2016 Three Rivers Public Health Department Community Health Needs Assessment

Transcription

1 2016 Public Health Department Community Health Needs Assessment Report prepared by Schmeeckle Research in conjunction with the Public Health Department

2 Table of Contents Overview of the Community Health Needs Assessment... 1 Community Health and the Local Public Health System... 2 Description of Data Sources... 3 Demographics... 4 Veterans... 7 Poverty... 9 Single Parent Families Minority Populations Health Disparities Access to Health Services Mental Health Bullying Youth Substance Abuse Adult Alcohol and Tobacco Use Alcohol-Impaired Driving Motor Vehicle Safety Unintentional Injury Crime Foster Care and Child Abuse/Neglect Education Physical Activity Nutrition Obesity Health Screening General Health Metrics Cancer Heart Disease Stroke High Blood Pressure and Cholesterol Diabetes Respiratory and Pulmonary Illnesses Child and Adolescent Mortality Maternal and Infant Health Teen Pregnancy Sexually Transmitted Disease Alzheimer s Disease Arthritis Oral Health Kidney Disease Flu and Pneumonia Vaccination Child Immunization Environmental Health Conclusion: Community Health Needs References... 87

3 Overview of the Community Health Needs Assessment Under the direction of the Public Health Department, the 2015 Community Health Needs Assessment has been created for the three counties in the Health District (Dodge, Saunders, and Washington Counties in ). This assessment will be the basis for the Community Health Improvement Plan (CHIP). This assessment will also serve as a reference document for the non-profit hospitals in the district to assist in strategic planning. It is the purpose of this assessment to inform all interested parties about the health status of the population within the district and to provide community partners with a wide array of data that can be used to educate and mobilize the community and its resources to improve the health of the population. The Community Health Needs Assessment process is collaborative and is intended to serve as a single data report for multiple coalitions, organizations, and hospitals in the three county region unified by the Public Health Department. It is the goal of the Community Health Needs Assessment to describe the health status of the population and identify areas for health improvement, with the hope that the data from this report will be used to target strategic initiatives focused on the areas of highest public health need in the District. This assessment will be updated and revised every three years, thus providing communities with up to date data to evaluate progress made towards identified health priorities, and for the selection of new ones. This report contains a broad array of demographic and public health data (see a description of the main sources of data in the Description of Data Sources section (page 3). Additional reports have been created for each county in which the county-level data indicative of need are highlighted. Schmeeckle Research of Lincoln, NE assembled this assessment of public health and community well-being under the direction of the District Health Department. 1

4 Community Health and the Local Public Health System Community health includes a broad array of issues addressed by numerous agencies. Topics that fall under community health include such things as access to health care, child welfare, crime, alcohol and tobacco use, drug use, poverty, obesity, diabetes, teen pregnancy, teen sexual activity, healthy children, environmental factors affecting health, cancer, heart disease, and a broad array of other epidemiological topics. Addressing needs of community health goes far beyond the work of hospitals and the public health department. A broad network of agencies must work in collaboration to meet the diverse health needs of the community. An example of the local public health system network is shown in Figure 1 below, in which over 20 agencies collaborate in various ways in order to form a multi-connected network of public, private, faith based, non-profit, and for-profit agencies that effectively addresses the health needs of the community. Figure 1: The Local Public Health System (an example) (Source: Rural Health Association) 2

5 Description of Data Sources A broad array of sources provide data for this report. Following is a summary of the most frequently cited sources (Figure 2). Note that statistical significance is only indicated on Behavioral Rick Factor Surveillance System (BRFSS) data. None of the other data sources provided indication of statistical significance. Figure 2 Frequently Cited Data Sources Data Source Behavioral Risk Factor Surveillance System (BRFSS) Health Rankings Crime Commission Department of Education Department of Health and Human Services (DHHS) Risk and Protective Factor Student Survey (NRPFSS) U.S. Census/American Community Survey Description - A comprehensive, annual health survey of adults ages 18 and over on risk factors such as alcohol use, tobacco use, obesity, physical activity, health screening, economic stresses, access to health care, mental health, physical health, cancer, diabetes, and many other areas impacting public health. Note that all BRFSS data are age-adjusted, except for indicators keying on specific age groups. The data are also weighted by other demographic variables according to an algorithm defined by the CDC. - A wide array of data from multiple sources combined to give an overall picture of health in a county. Examples of data include premature deaths, access to locations for physical activity, ratio of population to health care professionals, violent crimes, and many other indicators. Health Rankings provides health outcomes and health factors rankings for 78 counties in. - Annual counts on arrests (adult and juvenile) by type submitted voluntarily by local and state-level police departments. - Data contained in 's annual State of the Schools Report, including graduation and dropout rates, student characteristics, and student achievement scores. - A wide array of data around births, mortality, child abuse and neglect, health professionals, and other areas. Note that all mortality data are age-adjusted. - A survey of youth in grades 8, 10, and 12 on risk factors such alcohol, tobacco, and drug use, and bullying. - U.S. Census Bureau estimates on demographic elements such as population, age, race/ethnicity, household income, poverty, health insurance, single parent families, and educational attainment. Annual estimates are available through the American Community Survey. 3

6 Demographics The total population of the District is 77,709 (Figure 3). Figure 3 Population (2013) Saunders Washington Dodge 36,675 20,800 20,234 77,709 Source: U.S. Census/American Community Survey 5-Year Estimates (2013) As a whole, the District is 91.7% White non-hispanic. There is a significantly sized minority population in Dodge (Figure 4). See also the Minority Populations section below (page 12). Figure 4 Race/Ethnicity (2013) White (non-hispanic) Dodge Saunders Washington Total 87.1% % 91.7% 81.7% Minority 12.9% % 8.3% 18.3% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Each of the three counties in the District has a median age of over 40, which is higher than the median age of 36.3 for the state (Figure 5). Figure 5 Median age (2013) Saunders Washington Dodge * *An average weighted by the population in each county. Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 4

