Community Health Status Assessment 2015

Transcription

1 Community Health Status Assessment 2015 Examining the Health of

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3 FOREWORD Once again on behalf of the POWER Coalition, I am pleased to present the 2015 Community Health Assessment Report. This report is the fifth community health assessment conducted by various social service, business, and government organizations in in an effort to collect data reporting the health and health behaviors of residents. Data was collected for this assessment with the assistance of the Hospital Council of Northwest Ohio. Monitoring the health of local residents to identify community health problems is an essential public health service. This health status assessment should be used as a guide for strategic planning and decision making. It can help our communities identify new health concerns, measure the impact of current community improvement efforts, and guide the judicious use of local resources. However, this is only one planning tool. A true plan of action for community improvement will require taking a closer look at these survey results; seeking additional information from community residents, service providers, and others; identifying populations at risk for specific health conditions, and choosing effective strategies that will truly improve the health of residents when put into action. This report would not have been possible without the help of members of the Power Coalition as well as the groups who contributed financially. Both are acknowledged on the following pages. It is vital that assessments such as this continue so that scarce resources are used in the most advantageous ways. All contributions whether financial or expertise is greatly appreciated. Addressing the needs of the community will take further collaborations and partnerships of many individuals and agencies. The work of public health is more a system than a single agency. Working together we can achieve a healthier. Sincerely, FOREWORD Kimberly J. Moss, MPH, BSN Health Commissioner General Health District

4 This report has been funded by: Four ADAMhs Board City of Community Memorial Hospital Commissioners General Health District Mercy Hospital ProMedica Regional Hospital United Way of This report has been commissioned by POWER : Promoting Overall Wellness and Empower Residents: City of Community Memorial Hospital Area Foundation Area YMCA City School Commissioners General Health District Help Me Grow- Early Intervention Juvenile Court Ohio State University Extension Office Development and Visitors Bureau Family and Children First Council Four ADAMhs Board Four Family Center Hicksville Village Mercy Hospital Ministerial Association Northwestern Ohio Community Action Commission ProMedica Regional Hospital Recovery Services of Northwest Ohio United Way of

5 Project Management, Secondary Data, Data Collection, and Report Development Britney L. Ward, MPH Director of Community Health Improvement Michelle Von Lehmden Health Assessment Coordinator Tessa Elliott Graduate Assistant Anna Crisp Undergraduate Assistant Data Collection & Analysis Hospital Council of Northwest Ohio James H. Price, Ph.D., MPH Emeritus Professor of Health Education University of Toledo Timothy R. Jordan, Ph.D., M.Ed. Professor of Health Education University of Toledo Margaret Wielinski, MPH Assistant Director of Community Health Improvement Selena Coley Community Health Improvement Assistant Derick Sekyere Graduate Assistant Joseph A. Dake, Ph.D., MPH Professor and Chair of Health Education University of Toledo To see data compared to other counties, please visit the Hospital Council of Northwest Ohio s Data Link website at The 2015 Health Assessment is available on the following websites: General Health District Hospital Council of Northwest Ohio Contact Information Kimberly J. Moss, MPH, BSN Health Commissioner General Health District 1300 E. Second St., Ste 100, Ohio healthcommish@defiance-county.com (419) ACKNOWLEDGEMENTS

6 TABLE OF CONTENTS EXECUTIVE SUMMARY PAGES 5-17 TREND SUMMARY PAGES Adult Health (Ages 19 and Over) HEALTH STATUS PERCEPTIONS PAGES 24 HEALTH CARE COVERAGE PAGES HEALTH CARE ACCESS AND UTILIZATION PAGES CARDIOVASCULAR HEALTH PAGES CANCER PAGES DIABETES PAGES ASTHMA AND OTHER RESPIRATORY DISEASE PAGES WEIGHT STATUS PAGES TOBACCO USE PAGES ALCOHOL CONSUMPTION PAGES DRUG USE PAGES WOMEN S HEALTH PAGES MEN S HEALTH PAGES PREVENTIVE MEDICINE AND HEALTH SCREENINGS PAGES SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES PAGES QUALITY OF LIFE PAGES SOCIAL CONTEXT AND SAFETY PAGES MENTAL HEALTH AND SUICIDE PAGES ORAL HEALTH PAGES PARENTING TEENS PAGES 105 Youth Health (Ages 12-18) WEIGHT CONTROL PAGES TOBACCO USE PAGES ALCOHOL CONSUMPTION PAGES DRUG USE PAGES SEXUAL BEHAVIOR AND TEEN PREGNANCY OUTCOMES PAGES MENTAL HEALTH AND SUICIDE PAGES YOUTH SAFETY PAGES YOUTH VIOLENCE ISSUES PAGES Child Health (Ages 0-11) HEALTH AND FUNCTIONAL STATUS PAGES HEALTH INSURANCE, ACCESS, UTILIZATION, AND MEDICAL HOME PAGES EARLY CHILDHOOD (0-5 YEARS) PAGES MIDDLE CHILDHOOD (6-11 YEARS) PAGES FAMILY FUNCTIONING, NEIGHBORHOOD & COMMUNITY CHARACTERISTICS PAGES PARENT HEALTH PAGE 146 Appendices HEALTH ASSESSMENT INFORMATION SOURCES APPENDIX I PAGES LIST OF ACRONYMS AND TERMS APPENDIX II PAGES WEIGHTING METHODS APPENDIX III PAGES SCHOOL PARTICIPATION APPENDIX IV PAGE 157 DEMOGRAPHIC PROFILE APPENDIX V PAGE 158 DEMOGRAPHICS AND HOUSEHOLD INFORMATION APPENDIX VI PAGES

7 EXECUTIVE SUMMARY This executive summary provides an overview of health-related data for adults (19 years of age and older), youth (ages 12 through 18), and children (ages 0-11) who participated in a county-wide health assessment survey during January 2015 through April The findings are based on self-administered surveys using a structured questionnaire. The questions were modeled after the survey instruments used by the Centers for Disease Control and Prevention for their national and state Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System (YRBSS) and the National Survey of Children s Health (NSCH) developed by the Child and Adolescent Health Measurement Initiative. The Hospital Council of Northwest Ohio collected the data, guided the health assessment process and integrated sources of primary and secondary data into the final report. Primary Data Collection Methods DESIGN This community health assessment was cross-sectional in nature and included a written survey of adults, adolescents, and parents within. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. INSTRUMENT DEVELOPMENT Three survey instruments were designed and pilot tested for this study: one for adults, one for adolescents in grades 6-12, and one for parents of children ages As a first step in the design process, health education researchers from the University of Toledo and staff members from the Hospital Council of NW Ohio met to discuss potential sources of valid and reliable survey items that would be appropriate for assessing the health status and health needs of adults and adolescents. The investigators decided to derive the majority of the adult survey items from the BRFSS. The majority of the survey items for the adolescent survey were derived from the YRBSS. The majority of the survey items for the parents of children 0-11 were derived from the NSCH. This decision was based on being able to compare local data with state and national data. The Project Coordinator from the Hospital Council of NW Ohio conducted a series of meetings with the planning committee from. During these meetings, banks of potential survey questions from the BRFSS, YRBSS, and NSCH surveys were reviewed and discussed. Based on input from the planning committee, the Project Coordinator composed drafts of surveys containing 115 items for the adult survey, 75 items for the adolescent grades 6-12 survey, and 81 items for the 0-11 survey. The drafts were reviewed and approved by health education researchers at the University of Toledo. SAMPLING Adult Survey Adults ages 19 and over living in were used as the sampling frame for the adult survey. Since U.S. Census Bureau age categories do not correspond exactly to this age parameter, the investigators calculated the population of those 18 years and over living in. There were 29,434 persons ages 18 and over living in. The investigators conducted a power analysis to determine what sample size was needed to ensure a 95% confidence level with a corresponding margin of error of 5% (i.e., we can be 95% sure that the true population responses are within a 5% margin of error of the survey findings.) A sample size of at least 379 adults was needed to ensure this level of confidence. The random sample of mailing addresses of adults from was obtained from Allegra Marketing Services in Louisville, KY. EXECUTIVE SUMMARY 5

8 SAMPLING Adolescent Survey A sample size of 349 adolescents was needed to ensure a 95% confidence interval with a corresponding 5% margin of error. Students were randomly selected and surveyed in the schools. SAMPLING 0-11 Survey Children ages 0-11 residing in were used as the sampling frames for the surveys. Using U.S. Census Bureau data, it was determined that 6,340 children age 0-11 reside in. The investigators conducted a power analysis based on a post-hoc distribution of variation in responses (70/30 split) to determine what sample size was needed to ensure a 95% confidence level with corresponding confidence interval of 5% (i.e., we can be 95% sure that the true population responses are within a 5% margin of error). Because many of the items were identical between the 0-5 and 6-11 surveys, the responses were combined to analyze data for children The sample size required to generalize to children ages 0-11 was 362. The random sample of mailing addresses of parents of children 0-11 from was obtained from Allegra Marketing Services in Louisville, KY. PROCEDURE Adult Survey Prior to mailing the survey to adults, an advance letter was mailed to 1,200 adults in. This advance letter was personalized, printed on Live Smart Health Partners stationery and was signed by Kimberly Moss, Health Commissioner, General Health District. The letter introduced the county health assessment project and informed the readers that they may be randomly selected to receive the survey. The letter also explained that the respondents confidentiality would be protected and encouraged the readers to complete and return the survey promptly if they were selected. Three weeks following the advance letter, a three-wave mailing procedure was implemented to maximize the survey return rate. The initial mailing included a personalized hand signed cover letter (on Live Smart Health Partners stationery) describing the purpose of the study; a questionnaire printed on colored paper; a self-addressed stamped return envelope; and a $2 incentive. Approximately three weeks after the first mailing, a second wave mailing included another personalized cover letter encouraging them to reply, another copy of the questionnaire on colored paper, and another reply envelope. A third wave postcard was sent three weeks after the second wave mailing. Surveys returned as undeliverable were not replaced with another potential respondent. The response rate for the mailing was 49% (n=552: CI=± 4.13). This return rate and sample size means that the responses in the health assessment should be representative of the entire county. PROCEDURE Adolescent Survey The survey was approved by all superintendents. Schools and grades were randomly selected. Each student in that grade had to have an equal chance of being in the class that was selected, such as a general English or health class. Classrooms were chosen by the school principal. Passive permission slips were mailed home to parents of any student whose class was selected to participate. The response rate was 95% (n=390: CI=± 4.7). 6

9 PROCEDURE Children 0-5 and 6-11 Prior to mailing the survey to parents of 0-11 year olds, an advance letter was mailed to 1,700 parents in. This advance letter was personalized, printed on Live Smart Health Partners stationery and was signed by Kimberly Moss, Health Commissioner, General Health District. The letter introduced the county health assessment project and informed the readers that they may be randomly selected to receive the survey. The letter also explained that the respondents confidentiality would be protected and encouraged the readers to complete and return the survey promptly if they were selected. Three weeks following the advance letter, a three-wave mailing procedure was implemented to maximize the survey return rate. The initial mailing included a personalized hand signed cover letter (on Live Smart Health Partners stationery) describing the purpose of the study; a questionnaire printed on colored paper; a self-addressed stamped return envelope; and a $2 incentive. Approximately three weeks after the first mailing, a second wave mailing included another personalized cover letter encouraging them to reply, another copy of the questionnaire on colored paper, and another reply envelope. A third wave postcard was sent three weeks after the second wave mailing. Surveys returned as undeliverable were not replaced with another potential respondent. The response rate was 25% (n=303: CI=± 5.49). DATA ANALYSIS Individual responses were anonymous and confidential. Only group data are available. All data was analyzed by health education researchers at the University of Toledo using SPSS Crosstabs were used to calculate descriptive statistics for the data presented in this report. To be representative of, the adult data collected was weighted by age, gender, race, and income using 2010 Census data. Multiple weightings were created based on this information to account for different types of analyses. For more information on how the weightings were created and applied, see Appendix iii. LIMITATIONS As with all county assessments, it is important to consider the findings in light of all possible limitations. First, the adult assessment had a high response rate. However, if any important differences existed between the respondents and the non-respondents regarding the questions asked, this would represent a threat to the external validity of the results (the generalizability of the results to the population of ). If there were little to no differences between respondents and non-respondents, then this would not be a limitation. Second, it is important to note that, although several questions were asked using the same wording as the CDC questionnaires and the NSCH questionnaire, the adult and parent data collection method differed. CDC adult data and NSCH child data were collected using a set of questions from the total question bank and adults were asked the questions over the telephone rather than as a mail survey. The youth CDC survey was administered in schools in a similar fashion as this county health assessment. Finally, this survey asked parents questions regarding their young children. Should enough parents feel compelled to respond in a socially desirable manner which is not consistent with reality, this would represent a threat to the internal validity of the results. EXECUTIVE SUMMARY 7

10 Data Summary HEALTH PERCEPTIONS In 2015, half (51%) of the adults rated their health status as excellent or very good. Conversely, 12% of adults, increasing to 15% of those over the age of 65, described their health as fair or poor. 100% 80% 60% Adult Health Perceptions* 0% 12% 13% 11% 15% 10% 15% 13% 20% 26% 37% 35% 38% 37% 34% 37% 34% 51% 17% 34% 40% 74% 20% 51% 52% 51% 48% 34% 46% 53% 51% 49% 0% Total Males Females Under years 65 & Over Income <$25K Income $25K Plus Excellent/Very Good Good Fair/Poor *Respondents were asked: Would you say that in general your health is excellent, very good, good, fair or poor? HEALTH CARE COVERAGE The 2015 Health Assessment data has identified that 6% of adults were without health care coverage. Those most likely to be uninsured were adults under age 30 and those with an income level under $25,000. In, 15.0% of residents live below the federal poverty level (Source: U.S. Census, American Community Survey 3 Year Estimate, 2013). 30% Uninsured Adults 20% 16% 20% 10% 6% 7% 6% 6% 4% 12% 10% 1% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus

11 HEALTH CARE ACCESS The 2015 Health Assessment project identified that 59% of adults had visited a doctor for a routine checkup in the past year. 57% of adults went outside of for health care services in the past year. CARDIOVASCULAR HEALTH Heart disease (17%) and stroke (3%) accounted for 20% of all adult deaths in 2013 (Source: ODH Information Warehouse, 2013 Preliminary Data). The 2015 Health Assessment found that 5% of adults had survived a heart attack and 3% had survived a stroke at some time in their life. Over one-third (36%) of adults were obese, 32% had been diagnosed with high blood pressure, 32% were sedentary, 27% had high blood cholesterol, and 15% were smokers, five known risk factors for heart disease and stroke. CANCER In 2015, 8% of adults had been diagnosed with cancer at some time in their life. The Centers for Disease Control and Prevention (CDC) indicates that from , a total of 455 residents died from cancer, the leading cause of death in the county. The American Cancer Society advises that not using tobacco products, maintaining a healthy weight, adopting a physically active lifestyle, eating more fruits and vegetables, limiting alcoholic beverages and early detection may reduce overall cancer deaths. DIABETES In 2015, 9% of adults had been diagnosed with diabetes. ASTHMA In 2015, 9% of adults had been diagnosed with asthma. ADULT WEIGHT STATUS Leading Types of Death 2013 (Preliminary) Total Deaths: Heart Disease (17% of all deaths) 2. Cancer (13%) 3. Chronic Lower Respiratory Diseases (6%) 4. Alzheimer s disease (5%) 5. Stroke (3%) (Source: ODH Information Warehouse, 2013) Incidence of Cancer, All Types: 1,049 cases Prostate: 179 cases (17%) Breast: 130 cases (12%) Lung and Bronchus: 169 cases (16%) Colon and Rectum: 106 cases (10%) In 2013, there were 70 cancer deaths in. (Source: Ohio Cancer Incidence Surveillance System, ODH Information Warehouse, Updated 1/9/2014) The 2015 Health Assessment identified that 70% of adults were overweight or obese based on Body Mass Index (BMI). More than one-third (36%) of adults were obese. The 2013 BRFSS indicates that 30% of Ohio and 29% of U.S. adults were obese by BMI. More than two-fifths (43%) of adults were trying to lose weight. EXECUTIVE SUMMARY 9

12 Adult BMI Classifications 100% 80% 36% 34% 38% 25% 40% 40% 42% 35% 35% 35% 60% 40% 34% 43% 24% 33% 36% 39% 20% 39% 32% 39% 20% 27% 20% 36% 35% 23% 17% 36% 24% 31% 24% 0% Total Male Female Under Years 65 & Over Income < $25K Income $25K Plus Normal Overweight Obese (Percentages may not equal 100% due to the exclusion of data for those who were classified as underweight) ADULT TOBACCO USE In 2015, 15% of adults were current smokers and 21% were considered former smokers. In 2015, the American Cancer Society (ACS) stated that tobacco use was the most preventable cause of death worldwide, and is responsible for the deaths of approximately half of long-term users. Each year, tobacco use is responsible for almost 6 million premature deaths, 80% of which are in low-and middle-income countries, and by 2030, this number is expected to increase to 8 million (Source: Cancer Facts & Figures, American Cancer Society, 2015). 100% Adult Smoking Behaviors 80% 60% 64% 63% 63% 86% 57% 59% 69% 60% 56% 50% 40% 20% 0% 21% 21% 21% 15% 16% 16% 5% 9% 25% 18% Total Male Female Under Years 30% 17% 11% 14% 16% 18% 21% 65 & Over Income <$25K 24% 26% Income $25K Plus Current smoker Former smoker Never smoked % 2012 Respondents were asked: Have you smoked at least 100 cigarettes in your entire life? If yes, do you now smoke cigarettes every day, some days or not at all? 10

13 ADULT ALCOHOL CONSUMPTION In 2015, the Health Assessment indicated that 10% of adults were considered frequent drinkers (drank an average of three or more days per week, per CDC guidelines). 44% of adults who drank had five or more drinks (for males) or 4 or more drinks (for females) on one occasion (binge drinking) in the past month. Four percent of adults drove after having perhaps too much to drink. 80% 60% 40% 20% 0% 44% Adult Drinkers Who Binge Drank in Past Month* 54% 32% 59% 35% Total Males Females Under Years 24% 26% 65 & Over Income <$25K 45% Income $25K Plus 36% % 2012 *Based on adults who have drunk alcohol in the past month. Binge drinking is defined as having five or more drinks (for males) or four or more drinks (for females) on an occasion. Adults must have reported drinking five or more drinks (for males) or four or more drinks (for females) on an occasion at least once in the previous month. ADULT MARIJUANA AND OTHER DRUG USE In 2015, 4% of adults had used marijuana during the past 6 months. 3% of adults had used medication not prescribed for them or took more than prescribed to feel good or high and/or more active or alert during the past 6 months. 10% 5% 0% 4% 4% Adult Marijuana Use in Past 6 Months 5% 4% 4% Total Males Females Under Years 1% 1% 65 & Over Income <$25K 5% 5% Income $25K Plus % 2012 EXECUTIVE SUMMARY 11

14 WOMEN S HEALTH In 2015, nearly two-thirds (66%) of women over the age of 40 reported having a mammogram in the past year. 57% of women ages 19 and over had a clinical breast exam and 43% had a Pap smear to detect cancer of the cervix in the past year. The Health Assessment determined that 4% of women survived a heart attack and 3% survived a stroke at some time in their life. Almost one-third (31%) had high blood pressure, 30% had high blood cholesterol, 38% were obese, and 16% were identified as smokers, known risk factors for cardiovascular diseases. Women's Health Exams Within the Past Year 100% 75% 50% 66% 57% 58% 59% 53% 55% 41% 43% 38% 38% 29% 45% 58% 45% 59% 62% 59% 38% 53% 50% 25% 0% 0% Total Under & Older Income <$25K Income >$25K Mammogram Breast Exam Pap Smear MEN S HEALTH In 2015, 50% of males over the age of 50 had a Prostate-Specific Antigen (PSA) test. Major cardiovascular diseases (heart disease and stroke) accounted for 33% and cancers accounted for 27% of all male deaths in from The Health Assessment determined that 4% of men survived a heart attack and 3% survived a stroke at some time in their life. Nearly one-third (32%) of men had been diagnosed with high blood pressure, 25% had high blood cholesterol, and 16% were identified as smokers, which, along with obesity (34%), are known risk factors for cardiovascular diseases. PREVENTIVE MEDICINE AND HEALTH SCREENINGS Over half (58%) of adults ages 65 and over had a pneumonia vaccination at some time in their life. More than half (51%) of adults ages 50 and over had a colonoscopy/sigmoidoscopy within the past 5 years. ADULT SEXUAL BEHAVIOR & PREGNANCY OUTCOMES In 2015, more than three-fifths (63%) of adults had sexual intercourse. Four percent of adults had more than one partner. Prevalence estimates suggest that young people aged years acquire half of all new STDs and that 1 in 4 sexually active adolescent females have an STD, such as chlamydia or human papilloma virus (HPV) (Source: CDC, STDs in Adolescents and Young Adults, 2014 STD Surveillance). QUALITY OF LIFE In 2015, 39% of adults were limited in some way because of a physical, mental or emotional problem. 12

15 SOCIAL CONTEXT In 2015, 7% of adults were threatened and 7% were abused in the past year (including physical, sexual, emotional, financial, and verbal abuse). 58% of adults reported having firearms in and around their homes. MENTAL HEALTH AND SUICIDE In 2015, 4% of adults considered attempting suicide. 14% of adults had a period of two or more weeks when they felt so worried, tense or anxious nearly every day that they stopped doing usual activities. ORAL HEALTH The 2015 Health Assessment project has determined that more than three-fifths (65%) of adults had visited a dentist or dental clinic in the past year. The 2012 BRFSS reported that 67% of U.S. adults and 68% of Ohio adults had visited a dentist or dental clinic in the previous twelve months. More than three-fourths (76%) of youth in grades 6-12 had visited the dentist for a check-up, exam, teeth cleaning, or other dental work in the past year (2013 YRBS reported 75% for Ohio). PARENTING The 2015 Health Assessment project identified that 82% of parents discussed dating and relationships with their 10-to-18 year-old in the past year. YOUTH WEIGHT STATUS The 2015 Health Assessment identified that 18% of youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 32% of youth reported that they were slightly or very overweight. 75% of youth were exercising for 60 minutes on 3 or more days per week. 94% of youth were involved in extracurricular activities. 100% 80% 60% 40% 20% 0% Youth BMI Classifications 4% 4% 4% 6% 3% 3% 9% 5% 62% 67% 16% 11% 57% 59% 23% 19% 18% 19% 16% 15% 19% 17% 14% 15% Total Male Female 13 or younger 58% 19% 71% 59% 9% 18% 13% 14 to & Older Total 2008 Obese Overweight Normal Weight Underweight 74% Total 2012 EXECUTIVE SUMMARY 13

16 YOUTH TOBACCO USE The 2015 Health Assessment identified that 8% of youth in grades 6-12 were smokers, increasing to 13% of those ages 17 and older. Nearly three-fourths 73% of youth identified as current smokers were also current drinkers, defined as having had a drink of alcohol in the past 30 days. In the past week, two-thirds (66%) of all youth were in a home or car with someone who was smoking. 30% Youth Who Are Current Smokers 20% 11% 13% 12% 11% 10% 8% 6% 4% 8% 0% Total Male Female 12 to to & Older Total 2008 Total 2012 YOUTH ALCOHOL CONSUMPTION In 2015, the Health Assessment results indicated that 50% of youth in grades 6-12 had drank at least one drink of alcohol in their life, increasing to 69% of youth seventeen and older. 35% of those 6th-12th graders who drank, took their first drink at 12 years or younger. 20% of all 6th-12th grade youth and 34% of those over the age of 17 had at least one drink in the past 30 days. Nearly half (48%) of the 6th-12th grade youth who reported drinking in the past 30 days had at least one episode of binge drinking. 2% of all youth drivers had driven a car in the past month after they had been drinking alcohol. 100% Youth Current Drinkers Binge Drinking in Past Month* 80% 60% 48% 48% 46% 46% 45% 50% 54% 56% 40% 20% 0% Total Male Female 12 to to & Older Total 2008 Total 2012 *Based on all current drinkers. Binge drinking is defined as having five or more drinks on an occasion. 14

17 YOUTH MARIJUANA AND OTHER DRUG USE In 2015, 9% of 6th-12th grade youth had used marijuana at least once in the past 30 days, increasing to 15% of high school youth. 9% of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life, increasing to 15% of those over the age of % 10% 5% 0% 4% 3% 3% 3% 3% 2% 2% 2% 2% 2% 1% 1% 1% 1% 1% <1% 1% 1% 1% 0% Cocaine Heroin Meth Steroids Inhalants YOUTH SEXUAL BEHAVIOR & PREGNANCY OUTCOMES 8% 7% 7% 6% 6% In 2015, nearly one-quarter (23%) of youth have had sexual intercourse, increasing to 42% of those ages 17 and over. 22% of youth had participated in oral sex and 7% had participated in anal sex. 22% of youth participated in sexting. Of those who were sexually active, 53% had multiple sexual partners. One school did not ask sexual behavior questions. 75% 50% 25% 0% Youth Lifetime Drug Use Total Male Female Total 2008 Total % 24% Youth Who Had Sexual Intercourse 21% 3% Total Male Female 13 or Younger 24% 42% 14 to & Older 24% Total % Total 2012 EXECUTIVE SUMMARY 15

18 YOUTH MENTAL HEALTH AND SUICIDE In 2015, the Health Assessment results indicated that 15% of 6th-12th grade youth had seriously considered attempting suicide in the past year and 5% admitted actually attempting suicide in the past year. 50% Youth Who Felt Sad or Hopeless Almost Every Day for Two Weeks or More in a Row 40% 30% 20% 23% 18% 29% 18% 28% 23% 22% 25% 10% 0% Total Male Female 12 to to & Older Total 2008 Total 2012 YOUTH SAFETY In 2015, 13% of youth had ridden in a car driven by someone who had been drinking alcohol in the past month and 2% of youth drivers had driven after drinking alcohol. 43% of youth drivers texted while driving. 18% of youth reported that they had suffered a blow or jolt to the head while playing with a sports team which caused them to get knocked out, have memory problems, double or blurry vision, headaches or pressure in the head, or nausea or vomiting, increasing to 24% of high school youth and 27% of those ages 17 and older. YOUTH VIOLENCE In, 26% of youth had been involved in a physical fight in the past year. 11% of youth reported an adult or caregiver hit, slapped, or physically hurt them on purpose in the past 12 months. 49% of youth had been bullied in the past year and 31% had been bullied on school property. 50% Youth Involved in a Physical Fight in the Past Year 40% 30% 26% 33% 31% 27% 28% 26% 20% 18% 17% 10% 0% Total Male Female 12 to to & Older Total 2008 Total

