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Community Health Improvement Plan 2008 – 2012 2011 Update ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 1 Table of Contents Healthy Priority Overweight, Obesity, and Lack of Physical Activity Health Priority Alcohol, Tobacco, and Other Substance Use 11 and Abuse 11 Douglas County CHIP Participants 20 Steering Committee 20 Subcommittees 21 Appendix 22 Purpose and Scope 24 Methods 25 Douglas County Profile 27 Location and Size 27 Gender and Age 27 Race, Ethnicity, and Household Languages 28 Births 28 Households 29 Employment 29 Education 29 Disability 30 Income 30 Insurance 30 Healthy Priority Overweight, Obesity, and Lack of Physical Activity 32 Definitions 32 Healthiest Wisconsin 2010 Goals 32 Douglas County Data 33 Health Priority Mental Health and Mental Disorders 34 Definitions 34 Healthiest Wisconsin 2010 Goals 34 Douglas County Data 35 Health Priority Alcohol, Tobacco, and Other Substance Use and Abuse 36 Definitions 36 Healthiest Wisconsin 2010 Goals – Alcohol and Other Drugs 37 Douglas County Data – Alcohol and Other Drugs 38 Healthiest Wisconsin 2010 Goals – Tobacco 39 Douglas County Data – Tobacco 40 Douglas County Health Assessment Summary 42 Sources 45 2008 Douglas County Physical Activity Survey 47 ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 2 Executive Summary The shared vision of Wisconsin’s public health system partners is that a healthy Wisconsin is a place where all residents reach their highest potential, communities support the physical, emotional, mental, spiritual, and cultural needs of all people, and people work together to create healthy, sustainable physical and social environments for their own benefit and that of future generations. Wisconsin Administrative Code requires, via Chapter HFS 140.04, that local health departments “participate in community health assessment; collect, review and analyze data on community health; and undertake case-finding to identify population groups, families and individuals at high risk of illness, injury, disability or premature death.” Community Health Improvement Plan (CHIP) process occurs every five years and is a locally based initiative that identifies local health concerns and develops health priorities that link local initiatives to state and national health priorities aimed at achieving shared visions of public health. Under the leadership of the Douglas County Department of Health and Human Services, and assisted by the Northern Lights Public Health Preparedness Consortia epidemiologist, the Douglas County Community Health Assessment Steering Committee was developed in March 2007 by invitation to community stakeholders. A health and safety assessment was conducted by review of compiled local, state, and national data. After review, the committee ranked health priorities numerically based on set criteria. The criteria included: Current activities existing in the community Size of the problem Feasibility of instituting interventions Seriousness of consequences of health issue Perceived importance and resources of community (capacity). The three health priorities for the 2008-2012 Douglas County CHIP are: Overweight, Obesity, and Lack of Physical Activity Mental Health and Mental Disorders Alcohol, Tobacco, and Other Substance Use and Abuse It is the intention of the Douglas County Community Health Improvement Committee to meet periodically throughout this five year period to implement the CHIP, evaluate its effectiveness, and modify the CHIP as needed. During 2010, the Steering Committee reviewed and approved relevant actions proposed by the Steering Committee’s three subcommittees. These actions included the development of new goals, objectives, strategies, activities, and surveys. The Steering Committee also developed a Grant Subcommittee that reviews and recommends grant work to support CHIP initiatives. Several grants were reviewed, but due to timeline constraints, no applications were made. The Steering Committee continues to meet at a ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 3 minimum four times per year and holds adhoc meetings to review timely recommendations made by subcommittee members. The results of the actions during 2009 have been incorporated into this updated Plan along with any supporting materials or updated data. The update of the 2010 U.S. Census will yield more accurate data pictures for Douglas County and the Steering Committee anxiously awaits the release of such data as it continues to review the progress of the three health priorities and their associated goals. To further align with the shared vision of health in Wisconsin, Douglas County embraces the vision and goals of Healthiest Wisconsin 2020. To align with the goals of Healthiest Wisconsin 2020, the Douglas County CHIP has worked to ensure measureable outcomes and progress with activities and objectives supporting the current goals of the CHIP. The current CHIP goals in the health focus areas of Overweight, Obesity, and Lack of Physical Activity; Mental Health and Mental Disorders; and, Alcohol, Tobacco, and Other Substance Use and Abuse align with health focus areas of the Healthiest Wisconsin 2020. With the opportunity for increased data accuracy due to the release of the 2010 U.S. Census, the importance of alignment with Healthiest Wisconsin 2020, and the desire for Douglas County to seek national public health accreditation, the county and Steering Committee have embraced an updated Community Health Assessment process and development of a 2012-2016 Douglas County CHIP. The Steering Committee convened meetings in February 2011 and to date has accomplished the following activities: Developed a vision and mission statement for the 2012-2016 CHIP Completed a Community and Themes Assessment Developed, distributed, collected, and analyzed the results of a Community Survey on the health of Douglas County Completed a Forces of Change Assessment Completed a Community Health Data Assessment Selected health focus areas to be addressed in the 2012-2016 CHIP It is anticipated that the 2012-2016 Douglas County CHIP will be released by December 31, 2011. The subcommittees identified in 2007 with the initial development of the Douglas County CHIP have continued to meet through 2011 and this document has been updated to reflect progress towards currently identified CHIP goals. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 4 2011 Update Healthy Priority Overweight, Obesity, and Lack of Physical Activity Goal 1: By 2012, Douglas County residents will increase their physical activity levels by defining more opportunities for activity. Objective 1a: The physical activity level of at least one 3rd grade level class, and their parents/guardians, in each of the three Douglas County public school districts will be assessed. Completion date: December 31, 2008 Baseline: To be established via objective. Anticipated Results of Objective 1a: Results of the survey will guide further planning for lineages with community-based activities, such as Fit City. Individuals participating in the survey will become conscious of their own physical activity levels. 2008 Strategies Developed an assessment tool used to survey children and parents/guardians. Survey focused on parent’s/guardian’s perception of the activity level of their child and themselves. Survey was modeled after questions in the National Behavior Risk Factor Survey and the Youth Risk Factor Behavior Survey. Selected 3 schools (one per school district) representing the demographic profile of Douglas County to target for participation in assessment. Contacted school districts regarding participating in assessment of 3rd grade students and their families. Survey administered to parents/guardians in 2 of 3 Douglas County school districts in October 2008. 2008 Results Children participated in 7 days per week of physical activity while parents had 5 days. Almost 2/3 of parents and ¼ of children had less than 4 days of physical activity per week. Children participated in 2 days and parents 1 day per week of exercise to strengthen or tone muscles. The majority of parents and children played on 1-2 sports teams in the past 12 months. Children participated in 2 days of physical activity class at school in the average week. During the past 5 days, ¾ of children were able to go outside for recess all 5 days. Parents and children participated in 45 minutes of physical activity on the average weekend day. Parents reported watching TV, playing video games or being on the computer for 2 hours on the average school day or weekend day while children reported 1 hour on the average school day and 3 hours on the average weekend day. Four-fifths of parents reported that the family spent time together doing physical activities. To review the full report on the survey results, please see the Appendix. Future Action Steps Results of the survey will be used to fuel the Action Steps for Objective 2a and to update the Douglas County Physical Activity Guide in 2010. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 5 Objective 1b: Increase the number of opportunities children and their families have to be physically active and increase fitness levels. Completion date: December 31, 2009 Baseline: Will be provided via objective 1a to ascertain physical activity levels. Anticipated Results of Objective 1b: Increase in the number of children who are fit and regularly active. Increased opportunities for fitness will lead to an increase in Douglas County residents who are participating in vigorous physical activity. 2010 Strategies Co-chairs of the subcommittee, the Health Officer and the Chair of the Douglas County’s Energy Committee jointly promoted a month-long campaign in August 2010 to encourage County employees to walk or bike to work to increase physical activity and reduce carbon emissions. Douglas County Physical Activity Guide was updated and allowed for increased access to information on available physical activities, hiking, and parks in Douglas County. Worked with local newspaper to have articles submitted on obesity, August Health and Energy Awareness month, and CHIP article with quotes from the Health Officer. Encourage Parish Nurses to use faith-based fitness initiatives in their churches to promote increased awareness. 2010 Results 2008 Results: Results of Douglas County employee initiative to promote physical activity and reduce carbon emissions: Fifteen employees participated in the initiative. 438.7 miles walked, 288.4 miles biked, 1,750 miles car pooled 58,276.6 calories burned 131.4 pounds of CO2 saved August was declared Energy and Health Awareness Month by the Douglas County Department of Health and Human Services Board. 