District Health Status Data Report 2012

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1 District Health Status Data Report 2012 As you are aware Mobilizing for Action through Planning and Partnerships (MAPP) is a nationally accepted, community driven, framework for assessing the health of a given community, or in our case the Two Rivers Public Health District, comprised of Buffalo, Dawson, Franklin, Gosper, Harlan, Kearney and Phelps counties. The MAPP process will serve as an in-depth analysis of the Public Health System and how its various partners address public health issues identified at the local, state and national level utilizing data gathered by various entities concerned with Public Health. MAPP will assist us to formulate a shared vision of what a Healthy Community is and enable us to prioritize health and quality of life issues identified by health assessment data. Furthermore, MAPP results will identify the many partners, services and capacity/performance of the health system and assist us in reinforcing the existing network, building new coalitions to address identified gaps and pin pointing redundancy in the system. Finally MAPP results will aid us to identify the forces of change, threats and opportunities that affect our ability to address the issues we have collectively deemed as priority. To facilitate the data driven aspects of the MAPP process the MAPP Steering Committee has compiled this report. The Nebraska Department of Health and Human Services (NDHHS) and the U.S. Department of Health and Human Services (USDHHS) have identified several leading or core indicators of health by which the health of the Two Rivers District will be assessed. USDHHS Healthy People 2020 Leading Indicators of Health were based on data gleaned from the 10 year, nationwide Healthy People 2010 project. The overall goals of Healthy People 2020 and NDHHS Core Indicator recommendations are to promote health, prevent illness, disability and premature death. The Leading Health Indicators from Healthy People 2020 were used to categorize data in the District Health Status report and the NDHHS Core Indicators were assigned to their corresponding Leading Health Indicator. You will find each indicator and its corresponding set of measures within the body of this document. As a group, the indicators reflect the major health concerns in the United States at the beginning of the 21 st century. The Leading Health Indicators were identified by USDHHS based on their ability to motivate action, the availability of data to measure progress and their importance as public health issues. They include: Physical Activity, Overweight and Obesity, Tobacco and Substance Abuse, Mental Health, Injury and Violence, Environmental Health, Immunization and Access to Care. Several Data sources including the 2009 Two Rivers District Community Health Status Measure (CHA 2009), County Health Rankings (2010 CHR), NDHHS Community Themes and Strengths Survey, Behavioral Risk Factor Surveillance System Survey (BRFSS), 2010 Census Data, and other data were accessed to develop the report. A variety of secondary data sources were accessed to improve the quality of this report, the additional data were obtained from the following sources: Centers for Disease Control & Prevention (CDC) 2010 U. S. Census Bureau Website 2011 Chronic Disease in Nebraska Nebraska State Immunization Information System (NESIIS) Morbidity and Mortality Weekly Report (MMWR) NDHHS Nebraska Risk and Protective Factor Student Survey 2010 (NRPFSS) 1

2 Youth Risk and Behavior Survey 2009 (YRBS) Nebraska s 2001 Dental Health Guide/The PEW Research Center Nebraska Dental Association Crime in Nebraska National Center for Health Statistics A copy of each document used in the development of this report is available to you during the entire course of the MAPP process should you require different or more in depth data than this report contains. It is our hope that the information provided in this report will inform the District MAPP process and enable us to work toward addressing the health priorities identified collectively as a Public Health System. The MAPP Steering Committee Terry Krohn Director Two Rivers Public Health Department Trish Sandstedt Outreach Services Coordinator Good Samaritan Hospital Connie Linder Safety Director Kearney County Health Services Pat Samway Director of Internal & External Affairs Lexington Regional Health Center Kim Ryan RN/BSN Public Health Nurse Two Rivers Public Health Department Marsha Carlson RN/BSN Public Health Nurse Two Rivers Public Health Department Dale Gibbs Director of Outreach Services Good Samaritan Hospital Amy Elwood Emergency Response Coordinator Two Rivers Public Health Department Rhonda Johnson Public Relations, Foundation & Volunteers Phelps Memorial Hospital Patsy Johnson RN Phelps Memorial Hospital Foundation Two Rivers Public Health Department Dick Pierce County Supervisor Buffalo County 2

