2018 Health Profiles by City and County of Broomfield

Health Profiles MARCH 2018

TOBACCO USE Despite recent downward trends, tobacco use is still the leading cause of death and disease in Colorado.1 Cigarette smoke contains more than 7,000 chemicals, including 69 that are known to cause cancer.2 It harms nearly every organ in the body and can cause lung cancer, heart disease, respiratory disease, stroke and other cancers and diseases.2 It is a contributor to four of the top five leading causes of death in Broomfield.3

Cigarette smoking, current — adults4

43% 31%

13%

16%

Broomfield

Colorado

11%

45%

26%

Cigarette smoking, current — high school students5

Electronic vapor device use, current — high school students5

Exposure to secondhand smoke drifting into their home — adults who live in multi-unit housing4

Health Statistics Region 16 (Broomfield and Boulder counties)

Colorado

CONSIDERATIONS FOR BROOMFIELD Smoking is higher among: • • • •

Adults with lower incomes or education levels; Young adults who work after high school rather than attend college; Adults with mental health conditions; and Lesbian, gay, bisexual, and transgender (LGBT) youth and adults.1

E-cigarettes/vaping: • The use of e-cigarettes by young people has grown dramatically in the past five years.6 • Nearly one of three Broomfield and Boulder adolescents (31%) use e-cigarettes, five percentage points higher than the state average of 26%;5 • More adolescents now use e-cigarettes than regular cigarettes;5 and • Youth who use e-cigarettes may be more likely to begin smoking cigarettes, a threat to the progress made in reducing youth tobacco use.7

Secondhand smoke: Colorado law requires indoor public areas to be smoke free;8 There is no safe level of smoke exposure; Secondhand smoke is linked to heart disease, stroke, respiratory diseases, and various cancers’ Among children, secondhand smoke is associated with an increased risk of SIDS, asthma, respiratory and ear infections, learning disabilities, and attention deficit disorder.7 • While Colorado requires indoor public areas to be smoke-free, secondhand smoke exposure still occurs in households;4 and • Secondhand smoke is significantly more common in multi-unit housing than single-family homes in Broomfield and Boulder.5 • • • •

SOURCES 1

State of Tobacco Control, 2018. American Lung Association. www.lung.org/assets/documents/ tobacco/state-of-tobacco-control.pdf. Accessed 5 March 2018.

Harms of Cigarette Smoking and Health Benefits of Quitting. National Cancer Institute at the National Institutes of Health. Reviewed: 19 December 2017. www.cancer.gov/about-cancer/causesprevention/risk/tobacco/cessation-fact-sheet. Accessed 5 March 2018.

Colorado Health Indicators, Health Statistics and Vital Records, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 5 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2014-2016. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 5 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/ cdphe/vision-data-tool. Accessed 5 March 2018.

Know the Risks e-cigarettes & Young People, 2016: U.S. Surgeon Generalâ&#x20AC;&#x2122;s Report on e-cigarette use among youth and young adults, Trends. U.S. Department of Health and Human Services. https://e-cigarettes.surgeongeneral.gov. Accessed 5 March 2018.

Smoking & Tobacco Use, Fast Facts and Fact Sheets. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Last Reviewed and Updated: 9 February 2017. www.cdc.gov/tobacco/data_statistics/fact_sheets/ index.htm. Accessed 5 March 2018.

State of Colorado Clean Indoor Air Act, C.R.S. 25-14. State of Colorado, Tobacco Enforcement Laws, Rules & Regulations. www.colorado.gov/pacific/enforcement/tobacco-enforcement-laws-rulesregulations-0. Accessed 5 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2012-2014. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 5 March 2018.

ACCESS TO HEALTH CARE Ready access to efficient and affordable health care can help people achieve better physical health, mental health and social health. But there are many barriers to accessing care, including the complexity of the health care and insurance systems, a lack of price transparency, too few primary care providers, and stigma around mental health and substance use services. These barriers often are experienced differently based on race/ethnicity, socioeconomic status, age, sex, and other factors. Insurance coverage, meanwhile, is key to accessing care. The good news is that Colorado has made historic gains in health insurance coverage, with 93.5% of Coloradans covered in 2017.1 However, coverage disparities remain, particularly among Hispanic Coloradans, low-income families and individuals, and immigrant residents without documentation.1

Uninsured1 HSR 16*

Percentage of adults with one or more regular health care providers2

81%

76%

Broomfield

Colorado

960:1

1,240:1

Ratio of population to mental health providers3

Colorado

Ratio of population to primary care physicians3

Broomfield

Colorado

Broomfield

Colorado

1,030:1

350:1

Percentage of population enrolled in Medicaid4,5 Broomfield

11%

Percentage of population ages 5 and older who needed mental health care or counseling services during past 12 months, but did not get it1

HSR 16*

Colorado

24%

* Health Statistics Region 16 (Broomfield and Boulder counties)

CONSIDERATIONS FOR BROOMFIELD In Boulder and Broomfield counties: • Nearly two of three residents (63%) have private insurance while 30% have public insurance, either Medicare, Medicaid, or Child Health Plan Plus (CHP+).1 • About 27,500 residents do not have health insurance.1 • The uninsured rate dropped by more than half between 2013 and 2015, from 11.8% to 5.2%. But it headed higher in 2017, reaching 7.4%.1 • The proportion of residents with health insurance has grown significantly since 2013.1 • About one of seven residents report that they didn’t get needed care from a primary care doctor or a specialist because it cost too much. About one of eight report having problems paying medical bills.1

In Broomfield County: • About 7,100 residents are enrolled in Medicaid. Just over half are adults. An additional 510 children are insured through CHP+.4 • The ratio of primary care physicians to residents is better than the state ratio.3 • But the ratio of mental health providers is far worse than the state ratio, which means that access to behavioral health services can be challenging.3 Four primary care practices in Broomfield have received funding to integrate medical care and behavioral health care in their clinics.