19 CHILD HEALTH AND FUNCTIONAL STATUS In 2015, 23% of children were classified as obese by Body Mass Index (BMI) calculations. 78% of parents had taken their child ages 0-11 to the dentist in the past year. 7% of parents reported their child ages 0-11 had been diagnosed with asthma. 6% of parents reported their child had been diagnosed with ADD/ADHD. CHILD HEALTH INSURANCE, ACCESS & UTILIZATION In 2015, 1% of parents reported their 0-11 year old did not have health insurance. 22% of parents reported they had taken their child to the hospital emergency room in the past year. 72% of parents had taken their child to the doctor for preventive care in the past year. EARLY CHILDHOOD (0-5 YEARS OLD) The following information was reported by parents of 0-5 year olds. 90% of mothers got prenatal care within the first three months during their last pregnancy. 6% of mothers smoked during their last pregnancy. 61% of parents put their child to sleep on his/her back. 25% of mothers never breastfed their child. MIDDLE CHILDHOOD (6-11 YEARS OLD) The following information was reported by parents of 6-11 year olds. In 2015, 67% of parents reported their child always feels safe at school. 44% of parents reported their child was bullied at some time in the past year. 85% of parents reported their child participated in extracurricular activities. 23% of parents reported their child had an or a social network account. FAMILY FUNCTIONING, NEIGHBORHOOD AND COMMUNITY CHARACTERISTICS In 2015, 71% of parents reported their 0-11 year old child slept hours per night. 95% of parents reported their neighborhood was always or usually safe enough for their child to go out and play. 1% of parents reported there was an unlocked and loaded firearm in their home. 8% of parents reported they received benefits from the SNAP/food stamps program. PARENT HEALTH In 2015, 10% of parents were uninsured. 38% of parents were overweight and 31% were obese. Parents missed work an average of 2.2 days per year due to their child being ill or injured. EXECUTIVE SUMMARY 17

20 Adult І TREND SUMMARY N/A - not available * 2012 BFRSS Data *** 2009 BRFSS Data Adult Variables 2008 Health Status Ohio 2013 Rated health as excellent or very good 53% 49% 51% 50% 52% Rated general health as fair or poor 13% 17% 12% 18% 17% Health Care Coverage U.S Uninsured 12% 10% 6% 14% 17% Arthritis, Asthma, & Diabetes Has been diagnosed with diabetes 12% 12% 9% 11% 11% Has been diagnosed with asthma 3% 12% 9% 14% 14% Cardiovascular Health Had angina 2% 2% 1% 5% 4% Had a heart attack 4% 5% 5% 5% 4% Had a stroke 2% 2% 3% 4% 3% Has been diagnosed with high blood pressure 18% 34% 32% 34% 31% Has been diagnosed with high blood cholesterol 18% 24% 27% 38% 38% Had blood cholesterol checked within the past 5 years Diagnosed with skin cancer (melanoma or other skin cancers) Diagnosed with any type of cancer, other than skin cancer Cancer Weight Status 76% 75% 70% 78% 76% N/A 4% 2% 6% 6% N/A 11% 6% 7% 7% Overweight 32% 39% 34% 35% 35% Obese 35% 35% 36% 30% 29% Ate 5 or more servings of fruits/vegetables per day N/A 8% 6% 21% *** 23% *** Alcohol Consumption Had at least one alcoholic beverage in past month 52% 53% 49% 53% 55% Binged in past month (5 or more drinks in a couple of hours on an occasion) Tobacco Use 20% 20% 23% 17% 17% Current smoker (currently smoke some or all days) 21% 18% 15% 23% 19% Former smoker (smoked 100 cigarettes in lifetime & now do not smoke) Drug Use 29% 26% 21% 25% 25% Adults who used marijuana in the past 6 months 5% 4% 4% N/A N/A Adults who misused prescription drugs in the past 6 months Adults who used other recreational drugs in the past 6 months 1% 7% 3% N/A N/A 6% 5% <1% N/A N/A 18

21 N/A - not available * 2012 BFRSS Data ** 2010 BRFSS Data Adult Variables 2008 Preventive Medicine Ohio 2013 Had a pneumonia vaccine (ages 65 and older) N/A N/A 58% 71% 70% Had a flu vaccine in the past year (ages 65 and over) Had a clinical breast exam in the past two years (ages 40 and older) Had a mammogram in the past two years (ages 40 and older) U.S N/A N/A 76% 63% 63% 74% 66% 73% 75% ** 77% ** 69% 67% 80% 74%* 74%* Had a pap smear in the past three years 79% 74% 73% 78%* 78%* Had a digital rectal exam within the past year 33% 22% 15% N/A N/A Had a PSA test within the past year 32% 28% 22% N/A N/A Limited in some way because of physical, mental or emotional problem Quality of Life Mental Health 25% 37% 39% 21% 20% Considered attempting suicide in the past year 3% 2% 4% N/A N/A Two or more weeks in a row felt sad or hopeless 11% 13% 16% N/A N/A Oral Health Adults who have visited the dentist in the past year 64% 65% 65% 68%* 67%* TREND SUMMARY 19

22 Youth І TREND SUMMARY Youth Variables (6 th -12 th ) (6 th -12 th ) Weight Control 2015 (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) U.S (9 th -12 th ) Obese 14% 15% 18% 20% 13% 14% Overweight 18% 13% 16% 14% 16% 17% Described themselves as slightly or very overweight 29% 29% 32% 33% 28% 31% Trying to lose weight 45% 48% 46% 49% 47% 48% Exercised to lose weight 50% 52% 49% 53% 61% 61% Ate less food, fewer calories, or foods lower in fat to lose weight 27% 34% 33% 39% 43% 39% Went without eating for 24 hours or more 4% 7% 7% 7% 10% 13% Took diet pills, powders, or liquids without a doctor s advice 1% 2% 2% 3% 5% 5% Vomited or took laxatives 2% 2% 2% 2% 5% 4% Ate 1 to 4 servings of fruits and vegetables per day Physically active at least 60 minutes per day on every day in past week Physically active at least 60 minutes per day on 5 or more days in past week Did not participate in at least 60 minutes of physical activity on any day in past week N/A 83% 85% 86% 85% 78% 31% 34% 31% 30% 26% 27% 53% 59% 55% 56% 48% 47% 11% 8% 11% 13% 13% 15% Watched TV 3 or more hours per day 36% 30% 23% 21% 28% 33% Unintentional Injuries and Violence Rarely or never wore a seatbelt 9% 10% 7% 7% 8% 8% Carried a weapon in past month 11% 13% 13% 13% 14% 18% Been in a physical fight in past year 27% 26% 26% 20% 20% 25% Did not go to school because felt unsafe 4% 4% 4% 3% 5% 7% Bullied on school property in past year N/A 36% 31% 21% 21% 20% Bullied in past year 51% 51% 49% 43% N/A N/A Electronically/cyber bullied in past year 8% 15% 13% 14% 15% 15% Physically forced to have sexual intercourse 3% 7% 4% 3% 8% 7% Hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend in past year 5% 6% 4% 5% 7% 9% Alcohol Consumption Ever tried alcohol 54% 57% 50% 62% 71%* 66% Current drinker 19% 24% 20% 28% 30% 35% Binge drinker (of all youth) 11% 14% 10% 14% 16% 21% Drank for the first time before age 13 (of all youth) 23% 14% 16% 13% 13% 19% Rode with someone who was drinking 18% 13% 13% 10% 17% 22% Drank and drove (of youth drivers) 5% 3% 2% 3% 4% 10% Obtained the alcohol they drank by 62% 39% 24% 28% 38% 42% someone giving it to them * Comparative YRBS data for Ohio and U.S. is 2011, Comparative YRBS data for Ohio is 2007 and U.S. is 2009 N/A Not available 20

23 Youth Variables 2008 (6 th -12 th ) 2012 (6 th -12 th ) Tobacco Use 2015 (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) U.S (9 th -12 th ) Ever tried cigarettes 30% 31% 23% 33% 52%* 41% Current smokers 12% 11% 8% 13% 15% 16% Tried to quit smoking (of those youth who smoked in the past year) Smoked cigarettes on 20 or more days during the past month (of all youth) Smoked a whole cigarette for the first time before the age of 13 (of all youth) Used chewing tobacco or snuff in the past month 46% 51% 52% 56% 56%* 48% 4% 2% 2% 3% 7% 6% 11% 7% 4% 3% 14%* 9% 6% 5% 3% 5% 9% 9% Sexual Behavior Ever had sexual intercourse 24% 28% 23% 35% 43% 47% Used a condom at last intercourse 66% 64% 61% 68% 51% 59% Used birth control pills at last intercourse 28% 32% 24% 29% 24% 19% Did not use any method to prevent pregnancy during last sexual intercourse Had four or more sexual partners (of all youth) Had sexual intercourse before age 13 (of all youth) Drank alcohol or used drugs before last sexual intercourse 19% 13% 13% 10% 12% 14% 4% 5% 6% 8% 12% 15% 4% 3% 3% 2% 4% 6% 17% 18% 18% 16% 18% 22% Drug Use Youth who used marijuana in the past month 8% 8% 9% 15% 21% 23% Ever used methamphetamines 3% 1% <1% 0% 6% 3% Ever used cocaine 2% 3% 2% 3% 4% 6% Ever used heroin 2% 1% 1% 0% 2% 2% Ever used steroids 2% 4% 2% 1% 3% 3% Ever used inhalants 7% 8% 6% 4% 9% 9% Ever used ecstasy/mdma N/A 2% 2% 2% N/A 7% Ever misused medications 7% 12% 9% 13% N/A 18% Ever been offered, sold, or given an illegal drug by someone on school property in the past year 16% 5% 4% 6% 20% 22% Preventive Care Suffered a blow or jolt to the head N/A N/A 18% 24% 12% N/A Visited a dentist for a check-up within the past year Ever told by a doctor or nurse they had asthma N/A 75% 76% 78% 75% N/A 20% 20% 18% 18% N/A 21% Mental Health Youth who had seriously considered attempting suicide in the past year 11% 15% 15% 14% 14% 17% Youth who had attempted suicide in the past year 7% 5% 5% 3% 6% 8% Youth who felt sad or hopeless almost every day for 2 or more weeks in a row 22% 25% 23% 24% 26% 30% * Comparative YRBS data for Ohio and U.S. is 2011, Comparative YRBS data for Ohio is 2007 and U.S. is 2009 N/A Not available TREND SUMMARY 21

24 Child І TREND SUMMARY Child Comparisons 2015 Ages 0-5 Ohio 2011/12 Ages 0-5 U.S. 2011/12 Ages Ages 6-11 Ohio 2011/12 Ages 6-11 U.S. 2011/12 Ages 6-11 Health and Functional Status Rated health as excellent or very good 94% 89% 86% 92% 86% 83% Dental care visit in past year 53% 50% 54% 89% 92% 88% Diagnosed with asthma 2% 6% 6% 9% 10% 10% Diagnosed with ADHD/ADD 2% N/A 2%* 8% 12% 9% Diagnosed with behavioral or conduct problems Diagnosed with vision problems that cannot be corrected Diagnosed with bone, joint, or muscle problems 0% N/A 2%** 3% 5% 4% 0% N/A <1% 4% N/A 2% 1% N/A 1% 2% N/A 2% Diagnosed with epilepsy 0% N/A <1% <1% N/A 1% Diagnosed with a head injury 1% N/A <1% 1% N/A <1% Diagnosed with diabetes 0% N/A N/A <1% N/A <1% Diagnosed with depression 0% N/A <1%* 2% N/A 2% Health Insurance, Access, Utilization and Medical Home Had public insurance 27% 40% 44% 19% 34% 37% Been to doctor for preventive care in past year 86% 94% 90% 64% 86% 82% 2 or more visits to the ER 10% 8%* 8%* 8% 6%* 4%* Received all the medical care they needed 88% 99%* 99%* 89% 98%* 98%* Have a personal doctor or nurse 80% 91% 91% 74% 93% 90% N/A Not available *2007 National Survey of Children s Health ** Ages

25 Child Comparisons Parent reads to child every day N/A Not available *2007 National Survey of Children s Health Children ages 4months-5 years 2015 Ages 0-5 Ohio 2011/12 Ages 0-5 Family Functioning U.S. 2011/12 Ages Ages 6-11 Ohio 2011/12 Ages 6-11 U.S. 2011/12 Ages % 53% 48% N/A N/A N/A Never breastfed their child 25% 29% 21% N/A N/A N/A Child did not miss any days of school because of illness or injury Child missed school 11 days or more because of illness or injury Parent felt child was usually/always safe at school Family eats a meal together every day of the week Child never attends religious services Neighborhood is usually or always safe Mother s mental or emotional health is fair/poor Father s mental or emotional health is fair/poor N/A N/A N/A 27% 16%* 22%* N/A N/A N/A <1% 8%* 5%* N/A N/A N/A 96% 96% 94% 50% 63% 61% 40% 45% 47% 5% N/A N/A 12% 22% 18% 96% 88% 86% 95% 86% 86% Parent Health 1% 7% 7% 5% 10% 8% 11% N/A 3% 2% 7% 5% TREND SUMMARY 23

26 Adult І HEALTH STATUS PERCEPTIONS Key Findings In 2015, half (51%) of the adults rated their health status as excellent or very good. Conversely, 12% of adults, increasing to 15% of those over the age of 65, described their health as fair or poor. General Health Status Adults Who Rated General Health Status Excellent or Very Good 51% (2015) Ohio 50% (2013) U.S. 52% (2013) (Source: BRFSS 2013 for Ohio and U.S.) In 2015, half (51%) of adults rated their health as excellent or very good. adults with higher incomes (53%) were most likely to rate their health as excellent or very good, compared to 46% of those with incomes less than $25, % of adults rated their health as fair or poor. The 2013 BRFSS has identified that 18% of Ohio and 17% of U.S. adults self-reported their health as fair or poor. adults were most likely to rate their health as fair or poor if they: Had been diagnosed with diabetes (27%) Were widowed (27%) Had an annual household income under $25,000 (20%) Had high blood cholesterol (20%) or high blood pressure (18%) The following graph shows the percentage of adults who described their personal health status as excellent/very good, good, and fair/poor. Examples of how to interpret the information include: 51% of all adults, 74% of those under age 30, and 34% of those ages 65 and older rated their health as excellent or very good. Adult Health Perceptions* 100% 80% 60% 12% 13% 11% 37% 35% 38% 0% 26% 15% 15% 20% 37% 34% 51% 10% 13% 37% 34% 17% 34% 40% 74% 20% 51% 52% 51% 48% 34% 46% 53% 51% 49% 0% Total Males Females Under years 65 & Over Income <$25K Income $25K Plus Excellent/Very Good Good Fair/Poor *Respondents were asked: Would you say that in general your health is excellent, very good, good, fair or poor? Adult Comparisons Ohio 2013 Rated health as excellent or very good 53% 49% 51% 50% 52% U.S Rated health as fair or poor 13% 17% 12% 18% 17% 24

27 Adult І HEALTH CARE COVERAGE Key Findings The 2015 Health Assessment data has identified that 6% of adults were without health care coverage. Those most likely to be uninsured were adults under age 30 and those with an income level under $25,000. In, 15.0% of residents live below the federal poverty level (Source: U.S. Census, American Community Survey 3 Year Estimate, 2013). General Health Coverage In 2015, 94% adults had health care coverage, leaving 6% who were uninsured. The 2013 BRFSS reports uninsured prevalence rates for Ohio (14%) and the U.S. (17%). and Ohio Medicaid Statistics Average Members Per Year 2010 Ages 0-18 Ages Ages 65 and Over Total Residents Enrolled in Medicaid 4,077 (58%) 2,570 (36%) 395 (6%) 7,042 (100%) In the past year, 6% of adults were uninsured, increasing to 16% of those under the age of 30 and 20% of those with incomes less than $25, % of adults with children did not have healthcare coverage, compared to 5% of those who did not have children living in their household. The following types of health care coverage were used: employer (45%), someone else s employer (20%), Medicare (14%), self-paid plan (6%), Medicaid or medical assistance (6%), multiple-including private sources (4%), multiple-including government sources (1%), military or VA (1%), and other (2%). 6% of adults were uninsured. adult health care coverage includes the following: medical (98%), prescription coverage (91%), preventive care (73%), immunizations (73%), dental (70%), outpatient therapy (67%), their spouse (65%), vision (63%), mental health (54%), their children (52%), mental health counseling (48%), alcohol and drug treatment (40%), home care (27%), skilled nursing (27%), their partner (26%), long-term care (26%), and hospice (26%). The top reasons uninsured adults gave for being without health care coverage were: 1. They lost their job or changed employers (43%) 2. They could not afford to pay the insurance premiums (22%) 3. They became a part-time/temporary employee (17%) (Percentages do not equal 100% because respondents could select more than one reason) Ohio Residents Enrolled in Medicaid 1,159,095 (55%) 787,749 (38%) 155,896 (7%) 2,102,740 (100%) *(Percent of Members Enrolled = Total Enrollment/Population per U.S. Census Bureau) (Source: Ohio Department of Job & Family Services, Profile, HEALTH CARE COVERAGE 25

28 The following graph shows the percentages of adults who were uninsured by demographic characteristics. Examples of how to interpret the information in the graph includes: 6% of all adults were uninsured, 20% of adults with an income less than $25,000 reported being uninsured and 16% of those under age 30 lacked health care coverage. The pie chart shows sources of adults health care coverage. 30% Uninsured Adults 20% 16% 20% 10% 6% 7% 6% 6% 4% 12% 10% 1% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus % of adults with incomes less than $25,000 were uninsured. Source of Health Coverage for Adults Medicaid 6% Employer 46% Medicare 14% Someone Else's Employer 20% Self-purchased 6% Other 2% Multiplegovt. sources 1% Military 1% Multiple-private sources 4% Adult Comparisons Ohio 2013 U.S Uninsured 12% 10% 6% 14% 17% 26

29 Objective AHS-1.1: Persons under age of 65 years with health care insurance Healthy People 2020 Access to Health Services (AHS) % age % age % age % age % age Ohio % age % age % age % age % age U.S % age % age % age % age % age Healthy People 2020 Target *U.S. baseline is age-adjusted to the 2000 population standard (Sources: Healthy People 2020 Objectives, 2013 BRFSS, 2015 Health Assessment) The following chart shows what is included in adults insurance coverage Health Coverage Includes: Yes No 100% Don t Know Medical 98% <1% 2% Prescription Coverage 91% 5% 4% Preventive Health 73% 5% 22% Immunizations 73% 7% 20% Dental 70% 27% 3% Outpatient Therapy 67% 3% 30% Their Spouse 65% 26% 9% Vision 63% 31% 6% Mental Health 54% 10% 36% Their Children 52% 37% 11% Mental Health Counseling 48% 11% 41% Alcohol and Drug Treatment 40% 7% 53% Home Care 27% 12% 61% Skilled Nursing 27% 11% 62% Their Partner 26% 44% 30% Long-Term Care 26% 22% 52% Hospice 26% 9% 65% Ohio Medicaid Assessment Survey More than 2.3 million Ohioans were enrolled in Medicaid in December An estimated 1.5 million Ohioans do not have health insurance, and most of them are from working families. In Ohio, 593,912 residents were uninsured with incomes below 138 percent of poverty in 2010, and 5,309 of these residents were from. Medicaid plays a critical role in protecting the health of low-income Ohioans, but it leaves out many people. Like many states, Ohio does not extend Medicaid coverage to adults unless they have children or are disabled. (Source: Office of Health Transformation, Extend Medicaid Coverage and Automate Enrollment, 1/31/2013, from: HEALTH CARE COVERAGE 27

30 Adult І HEALTH CARE ACCESS AND UTILIZATION Key Findings The 2015 Health Assessment project identified that 59% of adults had visited a doctor for a routine checkup in the past year. 57% of adults went outside of for health care services in the past year. Health Care Access Almost half (46%) of adults rated their satisfaction with their overall health care as excellent or very good. Conversely, 11% of adults rated their satisfaction with their health care as fair or poor, increasing to 24% of those with no health care coverage. Health Care Access among Employed and Unemployed Adults In , 48.1% of unemployed adults aged years had health insurance compared with 81.4% of employed adults. The unemployed were less likely to receive needed prescriptions due to cost than the employed in all insurance categories. Unemployed adults in were more likely to have fair or poor health than employed adults across all categories of insurance coverage. (Source: CDC, Access to Health Care, 2012, Nearly three-fifths (59%) of adults visited a doctor for a routine checkup in the past year, increasing to 81% of those over the age of % of adults had seen a physician assistant or nurse practitioner for their health care needs in the past year. 29% of adults visited the emergency room in the past year, increasing to 41% of those with incomes less than $25, % of adults reported they had one particular place they usually went if they were sick or needed advice about their health. Reasons for not having a usual source of medical care included: had not needed a doctor (34%), had two or more usual places (22%), cost/no insurance (8%), previous doctor unavailable/moved (8%), do not like/trust/ believe in doctors (5%), did not know where to go (2%), multiple reasons (2%), and other reasons (12%). Adults visited the following places for health care services: doctor s office (74%), urgent care center (8%), multiple places- including doctor s office (7%), Internet (3%), public health clinic or community health department (3%), hospital emergency room (3%), multiple places- not including a doctor s office (1%), Department of Veterans Affairs (VA) (1%), in-store health clinic (<1%), and some other kind of place (1%). <1% of adults indicated they had no usual place for health care services. The following might prevent adults from seeing a doctor if they were sick, injured, or needed some kind of health care: cost (35%), difficult to get an appointment (17%), hours not convenient (10%), could not get time off work (8%), worried they might find something wrong (3%), frightened of the procedure or doctor (3%), difficult to find/no transportation (3%), do not trust or believe doctors (2%), and some other reason (3%). 28

31 adults had the following problems when they needed health care in the past year: could not get appointments when they wanted them (13%), did not have enough money to pay for health care or insurance (8%), could not find a doctor to take them as a patient (7%), had to change doctors because of their healthcare plan (5%), could not find a doctor they were comfortable with (4%), did not have insurance (3%), did not have transportation (2%), too busy to get the healthcare they needed (1%), healthcare plan did not allow them to see doctors in (1%), too embarrassed to seek help (1%), did not have child care (<1%), did not get health services because they were concerned about their confidentiality (<1%), did not get health services because of discrimination (<1%), and other problems that prevented them from getting health care (1%). adults did not get the following major or preventive care because of cost: medications (7%), mammograms (6%), Pap smears (6%), lab testing (6%), colonoscopies (5%), surgery (4%), weight loss program (3%), PSA tests (2%), mental health services (2%), immunizations (2%), smoking cessation (1%), family planning services (1%), and alcohol or drug treatment (1%). 57% of adults went outside of for the following health care services in the past year: specialty care (26%), dental services (17%), primary care (11%), cardiac care (5%), obstetrics/gynecology/nicu (4%), pediatric care (3%), orthopedic care (2%), cancer care (2%), pediatric therapies (2%), mental health care (1%), counseling (1%), addiction services (<1%), developmental disability services (<1%), and other services (8%). adults had the following issues regarding their healthcare coverage: deductibles were too high (44%), co-pays were too high (27%), premiums were too high (25%), high HSA account deductible (10%), could not understand their insurance plan (7%), working with their insurance company (7%), limited visits (7%), service is no longer covered (6%), opted out of certain coverage because they could not afford it (6%), provider is no longer covered (5%), service not deemed medically necessary (4%), difficulty navigating the Marketplace (3%), and opted out of certain coverage because they did not need it (1%). adults had the following transportation issues when they needed health services: no car (3%), no driver s license (3%), could not afford gas (3%), disabled (3%), limited public transportation available or accessible (2%), no car insurance (1%), car did not work (1%), no transportation before or after 8 a.m.- 4:30 p.m. (1%), no public transportation available or accessible (1%), and other car issues/expenses (1%). adults preferred to obtain information about their health or healthcare services from: their doctor (71%), a family member or friend (11%), Internet searches (9%), newspaper articles or radio/television news stories (2%), advertisings or mailings from hospitals, clinics or doctor s offices (2%), text messages (1%), and Facebook (<1%). Availability of Services 5% of adults have looked for a program to assist in care for the elderly (either in-home or out-of-home) for either themselves or a loved one. Of those who looked, 26% looked for in-home care, 19% looked for an assisted living program, 19% looked for out-ofhome placement, and 4% looked for end-of-life care. 33% of adults looked for multiple types of elderly care programs. adults reported they had looked for the following programs for themselves or a loved one: family planning (5%) and alcohol or drug abuse/addiction (1%). HEALTH CARE ACCESS 29

32 Adults Able to Access Assistance Programs/Services Types of Programs (% of all adults who looked for the programs) Family Planning (5% of all adults looked) Alcohol or Drug Abuse/Addiction (1% of all adults looked) adults who have looked but have NOT found a specific program adults who have looked and have found a specific program 5% 95% 0% 100% Health Care Access and Utilization among Young Adults Ages From January through September 2011, 77.9% of women ages had a usual place for health care compared with 62.5% of men in the same age group. Among adults ages 19 25, those with public health coverage were more likely to have had an emergency room visit in the past 12 months than those with private coverage or the uninsured. In 2011, 57.9% of Hispanic persons ages had a usual place for health care. This was significantly less than non-hispanic white (74.9%) and non-hispanic black (68.4%) persons. In the first 9 months of 2011, adults ages19 25 who were poor (67.2%) and those who were near poor (63.0%) were less likely than those who were not poor (76.0%) to have had a usual place for health care. 28% of uninsured adults ages delayed or did not get needed medical care due to cost compared with 7.6% of those with private health insurance and 10.1% of those with public coverage. (Source: CDC, Health Care Access and Utilization among Young Adults Aged 19-25, 2012, 30

33 Adult І CARDIOVASCULAR HEALTH Key Findings Heart disease (17%) and stroke (3%) accounted for 20% of all adult deaths in 2013 (Source: ODH Information Warehouse, 2013 Preliminary Data). The 2015 Health Assessment found that 5% of adults had survived a heart attack and 3% had survived a stroke at some time in their life. Over one-third (36%) of adults were obese, 32% had been diagnosed with high blood pressure, 32% were sedentary, 27% had high blood cholesterol, and 15% were smokers, five known risk factors for heart disease and stroke. Heart Disease and Stroke In 2015, 5% of adults reported they had survived a heart attack (myocardial infarction), increasing to 8% of those over the age of % of adults who had survived a heart attack were receiving treatment as a result of their heart attack. 5% of Ohio and 4% of U.S. adults reported they had a heart attack or myocardial infarction in 2013 (Source: 2013 BRFSS). 3% of adults reported they had survived a stroke, increasing to 5% of those over the age of 65. 9% of adults who had survived a stroke were receiving treatment as a result of their stroke. 4% of Ohio and 3% of U.S. adults reported having had a stroke in 2013 (Source: 2013 BRFSS). 8% of adults reported they had angina or coronary heart disease, increasing to 15% of those over the age of % of adults with angina or coronary heart disease were receiving treatment for their angina or heart disease. 5% of Ohio and 4% of U.S. adults reported having had angina or coronary heart disease in 2013 (Source: 2013 BRFSS). High Blood Pressure (Hypertension) Leading Types of Death 2013 (Preliminary) Total Deaths: Heart Disease (17% of all deaths) 2. Cancer (13%) 3. Chronic Lower Respiratory Diseases (6%) 4. Alzheimer s disease (5%) 5. Stroke (3%) (Source: ODH Information Warehouse, 2013) Ohio Leading Types of Death 2013 (Preliminary) Total Deaths: 110, Heart Disease (17% of all deaths) 2. Cancers (15%) 3. Chronic Lower Respiratory Diseases (5%) 4. Stroke (4%) 5. Accidents, Unintentional Injuries (3%) (Source: ODH Information Warehouse, 2013) Almost one-third (32%) of adults had been diagnosed with high blood pressure. The 2013 BRFSS reports hypertension prevalence rates of 34% for Ohio and 31% for the U.S. 88% of adults with high blood pressure were receiving treatment for their high blood pressure. CARDIOVASCULAR 82% of adults had their blood pressure checked within the past year. 31