3 Population Two Rivers District Demographic Characteristics Demographic characteristics include measures of total population as well as total population by age group, gender, race and ethnicity, where these populations and subpopulations are located, and the rate of change in population density over time, due to births, deaths and migration patterns. Located in South Central Nebraska, Two Rivers Public Health (TRPH) District covers 4,624 miles and is primarily rural. Buffalo County is 968 square miles, Dawson County is 1,013 square miles, Franklin County is 576 square miles, Gosper County is 458 square miles, Harlan County is 553 square miles, Kearney County is 516 square miles, and Phelps County is 540 square miles. There are 25 villages in the district with a population below 500 each. There are 6 villages with a population over 500. There are 8 towns in the district with a population under 5,000 and 3 cities with a population over 5,000. The District has many large industries including meat packing plants in Lexington (Dawson County) and Gibbon (Buffalo County), an Ethanol Plant, and Phelps County contains a large producer of medical supplies. Buffalo County has the greatest number of industries with the majority being in or around the City of Kearney. Overall Demographic Information (2010 US Census Data) 100,000 80,000 60,000 40,000 20,000-20,000 Population Change Between Years 2000 and Buffalo County Dawson County Franklin County Gosper County Harlan County Kearney County Phelps County Two Rivers District 2000 Census Data 42,259 24,365 3,574 2,143 3,786 6,882 9,747 92, Census Data 46,102 24,326 3,225 2,044 3,423 6,489 9,188 94,797 Population Change 9.10% -0.20% -9.80% -4.60% -9.60% -5.70% -5.70% 2.20% 3

4 2000 Population Density- US Census Bureau 2010 US Census Demographic Profile: Age and Sex 30,000 Age of Total Two Rivers District Population 25,000 20,000 22,303 24,197 15,000 10,000 12,909 14,717 Age of Total Population 5, , years 6-14 years years years years 6, years 4,765 2, years 85+ years 4

5 Percent of Population 2010 US Census Data 50.6 Percent of Population by Sex-2010 Data Two Rivers District Nebraska Males Females Demographic Profile: Race / Ethnic Distribution (2010 Data US Census) White (Race) African American (Race) Asian (Race) American Indian or Alaska Native (Race) Native American or Pacific Islander (Race) Other (Race) Hispanic or Latino (Ethnicity) Non- Hispanic or Latino (Ethnicity) Buffalo 42, ,235 3,432 42,670 Dawson 18, ,220 7,746 16,580 Franklin 3, ,192 Gosper 1, ,995 Harlan 3, ,378 Kearney 6, ,245 Phelps 8, ,815 District Total 85,421 1, ,960 11,922 82,875 Nebraska Total 1,572,838 82,885 32,293 18,427 1, , ,405 1,658,936 5

6 Demographic Profile: Poverty/Unemployment Distribution ( Data US Census) Core Indicators Buffalo Dawson Franklin Gosper Harlan Kearney Phelps NE 2.6% 4.3% 2.6% 4.1% 2.7% 2.5% 2.7% Percent Unemployed (2011 Data) Bureau of Labor Percent Below Poverty Level (2009 Data)US Census *Percent Children Below Poverty Level (2008 Data) Community Health Assessment Median Household Income (2009 Data) US Census Special Populations Migrant persons (foreign born persons) Data US Census Non-English speaking persons (2009 Data) US Census 15.8% 14.8% 12% 9.4% 13.1% 9.2% 11% 12.2% 10.7% 14.1% 15% 12.7% 14.9% 9.9% 11% 11.7% $45,009 $40,048 $38,510 $49,336 $41,112 $51,165 $46,567 $47, % 17.1%.3%.3%.2% 2.1% 4.1% 9.2% 5.8% 28.7% 1.2% 2.2% 1.4% 4.2% 5.8% 9.2% Single parent families 1, Unknown Access To Health Services This domain represents factors associated with health system capacity, which may include both the number of licensed and credentialed health personnel and the physical capacity of health facilities. In addition, the category of health resources includes measures of access, utilization, cost and quality of health care and prevention services. Service delivery patterns and roles of public and private sectors as payers and/or providers may also be relevant. Access to health services comprises more factors than strictly the ability to pay, whether by private insurance, Medicare, Medicaid, or self pay. Access involves understanding the navigation of the system, including expectations and cultural norms. It involves the realization that preventative care is important and necessary. Some of the factors we can measure, some will be spoken of in qualitative modes, and some we can only imagine. Persons with medical insurance: (CHA 2009) Percent with no health insurance: 21.6% of TRPH District residents compared to 31.5% in Nebraska (NE). Persons with health care coverage: Ages years (CHA 2009) 87.3% of TRPH District residents report coverage compared to 84.1% in NE. Persons with a usual primary care provider (CHA 2009) 90.9% of TRPH District residents report a usual provider compared to 84.5% in NE. Number of licensed physicians per 1,000 TRPH District residents is