7 Among the three counties in the District, Dodge has the highest percentage of the population that is age 65 or older at 18.6%. As a whole, 16.9% of the Three Rivers District is 65 or older (compared to 13.7% for the state) (Figure 6). Figure 6 Number and percentage of the population age 65 and over (2013) Dodge 6,833 (18.6%) Saunders 3,327 (16.) Washington 2,944 (14.5%) 13,104 (16.9%) 252,585 (13.7%) Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Just under one-fourth (24.3%) of the population is under the age of 18 (Figure 7). Figure 7 Number and percentage of the population under the age of 18 (2013) Dodge Saunders Washington 8,624 (23.5%) 5,349 (25.7%) 4,890 (24.2%) 18,863 (24.3%) 460,116 (25.) Source: U.S. Census/American Community Survey 5-Year Estimates (2013) From 2010 to 2013, the birth rate was lower for each of the three counties in the District than it was for the state. In 2013, there were 941 births in the district, which makes for a rate of 12.1 births per 1,000 population (compared to a rate of 14.0 per 1,000 for the state) (Figure 8). Figure 8. Number of births and birth rate per 1,000 population Dodge 491 (13.4) 422 (11.5) 500 (13.7) 476 (13.0) Saunders 270 (13.0) 261 (12.5) 235 (11.3) 226 (10.8) Washington 210 (10.4) 213 (10.5) 182 (9.0) 239 (11.8) 971 (12.5) 896 (11.5) 917 (11.8) 941 (12.1) 25,916 (14.2) 25,722 (14.0) 25,939 (14.0) 26,094 (14.0) 5

8 Dodge stands out as having a notably lower median household income and per capita income as compared to the state. Saunders and Washington Counties each have higher median household incomes and per capita incomes as compared to the state (Figure 9). Figure 9 Income (2013) Median household income Dodge Saunders Washington * $59,038 $75,270 $76,170 $67,844 $67,023 Per capita income $24,588 $30,039 $29,328 $27,281 $26,899 *An average weighted by the population in each county. Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 6

9 Veterans Across the District there are 6,651 veterans, accounting for 11.3% of the total population aged 18 and over (Figure 10). Figure 10 Veterans (2013) Number of veterans Veterans as percentage of total population aged 18 years and over Dodge Saunders Washington 2,959 1,883 1,809 6, , % 12.2% 11.8% 11.3% 10.3% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Compared to the state, there is a lower proportion of younger veterans in the District. Veterans aged 18 to 34 comprise just 5.9% of the total veteran population in the Three Rivers District (compared to 9.4% for the state) (Figure 11). Figure 11 Age of veterans (2013) Dodge Saunders Washington * 18 to 34 years 3.8% 7.5% 7.7% 5.9% 9.4% 35 to 54 years 22.3% 22.8% 26.1% 23.5% to 64 years 17.4% 23.9% 23.1% 20.8% 22.5% 65 to 75 years 23.7% 22.5% % 19.2% 75 years and over 32.7% 23.3% 22.2% 27.2% 23.9% *An average weighted by the population in each county. Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 7

10 Across the state veterans have considerably lower rates of poverty compared to non-veterans. In the District an estimated 4.5% of veterans are in poverty, compared to a poverty rate of 8.5% for nonveterans (Figure 12). Figure 12 Poverty rates: veterans and non-veterans (2013) Veterans in poverty Non-veterans in poverty Dodge *An average weighted by the population in each county. Saunders Washington * 5.6% 3.2% % 5.8% 10.1% 7.2% 6.7% 8.5% 11.9% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Across the state veterans have considerably higher rates of disability compared to nonveterans. In the District an estimated 28.9% of veterans have a disability, compared to a disability rate of 12.7% for non-veterans. Figure 13 Disability status (2013) Veterans with a disability Non-veterans with a disability Dodge *An average weighted by the population in each county. Saunders Washington * 29.1% 27.6% 30.1% 28.9% 26.2% 14.7% 11.1% 10.7% 12.7% 12. Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 8

11 Poverty Despite having a lower median household income and per capita income as compared to the state (see Figure 9 directly above), Dodge has lower rates of poverty as compared to the state. Saunders and Washington Counties have rates of poverty that are also lower than the state. According to the U.S. Census, 9.2% of the total population is in poverty (compared to 12.8% for the state), and 12.3% of the under 18 population in the District is in poverty (compared to 17.4% for the state) (Figure 14). Figure 14. Individuals in poverty (2013) 2 15% 1 5% Dodge Saunders Washington Total population in poverty 10.7% % 9.2% 12.8% Under 18 population in poverty % 11.7% 12.3% 17.4% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) An estimated total of 6,966 individuals are in poverty in the Three Rivers District (Figure 15). Figure 15 Number of individuals in poverty (2013) Saunders Washington Dodge 3,801 1,648 1,517 6,966 Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 9

12 Unemployment is relatively low in the District at around 3% for each county (Figure 16). Figure 16 Unemployment (July, 2015) Saunders Washington Dodge * 3.3% 2.9% 3.1% 3.1% 3. *An average weighted by the population in each county. Source: Department of Labor (2015) In there was a substantial increase in the percentage of children in the District as well as the State eligible for free and reduced school meals. The increase may be due to a change in the guidelines for determining eligibility. In , 4,863 children in the District were eligible for free and reduced school meals, and over half (51.7%) of the children in Dodge were eligible (Figure 17). Figure 17. Number and percentage of children eligible for free and reduced school meals Dodge 2,073 (39%) 3,036 (51.7%) Saunders 815 (26%) 1,064 (34.2%) Washington 709 (16%) 763 (20.7%) 3,597 (28%) 4,863 (38.4%) 93,575 (36%) 133,972 (44.2%) Dept. of Education, contained in Kids Count (2015) In 2013, 5,482 District children were enrolled in Medicaid or the Children s Health Insurance Plan (CHIP), of these 3,505 were from Dodge (Figure 18). Figure 18. Number and percentage of children enrolled in Medicaid or CHIP Dodge 3,051 (36.) 3,505 (40.2%) Saunders 941 (18.4%) 1,174 (22.1%) Washington 774 (15.4%) 803 (16.2%) 4,766 (25.6%) 5,482 (28.9%) 140,281 (31.5%) 161,729 (35.5%) DHHS, Financial & Program Services, contained in Kids Count (2015) 10

