From the Health Commissioner: Dear Family, Friends, and Neighbors: Is Montgomery County healthier today than it was in 2010? This Community Health Assessment 2014 attempts to answer that difficult question and provides all of our citizens with valuable information on the community’s health status. Following our initial 2010 baseline study, this in-depth update offers information for comparisons as well as data on new topics. In general a four-year period is not sufficient to reflect community trends in a significant way; however, the data can show incremental changes, both positive and negative. That’s what you’ll find inside. You will also see startling numbers in areas such as infant mortality and drug overdose deaths. These unfortunate statistics represent major shortfalls in our community, impact everyone either directly or indirectly and require multi-faceted community approaches of intervention. Indeed, we have a lot of work to do. One thing hasn’t changed: the need for all of us to take action to improve our own health and the well-being of others. We continue to eat poorly, are too sedentary and smoke excessively. These unhealthy behaviors, along with others, are reducing our quality of life and ending lives prematurely. While I am proud of the fact that our community has worked together in recent years and made incremental progress in a variety of health-related areas, we still need more walking and less talking. We can be inspired by the data and take charge of our community’s health, or we can continue with the unhealthy behaviors and review the unchanged data in our next community health assessment. The choice is ours. Sincerely,
Jim Gross, MPH Montgomery County Health Commissioner
Board of Health Members Emmett C. Orr, MPA, President • Ken Spires, President Elect • Lloyd L. Laubach, Ph.D. Jan Lepore-Jentleson • Gary L. LeRoy, MD • Patricia S. Meadows, MSSW • David Page, MD John E. Rhodes, DDS • J. Michael Sims
Executive Summary Public Health - Dayton & Montgomery County (PHDMC) conducted this collaborative community health assessment (CHA) to summarize Montgomery County’s population health status and needs. The findings of this CHA will inform community decision-makers, help identify priority public health issues, and guide health improvement strategies. PHDMC will use the data to engage stakeholders in the development and implementation of a community health improvement plan for Montgomery County. The data presented in this CHA is from multiple sources, including secondary quantitative data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS), Ohio Department of Health Vital Statistics, U.S. Census Bureau, Greater Dayton Area Hospital Association emergency department and hospitalization records, Dayton Children’s Hospital’s Community Health Needs Assessment, CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), and the Ohio Disease Reporting System (ODRS). Information from these sources is summarized into seven sections: Overall Health, About Montgomery County, Health Risks, Health Outcomes, Special Interest (drug overdose and infant mortality), Built Environment, and Access to Care. Additionally, primary qualitative data was collected from focus groups representing four underserved communities; African Americans, Asians, Latinos, and Senior Citizens. These groups shared their views on issues that impact the health of their respective communities.
Overall Health This assessment measured overall health as an individual’s perceived physical and mental health over time, also referred to as their health-related quality of life (HRQOL). Women more than men and Blacks more than Whites perceive their health to be fair-to-poor health and have more unhealthy days per month. The same is true for adults whose annual household income is below $15,000.
About Montgomery County Montgomery County’s population of 534,325 is comprised of 72% White, 21% Black, 2% Asian, 2.5% Native American or two or more races, and 2% Hispanic. Children less than 18 years of age make up 22% of the population while 16% of the population is 65 years and older. The composition of the family household differs significantly between Whites and Blacks. Among Whites, 44% of households are married couples compared to 21% of Black households, and 12% of White households are headed by an unmarried female compared to 27% of Black households. Sixty percent of the Black female, head of household families with children under the age of 5 live below poverty level.
Health Risks Participating in regular exercise, eating a balanced diet, maintaining a healthy weight, limiting alcohol use, and quitting smoking are all part of a healthy lifestyle. In the county, less than half of adults meet the recommended physical activity guidelines. Most children spend one hour participating in physical activity, but have two or more hours of screen time a day. Many adults eat take-out, delivery, or fast food more than 10 times a month. Not surprisingly, obesity is a problem for both adults and children. Among 12 to 17 year olds, 12% drink alcohol and 10% use tobacco.
Health Outcomes Many of the poor health outcomes are directly related to inactivity, poor nutrition, obesity, and tobacco and excessive alcohol use. Thirteen percent of women smoke during their pregnancy and almost 10% of babies are born with low birth weight. Two times as many low birth weight babies are born to Black women than to White women.
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At birth, the estimated life expectancy of a Montgomery County resident is 76.6 years. There is almost a 10 year difference between the life expectancy of a White woman and a Black man. Cancer and heart disease are the two leading causes of death. The rate of new cancers is highest for breast, prostate, and lung and bronchus cancers, and the cancers with the highest mortality rate are lung and bronchus, breast, and prostate cancers. Lung and bronchus cancers have the highest percent of late stage diagnosis. Two of the risk factors for heart disease, high blood pressure and high cholesterol, are diagnosed more often in men than women. The mortality rate for heart disease is one and half times greater in men than women, and black men have the highest mortality rate for heart disease. Diabetes also disproportionately affects Black men as they have the highest diabetes mortality rate. The third leading cause of death is accidents. Among individuals 65 and older, the leading cause of injury-related deaths due to accidents is from falls. Sexually transmitted diseases such as HIV, chlamydia, gonorrhea, and syphilis remain a serious public health problem. Since 2009, the rate of new syphilis cases has increased 114%. The rate of chlamydia is 10 times higher and the rate of gonorrhea is 16 times higher in Blacks than it is in Whites. Hepatitis C and influenza-associated hospitalizations were the most commonly reported communicable diseases in 2013. Among children, pertussis accounted for more than 50% of diseases reported to Public Health; a 481% increase in one year. Four out of every 1,000 children under the age of one were diagnosed with pertussis.
Special Interest From 2010 to 2013, the number of drug overdose deaths increased 78% in Montgomery County. These deaths were most often associated with heroin use, but deaths from prescription drugs are also on the rise. The populations most impacted by drug overdoses are Whites, males, and individuals between 35 and 44 years old. Infant mortality is an important indicator of the overall health of a community. In 2012, eight infants died for every 1,000 live births in Montgomery County. The Black infant mortality rate was over 2 times higher than the White infant mortality rate. Actions that can change the negative birth outcomes of our infants can take place before conception, during pregnancy, and after the infant’s birth.
Built Environment Among the bike paths, hiking trails, and parks within Montgomery County, residents have multiple outdoor physical activity options. Almost a third of the population has low access to a grocery store, and more than half of the low income population has low access to a grocery store. There are federal, state, and local programs that are available to assist families who are unable to afford or have insufficient access to food.
Access to Care Accessing medical and dental care remains a challenge for many residents of Montgomery County. Due to a lack of insurance, cost prohibits some adults from visiting a doctor. Many adults and children have unmet dental needs that could lead to serious health problems if left untreated.
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key community health indicators Birth Outcomes Indicator
Montgomery County
Ohio 2012
Low Birth Weight ( < 2500g)
9.7%
8.5%
Women Who Smoked During Pregnancy
13.1%
13.7%
Preterm Births (< 37 weeks gestation)
14.0%
12.3%
Montgomery County
Ohio
76.7 years
77.4 years
8.0 per 1,000 births
7.6 per 1,000 births
8.0 per 1,000 births and fetal deaths
6.6 per 1,000 births and fetal deaths
24.9 per 100,000
16.6 per 100,000
Mortality Indicator Life Expectancy (2011-2012) Infant Mortality Rate (2012) Fetal Mortality Rate (2011-2012) Drug Overdose Death Rate (2011)
2011-2012
Leading Causes of Death
Rate per 100,000
Cancer
188.8
187.0
Heart Disease
174.1
193.1
Accidents
61.1
46.7
Chronic Lower Respiratory Disease
51.8
52.5
Alzheimer's Disease
38.3
28.5
Montgomery County
Ohio
Cancer Indicator
2010-2011 Rate per 100,000
All Sites/Types
441.4
448.0
Breast (female)
123.9
117.7
Prostate
111.6
123.5
Lung and Bronchus
75.8
69.5
Montgomery County
Ohio
Met Aerobic Recommendations (2011 & 2013)
43.1%
44.4%
Overweight (2011-2013)
35.9%
35.4%
Obese (2011-2013)
30.8%
30.0%
Food Insecurity (2012)
18.0%
17.2%
Current Smoker (2011-2013)
22.7%
23.3%
Montgomery County
Ohio
Percent Uninsured (2012)
12.7%
11.5%
Could not see a doctor because of cost (2011-2013)
17.1%
14.5%
Have not seen the dentist in 5 or more years (2012)
14.7%
11.9%
Health Risks Indicator
Access to Care Indicator
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Calls to Action Based on the population health data presented in this assessment and the documented disparities in health status among racial groups, Public Health - Dayton & Montgomery County offers the following crucial calls to action. Additional calls to action are provided within the various sections of this document.
1. We challenge Montgomery County adults to serve daily as role models for healthy lifestyles. Serving as a role model is a duty incumbent on all adults, but particularly on individuals in positions of leadership. 2. We challenge all individuals to adopt a healthy diet; exercise more; avoid tobacco, alcohol, drugs, and unsafe sexual practices; and serve as mentors to help the next generation do the same. We must make significant improvements in our collective behaviors and lifestyle choices, because they are directly related to our health outcomes. 3. We urge all individuals to establish a relationship with a primary care provider. We believe this linkage is essential to early disease detection and treatment. 4. We encourage local public health system partners to continue promoting health equity to eliminate disparities in health outcomes. 5. We challenge local public health system partners to explore policy, systems, and environmental changes to prevent chronic disease development.
A ction C hanges T hings
Table of Contents Letter from the Health Commissioner...................... i
Health Outcomes
Executive Summary.................................................... ii
Births................................................................... 42
Table of Contents......................................................... 1
Deaths.................................................................. 44
List of Figures and Tables........................................... 2
Injuries................................................................. 46
List of Appendices....................................................... 6
Diabetes............................................................... 48
Introduction................................................................. 7
Heart Disease...................................................... 50
Tools for Understanding This Report....................... 8
Cancer................................................................. 52
Key Terms................................................................... 10
Asthma................................................................ 54
Community Health Focus Groups Summary..... 14
HIV/AIDS........................................................... 56
Overall Health
Sexually Transmitted Diseases......................... 58
Communicable Diseases................................... 60
Health-Related Quality of Life......................... 18
About Montgomery County
Special Interest
Population Characteristics................................ 20
Accidental Drug Overdose............................... 62
Disability............................................................. 22
Infant Mortality.................................................. 66
Socioeconomics.................................................. 24
Built Environment
Crime................................................................... 26
Outdoor Environment...................................... 72
Behavioral Health Risks
Air Quality.......................................................... 74
Physical Activity................................................. 28
Access to Food.................................................... 76
Nutrition............................................................. 30
Access to Care
Weight................................................................. 32
Medical Care....................................................... 78
Alcohol Use......................................................... 34
Dental Health..................................................... 79
Tobacco Use........................................................ 36
Data Sources............................................................... 80
Vaccination......................................................... 38
References................................................................... 82
Preventive Cancer Screenings.......................... 40
Acknowledgements................................................... 85 Appendix.................................................................... 87
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List of Figures and Tables Health-Related Quality of Life (pages 18-19)
Figure: Adults with fair-to-poor health by sex and race Figure: Average number of adult unhealthy days and activity limitation days in the past 30 days by sex and race Figure: Average number of adult unhealthy days and activity limitation days in the past 30 days by annual household income Figure: Adults with fair-to-poor health by annual household income Figure: Children (14 and below) in fair or poor
Population Characteristics (pages 20-21) Figure: Population by age and sex Figure: Population by race and ethnicity Table: Population and family characteristics by race
Disability (pages 22-23)
Figure: Disabled population by age group Figure: Disability type by age group Table: Types of disabilities among children with a disability
Socioeconomic Status (pages 24-25)
Table: Socioeconomic characteristics Figure: Families or people below the poverty level Figure: Unemployment rate Figure: Educational attainment by sex Figure: Educational attainment by race
Crime (pages 26-27)
Figure: All violent crimes known to law enforcement Figure: Murder Figure: Forcible Rape Figure: Robbery Figure: Aggravated Assault Figure: All property crimes known to law enforcement Figure: Burglary Figure: Larceny â&#x20AC;&#x201C; Theft Figure: Motor Vehicle Theft Figure: Arson Figure: Violent and property crimes committed by juveniles
Physical Activity (pages 28-29)
Figure: Adults aerobic activity level by race Figure: Adults aerobic activity level by annual household income Figure: Childrenâ&#x20AC;&#x2122;s (6 to 10 years) daily habits and activities Figure: Adults aerobic and strengthening physical activity level
Nutrition (pages 30-31)
Figure: Adults who do not eat one or more servings of fruits or vegetables a day by race Figure: Adults who do not eat one or more servings of fruits or vegetables a day by annual household income Figure: Adults who ate a meal from a quick service or sit-down restaurant in the past 30 days
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Weight (pages 32-33)
Figure: Overweight and obese adults by sex Figure: Overweight and obese adults by race Figure: Weight categories among children by sex
Alcohol Use (pages 34-35)
Figure: Adults who are heavy drinkers by age and sex Figure: Adults who binge drink by age and sex Figure: Population characteristics of alcohol-related disease deaths Figure: Alcohol impaired driver crashes and fatalities among 15 to 24 year olds
Tobacco Use (pages 36-37)
Figure: Adult smoking status by sex Figure: Adult smoking status by race
Vaccinations (pages 38-39)
Figure: Adults who have received a flu vaccine in the past 12 months by race Figure: Adults 65 and older who have ever received a pneumonia vaccine by race Figure: Adults 65 and older who have ever received a pneumonia vaccine by sex Table: Reportable vaccine-preventable diseases, confirmed cases Table: Children (ages 6 to 14) receiving the flu vaccine by poverty level
Preventive Cancer Screenings (pages 40-41)
Figure: Women age 50 to 74 years who have had a mammogram within the past 2 years by race Figure: Adults age 50 to 75 years who have ever had a colonoscopy or sigmoidoscopy by race and sex Figure: Women age 21 to 65 years who had a Pap smear within the past 3 years Figure: Adults who received recommended cancer screenings by annual household income
Births (pages 42-43)
Figure: Low birth weight by race Figure: Women who smoked during pregnancy by race Figure: Women giving birth who are married by race Figure: First trimester prenatal care by method of payment
Deaths (pages 44-45)
Figure: Age-adjusted death rate of the top 10 causes of death Table: Top ten causes of death by sex Table: Top ten causes of death by race Figure: Life expectancy at birth
Injuries (pages 46-47)
Table: Leading causes of injury-related deaths by age group Table: Intentional and unintentional injuries resulting in an emergency department visit or hospitalization Figure: Unintentional injuries resulting in an emergency department visit or hospitalization by age group Figure: Intentional injuries resulting in an emergency department visit or hospitalization by age group
Diabetes (pages 48-49)
Figure: Adult diabetes-related emergency department visits or hospitalizations by age Figure: Rate of adult diabetes-related emergency department visits and hospitalizations by sex Figure: Adults who have ever been diagnosed with diabetes by race Figure: Adults who have ever been diagnosed with diabetes by annual household income Figure: Age-adjusted death rate for diabetes by sex and race 2014 Community Health Assessment
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List of Figures and Tables (continued) Heart Disease (pages 50-51)
Figure: Adults with high blood pressure by sex and race Figure: Adults with high cholesterol by sex and race Figure: Age-adjusted death rate for heart disease by sex and race
Cancer (pages 52-53)
Figure: Cancer incidence Figure: Cancer deaths Figure: Cancer mortality rate by race Table: Cancer cases by stage at diagnosis for the leading and screenable sites/types of cancer
Asthma (pages 54-55)
Figure: Rate of adult asthma resulting in an emergency department visit or hospitalization Figure: Rate of childhood asthma resulting in an emergency department visit or hospitalization by sex Figure: Adults who have ever been diagnosed with asthma by annual household income Figure: Adults who have ever been diagnosed with asthma by sex
HIV/AIDS (pages 56-57)
Figure: Number of new HIV and AIDS cases Figure: Rate of new HIV and AIDS cases by age group Figure: Rate of new HIV and AIDS cases by sex and race Figure: New HIV and AIDS cases by transmission category
Sexually Transmitted Diseases (pages 58-59)
Table: Sexually transmitted disease incidence rate and case count by age Table: Sexually transmitted disease incidence rate and case count and race and ethnicity Figure: Sexually transmitted disease incidence rate Figure: Syphilis incidence rate Table: Sexually transmitted disease incidence rate and case count by sex
Communicable Disease (pages 60-61)
Figure: Most commonly reported communicable diseases Figure: Most commonly reported communicable diseases among children Figure: Pertussis cases Table: Pertussis cases by age
Accidental Drug Overdose (pages 62-65)
Table: Characteristics of accidental drug overdose deaths Figure: Accidental drug overdose deaths Figure: Accidental drug overdose deaths by age group Figure: Drug category mentions in accidental drug overdose deaths Figure: Heroin, prescription opioid, and benzodiazepine mentions in accidental drug overdose deaths Table: Most frequently mentioned benzodiazepines in accidental drug overdose deaths Table: Most frequently mentioned prescription opioids in accidental drug overdose deaths Figure: Rate of accidental drug overdoses resulting in an emergency department visit or hospitalization by age group
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Infant Mortality (pages 66-71)
Figure: Infant mortality rate by race Figure: Fetal mortality rate by race Table: Top 5 causes of infant deaths Figure: Pre-pregnancy BMI category by race Figure: Pre-pregnancy multivitamin use Table: Tobacco and alcohol use prior to pregnancy Figure: Women who received late or no prenatal care by race Table: Motherâ&#x20AC;&#x2122;s safety during pregnancy Figure: Preterm births by race Figure: Women who were breastfeeding at hospital discharge by race Figure: Preterm births by smoking status during pregnancy Table: Sleep position and exposure to secondhand smoke
Outdoor Environment (pages 72-73)
Table: Miami Valley Bikeways, paved & non-paved trails that pass through Montgomery County Table: Additional physical activities available at Five Rivers MetroParks Figure: Adults who walked outdoors or rode a bike for transportation in the past 7 days by race Figure: Adult participation in outdoor activities in the past 12 months
Air Quality (pages 74-75)
Figure: Percent of days per year by AQI level of health concern Figure: AQI for ozone by month Figure: Average grass pollen count by month Figure: Average weed pollen count by month Figure: Average tree pollen count by month Figure: Average mold spore count by month Figure: Percent of pollen and mold count days per year by level of severity
Access to Food (pages 76-77)
Figure: Low access to grocery stores Table: National School Lunch Program (NSLP) Table: Supplemental Nutrition Assistance Program (SNAP) Figure: Food insecurity Table: Women, Infants, and Children (WIC) program
Medical Care Coverage (page 78)
Figure: Uninsured Figure: Adults who could not see a doctor because of cost by annual household income Table: Medical professional
Dental Health Coverage (page 79) Figure: Most recent dental visit among adults by race Figure: Unmet dental care needs by age Table: Dental care resources
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List of Appendices Appendix 1: Map - Total Population by Zip Code Appendix 2: Map - Families Living Below Poverty Level by Zip Code Appendix 3: Map - Crime Rate by City and Township Appendix 4: Table - Violent and Property Crimes by Jurisdiction Appendix 5: Map - Overweight or Obese Adults (18 and older) by Zip Code Appendix 6: Map - Number of Liquor Store Carryouts per a Square Mile by Zip Code Appendix 7: Map - Low Birth Weight (<2500g) by Zip Code Appendix 8: Map - Asthma-related Hospital Visits by Zip Code Appendix 9: Map - Chlamydia Infections (13 and older) by Zip Code Appendix 10: Map - Gonorrhea Infections (13 and older) by Zip Code Appendix 11: Map - Accidental Drug Overdose Death Rate by Zip Code Appendix 12: Map - Infant Mortality Rate by Zip Code Appendix 13: Map - Ohio Perinatal Region Map Appendix 14: Map - No Prenatal Care within the First Trimester of Pregnancy by Zip Code Appendix 15: Map - Preterm Births by Zip Code Appendix 16: Map - Five Rivers MetroParks Appendix 17: Map - Miami Valley Bikeways Appendix 18: Map - Food Deserts by Census Tract
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Introduction Public Health - Dayton & Montgomery County (PHDMC) conducted this collaborative community health assessment to characterize the health status of Montgomery County’s population, identify factors contributing to higher health risks and health disparities, and identify existing resources which can be mobilized for community action. The information in this report will be used by PHDMC and our local public health system partners to identify population health improvement priorities for Montgomery County. Montgomery County’s local public health system includes all public, private, and volunteer groups/ organizations that contribute to the delivery of essential public health services that prevent the spread of disease, promote healthy behaviors and protect against health threats in air, food and water. Altogether, these services benefit all 534,325 Montgomery County residents as well as its workers and visitors.
