PRC COMMUNITY HEALTH ASSESSMENT Allen, Huntington, LaGrange, Noble, and Whitley Counties, Indiana Sponsored By Prepared By PROFESSIONAL RESEARCH CONSULTANTS, INC. 11326 P Street Omaha, Nebraska 68137-2316 (800) 428-7455 www.prconline.com -0026-02
TABLE OF CONTENTS INTRODUCTION 1 PROJECT OVERVIEW 1 Project Goals...1 Community Defined for This Assessment...1 METHODOLOGY 3 Community Health Survey...3 Public Health, Vital Statistics and Other Data...5 Benchmark Data...5 SUMMARY OF ASSESSMENT FINDINGS 7 SUMMARY OF FINDINGS 7 OPPORTUNITY FOR COMMUNITY HEALTH IMPROVEMENT 11 Areas of Opportunity...11 Summary of Priority Area Findings...13 SELF-REPORTED HEALTH STATUS 20 PHYSICAL HEALTH STATUS 20 MENTAL HEALTH & MENTAL DISORDERS 22 Self-Reported Mental Health Status...23 Symptoms of Chronic Depression...24 Stress...26 Mental Health Treatment...28 Alzheimer s Disease...29 PRC COMMUNITY HEALTH ASSESSMENT ii
DEATH & DISABILITY 30 LEADING CAUSES OF DEATH 30 Leading Causes of Death...30 Age-Adjusted Death Rates for All Causes...31 Age-Adjusted Death Rates for Selected Causes...33 CARDIOVASCULAR DISEASE 34 Age-Adjusted Heart Disease & Stroke Deaths...34 Heart Disease 34 Stroke Deaths 36 Self-Reported Heart Disease & Stroke...38 Prevalence of Heart Disease 38 Prevalence of Stroke 38 Cardiovascular Risk Factors...39 Hypertension (High Blood Pressure) 39 High Blood Cholesterol 43 CANCER 47 Age-Adjusted Cancer Deaths...47 Self-Reported Cancer...49 Cancer Risk...50 Cancer Screenings...51 Colorectal Cancer Screenings 51 Female Breast Cancer Screening 54 Cervical Cancer Screenings 56 Prostate Cancer Screenings 58 RESPIRATORY DISEASE 60 Age-Adjusted Respiratory Disease Deaths...60 Chronic Lower Respiratory Disease (CLRD) Deaths 60 Pneumonia/Influenza Deaths 62 Asthma...64 Adults 64 Children 65 Self-Reported Chronic Lung Disease...67 INJURY & VIOLENCE 68 Unintentional Injury...68 Leading Causes of Unintentional Injury Deaths 68 Age-Adjusted Unintentional Injury Deaths 69 Age-Adjusted Motor-Vehicle Related Deaths 70 Injury Control 72 Bicycle Helmet Usage 75 PRC COMMUNITY HEALTH ASSESSMENT iii
Intentional Injury & Violence...76 Age-Adjusted Intentional Injury Deaths 76 Violent Crime 77 Family Violence 78 Perceptions of Neighborhood Safety 79 DIABETES 81 Age-Adjusted Diabetes Mellitus Deaths...81 Diabetes Prevalence...83 Adults 83 Children 87 DISABILITY & SECONDARY CONDITIONS 88 Activity Limitations...88 ENVIRONMENTAL HEALTH 90 Lead Poisoning...90 INFECTIOUS DISEASE 91 IMMUNIZATION & INFECTIOUS DISEASE 91 Influenza/Pneumonia Vaccination...91 Influenza Vaccination 91 Pneumonia Vaccination 93 Tuberculosis...96 HEALTH & SEXUALITY 97 Sexual Activity...97 Sexual Partners 97 Condoms 97 HIV...98 Age-Adjusted HIV Deaths 98 Residents Living With HIV/AIDS 99 HIV/STD Testing 100 Sexually Transmitted Diseases...101 Gonorrhea 101 Syphilis 103 Chlamydia 104 PRC COMMUNITY HEALTH ASSESSMENT iv
BIRTHS 105 MATERNAL, INFANT & CHILD HEALTH 105 Birth Rate...105 Timely Prenatal Care...107 Cesarean Section Births...109 Birth Outcomes...110 Low-Weight Births 110 Very Low-Weight Births 112 Infant Mortality 113 Maternal Risk Behaviors...114 Smoking During Pregnancy 114 Drinking During Pregnancy 115 Lack of High School Education 116 FAMILY PLANNING 118 Births to Unwed Mothers...118 Births to Teenage Mothers...121 MODIFIABLE HEALTH RISKS 123 ACTUAL CAUSES OF DEATH 123 NUTRITION & OVERWEIGHT 125 Nutrition...125 Adult Consumption of Fruits & Vegetables 125 Children s Consumption of Fruits & Vegetables 128 Fast Food 130 Junk Food 132 Body Weight...133 Adults 133 Children 138 PHYSICAL ACTIVITY & FITNESS 140 Adults...140 Work-Related Physical Activity 141 Moderate Physical Activity 141 Potential for Local Exercise/Nutrition Programs 143 Children...145 Vigorous Physical Activity 145 Television, Video Games & Computer Time 145 PRC COMMUNITY HEALTH ASSESSMENT v
SUBSTANCE ABUSE 147 Alcohol Use...147 High-Risk Alcohol Use 147 Drinking & Driving 150 Age-Adjusted Cirrhosis/Liver Disease 152 Self-Reported Illicit Drug Use...153 Substance Abuse Treatment...154 TOBACCO USE 155 Cigarette Smoking...155 Cigarette Smoking Prevalence 155 Heavy Smoking 157 Environmental Tobacco Smoke...157 Smoking Cessation...159 Smoking Cessation Attempts 159 Interest in Free Smoking Cessation Programs 159 Other Tobacco Use...160 ACCESS TO HEALTHCARE SERVICES 161 HEALTH INSURANCE COVERAGE 161 Healthcare Coverage...161 Lack of Health Insurance Coverage...162 Uninsured Population 162 Lack of Coverage Among Children 163 Impact of Poor Access 164 Lacked Coverage in the Past Year 164 Underinsured Adults...166 DIFFICULTIES ACCESSING HEALTHCARE 167 Barriers to Healthcare Access...167 Finding a Physician 167 Cost of Physician Visits 169 Cost of Prescription Medications 170 Lack of Transportation 173 Children...175 PRIMARY CARE SERVICES 176 Particular Site for Medical Care...176 Utilization of Primary Care Services...178 PRC COMMUNITY HEALTH ASSESSMENT vi
EMERGENCY ROOM SERVICES 181 ORAL HEALTH 183 Recent Dental Care...183 Dental Insurance Coverage...185 VISION CARE 187 Recent Eye Exams...187 Vision Prescriptions...188 RATING OF LOCAL HEALTHCARE SERVICES 189 HEALTH EDUCATION & OUTREACH 191 HEALTHCARE INFORMATION SOURCES 191 EDUCATIONAL & COMMUNITY-BASED PROGRAMS 192 Participation in Health Promotion Activities...192 PRC COMMUNITY HEALTH ASSESSMENT vii
