Community Health Assessment 2012

Community Health Assessment 2012

Licking County Health Department 675 Price Road Newark, Ohio 43055 www.lickingcohealth.org Assessment Commissioned By: R. Joseph Ebel, RS, MS, MBA Health Commissioner Assessment Completed By: Adam Masters, MPH Epidemiologist Licking County Health Department 1

Introduction The Licking County Health Department (LCHD), in keeping with its vision of Healthy People Living in Healthy Communities, has developed this community health assessment. This document provides an overview of a variety of factors that affect the overall public health system in Licking County. This information will be used as a tool to evaluate the overall health status of Licking County and as a means for LCHD and the Licking County Community Health Improvement Committee to set their public health priorities. In doing so, LCHD will work collaboratively with its partners in order to address the issues that are negatively impacting the public health of the residents of Licking County. Demographics Table 1: Demographic Profile Licking County, Ohio Sex and Age Estimate (2010) Percent Total Population 166,492 **** Male 81,524 48.97% Female 84,968 51.03% Under 5 Years 10,588 6.36% 5 to 9 Years 11,362 6.82% 10 to 14 Years 12,000 7.21% 15 to 19 Years 12,230 7.35% 20 to 24 Years 9,650 5.80% 25 to 34 Years 18,723 11.25% 35 to 44 Years 22,550 13.54% 45 to 54 Years 26,398 15.86% 55 to 59 Years 11,104 6.67% 60 to 64 Years 9,800 5.89% 65 to 74 Years 12,666 7.61% 75 to 84 Years 6,875 4.13% 85 Years and Over 2,546 1.53% Median Age 39.1 **** 18 Years and Over 125,367 75.30% 21 Years and Over 118,139 70.96% 62 Years and Over 27,784 16.69% 65 Years and Over 22,087 13.27% 18 Years and Over 125,367 75.30% Male 60,332 48.12% Female 65,035 51.88% 65 Years and Over 22,087 13.27% Male 9,606 43.49% Female 12,481 56.51% Licking County Health Department 2

Race Estimate (2010) Percent Total Population 166,492 **** One Race 163,324 98.10% White 155,190 93.21% Black or African American 5,701 3.42% American Indian and Alaska Native 462 0.28% Asian 1,237 0.74% Native Hawaiian or Other Pacific Islander 36 0.02% Some Other Race 698 0.42% Two or More Races 3,168 1.90% White and Black or African American 1,354 0.81% White and American Indian and Alaska Native 782 0.47% White and Asian 420 0.25% Black or African American and American Indian and Alaska Native 64 0.04% Race Alone or In Combination with One or More Other Races Estimate (2010) Percent White 158,164 95.00% Black or African American 7,309 4.39% American Indian and Alaska Native 1,454 0.87% Asian 1,787 1.07% Native Hawaiian and Other Pacific Islander 124 0.07% Some Other Race 1,009 0.61% Hispanic or Latino and Race Estimate (2010) Percent Hispanic or Latino (of any race) 2,312 1.39% Mexican 1,197 0.72% Puerto Rican 400 0.24% Cuban 72 0.04% Other Hispanic or Latino 643 0.39% Source: United States Census Bureau Licking County is located in central Ohio and is the second largest county by square miles in the state. It was the 17 th largest county in the state by population in 2010. The population of the county has increased from 156,590 in 2008 to an estimated 166,492 in 2010. However, the race and ethnic population distribution in the county has remained relatively unchanged since 2008. Licking County Health Department 3

Table 2: Household Income Licking County, Ohio Income and Benefits Number of Households (2010) Percent Less Than $10,000 4,616 7.22% $10,000 to $14,999 3,206 5.01% $15,000 to $24,999 7,408 11.58% $25,000 to $34,999 6,454 10.09% $35,000 to $49,999 9,578 14.97% $50,000 to $74,999 13,091 20.46% $75,000 to $99,999 7,306 11.42% $100,000 to $149,999 9,083 14.20% $150,000 to $199,999 2,480 3.88% $200,000 or More 750 1.17% Total 63,972 100% Median Household Income $51,132 Source: United States Census Bureau Table 3: Household Type Licking County, Ohio Households By Type Count (2010) Total Households 63,989 Family Households 45,162 With Own Children Under 18 19,710 Married-Couple Family 34,857 With Own Children Under 18 13,657 Male Householder No Wife Present 3,115 With Own Children Under 18 1,822 Female Householder, No Husband Present 7,190 With Own Children Under 18 4,231 Nonfamily Households 18,827 Householder Living Alone 15,254 65 Years and Over 5,928 Source: United States Census Bureau Income, as well as education, is considered a social determinant of health, and it has been proven that individuals who lack in these areas are more at risk of suffering from adverse health risks. The median household income in Licking County has decreased from $53,757 in 2008 to $51,132 in 2010. The population of Licking County has continued to increase and as of just recently the number of households has increased as well. There were a total of 59,399 households in 2008 and 63,989 in 2010. This represents a significant increase of 4,590 new households. Licking County Health Department 4

