Brown Nicollet Community Health Board Community Health Status Assessment Report

Transcription

1 Community Health Assessment Report Brown Nicollet Community Health Board Community Health Status Assessment Report Brown County Public Health Karen Moritz, Public Health Director 1117 Center Street New Ulm, MN * (507) Nicollet County Public Health Mary Hildebrandt, Public Health Director 501 South Minnesota Avenue St. Peter, MN *(507) Published September 2014

2 Community Health Assessment Report Table of Contents Community Health Status Assessment Report... 2 Introduction... 2 About Brown and Nicollet Counties... 3 People and Place... 4 Population by gender... 4 Population by Race... 6 Birth Rate... 7 Death Rate... 8 Dependency Ratios... 8 Students with Limited English Proficiency... 9 Opportunity for Health Total Per Capita Income Unemployment Rate Percent living in Poverty High School Graduation Rates Free and Reduce Lunch Eligibility First Trimester Prenatal Care Healthcare Access and Coverage Primary and Mental Health Providers Uninsured Population Elevated Blood Levels, CO Poisoning, & Age of Dwellings Radon Healthy Living Low Birth Weight Preterm Births Teen Birth Rate Infant Deaths Death Rate Overall crude and adjusted Smoking Alcohol Use Marijuana Use Physical Activity Nutrition Teen Sexual Activity Sexual Violence Childhood Immunization Rates Mental Health Chronic Diseases & Conditions Obesity Death from Chronic Conditions Leading Causes of Death Cancer Diabetes Infectious Disease STD HIV TB Injury and Violence Unintended Injury Motor Vehicle Injuries and Deaths Years of Potential Life Lost Cause of Death Purpose Report Source: References Appendix A

3 Community Health Status Assessment Report Introduction The health status of a community is a dynamic indicator of a community s social and economic prosperity, therefore it is imperative that a community strives to continually improve and uphold its health status. Brown County Public Health and Nicollet County Public Health are two separate agencies that deliver health programs and are joined as a community health board (CHB). Because each county provides health programs, knowledge regarding the health status of the community is essential when planning successful health programs. Additionally, efficacious health programming requires input from the community members, organizations within the community, and those who live in the community. An important component in improving the health status of any community is to complete a community health status assessment. A community health status assessment is a methodical collection and analysis of data gleaned from a variety of methods such as surveys and reports. The results of the community health status assessment can facilitate the creation of innovative and sustainable strategies to improve and preserve the health of the community The Brown Nicollet Community Health Board used the MAPP process to complete the Community Health Assessment and Planning Process. One of the Four MAPP assessments is the Community Health Status Assessment The Brown Nicollet Community Health Status Assessment was completed in several phases to be inclusive of all the community partners and stakeholders, and to get a complete picture of health in the Brown Nicollet Community. Both Brown and Nicollet County Public Health Departments participated with the hospital/clinic community health assessments in the summer/fall of Nicollet County Public Health participated in a Community Health Needs Assessment with River s Edge Hospital and Clinic that was completed November 6,

4 Brown County Public Health participated with the New Ulm Medical Center in New Ulm, MN, the assessment and identified top 3 health issues was completed in August of Brown County Public Health completed a more county wide community health assessment session that was held October 13, The data was also reviewed by the Brown County Advisory Committee which is made up of community members from around the county. Both Brown and Nicollet Public Health also partnered with Mayo Health Systems Southwest Region to conduct a regional Health Survey. The results of that survey were reviewed for inclusion in the Brown Nicollet Community Health Status Assessment. In each community health assessment session data that was collected and displayed on a power point and reviewed by the group in categories. The top health issues were identified by each group. The Community partners/stakeholders that participated in the community health assessment process are listed in Appendix A. About Brown and Nicollet Counties Brown County is located in the south central part of Minnesota, approximately 100 miles southwest of the Twin Cities. Brown County has a population of 25,893 with New Ulm as the largest city and county seat. The county is mostly agricultural, but also has many industrial and commercial businesses. Brown County was officially organized by the U.S. Territorial Legislature on February 18, 1856 and is named after territorial councilor Joseph Renshaw Brown. The earliest pioneers included Germans, Norwegians, English, Irish, Luxembourgers, and Danes. Brown County is very proud of its historic roots and you will find history celebrated wherever you go. Nicollet County, named in honor of Joseph N. Nicollet, a French explorer, lies in south central Minnesota and closely resembles an isosceles triangle with miles of Minnesota River front. Within the 280, total acres in the County, almost 245,000 acres are farmland with 24,000 acres of forest land and 12,000 acres of wetland. The County is composed of 5 cities and 13 townships. As of the 2010 census, the population was 32,727. Its county seat is St. Peter. Nicollet County is part of the Mankato-North Mankato Metropolitan Statistical Area. Brown and Nicollet Counties are a part of the South West/South Central (SW/SC) Region. The following counties make up the SW/SC Region: Big Stone, Blue Earth, Brown, Chippewa, Cottonwood, Faribault, Jackson, Kandiyohi, Lac Qui Parle, Le Sueur, Lincoln, Lyon, McLeod, Martin, Meeker, Murray, Nicollet, Nobles, Pipestone, Redwood, Renville, Rock, Sibley, Swift, Waseca, Watonwan, and Yellow Medicine. 3