INTRODUCTION PROJECT OVERVIEW Project Goals This Community Health Assessment, a follow-up to similar studies administered locally in 2001 and 2003, is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in a defined geographical region. Subsequently, this information may be used to formulate strategies to improve community health and wellness. This assessment provides the information needed to consider when developing effective interventions so that communities may identify issues of greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact on community health status. This Community Health Assessment will serve as a tool toward reaching three basic goals: To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life. To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents' health. To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care. Community Defined for This Assessment The community defined for this assessment includes Allen, Huntington, LaGrange, Noble, and Whitley Counties in Indiana, known for purposes of this report as the Total Area. For more in-depth analysis of survey findings, the Total Area is broken out into two main areas (those of Allen and the combined 4-county area of Huntington, LaGrange, Noble, and Whitley Counties, known as the Other Counties ), with the addition of each county breakout where meaningful. [Note the slight variation in study areas: the 2001 and surveys include LaGrange, while the 2003 survey does not.] PRC COMMUNITY HEALTH ASSESSMENT 1
The following map describes the Total Area geographical definition. PRC COMMUNITY HEALTH ASSESSMENT 2
METHODOLOGY Community Health Survey The survey instrument used for this study is largely based on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as other public health surveys and customized questions addressing gaps in indicator data relative to national health promotion and disease prevention objectives and other recognized health issues. A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Community Health Survey. Thus, to ensure the best representation of the population surveyed, a telephone interview methodology was employed. The primary advantages of telephone interviewing are timeliness, efficiency and random selection capabilities. Sample Design The sample design used for this effort consisted of a random sample of 1,800 individuals aged 18 and older in the defined community, including 600 interviews in Allen, and 200 in each of the four remaining counties. Once these data were collected, the sample was weighted in proportion to the actual population distribution at the county level. Population estimates were based on census projections of adults aged 18 and over provided in the latest ESRI BIS Demographic Portfolio. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). Sampling Error For statistical purposes, the maximum rate of error associated with a sample size of 1,800 respondents is ±2.3% at the 95 percent level of confidence. ±2.5% Expected Error Ranges for a Sample of 1,800 Respondents at the 95 Percent Level of Confidence Maximum Rate of Error ±2.0% ±1.5% ±1.0% ±0.5% ± 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Response Rate Note: The "response rate" (the percentage of a population giving a particular response) determines the error rate associated with that response. A "95 percent level of confidence" indicates that responses would fall within the expected error range on 95 out of 100 trials. Example 1: For example, if 10% of the sample of 1,800 respondents answered a certain question with a "yes," it can be asserted that between 8.6% and 11.4% (10% ± 1.4%) of the total population would offer this response. Example 2: If 50% of respondents said "yes," one could be certain with a 95 percent level of confidence that between 47.7% and 52.3% (50% ± 2.3%) of the total population would respond "yes" if asked this question. PRC COMMUNITY HEALTH ASSESSMENT 3
In addition, for further analysis, keep in mind that each percentage point recorded among the total sample of survey respondents is representative of approximately 7,300 residents aged 18 and older in the Total Area (based on current population estimates). Thus, in a case where 3.4% of the total sample gives a particular response to a survey question, this is representative of nearly 25,000 people and therefore must not be dismissed as too small to be significant. Sample Characteristics To accurately represent the population studied, PRC strives to minimize bias through application of a proven telephone methodology and random-selection techniques. And, while this random sampling of the population produces a highly representative sample, it is a common and preferred practice to weight the raw data to improve this representativeness even further. This is accomplished by adjusting the results of a random sample to match the demographic characteristics of the population surveyed (poststratification), so as to eliminate any naturally occurring bias. Specifically, once the raw data are gathered, respondents are examined by key demographic characteristics (namely gender, age, race, ethnicity, and poverty status) and a statistical application package applies weighting variables that produce a sample which more closely matches the population for these characteristics. Thus, while the integrity of each individual s responses is maintained, one respondent s responses may contribute to the whole the same weight as, for example, 1.1 respondents. Another respondent, whose demographic characteristics may have been slightly oversampled, may contribute the same weight as 0.9 respondents. The following chart outlines the characteristics of the sample for key demographic variables, compared to actual population characteristics revealed in census data. [Note that the sample consisted solely of area residents aged 18 and older; data on children were given by proxy by the person most responsible for that child s healthcare needs, and these children are not represented demographically in this chart.] 10 8 Actual Population Population and Sample Characteristics (Total Area, ) Weighted Survey Sample 83.9% 83.4% 6 4 49.4% 49.5% 50.6% 50.5% 40.7% 40.9% 43.5% 43.8% 2 15.7% 15.3% Men Women 18 to 39 40 to 64 65+ White* Black or African Am* 8.3% 8.0% 4.1% 4.2% Hispanic* 8.4% 8.6% <Poverty Source: Census 2000, Summary File 3 (SF 3). U.S. Census Bureau. PRC Community Health Survey, Professional Research Consultants. Hispanic can be of any race. *White and Black or African American sample percentages do not include Hispanic respondents who did not offer a race response. NOTE: Data from the 2006 Allen Low-Income Survey were merged with the data from this study in order to augment the income category subsamples. These data are included in the income breakouts, as well as presented separately in comparison charts. PRC COMMUNITY HEALTH ASSESSMENT 4