Table 4: WIC Enrollment Licking County, Ohio WIC Enrollment Count 2008 3,568 2009 3,701 2010 3,571 Source: Licking County Health Department WIC Program Figure 1: WIC Enrollment (2008-2010) The number of individuals seeking assistance from the county's Women, Infants, and Children (WIC) program in 2010 was almost identical to 2008 after an increase in 2009. In order to qualify for WIC, a participant's gross monthly income must be within 185% of the federal poverty level. Licking County Health Department 5

Table 5: Food Assistance Licking County, Ohio Food Assistance 2008 2009 2010 2011 Average Monthly Adult Recipients 8,112 10,649 16,245 17,682 Average Monthly Child Recipients 6,686 8,302 11,260 11,734 Total Number of Recipients (Annual Unduplicated) 22,906 27,532 27,505 29,416 Percent of Population 14.5% 17.4% 17.3% N/A Source: Ohio Department of Jobs and Family Services Figure 2: Food Assistance (2008-2011) The median household income in Licking County decreased from 2008 to 2010 and as a result more individuals were in need of food assistance. To qualify for food stamps the gross monthly income amount must be within 130% of the federal poverty level. Licking County Health Department 6

Table 6: School Enrollment Licking County, Ohio School Enrollment Count (2010) Nursery School and Preschool 2,144 Kindergarten 2,258 Elementary School (Grades 1-8) 19,015 High School (Grades 9-12) 8,481 College or Graduate School 12,963 Total Population Over 3 Years Enrolled in School 44,861 Source: United States Census Bureau Table 7: Educational Attainment Licking County, Ohio Educational Attainment Count (2010) Less Than 9th Grade 3,346 9th to 12th Grade (No Diploma) 10,260 High School Graduate (Includes GED) 41,152 Some College (No Degree) 22,305 Associate's Degree 10,037 Bachelor's Degree 17,063 Graduate or Professional Degree 7,361 Percent of Population High School Graduate or Higher 87.8% Percent of Population Bachelor's Degree or Higher 21.9% Source: United States Census Bureau The number of students enrolled in school has increased from 40,663 in 2008 to 44,861 in 2010. This increase is mainly attributed to the number of students that were enrolled in elementary school and college or graduate school over this period. The number of students enrolled in elementary school increased by a total of 2,421 from 2008 to 2010. The number of students enrolled in college or graduate school increased by a total of 2,418 from 2008 to 2010. The number of individuals in the county with a Bachelor s Degree or higher increased by a total of 1,709 during this time period. Licking County Health Department 7

Leading Causes of Death Table 8: Leading Causes of Death in Licking County, Ohio Cause of Death 2005 2007 2008 Cardiovascular Disease 425 374 396 Cancer (All Sites) 327 341 306 Coronary Heart Disease 224 197 212 Lung Cancer 87 94 106 Stroke 64 57 62 Diabetes 66 47 59 Unintentional Injuries 67 75 75 Colorectal Cancer 30 31 34 Breast Cancer 32 24 22 Motor Vehicle Traffic Related Causes 28 24 24 Intentional Self Harm (Suicide) 20 19 11 Pneumonia/Influenza 20 15 34 Chronic Liver Disease and Cirrhosis 12 13 25 Assault (Homicide) 2 6 7 Cervical Cancer 1 1 1 Source: Ohio Department of Health Information Warehouse Licking County Health Department 8

Figure 3: Licking County Leading Causes of Death (2005, 2007, 2008) The leading cause of death in Licking County from 2005-2008 was cardiovascular disease. When examining the top five causes of death for 2008, everything except lung cancer was below the number of cases reported in 2005. The top five leading causes of death for Licking County matched the top five for the state of Ohio. The number of chronic liver disease and cirrhosis cases were near the bottom of the leading causes of death list for Licking County but from 2005-2008 the number of cases doubled. Licking County Health Department 9