5 Age Group Age Group People and Place Population by gender In 2011, individuals 65 years of age and older comprised a marginally higher percentage of the population in Brown/Nicollet CHB at 15.3% compared to the state of Minnesota at 13%. The percentage for those aged years is higher at 12.6% in Brown/Nicollet CHB when compared to the state of MN at 9.4%. The following figures depict the population when broken down by gender for the state, the counties separately and the CHB together. (Figures 1, 2, 3, and 4 below illustrate the population according to gender.) Population: male/female by age Source: U.S. Census Bureau, Figure 1. Brown Population by Age and Gender, & up Percent Figure 2. Nicollet Population by Age and Gender, & up Percent 4

6 Age Group Age Group Figure 3. Brown-Nicollet Population by Gender, & up Percent Figure 4. Minnesota Population by Gender, & up Percent 5

7 Population by Race The diversity of the population is broken down by race. Brown/Nicollet Counties are less diverse when compared to the state of MN. Together the CHB is predominantly White at 96.16%, specifically a Latino population of.99%, an Asian population of 1.13%, American Indian population 0.31%, and African American population of 1.41%. In comparison the state of MN comprises a total White population of 86.9%. Nicollet County has a more diverse population than Brown County with 5.48% non-white compared to Brown County at 1.76% (Table 1 below illustrates the percent of population by race individually.) Table 1 Population: By Race, 2011 Source: U.S. Census Bureau, Total White Black/ African American Amer. Indian/ Alaskan Native Asian/ Pacific Islander Two or More Races Hispanic/ Latino (any race) State of Minnesota 5,344,861 4,645, ,301 68, , , ,297 CHB - Brown, Nicollet 58,554 56, ,108 Brown County 25,734 25, Nicollet County 32,820 31, ,249 6

8 Birth Rate Natality is examined to analyze the ratio of the births to the size of the population: the birth rates. The State of MN reports a slightly higher birth rate than Brown- Nicollet at 13.4 per 1,000 population; with the Brown Nicollet CHB at a 11.9 birth rate. The birth rate for all entities has fluctuated throughout the reported years of 1992 to 2011 with a noted drop for Brown County during the reporting period and an increase for Nicollet County during the reporting period. The number of total births was higher in Nicollet County with 2,021 than Brown County with 1,142 from (Figure 5 below illustrates the birth rate fluctuations from Table 2 depicts the trend of total number births per entity.) Figure 5: Birth rate per 1,000 Population Minnesota Department of Health, Center for Health Statistics, Table 2: Number of Births Entity State of Minnesota Brown-Nicollet CHB Number of Births , , , ,497 3,304 3,176 3,455 3,463 Brown 1,601 1,412 1,485 1,442 Nicollet 1,703 1,764 1,970 2,021 Minnesota Department of Health, Center for Health Statistics, 7

9 Death Rate The total number of deaths for the years for the State of MN was 191,974, which was an increase of 4,461 deaths from the previous reported period for the years Brown and Nicollet Counties both reported a small increase of total deaths for the years with a total of 2,442 deaths for the CHB. (Table 3 below shows the number of deaths for each entity for the years ) Table 3: Number of Deaths Number of Deaths Entity State of Minnesota 182, , , ,974 Brown-Nicollet CHB 2,210 2,262 2,364 2,442 Brown 1,323 1,382 1,387 1,428 Nicollet ,014 Minnesota Department of Health, Center for Health Statistics, Dependency Ratios The dependency ratio of the population represents the ratio of those typically not in the work force. The Elderly Dependency Ratio for the CHB has remained fairly stable from ranging from 22.0 to 23.0, but is higher than the state of Minnesota ranging from 18.0 to Notably, Brown County has a substantially higher ratio ranging from 28.0 to 30.5 compared to Nicollet County which ranged from 17.4 to 18.4 over the same time period. Brown and Nicollet Counties have fairly similar child dependency ratios compared to each other but they are lower than the state of MN. (Figures 6 & 7 below provide specific numbers and trends for each entity for Elderly and Child Dependency Ratios for the current and past reporting periods.) Figure 6: Elderly (65+years) dependency ratio (per 100 population 15-64) US Census Poverty estimates and median household income: 8

10 Figure 7: Child (under 15 years) dependency ratio (per 100 population 15-64) US Census Poverty estimates and median household income: Students with Limited English Proficiency Brown/Nicollet CHB has a notably lower percent of prekindergarten-12 th Grade students with limited English proficiency than Minnesota at an average of 2.9% for the 4 school years from compared to Minnesota at 7.65%. Nicollet County s higher percentage correlates with a higher nonwhite population. (Figure 8 below depicts the percent of prekindergarten-12 th grade students with limited English proficiency) Figure 8: Percent of Prekindergarten 12 th Grade Students with Limited English Proficiency Minnesota Department of Education - 9

11 Opportunity for Health Total Per Capita Income Each entity reported an increase in total per capita income from 2007 to 2008, 2009 to 2010 and from 2010 to 2011; each entity reported a decrease from 2008 to In 2011 the state of MN averaged 44,560 dollars per person annually and the CHB reported 38,883 dollars per person annually. Thus, Brown/Nicollet County residents are earning less money than the residents of the State of MN. (Figure 9 below illustrates the trend of per capita income from for each entity individually.) Figure 9: Total per Capita Income US Department of Commerce, Bureau of Economic Analysis, Unemployment Rate The unemployed rate (annual average) from for the CHB was 5.62%, with the highest percent in 2009 at 7% of the population. When compared to the state of MN the CHB remains at a lower average; the annual average from for MN was 6.4%. The average for Brown and Nicollet County individually was 6.26% and 5.14% respectively. (Figure 10 below illustrates the individual annual unemployment rates from by entity.) 10

