North Mississippi Medical Center

Transcription

1 North Mississippi Medical Center h e a l t h a s s e s s m e n t Lee County

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3 Lee County Health Assessment, 2013 August 2013

4 Preface This health assessment is a source of health information for NMMC. Modeled on the Healthy People 2020 objectives, this survey was administered to a representative sample of 701 NMMC adults and 318 Lee County adults using random digit dialing methods, computer-assisted telephone interviews, and an address-based frame that included households that receive deliveries from the US Postal Service. This assessment provides a report card based on the Leading Health Indicators, as well as information regarding health status, utilization of health services, health beliefs, satisfaction with health care services, and health care reimbursements. This information serves both as a planning tool and as a benchmark by which results of future health programs and prevention strategies can be evaluated. In this report, a series of tables that describe numerous issues related to the health of the adults in the NMMC area are presented. The first table provides data on the Healthy People 2020 Leading Health Indicators, as well as the Healthy People 2020 targets for each of these indicators. In subsequent sections, MSHA findings are presented for seven health topic areas: - Risk Factors - Clinical Prevention Screenings - Health Status - Access to Health Care - Satisfaction with Health Care - Community Involvement - Sex-Specific Health Issues In each of these sections, the results are presented in tables that provide estimates for the entire adult population, as well as for males and females separately. The Mississippi Health Assessment was made possible through support provided by North Mississippi Medical Center. This survey was approved by the MSU Institutional Review Board in ii

5 Chapter 2: Risk Factors Risk Factors Trends, 2001 to 2013 North Mississippi Medical Center Catchment Area Binge Drinkers 13.8% 9.2% 10.0% 10.3% 19.9% Drinking and Driving 2.1% 3.5% 5.6% 3.3% 5.3% Current Smokers 25.0% 21.6% 18.2% 15.6% 15.6% Quit Attempts 60.6% 68.7% 62.1% 43.7% 61.6% Physically Inactive For the Past 7 Days 40.9% 39.8% 42.8% 50.7% 46.5% No Regular Physical Activity Did Not Exercise 5 or More Days 76.2% 76.6% 76.7% 82.5% 84.3% Overweight 63.8% 67.8% 64.2% 69.1% 72.7% Obese 26.8% 27.6% 30.1% 27.9% 33.9% Trying to Lose Weight and Overweight 48.0% 44.5% 27.8% 39.4% 51.4% Children Do Not Wear Bicycle Helmets 49.3% 62.7% 44.2% 62.8% 45.4% Does Not Use a Seatbelt Most of the Time 11.3% 6.4% 1.7% 5.0% 4.7% Persons Without Health Insurance 16.0% 15.2% 16.9% 19.0% 10.0% Has Not Visited a Doctor for a Routine Checkup Within the Past Year 27.1% 28.2% 24.4% 18.5% 14.9% Lee County Binge Drinkers 12.1% 6.0% 9.5% 7.5% 16.0% Drinking and Driving 1.7% 1.5% 3.5% 3.5% 3.5% Current Smokers 24.7% 24.6% 18.7% 10.9% 13.0% Quit Attempts 61.0% 63.3% 70.8% 45.1% 72.5% Physically Inactive For the Past 7 Days 39.8% 33.3% 37.1% 51.4% 40.9% No Regular Physical Activity Did Not Exercise 5 or More Days 60.2% 51.0% 76.0% 84.3% 81.8% Overweight 58.8% 58.1% 61.5% 70.8% 69.5% Obese 23.8% 19.9% 23.7% 31.9% 34.1% Trying to Lose Weight and Overweight 50.9% 44.1% 21.8% 38.4% 52.6% Children Do Not Wear Bicycle Helmets 51.0% 48.9% 44.1% 49.1% 35.9% Does Not Use a Seatbelt Most of the Time 13.8% 5.2% 3.5% 9.0% 3.2% Persons Without Health Insurance 17.3% 17.8% 14.7% 16.5% 7.8% Has Not Visited a Doctor for a Routine Checkup Within the Past Year 30.0% 24.4% 24.7% 14.1% 13.2% iii

6 Clinical Prevention Screenings Trends, 2001 to 2013 North Mississippi Medical Center Catchment Area Chapter 3: Clinical Prevention Screenings Blood Pressure Checked Within the Past Year 88.0% 88.2% 79.6% 75.2% 88.5% Had a Flu Shot in the Past Year 69.9% 63.9% 58.0% 49.2% 60.7% Had Pneumonia Vaccine 61.1% 60.8% 46.6% 33.2% 38.6% Eye Exam Within the Past Year 43.6% 41.8% 49.7% 48.5% 57.1% Blood Test for Glucose or Sugar 44.9% 44.0% 57.0% 58.0% 63.5% Dental Exam 41.1% 44.5% 48.1% 45.9% 52.6% Blood Stool Test 17.3% 21.0% 24.7% 23.9% 24.1% Blood Cholesterol Test 69.1% 61.1% 75.1% 79.0% 88.5% Glaucoma Exam 34.6% 30.5% 43.5% 40.2% 41.9% Lee County Blood Pressure Checked Within the Past Year 90.5% 90.0% 80.4% 81.3% 87.6% Had a Flu Shot in the Past Year 67.7% 77.9% 64.4% 60.1% 66.1% Had Pneumonia Vaccine 58.5% 44.3% 58.8% 39.1% 41.4% Eye Exam Within the Past Year 45.9% 41.2% 50.7% 57.9% 57.0% Blood Test for Glucose or Sugar 44.7% 47.5% 58.7% 62.7% 65.3% Dental Exam 46.2% 44.2% 52.0% 55.4% 58.0% Blood Stool Test 18.7% 18.6% 28.6% 30.6% 23.2% Blood Cholesterol Test 67.8% 63.5% 78.3% 78.4% 88.5% Glaucoma Exam 36.7% 32.3% 45.7% 49.4% 44.3% iv

7 Chapter 4: Health Status Health Status Trends, 2001 to 2013 North Mississippi Medical Center Catchment Area Current Health Status: Fair or Poor 25.1% 24.5% 25.7% 29.1% 27.5% Health Worse Than a Year Ago 13.2% 10.1% 12.6% 11.3% 13.4% At Least One Bad Physical Health Day in the Last Month 43.4% 30.3% 32.4% 35.5% 48.5% At Least One Bad Mental Health Day in the Last Month 30.6% 23.3% 17.7% 16.8% 21.4% Missed Work: At Least One Day Last Year 29.7% 23.6% 18.9% 13.7% 21.1% Coronary Heart Disease 5.8% 7.5% 10.5% 10.2% 9.7% Angina Pectoris 3.9% 6.3% 5.0% 4.6% 3.9% Heart Attack 4.3% 6.3% 7.8% 7.3% 6.4% Other Heart Condition or Heart Disease 12.7% 12.1% 15.5% 13.4% 15.3% Stroke 4.2% 4.8% 5.2% 6.7% 6.5% Emphysema 2.0% 3.2% 3.5% 3.0% 4.1% Cancer 7.4% 7.6% 9.0% 11.5% 15.4% Diabetes 11.9% 10.0% 14.5% 20.0% 19.4% Asthma 9.2% 9.0% 9.5% 11.2% 9.5% Currently Have Asthma 7.2% 6.3% 8.2% 7.4% 7.7% Fruits and Vegetables: At Least 5 Servings per Day 9.6% 12.5% 10.4% 9.3% 16.0% Trying to Lose Weight 37.6% 37.1% 27.8% 31.6% 42.2% Counseled to Lose Weight 18.9% 37.2% 34.4% 40.5% 64.0% Lee County Current Health Status: Fair or Poor 18.9% 18.4% 17.6% 23.1% 21.4% Health Worse Than a Year Ago 8.4% 10.3% 7.3% 9.9% 10.8% At Least One Bad Physical Health Day in the Last Month 44.2% 26.2% 24.5% 38.4% 36.7% At Least One Bad Mental Health Day in the Last Month 34.4% 22.4% 17.4% 20.5% 18.2% Missed Work: At Least One Day Last Year 34.5% 20.7% 16.1% 21.2% 19.2% Coronary Heart Disease 5.7% 8.0% 10.5% 9.2% 8.8% Angina Pectoris 2.3% 4.8% 4.4% 7.4% 4.3% Heart Attack 5.7% 3.9% 6.2% 8.9% 7.2% Other Heart Condition or Heart Disease 11.4% 9.2% 12.8% 17.0% 11.3% Stroke 2.7% 3.9% 3.5% 4.0% 5.3% Emphysema 2.0% 2.5% 3.8% 3.0% 1.4% Cancer 6.2% 8.2% 6.9% 17.8% 17.8% Diabetes 9.4% 10.7% 10.9% 19.3% 18.8% Asthma 10.6% 13.0% 9.5% 12.1% 6.8% Currently Have Asthma 6.7% 6.4% 6.8% 8.1% 3.7% Fruits and Vegetables: At Least 5 Servings per Day 11.5% 11.5% 12.9% 11.6% 12.4% Trying to Lose Weight 39.2% 36.9% 35.5% 31.5% 44.6% Counseled to Lose Weight 19.2% 42.8% 35.0% 42.5% 62.4% v

