Bureau & Putnam County Health Department 2007 IPLAN

Transcription

1 Bureau & Putnam County Health Department 2007 IPLAN -Serving Bureau & Putnam County Residents Prepared by: Diana Rawlings Public Health Administrator 526 Bureau Valley Parkway Princeton, Illinois /

2 2 COMMUNITY HEALTH PROBLEMS: 1. Heart Disease 2. Substance Abuse 3. Obesity

3 3 COMMUNITY HEALTH PLANNING COMMITTEE Claudia Bachman Donna Barker Ana Basecki Lonnie Caldwell Sue Cater Beth Coleman Dawn Conerton Deb Dalton Luke Davis Kris Donarski Jill Fruch Mary Sue Goldsmith Hector Gomez Les Grant Denise Jackson Joy Jaraczewski Phil Kaufman Pat Lebahn Kristin Ledergerber Trent Munson Tim Muntz Carey Panier Deb Piper Terry Polhemus Diana Rawlings Tom Root Julia Slaight Kate Terlep Deb Thompson John Thompson Ernesto Villalobos Julie Wagner Janice Wamhoff Deb Wood North Central Behavioral Health System Reporter Bureau County Republican Freedom House Coordinator, WIC & FCM, Putnam County Health Dept Nurse, Princeton School System Bureau County Metro Center Health Educator, Bureau County Health Department Superintendent Malden School Princeton Fire Department Bureau County Zoning & ESDA Officer Bureau County Farm Bureau Bureau County Board of Health Coordinator, Fiscal Department, BCHD Coordinator, Disaster Response, BCHD Perry Memorial Hospital Coordinator, Health Education, Bureau County Health Dept CEO, Greenfield Retirement Home Coordinator, CDC, Immuns., Bureau County Health Dept Nurse, Bureau Valley Schools University of IL Extension CEO, St. Margaret s Hospital Coordinator, Environ. Health, Bureau County Health Dept Coordinator, WIC & FCM, Bureau County Health Dept Princeton Police Department Public Health Administrator, Bureau County Health Dept Princeton Police Chief Access Services of Northern Illinois CEO Bureau County Health & Wellness Clinic Freedom House Bureau County Sheriff Public Health Dentist Director, Illinois Department of Human Services Bureau County Coroner Perry Memorial Hospital

4 4 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS As part of the process of Local Health Department certification, the Bureau County Health Department conducted an Organizational Capacity Self-Assessment, completed a Community Health Needs Assessment, organized a Community Health Advisory Committee, and created a Community Health Plan using the IPLAN process. Meetings of the Community Health Advisory Committee were held on September 13, October 4 and October 18, The Organization Capacity Self-Assessment was completed by the health department management group in April, The management group then created the Community Health Needs Assessment by gathering applicable statistics from the sources listed in the reference section of this document. The data included in the assessment was significant in that it either showed a rate or percentage of disease in Bureau County that was higher than the State of Illinois or higher than that in rural counties comparable to Bureau County in frontier status, population and income. These counties included Iroquois and Stephenson Counties. Data from neighboring counties LaSalle, Henry and Lee Counties - were also used for comparison purposes. The Community Health Needs Assessment was mailed to committee members prior to the first meeting. After reviewing the assessment, each committee member submitted to the health department a list of what they saw as the top three health problems in the County. These were compiled into a list of the top five health problems submitted. Twenty-six community members responded and of these, twenty-three agreed to become a part of the Community Health Committee. All nine of the health department managers also attended the meetings. During the first meeting the committee received an overview of IPLAN and the role of the committee in the process. In addition, they were given updates on the work that has been accomplished on health problems identified in the two previous IPLAN Health Plans. The committee then reviewed and discussed the top five health problems that were submitted prior to the meeting. The Hanlon Method for prioritizing health problems, from the APEXPH Manual was used to determine which three of these health problems would be chosen. The following health problems were chosen: 1. Heart Disease 2. Substance Abuse 3. Obesity