12 Figure 10: Unemployed Rate: Annual Average Minnesota Department of Employment and Economic Development, Percent living in Poverty The percentage of those living in poverty for the CHB has increased each year since 2007 with the exception of 2010; the percent decreased 1% from from 10.28% to 9.2% respectively. The average percent of all ages living in poverty in Brown/Nicollet counties combined was 9.5% from , which is lower than the state of MN at an average of 10.7%. (Figure 11 below depicts the percent of all ages living in poverty from by each individual entity. Figure 12 illustrates percent of all people living at or below the 200% poverty level.) Figure 11: Percent of all Ages Living in Poverty US Census Poverty estimates and median household income: 11

13 Figure 12: Percent of all People of all Ages living at or below 200% Poverty Level US Census Poverty estimates and median household income: High School Graduation Rates Overall, Brown and Nicollet Counties boast a higher graduation rate when compared to the State of MN for the years In , Brown County reports a graduation rate of 85.5 per 100 and Nicollet County 86.6 per 100 compared to the state of Minnesota at 77.6 per 100. (Figure 13 below depicts the four year high school graduation rate per 100 people for each entity for the years The Four Year Graduation Rate is a four-year, on-time graduation rate based on a cohort of first time ninth grade students plus transfers into the cohort within the four year period minus transfers out of the cohort within the four year period.) Figure 13: Four Year High School Graduation Rate Minnesota Department of Education

14 The percent of population aged 25 years and older with less than or equal to high school education or equivalent (e.g. GED) is higher for the Brown/Nicollet CHB at 42.3% than the state of Minnesota at 35.9%. Specifically Brown County is substantially higher than the state at 51% with Nicollet County below the state at 34.5%. (Figure 14 below depicts the percent of population aged 25 years and older with less than or equal to High School Education or Equivalent (e.g. GED) ) Figure 14: Percent of Population Aged 25 years and older with less than or equal to High School Education or Equivalent (e.g. GED) American Community Survey (ACS), US Census Series 1501 Free and Reduce Lunch Eligibility In , the percent of students eligible for free and reduced lunch for the CHB was slightly higher at 37.4% than the state of Minnesota at 37.2%. Nicollet County specifically was at 39.3% which is 2 percentage points higher than the state for that year. (Figure 15 below depicts the percent of those eligible for free or reduced meals for preschool through 12 th grade.) Figure 15: Percent of students eligible for free or reduced meals for preschool through 12 th grade Minnesota Department of Education: 13

15 First Trimester Prenatal Care There has been a steady increase in women seeking 1 st trimester prenatal care (within the first 3 months of pregnancy) for the years with the exception of a slight drop of 0.2% in Brown County between the and the reporting periods. Together as a CHB Brown-Nicollet have a higher % of women seeking 1 st trimester prenatal care than the State of MN by 4.3% (Figure 16 below displays percent of births in which prenatal care was initiated in the first trimester for each entity.) Figure 16: Prenatal Care in the First Trimester Minnesota Department of Health, Center for Health Statistics, Healthcare Access and Coverage Primary and Mental Health Providers Neither Brown nor Nicollet County have been designated as a Geographic Health Professional Shortage Area for Primary Care Providers. Both counties averaged 16 or more physicians per 10,000 population in (Map below) 14

16 Noteworthy: in 2012, both Brown and Nicollet Counties were designated as a Mental Health Professional Shortage Areas. (Table 4 below shows the designation for Brown and Nicollet County in February 2012.) Table 4: Mental Health Professional Shortage Area Mental Health Professional Shortage Area County 2012 Brown Designated 2/2012 Nicollet Designated 2/2012 Source: Minnesota Department of Health Office of Rural Health, Jan HPSA designations 1_2013.mxd Uninsured Population The Brown County percentages of the population without health insurance from 2008 to 2010 have been quite stable with 8.9%, 9.1% and 9.0% respectively. Nicollet County reported more fluctuation with 7.61% in 2008, 9.5% in 2009 and 8.3% in The State of MN reports are also quite stable at 9.5%, 9% and 9.2% of the population without health insurance in each respective year. (Figure 17 below depicts the trends over the past three years for each entity.) Figure 17 Figure 20: Percent of Population Currently Uninsured MN Public Health Data Access, 15

17 Elevated Blood Levels, CO Poisoning, & Age of Dwellings The percent of children with elevated blood lead levels has remained lower than the State of MN for Nicollet County for the reporting years Brown County shows a higher % of elevated blood levels than the State of MN or Nicollet County in Brown County showed a 1.53% of the birth cohort showing elevated blood lead levels compared to the state at.40% and Nicollet County at 0% in that year. In 2009 Brown County again showed a remarkable higher % at 1.08% compared to the state at.32% and Nicollet County at.28%. An elevated blood lead level is considered 10 μg/dl. Notably Brown County has nearly 20% more dwellings built prior to 1970 than Nicollet County which is shown to be an indicator of high lead levels. (Figure 18 below portrays specific information for each entity for years ; Table 5 depicts the percent of homes built before 1970; Table 6 depicts the trends for Carbon Monoxide.) Figure 18: Percent of Birth Cohort tested with Elevated Blood Lead Levels MN Public Health Data Access, A cohort is defined as a group of persons who share a common characteristic. For this data it is specific to all infants born to Minnesota residents for the years who had their blood lead tested elevated ( 10 μg/dl). Table 5: Percent of Dwellings Built Before 1970 Percent of Dwellings Built Before 1970 Brown 61.4 US Census ACS B25034 Nicollet