8 Chapter 5: Access to Health Care Access to Health Care Trends, 2001 to 2013 North Mississippi Medical Center Catchment Area Have Seen a Doctor Within the Past Year 78.4% 79.0% 86.8% 83.3% 91.1% Some Type of Health Care Coverage 84.0% 84.6% 83.1% 81.0% 90.0% Usual Provider of Routine Care: Clinic or Health Center 27.8% 24.3% 19.8% 31.5% 23.7% Doctor s Office or HMO 64.7% 68.1% 76.3% 62.5% 71.1% Hospital Emergency Room 0.7% 1.1% 0.5% 1.2% 0.3% Hospital Outpatient Department 3.2% 1.4% 1.2% 1.7% 1.1% Some Other Place 1.5% 3.4% 1.4% 2.2% 2.0% No Usual Provider 2.0% 1.6% 0.5% 0.7% 1.8% Could Not Afford Health Care 18.0% 16.3% 16.1% 15.1% 12.8% Could Not Afford Needed Prescription Medicines 13.7% 22.1% 17.8% 12.1% 11.6% Could Not Afford Needed Mental Health Care 5.0% 6.2% 5.1% 3.6% 3.7% Could Not Afford Needed Dental Care 19.1% 19.9% 16.6% 16.1% 18.8% Lee County Have Seen a Doctor Within the Past Year 81.0% 76.6% 85.8% 88.9% 91.7% Some Type of Health Care Coverage 82.7% 82.0% 84.6% 83.5% 92.2% Usual Provider of Routine Care: Clinic or Health Center 42.0% 30.5% 22.6% 41.4% 29.8% Doctor s Office or HMO 50.0% 64.1% 71.5% 54.9% 65.8% Hospital Emergency Room 1.3% 1.2% 1.1% 1.0% 0.7% Hospital Outpatient Department 2.3% 1.2% 1.0% 1.0% 0.2% Some Other Place 1.5% 1.2% 1.9% 1.0% 0.7% No Usual Provider 3.0% 1.8% 0.9% 0.7% 2.7% Could Not Afford Health Care 19.0% 15.8% 14.7% 14.1% 9.9% Could Not Afford Needed Prescription Medicines 14.8% 17.8% 18.6% 18.7% 12.8% Could Not Afford Needed Mental Health Care 3.7% 2.9% 5.8% 3.2% 4.0% Could Not Afford Needed Dental Care 18.0% 18.6% 17.4% 19.0% 14.5% vi

9 Satisfaction with Health Care Trends, 2001 to 2013 North Mississippi Medical Center Catchment Area Chapter 6: Satisfaction with Health Care Doctors or Health Providers Listened Carefully 59.5% 61.4% 65.3% 64.1% 64.2% Doctors or Health Providers Explained Things Clearly 65.3% 68.1% 68.4% 69.4% 65.8% Doctors or Health Providers Showed Respect 65.9% 68.1% 70.6% 72.4% 69.3% Doctors or Health Providers Spent Enough Time 56.5% 61.9% 62.9% 62.8% 59.8% Received Best Possible Care 77.6% 78.1% 83.8% 83.9% 87.0% Lee County Doctors or Health Providers Listened Carefully 58.8% 55.6% 68.3% 63.0% 62.7% Doctors or Health Providers Explained Things Clearly 67.0% 64.3% 71.5% 69.7% 61.9% Doctors or Health Providers Showed Respect 69.0% 68.6% 70.8% 72.9% 69.8% Doctors or Health Providers Spent Enough Time 59.0% 61.4% 66.1% 62.8% 63.0% Received Best Possible Care 83.2% 74.1% 82.7% 88.8% 83.2% vii

10 Sex-specific Health Issues Trends, 2001 to 2013 North Mississippi Medical Center Catchment Area Chapter 8: Sex-Specific Health Issues Ever Had a Mammogram 61.8% 65.8% 76.6% 78.1% 86.5% Mammogram: Within the Past Year 64.5% 67.0% 59.9% 63.6% 66.4% Reasons for Getting a Mammogram: Routine Check-up 85.7% 90.5% 88.9% 91.4% 90.7% Breast Problem, Not Cancer 12.0% 7.5% 9.1% 6.7% 6.8% Breast Cancer 2.3% 1.2% 2.0% 1.8% 2.6% Ever Had a Clinical Breast Exam 82.6% 80.4% 84.1% 75.3% 85.2% Breast Exam: Within the Past Year 69.2% 72.7% 70.7% 69.1% 66.8% Reasons for Getting Clinical Breast Exam: Routine Check-up 91.0% 92.6% 93.5% 93.3% 91.1% Breast Problem, Not Cancer 7.6% 6.1% 4.9% 5.1% 5.3% Breast Cancer 1.5% 0.9% 1.4% 1.6% 3.6% Ever Had a Pap Smear 94.8% 89.0% 91.5% 83.3% 92.8% Pap Smear: Within the Past Year 63.5% 62.8% 58.3% 52.7% 48.4% PSA Test: Within Past Year DNC 71.8% 65.7% 73.0% 63.6% Digital Rectal Exam: Within Past Year DNC 23.4% 27.2% 20.2% 28.5% Testicular Exam: Within the Past Year 24.8% 25.8% 30.8% 15.9% 22.7% Lee County Ever Had a Mammogram 61.4% 63.6% 75.4% 77.9% 85.1% Mammogram: Within the Past Year 68.0% 70.7% 64.3% 66.0% 60.1% Reasons for Getting a Mammogram: Routine Check-up 89.0% 92.2% 91.0% 93.2% 93.0% Breast Problem, Not Cancer 8.7% 5.7% 8.0% 4.9% 3.5% Breast Cancer 2.4% 1.0% 1.0% 1.9% 3.5% Ever Had a Clinical Breast Exam 86.1% 82.0% 81.7% 83.0% 79.2% Breast Exam: Within the Past Year 75.7% 77.0% 75.7% 71.7% 67.7% Reasons for Getting Clinical Breast Exam: Routine Check-up 93.2% 95.6% 96.7% 94.9% 94.8% Breast Problem, Not Cancer 5.6% 3.2% 3.3% 3.4% 3.0% Breast Cancer 1.1% 1.3% 0% 1.7% 2.2% Ever Had a Pap Smear 95.3% 90.4% 90.4% 89.1% 92.9% Pap Smear: Within the Past Year 68.7% 70.7% 62.8% 60.0% 53.8% PSA Test: Within Past Year DNC 77.7% 74.3% 77.8% 71.7% Digital Rectal Exam: Within Past Year DNC 18.5% 32.9% 34.1% 32.1% Testicular Exam: Within the Past Year 27.8% 19.2% 36.5% 18.5% 16.4% viii

11 TABLE OF CONTENTS Introduction...12 Chapter 1: Leading Health Indicators...16 Chapter 2: Risk Factors Chapter 3: Clinical Prevention Screenings...31 Chapter 4: Health Status...36 Chapter 5: Access to Health Care...48 Chapter 6: Satisfaction with Health Care...53 Chapter 7: Involvement with Community Affairs...56 Chapter 8: Sex-Specific Health Issues...57 Appendix A: Survey Instrument...61 Appendix B: Description of BRFSS and NHIS...70 Appendix C: Data Resources for Decision-makers

12 LIST OF TABLES Introduction Table I.1. Sample Characteristics...14 Chapter 1: Healthy People 2020: Ten Leading Health Indicators Table 1.1. Leading Health Indicators...19 Chapter 2: Risk Factors Table 2.1. Binge Drinkers...21 Table 2.2. Average Number of Drinks When Drinking...21 Table 2.3. Drinking and Driving...22 Table 2.4. Current Smokers...22 Table 2.5. Tried to Quit...23 Table 2.6. Secondhand Smoke...23 Table 2.7. Physically Inactive...24 Table 2.8. Some Physical Activity...25 Table 2.9. Regular Physical Activity...25 Table Healthy Weight...26 Table Overweight...26 Table Obese...27 Table Trying to Lose Weight...27 Table Health Care Provider Gave Advice to Lose Weight...28 Table Bicycle Helmets...28 Table Seatbelt Use...29 Table Persons Without Health Insurance...29 Table Routine Check-up: Within the Past Year...30 Chapter 3: Clinical Prevention Screenings Table 3.1. Blood Pressure Checked Within Past Year...31 Table 3.2. Adults 65+ Who Have Had a Flu Shot Within the Past Year...32 Table 3.3. Adults 65+ Who Have Ever Had a Pneumonia Vaccination...32 Table 3.4. Eye Exam...33 Table 3.5. Blood Test for Glucose or Sugar...33 Table 3.6. Dental Exam...34 Table 3.7. Blood Stool Test...34 Table 3.8. Blood Cholesterol Test...35 Table 3.9. Glaucoma Exam...35 Chapter 4: Health Status Table 4.1. Overall Health Status...36 Table 4.2. Health Worse Than a Year Ago...36 Table 4.3. Health in the Last Month...37 Table 4.4. Poor Mental Health...37 Table 4.5. Sad, Blue, or Depressed...38 Table 4.6. Received Treatment for Psychological Problems or Emotional Difficulties...38 Table 4.7. Missed Work...39 Table 4.8. High Blood Pressure...39 Table 4.9. High Blood Pressure is Under Control