SOURCES 1

2017 Colorado Health Access Survey. Colorado Health Institute. Last Revised:18 September 2017 www.coloradohealthinstitute.org/research/colorado-health-access-survey. Accessed 7 February 2018.

Colorado Health Indicators, Colorado Behavioral Risk Factor Surveillance System 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 5 March 2018.

County Health Rankings Snapshot. Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. 2017. www.countyhealthrankings.org/app/colorado/2017/rankings/ broomfield/county/outcomes/overall/snapshot. Accessed 7 February 2018.

Broomfield County Fact Sheet. Colorado Department of Health Care Policy & Financing. 2016. www.colorado.gov/pacific/sites/default/files/Broomfield%20County%20Fact%20Sheet.pdf. Accessed 7 February 2018.

State of Colorado Fact Sheet. Colorado Department of Health Care Policy & Financing. 2016. www.colorado.gov/pacific/sites/default/files/State%20of%20Colorado%20Medicaid%20Fact%20Sheet. pdf. Accessed 7 February 2018.

Small Area Health Insurance Estimates. U.S. Census Bureau. Last Revised: 12 July 2017. www.census. gov/data-tools/demo/sahie/sahie.html. Accessed 7 February 2018.

MENTAL HEALTH Good mental health is a state of well-being that allows a person to realize his or her potential, cope with life’s normal stresses, do productive work, and actively contribute to the community.1 Mental disorders are linked to an increased risk of chronic diseases such as heart disease and diabetes.2 They also are among the leading causes of disability. Early detection of mental disorders, including anxiety and depression, can help prevent more serious problems later. Access to mental health care services can improve overall health and quality of life. Colorado ranks near the national average for prevalence of mental illness and access to mental health care, but suicide is a different story. Colorado consistently ranks in the top 10 nationally for its high rate of suicides.3,4

At least eight days of poor mental health during past 30 days.***9 HSR 16*

11% Colorado

12%

Mental health-diagnosed hospitalizations (rate** per 100,000)

23%

20%

Broomfield

Colorado

2,294.3

2,833.8

17%

16%

Percentage of parents who say their children (ages 1-14) have behavioral health problems.6

Percentage of high school students who seriously considered attempting suicide, past 12 months.7

Suicide hospitalizations (rate** per 100,000)5

Broomfield

Colorado

35.1

52.0

Did not get needed mental health care.***9

HSR 16*

Health Statistics Region 16 (Broomfield and Boulder counties)

Colorado

* Health Statistics Region 16 (Broomfield and Boulder counties) **Age-adjusted *** Ages 5 and older

CONSIDERATIONS FOR BROOMFIELD • Suicide is the 7th leading cause of death in Broomfield, which has a rate of 13.9 suicide deaths for each 100,000 residents.8 That is less than the statewide suicide rate of 19.1 deaths per 100,000.8 • Suicide deaths are more common among men.8 Suicide attempts are more common among women.8 • Adolescent depression and suicide is a major concern. Nearly a third of high school students surveyed in Boulder and Broomfield Counties felt so sad or hopeless for more than two weeks that they stopped their normal activities, and 16% have seriously considered a suicide attempt.10 • In Broomfield and Boulder counties, lesbian, gay, and bisexual adolescents are much more likely to attempt suicide than their heterosexual peers.10 • About one in 13 Coloradans (8%) who need mental health services say they don’t have access to care or that stigma stops them from seeking care.9 • Medical providers in Broomfield report that their patients experience a variety of barriers in accessing mental health care.

SOURCES 1

Fact sheet, Mental health: strengthening our response. World Health Organization. Updated: April 2016. www.who.int/mediacentre/factsheets/fs220/en. Accessed 5 March 2018.

2020 Leading Health Indicators Topics, Mental Health. U.S. Department of Health and Human Services. www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Mental-Health. Accessed 5 March 2018.

State of Mental Health in America 2017. Mental Health America. www.mentalhealthamerica.net/ sites/default/files/2017%20MH%20in%20America%20Full.pdf. Accessed 5 March 2018.

Suicides in Colorado Reach All-Time High. Colorado Health Institute. Updated: 7 February 2017. https://www.coloradohealthinstitute.org/research/suicides-colorado-reach-all-time-high. Accessed 5 March 2018.

Colorado Health Indicators, Colorado Health and Hospital Association, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-healthindicators. Accessed 5 March 2018.

Colorado Health Indicators, Colorado Child Health Survey, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 5 March 2018.

Colorado Health Indicators, Colorado Child Health Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 5 March 2018.

2017 Colorado Health Access Survey. Colorado Health Institute. Last Revised: 18 September 2017 www.coloradohealthinstitute.org/research/colorado-health-access-survey. Accessed 5 March 2018.

Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 5 March 2018.