18 Table 6: Carbon Monoxide Poisoning (hospitalizations age adjusted rates per 100,000) Carbon Monoxide Poisoning (hospitalizations and ED visits age adjusted rates per 100,000) Hospitalizations ED Visits State of Minnesota Brown-Nicollet CHB Brown * 33.7 Nicollet * * MN Public Health Data Access, Radon Radon is a naturally occurring radioactive gas that is the second leading cause of lung cancer in the United States. In 2012, the radon levels for each entity were classified as high. Carbon Monoxide is also a gas that is harmful to the population s health. In Nicollet County reported zero incidents of Carbon Monoxide Poisoning while Brown County reported at rate of 33.7 ED visit rate for carbon monoxide poisoning compared to the State of MN at 7.6. (Table 7 below portrays radon levels by zone.) Table 7: Radon Levels by Zone (low, moderate, high). Entity Brown-Nicollet CHB Brown Nicollet MN Public Health Data Access, Radon Levels by Zone (low, moderate, high) Year 2012 High High High 17

19 Healthy Living Low Birth Weight While the State of MN low birth weight % remained the same from the Brown Nicollet CHB % decreased 0.6 percentage points with Brown County experiencing the largest decrease of 0.9 percentage points. Brown & Nicollet CHB low birth weight % is lower than the State of MN at 4.8% compared to 3.8% respectively. (Table 8 under the Natality subsection depicts the percent of low birth weight singleton births for each entity individually for the years ) Table 8: Percent births born low birth weight (less than 2,500 grams) singletons births Minnesota Department of Health, Center for Health Statistics, State of Minnesota 13,574 14,290 16,325 16,394 Brown and Nicollet BROWN NICOLLET Preterm Births The percent of infants born premature (less than 37 weeks gestation) for all entities increased in from compared to the reporting period. Specifically Brown County has a higher percentage of premature births than the State of MN and Nicollet County. For period Brown was at 8.3% compared to MN at 8.0 % and Nicollet at 6.9 %. A similar difference is noted from All entities rates decreased from (Figure 19 below depicts the percent of preterm births for each entity for the years ) 18

20 Figure 19: Percent Preterm Births Minnesota Department of Health, Center for Health Statistics, Teen Birth Rate The Teen birth rate has steadily shown a decline since 1992 in the State of MN and Brown and Nicollet Counties. Nicollet County noted a 1.17 increase in the period of but then experienced a 2.2 rate decrease between the and the reporting periods. Overall Brown and Nicollet CHB have a notably lower Teen Birth rate from In the Brown-Nicollet CHB had a rate of 15.8 compared to 24.3 for the state of MN. Figure 20: Teen Birth Rate Minnesota Department of Health, Center for Health Statistics, 19

21 Infant Deaths The Brown Nicollet CHB had 18 infant deaths from with 14 of them in Nicollet County when they only had 6 in the prior reporting period of Brown County has had a steady decrease in infants deaths since 1991(Table 9 below displays infant deaths for each entity from ) Table 9: Number of Infant Deaths State of Minnesota Brown and Nicollet BROWN NICOLLET Minnesota Department of Health, Center for Health Statistics, linked birth/death cohort Death Rate Overall crude and adjusted The age adjusted death rate reveals that the trend for Brown and Nicollet Counties mirrors Minnesota s downward trend from 1992 through Minnesota s age adjusted death rate for females was per 100,000 females for the years compared to for Brown County and for Nicollet County. The age adjusted male death rate is higher than the female rate for all entities. Minnesota s age adjusted death rate for males was per 100,000 males for the years compared to for Brown County and for Nicollet County. (Table 10 below depicts the trends for each entity for females and males specifically.) Table 10: Death Rate Overall; crude and age adjusted rated and top 15 causes Age Adjusted Death Rate per 100,000 Females Entity Females Females Females Females State of Minnesota Brown-Nicollet CHB Brown Nicollet Minnesota Department of Health, Center for Health Statistics, 20

22 Age Adjusted Death Rate per 100,000 Males Entity Males Males Males Males State of Minnesota Brown-Nicollet CHB Brown Nicollet Minnesota Department of Health, Center for Health Statistics, Smoking In 2010, 15.5% of adults in Brown County were current smokers and 10% of the 9 th graders reported they smoked within the last 30 days. In 2010, 14.1% of the adults in Nicollet County were current smokers and 11% of the 9 th graders reported they smoked within the last 30 days. Overall, the State of MN reports that 9% of 9 th graders have smoked in the last 30 days, thus Brown County and Nicollet County have a higher percent than the state as a whole. However, Nicollet County, the CHB, and State of MN have seen a continuing decline in the percent of 9 th graders who have smoked in the last 30 days; specifically a 7 percentage point decline for Nicollet County and a 3 percentage point decline for the CHB. Brown County reported a remarkable 5 percentage point increase from the last reporting period in 2007 but saw a continuous decline previous to that. (Figures 21 and 22 below depict the specific results for adults and trends for 9 th graders. Table 13 depicts exposure to second hand smoke.) Figure 21: Smoking: Percent of Adults who are Current Smokers Wilder Research, 2010 Southwest/South Central Adult Health Survey 21