13 Table Coronary Heart Disease...40 Table Angina Pectoris...41 Table Heart Attack...41 Table Other Heart Condition or Heart Disease...42 Table Stroke...42 Table Emphysema...43 Table Diabetes...43 Table Diabetes Management...44 Table Asthma...44 Table Currently Have Asthma...45 Table Asthma Management...45 Table Fruits and Vegetables...46 Table Trying to Lose Weight...46 Table Counseled to Lose Weight...47 Chapter 5: Access to Health Care Table 5.1. Have Seen a Doctor Within the Past Year...48 Table 5.2. Routine Check-up: Within the Past Year...48 Table 5.3. Health Care Coverage...49 Table 5.4. Usual Provider of Routine Care...50 Table 5.5. Could Not Afford Health Care...51 Table 5.6. Could Not Afford Needed Prescription Medicines...51 Table 5.7. Could Not Afford Needed Mental Health Care...52 Table 5.8. Could Not Afford Needed Dental Care...52 Chapter 6: Satisfaction with Health Table 6.1. Doctors or Health Providers Listened Carefully...53 Table 6.2. Doctors or Health Providers Explained Things Clearly...53 Table 6.3. Doctors or Health Providers Showed Respect...54 Table 6.4. Doctors or Health Providers Usually or Always Spent Enough Time...54 Table 6.5. Received Best Health Care Possible...55 Chapter 7: Involvement with Community Affairs Table 7.1. Years In the Community...56 Chapter 8: Sex-specific Health Issues Table 8.1. Ever Had a Mammogram...57 Table 8.2. Mammogram: Within the Past Year...57 Table 8.3. Reasons for Getting a Mammogram...57 Table 8.4. Ever Had a Clinical Breast Exam...58 Table 8.5. Breast Exam: Within the Past Year...58 Table 8.6. Reasons for Getting a Clinical Breast Exam...58 Table 8.7. Ever Had a Pap Smear...59 Table 8.8. Pap Smear Within the Past Year...59 Table 8.9. PSA Test: Within the Past Year...59 Table Digital Rectal Exam...60 Table Testicular Exam

14 Introduction Background North Mississippi Medical Center (NMMC) currently serves over 700,000 people in 24 counties throughout northeast Mississippi and northwest Alabama. This area is characterized by both a high prevalence of health problems such as heart disease, obesity, and poor utilization of prenatal care, as well as a high prevalence of social problems such as poverty. These issues need to be considered when developing health programs. NMMC can benefit from a community health assessment that will assist in the planning and implementation of strategies to improve the health status of the residents within the context of changes in health care financing. Health status refers to an individual s overall quality of physical, psychological, and social well-being. A thorough understanding of the health status of the general population is vital to developing intervention strategies that can prevent disease and trauma. This information is especially important as the emphasis of the health care industry continues to shift from the treatment of illness to prevention and early detection of disease. Although the Behavioral Risk Factor Surveillance System (BRFSS) provides population estimates for many issues related to health and risky behaviors, the core survey does not include measures for many of the issues that impact the health of Mississippians. Specifically, health decision-makers need more information on Mississippians health status, use of clinical prevention screenings, access to health care, satisfaction with health care, and community involvement. A community health assessment is necessary as a planning tool for developing strategies to support a changing system of health care financing. The results of the assessment can also be used as an evaluation tool to determine if certain health strategies are effectively meeting Healthy People 2020 Objectives. This assessment informs researchers, practitioners, and policy makers about health behaviors of the population and beliefs that guide people s actions. This research also provides an assessment of Mississippians health status, utilization of health services, health beliefs, and satisfaction with health care services. Finally, the survey serves as a yardstick by which future results of health programs and prevention strategies may be evaluated. Survey Design The 2013 North Mississippi Medical Center Community Health Assessment (CHA) was developed to elicit information on the demographics, risk factors, health status, health care access, satisfaction with health care, community involvement, and sex-specific health issues of adults who reside in Mississippi. (The survey instrument is presented in Appendix A.) Specifically, many items were replicated from the National Health Interview Survey (NHIS) and the BRFSS. (See Appendix B for detailed descriptions of these data series.) The advantages of this approach are two-fold. First, these are items with established reliability and validity. Second, the use of these items allows researchers to interpret the results of this health assessment within a state-level context. Sample The data collection for the 2013 Lee County Health Study was done via telephone interviews with a simple random sample of adults living in households with telephones in Lee County (Mississippi), and via an address-based frame that included households that receive deliveries from the US Postal Service. The data were collected in the Spring of Households were selected using random digit dialing procedures (this includes households with unlisted numbers), within a household an adult (18 years old or older) was randomly selected and interviewed using the next birthday method. The sampling error (binomial questions with a 50/50 split) for this data set is no larger than + 5.5% (95% confidence interval). The sample was weighted by race and gender, based upon U.S. Census 2011 estimates, to ensure that it was representative of Lee County. The data collection for the 2013 North Mississippi Health Study was done via telephone interviews with a simple random sample of adults living in households with telephones in North East Mississippi and via an address-based frame that included households that receive deliveries from the US Postal Service (Alcorn, Benton, Calhoun, Chickasaw, Choctaw, Clay, Itawamba, Lafayette, Lee, Lowndes, Marshall, Monroe, 12

15 Oktibbeha, Pontotoc, Prentiss, Tippah, Tishomingo, Union, and Webster Counties) and North West Alabama (Franklin, Lamar, and Marion Counties). The data were collected in March of 2013 by the Survey Research Unit in the Social Science Research Center at Mississippi State University. Households were selected using a random digit dialing procedures (this includes households with unlisted numbers), within a household an adult (18 years old or older) was randomly selected and interviewed using the next birthday method. The sampling error (binomial questions with 50/50 split) for this data set is no larger than + 3.7% (95% confidence level). The sample was weighted by race and gender, based upon U.S. Census 2011 estimates, to ensure that it was representative of the Northeast Mississippi Catchment Area. 13

16 Age Education Employment Status Income Child in Household Introduction Table I.1 Sample Characteristics Lee County NMMC Area Weighted Weighted N= Percent Percent N= Percent Percent Gender Female Male White Race and Black or African Ethnicity American American Indian/Alaska Native Asian or Pacific Islander Other Race Refused Hispanic or Latino Not Hispanic or Latino years of age years of age years of age years of age or older Not a high school graduate High school graduate Some college College graduate Employed for wages Self-Employed Out of work a year or less Out of work more than a year A homemaker A student Retired Unable to work Less than $10, Between $10 and $15, Between $15 and $20, Between $20 and $25, Between $25 and $35, Between $35 and $50, Between $50 and $75, Over $75, Yes No

17 Introduction Presentation of Results The results of this health assessment are grouped into the following categories: 1) Healthy People 2020, Leading Health Indicators; 2) Risk Factors; 3) Clinical Prevention Screenings; 4) Health Status; 5) Access to Health Care; 6) Satisfaction with Health Care; 7) Community Involvement; and 8) Sex-Specific Health Issues. The first section provides a brief overview of the Leading Health Indicators. In Table 1.1, 2013 Lee County estimates and estimates from the NMMC catchment area for the Leading Health Indicators are presented along with the Healthy People 2020 Targets. Subsequent sections provide prevalence estimates from the 2013 health assessments for each variable, as well as Healthy People targets for the year The MSHA estimates are presented for the purpose of comparing NMMC and state estimates. In general, the format consists of questions posed in the survey, followed by data in table format that display respondents answers to the questions. The first row in each table refers to the total sample for the NMMC catchments area; the second row refers to the total sample for Lee County, the third row refers to the Mississippi Behavioral Risk Surveillance System (BRFSS) estimates; and the fourth row refers to the National BRFSS median. Subsequent rows provide estimates by gender for each population. Numbers in the first column refer to the number of respondents in the sample who endorsed a particular response; the second column refers to the weighted percentage of respondents who endorsed a particular response; and the final column refers to the number in the state s adult population projected to endorse a particular response (based on U.S. Census 2011 population estimates for Mississippi). Population projections were calculated by multiplying the percentage of respondents who endorsed a particular response by the population of adults in each area. Some characteristics of the methodology and subsequent data warrant consideration. Estimates exclude individuals who reported don t know, those who refused to answer the question, or those who had no response coded (missing or skipped). In addition, all data collection approaches are subject to error; records may be incomplete or contain inaccurate information. The data presented in this report were collected via telephone surveys and an address-based frame. There are certain limitations to telephone surveys: 1) the methodology excludes members of the population who do not have a telephone in the home; 2) respondents may not remember essential information; 3) a question may mean different things to different respondents; and 4) some individuals may not respond at all. 15