Essential Public Health Services • Monitor health status to identify community health problems.
• Diagnose and investigate health problems and health hazards in the community. • Inform, educate, and empower people about health issues. • Mobilize community partnerships to identify and solve health problems. • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure a competent public health and personal healthcare workforce. • Evaluate effectiveness, accessibility, and quality of personal and population-based health services. • Research for new insights and innovative solutions to health problems.
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Tools for Understanding This Report Report Layout The first section of this Community Health Assessment (CHA) is a summary report of four focus groups representing underserved communities within Montgomery County. The following section contains data organized into 7 categories each with several subcategories. These categories include overall health status, characteristics about Montgomery County, behavioral health risks, health outcomes, emerging public health issues, built environment, and access to care. If applicable, a Public Health Importance and Call to Action are identified for subcategory topics. The impact of the health condition or risk on the population is described in the Public Health Importance section and actions an individual can take to live a healthier lifestyles are identified in the Call to Action. Finally, an Across the Nation section is included to compare Montgomery County with Ohio and the United States. The final section of this assessment includes a series of maps. These maps show, by zip code, city, township, or census track, the prevalence of different diseases or health risks within Montgomery County. Data Sources American Community Survey (ACS) The U.S. Census Bureau conducts the ACS every year. This survey provides communities with population data during the years between the Population and Housing Census that surveys the entire United States population every 10 years. Survey participants are selected by a random sampling of addresses from every state to produce population, demographics, and housing unit estimates. Behavioral Risk Factor Surveillance System (BRFSS) The Centers for Disease Control and Prevention (CDC) began using the BRFSS in 1993 to collect state data about residentsâ&#x20AC;&#x2122; health risk behaviors, chronic health conditions, use of preventive services, and emerging health issues. As one of the largest, on-going telephone health survey system, the BRFSS interviews more than a half million people to ensure the results are representative of the health of the nation. OHA Insight Developed by the Ohio Hospital Association, OHA Insight is a web-based software program that hospitals use to run customized and standard reports using inpatient, outpatient, and emergency room data. Vital Statistics - Ohio Department of Health (ODH) ODH receives birth and death certificates for all births or deaths occurring in Ohio and also for births or deaths occurring outside of the state to Ohio residents.
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Technical Notes BRFSS 1. The BRFSS began conducting interviews by both cell phone and landline in 2011. Because of this change and changes to the weighting structure, the data collected from surveys prior to 2011 cannot be compared to the data presented in this assessment. 2. Values in a given figure or table may not add to 100%. This may be due to values being rounded off or due to survey respondents refusing to answer a question or answering, “Don’t Know” or “Not Sure.” Across the Nation The data presented in the Across the Nation tables may not be the same as the data presented in the figures and tables within the section. In order to find data at the county, state, and national level, data from different years may be used. Mapping Limitations In order for data to be mapped, a zip code must have:
- 50 or more BRFSS survey respondents in a zip code
- At least 5 deaths or 10 births in a zip code
- At least 10 cases of a sexually transmitted disease in a zip code
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Key Terms Age-adjusted Rate A rate of morbidity or mortality in a population that is statistically modified to eliminate the effect of age differences in a population.
Air Quality Index (AQI) An index for reporting daily air quality. It tells you how clean or polluted your air is and what associated health effects might be a concern for you.
Angina Chest pain or discomfort that occurs if an area of your heart muscle does not get enough oxygen-rich blood.
Arrhythmia A problem with the rate or rhythm of the heartbeat; heart can beat too fast, too slow, or with an irregular rhythm.
Behavioral Risk Factor Surveillance System (BRFSS) A telephone (landline and cellphone) survey that collects data on health-related risk behaviors, chronic health conditions, and use of preventive services from U.S. residents 18 years of age and older.
Binge Drinking Adult males having 5 or more drinks on one occasion, and adult females having 4 or more drinks on one occasion.
Body Mass Index (BMI) A common measure of body fat calculated from a personâ&#x20AC;&#x2122;s weight and height. In adults, a BMI between 18.5 and 24.9 is considered healthy. A BMI of 25 to 29.9 is overweight and a BMI of 30 or more is obese. A childâ&#x20AC;&#x2122;s (ages 2 to 19 years) BMI is calculated using a height and weight calculation, and the category is determined by plotting the BMI value on a gender and age specific growth chart.
Built Environment Human-made surroundings in which people live, work, and play.
Cancer Diseases in which abnormal cells divide without control and are able to invade other tissues. There are more than 100 different types of cancer.
Census Tract Small subdivisions of a county used by the U.S. census to provide a geographic boundary in which to collect statistical data. The average population size of a census tract is 4,000 people, but it can range between 1,200 and 8,000 people.
Chronic Lower Respiratory Disease (CLRD) Diseases that affect the lungs and airways such as asthma and chronic obstructive pulmonary disease (COPD). Forms of COPD include emphysema and chronic bronchitis.
Communicable Diseases Diseases that spread from one person to another or from an animal to a person. The spread often happens by airborne virus or bacteria, but also through blood or other bodily fluid.
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Fetal Death Death of a fetus before it is born; also known as a stillbirth. It includes any death of a fetus after 20 weeks of gestation.
Focus Group A small-group discussion guided by a trained leader. It is used to learn more about opinions, perceptions, beliefs, and attitudes on a designated topic, and then to guide future action.
Food Desert Urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food. Instead of supermarkets and grocery stores, these communities may have no food access or are served only by fast food restaurants and convenience stores that offer few healthy, affordable food options.
Food Insecurity Consistent access to adequate food is limited by a lack of money and other resources.
Health-related Quality of Life (HRQOL) A multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning.
Heavy Drinking Adult males having more than 2 drinks per day and adult females having more than 1 drink per day.
Hispanic/Latino Ethnicity A person of Latin-American or Spanish descent.
HIV vs. AIDS Diagnosis Human immunodeficiency virus (HIV) is the virus that can lead to acquired immunodeficiency syndrome (AIDS). AIDS is the final stage of HIV infection. People at this stage of HIV infection have badly damaged immune systems and are vulnerable to infections and infection-related cancers.
Incidence The number of newly diagnosed cases of a disease.
Incidence Rate An estimate of the number of new cases of disease in a population.
Infant Mortality Rate The number of infant deaths (less than 1 year of age) for every 1,000 live births.
Invasive Cancer Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues.
Life Expectancy The number of years that a person is expected to live.
Low Birth Weight (LBW) A baby weighing less than 2500 grams or 5 pounds, 8 ounces at birth.
Morbidity A term used to refer to an illness or illnesses in a population. 2014 Community Health Assessment
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Key Terms (continued) Mortality A term used to refer to death or deaths in a population.
Mortality Rate (Death Rate) A measure of the frequency of death in a defined population during a specified interval of time.
The National School Lunch Program (NSLP) A federally assisted meal program operating in public and nonprofit private schools and residential child care institutions that offers nutritionally balanced, low-cost or free lunches to children each school day.
Obese and Overweight Labels for ranges of weight that are greater than what is generally considered healthy for a given height. An adult who has a BMI between 25 and 29.9 is considered overweight and a BMI of 30 or higher is considered obese.
Ozone A gas that occurs both in the Earth’s upper atmosphere and at ground level. Ozone can be “good” or “bad” for people’s health and for the environment, depending on its location in the atmosphere. The air closest to the Earth’s surface, ground-level or “bad” ozone is a pollutant that is a significant health risk, especially for those with respiratory conditions. The “good” ozone layer extends upward from about 6 to 30 miles and protects life on Earth from the sun’s harmful ultraviolet (UV) rays.
Per Capita For each person
Percent A ratio “out of 100.” Example: 75% means 75 out of 100.
Preterm A birth occurring before 37 weeks of pregnancy.
Prevalence The total proportion of disease within a population.
Race A group of people united or classified together on the basis of common history, nationality, or geographic distribution.
Rate Occurrence of a disease within a population in a given time period expressed as a ratio. Example: 5.0 per 100,000 means 5 cases for every 100,000 people.
Risk Factor Any characteristic or exposure of an individual that increases the likelihood of developing a disease or injury.
Socioeconomic Status Social standing or class of an individual or group often measured as a combination of education, income, and occupation.
Cancer Staging The process of determining the extent to which a cancer has developed by spreading.
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Supplemental Nutrition Assistance Program (SNAP) A program that offers nutrition assistance to eligible, low-income individuals and families and provides economic benefits to communities.
Trimester A full-term pregnancy is 40 weeks. Pregnancy is divided into three trimesters: first trimester (0 to 13 weeks), second trimester (14 to 26 weeks), and third trimester (27 to 40 weeks).
Weighting A correction technique applied to survey results (i.e. BRFSS) that assigns an adjustment weight to each respondent. This weight corrects for under-representation or over-representation of a population subgroup so that reliable conclusions can be made from the data.
Women, Infants, and Children (WIC) Program A federal program that provides nutritious foods, breastfeeding support and nutrition education to low-income pregnant, postpartum and breastfeeding women, and infants and children until 5 years of age who are found to be at nutritional risk.
WIC Farmersâ&#x20AC;&#x2122; Market Nutrition Program (FMNP) A program within WIC that provides WIC participants with the opportunity to visit local Farmersâ&#x20AC;&#x2122; Markets to choose fresh, locally grown fruits and vegetables.
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community health focus groups summary As part of this health assessment, community focus groups were conducted with four populations that are subject to greater health disparities than other populations. The goal of these focus groups was to solicit feedback from representatives of these underserved populations regarding the factors that influence their health and quality of life. The populations selected for the focus groups were African Americans, Asians, Latinos, and Senior Citizens. The focus groups were held at various locations in Montgomery County in August and September of 2014. The number of participants ranged from ten participants in the Asian focus group to 30 in the Senior Citizen focus group. With the assistance of a translator, the Latino focus group was conducted in Spanish. All sessions were recorded and transcribed for analyzing and coding into major themes. The focus group discussions explored the participants’ perceptions of the following questions: 1. What is the first thing that comes to mind when you hear the phrase, “healthy lifestyle?”
2. What do you and others do to stay healthy?
3. What are the top health issues you see facing your community? 4. Do you or your family deal with any of these problems? 5. When you face these problems, where do you go for help? 6. What is something that your community could change to help you to be healthier?
The following tables provide a summary of common responses per question and focus group. Bolded responses are the common and repeated responses.
1. What is the first thing that comes to mind when you hear the phrase, "Healthy Lifestyle"? African American Community
Asian Community
Latino Community Senior Citizen Community
exercise; good eating habits; rest; no drugs, alcohol, or smoking; eating organic and locally farmed food; understand the environment around you balance between mind, body, and spirit; physical fitness; positive social interactions; vaccines; avoiding harmful substances (i.e. tobacco); good friends and social life; stress management; regular check-ups no drugs, drinking, or smoking; eat healthy and exercise; tranquil life to reduce stress; mental health; fresh foods; annual exams; good self-esteem exercise, good eating habits, positive environment, vitamins, taking medication as prescribed, avoiding bad habits, good hygiene, spirituality, financial stability
2. What do you and others do to stay healthy?
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2014 Community Health Assessment
Public Health - Dayton & Montgomery County
African American Community
exercising 3 times a week, exercising with a group, drinking water, proper amount of rest, dental care, being positive, community and
community health focus groups summary
3. What are the top health issues you see facing your community - among the people you know or in your neighborhood? African American Community
Asian Community
Latino Community
Senior Citizen Community
deterioration of the community (abandoned homes, chipping lead paint, mold, dead animals), no quality dining and food options (too much fast food), Black men don't go to the doctor, diabetes, high cholesterol, high blood pressure, obesity, infant mortality, aging (arthritis, inability to exercise) depression, mental health stigma, health literacy, smoking, liver disease, healthy food, not seeking treatment (due to culture, immigration, and generational factors), affordable health care, health not a priority, cultural competence by health care providers diabetes, obesity, high cholesterol, dental care access, access to health care, lack of bi-lingual health care providers (especially psychologists), Latino men do not go to doctors access to care (specialists outside of the community), lack of transportation, medical services are too expensive, quality of care (short appointments, doctors not familiar with issues of the population), no fresh produce, food banks offer processed and high sodium food, safety within the community (abandoned houses), Alzheimer's disease, high blood pressure, high cholesterol, diabetes, obesity, depression, drug abuse
4. Do you or your family deal with any of these problems? African American Community Asian Community Latino Community Senior Citizen Community
high blood pressure, diabetes, pre-diabetes, high cholesterol, arthritis, access to healthy, fresh food Question was skipped since attendees were health care providers who would have ready access to care affordable health care, access to healthy food, language and communication barriers Combined with Question 3
5. When you face these problems, where do you go for help? African American Community Asian Community Latino Community
family doctor, specialists, lack of quality care at free clinics, no personalized care at larger hospitals Reach Out Montgomery County, language barrier issues
2014 Community Health Assessment
Public Health - Dayton & Montgomery County Reach Out Montgomery County, Cassano, Grandview Medical Center, Miami Valley Hospital
15
care (short appointments, doctors not familiar with issues of the
Community fresh produce, food banks offer processed and high 2.Senior WhatCitizen do you and otherspopulation), do to staynohealthy? sodium food, safety within the community (abandoned houses),
exercising 3 times a week, exercising with a group, drinking water, community health focus groups summary Alzheimer's disease, blood pressure, high cholesterol, African American Community proper amount of rest,high dental care, being positive, community and diabetes, obesity, depression, drug abuse personal gardens culture impacts health, social events to relieve stress (dancing), control of eating and drinking, sleep, nutrition, Asian Community 4. Do you or your familymoderation deal withand any of these problems? exercise, preventive health care high blood pressure, diabetes, pre-diabetes, high cholesterol, African American Community exercise, with food at home, arthritis, cook access to fresh healthy, fresh food avoid fast food places, Latino Community clear mind, do what is best, giving back to your community, Question was skipped since attendees were health care providers Asian Community sleep (8 hours) who would have ready access to care walking, water aerobics, dancing, yoga, play games, read, listen Senior Community health care, access to healthy food, time language and LatinoCitizen Community toaffordable music, good conversation, stress relief, family communication barriers Senior Citizen Community Combined with Question 3
5. When you face these problems, where do you go for help? family doctor, specialists, lack of quality care at free clinics, no African American American Community Community personalized care at larger hospitals Asian Community Reach Out Montgomery County, County, language language barrier barrier issues issues Reach Out Montgomery County, Cassano, Grandview Reach Out Montgomery County, Cassano, Grandview Medical Medical Latino Community Center, Center, Miami Miami Valley Valley Hospital Hospital practice practice personal personal safety, safety, needs needs have have been been expressed expressed within within the the Senior Senior Citizen Citizen Community Community community in the past but we have not seen changes seen any any changes
6. What is something that your community could change to help you to be healthier? African American Community
Asian Community
Latino Community
Senior Citizen Community
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2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Page 1 of 3 groups for action planning; free health fairs; health education; focus more grocery stores, farmers markets, and community gardens; teach healthy eating habits at a young age; unsafe neighborhoods for outdoor exercise creation of an Asian Community Center, programs to empower youth, health education clinic to address the health needs of Latinos with services and interpreters they can trust, insurance company that will provide coverage without Social Security numbers, lower cost of immunizations for children new to the U.S. provide affordable (or free) services, Senior Day at food banks without long waits, transportation services to doctor's appointments, RTA senior boarding times and locations, announcements of food giveaways and health screenings
community health focus groups summary Each community had concerns or issues that significantly impacted their health and quality of
Each community concerns orforissues that significantly impacted theirimpacted healthtable. and quality of and life. quality of Eachhad community concerns or issues that significantly their health life. The top concerns or issueshad each community are listed in the following life. The top concerns or issues for are listed in the following table. The top concerns or issues in each community areeach listedcommunity in the following table.
Focus Group Focus Group
Top Concerns/Issues Top Concerns/Issues
African American Community Access to healthy food African American Community Access to healthy food Asian Community Depression, health education Asian Community Depression, health education Latino Community Access to care Latino Community Access to care Senior Citizen Community Lack of transportation, financial stability Senior Citizen Community Lack of transportation, financial stability A list of the 6 questions and a collective overall response from the 4 focus groups is included in A list of the 6 questions and a collective overall response from the 4 focus groups is included in the table. A listfollowing of the 6 questions and table. an aggregate response from the 4 focus groups is included in the following table. the following
Focus Group Questions Focus Group Questions
Most Common Responses Most Common Responses
1. What is the first thing that comes to mind exercise, 1. the What is the "healthy first thing that comes to mindgood nutrition, adequate rest, avoiding vices when you hear phrase, exercise, good nutrition, adequate rest, avoiding vices (drinking, smoking, drugs) when you hear the phrase, "healthy lifestyle"? (drinking, smoking, drugs) lifestyle"? 2. What do you and others do to stay exercise, eating right, drinking plenty of water, being 2. What do you and others do to stay exercise, eatingevents, right, drinking plenty of water, being healthy? positive, dancing and social preventive care healthy? positive, dancing and social events, preventive care 3. What are the top health issues you see diabetes, high cholesterol, high blood pressure, 3. What are the top health issues you see access diabetes, high cholesterol, blood pressure, facing your community - among the people obesity, to quality food, access tohigh quality facing community - among the people obesity, access access to food, access to quality you know or in youryour neighborhood? health care services, to quality dental care you know or in your neighborhood? health care services, access to dental care diabetes, pre-diabetes, high cholesterol, high blood 4. Do you or your family deal with any of diabetes, pre-diabetes, high cholesterol, high blood pressure, 4. Do you or your family deal with any of arthritis, cultural barriers, no fresh produce, these problems? pressure, arthritis, cultural barriers, no fresh produce, no health care coverage these problems? no health care coverage family physicians, specialists, free mammograms, 5. When you face these problems, where family physicians, specialists, free mammograms, language barriers make access difficult at clinics (i.e. When you face these problems, where do you go for5.help? language barriers make access difficult at clinics (i.e. Cassano, Reach Out Montgomery County) do you go for help? Cassano, Reach Out Montgomery County) access to healthier foods, culturally competent health 6. What is something that your community access to healthier foods, culturally competent health care providers, financially affordable health care and something that your community could change6.toWhat help is you to be healthier? care providers, financially affordable health care and transportation services, health education, advocacy could change to help you to be healthier? transportation services, health education, advocacy
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HRQOL
Overall Health
Across the Nation - 2012
Health-related quality of life (HRQOL) is an individual’s or group’s perceived physical and mental health over time. Questions used to measure health-related quality of life:
Core “Healthy Days” Measures* 1. Would you say that in general your health is excellent, very good, fair or poor? 2 Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? 3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
Montgomerya
Ohioa
United Statesa
18.8%
18.8%
18.0%
Average adult (18 and older) unhealthy days in the past 30 days
7.7
7.7
7.4
Average adult (18 and older) activity limitation days in the past 30 days
5.5
5.5
4.8
Percent of adults (18 and older) in fairto-poor health
a
Behavioral Risk Factor Surveillance System (BRFSS)
Adults* with fair-to-poor health by sex and race Montgomery County, 2011-2013
4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? *Responses to questions #2 and #3 are combined to create the summary value “unhealthy days.” Source: Behavioral Risk Factor Surveillance System (BRFSS)
Key survey findings as self-reported: • Blacks had an average of 2 more unhealthy days a month than Whites. • Women had almost 2 more unhealthy days a month than men.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Average number of adult* unhealthy days and activity limitation days in the past 30 days by sex and race Montgomery County, 2011-2013
Source: Behavioral Risk Factor Surveillance System (BRFSS)
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2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Key survey findings as self-reported: • 35% more Blacks report being in fair-to-poor health compared to Whites.