34 adults diagnosed with high blood pressure were more likely to: o Have been age 65 years or older (65%) o Have been classified as obese by Body Mass Index-BMI (48%) o Have rated their overall health as fair or poor (48%) High Blood Cholesterol More than one-fourth (27%) of adults had been diagnosed with high blood cholesterol. The 2013 BRFSS reported that 38% of both Ohio and U.S. adults have been told they have high blood cholesterol. 75% of adults with high blood cholesterol were receiving treatment for their high blood cholesterol. More than two-thirds (70%) of adults had their blood cholesterol checked within the past 5 years. The 2013 BRFSS reported 78% of Ohio and 76% of U.S. adults had their blood cholesterol checked within the past 5 years. adults with high blood cholesterol were more likely to: o Have been age 65 years or older (60%) o Have rated their overall health as fair or poor (44%) o Have been classified as obese by Body Mass Index-BMI (36%) The following graph demonstrates the percentage of adults who had major risk factors for developing cardiovascular disease (CVD). 50% Adults with CVD Risk Factors 36% 32% 32% 27% 25% 15% 9% 0% Obesity High Blood Pressure Sedentary High Blood Cholesterol Smoking Diabetes Adult Comparisons (Source: 2015 Health Assessment) Ohio 2013 U.S Had angina 2% 2% 1% 5% 4% Had a heart attack 4% 5% 5% 5% 4% Had a stroke 2% 2% 3% 4% 3% Had high blood pressure 18% 34% 32% 34% 31% Had high blood cholesterol 18% 24% 27% 38% 38% 32

35 The following graphs show the number of adults who have been diagnosed with high blood pressure, high blood cholesterol and cardiovascular disease prevalence. Examples of how to interpret the information on the first graph include: 32% of all adults have been diagnosed with high blood pressure, 32% of all males, 31% of all females, and 65% of those 65 years and older. 80% 60% 40% 20% 0% 80% 60% 40% 20% 0% 10% 5% 0% 32% 32% 31% Total Male Female Under Years *Does not include respondents who indicated high blood pressure during pregnancy only. 27% 25% 5% Diagnosed with High Blood Pressure* Heart Attack 7% Cardiovascular Disease Prevalence 5% 38% 65% 65 & Over Income <$25K 2015 Ohio % 34% Income $25K Plus 2008 Diagnosed with High Blood Cholesterol 30% 5% 33% Total Male Female Under Years 60% 65 & Over Income <$25K 29% 30% 3% Income $25K Plus Stroke 4% 18% 18% % % 2012 CARDIOVASCULAR (Source: 2015 Health Assessment and 2013 BRFSS) 33

36 The following graphs show the age-adjusted mortality rates per 100,000 population for heart disease and stroke. When age differences are accounted for, the statistics indicate that the 2010 heart disease mortality rate was lower than the figure for the state and the U.S. figure, but higher than the Healthy People 2020 target. The age-adjusted stroke mortality rate for 2010 was lower than the state and the U.S. figure. The age-adjusted stroke mortality rate for 2010 was equal to the Healthy People 2020 target objective. From , the age-adjusted heart disease mortality rate has decreased for both sexes. Age-Adjusted Heart Disease and Stroke Mortality Rates Rate per 100,000 population Heart Disease Stroke 2010 Ohio 2010 U.S HP 2020 Target* *The Healthy People 2020 Target objective for Coronary Heart Disease is reported for heart attack mortality. (Source: ODH Information Warehouse, updated , Healthy People 2020) 400 Age-Adjusted Heart Disease Mortality Rates by Gender Rate per 100,000 population Total Male Female (Source: CDC Wonder, Underlying Cause of Death, ) 34

37 The following graph shows the age-adjusted mortality rates per 100,000 population for stroke by gender. From , the stroke mortality rate was higher for males than for females. Rate per 100,000 population 59 (Source: CDC Wonder, About Underlying Cause of Death, ) Objective HDS-5: Reduce proportion of adults with hypertension HDS-6: Increase proportion of adults who had their blood cholesterol checked within the preceding 5 years HDS-7: Decrease proportion of adults with high total blood cholesterol (TBC) Age-Adjusted Stroke Mortality Rates by Gender Total Male Female Healthy People 2020 Objectives Heart Disease and Stroke (HDS) Survey Population Baseline 32% (2015) 70% (2015) 27% (2015) 2013 U.S. Baseline* 31% Adults age 18 and up 76% Adults age 18 & up 38% Adults age 20 & up with TBC>240 mg/dl *All U.S. figures age-adjusted to 2000 population standard. (Source: Healthy People 2020, 2013 BRFSS, 2015 Health Assessment) 48 Healthy People 2020 Target 27% 82% 14% CARDIOVASCULAR 35

38 Stroke Warning Signs and Symptoms F.A.S.T. is an easy way to remember the sudden signs and symptoms of a stroke. When you can spot the signs, you'll know quickly that you need to call for help. This is important because the sooner a stroke victim gets to the hospital, the sooner they'll get treatment. Being prompt can make a remarkable difference in their recovery. F.A.S.T is: Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile. Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? Speech Difficulty: Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like the sky is blue. Is the sentence repeated correctly? Time to call 911: If the person shows any of these symptoms, even if the symptoms go away, call and get them to the hospital immediately. Beyond F.A.S.T- Other Symptoms to Know Sudden confusion or trouble understanding Sudden numbness or weakness of the leg Sudden severe headache with no known cause Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination (Source: American Heart Association, Stroke Warning Signs and Symptoms, 2013, Symptoms_UCM_308528_SubHomePage.jsp) 36

39 Adult І CANCER Key Findings In 2015, 8% of adults had been diagnosed with cancer at some time in their life. The Centers for Disease Control and Prevention (CDC) indicates that from , a total of 455 residents died from cancer, the leading cause of death in the county. The American Cancer Society advises that not using tobacco products, maintaining a healthy weight, adopting a physically active lifestyle, eating more fruits and vegetables, limiting alcoholic beverages and early detection may reduce overall cancer deaths. 8% of adults had been diagnosed with cancer at some time in their life. Adult Cancer 8% of adults were diagnosed with cancer at some point in their lives. Of those diagnosed with cancer, they reported the following types: breast (28%), prostate (25%), other skin cancer (24%), cervical (11%), endometrial (6%), head and neck (5%), bladder (5%), melanoma (3%), thyroid (3%), liver (3%), colon (3%), and other types of cancer (8%). Cancer Facts Incidence of Cancer, All Types: 1,049 cases Prostate: 179 cases (17%) Breast: 130 cases (12%) Lung and Bronchus: 169 cases (16%) Colon and Rectum: 106 cases (10%) In 2013, there were 70 cancer deaths in. (Source: Ohio Cancer Incidence Surveillance System, ODH Information Warehouse, Updated 1/9/2014) The Centers for Disease Control and Prevention (CDC) indicates that from , cancers caused 25% (455 of 1,843 total deaths) of all resident deaths. The largest percent (30%) of cancer deaths were from lung and bronchus cancer (Source: CDC Wonder). CANCER The American Cancer Society reports that smoking tobacco is associated with cancers of the mouth, lips, nasal cavity (nose) and sinuses, larynx (voice box), pharynx (throat), and esophagus (swallowing tube). Also, smoking has been associated with cancers of the lung, colorectal, stomach, pancreas, kidney, bladder, uterine cervix, ovary (mucinous) and acute myeloid leukemia. The 2015 health assessment project has determined that 15% of adults were current smokers and many more were exposed to environmental tobacco smoke, also a cause of heart attacks and cancer. Adult Comparisons Ohio 2013 Diagnosed with skin cancer* N/A 4% 2% 6% 6% U.S Diagnosed with any type of cancer, other than skin cancer N/A 11% 6% 7% 7% N/A Not available *Melanoma and other skin cancers are included for diagnosed with skin cancer 37

40 Lung Cancer A current smoker is defined as someone who has smoked over 100 cigarettes in their lifetime and currently smokes some or all days. The CDC reports that lung cancer (n=78) was the leading cause of male cancer deaths from in, followed by prostate cancer (n=23) and cancer of the colon (n=12) (Source: CDC Wonder). In, 16% of male adults were current smokers and 44% had stopped smoking for one or more days in the past 12 months because they were trying to quit (Source: 2015 Health Assessment). The CDC reports that lung cancer was the leading cause of female cancer deaths (n=57) in from followed by breast (n=33) and colon (n=17) cancers (Source: CDC Wonder). Approximately 16% of female adults in the county were current smokers and 64% had stopped smoking for one or more days in the past 12 months because they were trying to quit (Source: 2015 Health Assessment). According to the American Cancer Society, smoking causes 90% of lung cancer deaths in the U.S. Men and women who smoke are about 25 times more likely to develop lung cancer than nonsmokers (Source: American Cancer Society, Facts & Figures 2015). 16% of male adults and 16% of female adults were current smokers. Breast Cancer In 2015, 57% of females reported having had a clinical breast examination in the past year. 66% of females over the age of 40 had a mammogram in the past year. The 5-year relative survival for women diagnosed with localized breast cancer (cancer that has not spread to lymph nodes or other locations outside the breast) is 99%. However, only 61% of breast cancer cases are diagnosed early at a localized stage (Source: American Cancer Society, Facts & Figures 2015). For women in their 20s and 30s, a clinical breast exam should be done at least once every 3 years. Mammograms for women in their 20s and 30s are based upon increased risk (e.g., family history, past breast cancer) and physician recommendation. Otherwise, annual mammography is recommended beginning at age 40 (Source: American Cancer Society, Facts & Figures 2015). Nearly two-thirds (66%) of females over the age of 40 had a mammogram in the past year. 38

41 Colon and Rectum Cancer More than half (51%) of adults ages 50 and over had a colonoscopy or sigmoidoscopy in the past 5 years. The CDC statistics indicate that colon, rectum, and anus cancer deaths accounted for 9% of all male and female cancer deaths from in. The American Cancer Society reports several risk factors for colorectal cancer including: age; personal or family history of colorectal cancer, polyps, or inflammatory bowel disease; obesity; physical inactivity; a diet high in red or processed meat; alcohol use; long-term smoking; and possibly very low intake of fruits and vegetables. In the U.S., 90% of colon cancers occur in individuals over the age of 50. Because of this, the American Cancer Society suggests that every person over the age of 50 have regular colon cancer screenings. In 2015, 70% of adults over the age of 50 reported having been screened for colorectal cancers at some time in their life and 51% had been screened in the past 5 years. The leading types of cancer diagnoses for adults were: breast (28%), prostate (25%), and other skin cancer (24%). Prostate Cancer CDC statistics indicate that prostate cancer deaths accounted for 9% of all male cancer deaths from in. Incidence rates for prostate cancer are 60% higher in African Americans than in whites and they are twice as likely to die of prostate cancer. In addition, about 56% of prostate cancers occur in men over the age of 65, and 97% occur in men 50 and older. Other risk factors include strong familial predisposition, diet high in processed meat or dairy foods, and obesity. African American men and Caribbean men of African descent have the highest documented prostate cancer incidence rates in the world (Source: American Cancer Society, Facts & Figures 2015) Cancer Estimations In 2015, about 1,658,370 new cancer cases are expected to be diagnosed. The World Cancer Research Fund estimates that about one-quarter to one-third of the new cancer cases expected to occur in the U.S. in 2015 will be related to overweight or obesity, physical inactivity, and poor nutrition, and thus could be prevented. About 589,430 Americans are expected to die of cancer in In 2015, about 171,000 cancer deaths will be caused by tobacco use. In Ohio, 65,010 new cases of cancer are expected, and 25,260 cancer deaths are expected. The Ohio female new breast cancer cases are expected to be 8,950. About 15% of all new cancer cases in Ohio are expected to be from lung and bronchus cancers. About 5,430 (8%) of all new cancer cases in Ohio are expected to be from colon and rectum cancers. The Ohio male, new prostate cancer cases are expected to be 8,150 (13%). (Source: American Cancer Society, Facts and Figures 2015, CANCER 39

42 The following graph shows the, Ohio and U.S. age-adjusted mortality rates (per 100,000 population, 2000 standard) for all types of cancer in comparison to the Healthy People 2020 objective. The graph indicates: When age differences are accounted for, had a lower cancer mortality rate than the U.S., but a higher rate than Ohio and the Healthy People 2020 target objective. The percentage of males who died from all cancers is higher than the percentage of females who died from all cancers. Healthy People 2020 Objective and Age-Adjusted Mortality Rates for All Cancers Rate per 100,000 population Ohio 2010 U.S HP 2020 Target (Source: ODH Information Warehouse, updated ; Healthy People 2020) Cancer As Percent of Total Deaths in by Gender, % 15% 13% 11% 10% 5% 0% Male (Source: CDC Wonder, ) Female 40

43 Incidence of Cancer Type of Cancer Number of Cases Percent of Total Incidence of Cancer Prostate % Lung and Bronchus % Breast % Colon and Rectum % Other/Unspecified 91 9% Bladder 54 5% Non-Hodgkins Lymphoma 44 4% Melanoma of Skin 38 4% Pancreas 32 3% Cancer and Corpus Uteri 32 3% Kidney and Renal Pelvis 30 3% Leukemia 20 2% Oral Cavity & Pharynx 16 1% Multiple Myeloma 15 1% Stomach 13 1% Esophagus 13 1% Brain and CNS 13 1% Thyroid 10 <1% Larynx 10 <1% Ovary 9 <1% Liver and Bile Ducts 9 <1% Hodgkins Lymphoma 7 <1% Testis 6 <1% Cancer of Cervix Uteri 3 <1% Total 1, % (Source: Ohio Cancer Incidence Surveillance System, ODH Information Warehouse, Updated 1/9/2014) CANCER 41

44 Adult І DIABETES Key Findings In 2015, 9% of adults had been diagnosed with diabetes. Diabetes The 2015 health assessment project has identified that 9% of adults had been diagnosed with diabetes, increasing to 25% of those age 65 and older. The 2013 BRFSS reports an Ohio and U.S. prevalence of 11%. 88% of adults with diabetes were receiving treatment for their diabetes. More than one-fourth (27%) of adults with diabetes rated their health as fair or poor. adults diagnosed with diabetes also had one or more of the following characteristics or conditions: o 88% were obese or overweight o o 76% had been diagnosed with high blood pressure 68% had been diagnosed with high blood cholesterol Diabetes Facts Nearly 30 million children and adults in the United States have diabetes. 86 million Americans have prediabetes. 1.7 million Americans are diagnosed with diabetes every year. Nearly 10% of the entire U.S. population has diabetes, including over 25% of seniors. As many as 1 in 3 American adults will have diabetes in 2050 if present trends continue. The economic cost of diagnosed diabetes in the U.S. is $245 billion per year. 8.1 million Americans have undiagnosed diabetes Diabetes kills more Americans every year than AIDS and breast cancer combined. Diabetes is the primary cause of death for 69,071 Americans each year, and contributes to the death of 231,051 Americans annually. (Source: American Diabetes Association, 2014 Fast Facts, %20Sean/14 fast facts june2014 final3.pdf) 30% Adults Diagnosed with Diabetes 25% 20% 19% 10% 9% 8% 11% 10% 8% 12% 12% 0% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus Adult Comparisons Ohio 2013 U.S Diagnosed with diabetes 12% 12% 9% 11% 11% 42

45 Diabetes Symptoms The most common symptoms of type 1 and type 2 diabetes are: TYPE 1 DIABETES Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue and irritability TYPE 2 DIABETES Any of the type 1 symptoms Blurred vision Tingling/numbness in hands or feet Recurring skin, gum, or bladder infections Cuts/bruises that are slow to heal Frequent infections (Source: American Diabetes Association, Diabetes Basics, Symptoms, Who is at Greater Risk for Type 2 Diabetes People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) People over age 45 People with a family history of diabetes People who are overweight or obese People who do not exercise regularly People with low HDL cholesterol or high triglycerides, high blood pressure Certain racial and ethnic groups (e.g. Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives) Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth DIABETES (Source: American Diabetes Association, Diabetes Basics, Your Risk: Who is at Greater Risk for Type 2 Diabetes, 43

46 The following graphs show prevalence of diabetes by gender and the age-adjusted mortality rates from diabetes for and Ohio residents with comparison to the Healthy People 2020 target objective. In 2010, the prevalence of diabetes was equal among males than females in. From 2009 to 2011, s age-adjusted diabetes mortality rate was less than the Ohio, the national rate, and the Healthy People 2020 target objective. Prevalence of Diabetes by Gender, % Percentage per 100,000 population 10% 5% 0% 11% 11% Male Female (Source: Network of Care: Health Indicators, Public Health Assessment and Wellness) Healthy People 2020 Objectives and Age-Adjusted Mortality Rates for Diabetes Rate per 100,000 population Ohio U.S HP 2020 Target (Source: Network of Care: Health Indicators, CDC, and Healthy People 2020) 44

47 The following graph shows the Ohio prevalence of diabetes and prediabetes by BMI weight status category. The following graph shows: The chance of developing diabetes and prediabetes increases relative to increases in BMI weight status category Ohio Prevalence of Diabetes and Prediabetes by BMI Weight Status Category 25% 20% 2.1% 15% 10% 5% 0% 0.1% 1.5% 0.8% 3.6% Underweight Normal Weight Overweight Obese Diabetes Overweight and Obese Type 2 Diabetes Risk by Sex in Ohio Category Increase in Risk Overweight Men 2.4 Overweight Women 3.9 Obese Men 6.7 Obese Women 12.4 (Source: ODH, Obesity and Diabetes in Ohio 2013, from 0.9% 8.5% Prediabetes 19.4% DIABETES 45

48 Adult І ASTHMA AND OTHER RESPIRATORY DISEASE Key Findings According to the survey data, 9% of adults had been diagnosed with asthma. Asthma and Other Respiratory Disease In 2015, 9% of adults had been diagnosed with asthma. 14% of both Ohio and U.S. adults have ever been diagnosed with asthma (Source: 2013 BRFSS). There are several important factors that may trigger an asthma attack. Some of these triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergens, pets, mold, smoke from burning wood or grass, infections linked to the flu, colds, and respiratory viruses (Source: CDC, 2013). Chronic lower respiratory disease was the 3 rd leading cause of death in and in Ohio, in 2013 (Source: ODH, Leading Causes of Death: 2013 Preliminary Data). 20% Adults Diagnosed with Asthma 12% 10% 9% 8% 10% 8% 10% 6% 6% 10% 3% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus Adult Comparisons Ohio 2013 U.S Had been diagnosed with asthma 3% 12% 9% 14% 14% 46

49 The following graphs demonstrate the lifetime and current prevalence rates of asthma by gender for Ohio and U.S. residents. Adult Lifetime Asthma Prevalence Rates By Gender Percentage Self-Reported Percentage Self-Reported 20% 15% 10% 5% 0% 15% 10% 5% 0% 16.5% 16.3% 11.8% 11.7% Males Females Ohio Lifetime U.S. Lifetime Adult Current Asthma Prevalence Rates By Gender 12.4% 11.3% 6.8% 6.7% Males Females Ohio Current U.S. Current ASTHMA (Source for graphs: 2013 BRFSS) Asthma Facts The number of Americans with asthma grows every year. Currently, 26 million Americans have asthma. Asthma mortality is almost 4,000 deaths per year. Asthma results in 456,000 hospitalizations and 2.1 million emergency room visits annually. Patients with asthma reported 13.9 million visits to a doctor s office and 1.4 million visits to hospital outpatient departments. Effective asthma treatment includes monitoring the disease with a peak flow meter, identifying and avoiding allergen triggers, using drug therapies including bronchodilators and anti-inflammatory agents, and developing an emergency plan for severe attacks. (Source: American College of Allergy, Asthma, & Immunology, Asthma Facts, from: 47

50 What Causes an Asthma Attack? Tobacco Smoke: People should never smoke near you, in your home, in your car, or wherever you may spend a lot of time if you have asthma. Tobacco smoke is unhealthy for everyone, especially people with asthma. If you have asthma and you smoke, quit smoking. Dust Mites: If you have asthma, dust mites can trigger an asthma attack. To prevent attacks, use mattress covers and pillowcase covers to make a barrier between dust mites and yourself. Do not use down-filled pillows, quilts, or comforters. Remove stuffed animals and clutter from your bedroom. Outdoor Air Pollution: This pollution can come from factories, automobiles, and other sources. Pay attention to air quality forecasts to plan activities when air pollution levels will be low. Cockroach Allergens: Get rid of cockroaches in your home by removing as many water and food sources as you can. Cockroaches are often found where food is eaten and crumbs are left behind. Cockroaches and their droppings can trigger an asthma attack, so vacuum or sweep areas that might attract cockroaches at least every 2 to 3 days. Pets: Furry pets can trigger an asthma attack. If you think a furry pet may be causing attacks, you may want to find the pet another home. If you can t or don t want to find a new home for a pet, keep it out of the person with asthma s bedroom. Mold: Breathing in mold can trigger an asthma attack. Get rid of mold in your home to help control your attacks. Humidity, the amount of moisture in the air, can make mold grow. An air conditioner or dehumidifier will help keep the humidity level low. Smoke from Burning Wood or Grass: Smoke from burning wood or other plants is made up of a mix of harmful gases and small particles. Breathing in too much of this smoke can cause an asthma attack. If you can, avoid burning wood in your home. Other Triggers: Infections linked to influenza (flu), colds, and respiratory syncytial virus (RSV) can trigger an asthma attack. Sinus infections, allergies, breathing in some chemicals, and acid reflux can also trigger attacks. Physical exercise, some medicines, bad weather, breathing in cold air, some foods, and fragrances can also trigger an asthma attack. (Source: Centers for Disease Control, Vital Signs, Asthma, updated November 18, 2014, 48

51 Adult І WEIGHT STATUS Key Findings The 2015 Health Assessment identified that 70% of adults were overweight or obese based on Body Mass Index (BMI). More than one-third (36%) of adults were obese. The 2013 BRFSS indicates that 30% of Ohio and 29% of U.S. adults were obese by BMI. More than two-fifths (43%) of adults were trying to lose weight. Adult Weight Status In 2015, the health assessment indicated that more than two-thirds (70%) of adults were either overweight (34%) or obese (36%) by Body Mass Index (BMI). This puts them at elevated risk for developing a variety of diseases. More than two-fifths (43%) of adults were trying to lose weight, 33% were trying to maintain their current weight or keep from gaining weight, and 3% were trying to gain weight. adults did the following to lose weight or keep from gaining weight: exercised (47%), ate less food, fewer calories, or foods low in fat (46%), ate a low-carb diet (11%), participated in a prescribed dietary or fitness program (2%), smoked cigarettes (2%), used a weight loss program (1%), took diet pills, powders or liquids without a doctor s advice (1%), took prescribed medications (1%), went without eating 24 or more hours (<1%), and vomited or took laxatives (<1%). Physical Activity 36% of adults are obese. In, 50% of adults were engaging in some type of physical activity or exercise for at least 30 minutes 3 or more days per week. 30% of adults were exercising 5 or more days per week. Nearly one-third (32%) of adults were not participating in any physical activity in the past week, including 4% who were unable to exercise. adults spent the most time doing the following physical activities in the past year: walking (41%), multiple types (17%), exercise machines (7%), running/jogging (7%), strength training (3%), cycling (1%), swimming (<1%), and other activities (7%). 17% of adults did not exercise at all, including 2% who were unable to do so. In, 50% of adults were engaging in some type of physical activity or exercise for at least 30 minutes 3 or more days per week. Reasons for not exercising included: time (29%), weather (24%), too tired (18%), laziness (17%), chose not to exercise (12%), pain or discomfort (9%), could not afford a gym membership (8%), no gym available (3%), no walking or biking trails (2%), did not have child care (2%), safety (1%), no sidewalks (1%), did not know what activities to do (1%), doctor advised them not to exercise (1%), and other reasons (3%). ADULT WEIGHT The CDC recommends that adults participate in moderate exercise for at least 2 hours and 30 minutes every week or vigorous exercise for at least 1 hour and 15 minutes every week. Whether participating in moderate or vigorous exercise, CDC also recommends musclestrengthening activities that work all major muscle groups on 2 or more days per week (Source: CDC, Physical Activity for Everyone). 49

52 Nutrition In 2015, 6% of adults were eating 5 or more servings of fruits and vegetables per day. 90% were eating between 1 and 4 servings per day. The American Cancer Society recommends that adults eat at least 2 ½ cups of fruits and vegetables per day to reduce the risk of cancer and to maintain good health. The 2009 BRFSS reported that only 21% of Ohio adults and 23% nationwide were eating the recommended number of servings of fruits and vegetables. adults reported the following reasons they chose the types of food they ate: taste (61%), enjoyment (54%), cost (49%), ease of preparation (38%), availability (37%), healthiness of food (36%), food they were used to (29%), time (28%), what their spouse prefers (22%), nutritional content (21%), calorie content (18%), what their child prefers (7%), if it is organic (7%), if it is genetically modified (5%), gluten free (3%), health care provider s advice (3%), other food sensitivities (3%), and other reasons (1%). Adults ate out in a restaurant or brought home take-out food an average of 2.3 times per week. More than two-fifths (43%) of adults were trying to lose weight. The following graph shows the percentage of adults who are overweight or obese by Body Mass Index (BMI). Examples of how to interpret the information include: 27% of all adults were classified as normal weight, 34% were overweight, and 36% were obese. 100% Adult BMI Classifications 80% 36% 34% 38% 25% 40% 40% 42% 35% 35% 35% 60% 40% 34% 43% 24% 33% 36% 39% 20% 39% 32% 39% 20% 0% 27% 20% 36% 35% 23% Total Male Female Under Years 17% 36% 65 & Over Income < $25K 24% 31% Income $25K Plus % 2012 Normal Overweight Obese (Percentages may not equal 100% due to the exclusion of data for those who were classified as underweight) 50

53 The following graph shows the percentage of adults who are obese compared to Ohio and U.S. Obesity in, Ohio, and U.S. Adults 60% 40% 20% 0% 36% Ohio U.S. Adult Comparisons (Source: 2015 Health Assessment and 2013 BRFSS) Ohio 2013 U.S Obese 35% 35% 36% 30% 29% Overweight 32% 39% 34% 35% 35% Obesity Facts More than one-third of U.S. adults (34.9%) are obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death. The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight. Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-hispanic whites (32.6%), and non-hispanic Asians (10.8%). (Source: CDC, Adult Obesity Facts, updated September 9, 2014, 30% 29% ADULT WEIGHT 51

54 Adult І TOBACCO USE Key Findings In 2015, 15% of adults were current smokers and 21% were considered former smokers. In 2015, the American Cancer Society (ACS) stated that tobacco use was the most preventable cause of death worldwide, and is responsible for the deaths of approximately half of long-term users. Each year, tobacco use is responsible for almost 6 million premature deaths, 80% of which are in low-and middle-income countries, and by 2030, this number is expected to increase to 8 million (Source: Cancer Facts & Figures, American Cancer Society, 2015). In 2015, 15% of adults were current smokers. Adult Tobacco Use Behaviors The 2015 health assessment identified that more than one-in-seven (15%) adults were current smokers (those who indicated smoking at least 100 cigarettes in their lifetime and currently smoke some or all days). The 2013 BRFSS reported current smoker prevalence rates of 23% for Ohio and 19% for the U.S. More than one-fifth (21%) of adults indicated that they were former smokers (smoked 100 cigarettes in their lifetime and now do not smoke). The 2013 BRFSS reported former smoker prevalence rates of 25% for both Ohio and the U.S. adult smokers were more likely to: o Have been separated (40%) or divorced (33%) o Have rated their overall health as fair or poor (22%) o Were ages (18%) adults used the following tobacco products in the past year: cigarettes (24%), chewing tobacco (7%), e-cigarettes (6%), cigars (3%), snuff (2%), hookah (2%), Black and Milds (1%), little cigars (1%), snus (1%), swishers (1%), flavored cigarettes (1%), and pipes (1%). 53% of current smokers responded that they had stopped smoking for at least one day in the past year because they were trying to quit smoking. adults had the following rules/practices about smoking in their home: never allowed (71%), not allowed when children are present (8%), allowed anywhere (6%), and allowed in certain rooms (4%). adults had the following rules/practices about smoking in their car: never allowed (76%), allowed with windows open (10%), allowed anywhere (4%), and not allowed when children are present (3%). Adult Comparisons Ohio 2013 U.S Current smoker 21% 18% 15% 23% 19% Former smoker 29% 26% 21% 25% 25% 52