SUBSTANCE ABUSE The misuse of alcohol, marijuana, illegal drugs, and prescription medication harms both children and adults as well as our communities. Broomfield is no exception. Repeated use of alcohol and drugs can lead to debilitating substance use disorders that increase the risk of infectious diseases, chronic health conditions, violence, traffic injuries, disability, crime and premature death.1 Among youth, substance misuse can lead to problems at school, problematic peer relationships, mental health issues, and altered brain development.1 But there is good news: policies and programs that focus on prevention have been shown to help youth avoid the misuse of alcohol and drugs, giving them the opportunity to live healthy, substance-free lives. For adults dealing with substance use disorders, help can come from harm reduction interventions, access to treatment, and recovery support.1 Percentage of men who had five or more drinks and women who had four or more drinks in past 30 days.3

Percentage of all high school students who . . . 38%

30% 22%

Broomfield

19%

Drank alcohol at least once in past 30 days.2

Colorado

18%

24% 17%

Had five or more drinks of alcohol in a row at least once in past 30 days.2

21%

Used marijuana in past 30 days.2

15%

Used prescription drugs in past 30 days without a prescription.2

Health Statistics Region 16 (Broomfield and Boulder counties)

Rate of prescription opioid overdose deaths per 100,000 population.5

14%

Colorado

Broomfield

3.8

Colorado

5.8

CONSIDERATIONS FOR BROOMFIELD In Boulder and Broomfield counties: • 78% of students have drunk alcohol by their senior year of high school, while 30% of students report recent binge drinking by that grade.2 • Only 51% of adolescents think it is wrong for someone their age to use marijuana compared with a statewide rate of 61%.2 Marijuana use by youth may make it more difficult to learn and problem solve. It may also impact memory, coordination and the ability to pay attention.6 • 15% of high school students report misusing prescription drugs at least once,2 a concern considering the national epidemic of opioid misuse and opioid deaths. The risk of becoming a long-term opioid user increases markedly after just 5 days of use.7

In Broomfield County: • Almost one in five adults report regular binge drinking.3 About 13% of Broomfield adults reported they had used marijuana within the past 30 days and 44% reported ever using marijuana.3, 8 • In 2012-2014, Broomfield experienced 19 hospitalization visits related to prescription opioids.9

SOURCES 1

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. November 2016. Department of Health and Human Services, Office of the Surgeon General. www.ncbi.nlm.nih. gov/books/NBK424857/pdf/Bookshelf_NBK424857.pdf. Accessed 6 March 2018.

Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/hkcs. Accessed 6 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System 2014-2016. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 6 March 2018.

County Health Rankings, Drug overdose deaths.Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. http://www.countyhealthrankings.org/app/colorado/2017/ measure/factors/138/data. Accessed 6 March 2018.

Broomfield Prescription Drug Profile. Colorado Department of Public Health and Environment, Violence and Injury Prevention-Mental Health Promotion Branch, Prescription Drug Overdose Prevention Unit. Last Updated: July 2017. https://www.colorado.gov/pacific/sites/default/files/ PW_ISVP_Broomfield%20County%20Rx%20Drug%20Data%20Profile.pdf. Accessed 2 February 2018.

Marijuana and Public Health, At A Glance Fact Sheets, Alcohol and Public Health, What You Need to Know About Marijuana Use in Teens. Centers for Disease Control and Prevention. Last Updated: 13 April 2017. www.cdc.gov/marijuana/factsheets/teens.htm. Accessed 2 February 2018.

Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long Term Opioid Use — United States, 2006–2015. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 2017;66:265–269. dx.doi.org/10.15585/mmwr.mm6610a1. Accessed 2 February 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System 2014-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 13 March 2018.

Colorado Prescription Drug Profile. Colorado Department of Public Health and Environment, Violence and Injury Prevention-Mental Health Promotion Branch, Prescription Drug Overdose Prevention Unit. Last Updated: July 2017. www.colorado.gov/pacific/sites/default/files/PW_ISVP_Colorado%20Rx%20 Drug%20Data%20Profile.pdf. Accessed 2 February 2018.

SEXUAL HEALTH AND REPRODUCTIVE HEALTH Good sexual health has a positive impact on many aspects of our lives, including reproductive health and well-being. Comprehensive health education and access to screening, diagnostic and treatment services helps to prevent disease and reduces health care costs. The community benefits by reducing sexually transmitted infections (STIs) and lowering the rate of unintended pregnancies.1 But there is work to be done. STI rates have increased since 2011 both nationally and in Colorado.2 And while teen pregnancy and birthrates have declined, the U.S. remains higher than other developed countries for both.3 The Colorado Family Planning Initiative has seen an estimated half to two-thirds decline in the number of births to women aged 15-24 between 2009 and 2014 due to long-acting reversible contraceptives (LARCs) and other efforts, with helping to avoid public assistance costs totaling between $66.1 and $69.6 million.10

Percentage of high school seniors who ever had sexual intercourse.7

Rate (per 100,000) of Chlamydia incidence; 15 to 29 year olds.5 Broomfield

Colorado

1,306.3

1,664.3

HSR 16*

39%

49%

Rate (per 100,000) of Gonorrhea incidence; 15 to 29 year olds.5 Broomfield

Colorado

124.4

218.6

Colorado

2.7

4.9

55%

30%

HSR 16*

Sexually active high school students using an effective method of birth control.6 HSR 16*

Rate (per 100,000) of HIV incidence5 Broomfield

Colorado

Percentage of live births resulting from unintended pregnancies.9

Colorado

Fertility rate of girls between ages 15 and 17.8 Broomfield

38%

32%

4.1

Colorado

9.3

* Health Statistics Region 16 (Broomfield and Boulder counties)

CONSIDERATIONS FOR BROOMFIELD • About one of three high school students in Broomfield and Boulder counties (29%) report being sexually active.6 • Broomfield’s teen birth rate is dropping. It has fallen from 20 births for each 1,000 teen girls in 2014 to 14 births for each 1,000 births in 2017.11 Colorado has seen an unprecedented decrease due to increased access to Long Acting Reversible Contraception (LARC) between 2009 and 2014, the most effective method of birth control.10

SOURCES 1

2020 Leading Health Indicators Topics, Reproductive and Sexual Health. U.S. Department of Health and Human Services. healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/ Reproductive-and-Sexual-Health. Accessed 7 March 2018.