Further note that the poverty descriptions and segmentation used in this report are based on 2006 administrative poverty thresholds determined by the U.S. Department of Health & Human Services. These guidelines define poverty status by household income level and number of persons in the household (e.g., the 2006 guidelines place the poverty threshold for a family of four at $20,000 annual household income or lower). In sample segmentation: <Poverty refers to community members living in a household with defined poverty status; 100% to 200% Poverty refers to households living just above the poverty level, earning up to twice the poverty threshold; and >200% Poverty refers to households with incomes more than twice the poverty threshold defined for their household size. The sample design and the quality control procedures used in the data collection ensure that the sample is representative. Thus, the findings may be generalized to the total population of community members in the Total Area with a high degree of confidence. Note that throughout the report, comparisons to 2001 and 2003 survey data will be made where possible and applicable. Public Health, Vital Statistics and Other Data A variety of existing (secondary) data sources was consulted to complement the research quality of this Community Health Assessment. Data were obtained from the following sources (specific citations are included the graphs throughout this report): ESRI BIS Demographic Portfolio (Projections Based on Census 2000) Centers for Disease Control and Prevention National Center for Health Statistics Indiana State Department of Health Indiana Department of Child Services Note that, in several instances, secondary data are not available or are not reliable for the individual counties that make up the Other Counties. Therefore, comparisons referenced in this report show the comparison between Allen and Other Counties combined. Benchmark Data Statewide Risk Factor Data Statewide risk factor data are provided where available as an additional benchmark against which to compare local findings. These data are reported in the most recent BRFSS (Behavioral Risk Factor Surveillance System) Summary Prevalence Reports published by the Centers for Disease Control and Prevention and the U.S. Department of Health & Human Services. Nationwide Risk Factor Data Nationwide risk factor data, which are also provided in comparison charts, are taken from the 2005 PRC National Health Survey. The methodological approach for the national study is identical to that employed in this assessment, and these data may be generalized to the U.S. population with a high degree of confidence. PRC COMMUNITY HEALTH ASSESSMENT 5
Healthy People 2010 Healthy People 2010: Understanding and Improving Health is part of the Healthy People 2010 initiative that is sponsored by the U. S. Department of Health & Human Services. Healthy People 2010 outlines a comprehensive, nationwide health promotion and disease prevention agenda. It is designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century. With [specific] health objectives in 28 focus areas, Healthy People 2010 will be a tremendously valuable asset to health planners, medical practitioners, educators, elected officials, and all of us who work to improve health. Healthy People 2010 reflects the very best in public health planning it is comprehensive, it was created by a broad coalition of experts from many sectors, it has been designed to measure progress over time, and, most important, it clearly lays out a series of objectives to bring better health to all people in this country. Donna E. Shalala, (Former) Secretary of Health & Human Services Like the preceding Healthy People 2000 initiative which was driven by an ambitious, yet achievable, 10-year strategy for improving the nation s health by the end of the 20th century Healthy People 2010 is committed to a single, overarching purpose: promoting health and preventing illness, disability and premature death. PRC COMMUNITY HEALTH ASSESSMENT 6
SUMMARY OF ASSESSMENT FINDINGS SUMMARY OF FINDINGS Self-Reported Health Status Positive Findings Two positive indicators of health status in the Total Area are lower prevalence of fair/poor physical health and lower prevalence of fair/poor mental health in comparison to national findings. On the other hand, negative findings compared to national data include: Negative Findings Mental Health. The Total Area death rate for Alzheimer s disease is higher than reported nationally, and has increased over the past few years. Death & Disability Positive Findings There are several positive indicators of death and disability in the Total Area in comparison with national findings: lower age-adjusted death rates (for heart disease, pneumonia/influenza, unintentional injuries, motor vehicle accidents, suicide, homicide, and HIV); a lower selfreported prevalence of cancer (other than skin cancer); higher prevalence of seat belt usage (including adults and children); a higher prevalence of flu shots among high-risk adults; and a lower incidence rate of primary/secondary syphilis. Further, over the past few years, there have been improvements in: age-adjusted death rates (for stroke, cancer and pneumonia/influenza); cancer screenings (female breast, prostate, and colorectal); cholesterol screenings; seat belt use; crime victimization; and pneumonia vaccination for seniors. Negative Findings However, the Total Area compares unfavorably to national findings in the following regards: Cancer Screenings. Total Area residents are less likely to have participated in preventive cancer screenings such as prostate exams, and sigmoidoscopies/colonoscopies than seen nationally. Respiratory Disease. The death rate for chronic lower respiratory disease is higher in the Total Area than it is nationwide. Diabetes. Diabetes prevalence, as well as death rates, have increased over the past few years. PRC COMMUNITY HEALTH ASSESSMENT 7