13 In 2013, 24.1% of adults reported housing insecurity, and 17.7% reported food insecurity (Figures 19 and 20). See the notes below each figure for definitions of housing and food insecurity. Figure 19. Housing insecurity* in the past year among those who own or rent their home % 24.1% 26.6% 28.8% *Percentage who report they were always, usually, or sometimes worried or stressed about having enough money to pay their rent or mortgage. Figure 20. Food insecurity* in the past year among adults 18 and over % 17.7% 17.6% 19. *Percentage who report that they were always, usually, or sometimes worried or stressed about having enough money to buy nutritious meals. 11

14 Single Parent Families More than one-in-five (22.6%) children in the District live in a single parent household, which is lower than the rate of 28.3% for the state as a whole. Dodge is more in line with rates for the state with 27.4% of children living in a single parent household. (Figure 21). 3 Figure 21. Percentage of children living in single parent households* (2013) 27.4% 28.3% % 22.6% % Dodge Saunders Washington *Children living in either female householder, no husband present, families or male householder, no wife present, families, as a percentage of all children living in family households. Source: U.S. Census/American Community Survey 5-Year Estimates (2013) In the District, just 5.2% of married couple families with children are in poverty, but poverty among single mother households ( female householder, no husband present ) with children is at 27.2% in the district (Figure 22). 12

15 Figure 22. Poverty among families with children under 18 (2013) Dodge Saunders Washington All families % 14.5% Married-couple families 6.3% 3.7% 5.2% 5.2% 6.3% Female householder, no husband present families 26.7% % 27.2% 37.9% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Approximately one-third of all children in the District and are born to unmarried mothers. In Dodge, 40.8% of all births were to unmarried mothers from , accounting for 976 births over this five-year period (Figure 23). Note that children born to unmarried mothers and living in a single mother household (also known as female householder, no husband present family ) are much more likely to be in poverty than children living in married couple families (see Figure 22 above). Figure 23. Number and percentage of births to unmarried mothers Dodge 968 (38.9%) 964 (40.) 990 (40.6%) 976 (40.8%) Saunders 274 (21.1%) 286 (21.7%) 288 (22.4%) 274 (21.6%) Washington 260 (24.1%) 263 (24.8%) 255 (25.) 269 (25.8%) 1,502 (30.9%) 1,513 (31.4%) 1,533 (32.3%) 1,519 (32.2%) 44,729 (33.5%) 44,658 (33.7%) 44,305 (33.7%) 43,854 (33.6%) 13

16 Minority Populations An estimated total of 6,424 minorities live in the District, the majority of which are of Hispanic/Latino ethnicity (Figure 24). Figure 24 Minorities (2013) Hispanic/ Latino Black/ African- American NH Asian NH American Indian/ Alaskan Native NH Native Hawaiian/ Pacific Islander NH Two or More Races NH Other NH Total Minorities Dodge 3, ,731 Saunders Washington , ,424 Note: NH=non-Hispanic. Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Among the foreign born population in the District, 57.2% are not U.S. citizens according to the U.S. Census. This is lower than the rate of 65.2% for the state (Figure 25). Figure 25 Foreign-born population (2013) Total foreignborn population Naturalized U.S. citizen Not a U.S. citizen Dodge 1, (40.3%) 1,182 (59.7%) Saunders (50.9%) 134 (49.1%) Washington (55.2%) 95 (44.8%) 2,466 1,055 (42.8%) 1,411 (57.2%) 116,630 40,566 (34.8%) 76,064 (65.2%) Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 14

17 One-in-ten (10.3%) individuals age five and over in Dodge speak a language other than English at home, which is comparable to the rate of 10.5% for the state. Saunders and Washington Counties have relatively small non-english speaking populations (Figure 26). 15% 1 5% Figure 26. Percentage of the population age 5 and over speaking a language other than English at home (2013) 10.3% Dodge 4.4% Saunders 1.9% Washington 6.5% 10.5% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) 15

18 Health Disparities Figure 27 presents health disparity data for minorities in the District. There were statistically significant differences between minorities and White non-hispanics, with minorities faring worse, for the following health indicators: No health care coverage, year olds No personal doctor or healthcare provider Needed to see a doctor, but could not due to cost in the past year There was one indicator in which minorities in the District had a statistically significant difference that was better than White non-hispanics: binge drank in the past 30 days. Figure 27. Health indicator comparisons by race/ethnicity among adults 18 and over ( ) White (non-hispanic) Minority Physical health was not good on 14 or more of the past 30 days 9.6% 9.1% Mental health was not good on 14 or more of the past 30 days 9.3% 5.7% No health care coverage, year olds 15.2% 42.5%* No personal doctor or healthcare provider 15.3% 37.1%* Needed to see a doctor but could not due to cost in the past year 11.9% 26.9%* Ever told they have diabetes (excluding pregnancy) 7.1% 13.4% Obese (BMI of 30 or higher) 29.7% 26.4% Overweight or obese (BMI of 25 or higher) 65.9% 70.2% Met aerobic physical activity recommendation 51.1% 49.6% Binge drank in the past 30 days 22.3% 10.4%* Currently smoke cigarettes 21.7% 14.4% *Statistically significant difference (p<.05) between minority and white non-hispanic categories. Figure 28 presents health disparity data by income in the District. There were statistically significant differences between those of low income (less than $25,000) and other income groups, with the low income group faring worse, for the following health indicators: Physical health was not good on 14 or more of the past 30 days Mental health was not good on 14 or more of the past 30 days No health care coverage, year olds Needed to see a doctor but could not due to cost in the past year Ever told they have diabetes (excluding pregnancy) Currently smoke cigarettes 16