Fact Sheet: Reported STDs in the United States, 2016; High Burden of STDs Threaten Millions of Americans. September 2017. Centers for Disease Control and Prevention. www.cdc.gov/nchhstp/ newsroom/docs/factsheets/std-trends-508.pdf. Accessed 7 March 2018.

Hamilton BE, Mathews TJ. Continued declines in teen births in the United States, 2015. NCHS data brief, no 259. National Center for Health Statistics. September 2016. www.cdc.gov/nchs/data/ databriefs/db259.pdf. Accessed 7 March 2018.

Association of Young Maternal Age with Adverse Reproductive Outcomes. 27 April 1995. N Engl J Med 1995; 332:1113-1118. DOI: 10.1056/NEJM199504273321701. Accessed 7 March 2018.

Colorado Health Indicators, Division of Disease Control and Environmental Epidemiology-STI/HIV Section, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/ pacific/cdphe/colorado-health-indicators. Accessed 7 March 2018.

Colorado Health Indicators, Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 7 March 2018.

Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www. colorado.gov/pacific/cdphe/hkcs. Accessed 7 March 2018.

Colorado Health Indicators, Colorado Pregnancy Risk Assessment Monitoring System, 2012-2014. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/coloradohealth-indicators. Accessed 7 March 2018.

Taking The Unintended Out Of Pregnancy: Coloradoâ&#x20AC;&#x2122;s Success With Long-Acting Reversible Contraception. January 2017. Colorado Department of Public Health and Environment, Prevention Services Division. www.colorado.gov/pacific/sites/default/files/PSD_TitleX3_CFPI-Report.pdf. Accessed 7 March 2018.

2017 County Health Rankings, Teen birth rate. Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. www.countyhealthrankings.org/app/colorado/2017/ rankings/broomfield/county/outcomes/overall/snapshot. Accessed 6 March 2018.

OVERWEIGHT AND OBESITY Obesity increases a person’s risk for serious health problems, including heart disease, stroke, diabetes, and cancer.1 While Colorado’s 2016 obesity rate of 22.3% is the nation’s lowest, the proportion of adults in our state who are obese has more than doubled over the past 20 years.2, 3 Childhood obesity is equally concerning, putting children at risk for high blood pressure, breathing problems and joint and muscle pain.4 Despite recent declines in obesity among U.S. children,5 nearly one in four (22%) children in Colorado had overweight or obesity in 2016.14

Adults who are obese

19%

21%

Broomfield

Colorado

Children ages 5 to 14 who are obese

Broomfield

14%

Children ages 5 to 14 who are overweight

Ate fruit 2+ times and vegetables 3+ times each day . . .

Adults who are overweight

34%

12%

10%

Ages 1 to 14

11%

H.S. students

15%

13%

36% Colorado

10% 5% High school students who are obese

Drank one or more times each day . . . SUGARY BEVERAGE

13%

15%

10%

17%

Ages 1 to 14 SODA H.S. students

11%

High school students who are obverweight Were physically active at least 60 minutes daily over past 7 days Ages 1 to 14

52% 47% H.S. students

22% 28%

Health Statistics Region 16 (Broomfield and Boulder counties)

Colorado

CONSIDERATIONS FOR BROOMFIELD In Boulder and Broomfield counties: • The proportion of children ages 5 to 14 who are obese has recently declined from 10% to 6%, but the proportion of children who are overweight has increased from 8% to 12%.7

In Broomfield County: • The adult obesity rate is 19%, having ranged between 17% and 22% since 2005.6 About one of three adults (34%) is overweight.13 This means that more than half of adults are overweight or obese. • One in four adults (22%) and nearly one of eight children (13%) drink at least one sugary beverage daily, a habit that has been shown to significantly contribute to weight gain and obesity.12, 7 • The adult obesity rate is 19%, having ranged between 17% and 22% since 2005.6 About one of three adults (34%) is overweight.13 This means that more than half of adults are overweight or obese. • A little over half of Broomfield adults met aerobic physical activity guidelines.12 • About 38% of adults ate fruit less than one time per day and one out of five adults (20%) ate vegetables less than one time per day.12

SOURCES 1

Health Risks of Being Overweight. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. February 2015. www.niddk.nih.gov/health-information/weightmanagement/health-risks-overweight. Accessed 9 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System 2016. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 8 March 2018.

The State of Obesity in Colorado, 2017. Trust for Americaâ&#x20AC;&#x2122;s Health and Robert Wood Johnson Foundation. stateofobesity.org/states/co. Accessed 8 March 2017.

Childhood Obesity Causes & Consequences. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Last Reviewed and Updated: 15 December 2016. www.cdc.gov/obesity/childhood/ causes.html. Accessed 8 March 2018.

Childhood Obesity Facts. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Last Reviewed and Updated: 10 April 2017. www.cdc.gov/obesity/data/childhood.html. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Child Health Survey, 2014-2016. Colorado Department of Public Health and Environment. www.colorado.gov/ pacific/cdphe/vision-data-tool. Accessed 8 March 2018.

Colorado Health Indicators, Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 5 March 2018.

Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/hkcs. Accessed 6 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2013 & 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 8 March 2018.

Colorado Health Information Dataset, Colorado Behavioral Risk Factor Surveillance System. Colorado Department of Public Health and Environment. www.chd.dphe.state.co.us/cohid/topics. aspx?q=Behavioral_Risk_Factors.