18 Chapter 1: Healthy People 2010 Leading Health Indicators Leading Health Indicators The Leading Health Indicators reflect the major public health concerns in the United States and were chosen based on their ability to motivate action, the availability of data to measure their progress, and their relevance as broad public health issues. The Leading Health Indicators illuminate individual behaviors, physical and social environmental factors, and important health system issues that greatly affect the health of individuals and communities. Underlying each of these indicators is the significant influence of income and education. The process of selecting the Leading Health Indicators mirrored the collaborative and extensive efforts undertaken to develop Healthy People The process was led by an interagency work group within the U.S. Department of Health and Human Services. Individuals and organizations provided comments at national and regional meetings or via mail and the Internet. A report by the Institute of Medicine, National Academy of Sciences, provided several scientific models on which to support a set of indicators. Focus groups were used to ensure that the indicators are meaningful and motivating to the public. For each of the Leading Health Indicators, specific objectives derived from Healthy People 2020 will be used to track progress. This small set of measures will provide a snapshot of the health of the nation. Tracking and communicating progress on the Leading Health Indicators through nationaland state-level report cards will spotlight achievements and challenges in the next decade. The Leading Health Indicators serve as a link to the nearly 600 objectives in Healthy People 2020 and can become the basic building blocks for community health initiatives. The Leading Health Indicators are intended to help everyone more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. Developing strategies and action plans to address one or more of these indicators can have a profound effect on increasing the quality of life and the years of healthy life and on eliminating health disparities creating healthy people in healthy communities. - Healthy People 2020, 16

19 Description of Each of the Leading Health Indicators Leading Health Indicators Physical Activity Regular physical activity throughout life is important for maintaining a healthy body, enhancing psychological well-being, and preventing premature death. Regular physical activity decreases the risk of death from heart disease, lowers the risk of developing diabetes, and is associated with a decreased risk of colon cancer. Regular physical activity helps prevent high blood pressure and plays a role in decreasing existing high blood pressure. Overweight and Obesity Overweight and obesity raise the risk of illness from high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing, and endometrial, breast, prostate, and colon cancers. Obese individuals may also suffer from social stigmatization, discrimination, and lowered self-esteem. Tobacco Use Cigarette smoking is the single most preventable cause of disease and death in the United States. Smoking results in more deaths each year in the United States than AIDS, alcohol, cocaine, heroin, homicide, suicide, motor vehicle crashes, and fires combined. Smoking is a major risk factor for heart disease, stroke, lung cancer, and chronic lung diseases. Smoking during pregnancy can result in miscarriages, premature delivery, and sudden infant death syndrome. Environmental tobacco smoke (ETS) increases the risk of heart disease and significant lung conditions, especially asthma and bronchitis in children. ETS is responsible for an estimated 3,000 lung cancer deaths each year among adult nonsmokers. Substance Abuse Alcohol and illicit drug use are associated with many of this country s most serious problems, including child and spousal abuse; sexually transmitted diseases including human immunodeficiency virus (HIV) infection; teen pregnancy; school failure; motor vehicle crashes; rising health care costs; low worker productivity; and homelessness. Alcohol and illicit drug use also can result in substantial disruptions in family, work, and personal life. Responsible Sexual Behavior Unintended pregnancies and sexually transmitted diseases (STDs), including infection with the HIV that causes AIDS, can result from unprotected sexual behaviors. Abstinence is the only method of complete protection. Condoms, if used correctly and consistently, can help prevent both unintended pregnancy and STDs. Mental Health Mental health is a state of successful mental functioning, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and one s contribution to society. Approximately 20 percent of the U.S. population is affected by mental illness during a given year; no one is immune. Of all mental illnesses, depression is the most common disorder. More than 19 million adults in the United States suffer from depression. Major depression is the leading cause of disability and is the cause of more than two-thirds of suicides each year. 17

20 Leading Health Indicators Injury and Violence More than 400 Americans die each day due primarily to motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons sustain a significant injury at some time during their lives. Environmental Quality An estimated 25 percent of preventable illnesses worldwide can be attributed to poor environmental quality. In the United States, air pollution alone is estimated to be associated with 50,000 premature deaths and an estimated $40 billion to $50 billion in health-related costs annually. Two indicators of air quality are ozone (outdoor) and ETS (indoor). Immunization Vaccines are among the greatest public health achievements of the 20 th century. Immunizations can prevent disability and death from infectious diseases for individuals and can help control the spread of infections within communities. Immunizations against influenza and pneumococcal disease can prevent serious illness and death. Pneumonia and influenza deaths together constitute the 6 th leading cause of death in the United States. Access to Health Care Strong predictors of access to quality health care include having health insurance, a higher income level, and a regular primary care provider or other source of ongoing health care. Persons with health insurance are more likely to have a specific source of care and to have received appropriate preventive care. 18

21 Leading Health Indicators Table 1.1. Leading Health Indicators for Mississippi 1 Physical Activity Regular Physical Activity in adults Overweight and Obesity Obesity in Adults (BMI greater than or equal to 30.0) Tobacco Use Cigarette Smoking by Adults Substance Abuse Binge Drinking by Adults Immunization (persons aged 65 years and older) Flu Shot Pneumonia Vaccination Access to Health Care Adults with Health Care Coverage 2007 NMMC Area 2007 Lee County 2010 NMMC Area 2010 Lee County 2020 Target NMMC Area 2013 Lee County The following table is provided as a brief summary of the Healthy People 2020 Leading Health Indicators. More detailed analyses, as well as descriptions of the measurement of these variables are provided in subsequent sections. 19

22 Chapter 2: Risk Factors Measuring health risks through surveillance is the essential underpinning for all efforts by the CDC and the states to promote health and prevent disease. Surveillance is the tool that provides the necessary data to define the disease burden, identify populations at highest risk, determine the prevalence of health risks, and guide and evaluate disease prevention efforts at the national, state, and local levels. Chronic diseases are now our nation s leading killers, unlike the situation a century ago. Two chronic diseases, cardiovascular disease and cancer, account for almost two-thirds of all deaths among Americans. The roots of chronic diseases are grounded in a limited number of healthdamaging behaviors practiced by people every day for much of their lives. These behaviors include Lack of physical activity Poor nutrition (e.g., high-fat, low-fiber diets) Tobacco use Under-use of known prevention strategies, such as breast, cervical, and colorectal cancer screening Reducing the prevalence of these and other behaviors that endanger the health of Americans demands strategies such as public and provider education, prevention research, and policy and environmental changes that facilitate healthy living. To be effective, however, these strategies must be supported by ongoing surveillance of health risks. BRFSS, Centers for Disease Control and Prevention 20

23 Table 2.1. Binge Drinking: 5 or more drinks on at least one occasion during the past month During the past 30 days, did you have 5 or more alcoholic beverages on at least 1 occasion? NMMC Catchment Area ,521 Lee County , Mississippi BRFSS , National BRFSS Median DNC 18.3 DNC NMMC Catchment Area ,005 Lee County , Mississippi BRFSS , National BRFSS Median DNC 12.6 DNC NMMC Catchment Area ,516 Lee County , Mississippi BRFSS , National BRFSS Median DNC 24.2 DNC Table 2.2. Average Number of Drinks When Drinking Asked to respondents who had at least one drink in the past 30 days "On the days when you drank, how many alcoholic beverages did you consume on average?" Mean Drinks NMMC Catchment Area Lee County NMMC Catchment Area Lee County NMMC Catchment Area Lee County

24 Table 2.3. Drinking and Driving: Driving after having too much to drink, one or more times in past month Asked to respondents who are current drinkers During the past 30 days, did you drive when you had too many alcoholic beverages on at least 1 occasion? NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table 2.4. Current Smokers: Smoked at least 100 cigarettes in lifetime and smokes everyday or some days Have you smoked at least 100 cigarettes in your lifetime? and How often do you now smoke cigarettes: everyday, some days, or not at all? NMMC Catchment Area ,097 Lee County , Mississippi BRFSS , National BRFSS Median DNC 21.2 DNC NMMC Catchment Area ,502 Lee County , Mississippi BRFSS , National BRFSS Median DNC 18.8 DNC NMMC Catchment Area ,910 Lee County , Mississippi BRFSS , National BRFSS Median DNC 23.6 DNC 22

25 Table 2.5. Tried to Quit: Current smoker who has quit smoking for one day or longer in past 12 months During the past 12 months, have you quit smoking for 1 day or longer? NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table 2.6. Secondhand Smoke: At least one day a week "During the past 7 days, how many days were you in the same room or rode in a car with someone who was smoking cigarettes?" NMMC Catchment Area ,471 Lee County ,108 NMMC Catchment Area ,636 Lee County ,735 NMMC Catchment Area ,353 Lee County ,184 23

26 Table 2.7. Physically Inactive: No reported activity in past week During the past week, how many days did you exercise or participate in sports activities for at least 30 minutes? (percentage of people who answered 0 days) NMMC Catchment Area ,865 Lee County , Mississippi BRFSS ,339, National BRFSS Median DNC 48.3 DNC NMMC Catchment Area ,632 Lee County , Mississippi BRFSS , National BRFSS Median DNC 50.1 DNC NMMC Catchment Area ,456 Lee County , Mississippi BRFSS , National BRFSS Median DNC 47.0 DNC 24