7 Unable to see a doctor due to cost (CHA 2009) 9.5% of TRPH District residents agree compared to 11.5% throughout NE. Visited doctor in last 12 months (CHA 2009) 55.6% of TRPH District residents said they had visited a doctor compared to 58.8% in NE. Getting routine checkups: Clinical breast exam in last 12 months (women 40+) (CHA 2009) 58.1% in TRPH District compared to 63% in NE. Health related quality of life: General health good to excellent (CHA 2009) 87.1% of TRPH District residents said yes compared to 87.4% in NE. 71.6% of TRPH District minority residents reached said yes compared to 78.2% of state minority respondents. Ten or more days in last month when physical health was not good (CHA 2009) 11.4% of TRPH District respondents agreed compared to 10.8% in NE. Minority Population Access to Health Services: Qualitative comments were synthesized from the 2010 Unnatural Causes Report developed from the Public Health Policy Leadership Summits which took place in Kearney and Lexington, NE and the 2011 Somali Needs Assessment that was held in Grand Island, NE Provide interpreter services. Explain health insurance and express the need to different cultures. Develop outreach to people s homes. Identify what health means to different people. Resource center for access to healthcare. Identify the respected individuals within minority groups. Empowerment of the women. Meet as a community to solve issues. Beliefs of different cultures can be inherent barriers to health care. Available Licensed Hospital Beds Licensed Hospital Beds in Two Rivers District NDHHS-2011 Harlan County Health Systems 19 Phelps Memorial Hospital 25 Cozad Community Hospital 21 Good Samaritan Hospital/Richard Young 226 Franklin County Memorial Hospital 14 Lexington Regional Health Center 25 Gothenburg Memorial Hospital 12 Kearney County Health Services 25 Total Licensed Medicare/Medicaid Beds 344 (Nebraska Health Care Resource Directory ) 7

8 Clinical Preventative Services Clinical preventive services, such as routine disease screening and scheduled immunizations, are key to reducing death and disability and improving the Nation s health. These services both prevent and detect illnesses and diseases from flu to cancer in their earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and medical care costs. Yet, despite the fact that these services are covered by Medicare, Medicaid, and many private insurance plans under the Affordable Care Act, millions of children, adolescents, and adults go without clinical preventive services that could protect them from developing a number of serious diseases or help them treat certain health conditions before they worsen. Healthy People 2020 Cancer Screenings (CHA 2009) Mammograms- 71.8% of TRPH District women 40 and over were screened in the last year. Pap tests-95.7% TRPH District women 18 and older reported ever having a pap smear. Prostate Specific Antigen (PSA) test- 75.3% of TRPH District men 50 and older reported ever having a PSA test. Screening Rates Colorectal Cancer (CDC/BRFSS 2006) persons per 100,000 population of NE adults over 50 years of age have had a lower endoscopy. TRPHD District residents that had lower endoscopy less than 10 yrs ago was 41.1 persons per 100,000 population. Blood Cholesterol Testing (BRFSS ) 76.2% of NE adults reported ever having a blood cholesterol level test. 64.8% of TRPH District adults report ever having a blood cholesterol level test. 72.0% of NE adults have had cholesterol testing in the past 5 years. 58.9% of TRPH District adults have had cholesterol testing in the past 5 years. Health Status Measurement of the community or district health status employs several different indicators to determine the overall health of population being assessed. Morbidity, mortality, disease incidence and actual case numbers of reportable conditions and diseases assist us to understand the physical health of the district. Nebraska Adult Diabetic Population (CHA 2009) Prevalence of diabetes among adults in NE was reported as 7.0 per 100,000/population. Prevalence of diabetes among adults in TRPH District was reported as % of TRPH District residents report having a hospitalization related to diabetes. Diabetes related deaths per 100,000 population in NE and the TRPH District were 81.2 and 83.1 respectively. 8