OLDER ADULT HEALTH Colorado will see rapid growth in the number of its older adults over the next decades.1 In Broomfield, forecasts call for the 60+ population to increase 40% by 2050, to 29,863 from 11,918 in 2016.2 Nearly one of three Broomfield residents will be part of that 60+ population in 2050.2 Aging carries a number of health-related risks. Aging adults experience a higher risk of chronic disease.1 Social isolation, declining health, diminishing cognitive abilities; and fall-related injuries affect the quality of life for older adults. Communities should begin planning now to ensure that their older adults maintain their independence and their ability to contribute to the life of the community. Adults who age in healthy ways require less care, meaning lower costs and better quality of life.3

Percentage of adults aged 65+ who reported a fall in past 12 months.4 HSR 16*

Colorado

35%

27%

Percentage of adults aged 65+ up-to-date on core preventive services.5

79% 48%

Colorado

11%

Rate (per 100,000) of influenza hospitalizations among 65+ population.7

Broomfield: 169.7

Percentage of adults aged 65+ who reported a fall that resulted in injury in past 12 months.5 Broomfield

Percentage of adults aged 65+ who have had a pneumonia shot. 6

Broomfield

75%

45%

Colorado

Colorado: 152.6 Rate* (per 100,0000) of Alzheimer’s disease deaths.8

Broomfield

Colorado

Broomfield: 24.0 Colorado: 28.3

* Health Statistics Region 16 (Broomfield and Boulder counties)

CONSIDERATIONS FOR BROOMFIELD • About 12% of Broomfield residents aged 65 and over say they have been told by a doctor that they have diabetes. • About 64% of Broomfield residents aged 65 and over say they have been told by a doctor, nurse or other health professional that they have high blood pressure. • The rate of falls for older adults in Broomfield and Boulder counties is higher than the state average.4 Effective prevention programs address medications and vision, home and community safety, and exercise. • Fewer than 60% of older adults in the U.S. engage in physical activity and strength training.1 Recognizing this opportunity, Broomfield is building a new senior center that will feature programs such as SilverSneakers and Healthy Hearts. • In 2017, 12% had Medicaid for Broomfield and Boulder counties compared to 14% in Colorado.9 Access to care and early screenings are cost effective, help to manage disease and successfully improve long-term health. • About 40% of Broomfield seniors live alone compared to 35% in Colorado.10 For older adults who are living alone, preventive measures and supports such as Meals on Wheels and EasyRide can help them retain their independence.

SOURCES 1

Crosstabs - A Closer Look at the Economics & Demographics of Colorado: Aging in Colorado Part 1: Why is Colorado Aging So Quickly? 20 September 2016. U.S. Department of Health and Human Services. https://demography.dola.colorado.gov/crosstabs/aging-part-1. Accessed 12 March 2018.

Successful Aging Study. City and County of Broomfield. 2017. Unpublished internal document. Accessed 8 March 2018.

Community Assessment Survey for Older Adults: Broomfield County, CO - 2015, Report of Results. National Research Center, Inc. drcog.org/sites/default/files/resources/Broomfield%20County%20 CASOA%20Full%20Report%202015.pdf. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2012, 2014. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 6 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2014 & 2016. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 6 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 6 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Health and Hospital Association, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 6 March 2018.

2017 Colorado Health Access Survey. Colorado Health Institute. Last Revised: 18 September 2017 www.coloradohealthinstitute.org/research/colorado-health-access-survey. Accessed 12 March 2018.

Colorado Seniors and Their Health: Where Are Older Adults Most Vulnerable?, Interactive Index Dashboard: Colorado Seniors and Their Health: CHIâ&#x20AC;&#x2122;s Aging Vulnerability Index. Colorado Health Institute. Last Revised: 28 November 2017 www.coloradohealthinstitute.org/research/coloradoseniors-and-their-health-where-are-older-adults-most-vulnerable. Accessed 12 March 2018.

ORAL HEALTH Oral diseases, from cavities to oral cancer, cause significant pain and disability.1 For U.S. children, cavities are the most common chronic disease in childhood.2 Safe, inexpensive preventive measures such as water fluoridation and dental sealants are available, but many children lack access to them. Colorado has significant need for improved oral health care access and use: 18% of kindergarteners and 15% of third graders — 21,0000 children — have untreated decay.3 Health habits that contribute to dental complications include unhealthy eating and drinking, using tobacco, and heavy alcohol consumption. In addition, smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth and gums, periodontal disease, and tooth loss.

Percentage of all ages reporting excellent, very good, or good oral health.9 HSR 16

89%

Incidence rate* (per 100,000) for oral cavity and pharynx cancer.4 Broomfield

Colorado

Broomfield

9.1 10.4

72%

84% 67%

Percentage of adults who have lost teeth due to decay or periodontal disease.5

26% 36%

78%

71%

64% 49%

Colorado

84%

Colorado

Percentage of adults with a dental visit in past year.5

Percentage of students with a dental exam in past year.6

Percentage of women who had their teeth cleaned during a recent pregnancy.7

Health Statistics Region 16 (Broomfield and Boulder counties)

62%

Percentage of adults with dental insurance.8

Colorado * Age adjusted

CONSIDERATIONS FOR BROOMFIELD • Broomfield receives fluoridated water, the most cost-effective preventive intervention to help prevent tooth decay.10,11 • Almost one-fourth of Broomfield adults have lost teeth due to decay or periodontal disease.5 • Broomfield adults have a slightly lower rate of oral cavity and pharynx cancer than the state average.4 • In Broomfield and Boulder counties, 46% of third graders had sealants on at least one molar and half reported having caries. About a third of kindergarten students reporting having dental caries, or tooth decay.12 • Five percent of children in Broomfield and Boulder counties visit a dentist by the time they’re one, below the state average of 9% in Colorado.13 The American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend a first dental visit by the age of one for all children, followed by regular dental visits. • A person’s mouth and teeth may serve as an early warning for diseases such as HIV infection and other immune system problems, another reason for regular dental visits.