19 As with the comparison between minorities and White non-hispanics, there was one indicator in which the low income group in the District had a statistically significant difference that was better than those of higher income: binge drank in the past 30 days. Figure 28. Health indicator comparisons by income among adults 18 and over ( ) Less than $25,000 $25,000- $49,999 $50,000 or higher Physical health was not good on 14 or more of the past 30 days 19.9%* 10.7% 5.1% Mental health was not good on 14 or more of the past 30 days 16.3%* 9.1% 5.4% No health care coverage, year olds 42.4%* 23.5% 6.3% No personal doctor or healthcare provider 22.4% 21.2% 14.4% Needed to see a doctor but could not due to cost in the past year 29.4%* 16.8% 5.1% Ever told they have diabetes (excluding pregnancy) 13.3%* 7.6% 4.8% Obese (BMI of 30 or higher) 35.3% 28.8% 27.1% Overweight or obese (BMI of 25 or higher) 68.5% 62.3% 67.2% Met aerobic physical activity recommendation 50.4% 43.2% 57.5% Binge drank in the past 30 days 15.1%* 21.4% 27.3% Currently smoke cigarettes 34.9%* 23.4% 14.8% *Statistically significant difference (p<.05) between the less than $25,000 income category and one or both of the other two income categories. 17

20 Access to Health Services Approximately 4.9% of the under 18 population in the District is without health insurance coverage (Figure 29). Percentage of the population under 18 without health insurance Figure 29 coverage (2013) Saunders Washington Dodge 6.5% 3.4% 3.6% 4.9% 5.9% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) Among the total population under the age of 65 in the District, there were an estimated 7,158 individuals without health insurance in 2012, accounting for 11.4% of the total population under the age of 65 (Figure 30). Figure 30. Number and percentage of the population under age 65 without health insurance Dodge 4,006 (13.7%) 4,252 (14.5%) 4,020 (13.8%) Saunders 1,788 (10.3%) 1,800 (10.4%) 1,742 (10.2%) Washington 1,545 (9.1%) 1,512 (8.9%) 1,396 (8.3%) 7,339 (11.5%) 7,564 (11.9%) 7,158 (11.4%) 206,100 (13.4%) 205,574 (13.3%) 200,265 (12.9%) Sauce: Small Area Health Insurance Estimates, contained in Health Rankings (2015) Among adults age in the District, 14.7% reported not having health care coverage in This represented a notable decline from 21.4% in 2012 (Figure 31). Figure 31. No health care coverage among adults % 2 15% 1 5% % 21.4% % 19.1% % 15.3% 18

21 In 2014, 17.4% of the population reported not having a personal doctor or health care provider, which represented an increase from 13.8% in 2012, but was still lower than the 2014 rate of 20.2% for the state (Figure 32). Figure 32. No doctor or personal health care provider among adults 18 and over 25% 2 15% 1 5% % 13.8% 14.9% 17.4% 18.4% 17.2% 20.9% 20.2% In 2014, 68.4% of adults reported having a routine checkup in the past year (compared to 63.3% for the state) (Figure 33). Figure 33. Had a routine checkup in the past year among adults 18 and over * * 2014* % 68.8% 68.4% 57.7% 60.4% 61.6% 63.3% *Statistically significant difference between and the state. 19

22 In 2014 among adults in the District, 10.7% reported needing to see a doctor but could not due to cost in the past year (compared to 11.9% for the state) (Figure 34). Figure 34. Needed to see a doctor but cold not due to cost in the past year among adults 18 and over 15% 12% 9% 6% 3% % 12.9% 11.2% 10.7% 12.5% 12.8% % Compared to the state, all three counties in the District have a higher ratio of population to primary care physicians, dentists, and mental health providers (Figure 35). Figure 35. Ratio of population to health care professionals Ratio of population to primary care physicians (2012) Ratio of population to dentists (2013) Ratio of population to mental health providers (2014) Dodge 1,656:1 1,739:1 664:1 Saunders 3,471:1 3,488:1 3,488:1 Washington 3,375:1 3,371:1 5,056:1 2,280:1 2,352:1 1,194:1 1,405:1 1,450:1 435:1 Source: Area Health Resource File/American Medical Association; CMS, National Provider Identification file, contained in Health Rankings (2015) 20

23 Figure 36 displays the number of primary care physicians, dentists, and mental health providers for each of the three counties in the District and Figure 37 displays a larger range of medical professionals. Figure 36 Number of health care professionals Number of primary care physicians (2012) Number of population to dentists (2013) Number of population to mental health providers (2014) Dodge Saunders Washington Source: Area Health Resource File/American Medical Association; CMS, National Provider Identification file, contained in Health Rankings (2015) Figure 37 Number of health professionals in area (2012) Dodge Saunders Washington Physicians FM/GP Internal Medicine Pediatrics OB/GYN Psychiatrists Dentists Pharmacists Physical Therapists (2010) Physician Assistants Nurse Practitioners RN's (2010) LPN's (2010) Source: Health Professions Tracking Center, University of Medical Center (2012) 21

24 Mental Health In 2014, 8.3% of adults in the District reported that their mental health was not good on 14 or more of the past 30 days (i.e., frequent mental distress) (Figure 38). Figure 38. Mental health was not good on 14 or more of the past 30 days among adults 18 and over 1 8% 6% 4% 2% % 9.3% 7.3% 8.3% 9.2% % 8.2% In 2014, 17.7% of adults in the District reported that they have ever been told by a mental health or medical professional that they have depression (Figure 39). Figure 39. Ever told they have depression among adults 18 and over % 14.2% 17.3% 17.7% 16.8% 16.7% 18.2% 17.7% 22