2009 Results: Results of Douglas County employee initiative to promote physical activity and reduce carbon emissions: 34 employees participated in the August 2009 Health and Energy Awareness event. 985 miles biked or walked, 3,472 flights of stairs climbed, 3,407 miles carpooled 154,052 calories burned 254.5 pounds of CO2 saved 2010 Results: Results of Douglas County employee initiative to promote physical activity and reduce carbon emissions: 31 employees participated in the August 2010 Health and Energy Awareness event 524 miles biked, walked, or jogged, 1,188 flights of stairs climbed, 1,175 miles carpooled 41,118 calories burned ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 6 207.9 pounds of CO2 saved Activities included: aerobics, bicycling, calisthenics, canoeing, golf, cleaning, dancing, gardenings, fishing, hiking, hockey, raking, yoga, swimming Conservation activities included: cooking from scratch, growing own food, second hand shopping, recycling, drying clothes on clothes line, farmers markets, using refillable water bottles Douglas County Physical Activity Guide was placed on the Douglas County website, Northern Wisconsin Community Services Agency, and other agencies in the county Future Action Steps Increase access to information on countywide trails through distribution at community centers, churches, community bulletin boards, internet site, libraries – such as Chamber of Commerce, DC. Work with local newspaper to have media focus on project. Parish Nurses – Faithfully Fit. Promote use of trails and parks within Douglas County. Create objective 3b regarding posting information from the CHIP onto the Douglas County website regarding overweight, obesity, and lack of physical activity. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Goal 2: By 2012, Douglas County residents will improve their healthy eating habits. Objective 2a: At least three organizations within Douglas County will offer at least 50% healthy food choices in their facility’s vending machines. Completion date: December 31, 2011 Baseline: To be established after selection of organizations to participate in objective. Anticipated Results of Objective 2a: Douglas County residents in participating organizations will become aware of healthy eating options by introducing more healthy food choices in facility vending machines. Douglas County residents in participating organizations will become aware of healthy eating options by providing education on healthy eating choices. 2011 Strategies Wellness policy information was gathered from the Superior School District and the Solon Springs School District. Targets include: Superior School District, Solon Springs School District, Northwestern School District, Superior Government Center / Douglas County Department of Health and Human Services, Wisconsin Indianhead Technical College, and YWCA. The subcommittee will be using the plan from the various school districts to incorporate health foods into the vending machines. 2011 Results Superior School district Wellness policy notes that all foods available on school grounds and at school- sponsored activities should meet or exceed the District Nutrition Standards (DNS). By the 2010-2011 school year, healthy choices and foods that meet DNS are served in school, outside school and at sporting events. In the 2009-2010 school year, at least 50% of beverage and vending ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 7 machines meet DNS. The YMCA has at least 50% healthy food choices in vending machines. Subcommittee chairs met with supplier of vending machine choices in the Douglas County Government Center. Future Action Steps Continue to support schools to encourage wellness policy efforts. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 3a: Identify target areas that need to be addressed/prioritized to move forward with a community coalition. Completion date: December 31, 2010 Baseline: To determine with this objective. Anticipated Results of Objective 3a: Increase awareness of obesity and lack of physical activity. 2011 Strategies Investigated nutrition/ wellness and physical activity activities taking place in worksite, schools, healthcare, faith based groups and other community groups in Douglas County utilizing resources from the State Nutrition and Physical Activity Plan. Utilized the Worksite Wellness Plan from the State Plan. Worksite wellness survey was completed through collaboration with the Superior Douglas County Chamber of Commerce. Encourage application to Healthy Wisconsin Leadership Institute for 2011 with evolving coalitions. 2011 Results Healthier Douglas County Coalition was formed in January 2011. Coalition’s mission is “Engaging community members to live healthier lifestyles.” Subcommittees were formed as well. The Coalition meets on a basis. Healthier Douglas County Coalition participated in the 4th of July Parade in the City of Superior in collaboration with the American Lung Association. Application to the Healthy Wisconsin Leadership Institute was accepted. Seven members of the Healthier Douglas County Coalition will be attending the year-long training. Met deliverables for the Active Schools Grant by meeting with local policy makers including the Mayor of Superior, Douglas County Administrator, Superior School District Superintendent, and WITC Campus Administrator. Minutes from the Subcommittee continue to be posted on the Douglas County website. Created objective 3b in 2011 to increase community awareness of CHIP objectives related to physical activity and healthy eating. Future Action Steps Continue to support work of the Healthier Douglas County Coalition. Participate in the Douglas County Youth Fair in September 2011. Mini-kick off for the Healthier Douglas County Coalition including activities for children and adults along with information about ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 8 joining the Coalition. Distribute activity water bottles and cinch bags that include the Coalition’s logo. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 3b: Increase community awareness of CHIP objectives related to physical activity and healthy eating. Completion date: December 31, 2011 Baseline: To determine with this objective. Anticipated Results of Objective 3b: Increase awareness of obesity and lack of physical activity. 2011 Strategies Receive approval to post subcommittee updates and meeting minutes to the Douglas County website. Place copy of Physical Activity Guide on the Douglas County website. 2011 Results Subcommittee meeting minutes are placed on the Douglas County website. Work continues on developing bullet points of Subcommittee updates to also include on the website. Physical Activity Guide continues to be distributed in hard copy. Anticipated that the brochure will be revised in 2012 and used in conjunction with the Healthier Douglas County Coalition. Future Action Steps Finalize bullet points of Subcommittee updates for the Douglas County website. In 2012, update the Physical Activity Guide in conjunction with the Healthier Douglas County Coalition. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 9 Health Priority Mental Health and Mental Disorders Goal 1: By 2012, increase awareness of mental health issues in Douglas County by offering training and educational opportunities to Douglas County providers and general public. Final Results The Subcommittee, with approval by the Steering Committee, opted to develop a new goal with more measureable outcomes to determine community mental health need. Goal 2: By 2012, accessibility to mental health services in Douglas County will be described in order to improve access to services. Objective 2a: Develop a plan to improve potential consumer’s awareness of available services, and means of accessing. Completion date: December 31, 2009 Baseline: To be established via this objective. Anticipated Results of Objective 2a: Increased knowledge of the accessibility of mental health services and perceived barriers within Douglas County. 2010 Strategies Distribute surveys, both online and in paper format. Review results and develop recommendations. 2010 Results 190 survey results, with 174 completed responses, were received by April 2010. Results to be analyzed for recommendations and future action steps. 2011 Results The following is data of significance derived from the survey: Half of the respondents have sought out information on mental health services. The age demographic most likely to seek out services were those from 36-55 years old. Women (78%) were much more likely to seek out services than men (22%) Those with post high school education are much more likely to seek out assistance. 78% of the respondents for this question had post high school education. 40% of the post high school educated sought out mental health treatment 20 of the respondents had military service backgrounds. There was an almost even distribution of those who had received mental health services vs. those that had not. 54% of the respondents stated they would seek out mental health treatment from their medical provider. 25% stated they would seek out mental health treatment from a specialized mental health provider. 78% of the respondents stated they had received treatment from their mental health resource, only 22% being referred on. 82 of the respondents included a name of a facility they attended. 26% of the responses were mental health specific agencies. 74% were agencies or departments associated with their primary provider. Seeking out mental health information; 35% would ask for information form their mental health provider, 34% from the internet. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 10 Most (62%) of the respondents were aware of the mental health coverage in their insurance plan. The largest concern (40%) about receiving mental health treatment was cost. This was followed by concerns about privacy (23%) and availability of good treatment Problems with the survey: There were a few questions that were not answered by the survey results. There is no indication to what kind of mental health problems people are seeking help for and who is able to treat that particular mental health problem. As the primary medical provider appears to be the most common mental health resource, it would be good to learn which mental health concerns are generally treated by the physician and which may be referred. The survey does not address the potential impact of the lack of providers in Superior, specifically medication prescriptions. In addition, it would be very helpful to learn where individuals are receiving medication, or if individuals are being under medicated as a result of lack of resources. Future Action Steps All results from the survey will be put into a format usable by area providers, to further enhance services. In addition, the data will be used to improve referrals made by the mental health unit at Douglas County Department of Health and Human Services. I Individual needs should be able to be addressed more directly, specifically how information about mental health is provided, addressing relevant concerns immediately, and examining opportunities to facilitate mental health assistance to those that may not seek it out. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 11 Health Priority Alcohol, Tobacco, and Other Substance Use and Abuse Goal 1: By 2012, reduce the incidence and impact of substance use and abuse in Douglas County. Objective 1a: Increase by 10% each year the number of Douglas County pregnant women in the Prenatal Care Coordination Program (PNCC) with Women, Infant, and Children (WIC) Program or Douglas County Public Health, who will cease use and abuse of alcohol and drugs during pregnancy. Completion date: December 31, 2012 Baseline: ~49 Douglas County women who give birth per year report using alcohol while pregnant [Extrapolation: CDC reports that 10% of women who give birth per year report using alcohol while pregnant. In Douglas County in 2006 there were 490 births.] Anticipated Results of Objective 1a: Harm reduction and prevention of complications from chemical dependency and mental illness to mother, infant, and family unit by offering available PNCC. 2009 Strategies Used “wrap around” to coordinate difficult cases and support family unity. Douglas County Human Services Dept. Alcohol and Other Drug Abuse (AODA) Unit, HDC Mental Health Center, and Superior Treatment Center partnered for ongoing treatment. PNCC pamphlets distributed to the Douglas County Jail, Lake Superior Life Care Center, ER and Urgent Care Clinics, Lake Superior Community Health Center, HDC Mental Health Center, WIC, Family Forum, Head Start, and Early Head Start. Pamphlets were to be placed in the waiting areas at these agencies. PNCC services offered to clients using illicit drugs. 2009 Results 6% decrease in PNCC client admissions from 2008-2009. Year 2007 Client Data: A total of 53 high-risk pregnant women were referred to Douglas County Public Health for prenatal care services and counseling. 27 of these high-risk pregnant women (51%) were admitted to the Douglas County PNCC services. Year 2008 Client Data: A total of 136 high-risk pregnant women were referred to Douglas County Public Health for prenatal care services and counseling. 79 of these high-risk pregnant women (58%) were admitted to Douglas County PNCC services. Year 2009 Client Data: A total of 125 high-risk pregnant women were referred to Douglas County Public Health for prenatal care services and counseling. 65 of these high-risk pregnant women (52%) were admitted to Douglas County PNCC services. Year 2010 Client Data: A total of 98 high-risk pregnant women were referred to Douglas County Public Health for prenatal ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 12 care services and counseling. 73 of these high-risk pregnant women (74%) were admitted to Douglas County PNCC services Year 2011 Client Data (through August): A total of 85 high-risk pregnant women were referred to Douglas County Public Health for prenatal care services and counseling. 55 of these high-risk pregnant women (65%) were admitted to Douglas County PNCC services Future Action Steps Continue to collaborate services* from intake to delivery through economic support with Douglas County Department of Health and Human Services (Women in Transition (WIT)), Douglas County Jail, Lake Superior Life Care Center, ER and Urgent Care Clinics, Lake Superior Community Health Center, HDC Mental Health Center, WIC, Family Forum, Health Start, and Early Head Start. *Services include: education, information and referral, health access, treatment, and case management. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 1b: Reduce by 10% every two years the number of Douglas County adolescents who report using drugs and alcohol, according to the Wisconsin Youth Risk Behavior Survey. Completion date: December 31, 2012 Baseline: Estimated 1,560 Douglas County adolescents aged 14-18 years old consumed at least one drink of alcohol in the past 30 days. [Extrapolation: According to the Youth Risk Behavior Survey (YRBS), in 2005, an estimated 49% of youth reported having at least one drink of alcohol in the past 30 days. The YRBS is administered to 9th-12th grade students (ages approximately 14- 18 years). According to the 2000 U.S. Census, there are 3,185 adolescents in Douglas County aged 14-18 years.] Anticipated Results of Objective 1b: Harm reduction for the youth of Douglas County. Prevention of long-term alcohol and drug use and abuse. Prevention of long-term financial impact to public services. Increase community safety. 2011 Strategies Provide education, consultation, and referral services with children in the rural school districts. Collaborate with local hospital to provide educational services and assessment referrals to youth presenting in emergency rooms for alcohol- or drug-related illness or injury treatment. Provide education to medical providers with tools and guidance for screening alcohol and other drug use during youth visits. Develop an educational forum for both professionals and community members to highlight the increased use of prescription drug use and abuse in youth. 2011 Results 2007 Data Extrapolation: Estimated 4% decrease in Douglas County adolescents who reported using drugs and alcohol from 2005-2007. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 13 Estimated 1,433 Douglas County adolescents aged 14-18 years old consumed at least one drink of alcohol in the past 30 days. [Extrapolation: According to the Youth Risk Behavior Survey (YRBS), in 2007, an estimated 45% of youth reported having at least one drink of alcohol in the past 30 days. The YRBS is administered to 9th-12th grade students (ages approximately 14-18 years). According to the 2000 U.S. Census, there are 3,185 adolescents in Douglas County aged 14-18 years.] Presentation was made in May 2011 to the Superior Optimists Club by Pat McKone, Director of the American Lung Association in Minnesota. Community leaders were present, including representatives from HeadStart, who expressed interest in partnering on the issue. All three school districts were mailed an educational DVD on youth use of alcohol and tobacco. Local pharmacies were contacted to provide information on the use and abuse of prescription medication by youth. 2009 Data Extrapolation: Estimated 12% decrease in Douglas County adolescents who reported using drugs and alcohol from 2005-2009. (Note: U.S. Census data from 2010 used as well a change in the age group provided from U.S. Census data from 14-18 years old to 15-19 years old.) Estimated 1,353 Douglas County adolescents aged 15-19 years old consumed at least one drink of alcohol in the past 30 days. [Extrapolation: According to the Youth Risk Behavior Survey (YRBS), in 2009, an estimated 41% of youth reported having at least one drink of alcohol in the past 30 days. The YRBS is administered to 9th-12th grade students (ages approximately 15-19 years). According to the 2010 U.S. Census, there are 3,006 adolescents in Douglas County aged 15-19 years.] Future Action Steps Subcommittee is interested in rewording the objective to “To increase awareness of Douglas County residents on the hazards of drug and alcohol use and abuse”. The Steering Committee, to date, has not approved this update. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 1c: Engage 5% of the Douglas County Jail inmate population per year in needed alcohol and drug treatment services. Completion date: December 31, 2012 Baseline: Current Douglas County jail population is ~175 inmates. Anticipated Results of Objective 1c: Fewer repeat drug-related crimes/incarcerations measured by the developed tracking system. Reduction of the financial impact on the community for incarceration, treatment services, and related medical costs. 2009 Strategies Partnered with Douglas County Jail, Douglas County Department of Health and Human Services, St. Mary’s Hospital of Superior, Human Development Center (HDC), WI Dept. of Corrections, The Superior Treatment Center. Provided role models who are recovering to mentor inmates and increase the chance of maintaining sobriety. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 14 2009 Results There are about 50 volunteers who provide counseling and educational services to inmates at the Douglas County Jail. There are at least 15 volunteers who provide services weekly. Volunteer services include education on a wide range of topics including drug addiction, basic life skills, money management, and employment after incarceration. Future Action Steps Utilize a new tracking system for successes in treatment programs for incarcerated individuals. Work with Douglas County Jail personnel to assess current programs and their attendance. Continue to contact other Wisconsin counties to obtain information on alcohol and drug treatment services provided to inmates. Develop system, in collaboration with Douglas County Jail personnel and Human Development Center (HDC), to initiate AODA programs consistent with HDC program. Determine additional local and regional resources for volunteer recruitment for collaboration and mentoring. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Goal 2: By 2012, reduce the health and financial impact of tobacco use on individuals and on the community in Douglas County. Objective 2a: Reduce by 10% each year the number of Douglas County women who smoke during their pregnancy. Completion date: December 31, 2012 Baseline: 93 Douglas County women who gave birth in 2006 reported smoking during pregnancy. This was 19% of all births in Douglas County in 2006. (Data from the Birth Counts Module, WISH Query, Wisconsin Department of Health Services.) Anticipated Results of Objective 2a: Increased number of women who deliver a healthy baby. Reduction of harm to the mother, baby, and the family unit. Reduction of financial impact of tobacco use in Douglas County as stated in the Burden of Tobacco in Wisconsin report. 2011 Strategies Continue to identify agencies in Douglas County who are currently serving populations with disparities and offering “new provider” training through University of Wisconsin Center for Tobacco Research and Intervention and local experts. Assist these agencies to develop a policy to identify and refer clients who use tobacco to the Wisconsin Tobacco Quit Line, Fax to Quit program, or other evidence-based tobacco addiction treatment services. 2011 Results 2007 Data: 3% increase in the proportion of Douglas County births to women who smoked during pregnancy from 2006 to 2007. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 15 111 Douglas County women who gave birth in 2007 reported smoking during pregnancy. This was 22% of all births in Douglas County in 2007. Refer all New Baby Referral clients who smoke to the Wisconsin Tobacco Quit Line. 2008 New Baby Referral Data: 171 women with high-risk births were referred to Douglas County Public Health for services and counseling. 144 of these women with high-risk births (84%) were admitted for New Baby services, including information on post delivery and tobacco cessation education and counseling. There were 60 Well Child Exams conducted in 2008 by Douglas County Public Health. At these exams, parents are counseled on tobacco use and provided education and counseling materials on tobacco cessation. 2008 Data: 1% increase in the proportion of Douglas County births to women who smoked during pregnancy from 2007 to 2008. 106 Douglas County women who gave birth in 2008 reported smoking during pregnancy. This was 23% of all births in Douglas County in 2008. 2009 New Baby Referral Data: 114 women with high-risk births were referred to Douglas County Public Health for services and counseling. 95 of these women with high-risk births (83%) were admitted for New Baby services, including information on post delivery and tobacco cessation education and counseling. There were 20 Well Child Exams conducted in 2009 by Douglas County Public Health. At these exams, parents are counseled on tobacco use and provided education and counseling materials on tobacco cessation. 2010 New Baby Referral Data: 149 women with high-risk births were referred to Douglas County Public Health for services and counseling. 107 of these women with high-risk births (72%) were admitted for New Baby services, including information on post delivery and tobacco cessation education and counseling. 2011 New Baby Referral Data (through August): 88 women with high-risk births were referred to Douglas County Public Health for services and counseling. 62 of these women with high-risk births (70%) were admitted for New Baby services, including information on post delivery and tobacco cessation education and counseling. 2011 Data: In 2009, 19% of Douglas County mothers reported smoking during pregnancy. This represents no change in the proportion of smoking mothers from 2006 to 2009. Douglas County has, over time, a higher proportion of mothers who smoke during pregnancy when compared to the state of Wisconsin as a whole. In 2009, 14% of Wisconsin mothers reported smoking during pregnancy. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 16 A presentation was done at the Superior Optimists Club by Pat McKone, Director of the American Lung Association of Minnesota. Community leaders were present, including representatives from HeadStart, who expressed interest in partnering on the issue. Future Action Steps Continue to identify agencies in Douglas County who are currently serving populations with disparities and offering “new provider” training through University of Wisconsin Center for Tobacco Research and Intervention and local experts. Assist these agencies to develop a policy to identify and refer clients who use tobacco to the Wisconsin Tobacco Quit Line, Fax to Quit program, or other evidence-based tobacco addiction treatment services. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 2b: Reduce by 10% every two years the number of Douglas County middle school and high school youth who use tobacco as reported in the Wisconsin Youth Risk Behavior Survey. Completion date: December 31, 2012 Baseline: Estimated 732 Douglas County adolescents 14-18 years old smoked one or more cigarettes in the past 30 days. [Extrapolation: According to the Youth Risk Behavior Survey (YRBS), in 2005, about 23% of Wisconsin youth reported smoking one or more cigarettes in the past 30 days. The YRBS is administered to 9th-12th grade students (ages approximately 14-18 years). According to the 2000 U.S. Census, there are 3,185 adolescents in Douglas County 14-18 years old.] Anticipated Results of Objective 2b: Decreased number of youth who initiate tobacco use. Increase the number of youth-led tobacco-related activities in the schools. Reduction of financial impact of tobacco use in Douglas County as stated in the Burden of Tobacco in Wisconsin report. 2011 Strategies Engaged youth in Wisconsin WINS compliance checks to ensure that access to tobacco for underage populations is limited. Promoted tobacco-related activities in schools through the Douglas County Tobacco Free Coalition. 2011 Results 2007 Data Extrapolation: Estimated 13% decrease in Douglas County adolescents who use tobacco from 2005-2007. Estimated 637 Douglas County adolescents 14-18 years old smoked one or more cigarettes in the past 30 days. [Extrapolation: According to the Youth Risk Behavior Survey (YRBS), in 2007, about 20% of Wisconsin youth reported smoking one or more cigarettes in the past 30 days. The YRBS is administered to 9th-12th grade students (ages approximately 14-18 years). According to the 2000 U.S. Census, there are 3,185 adolescents in Douglas County 14-18 years old.] 2009 Data Extrapolation: Estimated 30% decrease in Douglas County adolescents who use tobacco from 2005-2009. (Note: U.S. Census data from 2010 used as well a change in the age group provided from U.S. Census data from ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 17 14-18 years old to 15-19 years old.) Estimated 511 Douglas County adolescents 14-18 years old smoked one or more cigarettes in the past 30 days. [Extrapolation: According to the Youth Risk Behavior Survey (YRBS), in 2009, about 17% of Wisconsin youth reported smoking one or more cigarettes in the past 30 days. The YRBS is administered to 9th-12th grade students (ages approximately 15-19 years). According to the 2010 U.S. Census, there are 3,006 adolescents in Douglas County aged 15-19 years.] Youth from multiple middle schools in Douglas County participated in the Wisconsin WINS program, in collaboration with the Northwest Wisconsin Tobacco-Free Coalition. One location in Douglas County did sell tobacco products to youth in 2011, compared to ten in 2010. Youth in Douglas County have the opportunity to participate in a youth-driven advocacy group titled FACT – Fighting Against Corporate Tobacco. In FACT, youth educated and engage their peers and decision makers on tobacco’s harm and the tobacco industry’s tactics. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 2c: From 2008-2012, reduce by 5% the number of adult smokers in Douglas County. Completion date: December 31, 2012 Baseline: Estimated 9,263 Douglas County adults smoke cigarettes. (According to the 2007 Wisconsin County Health Rankings, 28% of Douglas County adults at least 18 years old smoke cigarettes). Anticipated Results of Objective 2c: Decrease number of adults using tobacco. Decrease mortality directly related to tobacco use. Decrease the financial impact of smoking/tobacco use in Douglas County as stated in the Burden of Tobacco in Wisconsin report. 2011 Strategies Partnered with Northwest Wisconsin Tobacco-Free Coalition to monitor compliance with tobacco laws, promote the Wisconsin Tobacco Quit Line, and track tobacco legislation. Asked each patient about smoking/tobacco use during each encounter and documented patient’s readiness to quit. Advised each patient on the readiness of quitting and the health effects of continued smoking/tobacco use. Assessed the patient’s willingness to quit within the next 30 days and their barriers to cessation. Assisted patients with their plan to quit smoking/tobacco use and refer to the Wisconsin Tobacco Quit Line. Arranged for follow-up with patients or use of the Fax to Quit program. 2011 Results 2008 Wisconsin County Health Rankings Data: 5% decrease in Douglas County adults who smoke cigarettes from 2007-2008. Estimated 7,610 (23%) Douglas County adults smoke cigarettes. 2008 Douglas County Public Health Data: ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 18 There were approximately 400 encounters at Douglas County Public Health in 2008 for exams, vaccinations, counseling and services. During each visit, clients are educated on tobacco use, cessation methods, and cessation services. 144 women with high-risk births were admitted to PNCC for services, including information on post delivery, tobacco cessation and Quit packages with education and counseling materials. There were 60 Well Child Exams conducted in 2008 by Douglas County Public Health. At these exams, parents are counseled on tobacco use and provided education and counseling materials on tobacco cessation. 2009 Wisconsin County Health Rankings Data: 4% increase in Douglas County adults who smoke cigarettes from 2008-2009. Estimated 8,933 (27%) Douglas County adults smoke cigarettes. 2009 Douglas County Public Health Data: There were approximately 700 encounters at Douglas County Public Health in 2009 for exams, vaccinations, counseling and services. During each visit, clients are educated on tobacco use, cessation methods, and cessation services. 114 women with high-risk births were referred to Douglas County Public Health for services and counseling. 95 of these women with high-risk births (83%) were admitted to PNCC for services, including information on post delivery, tobacco cessation and Quit packages with education and counseling materials. There were 20 Well Child Exams conducted in 2009 by Douglas County Public Health. At these exams, parents are counseled on tobacco use and provided education and counseling materials on tobacco cessation. 2010 Douglas County Public Health Data: There were approximately 848 encounters at Douglas County Public Health in 2010 for exams, counseling and services. During each visit, clients are educated on tobacco use, cessation methods, and cessation services. 149 women with high-risk births were referred to Douglas County Public Health for services and counseling. 107 of these women with high-risk births (72%) were admitted for New Baby services, including information on post delivery and tobacco cessation education and counseling. There were 6 Well Child Exams conducted in 2010 by Douglas County Public Health. At these exams, parents are counseled on tobacco use and provided education and counseling materials on tobacco cessation. 2011 Wisconsin County Health Rankings Data: Estimated 9,367 (27%) Douglas County adults smoke cigarettes. (Note: U.S. Census Bureau population estimates for 2010 estimate there are 34,694 adults in Douglas County at least 18 years old.) 2011 Douglas County Public Health Data (through August): There were approximately 640 encounters at Douglas County Public Health in 2011 for exams, counseling and services. During each visit, clients are educated on tobacco use, cessation methods, ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 19 and cessation services. 