27 Table 2.8. Some Physical Activity: Exercised for at least 30 minutes, 3 or more times in past week During the past week, how many days did you exercise or participate in sports activities for at least 30 minutes? (percentage of people who answered 3 or more days) NMMC Catchment Area ,842 Lee County ,876 NMMC Catchment Area ,138 Lee County ,246 NMMC Catchment Area ,891 Lee County ,498 Table 2.9. Regular Physical Activity: Exercised for at least 30 minutes, 5 or more times in past week During the past week, how many days did you exercise or participate in sports activities for at least 30 minutes? (percentage of people who answered 5 or more days) NMMC Catchment Area ,572 Lee County , Mississippi BRFSS , National BRFSS Median DNC 51.7 DNC NMMC Catchment Area ,473 Lee County , Mississippi BRFSS , National BRFSS Median DNC 49.9 DNC NMMC Catchment Area ,282 Lee County , Mississippi BRFSS , National BRFSS Median DNC 53.0 DNC 25

28 Table Healthy Weight: BMI 2 less than or equal to 24.9 About how much do you weigh without your shoes? & About how tall are you without your shoes? NMMC Catchment Area ,669 Lee County , Mississippi BRFSS , National BRFSS Median DNC 36.3 DNC NMMC Catchment Area ,173 Lee County , Mississippi BRFSS , National BRFSS Median DNC 43.5 DNC NMMC Catchment Area ,115 Lee County , Mississippi BRFSS , National BRFSS Median DNC 29.6 DNC Table Overweight: BMI 3 greater than or equal to 25.0 About how much do you weigh without your shoes? & About how tall are you without your shoes? NMMC Catchment Area ,309 Lee County , Mississippi BRFSS , National BRFSS Median DNC 35.7 DNC NMMC Catchment Area ,042 Lee County , Mississippi BRFSS , National BRFSS Median DNC 29.2 DNC NMMC Catchment Area ,648 Lee County , Mississippi BRFSS , National BRFSS Median DNC 41.6 DNC 2 To determine BMI, weight in pounds is divided by height in inches squared, and then multiplied by

29 Table Obese: BMI 3 greater than or equal to 30.0 About how much do you weigh without your shoes? & About how tall are you without your shoes? NMMC Catchment Area ,018 Lee County , Mississippi BRFSS , National BRFSS Median DNC 27.8 DNC NMMC Catchment Area ,131 Lee County , Mississippi BRFSS , National BRFSS Median DNC 27.4 DNC NMMC Catchment Area ,059 Lee County , Mississippi BRFSS , National BRFSS Median DNC 28.3 DNC Table Trying to Lose Weight: Overweight respondents Are you trying to lose weight? NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a 27

30 Table Health Care Provider Gave Advice to Lose Weight: Overweight respondents During the past 12 months, has a health care provider given you advice about losing weight? NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table Bicycle Helmets: Children always or nearly always wear bicycle helmets Asked to parents During the past 12 months, how often did your children wear a bicycle helmet when riding a bicycle: always, nearly always, sometimes, seldom, or never? NMMC Catchment Area ,518 Lee County ,096 NMMC Catchment Area ,465 Lee County ,416 NMMC Catchment Area ,047 Lee County ,408 28

31 Table Seatbelt Use: Children use seatbelts most of the time During the past 12 months, how often did your children wear a seatbelt or sit in a child safety-seat when riding in a car: never, rarely, sometimes, or most of the time? NMMC Catchment Area ,654 Lee County ,023 NMMC Catchment Area ,776 Lee County ,546 NMMC Catchment Area ,343 Lee County ,573 Table Persons Without Health Insurance Do you have any kind of health care coverage, including health insurance, pre-paid plans, such as HMOs, or government plans such as Medicare? NMMC Catchment Area ,798 Lee County , Mississippi BRFSS , National BRFSS Median DNC 17.9 DNC NMMC Catchment Area ,346 Lee County , Mississippi BRFSS , National BRFSS Median DNC 15.5 DNC NMMC Catchment Area ,581 Lee County , Mississippi BRFSS , National BRFSS Median DNC 19.9 DNC 29

32 Table Routine Check-up: Within the Past Year How long has it been since you last visited a doctor for a routine check-up? NMMC Catchment Area ,206 Lee County ,029 NMMC Catchment Area ,167 Lee County ,503 NMMC Catchment Area ,132 Lee County ,079 30

33 Chapter 3: Clinical Prevention Screenings The nation has seen a great deal of change over the past 100 years in the leading causes of death. At the beginning of the 1900s, infectious diseases ran rampant in the United States and worldwide and topped the leading causes of death. A century later, with the control of many infectious agents and the increasing age of the population, chronic disease tops the list. Clinical preventive services have a substantial impact on many of the leading causes of disease and death. People must have access to clinical preventive services that are effective in preventing disease (primary prevention) or in detecting asymptomatic disease or risk factors at early, treatable stages (secondary prevention). Healthy People 2020 Table 3.1. Blood Pressure Checked Within the Past Year 3 During the past 12 months, have you had any of the following procedures done? Blood pressure measured" NMMC Catchment Area ,356 Lee County ,508 NMMC Catchment Area ,386 Lee County ,960 NMMC Catchment Area ,923 Lee County ,154 3 Note that annual screenings are not recommended for all populations. 31

34 Table 3.2. Adults 65+ Who Have Had a Flu Shot Within the Past Year During the past 12 months, have you had any of the following procedures done? A flu shot NMMC Catchment Area n/a Lee County n/a 2011 Mississippi BRFSS n/a 2011 National BRFSS Median DNC 61.3 n/a NMMC Catchment Area n/a Lee County n/a 2011 Mississippi BRFSS n/a 2011 National BRFSS Median DNC 61.6 n/a NMMC Catchment Area n/a Lee County n/a 2011 Mississippi BRFSS n/a 2011 National BRFSS Median DNC 60.1 n/a Table 3.3. Adults 65+ Who Have Ever Had a Pneumonia Vaccination Have you ever had a pneumonia vaccination? NMMC Catchment Area n/a Lee County n/a 2011 Mississippi BRFSS n/a 2011 National BRFSS Median DNC 70.0 n/a NMMC Catchment Area n/a Lee County n/a 2011 Mississippi BRFSS n/a 2011 National BRFSS Median DNC 72.1 n/a NMMC Catchment Area n/a Lee County n/a 2011 Mississippi BRFSS n/a 2011 National BRFSS Median DNC 67.7 n/a 32

35 Table 3.4. Eye Exam: Within the past year "During the past 12 months, have you had any of the following procedures done? An eye exam NMMC Catchment Area ,212 Lee County ,166 NMMC Catchment Area ,156 Lee County ,842 NMMC Catchment Area ,504 Lee County ,047 Table 3.5. Blood Test for Glucose or Sugar: Within the past year "During the past 12 months, have you had any of the following procedures done? A blood test for glucose or sugar NMMC Catchment Area ,611 Lee County ,141 NMMC Catchment Area ,106 Lee County ,034 NMMC Catchment Area ,634 Lee County ,867 33

36 Table 3.6. Dental Exam: Within the past year "During the past 12 months, have you had any of the following procedures done? A dental exam NMMC Catchment Area ,838 Lee County , Mississippi BRFSS ,297, National BRFSS Median DNC 69.7 n/a NMMC Catchment Area ,575 Lee County , Mississippi BRFSS , National BRFSS Median DNC 72.4 n/a NMMC Catchment Area ,865 Lee County , Mississippi BRFSS , National BRFSS Median DNC 68.0 n/a Table 3.7. Blood Stool Test: Have had a blood stool test During the past 12 months, have you had any of the following procedures done? A blood stool test NMMC Catchment Area ,470 Lee County ,906 NMMC Catchment Area ,557 Lee County ,182 NMMC Catchment Area ,155 Lee County ,590 34

37 Table 3.8. Blood Cholesterol Test: Have had blood cholesterol checked Have you ever had your blood cholesterol checked? NMMC Catchment Area ,356 Lee County , Mississippi BRFSS ,667, National BRFSS Median DNC 79.2 n/a NMMC Catchment Area ,174 Lee County , Mississippi BRFSS , National BRFSS Median DNC 81.5 n/a NMMC Catchment Area ,366 Lee County , Mississippi BRFSS , National BRFSS Median DNC 76.2 n/a Table 3.9. Glaucoma Exam: Within the past year "During the past 12 months, have you had any of the following procedures done? A glaucoma test?" NMMC Catchment Area ,016 Lee County ,554 NMMC Catchment Area ,895 Lee County ,267 NMMC Catchment Area ,501 Lee County ,077 35

38 Chapter 4: Health Status Health status refers to an individual s overall quality of physical, psychological, and social wellbeing. A thorough understanding of the health status of the general population is vital to developing intervention strategies that can prevent disease and trauma. This information is especially important as the emphasis of the health care industry continues to shift from the treatment of illness to prevention and early detection of disease. - Healthy People 2020 Table 4.1. Overall Health Status: Fair or poor "In general, would you say that your health is excellent, very good, good, fair, or poor?" NMMC Catchment Area ,619 Lee County , Mississippi BRFSS , National BRFSS Median DNC 16.9 DNC NMMC Catchment Area ,734 Lee County , Mississippi BRFSS , National BRFSS Median DNC 17.3 DNC NMMC Catchment Area ,732 Lee County , Mississippi BRFSS , National BRFSS Median DNC 16.6 DNC Table 4.2. Health Worse Than a Year Ago "Compared to 12 months ago, would you say that your health is better, worse, or about the same?" NMMC Catchment Area ,647 Lee County ,474 NMMC Catchment Area ,268 Lee County ,117 NMMC Catchment Area ,520 Lee County ,289 36