Overall Health
HRQOL
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Public Health Importance
Average number of adult* unhealthy days and activity limitation days in the past 30 days by annual household income Montgomery County, 2011-2013
Measuring a person’s perceived level of physical and mental health can serve as a predictor of illness and death. Many chronic diseases such as diabetes, hypertension, stroke, heart disease, and cancer are associated with mental health disorders like depression. The HRQOL measurement can be used to build relationships between social, mental, and medical services; help recognize health disparities within the community; and identify needs for new Public Health interventions.
Key survey findings as self-reported: • The average number of unhealthy days and days when activity was limited due to poor physical or mental health decreased as income increased. Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults* with fair-to-poor health by annual household income, Montgomery County, 2011-2013 “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” (WHO, 1948)
Source: Dayton Children’s Community Health Needs Assessment
Children (14 and below) in fair or poor health, Montgomery County and surrounding areas, 2014 Key survey findings as reported by parents: • Children that are more likely to be in fair or poor health are: - African American (9.9%) - In families with an income under 200% of the FPL (8.3%)
Key survey findings as self-reported: • The percent of adults reporting fair-to-poor health decreases as annual household income increases.
- Obese (7.2%) 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
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population characteristics
About Montgomery County
Population by age and sex, Montgomery County, 2012 Key findings: • Beginning at age 55, the percent of females is greater than males. • Children under the age of 18 comprise 22% of the population. • The population 65 and older make up 16% of the population.
Source: American Community Survey, U.S. Census
Public Health Importance In order to better understand the health issues in the county, it is important to first have an accurate description of the residents. Knowing the racial, ethnic, and age makeup of a population aids in the selection of appropriate public health interventions and services, and helps to define the relationship between social, economic, political, biologic, genetic, and environmental factors and a population’s health. Across the Nation - 2012
a
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2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Montgomerya
Ohioa
United Statesa
White, Non-Hispanic
72.3%
80.6%
62.8%
Black or African American, Non-Hispanic
20.6%
12.1%
12.3%
Asian
2.0%
1.7%
4.9%
American Indian/Alaska Native
0.1%
0.2%
0.7%
Hispanic or Latino
2.4%
3.2%
16.9%
Under 5 years
6.1%
6.0%
6.3%
Under 18 years
22.6%
23.0%
23.5%
65 years and over
16.0%
14.8%
13.7%
American Community Survey, U.S. Census
About Montgomery County
0.1% 2.4% 2.0% 0.2%
population characteristics
Population by race and ethnicity Montgomery County, 2012
2.4% White, Non-Hispanic Black, Non-Hispanic
20.6%
Hispanic
Key findings: • The population of Montgomery County is: - 72% White, Non-Hispanic - 21% Black, Non-Hispanic - 2% Hispanic or Latino - 2% Asian
Asian
72.3%
Native American Two or More Races Other
Source: American Community Survey, U.S. Census
Appendix 1: Total Population by Zip Code
Key findings: • There are more women (277,433) than men (256,892) in Montgomery County. • Since 2000, the percent of married couple families decreased 15%, and families with a female head of household increased 11% (2000 data not shown in table).
Population and Family Characteristics by Race, Montgomery County, 2012 Montgomery County
White, Non-Hispanic
Black, Non-Hispanic
Population
534,325
386,293
109,817
Males
48.1%
48.5%
46.1%
Females
51.9%
51.5%
53.9%
10.3%
10.7%
10.0%
59.0%
60.2%
53.1%
Veterans Household Type Family Households Married couple family
39.4%
44.4%
21.4%
Male head of household family, no wife present
4.3%
4.0%
4.8%
Female head of household family, no husband present
15.3%
11.8%
26.9%
41.0%
39.8%
46.9%
35.4%
33.9%
42.8%
3.04
2.98
3.22
Nonfamily Households Living alone Average Family Size Source: American Community Survey, U.S. Census
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
21
disability
About Montgomery County
Disabled population by age group Montgomery County, 2012
Key findings: • Almost 16% of the population (roughly 85,000 individuals) have some form of disability. • 38% of those age 65 and older have a disability.
Source: American Community Survey, U.S. Census
Disability type by age group Montgomery County, 2012 Key findings: • The most reported disability type for 18 to 64 year olds and individuals aged 65 and older is difficulty walking. • Cognitive and self-care disabilities are higher among 18 to 64 year olds than in the older population; a 94% and 8% difference, respectively.
Source: American Community Survey, U.S. Census
Types of Disabilities among Children with a Disability, Montgomery County, 2012 Age Group Type of Disability
22
Under 5
5 to 17
Hearing
46.0%
7.8%
Vision
65.7%
15.5%
Cognitive
NA
79.1%
Walking
NA
8.7%
Self-care
NA
11.5%
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Key findings: • For children under age 5, the most common disability is related to their vision (66%). • Between the ages of 5 and 17, 80% of children with a disability have a cognitive disability. Source: American Community Survey, U.S. Census
About Montgomery County
disability
Disability Types A person who reports having one of six disability types is considered to have a disability
Public Health Importance Whether an individual is born with a disability or becomes disabled later in life, it is important to ensure they have the opportunity to fully participate in all aspects of everyday life. Those with disabilities often experience health disparities such as access to healthcare, obesity, inactivity, high blood pressure, and neglected preventive health and dental screenings (HP2020, 2014). By recognizing the types of disabilities found in this county, an effort can be made to strategically offer services that will promote the health and well-being of all individuals with disabilities.
1. Hearing difficulty – deaf or having serious difficulty hearing 2. Vision difficulty – blind or having serious difficulty seeing, even when wearing glasses 3. Cognitive difficulty – difficulty remembering, concentrating or making decisions because of a physical, mental, or emotional problem 4. Ambulatory difficulty – difficulty walking or climbing stairs 5. Self-care difficulty – difficulty bathing or dressing 6. Independent living difficulty – difficulty doing errands because of a physical, mental, or emotional problem
Across the Nation - 2012
a
Montgomerya
Ohioa
United Statesa
Total
15.9%
13.6%
12.2%
Under 5 years
1.2%
0.8%
0.8%
5 to 17 years
6.9%
0.5%
0.5%
18 to 64 years
14.2%
11.8%
10.1%
65 years and over
37.8%
35.3%
35.9%
American Community Survey, U.S. Census
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
23
socioeconomics
About Montgomery County
Socioeconomic Characteristics, Montgomery County, 2012
Key findings:
Montgomery County
White, NonHispanic
Black, NonHispanic
• The estimated per person income for Blacks is almost $10,000 less than the per person income for Whites.
Median family income
$42,524.00
$46,866.00
$26,827.00
Per capita income (dollars)
$23,902.00
$26,565.00
$16,846.00
• Poverty within Black families is more than 3 times higher than in White families.
Families
13.4%
8.9%
29.0%
Female head of household
36.7%
30.1%
45.2%
Female head of household with a related child under 5 years
49.4%
41.1%
64.3%
Owner-occupied
60.1%
66.3%
39.7%
Renter-occupied
39.9%
33.7%
60.3%
Income
Below Poverty Level
Housing Tenure
• 64% of Black, female head of household families with a child under the age of 5 live in poverty. • While 66% of the White population resides in a home they own, only 40% of Blacks own their home. Appendix 2: Families Living Below Poverty Level by Zip Code
Source: American Community Survey, U.S. Census
• Children under the age of 5 represent the greatest proportion of individuals living in poverty. • Families with a Black, female head of household represent the largest family type living in poverty.
Source: American Community Survey, U.S. Census
Families or people below the poverty level, Montgomery County, 2012
Key findings:
• Married couples have the lowest percent of poverty.
a
b
Montgomery
Per capita incomea (dollars)
$ 23,902.00
$ 25,445.00 $ 27,319.00
Mean household incomea (dollars)
$ 56,242.00
$ 62,775.00 $ 71,317.00
Ohio
United States
Unemployment Rateb
8.0%
7.4%
7.4%
Poverty: Familiesa
13.4%
12.0%
11.8%
Poverty: Children under 5 yearsa
35.7%
28.6%
25.6%
Poverty: Under 18 yearsa
27.7%
23.8%
22.6%
Poverty: 65 years and overa
8.3%
8.0%
9.5%
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Unemployment rate Montgomery County, 2009 - 2013
Key findings: • Since 2009, the unemployment rate has decreased 29%.
Source: Bureau of Labor of Statistics, U.S. Department of Labor
American Community Survey, U.S. Census Bureau of Labor of Statistics, U.S. Department of Labor
24
Across the Nation - 2012 Poverty, Income, & Unemployment
About Montgomery County
socioeconomics
Across the Nation - 2012 Educational Attainmenta
a
Montgomery
Ohio
United States
No High School
3.2%
3.1%
5.8%
Some High School
8.7%
8.1%
7.9%
High School Graduate
29.2%
34.6%
28.0%
Some College
25.2%
20.9%
21.3%
Associate's degree
8.7%
8.1%
8.0%
Bachelor's degree
15.1%
16.0%
18.2%
Graduate or professional degree
9.9%
9.3%
10.9%
American Community Survey, U.S. Census
Public Health Importance Socioeconomic status (SES), which is frequently measured by educational attainment and poverty, is associated with health. High SES individuals have a tendency to be healthier. They are more likely to choose healthy behaviors, receive proper preventive health services, and live and work in healthier environments. On the other end of the spectrum, low SES individuals tend to live in neighborhoods with low access to healthy foods and other services and have limited access to healthcare services. Cigarette smoking and physical inactivity are more common among those with lower SES (CDC, 2011).
Educational attainment* by sex, Montgomery County, 2012
Key findings: • 25% of all residents receive a Bachelor’s, Graduate, or professional degree. • The percent of men receiving Bachelor’s, Graduate, or professional degrees is 9% more than women. Source: American Community Survey, U.S. Census Source: American Community Survey, U.S. Census
Educational attainment* by race, Montgomery County, 2012
Key findings: • The percent of Blacks that attended some college or earned an Associate’s degree is 22% higher than Whites. • The percent of Whites receiving either a Bachelor’s, Graduate, or other professional degree is 27% compared to 18% of Blacks.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
25
crime
About Montgomery County
All violent crimes known to law enforcement Montgomery County, 2009-2012
Key findings: • Violent crimes decreased 17% from 2009 to 2012. • Murder, robbery, and aggravated assault all decreased over the 4 year period, but rape increased 3%.
Source: National Incident Based Reporting System, FBI
All property crimes known to law enforcement Montgomery County, 2009-2012
Key findings: • Property crime decreased 8% from 2009 to 2012. • Arson declined 34% which was the greatest decrease among all property crime types.
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2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Source: National Incident Based Reporting System, FBI
About Montgomery County
crime
Appendix 3: Crime Rate by City and Township Appendix 4: Violent and Property Crimes by Jurisdiction
Public Health Importance
Across the Nation - 2011 Crime Rate per 100,000
Montgomerya
Ohioa
United Statesa
402.4
307.4
386.3
Murder
8.8
4.4
4.7
Forcible Rape
41.7
31.5
26.8
Robbery
177.7
139.1
113.7
Aggravated Assault
174.2
132.4
241.1
3,799.5
3,354.7
2,908.7
Burglary
1,152.2
976.3
702.2
Larceny-Theft
2,413.0
2,195.9
1,976.9
234.3
182.5
229.6
Violent Crime
Property Crime
Motor Vehicle Theft a
National Incident Based Reporting System, FBI
More than 1.2 million violent crimes were committed nationally in 2012. Losses from property crimes were estimated at $15.5 billion (Federal Bureau of Investigation, 2013). Unsafe neighborhoods discourage adults from walking their streets for exercise and children from playing in nearby parks. There is less investment in community resources such as the development of parks and recreation facilities in unsafe neighborhoods. High crime rates serve as a deterrent to companies, such as healthy food establishments (Prevention Institute, 2011). The long-term health consequences of unsafe neighborhoods can include higher rates of obesity, type 2 diabetes, heart disease, hypertension, and gastrointestinal issues.
Violent and property crimes committed by juveniles Montgomery County, 2011
Murder
15.6%
Rape
5.7% 7.2%
Robbery
66.4%
0.9% 0.3% 1.2% 2.6%
Source: National Incident Based Reporting System, FBI
Aggravated Assault Burglary Larceny - Theft
Key findings: â&#x20AC;˘ More than 85% of crimes committed by juveniles are property crime. â&#x20AC;˘ Robbery accounted for 51% of violent crimes and larceny - theft accounted for 77% of property crimes (data not shown in figure).
Motor Vehicle Theft Arson
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
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physical Activity
Behavioral Health Risks
Adults* aerobic activity level by race Montgomery County, 2011 & 2013
Physical Activity Recommendation: Adults need at least 2 hours and 30 minutes (150 minutes) of moderate intensity aerobic activity a week and muscle strengthening activities that work all major muscle groups on 2 or more days a week (2008 Physical Activity Guidelines for Americans).
Key findings as self-reported: • Black adults (32%) are more inactive than White adults (27%).
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Public Health Importance Half of adults and less than a third of youth meet the aerobic physical activity recommendation (CDC, 2014). Physical activity lowers the risk for heart disease, stroke, type 2 diabetes, and some cancers, and it plays a role in improving mental health and overall mood. In children, regular physical activity helps to build healthy bones and muscles and is beneficial to their academic performance. As we age, physical activity can help with joint swelling and arthritis pain and reduce the risk of injuries from falling.
Across the Nation - 2011 Montgomery a County
Ohioa
United Statesa
Met Aerobic Activity Recommendation
46.0%
46.1%
46.6%
Met Strength Training Recommendation
25.2%
27.3%
26.5%
Met Both Physical Activity Recommendations
21.1%
19.2%
18.5%
Did Not Meet Either Physical Activity Recommendation
38.2%
36.8%
36.3%
Adults (18 and older)
a
Behavioral Risk Factor Surveillance System (BRFSS)
»« Call to Action »« Finding time to exercise between work, home, and family responsibilities may seem difficult, but there are easy ways to incorporate physical activity into these activities. You can take a brisk 10 minute walk during a break at work, mow the lawn or clean the house, or enjoy a bike ride. Other moderate physical activities include dancing, yoga, water aerobics, and martial arts. Make exercise fun for you. Start slowly and gradually increase your level of activity. The 2 hour and 30 minute physical activity recommendation can be spread throughout the week and can be reached in 10 minute increments. 28
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Behavioral Health Risks Adults* aerobic activity level by annual household income, Montgomery County, 2011 & 2013
physical Activity
Key findings as self-reported: • As annual household income increases, the percent of adults who meet the aerobic recommendations also increases. • The highest percentages of inactive adults are among those with household incomes less than $15,000 and between $25,000 and $34,999.
Key findings as reported by parents: • The majority of children ages 6 to 10 have 2 hours of screen time, participate in 1 hour of physical activity, and spend 1 hour doing homework a day.
Source: Behavioral Risk Factor Surveillance System (BRFSS) Source: Dayton Children’s Community Health Needs Assessment
Children’s (6 to 10 yrs) daily habits and activities, Montomery County and surrounding areas, 2014
Adults* aerobic and strengthening physical activity level Montgomery County, 2011 & 2013
Key findings as self-reported: • 44% of adults meet the aerobic recommendation and 26% meet the strengthening recommendation. • Only 18% of adults meet the complete (aerobic and strengthening) physical activity recommendation. 2014 Community Health Assessment
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Public Health - Dayton & Montgomery County
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nutrition
Behavioral Health Risks
Adults* who do not eat one or more servings of fruits or vegetables a day by race Montgomery County, 2011 & 2013
Key findings as self-reported: • 24% of adults do not eat one or more servings of vegetables a day and 41% do not eat one or more servings of fruits a day.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
• More than 50% of adults with an annual household income of less than $15,000 eat less than one serving of fruit a day.
»« Call to Action »« Good nutrition is a key part of a healthy lifestyle. Your diet should include a selection of fruits and vegetables (red, orange and dark green); whole grain foods; small, lean portions of meat, poultry, and seafood; and skim or 1% milk. As your child grows, you should steer them on a path toward good nutrition by encouraging them to make healthy food choices and by being a positive example. 30
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Key findings as self-reported:
Adults* who do not eat one or more servings of fruits or vegetables a day by annual household income Montgomery County, 2011 & 2013
nutrition
Behavioral Health Risks
Adults who ate a meal from a quick service* or sit-down restaurant in the past 30 days Montgomery County, 2013
Key findings as self-reported: • Quick service restaurants are used more frequently than sit-down restaurants. • 10% of people use quick service restaurants 10 or more times a month.
Source: Scarborough Market Survey
Childhood Nutrition (Ages 2 to 14) in Montgomery County and Surrounding Areas, 2014 • On average, obese children have one serving of fried foods and one sugary drink a day. • 20% of parents of obese children report that their child eats too much junk food, and 15% of parents report that their child eats too many sweets. Source: Dayton Children’s Community Health Needs Assessment
Across the Nation
Public Health Importance A healthy diet that includes fruits, vegetables, healthy proteins, and low fat milk is beneficial to a child’s growth and development. Proper nutrition, in addition to physical activity, can help prevent obesity in children and adults as well as decrease the risk of diseases such as cancer, type 2 diabetes, and heart disease.
a b
Montgomery a County
Ohioa
United Statesb
Percent of adults (18 and older) not eating vegetables one or more times a day
24.3%
25.9%
22.5%
Percent of adults (18 and older) not eating fruit one or more times a day
40.8%
40.5%
36.8%
Behavioral Risk Factor Surveillance System (BRFSS), 2013 Behavioral Risk Factor Surveillance System (BRFSS), 2011 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
31
weight
Behavioral Health Risks
Overweight or obese adults* by sex Montgomery County, 2011-2013
Body Mass Index (BMI) is a measurement of body fat based on height and weight. Normal weight = 18.5 to 24.9 Overweight = 25.0 to 29.9 Obese = 30 and over
Key findings as self-reported: • 28% more men than women are overweight or obese (78.6% vs. 61.6%).