23 Figure 22: Percent of 9 th graders who Smoked Cigarettes in the last 30 days Minnesota Student Survey Selected Single Year Results by State, County and CHB, Table 11: Exposure to Second Hand Smoke in the Last 7 Days Exposure to Second Hand Smoke in the Last 7 Days Entity Home Car Other Brown Nicollet Wilder Research, 2010 Southwest/South Central Adult Health Survey 22

24 Alcohol Use Binge drinking is defined as a pattern of drinking that brings a person s blood alcohol concentration to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks, and women consume 4 or more drinks, in about 2 hours. (Centers for Disease Control and Prevention [CDC], para 1, 2012). In 2010, 13% of 9 th graders in Brown County engaged in binge drinking in the past 2 weeks and 15% of Nicollet County 9 th graders did. The State of MN reported an average of 10% of 9 th graders who engaged in binge drinking. Over all the reported binge drinking among 9 th graders has decreased for all entities from (Figure 23 below depicts the specific trends for the 9 th graders from and Figure 24 depicts the percent of 9 th graders who have used alcohol one or more times in the last 12 months.) Figure 23: Alcohol Use Amongst 9 th graders - Percent of 9th graders who engaged in binge drinking in the last two weeks Minnesota Student Survey Selected Single Year Results by State, County and CHB, Figure 24: Percent of 9 th Graders Who Have Used Alcohol One or More Times in the Last 12 Months Minnesota Student Survey Selected Single Year Results by State, County and CHB,

25 Marijuana Use In % of 9th graders reported using marijuana one or more times in the last 12 months in Brown County with Nicollet County reporting 6%. The Brown Nicollet CHB reported 8% of marijuana use vs the State of MN at 10%. (Figure 25 below depicts the percent of 9 th graders that used marijuana one or more times in the last 12 months.) Figure 25: % 9th graders who used marijuana one or more times in the last 12 months Minnesota Student Survey Selected Single Year Results by State, County and CHB, Physical Activity In 2010, 46.7% of adults and 53% of 9 th graders in Brown County reported they were physically active for at least 30 minutes five out of seven days. In 2010, 47.3% of adults and 61% of 9 th graders in Nicollet County reported they were physically active for at least 30 minutes five out of seven days. The Brown- Nicollet CHB at 57% was slightly above the State of MN average of 56 % for 9 th graders being physically active. Both Brown and Nicollet Counties show a decrease in physical activity among 9 th graders from 2007 to (Figure 26 below depicts the specific results for adults and Figure 27 depicts trends for 9 th graders.) Figure 26: Percent of Adults Who Reported 30 plus Minutes of Moderate Physical Activity on Five or More Days per Week Wilder Research: 2010 Southwest/South Central Adult Health Survey 24

26 Figure 27: Percent of 9 th Graders Who Reported 30 plus Minutes of Moderate Physical Activity on Five or More Days per Week Minnesota Student Survey Selected Single Year Results by State, County and CHB, Nutrition In 2010, 31.5% of the adults and 20% of the 9 th graders in Brown County reported they consumed five or more servings of fruit and vegetables the day before the survey. In 2010, 38.1 % of the adults and 16% of the 9 th graders in Nicollet County reported they consumed five or more servings of fruit and vegetables the day before the survey. Brown and Nicollet Counties are at the state average of 18% of 9 th graders who consumed five or more servings of fruits and vegetables the day before the survey. More adults consumed five or more servings of fruits and vegetables in Nicollet County in 2010 but conversely more 9 th graders in Brown County consumed fruits and vegetables at 20% vs. Nicollet County at 16% (Figure 28 below depicts the specific results for adults. Figure 29 depicts trends for 9 th graders.) Figure 28: Percent of Adults Who Consumed Five or More Servings of Fruit and Vegetables Yesterday Wilder Research: 2010 Southwest/South Central Adult Health Survey 25

27 Figure 29: Percent of 9 th Graders Who Ate Five or More servings of Fruit and Vegetables Yesterday Minnesota Student Survey Selected Single Year Results by State, County and CHB, Teen Sexual Activity In % of 9 th graders in the Brown Nicollet CHB and 57% of 12 graders reported ever having sexual intercourse. While the reported sexual activity among 9 th graders in the Brown-Nicollet CHB is 1% lower than the State of MN the % of 12 th graders reporting ever having sexual intercourse is 6% higher for Brown- Nicollet CHB than the State of MN. There was a remarkable increase in the same measure in Brown County among 9 th graders from 2007 at 9% compared to 21 % in Nicollet County showed a remarkable decrease in 9 th graders ever having sexual intercourse from 34% in 2007 to 16 % in 2010 but reported a remarkable increase in 12 graders from 45% to 55% for those same reporting periods. (Figure 30 below depicts the Percent of 9th graders who have ever had sexual intercourse.) Figure 30: Percent of 9 th and 12 th Graders Who Have Ever Had Sexual Intercourse Minnesota Student Survey Selected Single Year Results by State, County and CHB,