9 Colorectal Cancer Incidence (CHA2009) The incidence of colorectal cancer in NE: 56.2 persons per 100,000 population with incidence in the TRPH District at 50.8 persons per 100,000 population. Deaths related to colorectal cancer in TRPH District were slightly lower at 17.6 persons per 100,000 population as opposed to NE at 18.2 persons per 100,000 population. Cancer (NDHHS Cancer Incidence and Mortality In NE ) Total Cases for All Types Cancer TRPH District County Actual Cases Rate Buffalo Dawson * Franklin Gosper Harlan Kearney * Phelps * * significantly lower than NE rate ** significantly higher than NE rate Cancer Mortality (All Sites) (NDHHS Cancer Incidence and Mortality In NE ) For NE there were16,856 cancer related deaths from TRPHD District deaths due to cancer from were 924. Incidence of Lung Cancer TRPH District: 54.1/100,000 population. (CHA 2009) TRPHD District lung cancer incidence is lower than NE at 65.6/100,000 population. NE deaths due to lung cancer 43.5/100,000 population. TRPH District lung cancer mortality is lower than NE at 47.1/100,000 population. Incidence of Breast Cancer TRPH District: 123.1/100,000 population. (CHA 2009) Virtually equal to NE at 123.2/100,000 population. Deaths due to breast cancer 24.7/100,000 population. Slightly higher than the state at 21.2/100,000 population. Incidence of Cervical Cancer TRPH District: 8.8/100,000 population. (CHA2009) Higher than the state at 7.2/100,000 population. Deaths due to cervical cancer 2.1/100,000 population. Higher than the state at 1.6/100,000 population. 9

10 Heart Disease and Stroke Heart disease is the #1 killer of Nebraskans, stroke is the #3 killer. (Chronic Disease in Nebraska 2011) NE has a 35% prevalence of high cholesterol which is more than double the national target at 17%. (Chronic Disease in Nebraska 2011) TRPH District deaths due to coronary heart disease: 92.0/100,000 population. (CHA 2009) TRPH District deaths due to stroke: 38.1/100,000 population. (CHA 2009) Buffalo, Dawson, Franklin and Kearney counties average stroke hospitalization rate per 1,000 persons from was 13 according to CDC Stroke maps. (CHA 2009) Similarly, average stroke hospitalization rate for Gosper, Harlan and Phelps counties was 11 per 1,000 persons. (CHA 2009) Prevalence of high blood pressure in TRPH District adults is 27.4 persons per 100,000 population as opposed to the NE rate of Chronic Obstructive Pulmonary Disease (CHA 2009) TRPH District deaths: 53.7/100,000 population. Higher than NE at: 47.8/100,000 population. Immunizations (National and State Vaccination Coverage Among Children Aged Months: United States, 2010 MMWR 9/2/2011) Children aged months who received recommended vaccinations- Nebraska 79.9%, which is above the national average of 74.9 %. NESIIS 2012 Immunization Data for TRPH District Immunizations by County Children months with immunizations up to date at 12 months of age. Children months with immunizations up to date at 24 months of age. Buffalo 86.4% 73.5% Dawson 62.6% 49.8% Franklin 55.6% 48.4% Gosper 56.3% 50.0% Harlan 74.4% 53.1% Kearney 72.5% 58.2% Phelps 76.1% 57.8% NDHHS estimates approximately 30% of Immunizations given in the state are entered in Nebraska State Immunization Information System (NESIIS 2012). Of the 30% recorded immunizations in the TRPH District the above percentages apply. 10