Appendix 5: Overweight or Obese Adults by Zip Code
Overweight or obese adults* by race Montgomery County, 2011-2013
Key findings as self-reported: • There are almost 3 times as many Blacks that are overweight or obese than are at a normal weight (71% compared to 26%). • There are two times more Whites that are overweight or obese than are at a normal weight (65% compared to 33%).
»« Call to Action »« Getting regular physical activity and having a healthy diet will help you maintain a healthy weight. Find time in your day for a brisk walk, a bike ride, or a trip to the gym. Making physical activity a part of your child’s life will encourage them to continue to be physically active as an adult. Find new ways to eat fruits, vegetables, fish, beans, and other healthy foods. Developing healthy eating habits and a physical activity routine at a young age will give your child a healthy advantage as they mature. 32
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
In order to increase healthy eating and active living within families, Public Health - Dayton & Montgomery County created, “GetUp.” This is an obesity prevention program that challenges families to adopt a healthy lifestyle prescription of “5-2-1-AN.” http://getupmc.org/
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Behavioral Health Risks
weight
Weight categories among children* by sex Montgomery County and surrounding areas, 2014
Key findings as reported by parents: • There is little difference between boys and girls in each weight category. • 54% of parents of obese children perceive their child as being at about the right weight; 5% think their child is very overweight (data not shown in figure). Source: Dayton Children’s Community Health Needs Assessment
Across the Nation - 2012
Public Health Importance
Percent of adults (18 and older) who are overweight or obese a
Almost 36% of adults and 17% of children (aged 2 to 19) in the U.S. are obese. Children who are obese are more likely to be obese as adults. Consequently, there is an increase in the rate of the chronic diseases and risk factors that are associated with obesity such as type 2 diabetes, coronary heart disease, hypertension, high cholesterol, stroke, and respiratory problems. Obese children and adults may suffer from depression, can develop an eating disorder, face discrimination, or have low self-esteem (CDC, 2014).
Montgomery a County
Ohioa
United Statesa
58.8%
62.0%
60.0%
Behavioral Risk Factor Surveillance System (BRFSS)
Obesity not only affects a person’s physical well-being. l There is also a socia and mental health impact.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
33
alcohol use
Behavioral Health Risks
Adults* who are heavy drinkers by age and sex, Montgomery County, 2011-2013
Heavy drinking: Adult males having more than 2 drinks per day; adult females having more than 1 drink per day.
Key findings as self-reported: • Women between the ages of 35 and 44 are 5 times more likely to be heavy drinkers than men. • The highest proportion of heavy drinkers in both men and women are between the ages of 18 and 24 and the ages of 45 and 54.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults* who binge drink by age and sex Montgomery County, 2011-2013 Source: Behavioral Risk Factor Surveillance System (BRFSS)
Binge drinking: Adult males having 5 or more drinks on one occasion; adult females having 4 or more drinks on one occasion. Key findings as self-reported: • Men and women who are 18 to 24 years of age have the highest prevalence of binge drinking.
»« Call to Action »«
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Across the Nation - 2012 Montgomery a County
Ohioa
United Statesa
Percent of adults (18 and over) who are heavy drinkers
10.7%
6.0%
5.5%
Percent of adults (18 and over) who binge drink
18.4%
17.2%
16.0%
Behavioral Risk Factor Surveillance System (BRFSS)
34
a
If you choose to drink, drinking in moderation is important. Women should have no more than 1 alcoholic drink a day and men should have no more than 2 drinks a day. Women who are pregnant or trying to become pregnant should not drink alcohol. Be careful not to mix prescription or over-thecounter medications with alcohol as serious and harmful reactions may occur.
Behavioral Health Risks
Population characteristics of alcohol-related disease* deaths, Montgomery County, 2010-2012
alcohol use
Key findings: • 0.8% of all deaths can be directly attributed to an excessive use of alcohol. • 75% of deaths from alcohol-related diseases occur between the ages of 45 and 64. • Alcohol-related diseases kill 7 times more Whites than Blacks and 2.5 times more men than women. • Alcoholic liver disease is the most common alcohol-related cause of death (data not shown in figure).
Source: Ohio Death Certificates, Ohio Department of Health
Public Health Importance Even though most people who binge drink are not alcoholics, excessive alcohol consumption is associated with numerous health problems. Unintentional injuries such as motor vehicle accidents, falls, burns, and drowning are often tied to alcohol use. Intentional injuries associated with alcohol use are firearm injuries, sexual assaults, and domestic violence (CDC, 2014). Long-term health risks include neurological problems, liver disease, depression, anxiety, suicide, gastrointestinal problems, cardiovascular problems (high blood pressure, stroke, and heart attack), and uncontrollable diabetes. Pregnant women who drink risk having a child born with fetal alcohol spectrum disorders (CDC, 2014).
Alcohol impaired driver crashes and fatalities among 15 to 24 year olds, Montgomery County, 2013
Appendix 6: Number of Liquor Store Carryouts by Zip Code
In Montgomery County Among 12 to 17 year olds: • 12% used alcohol during the past month • 6% reported binging on alcohol during the past month Source: National Survey on Drug Use and Health (2010-2012)
In Ohio Among high school students: • 13% reported drinking alcohol before the age of 13 • 4% have driven while drinking alcohol • 17% were passengers with a driver who had been drinking alcohol Source: Youth Risk Behavior Survey, 2013
2014 Community Health Assessment
Source: Crash Statistics Database, Ohio Department of Public Safety
Public Health - Dayton & Montgomery County
35
tobacco use
Behavioral Health Risks
Adult* smoking status by sex Montgomery County, 2011-2013 Key findings as self-reported: • 23% of adults currently smoke cigarettes and 24% have been able to stop smoking. • More women than men report never having smoked cigarettes (56% vs. 46%). • More men are former smokers than women (28% vs. 21%).
Source: Behavioral Risk Factor Surveillance System (BRFSS)
»« Call to Action »« To lower your risk of developing the negative health outcomes associated with tobacco, you must quit smoking and using smokeless tobacco.
Public Health Importance Smoking is linked to more than 480,000 deaths every year in the U.S. Damage to blood vessels puts smokers at a 2 to 4 times greater risk of developing cardiovascular disease or having a stroke. Smoking can cause cancer almost anywhere in the body. Cancer of the esophagus, pancreas, mouth, and throat can be caused by smokeless tobacco products. Secondhand smoke is responsible for more than 200,000 cases of bronchitis and pneumonia a year among children 18 months or younger and is linked to more than 7,300 lung cancer deaths a year among nonsmokers. Women who smoke while pregnant are at an increased risk for having a preterm or low birth weight baby. They can also have a stillbirth or an infant death (CDC, 2014). 36
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Two to 5 years after you quit smoking, your risk of having a stroke could be the same as nonsmokers. After 10 years, your risk of lung cancer is cut in half (CDC, 2014). There are many resources to prepare you to quit and to help you through the process. Available support options include cessation classes, on-line tools, telephone and in-person counseling, and medications.
tobacco use
Behavioral Health Risks
Adult* smoking status by race Montgomery County, 2011-2013
Key findings as self-reported: • Among Whites, there are more former smokers (26%) than current smokers (21%). • Among Blacks, there are more current smokers (25%) than former smokers (18%). Source: Behavioral Risk Factor Surveillance System (BRFSS)
Across the Nation - 2012 Montgomerya
Ohioa
United Statesa
Percent of adults (18 and over) who are current smokers
25.5%
22.6%
18.4%
Percent of adults (18 and over) who are former smokers
22.7%
24.0%
24.2%
Percent of adults (18 and over) who never smoked
50.8%
50.7%
55.4%
a
Behavioral Risk Factor Surveillance System (BRFSS)
In Montgomery County Among 12 to 17 year olds: • 10% used tobacco products in the past month • 8% used cigarettes in the past month Source: National Survey on Drug Use and Health, 2010-2012
In Ohio Among high school students: • 22% currently use tobacco (cigarettes, smokeless tobacco, or cigars) • 15% use tobacco once a day • 5% of high school students smoke daily • 9% use smokeless tobacco (chewing tobacco, snuff, or dip) • 12% use cigars (cigars, cigarillos, or little cigars) Source: Youth Risk Behavior Survey (YRBS), 2013
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
37
vaccination
Behavioral Health Risks
Adults* who have received a flu vaccine in the past 12 months by race, Montgomery County, 2011-2013
Key findings as self-reported: • There are more Whites (45%) that received the flu vaccine within the past year than Blacks (25%).
Key findings as self-reported:
Source: Behavioral Risk Factor Surveillance System (BRFSS)
• More than 60% of both White and Black adults over the age of 65 have ever received a pneumonia vaccine.
»« Call to Action »« • A baby receives its first vaccination before leaving the hospital. Children need to continue to be vaccinated to fully protect them against harmful diseases. Ensure your child receives all their vaccinations on-time at their pediatrician or the public health immunization clinic.
Adults 65 and older who have ever received a pneumonia vaccine by race, Montgomery County, 2011-2013
• Every year, those 6 months and older should get the seasonal flu vaccine. • All adults are recommended to receive a one-time dose of Tdap vaccine for protection against pertussis.
38
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Across the Nation - 2012 Montgomery a County
Ohioa
United Statesa
Percent of adults (18 and older) who had the flu vaccine in the past year
64.5%
62.9%
60.1%
Percent of adults (65 and older) who have had a pneumonia vaccine
38.5%
37.2%
35.3%
Behavioral Risk Factor Surveillance System (BRFSS)
• At age 60, adults should get the shingles vaccine, and at age 65, they should get a series of two different pneumonia vaccines.
a
• Pregnant women should receive the Tdap vaccine during the third trimester of each pregnancy.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Behavioral Health Risks Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults 65 and older who have ever received a pneumonia vaccine by sex Montgomery County, 2011-2013
vaccination
Key findings as self-reported: • A higher percent of women over the age of 65 (68%) have received the pneumonia vaccine compared to men of the same age (57%).
Public Health Importance
Reportable Vaccine-Preventable Diseases, Confirmed Cases Montgomery County and Ohio, 2011-2013 Montgomery County Confirmed Cases
Rate per 100,000
Ohio Confirmed Cases
Rate per 100,000 0.0
Diphtheria
0
0.0
0
Haemophilus influenzae
41
2.6
482
1.4
Hepatitis A
3
0.2
140
0.4
135
8.2
1,698
4.9
5
0.3
110
0.3
Influenza-associated hospitalization
435
27.4
9,652
28.2
Influenza-associated pediatric mortality
1
0.1
9
0.0 0.0
Hepatitis B (acute & chronic) Influenza A (novel virus infection)
Measles
0
0.0
1
Meningococcal disease
1
0.1
53
0.2
Mumps
0
0.0
16
0.0
222
13.8
2,859
8.3
Poliomyelitis
Pertussis
0
0.0
0
0.0
Rubella
0
0.0
1
0.0
242
15.1
3,606
10.4
Tetanus
0
0.0
24
0.1
Varicella (chickenpox)
26
1.6
692
2
Streptococcus pneumoniae
Vaccines protect individuals against serious, preventable, and sometimes deadly contagious diseases. By the time a fully vaccinated child is 2 years old, they are protected from 14 serious diseases. Annual flu vaccines are available to those 6 months and older. Those over the age of 65 and pregnant women are especially vulnerable to diseases. In addition to an annual flu vaccine, women who are pregnant should receive a vaccine to protect against pertussis, and older adults should get pneumonia and shingles vaccines.
Key findings: • Of the reportable, vaccine-preventable illnesses, influenza-associated hospitalizations has the highest rate of confirmed cases in both Montgomery County and Ohio. • The rates of Haemophilus influenza, Hepatitis B, Pertussis, and Streptococcus pneumoniae were all higher in Montgomery County than in Ohio.
Source: Ohio Disease Reporting System (ODRS)
Children (Ages 6 to 14) Receiving the Flu Vaccine by Poverty Level, Montgomery County and Surrounding Areas, 2014 Ages 6 to 14
Flu Shot in the Last Year
Never Received a Flu Shot
Above 200% of poverty
59%
19%
Below 200% of poverty
62%
25%
Source: Dayton Children’s Community Health Needs Assessment
Key findings as reported by parents: • 62% of children living below 200% of poverty received the flu vaccine in the last year compared to 59% of children living above 200% of poverty. • More children living below 200% of poverty have never received a flu vaccine compared to children living above 200% of poverty. 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
39
preventive cancer screenings
Behavioral Health Risks
U.S. Preventative Services Task Force recommendation:
Breast cancer screening using mammography every 2 years for women aged 50 to 74 years.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Women age 50 to 74 years who have had a mammogram within the past 2 years by race Montgomery County, 2011-2012
Key findings as self-reported: • 24% more Black women age 50 to 74 years have met the recommended mammogram screening guidelines than White women.
Public Health Importance
U.S. Preventative Services Task Force recommendation:
Colorectal cancer screening with sigmoidoscopy every 5 years for adults aged 50 to 75 years and colonoscopy every 10 years for adults aged 50 to 75 years.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults age 50 to 75 years who have ever had a colonoscopy or sigmoidoscopy by race and sex Montgomery County, 2011-2012
Breast, colon, and cervical cancer can be found in the early stages of the disease with regular preventive cancer screenings. There are over 230,000 new breast cancer cases a year and approximately 40,000 deaths from breast cancer. Mammograms can reduce the risk of dying from breast cancer by 15 to 20% (American Cancer Society, 2014). Pap smears can identify cervical precancerous cells. With increased screening over the past 40 years, new cases and deaths from cervical cancer have decreased significantly. Approximately 4.8% of men and women will be diagnosed with colon and rectum cancer at some point in their lifetime. If found and treated early, there is a 90% 5-year survival rate (American Cancer Society, 2014).
Key findings as self-reported: • Among adults age 50 to 75, more Blacks (78%) than Whites (67%) have had a colonoscopy or sigmoidoscopy. • More women (71%) than men (67%) have had colorectal cancer screening.
»« Call to Action »« Beginning at age 21 until the age of 65, women should get a Pap smear every 3 years. Additionally, women should begin getting mammograms every 2 years beginning at age 50. There are 3 recommended screening tests for colon cancer that should begin at age 50. A fecal occult blood test (FOBT) or stool test should be completed once a year to detect blood in your stool. To examine the lower third of your colon, a flexible sigmoidoscopy should be performed every 5 years, and the entire colon should be checked every 10 years with a colonoscopy. For those with a family history or a genetic condition that predisposes you to one of these cancers talk to your doctor about the age and frequency at which these screening tests should be performed (U.S. Preventative Task Force, 2008). 40
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Behavioral Health Risks
preventive cancer screenings
U.S. Preventative Services Task Force recommendation:
Cervical cancer screening with a Pap smear every 3 years in women aged 21 to 65 years.
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Women age 21 to 65 years who had a Pap smear within the past 3 years Montgomery County, 2011-2012
Key findings as self-reported: • Black women between the ages of 21 and 65 are more likely than White women to have had a Pap smear within the past 3 years (93% compared to 79%). Colonoscopy
Across the Nation - 2012 Montgomerya
Ohioa
United Statesa
Percent of women age 50 to 74 years who have had a mammogram within the past 2 years
75.5%
81.5%
81.6%
Percent of adults age 50 to 75 years who have ever had a colonoscopy or sigmoidoscopy
71.7%
63.7%
64.5%
Percent of women age 21 to 65 years who have had a Pap smear within the past 3 years
79.7%
82.5%
84.6%
Behavioral Risk Factor Surveillance System (BRFSS)
a
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults who received recommended cancer screening by annual household income, Montgomery County, 2011-2012
Key findings as self-reported: • Only 30% of 50 to 75 year olds who have an annual household income of less than $15,000 have had the recommended colorectal cancer screening tests. • Less than 70% of adults who have an annual household income between $25,000 and $34,999 have met the recommended screening guidelines for breast, colon, or cervical cancer.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
41
BIRTHs
Health Outcomes Low birth weight* by race Montgomery County, 2008-2012
Key findings: • The percent of babies born with low birth weight has increased slightly from 2008 to 2012. • The percent of low birth weight babies born to White women increased 23% from 2008 to 2012. • In 2012, almost two times as many low birth weight babies were born to Black women (15%) than to White women (8%).
Appendix 7: Low Birth Weight by Zip Code
Source: Ohio Birth Certificates, Ohio Department of Health
Key findings:
Women who smoked during pregnancy* by race, Montgomery County, 2008-2012
• The percent of women who smoked during the last trimester of their pregnancy has declined over the last four years. • In 2012, a higher percent of White women (15%) smoked during their pregnancy than Black women (10%). • The highest percent of women who smoked during their pregnancy was between the ages of 18 and 24 (17%) (data not shown in figure).
Source: Ohio Birth Certificates, Ohio Department of Health
In 2012, almost two times as many low birth weight babies were born to Black women (15%) than to White women (8%).
42
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
»« Call to Action »« Certain behaviors such as the use of illicit drugs, drinking alcohol, and smoking can result in poor birth outcomes. Pregnant women who smoke are almost two times more likely to have a low birth weight baby than women who do not smoke (March of Dimes, 2013). It is important that all pregnant women begin prenatal care within the first trimester. By having early and regular visits, existing health risks in a pregnant woman can be identified and future health problems of the baby may be prevented; improving the likelihood of having a healthy baby.
Health Outcomes
BIRTHs
Source: Ohio Birth Certificates, Ohio Department of Health
Women giving birth who are married by race Montgomery County, 2008-2012
Public Health Importance Babies born prematurely are often born with a low birth weight (<2,500g or 5lb, 8oz). As a result, they can suffer from a multitude of lifelong medical conditions that can affect their heart, lungs, intestines, kidneys, and eyes. In some cases, the baby’s health problems are too severe to survive. As these babies mature, developmental delays and learning disabilities can become apparent.
Key findings: • The percent of women giving birth who are married has remained relatively stable from 2008 to 2012. • The percent of Black women giving birth who are married declined 7% from 2008 to 2012. Source: Ohio Birth Certificates, Ohio Department of Health
First trimester prenatal care by method of payment Montgomery County, 2008-2012
Across the Nation - 2012a Montgomerya
Ohioa
United Statesb
9.7%
8.5%
8.0%
White
8.0%
7.4%
7.0%
Black
14.8%
13.8%
12.8%
Percent first trimester care
74.7%
72.4%
61.8%
Percent women who smoked during pregnancy
13.1%
13.7%
7.1%
Percent women giving birth who are married
50.6%
55.4%
59.3%
White
62.2%
62.7%
64.1%
Black
17.4%
21.1%
28.4%
Percent low birth weight
Ohio Birth Certificates, Ohio Department of Health Natality public-use data on CDC WONDER Online Database
a b
Key findings: • In 2012, 75% of women received prenatal care during the first trimester of their pregnancy (data not shown in figure). • More than 84% of women paying by either private insurance or military insurance (Tricare), received prenatal care during their first trimester between 2008 and 2012. • The highest percent of births in 2012 was paid by Medicaid (data not shown in figure), but only 64% of those women received prenatal care in the first trimester.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
43
deaths
Health Outcomes
Source: Ohio Death Certificates, Ohio Department of Health
Age-adjusted death rate of the top 10 causes of death Montgomery County, 2011-2012
Key findings: • Cancer and heart disease are the top 2 causes of death in Montgomery County. • The top 3 causes of death among those between the ages of 1 and 24 were accidents, homicide, and suicide (data not shown in figure).
