1 2008 york county community health needs assessment summary of results presented by: lisa lehman,...
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1
2008 York County Community Health Needs Assessment
Summary of Results
Presented By:Lisa Lehman, HolleranDr. David Polk, York CollegeApril 3, 2009
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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.
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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
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General Health Status of York County Residents
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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
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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%
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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%)
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88
Trends – Subjective Health Assessment
1994 1997 2000 2003 2008
Poor to fair health 10% 13% 11% 11% 16%
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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
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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)
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Exercise, Weight, & Nutrition
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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.
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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
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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
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Access to Health Care
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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
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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.
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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
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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%
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Oral Health
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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
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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.
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Disability
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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.
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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
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Alcohol Consumption
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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.
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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
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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.
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3030
Trends – Behavioral Risks
1994 1997 2000 2003 2008
Currently smoke 20% 19% 23% 22% 26%
Binge drinking 13% 20% 12% 16% 9%
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Seniors & Immunizations
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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
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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.
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Safety
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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.
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3636
Trends – Behavioral Risks
1994 1997 2000 2003 2008
Don’t always wear seatbelt
39% 35% 33% 25% 17%
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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
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Preventive Screenings
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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
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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
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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
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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
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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
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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%
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HIV/AIDS
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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
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47
Emotional Health
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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.
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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.
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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.
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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.
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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
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Eye Care
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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
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Household Issues
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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
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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
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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
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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
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Public Health
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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
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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
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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
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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
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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
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Birth Statistics
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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
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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
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Preventable Disease
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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
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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
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Prioritizing Issues & Developing Goals
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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.