Pneumonia/Influenza. The prevalence of Total Area adults aged 65+ with pneumonia vaccinations falls below that recorded across the country. Sexually-Transmitted Diseases. The gonorrhea and chlamydia incidence rates reported across the Total Area exceed those found nationally. In addition, findings have worsened since 2003 for the following: Blood cholesterol prevalence. Prevalence of cancer (non-skin). Prevalence of asthma in adults. Tuberculosis incidence. Injury deaths (including motor vehicle crash deaths). Sexually transmitted diseases (specifically, gonorrhea and chlamydia). Births Positive Findings The percentage of women receiving timely prenatal care has improved over the past few years, as has the proportion of births to teenagers. Negative Findings Regarding maternal, infant, and child health, negative findings include: Prenatal Care. The prevalence of mothers in the Total Area with prenatal care during the first trimester of pregnancy remains lower than that reported across the United States. In addition, findings have worsened over the past few years with regard to: Low-weight births. Births to unmarried women. Modifiable Health Risks Positive Findings Positive findings in the Total Area with regard to modifiable health risks relate to alcohol: the age-adjusted cirrhosis/liver disease death rate is lower in the community when compared with the nation as a whole. Additionally, the prevalence of current and chronic drinking is lower in the Total Area when compared with the national percentage. Improvements in health risks since the 2003 survey are found for: fruit/vegetable consumption; use of illicit drugs; cirrhosis/liver disease deaths; cigarette smoking; and kids exposure to tobacco smoke in the home. PRC COMMUNITY HEALTH ASSESSMENT 8
Negative Findings However, note the following negative findings when compared with national results: Substance Abuse. The percentage of community residents who drink and drive is higher than the nationwide prevalence. Tobacco Use. Smokers in the Total Area are less likely than their national counterparts to have attempted to quit smoking in the past year. Compared to 2003 findings, the following indicators have worsened: Overweight & obesity. Seeking help for an alcohol/drug problem. Smoking cessation attempts. Access to Healthcare Services Access is a key issue for communities across the country. Barriers such as cost, transportation, insurance acceptance, physician and appointment availability, and inconvenient office hours are prohibitive factors for many residents. While the levels for access limitations in the Total Area as a whole are comparable to or better than the U.S. for most of these items, the important analysis is how these barriers impact various subsegments of the population, particularly lowincome residents, Blacks/African Americans and Hispanics. Positive Findings Positive findings related to access in the Total Area include the following: less difficulty finding a physician in the past year among adults; less access difficulty among parents when seeking medical care for their children; a lower percentage of adults without healthcare insurance coverage; a lower prevalence of fair/poor ratings with regard to local healthcare; a higher ratio of children receiving checkups in the past year; and a higher percentage of dental exams (both adults and children). Since the 2003 survey, the following indicators have improved in the Total Area: health insurance coverage; cost as a barrier to doctor visits or prescriptions; routine checkups among adults; ER utilization; and children s dental visits. Negative Findings None of the tested access indicators compared unfavorably to either national data or 2003 findings. PRC COMMUNITY HEALTH ASSESSMENT 9
Health Education & Outreach Positive Findings In a positive finding, community members aged 65+ in the Total Area are more likely than adults nationally to have attended a health event in the past year. Negative Findings None of the tested indicators compared unfavorably to either national data or 2003 findings. PRC COMMUNITY HEALTH ASSESSMENT 10
OPPORTUNITY FOR COMMUNITY HEALTH IMPROVEMENT Areas of Opportunity The following health priorities represent recommended areas of intervention, based on the information gathered through this Community Health Assessment and the guidelines set forth in Healthy People 2010. From these data, significant opportunities for health improvement exist in the Total Area with regard to the following health areas (see also the summary tables presented in the following section). These areas of concern are presented in no particular order, and are subject to the discretion of area providers, the steering committee, or other local organizations and community leaders as to actionability and priority. Access to Healthcare Services Health Insurance Coverage Prescription Medication Births Family Planning Prenatal Care Death & Disability Heart Disease Cancer Respiratory Disease Diabetes Influenza/Pneumonia Sexually-Transmitted Diseases Modifiable Health Risks Overweight/Obesity Smoking Cessation Smokeless Tobacco Selecting Health Priorities There are various mechanisms through which individual organizations may wish to identify priority areas, such as through community direction and feedback, through analyses of primary and secondary data, or through a combination of the two. Regardless of which mechanism is PRC COMMUNITY HEALTH ASSESSMENT 11