25 In 2012, 10.9% of adults in the District reported that they are currently taking medication or receiving treatment for a mental health condition, and 3.9% responded to a series of questions that indicated symptoms of a serious mental health illness in the past 30 days (Figure 40). Figure 40. Mental health indicators among adults 18 and over (2012) Currently taking medication or receiving treatment for a mental health condition Symptoms of serious mental health illness in past 30 days* 10.9% % 3.2% *Percentage reporting answers to six questions measuring risk for serious psychological distress during the past 30 days based on the Kessler 6 (KS) instrument that generate a score of 13 or higher, suggesting serious mental illness. Saunders is conspicuous for having a high rate of suicide from There were 19 suicides in Saunders during this five-year period and 47 in the District as a whole (Figures 41 and 42). 20 Figure 41. Death rate due to suicide per 100,000 (age-adjusted) Dodge Saunders Washington Figure 42 Number of deaths due to suicide ( ) Saunders Washington Dodge

26 Bullying Figure 39 presents four indicators of bullying among 8 th, 10 th, and 12 th graders. In 2014, 41.8% of 8 th graders, 40.2% of 10 th graders, and 30.9% of 12 th graders in the District reported some form of being bullied in the past year (either on school property, away from school property, or electronically) (Figure 43). Figure 43 Bullying among 8 th, 10 th, and 12 th graders in the past year (2014) Any bullying Bullied on school property Bullied away from school property Electronically bullied ( , text, chat, etc.) 8 th 10 th 12 th 41.8% 40.2% 30.9% 41.4% 34.3% 27.2% 32.3% 32.6% % 27.4% 20.4% 27.5% % 25.8% 21.7% 18.3% 22.3% 24.2% 20.8% % 17.1% Source: Risk and Protective Factors Student Survey (2014) 24

27 Youth Substance Abuse Past 30-day alcohol use among youth has generally been on the decline in both the District and the state as a whole from 2003 to 2014 (Figure 44). 6 Figure 44. Past 30-day alcohol use among 8th, 10th, and 12th graders th grade 10th grade 12th grade 15.8% 10.3% 10.2% 7.5% 5.4% 4.5% 41.3% 33.3% 26.4% 20.7% 19.7% 17.4% 47.4% 50.4% 45.7% 31.7% 29.7% 31.1% 18.1% 13.9% 10.3% 7.9% 6.3% 4.4% 36.2% 31.6% 27.1% % 15.9% 48.9% 47.2% 41.8% 34.7% 31.4% 29.6% Source: Risk and Protective Factors Student Survey (2014) As with alcohol use, past 30-day cigarette use among youth has generally been on the decline in both the District and the state as a whole from 2003 to 2014 (Figure 45). 4 Figure 45. Past 30-day cigarette use among 8th, 10th, and 12th graders th grade 10th grade 12th grade 5.9% 5.3% 4.1% 5.9% 4.1% 3.6% % 12.5% 13.7% 8.1% 8.5% % 30.4% 20.9% 17.6% 16.8% 7.7% 6.9% 4.7% 4.8% 3.3% 2.9% 19.3% 15.3% 13.4% 11.7% 9.3% 7.6% % 24.1% 20.9% 18.8% 15.8% Source: Risk and Protective Factors Student Survey (2014) 25

28 In 2014, 8.8% of 10 th graders and 17.6% of 12 th graders in the District reported marijuana use in the past 30 days. Both of these rates are higher than the state. In past years, 12 th graders have consistently reported higher rates of past 30-day marijuana use compared to the state (Figure 46). 3 Figure 46. Past 30-day marijuana use among 8th, 10th, and 12th graders th grade 10th grade 12th grade 2.4% 2.4% 1.7% 2.4% 2.4% 2.7% % 9.1% 8.9% 9.5% 8.8% 21.3% 20.2% 22.2% 15.5% 13.3% 17.6% % 2.1% 2.4% 2.3% 2.3% 11.9% 9.4% 8.5% % 7.6% 15.6% 13.6% 13.2% 11.8% 11.7% 12.7% Source: Risk and Protective Factors Student Survey (2014) Past 30-day prescription drug use has been declining in both the District and the state as whole since However, past 30-day prescription drug use has been consistently higher among youth than in the state (Figure 47). Figure 47. Past 30-day prescription drug use among 8th, 10th, and 12th graders 12% 9% 6% 3% th grade 10th grade 12th grade 3.2% % % 7.1% 4.8% 3.7% 2.3% 2.6% 10.3% % 4.6% 5.2% 3.8% 1.8% 1.1% 0.7% 0.6% 6.2% 4.3% 2.8% 2.4% 2.2% 7.4% 4.8% 4.2% 3.8% 3.3% Source: Risk and Protective Factors Student Survey (2014) 26

29 Adult Alcohol and Tobacco Use Rates of tobacco-related deaths in the District are basically on par with the rest of the state. However, Dodge has a higher rate of tobacco-related deaths compared to the state. There were 570 such deaths in the District from (Figures 48 and 49). 150 Figure 48. Tobacco-related deaths per 100,000 (age-adjusted) Dodge Saunders Washington Figure 49 Number of tobacco-related deaths ( ) Saunders Washington Dodge ,183 27

30 Both cigarette smoking and tobacco use appear to be on the decline since 2011 in the Three Rivers District. In 2014, 17.9% of adults reported currently smoking cigarettes and 4.5% reported current smokeless tobacco use (Figures 50 and 51). In addition, in the District in 2014, 63.6% of current smokers reported that they attempted to quit smoking in the past year (state comparison: 58.2%) (Source: Behavioral Risk Factors Surveillance System, 2014). Figure 50. Currently smoke cigarettes among adults 18 and over % 22.1% 16.5% 17.9% % 18.5% 17.4% Figure 51. Current smokeless tobacco use among adults 18 and over 1 8% 6% 4% 2% % 4.2% 5.1% 4.5% 5.6% 5.1% 5.3% 4.7% 28