Cause of Death Ranking The number of deaths within each cause of death category ranked in order from high to low.
Top Ten Causes of Death by Sex Montgomery County, 2010-2011
Key differences: Rank
Male
Female
• Suicide is the 8th and chronic liver disease is the 10th leading causes of death in men.
1
Cancer
Cancer
2
Heart Disease
Heart Disease
3
Accidents
CLRD*
4
CLRD*
Alzheimer's Disease
5
Stroke
Stroke
6
Diabetes
Diabetes
7
Alzheimer's Disease
Influenza/Pneumonia
8
Suicide
Septicemia
9
Nephritis
Accidents
10
Chronic Liver Disease
Nephritis
• Alzheimer’s disease is the 4th leading cause of death in women and the 7th in men. • Influenza/pneumonia is the 7th leading cause of death for women.
Top Ten Causes of Death by Race Montgomery County, 2010-2011 Race Rank
White
Black
1
Cancer
Heart Disease
2
Heart Disease
Cancer
3
CLRD*
Diabetes
Key differences:
4
Accidents
Accidents
5
Alzheimer's Disease
Stroke
• The number one cause of death for Whites is cancer and for Blacks is heart disease.
6
Stroke
Alzheimer's Disease
7
Diabetes
Homicide
8
Influenza/Pneumonia
CLRD*
9
Suicide
Nephritis
10
Septicemia
Septicemia
* Chronic Lower Respiratory Disease Source: Ohio Death Certificates, Ohio Department of Health
44
Sex
• Accidents are the 3rd leading cause of death for men and the 9th for women.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
* Chronic Lower Respiratory Disease Source: Ohio Death Certificates, Ohio Department of Health
• Diabetes is the 3rd leading cause of death for Blacks and the 7th for Whites. • Homicide is the 7th leading cause of death for Blacks. • Suicide is the 9th leading cause of death for Whites.
Health Outcomes
Public Health Importance
deaths
Source: Ohio Death Certificates, Ohio Department of Health Source: Ohio Birth Certificates, Ohio Department of Health
Life expectancy at birth Montgomery County, 2011-2012
The leading causes of death in the U.S. are due to chronic diseases with heart disease and cancer accounting for almost 48% of all deaths. Knowing the leading causes of death is a valuable tool for public health agencies. It allows agencies to measure and compare the impact of a disease within the population. With this information, prevention strategies can be implemented; new public health policies can be introduced; and health disparities within the community can be identified.
Key findings: • At birth, the life expectancy of Whites is 3.2 years more than Blacks. • The difference in life expectancy between males and females is 5.5 years (74.1 years vs. 79.6 years).
Across the Nation - 2010 Montgomerya
Ohioa
United Statesb
Life Expectancy at Birth
76.1
77.8c
78.7d
Death rate: All causes of mortality
858.7
815.7
747.0
Death rate: Cancer
196.6
187.7
172.8
Death rate: Heart Disease
177.2
192.4
179.1
Death rate: Accidents
57.0
42.4
38.0
Death rate: Stroke
39.9
42.6
39.1
Death rate: Diabetes
31.5
25.8
20.8
Death rate: Alzheimer's disease
38.1
29.7
25.1
• At 80.1 years, the life expectancy of White females is the highest. Black males life expectancy is the lowest at 70.7 years; an almost 10 year difference.
Unless otherwise stated, death rates are per 100,000 and are age-adjusted a Ohio Death Certificates, Ohio Department of Health b Mortality public-use data on CDC WONDER Online Database c The Henry J. Kaiser Family Foundation d National Vital Statistics System (NVSS)
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
45
injuries
Cause of Death Ranking
Health Outcomes
The number of deaths within each cause of death category ranked in order from high to low.
Source: Ohio Death Certificates, Ohio Department of Health
Leading Causes of Injury-Related Deaths by Age Group , Montgomery County, 2011-2012
Across the Nation - 2011 Montgomery
Ohio
United States
Assaults
9.6
5.6
5.3
Suicide
16.4
12.3
12.3
Falls
13.8
8.5
8.1
Age-adjusted Death Ratea (per 100,000)
1st Leading Cause
2nd Leading Cause
Suffocation
Homicide
1 to 4
Homicide
Motor Vehicle Accident
5 to 24
Motor Vehicle Accident
Homicide
Poisonings
24.9
16.6
11.6
25 to 34
Poisoning
Suicide & Homicide
Motor Vehicle Accidents
10.2
10.0
11.1
35 to 54
Poisoning
Suicide
55 to 64
Poisoning
Suicide
Falls
Motor Vehicle Accident
Poisoning
Falls
Age Group
< 1 year
65 and older All Ages
a
Mortality public-use data on CDC WONDER online database
Key findings: • Poisoning (drugs, alcohol, pesticides, gases and vapors, chemicals) is the leading cause of injury-related death; the second cause is falls. • Falls are the second leading cause of injury-related deaths. Source: OHA Insight, Greater Dayton Area Hospital Association
Intentional and Unintentional Injuries Resulting in an Emergency Department Visit or Hospitalization, Montgomery County, 2013 Intentional Injuries
Assaults
Unintentional Injuries
Suicide
Falls
Poisonings
Motor Vehicle Accidents
Number
Rate per 100,000
Number
Rate per 100,000
Number
Rate per 100,000
Number
Rate per 100,000
Number
Rate per 100,000
Total
1,414
264.6
778
145.6
12,591
2,356.4
741
138.7
3,146
588.8
Male
716
278.6
256
99.6
5,355
2,083.3
375
145.9
1,402
545.4
Female
698
251.7
522
188.3
7,236
2,609.6
366
132.0
1,744
629.0
Key findings: • Falls are responsible for the highest rate of hospital visits for injuries. • Although the rate for women taken to the hospital for a suicide attempt is almost 2 times higher than men, the death rate for suicide among men is 4 times higher than women (2010-2011) (data not shown in table). 46
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Health Outcomes
Public Health Importance In 2011, more than 187,000 people in the U.S. died from injuries or violence; that is approximately 1 person every 3 minutes (CDC, 2014).
injuries
Source: OHA Insight, Greater Dayton Area Hospital Association
Unintentional injuries resulting in an emergency department visit or hospitalization by age group, Montgomery County, 2013
• One out of 3 adults 65 and older fall every year (CDC, 2013). • Approximately 13 people between the ages of 10 and 24 are murdered every day (CDC, 2012). • Annually, 1 million people make suicide attempts and 2 million adults report thinking about committing suicide (CDC, 2012). Injury prevention is essential to improving health outcomes.
Key findings: • Unintentional injuries related to falls occur most often in those 65 and older (24%) and in children between the ages of 1 and 9 (23%). • The top cause for emergency department visits or hospitalizations in children aged 1 to 9 is poisoning (31%). • The majority of hospital visits due to a motor vehicle accident occurred among adults between the ages of 25 and 34 years (21%). Source: OHA Insight, Greater Dayton Area Hospital Association
»« Call to Action »«
Intentional injuries resulting in an emergency department visit or hospitalization by age group, Montgomery County, 2013
Injury Prevention • Decrease injuries from falls in older adults - regular exercise - annual eye exams - review medication side effects with doctors or pharmacists - home safety features (grab bars, improved lighting) • Encourage those with a drug problem to seek treatment. • Decrease the risk of death or injury from a motor vehicle accident - wear a seat belt - do not text and drive - properly install child safety seats - do not drive while intoxicated • Support evidence-based community programs and policies that address youth violence • Connect someone you feel is considering suicide with supportive services
Key findings: • Youth 10 to 17 years of age accounted for 35% of hospital visits from suicide attempts. • The percent of hospital visits for assaults peaks at the 25 to 34 year old age group.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
47
diabetes
Health Outcomes
Source: OHA Insight, Greater Dayton Area Hospital Association
Adult* diabetes-related emergency department visits or hospitalizations by age, Montgomery County, 2013
Key findings: • The greatest proportion of diabetes-related emergency department visits or hospitalizations occurred among those 65 years and older.
Key findings: • Women visit the emergency department and are hospitalized for diabetes more often than men, but the diabetes death rate for men is one and a half times greater than for women (data not shown in figure).
Key findings as self-reported: • A higher proportion of Blacks (14%) have been diagnosed with diabetes than Whites (12%). 48
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults* who have ever been diagnosed with diabetes by race, Montgomery County, 2011-2013
Source: OHA Insight, Greater Dayton Area Hospital Association
Rate of adult* diabetes-related emergency department visits and hospitalizations by sex, Montgomery County, 2013
Health Outcomes Source: Behavioral Risk Factor Surveillance System (BRFSS)
Public Health Importance In 2012, 21 million Americans were diagnosed with diabetes; a number that has more than tripled since 1980 (5.6 million). Of those diagnosed, 215,000 were youth under the age of 20 (CDC, 2014). Risk factors include obesity, high blood pressure, high cholesterol, and physical inactivity. The complications of diabetes can be severe. They include heart disease, stroke, vision loss, kidney failure, lower extremity amputations, and death. Diabetes is currently the 7th leading cause of death.
diabetes
Adults* who have ever been diagnosed with diabetes by annual household income, Montgomery County, 2011-2013
Key findings as self-reported: • The percent of adults diagnosed with diabetes is highest within the $15,000 to $34,999 income range. At higher incomes, the prevalence of diabetes decreases.
»« Call to Action »«
Age-adjusted death rate for diabetes by sex and race, Montgomery County, 2011-2012
If you have been diagnosed with diabetes, you should focus on managing your diabetes. This includes: - doctor and dentist visits, at least twice a year - an annual flu shot - an annual dilated eye exam - an annual comprehensive foot check - an annual cholesterol level check - an annual kidney function check - an A1C levels check every 3 to 6 months
Source: Ohio Death Certificates, Ohio Department of Health
In order to prevent and/or manage diabetes, it is important that you maintain a healthy weight; eat a wellbalanced diet; and stay physically active.
Key findings: Across the Nation
Percent adults (18 and over) who have ever been diagnosed with diabetes (2012)a Age-adjusted death rate (per 100,000) for diabetes (2011)b a b
Montgomery
Ohio
United States
12.9%
11.6%
10.2%
33.7
26.8
21.6
Behavioral Risk Factor Surveillance System (BRFSS) Mortality public-use data on CDC WONDER online database
• Black men have the highest rate of death from diabetes, 59.8 per 100,000; followed by Black women, 47.0 per 100,000. • The diabetes death rate among men is 63% higher than in women.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
49
heart disease
Health Outcomes
Heart disease describes a range of conditions that affect your heart, the most common being coronary artery disease. These conditions can cause heart attacks, angina, arrhythmias, and heart failure. Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults* with high blood pressure by sex and race Montgomery County, 2011 & 2013 Key findings as self-reported: • Men report having high blood pressure more than women (40% vs. 32%). • A higher percent of Blacks have high blood pressure compared to Whites; a 31% difference.
Adults* who have high cholesterol by sex and race Montgomery County, 2011 & 2013
• More men (47%) than women (40%) have high cholesterol. • High cholesterol is more prevalent in Whites than in Blacks. • 23% of Blacks reported that they have never had their cholesterol checked, compared to 14% of Whites (data not shown in figure).
Across the Nation - 2011
a
50
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
b
Montgomery
Ohio
United States
Percent of adults (18 and older) with high blood pressurea
35.4%
32.6%
31.5%
Percent of adults (18 and older) with high cholesterola
45.6%
38.6%
38.3%
Age-adjusted death rate (per 100,000) for heart diseaseb
170.5
190.0
173.7
Behavioral Risk Factor Surveillance System (BRFSS) Mortality public-use data on CDC WONDER online database
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Key findings as self-reported:
Health Outcomes
heart disease
Source: Ohio Death Certificates, Ohio Department of Health
Public Health Importance The leading cause of death for both men and women in the U.S. is heart disease. Heart disease accounts for 1 in every 4 deaths (CDC, 2014). The health conditions that put you at higher risk of heart disease are high blood pressure, high cholesterol, obesity, and diabetes. Other behavioral risk factors include smoking, poor nutrition, physical inactivity, and excessive alcohol use.
Age-adjusted death rate for heart disease by sex and race, Montgomery County, 2011-2012
Key findings: • The death rate for heart disease is more than one and a half times greater in men than in women. • Heart disease is 27% higher in Black men than in White men and 31% higher in Black women than in White women.
»« Call to Action »« You can reduce your risk of developing heart disease by adopting a healthy lifestyle. • Eat a diet low in sodium, saturated fats, and cholesterol • Exercise daily • Quit smoking • Limit alcohol use Even if heart disease runs in your family, a healthy lifestyle can decrease the odds of developing heart disease. It is important to know the signs and symptoms of a heart attack so if you are having one, you can seek treatment immediately. Symptoms of a heart attack: • Pain or discomfort in the jaw, neck, or back • Feeling weak, light-headed, or faint • Chest pain or discomfort • Pain or discomfort in arms or shoulder • Shortness of breath 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
51
cancer
Health Outcomes
Cancer Incidence1 Montgomery County, 2010-2011
Cancer Deaths2 Montgomery County, 2011-2012
Incidence rate per 100,000a
Cancer Site/Type
Cancer Site/Type
Number of Cases
Rate
All Sites/Types
5,737
441.4
All Sites/Types
Breast (female)
869
123.9
Mortality rate per 100,000a Number of Deaths
Rate
2,537
188.8
Lung and Bronchus
751
56.2
678
111.6
Breast (female)
194
25.7
Lung and Bronchus
1,002
75.8
Prostate
132
24.2
Colon and Rectum
468
35.6
Colon and Rectum
210
15.3
Uterus
175
24.8
Pancreas
126
9.4
Bladder
267
20.1
Ovary
56
7.4
Melanoma of the Skin
242
19.3
Leukemia
94
7.2
Kidney and Renal Pelvis
211
16.6
Non-Hodgkin’s Lymphoma
88
6.6
Non-Hodgkin’s Lymphoma
217
16.5
Liver and IBDc
80
5.7
Thyroid
143
12.8
Bladder
77
5.6
Oral Cavity and Pharynx
146
11.3
Kidney and Renal Pelvis
61
4.6
Prostate
Ovary
82
11.3
Uterus
35
4.4
Pancreas
143
10.7
Esophagus
55
4.1
Leukemia
122
9.6
Melanoma of the Skin
46
3.5
Cervix
42
7.4
Brain and Other CNSb
45
3.5
71
5.9
Multiple Myeloma
48
3.5
72
5.5
Oral Cavity and Pharynx
39
2.9
Brain and Other CNS
b
Stomach
71
5.4
Stomach
30
2.3
Esophagus
72
5.2
Cervix
13
2.2
Larynx
65
5.0
Larynx
21
1.6
Testis
24
5.0
Hodgkin’s Lymphoma
7
0.7
Multiple Myeloma
65
4.8
Thyroid
0
0
Hodgkin’s Lymphoma
31
2.7
Testis
0
0
Other Sites/Types
459
NA
Other Sites/Types
329
NA
Liver and IBD
c
Key findings: • The rate of new cancers is highest for breast (female), prostate, lung and bronchus, and colon and rectum cancers.
Key findings: • Mortality rates are highest for lung and bronchus, breast (female), and prostate cancers.
Age-adjusted rate Central Nervous System c Intrahepatic Bile Duct NA - not applicable Source: 1 Ohio Cancer Incidence Surveillance System (OCISS) 2 Ohio Death Certificates, Ohio Department of Health a b
»« Call to Action »« There are individual choices that can be made to reduce one’s risk of developing cancer. Stopping the use of tobacco products decreases the user’s risk of developing cancer and improves the health of those who may be exposed to secondhand smoke. Adopting a healthy lifestyle that involves maintaining a healthy weight, making nutritious food choices, and being physically active can also lower a person’s lifetime risk of cancer. In addition to these behavior changes, following the recommended screening guidelines can help detect cancer early. 52
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Health Outcomes
Public Health Importance
cancer
Across the Nation - 2011 Incidence Rate per 100,000
Nationally, more than 1.5 million people are diagnosed with cancer each year. In Montgomery County, cancer is the leading cause of death. Tobacco use is the number one risk factor for cancer. An estimated 30% of all cancer deaths and 80% of lung cancer deaths are attributed to smoking. Annually, an additional 3,400 nonsmoking adults die of lung cancer due to exposure to secondhand smoke. An estimated one-quarter to one-half of all cancer diagnoses are attributed to an unhealthy diet, excess weight, and inactivity (American Cancer Society, 2014).
Montgomerya
Ohioa
United Statesb
441.4
448.0
450.6
Black
443.1
452.1
458.3
White
All Cancer Sites
431.9
438.3
449.7
Childhood (< 15)
12.4
16.2
16.5
Breast (female)
123.9
117.7
121.2
Colon and Rectum
35.6
40.6
39.9
Lung and Bronchus
75.8
69.6
61.0
Melanoma of the Skin
19.3
18.8
19.7
Prostate
111.6
123.5
128.3
Ohio Cancer Incidence Surveillance System (OCISS) b National Program of Cancer Registries a
Source: Ohio Death Certificates, Ohio Department of Health
Cancer mortality rate by race Montgomery County, 2011-2012
Key findings: • The overall cancer mortality rate is greater in Blacks than in Whites. • The mortality rate of prostate cancer in Black men is almost twice as high as the mortality rate in White men (38.3 vs 19.6 per 100,000). • Among women, the mortality rate of breast cancer is 44% higher in Blacks. Source: Ohio Cancer Incidence Surveillance System (OCISS)
Cancer Cases by Stage at Diagnosis for the Leading and Screenable Sites/Types of Cancer in Montgomery County with Comparison to Ohio, 2010 - 2011 Montgomery
Ohio
Late Stage
Unstaged/ Unknown
Late Stage
Unstaged/ Unknown
Breast (female)
27.4%
2.4%
29.4%
2.5%
Cervix
59.5%
0.0%
51.8%
6.8%
Colon and Rectum
51.5%
11.9%
51.9%
9.7%
Lung and Bronchus
72.1%
9.0%
71.4%
11.9%
7.3%
7.3%
8.8%
4.9%
Oral Cavity and Pharynx
57.9%
6.6%
65.7%
4.8%
Prostate
15.6%
4.9%
13.5%
6.2%
Testis
25.0%
0.0%
28.4%
2.9%
Melanoma of the Skin
Key findings: • In both Montgomery County and Ohio, lung and bronchus cancers have the highest percent of late stage diagnosis. • Melanoma of the skin has the lowest percent of late stage diagnosis for both the county and the state.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
53
asthma
Health Outcomes
Source: OHA Insight, Greater Dayton Area Hospital Association
Rate of adult* asthma resulting in an emergency department visit or hospitalization, Montgomery County, 2010-2013
Key findings: • The rate of visits to the hospital for asthma increased 12% from 2010 to 2013. • The increase in asthma hospital visits is due to an 18% increase in visits to the emergency department.