Table 9: Top 6 Causes of Death in Ohio 2010, Age Adjusted Death Rate per 100,000 Cause of Death Ohio 2010 Licking County 2010 Heart Disease 191.7 160.9 Cancer 187.3 198.6 Chronic Lower Respiratory Disease 50.4 66.4 Stroke 42.4 44.5 Unintentional Injury (Accident) 41.6 51.0 Alzheimer s Disease 29.7 36.7 Source: Ohio Department of Health Death - Data and Statistics Figure 4: Top 6 Causes of Death in Ohio 2010, Age Adjusted Death Rate per 100,000 In 2010, Licking County ranked higher for all of the top 6 causes of death identified for Ohio other than heart disease. The age adjusted death rates for stroke, unintentional injury (accident), and Alzheimer's disease increased from 2009 to 2010 in Licking County. Licking County Health Department 10

Table 10: Cancer Deaths Licking County, Ohio Cancer Deaths 2003-2005 2006-2008 Trachea, Bronchus & Lung 262 287 Colon, Rectum & Anus 93 94 Breast 93 76 Prostate 45 45 Pancreas 37 59 Leukemia 37 34 Ovary 31 22 Non-Hodgkins Lymphoma 23 27 Kidney & Renal Pelvis 23 22 Brain and Central Nervous System 19 24 Esophagus 28 33 Bladder 17 19 Melanoma of Skin 13 14 Multiple Myeloma 20 16 Stomach 13 11 Liver and Bile Ducts 16 22 Lip, Oral Cavity & Pharynx 12 23 Corpus Uteri 13 11 Larynx 5 2 Cervix Uteri 4 3 Other & Unspecified 101 112 Total 905 956 Source: Ohio Department of Health Information Warehouse Licking County Health Department 11

Figure 5 : Licking County Cancer Deaths (2003-2005, 2006-2008) Overall, Licking County has seen a rise in the total number of cancer deaths from 2006 to 2008 compared to 2003-2005. Specifically, an increase has been seen in Trachea, Bronchus and Lung Cancer deaths as well as Pancreatic, Esophageal, and Lip, Oral Cavity and Pharynx cancer deaths. Three of these types of cancer can be attributed to tobacco use. The Licking County Health Department s community health assessments from 2006 and 2008 have shown that the use of tobacco products by county residents has also increased during this time period. Licking County Health Department 12

Table 11: Percent of Late Stage Cancer Diagnosis Licking County, Ohio Type of Cancer Diagnosed in Late Stage (Licking County) State of Ohio Lung and Bronchus 72.0% 69.4% Colon and Rectum 55.5% 46.7% Prostate 10.5% 11.0% Cervical 48.7% 48.6% Breast 27.5% 29.3% Source: Ohio Cancer Incidence Surveillance System, Ohio Department of Health, 2011 Figure 6: Licking County Late Stage Cancer Diagnosis (2004-2008) The American Cancer Society indicates that early detection and diagnosis of cancer are critical in increasing the patient s chances of survival. Licking County residents from 2004-2008 were in the highest percentage category of late stage diagnosis in Ohio for lung and bronchus cancer as well as colon and rectum cancer. Trachea, Bronchus, and Lung cancers were identified as the leading cause of cancer deaths in Licking County from 2006-2008 followed by colon and rectum cancer. Other cancers including prostate and cervical were in the midrange category for late stage diagnosis in Ohio from 2004-2008 and breast cancer was reported as being in the lowest category. Breast cancer deaths have decreased by 18.3% during 2004-2008 compared to the number of deaths in 2003-2005 which shows the importance of early detection and diagnosis related to the health outcomes of a patient. Licking County Health Department 13

Table 12: Number of New Cancer Cases in Licking County, Ohio New Cancer Cases 2008 2009 2010 Female Breast 127 142 138 Lung and Bronchus 138 148 130 Prostate 118 114 96 Colon & Rectum 78 81 81 Bladder 42 52 37 Melanoma of Skin 92 73 71 Non-Hodgkins Lymphoma 33 27 26 Kidney & Renal Pelvis 30 38 36 Corpus Uteri 22 34 32 Oral Cavity & Pharynx 16 21 14 Leukemia 28 22 18 Thyroid 22 14 22 Brain and Central Nervous System 33 29 25 Pancreas 16 13 12 Esophagus 10 19 13 Ovary 9 11 13 Larynx 8 5 9 Cervix Uteri 7 5 4 Testis 4 6 2 Liver & Intrahepatic Bile Duct 10 8 16 Hodgkins Lymphoma 5 5 9 Multiple Myeloma 7 9 8 Stomach 12 6 8 Other 60 76 51 Total 927 958 871 Source: Ohio Public Health Information Warehouse Licking County Health Department 14