5 5 After several hours discussing each health priority the group determined the risk factors, direct & indirect contributing factors for each of the health problems. The statistics reviewed indicate that heart disease is still the leading cause of death in Bureau County. An average of 30% of the deaths in Bureau County each year is due to heart disease. This has gone unchanged since 1994, and may be partially due to the high dependency indicators. This county has a 5.4% higher dependency indicator for its elderly population (over age 64). Substance abuse also continues to be a major health problem in Bureau County. The committee decided to include alcohol, drug and tobacco use under this category. Substance abuse has contributed to a high rate of motor vehicle fatalities involving alcohol in 1994 and Data obtained from the BRFSS report indicate that Bureau County residents are at a higher risk of both chronic drinking and binge drinking than the other rural counties in Illinois and the State as a whole. The percentage of Bureau County residents that smoke has decreased from 1997 to 2004 and remains comparable to peer counties. However, it is still well above the Healthy People 2010 target of 12%. The number of mothers who smoke during pregnancy is dramatically higher than the State percentages. The percentage of 8 th graders in Bureau County, who had used alcohol in the past month, had been binge drinking in the past two weeks, was suspended from school, or was drunk or high at school was substantially higher than the State percentages. In over half of Bureau County residents were either overweight or obese. In all of the data reviewed the percentage of Bureau County residents that are obese and / or sedentary exceeded the state percentage. Nutrition data showed that diet is poor with over half of Bureau County residents eating less than three servings of fruits and vegetables a day. At the second meeting the committee reviewed the Health Problem Analysis Worksheets that were created from the data obtained in the first meeting. Then after a brief description of how to set objectives for the health plan, the group divided into three workgroups. Each workgroup set an outcome objective and the impact objectives for the health problem they were working on. The Healthy People 2010 objectives were used as a guideline. Each group then discussed proven intervention strategies that could be implemented as well as possible programs, resources available and possible barriers. The entire committee then gathered and each workgroup presented their plan for committee input and approval. Because of the animated discussion on proven intervention strategies and potential programs in Substance Abuse, that workgroup decided to meet regularly to develop collaborative programs that include the health department, the schools and law enforcement. Prior to the final meeting, the committee was mailed the draft of the IPLAN report and a few additional statistics for the county. They then met to discuss any

6 6 changes that should be made. It was noted that several of the original objectives that were set were difficult to measure, so the committee spent several hours reviewing these and rewording them. The additional statistics that were reviewed at this meeting were examples of data that is available for tracking objectives. The committee then went through each of the proven intervention strategies again and added a few ideas on how the health department could collaborate with other agencies. Finally, a vote was taken and the committee unanimously voted to approve the IPLAN. On October 25, 2007 the Board of Health met and approved the final draft of the IPLAN and the Organization Capacity Self-Assessment. A letter of approval from the Board of Health President is included.

7 7 COMMUNITY HEALTH PLAN I. Health Problem - Heart Disease Outcome Objective: By 2012, decrease the number of Bureau County residents under age 65 that die from coronary heart disease by 10% from 18 people in 2004 to 16 people. Risk Factor: Impact Objective: Tobacco Use By 2010, decrease the proportion of adults, aged 18 and older, who use tobacco products from 18.8% to 15%. (BRFSS Report, 2004) Hypertension By 2012, increase the proportion of adults aged 18 and older with high blood pressure who are taking action to control their blood pressure from 80.9 percent to 95% (BRFSS Report, 2004). Cholesterol By 2010, increase to at least 75 percent the proportion of adults who have had their blood cholesterol checked within the preceding 5 years. Direct and Indirect Contributing Factors: The contributing factors that were identified include peer pressure, social acceptance and perception of tobacco use, self esteem issues, tobacco marketing, including premium gifts and incentives, the acceptance of candy cigarettes and flavored tobacco, availability, lack of law enforcement of tobacco use, lack of parental involvement, addiction, mental health and dependency, stress, lifestyle, coping and social skills, diet, culture and socioeconomic factors, obesity, lack of activity and exercise, medications and medical issues, ethnicity and heredity, lack of education, physician education practices, lack of access to care.