88 women with high-risk births were referred to Douglas County Public Health for services and counseling. 62 of these women with high-risk births (70%) were admitted for New Baby services, including information on post delivery and tobacco cessation education and counseling. Wisconsin is ranked #8 in the country for tobacco tax, the most effective strategy in reducing tobacco use. The Northwest Wisconsin Tobacco-Free Coalition tracks legislation related to taxation on both cigarettes and smokeless tobacco, assuring that “cheap” tobacco is not an alternative. Future Action Steps Coordinate actions with the Wisconsin Youth Tobacco Survey for 2008, as well as in conjunction with the Clean Air Workplace law. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. Objective 2d: Assess the establishments that are licensed by the Douglas County Environmental Services and are required by WI Act 12/Senate Bill 181 for compliance with smoke free air. Completion date: July 1, 2011 Baseline: To be determined with this objective. 2011 Strategies Assessed the number of worksites who will be affected by the Wisconsin Act 12/ Senate Bill 181 and provided them with guidance for complying with the new smoke free law that goes into effect on July 5, 2010. Explored barriers for compliance and assisted in problem solving to assure compliance. Supplied “business materials” to workplaces and responded to questions regarding compliance issues. Ascertained businesses not in compliance and reported through the process recommended by the new Multi Jurisdictional Coalition, the Northwest Wisconsin Tobacco-Free Coalition, only after assistance had been provided. 2011 Results All businesses in Douglas County were provided with a Smoke-Free Implementation Packet that included definitions of the law, a list of cessation resources available, information on informing customers, a window cling and an informational brochure with frequently asked questions for business owners. The Northwest Wisconsin Tobacco-Free Coalition received copies of complaints regarding noncompliance in Douglas County and followed up at the local level. The Northwest Wisconsin Tobacco-Free Coalition regularly promoted the “complaint line” to the general public, along with meeting with Douglas County Department of Health and Human Services Public Health to coordinate efforts. As objectives are assessed or obtained, further objectives or strategies will be modified or defined. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 20 Douglas County CHIP Participants Steering Committee Lynne Bauer, Public Health Nurse – Douglas County Department of Health and Human Services Deb Clasen*, Health Officer/Deputy Director Health Services – Douglas County Department of Health and Human Services Tom Dalbec, Sherriff – Douglas County Sherriff Department Steve Engelson, CSP Clinical Coordinator – HDC Douglas County June Farkas – Wisconsin Indianhead Technical College (WITC) Grace Gee, Nutritionist – UW Extension Nutrition Education Mary Holschuh, Director – Aging and Disability Resource Center (ADRC) of Douglas County Alan Jacques – Tavern League Chuck LaGesse, Captain – Superior Police Department Kathi Madsen, Director – United Way of Superior, Douglas County Mary Mahan, Director – Northwestern Wisconsin Community Services Agency WIC Program John Nousane, Director – North Country Independent Living Pat Schanen, Director – Douglas County Department of Health and Human Services Mary Shaw, Administration – St. Mary’s/Duluth Clinic, Superior Nancy Smith, Director – Superior School District, Health Services Karen Strauman, Director of Patient Care Services – SMDC , St. Mary’s Superior and Clinic Reverend Barbara Certa Werner – Harbor House Crisis Center Dave Longsdorf, Supervisor, Mental Health / AODA – Douglas County Department of Health and Human Services Ken Zurian, RS – Douglas County Department of Health and Human Services * Steering Committee Lead ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 21 Subcommittees Overweight, Obesity, and Lack of Physical Activity Cathi Austin, Health Enhancement Coordinator – Superior Douglas County YMCA Lynne Bauer**, Public Health Nurse – Douglas County Department of Health and Human Services Michelle Arhnold Davies, Assistant Professor, Physiology Natural Sciences – University of Wisconsin-Superior Grace Gee**, Nutritionist – UW Extension Nutrition Education Program Jeanne Hopkins, Food Service Director – Superior School District Mary Mahan, WIC Director – Northwestern Wisconsin Community Services Agency Jenice Meyer, Coordinator – Center for Academic Service Learning, University of Wisconsin-Superior Kim Lebard-Rankila, Senior Lecturer, Health and Human Performance – University of Wisconsin-Superior Jan Stevens, Director – Parish Nurse Ministries Mental Health and Mental Health Disorders Steve Engelson, CSP Clinical Coordinator – HDC Douglas County Mary Holschuh, Director – Aging and Disability Resource Center (ADRC) of Douglas County Dave Longsdorf**, Supervisor, Mental Health/AODA – Douglas County Department of Health and Human Services Peggy Nichols**, Public Health Nurse – Douglas County Department of Health and Human Services John Nousane, Director – North Country Independent Living Pat Schanen, Director – Douglas County Department of Health and Human Services Mary Shaw, Administration – St. Mary’s/Duluth Clinic, Superior Reverend Barbara Certa Werner – Harbor House Crisis Center Alcohol, Tobacco, and Other Substance Use and Abuse Chad Braafladt – Superior Treatment Center Gwen Brand – Douglas County Jail Tom Dalbec, Sherriff – Douglas County Sherriff Department June Farkas – Wisconsin Indianhead Technical College (WITC) Scott Finn – St. Luke’s Brette Garnatz – American Lung Association Bob Galovich – Douglas County Jail Michele Hughes**, Public Health Nurse – Douglas County Department of Health and Human Services Joan Keeler Pellman – Family Forum, Inc. Andrea Kubarek, Public Health Nurse – Douglas County Department of Health and Human Services Jane Larson – HDC Douglas County Matt Markon, Captain – Superior Police Department Mike Miller – Superior Police Department Julie Newman – St. Mary’s/Duluth Clinic, Superior Nancy Smith, Director – Superior School District, Health Services ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 22 Subcommittee Leads ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 23 Appendix ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 24 Purpose and Scope The shared vision of Wisconsin’s public health system partners describes a vision that a healthy Wisconsin is a place where… All residents reach their highest potential Communities support the physical, emotional, mental, spiritual, and cultural needs of all people People work together to create healthy, sustainable physical and social environments for their own benefit and that of future generations This vision led to a mission for the public health system in Wisconsin to protect and promote the health of the people of Wisconsin. In order to achieve such mission, three overarching goals have been developed: 1. Eliminate health disparities 2. Promote and protect health for all 3. Transform the public health system These goals are then subdivided into system (infrastructure) priorities and health priorities. By assessing health priorities regularly through the process of the Community Health Improvement Plan (CHIP), progress is maintained to fulfill the objectives and mission of the Wisconsin public health system and strive towards its healthy Wisconsin vision. Wisconsin Administrative Code for the Department of Health and Family Services requires, via Chapter HFS 140.04 that local health departments “participate in community health assessment; collect, review and analyze data on community health; and undertake case-finding to identify population groups, families and individuals at high risk of illness, injury, disability or premature death.” The CHIP process occurs every five years and is described as: A locally based initiative Identifying local factors causing health concerns Recognizing community assets and resources Addressing local health priorities Linking to state and national priorities Mobilizing community resources to improve the health of residents The purpose of the CHIP is to: Form and strengthen partnerships Increase community awareness Tap community’s innovative ideas Integrate isolated efforts…build on existing services Conserve resources…prevent duplication of efforts Develop comprehensive strategies that will work in your community ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 25 The CHIP process should include participation and feedback from representatives of the community, community leaders, and individuals interested and committed to creating a healthier community. Methods A Community Health Assessment Steering Committee was developed in March 2007. An invitational letter for participating on the steering committee was sent out on behalf of the Douglas County Department of Health and Human Services. Membership was selected based on previous membership of community health assessment processes and expanded interest of agencies throughout the jurisdiction. The organization and facilitation of the committee was led by the Health Officer from Douglas County. Members of the steering committee represent the Douglas County Department of Health and Human Services, local hospitals, local school district, Douglas County law enforcement, City of Superior police department, UW Extension program, mental health and crisis centers, disability resources, aging resources, nutrition resources, faith-based community organization, the Douglas County Board, and the United Way. steering committee meetings were held to guide the CHIP and its development. A health assessment was conducted by review of compiled local, state, and national data on the following the health priorities designated in the Healthiest Wisconsin 2010 plan: Demographic information Access to primary and preventative health services Adequate and appropriate nutrition Alcohol and other substance use and addiction Environmental and occupational health hazards Existing, emerging, and re-emerging communicable diseases High risk sexual behavior Intentional and unintentional injuries and violence Mental health and mental disorders Overweight, obesity, and lack of physical activity Social and economic factors that influence health Tobacco use and exposure Summaries of these above health topics as they pertain to Douglas County can be found in the section titled Douglas County Health Assessment Summary. A list of information sources used can be found in the section titled Sources. Access to the 123-page document of the full data assessment used for the Douglas County CHIP is available to the public . Please navigate to the below link