55 The following graph shows the percentage of adults who used tobacco. Examples of how to interpret the information include: 15% of all adults were current smokers, 21% of all adults were former smokers, and 64% had never smoked. 100% 80% 60% 40% 20% 0% 64% 63% 63% 21% 21% 21% 15% 16% 16% Total Male Female Under Years Adult Smoking Behaviors 86% 5% 9% 57% 59% 25% 18% 11% 14% 16% 21% 18% 65 & Over Income <$25K Income $25K Plus 2008 If yes, do you now smoke cigarettes every day, some days or not at all? Respondents were asked: Have you smoked at least 100 cigarettes in your entire life? % of current smokers responded that they had stopped smoking for at least one day in the past year because they were trying to quit smoking. 30% 69% 17% 60% 24% Current smoker Former smoker Never smoked Smoke-free Living: Benefits & Milestones 50% 56% According to the American Heart Association and the U.S. Surgeon General, this is how your body starts to recover: In your first 20 minutes after quitting: your blood pressure and heart rate recover from the cigarette-induced spike. After 12 hours of smoke-free living: the carbon monoxide levels in your blood return to normal. After two weeks to three months of smoke-free living: your circulation and lung function begin to improve. After one to nine months of smoke-free living: clear and deeper breathing gradually returns as coughing and shortness of breath diminishes; you regain the ability to cough productively instead of hacking, which cleans your lungs and reduce your risk of infection. One year after quitting smoking, a person s risk of coronary heart disease is reduced by 50 percent. Five to 15 years after quitting smoking, a person s risk of stroke is similar to that of a nonsmoker. After 10 years of smoke-free living, your lung cancer death rate is about half that of a person who has continued to smoke. The risk of other cancers, such as throat, mouth, esophagus, bladder, cervix and pancreas decreases too. 29% 26% ADULT TOBACCO (Source: AHA, Smoke-free Living: Benefits & Milestones, 2012, from: Milestones_UCM_322711_Article.jsp) 53

56 Electronic Cigarettes Facts Electronic cigarettes (e-cigarettes) are a type of electronic smoking device, resembling cigarettes. They can also look like pipes, pens, or USB memory sticks. E-cigarettes cost approximately $30-60, and refill cartridges cost $7-$10. More recently, disposable e-cigarettes that last up to two packs are being sold for under $10 in local and national convenience stores. Cartridges generally contain mg of nicotine. However, as e-cigarettes are unregulated by the Food and Drug Administration (FDA), their contents and the level of these contents can be highly variable. Ever use of e-cigarettes is highest among current cigarette smoking adults in the U.S. and increased from 9.8% in 2010 to 21.2% in 2011 to 32% in Early studies by the FDA found varying levels of nicotine and other potentially harmful ingredients, including cancer-causing substances and di-ethylene glycol, which is found in antifreeze. However, these substances were found at much lower levels than in traditional cigarettes. The awareness and use of electronic cigarettes are increasing. In 2011, 6 of 10 U.S. adults were aware of electronic cigarettes with 21% of smokers having ever used an electronic cigarette. Nicotine is found in both inhaled and exhaled vapor of electronic cigarettes. Studies have also found heavy metals, silicates, and cancer-causing compounds in exhaled e-cigarette vapor. (Source: Philadelphia Department of Public Health, Electronic Cigarette Fact sheet, published February 2014, from: & Legacy for Health, Tobacco Fact Sheet, May 2014, from: FactSheet-eCigarettes-JUNE2013.pdf) 21% of adults indicated that they were former smokers. The following graph shows, Ohio, and U.S. adult cigarette smoking rates. The BRFSS rates shown for Ohio and the U.S. were for adults 18 years and older. This graph shows: adult cigarette smoking rate was lower than the Ohio and U.S. rates, and higher than the Healthy People 2020 Goal. Healthy People 2020 Objective & Cigarette Smoking Rates 40% 30% 20% 15% 23% 19% 12% 10% 0% 2015 Ohio 2013 U.S HP 2020 Target (Source: 2015 Health Assessment, 2013 BRFSS and Healthy People 2020) 54

57 The following graphs show, Ohio, and U.S. age-adjusted mortality rates per 100,000 population for chronic lower respiratory diseases (formerly COPD) in comparison with the Healthy People 2020 objectives and the percentage of and Ohio mothers who smoked during pregnancy. These graphs show: From , s age-adjusted mortality rate for chronic lower respiratory disease was higher than the Ohio and the U.S. rate, but lower than the Healthy People 2020 target objective. Disparities existed by gender for chronic lower respiratory disease mortality rate. The male rates were higher than the female rates. Rate per 100,000 population 50% 40% 30% 20% 10% 0% % 55 Age-Adjusted Mortality Rates for Chronic Lower Respiratory Diseases (Formerly COPD) Total Male Female Ohio U.S HP 2020 Target* (Source: ODH Information Warehouse and Healthy People 2020) * Healthy People 2020 s target rate and the U.S. rate is for adults aged 45 years and older. **HP2020 does not report different goals by gender. and Ohio Births to Mothers Who Smoked During Pregnancy 23% 19% 20% 19% 21% 19% 19% Mothers Ohio Mothers % 38 18% ADULT TOBACCO (Source: ODH Information Warehouse) 55

58 The following graphs show, Ohio, and U.S. age-adjusted mortality rates per 100,000 population for lung and bronchus cancer in comparison with the Healthy People 2020 objectives and mortality rates by gender. These graphs show: Disparities existed by gender for lung and bronchus cancer age-adjusted mortality rates. The lung and bronchus cancer mortality rates for males were substantially higher than the female rates. Rate per 100,000 population Age-Adjusted Mortality Rates for Lung and Bronchus Cancer Ohio U.S HP 2020 Target* *Healthy People 2020 Target data is for lung cancer only (Sources: Healthy People 2020, National Cancer Institute, ODH Information Warehouse, updated 2014) Rate per 100,000 population Age-Adjusted Mortality Rates by Gender for Lung and Bronchus Cancer 90 Males Females (Source: ODH Information Warehouse, updated 2014) U.S. Adult Smoking Facts The percentage of American adults who smoke decreased from (20.9%) in 2005 to (19.3%) in About 1 in 5 (46.6 million) adults still smoke. 443,000 Americans die of smoking or exposure to secondhand smoke each year. More men (about 22%) than women (about 17%) smoke. Adults living below poverty level (29%) are more likely to smoke than adults living at or above poverty level (18%). Smoking rates are higher among people with a lower education level. (Source: CDC, Vital Signs, Tobacco Use: Smoking & Secondhand Smoke, September 2011, 56

59 Cigarette Expenditures, Percent of Total Expenditures, National Rank by Tract, Nielsen 2011 (Source: Community Commons, updated 2/4/2015) ADULT TOBACCO 57

60 Adult І ALCOHOL CONSUMPTION Key Findings In 2015, the Health Assessment indicated that 10% of adults were considered frequent drinkers (drank an average of three or more days per week, per CDC guidelines). 44% of adults who drank had five or more drinks (for males) or 4 or more drinks (for females) on one occasion (binge drinking) in the past month. Four percent of adults drove after having perhaps too much to drink. 49% of adults had at least one alcoholic drink in the past month. Adult Alcohol Consumption In 2015, 49% of the adults had at least one alcoholic drink in the past month, increasing to 56% of males and 64% of those under the age of 30. The 2013 BRFSS reported current drinker prevalence rates of 53% for Ohio and 55% for the U.S. One-in-ten (10%) adults were considered frequent drinkers (drank on an average of three or more days per week). Of those who drank, adults drank 2.5 drinks on average, increasing to 2.9 drinks for those with incomes less than $25,000. Almost one-quarter (23%) of adults were considered binge drinkers. The 2013 BRFSS reported binge drinking rates of 17% for both Ohio and for the U.S. 44% of those current drinkers reported they had five or more alcoholic drinks (for males) or 4 or more drinks (for females) on an occasion in the last month and would be considered binge drinkers by definition. 4% of adults reported driving after having perhaps too much to drink. adults drove the following after having 5 or more alcoholic beverages: motor vehicle (3%), ATV (1%), and other (2%). No one reported driving a boat, watercraft, snowmobile, or motorcycle after having 5 or more alcoholic beverages. adults reported that as a result of drinking, they or a family member repeatedly: placed themselves or a family member in dangerous situations (3%), had legal problems (3%), failed to fulfill obligations at home (2%), and failed to fulfill obligations at work (1%). Adult Comparisons Ohio 2013 U.S Drank alcohol at least once in past month 52% 53% 49% 53% 55% Binge drinker (drank 5 or more drinks for males and 4 or more for females on an occasion) 20% 20% 23% 17% 17% 58

61 The following graphs show the percentage of adults consuming alcohol and the amount consumed on average. Examples of how to interpret the information shown on the first graph include: 45% of all adults did not drink alcohol, 37% of males did not drink, and 52% of adult females reported they did not drink % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 33% 16% 45% Average Number of Days Drinking Alcohol in the Past Month 39% 17% 37% 27% 16% 52% 40% 24% 28% 33% 17% 45% Total Male Female Under Years 65 & Over Income <$25K Income $25K Plus 2008 Percentages may not equal 100% as some respondents answered don t know % of adults were considered frequent drinkers (drank on an average of three or more days per week). 15% 7% 75% 26% 24% 48% Did not drink any 1-2 days 3 or more days 38% 12% 35% 43% 48% 31% 17% 15% Adults Average Number of Drinks Consumed Per Drinking Occasion Total Males Females Under Years & Over Income <$25K Income $25K Plus % ADULT ALCOHOL 59

62 The following graphs show the percentage of drinkers who binge drank in the past month and a comparison of binge drinkers with Ohio and U.S. 80% Adult Drinkers Who Binge Drank in Past Month* 60% 54% 59% 40% 44% 32% 35% 45% 36% 41% 24% 26% 20% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus *Based on adults who have drunk alcohol in the past month. Binge drinking is defined as having five or more drinks (for males) or four or more drinks (for females) on an occasion. Adults must have reported drinking five or more drinks (for males) or four or more drinks (for females) on an occasion at least once in the previous month. 4% of adults reported driving after having perhaps too much to drink. 40% Adult Binge Drinkers* 30% 23% 20% 17% 17% 10% 0% 2015 Ohio 2013 U.S (Source: 2013 BRFSS, 2015 Health Assessment) *Based on all adults. Binge drinking is defined as males having five or more drinks on an occasion, females having four or more drinks on one occasion. 60

63 The following table shows the city of, Hicksville,, and Ohio motor vehicle accident statistics. The table shows: 28% of all fatal injury crashes in were alcohol-related compared to 29% in Ohio. (Source: Ohio Department of Public Safety, Crash Reports, Updated 2/6/2015, Traffic Crash Facts) Caffeinated Alcoholic Beverages City of Hicksville 2014 City of Ohio 2014 Total Crashes , ,341 Alcohol-Related Total Crashes ,954 Fatal Injury Crashes Alcohol-Related Fatal Crashes Alcohol Impaired Drivers in Crashes ,833 Injury Crashes ,320 Alcohol-Related Injury Crashes ,847 Property Damage Only ,120 Alcohol-Related Property Damage Only ,844 Deaths Alcohol-Related Deaths Total Non-Fatal Injuries ,77 Alcohol-Related Injuries ,719 Excessive alcohol consumption is responsible for about 88,000 deaths and 2.5 million years of potential life lost (YPLL) in the United States each year. Drinkers who consume alcohol mixed with energy drinks are 3 times more likely to binge drink than drinkers who do not report mixing alcohol with energy drinks. Drinkers who consume alcohol with energy drinks are about twice as likely as drinkers who do not report mixing to report being taken advantage of sexually, to report taking advantage of someone else sexually, and to report riding with a driver who was under the influence of alcohol. ADULT ALCOHOL (Source: CDC, Alcohol and Public Health, Fact Sheets, Caffeinated Alcoholic Beverages, November 2014, 61

64 Alcohol Beverage Expenditures, Percent of Total Expenditures, National Rank by Tract, Nielsen 2011 (Source: Community Commons, updated 2/6/2015) 62

65 Bars and Drinking Establishments, Rate (Per 100,000 Pop.) by Zip Code Tract Area, Census Business Patterns 2012 (Source: Community Commons, updated 2/6/2015) ADULT ALCOHOL 63

66 Beer, Wine and Liquor Stores, Rate (Per 100,000 Pop.) by, Census Business Patterns 2012 (Source: Community Commons, updated 2/6/2015) 64

67 Adult І DRUG USE Key Findings In 2015, 4% of adults had used marijuana during the past 6 months. 3% of adults had used medication not prescribed for them or took more than prescribed to feel good or high and/or more active or alert during the past 6 months. Adult Drug Use 4% of adults had used marijuana in the past 6 months, increasing to 5% of those with incomes more than $25,000. <1% of adults reported using other recreational drugs in the past six months such as cocaine, synthetic marijuana/k2, heroin, LSD, inhalants, Ecstasy, bath salts, and methamphetamines. When asked about their frequency of marijuana and other recreational drug use in the past six months, 24% of adults who used drugs did so almost every day, and 14% did so less than once a month. 3% of adults had used medications not prescribed for them or they took more than prescribed to feel good or high and/or more active or alert during the past 6 months, increasing to 7% of those over the age of 65. When asked about their frequency of medication misuse in the past six months, 6% of adults who used these drugs did so 3 to 4 days a week, and 22% did so less than once a month. Adult Comparisons Adults who used marijuana in the past 6 months Adults who used other recreational drugs in the past 6 months Adults who misused prescription drugs in the past 6 months N/A Not available Ohio 2013 U.S % 4% 4% N/A N/A 6% 5% <1% N/A N/A 1% 7% 3% N/A N/A ADULT DRUG USE 65

68 The following graphs are data from the 2015 Health Assessment indicating adult marijuana use in the past six months and medication misuse in the past six months. Examples of how to interpret the information include: 4% of all adults used marijuana in the past six months, 4% of adults under the age of 30 were current users, and 1% of adults with incomes less than $25,000 were current users. 10% Adult Marijuana Use in Past 6 Months 5% 4% 4% 5% 4% 4% 5% 5% 4% 1% 1% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus % Adult Medication Misuse in Past 6 Months 6% 7% 7% 5% 4% 4% 3% 3% 3% 2% 1% 0% Total Males Females Under Years 65 & Over Income <$25K Income $25K Plus

69 The following graph shows accidental deaths due to drug overdose from January 1, 2013 to August 4, The graph shows that: There were a total of 13 accidental deaths due to drug overdose in from 2013 to Number of Fatalities Accidental Deaths Due to Drug Overdose * *There were 5 deaths in 2015 attributed to drug overdoses, with 4 more probable deaths pending toxicology results. (Source: General Health District Vital Statistics, Death Certificate Data) Heroin Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. In 2011, 4.2 million Americans aged 12 or older had used heroin at least once in their lives. It is estimated that about 23% of individuals who use heroin become dependent on it. Heroin overdoses frequently involve a suppression of breathing. This can affect the amount of oxygen that reaches the brain, a condition called hypoxia. Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease. (Source: National Institute on Drug Abuse, Drug Facts: Heroin, October 2014, from: 9 ADULT DRUG USE 67

70 The following graphs are data from the Ohio Automated Prescription Reporting System indicating and Ohio opiate and pain reliever doses per patient, as well as opiate and pain reliever doses per capita. and Ohio Number of Opiate and Pain Reliever Doses Per Patient Doses per Patient Ohio and Ohio Number of Opiate and Pain Reliever Doses Per Capita Doses per Capita Ohio (Source: Ohio Automated Rx Reporting System, April 22, 2015, from: 68

71 Unintentional Drug Overdose Death Rates The average age-adjusted unintentional drug overdose death rate was 9.1 deaths per 100,000 in from The average age-adjusted unintentional drug overdose death rate was 15.0 deaths per 100,000 in Ohio from (Source: Ohio Department of Health, Office of Vital Statistics, Unintentional Drug Overdose Death Rates for Ohio Residents by, obtained from: ADULT DRUG USE 69

72 Prescription Analgesic Doses Per Capita In 2012, the statewide average per capita dosage rate was 66.7 doses per person. The average per capita dosage rate was doses per person in in (Source: Ohio Mental Health and Addiction Services, Doses Per Capita September 2013, obtained from: 70

73 Felony Cases and Drug Arrests January June 2015 Ohio State Highway Patrol (OSHP) investigated a wide range of felony offenses during the first half of 2015, including vice (1,820); assault (717); larceny (292); false pretense (100); property crimes (77); homicide/death (16); robbery/burglary (7); and various other types of felony offenses (150). OSHP Troopers made 6,256 total drug arrests during the first 6 months of 2015 a 10% increase compared to 2014 and a 30% increase compared to the previous 3-year average ( ). Of the 6,256 drug arrests, over one-quarter (1,720 or 27%) included one or more felony drug charges. This represents a 36% increase over the previous 3-year average ( ). ADULT DRUG USE (Source: Ohio State Highway Patrol, Felony Cases and Drug Arrests, January June 2015, from 71

74 Adult І WOMEN S HEALTH Key Findings In 2015, nearly two-thirds (66%) of women over the age of 40 reported having a mammogram in the past year. 57% of women ages 19 and over had a clinical breast exam and 43% had a Pap smear to detect cancer of the cervix in the past year. The Health Assessment determined that 4% of women survived a heart attack and 3% survived a stroke at some time in their life. Almost one-third (31%) had high blood pressure, 30% had high blood cholesterol, 38% were obese, and 16% were identified as smokers, known risk factors for cardiovascular diseases. Women s Health Screenings In 2015, 67% of women had a mammogram at some time and two-fifths (41%) had this screening in the past year. Female Leading Types of Death, Heart Diseases (23% of all deaths) 2. Cancers (21%) 3. Stroke (8%) 4. Chronic Lower Respiratory Diseases (7%) 5. Alzheimer s (6%) (Source: CDC Wonder, ) Ohio Female Leading Types of Death, Heart Diseases (23% of all deaths) 2. Cancers (21%) 3. Chronic Lower Respiratory Diseases (7%) 4. Stroke (6%) 5. Alzheimer s disease (5%) (Source: CDC Wonder, ) Nearly two-thirds (66%) of women ages 40 and over had a mammogram in the past year and 80% had one in the past two years. The 2012 BRFSS reported that 74% of women 40 and over in both Ohio and the U.S., had a mammogram in the past two years. Most (93%) women have had a clinical breast exam at some time in their life and 57% had one within the past year. Nearly three-fourths (73%) of women ages 40 and over had a clinical breast exam in the past two years. The 2010 BRFSS reported that 75% of women 40 and over in Ohio and 77% in the U.S., had a clinical breast exam in the past two years. This assessment has identified that 93% of women have had a Pap smear and 43% reported having had the exam in the past year. 73% of women had a pap smear in the past three years. The 2012 BRFSS indicated that 78% of both Ohio and U.S. women had a pap smear in the past three years. women completed an average of 4.2 self-breast exams in the past year, increasing to 5.6 for those ages 40 and older. Pregnancy 16% of women had been pregnant in the past 5 years. Thinking back to their last pregnancy: 43% of women wanted to be pregnant then, 33% did not want to be pregnant then or any time in the future, 15% wanted to be pregnant sooner, 7% wanted to be pregnant later, and 4% of women did not recall. During their last pregnancy, women: got a prenatal appointment in the first 3 months (95%), took a multi-vitamin (86%), took folic acid during pregnancy (41%), took folic acid prepregnancy (22%), smoked cigarettes (16%), experienced perinatal depression (8%), consumed alcoholic beverages (5%), and used marijuana (5%). 72

75 Women s Health Concerns From , major cardiovascular diseases (heart disease and stroke) accounted for 31% of all female deaths in (Source: CDC Wonder, Underlying Cause of Death). Women used the following as their usual source of services for female health concerns: general or family physician (40%), private gynecologist (28%), nurse practitioner/physician s assistant (10%), multiple places (4%), family planning clinic (3%), community health center (3%), and health department clinic (2%). 11% indicated they did not have a usual source of services for female health concerns. In 2015, the health assessment determined that 4% of women had survived a heart attack and 3% had survived a stroke at some time in their life. Major risk factors for cardiovascular disease include smoking, obesity, high blood cholesterol, high blood pressure, physical inactivity, and diabetes. In, the 2015 Health Assessment has identified that: 62% were overweight or obese (60% Ohio, 58% U.S., 2013 BRFSS) 31% were diagnosed with high blood pressure (32% Ohio, 30% U.S., 2013 BRFSS) 30% were diagnosed with high blood cholesterol (36% Ohio, 37% U.S., 2013 BRFSS) 16% of all women were current smokers (23% Ohio, 17% U.S., 2013 BRFSS) 11% had been diagnosed with diabetes (12% Ohio, 12% U.S., 2013 BRFSS) The following graph shows the percentage of female adults that had various health exams in the past year. Examples of how to interpret the information shown on the graph include: 41% of females had a mammogram within the past year, 57% had a clinical breast exam, and 43% had a Pap smear. 100% 75% 50% 25% 0% 41% 66% 57% 58% 59% 53% 43% Adult Comparisons Had a clinical breast exam in the past two years (age 40 & over) Had a mammogram in the past two years (age 40 & over) Had a pap smear in the past three years N/A Not Available *2010 BRFSS Data **2012 BRFSS Data Women's Health Exams Within the Past Year 0% 29% Total Under & Older Income <$25K Income >$25K % 38% 38% 45% % 45% % 62% 59% Mammogram Breast Exam Pap Smear Ohio % 53% 50% U.S % 66% 73% 75%* 77%* 69% 67% 80% 74%** 74%** 79% 74% 73% 78%** 78%** WOMEN S HEALTH 73

76 The following graphs show the and Ohio age-adjusted mortality rates per 100,000 population for cardiovascular diseases. The graphs show: From , the and Ohio female age-adjusted mortality rate was lower than the male rate for heart disease. The female heart disease mortality rate was lower than the Ohio female rate from 2009 to Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, Rate per 100,000 population Male Female 0 Heart Disease Stroke Ohio Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, Rate per 100,000 population Male Female 0 Heart Disease Stroke (Source: Health Indicators Warehouse, ) 74

77 The following graphs show the age-adjusted cancer mortality rates per 100,000 population for women with comparison to Healthy People 2020 objectives when available. The graphs show: From , the age-adjusted mortality rate for female lung cancer mortality rate was less than the Ohio rate. The breast cancer and colon/rectum mortality rates were greater than the Ohio rate. Rate per 100,000 population Female Age-Adjusted Cancer Mortality Rates Lung Cancer Colon/Rectum Cancer Breast Cancer (Source: CDC Wonder and Healthy People 2020) *Note: Healthy People 2020 target rates are not gender specific; Healthy People 2020 Targets may not be available for all diseases Ohio HP 2020 Target* Human Papilloma Virus (HPV and Vaccine) Approximately 79 million Americans are infected with human papillomavirus (HPV); approximately 14 million people will become newly infected each year. Some HPV types can cause cervical, vaginal, and vulvar cancer among women, penile cancer among men, and anal and some oropharyngeal cancers among both men and women. Other HPV types can cause genital warts among both sexes. Each year in the United States an estimated 27,000 new cancers attributable to HPV occur, 17,600 among females (of which 10,400 are cervical cancer) and 9,300 among males (of which 7,200 are oropharyngeal cancers). There are, however, two HPV vaccines available (Gardasil and Cervarix ) which protect against the types of HPV infection that cause most cervical cancers (HPV types 16 and 18). Both vaccines should be given as a three-shot series. Clinical trials and postlicensure monitoring data show that both vaccines are safe. CDC recommends HPV vaccination for the prevention of HPV infections responsible for most types of cervical cancer. (Sources: Centers for Disease Control and Prevention, Vaccine Safety, Human Papillomavirus (HPV) Vaccine, updated January 26, 2015, from WOMEN S HEALTH 75

78 Adult І MEN S HEALTH Key Findings In 2015, 50% of males over the age of 50 had a Prostate-Specific Antigen (PSA) test. Major cardiovascular diseases (heart disease and stroke) accounted for 33% and cancers accounted for 27% of all male deaths in from The Health Assessment determined that 4% of men survived a heart attack and 3% survived a stroke at some time in their life. Nearly onethird (32%) of men had been diagnosed with high blood pressure, 25% had high blood cholesterol, and 16% were identified as smokers, which, along with obesity (34%), are known risk factors for cardiovascular diseases. Men s Health Screenings and Concerns Male Leading Types of Death, Cancers (27% of all deaths) 2. Heart Diseases (24%) 3. Chronic Lower Respiratory Diseases (9%) 4. Stroke (6%) 5. Accidents, Unintentional Injuries (5%) (Source: CDC Wonder, ) Ohio Male Leading Types of Death, Heart Diseases (25% of all deaths) 2. Cancers (24%) 3. Chronic Lower Respiratory Diseases (6%) 4. Accidents, Unintentional Injuries (6%) 5. Stroke (4%) (Source: CDC Wonder, ) More than one-third (37%) of males had a Prostate-Specific Antigen (PSA) test at some time in their life and 22% had one in the past year. 76% of males age 50 and over had a PSA test at some time in their life, and 50% had one in the past year. 51% of men had a digital rectal exam in their lifetime and 15% had one in the past year. From , major cardiovascular diseases (heart disease and stroke) accounted for 33% of all male deaths in (Source: CDC Wonder). In 2015, the health assessment determined that 4% of men had a heart attack and 3% had a stroke at some time in their life. 15% of males had a digital rectal exam in the past year. Major risk factors for cardiovascular disease include smoking, obesity, high blood cholesterol, high blood pressure, physical inactivity, and diabetes. In the 2015 health assessment has identified that: o 77% were overweight or obese (71% Ohio, 71% U.S., 2013 BRFSS) o 32% were diagnosed with high blood pressure (36% Ohio, 34% U.S., 2013 BRFSS) o 25% were diagnosed with high blood cholesterol (40% Ohio, 40% U.S., 2013BRFSS) o 16% of all men were current smokers (24% Ohio, 22% U.S., 2013 BRFSS) o 8% had been diagnosed with diabetes (10% Ohio, 10% U.S., 2013 BRFSS) From , the leading cancer deaths for males were lung, prostate, and colon and rectum cancers. Statistics from the same period for Ohio males show lung, prostate, and colon and rectum cancers as the leading cancer deaths (Source: ODH Information Warehouse). 76

79 The following graph shows the percentage of male adults that had various health exams in the past year. Examples of how to interpret the information shown on the graph include: 22% of males had a PSA test within the past year and 15% had a digital rectal exam. 60% Men's Health Exams Within the Past Year 50% 40% 20% 0% 22% 15% Adult Comparisons Had a digital rectal exam within the past year N/A Not Available 5% 5% 33% Total Under & Older Income <25K % 11% Prostate-Specific Antigen 2012 Income >25K Ohio U.S % 22% 15% N/A N/A Had a PSA test within the past year 32% 28% 22% N/A N/A 26% 18% 32% 33% Digital Rectal 28% 22% MEN S HEALTH 77