applied, a variety of criteria must be considered when identifying priority areas, and these are outlined below. Keep in mind that no single criterion determines a specific area of need. Rather, the interplay among the different criteria should be considered in identifying priority areas. Furthermore, it is important to recognize two important facts: 1) that many local efforts are currently active in addressing aspects of several of the outlined issues; and 2) that no individual or organization acting alone can remedy all of the implications of a given issue or problem. In identifying priorities for community action and designing strategies for implementation, a variety of criteria should be applied to the consideration process, including: Impact. The degree to which the issue affects or exacerbates other quality of life and health-related issues. Magnitude. The number of persons affected, also taking into account variance from benchmark data and Year 2010 targets. Seriousness. The degree to which the problem leads to death, disability or impairs one s quality of life. Feasibility. The ability of organizations to reasonably impact the issue, given available resources. Consequences of Inaction. The risk of exacerbating the problem by not addressing at the earliest opportunity. The following section outlines potential health priorities and supporting health status and risk reduction data. PRC COMMUNITY HEALTH ASSESSMENT 12
Summary of Priority Area Findings The following tables provide an overview of indicators in five-county area. These data are grouped to correspond with the Focus Areas presented in Healthy People 2010. Reading the Summary Tables In the following charts, Total Area results are shown in the larger, blue column. The green columns [to the left of the Total Area column] provide comparisons between Allen and the combined Other Counties, identifying differences as better than (B), worse than (h), or similar to (d) the opposing area. The orange columns [to the right of the Total Area column] provide tending information, and comparisons between the Total Area and available state and national findings, as well as Healthy People 2010 targets. Again, symbols indicate whether the Total Area compares favorably (B), unfavorably (h), or comparably (d) to these external data. Each Sub-Area vs. The Other Total Area vs. Benchmarks Access to Healthcare Services Allen Other Counties Total Area % Lack Health Insurance (Aged 18-64) % Difficulty Finding Physician in Past Year % Transportation Prevented Dr Visit in Past Year % Cost Prevented Physician Visit in Past Year % Cost Prevented Getting Rx in Past Year % Skipped Rx Doses to Save Costs % Went w/o Med. Care or Had Distress b/c of HC Coverage % Went w/o Healthcare Coverage in Past Year % Difficulty Getting Child's Healthcare in Past Year % No Healthcare Coverage for Child % Trouble Affording Rx for Child in Past Year % Have Had Routine Checkup in Past Year % Child Has Had Checkup in Past Year % Gone to ER More Than Once in Past Year % Rate Local Healthcare "Excellent/Very Good" TREND (vs. 2003) vs. IN vs. US vs. HP2010 h B 8.7 B B B h 9.8 6.0 19.8 18.2 20.0 0.0 h B 5.9 B 6.6 4.4 h B 4.7 d d 5.8 2.3 8.6 6.1 6.2 d d 11.0 B B d 10.9 11.1 18.1 13.7 13.0 d d 12.9 B d 13.5 11.4 22.1 15.5 d d 16.3 h 16.8 15.3 d d 11.1 9.4 10.6 d d 8.9 d 9.2 8.3 d d 2.6 B 3.1 1.5 d d 3.6 2.5 d d 6.6 6.1 3.3 6.5 B h 63.9 B B d 66.3 58.4 8.5 8.9 6.1 58.5 60.8 65.6 d d 84.4 d B 85.4 82.0 80.0 76.6 d d 6.4 B d 6.4 6.3 10.5 5.9 % Rate Local Healthcare "Fair/Poor" B h 7.1 B B 5.0 10.7 Note: Allen is compared against all other counties combined, and vice versa. 9.6 15.4 -blankno data B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 13
Each Sub-Area vs. The Other Total Area vs. Benchmarks Cancer Allen Other Counties Total Area Cancer (Age-Adjusted Death Rate) % Skin Cancer % Cancer (Other Than Skin) % Sigmoid/Colonoscopy Ever (Aged 50+) % Blood Stool Test in Past 2 Yrs (Aged 50+) % Mammogram in Past 2 Years (Women 40+) % Pap Smear in Past 3 Years (Women) % Prostate Exam in Past 2 Years (Men 50+) TREND (vs. 2003) vs. IN vs. US vs. HP2010 d d 197.1 d d d h 197.5 196.6 200.0 205.1 191.1 159.9 d d 4.9 h d 4.9 5.0 2.6 4.7 d d 3.9 B B 3.3 4.8 6.7 6.8 B h 60.1 B B h B 64.0 51.4 45.7 54.7 65.4 50.0 d d 35.3 d B d h 35.8 34.2 31.3 23.3 36.7 50.0 d d 72.7 B d d 74.5 69.1 61.0 70.2 70.0 B h 81.4 d d h 83.8 76.1 80.3 79.2 90.0 d d 77.1 B h 77.4 76.5 Note: Allen is compared against all other counties combined, and vice versa. 70.0 85.1 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Diabetes Allen Other Counties Total Area Diabetes Mellitus (Age-Adjusted Death Rate) % Diabetes/High Blood Sugar % Child Has Been Diagnosed With Diabetes TREND (vs. 2003) vs. IN vs. US vs. HP2010 B h 25.2 d B d h 24.5 26.6 24.1 27.2 25.1 15.1 d d 10.8 d h d 11.3 9.6 d d 0.1 0.8 Note: Allen is compared against all other counties combined, and vice versa. 0.3 10.0 8.3 10.2 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Disability Allen Other Counties Total Area % Activity Limitations TREND (vs. 2003) d d 17.0 d d 17.1 16.6 Note: Allen is compared against all other counties combined, and vice versa. -blankno data vs. IN vs. US 17.2 19.8 vs. HP2010 B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Education & Community-Based Programs Allen Other Counties Total Area % Attended Health Event in Past Year (Aged 65+) TREND (vs. 2003) vs. IN vs. US vs. HP2010 d d 14.5 B h 15.2 13.1 Note: Allen is compared against all other counties combined, and vice versa. -blankno data 7.4 90.0 B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Environmental Health Allen Other Counties Total Area % Child Has Been Tested for Lead Poisoning d d 13.3 19.4 Note: Allen is compared against all other counties combined, and vice versa. 15.5 TREND (vs. 2003) -blankno data vs. IN vs. US vs. HP2010 B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 14