and click on the link labeled “Douglas County Population Data and Other Demographics”. http://www.douglascountywi.org/Community%20Health%20Assessment/community%20health%20a ssessment.htm ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 26 After review of available data, the subcommittee ranked health priorities numerically based on set criteria. The criteria included current activities existing in the community, size of the problem, feasibility of instituting interventions, seriousness of consequences of health issue, and perceived importance and resources of community (capacity). Three healthy priorities were selected by the group to be those most fitting of need while meeting the above criteria. The three health priorities selected for the 2008-2012 Douglas County CHIP are: Overweight, Obesity, and Lack of Physical Activity Mental Health and Mental Disorders Alcohol, Tobacco, and Other Substance Use and Abuse Three subcommittees were developed to lead the development of goals and objectives for each of the health priorities. Subcommittee composition included members from the Steering Committee and additional organizations throughout the jurisdiction. These subcommittees met outside of the regular steering committee meeting and reported back their ideas and development to the steering committee for approval. Public information flyers were developed and distributed within the jurisdiction via notice in the local newspaper, drop-off sites throughout the jurisdiction, and on the Douglas County website. These flyers requested public feedback on how to address the three health priority areas. Feedback received from the public was incorporated into conversations at the Steering Committee and appropriate subcommittee levels. The work in the individual subcommittees was disbanded in September and the steering committee then worked as a whole to finalize the goals and objectives for each of the three health priority areas. Detailed in this CHIP are the proposed goals and objectives for each health priority. The achievement of the objectives is described by proposed strategies, action steps, and anticipated results. All objectives are meant to be specific, measurable, attainable, realistic, and timely. Some of the goals and objectives for health priorities are for later years of this CHIP and relying on information collected in surveys and assessments in 2008 and 2009. These goals and objectives will be further developed as the plan goes on to ensure that steady achievement continues. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 27 Douglas County Profile Location and Size Douglas County is located in the very northwest corner of Wisconsin. Bordering Douglas County include Bayfield County to the east, Washburn and Burnett Counties to the south, the state of Minnesota to the west, and Lake Superior to the north. The county is approximately 1,309 square miles and is mostly rural. The 2000 census for Douglas County reports 43,287 residents with 63% of the residents living in the city of Superior, the county seat. Gender and Age In Douglas County, 49% of the population is male while 51% is female. Just under one-quarter of the population is under 18 years old and approximately 15% is 65 years old or older. The median age for a Douglas County resident is 37.7 years old. Estimated Population Size by Age Group, Douglas County and Wisconsin, 2000. United States Census Bureau., American FactFinder. Available at: http://www.factfinder.census.gov 0% 5% 10% 15% 20% Percent of Estimated Population Douglas County Wisconsin ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 28 Race, Ethnicity, and Household Languages Ninety-nine percent of Douglas County residents are one race and the majority of them are white. Two percent of Douglas County residents are foreign-born while 4% of residents speak a language other than English at home. Of those who speak other a language other than English at home, 30% speak Spanish, 36% speak other Indo-European languages, and 12% speak an Asian or Pacific Island language. Race/Ethnicity Distribution of Douglas County and Wisconsin, 2000. United States Census Bureau., American FactFinder. Available at: http://www.factfinder.census.gov Births The birth rate in Douglas County has declined steadily over time. The birth rate in Douglas County in 2005 was 107.7 births per 10,000 population. In 2005, the majority of births in Douglas County were to women aged 20-34 years old. The majority of births to non-White mothers in Douglas County in 2005 were to American Indian mothers In 2005 in Douglas County, the majority of births were to mothers who were a high school graduate or had some college education. This is similar to that seen in other regions of the state and in the state as a whole. The proportion of all births that are to teen mothers (or those less than 20 years old) has decreased over time in Douglas County, the Western DHFS region, and Wisconsin. In 2005, 8.6% of births were to teens in Wisconsin, 8.2% in Douglas County, and 7.1% in the Western DHFS region. Race Douglas County Wisconsin White 95.3% 88.9% Black or African American 0.6% 5.7% American Indian or Alaska Native 1.8% 0.9% Asian 0.6% 1.7% Native Hawaiian or Pacific Islander < 0.1% < 0.1% Two or More Races 1.4% 1.2% Hispanic or Latino (of any race) 0.7% 3.6% ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 29 Birth Rate per 10,000 Population, Douglas County, Births by Maternal Age Group, Douglas County and 1980-2005. Wisconsin, 2005. Wisconsin Department of Health and Human Services, Division of Public Wisconsin Department of Health and Human Services, Division of Health, Bureau of Health and Information Policy. Wisconsin Births and Public Health, Bureau of Health and Information Policy. Wisconsin Infant Deaths, 2005, (PPH 5364-05), September 2006. Births and Infant Deaths, 2005, (PPH 5364-05), September 2006. Households The average household size for Douglas County is 2.4 persons and the average family size is 2.9 persons. Sixty-three percent of the households are family households, of which 10% have a female householder with no husband present. Over one-third of the households in Douglas County are nonfamily households. An example of this would be friends living together. One-quarter of the households in Douglas County have individuals at least 65 years old, much higher than the state of Wisconsin at 10%. Employment Of those 16 years old or older in Douglas County, 65% were in the labor force in 2000. Within the 65% in the labor force, 5% were unemployed. The 2007 Wisconsin County Health Rankings state a 5% unemployment rate for Douglas County. The unemployment rate for the state of Wisconsin is 4.7% Education Of the Douglas County population that is at least 25 years old, 86% at least have a high school diploma and 18% have a bachelor’s degree or even higher educational degree such as a Masters. This compares to 85% of Wisconsin residents at least 25 years old having at least a high school diploma and 22% having a bachelor’s degree or higher. According to the 2007 Wisconsin County Health Rankings, 14% of Douglas County residents do not have a high school degree. This number is similar to that of the State of Wisconsin 0 20 40 60 80 100 120 140 160 180 Birth Rate per 10,000 population ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 30 Disability Almost one-fifth of Douglas County residents over 5 years old have reported a disability on the year 2000 census. These disabilities include sensory, physical, mental, or self-care disabilities. Half of the Douglas County residents that are 21-64 years old with a disability are employed. Income The median household income based on 1999 income for a Douglas County household is $35,226 and the median income for a family is $43,813. Compared to the state of Wisconsin, a greater proportion of Douglas County individuals, families, and families with female householders are below the poverty level. In Douglas County families with a female householder that are below the poverty level, one-third have children less than 18 year old and almost half have children less than 5 years old. According to the 2007 County Health Rankings, almost 14% of children in Douglas County are in poverty, compared to 11% of children in Wisconsin. (Note: U.S. Census Bureau uses a set of money income thresholds that vary by family size and composition to detect who is poor. If the total income for a family or unrelated individual falls below the relevant poverty threshold, then the family or unrelated individual is classified as being "below the poverty level.") Percent Below Poverty Level Douglas County Wisconsin Individuals 11% 9% Families 8% 6% Families with Female Householder 25% 22% Poverty Levels in Douglas County and Wisconsin, 2000. United States Census Bureau., American FactFinder. Available at: http://www.factfinder.census.gov Insurance In 2000 in Douglas County, it was estimated that about 8-12% of all residents were uninsured. Of those less than 18 years old, 4-10% were uninsured. According to the 2007 County Health Rankings, almost 13% of Douglas County residents are uninsured compared to 7% of all Wisconsinites. County Health Rankings The 2007 Wisconsin County Health Rankings, provided by the University of Wisconsin Population Health Institute, is an annual report “health check-up” of the 72 Wisconsin counties and the City of Milwaukee. The summary of the health in each county in Wisconsin stems from 34 measures of health from multiple data sources. Counties having a high ranking 1 or 2) are considered to be the “healthiest”. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 31 There are two major health categories included in the report – health outcomes and health determinants. Health outcomes measure the state of health in a county and include mortality and morbidity data. Douglas County ranks 65 out of 73 jurisdictions. Counties ranking in the top five and bottom five of all 73 jurisdictions for the health outcomes measure are listed below. Top Five Bottom Five 1. Ozaukee 69. Adams 2. Waukesha 70. Marquette 3. Eau Claire 71. Juneau 4. Iowa 72. Milwaukee City 5. Dane 73. Menominee Counties Ranked in the Top Five and Bottom Five for the Health Outcomes Measure. Athens JK, Taylor KW, Booske BC, Kempf AM, Remington PL. 2007 Wisconsin County Health Rankings Full Report, University of Wisconsin Population Health Institute. 2007. Health determinants measure the predictors of future health outcomes in a county. It includes data on health care, health behaviors, socioeconomic factors, and the physical environment. Douglas County ranks 64 out of 73 jurisdictions. Counties ranking in the top five and bottom five of all 73 jurisdictions for the health determinants measure are listed below. Top Five Bottom Five 1. Ozaukee 69. Marquette 2. Waukesha 70. Adams 3. Lafayette 71. Milwaukee County 4. Washington 72. Milwaukee City 5. Dane 73. Menominee Counties Ranked in the Top Five and Bottom Five for the Health Determinants Measure. Athens JK, Taylor KW, Booske BC, Kempf AM, Remington PL. 2007 Wisconsin County Health Rankings Full Report, University of Wisconsin Population Health Institute. 