Figure 7: Top 5 Cancer Cases in Licking County This graph represents the top five cancer cases in Licking County from 2008-2010. Cancer data is available from 2011 however it takes approximately two years to verify and account for 90-95% of all cases for a calendar year. This is an important consideration when comparing the figures from 2008 and 2009. For this report, 2008 and 2009 should be considered complete and 2010 should be considered an estimate. These figures are provided to give readers an idea if the number of cases of a particular cancer are on the rise or declining. Licking County Health Department 15

Table 13: Injury Related Deaths in Licking County, Ohio Injury Related Deaths 2003-2005 2006-2008 Motor Vehicle Accidents 78 55 Other and Unspecified Non Transport Accidents 38 47 Accidental Poisoning 37 56 Suicide By Firearm 28 29 Suicide By Other Means 23 28 Falls 15 38 Homicide By Firearms 9 8 Accidental Drowning and Submersion 7 4 Accidental Discharge of Firearms 2 1 Other Land Transport Accidents 1 1 Source: Ohio Department of Health Information Warehouse Licking County experienced a 29.0% reduction in deaths associated with motor vehicle accidents from 2003-2005 to 2006-2008. The state of Ohio experienced only a 3.0% reduction over the same timeframe. However, the county saw deaths associated with accidental poisonings rise 51.4% over this period, as well as a 150% increase in deaths associated with falls. Across Ohio a sharp increase in deaths associated with accidental poisonings was found as well, along with a slight increase in falls as the cause of death. Licking County Health Department 16

Maternal and Child Health Indicators Table 14: Live Births in Licking County, Ohio Licking County Live Births Year Number of Births 2005 2,010 2006 2,128 2007 2,072 2008 2,027 Source: Ohio Department of Health Information Warehouse Figure 8: Number of Live Births in Licking County The number of births in the county fluctuated over this period. On average 2,060 births occurred in Licking County from 2005-2008. However, this number represents the number of births that occurred in the county and not the total number of county residents that gave birth during this time period. A significant amount of Licking County residents are born in surrounding counties, which are not reflected by this statistic. Licking County Health Department 17

Table 15: Infant Mortality in Licking County, Ohio Licking County Infant Mortality Year Number of Deaths 2005 12 2006 13 2007 15 2008 18 Source: Ohio Department of Health Information Warehouse Figure 9: Number of Infant Deaths in Licking County Licking County experienced a 50% increase in infant deaths from 2005 to 2008. In comparison, Ohio realized a 7.1% decrease in infant mortality during this time period. The fact a much larger data pool exists related to infant mortality for the state of Ohio in comparison to Licking County must be taken into account when analyzing these figures. However, this trend should be noted and explored as more current data becomes available. Licking County Health Department 18

Top Causes of Infant Deaths Table 16: Top Causes of Infant Deaths in Licking County, Ohio Cause of Death 2005 2006 2007 2008 1.) Congenital Malformations, Deformations and Chromosomal Abnormalities 4 6 5 3 2.) Sudden Infant Death Syndrome 3 0 1 2 3.) Disorders Related to Short Gestation and Low Birth Weight, Not Elsewhere Classified 0 2 2 3 4.) Neonatal Hemorrhage 0 0 4 1 5.) Newborn Affected By Complications of Placenta, Cord, and Membranes 0 0 0 1 6.) Newborn Affected By Complications of Pregnancy 1 1 0 1 7.) Bacterial Sepsis of Newborn 0 0 0 1 8.) Diseases of the Circulatory System 0 0 0 1 9.) Respiratory Distress of Newborn 0 0 0 1 10.) Accidents (Unintentional Injuries) 0 0 0 1 11. All Others 4 4 3 3 Total 12 13 15 18 Source: Ohio Department of Health Information Warehouse Table 17: Births by Gestational Age in Licking County, Ohio Gestational Stage 2005 2006 2007 2008 Very Preterm* 29 41 30 56 Preterm** 228 287 230 253 Term*** 1,706 1,780 1,791 1,723 Post-Term**** 70 59 49 50 Source: Ohio Department of Health Information Warehouse *Very Preterm is considered when an infant is born after less than 32 weeks of gestation **Preterm is considered when an infant is born after less than 37 weeks of gestation ***Term is considered when an infant is born after 37 weeks of gestation ****Post-Term is considered when an infant is born after more than 37 weeks of gestation Licking County Health Department 19