8 8 Proven Intervention Strategies: 1. Provide health education to the public, school-aged children, pregnant women, WIC clients and Family Practitioners. 2. Support the enforcement of Smoke-Free Illinois legislation. 3. Provide health education to families and providers on hypertension by utilizing DHHS guidelines. 4. Acknowledge businesses that promote healthy lifestyles. 5. Provide health education to the public on healthy eating and physical activity. 6. Begin a restaurant campaign to acknowledge the restaurants that offer healthy choices. Resources Available: There are two hospitals in Bureau County with heart disease treatment programs, including a cardiac rehabilitation unit and a cardiology clinic. In addition, both hospitals provide community outreach blood pressure screening and cholesterol clinics. The area newspaper has done extensive reporting on heart and healthrelated topics, including a Thin to Win weight loss competition. There is an active chapter of Weight Watchers. The University of Illinois County Extension has several programs that address heart health and nutrition. The health department currently operates several programs that provide health education to children on not smoking and healthy choices, including the Tar Wars Program and Heart Smart for Teens. In addition, the health department provides nicotine patches free-of-charge in collaboration with the IL Tobacco Quit Line. The recent Smoke-Free Illinois legislation will also have an impact on this issue. Barriers: Public information on nutrition, regular exercise, weight reduction and other preventative measures is available, but not utilized fully. Possible barriers to meeting this goal include addiction, peer pressure, social acceptance of tobacco use, tobacco marketing, the cost of medications, lack of access to care, economic factors, the lack of availability of restaurants that offer healthy choices, school lunches and lack of physical activity.

9 9 Program Evaluation: Evaluating the effects of the heart disease prevention programs will focus on measuring the achievements of the outcome and impact objectives. This will include measuring the number of programs and presentations offered, number of attendees, number of people that quit smoking, including pregnant women, number of respondents to the IL BRFSS Report that eat three or more servings of vegetables a day, the number of respondents to the IL BRFSS Report who identify themselves as either overweight or obese, the number of businesses that promote healthy lifestyles and the number of restaurants that offer healthy choices. In addition, a survey asking when the last time a person had their cholesterol checked and if it was in the past 5 years will be given at area businesses and the County fair annually. The data gathered in the first surveys will be used as the baseline from which success of the program will be measured.

10 10 II. Health Problem - Substance Abuse Outcome Objective By 2012, decrease the percentage of 8 th graders who have used alcohol, tobacco or marijuana in the past month by 10% (DHS Chestnut Health Systems Youth Study). Risk Factor: Impact Objective: Mental Health By 2010, increase the percentage of 8 th graders who perceive a moderate or great risk of harm from regular alcohol use from 52% to 61% (DHS Chestnut Health Systems Youth Study). Stress By 2010, provide education in stress reduction to at least 200 adolescents aged 12 though 17. Cycle of Addiction By 2010, increase the percentage of 10 th graders that feel their parents disapprove of alcohol use from 76% to 84% (DHS Chestnut Health Systems Youth Study). Contributing Factors (Indirect / Direct): The contributing factors that were identified include social influences, family structure and environment, physical dependency, availability, acceptability and peer pressure, media influences, lack of support and parental involvement, codependency, lack of consequences, lack of alternative activities, the age of first use, lack of access to care, school bullying, economics, one-parent households, physical health, obesity, chronic illness, sandwich generation, poor self image, abuse, PTSS and lack of coping skills, grief and loss, poor role modeling, drug-induces psychosis, heredity of psychosis, no way out attitude. Also included were work-related factors including overwork, drive to succeed, poor work relationships and poor compensation.