2007. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 32 Douglas County Health Priorities – 2008-2012 Healthy Priority Overweight, Obesity, and Lack of Physical Activity Obesity and physical inactivity is related to the development of various chronic diseases including cardiovascular disease, cancer, and diabetes. Colorectal cancer is associated with a sedentary lifestyle, obesity, and diets high in fat and low in fruits and vegetables. Female breast cancer is related to obesity after menopause while prostate cancer is related to a diet high in fat and red meats and low in fruits and vegetables. Lack of nutrition, physical inactivity, and obesity is associated with diabetes. Diabetics are three times as likely to be obese, three times as likely to have high blood pressure, and more than twice as likely to have high cholesterol compared to those who do not have diabetes. It is estimated that almost 7% of Douglas County residents have diabetes, with almost 30% of these cases undiagnosed. Over one-fifth of the hospitalizations in Douglas County in 2002 were diabetes-related costing an estimated $1.25 million. It is estimated that in 2002, the direct and indirect costs for diabetes in Douglas County was $33.8 million. Definitions Individuals are considered overweight or obese based on their Body Mass Index (BMI). BMI is a mathematical ratio of weight and height correlated with body fat (kg/m2). BMI is a better predictor of disease risk than body weight alone. BMI between 18.5 and 24.9 is considered “normal weight”. Overweight is having a BMI between 25.0 and 29.9. Obese is having a BMI of at least 30.0. Risk of mortality from many chronic diseases increases with a BMI over 25.0. As a guideline, the 1996 Surgeon General’s Report on Physical Activity and Health recommends each person accumulate 30 minutes of moderately intensive physical activity for five or more days of the week, minimally 150 minutes a week of activity. (Healthiest Wisconsin 2010 Implementation Plan Summary, June 2005). Healthiest Wisconsin 2010 Goals By 2010, infrastructure will be in place that fosters the development, support, and sustainability of healthy lifestyles among Wisconsin residents. Between 2001 and 2010, increase the proportion of Wisconsin adolescents who report they engaged in at least 30 minutes of moderate physical activity, on five or more of the previous seven days from 27% to 37%. Between 2000 and 2010, increase the proportion of Wisconsin adults who reported they engaged in any physical activities in the past month from 78% to 88%. Between 2000 and 2010, reduce the proportion of Wisconsin children who are overweight from 11.4% to 9.4% ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 33 Between 2000 and 2010, reduce the proportion of Wisconsin adolescents who are overweight from 10% to Between 2000 and 2010, reduce the proportion of Wisconsin adults who are obese from 20% to 15%. Douglas County Data The 2007 Wisconsin County Health Rankings state that 66% of Douglas County residents are overweight and 24% are obese. Twenty-three percent of Wisconsin residents are reported to be obese. The 2005 Bridge to Health Survey reports drastic differences in how individuals in Douglas County perceive their own weight. According to the 2005 Bridge to Health Survey, about 27% of Douglas County residents felt there are overweight while 71% felt their weight is about average. Just over 30% of Wisconsin youth report that they are or very overweight. Additionally, 45% of Wisconsin youth reported that they are trying to lose weight. From 2000-2005, about 81% of Wisconsin Western Region residents reported any exercise in the past month. Exercise included things such as running, calisthenics, golfing, gardening, or walking. more men than women reported exercise in the past month. According to the 2007 Wisconsin County Health Rankings, 53% of Douglas County residents are inactive. This is 10% higher than the state of Wisconsin. These individuals do not meet the recommended levels for moderate physical activity (30 minutes of moderate physical activity per day for five or more days per week) or vigorous physical activity (20 minutes per day of vigorous physical activity for three or more days per week). From 1997- 2005, the proportion of youth in Wisconsin who participated in physical activity ranged from to 60% to 67%. This physical activity was described as activity that made them sweat and breathe hard for at least 20 minutes on at least three of the past seven days. Prevalence of Overweight and Obese Adults by Age Self-reported Youth Perception of Weight in Group, Western WI, 2000-2005. WI, 1997-2005. Wisconsin Department of Health and Family Services, Division of Wisconsin Department of Public Instruction. 2005 Wisconsin Public Health, Bureau of Health Information and Policy. Wisconsin Risk Behavior Survey, Trends, January 25, 2006. Interactive Statistics on Health (WISH) data query system, Available at: http://wisconsin.gov/wish/ 0% 10% 20% 30% 40% 50% Percent of Respondents Overweight Obese 0% 10% 20% 30% 40% 50% 60% 1997 1999 2001 2003 2005 Percent of Youth Respondents Self-described or very overweight Trying to lose weight ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 34 When examining the prevalence of overweight and obese adults in the Wisconsin Western Region, about 20% of those aged 18-24 years old are overweight while almost 50% of those 55-64 years old are overweight. Moreover, 14% of those Wisconsin Western Region residents who are 18-24 years old are obese while twice the amount of 55-64 years old Wisconsin Western Region residents are obese. Health Priority Mental Health and Mental Disorders Just over one-fourth of U.S. adults have a diagnosable mental disorder and, in 2005, suicide was the 11th leading cause of death in the U.S. Mental health disorders vary in severity and in the way they impact one’s life. There is no “one size fits all” treatment method for mental disorders yet modern treatment methods are highly effective. Unfortunately, 40% of Americans who have a severe mental disorder do not seek treatment. Similar staggering numbers are prevalent in Douglas County as well. Definitions 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 indispensible to personal well-being, family and interpersonal relationships, and meaningful contribution to community and society. Mental illness is the term that refers collectively to all diagnosable mental disorders. 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 impaired functioning and result in human problems that may include disability, pain, or death. (Healthiest Wisconsin 2010 Implementation Plan Summary, June 2005). Healthiest Wisconsin 2010 Goals By 2010, 80% of State-administered employee group health plans, Medicaid –funded programs, BadgerCare, and SSI managed care will, by contract, incorporate questions for mental health problems into their screening and referral process. By 2010, an additional 15% of the general public will demonstrate an understanding that individuals with mental disorders can recover through treatment to lead productive, healthy, and happy lives. By 2010, an additional 15% of the general public will demonstrate the belief that individuals with mental disorders are capable of sustaining long-term productive employment. By 2010, 80% of publicly funded mental health consumers will feel their service provider was sensitive to their culture during the treatment, planning, and delivery process. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 35 By 2010, Wisconsin’s public mental health clients who have access to “best practice” mental health treatments will increase by 10%. By 2010, Wisconsin’s public mental health clients who have access to “evidence-based” mental health treatments will increase by 10%. Douglas County Data In Wisconsin high school students in 2005, 18% considered attempting suicide in past year, 15% made a suicide plan, 9% actually attempted suicide, and 2% of Wisconsin high school students required medical treatment after a suicide attempt in the past year. According to the 2005 Bridge to Health Survey, almost 11% of Douglas County adults wanted mental health assistance but did not talk or delayed talking to someone about the issue. Among this group, 25% did not talk or delayed talking to someone about mental health assistance because it cost too much, 18% did so because insurance did not cover it, and 18% did not think it was serious enough. Although Douglas County is just across the bridge from Duluth, Minnesota, the perceptions of where to seek mental health service information in Douglas County is much different than counterparts in Duluth. According to the 2005 Bridge to Health Survey, the majority of both Douglas County (45%) and Duluth (53%) residents will first refer a family or friend to a physician or health care provider for mental health assistance. Other resources for Douglas County residents referring a family or friend for mental health assistance included family or friends church or faith community or mental health services from the phone book Conversely, residents in neighboring Duluth, Minnesota will refer a family or friend for mental health assistance to mental health services from a phone book their family or friends or church or faith community Mental Health Services Outreach and Reasons for Delaying or Not Seeking Mental Health Assistance, Douglas County, 2005. Finch, M.D., Vezina, J.M., Kinney, A.M., Peterson, J.M.; Bridge to Health Collaborative (2005). Bridge to Health Survey 2005: Northeastern Minnesota and Northwestern Wisconsin Regional Health Status Survey. June 2006 ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 36 Health Priority Alcohol, Tobacco, and Other Substance Use and Abuse Serious health and economic impacts stem from the use and abuse of alcohol, tobacco, and other substances in Douglas County. Alcohol and other drug abuse is the fourth leading cause of death in Wisconsin behind heart disease, cancer, and stroke. Behavioral outcomes of alcohol consumption include unintentional injuries crashes, falls, drowning) and violence. In 2002, about 6% of all crashes in Douglas County were alcohol-related with drinking drivers. Health outcomes associated with the consumption of alcohol include chronic diseases liver cirrhosis, pancreatitis, cancer, high blood pressure, disorders) and harm to the developing fetus. It is estimated that 3% of the total cancer deaths in