39 Table 4.3. Health in the Last Month: At least one bad day "During the past 30 days, was your health NOT good on at least 1 day?" Number Percentage Population NMMC Catchment Area ,364 Lee County ,998 NMMC Catchment Area ,931 Lee County ,927 NMMC Catchment Area ,556 Lee County ,934 Table 4.4. Poor Mental Health: At least one bad day in last month "During the past 30 days, was your mental health NOT good on at least 1 day?" NMMC Catchment Area ,645 Lee County ,909 NMMC Catchment Area ,316 Lee County ,958 NMMC Catchment Area ,498 Lee County ,778 37

40 Table 4.5. Sad, Blue, or Depressed: For two weeks in a row "During the past 12 months, was there ever a time when you felt sad, blue, or depressed for 2 weeks in a row or more?" NMMC Catchment Area ,071 Lee County ,610 NMMC Catchment Area ,870 Lee County ,150 NMMC Catchment Area ,520 Lee County ,364 Table 4.6. Received Treatment for Psychological Problems or Emotional Difficulties "During the past 12 months, have you received treatment for psychological problems or emotional difficulties from a mental health professional?" NMMC Catchment Area ,224 Lee County ,316 NMMC Catchment Area ,666 Lee County ,266 NMMC Catchment Area ,245 Lee County ,068 38

41 Table 4.7. Missed Work: At least one day in the past year "During the past 12 months, not including maternity leave, did you miss work at least 1 day because of illness or injury?" NMMC Catchment Area ,220 Lee County ,509 NMMC Catchment Area ,388 Lee County ,160 NMMC Catchment Area ,434 Lee County ,239 Table 4.8. High Blood Pressure: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following High blood pressure?" NMMC Catchment Area ,513 Lee County , Mississippi BRFSS , National BRFSS Median DNC 30.8 DNC NMMC Catchment Area ,206 Lee County , Mississippi BRFSS , National BRFSS Median DNC 29.9 DNC NMMC Catchment Area ,184 Lee County , Mississippi BRFSS , National BRFSS Median DNC 31.9 DNC 39

42 Table 4.9. High Blood Pressure is Under Control "Is your high blood pressure under control?" NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table Coronary Heart Disease: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following Coronary heart disease?" NMMC Catchment Area ,073 Lee County ,275 NMMC Catchment Area ,638 Lee County ,266 NMMC Catchment Area ,840 Lee County ,033 40

43 Table Angina Pectoris: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following Angina or angina pectoris?" NMMC Catchment Area ,524 Lee County ,577 NMMC Catchment Area ,177 Lee County ,309 NMMC Catchment Area ,163 Lee County ,130 Table Heart Attack: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following A heart attack?" NMMC Catchment Area ,399 Lee County , Mississippi BRFSS , National BRFSS Median DNC 4.4 DNC NMMC Catchment Area ,163 Lee County , Mississippi BRFSS , National BRFSS Median DNC 3.1 DNC NMMC Catchment Area ,688 Lee County , Mississippi BRFSS , National BRFSS Median DNC 5.7 DNC 41

44 Table Other Heart Condition or Heart Disease: Have been informed by health care provider that condition exists Have you ever been diagnosed with any of the following Any other kind of heart condition or heart disease?" NMMC Catchment Area ,672 Lee County ,773 NMMC Catchment Area ,480 Lee County ,660 NMMC Catchment Area ,922 Lee County ,068 Table Stroke: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following A stroke?" NMMC Catchment Area ,874 Lee County , Mississippi BRFSS , National BRFSS Median DNC 2.9 DNC NMMC Catchment Area ,354 Lee County , Mississippi BRFSS , National BRFSS Median DNC 2.9 DNC NMMC Catchment Area ,885 Lee County , Mississippi BRFSS , National BRFSS Median DNC 2.7 DNC 42

45 Table Emphysema: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following Emphysema?" NMMC Catchment Area ,474 Lee County NMMC Catchment Area ,177 Lee County NMMC Catchment Area ,844 Lee County Table Diabetes: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following Diabetes?" NMMC Catchment Area ,146 Lee County , Mississippi BRFSS , National BRFSS Median DNC 9.5 DNC NMMC Catchment Area ,402 Lee County , Mississippi BRFSS , National BRFSS Median DNC 9.0 DNC NMMC Catchment Area ,446 Lee County , Mississippi BRFSS , National BRFSS Median DNC 10.0 DNC 43

46 Table Diabetes Management "Have you ever taken a course about how to manage your diabetes yourself?" NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table 4.18 Asthma: Have been informed by health care provider that condition exists "Have you ever been diagnosed with any of the following Asthma?" NMMC Catchment Area ,123 Lee County , Mississippi BRFSS , National BRFSS Median DNC 13.6 DNC NMMC Catchment Area ,779 Lee County , Mississippi BRFSS , National BRFSS Median DNC 15.6 DNC NMMC Catchment Area ,286 Lee County Mississippi BRFSS , National BRFSS Median DNC 11.6 DNC 44

47 Table Currently Have Asthma Asked to respondents who have ever been told that they have asthma "Do you still have asthma?" NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table Asthma Management: Have taken a class in how to manage asthma Asked to respondents who have ever been told that they have asthma "Have you ever taken a course about how to manage your asthma yourself?" NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a 45

48 Table Fruits and Vegetables: At least five servings per day Do you eat at least 5 servings of fruits and vegetables per day? NMMC Catchment Area ,996 Lee County , Mississippi BRFSS , National BRFSS Median DNC 23.4 DNC NMMC Catchment Area ,700 Lee County , Mississippi BRFSS , National BRFSS Median DNC 27.7 DNC NMMC Catchment Area ,241 Lee County , Mississippi BRFSS , National BRFSS Median DNC 19.2 DNC Table Trying to Lose Weight "Are you trying to lose weight?" NMMC Catchment Area ,441 Lee County ,734 NMMC Catchment Area ,243 Lee County ,289 NMMC Catchment Area ,694 Lee County ,195 46

49 Table Counseled to Lose Weight "During the past 12 months, has a health care provider given you advice about losing weight?" NMMC Catchment Area ,986 Lee County ,403 NMMC Catchment Area ,034 Lee County ,268 NMMC Catchment Area ,151 Lee County ,255 47

50 Chapter 5: Access to Health Care Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all persons in the United States. Adequate access to health care and related services can increase appropriate patient use of the health care system and, ultimately, improve health outcomes. Consequently, measures of access across a continuum of care are an important way to evaluate the quality of the nation s health care system. - Healthy People 2020 Table 5.1. Have Seen a Doctor Within the Past Year "During the past 12 months, have you seen a health care provider?" NMMC Catchment Area ,705 Lee County ,966 NMMC Catchment Area ,308 Lee County ,003 NMMC Catchment Area ,284 Lee County ,540 Table 5.2. Routine Check-up: Within the Past Year How long has it been since you last visited a doctor for a routine check-up? NMMC Catchment Area ,206 Lee County ,029 NMMC Catchment Area ,167 Lee County ,503 NMMC Catchment Area ,132 Lee County ,079 48

51 Table 5.3. Health Care Coverage: Have some type of health care coverage "Do you have any kind of health care coverage, including health insurance, pre-paid plans such as HMOs, or government plans such as Medicare?" NMMC Catchment Area ,480 Lee County , Mississippi BRFSS ,658, National BRFSS Median DNC 82.1 DNC NMMC Catchment Area ,869 Lee County , National BRFSS Median DNC 84.5 DNC NMMC Catchment Area ,912 Lee County , Mississippi BRFSS , National BRFSS Median DNC 80.1 DNC 49

52 Table 5.4. Usual Provider of Routine Care "What kind of place do you usually go to when you need routine preventive care, such as a physical or check-up?" Population Number Percentage NMMC Catchment Area 2013 Clinic or Health Center ,570 Doctor's Office or HMO ,709 Hospital Emergency Room ,425 Hospital Outpatient Department ,225 Some Other Place ,500 No Usual Provider ,550 Lee County 2013 Clinic or Health Center ,862 Doctor's Office or HMO ,441 Hospital Emergency Room Hospital Outpatient Department Some Other Place No Usual Provider ,618 NMMC Catchment Area 2013 Clinic or Health Center ,097 Doctor's Office or HMO ,183 Hospital Emergency Room ,361 Hospital Outpatient Department ,489 Some Other Place ,475 No Usual Provider ,730 Lee County 2013 Clinic or Health Center ,086 Doctor's Office or HMO ,098 Hospital Emergency Room Hospital Outpatient Department Some Other Place No Usual Provider NMMC Catchment Area 2013 Clinic or Health Center ,237 Doctor's Office or HMO ,652 Hospital Emergency Room Hospital Outpatient Department ,401 Some Other Place * ,123 No Usual Provider ,123 Lee County 2013 Clinic or Health Center ,693 Doctor's Office or HMO ,198 Hospital Emergency Room Hospital Outpatient Department Some Other Place No Usual Provider ,324 50