11 11 Proven Intervention Strategies: 1. Increase access to care by providing a school-linked clinic for the community. 2. Promote a mentoring and counseling program by collaborating with school counselors, the law enforcement resource officer and parents. 3. Provide health education on stress reduction and positive ways to release stress to adolescents aged 12 through 17 and parents. 4. Provide health education for adolescents aged 12 through 17 and parents on preventing alcohol and drug use. Resources Available: The Bureau County Sheriff s Department and local police departments participate in several substance abuse preventions programs, including Project Alert, DARE, and a Local Law Enforcement Drug Task Force. In addition, area high schools have a law enforcement resource officer located in the school. The University of Illinois Extension operates a very active Youth Coalition that brings together leaders from several professions to deal with youth issues. The health department has a Coordinated School Health Grant for two local schools that would allow limited funding for programs associated with those schools. The County medical leaders have been meeting regularly since March to research the feasibility of opening a school-linked clinic, and the health department has hired a consultant to assist in this. Barriers Potential barriers include legislation that would limit funding for school-linked clinics and potential limited funding resources, social environments, negative peer pressure, resistance to change, availability of alcohol and drugs and parental apathy. Program Evaluation Evaluating the effects of the substance abuse prevention programs will focus on measuring the achievements of the outcome and impact objectives. This will include measuring the number of programs and presentations offered, number of attendees and the number of youth mentored.

12 12 III. Health Problem - Obesity Outcome Objective: By 2012, decrease number of Bureau County residents that are overweight or obese from 66.7% to 63%. Risk Factor: Impact Objective: Diet By 2010, increase the proportion of persons aged 2 and older who consume 3 or more servings of vegetables and fruits from 46% to 51% (Based on BRFSS). Lack of Activity By 2010, increase the proportion of people aged 18 and older who engage regularly, preferably daily, in sustained physical activity for at least 30 minutes per day from 37.4% to 40% (Based on BRFSS). Contributing Factors (Indirect / Direct): The contributing factors that were identified include stress and depression, time management, socio-economic factors including the high cost of healthy food, availability or lack of options, food viewed as a reward, lack of support, physical health, habit, exercise viewed as punishment, medical problems, a family history of obesity and lack of access to care.

13 13 Proven Intervention Strategies 1. Provide education to the public on healthy eating through community health fairs. 2. Encourage schools to increase healthy food choices, such as at lunch through the use of salad bars, whole grain foods and fresh fruit in vending machines, at concession stands by adding healthy foods, at special school events by suggesting to parents or creating a policy that only healthy foods are brought into the schools. 3. Promote a Family Fit Program and summer events that promote physical activity for families and children. 4. Encourage families and schools to offer physical activities as a reward. 5. Provide the CATCH program to at least 3 new schools. 6. Include genetic impacts on obesity in health education given to the public on diet and physical activity. 7. Encourage the public to get regular physical checkups. Resources Available: The area newspaper has done extensive reporting on heart and health-related topics, including a Thin to Win weight loss competition. There is an active chapter of Weight Watchers in the County. The University of Illinois County Extension has several programs that address nutrition and healthy food choices. In addition, they sponsor the After School Program that provides education on healthy eating and a healthy snack. The health department currently operates a healthy lifestyle program for girls, Heart Smart for Teens and provides WIC vouchers, which now include fresh fruits and vegetables, for eligible families. Per law, Illinois schools are required to offer five days a week. The physical education requirement in the schools helps children learn fun ways to get exercise. Finally, Bureau County the Bureau County Health and Wellness Clinic is a free clinic in Bureau County that offers education in healthy choices. Barriers Public information on nutrition, regular exercise, weight reduction and healthy lifestyles is available, but not utilized fully. Possible barriers to meeting this goal include lack of access to care, economic factors including the cost of fresh fruit and healthy foods, funding loss from pop sales, insurance coverage, lack of time, lack of energy, lack of parent education, lack of availability of restaurants that offer healthy choices, school lunches, candy used as a reward, television ads.

14 14 Program Evaluation Several measures will be used to evaluate an obesity prevention program. These include measuring the achievements of the outcome and impact objectives, including measuring the number of programs and presentations offered and number of attendees.