80 The following graphs show the and Ohio age-adjusted mortality rates per 100,000 population for cardiovascular diseases by gender. The graphs show: From , the and Ohio male age-adjusted mortality rate was higher than the female rate for heart disease. The male age-adjusted mortality rate was lower than the female rate for stroke in The male age-adjusted heart disease mortality rate was lower than the Ohio male rate. 300 Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, Rate per 100,000 population Male Female 0 Heart Disease Stroke Ohio Age-Adjusted Heart Disease and Stroke Mortality Rates By Gender, Rate per 100,000 population Male Female 0 Heart Disease Stroke (Source: Health Indicators Warehouse, ) 78

81 The following graph shows the age-adjusted cancer mortality rates per 100,000 population for men with comparison to Healthy People 2020 objective. The graph shows: From , the age-adjusted mortality rate for male lung cancer was higher than the Ohio average. The colon/rectum cancer age-adjusted mortality rate for males was lower than the Ohio rates for The age-adjusted prostate cancer mortality rate in for was higher than the Ohio rate and the Healthy People 2020 objective. Rate per 100,000 population Male Age-Adjusted Cancer Mortality Rates Lung Cancer Colon/Rectum Cancer Prostate Cancer Ohio HP 2020 Target* *Note: the Healthy People 2020 target rates are not gender specific. (Source: CDC Wonder and Healthy People 2020) Men s Health Data Approximately 12% of adult males ages 18 years or older reported fair or poor health. 21% of adult males in the U.S. currently smoke. Of the adult males in the U.S., 31% had 5 or more drinks in 1 day at least once in the past year. Only 54% of adult males in the U.S. met the 2008 federal physical activity guidelines for aerobic activity through leisure-time aerobic activity. 35% of men 20 years and over are obese. There are 19% of males under the age of 65 without health care coverage. The leading causes of death for males in the United States are heart disease, cancer and accidents (unintentional injuries). (Source: CDC, National Center for Health Statistics, Men s Health, Fast Stats, July 14, 2014, from MEN S HEALTH 79

82 Cancer and Men Every year, more than 300,000 men in America lose their lives to cancer. The most common kinds of cancer among men in the U.S. are skin cancer, prostate cancer, lung cancer, and colorectal cancer. Skin cancer is the most common cancer in the United States. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to ultraviolet (UV) light from the sun and tanning devices. More men in the U.S. die from lung cancer than any other type of cancer, and cigarette smoking accounts for 90% of lung cancer deaths. Smoking increases the risk of developing the following types of cancer: esophagus, pancreas, pharynx, larynx, lip, oral cavity, kidney, bladder, stomach, colorectal, and acute myeloid leukemia. In men, the following cancers are associated with being overweight: colorectal cancer, esophageal adenocarcinoma (a type of cancer of the tube that connects your throat to your stomach), and cancer of the kidney and pancreas. Adopting a lifestyle that includes healthy eating and regular physical activity can help lower the risk for several types of cancers. Prostate cancer is the most frequently diagnosed cancer in men aside from skin cancer. For unclear reasons, incidence rates are 63% higher in African Americans than in whites. It is the second most common cause of cancer death in men. (Source: Center for Disease Control and Prevention, Cancer Prevention and Control, June 9, 2015, and American Cancer Society, Cancer Facts & Figures 2015, 80

83 Adult І PREVENTIVE MEDICINE AND ENVIRONMENTAL HEALTH Key Findings Over half (58%) of adults ages 65 and over had a pneumonia vaccination at some time in their life. More than half (51%) of adults ages 50 and over had a colonoscopy/sigmoidoscopy within the past 5 years. Preventive Medicine Half (50%) of adults had a flu vaccine during the past 12 months. Of those who had a flu vaccine, 96% had the shot and 4% had the nasal spray. 76% of adults ages 65 and over had a flu vaccine in the past 12 months. The 2013 BRFSS reported that 63% of U.S. and Ohio adults ages 65 and over had a flu vaccine in the past year. More than one-fourth (27%) of adults have had a pneumonia shot in their life, increasing to 58% of those ages 65 and over. The 2013 BRFSS reported that 71% of Ohio and 70% of U.S. adults ages 65 and over had a pneumonia shot in their life. adults have had the following vaccines: tetanus booster (including Tdap) in the past 10 years (50%), pneumonia vaccine in their lifetime (27%), Zoster (shingles) vaccine in their lifetime (16%), pertussis vaccine in the past 10 years (7%), and human papillomavirus vaccine in their lifetime (3%). Preventive Health Screenings and Exams More than half (51%) of adults ages 50 and over had a colonoscopy or sigmoidoscopy in the past 5 years. In the past year, 66% of women ages 40 and over have had a mammogram. In the past year, half (50%) of men ages 50 and over have had a PSA test. See the Women and Men s Health Sections for further prostate, mammogram, clinical breast exam, and Pap smear screening test information for adults. Environmental Health Skin Cancer Prevention Recommendations Seek shade, especially during midday hours. Wear clothing to protect exposed skin. Wear a hat with a wide brim to shade the face, head, ears, and neck. Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible. Use sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection. Avoid indoor tanning. (CDC, Skin Cancer Prevention, Updated 5/29/2014, 46% of adults used a septic tank for wastewater. Of those who had a septic tank, 41% had it pumped within the past 5 years, and 20% never had it pumped. 24% did not know the last time their septic tank had been pumped. PREVENTIVE MEDICINE 81

84 47% of adults had a private water source for drinking water. Of those who had a private water source, 20% had it tested within the past year, and 24% have never had it tested. 18% did not know the last time their water source had been tested. households had the following disaster preparedness supplies: cell phone (91%), working flashlight and working batteries (88%), 3-day supply of nonperishable food for everyone in the household (64%), working battery-operated radio and working batteries (53%), 3-day supply of prescription medication for each person who takes prescribed medicines (53%), 3-day supply of water for everyone in the household (1 gallon of water per person per day) (41%), communication plan (12%), and a disaster plan (8%). 11% of adults reported their household was well-prepared to handle a large-scale disaster or emergency, and 21% felt their household was not prepared at all. adults indicated the following as their main method or way of getting information from authorities in a large-scale disaster or emergency: television (63%), radio (44%), internet (36%), neighbors (13%), print media (6%), and other methods (2%). adults thought the following threatened their health in the past year. Mold (8%) Excess medications in home (1%) Insects (7%) Plumbing problems (1%) Moisture issues (3%) Radon (1%) Rodents (3%) General living conditions (1%) Temperature regulation (3%) Safety hazards (<1%) Chemicals found in products (2%) Sanitation issues (<1%) Unsafe water supply/wells (2%) Bed bugs (<1%) Sewage/waste water problems (1%) Cockroaches (<1%) Adult Comparisons Had a pneumonia vaccination (ages 65 and over) Had a flu vaccine in the past year (ages 65 and over) Ohio 2013 U.S N/A N/A 58% 71% 70% N/A N/A 76% 63% 63% N/A Not available 82

85 Adults Having Discussed Healthcare Topics With Their Healthcare Professional in the Past 12 Months HEALTHCARE TOPICS Total 2015 Physical Activity or Exercise 29% Weight, Dieting or Eating Habits 28% Self-Breast or Self-Testicular Exam 24% Immunizations 23% Significance of Family History 17% Depression, Anxiety, or Emotional Problems 15% Quitting Smoking 6% Alternative Pain Therapy 6% Sexual Practices Including Family Planning, STDs, AIDS, & Condom Use 4% Injury Prevention Such As Safety Belt Use & Helmet Use 4% Alcohol Use 4% Alcohol Use When Taking Prescription Drugs 3% Domestic Violence 1% Illicit Drug Abuse 1% Adult Health Screening Results GENERAL SCREENING RESULTS Total Sample Diagnosed with High Blood Pressure 32% Diagnosed with High Blood Cholesterol 27% Diagnosed with Diabetes 9% Diagnosed with a Heart Attack 5% Diagnosed with a Stroke 3% Healthy People 2020 Immunization and Infectious Diseases (IID) - Pneumonia Vaccination Objective IID-13.1: Increase the percentage of non-institutionalized high-risk adults aged 65 years and older who are vaccinated against pneumococcal disease (Percentages based on all adults surveyed) 2015 Ohio 2013 U.S Healthy People 2020 Target 58% 71% 70% 90% *U.S. baseline is age-adjusted to the 2000 population standard (Sources: Healthy People 2020 Objectives, 2013 BRFSS, 2015 Health Assessment) PREVENTIVE MEDICINE 83

86 Basic Disaster Supplies Kit A basic emergency supply kit could include the following recommended items: One gallon of water per person per day for at least three days, for drinking and sanitation. At least a three-day supply of non-perishable food. A working battery operated radio and working batteries. Flashlight and extra batteries. First aid kit. Whistle to signal for help. Dust mask to help filter contaminated air. Moist towelettes, garbage bags and plastic ties for personal sanitation. Cell phone with chargers, inverter or solar charger. Manual can opener for food. (Source: Federal Emergency Management Agency (FEMA), Ready: Prepare. Basic Disaster Supplies Kit, Updated 6/10/2014, from: Who Should Get a Yearly Flu Shot? The following groups are recommended to get a yearly flu vaccine: All persons aged 6 months and older should be vaccinated annually. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons who: Are aged 6 months through 4 years. Are aged 50 years and older. Have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus). Are or will be pregnant during the influenza season. Are American Indians/Alaska Natives. Are morbidly obese (body-mass index is 40 or greater. Are health-care personnel. Are household contacts and caregivers of children aged younger than 5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged younger than 6 months. Are household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza. (Source: CDC, Seasonal Influenza (Flu), Who Should Get Vaccinated Against Influenza, Updated in 2014, from: 84

87 Adult І SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES Key Findings In 2015, more than three-fifths (63%) of adults had sexual intercourse. Four percent of adults had more than one partner. Prevalence estimates suggest that young people aged years acquire half of all new STDs and that 1 in 4 sexually active adolescent females have an STD, such as chlamydia or human papilloma virus (HPV) (Source: CDC, STDs in Adolescents and Young Adults, 2014 STD Surveillance). Adult Sexual Behavior 4% of adults reported they had intercourse with more than one partner in the past year, increasing to 8% of those under the age of 30. adults used the following methods of birth control: vasectomy (21%), tubes tied (17%), they or their partner were too old (16%), birth control pill (13%), hysterectomy (11%), condoms (10%), withdrawal (7%), abstinence (4%), infertility (4%), rhythm method (3%), IUD (2%), diaphragm (1%), and shots (1%). HIV in the United States More than 1.2 million people in the United States are living with HIV infection, and almost 1 in 7 (14%) are unaware of their infection. By race, African Americans face the most severe burden of HIV. The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year. In 2012, an estimated 47,989 people were diagnosed with HIV infection in the United States. In that same year, an estimated 27,928 people were diagnosed with AIDS. Since the epidemic began, an estimated 1,170,989 people in the United States have been diagnosed with AIDS An estimated 13,834 people with an AIDS diagnosis died in 2010, and approximately 648,459 people in the United States with an AIDS diagnosis have died since the epidemic. (Source: CDC, HIV in the United States: At a Glance, 11/25/2014, from: 11% of adults were not using any method of birth control. adults did not use birth control for the following reasons: They or their partner had a hysterectomy/vasectomy/tubes tied (42%) They or their partner were too old (20%) They did not think they or their partner could get pregnant (6%) They did not want to use birth control (6%) They wanted to get pregnant (4%) They did not care if they or their partner got pregnant (3%) Their partner did not want to use birth control (3%) They or their partner did not like birth control/fear of side effects (2%) They or their partner were currently pregnant (2%) They could not pay for birth control (2%) No regular partner (2%) They had a problem getting birth control when they needed it (1%) They or their partner had just had a baby (1%) They or their partner were currently breast feeding (1%) Lapse in use of method (1%) Religious preferences (1%) SEXUAL BEHAVIOR 85

88 adults were treated for the following sexually transmitted diseases in the past five years: genital herpes (1%), multiple STDs (1%), and human papilloma virus (HPV) (<1%). 19% of adults have been tested for HIV as part of a blood donating process, and 13% of adults have been tested for HIV not as part of a blood donating process. 4% of adults reported being forced to have sexual activity when they didn t want to, increasing to 8% of females. The following graph shows the sexual activity of adults. Examples of how to interpret the information in the graph include: 59% of all adults had one sexual partner in the last 12 months and 4% had more than one, and 54% of males had one partner in the past year. 100% Number of Sexual Partners in the Past Year 80% 60% 40% 20% 37% 42% 4% 4% 59% 54% 30% 4% 66% 47% 8% 45% 28% 2% 70% 67% 61% 4% 33% 35% 29% 31% 4% 7% 67% 62% 29% 4% 66% 0% Total Male Female Under Years 65 & Over Income <$25K Income $25K Plus One More than one None Respondents were asked: During the past 12 months, with how many different people have you had sexual intercourse? Adult Comparisons Had more than one sexual partner in past year N/A Not available Ohio 2013 U.S % 4% 4% N/A N/A 86

89 The following graphs show chlamydia disease rates per 100,000 population updated June 27, 2014 by the Ohio Department of Health. The graphs show: chlamydia rates fluctuated from 2009 to rates remained below the Ohio rates. In 2012, the U.S. rate for new chlamydia cases was per 100,000 population (Source: CDC, STD Trends in the U.S., 2014). Rate per 100,000 Population Number of cases reported Chlamydia Annualized Disease Rates for and Ohio Ohio Annualized Count of Chlamydia Cases for (Source for graphs: ODH, STD Surveillance, data reported through ) SEXUAL BEHAVIOR 87

90 The following graphs show gonorrhea disease rates per 100,000 population updated June 27, 2014 by the Ohio Department of Health. The graphs show: The gonorrhea rate increased from 2009 to 2011, then decreased from 2011 to The gonorrhea rate remained below the Ohio rate. The Ohio gonorrhea rate fluctuated from 2009 to In 2012, the U.S. rate for new gonorrhea cases for the total population was per 100,000 population (Source: CDC, STD Trends in the U.S., 2014). The Healthy People 2020 objective for gonorrhea is 257 new female and 198 new male cases per 100,000 population. 200 Gonorrhea Annualized Disease Rates for and Ohio Rate per 100,000 population Ohio Number of cases reported Annualized Count of Gonorrhea Cases for (Source for graphs: ODH, STD Surveillance, data reported through ) 88

91 The following graph shows HIV/AIDS rates per 100,000 population updated December 31, 2013 by the Ohio Department of Health. The graph shows: From , the number of people living with HIV/AIDS in increased. (Source for graphs: ODH HIV/AIDS Surveillance Program, Updated ) Pregnancy Outcomes *Please note that the pregnancy outcomes data includes all births to adults and adolescents. From , there was an average of 400 live births per year in. Number of Live Births Number of Cases Reported Living with HIV/AIDS in 19 Total Live Births ** 2014** SEXUAL BEHAVIOR (Source for graphs: ODH Information Warehouse Updated ) ** Indicates preliminary data that may change 89

92 Adult І QUALITY OF LIFE Key Findings In 2015, 39% of adults were limited in some way because of a physical, mental or emotional problem. Impairments and Health Problems In 2015, nearly two-fifths (39%) of adults were limited in some way because of a physical, mental or emotional problem (21% Ohio, 20% U.S., 2013 BRFSS). Among those who were limited in some way, the following most limiting problems or impairments were reported: back or Simple Tips for Healthy Eyes Follow these simple guidelines for maintaining healthy eyes: Have a comprehensive dilated eye exam. Know your family s eye health history. Eat right to protect your sight. Wear sunglasses to protect your eyes from the sun s ultraviolet rays. Give your eyes a rest. Quit smoking or never start. Clean your hands and your contact lenses properly. (Source: CDC, Vision Health Initiative, 2012, from: althtips.htm) neck problems (43%), arthritis/rheumatism (35%), stress, depression, anxiety, or emotional problems (18%), walking problems (17%), high blood pressure (13%), diabetes (12%), hearing problems (11%), fractures, bone/joint injuries (10%), lung/breathing problems (9%), heart problems (8%), eye/vision problems (8%), tobacco dependency (8%), cancer (3%), strokerelated problems (2%), and a learning disability (<1%). adults had fallen in the past 6 months due to the following: same-level fall (slipping, tripping or stumbling) (14%), stairs (2%), shower (<1%), ladders (<1%), and some other way/place (3%). One-quarter (25%) of adults 65 and older had fallen in the past 6 months due to the following: same-level fall (slipping, tripping or stumbling) (17%), stairs (1%), shower (1%), ladders (1%), and some other way/place (8%). 3% of adults ages 65 and older have fallen more than once. adults needed help with the following because of an impairment or health problem: household chores (3%), shopping (2%), finances (2%), getting around for other purposes (2%), doing necessary business (2%), bathing (1%), getting around the house (1%), dressing (<1%), and eating (<1%). adults were responsible for providing regular care or assistance to the following: multiple children (12%), an elderly parent or loved one (7%), a friend, family member or spouse with a health problem (4%), grandchildren (3%), an adult child (2%), someone with special needs (2%), a friend, family member or spouse with dementia (2%), foster children (1%), and a friend, family member or spouse with a mental health issue (1%). Adult Comparisons Limited in some way because of a physical, mental, or emotional problem Ohio 2013 U.S % 37% 39% 21% 20% 90

93 The following graph shows the most limiting health problems of adults who reported being limited by a physical, mental or emotional problem. Examples of how to interpret the information shown on the graph includes: 43% of adults who had a limitation reported back and neck problems. 60% 50% 40% 30% 20% 10% 0% 43% Back and Neck Problems Most Limiting Health Problems Healthy People 2020 Arthritis, Osteoporosis, and Chronic Back Conditions (AOCBC) Objective 35% Arthritis/Rheumatism Stress, Depression, Anxiety, Emotional Problems AOCBC-2: Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation in activity due to arthritis or joint symptoms 2015 Walking Problems Healthy People 2020 Target 35% 36% *U.S. baseline is age-adjusted to the 2000 population standard (Sources: Healthy People 2020 Objectives, 2015 Health Assessment) Hearing Loss in Older Adults 18% 17% Hearing loss is one of the most common conditions affecting older adults. Approximately 17 percent, or 36 million, of American adults report some degree of hearing loss. There is a strong relationship between age and reported hearing loss: 18 percent of American adults years old, 30 percent of adults years old, and 47 percent of adults 75 years old, or older, have a hearing impairment. Men are more likely to experience hearing loss than women. People with hearing loss may find it hard to have a conversation with friends and family. They may also have trouble understanding a doctor's advice, responding to warnings, and hearing doorbells and alarms. (Source: NIH Senior Health, Hearing Loss, QUALITY OF LIFE 91

94 Adult І SOCIAL CONTEXT AND SAFETY Key Findings In 2015, 7% of adults were threatened and 7% were abused in the past year (including physical, sexual, emotional, financial, and verbal abuse). 58% of adults reported having firearms in and around their homes. Social Context 7% of adults were threatened in the past year. They were threatened by the following: a spouse or partner (74%), another family member (11%), a parent (8%), and someone else (37%). 7% of adults were abused in the past year. They were abused by the following: a spouse or partner (57%), a parent (14%), another family member (9%), and someone else (40%). 7% of adults were threatened, and 7% were abused in the past year. adults experienced the following as a child: lived with someone who was a problem drinker or alcoholic (15%), a parent or adult in their home swore at, insulted, or put them down (14%), their parents became separated or were divorced (14%), lived with someone who was depressed, mentally ill, or suicidal (10%), someone at least 5 years older than them or an adult touched them sexually (8%), a parent or adult in their home hit, beat, kicked, or physically hurt them (7%), their parents or adults in their home slapped, hit, kicked, punched, or beat each other up (6%), lived with someone who used illegal stress drugs, or who abused prescription medications (4%), someone at least 5 years older than them or an adult tried to make them touch them sexually (4%), lived with someone who served time or was sentenced to serve time in prison, jail or other correctional facility (2%), someone at least 5 years older than them or an adult forced them to have sex (2%), and their parents were not married (1%). adults experienced the following in the past year: had to choose between paying bills and buying food (8%), their food assistance was cut (3%), were worried they would run out of food (3%), a loss of income led to food insecurity issues (2%), went hungry/ate less to provide more food for their family (2%), and were hungry but did not eat because they did not have money for food (2%). adults experienced the following stressful situations in the past 12 months: a close family member went to the hospital (35%), death of a family member or close friend (32%), had bills they could not pay (13%), someone in their household had their hours at work reduced (6%), moved to a new address (4%), someone in their household lost their job (4%), someone close to them had a problem with drinking or drugs (3%), someone in their household went to jail (3%), became separated or divorced (2%), had someone homeless living with them (2%), were involved in a physical fight (1%), their child was hit or slapped by their spouse or partner (<1%), and were hit or slapped by their spouse or partner (<1%). In the past month, 11% of adults needed help meeting their general daily needs, such as food, clothing, shelter or paying utility bills, increasing to 25% of those with incomes less than $25,

95 adults who needed help meeting their general daily needs sought assistance from the following: friend or family member (57%), social service agency (5%), church (3%), Welfare Department/Job & Family Services (3%), First Call for Help/2-1-1 (2%), and somewhere else (10%). residents reported the following concerns in their community: drug use (41%), unemployment (27%), distracted driving (26%), bullying (25%), youth substance abuse (22%), opiate/prescription drug abuse (17%), lack of affordable healthcare (16%), traffic (16%), school funding (16%), OVI (15%), senior/elder care (15%), sexting (15%), healthy eating (14%), physical fitness (14%), violence (12%), underemployment (12%), teen pregnancy (12%), parents hosting/allowing underage drinking (12%), nutrition (10%), homelessness (10%), suicide prevention (9%), tobacco use (9%), lack of affordable housing (8%), speeding (6%), lack of affordable transportation (6%), cancer prevention screenings (6%), lack of health education (5%), disaster preparedness (5%), chronic disease prevention (4%), discrimination based on race, ethnicity, sexual orientation, etc. (4%), bicycle safety (4%), cooking (4%), seat belt or restraint usage (3%), falls (3%), and gambling (3%). Safety 58% of adults had firearms in or around their home for the following reasons: hunting or sport (42%), protection (33%), work (2%), and some other reason (5%). adults reported doing the following while driving: eating (53%), talking on hand-held cell phone (49%), talking on hands-free cell phone (19%), not wearing a seatbelt (15%), texting (14%), using internet on their cell phone (7%), being under the influence of alcohol (5%), checking Facebook on their cell phone (5%), reading (1%), being under the influence of drugs (1%), and other activities (such as applying makeup, shaving, etc.) (2%). 2% of adults reported they or a family member contacted the poison control hotline or had gone to the emergency room for a potential poisoning in the past year. adults reported always wearing a helmet while riding the following: snowmobile (88%), motorcycle (20%), ATV (17%), and bike (7%). adults reported never wearing a helmet while riding the following: bike (81%), ATV (51%), and motorcycle (33%). Distracted Driving Distracted driving is driving while doing another activity that takes your attention away from driving. Distracted driving can increase the chance of a motor vehicle crash. Each day, more than 9 people are killed and more than 1,060 people are injured in crashes that were reported to involve a distracted driver. In 2011, 3,331 people were killed in crashes involving a distracted driver. An additional 387,000 people were injured in motor vehicle crashes involving a distracted driver in % of drivers in the U.S. ages reported that they had talked on their cell phone while driving, and 31% reported that they had read or sent text messages or messages while driving at least once within the last 30 days. Nearly half of all U.S. high school students aged 16 years or older text or while driving. (Source: CDC, Distracted Driving, updated October 10, 2014, SOCIAL CONTEXT 93

96 The following graph shows the percentage of adults that had a firearm in the home. Examples of how to interpret the information shown on the first graph include: 58% of all adults kept a firearm in their home, 66% of males, and 57% of those ages kept a firearm in their home. 100% Adults With a Firearm in the Home 80% 60% 58% 66% 50% 73% 57% 57% 48% 60% 50% 56% 40% 20% 0% Total Male Female Under Years 65 & Over Income <$25K Income $25K Plus Victims of Gun Violence in America More than 100,000 people are shot in murders, assaults, suicides, and suicide attempts, accidents or by police intervention in America in an average year. o 31,537 people die from gun violence and 71,386 people survive gun injuries. Every day, an average of 282 people are shot in America. Of those 282 people, 86 people die and 196 are shot, but survive. o Of the 282 people who are shot every day, an average of 50 are children and teens. o Of the 86 people who die, 32 are murdered, 51 are suicides, 2 die accidently and 1 with an unknown intent. o Of the 196 people who are shot but survive, 140 are from assault, 43 are shot accidently, 10 are suicide attempts, 2 are police interventions and 1 is of unknown intent. (Source: Brady Campaign to Prevent Gun Violence, There Are Too Many Victims of Gun Violence fact sheet, retrieved from: 94

97 Ohio State Patrol Activity Statistics The table below shows activity that has been produced by the Ohio State Highway Patrol for from 1/1/2015 through 8/2/2015. The table also shows a previous year comparison for the same time frame. Year to Date Activity Enforcement Stops 2,734 2,476 Non-Enforcement Activity 3,425 3,933 Warnings 2,194 2,527 Motorist Assists 925 1,082 Crashes Investigated OVI Enforcement Driving Under Suspension Enforcement Seat Belt Enforcement Commercial Vehicle Enforcement Felony Arrests 4 14 Felony Warrants Served 1 1 Misdemeanor Summons Issued Misdemeanor Warrants Served 3 4 Drug Violations Identity Theft Enforcements 0 0 Resisting Arrest Violations 0 2 Weapons Violations 0 1 (Source: Ohio State Highway Patrol Statistics, Activity Statistics, Updated 8/2/2015, obtained from: SOCIAL CONTEXT 95

98 (Source: Ohio State Highway Patrol Statistics, Fatal Traffic Crash Statistics, Updated 6/30/2015, obtained from: 96

99 Ohio State Highway Patrol Statistics Below are the yearly activity summaries and officer complaints from In 2013 there were 64,468 total crashes in the state of Ohio. Crashes Investigated (Source: OSHP Computer-Aided Dispatch (CAD) System and DPS Electronic Crash Record System. Updated: 01/30/2014) Traffic Stop Data This data is compiled from all traffic stops in which a citation, inspection, warning, or vehicle defect notice was issued by Ohio State Highway Patrol Troopers in Year Total Total Crashes 67,695 69,077 66,628 64,561 64, ,429 Fatal ,510 Injury 20,271 20,741 20,118 19,498 18,586 99,214 Property/Unknown 46,930 47,822 46,011 44,528 46, ,705 Traffic Enforcement Year Total Total Contacts 1,428,830 1,386,383 1,404,060 1,495,564 1,582,694 7,307,531 Enforcement 523, , , , ,371 2,719,126 Non-Enforcement 915, , , , ,323 4,588,405 OVI Arrests 24,254 22,090 23,747 24,529 24, ,748 Speed Citations 318, , , , ,500 1,711,765 Safety Belt Citations 98,039 86,623 84,176 91,595 97, ,896 Driver License Citations 26,019 25,367 25,656 28,299 32, ,685 Traffic Warnings 410, , , , ,349 1,998,861 Motorist Assists 324, , , , ,837 1,541,713 Crime Enforcement Year Total Cases 11,191 11,209 9,040 9,244 9,975 50,659 Stolen Vehicles Recovered ,391 Drug Arrests 5,327 5,665 6,164 7,644 9,628 34,428 Illegal Weapon Arrests ,972 Resisting Arrests ,593 SOCIAL CONTEXT Crime Enforcement Asian Black Hispanic White Unknown Total Traffic Stop Contracts 13, ,805 21, ,994 4, ,001 (Source: OSHP Computer-Aided Dispatch (CAD) System and DPS Electronic Crash Record System. Updated: 01/30/2014) 97