28 In 2010, while 68% of the sexually active 9 th graders for Brown Nicollet CHB report using condoms only 51 % of the 12 th graders report the same. Notably in Brown County the sexually active 9 th graders reporting using a condom decreased from 2007 to 2010 from 89% to 61% but the Nicollet County 9 th graders reporting using a condom increased from 2007 to 2010 from 60% - 84%. The use of condoms in the Brown- Nicollet CHB for 9 th and 12 th graders was greater than the State of MN in (Figure 31 below depicts the percent among sexually active students, percent reporting always using a condom.) Figure 31: Among Sexually Active Students, Percent Reporting Always Using a Condom Minnesota Student Survey Selected Single Year Results by State, County and CHB, Sexual Violence Brown County reported an increase in the percent of 9 th graders who reported that someone they were going out with had ever hit, hurt, threatened or forced them to have sex. Brown County reported an increase of 6 percentage points from 2007 to 2010 and the CHB had a 1 percentage point decrease attributable to Nicollet County reporting a 6 percentage point decrease from 2007 to 2010 and the State of MN remained at 10% for both reporting periods. (Figure 32 below portrays specific numbers for each entity.) Figure 32: Percent of 9 th Graders who report they were threatened (hit, hurt, or forced to have sex) 15 9th Graders Experiencing Sexual Violence State of Minnesota Brown and Nicollet BROWN NICOLLET Minnesota Student Survey Selected Single Year Results by State, County and CHB,

29 In 2011, Brown County reported a rate of 30.3/1,000 population for children who have experienced maltreatment. Nicollet County reported 12.8/1,000 and the State of MN reported 17.7/1,000 population. The Brown Nicollet rate was 2.7 higher than the State of MN (Table 12 below portrays specific details for each entity regarding family assessment; investigation alleged and determined rate/1,000.) Table 12: Rate of Child Maltreatment per 1,000 Children Aged 0-17, 2011 Rate of Child Maltreatment per 1,000 children aged 0-17, 2011 Entity Child Pop. Age 0-17 Total Rate per 1,000 Family Assessment Rate per 1,000 Investigation - Alleged Rate per 1,000 Investigation Determined Rate per 1,000 State of Minnesota 1,277, Brown-Nicollet CHB 12, Brown 5, Nicollet 7, Minnesota Department of Human Services Children and Family Services 2011 Minnesota s Child Welfare Report Childhood Immunization Rates In 2011, Brown County reported that 77.0% of children aged months were up to date with their immunizations and Nicollet County reported that 77.1% of their children aged months were up to date. Both counties reported notably higher percentages than the State of MN, who reported that 55.7% of the total population aged months, were up to date. (Table 13 below shows the number percentages of each entity for 2011.) Table 13: Percent of Children age Months Up to Date with Immunizations (vaccine series) Percent of Children age Months Up to Date with Immunizations Entity 2011 State of Minnesota 55.7 Brown 77.0 Nicollet 77.1 Minnesota Immunization Information Connection (MIIC), MDH 28

30 Mental Health In 2010, the percent of 9 th graders who had suicidal thoughts increased from 20% in 2007 to 24% for Brown County; Nicollet County reduced from 26% in 2007 to 13% in Together the CHB had a total of 19% for The State of MN also stayed the same from 2007 to 2010 at 17% total 9 th graders. Similarly, the percent of 9 th graders who reported they tried to kill themselves in the last year increased for Brown County from 3% in 2007 to 6% in Nicollet dropped 2 percentage points from the last reporting period, from 5% to 3% respectively; together the CHB increased 1 percentage point from 4% to 5%. The State of MN decreased 1 percentage point from 4% in 2007 to 3% in (Figures below depict the specific trends for each entity from ) Figure 33: Percent of 9 th Graders who had suicidal thoughts in the last year Minnesota Student Survey Selected Single Year Results by State, County and CHB, Figure 34: Percent of 9 th Graders who have felt nervous, worried or upset all or most of the time during the last 30 days Minnesota Student Survey Selected Single Year Results by State, County and CHB,

31 Figure 35: Percent of 9 th Graders who tried to kill themselves in the last year Minnesota Student Survey Selected Single Year Results by State, County and CHB, Chronic Diseases & Conditions Obesity In 2010, 38.9% of the adults in Brown County were considered overweight according to BMI [body mass index] and 39.8% were overweight in Nicollet County. In 2010, 14% of the 9 th graders were considered overweight for Brown County and 11% for Nicollet County with the Brown Nicollet CHB at 12% slightly under the State of MN at 13%. Obesity among adults in 2010 was 28.4% in Brown County and 24.9% in Nicollet County. (Figures 36, 37, 38 and 39 show specific data regarding the percent of those overweight and those who are obese for each entity.) Figure 36: Percent of Adults Who Are Overweight According to BMI Wilder Research: 2010 Southwest/South Central Adult Health Survey 30

32 Figure 37: Percent of 9 th Graders Who Are Overweight But Not Obese According to BMI Minnesota Student Survey Selected Single Year Results by State, County and CHB, Figure 38: Percent of Adults Who Are Obese According to BMI Wilder Research: 2010 Southwest/South Central Adult Health Survey Figure 39: Percent of 9 th Graders Who Are Obese According to BMI Minnesota Student Survey Selected Single Year Results by State, County and CHB,