• The rate of youth males (46.6 per 1,000) taken to the emergency department or admitted to the hospital because of asthma is greater than the percent of youth females (35.5 per 1,000).
»« Call to Action »«
54
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Proper asthma management is essential to avoiding life-threatening emergencies. This includes remaining under the care of a doctor, developing an asthma action plan, taking prescribed medication, and recognizing and avoiding your asthma triggers such as tobacco smoke, air pollution, dust mites, pets, and mold. An asthma action plan contains a list of medications and a step-by-step guide of what to do in the event of an asthma attack. This information is important to share with family members, teachers, and co-workers so that they can assist during an asthma attack.
Source: OHA Insight, Greater Dayton Area Hospital Association
Key findings:
Rate of childhood* asthma resulting in an emergency department visit or hospitalization by sex, Montgomery County, 2013
asthma
Health Outcomes
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Public Health Importance In 2010, it was estimated that 1 in 12 adults and 1 in 11 children were living with asthma. The percent of people with asthma in the U.S. has increased 15% in 10 years. Approximately 9 people die from asthma each day. In 2009, there were 1.9 million visits to the emergency department for asthma attacks, children with asthma missed 10.5 million days of school, and adults missed 14.2 million days of work (CDC, 2012). Two risk factors for the development of asthma are obesity and smoking.
Adults* who have ever been diagnosed with asthma by annual household income, Montgomery County, 2011-2013
Source: Ohio Birth Certificates, Ohio Department of Health
Key findings as self-reported: â&#x20AC;˘ A diagnosis of asthma is more likely in adults with a low annual household income (below $25,000).
Adults* who have ever been diagnosed with asthma by sex, Montgomery County, 2011-2013
Across the Nation - 2012 Montgomerya
Ohioa
United Statesa
Percent of adults (18 and older) who currently have asthma
10.8%
10.4%
8.8%
Percent of adults (18 and older) who no longer have asthma
3.7%
3.4%
4.0%
Behavioral Risk Factor Surveillance System (BRFSS)
a
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Appendix 8: Asthma-related Hospital Visits by Zip Code
Key findings as self-reported: â&#x20AC;˘ More women than men currently have asthma, but more men previously had asthma.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
55
HIV/AIDS
Health Outcomes Number of new HIV and AIDS cases Montgomery County, 2008-2012
A new HIV case includes someone who is: - diagnosed with HIV but not AIDS, - diagnosed HIV and later diagnosed with AIDS (within 12 months), or - diagnosed with both HIV and AIDS. An AIDS case includes all reported AIDS diagnoses.
Key findings: • After a 45% increase in cases from 2008 to 2011, there were 17 fewer new HIV cases reported in 2012. • From 2008 to 2012, the number of new AIDS cases decreased by 8; from 43 to 35 cases. Data reported through 12/31/2012 Source: HIV/AIDS Surveillance Program, Ohio Department of Health
Rate Rateof ofnew newHIV HIVand andAIDS AIDScases casesby byage agegroup group Montgomery County, 2012 Montgomery County, 2008-2012
Key findings: • The rate of new HIV cases is highest among 20 to 29 year olds (41.6 per 100,000). Data reported through 12/31/2012 Source: HIV/AIDS Surveillance Program, Ohio Department of Health
Rate of new HIV and AIDS cases by sex and race Montgomery County, 2008-2012 Key findings: • The rate of new HIV cases in men is more than 3 times the rate of new cases in women. • Males represent 91% of new AIDS diagnoses (32 of 35 cases) (data not shown in figure). • Black males are diagnosed with HIV at a rate 4 times higher than White males and 3 times higher than Black females.
56
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Data reported through 12/31/2012 Source: HIV/AIDS Surveillance Program, Ohio Department of Health
Health Outcomes
HIV/AIDS
Public Health Importance It is estimated that HIV prevention efforts have averted more than 350,000 HIV infections in the U.S. since the peak of the HIV epidemic, but HIV still remains a serious public health problem. In the U.S., there are approximately 50,000 new HIV cases reported every year, 1.1 million people are living with the virus, and 16% of those individuals do not know they are HIV positive (CDC, 2014). Public Health continues to educate and stress the importance of HIV testing and safer sex practices.
New HIV and AIDS cases by transmission category Montgomery County, 2012
Data reported through 12/31/2012 Source: HIV/AIDS Surveillance Program, Ohio Department of Health
Key findings: • The majority of new HIV (60%) and AIDS (71%) cases are transmitted through male-to-male sexual contact.
Across the Nation - 2011 Montgomerya
Ohioa
United Statesb
New HIV cases
15.0
10.6
15.8
Living with HIV
204.6
178.4
282.2
New AIDS cases
5.8
5.7
10.3
Living with AIDS
103.2
84.2
157.7
Rate per 100,000
a b
HIV/AIDS Surveillance Program, Ohio Department of Health Division of HIV/AIDS Prevention, Center for Disease Control and Prevention
»« Call to Action »« HIV infection is preventable. It is important that you practice safer sex by limiting your sexual partners and using condoms correctly and consistently. Ensure any needles used for medication or tattoos are either new or sterilized. Finally, get tested for HIV. Early HIV detection can lower the chance of infecting others and increase the effectiveness of treatment. 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
57
Sexually transmitted diseases
Health Outcomes
Sexually Transmitted Disease Incidence Ratea and Case Count by Age, Montgomery County, 2013 Chlamydia AGE
Cases
Rate
Gonorrhea Cases
Rate
Key findings:
Syphilis Cases
Rate
0-9
0
0.0
0
0.0
0
0.0
10-14
41
119.5
16
46.6
0
0.0
15-19
984
2,844.9
267
771.9
6
17.3
20-24
1,141
3,084.5
398
1,075.9
19
51.4
25-29
480
1,365.1
221
628.5
10
28.4
30-34
205
606.6
132
390.6
8
23.7
35-39
101
381.6
44
166.2
6
22.7
40-44
35
105.5
30
90.5
4
12.1
45-54
28
37.1
35
46.4
8
10.6
55-64
15
21.2
17
24.1
5
7.1
65+
1
1.2
2
2.4
0
0.0
Not specified
5
(-)
1
(-)
0
(-)
3,036
568.2
1,163
217.7
66
12.4
TOTAL
• There are more than 2.5 times as many cases of chlamydia (3,036 cases) as compared to cases of gonorrhea (1,163 cases), and 46 times more cases of chlamydia than syphilis (66 cases). • The highest rates of chlamydia and gonorrhea are within the 20 to 24 year old age group, 3,084.5 and 1,075.9 per 100,000, respectively. • The second highest rates of chlamydia and gonorrhea are within the 15 to 19 year old age group. • The three age groups with the highest incidence rate of syphilis are 20 to 24 year olds (51.4 per 100,000), 25 to 29 year olds (28.4 per 100,000), and 30 to 34 year olds (23.7 per 100,000).
Rate per 100,000 Data is reported through 3/23/2014 Source: STD Surveillance Program, Ohio Department of Health
a
Sexually Transmitted Disease Incidence Ratea and Case Count by Race and Ethnicity, Montgomery County, 2013
Public Health Importance Out of the estimated 20 million new sexually transmitted disease (STD) infections reported each year, one-half of those infections occur in individuals between the ages of 15 and 24 (CDC, 2013). Untreated STDs can cause infertility in women and can be lifethreatening to a pregnant woman and her baby. STDs can also increase the likelihood of becoming infected with HIV through sexual contact. Public Health works diligently to educate, test, and treat STD cases within the community.
Chlamydia RACE
Cases
Rate
Cases
Rate
American Indian/ Alaskan Native
1
51.3
0
0.0
0
0.0
Asian/Pacific Islander
7
62.0
0
0.0
0
0.0
1,327
1,125.4
675
572.4
42
35.6
Black/ African American White
428
106.2
145
36.0
22
5.5
Other/Multiple
60
NA
17
NA
2
NA
Not specified
1,213
NA
326
NA
0
NA
ETHNICITY 20
152.9
6
45.9
1
7.6
Non-Hispanic
Hispanic
1,685
323.3
741
142.2
65
12.5
Not specified
1,331
NA
416
NA
0
NA
TOTAL
3,036
568.2
1,163
217.7
66
12.4
Rate per 100,000 NA - Not applicable Data is reported through 3/23/2014 Source: STD Surveillance Program, Ohio Department of Health
a
There are many things that you can do to avoid or reduce your risk of STDs. The most effective way is to abstain from sexual activity. Correctly using condoms, having limited sexual partners or choosing to be mutually monogamous, and by talking with your sexual partners about STDs prior to sexual activity are ways to decrease your risk of infection. Additionally, the human papillomavirus (HPV) and hepatitis B vaccinations are available as a means of STD prevention. Finally, if you are sexually active, you should get tested for STDs often. 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Syphilis
Rate
»« Call to Action »«
58
Gonorrhea
Cases
Key findings: • The incidence rates of chlamydia, gonorrhea, and syphilis are highest in the Black population. • The rate of chlamydia for Blacks (1,125.4 per 100,000) is 10.6 times higher than the rate for Whites (106.2 per 100,000). • The Black gonorrhea rate is 16 times higher than the rate for Whites.
Sexually transmitted diseases
Health Outcomes Data is reported through 3/23/2014 Source: STD Surveillance Program, Ohio Department of Health
Sexually transmitted disease incidence rate Montgomery County, 2009-2013
Syphilis incidence rate Montgomery County, 2009-2013
Key findings: • The rate of chlamydia increased every year between 2009 and 2013 resulting in an 18% increase over the past 5 years. • Gonorrhea infection rates increased 10% from 2009 to 2013. • Since 2010, syphilis rates have increased 114%. Appendix 9: Chlamydia Infections by Zip Code Appendix 10: Gonorrhea Infections by Zip Code
Data is reported through 3/23/2014 Source: STD Surveillance Program, Ohio Department of Health
Data is reported through 3/23/2014 Source: STD Surveillance Program, Ohio Department of Health
Across the Nation - 2012
Sexually Transmitted Disease Incidence Rate and Case Count by Sex, Montgomery County, 2013 a
Chlamydia
Gonorrhea
Syphilis
SEX
Cases
Rate
Cases
Rate
Cases
Rate
Male
798
310.5
498
193.7
52
20.2
2,238
807.1
665
239.8
14
5.0
3,036
568.2
1,163
217.7
66
12.4
Female TOTAL a
Ohioa
United Statesb
Chlamydia
546.9
462.0
456.7
Gonorrhea
212.6
143.5
107.5
Syphilis
12.4
9.9
16.0
3.9
3.7
5.0
Primary and Secondary
Rate per 100,000
Key findings:
Montgomery a County
Rate per 100,000
a b
STD Surveillance Program, Ohio Department of Health Division of STD Prevention, Centers for Disease Control and Prevention
• The chlamydia rate for women (807.1 per 100,000) is more than 2.5 times greater than the rate seen in men (310.5 per 100,000). • Gonorrhea incidence in women is 24% higher than in men. • The incidence rate of syphilis among men is 4 times higher than in women, 20.2 compared to 5.0 per 100,000. 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
59
COMMUNICABLE DISEASES
Health Outcomes
Most commonly reported communicable diseases Montgomery County, 2013 n Hepatitis C (n=458) n Influenza-Associated Hospitalization (n=186) n Pertussis (n=186) n Streptococcus pneumoniae, invasive (n=59) n Mycobacterial disease, other than tuberculosis (MOTT) (n=44) n Meningitis, aseptic (n=41) n Hepatitis B (n=41) n Salmonellosis (n=35) n Shigellosis (n=32) n Legionnaires’ Disease (n=31) n Other (n=120)
Key findings: • Hepatitis C, pertussis, and hospitalized cases of influenza are the most commonly reported communicable diseases. • Of the 186 reported pertussis cases within the county, 96% of cases were diagnosed in children. • Diseases most commonly associated with foodborne illnesses accounted for 14% of the reported communicable diseases. - E. coli - 5 cases - Listeriosis - 1 case - Salmonellosis - 35 cases - Shigellosis - 32 cases - Yersiniosis - 1 case
Source: Ohio Disease Reporting System (ODRS)
Key findings: • The most commonly reported communicable diseases among children less than 18 years of age were pertussis and hospitalized influenza cases. • Diseases that can be prevented by a vaccine accounted for 75% of communicable diseases in children. - Pertussis - 179 cases - Influenza-associated hospitalization and pediatric mortality - 65 cases - Varicella (chickenpox) - 3 cases
Most commonly reported communicable diseases among children*, Montgomery County, 2013
n Pertussis (n=179) n Influenza-Associated Hospitalization (n=64) n Shigellosis (n=24) n Campylobacteriosis (n=16) n Meningitis, aseptic (n=10) n Giardiasis (n=9) n Salmonellosis (n=8) n E. coli (n=3) n Hepatitis C (n=3) n Varicella (n=3) n Other (n=11)
Source: Ohio Disease Reporting System (ODRS)
»« Call to Action »«
60
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
“Wet, Lather, Scrub, Rinse, Dry” - Five simple steps that can effectively reduce the spread of communicable diseases (CDC, 2013). Washing your hands after blowing your nose, coughing or sneezing, before eating or preparing food, after touching animals, and after using the restroom can help you avoid getting sick or prevent the spread of germs to others. In addition to handwashing, immunizations reduce the risk of getting a disease that is vaccine preventable.
Health Outcomes
COMMUNICABLE DISEASES
Public Health Importance One of the roles of public health is to control the spread of communicable diseases. To do this, Public Health monitors the water supply, air quality, and the mosquito population and inspects food establishments, hotels, swimming pools, and schools for potential health threats. Additionally, Public Health provides vaccinations and continues to educate the public on how they can best protect themselves from illness. Through continued monitoring, Public Health can detect potential disease outbreaks so that an appropriate response can begin immediately.
Source: Ohio Disease Reporting System (ODRS) Source:cases Ohio Birth Certificates, Ohio Department of Health Pertussis Montgomery County, 2001-2013
Pertussis Cases by Age Montgomery County, 2013
Key findings:
Number of Cases
Percent
Rate per 100,000
< 1 year
26
14.0%
400.3
1 - 6 years
43
23.1%
108.3
• In 2013, 4 out of every 1,000 children under the age of 1 were diagnosed with pertussis.
7 - 10 years
45
24.2%
170.0
• The majority of pertussis cases were diagnosed in children between the ages of 11 and 19.
11 - 19 years
66
35.5%
106.2
20+ years
6
3.2%
1.5
186
100.0%
34.8
Age
Total
Source: Ohio Disease Reporting System (ODRS)
• The number of pertussis cases increased 481% from 2012 to 2013.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
61
accidental DRUG OVERDOSE
Special Interest
Cases
Total Overdose Deaths
Percent
Rate per 100,000
226
Sex
“This is a problem that has cast a terrible shadow across our nation and led to a public health crisis of dev astating proportions. It is a crisis that has affected us all . . .” (Dougla s C. Throckmorton, M.D., U.S . Food and Drug Administration)
Public Health Importance Currently, the leading cause of injuryrelated death in the U.S. is drug overdoses; 113 people die each day (CDC, 2014). Most drug overdose deaths involve either prescription drugs (opioids or benzodiazepines) or heroin, or a combination of both. From 2002 to 2011, the annual number of drug overdose deaths in the U.S. involving heroin doubled (CDC, 2014). Along with the increase in prescription drug overdoses is an increase in the admission rate to substance abuse treatment facilities. The admission rate in 2009 was six times higher than in 1999. In Ohio, prescription drug records in 2012 show that there were enough opioids dispensed to provide 67 doses of opioids to every Ohio resident (ODH, 2014). While most prescription drugs are prescribed for a medical condition, many of these drugs are used for a nonmedical purpose. 62
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Male
152
67.3%
59.13
Female
74
32.7%
26.69
White
196
86.7%
48.6
Black
25
11.1%
21.2
Other
5
2.2%
NA
<15
0
0.0%
0.0
15-24
8
3.5%
11.2
25-34
59
26.1%
85.6
35-44
63
27.9%
100.6
45-54
60
26.5%
79.6
55-64
30
13.3%
42.5
65-74
6
2.7%
13.4
75+
0
0.0%
0.0
Single
98
43.4%
69.1
Married
44
19.5%
23.9
Divorced
72
31.9%
110.2
Separated
5
2.2%
46.1
Widowed
6
2.7%
18.8
Less than High School
65
28.8%
High School diploma
146
64.6%
College degree
9
4.0%
Post-graduate degree
2
0.9%
Unknown
4
1.8%
Race
Age
Marital Status
Education
Key findings: • The rate of overdose deaths for men is more than 2 times that of women. • Whites were more than twice as likely to die from an accidental drug overdose than Blacks. • The highest rate of overdose deaths occurred among 35 to 44 year olds (100.6 per 100,000) and among those who were divorced (110.2 per 100,000).
Source: Montgomery County Poisoning Death Review
Characteristics of Accidental Drug Overdose Deaths in Montgomery County, 2013
Special Interest Source: Montgomery County Poisoning Death Review
Accidental drug overdose deaths in Montgomery County, 2010 - 2013
accidental DRUG OVERDOSE Key findings: • Since 2010, there has been a 78% increase in the number of drug overdose deaths.
Key findings: • The highest proportions of drug overdose deaths were among 35 to 44 year olds (28%), 45 to 54 year olds (27%), and 25 to 34 year olds (26%).
Accidental drug overdose deaths by age group in Montgomery County, 2013
Drug Mention The presence of more than one drug can result in more than one mention from a person who has died.
Source: Montgomery County Poisoning Death Review
Drug category mentions in accidental drug overdose deaths in Montgomery County, 2013 Key findings: • Heroin (58%) was the most mentioned drug in autopsy records. • At least half of deaths mentioned benzodiazepines (52%) and prescription opioids (50%).
2014 Community Health Assessment
Source: Montgomery County Poisoning Death Review
Public Health - Dayton & Montgomery County
63
accidental DRUG OVERDOSE
Drug Mention
Special Interest
The presence of more than one drug can result in more than one mention from a person who has died.
Heroin, Prescription Opioid, and Benzodiazepine mentions in accidental drug overdose deaths in Montgomery County, 2010-2013
Key findings: • Since 2010, heroin mentions in drug overdose deaths has increased 239%. • After decreasing 20% from 2010 to 2012, prescription opioid and benzodiazepine mentions in 2013 increased 50% and 68%, respectively.
Source: Montgomery County Poisoning Death Review
Key findings: • Alprazolam (Xanax) is the most mentioned benzodiazepine in overdose deaths.