15 15 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Heart Disease Risk Factors: Tobacco Use Contributing Factors: Peer Pressure Social Acceptance / Perception Self Esteem Marketing Premium Gifts / Incentives Big Advertisements Candy Cigarettes / Flavored Tobacco Availability Lack of Law Enforcement Lack of Parental Involvement Addiction Mental Health / Dependency Resources Available: Tar Wars Program Health Department Programs that provide health education to children on not smoking. Tobacco Quit line Smoke-Free Illinois Outcome Objective (5 year goal for change in the health problem): By 2012, increase the average age of death from heart disease in Bureau County from to. Impact Objectives (2 3 year goal for change in a risk factor): By 2010, decrease the proportion of adults, aged 18 and older, who use tobacco products from 18.8% to 15%. (BRFSS Report, 2004) Proven Intervention Strategies (1 2 year goal for change in contributing factors): Provide health education to the public, school-aged children, pregnant women, WIC clients and Family Practitioners. Support the enforcement of Smoke-Free Illinois. Barriers: Addiction Peer Pressure Social Acceptance Tobacco Marketing

16 16 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Heart Disease Risk Factors: Hypertension Contributing Factors: Stress Lifestyle Economic Factors Coping / Social Skills Diet Culture / Socioeconomic Availability Obesity Lifestyle / Lack of Exercise Medications / Medical Ethnicity / Heredity Resources Available: Community Outreach Blood Pressure Clinics facilitated by local hospitals. Heart Smart for Teens Thin to Win County Extension Programs Outcome Objective (5 year goal for change in the health problem): By 2012, increase the average age of death from heart disease in Bureau County from to. Impact Objectives (2 3 year goal for change in a risk factor): Increase to at least 95% the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high. Proven Intervention Strategies (1 2 year goal for change in contributing factors): Provide health education to families and providers on hypertension by utilizing DHHS guidelines. Acknowledge businesses that promote healthy lifestyles. Barriers: Cost of medications Access to Care Economic Factors

17 17 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Heart Disease Risk Factors: Cholesterol Contributing Factors: Lifestyle Poor Diet Lack of Activity Education Physician Education Practices Access to Care Economics Heredity Resources Available: Weight Watchers Cholesterol Screenings County Extension Healthy Eating Programs. Outcome Objective (5 year goal for change in the health problem): By 2012, increase the average age of death from heart disease in Bureau County from to. Impact Objectives (2 3 year goal for change in a risk factor): Increase to at least 75 percent the proportion of adults who have had their blood cholesterol checked within the preceding 5 years. Proven Intervention Strategies (1 2 year goal for change in contributing factors): Provide health education to the public on healthy eating and physical activity. Begin a restaurant campaign to acknowledge the restaurants that offer healthy choices. Barriers: Availability of restaurants that offer healthy choices. School lunches Access to Care Access to physical activity

18 18 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Substance Abuse Risk Factors: Mental Health Contributing Factors: Poor Self Image Peer Pressure / Society Weight / Body Image Abuse PTSS / Coping Skills Return from War Abuse Grief / Loss Poor Role Model / Parenting Drug Induced Psychosis Access to Care Heredity of Psychosis Resources Available: DARE Outcome Objective (5 year goal for change in the health problem): By 2012, decrease the percentage of 8 th graders who have used alcohol, tobacco or marijuana in the past month by 10% (DHS Chestnut Health Systems Youth Study). Impact Objectives (2 3 year goal for change in a risk factor): By 2010, increase the percentage of 8 th graders who perceive a moderate or great risk of harm from regular alcohol use from 52% to 61% (DHS Chestnut Health Systems Youth Study). Proven Intervention Strategies (1 2 year goal for change in contributing factors): Provide health education in positive mental health, mental health support and positive activities for families, parents and adolescents aged 12 through 17. Increase Access to Care by providing a School-Linked Clinic for the community. Barriers: Legislation Funding