Each Sub-Area vs. The Other Total Area vs. Benchmarks Family Planning Allen Other Counties Total Area % of Births to Unwed Mothers % Births to Teenagers TREND (vs. 2003) h B 34.2 h h d 37.1 27.5 vs. IN vs. US 32.0 30.7 34.8 h B 10.3 B B d 10.5 9.9 Note: Allen is compared against all other counties combined, and vice versa. 12.1 11.1 10.4 -blankno data vs. HP2010 B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Heart Disease & Stroke Allen Other Counties Total Area Diseases of the Heart (Age-Adjusted Death Rate) Stroke (Age-Adjusted Death Rate) % Chronic Heart Disease % Stroke % Blood Pressure Checked in Past 2 Years % Told Have High Blood Pressure % Cholesterol Checked in Past 5 Years % Told Have High Cholesterol TREND (vs. 2003) vs. IN vs. US vs. HP2010 B h 215.4 d B B d 206.9 232.6 222.7 240.7 233.1 213.7 B h 52.9 B B d h 46.5 66.2 55.9 57.1 53.2 48.0 d d 6.4 d d d 5.9 7.4 6.4 7.1 8.2 d d 1.9 B d d 1.4 2.6 3.2 2.6 2.4 d d 94.6 d d d 94.8 94.1 95.2 94.6 95.0 d d 32.9 d h d h 32.5 34.0 30.9 26.2 34.2 16.0 B h 84.1 B B d B 86.4 79.3 76.5 71.3 86.8 80.0 d d 29.6 h d d h 29.5 29.9 Note: Allen is compared against all other counties combined, and vice versa. 26.2 28.9 32.9 17.0 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other HIV Allen Other Counties Total Area HIV (Age-Adjusted Death Rate) 2.2 Note: Allen is compared against all other counties combined, and vice versa. Total Area vs. Benchmarks TREND (vs. 2003) vs. IN vs. US vs. HP2010 d h B h 2.2 1.8 4.4 0.7 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Immunization & Infectious Disease Allen Other Counties Total Area % Flu Shot in Past Yr (Aged 65+) % Flu Shot in Past Yr (High-Risk Aged 18-64) % Pneumonia Vaccine Ever (Aged 65+) % Pneumonia Vaccine Ever (High-Risk Aged 18-64) TREND (vs. 2003) vs. IN vs. US vs. HP2010 d d 64.9 d d d h 62.7 69.5 61.3 64.0 71.5 90.0 d d 38.3 d B h 39.1 36.5 35.5 22.4 60.0 d d 66.6 B d h h 67.3 65.3 47.7 65.3 74.2 90.0 d d 32.0 d d h 30.3 35.5 Note: Allen is compared against all other counties combined, and vice versa. 25.8 26.3 60.0 -blankno data B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 15
Each Sub-Area vs. The Other Total Area vs. Benchmarks Injury & Violence Allen Other Counties Total Area Unintentional Injury (Age-Adjusted Death Rate) Motor Vehicle Crashes (Age-Adjusted Death Rate) TREND (vs. 2003) vs. IN vs. US vs. HP2010 B h 34.2 h B B h 31.5 39.7 30.2 36.0 37.2 17.5 B h 13.2 h B B h 9.6 20.8 Homicide (Age-Adjusted Death Rate) 4.3 Suicide (Age-Adjusted Death Rate) 9.7 % "Always" Wear Seat Belt % Child (Aged 0-4) "Always" Uses Auto Child Restraint % Child (Aged 5-17) "Always" Uses Seat Belt % Child (Aged 0-17) "Always" Uses Seat Belt/Car Seat % Child "Always" Wears Bicycle Helmet (Aged 5-16) % Victim of Violent Crime in Past 5 Years % Do Not Feel Completely Safe in Neighborhood/Community % Someone in Household Makes Respondent Feel Unsafe 10.6 15.6 15.4 9.2 d B B h 4.3 5.5 6.1 3.0 B B B h 11.8 11.4 11.0 5.0 B h 85.7 B B h 88.3 81.2 77.1 78.3 92.0 d d 99.6 B d d 99.4 100.0 87.2 98.9 100.0 d d 95.8 B B B 97.1 93.0 90.9 74.5 92.0 d d 97.1 B B 97.9 95.3 87.2 81.3 d d 29.0 d d 30.4 26.2 30.0 28.8 h B 2.3 B d 3.1 0.6 h B 34.2 21.4 d d 1.7 0.9 Note: Allen is compared against all other counties combined, and vice versa. 30.3 1.5 5.0 1.5 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Maternal, Child & Infant Health Allen Other Counties Total Area % No Prenatal Care in 1st Trimester % of Low Birthweight Births Infant Death Rate TREND (vs. 2003) vs. IN vs. US vs. HP2010 B h 20.3 B d h h 16.1 29.9 24.6 19.9 16.2 10.0 h B 8.2 h d d h 8.8 6.9 7.6 7.9 7.9 5.0 B h 7.1 d B d h 7.4 8.7 Note: Allen is compared against all other counties combined, and vice versa. 6.9 7.9 6.9 4.5 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Mental Health & Mental Disorders Allen Other Counties Total Area % "Fair/Poor" Mental Health % Chronic Depression (2+ Years) % Depressed Persons Seeking Help % Typical Day Is "Extremely/Very" Stressful TREND (vs. 2003) d d 8.7 B 8.4 9.4 d d 26.4 d d 26.7 25.6 vs. IN vs. US 11.7 25.5 24.9 vs. HP2010 d d 55.2 d B B 54.9 55.9 60.3 47.2 50.0 d d 10.5 d 10.1 11.3 Alzheimer's Disease (Age-Adjusted Death Rate) 37.3 Note: Allen is compared against all other counties combined, and vice versa. 8.5 h h h 31.5 23.9 22.5 -blankno data B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 16
Each Sub-Area vs. The Other Total Area vs. Benchmarks Nutrition & Overweight Allen Other Counties Total Area % Eat 5+ Servings of Fruit or Vegetables per Day % Eat 2+ Servings of Fruit per Day % Eat 3+ Servings of Vegetables per Day % Keep Fresh Fruits/Veggies in Home for Snacks % "Very Likely" to Participate in a Fitness/Nutrition Program % Unhealthy Weight (BMI <18.5 or 25+) % Overweight % Obese % Overweight Trying to Lose % Children (Aged 6-17) Overweight % Child Eats 5+ Servings of Fruits/Vegetables Daily % Child Eats 2+ Fast Food Meals Per Week % Child Eats Junk Food At Least Daily % Child Eats 2+ Servings of Fruit Daily % Child Eats 3+ Servings of Vegetables Daily TREND (vs. 2003) d d 34.8 B B d 35.0 34.3 vs. IN vs. US 25.9 22.0 36.2 vs. HP2010 d d 48.4 B d h 47.9 49.5 43.0 46.5 75.0 d d 32.3 d h 31.9 33.3 d d 91.7 92.9 92.1 B h 38.4 h 41.1 32.3 43.5 34.6 50.0 B h 66.7 d d d h 64.0 72.8 63.6 64.5 67.9 40.0 B h 65.6 h h d 62.9 71.3 62.0 62.3 66.1 B h 30.4 h h d h 27.4 36.8 25.2 27.2 27.3 15.0 d d 56.8 d 57.0 56.7 h B 19.0 d d 21.8 13.0 h B 37.9 d 35.2 44.4 d d 41.7 B 42.5 40.0 d d 53.6 55.5 d d 58.3 64.2 d d 30.5 37.5 Note: Allen is compared against all other counties combined, and vice versa. 54.2 60.1 32.6 56.9 19.3 14.1 37.0 52.6 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Oral Health Allen Other Counties Total Area % Have Visited Dentist in Past Yr (18+) % Child (Aged 2-17) Has Visited Dentist in Past Year TREND (vs. 2003) vs. IN vs. US vs. HP2010 B h 71.9 d B B 73.2 68.7 69.3 65.4 56.0 d d 80.6 B B B 80.7 80.1 Note: Allen is compared against all other counties combined, and vice versa. 74.5 73.8 56.0 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Physical Activity & Fitness Allen Other Counties Total Area % Moderate Physical Activity % "Very Likely" to Participate in a Fitness/Nutrition Program % Child Participates in Vigorous Activity 5x Weekly/10 Minutes % Child Spends 3+ Hrs Daily on TV/Video Games/Computer TREND (vs. 2003) vs. IN vs. US vs. HP2010 d d 33.9 d d B 34.7 32.1 B h 38.4 h 41.1 32.3 d d 55.0 d 55.6 53.7 d d 13.5 11.8 Note: Allen is compared against all other counties combined, and vice versa. 13.1 43.5 50.6 -blankno data 34.8 31.8 30.0 B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 17