Most Frequently Mentioned Benzodiazepines in Accidental Drug Overdose Deaths in Montgomery County, 2013 Count Benzodiazepines
118
Alprazolam (Xanax)
75
Clonazepam (Klonopin)
48
Diazepam (Valium)
30
Lorazepam (Ativan)
8
Source: Montgomery County Poisoning Death Review
Most Frequently Mentioned Prescription Opioids in Accidental Drug Overdose Deaths in Montgomery County, 2013 Count Prescription Opioids
64
112
Fentanyl
34
Methadone
31
Oxycodone
24
Hydrocodone
22
Morphine
16
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Key findings: • Fentanyl and methadone are the most common prescription opioids mentioned in drug overdose deaths. Source: Montgomery County Poisoning Death Review
Special Interest
accidental DRUG OVERDOSE
Source: OHA Insight, Greater Dayton Area Hospital Association
Rate of accidental drug overdoses resulting in an emergency department visit or hospitalization by age group, Montgomery County, 2013
Appendix 11: Accidental Drug Overdose Death Rate by Zip Code
Across the Nation - 2012 Rate per 100,000 Age-adjusted drug overdose death rate a
Montgomerya Ohioa 24.9
16.6
United Statesa 11.6
Mortality public-use data on CDC WONDER online database
»« Call to Action »« The regular use of heroin leads to a tolerance for the drug which creates the need for more and more heroin to have the same effect. The best and only way to avoid accidently overdosing is to never begin using heroin or any other illegal drug. Prescription drug overdose deaths are often due to the misuse of medications. Ensure you are taking your prescription medication as prescribed and ask your doctor before taking other medications, especially over-the-counter drugs, at the same time. When you are finished with your medication, dispose of it properly and never sell or share your prescription. If you have questions about a prescription, you can call the Poison Control line at 800-222-1222. Finally, if you or a family member has a substance abuse problem, find help by calling 1-800-622-HELP (4357); a free, confidential information service.
Key findings: • The rate of hospital visits for accidental drug overdoses was similar for both men (74.3 per 100,000) and women (79.3 per 100,000) (data not shown in figure). • The highest rate of inpatient hospital stays was among 35 to 44 year olds (35.1 per 100,000). • Emergency department visits were highest for youth less than 15 years of age (97.8 per 100,000).
In Montgomery County Among 12 to 17 year olds: • 7% used pain relievers for a nonmedical purpose in the past year • 4% used illicit drugs (other than marijuana) in the past month • 15% used marijuana in the past month Source: National Survey on Drug Use and Health, 2010-2012
In Ohio Among high school students: • 2% have tried heroin • 6% have tried cocaine • 6% tried marijuana before the age of 13 • 2% have injected an illegal drug into their body • 19% were offered, sold, or given an illegal drug on school property Source: Youth Risk Behavior Survey (YRBS), 2013
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
65
infant mortality
Special Interest
Source: Ohio Death Certificates, Ohio Department of Health
Infant mortality rate by race Montgomery County, 2003-2012
Key findings: • In 2012, there were 8 infant deaths for every 1,000 live births in Montgomery County. • Since 2003, the infant mortality rate has increased 10%. • The Black infant mortality rate is more than 2 times higher than the White infant mortality rate (14.2 vs 6.3 per 1,000 live births).
66
2014 Community Health Assessment
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Special Interest
INFAnt Mortality
Source: Ohio Fetal Death Certificates, Ohio Department of Health
Fetal mortality rate by race Montgomery County, 2011-2012
Public Health Importance Infant Mortality Infant mortality is an important indicator of the overall health of a community. In 2011, Ohio had the 5th highest infant mortality rate in the U.S.; Montgomery County’s rate was higher than Ohio’s. A significant portion of infant deaths occur when an infant is born too early (before 37 weeks) and too small. There are actions that can be taken before conception, during pregnancy, and after the birth of the baby to decrease the chances of an infant death.
Key findings: • The fetal death rate is 3 times higher among Black women than White women.
Source: Ohio Death Certificates, Ohio Department of Health
Top 5 Causes of Infant Deaths 2010-2012 Rank
Percent of Deaths
Cause
1
Disorders related to short gestation and low birth weight
24.1%
2
Congenital malformations, deformations, and chromosomal abnormalities
21.6%
3
Accidents
11.7%
4
Newborn affected by maternal complications of pregnancy
8.0%
5
Newborn affected by complications of the placenta, cord, and membranes
4.9%
Key findings: • The top cause of infant death is related to prematurity and low birth weight. • Congenital malformations of the heart account for 29% of all congenital malformation, deformation, and chromosomal abnormality deaths (data not shown in table).
Appendix 12: Infant Mortality Rate by Zip Code Appendix 14: Prenatal Care by Zip Code Appendix 15: Preterm Births by Zip Code
• The most common cause of infant accidental death is due to suffocation and strangulation (90% of all accidents) (data not shown in table).
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
67
infant mortality
Preconception
Special Interest
Pre-pregnancy BMI category by race Montgomery County, 2012
Key findings: • Overall, more than 50% of women were overweight or obese prior to pregnancy. • 62% of Black women were overweight or obese prior to pregnancy. Source: Ohio Birth Certificates, Ohio Department of Health
Public Health Importance Preconception Period
Source: Pregnancy Risk Assessment Monitoring System (PRAMS)
Pre-pregnancy multivitamin use Dayton (Region 2), 2009-2011
Since about half of pregnancies in the U.S. are unplanned, women of childbearing age should take steps to ensure that they are living well and staying healthy. Preconception health includes having proper nutrition, exercising, maintaining a healthy weight, taking folic acid, and controlling existing medical conditions. Taking healthy steps now can protect the health of a baby a woman may have in the future.
An Ohio PRAMS Regional Map is located in Appendix 13.
Key findings as self-reported: • More than 50% of women were not taking a multivitamin prior to becoming pregnant. Source: Pregnancy Risk Assessment Monitoring System (PRAMS)
68
Tobacco and Alcohol Use Prior to Pregnancy, Regional and State Comparison, 2009-2011 Dayton Region 2
Cincinnati Region 1
Akron Region 6
Ohio
Smoked in the 3 months before pregnancy
37.8%
28.2%
30.9%
32.0%
Used alcohol in the 3 months before pregnancy
63.9%
57.0%
60.0%
61.1%
Key findings as self-reported: • Compared to Cincinnati, Akron, and Ohio, more Dayton area women smoked and used alcohol 3 months prior to becoming pregnant.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Prenatal
INFAnt Mortality
Special Interest
Source: Ohio Birth Certificates, Ohio Department of Health
Women who received late* or no prenatal care by race Montgomery County, 2008-2012
Key findings: • Overall, the percent of women receiving late or no prenatal care has increased over the last 5 years. • A higher percentage of Black women (8%) received late or no prenatal care than White women (5%) in 2012.
Public Health Importance Prenatal Period Regular prenatal care that begins in the first trimester plays an important role in a healthy pregnancy. During prenatal appointments, health care providers monitor the health of the mother and baby and provide education on proper nutrition, vitamin supplements, immunizations, and the importance of breastfeeding. Additionally, they will stress the importance of not smoking, drinking, or using illegal drugs during pregnancy. The health care providers will also discuss the risk factors for a preterm birth as well as the symptoms of preterm labor.
Source: Pregnancy Risk Assessment Monitoring System (PRAMS)
Mother’s Safety During Pregnancy, Regional and State Comparison, 2009-2011 Dayton Region 2
Cincinnati Region 1
Akron Region 6
Ohio
Mother was physically abused by husband/partner during pregnancy
3.8%
4.1%
4.5%
4.2%
Mother always or often felt unsafe in the neighborhood where she lived
3.9%
4.2%
4.8%
4.0%
Key findings as self-reported: • 4% of women were physically abused during their pregnancy in the Dayton area. • 4% of women did not feel safe in their neighborhood during their pregnancy in the Dayton area. 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
69
infant mortality
Postpartum
Special Interest
Across the Nation - 2011 Montgomerya
Ohioa
United Statesb
8.8
7.9
6.1
White
6.0
6.4
5.1
Black
17.1
16.0
11.5
Preterm Births
13.1%
12.3%
11.7%
Late or No Prenatal Care
4.8%
5.6%
4.8%
Infant mortality rate (per 1,000 births)
a b
Ohio Birth and Death Certificates, Ohio Department of Health Natality and Mortality public-use data on CDC WONDER Online Database
Preterm births* by race Montgomery County, 2008-2012
Public Health Importance Postpartum Period Although the exact cause of Suddeen Infant Death Syndrome (SIDS) is unknown, always placing infants on their back for every sleep is one way to reduce the risk of SIDS. An infant who is breastfed has a lower risk of SIDS in addition to a lower risk in the development of asthma, lower respiratory infections, childhood obesity, and type 2 diabetes. Secondhand smoke exposure puts infants at a higher risk of a SIDS death as well.
Key findings: • In Montgomery County, the percent of births that were preterm increased 21% from 2008 to 2012. • Preterm births increased 31% for Blacks and 19% for Whites from 2008 to 2012.
Source: Ohio Birth Certificates, Ohio Department of Health
• Since 2008, the percent of women who were breastfeeding at hospital discharge has increased 9%. • The highest percent increase in breastfeeding at hospital discharge was among Black women. • Despite the increase, Black women breastfed at discharge 19% less than White women in 2012. 70
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Source: Ohio Birth Certificates, Ohio Department of Health
Key findings:
Women who were breastfeeding at hospital discharge by race Montgomery County, 2008-2012
Postpartum
INFAnt Mortality
Special Interest
Source: Ohio Birth Certificates, Ohio Department of Health
Preterm births* by smoking status during pregnancy Montgomery County, 2008-2012
Key findings: • Women who smoke during their pregnancy are more likely to have a preterm birth than women who do not smoke.
Key findings as self-reported: • In the Dayton area, almost a quarter of infants were not placed to sleep on their backs. • 16% of infants were exposed to secondhand smoke inside their home.
Source: Pregnancy Risk Assessment Monitoring System (PRAMS)
Sleep Position and Exposure to Secondhand Smoke Regional and State Comparison, 2009-2011 Dayton Region 2
Cincinnati Region 1
Akron Region 6
Ohio
76.7%
71.0%
72.9%
74.9%
Not allowed anywhere
84.3%
91.2%
88.4%
87.8%
Allowed some places or times
14.1%
6.8%
10.2%
10.7%
Permitted anywhere
1.7%
2.0%
1.5%
1.5%
Infant was placed to sleep on his or her back Rules about smoking inside the home
»« Call to Action »« “The best possible birth outcomes require high-quality preventive health care from birth through a woman’s reproductive years.”
Steps to reduce the risk of an infant dying within the first year of life can begin before becoming pregnant and continue once the infant comes home from the hospital. Preconception - Manage existing medical conditions - Eat a proper, nutritious diet - Maintain a healthy weight Prenatal - Begin prenatal care during the first trimester - Quit smoking and drinking alcohol - Know the signs of preterm labor Postpartum - Breastfeed - Avoid infant’s exposure to secondhand smoke - Place infant to sleep on his or her back 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
71
outdoor environment
Built Environment
The Miami Valley Bikeways is the nationâ&#x20AC;&#x2122;s largest network of paved, off-street trails. Seven of these trails pass through Montgomery County. They are great for cycling, walking, running, rollerblading, and even cross-country skiing. The Great Miami River, Mad River, and Stillwater River trails are all water trails that run near a river or creek that can be used for recreational canoeing and kayaking. Additionally, the hiking trails offer residents a great location to backpack, trail run, or camp. The Buckeye trail is part of the North Country National Scenic Trail that stretches for 4,600 miles across seven northern states. Many local communities within the county also have paved hiking and bike trails.
Source: Miami Valley Regional Planning Commission Source: Five Rivers MetroParks
Miami Valley Bikeways Paved & Non-Paved Trails that Pass Through Montgomery County Trail (paved)
Mileage
County
Creekside Trail
17.8
Montgomery, Greene
Stillwater River Trail
5.3
Montgomery
Mad River Trail
6.2
Montgomery
Iron Horse Trail
5.4
Montgomery
Great Miami River Trail
41.1
Montgomery, Miami, Warren
Wolf Creek Trail
15.9
Montgomery
Medlar Trail
2.25
Montgomery
1,400
48 Ohio Counties
22
Montgomery
Hiking Trails (non-paved) Buckeye Trail Twin Valley Backpacking Trail
Source: Five Rivers MetroParks
Additional Physical Activities Available at Five Rivers MetroParks MetroParks
Walking or Hiking
Bicycling
Aullwood Garden
X
Carriage Hill
X
Cox Arboretum
X
Deeds Point
X
X
Eastwood
X
X
Englewood
X
X
Germantown
X
Hills & Dales
X
X
Huffman
X
X
Island
X
X
Possum Creek
X
RiverScape
X
Sugarcreek
X
Sunrise
X
X
Taylorsville
X
X
Twin Creek
X
Wegerzyn Gardens
X
X
Wesleyan
X
X
Playground
Water Play
Canoeing
Ice Skating
Crosscountry Skiing X
X
X
X
X
X
X
X X
X X
X
X X
X
X
X
X
X
X
X
X X X
X
X X
X
X
X X
Five Rivers MetroParks offers additional opportunities for participating in outdoor physical activity. Each park offers a unique opportunity for Montgomery County residents to participate in physical fitness activities in a natural environment. Trails are clearly marked and maps are available to help you select the path where you want to begin your adventure. 72
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Appendix 16: Map of Five Rivers MetroParks Appendix 17: Map of Miami Valley Bikeways
Built Environment
Public Health Importance Physical inactivity is linked to a number of chronic diseases including diabetes, heart disease, and obesity. A lack of sidewalks, heavy traffic, and criminal activity can make it unsafe and difficult to walk within a neighborhood for exercise. Recreation center or gym membership fees may not be affordable to everyone. Parks and green spaces provide a safe, clean, and free location where people of all ages can participate in physical activity.
Outdoor Environment
Source: Scarborough Market Survey
Adults* who walked outdoors or rode a bike for transportation in the past 7 days by race, Montgomery County, 2013
Key findings as self-reported: • Nearly half of adults surveyed did not walk outdoors. • Only 6% of adults in Montgomery County used a bicycle as a form of transportation.
Source: Scarborough Market Survey
Adult* participation in outdoor activities in the past 12 months Montgomery County, 2013
»« Call to Action »« GetUp Montgomery County! Take advantage of the green spaces available within the county. There are miles of paved trails that can be used for running, walking, bicycling, and skating. Additionally, there are 18 MetroParks within the county with walking trails, bike paths, and playgrounds that are free to residents and visitors. Engaging in physical activity outdoors can be a motivating and fun way to adopt a healthy lifestyle.
Key findings as self-reported: • Bicycling (23%) was the most popular outdoor activity among adults in the past year.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
73
air quality
Built Environment
Air Quality Index (AQI) Guide Air Quality Index Levels
Numerical Value
Health Concern
Good
0 to 50
Air quality is considered satisfactory, and air pollution poses little or no risk.
Moderate
51 to 100
Air quality is acceptable; however, for some pollutants there may be a moderate health concern for a very small number of people who are unusually sensitive to air pollution.
Unhealthy for Sensitive Groups
101 to 150
Members of sensitive groups may experience health effects. The general public is not likely to be affected.
Unhealthy
151 to 200
Everyone may begin to experience health effects; members of sensitive groups may experience more serious health effects.
Very Unhealthy
201 to 300
Health warnings of emergency conditions. The entire population is more likely to be affected.
Hazardous
301 to 500
Health alert: everyone may experience more serious health effects.
Source: Regional Air Pollution Control Agency
Percent of days per year by AQI level of health concern Montgomery County, 2004 - 2013
Public Health Importance The AQI is a daily report of the quality of the outside air. The AQI is calculated based on measured levels of ground-level ozone, particle pollution, carbon monoxide, sulfur dioxide, and nitrogen dioxide in the air. High ozone levels can aggravate the lungs and respiratory system affecting those with chronic lung conditions such as asthma, chronic bronchitis, and emphysema; young children; and older adults.
Key findings: â&#x20AC;˘ In the last 10 years, the AQI in Montgomery County reached the Unhealthy level on only one day in 2007. â&#x20AC;˘ In 2013, the AQI level never reached the Unhealthy for Sensitive Groups level.
74
2014 Community Health Assessment
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Seasonal allergies from allergens such as tree, grass, and weed pollen and mold spores are responsible for almost 4 million missed or lost workdays each year; a loss of more than $700 million in lost productivity (Asthma and Allergy Foundation of America, 2014).
Built Environment
air quality
Source: Regional Air Pollution Control Agency
AQI for ozone by month Montgomery County, 2011-2013
Key findings: • There were 61 days in 2013 where the tree pollen count was at high or very high levels; compared to 29 days for mold, 22 days for grass pollen, and 34 days for weed pollen. Source: Regional Air Pollution Control Agency
Percent of pollen and mold count days per year by level of severity, Montgomery County, 2013
Key findings: • In the summer months or when hot and sunny days occur, the AQI for ozone tends to increase.
»« Call to Action »« When the AQI is at the Unhealthy for Sensitive Groups level, those with chronic lung conditions, children, and older adults should limit their outdoor activities and exposures. Reduce air pollution by: • Using public transportation, walking, riding a bike, or carpooling. • Refueling your vehicle during the evening to cut down on evaporation. Source: Reginal Air Pollution Control Agency
• Tightening your gas cap securely. If you suffer from severe seasonal allergies: • Limit outdoor activity when pollen or mold counts are high. • Use a central air conditioning system to recirculate the air in your home.
Key findings: • The pollen counts are highest for grasses in May, for trees in April and May, and for weeds in August and September. • The mold counts begin increasing in April, peak in September and October and begin to decline in November. .
• Visit a doctor if allergy symptoms begin to interfere with your daily activities. 2014 Community Health Assessment
Public Health - Dayton & Montgomery County
75
access to food
Built Environment
Source: Food Environment Atlas, USDA
Low access to grocery stores* Montgomery County, 2006-2010
Key findings: • More than half of the low income population has low access to a grocery store.
Public Health Importance
Source: National School Lunch Program, Ohio Department of Education
National School Lunch Program (NSLP) Montgomery County, 2013 Schools enrolled in NSLP
165
Free lunch eligible students
52.0%
Reduced price lunch eligible students
5.0%
Free or reduced price lunch eligible students
57.0%
Schools serving free breakfast
89.1%
Key findings: • Over half of Montgomery County students are eligible for free lunch. • Of the 165 schools enrolled in the school lunch program, 147 served breakfast as well. Source: Economic Research Service, USDA
Supplemental Nutrition Assistance Program (SNAP) Montgomery County, 2012 Active participants
87,252
Percent of population enrolled in SNAP
16.3%
Percent of population 100% below FPL* enrolled in SNAP
93.1%
Total annual amount of SNAP benefits issued Average monthly benefits issued per a participant *Federal Poverty Level
76
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
Many communities are located within food deserts or areas that lack access to affordable fruits, vegetables, whole grains, low fat milk, and other foods that make up a healthy diet. These areas are neighborhoods with a high percent of poverty, predominately minority with a low vehicle access rate. Regardless of a household’s proximity to a grocery store, there are many households that are considered food insecure. Women, Infants, and Children (WIC) can provide food, breastfeeding support, and nutrition education to lowincome pregnant, postpartum, and breastfeeding women, and infants and children until 5 years of age. Low income school age children can qualify for the free or reduced price school lunch and breakfast programs through the National School Lunch Program (NSLP).
$148,386,600 $141.72
Key findings: • Only 7% of the population below 100% of the FPL are not enrolled in SNAP.
Appendix 18: Food Deserts by Census Tract
Built Environment
Access to food
Across the Nation Food insecure households have limited or uncertain access to adequate food. These households worry that food will run out, that they cannot afford a balanced meal, or may cut the size of a meal or skip meals (USDA, 2014).
