1 2008 York County Community Health Needs Assessment Summary of Results Presented By: Lisa Lehman,...

1

2008 York County Community Health Needs Assessment

Summary of Results

Presented By:Lisa Lehman, HolleranDr. David Polk, York CollegeApril 3, 2009

2

Methodology

A total of 625 York County adults were interviewed by telephone to assess their health practices and health status.

There was a 25% over-sampling in York City to allow for results to be tabulated for the city alone.

Interviews were conducted between April 7 and May 9, 2008 with additional interviews in York City conducted in November of 2008. Each interview lasted approximately 12-15 minutes.

3

Key Areas Examined

General Health Status (Mental Health, Physical Health) Access to Care Chronic Disease (Diabetes, Cardiovascular Health, Cancer) Risky Behavior (Substance Abuse, Communicable Disease) Oral Health Immunizations Children’s Health Women’s Health Teen Risky Behaviors Crime, Violence, and Race Relations Environmental Health

4

General Health Status of York County Residents

5

Would you say in general that your health is…?

4.3%

12.2%

32.5%

20.9%

3.3%

11.4%

30.4%

34.4%

20.4%

3.6%

12.8%

29.4%

36.2%

1.7%

19.4%

36.2%

28.6%

14.1%

30.3%

17.9%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Poor

Fair

Good

Very good

Excellent

National Pennsylvania York County '08 York City '08

66

Community Health Status Indicators(www.community health.hhs.gov)

Compared to Peer Counties

Peer Counties York, PA Chester, PAHillsborough,

NH

Size 408,801 474,027 401,291

Density 452 627 458

% Below Poverty 7.5% 5.3% 6.3%

% 65+ 13.6% 11.9% 11.0%

% White 93.4% 89.6% 94.0%

7

12.7%

9.3%

9.8%

0% 2% 4% 6% 8% 10% 12% 14%

York

Chester

Hillsborough

Hillsborough

Chester

York

7

Would you say in general that your health is…?

% Fair or Poor (Median 17.1%; Peers 8.2%-14.4%)

88

Trends – Subjective Health Assessment

1994 1997 2000 2003 2008

Poor to fair health 10% 13% 11% 11% 16%

9

During the past 30 days, for about how many days did poor physical or mental health keep you from doing

your usual activities?

11.9%

4.4%

11.8%

12.5%

59.4%

11.3%

4.4%

10.8%

12.0%

61.5%

14.2%

2.5%

15.4%

13.1%

54.8%

18.7%

1.8%

17.4%

25.9%

36.2%

0% 10% 20% 30% 40% 50% 60% 70%

15-30 days

8-14 days

3-7 days

1-2 days

None

National Pennsylvania York County '08 York City "08

Respondents reporting 1 or more days of poor physical or mental health

10

6.0

5.3

4.8

4.0 4.2 4.4 4.6 4.8 5.0 5.2 5.4 5.6 5.8 6.0 6.2 6.4 6.6 6.8 7.0

York

Chester

Hillsborough

Hillsborough

Chester

York

10

Average Number of Unhealthy Days In Past Month

(Median 6.0; Peers 4.8-6.4)

11

Exercise, Weight, & Nutrition

12

Body Mass Index (BMI)

60.0%

25.0%

15.0%

38.3%

33.9%

27.8%

38.6%

35.0%

26.4%

32.5%

38.6%

28.9%

26.9%

44.5%

28.6%

0% 10% 20% 30% 40% 50% 60%

Neither overweight norobese***

Overweight***

Obese

Healthy People 2010 National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

13

Do you now consider yourself to be overweight, underweight, or about average?

54.2%

3.9%

41.9%

53.5%

5.7%

40.8%

0% 10% 20% 30% 40% 50% 60%

About average

Underweight

Overweight

York County '08 York City '08

14

During the past month, other than your regular job, did you participate in any physical activities or exercises?