Table 18: Live Births by Birth Weight in Licking County, Ohio Weight 2005 2006 2007 2008 Very Low Birth Weight* 17 28 25 46 Low Birth Weight** 135 181 143 167 Normal Birth Weight 1,708 1,778 1,745 1,670 High Birth Weight 164 167 181 188 Unknown 2 2 3 2 Source: Ohio Department of Health Information Warehouse *Very Low Birth Weight consists of infants weighing less than 3.3 pounds **Low Birth Weight consists of infants weighing less than 5.5 pounds Figure 10: Licking County Infant Mortality Factors A mother failing to carry a pregnancy to term or delivering an infant with a lower than normal birth weight can put the infant at a higher risk of developing negative health consequences and also lessen the child s survival chances. The American Congress of Obstetricians and Gynecologists indicates that infants born very preterm or preterm are at a higher risk of developing both short-term and long-term disabilities then those carried to term. Specifically, these infants are at risk of developing bleeding in their brains, having trouble communicating or making sounds, cerebral palsy and developmental delays. The incidences of these health risks fluctuated in Licking County from 2005-2008. However, 2008 saw the highest incidence of infants born very preterm and with very low birth weights. These infants are considered the most vulnerable to suffer from both negative health issues and mortality. Licking County Health Department 20

Table 19: Trimester of Entry into Prenatal Care for Licking County, Ohio Trimester of Entry into Prenatal Care 2005 2006 2007 2008 First Trimester 82.5% 57.1% 60.2% 58.6% Second Trimester 7.1% 18.7% 16.3% 14.5% Third Trimester 1.0% 2.6% 2.6% 2.3% None 1.0% 1.5% 1.9% 1.8% Unknown 8.4% 20.1% 19.0% 22.8% Source: Ohio Department of Health Information Warehouse Figure 11: Trimester of Entry into Prenatal Care The Mayo Clinic indicates that prenatal care is essential to improving the chances that a mother and her child do not experience adverse health effects that would lead to factors that could negatively impact both of their health. Licking County saw the number of pregnant women entering prenatal care for the first trimester decrease during 2005 2008. The number of women in the second trimester entering prenatal care during 2005 2008 increased from 7.1% to 14.5%. Women in the third trimester requiring prenatal care slightly increased during 2005 2008. Licking County Health Department 21

Table 20: Teen Pregnancy and Births in Licking County, Ohio Teen Pregnancy Rates 2006 2007 2008 2009 2010 Ages 10-14 1.1 1.3 0.6 0.6 0.3 Ages 15-17 32.1 37.0 36.8 26.9 24.2 Ages 18-19 107.5 100.9 95.4 96.1 87.3 Teen Birth Rates 2006 2007 2008 2009 2010 Ages 10-14 0.8 0.6 0.0 N/A N/A Ages 15-17 15.5 15.9 21.3 N/A N/A Ages 18-19 81.9 71.2 70.2 N/A N/A Source: Ohio Department of Health Information Warehouse An additional factor related to negative health effects of both mothers and babies is teen pregnancy. This factor can lead to a higher risk of low birth weight, an increased likelihood that the mother will smoke during pregnancy, and a lesser chance that the mother will access prenatal care. Also, teen mothers are more likely to live in poverty, have a reduced chance of having healthcare, and the children of these mothers are more likely to become teen mothers themselves. Licking County experienced a decline in teen pregnancy rates from 2006 to 2010. The teen birth rate for most age groups in Licking County also experienced a decline from 2006 to 2008. Licking County Health Department 22

Behavior Risk Factors In 2011, the Center for Urban and Public Affairs (CUPA) at Wright State University (WSU) conducted the Behavioral Risk Factor Surveillance System (BRFSS) for the Licking County Health Department (LCHD). The BRFSS was developed by the Centers for Disease Control and Prevention (CDC), and has been used nationwide by public health professionals to assess the health status, quality of life, and health risk factors that may negatively impact their communities. The 2011 BRFSS included 583 Licking County adults who participated in the telephone survey. Table 21: Licking County BRFSS Trend Data (2006-2011) Licking County Health Department 23

Figure 12: Licking County Healthcare Access and Utilization The results from the 2011 BRFSS indicate the number of Licking County residents without healthcare coverage has been increasing since 2006, along with the number of people with no access to healthcare when needed. The survey was able to estimate that 15% of people in Licking County were without healthcare coverage and 15% of people were also without access to health care when needed. Around 74% of people surveyed, reported seeking preventative healthcare which was up from 63% in 2006. The number of individuals reporting dental visits in the last year was around 73% which was similar to the number of dental visits from 2006. Licking County Health Department 24