Montgomery
Ohio
United States
Overall
18.0%
17.2%
15.9%
Child
23.6%
25.2%
21.6%
57.0%
47.7%
70.5%
Food Insecuritya (2012)
Free or Reduced Price Lunch Eligible Studentsb, c (2013)
Feeding America National School Lunch Program, Ohio Department of Education c Economic Research Service, USDA a
Source: Feeding America
Food insecurity, Montgomery County, 2009-2012
b
»« Call to Action »« If you are unable to afford food, many federal, state, and local programs are available for assistance (i.e. SNAP, WIC, and NSLP). There are several food pantries and soup kitchens throughout the county that can provide emergency food supplies or a hot meal to those in need.
Key findings as self-reported: • A 6% decrease in overall food insecurity occurred over the last four years (2009 to 2012). • Child food insecurity decreased 12% from 2009 to 2012.
Source: Montgomery County WIC Program
Women, Infants, and Children (WIC) Program Montgomery County, 2013 Number of WIC participants
11,276
WIC authorized stores
44
WIC authorized pharmacies
4
WIC Farmers’ Market Nutrition Program (FMNP) Maximum vouchers available through FMNP Farmers authorized to participate in FMNP
Key findings: • Only 8% of WIC participants are able to receive a voucher for fruits and vegetables through the Farmers’ Market Nutrition Program (FMNP).
850 9
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Public Health - Dayton & Montgomery County
77
Medical Care
Access to Care
Source: American Community Survey, U.S. Census
Uninsured, Montgomery County, 2012 Key findings: • 16% of the population who are employed do not have health insurance. • 25% of the population between the ages of 19 and 25 are uninsured.
Across the Nation - 2012
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Adults* who could not see a doctor because of cost by annual household income Montgomery County, 2011-2013
Montgomery
Ohio
United States
Percent uninsureda
12.7%
11.5%
14.8%
Percent adults (18 and over) who could not see a doctor because of costb
15.0%
14.4%
16.5%
a b
Public Health Importance
Key findings as self-reported: • As income increases, the percent of adults unable to see a doctor due to cost decreases.
Montgomery
Summit
Lucas
Hamilton
Count
Rate per 100,000
Rate per 100,000
Rate per 100,000
Rate per 100,000
Primary Care Physicians
490
91.1
94.3
90.9
102.1
General/Family Practice
223
41.5
39.6
43.2
26.7
Internal Medicine
194
36.1
33.7
27.7
45.0
Pediatricians
73
53.6
83.3
74.8
115.2
OB/GYN
83
29.7
29.1
27.3
37.3
Psychiatrists
44
8.2
10.7
11.1
16.7
Source: Health Resources Management Tool, HRSA
Medical Professionals - County Comparison, 2011
Key findings: • Compared to Summit, Lucas, and Hamilton Counties, Montgomery County has the fewest Pediatricians per child. 78
American Community Survey, U.S. Census Behavioral Risk Factor Surveillance System (BRFSS)
• There is approximately one Psychiatrist for every 12,218 people in Montgomery County.
2014 Community Health Assessment
Public Health - Dayton & Montgomery County
In 2012, 57.7 million people in the U.S. were uninsured at some time during the year. Without insurance, individuals either fail to receive needed medical care or suffer financial hardships due to high medical bills. An estimated 1 in 3 people are in a family that is experiencing a financial burden due to medical care (CDC, 2013). Access to health care is important to the early detection, maintenance, and treatment of health conditions; the prevention of diseases and disability; and to overall quality of life.
Access to Care Key findings as self-reported:
dental health
Most recent dental visit among adults* by race Montgomery County, 2012
• More than half of Blacks have not visited the dentist within the past year.
Key findings: • More than 50% of individuals age 65 and older do not have dental insurance. Source: Ohio Family Health Survey
Unmet dental care needs by age Montgomery County, 2010
Source: Behavioral Risk Factor Surveillance System (BRFSS)
Public Health Importance
Dental Issues among Montgomery County Third Graders • 47.7% - History of tooth decay • 12.4% - Untreated cavities • 48.5% - One or more sealants • 12.0% - Urgent or early dental needs • 11.5% - Toothache in the last 6 months • 83.0% - Dental visit during the past year Oral Health Survey of Ohio School Children, 2009-2010
Montgomerya
Ohioa
United Statesa
65.0%
66.9%
64.9%
Percent adults (18 and over) who have visited the dentist within the past year
a Behavioral Risk Factor Surveillance System (BRFSS)
Across the Nation - 2012
Source: Ohio Oral Health Surveillance System
Poor oral health can cause bad breath, difficulty eating or chewing, and significant jaw pain. Advanced gum disease affects 4 to 12% of adults, 25% of adults 65 or older have lost all their teeth, and one half of children 12 to 15 years of age have tooth decay (CDC, 2011). Regular visits to the dentist can help treat and prevent these problems, yet from 2007 to 2011, the percent of people over the age of 2 who visited their dentist in the past year decreased (CDC, 2012).
Dental Care Resources - County Comparison, 2012 Summit
Lucas
Hamilton
Number
Montgomery Ratio
Ratio
Ratio
Ratio
Licensed Dentists
279
1:1,915
1:1,717
1:1,653
1:1,448
Primary Care Dentists (General & Pediatric)
218
1:2,451
1:2,121
1:2,047
1:1,802
Dentists accepting Medicaid
90
1:1,454
1:1,232
1:917
1:1,097
Key findings: • There is only one dentist for every 1,454 people enrolled in Medicaid within Montgomery County. • Montgomery County has 218 primary care dentists for a population of 534,325; a 1 to 2,451 ratio.
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Data Sources • American Community Survey, United States Census Bureau • Behavioral Risk Factor Surveillance System (BRFSS) Survey, Centers for Disease Control and Prevention • Bureau of Labor and Statistics, United States Department of Labor • CDC WONDER Online Database, Mortality and Natality, Centers for Disease Control and Prevention • Crash Statistics Database, Ohio Department of Public Safety. Accessed at https://ext.dps.state.oh.us/crashstatistics/CrashReports.aspx • Dayton Children’s Hospital 2014 Community Health Needs Assessment. Accessed at http://www.childrensdayton.org/cms/pediatric_health_assessment/index.html • Division of Liquor Control, Ohio Department of Commerce • Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention • Division of STD Prevention, Centers for Disease Control and Prevention • Economic Research Service, Food Environment Atlas and Food Access Research Atlas. United States Department of Agriculture (USDA) • Feeding America. Accessed at http://feedingamerica.org/ • Five Rivers MetroParks. Accessed at http://www.metroparks.org/ • Health Resources Management Tool, Health Resources and Services Administration (HRSA). Accessed at http://ahrf.hrsa.gov/ • The Henry J. Kaiser Family Foundation. Accessed at http://kff.org/other/state-indicator/life-expectancy/ • High School Youth Risk Behavior Survey (YRBS), Centers for Disease Control and Prevention • HIV/AIDS Surveillance Program, Ohio Department of Health • Miami Valley Regional Planning Commission (MVRPC). Accessed at http://www.mvrpc.org/ • Montgomery County Community Focus Group Synthesis Report, Wright State University, Center for Urban and Public Affairs (CUPA) • Montgomery County Poisoning Death Review: 2010-2013, WSU Center for Interventions, Treatment and Addictions Research (CITAR) • Montgomery County Women, Infants, and Children (WIC) Program, Public Health - Dayton & Montgomery County • National Incident-Based Reporting System, Federal Bureau of Investigation (FBI) • National Program of Cancer Registries (NPCR), Centers for Disease Control and Prevention • National School Lunch Program (NSLP), Ohio Department of Education
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• National Survey of Drug Use and Health (NSDUH): 2010-2012 Substrate Estimates of Substance Use and Mental Disorders, Substance Abuse and Mental Health Services Administration (SAMHSA) • National Vital Statistics System (NVSS) Health Data Interactive, Centers for Disease Control and Prevention • Ohio Birth Certificates and Ohio Death Certificates, Ohio Department of Health • Ohio Cancer Incidence Surveillance System (OCISS), Ohio Department of Health • Ohio Disease Reporting System (ODRS), Ohio Department of Health • Ohio Hospital Association (OHA) Insight, Greater Dayton Area Hospital Association (GDAHA) • Ohio Oral Health Surveillance System, Ohio Department of Health • Oral Health Survey of Ohio Schoolchildren, Ohio Department of Health • Pregnancy Risk Assessment Monitoring System (PRAMS), Centers for Disease Control and Prevention • Regional Air Pollution Control Agency (RAPCA), Public Health - Dayton & Montgomery County • Scarborough Market Survey, Nielsen Company • STD Surveillance Program, Ohio Department of Health
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References Health-Related Quality of Life World Health Organization. (1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948
Disability Healthy People 2020. (2014). Disability and Health. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=9
Socioeconomics Centers for Disease Control and Prevention. Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Retrieved from http://www.cdc.gov/nchs/data/hus/hus11.pdf
Crime Federal Bureau of Investigation. (2013). Crime in the United States 2012. Retrieved from http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012 Prevention Institute. (2011). Fact Sheet: Violence and Chronic Illness. Making the Case. Retrieved from http://www.preventioninstitute.org/component/jlibrary/article/id-301/127.html
Physical Activity U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Retrieved from http://www.health.gov/paguidelines/pdf/paguide.pdf Centers for Disease Control and Prevention. 2014 State Indicator Report on Physical Activity. Retrieved from http://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf
Weight Centers for Disease Control and Prevention. (2014). Adult Obesity Facts, Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/data/adult.html Centers for Disease Control and Prevention. (2014). Childhood Obesity Facts, Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/data/childhood.html
Alcohol Use Centers for Disease Control and Prevention. (2014) Fact Sheets - Binge Drinking. Alcohol and Public Health. Retrieved from http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm Centers for Disease Control and Prevention. (2014) Fact Sheets - Alcohol Use and Your Health. Alcohol and Public Health. Retrieved from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
Tobacco Use Centers for Disease Control and Prevention. (2014) Health Effects of Cigarette Smoking. Smoking & Tobacco Use. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/ Centers for Disease Control and Prevention. (2014). Quitting Smoking. Smoking & Tobacco Use. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm
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Preventive Cancer Screening American Cancer Society. (2014). Breast Cancer Facts & Figures 2013-2014. Retrieved from http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-042725.pdf American Cancer Society. (2014). Colon Cancer: Catching it Early. Retrieved from http://www.cancer.org/acs/groups/content/@marketing/documents/webcontent/acspc-042160.pdf
Birth March of Dimes. (2013). Low Birthweight. Your Premature Baby. Retrieved from http://www.marchofdimes.org/baby/low-birthweight.aspx.
Injuries Centers for Disease Control and Prevention. (2014) Saving Lives and Protecting People from Violence and Injuries. Injury Prevention & Control. Retrieved from http://www.cdc.gov/injury/overview/index.html Centers for Disease Control and Prevention. (2013). Falls Among Older Adults: An Overview. Home & Recreational Safety. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Centers for Disease Control and Prevention. Understanding Youth Violence: Fact Sheet, 2012. Retrieved from http://www.cdc.gov/violenceprevention/pdf/yv_factsheet2012-a.pdf Centers for Disease Control and Prevention. Suicide: Facts at a Glance, 2012. Retrieved from http://www.cdc.gov/violenceprevention/pdf/suicide_datasheet_2012-a.pdf
Diabetes Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report, 2014. Retrieved from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
Heart Disease Centers for Disease Control and Prevention. (2014). Heart Disease Facts. Heart Disease. Retrieved from http://www.cdc.gov/heartdisease/facts.htm
Cancer American Cancer Society. (2014). Cancer Facts & Figures, 2014. Retrieved from http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf
Asthma Centers for Disease Control and Prevention. (2012). Asthmaâ&#x20AC;&#x2122;s Impact on the Nation: Data from the CDC National Asthma Control Program. Retrieved from http://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf
HIV/AIDS Centers for Disease Control and Prevention. (2014). Basic Statistics. HIV/AIDS. Retrieved from http://www.cdc.gov/hiv/basics/statistics.html
Sexually Transmitted Diseases Centers for Disease Control and Prevention. (2013). Adolescents and Young Adults. Sexually Transmitted Diseases (STDs). Retrieved from http://www.cdc.gov/std/life-stages-populations/adolescents-YoungAdults.htm
Communicable Diseases Centers for Disease Control and Prevention. (2013). Wash your hands. CDC Features. Retrieved from http://www.cdc.gov/features/handwashing 2014 Community Health Assessment
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References (continued) Accidental Drug Overdose Centers for Disease Control and Prevention. (2014). Prescription Drug Overdose in the United States: Fact Sheet. Home & Recreational Safety. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html Centers for Disease Control and Prevention. (2014). QuickStats: Rates of Drug Poisoning Deaths Involving Heroin, by Selected Age and Racial/Ethnic Groups-United States, 2002 and 2011. Morbidity and Mortality Weekly Report (MMWR); 62(27):595. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6327a5.htm?s_cid=mm6327a5_w Ohio Department of Health. (2014). 2012 Ohio Drug Overdose Death Data. Retrieved from http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/injury%20prevention/2012%20 overdose%20data/1finalCB_2012_Bullets%20for%20reporters%20on%20drug%20related%20poisoning.ashx
Air Quality Asthma and Allergy Foundation of America (AAFA) (2014). Overview. Allergy Facts and Figures. Retrieved from http://www.aafa.org/display.cfm?id=9&sub=30
Access to Food United States Department of Agriculture. (2014). Definitions of Food Security. Retrieved from http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-offood-security.aspx#.VA4AQfldXpU
Medical Care Coverage Centers for Disease Control and Prevention (2013). Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2012. Retrieved from http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201306.pdf
Dental Health Coverage Centers for Disease Control and Prevention. (2011). Oral Health: Preventing Cavities, Gum Disease, Tooth Loss, and Oral Cancer. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/oral-health-aag-pdf-508.pdf Centers for Disease Control and Prevention. (2012). Oral Health Status and Access to Oral Health Care for U.S. Adults Aged 18-64: National Health Interview Survey, 2008. Vital and Health Statistics; 10(253), Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_253.pdf
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Acknowledgements The authors wish to thank all of the following community members who devoted their time, expertise, and ideas to the community health assessment process in Montgomery County, Ohio. Data Committee Members John DeFluri, Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board of Montgomery County Shawn Dunlavy, Montgomery County Sheriff ’s Office Sylvia Ann Ellison, MA, MPH, Wright State University Mark Feighery, CareSource Lisa Rindler, Greater Dayton Area Hospital Association (GDAHA) Jessica Saunders, MPA, Dayton Children’s Hospital William Spears, Ph.D., Wright State University Richard Stock, Ph.D., University of Dayton Robert L. Stoughton, MS, Fitz Center for Leadership in Community, University of Dayton and Montgomery County Office of Family and Children First Community Focus Groups Jane L. Dockery, moderator, Wright State University, Center for Urban and Public Affairs Melissa Ann McCarthy, moderator, Wright State University, Center for Urban and Public Affairs Emily Surico, graduate student intern, Wright State University Alyssa Wagner, Spanish Interpreter Community Focus Groups Organizers Nicole Berger Lamonte Hall Stephan Marcellus Tony Ortiz Jerry Perkins Munsup Seoh Sister Maria F. Stacy Community Focus Groups Locations St. Mary’s Catholic Church Greater Dayton Recreation Center Korean Seventh Day Adventist Church Northwest Recreation Center Public Health - Dayton & Montgomery County Community Assessment Team Dawn L. Ebron, MS, MPH, CPH, Epidemiologist Sara J. Paton, PhD, Epidemiologist Cheryl Scroggins, Office of Minority Health John Steele, Public Information Jeff Cooper, MS, Assistant to the Health Commissioner Bill Wharton, MA, Public Information 2014 Community Health Assessment
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Appendix
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Appendix 1
88
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Appendix 2
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Appendix 3
90
2014 Community Health Assessment â&#x20AC;˘ Public Health - Dayton & Montgomery County
d
German Township
c
1 5
Englewood
0 1 0 2 0 0
0 1 0 0 0
39 31 296 29 6 0 45 0 5 75 2 21 25
Kettering
Miami Township
Miamisburg
Moraine
New Lebanon
Perry Township
Sinclair Community College
2014 Community Health Assessment â&#x20AC;˘ Public Health - Dayton & Montgomery County
Trotwood
Union
Vandalia
West Carrollton
0
1
7
2 4
2 16
0
0 4
4
5
35
6
9
22
1
7
1 2
2
2 112
0 2
1
3
Forcible Rape
10
5
0
0 48
0
0 14
0
16
109
11
21
1 20
45
0
0
5
633
5 5
0
2 11
Robbery
Source: National Incident Based Reporting System, FBI
b
Crime statistics were not available for Clay Township, Oakwood City, Phillipsburg, and Verona Huber Heights crime statistics are from 2011 c Jackson Township Police Department covers Farmersville d The Montgomery County Sheriffâ&#x20AC;&#x2122;s Office covers Harrison, Jefferson, and Washington Townships
a
Springboro
Riverside
Montgomery County Sheriff's Office
0
0
Jackson Township
2
1
0
0
0
50
Huber Heights
82
9
Dayton
b
0
1,384
Clayton
Germantown
0 24
9
Centerville
0
1 19
Carlisle
0 0
Murder
Butler Township
11
Violent Crime
14
Brookville
Agency Name
8
12
0
10
0 3
0 26
2
8
150
14
8
0 8
29
0 3
2
615
2
1 12
2
6
Aggravated Assault
40
437
11
41 35
10
200 0 27
742 23
415
405
106
1,374
133
94
31
511
20
49
181
27
76
702
182
152
317
124
725
1,736
641
1,157
1,291
250
25
69 1,379
37
3,043
384
8,385
52
17
39 214
23
14
Burglary
301
71
Property Crime
Violent and Property Crimes by Jurisdiction, Montgomery Countya, 2012
262
294
73
754
154
23
503
23
83
634
883
437
963
935
21
1,088
30
42
336
4,649
144
388
22
269
55
LarcenyTheft
20
2 17
0 109
0
39
6
14
15
151
22
42
39
4
41
0
2
11
693
18
0 9
9
2
Motor Vehicle Theft
2
0 7
4 11
0
0 4
0
2
15
5
0
0 11
24
0 1
0
129
0
0 2
0
1
Arson
Appendix 4
Source: National Incident Based Reporting System, FBI
91
Appendix 5
92
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Appendix 6
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Appendix 7
94
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Appendix 8
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Appendix 9
96
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Appendix 10
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Appendix 11
98
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Appendix 12
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Appendix 13
III
V
VI
II
IV I
100
2014 Community Health Assessment â&#x20AC;˘ Public Health - Dayton & Montgomery County
Appendix 14
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Appendix 15
102
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Appendix 16
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103
Appendix 17
104
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Appendix 18
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Our Mission Our mission is to lead and innovate by working with our community to achieve the goals of public health: prevention, promotion, and protection.
Our Vision Our vision is to be an innovative leader in achieving the highest possible health and well-being for Dayton and Montgomery County residents and visitors. To that end, we provide vital, cost-effective and culturally competent health services that protect and promote people’s health and support and create healthy environments and communities. Through our services, we: • Prevent the spread of disease • Protect against health threats in air, food and water • Promote healthy behaviors • Reach out to vulnerable populations, linking or providing direct services • Mobilize community action through partnerships • Prepare for and respond to public health emergencies • Serve as a public health information resource