33 Death from Chronic Conditions Cancer had the highest number of deaths for all entities; 47, 249 for the State of MN, 566 for the CHB, 326 for Brown County, and 240 for Nicollet County. The number of deaths from heart disease followed a similar pattern with the State of MN of 35,467, the CHB 499, Brown County 302, and Nicollet County 197 for the years Stroke had the lowest number of deaths for all entities. (Table 14 below depicts the number of deaths for each entity from the years for cancer, heart disease, and stroke.) Table 14: Chronic Conditions Mortality (Number of deaths) For cancer State of Minnesota 43,001 44,505 45,364 47,249 Brown-Nicollet Brown CHB Nicollet For heart disease State of Minnesota 51,358 45,945 40,060 35,467 Brown-Nicollet Brown CHB Nicollet For stroke State of Minnesota 14,889 14,294 12,374 10,409 Brown-Nicollet Brown CHB Nicollet Minnesota Department of Health, Center for Health Statistics, Leading Causes of Death The number one cause of death for all entities for the years was cancer with heart disease as the second leading cause of death. Brown County reported a total of deaths per 100,000 population for cancer deaths and for heart disease. Similarly, Nicollet County had deaths per 100,000 population from cancer and for heart disease. Together the CHB averaged and deaths per 100,000 population for cancer and heart disease respectively. The State of MN averaged deaths from cancer and deaths from heart disease for the same reporting period. It is notable that the rates of death for the CHB are lower than the state rate for cancer, but higher for heart disease. (Table 15 below depicts the leading causes of death-age adjusted rates per 100,000 for cancer, heart disease, and stroke for each entity. Furthermore Figures 40 and 41 illustrate the cancer incidence of all types combined and the prevalence of the chronic disease Diabetes among adults over the age of 20 years in 2009.) 32

34 Table 15: Leading Causes of Death For stroke State of Minnesota Brown-Nicollet CHB Brown Nicollet For cancer State of Minnesota Brown-Nicollet CHB Brown Nicollet For heart disease State of Minnesota Brown-Nicollet CHB Brown Nicollet Minnesota Department of Health, Center for Health Statistics, Cancer Figure 40: Cancer Incidence (all types combined, age adjusted per 100,000) Minnesota Department of Health, Public Health Data Access Network (extracted from Minnesota Cancer Surveillance System (MCSS), Minnesota Department of Health) 33

35 Diabetes Figure 41: Percent of Diabetes Prevalence among Adults Over 20 Years of Age; 2009 CDC Behavioral Risk Factor Surveillance System via Diabetes Interactive Atlas Infectious Disease STD In 2011, Chlamydia continues to be the highest reported sexually transmitted disease for all entities; Brown and Nicollet Counties reported 45 cases and 28 cases respectively. The State of MN reported 16,898 cases for the year Unlike the State of MN, the CHB did not report any cases of Syphilis and a marginal number of Gonorrhea cases. (Table 16 below depicts the reported numbers for 2011 for STD and Table 17 portrays number of HIV.) Table 16: STD Numbers for 2011 STD Numbers for 2011 Entity Chlamydia Gonorrhea Primary/Secondary Syphilis Syphilis - All Stages State of Minnesota 16,898 2, Brown-Nicollet CHB Brown Nicollet Minnesota Department of Health, STD & HIV Surveillance Systems 34

36 HIV Table 17: HIV Numbers for 2011 HIV Numbers for 2011 State of Minnesota 292 Brown-Nicollet CHB 3 Brown 2 Nicollet 1 Minnesota Department of Health, STD & HIV Surveillance Systems TB Brown County and Nicollet County did not have any TB cases for the reporting period, unlike the State of MN who had 137 cases in (Table 18 below shows the number of TB cases.) Table 18: Number of TB Cases in 2011 Number of Tuberculosis cases for 2011 Entity Tuberculosis cases in 2011 State of Minnesota 137 Brown-Nicollet CHB 0 Brown 0 Nicollet 0 Minnesota Department of Health, Acute Disease Epidemiology Injury and Violence Unintended Injury The age adjusted unintentional injury death rate has declined for all entities except the State of MN over the reporting periods. In , Nicollet County had the lowest rate at 19.1 then the CHB at 23.5, with Brown following at 29.0 and the State of MN the highest at 36.9 per 100,000 population. Each entity except the State of MN experienced a decline of at least 1.7 from the previous reporting period. (Figure 42 under the Unintentional Injury subsection portrays the specific rates for each entity from ) 35

37 Figure 42: Unintentional Injury Death- Age Adjusted rate per 100,000 Minnesota Department of Health, Center for Health Statistics, Motor Vehicle Injuries and Deaths In 2010, Brown County had 2 people killed in automobile crashes with 1 (50%) of motor vehicle fatalities related to alcohol. Nicollet County had 3 persons killed in crashes with 1 (33.3%) of crash fatalities related to alcohol. Brown County had 149 motor vehicle related injuries with 15 (10.1%) of the injuries related to alcohol. Nicollet County had 148 motor vehicle related injuries with 7 (4.7%) injuries related to alcohol in that same year of reporting. (Table 19 under the Unintentional Injury subsection depicts the percent of injuries and deaths related to alcohol.) Table 19: Percent of Motor Vehicle Injuries and Deaths that are related to Alcohol Fatalities Injuries State of Minnesota Brown County Nicollet County Minnesota Department of Public Safety Years of Potential Life Lost The years of potential life lost (YPLL) is viewed as an estimated average time a person would have lived had he or she not died prematurely, or a measure of premature mortality (Gardner and Sanborn, 1990). In 2010, unintentional injury, heart disease, and cancer assumed the largest amount of years of potential life lost for Brown County for the reference age of 65 with 135, 110 and 75 years lost respectively. For the reference age of 75, the order reversed for Brown County. 262 YPLL for cancer, for heart disease and for unintentional injury.. In 2010, the other category, congenital anomalies, and cancer assumed the largest amount of YPLL for Nicollet County for the reference age of 65 with 227.5, 200, and 165 years lost respectively. For the reference age of 75, the categories remained the same, however, cancer was responsible for the highest amount of YPLL at The high rates of YPLL for other and 36