19 19 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Substance Abuse Outcome Objective (5 year goal for change in the health problem): By 2012, decrease the percentage of 8 th graders who have used alcohol, tobacco or marijuana in the past month by 10% (DHS Chestnut Health Systems Youth Study). Risk Factors: Stress Contributing Factors: Work-Related Factors Overworked / Drive to Succeed Poor Work Relationships Poor Compensation Social Influences Environment School / Bullying Lack of Support / Parental Involvement Economics One-Parent Household Physical Health Obesity Chronic Illness Sandwich Generation Resources Available: Project Alert DARE Impact Objectives (2 3 year goal for change in a risk factor): By 2010, provide education in stress reduction to at least 200 adolescents aged 12 though 17. Proven Intervention Strategies (1 2 year goal for change in contributing factors): Promote a mentoring and counseling program by collaborating with school counselors, the law enforcement resource officer and parents. Provide health education on stress reduction to adolescents aged 12 through 17 and parents. Barriers: Funding

20 20 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Substance Abuse Outcome Objective (5 year goal for change in the health problem): By 2012, decrease the percentage of 8 th graders who have used alcohol, tobacco or marijuana in the past month by 10% (DHS Chestnut Health Systems Youth Study). Risk Factors: Cycle of Addiction Contributing Factors: Social Influences Family Structure / Environment Physical Dependency Availability Acceptability / Peer Pressure Media Influences Lack of Support Codependency Lack of Consequences No Alternative Activities Age of First Use Access to Care Mental Health Resources Available: Local Law Enforcement Drug Task Force DARE Program Project Alert Program Impact Objectives (2 3 year goal for change in a risk factor): By 2010, increase the percentage of 10 th graders that feel their parents disapprove of alcohol use from 76% to 84% (DHS Chestnut Health Systems Youth Study). Proven Intervention Strategies (1 2 year goal for change in contributing factors): Promote a mentoring and counseling program by collaborating with school counselors, the law enforcement resource officer and parents. Provide health education on preventing alcohol and drug use to adolescents aged 12 through 17 and parents. Barriers: Social Environment Negative Peer Pressure Resistance to Change Availability of Alcohol and Drug Parental Apathy

21 21 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Obesity Risk Factors: Diet Contributing Factors: Stress / Depression Economics Social Influences Physical Health Poor Food Choices Poor Time Management High Cost of Healthy Food Availability / Lack of Options Food Uses as a Reward Drug Induces Psychosis Access to Care Heredity of Psychosis Resources Available: County Extension Food Programs After School Programs WIC Vouchers for fresh fruits and vegetables Outcome Objective (5 year goal for change in the health problem): Decrease by 5% the number of Bureau County residents that are overweight or obese. Impact Objectives (2 3 year goal for change in a risk factor): Increase by 10% the proportion of persons aged 2 and older who meet the Dietary Guidelines average daily goal of at least 5 servings of vegetables and fruits. Proven Intervention Strategies (1 2 year goal for change in contributing factors): Provide education in healthy eating to the public, possibly through community health fairs. Encourage schools to increase healthy food choices at lunch through the use of salad bars, whole grain foods, fresh fruit in vending machines, only healthy foods at concession stands and suggesting to parents or creating a policy that only healthy foods are brought into the schools for special occasions. Barriers: Cost of fresh fruit and healthy foods Funding loss from pop sales Candy used as a reward Lack of parent education Television ads

22 22 HEALTH PLAN WORKSHEETS Community Health Plan Worksheet Health Problem: Obesity Risk Factors: Lack of Activity Contributing Factors: Lack of Support Isolation Depression Economics Social Influences Physical Health Chronic Illness Lack of Mobility Poor Exercise Habits Exercise Seen as Punishment Outcome Objective (5 year goal for change in the health problem): Decrease by 5% the number of Bureau County residents that are overweight or obese. Impact Objectives (2 3 year goal for change in a risk factor): Increase by 5% the proportion of people aged 18 and older who engage regularly, preferably daily, in sustained physical activity for at least 30 minutes per day. Proven Intervention Strategies (1 2 year goal for change in contributing factors): Promote a Family Fit Program and summer events that promote physical activity for families and children. Encourage families and schools to offer physical activities as a reward. Provide the CATCH program to at least 3 new schools. Resources Available: PE classes After School Programs Barriers: Time Energy Funding / Cost