31 Rates of alcohol-related deaths are basically on par with the rest of the state. There were 145 such deaths in the District from (Figures 52 and 53). 40 Figure 52. Alcohol-related deaths per 100,000 (age-adjusted) Dodge Saunders Washington Figure 53 Number of alcohol-related deaths ( ) Saunders Washington Dodge ,042 29

32 In 2014, 15.7% of adults in the District reported binge drinking in the past 30 days (compared to 20.3% for the state). This rate of binge drinking has been declining in the District every year since (Figure 54) Figure 54. Binge drank (5 or more drinks in one occassion for men, 4 for women) in the past 30 days among adults 18 and over * 21.3% 20.3% 18.5% 15.7% 22.7% 22.1% % *Statistically significant difference between and the state. Heavy drinking (see the note below the figure for the definition) was reported by 4.3% of Three Rivers adults in 2014 (compared to 6.4% for the state). This rate has also been declining since 2014 (Figure 55). Figure 55. Heavy drinking* in the past 30 days among adults 18 and over 1 8% 6% 4% 2% % 7.6% 5.2% 4.3% 7.5% 7.2% 6.8% 6.4% *Percentage of men who report drinking more than 60 alcoholic drinks during the past 30 days and percentage of women who report drinking more than 30 alcoholic drinks in the past 30 days. 30

33 Alcohol-Impaired Driving From , there were 10 alcohol-impaired driving deaths in the District, accounting for 21.3% of all driving deaths in the district (Figure 56). Figure 56. Alcohol-impaired driving deaths ( ) Number of alcohol-impaired driving deaths Number of driving deaths Alcoholimpaired driving deaths as a percentage of all driving deaths Dodge % Saunders % Washington % % 360 1, % Fatality Analysis Reporting System, contained in Health Rankings (2015) In 2014, 1.4% of 10 th graders and 11.8% of 12 th graders reported driving under the influence of alcohol in the past year. The rates of youth reporting driving under the influence have been declining considerably across the state (Figure 57). 5 Figure 57. Drove a vehilcle under the influence of alcohol in the past year among 8th, 10th, and 12th graders th grade 10th grade 12th grade 2.8% 2.8% 2.7% 1.9% 1.3% 1.1% 14.9% 11.8% 7.5% 4.5% 3.5% 1.4% 37.3% 43.6% 33.2% 13.4% 11.1% 11.8% 5.4% 5.1% 3.4% 1.3% % 15.9% % 5.1% % % 31.5% 20.1% 14.8% 13.5% Source: Risk and Protective Factors Student Survey (2014) 31

34 In 2014, 15.5% of 8 th graders, 14.8% of 10 th graders, and 13. of 12 th graders reported riding in a vehicle driven by someone who had been drinking alcohol in the past 30 days (Figure 58). Rode in a vehicle driven by someone who had been Figure 58 drinking alcohol in the past 30 days among 8 th, 10 th, and 12 th graders (2014) 8 th 10 th 12 th 15.5% 14.8% % 15.7% 15.9% Source: Risk and Protective Factors Student Survey (2014) In 2014, 0.9% of adults in the District reported alcohol impaired driving in the past 30 days (compared to 2.5% for the state) (Figure 59). Figure 59. Alcohol impaired driving in the past 30 days among adults 18 and over 6% 5% 4% 3% 2% 1% * 3.3% 0.9% 3.4% 2.5% *Statistically significant difference between and the state. 32

35 Motor Vehicle Safety See also the previous section for data on alcohol-impaired driving. In 2014, less than three-fourths (72.8%) of adults from the Three Rivers District reported always wearing a seat belt when driving or riding in a car (Figure 60). Figure 60. Always wear a seatbelt when driving or riding in a car among adults 18 and over 10 75% 5 25% % 69.4% 74.3% 72.8% 71.3% 69.7% 74.1% 72.4% In 2012, 23.9% of adults from the District reported texting on a cell phone while driving in the past 30 days and 67.6% reported talking on a cell phone while driving (Figure 61). Figure 61. Indicators of distracted driving among adults 18 and over (2012) Texted on a cell phone while driving in the past 30 days Talked on a cell phone while driving in the past 30 days 23.9% 26.8% 67.6% 69.1% 33

36 As a whole, the District has a higher rate of motor vehicle deaths compared to the state. Furthermore, each county in the district has a higher rate of motor vehicle deaths compared to the state. From there were 69 motor vehicle deaths in the District, making for a rate of 18.1 per 100,000 (compared to 12.2 per 100,000 for the state) (Figures 62 and 63). 30 Figure 62. Motor vehicle deaths per 100,000 (age-adjusted) Dodge Saunders Washington Figure 63 Number of motor vehicle deaths ( ) Saunders Washington Dodge ,133 34

37 Unintentional Injury Unintentional injury includes a broad array of injuries including motor vehicle accidents, falls, drug poisoning, fires and burns, drowning, suffocation, work-related accidents, and other similar types of unintentional injuries. See also the previous two sections for data on alcoholimpaired driving and motor vehicle safety. From 2009 to 2013 the rate of unintentional injury deaths was 39.5 per 100,000 in the District (compared to 35.9 per 100,000 for the state). Over this five-year period, there were 180 unintentional injury deaths in the district. Dodge has the highest rates of unintentional injury in the district (Figures 64 and 65). 50 Figure 64. Unintentional injury deaths per 100,000 (age-adjusted) Dodge Saunders Washington Figure 65 Number of deaths due to unintentional injury ( ) Saunders Washington Dodge ,541 One-in-ten (10.1%) of adults age 45 and over reported being injured due to a fall in the past year in 2014 (Figure 66). Figure 66. Falls among adults 45 and over (2014) Had a fall in the past year 28.3% 26.1% Injured due to a fall in the past year 10.1% 8.8% 35