24.2%

75.8%

22.9%

77.1%

26.9%

73.1%

36.2%

63.8%

0% 10% 20% 30% 40% 50% 60% 70% 80%

No

Yes

National Pennsyvania York County '08 York City '08

15

Access to Health Care

16

Do you have any kind of health care coverage?

15.6%

84.4%

10.5%

89.5%

9.2%

90.8%

11.4%

88.6%

0% 20% 40% 60% 80% 100%

No

Yes

National Pennsylvania York County '08 York City "08

17

About how long has it been since you last visited a doctor for a routine checkup?

68.2%

14.4%

9.2%

8.3%

67.7%

14.0%

10.1%

8.2%

75.4%

8.7%

8.6%

7.3%

80.6%

8.0%

6.1%

5.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Within past year***

Within past 2 years***

Within past 5 years

5 or more years ago

National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

18

Was there a time in the past 12 months when your doctor prescribed medication to you that you did not

access because of cost?

86.2%

13.8%

77.7%

22.3%

0% 20% 40% 60% 80% 100%

No

Yes

York County '08 York City '08

1919

Trends – Access to Care

1994 1997 2000 2003 2008

Cost prevented seeing MD

8% 6% 5% 8% 12%

No usual provider of care 10% 12% 11% 10% 10%

No health insurance 6% 9% 9% 13% 9%

20

Oral Health

21

How long has it been since you last visited a dentist or dental clinic for any reason?

68.0%

11.8%

9.0%

10.0%

1.2%

70.1%

10.0%

9.1%

10.2%

0.7%

69.7%

10.7%

8.0%

11.0%

0.7%

60.4%

21.3%

7.9%

10.4%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Within the past year

Within the past 2 years

Within the past 5 years

5 or more years ago

Never

National Pennsylvania York County '08 York City '08

22

How many of your permanent teeth have been removed because of tooth decay or gum disease?

54.2%

29.4%

10.9%

5.5%

50.1%

30.8%

12.1%

7.1%

57.4%

25.1%

10.8%

6.7%

49.4%

33.6%

12.7%

4.3%

0% 10% 20% 30% 40% 50% 60%

None**

1 to 5**

6 or more but not all

All

National Pennsylvania York County '08 York City '08

**Scores are significantly different than the Pennsylvania comparison.

23

Disability

24

Are you limited in any way in any activities because of physical, mental, or

emotional problems?

80.0%

20.0%

81.2%

18.8%

75.8%

24.2%

68.6%

31.4%

0% 20% 40% 60% 80% 100%

No***

Yes***

National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

25

Do you now have any health problem that requires you to use special equipment?

93.0%

7.0%

92.9%

7.1%

91.9%

8.1%

85.1%

14.9%

0% 20% 40% 60% 80% 100%

No

Yes

National Pennsylvania York County '08 York City '08

26

Alcohol Consumption

27

During the past 30 days, how many days per weekor per month did you have at least one drink of

any alcoholic beverage?

38.4%

37.6%

16.6%

7.4%

40.7%

38.6%

14.3%

6.3%

41.9%

37.9%

13.0%

7.2%

34.3%

28.5%

17.4%

19.8%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Less than 1 per week***

1-2 times per week

3-6 days per week***

Daily

National Pennsylvania York County '08 York City '08

Respondents who had an alcoholic drink in the past 30 days

***Scores are significantly different than the National and Pennsylvania comparison.

28

On the days when you drank, about how manydrinks did you drink on average?

11.6%

18.8%

29.4%

40.2%

12.3%

20.0%

28.6%

39.1%

9.2%

20.4%

27.6%

42.7%

1.9%

24.1%

20.1%

53.9%

0% 10% 20% 30% 40% 50% 60%

5 or more

3-4 drinks

Two

One

National Pennsylvania York County '08 York City '08

Respondents who had an alcoholic drink in the past 30 days

29

How many times during the past 30 days did you have 5 or more drinks on an occasion?