100 Crime Data In 2013, the total population in was 38,649. There were a total of 641 property crimes and 36 violent crimes in Total Number of Crimes in in Larceny- Theft Burglary Aggravated Assault Forcible Rape Arson Robbery Motor Vehicle Theft Murder (Source: Office of Criminal Justice Services, Crime Statistics and Crime Reports, 2013, from Arrests/Incarceration Data In 2014, the total inmate population in the state of Ohio was 50,403. In FY 2015, the total budget is $1,619,085,171. The budget has increased $55,986,365 since FY The average daily cost per inmate in 2014 was $62.57, and the annual budget was $22, Ohio Department of Rehabilitation and Correction Counts 2014 Inmates Under 18 Years of Age 38 Inmates Over 50 Years of Age 8,071 Pregnant Females 53 Mothers/Babies in the ABC Nursery 9 Inmates Serving Life Without Parole (LWOP) 531 Age Range of Offender Population 2014 Male Female Average Stay in Prison years years 2.26 years (Source: Ohio Department of Rehabilitation and Correction, Fact Sheet, July 2015, from 98

101 The following graphs show the Ohio inmate population in 2014 by gender and race. These graphs show: The percentage of Ohio males who are incarcerated is extremely higher than the percentage of females. More than half (53%) of the Ohio population that is incarcerated is White, followed by African Americans at 45%. 100% 75% 50% 25% 0% 75% 50% 25% 0% Male 53% 92% Inmate Population by Gender, 2014 Inmate Population by Race, % Female White Black Other (Source: Ohio Department of Rehabilitation and Correction, Fact Sheet, July 2015, from 8% 2% SOCIAL CONTEXT 99

102 Adult І MENTAL HEALTH AND SUICIDE Key Findings In 2015, 4% of adults considered attempting suicide. 14% of adults had a period of two or more weeks when they felt so worried, tense or anxious nearly every day that they stopped doing usual activities. Adult Mental Health In the past year, 14% of adults had a period of two or more weeks when they felt so worried, tense or anxious nearly every day that they stopped doing usual activities. 16% of adults had a period of two or more weeks when they felt sad, blue or depressed nearly every day, increasing to 24% of those with incomes less than $25,000. 4% of adults considered attempting suicide in the past year. One percent (1%) of adults reported attempting suicide in the past year. Suicide Facts 38,364 people in the U.S. died from suicide, and 959,100 people attempted suicide in the Every 13.7 minutes an average of one person kills themselves, and every 32 seconds a person attempts suicide in the United States. Suicide is the 10 th ranking cause of death in the U.S. For every female death by suicide, there are 3.7 male deaths. In 2010, there were 1,439 suicide deaths in Ohio. The leading suicide methods included: Firearm suicides (50.5%) Suffocation/Hanging (24.7%) Poisoning (17.2%) Cutting/Piercing (1.8%) Drowning (1.1%) (Sources: American Association of Suicidology, Statistics, September 21, 2012, from: 16% of adults looked for a program or service to help with depression, anxiety or emotional problems. Of those who looked, 87% found a program, and 13% did not find a program to help with depression, anxiety or emotional problems. adults reported they or a family member had been diagnosed with or treated for the following mental health issues: depression (41%), anxiety or emotional problem (29%), anxiety disorder (27%), attention deficit disorder (17%), bipolar (11%), developmental disability (7%), illicit drug abuse (5%), psychotic disorder (5%), post-traumatic stress disorder (5%), life adjustment disorder (4%), and another mental health disorder (4%). 25% of adults indicated they or a family member had taken medication for a mental health issue, and 8% had been hospitalized for a mental health issue. Adult Comparisons Two or more weeks in a row felt sad or hopeless Considered attempting suicide in the past year N/A Not available Ohio 2013 U.S % 13% 16% N/A N/A 3% 2% 4% N/A N/A 100

103 The following graph shows adults who felt sad or hopeless for two or more weeks in a row in the past year. Examples of how to interpret the information in the graph include: 16% of all adults felt sad or hopeless for two or more weeks in a row, 15% of males, and 19% of females. 35% 30% 25% 20% 15% 10% 5% 0% 16% 15% Warning Signs for Suicide More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, in particular: Major depression Bipolar depression Schizophrenia Drug abuse & dependence Alcohol abuse & dependence Post-Traumatic Stress Disorder (PTSD) Eating disorders Personality disorders The core symptoms of major depression are a down or depressed mood most of the day or a loss of interest or pleasure in activities that were previously enjoyed for at least two weeks, as well as: Changes in sleeping patterns Change in appetite or weight Intense anxiety, agitation, restlessness Fatigue or loss of energy Decreased concentration, indecisiveness, or poorer memory Feelings of hopelessness, worthlessness, self-reproach or excessive or inappropriate guilt Recurrent thoughts of suicide Prevention: Take it Seriously Adults Feeling Sad or Hopeless for Two or More Weeks in a Row 19% 19% 19% Total Male Female Under Years 65 & Over Income <$25,000 Income >$25, Fifty to 75% of all suicides give some warning of their intentions to a friend or family member. Recognize the Imminent Dangers: Threatening to hurt or kill oneself Talking or writing about death, dying, or suicide Looking for ways to kill oneself (weapons, pills, or other means) Has made plans or preparations for a potentially serious attempt (Source: American Foundation for Suicide Prevention, When You Fear Someone May Take Their Life, 9% 24% 13% 11% 13% 2012 MENTAL HEALTH 101

104 Adult and Youth І ORAL HEALTH Key Findings The 2015 Health Assessment project has determined that more than three-fifths (65%) of adults had visited a dentist or dental clinic in the past year. The 2012 BRFSS reported that 67% of U.S. adults and 68% of Ohio adults had visited a dentist or dental clinic in the previous twelve months. Over three-fourths(76%) of youth in grades 6-12 had visited the dentist for a check-up, exam, teeth cleaning, or other dental work in the past year, increasing to 81% of those ages 17 and older (2013 YRBS reported 75% for Ohio). Dental Care Resources 2012 Number of licensed dentists- 15 Number of primary care dentists- 12 Ratio of population per dentist- 2,578:1 Number of dentists who treat Medicaid patients- 3 Ratio of Medicaid population per dentist who treats Medicaid patients- 2,853:1 (Source: ODH Ohio Oral Health Surveillance System, 2012) Access to Dental Care In the past year, 65% of adults had visited a dentist or dental clinic, decreasing to 56% of adults with annual household incomes less than $25,000. The 2012 BRFSS reported that 67% of U.S. adults and 68% of Ohio adults had visited a dentist or dental clinic in the previous twelve months. Nearly three-fourths (72%) of adults with dental insurance have been to the dentist in the past year, compared to 63% of those without dental insurance. When asked the main reason for not visiting a dentist in the last year, 29% said cost, 27% had no oral health problems, 12% indicated multiple reasons, 8% said fear, apprehension, nervousness, pain, and dislike going, 5% had not thought of it, 3% could not get to the office, 2% did not have/know a dentist, 1% said their dentist did not accept their medical coverage, 1% could not find a dentist to who took Medicaid, 1% had other priorities, and 1% could not find a dentist who treats special needs clients. youth last saw a dentist for a check-up, exam, teeth cleaning, or other dental work: less than a year ago (76%), 1 to 2 years ago (11%), 2 or more years ago (2%), never (1%), and do not know (10%). What You Can Do to Maintain Good Oral Health Drink fluoridated water and use fluoride toothpaste. Fluoride's protection against tooth decay works at all ages. Take care of your teeth and gums. Thorough tooth brushing and flossing to reduce dental plaque can prevent gingivitis the mildest form of gum disease. Avoid tobacco. In addition to the general health risks posed by tobacco, smokers have 4 times the risk of developing gum disease compared to non-smokers. Limit alcohol. Heavy use of alcohol is a risk factor for oral and throat cancers. Eat wisely. Adults should avoid snacks full of sugars and starches. Visit the dentist regularly. Check-ups can detect early signs of oral health problems and can lead to treatments that will prevent further damage, and in some cases, reverse the problem. (Source: CDC: Oral Health for Adults, July 2013, from: 102

105 The following graphs provide information about the frequency of adult and youth dental visits. Examples of how to interpret the information on the first graph include: 65% of all adults had been to the dentist in the past year, 75% of those under the age of 30, and 56% of those with incomes less than $25, % 80% 60% 40% 20% 0% 100% 80% 60% 40% 20% 0% Adults Visiting a Dentist in the Past Year 65% 63% 65% 75% 65% Total Males Females Under Years 58% 56% 65 & Over Income <$25K 68% Income $25K Plus 64% 65% 2008 Youth Visiting a Dentist in the Past Year 76% 77% 76% 72% Total Males Females 13 or younger 75% 81% 69% or older % 2012 ORAL HEALTH 103

106 Adult Oral Health Within the Past Year Within the Past 2 Years Within the Past 5 Years 5 or More years Never Time Since Last Visit to Dentist/Dental Clinic Males 63% 11% 10% 14% <1% Females 65% 13% 9% 10% 0% Total 65% 12% 9% 12% <1% Totals may not equal 100% as some respondents answered do not know. Adult Comparisons Adults who have visited the dentist in the past year *2012 BRFSS Data Ohio 2013 U.S % 65% 65% 68%* 67%* Oral Health in Older Adults Older adults are at risk for getting cavities, gum disease and mouth cancer and these may not cause any pain or discomfort until they are advanced. Everyone needs to see their dentist for a checkup at least once a year preferably more often. People without natural teeth are at risk for mouth cancer as well as gum problems. Denture wearers need to have their mouth and their dentures checked at least once a year. As with many other cancers, older adults are more likely to get mouth cancer than younger people. Everyone is at a greater risk of getting mouth cancer if they use tobacco, drink alcohol a lot, or are repeatedly exposed to the sunlight. Severe gum disease has also been associated with pneumonia in long-term care patients, heart disease, stroke, and poor diabetic control. Periodontal disease can be prevented by: Cleaning your teeth and gums thoroughly every day. Getting regular checkups from your dentist. Following the advice of your dentist and dental hygienist. (Source: American Dental Association: Oral Longevity Questions and Answers, from: 104

107 Adult І PARENTING TEENS Key Findings 82% of parents discussed dating and relationships with their 10-to-18 year-old in the past year and 47% discussed negative effects of alcohol. Parenting Parents discussed the following sexual health and other health topics with their 10-to-18 year-old in the past year: Dating and relationships (82%) Screen time (51%) Abstinence/refusal skills (51%) Eating habits (48%) Negative effects of alcohol (47%) Negative effects of tobacco (47%) Negative effects of marijuana and other drugs (47%) Safe sex/std prevention (43%) Body image (42%) Birth control/use of condoms (35%) Sexually transmitted infections (32%) HIV infections/aids (30%) Reproduction (24%) Refusal skills (24%) Anatomy (19%) Tips for Parents Ideas to Help Children Maintain a Healthy Weight Encourage healthy eating habits by providing fruits, vegetables, whole grains, low-fat or nonfat dairy products, and lean meats and proteins for your family. Find ways to make your family s favorite dishes in a healthier way. Talking to your teen about drinking Be honest and direct. Encourage your teen to talk to you about drinking, remain calm when listening. Try not to judge or criticize. Make it comfortable for your teen to talk honestly. Remind your teen that drinking comes with serious risks. Emphasize that your teen should never drink and drive or ride with a driver who has been drinking. (Source: MedlinePlus, Talking to your teen about drinking tions/ html, May 14, 2014) Limit or reduce the consumption of calorie-rich, sugary and/or saturated fat in your home. PARENTING Adding physical activity into the family s routine will lead to it becoming a healthy habit. Some examples of moderate intensity physical activity include brisk walking, playing tag, jumping rope, playing soccer, swimming and dancing. Encourage fun activities to reduce the amount of sedentary time watching TV, playing video games or on the computer. The goal is to reduce the rate of weight gain in overweight and obese children and teens while still accounting for normal growth and development. Children and teens should not be placed on a diet without consulting a doctor. (Source: CDC, Healthy Weight, Tips for Parents Ideas to Help Children Maintain a Healthy Weight, November 25, 2014) 105

108 Youth І WEIGHT STATUS Key Findings The 2015 Health Assessment identified that 18% of youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 32% of youth reported that they were slightly or very overweight. 75% of youth were exercising for 60 minutes on 3 or more days per week. 94% of youth were involved in extracurricular activities. Youth Weight Status BMI for children is calculated differently from adults. The CDC uses BMI-for-age, which is gender and age specific as children s body fatness changes over the years as they grow. In children and teens, BMI is used to assess underweight, normal, overweight, and obese. In 2015, 18% of youth were classified as obese by Body Mass Index (BMI) calculations (2013 YRBS reported 13% for Ohio and 14% for the U.S.). 16% of youth were classified as overweight (2013 YRBS reported 16% for Ohio and 17% for the U.S.). 62% were normal weight, and 4% were underweight. 18% of youth were classified as obese. 32% of youth described themselves as being either slightly or very overweight (2013 YRBS reported 28% for Ohio and 31% for the U.S.). Nearly half (46%) of all youth were trying to lose weight, increasing to 60% of female youth (compared to 32% of males) (2013 YRBS reported 47% for Ohio and 48% for the U.S.). youth reported doing the following to lose weight or keep from gaining weight in the past 30 days: 49% of youth exercised. 42% of youth drank more water. 33% of youth ate less food, fewer calories, or foods lower in fat. 29% of youth ate more fruits and vegetables. 14% of youth skipped meals. 7% reported going without eating for 24 hours or more (2013 YRBS reported 10% for Ohio and 13% for the U.S.). 2% reported taking diet pills, powders, or liquids without a doctor s advice (2013 YRBS reported 5% for Ohio and the U.S.). 2% vomited or took laxatives (2013 YRBS reported 5% for Ohio and 4% for the U.S.). 2% reported smoking to lose weight. Nutrition 12% of youth ate 5 or more servings of fruits and vegetables per day. 85% ate 1 to 4 servings of fruits and vegetables per day. youth reported eating out in a restaurant or bringing food home to eat an average of 2.3 times in a typical week. In the past month, youth reported they went to bed hungry because there was not enough food in their home: sometimes (7%), most of the time (2%), and always (1%). 90% of youth reported they rarely or never went to bed hungry. 106

109 Physical Activity 75% of youth participated in at least 60 minutes of physical activity on 3 or more days in the past week. 55% did so on 5 or more days in the past week (2013 YRBS reports 48% for Ohio and 47% for the U.S.), and 31% did so every day in the past week (2013 YRBS reports 26% for Ohio and 27% for the U.S.). 11% of youth did not participate in at least 60 minutes of physical activity on any day in the past week (2013 YRBS reports 13% for Ohio and 15% for the U.S.). The CDC recommends that children and adolescents participate in at least 60 minutes of physical activity per day. As part of their 60 minutes per day; aerobic activity, muscle strengthening, and bone strengthening are three distinct types of physical activity that children should engage in, appropriate to their age. Children should participate in each of these types of activity on at least three days per week. youth spent an average of 3.4 hours on their cell phone, 1.6 hours watching TV, 1.8 hours on their computer/tablet and.09 hours playing video games on an average day of the week. Nearly one-quarter (23%) of youth spent 3 or more hours watching TV on an average day (2013 YRBS reported 28% for Ohio and 33% for the U.S.). 94% of youth participated in extracurricular activities. They participated in the following: sports or intramural programs (62%), exercising (outside of school) (49%), school club or social organization (36%), church youth group (35%), church or religious organization (33%), part-time job (23%), caring for siblings after school (19%), volunteering in the community (17%), babysitting for other kids (15%), caring for parents or grandparents (4%) or some other organized activity (Scouts, 4H, etc.) (17%). 6 th -12 th Grade Youth did the following to lose weight in the past 30 days: Percent Exercised 49% Drank more water 42% Ate less food, fewer calories, or foods lower in fat 33% Ate more fruits and vegetables 29% Skipped meals 14% Went without eating for 24 hours 7% Took diet pills, powders, or liquids without a doctor s advice 2% Vomited or took laxatives 2% Smoked cigarettes 2% YOUTH WEIGHT 107

110 The following graph shows the percentage of youth who were classified as obese, overweight, normal weight or underweight by Body Mass Index (BMI). Examples of how to interpret the information in the first graph include: 62% of all youth were classified as normal weight, 18% were obese, 16% were overweight, and 4% were underweight for their age and gender. 100% Youth BMI Classifications 4% 4% 4% 6% 3% 3% 9% 5% 80% 60% 62% 67% 57% 59% 58% 71% 59% 74% 40% 20% 16% 11% 23% 19% 19% 9% 18% 13% 0% 18% 19% 16% 15% 19% 17% 14% 15% Total Male Female 13 or younger 14 to & Older Total 2008 Total 2012 Obese Overweight Normal Weight Underweight Physical Activity Facts Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels. The U.S. Department of Health and Human Services recommends that young people ages 6 17 years participate in at least 60 minutes of physical activity daily. The percentage of high school students who attended physical education classes daily decreased from 42% in 1991 to 25% in 1995 and remained stable at that level until 2011 (31%). Regular physical activity: Helps build and maintain healthy bones and muscles. Helps reduce the risk of developing obesity and chronic diseases, such as diabetes, cardiovascular disease, and colon cancer. Reduces feelings of depression and anxiety and promotes psychological wellbeing. May help improve students academic performance, including academic achievement and academic behavior. (Sources: CDC, Adolescent and School Health, Updated: 2/19/2013, from: 108

111 Youth Comparisons 2008 (6 th -12 th ) 2012 (6 th -12 th ) N/A Not available Comparative YRBS data for Ohio is 2007 and U.S. is (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) U.S (9 th -12 th ) Obese 14% 15% 18% 20% 13% 14% Overweight 18% 13% 16% 14% 16% 17% Described themselves as slightly or very overweight 29% 29% 32% 33% 28% 31% Trying to lose weight 45% 48% 46% 49% 47% 48% Exercised to lose weight 50% 52% 49% 53% 61% 61% Ate less food, fewer calories, or foods lower in fat to lose weight 27% 34% 33% 39% 43% 39% Went without eating for 24 hours or more 4% 7% 7% 7% 10% 13% Took diet pills, powders, or liquids without a doctor s advice 1% 2% 2% 3% 5% 5% Vomited or took laxatives 2% 2% 2% 2% 5% 4% Ate 1 to 4 servings of fruits and vegetables per day N/A 83% 85% 86% 85% 78% Physically active at least 60 minutes per day on every day in past week Physically active at least 60 minutes per day on 5 or more days in past week Did not participate in at least 60 minutes of physical activity on any day in past week Watched TV 3 or more hours per day 31% 34% 31% 30% 26% 27% 53% 59% 55% 56% 48% 47% 11% 8% 11% 13% 13% 15% 36% 30% 23% 21% 28% 33% YOUTH WEIGHT 109

112 Youth І TOBACCO USE Key Findings The 2015 Health Assessment identified that 8% of youth in grades 6-12 were smokers, increasing to 13% of those ages 17 and older. Nearly three-fourths (73%) of youth identified as current smokers were also current drinkers. In the past week, two-thirds (66%) of youth were in a home or car with someone who was smoking. In 2015, 8% of youth were current smokers, having smoked at some time in the past 30 days. Youth Tobacco Use Behaviors The 2015 health assessment indicated that 23% of youth had tried cigarette smoking (2013 YRBS reported 41% for the U.S.). 10% of those who had smoked a whole cigarette did so at 10 years old or younger, and another 17% had done so by 12 years old. The average age of onset for smoking was 13.7 years old. 4% of all youth had smoked a whole cigarette for the first time before the age of 13 (2013 YRBS reported 9% for the U.S.). In 2015, 8% of youth were current smokers, having smoked at some time in the past 30 days, increasing to 13% of youth ages 17 and older (2013 YRBS reported 15% for Ohio and 16% for the U.S). 10% of current smokers smoked cigarettes daily. 2% of all youth smoked cigarettes on 20 or more days during the past month (2013 YRBS reported that 7% of youth in Ohio smoked cigarettes on 20 or more days during the past month and 6% for the U.S). Nearly three-fourths (73%) of youth identified as current smokers were also current drinkers, defined as having had a drink of alcohol in the past 30 days. 38% of youth smokers borrowed cigarettes from someone else, 26% indicated they bought cigarettes from a store or gas station (2013 YRBS reported 18% for the U.S.), 24% took them from a family member, 24% gave someone else money to buy them cigarettes 10% said a person 18 years or older gave them the cigarettes, 5% got them on the internet and 14% got them some other way. No one reported buying them from a vending machine or taking them from a store. In the past 30 days, 3% of youth used chewing tobacco or snuff, (2013 YRBS reported 9% for both Ohio and the U.S.). youth used the following forms of tobacco the most in the past year: e- cigarette (12%), cigarettes (12%), hookah (7%), Black and Mild s (6%), cigars (5%), swishers (4%), chewing tobacco or snuff (4%), cigarillos (4%), flavored cigarettes (2%), snus (1%) and bidis (1%). No one reported using dissolvable tobacco products or little cigars. Over half (52%) of the youth who smoked in the past year had tried to quit smoking (2013 YRBS reported 48% for the U.S.). In the past week, two-thirds (66%) of all youth were in a home or car with someone who was smoking. 110

113 In the past month, 35% of youth smokers bought cigarettes in a store. Of those who bought or attempted to buy cigarettes, three-quarters (75%) were asked to show proof of age, and onequarter (25%) were not asked to show proof of age. The following graph shows the percentage of youth who smoke cigarettes. Examples of how to interpret the information include: 8% of all youth were current smokers, 11% of males smoked, and 6% of females were current smokers. 30% 20% 10% 0% 8% Youth Who Are Current Smokers 11% 6% Behaviors of Youth Current Smokers vs. Non-Current Smokers Youth Behaviors 4% Total Male Female 12 to to & Older Total 2008 Current Smoker Total 2012 Non- Current Smoker Participated in extracurricular activities 90% 94% Exposed to second hand smoke in the past week 80% 30% Have had sexual intercourse 76% 17% Have had at least one drink of alcohol in the past 30 days 73% 17% Have been bullied in the past 12 months 65% 48% Have used marijuana in the past 30 days 52% 5% Misused prescription medications in the past 30 days 40% 6% Attempted suicide in the past 12 months 13% 5% 8% 13% 12% 11% Current smokers are those youth surveyed who have self-reported smoking at any time during the past 30 days. 73% of youth identified as current smokers were also current drinkers. YOUTH TOBACCO 111

114 Youth Comparisons 2008 (6 th -12 th ) 2012 (6 th -12 th ) 2015 (6 th -12 th ) 2015 (9 th 12 th ) Ohio 2013 (9 th 12 th ) U.S (9 th 12 th ) Ever tried cigarettes 30% 31% 23% 33% 52%* 41% Current smokers 12% 11% 8% 13% 15% 16% Tried to quit smoking (of those youth who smoked in the past year) Smoked cigarettes on 20 or more days during the past month (of all youth) Smoked a whole cigarette for the first time before the age of 13 (of all youth) Used chewing tobacco or snuff in the past month * Comparative YRBS data for Ohio is % 51% 52% 56% 56%* 48% 4% 2% 2% 3% 7% 6% 11% 7% 4% 3% 14%* 9% 6% 5% 3% 5% 9% 9% Electronic Cigarettes and Teenagers in the U.S. The percentage of U.S. middle and high school students who tried electronic cigarettes more than doubled from 2011 to E-cigarettes look like regular cigarettes, but they are operated by battery. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled. The percentage of high school students who had ever used e-cigarettes rose from 4.7% in 2011 to 10% in In the same time period, high school students using e- cigarettes within the past 30 days rose from 1.5% to 2.8%. The percentage of middle school students who had ever used e-cigarettes also doubled from 1.4% to 2.7%. Altogether, as of 2012 more than 1.78 million middle and high school students in the US had tried e-cigarettes. 76% of current young e-cigarette users also smoked regular cigarettes. Some experts fear that e-cigarettes may encourage children to try regular cigarettes. Nicotine is a highly addictive drug. Many teens that start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes." (Source: CDC, Press Release, September 5, 2013, & ACS, Electronic Cigarette Use Doubles Among Teenagers, September 9, 2013, 112

115 Youth І ALCOHOL CONSUMPTION Key Findings In 2015, the Health Assessment results indicated that 50% of youth in grades 6-12 had drank at least one drink of alcohol in their life, increasing to 69% of youth seventeen and older. 20% of all youth were current drinkers, having had at least one drink in the past 30 days. Nearly half (48%) of youth who reported drinking in the past 30 days had at least one episode of binge drinking. 2% of all youth drivers had driven a car in the past month after they had been drinking alcohol. In in 2015, 20% of youth had at least one drink in the past 30 days. Youth Alcohol Consumption In 2015, the Health Assessment results indicated that half (50%) of all youth (ages 12 to 18) had at least one drink of alcohol in their life, increasing to 69% of those ages 17 and older (2013 YRBS reports 66% for the U.S.). One-fifth (20%) of youth had at least one drink in the past 30 days, increasing to 34% of those ages 17 and older (2013 YRBS reports 30% for Ohio and 35% for the U.S.). Of those who drank, 48% had five or more alcoholic drinks on an occasion in the last month and would be considered binge drinkers by definition. Based on all youth surveyed, 10% were defined as binge drinkers, increasing to 17% of those ages 17 and older (2013 YRBS reports 16% for Ohio and 21% for the U.S.). Over one-third (35%) of youth who reported drinking at some time in their life had their first drink at 12 years old or younger; 27% took their first drink between the ages of 13 and 14, and 38% started drinking between the ages of 15 and 18. The average age of onset was 13.3 years old. Of all youth, 16% had drunk alcohol for the first time before the age of 13 (2013 YRBS reports 13% of Ohio youth drank alcohol for the first time before the age of 13 and 19% for the U.S.). youth drinkers reported they got their alcohol from the following: a parent gave it to them (29%), someone gave it to them (24%)(2013 YRBS reports 38% for Ohio and 42% for the U.S.), someone older bought it (14%), an older friend or sibling bought it (13%), gave someone else money to buy it (12%), took it from a store or family member (12%), a friend s parent gave it to them (10%), bought it at a restaurant/bar/club (3%), bought it in a liquor store/ convenience store/gas station (1%), bought it at a public event (1%), bought it with a fake ID (1%), and some other way (24%). During the past month 13% of all youth had ridden in a car driven by someone who had been drinking alcohol (2013 YRBS reports 17% for Ohio and 22% for the U.S.). YOUTH ALCOHOL 2% of youth drivers had driven a car in the past month after they had been drinking alcohol (2013 YRBS reports 4% for Ohio and 10% for the U.S.). 113

116 The following graphs show the percentage of youth who have drank in their lifetime and those who are current drinkers. Examples of how to interpret the information include: 50% of all youth have drank at some time in their life: 53% of males and 48% of females. 100% Youth Having At Least One Drink In Their Lifetime 80% 69% 60% 50% 53% 48% 52% 54% 57% 40% 33% 20% 0% Total Male Female 12 to to & Older Total 2008 Total 2012 Based on all youth surveyed, 10% were defined as binge drinkers. 60% Youth Who Are Current Drinkers 40% 34% 20% 20% 23% 19% 11% 21% 19% 24% 0% Total Male Female 12 to to & Older Total 2008 Total