Each Sub-Area vs. The Other Total Area vs. Benchmarks Physical Health Allen Other Counties Total Area % "Fair/Poor" Physical Health TREND (vs. 2003) d d 14.2 d B B 14.5 13.8 Note: Allen is compared against all other counties combined, and vice versa. vs. IN vs. US 16.6 16.7 18.6 -blankno data vs. HP2010 B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Respiratory Disease Allen Other Counties Total Area CLRD (Age-Adjusted Death Rate) Pneumonia/Influenza (Age-Adjusted Death Rate) % Chronic Lung Disease % Asthma % Child Has Asthma TREND (vs. 2003) d d 49.0 d d h 49.5 48.3 vs. IN vs. US 47.9 51.1 42.6 B h 18.0 B B B 16.2 21.6 20.1 20.3 21.5 d d 10.0 d d 10.5 9.1 9.0 8.6 d d 11.9 h d d 12.6 10.5 9.5 12.7 10.4 d d 12.1 d d d 11.3 13.7 Tuberculosis Incidence/100,000 5.4 Note: Allen is compared against all other counties combined, and vice versa. 16.2 11.8 11.1 vs. HP2010 h h d h 3.4 2.2 5.4 1.0 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Sexually Transmitted Diseases Allen Other Counties Total Area Gonorrhea Incidence/100,000 Primary & Secondary Syphilis Incidence/100,000 Chlamydia Incidence/100,000 TREND (vs. 2003) vs. IN vs. US vs. HP2010 h B 132.7 h h h h 184.9 14.4 121.3 125.3 117.2 19.0 h B 0.8 d B B h 1.2 0.0 0.8 1.1 2.5 0.2 h B 354.9 h h h 475.4 75.5 Note: Allen is compared against all other counties combined, and vice versa. 203.0 311.2 304.4 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Substance Abuse Allen Other Counties Total Area Cirrhosis/Liver Disease (Age-Adjusted Death Rate) 5.9 % Current Drinker % Chronic Drinker % Binge Drinker % Drinking & Driving in Past Month % Driving Drunk or Riding with Drunk Driver % Illicit Drug Use in Past Month % Sought Help for Alcohol or Drug Problem TREND (vs. 2003) vs. IN vs. US vs. HP2010 B B B h 7.1 8.0 9.2 3.0 h B 49.4 d d B 52.4 42.7 50.5 50.1 58.0 h B 3.4 d d B 4.0 2.2 3.4 4.2 5.3 d d 13.7 B d d h 14.2 12.6 22.3 14.3 16.3 6.0 h B 4.0 d h 5.1 1.6 4.5 2.6 h B 6.4 d d 8.2 2.3 7.9 5.2 h B 1.5 B d d 2.0 0.5 4.0 2.5 2.0 d d 4.0 h d 4.4 3.1 Note: Allen is compared against all other counties combined, and vice versa. 6.9 3.3 -blankno data B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 18
Each Sub-Area vs. The Other Total Area vs. Benchmarks Tobacco Use Allen Other Counties Total Area % Current Smoker % Have Quit Smoking 1+ Days in Past Year (Smokers) % "Very Likely" to Participate in a Program to Quit Smoking % Someone Smokes at Home % Children <18 Exposed to Smoke at Home % Use Smokeless Tobacco TREND (vs. 2003) vs. IN vs. US vs. HP2010 d d 19.2 B B d h 19.5 18.4 31.5 27.3 22.2 12.0 d d 43.0 h h h h 42.9 43.3 d d 37.1 34.8 36.4 52.7 55.4 57.9 75.0 d d 16.4 d h 16.0 17.2 d d 15.6 B d 15.8 15.1 26.2 20.4 19.0 0.0 B h 3.5 d d h 2.3 6.3 Note: Allen is compared against all other counties combined, and vice versa. 3.0 4.5 0.4 -blankno data B h d favorable unfavorable similar Each Sub-Area vs. The Other Total Area vs. Benchmarks Vision & Hearing Allen Other Counties Total Area % Eye Exam in Past Year TREND (vs. 2003) d d 45.9 d 46.6 44.3 Note: Allen is compared against all other counties combined, and vice versa. -blankno data vs. IN vs. US 42.2 vs. HP2010 B h d favorable unfavorable similar PRC COMMUNITY HEALTH ASSESSMENT 19
SELF-REPORTED HEALTH STATUS PHYSICAL HEALTH STATUS The initial inquiry of the Community Health Survey asked respondents the following: Would you say that in general your health is: excellent, very Self-Reported Health Status good, good, fair or poor? (Total Area, ) A majority of Total Area adults (57.8%) rate their overall physical health as excellent or very good. Very Good 35.8% However, 14.2% of adults believe that their overall health is fair or poor. Good 28.0% More favorable than Indiana findings (16.7% fair/poor ). More favorable than national findings (18.6% fair/poor ). Fair 10.8% Poor 3.4% Excellent 22.0% Source: PRC Community Health Survey, Professional Research Consultants. PRC [Item 6] Note: Asked of all respondents. Comparable between Allen and the other combined county prevalence. Statistically unchanged from the 16.6% reported locally in 2003. Note that Allen findings are significantly better than findings among lower-income adults (under 200% of poverty) in the 2006 Allen Low-Income Health Survey. 5 Experience "Fair" or "Poor" Overall Health (Total Area By Region, ; 2001- Trend Data) 4 33.4% 3 2 1 14.5% 13.8% 16.8% 16.7% 9.3% 13.8% 14.2% 16.7% 18.6%!!! 13.3% 16.6% 14.2% Allen Other Counties Huntington LaGrange Noble Whitley Allen Co. Low-Inc. 2006 IN 2005 US 2005 2001 2003 Source: PRC Community Health Surveys, Professional Research Consultants. PRC [Item 6] Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2005 Indiana data. 2005 PRC National Health Survey, Professional Research Consultants. PRC 2005 Note: Asked of all respondents. 2001 and Total Area percentages include LaGrange ; 2003 data does not. PRC COMMUNITY HEALTH ASSESSMENT 20