53 Table 5.5. Could Not Afford Health Care "During the past 12 months, did you need any of the following medical services, but did not receive them because you could not afford it? Doctor visit NMMC Catchment Area ,797 Lee County ,934 NMMC Catchment Area ,509 Lee County ,958 NMMC Catchment Area ,212 Lee County ,040 Table 5.6. Could Not Afford Needed Prescription Medicines "During the past 12 months, did you need any of the following medical services, but did not receive them because you could not afford it? Prescription medicines NMMC Catchment Area ,097 Lee County ,672 NMMC Catchment Area ,239 Lee County ,075 NMMC Catchment Area ,048 Lee County ,647 51

54 Table 5.7. Could Not Afford Needed Mental Health Care "During the past 12 months, did you need any of the following medical services, but did not receive them because you could not afford it? Mental health care or counseling NMMC Catchment Area ,574 Lee County ,398 NMMC Catchment Area ,411 Lee County ,043 NMMC Catchment Area ,442 Lee County Table 5.8. Could Not Afford Needed Dental Care "During the past 12 months, did you need any of the following medical services, but did not receive them because you could not afford it? Dental Care (including check-ups) NMMC Catchment Area ,296 Lee County ,691 NMMC Catchment Area ,898 Lee County ,426 NMMC Catchment Area ,364 Lee County ,198 52

55 Chapter 6: Satisfaction with Health Care Satisfactory care and related services can increase appropriate patient use of the health care system and, ultimately, improve health outcomes. Consequently, measures are an important way to evaluate the quality of the nation s health care system. - Adapted from Healthy People 2010 Table 6.1. Doctors or Health Providers Always Listened Carefully During the past 12 months, how often would you say health providers listened carefully to you?" NMMC Catchment Area ,936 Lee County ,583 NMMC Catchment Area ,850 Lee County ,917 NMMC Catchment Area ,128 Lee County ,399 Table 6.2. Doctors or Health Providers Always Explained Things Clearly "During the past 12 months, how often would you say health providers explained things in a way you could understand?" NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a 53

56 Table 6.3. Doctors or Health Providers Always Showed Respect During the past 12 months, how often would you say health providers showed respect for what you had to say?" NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a Table 6.4. Doctors or Health Providers Always Spent Enough Time During the past 12 months, how often would you say health providers spent enough time with you? NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a 54

57 Table 6.5. Received Best Possible Care: Score of 4 or 5 "During the past 12 months, how would you rate all the health care you received from all health care providers? (On a scale of 1 to 5, with 1 being worst health care possible and 5 being best health care possible") NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a NMMC Catchment Area n/a Lee County n/a 55

58 Chapter 7: Involvement with Community Affairs The degree of social integration or connection and the social networks in which people are embedded are related to morbidity and mortality. Like economic inequality, social cohesion and social capital are associated with health. - Adapted from The Institute of Medicine 2001 Report Table 7.1. Years in the Community "How many consecutive years have you lived in your current community?" Mean Years NMMC Catchment Area NMMC Catchment Area 2010 NMMC Catchment Area NMMC Catchment Area Lee County Lee County 2010 Lee County Lee County Mississippi 2013 X Mississippi NMMC Catchment Area NMMC Catchment Area 2010 NMMC Catchment Area NMMC Catchment Area Lee County Lee County 2010 Lee County Lee County Mississippi 2013 X Mississippi

59 Chapter 8: Sex-Specific Health Issues Table 8.1. Ever Had a Mammogram "Have you ever had a mammogram?" NMMC Catchment Area ,706 Lee County ,162 Table 8.2. Mammogram: Within the past year 4 "How long has it been since your last mammogram?" NMMC Catchment Area n/a Lee County n/a Table 8.3. Reasons for Getting a Mammogram "Was your last mammogram part of: a routine checkup, breast cancer, or a breast problem other than cancer? Routine Breast Problem Breast Check-up Not Cancer Cancer NMMC Catchment Area Lee County Among females who have ever had a mammogram 57

60 Table 8.4. Ever Had a Clinical Breast Exam "Have you ever had a clinical breast exam?" NMMC Catchment Area ,479 Lee County ,279 Table 8.5. Breast Exam: Within the past year 5 "How long has it been since your last breast exam?" NMMC Catchment Area n/a Lee County n/a Table 8.6. Reasons for Getting a Clinical Breast Exam "Was your last breast exam part of: a routine checkup, breast cancer, a breast problem other than cancer? Routine Breast Problem Breast Check-up Not Cancer Cancer NMMC Catchment Area Lee County Among females who have ever had a breast exam 58

61 Table 8.7. Ever Had a Pap Smear "Have you ever had a Pap smear?" NMMC Catchment Area ,344 Lee County ,652 Table 8.8. Pap Smear: Within the past year "How long has it been since your last pap smear?" NMMC Catchment Area ,136 Lee County ,172 Table 8.9. PSA Test: Within the past year A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer. How long has it been since your last PSA test? NMMC Catchment Area ,221 Lee County ,770 59

62 Table Digital Rectal Exam: Within the past year "During the past 12 months, have you had a digital rectal exam? NMMC Catchment Area ,627 Lee County ,851 Table Testicular Exam: Within the past year How long has it been since your last testicular exam? NMMC Catchment Area ,475 Lee County ,522 60

63 Appendix A: Survey Instrument 2013 Community Health Assessment Social Science Research Center, Mississippi State University Q1. During the past 12 months, have you seen a health care provider? Yes No Q2. During the past 12 months, have you had any of the following procedures done? Check all that apply: A flu shot An eye exam A glaucoma test A blood test for glucose or sugar A dental exam A blood stool test Blood pressure measured Q3. Have you ever had a pneumonia vaccination? Yes No Q4. Have you ever had your blood cholesterol checked? Yes No Q5. How long has it been since you last had your blood pressure taken by a health care provider? Never Within the past 6 months Within the past year Within the past 2 years Within the past 5 years 5 or more years ago Q6. How long has it been since your last colorectal cancer screening? Never Within the past 6 months Within the past year Within the past 2 years Within the past 5 years 5 or more years ago Q7. In general would you say that your health is: Excellent Very good Good Fair Poor 61

64 Q8. Compared to 12 months ago, would you say that your health is: Better Worse About the Same Q9. During the past 30 days was your health NOT good on at least 1 day? Yes No Q10. During the past 12 months, not including maternity leave, did you miss work at least 1 day because of illness or injury? Yes No Q11. During the past 30 days, was your mental health NOT good on at least 1 day? Yes No Q12. During the past week, how many days did you exercise or participate in sports activities for at least 30 minutes? 0 days 1 or 2 days 3 or 4 days 5 or more days Q13. Have you ever been diagnosed with any of the following? Check all that apply: Coronary heart disease Angina or angina pectoris A heart attack Any other kind of heart condition or heart disease A stroke Emphysema Cancer or a malignancy of any kind Diabetes Asthma High blood pressure Q14. Have you ever taken a course about how to manage your diabetes yourself? I have never been told I have diabetes. Yes No Q15. Have you ever taken a course about how to manage your asthma yourself? I have never been told I have asthma. Yes No Q16. Do you still have asthma? Yes No 62

65 Q17. Is your high blood pressure under control? I have never been told I have high blood pressure. Yes No Q18. During the past 12 months, have you received treatment for psychological problems or emotional difficulties from a mental health professional? Yes No Q19. During the past 12 months, was there ever a time when you felt sad, blue, or depressed for 2 weeks in a row or more? Yes No Q20. How long has it been since you last visited a doctor for a routine checkup? Never Within the past 6 months Within the past year Within the past 2 years Within the past 5 years 5 or more years ago Q21. What kind of place do you usually go to when you need routine preventive care, such as a physical or check-up? Clinic or health center Doctor's office or HMO Hospital emergency room Hospital outpatient department Some other place I do not receive preventive care anywhere Q22. Do you have any kind of health care coverage, including health insurance, pre-paid plans such as HMOs, or government plans such as Medicare? Yes No Q23. Is the health care coverage that pays most of your medical care through: Your employer Someone else's employer A plan that you or someone else buys on your own Medicare Medicaid or Medical Assistance The military, CHAMPUS, TriCare, or the VA [or CHAMP-VA] The Indian Health Service Other source 63

66 Q24. During the past 12 months, did you need any of the following medical services, but did not receive them because you could not afford it? Check all that apply: Prescription medicines Mental health care or counseling Dental care (including checkups) Doctor visit During the past 12 months, how would you say health providers: Q25. Listened carefully to you? Never Sometimes Usually Always Q26. Explained things in a way you could understand? Never Sometimes Usually Always Q27. Showed respect for what you had to say? Never Sometimes Usually Always Q28. Spent enough time with you? Never Sometimes Usually Always Q29. During the past 12 months, how would you rate all the health care you received from all health care providers? 1 - Dissatisfied Satisfied 6 I did not receive any health care services in the past 12 months Q30. During the past 12 months, what is the main reason for not being satisfied with the health care you received? Cost too much Had to wait too long Doctor/nurse practitioner did not communicate well Doctor/nurse practitioner did not spend enough time Mistreated by other staff Condition did not improve after treatment or medication Other 64