6.6%

5.5%

6.3%

11.3%

70.4%

6.7%

5.4%

6.8%

10.8%

70.3%

2.2%

5.6%

4.6%

12.5%

75.2%

8.1%

91.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

5 or more times

3-4 times

Twice

Once

None***

National Pennsylvania York County '08 York City '08

Respondents who have had a drink in the past 30 days

***Scores are significantly different than the National and Pennsylvania comparison.

3030

Trends – Behavioral Risks

1994 1997 2000 2003 2008

Currently smoke 20% 19% 23% 22% 26%

Binge drinking 13% 20% 12% 16% 9%

31

Seniors & Immunizations

32

During the past 12 months, have you had a flu shot?

32.9%

67.1%

31.7%

68.3%

26.1%

73.9%

35.6%

64.4%

0% 10% 20% 30% 40% 50% 60% 70% 80%

No

Yes

National Pennsylvania York County '08 York City '08

Respondents age 65 and over

33

During the past 12 months, have you had a flu shot?

68.3%

31.7%

65.7%

34.3%

60.3%

39.7%

56.5%

43.5%

0% 10% 20% 30% 40% 50% 60% 70%

No***

Yes***

National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

34

Safety

35

How often do you use seat belts when you drive or ride in a car?

82.4%

10.2%

3.9%

1.7%

1.8%

71.6%

14.7%

7.1%

3.1%

3.5%

83.0%

5.9%

3.3%

5.5%

2.3%

81.7%

6.0%

2.5%

5.9%

3.9%

0% 20% 40% 60% 80% 100%

Always**

Nearly always***

Sometimes

Seldom

Never

National Pennsylvania York County '08 York City '08

**Scores are significantly different than the Pennsylvania comparison.

***Scores are significantly different than the National and Pennsylvania comparison.

3636

Trends – Behavioral Risks

1994 1997 2000 2003 2008

Don’t always wear seatbelt

39% 35% 33% 25% 17%

37

How safe from crime do you consider your neighborhood to be?

3.5%

8.6%

35.4%

45.1%

7.4%

9.9%

22.7%

52.2%

15.2%

0% 10% 20% 30% 40% 50% 60%

Extremely Unsafe

Slightly Unsafe

Safe

Very Safe

Extremely Safe

York County '08 York City '08

38

Preventive Screenings

39

Have you ever had a mammogram?

8.9%

91.1%

10.0%

90.0%

7.3%

92.7%

12.4%

87.6%

0% 20% 40% 60% 80% 100%

No

Yes

National Pennsylvania York County '08 York City '08

Females 40 and Over

40

Have you ever been told by a doctor, nurse, or other health professional that you had prostate cancer?

96.0%

4.0%

95.5%

4.5%

96.5%

3.5%

86.9%

13.1%

0% 20% 40% 60% 80% 100%

No

Yes

National Pennsylvania York County '08 York City '08

Males 40 and Over

41

Have you ever used a home blood stool test?

57.2%

42.8%

57.9%

42.1%

48.6%

51.4%

39.1%

60.9%

0% 10% 20% 30% 40% 50% 60%

No***

Yes***

National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

Respondents 50 and Over

42

Have you ever had a sigmoidoscopy or colonoscopy?

41.5%

58.5%

41.4%

58.6%

40.1%

59.9%

53.5%

46.5%

0% 10% 20% 30% 40% 50% 60%

No

Yes

National Pennsylvania York County '08 York City '08

43

82.4%

77.5%

44.4%

70.8%

71.5%

84.8%

84.1%

49.7%

61.6%

69.7%

85.7%

83.6%

51.9%

67.3%

72.1%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Pap smears (18+)

Mammography(50+)

Sigmoidoscopy(50+)

Pneumoniavaccine (65+)

Flu vaccine (65+)

York Chester Hillsborough43

Adult Preventive Services Used

4444

Trends – Access to Screening and Preventative Services

1994 1997 2000 2003 2008

Dental exam last year na 75% 82% 75% 70%

Breast exam last year (40+) 66% 67% 77% 64% 94%

Flu shot last year 27% 36% 34% 43% 40%

Ever had mammogram (40+) 78% 87% na 94% 93%

Mammogram last two years (50+)

59% 60% 81% 74% 87%

Pap exam last year 63% 67% 69% 83% 66%

45

HIV/AIDS

46

Have you ever been tested for HIV?