117 The following graph shows the percentage of youth who were binge drinkers. Examples of how to interpret the information include: 48% of current drinkers binge drank in the past month, 48% of males, and 46% of females had binge drank. The table shows differences in specific risk behaviors between current drinkers and non-current drinkers. 100% 80% 60% 40% 20% 0% Youth Current Drinkers Binge Drinking in Past Month* 48% 48% 46% 46% 45% Total Male Female 12 to to & Older Total 2008 *Based on all current drinkers. Binge drinking is defined as having five or more drinks on an occasion. Behaviors of Youth Current Drinkers vs. Non-Current Drinkers Youth Behaviors Current Drinker Total 2012 Non- Current Drinker Participated in extracurricular activities 94% 95% Have been bullied in the past 12 months 52% 49% Have had sexual intercourse 48% 15% Misused prescription medications in the past 30 days 31% 2% Have used marijuana in the past 30 days 30% 3% Have smoked cigarettes in the past 30 days 28% 3% Attempted suicide in the past 12 months 14% 3% Current drinkers are those youth surveyed who have self-reported drinking at any time during the past 30 days. 50% 54% 56% 29% of youth drinkers reported they got their alcohol from a parent giving it to them. Of all youth, 16% had drunk alcohol for the first time before the age of 13. YOUTH ALCOHOL 115

118 Youth Comparisons 2008 (6 th -12 th ) 2012 (6 th -12 th ) 2015 (6 th -12 th ) 2015 (9 th 12 th ) Ohio 2013 (9 th 12 th ) U.S (9 th 12 th ) Ever tried alcohol 54% 57% 50% 62% 71%* 66% Current drinker 19% 24% 20% 28% 30% 35% Binge drinker (of all youth) 11% 14% 10% 14% 16% 21% Drank for the first time before age 13 (of all youth) 23% 14% 16% 13% 13% 19% Rode with someone who was drinking 18% 13% 13% 10% 17% 22% Drank and drove (of youth drivers) Obtained the alcohol they drank by someone giving it to them * Comparative YRBS data for Ohio is % 3% 2% 3% 4% 10% 62% 39% 24% 28% 38% 42% Teen Binge Drinking: All Too Common Risks Associated with Binging: It is estimated that alcohol consumption is responsible for about 80,000 deaths in the US each year. Binge drinking has also been associated with many health problems, including: Heart disease Stroke Cancer Liver disease Chemical dependency Pregnancy STDs Alcohol poisoning MRI scans of the brains of teens that drank heavily showed damaged nerve tissue compared to those who did not. Studies have shown that alcohol can cause long-term damage to the brain and impair memory, coordination and movement. (Source: Psychology Today, Teen Angst, Teen Binge Drinking: All Too Common, 1/26/2013, from: 116

119 Youth І DRUG USE Key Findings In 2015, 9% of 6th-12th grade youth had used marijuana at least once in the past 30 days. 9% of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life. Youth Drug Use In 2015, 9% of youth had used marijuana at least once in the past 30 days, increasing to 15% of high school youth. The 2013 YRBS found a prevalence of 21% for Ohio youth and a prevalence of 23% for U.S. youth. 9% of youth used medications that were not prescribed for them or took more than prescribed to feel good or get high at some time in their lives, increasing to 15% of those over the age of 17. Youth who misused prescription medications got them in the following ways: a friend gave it to them (37%), a parent gave it to them (33%), they took it from a friend or family member (23%), bought it from a friend (16%), bought it Drug Facts: Drugged Driving Vehicle accidents are the leading cause of death among youth people aged 16 to 19. When teens relative lack of driving experience is combined with the use of marijuana or other substances that affect cognitive and motor abilities, the results can be tragic. According to the 2013 National Survey on Drug Use and Health (NSDUH), an estimated 9.9 million people aged 12 or older reported driving under the influence of illicit drugs during the year prior to being surveyed. After alcohol, THC (delta-9- tetrahydrocannabinol), the active ingredient in marijuana is the substance most commonly found in the blood of impaired drivers, fatally injured drivers, and motor vehicle crash victims. Studies in several localities have found that approximately 4 to 14 percent of drivers who sustained injury or died in traffic accidents tested positive for THC. (Source: National Institute on Drug Abuse, The Science of Drug Abuse & Addiction: Drug Facts: Drugged Driving, ed-driving, revised 12-14) from someone else (9%), got it on the internet (5%), and another family member gave it to them (2%), youth had tried the following in their life: o 6% of youth used inhalants, (2013 YRBS reports 9% for both Ohio and U.S.) o 4% used posh/salvia/synthetic marijuana o 3% misused cough syrup o 3% misused over-the-counter medications o 3% used K2/spice o 2% used cocaine, (2013 YRBS reports 4% for Ohio and 6% for U.S.) o 2% used steroids, (2013 YRBS reports 3% for both Ohio and U.S.) o 2% used ecstasy/mdma (2013 YRBS reports 7% for the U.S.) o 2% used Cloud 9 o 2% used liquid THC o 1% misused hand sanitizer o 1% used heroin, (2013 YRBS reports 2% for Ohio and U.S.) o 1% had been to a pharm party/used skittles o <1% used methamphetamines, (2013 YRBS reports 3% for the U.S.) o No one reported using GhB or bath salts. YOUTH DRUG USE During the past year, youth reported that someone had offered, sold, or given them an illegal drug in the following places: at a party (11%), on school property (4%), (2013 YRBS reports 20% for Ohio and 22% for the U.S.), on public property (4%), close to school grounds, but on a nearby public street (2%), and at a school sporting event (2%). 117

120 The following graphs are data from the 2015 Health Assessment indicating youth lifetime drug use and marijuana use in the past 30 days. Examples of how to interpret the information include: 2% of youth have used cocaine at some point in their lives, and 6% of youth have used inhalants at some point in their life. 15% Youth Lifetime Drug Use 10% 5% 0% 8% 7% 7% 6% 6% 4% 3% 3% 3% 3% 2% 2% 2% 2% 2% 1% 1% 1% 1% 1% <1% 1% 1% 1% 0% Cocaine Heroin Meth Steroids Inhalants Total Male Female Total 2008 Total % of youth had used marijuana in the past month. 25% Youth Marijuana Use in Past Month 20% 15% 11% 12% 12% 10% 9% 7% 8% 8% 5% 3% 0% Total Male Female 13 or younger 14 to or older Total 2008 Total

121 The following graph is data from the 2015 Health Assessment indicating youth lifetime prescription medication abuse. Examples of how to interpret the information include: 9% of youth have misused medication at some point in their life. 25% 20% 15% 10% 5% 0% Youth Lifetime Prescription Medication Abuse 9% 9% Youth Comparisons 8% 2008 (6 th -12 th ) 3% Total Male Female 13 or younger 2012 (6 th -12 th ) 14 to or older Total (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) Total 2012 U.S (9 th -12 th ) Youth who used marijuana in the past month 8% 8% 9% 15% 21% 23% Ever used methamphetamines 3% 1% <1% 0% 6% 3% Ever used cocaine 2% 3% 2% 3% 4% 6% Ever used heroin 2% 1% 1% 0% 2% 2% Ever used steroids 2% 4% 2% 1% 3% 3% Ever used inhalants 7% 8% 6% 4% 9% 9% Ever used ecstasy/mdma N/A 2% 2% 2% N/A 7% Ever misused medications 7% 12% 9% 13% N/A 18% Ever been offered, sold, or given an illegal drug by someone on school 16% 5% 4% 6% 20% 22% property in the past year N/A Not available Comparative YRBS data for Ohio is % 15% 7% 12% YOUTH DRUG USE 119

122 Youth І SEXUAL BEHAVIOR AND TEEN PREGNANCY OUTCOMES Key Findings In 2015, nearly one-quarter (23%) of youth have had sexual intercourse, increasing to 42% of those ages 17 and over. 22% of youth had participated in oral sex and 7% had participated in anal sex. 22% of youth participated in sexting. Of those who were sexually active, 53% had multiple sexual partners. One school did not ask sexual behavior questions. 42% of youth ages 17 and over have had sexual intercourse Youth Sexual Behavior One school did not ask sexual behavior questions. Nearly one-quarter (23%) of youth have had sexual intercourse, increasing to 42% of those ages 17 and over (The 2013 YRBS reports 43% for Ohio and 47% of U.S. youth have had sexual intercourse). 22% of youth had participated in oral sex, increasing to 46% of those ages 17 and over. 7% of youth had participated in anal sex, increasing to15% of those ages 17 and over. 22% of youth had participated in sexting, increasing to 36% of those ages 17 and over. 28% of youth had viewed pornography, increasing to 41% of males and 45% of those ages 17 and over. Of those youth who were sexually active in their lifetime, 47% had one sexual partner and 53% had multiple partners. 6% of all youth had 4 or more sexual partners (2013 YRBS reports 12% for Ohio and 15% for the U.S.). Of those youth who were sexually active, 27% had done so by the age of 13. Another 39% had done so by 15 years of age. The average age of onset was 14.8 years old. Of all youth, 3% were sexually active before the age of 13 (2013 YRBS reports 4% for Ohio and 6% for the U.S). 61% of youth who were sexually active used condoms to prevent pregnancy, 24% used birth control pills, 17% used the withdrawal method, 6% used a shot, patch or birth control ring, 3% used an IUD and 5% used some other method. 3% reported they were gay or lesbian. However, 13% were engaging in intercourse without a reliable method of protection and 12% reported they were unsure. Of the youth who were sexually active, 18% had drunk alcohol or used drugs before their last sexual encounter, (2013 YRBS reports 18% for Ohio and 22% for the U.S). Youth had experienced the following situations in the past 30 days: had received a text or with a revealing photo of someone (15%), had texted, ed, or posted electronically a revealing or sexual photo of themselves (9%), and a revealing or sexual photo of themselves was texted, ed, or posted electronically without their permission (2%). 120

123 The following graphs show the percentage of youth who participated in sexual intercourse and oral sex. Examples of how to interpret the information include: 23% of all youth had sexual intercourse, 24% of males, and 21% of females had sex. 75% 50% 25% 0% 75% 50% 25% 0% 23% 24% Youth Who Had Sexual Intercourse 21% 3% Total Male Female 13 or Younger 24% 42% 24% 14 to & Older Total % Total % of youth who were sexually active were not using a reliable method of protection to prevent pregnancy. 22% Youth Who Participated in Oral Sex 26% 20% Total Male Female 13 or Younger 14 to & Older 4% 19% 46% SEXUAL BEHAVIOR 121

124 The following graphs show the percentage of youth who participated in anal sex and sexting. Examples of how to interpret the information include: 7% of all youth participated in anal sex, 10% of males, and 4% of females. 50% Youth Who Participated in Anal Sex 25% 15% 7% 10% 4% 2% 5% 0% Total Male Female 13 or Younger 14 to & Older 75% Youth Who Participated in Sexting 50% 36% 25% 22% 23% 22% 25% 6% 0% Total Male Female 13 or Younger 14 to & Older 122

125 Youth Comparisons 2008 (6 th 12 th ) 2012 (6 th 12 th ) 2015 (6 th 12 th ) 2015 (9 th 12 th ) Ohio 2013 (9 th 12 th ) U.S (9 th 12 th ) Ever had sexual intercourse 24% 28% 23% 35% 43% 47% Used a condom at last intercourse 66% 64% 61% 68% 51% 59% Used birth control pills at last intercourse Did not use any method to prevent pregnancy during last sexual intercourse Had four or more sexual partners (of all youth) Had sexual intercourse before age 13 (of all youth) Drank alcohol or used drugs before last sexual intercourse 28% 32% 24% 29% 24% 19% 19% 13% 13% 10% 12% 14% 4% 5% 6% 8% 12% 15% 4% 3% 3% 2% 4% 6% 17% 18% 18% 16% 18% 22% Sexual Risk Behavior Many young people engage in sexual risk behaviors that can result in unintended health outcomes. For example, among U.S. high school students surveyed in 2013: 47% had ever had sexual intercourse 34% had had sexual intercourse during the previous 3 months, and, of these 41% did not use a condom the last time they had sex 15% had had sex with 4 or more people during their life Only 22% of sexually experienced students have ever been tested for HIV Sexual risk behaviors place adolescents at risk for HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy: Approximately 10,000 young people aged years were diagnosed with HIV infection in the United States in 2013 Nearly half of the 20 million new STDs each year are among young people aged years In 2013, about 273,000 babies were born to teenage girls (Source: CDC, Adolescent and School Health, updated 3/25/2015, from: SEXUAL BEHAVIOR 123

126 Youth І MENTAL HEALTH AND SUICIDE Key Findings In 2015, the Health Assessment results indicated that 15% of 6th-12th grade youth had seriously considered attempting suicide in the past year and 5% admitted attempting suicide in the past year. Youth Mental Health In 2015, nearly one-quarter (23%) of youth reported they felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities, increasing to 29% of females (2013 YRBS reported 26% for Ohio and 30% for the U.S.) Ohio Suicide Statistics for Youth Grades % of Ohio youth seriously considered attempting suicide in the 12 months prior to the survey. 11% of Ohio youth made a plan about how they would attempt suicide in the 12 months prior to the survey. 6% of youth had attempted suicide one or more times in the 12 months prior to the survey. 1% of youth had a suicide attempt that resulted in an injury, poisoning, or an overdose that had to be treated by a doctor or nurse in the 12 months prior to the survey. (Source: Centers for Disease Control and Prevention, Healthy Youth, YRBS 2013) 15% of youth reported they had seriously considered attempting suicide in the past 12 months, increasing to 18% of females (2013 YRBS rate of 17% for U.S. youth and 14% for Ohio youth). In the past year, 5% of youth had attempted suicide, increasing to 9% of females. 3% of youth had made more than one attempt. The 2013 YRBS reported a suicide attempt prevalence rate of 8% for U.S. youth and a 6% rate for Ohio youth. 14% of youth stated that they would be very likely to seek help if they were feeling depressed or suicidal. 11% reported that it would be very unlikely they would seek help. youth reported the following causes of anxiety, stress and depression: academic success (46%), fighting with friends (40%), sports (37%), self-image (32%), fighting at home (32%), death of close family member or friend (30%), peer pressure (29%), breakup (29%), dating relationship (26%), being bullied (25%), parent divorce/separation (18%), poverty/no money (15%), caring for younger siblings (14%), alcohol or drug use at home (9%), ill parent (7%), parent lost their job (7%), not feeling safe at home (7%), parent with a mental illness (7%), not having enough to eat (6%), sexual orientation (6%), parent/caregiver with a substance abuse problem (5%), not having a place to live (4%), family member in the military (3%), not feeling safe in the community (3%), and other stress at home (26%). youth reported the following ways of dealing with anxiety, stress, or depression: sleeping (48%), hobbies (42%), texting someone (38%), exercising (31%), praying (29%), talking to a peer (29%), talking to someone in their family (26%), eating (24%), using social media (18%), reading the Bible (13%), breaking something (12%), shopping (10%), writing in a journal (10%), self-harm (9%), talk to a counselor /teacher (7%), drinking alcohol (6%), using illegal drugs (5%), using prescribed medication (5%), smoking/using tobacco (4%), vandalism/violent behavior (4%), talking to a medical professional (4%), harming someone else (2%), gambling (1%), and using un-prescribed medication (1%). 14% of youth reported they did not have anxiety, stress, or depression. When youth are dealing with feelings of depression or suicide, they usually talk to the following: best friend (28%), girlfriend/boyfriend (14%), parent/guardian (17%), brother/sister (8%), adult friend (6%), adult relative (5%), caring adult (5%), teacher (3%), professional counselor (3%), pastor/priest/religious leader (3%), school counselor (2%), youth minister (2%),Teen Line or First Call for Help (1%), and someone else (6%). 15% of youth reported they talked to no one. 124

127 The following graphs show the percentage of youth who had felt sad or hopeless almost every day for two weeks or more in a row and attempted suicide in the past 12 months (i.e., the first graph shows that 23% of all youth had felt sad or hopeless for two weeks or more, 18% of males and 29% of females). 50% 40% 30% 20% 10% 0% 15% 10% 5% 0% 23% Youth Who Felt Sad or Hopeless Almost Every Day for Two Weeks or More in a Row 18% 29% 18% 28% 23% 22% Total Male Female 12 to to & Older Total % Total 2012 youth reported the following leading causes of anxiety, stress and depression: academic success (46%), fighting with friends (40%), sports (37%), fighting at home (32%) and self-image (32%). 5% Youth Who Attempted Suicide in Past 12 Months 1% 9% 7% Total Male Female 12 to to & Older Total % 3% 7% 5% Total 2012 MENTAL HEALTH 125

128 Youth Comparisons 2008 (6 th -12 th ) 2012 (6 th -12 th ) 2015 (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) U.S (9 th -12 th ) Youth who had seriously considered attempting suicide in the past year Youth who had attempted suicide in the past year Youth who felt sad or hopeless almost every day for 2 or more weeks in a row 11% 15% 15% 14% 14% 17% 7% 5% 5% 3% 6% 8% 22% 25% 23% 24% 26% 30% Youth Suicide Suicide affects all youth, but some groups are at a higher risk than others. Boys are more likely than girls to die from suicide. Girls, however, are more likely to report attempting suicide than boys. Several factors can put a young person at risk for suicide. However, having these risk factors does not always mean that suicide will occur. Risk Factors Include: History of previous suicide attempts Family history of suicide History of depression or other mental illness Alcohol or drug abuse Stressful life event or loss Easy access to lethal methods Exposure to the suicidal behavior of others Incarceration (Source: CDC 2014, Injury Center: Violence Prevention; Suicide Prevention; Youth Suicide 126

129 Youth І SAFETY Key Findings In 2015, 13% of youth had ridden in a car driven by someone who had been drinking alcohol in the past month and 2% of youth drivers had driven after drinking alcohol. 43% of youth drivers texted while driving. Personal Safety 7% of youth rarely or never wore a seatbelt when riding in a car driven by someone else (2013 YRBS reported 8% for both Ohio and the U.S.). 54% reported they always wore a seatbelt. In the past 30 days, 13% of youth had ridden in a car driven by someone who had been drinking alcohol, (2013 YRBS reported 17% for Ohio and 22% for the U.S.) and 2% of youth drivers had driven a car themselves after drinking alcohol, (2013 YRBS reported 4% for Ohio and 10% for the U.S.). 9% of youth played the choking game. Texting While Driving Statistics and Information Be Smart: Don t text and drive. No text message is worth the distraction. Be in Control: Remember it s your phone. You decide if and when to send and read texts so take control. Consider turning your phone off, setting it to silent or even storing it in the glove box before hitting the road. Be Caring: Never send a text message to a friend that is driving to meet you, or to anyone you know is likely behind the wheel. Be a Friend: Friends don t let each other text and drive. (Source: Enough is Enough: Internet Safety 101, Texting and Driving, from: youth drivers did the following while driving in the past month: wore a seatbelt (74%), talked on their cell phone (51%), ate (49%), texted (43%), used the internet on their cell phone (21%), used cell phone for other things (13%), checked Facebook on their cell phone (8%), played electronic games on cell phone (4%), applied makeup (4%), drank alcohol (3%), used illegal drugs (3%), read (2%) and misused prescription drugs (1%). 18% of youth had suffered a blow or jolt to their head while playing with a sports team in the past year, increasing to 27% of those ages 17 and older. youth always wore a helmet when they rode the following in the past year: a motorcycle or dirt bike (13%), a snowmobile (10%), an ATV (8%), and a bicycle (3%) youth never wore a helmet when they rode the following in the past year: a bicycle (58%), an ATV (19%), a motorcycle or dirt bike (11%) and snowmobile (6%). YOUTH SAFETY 18% of youth reported that they had suffered a blow or jolt to the head while playing with a sports team which caused them to get knocked out, have memory problems, double or blurry vision, headaches or pressure in the head, or nausea or vomiting, increasing to 24% of high school youth and 27% of those ages 17 and older (2013 YRBS reported 12% for Ohio). More than two-thirds (69%) of youth reported there was a firearm in or around their home. 1% of youth reported they were unlocked and loaded. 91% of youth had a Twitter, Instagram, facebook, online gaming, or other social network account. 127

130 Of those who had an account, they reported the following: o They knew all of my friends (45%) o Their account was currently checked private (44%) o Their parents had their password (23%) o They knew all of the people they play online (15%) o They had been asked to share personal info (15%) o They had been asked to meet someone they met online (10%) o They were bullied because of their accounts (10%) o Their friends had their password (8%) o They share personal information (7%) o They had problems as a result of their account (5%) o Their parents do not know they have an account (5%) o They had participated in sexual activity with someone they met online (2%) Over half (52%) of the youth who had a Twitter, Instagram, facebook, online gaming, or other social network account believed that sharing information online is dangerous. Personal Health Over three-fourths (76%) of youth had been to the dentist for a check-up, exam, teeth cleaning or other dental work in the past year, increasing to 81% of those ages 17 and older (2013 YRBS reported 75% for Ohio). youth had been told by a doctor or other health professional that they had: asthma (18%) (2013 YRBS reported 21% for the U.S.), needed to lose weight to improve their health (7%), high blood pressure (3%), diabetes (2%), high blood cholesterol (1%) and skin cancer (<1%). Youth reported they felt they were putting their health at a greater risk by doing the following: smoking cigarettes (84%), drinking and driving (83%), ride in a car with someone who had been drinking alcohol (83%), texting while driving (82%), drinking alcohol (78%), bullying others (74%), using marijuana (68%), carrying a weapon (65%), participating in other sexual activities (56%) and participating in sexual intercourse (55%). Youth reported they preferred to get information about their health from the following: parents (68%), the internet (36%), school (28%), friends (28%), siblings (13%), TV (11%), social media/facebook (11%) and the radio (4%). Youth Comparisons Ever told by a doctor or nurse they had asthma N/A Not available 2008 (6 th -12 th ) 2012 (6 th -12 th ) 2015 (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) U.S (9 th -12 th ) Always wore a seatbelt 41% 42% 54% 55% N/A N/A Rarely or never wore a seatbelt 9% 10% 7% 7% 8% 8% Ridden with someone who had been drinking alcohol in past month Drove a car after drinking alcohol (of all youth drivers) 18% 13% 13% 10% 17% 22% 5% 2% 2% 3% 4% 10% Suffered a blow or jolt to the head N/A N/A 18% 24% 12% N/A Visited a dentist for a check-up within the past year N/A 75% 76% 78% 75% N/A 20% 20% 18% 18% N/A 21% 128

131 Youth І VIOLENCE ISSUES Key Findings In, 26% of youth had been involved in a physical fight in the past year. 11% of youth reported an adult or caregiver hit, slapped, or physically hurt them on purpose in the past 12 months. 49% of youth had been bullied in the past year and 31% had been bullied on school property. Violence-Related Behaviors In 2015, 13% of youth had carried a weapon (such as a gun, knife or club) in the past 30 days; increasing to 20% of males (2013 YRBS reported 14% for Ohio and 18% for the U.S.). 4% of youth did not go to school on one or more days because they did not feel safe at school or on their way to or from school (2013 YRBS reported 5% for Ohio and 7% for the U.S.). 49% of youth had been bullied in the past year. The following types of bullying were reported: o 36% were verbally bullied (teased, taunted or called harmful names) o 29% were indirectly bullied (spread mean rumors about them or kept them out of a group ) o 13% were cyber bullied (teased, taunted or threatened by or cell phone) (2013 YRBS reported 15% for Ohio and the U.S.). o 10% were physically bullied ( were hit, kicked, punched or people took their belongings) o 2% were sexually bullied (used nude or semi-nude pictures to pressure someone to have sex that did not want to, blackmail, intimidate, or exploit another person) In the past year, 31% of youth had been bullied on school property (2013 YRBS reported 21% for Ohio and 20% for the U.S.). In the past year, 26% of youth had been involved in a physical fight, increasing to 33% of males. 14% had been in a fight on more than one occasion (2013 YRBS reported 20% for Ohio and 25% for the U.S.). 4% of youth reported a boyfriend or girlfriend hit, slapped, or physically hurt them on purpose in the past 12 months (2013 YRBS reported 7% for Ohio). 11% of youth reported an adult or caregiver hit, slapped, or physically hurt them on purpose in the past 12 months. youth had been forced to engage in the following: touched in an inappropriate sexual way (7%), sexual intercourse (4%), other sexual activity (3%), and oral sex (2%). In the past year, 15% of youth had purposefully hurt themselves one or more times without wanting to die, such as by cutting or burning themselves. 4% of youth had purposely hurt themselves 6 or more times. YOUTH VIOLENCE 129

132 The following graph shows youth involved in a physical fight in the past year. The graph shows the number of youth in each segment giving each answer (i.e., the graph shows that 26% of all youth had been in a fight in the past year, 33% of males and 18% of females). 50% Youth Involved in a Physical Fight in the Past Year 40% 30% 26% 33% 31% 27% 28% 26% 20% 18% 17% 10% 0% Total Male Female 12 to to & Older Total 2008 Total 2012 Types of Bullying Youth Experienced in Past Year or 17 and Youth Behaviors Total Male Female Years younger older old Verbally Bullied 36% 30% 41% 43% 41% 21% Indirectly Bullied 29% 19% 39% 33% 30% 23% Cyber Bullied 13% 8% 18% 13% 15% 11% Physically Bullied 10% 12% 8% 13% 12% 3% Sexually Bullied 2% 0% 4% 3% 2% 2% Behaviors of Youth Bullied vs. Non-Bullied Youth Behaviors Bullied Non- Bullied Have drank alcohol in the past 30 days 22% 20% Contemplated suicide in the past 12 months 22% 8% Have smoked cigarettes in the past 30 days 11% 6% Have used marijuana in the past 30 days 11% 7% Misused prescription medications in the past 30 days 11% 6% Attempted suicide in the past 12 months 10% 1% 130

133 Youth Comparisons 2008 (6 th -12 th ) 2012 (6 th -12 th ) 2015 (6 th -12 th ) 2015 (9 th -12 th ) Ohio 2013 (9 th -12 th ) U.S (9 th -12 th ) Carried a weapon in past month 11% 13% 13% 13% 14% 18% Been in a physical fight in past year 27% 26% 26% 20% 20% 25% Did not go to school because felt unsafe 4% 4% 4% 3% 5% 7% Bullied on school property in past year N/A 36% 31% 21% 21% 20% Bullied in past year 51% 51% 49% 43% N/A N/A Electronically/cyber bullied in past year 8% 15% 13% 14% 15% 15% Physically forced to have sexual intercourse 3% 7% 4% 3% 8% 7% Hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend in past year N/A Not available Comparative YRBS data is for % 6% 4% 5% 7% 9% Understanding Bullying Bullying is a form of youth violence. CDC defines bulling as any unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated. Bulling can result in physical injury, social and emotional distress, and even death. Victimized youth are at increased risk for depression, anxiety, sleep difficulties, and poor school adjustment. Youth who bully others are at increased risk for substance use, academic problems, and violence later in adolescents and adulthood. Some of the factors associated with a higher likelihood of bullying behavior include: Externalizing problems such as defiant and disruptive behavior Harsh parenting by caregivers Attitudes accepting of violence Some of the factors associated with a higher likelihood of victimization include: Poor peer relationships Low self-esteem Perceived by peers as different or quiet (Source: CDC, Injury Center: Violence Prevention, Understanding Bullying Fact Sheet, January 2014, YOUTH VIOLENCE 131