11 Environmental Quality The physical environment directly impacts health and quality of life. Clean air and water, as well as safely prepared food, are essential to physical health. Exposure to environmental substances such as lead or hazardous waste increases risk for preventable disease. Unintentional home, workplace, or recreational injuries affect all age groups and may result in premature disability or mortality. Outdoor Air Quality Index (County Health Rankings 2010) Air pollution-particulate matter days is the number of unhealthy air quality days due to fine particulate matter. The number of air pollution days within the TRPH District for 2010 is zero.. Air pollution-ozone days represent the number of unhealthy air quality days due to ozone within all counties in the Two Rivers Public Health District. Ozone days in 2010 were zero. Nitrate Levels By County CHA Data Nitrate Levels in Community Water Systems Nitrate levels in community water systems Buffalo Dawson Franklin Gosper Harlan Kearney Phelps TRPHD NE Above rates indicate parts per million. EPA Maximum Contaminate Level (MCL) for nitrate-nitrogen in public water supplies is

12 Injury and Violence Injury and Violence Data within a community is presented in terms of mortality (rates of death within a population. Mortality is represented in this report as a crude rate and by cause (non-cancer or injury unintentional injury). Fatal Injuries Incidence of Unintentional Injury Death: Data (CHA 2009)** Buffalo-43.5 Dawson-45.4 Gosper-38.2 Phelps-53.1 Kearney-53.4 Harlan-36.9 Franklin-72.9 Nebraska-36.5 Two Rivers Total-44.6 Incidence of Homicide: Data (CHA 2009)** Dawson-2.7 Buffalo-0.3 Gosper-0 Phelps-0 Kearney-0 Harlan-0 Franklin-0 Nebraska-3.4 Two Rivers Total-0.8 ** expressed as persons per 100,000 population. TPHD District Motor Vehicle Crashes (Crash Outcomes Data Evaluation System/ CODES) County Total number of crashes Total number of fatalities The number of fatalities with age ranges Buffalo 5, Dawson 2, Franklin Gosper Harlan Kearney Phelps Total 10,

13 Maternal, Infant and Child Health One of the most significant areas for monitoring and comparison relates to the health of a vulnerable population: infants and children. This category focuses on birth data and outcomes as well as mortality data for infants and children. Because maternal care is correlated with birth outcomes, measures of maternal access to, and/or utilization of, care is included. Rate of births to teen mothers is a critical indicator of increased risk for both mother and child. At first consideration, the topic of Maternal, Infant, and Child Health can be assigned a narrow focus. For example, we can look at the number of pre-term births and the number of infant and child deaths. We can also examine the birth rate, the teen birth rate, and prenatal care provided during pregnancy. Each of these rates, however, must be examined in conjunction with social and economic factors that either promote or stifle healthy behaviors. Prenatal care during pregnancy: First Trimester Care ( CHA) 72.65% of births in TRPHD vs % in NE. Infant mortality (Rate per 1,000 live births from CHA) Caucasian Two Rivers 6.94 Nebraska 5.72 Black Two Rivers Nebraska Native American Two Rivers 0 Nebraska Asian Two Rivers 0 Nebraska 5.31 Hispanic Two Rivers 7.91 Nebraska 6.07 Total Two Rivers 5.89 Nebraska 5.75 Child deaths: Number of deaths 1-19 years ( CHA) 44 in TRPH District vs. 753 in NE. Death rate per 100,000: 33.5 TRPH District vs NE. Pre-term births: Percentage of births ( CHA) 8.62 % TRPH District vs. 9.75% NE. Birth rates: Total live births( CHA) 6786 TRPH District of 133,723 in NE. Total live births 2009: 1342 TRPH District vs. 26,931 in NE. Teen birth rates: (ages years) Number of teen births : 591 TRPH District vs. 11,165 in NE. % of Total Live Births ( CHA) 8.71 TRPH District vs NE. Incidence of birth defects: Rate per 1,000 Live Births ( CHA) 62.6 TRPHD vs NE. 13