The following chart further examines self-reported health status by various demographic characteristics. Note that reports of fair or poor overall health are notably higher among the following population segments: Adults aged 65+. Residents living at lower incomes. Blacks/African Americans. Hispanics. 10 Experience "Fair" or "Poor" Overall Health (Total Area, ) 8 6 44.5% 4 2 13.3% 15.1% 9.6% 14.4% 25.3% 26.1% 6.6% 12.6% 26.5% 21.8% 14.2% Men Women 18 to 39 40 to 64 65+ 100-200% Pov <Poverty >200% Pov White Hispanic Black/Afr Am Source: PRC Community Health Survey, Professional Research Consultants. PRC [Item 6] Note: Asked of all respondents. White and Black/Afr Am reflect non-hispanic race categorizations; Hispanic can be of any race. PRC COMMUNITY HEALTH ASSESSMENT 21
MENTAL HEALTH & MENTAL DISORDERS Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof), which are associated with distress and/or impaired functioning and spawn a host of human problems that may include disability, pain, or death. Mental illness is the term that refers collectively to all diagnosable mental disorders Mental disorders generate an immense public health burden of disability. The World Health Organization, in collaboration with the World Bank and Harvard University, has determined that the impact of mental illness on overall health and productivity in the United States and throughout the world often is profoundly underrecognized [Global Burden of Disease study]. In established market economies such as the United States, mental illness is on a par with heart disease and cancer as a cause of disability. Suicide a major public health problem in the U.S. occurs most frequently as a consequence of a mental disorder. Mental disorders occur across the lifespan, affecting persons of all racial and ethnic groups, both genders, and all educational and socioeconomic groups Modern treatments for mental disorders are highly effective, with a variety of treatment options available for most disorders [however], the majority of persons with mental disorders do not receive mental health services. The co-occurrence of addictive disorders among persons with mental disorders is gaining increasing attention from mental health professionals Having both mental and addictive disorders is a particularly significant clinical treatment issue, complicating treatment for each disorder There is increasing awareness and concern in the public health sector regarding the impact of stress, its prevention and treatment, and the need for enhanced coping skills Evidence that mental disorders are legitimate and highly responsive to appropriate treatment promises to be a potent antidote to stigma. Stigma creates barriers to providing and receiving competent and effective mental health treatment and can lead to inappropriate treatment, unemployment, and homelessness. As the life expectancy of individuals continues to grow longer, the sheer number although not necessarily the proportion of persons experiencing mental disorders of late life will expand. This trend will present society with unprecedented challenges in organizing, financing, and delivering effective preventive and treatment services for mental health. Healthy People 2010, 2 nd Edition. U.S. Department of Health and Human Services. Washington, DC: U.S. Government Printing Office, November 2000. PRC COMMUNITY HEALTH ASSESSMENT 22
Self-Reported Mental Health Status Nearly 7 in 10 Total Area adults (69.5%) rate their overall mental health as excellent or very good. Another 21.8% of Total Area residents gave good ratings. Self-Reported Mental/Emotional Health Status (Total Area, ) Very Good 36.6% Excellent 32.9% Good 21.8% Fair 6.7% Poor 2.0% Source: PRC Community Health Survey, Professional Research Consultants. PRC [Item 118] Note: Asked of all respondents. However, 8.7% of adults believe that their overall mental health is fair or poor. More favorable than national findings (11.7% fair/poor ). No statistical difference between Allen and the Other Counties (the combined area of Huntington, LaGrange, Noble, and Whitley counties). Note that Allen findings are significantly better than findings among lower-income adults (under 200% of poverty) in the 2006 Allen Low-Income Health Survey. 5 Experience "Fair" or "Poor" Mental/Emotional Health (Total Area, ) 4 3 2 1 8.4% 9.4% 8.7% 12.1% 8.1% 9.1% 8.7% 17.8% 11.7% Allen Other Counties Huntington LaGrange Noble Whitley Allen Co. Low-Inc. 2006 US 2005 Source: PRC Community Health Survey, Professional Research Consultants. PRC [Item 118] 2005 PRC National Health Survey, Professional Research Consultants. PRC 2005 Note: Asked of all respondents. Percentages represent combined fair and poor responses. PRC COMMUNITY HEALTH ASSESSMENT 23
There is a negative correlation between reports of fair/poor mental health and income. In addition, Hispanics are more likely to give low ratings of their own mental or emotional health. 5 Experience "Fair" or "Poor" Mental/Emotional Health (Total Area, ) 4 3 28.8% 2 1 8.2% 9.3% 10.3% 7.8% 6.8% 12.7% 4.6% 7.3% 12.4% 17.6% 8.7% Men Women 18 to 39 40 to 64 65+ 100-200% Pov <Poverty >200% Pov White Hispanic Black/Afr Am Source: PRC Community Health Survey, Professional Research Consultants. PRC [Item 118] Note: Asked of all respondents. White and Black/African American reflect non-hispanic race categorizations; Hispanic can be of any race. Percentages represent combined fair and poor responses. Symptoms of Chronic Depression Depression is a serious illness affecting many in the population, whether occasionally or, in many cases, for prolonged periods of time. Just over one in four Total Area adults (26.4%) report that they have had two or more years in their lives when they felt depressed or sad on most days, although they may have felt okay sometimes. Statistically similar to national findings (24.9%). Statistically similar between Allen and the Other Counties. This represents roughly 192,720 adults in the Total Area who have faced or are facing prolonged bouts with depression. Comparable to the 25.5% reported locally in 2003. Note that Allen findings are significantly better than findings among lower-income adults (under 200% of poverty) in the 2006 Allen Low-Income Health Survey. PRC COMMUNITY HEALTH ASSESSMENT 24