64.0%

36.0%

70.9%

29.1%

53.9%

46.1%

39.2%

59.4%

0% 10% 20% 30% 40% 50% 60% 70% 80%

No***

Yes***

National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

Respondents under 65 years

47

Emotional Health

48

How often do you receive the emotional support you need?

49.5%

29.9%

11.9%

3.5%

5.1%

45.9%

31.7%

12.7%

3.8%

5.9%

56.3%

26.2%

9.2%

5.0%

3.3%

46.2%

29.7%

7.3%

12.1%

4.7%

0% 10% 20% 30% 40% 50% 60%

Always***

Usually***

Sometimes

Rarely

Never

National Pennsylvania York County '08 York City '08

***Scores are significantly different than the National and Pennsylvania comparison.

49

In general, how satisfied are you with your life?

45.7%

49.3%

4.0%

1.0%

43.7%

50.8%

4.2%

1.3%

50.3%

44.3%

3.4%

2.0%

32.8%

57.4%

9.1%

0.7%

0% 10% 20% 30% 40% 50% 60% 70%

Very satisfied**

Satisfied**

Dissatisfied

Very dissatisfied

National Pennsylvania York County '08 York City '08

**Scores are significantly different than the Pennsylvania comparison.

50

Has a doctor or other healthcare provider ever told you that you had an anxiety disorder?

88.7%

11.3%

81.8%

18.2%

78.0%

22.0%

0% 20% 40% 60% 80% 100%

No*

Yes*

National York County '08 York City '08

*Scores are significantly different than the National comparison.

51

Has a doctor or other healthcare provider ever told you that you have a depressive disorder?

84.3%

15.7%

76.9%

23.1%

70.4%

29.6%

0% 20% 40% 60% 80% 100%

No*

Yes*

National York County '08 York City '08

*Scores are significantly different than the National comparison.

52

Does your family experience any problems with children or teenagers having behavior or emotional problems?

88.7%

5.5%

3.0%

2.9%

89.5%

10.5%

0% 20% 40% 60% 80% 100%

Not a problem

Minor problem

Moderate problem

Major problem

York County '08 York City '08

53

Eye Care

54

When was the last time you had your eyes examined byany doctor or eye care provider?

11.5%

39.4%

15.0%

23.2%

10.9%

26.0%

39.5%

20.8%

11.8%

2.0%

29.0%

33.9%

11.5%

14.6%

11.1%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Within the past month*

Within the past year

Within the past 2 years*

2 or more years ago*

Never*

National York County '08 York City '08

*Scores are significantly different than the National comparison.

Cost was #1 reason for not having eyes examined

55

Household Issues

56

In the past 30 days, have you been concerned about having enough food for you or your family?

90.6%

9.4%

88.0%

12.0%

0% 20% 40% 60% 80% 100%

No

Yes

York County '08 York City '08

57

Does your family experience any problems living in an apartment or house that needs major repairs?

85.7%

6.5%

5.6%

2.2%

76.7%

16.6%

6.7%

0% 20% 40% 60% 80% 100%

Not a problem

Minor problem

Moderate problem

Major problem

York County '08 York City '08

58

Does your family experience any problems in lacking money to pay for housing?

84.2%

6.6%

4.7%

4.5%

78.5%

14.1%

4.9%

2.5%

0% 20% 40% 60% 80% 100%

Not a problem

Minor problem

Moderate problem

Major problem

York County '08 York City '08

59

Does your family experience any problems in lacking money to pay the utility bills?