Figure 13: Smoking and Binge Drinking in Licking County, Ohio The 2011 BRFSS examined the smoking rate in Licking County residents, along with binge drinking. The adult smoking rate increased from 21% to 25% from 2006 2011. Binge drinking also increased during this time period from 11% to 15%. Even though the smoking status of Licking County residents was up in 2011 compared to 2006, progress is being made in the county to promote smoke free schools and worksites. In fact, a reduction in the adult smoking rate was identified from 2008 to 2011. Licking County Health Department 25

Figure 14: Mammogram in Past 2 Years (Ages 40+) in Licking County, Ohio One of the highlights from the Licking County BRFSS 2011 report was the percentage of residents receiving mammograms in the past two years. In 2011, 84% of respondents stated they had a mammogram in the last two years compared to 77% in 2008. The state of Ohio's BRFSS report from 2007 listed 77% of respondents stating they had a mammogram in the past 2 years. Licking County Health Department 26

Figure 15: Colonoscopy in Past 2 Years (Ages 50+) in Licking County, Ohio One of the main areas for improvement identified from the 2011 BRFSS report was the number of colonoscopies residents received between in 2009 and 2011. From 2006 to 2008 around 59% of respondents indicated that they had received a colonoscopy in the last two years. In 2011, the percentage of residents receiving a colonoscopy in the last two years dropped to 33%. Licking County Health Department 27

Environmental Public Health Concerns According to the University of Toledo, Licking County has the highest recorded levels of radon gas in the state of Ohio. In fact, the University of Toledo reports the median level of radon gas found in homes in Licking County is 8.3 pci/l, which is more than double the United States Environmental Protection Agency s (USEPA) Radon Action Level of 4.0 pci/l. The USEPA indicates radon is the second leading cause of lung cancer in the United States, and is responsible for approximately 21,000 deaths each year. The LCHD operates a Radon Education Program that provides free radon test kits to county residents and educational information at a variety of community events. The department also leads a coalition of three local health departments conducting similar programs in the Central Ohio area. To obtain a free radon test kit please visit http://www.lickingcohealth.org In looking at the built environment in Licking County, there is an extensive bike and walking trail system and a variety of other physical activity opportunities in existence. However, the obesity rate in the county continues to climb. This is true especially for individuals living in households making less than $25,000 annually, as these individuals were found to be 45% less likely to be physically active than individuals living in households making more than $75,000 annually. These statistics indicate that even though there s an infrastructure in place related to physical activity barriers are still present preventing individuals in lower socioeconomic classes from taking advantage of these opportunities. Community Resources The Licking County Community Health Improvement Committee (CHIC) was formed in 2010. The committee is comprised of representatives from over 20 agencies from across the public health system in Licking County and it is coordinated by LCHD personnel. The CHIC members conducted the Mobilizing for Action through Planning and Partnerships (MAPP) process and as a result developed a community health improvement plan that addresses the top four public health priorities in the county. The plan demonstrates a long term commitment by CHIC members to address these priorities and future priorities as they are identified. This collaborative approach to protecting and improving the public health and quality of life of the citizens of Licking County has provided the participating agencies with an opportunity to broaden the impact of their programs. As a result of this process, CHIC member agencies have gained a more detailed perspective of the programs and resources available to their clients. A comprehensive database of resources available in Licking County has been developed by LCHD. To view the resource list CLICK HERE Licking County Health Department 28

Mobilizing for Action through Planning and Partnerships (MAPP) As stated previously, LCHD staff members coordinate the CHIC in Licking County. In order to have a positive impact on the health of county residents and to achieve measureable and effective results, CHIC members committed to conducting the MAPP process. The process was developed by the National Association of County and City Health Officials, and the process includes four assessments. The CHIC members conducted all four MAPP assessments in 2010, which included a Forces of Change Assessment, a Community Themes and Strengths Assessment, a Local Public Health System Assessment, and this Community Health Assessment. More information regarding the CHIC and its activities can be found here: www.healthylc.org Community Themes and Strengths Assessment In March 2012, the Licking County Health Department (LCHD) conducted a Community Themes and Strengths Assessment. In conducting the assessment LCHD staff facilitated 5 focus groups in different locations around Licking County. The focus groups participants discussed their thoughts on quality of life issues and health concerns in their communities. The assessment provided LCHD staff members with an excellent opportunity to personally interact with the department s constituents and discuss the most prominent issues affecting their health. Listed below were the most frequent topics discussed at the Community Themes and Strengths locations voted on by the participants. Community Strengths 1.) Food Pantry Network 2.) Bike Paths and Parks 3.) Community Unity Healthy Things 1.) Health Department/Public Health Services 2.) Bike Paths and State Parks 3.) Farmers Markets Challenges 1.) Environmental Challenges 2.) Nutrition (Access to Healthy Foods) 3.) Affordable Housing/Homelessness Unhealthy Things 1.) Risky Behaviors (STDs, Drugs, and Alcohol) 2.) Environmental Challenges 3.) Unhealthy Food Choices The CHIC members have already started to address some of the issues mentioned during the focus groups. The Licking County Wellness Coalition is currently working on items involving nutrition and access to healthy foods. However, they will use the feedback from focus group participants in their program planning. An environmental committee is currently being assembled to address potential concerns related to hydraulic fracturing in the county. The LCHD staff will be a part of this committee and will work to protect against negative environmental impacts from the fracking process. Overall the focus groups were extremely successful and provided LCHD with a great opportunity to interact with its constituents. The data collected as part of this process will be integrated into LCHD s comprehensive community health improvement efforts, and it will be used to better the health of Licking County residents. For more information regarding the CHIC s efforts to improve public health in Licking County please visit their website at www.healthylc.org Licking County Health Department 29