67 Q31. Have you smoked at least 100 cigarettes in your lifetime? Yes No Q32. How often do you now smoke cigarettes? Everyday Some days Not at all -> skip to question 34 Q33. During the past 12 months, have you quit smoking for 1 day or longer? Yes No Q34. During the past 7 days, how many days were you in the same room or rode in a car with someone who was smoking cigarettes? 0 days 1 or 2 days 3 or 4 days 5 or 6 days 7 days Q35. Would you favor or oppose a law that would prohibit smoking in all indoor workplaces, including offices, restaurants, and bars? Favor Oppose Neither favor nor oppose Q36. During the past 30 days, did you consume at least 1 alcoholic beverage? Yes No Q37. On those days, how many alcoholic beverages did you consume on average? Q38. During the past 30 days, did you have 5 or more alcoholic beverages on at least 1 occasion? Yes No Q39. During the past 30 days, did you drive when you had too many alcoholic beverages on at least 1 occasion? Yes No Q40. Do you eat at least 5 servings of fruits and vegetables per day? Yes No Q41. Are you trying to lose weight? Yes No 65

68 Q42. During the past 12 months, has a health care provider given you advice about: Losing weight Gaining weight Maintaining your current weight Didn't discuss weight with health care provider Q43. What is your gender? Female Male Q44. Have you ever had a mammogram? Yes No Q45. How long has it been since your last mammogram? Within the past year Within the past 2 years Within the past 3 years Within the past 5 years 5 or more years ago Q46. Was your last mammogram part of: A routine checkup A breast problem other than cancer Breast cancer Q47. Have you ever had a clinical breast exam? Yes No Q48. How long has it been since your last breast exam? Within the past year Within the past 2 years Within the past 3 years Within the past 5 years 5 or more years ago Q49. Was your last breast exam part of: A routine checkup A breast problem other than cancer Breast cancer Q50. Have you ever had a Pap smear? Yes No 66

69 Q51. How long has it been since your last Pap smear? Within the past year Within the past 2 years Within the past 3 years Within the past 5 years 5 or more years ago Q52. A Prostrate-Specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer. Have you ever had a PSA test? Yes No Q53. How long has it been since your last PSA test? Within the past year Within the past 2 years Within the past 3 years Within the past 5 years 5 or more years ago Q54. During the past 12 months, have you had a digital rectal exam? Yes No Q55. How long has it been since your last testicular exam? Never Within the past 6 months Within the past year Within the past 2 years Within the past 5 years 5 or more years ago Q56. Do you currently have any children living in your household? Yes No Q57. During the past 12 months, how often did your children wear a bicycle helmet when riding a bicycle? Always Nearly Always Sometimes Seldom Never Never rides a bicycle Q58. During the past 12 months, how often did your children wear a seatbelt or sit in a child seat when riding in a car? Never Rarely Sometimes Most of the time 67

70 Q59. Do your children receive regular dental care? Yes No Child is not old enough Q60. How many consecutive years have you lived in your current community? Q61. If you could live any place in the United States, would you choose the community you live in now? Definitely yes Probably yes Probably not Definitely not Q62. About how much do you weigh without your shoes? Q63. About how tall are you without your shoes? Q64. In what year were you born? Q65. What is your race? White Black Asian or Pacific Islander American Indian or Alaska Native Other (Please Specify): Q66. Are you of Latino or Hispanic origin? Yes No Q67. What is the highest grade or year of school you completed? Never attended school or only attended kindergarten Grades 1 through 8 Grades 9 through 11 Grade 12 or GED College 1 year to 3 years College 4 years or more Q68. Are you currently: Employed for wages Self-employed Out of work for more than 1 year Out of work for less than 1 year A homemaker A student Retired Unable to work 68

71 Q69. In which Mississippi county do you live? I do not live in Mississippi Alcorn Benton Calhoun Chickasaw Choctaw Clay Itawamba Lafayette Lee Lowndes Marshall Monroe Oktibbeha Pontotoc Prentiss Tippah Tishomingo Union Webster Other MS County Q70. In which Alabama county do you live? I do not live in Alabama Franklin Lamar Marion Other AL County Q71. Which best describes your total 2012 household income BEFORE taxes? Less than $10,000 $10,000 to $15,000 $15,000 to $20,000 $20,000 to $25,000 $25,000 to $35,000 $35,000 to $50,000 $50,000 to $75,000 $75,000 or more If you have questions about the study, please contact Robert McMillen, Mississippi State University, Social Science Research Center, Mississippi State, MS, 39762, or the Regulatory Compliance Officer at Mississippi State University,

72 Appendix B: Description of BRFSS and NHIS Sponsor Mode of Administration Survey Sample Design Response Rates Primary Survey Content Population Targeted Demographic Data Behavioral Risk Factor Surveillance System (BRFSS) 6 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Telephone interview. Data collection is conducted separately by each state. Sample design uses state-level, random-digit-dialed probability samples of the adult (aged 18 years and over) population. Most states currently use disproportionate random sampling methods. Increasing state participation over time, with 15 states in 1984 and all 50 states and the District of Columbia since In 1998, state-specific sample sizes ranged from 1,499 to 6,005. The median sample size was 2,648. State response rates vary from year to year. In 1998, upper-bound response rates ranged from 45 to 95 percent (median response rate: 73 percent). The survey consists of a core of questions asked in all states, standardized optional questions on selected topics that are administered at the state s discretion, a rotating core of questions asked every other year in all states, and state-added questions developed to address state-specific needs. Questions cover behavioral risk factors (for example, alcohol and tobacco use), preventive health measures, HIV/AIDS, health status, limitation of activity, and health care access and utilization. Civilian, noninstitutionalized population 18 years of age and older who reside in households with telephones. Gender, age, educational attainment, race/ethnicity, household income, employment status, and marital status. Years Collected Annually since 1984 Schedule Geographic Estimates Notes Annual National; state; smaller area estimates possible in some states The BRFSS is a partnership between State Health Departments and CDC; CDC provides about one-half of the financial resources for states to use for data collection efforts. States have substantial input on questions used by all states through the BRFSS. Many Healthy People objectives are tracked with questions that are asked every other year or are optional. Persons who do not have telephones or have telephones but are either in institutional settings or cannot be understood over the telephone are excluded. 6 Tables provided by Healthy People 2010, 70

73 Sponsor Mode of Administration Survey Sample Design Response Rates Primary Survey Content Population Targeted Demographic Data Years Collected Schedule Geographic Estimates National Health Interview Survey (NHIS) U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). Personal interview in households using computer-assisted personal interviewing (CAPI), administered by professional interviewers, and conducted in English and Spanish (for CAPI, Spanish version was initiated in mid-1998). The NHIS uses a stratified multistage probability design that permits a continuous sampling of 358 primary sampling units (PSUs), with oversampling of African Americans and Hispanics. A typical NHIS sample for the data collection years consists of approximately 7,000 secondstage units (segments) within a PSU. The expected sample of 43,000 occupied respondent households yields a probability sample of about 111,000 persons. The survey is designed so that the sample scheduled for each week is representative of the target population and the weekly samples are additive over time. Response rates for the basic NHIS core questionnaire have ranged from 91 to 96 percent over the years, with rates of sample person components generally ranging from 85 to 90 percent of eligible respondents. Response rates for special health topics (supplements) have generally also been in this lower range. The effect, if any, of the new CAPI technology is not yet known. Information is obtained on demographic characteristics, illnesses, injuries, impairments, chronic conditions, utilization of health resources, health insurance, and other health topics. The core household interview asks about everyone in the household. Additional questions are asked of one sample adult and one sample child (under 18 years) per family in the household. The sample adult questionnaire includes chronic health conditions and limitations in activity, health behaviors, health care access, health care provider contacts, immunizations, and AIDS knowledge and attitudes. The sample child questionnaire includes questions about chronic health conditions, limitation of activities, health status, behavior problems, health care access and utilization, and immunizations. Child data are proxy-reported by a parent or other knowledgeable adult respondent. Adult sample person data are all selfreported. Special modules are fielded periodically, and cover areas such as cancer, prevention, and disability. Civilian noninstitutionalized population residing in the United States, all ages Gender, age, race/hispanic ethnicity, education, income, marital status, place of birth, industry, and occupation Continuously since Current sample design began in 1995; current questionnaire design began in 1997 Annual National; four U.S. Census Bureau regions; some of the 10 HHS regions, some states; metropolitan and nonmetropolitan areas 71

74 Appendix C: Data Resources for Decision-makers BRFSS Healthfinder - the Federal Gateway to Health Information Healthy People Mississippi State Department of Health County Health Rankings Mississippi Tobacco Data Center for Mississippi Health Policy Mississippi Public Health Institute Mississippi Public Health Association 72

75 FOR FURTHER INFORMATION CONTACT Robert McMillen Social Science Research Center, Mississippi State University, One Research Park, Suite 103 Starkville, MS Phone: Fax: Mississippi State University does not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or veteran status. 73

76 mississippi s tat e u n i v e rs i t y d o es n ot d i s c r imi n at e o n t h e bas i s o f r ac e, co lo r, r e l i g i o n, n at i o n a l o r i g i n, s e x, ag e, d i s a b i l i t y, o r v e t e r a n s tat us. t h i s r e p o rt i s fu n d e d by a g r a n t o f t h e mississippi s tat e d e pa rtme n t o f h e a lt h.

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