SOURCES 1

2020 Leading Health Indicators Topics, Oral Health. U.S. Department of Health and Human Services. www.healthypeople.gov/2020/topics-objectives/topic/oral-health. Accessed 8 March 2018.

Children’s Oral Health. Centers for Disease Control and Prevention. www.cdc.gov/healthywater/ hygiene/disease/dental_caries.html. Accessed 8 March 2018.

Tooth Be Told...Colorado’s Basic Screening Survey Children’s Oral Health Screening: 2016-17. February 2018. www.colorado.gov/pacific/sites/default/files/PW_OH_BSSReport.pdf. Accessedd 8 March 2018.

Oral Cavity and Pharynx Cancer Incidence Rate, National Cancer Institute, 2010-2014. Conduent Healthy Communities Institute. November 2017. www.bouldercountyhealthcompass.org/index. php?module=indicators&controller=index&action=view&indicatorId=333&localeId=303. Accessed 8 March 2018.

Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/hkcs. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Pregnancy Risk Assessment Monitoring System, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 8 March 2018.

Colorado Health Access Survey Data: Health Statistics Region 16, Boulder and Broomfield counties. Last Updated: 18 September 2017. www.coloradohealthinstitute.org/research/colorado-healthaccess-survey. Accessed 8 March 2018.

Centers for Disease Control and Prevention. 2012 Water Fluoridation Statistics. www.cdc.gov/fluoridation/statistics. Accessedd 8 March 2018.

2016 Annual Drinking Water Quality Report. City and County of Broomfield. www.broomfield.org/DocumentCenter/View/23606. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Basic Screening Survey, 2011 - 2012. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/ cdphe/vision-data-tool. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, asic Screening Tool, 2011 - 2012. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/ vision-data-tool. Accessed 8 March 2018.

CHRONIC DISEASES Chronic diseases such as heart disease, cancer, stroke, and diabetes are among the most common health problems in the United States and Colorado.1 They are also the most preventable — and the most costly. Three fourths of our nation’s health care resources are spent on treating chronic diseases.2 Seven of 10 deaths in Colorado can be attributed to chronic diseases. Combined, heart disease and stroke are the leading cause of death.3 High blood pressure, cigarette smoking, and high blood cholesterol are major contributors.4 About 7% of Coloradans have been diagnosed with diabetes, which can lead to end-stage renal disease, lower-extremity amputation, and blindness.6 Two of every three Coloradans diagnosed with diabetes also had high blood pressure.5 Half of Colorado men and two of five Colorado women will be diagnosed with cancer in their lifetime.7

Percentage of adults reporting one or more chronic conditions.8

37%

34%

32%

26% 8%

Broomfield

67% Colorado

62%

Percentage of adults ever diagnosed with high cholesterol.8

Percentage of adults ever diagnosed with skin cancer.9

Percentage of adults ever diagnosed with high blood pressure.8

Percentage of adults ever diagnosed with a non-skin cancer.9 Broomfield

Percentage of adults ever diagnosed with diabetes.9

Percentage of adults ever diagnosed with coronary heart disease.9

Percentage of adults with asthma.9

Percentage of adults ever diagnosed with a stroke.9

Colorado

CONSIDERATIONS FOR BROOMFIELD • About 37% of Broomfield adults have high cholesterol, 32% have high blood pressure, and 8% have diabetes, all of which contribute to an increased risk for heart disease and other chronic diseases.8,9 • Almost 72% of residents in Boulder and Broomfield counties who are living with diabetes also have high blood pressure,8 which can lead to heart disease, heart failure, stroke and kidney disease.12 • Cancer is the leading cause of death in Broomfield. 10 Breast cancer and prostate cancer were the most common cancers between 2013 and 2015.10 The cancer rate among Broomfield’s Medicare population is higher than the state average, and is increasing.11 • Broomfield rate of screening for colorectal cancer and other cancers, as well as mammogram screenings, are better than the state average.9 Early detection of cancer greatly increases chances of successful treatment. • Primary prevention for chronic diseases is to eat healthy, be active, don’t smoke, limit alcohol, and schedule regular visits with health care providers and screenings.12

SOURCES 1

Chronic Disease Overview. Centers for Disease Control and Prevention. Last Updated: 28 June 2017. www.cdc.gov/chronicdisease/overview/index.htm. Accessed 8 March 2018.

Chronic disease prevention. Colorado Department of Public Health and Environment. www.colorado. gov/pacific/cdphe/categories/services-and-information/health/prevention-and-wellness/chronicdisease-prevention. Accessed 8 March 2018.

Cardiovascular disease data. Colorado Department of Public Health and Environment. www.colorado. gov/pacific/cdphe/cardiovascular-disease-data. Accessed 8 March 2018.

2020 Leading Health Indicators Topics, Mental Health. U.S. Department of Health and Human Services. www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 8 March 2018.

Adults with Diabetes, Why is this important? Conduent Healthy Communities Institute. Last update: March 2016. www.bouldercountyhealthcompass.org/indicators/index/ view?indicatorId=81&periodId=241&localeId=303. Accessed 8 March 2018.

Chronic disease prevention. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/cancer. Accessed 8 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System 2013 & 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/vision-data-tool. Accessed 8 March 2018.

ENVIRONMENTAL HEALTH Environmental health is the field of science that studies how the environment influences human health and disease. In Broomfield, the Environmental Health section of Public Health provides oversight of programs that are designed to prevent or minimize health effects caused by environmental factors. This includes food safety, air quality, water quality, emergency planning and response, onsite wastewater treatment systems, among other programs.