LCHD 2011 Annual Infectious Disease Report The Licking County Health Department conducts infectious disease surveillance and generates monthly reports to summarize disease activity in the county. At the end of each year an annual report is created and diseases of interest are compared to Ohio rates to help identify areas where the health department can work to lower the incidence of those diseases. The top five diseases reported in Licking County were listed and compared to Ohio rates. Table 23: STDs in Licking County, Ohio STDs in Licking County *Incidence Rate = # of New Cases per 100,000 Chlamydia Gonorrhea STD (2011) Licking Rate Ohio Rate 198.8 16.8 433.3 136.9 Table 22: Top 5 Disease Issues in Licking County, Ohio Top 5 Issues in Licking County *Incidence Rate = # of New Cases per 100,000 Disease (2011) Licking Rate Ohio Rate 1.) Hepatitis C-Chronic 2.) Campylobacteriosis 3.) Meningitis-aseptic/ 4.) Salmonellosis 5.) Mycobacterial disease 41.4 31.8 15.0 13.8 10.2 46.6 10.2 11.7 10.3 N/A *Campy increase could be due to use of antigen test *Influenza and STDs not included Figure 16: Licking County Chlamydia Trends The LCHD has noticed a significant increase in the number of Chlamydia cases reported in 2011 and from the Community Themes and Strengths Assessment, residents were aware and concerned about STDs. In order to address this issue, an STD Task Force has been formed involving representatives in the county who have STD clinics along with LCHD. The group will work together to understand why Chlamydia is on the rise and discuss methods on how to reduce the incidence. Licking County Health Department 30

Contributing Causes of Health Challenges The data collected for this assessment indicates that behavioral risk factors are directly influencing health status in Licking County. For example, the number of individuals 50 years of age receiving a colonoscopy was reported at 33% for the 2011 BRFSS. This represented a 26% decrease from the 2008 BRFSS conducted by LCHD. This significant drop in colonoscopies can be associated with Licking County being in the highest tier for late stage diagnosis for colon and rectum cancer throughout the state along with colon and rectum cancer being the second leading cause of cancer death in the county. Access to healthcare can compound the issue of early detection for different types of cancer. The 2011 BRFSS identified a slight increase from 2008 for individuals stating they had no health care coverage and no access to health care when needed. If more individuals can gain access to affordable health care in Licking County, then the percent of late stage diagnosis for cancers like colon and rectum should decrease. The LCHD has also identified a significant increase in the number of Chlamydia cases reported in the county for the last two years. Additionally, the number of individuals becoming reinfected with Chlamydia is also increasing stressing the importance of treatment for the patient and partner. A few barriers have been identified for partner treatment and the LCHD has started an STD Task Force to work on these issues. Data Collection This assessment contains both primary and secondary data. Including both types of data is imperative in order to gain a true perspective of the overall health status of the county. In addition, the data utilized also provides an opportunity to identify gaps in services and the most prominent public health issues facing the county. The assessment also serves as a means to validate and promote interventions that are positively impacting the health of county residents. Primary data was collected through a contractual agreement with the Center for Urban and Public Affairs (CUPA) at Wright State University (WSU). The agreement resulted in the completion of the Behavior Risk Factor Surveillance Survey (BRFSS) in 2011. The survey included telephone interviews of 583 Licking County residents. The BRFSS is a nationally recognized scientific data collection tool, and in conducting the survey LCHD was able to collect accurate and reliable data related to public health issues such as tobacco use, healthcare access and utilization, obesity, and physical activity. In addition to the BRFSS data, primary data was also collected as part of the MAPP process. The Local Public Health, Forces of Change, and Community Themes and Strength Assessments involved CHIC members and the public at large. The data was used in conjunction with the secondary data contained in this document to determine the main public health priorities in Licking County, which led to the development of the county s CHIP. Licking County Health Department 31