14 Incidence of neural tube defects: Rate per 1,000 Live Births ( CHA) 1.4 in TRPH District vs. 1.0 in NE. Breastfeeding According to the Agency for Healthcare Research and Quality (ARHQ) a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance. 14

15 Mental Health This category represents social and mental factors and conditions which directly or indirectly influence overall health status and individual and community quality of life. Mental health conditions and overall psychological well-being and safety may be influenced by substance abuse and violence within the home and within the community. The World Health Organization states that, Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. Note that mental health is more encompassing than merely the absence of specific mental disorders or disabilities. Although Mental Health is considered one of the Leading Health Indicators for Healthy People 2020, the data we possess most often measures the lack thereof. The data we do have must also be examined along with other economic and social determinants. Adolescents who experience major depressive episodes: In Brief In 2004, 9.0 percent of adolescents aged 12 to 17 (an estimated 2.2 million adolescents) experienced at least one major depressive episode (MDE) in the past year. Among adolescents aged 12 to 17 who reported having experienced an MDE in the past year, less than half (40.3 percent) received treatment for depression during that time. Adolescents who had experienced a past year MDE were more than twice as likely to have used illicit drugs in the past month than their peers who had not. (21.2 vs. 9.6 percent) Suicides: Deaths per 100,000 ( CHA) TRPHD 9.3 vs NE. Prevalence of mental illness in TRPHD area ( Behavioral Risk Factor Surveillance System Survey/ BRFSS) 3% TRPHD adults reported symptoms of serious psychological distress in the last 30 days. Current depression was reported by 5.3% of adults with women (13.5%) more likely than men (1.8%) to report. 21.1% of adults said they had ever been diagnosed with a depressive disorder, with women (31.1%) more likely to report a lifetime diagnosis than men (12.4%). 7.8% of adults stated they had received a diagnosis of an anxiety disorder at some point in their lifetime; women reported (18.2%) while men reported (1.8%). 15

16 Nutrition Physical Activity and Obesity Good nutrition, physical activity, and a healthy body weight are essential parts of a person s overall health and well-being. Together, these can help decrease a person s risk of developing serious health conditions, such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancer. A healthful diet, regular physical activity, and achieving and maintaining a healthy weight also are paramount to managing health conditions so they do not worsen over time. Adults who are obese (BRFSS One-fourth of the respondents in TRPH District (26.3 percent) reported heights and weights that placed them in the obese category. (Body Mass Index = 30.0+) An additional 39.9% of TRPH District residents are classified as overweight (Body Mass Index = ). Thus, 66.2% of adults in the TRPH District were classified as overweight or obese in ) 16 9th - 12th Grade Obesity Rates In Nebraska in th - 12th Grade Obesity Rates In Nebraska in Females-7.8% Males-14.0% In addition to the above Obesity Rates, 13.8% of NE Children grades 9-12 were in the overweight classification, but not obese. The breakdowns are as follows, females, 12.8% and males 14.7% (2005 Data derived from C.D.C.) 16

17 Adults who meet current Federal physical activity guidelines for aerobic physical activity and muscle strengthening activity 35 Persons Who Participate In Regular Vigorous Physical Activity * Nebraska Two Rivers * (CHA 2009) Persons per 100,000 population. Total vegetable intake for persons aged 2 and older Persons Who Intake 5 or More Fruits and Vegetables Daily in TRPH District * 30 Nebraska 25 Two Rivers