38 Crime In 2013, there were 2,304 total arrests in the District, accounting for a rate of 29.6 arrests per 1,000 population (compared to 39.5 per 1,000 for the state) (Figure 67). Note: statelevel arrest data provided by the Crime Commission are unreliable as law enforcement agencies are not required to submit arrest data, and some agencies choose not to. In 2011 and 2013, all law enforcement agencies in the District reported arrest data. Figure 67. Number and rate of total arrests per 1,000 population Dodge 1,525 (41.6) 1,466 (40.0) Saunders 450 (21.8) 471 (22.6) Washington 574 (28.4) 367 (18.1) 2,549 (32.9) 2,304 (29.6) * 82,442 (45.5) 72,804 (39.5) *State-level data are unreliable as law enforcement agencies are not required to submit arrest data, and some agencies choose not to. Source: Crime Commission (2013) There were 333 juvenile arrests in the District in 2013 (Figure 68). Figure 68. Number and rate of juvenile arrests per 1,000 population Dodge 256 (29.7) 220 (25.5) Saunders 53 (9.9) 78 (14.6) Washington 80 (16.4) 35 (7.2) 389 (20.6) 333 (17.7) * 13,134 (28.5) 10,534 (22.9) *State-level data are unreliable as law enforcement agencies are not required to submit arrest data, and some agencies choose not to. Source: Crime Commission (2013) 36

39 From there were 63 violent crimes in the District, which account for a rate of 80.5 per 100,000, notably lower than the rate of per 100,000 for the state (Figure 69). Figure 69. Number of violent crimes and rate per 100, Dodge 54 (152.7) 51 (140.7) 46 (126.5) Saunders 14 (68.7) 14 (67.9) 13 (60.6) Washington 7 (37.4) 5 (22.3) 4 (19.6) 75 (100.4) 70 (88.3) 63 (80.5) 5,239 (290.7) 4,939 (270.9) 4,857 (263.6) Source: Uniform Crime Reporting - FBI, contained in Health Rankings (2015) The percentage of 8 th, 10 th, and 12 th graders reporting that they have attacked someone with the idea of seriously hurting them has generally been declining in the District, as well as across the state. In 2014, 5.5% of 8 th graders, 7.4% of 10 th graders, and 6.9% of 12 th graders reported such behavior (Figure 70). Figure 70. Attacked someone with the idea of seriously hurting them in the past year among 8th, 10th, and 12th graders 12% 9% 6% 3% th grade 10th grade 12th grade 7.4% % 9.8% 7.8% 5.5% 11.5% 9.1% 8.8% 10.4% 8.2% 7.4% 7.4% 10.4% 9.7% 6.8% % 9.2% 9.4% 8.4% % 6.8% 10.6% 9.6% 8.8% 9.6% 7.8% 7.8% 8.3% 8.6% 7.6% 7.4% 6.3% 5.4% Source: Risk and Protective Factors Student Survey (2014) 37

40 During the five-year period of , there were 6 homicides in the District, which makes for a rate of 1.6 per 100,000 (compared to 3.5 for the state). Four of the six homicides in the district occurred in Saunders (Figures 71 and 72). Figure 71. Homicides per 100,000 (age-adjusted) Note: numbers too small to present rates by county. Figure 72 Number of homicides ( ) Saunders Washington Dodge

41 Foster Care and Child Abuse/Neglect From 2011 to 2014, the rate of substantiated cases of child abuse and neglect has been lower in the District, as compared to the state. However, in 2014 there was a slightly higher rate in Dodge compared to the state. There were a total of 89 cases of substantiated child abuse and neglect in the District in 2014 (Figure 73). Figure 73. Number of substantiated cases of child abuse and neglect and rate per 1, Dodge 36 (4.0) 44 (4.9) 48 (5.3) 55 (6.1) Saunders 29 (5.3) 20 (3.7) 11 (2.0) 27 (4.9) Washington 8 (1.6) 15 (2.9) 15 (2.9) 7 (1.4) 73 (3.7) 79 (4.0) 74 (3.8) 89 (4.5) 3,410 (6.9) 2,723 (5.5) 2,892 (5.9) 2,575 (5.2) Source: DHHS Child Abuse and Neglect Reports (2014) While the rate of youth in foster care in the District has been consistently lower than the state from 2012 to 2014, there was a notable increase in the number of youth in foster care in Dodge from 2013 (71 youth in foster care) to 2014 (101 youth in foster care). This increase caused the rate of youth in foster care in Dodge to surpass the rate for the state (Figure 74). Figure 74. Number in foster care and rate per 1, Dodge 73 (8.1) 71 (7.9) 101 (11.2) Saunders 26 (4.7) 21 (3.8) 22 (4.0) Washington 23 (4.5) 25 (4.9) 9 (1.7) 122 (6.2) 117 (6.0) 132 (6.7) 4,320 (8.8) 3,892 (7.9) 3,026 (6.2) Source: Foster Care Review Board (2014) 39

42 Education Nine-in-ten residents (90.3%) in the District have at least a high school diploma, which is also true for the state. Less than one fourth (22.9%) of the population in the Three Rivers District has a Bachelor s degree or higher, which is lower than the rate of 28.5% for the state. Dodge is conspicuous for having relatively low levels of educational attainment (Figure 75). Figure 75. Educational attainment of the population ages 25 and over (2013) % with at least a high school diplpoma or equivalent % with a Bachelor's degree or higher Dodge Saunders Washington % % 90.5% 18.7% 24.4% 28.9% 22.9% 28.5% Source: U.S. Census/American Community Survey 5-Year Estimates (2013) High school graduation rates are presented below in Figure 76. District-wide data were unavailable. Figure 76. High School Graduation Rate ( ) % 94.9% 95.3% 88.5% Dodge Saunders Washington Source: Department of Education, data provided by the Children and Families Foundation ( ) 40