Retail food inspection compliance rate:1 Broomfield 97% Colorado 92% Air Quality: Air quality is measured on a statewide basis and includes 5 air pollutants: ozone (O3), particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2).2 All five have improved since 2006.2 Air quality has improved for five criteria pollutants since 2006 in the Denver-metro area.2

Water Quality: Water quality has not been an issue of concern in Broomfield. As of 2015, the City and County of Broomfield has one community drinking water system.3 Since 2006, contaminant levels have not exceeded regulated levels established by the Environmental Protection Agency.3

CONSIDERATIONS FOR BROOMFIELD • New food safety regulations will go into effect in 2019.4 The Environmental Health department will work with restaurants to ensure compliance and minimize the potential for foodborne illness. • Air pollutants are trending down,5 but potential new sources are emerging. Environmental Health works with state partners to monitor emissions sources to verify compliance. • Oil and gas is an emerging issue that could impact air and water quality as well as emergency preparedness.6 Environmental Health conducts site inspections and advises City Council on air monitoring.

SOURCES 1

Colorado Retail Food High Risk Inspections Measures, 2015. Colorado Department of Public Health and Environment. www.cohealthviz.dphe.state.co.us/t/EnvironmentalProgramsPublic/views/ColoradoEnvironmentalDashboard/ Food?%3Aembed=y&%3AshowAppBanner=false&%3AshowShareOptions=true&%3Adisplay_ count=no&%3AshowVizHome=no. Accessed 8 March 2018.

Colorado Air Quality Measures, 2006-2015. Colorado Department of Public Health and Environment. cohealthviz.dphe.state.co.us/t/EnvironmentalProgramsPublic/views/ColoradoEnvironmentalDashboard/ Air?%3Aembed=y&%3AshowAppBanner=false&%3AshowShareOptions=true&%3Adisplay_ count=no&%3AshowVizHome=no. Accessed 8 March 2018.

Colorado Water Quality Measures, 2016. Colorado Department of Public Health and Environment cohealthviz.dphe.state.co.us/t/EnvironmentalProgramsPublic/views/ColoradoEnvironmentalDashboard/ Water?%3Aembed=y&%3AshowAppBanner=false&%3AshowShareOptions=true&%3Adisplay_ count=no&%3AshowVizHome=no. Accessed 8 March 2018.

FDA Food Code Transition. Colorado Department of Public Health and Environment. www.colorado.gov/ pacific/cdphe/food-code-transition. Accessed 8 March 2018.

Annual Air Quality Data Report. Colorado Department of Public Health and Environment. www.colorado.gov/airquality/tech_doc_repository.aspx. Accessed 8 March 2018.

Unconventional Oil and Natural Gas Development. United States Environmental Protection Agency. www.epa.gov/uog. Accessed 8 March 2018.

VACCINATIONS Vaccinations are critical to decreasing vaccine-preventable diseases among children and adults and preventing community outbreaks. In the U.S., vaccinations target 17 diseases, including cervical cancer, hepatitis, measles, pertussis (whooping cough), pneumonia, polio, and tetanus.1 Among vaccine-preventable diseases, the leading causes of illness and death are influenza, pneumonia, and viral hepatitis.2 In Colorado, 75% of children between 19 months and 35 months had received their recommended vaccines in 2015, a bit above the national average of 72%.3 The national goal established by Healthy People 2020 is 80%.4 For longterm health, everyone should stay up-to-date on recommended vaccines.

Percentage of Adults who received a flu shot or nasal flu vaccine within the past year.5 Broomfield

49%

Colorado

44%

Rate (per 100,000) of influenza hospitalizations in population aged 65+ 7 Broomfield

Colorado

169.7 152.6

Rate (per 100,000) of pertussis incidence 6 Broomfield

Colorado

25.2 22.4 Rate (per 100,000) of Hepatitis B incidence8 Broomfield

Colorado

11.3 10.1

CONSIDERATIONS FOR BROOMFIELD • Vaccines that are not required by schools have lower vaccination rates. For example, rate of Human papillomavirus (HPV) vaccinations among Broomfield teens is between 31% to 40% for females and between 21% to 30% for males.9 • About 92% of Broomfield’s students are up-to-date on school-required vaccinations.10 • The most recent peak year for pertussis in the U.S. was 2012. That year, 1,433 cases were reported in Colorado with 35 in Broomfield. In 2017, Broomfield reported 13 of the 680 pertussis cases in the state.11, 12 • In Broomfield, the estimated vaccination coverage rate for children between 19 months and 35 months is between 61% and 70%.9 • Only about half of Broomfield adults report having a flu shot in the past 12 months.13 • About 70% of older adults in Broomfield have had a flu shot in the past 12 months and 80% have ever had a pneumonia shot.13 • For the past five years, the most reported vaccine-preventable diseases in Broomfield include pertussis, pneumonia, and hepatitis B.14

SOURCES 1

2020 Leading Health Indicators Topics, Immunization and Infectious Diseases. U.S. Department of Health and Human Services. www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectiousdiseases. Accessed 10 March 2018.

Vaccine-Preventable Adult Diseases. Last Updated: 16 December 2016. Centers for Disease Control and Prevention. www.cdc.gov/vaccines/adults/vpd.html. Accessed 9 March 2018.

The State of the State’s Immunizations, A Report on Colorado΄s Vaccine Protection for Its Communities. Colorado Children’s Immunization Coalition. September 2017. www.childrensimmunization.org/resourcelibrary/state-of-the-states-immunizations-a-report-on-colorados-vaccine-protection-for-its-communities. Accessed 9 March 2018.