18 Percent of Population *(CHA 2009) persons per 100,000 population. Oral Health Oral diseases ranging from dental caries (cavities) to oral cancers cause pain and disability for millions of Americans. The impact of these diseases does not stop at the mouth and teeth. A growing body of evidence has linked oral health, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke. In pregnant women, poor oral health has also been associated with premature births and low birth weight. These conditions may be prevented in part with regular visits to the dentist. Healthy People 2020 Persons who have used the oral healthcare system in the past 12 months 70.3% of TRPH District adults have visited a dentist, dental hygienist or a dental clinic within the past year. (BRFSS 2010) 16.2% of TRPH District adults aged 65+ have had all of their teeth extracted. (BRFSS 2010) NE 3 rd Graders: (Open Mouth Survey of 3 rd Graders 2005) 60% have dental decay 17% have untreated dental decay Young Children Priority One (YCPO) Two Rivers Public Health Department dental program has provided 8,152 fluoride varnish treatments (fall 2009 to December 2011) to children and adults in Kearney, Lexington, Holdrege and Gibbon through WIC, Head Start, Preschools and daycares. Dental decay rates among these children range from 15-36%. The UNMC College of Dentistry Dental Day has served 361 children from the Lexington area from 2004 to Children have also been served by the Ronald McDonald Dental Van. Lexington Public Schools and local dental professionals have donated their services to screen and provide a treatment plan before services are delivered. Community Water and Fluoridation % Population served by community water % Population receiving optimally fluoridated water Buffalo Dawson Franklin Gosper Harlan Kearney Phelps TRPHD NE (CHA ) Information about Harlan County reported by City of Alma 1/

19 Reproductive/Sexual Health and Adult Immunization Measures within this category include diseases which are usually transmitted through person-to-person contact or shared use of contaminated instruments /materials. Many of these diseases can be prevented through a high level of vaccine coverage of vulnerable populations, or through the use of protective measures such as condoms for the prevention of sexually-transmitted diseases. Sexually transmitted infection TRPH District Reportable Disease Data (CHA 2009) Indicator Per 100,000 Population unless otherwise indicated Hepatitis A and B Primary Syphilis Case Count Secondary Syphilis Case Count Chlamydia Case Count Incidence of Gonorrhea Incidence of TB per Dawson Buffalo Gosper Phelps Kearney Harlan Franklin Two Rivers District , NE National Electronic Disease Surveillance System (NEDSS) reports for 2010 state that chronic or resolved Hepatitis C cases in the TRPH District were 39 and 24 total cases in Total NE persons reported to be living with HIV in 2008 was 704. (CDC 2008) Data at the TRPH District or county level unavailable at the time of this report. Adult Immunization (CHA 2009) TRPH District adults were immunized against influenza at the rate of 75.8 persons per 100,000 population in 2009, as opposed to NE at 74.0 for the same year. TRPH District adults were immunized against Pneumonia at the rate of 72.1 persons per 100,000 population in 2009, as opposed to NE at 69.1 for the same year. 19

20 Social Determinates of Health A range of personal, social, economic, and environmental factors contribute to individual and population health. For example, people with a quality education, stable employment, safe homes and neighborhoods, and access to preventive services tend to be healthier throughout their lives. Conversely, poor health outcomes are often made worse by the interaction between individuals and their social and physical environment. Social determinants are in part responsible for the unequal and avoidable differences in health status within and between communities. Healthy People 2020 Percentage of students who graduate with a regular diploma 4 years after starting the 9 th grade TRPH District High School Diploma Attainment in year 2000 Dawson-38.1 Buffalo-26.5 Gosper-39 Phelps-35.8 Kearney-35.9 Harlan-38.4 Franklin-39.3 (2010 CHR) Substance Abuse Risk factors in this category include behaviors which are believed to cause, or to be contributing factors to, injuries, disease, and death during youth and adolescence and significant morbidity and mortality in later life. Although progress has been made in substantially lowering rates of substance abuse in the United States, the use of mind and behavior-altering substances continues to take a major toll on the health of individuals, families, and communities nationwide. Substance abuse involving drugs, alcohol, or both is associated with a range of destructive social conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child abuse, and crime. Moreover, both social attitudes and legal responses to the consumption of alcohol and illicit drugs make substance abuse one of the most complex public health issues. 20

