researchers from the University of Toledo and staff members from the Hospital Council of NW Ohio met to discuss potential sources of valid and reliable survey items that would be appropriate for assessing the health status and health needs of adults and adolescents. The investigators decided to derive the majority of the adult survey items from the BRFSS. The majority of the survey items for the adolescent survey were derived from the YRBSS. This decision was based on being able to compare local data with state and national data. The Project Coordinator from the Hospital Council of NW Ohio conducted a series of meetings with the planning committee from Seneca County. During these meetings, banks of potential survey questions from the BRFSS and YRBSS surveys were reviewed and discussed. Based on input from the Seneca County planning committee, the Project Coordinator composed drafts of surveys containing 115 items for the adult survey and 76 items for the adolescent survey. The drafts were reviewed and approved by health education researchers at the University of Toledo. SAMPLING | Adult Survey Adults ages 19 and over living in Seneca County were used as the sampling frame for the adult survey. Since U.S. Census Bureau age categories do not correspond exactly to this age parameter, the investigators calculated the population of those 18 years and over living in Seneca County. There were 43,377 persons ages 18 and over living in Seneca County. The investigators conducted a power analysis to determine what sample size was needed to ensure a 95% confidence level with a corresponding confidence interval of 5% (i.e., we can be 95% sure that the “true” population responses are within a 5% margin of error of the survey findings.) A sample size of at least 381 adults was needed to ensure this level of confidence. The response rate for the mailing was 49% (n=467). This return rate and sample size means that the responses in the health assessment should be representative of the entire county. The random sample of mailing addresses of adults from Seneca County was obtained from American Clearinghouse