23 HEALTH PROBLEM ANALYSIS WORKSHEETS 23

24 24 Health Problem Heart Disease Risk Factor Tobacco Use Risk Factor Hypertension Risk Factor Cholesterol Peer Pressure Stress Lifestyle Social Acceptance / Perception Self Esteem Lifestyle Economic Factors Poor Diet Lack of Activity Marketing Coping / Social Skills Education Premium Gifts / Incentives Diet Dr. Education Practices Big Advertisements Culture / Socioeconomic Access to Care Candy Cigarettes Flavored Tobacco Stress Economics Availability Availability Heredity Lack of Law Enforcement Obesity Lack of Parental Involvement Lifestyle / Lack of Exercise Addiction Medications / Medical Probs. Mental Health / Dependency Ethnicity

25 25 Health Problem Substance Abuse Risk Factor Mental Health Risk Factor Stress Risk Factor Cycle of Addiction Poor Self Image Work-Related Factor Social Influences Peer Pressure /Society Overworked / Drive to Succeed Family Structure / Environment Wt. / Body Image Poor Work Relationships Physical Dependency Abuse Poor Compensation Availability PTSS / Coping Skills Social Influences Acceptability / Peer Pressure Return from War Environment Media Influences Abuse School / Bullying Lack of Support Grief / Loss Lack of Support Parental Involve Codependency Poor Role Model / Parenting Economics Lack of Consequences Drug Induced Psychosis One Parent Household No Alternative Activities Access to Care Physical Health Age of First Use Heredity of Psychosis Obesity Access to Care Chronic Illness Mental Health / Denial Sandwich Generation

26 26 Health Problem Obesity Risk Factor Diet Risk Factor Lack of Activity Risk Factor Heredity Stress/Depression Lack of Support Medical Problem Economics Isolation Family History Social Influences Depression Access to Care Physical Health Economics Poor Food Choice Social Influences Poor Time Mgmt. Physical Health Cost of Healthy Food Physical Health Availability / Options Chronic Illness Food as a Reward Lack of Mobility Drug Induced Psychosis Poor Exercise Habits Access to Care Exer = Punishment Heredity of Psychosis

27 27 REFERENCES APEXPH Assessment Protocol for Excellence in Public Health (1996) National Association of County Health Officials 440 First Street, NW, Suite 450 Washington, DC Census 2000 Data for the State of Illinois U.S. Census Bureau Public Information Office 4600 Silver Hill Road Washington DC DHS Chestnut Health Systems Youth Study Chestnut Health Systems 720 West Chestnut Bloomington, IL Healthy People 2010 Objectives Office of Disease Prevention and Health Promotion 200 Independence Ave. SW Washington, DC Illinois & Chicago Kids Count: Compare Indicators Voices for Illinois Children 208 S. LaSalle Street Suite 1490 Chicago, IL Illinois County Behavioral Risk Factor Surveillance System Illinois Department of Public Health Illinois Center for Health Statistics 525 West Jefferson Street Springfield, Illinois 62761

28 28 Illinois Project for Local Assessment of Needs IPLAN Data Set (1990, 1994, ) Illinois Department of Public Health Illinois Center for Health Statistics Springfield, IL Immunization & WIC Records Bureau County Health Department 526 Bureau Valley Parkway Princeton, IL U.S. Bureau of Labor Statistics Postal Square Building 2 Massachusetts Ave., NE Washington, DC The American Lung Association Website The American Lung Association 61 Broadway, 6th Floor NY, NY 10006