21 Adolescents using alcohol or any illicit drugs during the past 30 days (NRPFS 2010) Respondents included 6 th (n=824), 8 th (n=858), 10 th (n=710) and 12 th (n=684) graders with unknown grade level (n=24) totaling 3,100 respondents. By gender, 51% (n=1581) were male, while 49% (n=1511) were female. The 6 th graders who reported using alcohol at least once in the past 30 days was 2% of respondents while the state was 3%. With 8 th graders, The TRPH District tied with NE at 8% for alcohol use, well below the national average of 14%. When looking at 10 th graders, there were 19% who reported alcohol use, below NE (21%) and the national (29%) averages. When looking at 12 th graders, TRPH District and NE tied with 35% of respondents reporting using alcohol within the last 30 days. The national average is 41%. TRPH District 6 th graders who reported using marijuana in the past 30 days was higher (1%) than NE at 0%. With 8 th graders, TRPH District tied NE, with 2% reporting marijuana use, well below the national average of 8%. When looking at 10 th graders, marijuana use was reported at 7% for TRPH District, 8% for NE, both which are less than half of the national average of 17%. For TRPH District 12 th graders, marijuana use was tied with NE at 12% but lower than the national average of 21%. There was no TRPH District data gathered on the other substances* for 6 th graders. For 8 th graders, the other substances came in at 5%, with the most use reported on inhalants (3%). When compared to NE, inhalant use is only 2% of respondents. For 10 th graders, other substance abuse totaled 13% with the most being inhalants (3%) and prescription drugs (3%) followed by non-prescription OTC drugs (2%) and LSD or other psychedelics (1%), steroids (1%), other performance-enhancing drugs (2%) and other illegal drugs (1%). The other substances category for 12 th graders totaled 17% for TRPH District. The breakdown of substances used in the last 30 days were: other performance-enhancing drugs (5%), prescription drugs (5%), other illegal drugs (3%), non-prescription OTC drugs (2%), LSD or other psychedelics (1%), inhalants (1%), and cocaine/crack (1%). * Other substances include: psychedelics, cocaine/crack, meth, inhalants, performanceenhancing drugs, prescription drugs (not prescribed for the user), non-prescription over the counter drugs, and other illegal drugs. Adults engaging in binge drinking during the past 30 days (CHA 2009) The total number of TRPH District adults (18+) who reported drinking five or more drinks on at least one occasion during the past 30 days for the region were 13.9% (n=998). When compared to NE, the TRPH District was lower (18.7%). When broken down by gender, both males and females were lower in the TRPH District (17.5% and 10.8%) than NE (25.2% and 12.5%). Broken down by age, TRPH District was lower in all categories than the NE. 21

22 Binge Drinking among Nebraska Adults by Age Region State 27.70% 27.80% 22% 16.10% 18.70% 23.40% 19.50% 16.90% 12.40% 12.50% 2.60% 3.20% (CHA 2009) Alcohol-related motor vehicle crashes ( CHA 2009) The total number of motor vehicle crashes for TRPH District was 2,525. A crash is defined as an accident in which a fatality, injury or property damage (exceeding an estimated $1,000 for a single vehicle) occurred. This number does not represent the number of people killed or injured in each crash. Of those crashes, the total number of crashes that involved alcohol totaled 134 (5.3%). NE has a total of 102,491 crashes where 5,348 involved alcohol (5.2%). Prevalence of alcohol impaired driving (CHA 2009) The total number of adults (18+) who reported driving after having had perhaps too much to drink during the past 30 days for TRPH District were 6.0% (n=243). When compared to NE at 4.9%, the District was higher. When broken down by gender, males were higher in the District (11.5%). When compared to NE (7.2%) while females were lower for the TRPH District (0.6%) than NE (2.4%). When broken down by age, the District was higher in the (12.1% vs 6.6%), (8% vs 3.3%) and (6.3% vs 4.4%) year olds than NE. 22

23 Tobacco Tobacco use is the single most preventable cause of disease, disability, and death in the United States, yet more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. For every person who dies from tobacco use, another 20 suffer from at least one serious tobaccorelated illness. Healthy People 2020 Among current smokers, 51.2 percent reported trying to quit smoking at least once in the past 12 months. CHA Nebraska Two Rivers District Smokeless Tobacco Use for Males in as per the CHA As shown by this graph, the Two Rivers District smokeless tobacco use is at a higher rate than Nebraska as a whole Nebraska Two Rivers 23

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