38 congenital anomalies would correlate with death at a very young age. (Tables 20 and 21 below illustrate the specific leading causes of death for Brown and Nicollet County. Tables 24 and 25 provide specific numbers to 23 causes of years of potential life lost and totals for both Brown and Nicollet County separately.) Table 20: Brown County Mortality Table: Minnesota s 15 Leading Causes of Death 2011 All Ages Cause Rank Number Alzheimer's Disease 8 8 Cancer 2 53 Cirrhosis 11 5 Chronic lower respiratory dis Diabetes 6 11 Heart Disease 1 61 Hypertension 15 0 Nephritis 6 11 Parkinson s 12 3 Pneumonia and Influenza 10 6 Pneumonitis due to solids/liquids 14 1 Septicemia 9 7 Stroke 3 20 Suicide 13 2 Unintentional Injury 5 16 Source: Minnesota Department of Health, Center for Health Statistics Table 21: Nicollet County Mortality Table: Minnesota s 15 Leading Causes of Death 2011 All Ages Cause Rank Number Alzheimer's Disease 15 0 Cancer 1 38 Cirrhosis 8 4 Chronic lower respiratory dis Diabetes 5 8 Heart Disease 1 38 Hypertension 14 1 Nephritis 7 6 Parkinson s 8 4 Pneumonia and Influenza 12 2 Pneumonitis due to solids/liquids 10 3 Septicemia 12 2 Stroke 3 17 Suicide 10 3 Unintentional Injury 5 8 Source: Minnesota Department of Health, Center for Health Statistics For more data on deaths in Minnesota go the Minnesota Vital Statistics Interactive Queries Website: 37

39 Table 22: Years of Potential Life Lost Brown County to Age 65 and 75, 2010 Brown County Years of Potential Life Lost Cause YPLL 65 YPLL 75 AIDS/HIV Alzheimer s Disease Atherosclerosis Cancer Cirrhosis Congenital Anomalies Chronic Lower Respiratory Disease Diabetes Heart Disease Homicide Hypertension Nephritis Perinatal Conditions Pneumonia and Influenza Septicemia SIDS Stroke Suicide Unintentional Injury Other Total ,111.5 Minnesota Department of Health, Center for Health Statistics 38

40 Table 23: Years of Potential Life Lost Nicollet County to Age 65 and 75, 2010 Nicollet County Years of Potential Life Lost Cause YPLL 65 YPLL 75 AIDS/HIV Alzheimer s Disease Atherosclerosis Cancer Cirrhosis Congenital Anomalies Chronic Lower Respiratory Disease Diabetes Heart Disease Homicide Hypertension Nephritis Perinatal Conditions Pneumonia and Influenza Septicemia SIDS Stroke Suicide Unintentional Injury Other Total ,476.5 Minnesota Department of Health, Center for Health Statistics 39

41 Cause of Death The number of deaths related to fatal unintentional injuries, homicides, suicides, fatal falls, and motor vehicle and pedestrian injuries differed amongst each entity. The highest number of deaths for Brown County was motor vehicle accidents and in Nicollet County it was attributed to suicide. In 2010 Suicide was the leading cause of death for the Brown-Nicollet CHB at 6 compared to the second leading cause of death among unintentional deaths which was 4 motor vehicle accidents. (Table 24 below shows specific data for each entity for the reporting year 2010.) Table 24: Number of Fatal Unintentional Injuries, Homicides, Suicides, Fatal Falls, Motor Vehicle and Pedestrian Injuries, 2010 Entity Number of Fatal Unintentional Injuries, Homicides, Suicides, Fatal Falls, Motor Vehicle and Pedestrian Injuries All Ages Unintentional Injury 2010 Homicide Suicide Fatal Falls Motor Vehicle Pedestrian State of Minnesota 2, Brown Nicollet Brown Nicollet Source: Minnesota Department of Health Center for Health Statistics Purpose The information in this report is an important step to a healthier Brown and Nicollet County. This assessment report serves as a foundation to further enhance both communities health and to enhance the public health services provided in each county together and separately. It is the hope that by identifying this kind of information the agencies are able to offer, create, and promote sustainable interventions to meet the public health needs of the community. Report Source: The data for the CHA (Community Health Assessment) was collected by MDH (Minnesota Department of Health) South Central District Epidemiologist, Brad Krier, with assistance from an intern. Brown County Public Health Director, Karen Moritz, PHN & Nicollet County Public Health Director, Mary Hildebrandt, PHN used the raw data to compile the tables, graphs and narrative analysis. Brown County Public Health Account Technician, Marylu Anderson created the tables and graphs, edited, and polished the document. Technical support was provided by MDH Center for Health Statistics: Senior Research Scientist, Ann Kinney, PhD and Epidemiologist, Kim Edelman, MPH. Specific data sources are referenced and noted throughout. The following reference page provides specifics related to information gleaned from other sources for supporting data. 40