The secondary data contained in this document was collected from a variety of reputable and accurate sources. Specifically, the Ohio Department of Health s Information Data Warehouse was utilized to gather data related to the leading causes of death, most prominent and deadly forms of cancer, injury related deaths, number and causes of infant mortality, and the percentage of women participating in prenatal care in Licking County. The United States Census Bureau s website was utilized in order to gather the demographic data contained in the assessment. The Ohio Department of Job and Family Services Licking County Profile was used to gather data to demonstrate the usage of safety net services in the county. Online surveillance systems were used to extract disease numbers to generate infectious disease reports. Finally, LCHD utilized its own internal data related to its WIC program and past community health assessments for comparison purposes. Conclusion The population in Licking County has grown approximately 6.3% since 2008. This indicates that the demand for public health services in the county has also grown with the population over this time period. Monitoring the health status of the population is a vitally important undertaking that allows the public health system to determine priority areas that are in need of being addressed. This allows the system to focus its resources on these issues and positively impact the public health of the residents of Licking County. In order to have a positive impact, LCHD will continue to work with its public health partners and the community at large to address the most prominent public health issues facing the county. This will be done by addressing data proven issues and implementing evidence and scientific based interventions and continually evaluating their impact. The LCHD is committed to conducting a community health assessment on a 3 year cycle. Doing so will provide the department with reliable data related to the most prominent issues affect the health status of the county and work to address them. Licking County Health Department 32

References: 1.) American Cancer Society (2012). Early Detection and Diagnosis of Cancer. Retrieved on June 22, 2012, from: www.cancer.org. 2.) American Congress of Obstetricians and Gynecologists (2012). ACOG Frequently Asked Questions on Early Preterm Birth. Retrieved on June 22, 2012, from: http://www.acog.org/~/media/for%20patients/faq173.pdf?dmc=1&ts=20120622t1003512967. 3.) Licking County Community Health Improvement Committee (2012). Community Themes and Strengths Assessment Report. Retrieved on June 13, 2012 from: http://www.lickingcohealth.org/admin/healthstats.html 4.) Licking County Community Health Improvement Committee (2010). Forces of Change Assessment Report. Retrieved on June 13, 2012 from: http://www.lickingcohealth.org/admin/healthstats.html 5.) Licking County Community Health Improvement Committee (2010). Local Public Health System Assessment Report. Retrieved on June 22, 2012 from: http://www.lickingcohealth.org/admin/healthstats.html 6.) Licking County Health Department (2010). Community Health Assessment. Retrieved on June 6, 2012 from: http:// www.lickingcohealth.org/admin/healthstats.html. 7.) Licking County Health Department (2011). Behavioral Risk Factor Surveillance System Report. Retrieved on June 11, 2012, from: http://www.lickingcohealth.org/admin/healthstats.html. 8.) Mayo Clinic (2010). Prenatal Care: First-Trimester Visits. Retrieved on June 22, 2012, from: http://www.mayoclinic.com/health/ prenatal-care/pr00008. 9.) Ohio Department of Health (2010). The Ohio Department of Health Information Warehouse. Retrieved on June 11, 2012, from: http://dwhouse.odh.ohio.gov/. 10.) Ohio Department of Health (2012). Death - Data and Statistics. Retrieved on July 23, 2012 from http://www.odh.ohio.gov/ healthstats/vitalstats/deathstat.aspx 11.) Ohio Department of Health (2012). Ohio Public Health Information Warehouse. Retrieved on June 13, 2012. These data were provided by the Center for Public Health Statistics and Informatics, Ohio Department of Health. The Department specifically disclaims responsibility for any analysis, interpretations or conclusions. 12.) Ohio Department of Jobs and Family Services (2012). Licking County Profile. Retrieved on June 11, 2012, from: http:// jfs.ohio.gov/county/cntypro/index.stm. 13.) United States Census Bureau (2011). American Fact Finder. Retrieved on November 1, 2011, from: http:// factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml. 14.) United States Environmental Protection Agency (2012). Radon Health Risks. Retrieved on June 13, 2012, from: http:// www.epa.gov/radon/healthrisks.html 15.) University of Toledo (2012). Radon Concentration Statistics for the State of Ohio. Retrieved on June 19, 2012, from: http:// www.eng.utoledo.edu/aprg/radon/testingapplet1.html Licking County Health Department 33