134 Child І HEALTH & FUNCTIONAL STATUS Key Findings In 2015, 23% of children were classified as obese by Body Mass Index (BMI) calculations. 78% of parents had taken their child ages 0-11 to the dentist in the past year. 7% of parents reported their child ages 0-11 had been diagnosed with asthma. 6% of parents reported their child had been diagnosed with ADD/ADHD. Health of Children Ages 0-11 National Survey of Children s Health 2011/12 6% of Ohio children ages 0-5 were diagnosed with asthma, increasing to10% of 6-11 year olds. 12% of Ohio children ages 6-11 were diagnosed with ADD/ADHD. (Source: National Survey of Children s Health, 2011/12, In 2015, almost two-thirds (63%) of parents of 0-11 year olds rated their child s health as excellent. 1% of parents rated their child s health as fair. About one-quarter (23%) of children were classified as obese by Body Mass Index (BMI) calculations. 17% of children were classified as overweight, 55% were normal weight, and 4% were underweight. children ate the following for breakfast: cereal (85%), milk (74%), toast (47%), eggs (46%), fruit/fruit juice (36%), yogurt (33%), oatmeal (30%), bacon/ham/sausage (23%), Pop Tart/donut/pastry (34%), soda pop (1%), and other (8%). 6% of children ate at the school breakfast program. 11% of children ate 5 or more servings of fruits and vegetables per day. 86% ate 1 to 4 servings of fruits and vegetables per day. children spent an average of 2.2 hours watching TV, 1.4 hours on the computer/tablet/cellphone, and 0.9 hours playing video games an average day of the week. 78% of children had been to the dentist in the past year, increasing to 89% of 6-11 year olds. Parents gave the following reasons for not getting dental care for their child: child was not old enough to go to the dentist (13%), cost (4%), dentist would not see child yet because of their age (3%), no insurance (3%), treatment was ongoing (3%), could not find a dentist who accepted their insurance (2%), not available in area/transportation problems (1%), child refused to go (<1%), health plan problem (<1%), did not know where to go for treatment (<1%), and other (2%). No one reported the dentist did not know how to treat/provide care to child that they missed an appointment and was not allowed to go back to clinic, or dissatisfaction with dentist. Children s Dental Health Dental disease remains a common problem among Ohio s children; 51% of children have experienced tooth decay by third grade. Dental care remains the single most common unmet health care need for nearly 157,400 children in Ohio, regardless of family income. Almost 486,000 (19%) of Ohio s children are without dental insurance; this is four times the number of children without medical insurance. Almost 340,000 children in Ohio have never been to the dentist. The overall percentage of children in Ohio with dental sealants has increased; however, children in rural/non-appalachian counties are significantly less likely to have dental sealants. (Source: ODH, Oral Health Isn t Optional, 2011, from: 132

135 Parents reported their child had the following allergies: Pollen (7%) Wheat (3%) Eggs (1%) Ragweed (7%) Milk/dairy products (3%) Soy (1%) House dust mites (6%) Horses (3%) Fish (1%) Grasses (6%) Red dye (2%) Kiwi (1%) Dogs (4%) Gluten (2%) Shellfish (1%) Cats (4%) Fungi (2%) Strawberries (1%) Peanuts (3%) Tree nuts (2%) Watermelon (1%) Mold (3%) Bees (1%) Other (5%) 1% of children had an epi-pen for their allergy. 18% of children ages 0-11 years old had at least one health condition. A doctor told parents their 0-11 year old child had the following conditions: Asthma (7%) Bone/joint/muscle problems (2%) Dental problems (7%) Head injury (1%) Speech and language problems (6%) Autism (1%) ADD/ADHD (6%) Depression problems (1%) Developmental delay or physical Intellectual disability/ mental impairment (5%) retardation (1%) Anxiety problems (4%) Other life threatening illness (1%) Learning disability (4%) Genetic disease (1%) Birth defect (4%) Cerebral palsy (1%) Urinary tract infection (4%) Appendicitis (1%) Hearing problems (4%) Diabetes (<1%) Vision problems that cannot be corrected Epilepsy (<1%) with glasses (3%) Digestive tract infections (<1%) Behavioral/conduct problem (2%) Pneumonia (2%) 40% of parents reported their child had been tested for lead poisoning, and the results were within normal limits. <1% reported the levels were elevated and medical follow-up was needed. 46% of parents had not had their child tested for lead poisoning and 13% of parents did not know if their child had been tested for lead. One-fifth (20%) of children ages 0-11 had difficulties in the following areas: concentration (12%) emotions (9%), behavior (7%), and being able to get along with people (1%). Of those with difficulties, 60% were minor and 5% were severe. Difficulties were managed in the following ways: family and friends take care of it (53%), professional help (26%), school/day care (26%), help was not needed (26%), and unable to access help (1%). 1% of parents reported their children usually felt unhappy, sad or depressed in the past month. HEALTH & FUNCTIONAL STATUS 133

136 Child Comparisons Rated health as excellent or very good 2015 Ages 0-5 Ohio 2011/12 Ages 0-5 U.S. 2011/12 Ages Ages 6-11 Ohio 2011/12 Ages 6-11 U.S. 2011/12 Ages % 89% 86% 92% 86% 83% Dental care visit in past year 53% 50% 54% 89% 92% 88% Diagnosed with asthma 2% 6% 6% 9% 10% 10% Diagnosed with ADHD/ADD 2% N/A 2%* 8% 12% 9% Diagnosed with behavioral or conduct problems Diagnosed with vision problems that cannot be corrected Diagnosed with bone, joint, or muscle problems 0% N/A 2%** 3% 5% 4% 0% N/A <1% 4% N/A 2% 1% N/A 1% 2% N/A 2% Diagnosed with epilepsy 0% N/A <1% <1% N/A 1% Diagnosed with a head injury 1% N/A <1% 1% N/A <1% Diagnosed with diabetes 0% N/A N/A <1% N/A <1% Diagnosed with depression 0% N/A <1%* 2% N/A 2% N/A Not available * - Ages 2-5 Attention-Deficit / Hyperactivity Disorder (ADHD) 5% of school-aged children have ADHD. However, studies have estimated higher rates in community samples. Parents report that approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of Parent-reported ADHD diagnosis in Ohio was 14.2% Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5% per year from 2003 to Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD. Rates of ADHD diagnosis increased at a greater rate among older teens as compared to younger children. The highest rates of parent-reported ADHD diagnosis were noted among children covered by Medicaid and multiracial children. (Source: CDC, Attention-Deficit / Hyperactivity Disorder (ADHD), 12/10/2014, from: 134

137 Asthma The following graph shows that has a lower percentage of children ages 0-5 and 6-11 who are diagnosed with asthma than both Ohio and the U.S. Child Fatalities The following graph shows child fatality data for youth from birth to 18 years old, from January 1, 2012 to December 31, The table shows that: There were a total of 13 child fatalities in from 2012 to 2014, averaging to 4 fatalities per year. Number of Fatalities 30% 25% 20% 15% 10% 10 5% 0% % 6% Children Diagnosed with Asthma 6% Ages 0-5 Ages 6-11 (Source: General Health District Vital Statistics, Death Certificate Data) 9% 10% 2015 Ohio 2011/12 U.S. 2011/12 4 Child Fatalities, 2012 to % HEALTH & FUNCTIONAL STATUS 135

138 Child І HEALTH INSURANCE, ACCESS, UTILIZATION AND MEDICAL HOME Key Findings In 2015, 1% of parents reported their 0-11 year old did not have health insurance. 22% of parents reported they had taken their child to the hospital emergency room in the past year. 72% of parents had taken their child to the doctor for preventive care in the past year. Health Insurance 1% of parents reported that their child did not currently have health insurance. children had the following types of health insurance: parent s employer (64%), Medicaid, Healthy Start, or other public health benefits (22%), someone else s employer (16%), National Survey of Children s Health 2011/12 7% of 0-5 year old and 5% of 6-11 year old Ohio children were without insurance at some time in the past year. 40% of 0-5 year old and 34% of 6-11 year old Ohio children had public insurance. 94% of 0-5 year old and 86% of 6-11 year old Ohio children had been to the doctor for preventive care in the past year. (Source: National Survey of Children s Health, 2011/12 self-paid (2%), Insurance Marketplace (1%), Medicare (<1%), or some other source of insurance (<1%). Parents reported their child s health insurance covered the following: doctor visits (98%), prescription coverage (96%), well visits (95%), hospital stays (95%), immunizations (92%), dental (85%), vision (75%), and mental health (72%). Access and Utilization 17% of parents reported their child did not get all of the prescription medications they needed in the past year for the following reasons: their child did not need prescription medication (14%), no referral (2%), cost (1%), treatment is ongoing (1%), dissatisfaction with doctor (<1%), health plan problem (<1%), transportation problems (<1%), doctor did not know how to treat or provide care (<1%), and other reasons (1%). No one reported their child did not have insurance, they could not find a doctor to accept child s insurance, they could not get an appointment, religious preference, or they did not know where to get treatment. 11% of parents reported their child did not get all of the medical care they needed in the past year. They reported the following reasons: cost (5%), no referral (3%), health plan problem (2%), inconvenient times/could not get an appointment (2%), treatment is ongoing (2%), no insurance (1%), not available in area/transportation problems (1%), doctor did not know how to treat or provide care (1%), could not find a doctor who accepted child s insurance (<1%), not available in area (<1%), vaccine shortage (<1%), and other reasons (1%). No one reported that they did not like the doctor, they didn t know where to go for treatment, there was a language barrier or that their child refused to go. 9% of children received mental health care or counseling in the past year, increasing to 14% of those with incomes less than $25,000. Almost one-quarter (22%) of parents took their child to the hospital emergency room for health care in the past year, increasing to 37% of parents with incomes less than $25,000. 3% of children had been to the ER three or more times in the past year. 136

139 12% of parents reported their child needed the following special services in the past year: speech therapy (6%), counseling (4%), physical therapy (3%), occupational therapy (3%), special education (3%), respite care (<1%), out of home care(<1%), or medical equipment, such as a wheelchair (<1%). 93% of children had received all of their recommended vaccinations. 7% of children did not get all of their recommended vaccinations for the following reasons: child had received some, but not all recommended vaccinations (7%), parents chose to not vaccinate their child (3%), fear of negative effects (1%), religious or cultural beliefs (1%), alternate vaccination schedule used (<1%), and other reasons (1%). Of those parents who chose not to vaccinate their child, they did not get their child the following vaccines: Influenza (75%), Chickenpox (Varicella) (63%), Hepatitis A (56%), Hepatitis B (56%), Prevnar 13 (Pneumococcal Conjugate) (50%), MMR (measles, mumps, and rubella) (44%), HIB (Haemophilus) (44%), Polio (44%), and DtaP/Tdap (diphtheria, tetanus, and pertussis) (31%). Medical Home 76% of parents reported they had one or more people they think of as their child s personal doctor or nurse, decreasing to 64% of those with incomes less than $25, % of children had visited their health care provider for preventive care in the past year, increasing to 86% of 0-5 year olds. In 2015, 98% of parents reported that their child had one particular place they usually went if they were sick or needed advice about their health. They reported the following places: a private doctor s office (78%), an urgent care center (9%), a community health center (1%), a hospital emergency room (<1%), and some other kind of place (1%). 8% reported multiple places. children have been referred to the following specialists: Ear, Nose, and Throat (ENT) doctor (18%), Allergist (6%), Cardiologist (heart doctor) (4%), Pediatric Ophthalmologist (4%), Psychiatrist (3%), Dermatologist (3%), Endocrinologist (diabetes doctor) (2%), Oncologist (cancer doctor) (<1%), and other specialist (12%). Child Comparisons Have a personal doctor or nurse *2003 national and state data 2015 Ages 0-5 Ohio 2011/12 Ages 0-5 U.S. 2011/12 Ages Ages 6-11 Ohio 2011/12 Ages 6-11 U.S. 2011/12 Ages 6-11 Had public insurance 27% 40% 44% 19% 34% 37% Been to doctor for preventive care in past year 86% 94% 90% 64% 86% 82% 2 or more visits to the ER 10% 8%* 8%* 8% 6%* 4%* Received all the medical care they needed 88% 99%* 99%* 89% 98%* 98%* 80% 91% 91% 74% 93% 90% CHILD HEALTH INSURANCE 137

140 Child І EARLY CHILDHOOD (0-5 YEAR OLDS) Key Findings The following information was reported by parents of 0-5 year olds. 90% of mothers got prenatal care within the first three months during their last pregnancy. 6% of mothers smoked during their last pregnancy. 61% of parents put their child to sleep on his/her back. 25% of mothers never breastfed their child. Early Childhood The following information was reported by parents of 0-5 year olds. Progress on Childhood Obesity 1 in 8 preschoolers is obese in the US. Obesity among low-income preschoolers declined, from 2008 through 2011, in 19 of 43 states and territories. Children who are overweight or obese as preschoolers are 5 times as likely as normal weight children to be overweight or obese as adults. (Source: CDC, Progress on Childhood Obesity, August 2013, from: html) During their last pregnancy, mothers did the following: got prenatal care within the first 3 months (90%), took a multi-vitamin (88%), took folic acid during pregnancy (53%), took folic acid pre-pregnancy (34%), experienced depression during or after pregnancy (14%), smoked cigarettes (6%), and used alcohol (2%). When asked how parents put their child to sleep as an infant, 61% said on their back, 10% said on their side, 10% said in bed with them or another person, 8% said on their stomach, and 5% said various methods. Children were put to sleep in the following places: pack n play (56%), crib/bassinette without bumper, blankets, or stuffed animals (50%), crib/bassinette with bumper, blankets, or stuffed animals(47%), in bed with parent or another person (42%), swing (39%), car seat (31%), floor (15%), couch or chair (11%). Mothers breastfed their child: more than 9 months (28%), 4 to 9 months (15%), 7 weeks to 3 months (18%), 3 to 6 weeks (6%), 2 weeks or less (6%), still breastfeeding (2%), and never breastfed (25%). Parents reported they or someone in the family reads to their 0-5 year old child: every day (19%), almost every day (40%), a few times a week (27%), and a few times a month (7%). 3% reported never reading to their child due to lack of interest from the child. Children 0-5 years old were more likely than children 6-11 years old to: Have visited a doctor for preventive care in the past year (86% compared to 64% of 6-11). Have public insurance (27% compared to 19% of 6-11). Have a personal doctor or nurse (80% compared to 74% of 6-11). Child Comparisons years Ohio 2011/ years U.S. 2011/ years Parent reads to child every day 19% 53% 48% Never breastfed their child 25% 29% 21% 138

141 Breastfeeding The following graph shows the percent of infants who have been breastfed or given breast milk from, Ohio, and U.S. The U.S. has a larger percent of children who have been breastfed for any length of time, compared to Ohio and. 100% 80% 60% 40% 20% 0% 25% 29% Never Breastfed Children Breastfed 21% Facts about Breastfeeding Breastfed The percent of infants who were ever breastfed is 65% in Ohio, compared to 77% in the U.S. Human milk provides virtually all the protein, sugar, and fat your baby needs to be healthy, and it also contains many substances that benefit your baby s immune system, including antibodies, immune factors, enzymes, and white blood cells. These substances protect your baby against a wide variety of diseases and infections not only while he is breastfeeding but in some cases long after he has weaned. Formula cannot offer this protection. With regard to allergy prevention, there is some evidence that breastfeeding protects babies born to families with a history of allergies, compared to those babies who are fed either a standard cow s milk based formula or a soy formula. Recent research even indicates that breastfed infants are less likely to b obese in adolescence and adulthood. They are also less vulnerable to developing both type 1 and type 2 diabetes. The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond. (Source: CDC, Breastfeeding, July, 31, 2013, from: & Healthy Children, Breastfeeding Benefits Your Baby s Immune System, 5/11/2013, from: 75% 71% 2015 Ohio 2011/12 U.S. 2011/12 (Source: National Survey of Children s Health, Data Resource Center, and 2015 Health Assessment) 79% EARLY CHILDHOOD 139

142 Child І MIDDLE CHILDHOOD (6-11 YEARS OLD) Key Findings The following information was reported by parents of 6-11 year olds. In 2015, 67% of parents reported their child always feels safe at school. 44% of parents reported their child was bullied at some time in the past year. 85% of parents reported their child participated in extracurricular activities. 23% of parents reported their child had an or a social network account. Middle Childhood The following information was reported by parents of 6-11 year olds. National Survey of Children s Health 2011/12 10% of Ohio and 9% of U.S. parents of 6-11 year olds reported their child watched 4 or more hours of TV or played video games each day. 83% of Ohio and 79% of U.S. parents of 6-11 year olds reported their child participated in one or more organized activities outside of school 96% of Ohio and 94% of U.S. parents of 6-11 year olds reported they felt their child was usually or always safe at school. (Source: National Survey of Children s Health, 2011/12, accessed from: Parents reported they had to contact the following agencies to help with problems with their child: child s school (8%), mental health agency (6%), Board of Developmental Disabilities (<1%), Children s Services (<1%), faith based agency (<1%), and law enforcement (<1%). No one reported contacting juvenile court. 88% of parents reported they have never called an agency for help with their child. 74% of parents of 6-11 year olds reported their child was physically active for at least 60 minutes on 3 or more days per week. 53% had done so on 5 or more days and 19% were physically active for at least 60 minutes every day per week. 1% reported no physical activity. 85% of parents reported their 6-11 year old child participated in extracurricular activities in the past year. Their child participated in the following: a sports team or sports lessons (71%), a religious group (39%), a club or organization such as Scouts (21%), Boys/Girls Club (2%), and some other organized activity (24%). Children missed school an average of 1.9 days per year because of illness or injury. children 6-11 years old were enrolled in the following types of schools: public (87%), private (7%), home-schooled (4%), and charter (<1%). 1% of children were not enrolled in school. 67% of parents reported they felt their child was always safe at school. 29% reported usually, 1% reported sometimes, and 1% reported they felt their child was never safe at school. 44% of parents reported their child was bullied in the past year. The following types of bullying were reported: 32% were verbally bullied (teased, taunted or called harmful names) 11% were indirectly bullied (spread mean rumors about or kept out of a group ) 8% were physically bullied (they were hit, kicked, punched or people took their belongings) 1% were cyber bullied (teased, taunted or threatened by or cell phone) 9% of parents reported they did not know if their child was bullied. 140

143 Almost one-quarter (23%) of parents of 6-11 year olds reported their child had an , Facebook, Twitter, Instagram or other social network account. Of those who had an account, they reported the following: they had their child s password (86%), they knew all of the people in their child s my friends (57%), their child s account was checked private (50%), their child had a problem as a result of their account (5%), and their child s friends had their passwords (2%). 2% of parents reported they did not know if their child had a social network account. Parents reported they or someone in the family reads to their 6-11 year old child: every day (8%), almost every day (15%), a few times a week (20%), a few times a month (8%), and a few times a year (5%). 39% of parents reported their child read to him/herself, and 1% reported never reading to their child due to lack of interest from the child. Children 6-11 years old were more likely than children 0-5 years old to: Have been diagnosed with asthma (9% compared to 2% of 0-5). Have ADD or ADHD (8% compared to 2% of 0-5). Have gone to the dentist in the past year (89% compared to 54% of 0-5). parents reported they were concerned a lot with the following issues with their 6-11 year old child: having enough time with their child (9%), child s academic achievement (8%), their relationship with their child (6%), how their child copes with stressful things (5%), learning difficulties with their child (4%), their child s anxiety (4%), their child s selfesteem (4%), their child being bullied by their classmates(4%), cell phone and technology use (3%), their child s depression (3%), internet use (2%), violence in the home, school or neighborhood (2%), their child talking (1%), eating disorders (1%), their child walking or running (1%), their child getting along with others (1%) and substance abuse (1%). Child Comparisons Child did not miss any days of school because of illness or injury Child missed school 11 days or more because of illness or injury Parent felt child was usually/always safe at school *2007 National Survey of Children s Health Years Ohio 2011/ Years U.S. 2011/ Years 27% 16%* 22%* <1% 8%* 5%* 96% 96% 94% MIDDLE CHILDHOOD 141

144 Child І FAMILY FUNCTIONING, NEIGHBORHOOD AND COMMUNITY CHARACTERISTICS Key Findings In 2015, 71% of parents reported their 0-11 year old child slept hours per night. 95% of parents reported their neighborhood was always or usually safe enough for their child to go out and play. 1% of parents reported there was an unlocked and loaded firearm in their home. 8% of parents reported they received benefits from the SNAP/food stamps program. Family Functioning National Survey of Children s Health 2011/12 63% of Ohio and 61% of U.S. parents of 0-5 year olds reported their family ate a meal together every night of the week. 29% of 0-5 year old and 34% of 6-11 year old Ohio children lived in a household with someone who smokes. (Source: National Survey of Children s Health, 2011/12 Almost three-quarters (71%) of parents reported their child slept hours per night. 22% reported their child slept 8-9 hours each night, <1% reported 5-7 hours, and 5% reported 12 or more hours a night. 1% of parents reported their child went to bed hungry at least one day per week because they did not have enough food. 43% of parents reported that every family member who lived in their household ate a meal together every day of the week. Families ate a meal together an average of 6.3 times per week. 30% of parents reported their child attended religious service one to three times per month and 58% reported four or more times per month. 12% reported their child has never attended a religious service. Parents reported their child attended religious services an average of 3.9 times per month. Parents reported their child regularly attended the following: elementary school (37%), child care outside of their home provided by a relative (30%), nursery school, pre-school, or kindergarten (22%), family-based child care outside of home (21%), child care in their home provided by a relative other than a parent/guardian (19%), child care center (8%), child care in their home provided by a baby sitter (7%), and Head Start or Early Start program (3%). Parents reported the following forms of discipline they used for their child: take away privileges (80%), time out (61%), grounding (40%), yelling (39%), spanking (32%), wash mouth out (3%) and other method (7%). Parents reported the following challenges they face in regards to the day-to-day demands of parenthood/raising children: demands of multiple children (44%), financial burdens (19%), being a single parent (9%), difficulty with lifestyle changes (3%), loss of freedom (3%), child has special needs (2%), post-partum depression (1%), alcohol and/or drug abuse (1%), and other challenges (7%). 142

145 Child Safety Characteristics Parents reported their neighborhood was: always safe (55%), usually safe (40%), sometimes safe (2%), and never safe (3%). Parents reported having the following safety items in their home: working smoke alarm/detector (96%), fire extinguisher (60%), carbon monoxide detector (58%), and Poison Control number by the phone (39%). 85% had more than one of these safety items in their home. 53% of parents reported they had a firearm in or around their home. 1% reported they were unlocked and loaded. 49% of parents reported their child always rode in a car seat/booster seat when a passenger in a car, decreasing to 29% of those children ages 6-11 years old. Parents reported their child spent the following unsupervised time after school on an average school day: no unsupervised time (72%), less than one hour (21%), 1-2 hours (6%), and 3-4 hours (1%). Parents reported their child always wore a helmet when riding the following: ATV (18%), a scooter/bike (14%), rollerblades/skates (3%), and a skateboard (3%). Parents reported their child never wore a helmet when riding the following: rollerblades/skates (12%), a scooter/bike (31%), a skateboard (12%), and an ATV (8%). Neighborhood and Community Characteristics parents had the following rules about smoking in their home: no one is allowed to smoke inside their home at any time (85%), smoking is not allowed when children are present (9%), smoking is allowed anywhere (3%), and smoking is allowed in some rooms only (2%). parents had the following rules about smoking in their car: no one is allowed to smoke inside their car at any time (80%), smoking is not allowed when children are present (6%), smoking is allowed as long as a window is open (6%), and smoking is allowed anywhere (1%). In the past year, parents reported that someone in the household received the following: free or reduced cost breakfast or lunches at school (18%), SNAP/food stamps (8%), benefits from WIC program (7%), mental health treatment (5%), cash assistance from a welfare program (3%), Help Me Grow (1%), and subsidized childcare through JFS (<1%). parents reported their child experienced the following: had at least one other adult in their school, neighborhood, or community who knows him/her well and who he/she can rely on for advice or guidance (42%), their parents became separated or were divorced (14%), lived with someone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks (4%), lived with a parent/guardian who served time or was sentenced to serve time in prison or jail after they were born (4%), lived with someone who had a problem with alcohol or drugs (4%), seen or heard any parents or adults in their home hit, beat, kicked, or physically hurt each other (2%), lived with a parent/guardian who died (2%), were treated or judged unfairly because his/her ethnic group (1%), and been the victim of violence or witness violence in their neighborhood (<1%). 143 FAMILY FUNCTIONING

146 Child Comparisons Family eats a meal together every day of the week Child never attends religious services Neighborhood is usually or always safe N/A Not available Years Ohio 2011/ Years U.S. 2011/ Years Years Ohio 2011/ Years U.S. 2011/ Years 50% 63% 61% 40% 45% 47% 5% N/A N/A 12% 22% 18% 96% 88% 86% 95% 86% 86% Family Dinners The following graph shows the percent of families that eat a meal together every day of the week along with the percent of Ohio families and the percent of U.S. families. U.S. families eat a meal together every day of the week more frequently than and Ohio families. Families that Eat Together Everyday of the Week 100% 80% 60% 43% 34% 53% 40% 20% 0% 2015 Ohio 2011/12 U.S. 2011/12 (Source: National Survey of Children s Health & 2015 Health Assessment) Children and Sleep Children five to twelve years old need hours of sleep. Sleep problems and disorders are prevalent at this age. Poor or inadequate sleep can lead to mood swings, behavioral problems such as hyperactivity and cognitive problems that impact their ability to learn in school. Sleep tips for school-aged children: Teach school-aged children about healthy sleep habits Emphasize need for regular and consistent sleep schedule and bedtime routine Make child's bedroom conducive to sleep dark, cool and quiet Keep TV and computers out of the bedroom. (Source: National Sleep Foundation, Children and Sleep; 144

147 Neighborhood Safety The following graph shows the percent of, Ohio, and U.S. parents who feel their neighborhood is always or usually safe. has the largest percent of parents for both the 0-5 age group and the 6-11 age group who feel that their neighborhood is always/usually safe as compared to Ohio and U.S. parents. 100% 90% 80% 70% 96% Parents Feel their Neighborhood is Always or Usually Safe 88% Ages 0-5 Ages % 86% 86% 86% 2015 Ohio 2011/12 U.S. 2011/12 (Source: National Survey of Children s Health & 2015 Health Assessment) Child Passenger Safety Facts In the United States during 2011, more than 650 children ages 12 years and younger died as occupants in motor vehicle crashes, and approximately 148,000 were injured. One CDC study found that, in one year, more than 618,000 children ages 0-12 rode in vehicles without the use of a child safety seat or booster seat or a seat belt at least some of the time. More than two-thirds of fatally injured children were killed while riding with a drinking driver. Restraint use among young children often depends upon the driver s seat belt use. Almost 40% of children riding with unbelted drivers were themselves unrestrained. Booster seats reduce the risk for serious injury by 45% for children ages 4 to 8 years. Child safety seats reduce the risk of death in passenger cars by 71% for infants, and by 54% for toddler s ages 1 to 4 years. Child restraint systems are often used incorrectly. One study found that 72% of nearly 3,500 observed car and booster seats were misused in a way that could be expected to increase a child s risk of injury during a crash. (Sources: CDC, Injury Prevention & Control: Motor Vehicle Safety, Updated: September 12, 2014, from: FAMILY FUNCTIONING