VISION: Visual Information System for Identifying Opportunities and Needs, Colorado Behavioral Risk Factor Surveillance System, 2014-2016. Colorado Department of Public Health and Environment. www.colorado.gov/ pacific/cdphe/vision-data-tool. Accessed 10 March 2018.

Colorado Health Indicators, Division of Disease Control and Environmental Epidemiology-Communicable Disease Epidemiology, 2013-2015. Colorado Department of Public Health and Environment. www.colorado. gov/pacific/cdphe/colorado-health-indicators. Accessed 10 March 2018.

Colorado Health Indicators, Division of Disease Control and Environmental Epidemiology-Viral Hepatitis Program, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/ cdphe/colorado-health-indicators. Accessed 10 March 2018.

Colorado Immunization Information System, July - December 2016. Colorado Department of Public Health and Environment. https://cohealthviz.dphe.state.co.us/t/DCEED_Public/views/CountyRateMaps/ Background?%3Aembed=y&%3AshowAppBanner=false&%3AshowShareOptions=true&%3Adisplay_ count=no&%3AshowVizHome=no. Accessed 10 March 2018.

School and Child Care Immunization Data 2016-2017. Colorado Department of Public Health and Environment. https://www.cohealthdata.dphe.state.co.us/Data/Details/1. Accessed 10 March 2018.

Pertussis Outbreak Questions and Answers. Center for Disease Control and Prevention. Last Updated: 7 August 2017. www.cdc.gov/pertussis/outbreaks/faqs.html. Accessed 10 March 2018.

Pertussis data and statistics. Colorado Department of Public Health and Environment. www.colorado.gov/ pacific/cdphe/pertussis-data-and-statistics. Accessed 10 March 2018.

Colorado Health Indicators, Colorado Behavioral Risk Factor Surveillance System, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 10 March 2018.

Colorado Electronic Disease Reporting System, 2013-2017. Colorado Department of Public Health and Environment. Internal Review and Analysis. Accessed 14 March 2018.

INJURY PREVENTION Injuries are preventable. They incur costs to our residents and to the community and affect the well-being of both. Intentional injuries are violence related deaths and injuries, such as homicides, assaults, and suicide. Suicide claimed 1,093 lives in Colorado in 2015, the most ever recorded in one year.1 Unintentional injuries — injuries resulting from motor vehicle collisions, prescription drug overdoses, poisonings, and falls — are a leading cause of death for Americans of all ages, regardless of gender, race, or economic status.2

Broomfield

Colorado

309.6

402.4

41.0

63.1

Rate* of deaths due to unintentional injuries.4

37.4

47.0

Rate* of deaths due to intentional injuries.4

15.3

22.8

Rate* of unintentional falls hospitalizations.3

219.6

240.9

Rate* of deaths due to falls.4

18.8

15.6

Rate* of unintentional poisoning hospitalizations.3

13.4

26.2

8.2

13.4

Rate* of unintentional motor vehicle traffic hospitalizations.3

28.0

51.6

Rate* of deaths due to motor vehicle injuries.4

3.7 34.3 13.9

9.6 46.7 19.1

Rate* of unintentional injury hospitalizations.3 Rate* of intentional injury hospitalizations

Rate* of deaths due to poisonings.4

Rate* of intentional suicide/self-inflicted injury hospitalizations.3 Rate* of deaths due to suicide.4 * Per 100,000. All rates are age-adjusted

CONSIDERATIONS FOR BROOMFIELD • Unintentional injuries are increasing in Broomfield and are now the fourth leading cause of death.5,6 • Between 2013 and 2015, most of the injury hospitalizations in Broomfield were due to falls, motor vehicle traffic accidents, and suicide.3 • Broomfield’s drug-poisoning death rate has increased in nearly every year since 2005.4 • Broomfield reported 1,526 crashes, with 31% due to distracted driving and four fatalities in 2016.7 • In 2015, 43% of students in Broomfield and Boulder counties reported they texted or emailed while driving on one or more of the past 30 days.8

SOURCES 1

Suicides in Colorado Reach All-Time High. Colorado Health Institute. Last updated: 7 February 2017. www.coloradohealthinstitute.org/research/suicides-colorado-reach-all-time-high. Accessed 10 March 2018.

2020 Leading Health Indicators Topics, Injury and Violence Prevention. U.S. Department of Health and Human Services. www.healthypeople.gov/2020/topics-objectives/topic/injury-and-violence-prevention. Accessed 10 March 2018.

Colorado Health Information Dataset, Colorado injury hospitalizations, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 10 March 2018.

Colorado Health Information Dataset, Death Data Statistics, 2013-2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/colorado-health-indicators. Accessed 10 March 2018.

Age-Adjusted Death Rate due to Suicide, Colorado Department of Public Health and Environment, 2014-2016. Conduent Healthy Communities Institute. Last Updated February 2018. www.bouldercountyhealthcompass. org/indicators/index/view?indicatorId=120&localeId=303. Accessed 8 March 2018.

2018 Colorado Motor Vehicle Problem Identification Dashboard. Colorado Department of Public Health and Environment. cohealthviz.dphe.state.co.us/t/ PSDVIP-MHPPUBLIC/views/ColoradoMotorVehicleCrashProblemIDReport/ ColoradoMotorVehicleDashboard?:iid=3&:isGuestRedirectFromVizportal=y&:embed=y. Accessed 10 March 2018.

Healthy Kids Colorado Survey, 2015. Colorado Department of Public Health and Environment. www.colorado.gov/pacific/cdphe/hkcs. Accessed 10 March 2018.