43 The following six figures (Figures 77 through 82) present education statistics for each public school district in the District. Figure 77 Education Statistics for Public Schools Districts in Dodge ( ) Accountability Scores Student Characteristics Fremont Public Schools Logan View Public Schools North Bend Central Public Schools Scribner- Snyder Community Schools Public Schools % Proficient in reading 7 85% 87% 85% 77% % Proficient in mathematics 66% 76% 85% 82% 71% % Proficient in science 75% 84% 88% 87% 72% % Proficient in writing ( ) 58% 74% 85% 72% 68% Enrollment 4, ,398 % Receiving free/reduced lunch 56.6% 43.6% 35.3% 52.2% 44.9% % of ELL students * -* 6. % School mobility rate 16.7% 12.4% 8.5% 16.1% 12.1% % of Students in special education 19.8% 21.2% 13.8% % *Data has been masked to protect the identity of students if there are fewer than 10 students in a group. Source: Department of Education ( ) Figure 78 Four-Year Graduation Rates for Public Schools Districts in Dodge ( ) Fremont Public Schools 83.7% 81.3% 85.4% 85.9% Logan View Public Schools 86.4% 91.8% 95.7% 89.6% North Bend Central Public Schools % 97.1% 97.3% Scribner-Snyder Community Schools 91.7% 94.1% -* 10 Public Schools 86.1% 87.6% 88.5% 89.7% *Data has been masked to protect the identity of students. Source: Department of Education ( ) 41

44 Figure 79 Education Statistics for Public Schools Districts in Saunders ( ) Accountability Scores Student Characteristics Ashland- Greenwood Public Schools Cedar Bluffs Public Schools Mead Public Schools Wahoo Public Schools Yutan Public Schools Public Schools % Proficient in reading 88% 72% 81% 84% 82% 77% % Proficient in mathematics 85% 63% 73% 83% 86% 71% % Proficient in science 89% 74% 81% 82% 81% 72% % Proficient in writing ( ) 82% 61% 89% 64% 78% 68% Enrollment ,398 % Receiving free/reduced lunch 35.4% 42.6% 34.5% 32.7% 27.5% 44.9% % of ELL students -* -* -* -* -* 6. % School mobility rate 7.3% 13.2% 13.7% % 12.1% % of Students in special education 17.2% 10.3% 15.3% 22.7% % *Data has been masked to protect the identity of students if there are fewer than 10 students in a group. Source: Department of Education ( ) Figure 80 Four-Year Graduation Rates for Public Schools Districts in Saunders ( ) Ashland-Greenwood Public Schools 92.9% 93.5% % Cedar Bluffs Public Schools -* % 89.5% Mead Public Schools -* -* -* 10 Wahoo Public Schools 92.5% % 92.9% Yutan Public Schools 92.7% 96.8% -* 10 Public Schools 86.1% 87.6% 88.5% 89.7% *Data has been masked to protect the identity of students. Source: Department of Education ( ) 42

45 Figure 81 Accountability Scores Student Characteristics Education Statistics for Public Schools Districts in Washington ( ) Arlington Public Schools Blair Community Schools Fort Calhoun Community Schools Public Schools % Proficient in reading 9 83% 92% 77% % Proficient in mathematics 82% 79% 86% 71% % Proficient in science 86% 85% 89% 72% % Proficient in writing ( ) 79% 74% 69% 68% Enrollment 582 2, ,398 % Receiving free/reduced lunch 21.7% 25.8% 20.1% 44.9% % of ELL students -* -* -* 6. % School mobility rate 7.2% 4.7% 4.1% 12.1% % of Students in special education 11.7% % 15.7% *Data has been masked to protect the identity of students if there are fewer than 10 students in a group. Source: Department of Education ( ) Figure 82 Four-Year Graduation Rates for Public Schools Districts in Washington ( ) Arlington Public Schools 94.7% 94.8% % Blair Community Schools 89.7% 93.9% % Fort Calhoun Community Schools 89.4% 98.1% -* 10 Public Schools 86.1% 87.6% 88.5% 89.7% *Data has been masked to protect the identity of students. Source: Department of Education ( ) 43

46 Physical Activity Saunders and Dodge Counties appear to have relatively low rates of the population with access to locations for physical activity (Figure 83). More than onein-five (22.6%) of the adults reported having no leisure time devoted to physical activity in the past 30 days in 2014 (Figure 84). Just over half (52.9%) of Three Rivers adults reported meeting the physical activity recommendation in the past 30 days in 2013 (see the definition below the figure) (Figure 85). Figure 83. Percentage of the population with adequate access to locations for physical activity (2010 & 2013) Dodge 90.5% Saunders 52.8% Washington % Source: Business Analyst, Delorme map data, ESRI, and US Census Tigerline Files, contained in Health Rankings (2015) Figure 84. No leisure-time physical activity in the past 30 days among adults 18 and over % 21.9% 26.4% 22.6% 26.3% % 21.3% Figure 85. Met aerobic physical activity recommendation* among adults 18 and over in the past 30 days % 52.9% % *At least 150 minutes of moderate-intensity physical activity, or at least 75 minutes of vigorous-intensity physical activity, or an equivalent combination of moderate and vigorousintensity aerobic activity per week during the past month. 44

47 Three-in-ten (30.3%) Three Rivers adults reported meeting the muscle strengthening recommendation in the past 30 days in 2013 (see the definition below the figure) (Figure 86). Figure 86. Met muscle strentghening recommendation* among adults 18 and over in the past 30 days % 30.3% 28.1% 28.4% *Engaged in physical activities or exercises to strengthen their muscles two or more times per week during the past month. One-in-five (21.3%) Three Rivers adults reported meeting both the aerobic physical activity and muscle strengthening recommendations in the past 30 days in 2013 (see the definition below the figure) (Figure 87). Figure 87. Met both aerobic physical activity and muscle strentghening recommendations* among adults 18 and over in the past 30 days % 21.3% % *At least 150 minutes of moderate-intensity physical activity, or at least 75 minutes of vigorous-intensity physical activity, or an equivalent combination of moderate and vigorousintensity aerobic activity per week during the past month and engaged in physical activities or exercises to strengthen their muscles two or more times per week during the past month. 45