79.6%

11.0%

4.7%

4.7%

72.5%

19.3%

5.0%

3.2%

0% 20% 40% 60% 80% 100%

Not a problem

Minor problem

Moderate problem

Major problem

York County '08 York City '08

60

Public Health

61

How important is it that your community has a strong system of public health?

69.0%

16.7%

11.0%

0.9%

2.5%

69.7%

8.9%

17.9%

0.6%

2.8%

0% 10% 20% 30% 40% 50% 60% 70%

Extremely important

Important

Neutral

Unimportant

Extremely unimportant

York County '08 York City '08

62

York City has an organized approach to address the health of the community

21.2%

78.8%

28.3%

71.7%

0% 10% 20% 30% 40% 50% 60% 70% 80%

False

True

York County '08 York City '08

63

York County has an organized approach to address the health of the community

25.6%

74.4%

32.5%

67.5%

0% 10% 20% 30% 40% 50% 60% 70% 80%

False

True

York County '08 York City '08

64

Another organization or agency serves my community’s public health needs

37.3%

62.7%

35.3%

64.7%

0% 10% 20% 30% 40% 50% 60% 70%

False

True

York County '08 York City '08

Mentions: WellSpan, Red Cross, Office of Aging, Fire/Police, VNA, Church, Salvation Army

65

On a scale of 1-5, how effective do you think public health is in your community?

16.3%

27.5%

43.0%

8.0%

5.3%

14.1%

22.4%

5.0%

7.5%

51.0%

0% 10% 20% 30% 40% 50%

Extremely effective

Effective

Neutral

Ineffective

Extremely ineffective

York County '08 York City '08

66

Birth Statistics

6767

Birth Measures (%s)Compared to Peer Counties

York, PAChester,

PAHillsborough,

NHUS

Low birth wt. 7.7 6.7 6.3 7.9

Premature births 12.0 9.8 9.2 12.3

Births to women under 18

3.3 1.5 1.5 3.4

Births to unmarried women

32.4 16.5 23.1 34.6

No care first trimester

13.0 13.0 8.4 16.0

6868

Infant Mortality (Rate – Deaths Under Age of 1/1000 Live Births)

Compared to Peer Counties

York, PAChester,

PAHillsborough,

NHUS

White 4.3 5.1 3.8 5.7

Black 16.3 14.5 na 13.6

Hispanic 6.4 6.4 1.9 5.6

69

Preventable Disease

70

23.5%

75.0%

23.3%

24.6%

21.3%

6.9%

17.8%

74.0%

15.4%

24.9%

18.9%

6.0%

21.3%

73.6%

20.5%

22.0%

21.5%

5.8%

0% 10% 20% 30% 40% 50% 60% 70% 80%

No exercise

Fewfruits/vegetables

Obesity

High bloodpressure

Smoker

Diabetes

York Chester Hillsborough

70

Risk Factors For Premature Death

7171

Death Measures (Rate per 100,000) Compared to Peer Counties

York, PAChester,

PAHillsborough,

NHUS

Breast cancer (female)

24.5 25.5 23.7 25.3

Colon cancer 21.2 20.2 20.2 19.1

Coronary heart disease

161.0 152.1 182.3 172.0

Homicide 2.6 1.2 2.0 6.0

Lung cancer 48.0 48.1 49.9 54.1

Motor veh injuries 15.9 10.3 9.4 14.8

Stroke 48.5 49.0 41.6 53.0

Suicide 10.8 8.0 10.9 10.8

Unintentional injury 22.2 16.5 18.0 37.3

72

Prioritizing Issues & Developing Goals

73

Sample goal statements:

To improve the quality of chronic disease care in South Central Pennsylvania.

To create a public health department to serve York County. To increase the number of York County children who are

physically active. To promote improved health literacy practices in York County. To reduce the incidence of dental caries among York County

children through prevention education and services. To increase access to oral health care for the uninsured and

underinsured population of York County. To advocate for policies that increase access to oral health

treatment and preventative services.