the U.S. are attributable to drinking alcohol. Oral cancers are six times more common in those who use alcohol compared to those who do not use alcohol. Consumption of alcohol causes severe, irreversible damage to a developing fetus. In 2003, 10% of pregnant women in the U.S. reported consuming alcohol while pregnant and 4% reported binge drinking while pregnant. From 2000-2004, 980 years of potential life were lost due to smoking in Douglas County residents. About 72 Douglas County residents die annually from a smoking-related illness. Tobacco use is responsible for one-third of all cancer deaths each year. Besides causing cancer, tobacco use is also associated with increased risk for cardiovascular disease and respiratory disease. Smoking is related to low bone density in post menopausal women and an increase in asthmatic episodes. There are multiple adverse reproductive and early childhood effects that result from cigarette smoking such as low birth weight, infertility, and sudden infant death The proportion of births to mothers who reported smoking during pregnancy has declined over time in both Douglas County and Wisconsin, although Douglas County still reports about 8% more smoking mothers than the state as a whole. The numerous adverse health outcomes from tobacco smoking led to an estimated $17.3 million in health care costs and an estimated $13.1 million in costs due to lost productivity were attributed to illness and premature death due to smoking in Douglas County residents. The dependence and abuse of illicit drugs or alcohol is related to serious distress. In 2005, 21% of U.S. adults with serious distress were dependent or abusing illicit drugs or alcohol. Among the 5.2 million Americans with serious distress and substance dependence or abuse in 2005, about half received mental health treatment or substance abuse treatment at a specialty facility; 9% received treatment for both issues. In 2005, persons with a major depressive episode in the last year were more likely to be dependent on or abuse illicit drugs or alcohol than those without a major depressive episode. Definitions According to the American Association (1994), inappropriate use is the use of a substance in a manner that exceeds the safe or prescribed amount or frequency, or poses a health or safety risk to the user or others. Examples of inappropriate use include use during pregnancy, intoxicated driving, drinking to incapacitation, underage drinking, or heavy or immoderate drinking. It also includes the infrequent or experimental use of illegal street drugs. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 37 The American Association (1994) has identified several disorders associated with the abuse of alcohol or other substances. Abuse is described as use resulting in a pattern of negative consequences such as school or work absences, neglect of children, legal problems, or heated arguments with a spouse. Dependence is defined as use leading to a pattern of clinically significant impairment in at least three areas such as tolerance, withdrawal inability to cut down or control use, or use despite physical or problems. Tobacco use and exposure is the active or passive introduction into the human body of toxins found in tobacco products. (Healthiest Wisconsin 2010 Implementation Plan Summary, June 2005). According for the Centers for Disease Control and Prevention, binge drinking is defined as, on one occasion, having more than three drinks for women and more than four drinks for men. Standard drink measures contain about 0.5 ounces of pure alcohol and are described as: 12 ounce regular beer or wine cooler, 8 ounce malt liquor, 5 ounce wine, and 1.5 ounce of 80-proof distilled liquor or spirits. Most people who binge drink are not alcoholics or alcohol dependent. Healthiest Wisconsin 2010 Goals – Alcohol and Other Drugs By 2010, 55% or more of Wisconsin’s general public will demonstrate a basic understanding of the scientific knowledge about alcohol and other drug use, addiction, addiction treatment, recovery, and alcohol or drug use during pregnancy. By 2010, 55% or more of Wisconsin’s general public will demonstrate positive, non-prejudicial attitudes towards persons with or recovering from alcohol and other drug use disorders. By 2010, reduce alcohol and other drug abuse among 12-17 year-old youth using evidence- based practices: By 2010, reduce the percentage of youth who report binge drinking in the past 30 days to 26.7%. By 2010, reduce the percentage of youth who report using marijuana in the past 30 days to 20.7%. By 2010, reduce the percentage of youth who report using tobacco in the past 30 days to 22.4%. By 2010, reduce the percentage of youth who report first use of alcohol prior to age 13 to 24.1%. By 2010, reduce the percentage of youth who report first use of marijuana prior to age 13 to 8.5%. By 2010, reduce the number of youth under the age of 18 arrested for operating while intoxicated to 641. By 2010, reduce the number of youth under the age of 18 arrested for liquor law violations to 11,647. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 38 Douglas County Data – Alcohol and Other Drugs In a national survey defining binge drinking as consuming five or more alcoholic drinks on one occasion, almost one-quarter of Douglas County adults reported binge drinking. Commonly it is thought that binge drinking occurs among young adults, typically in a college setting. Seventy percent of binge drinking episodes in the U.S. are in adults over 25 years old. First Drink of Alcohol, not just a few sips, Before Frequency of Alcohol Consumption in the Past 30 Age 13, WI Youth, 1997-2005. Days, WI Youth, 1997-2005. Wisconsin Department of Public Instruction. 2005 Wisconsin Youth Wisconsin Department of Public Instruction. 2005 Wisconsin Risk Behavior Survey, Trends, January 25, 2006. Youth Risk Behavior Survey, Trends, January 25, 2006. From 1997-2005, the proportion of Wisconsin youth who reported having their first drink of alcohol (not just a few sips) before age 13 has decreased. In 2005, almost 25% of Wisconsin youth reported having their first drink of alcohol before age 13. Among those Wisconsin youth who reported drinking alcohol in the past 30 days in 2005, about half reported having at least one drink of alcohol while about one third reported having at least 5 drinks of alcohol in a row. Alcohol and other drug abuse is the fourth leading cause of death in Wisconsin behind heart disease, cancer, and stroke. In 2004-04, 8% of Wisconsin residents who were at least 12 years old reported illicit drug use in the past year. Illicit drugs include marijuana, hashish, crack, cocaine, heroin, hallucinogens, inhalants, and prescription-type used for nonmedical purposes. 10% 20% 30% 40% 1997 1999 2001 2003 2005 Percent of Respondents 0% 20% 40% 60% 80% 100% 1997 1999 2001 2003 2005 Percent of Respondents At least 1 drink at least 5 drinks in a row ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 39 High School Youth Lifetime Substance Use, National Median and WI, 2005. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance – United States, 2005. Surveillance Summaries, June 9, 2006. MMWR 2006;55(SS-5). When compared with the national median, about the same amount of Wisconsin high school students report ever using marijuana cocaine methamphetamine or heroin A greater proportion of Wisconsin high school youth report any lifetime use of inhalants compared to the national median (17% WI; 12% In 2005, it was reported that at least 3% of Wisconsin residents who were 12 years old or older did not receive treatment for illicit drug use in the last year. Ten percent did not receive needed treatment for alcohol use. Healthiest Wisconsin 2010 Goals – Tobacco Between 2000 and 2010, tobacco use among Wisconsin middle school youth will decrease from 16% to 12%. Between 2000 and 2010, tobacco use among Wisconsin high school youth will decrease from 39% to 29%. Between 2000 and 2010, current cigarette smoking among adults (18+) will decrease from 24% to 19%. Between 2000 and 2010, current cigarette smoking among young adults (18-24) will decrease from 40% to 32%. Between 2000 and 2010, adults reporting that they or someone else smoked in their home in the past 30 days will decrease from 28% to 21%. Between 2000 and 2010, adults who reported that smoking is allowed in some or all work areas as their place of work’s official smoking policy will decrease from 26% to 19%. Between 2000 and 2010, youth that reported that they live with someone who smokes will decrease from 44% to 33%. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 40 Douglas County Data – Tobacco According to the 2007 Wisconsin County Health Rankings, 28% of Douglas County residents smoke cigarettes, compared to 22% of Wisconsin residents. The national Healthy People 2010 target is to have 12% or less of the population smoke cigarettes. According to the 2005 Bridge to Health Survey, almost half of Douglas County smokers tried to quit in the past year and 21% were seriously thinking of quitting in the next 30 days. Prevalence of Youth who Smoked Cigarettes One or Prevalence of High School and Middle School Youth More of the Past 30 Days, WI, 1997-2005. Who Consider Themselves to be Smokers, Douglas Wisconsin Department of Public Instruction. 2005 Wisconsin Youth County, 2004. Risk Behavior Survey, Trends, January 25, 2006. Umland MA, Palmersheim KA, Ullsvik JC, Wegner MV. Burden of Tobacco in Wisconsin. University of Wisconsin Comprehensive Cancer Center. Madison, WI, February, 2006. The trend of youth smoking in Wisconsin has been declining over time. According to the 2004 Youth Tobacco Survey, 23% of Wisconsin youth reported smoking cigarettes in the past 30 days. In 1997, 36% Wisconsin youth reported smoking in the last 30 days. Although the decreasing trend is promising, a significant number of Wisconsin youth are still smoking tobacco on a regular occasion. In the same 2004 survey, 21% of high school students and 8% of middle school students in Douglas County consider themselves smokers. Each year, 8,200 Wisconsin youth under 18 years become new daily smokers. 0% 10% 20% 30% 40% 50% 1997 1999 2001 2003 2005 Percent of Youth Respondents 0% 5% 10% 15% 20% 25% High School Youth Middle School Youth Percent of Youth Who are Smokers ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 41 Births to Mothers Who Smoked During Pregnancy, WI and Douglas County, 1995-2003. Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH) data query system, Available at: http://wisconsin.gov/wish/ There are multiple adverse reproductive and early childhood effects that result from cigarette smoking such as low birth weight, infertility, and sudden infant death The proportion of births to mothers who reported smoking during pregnancy has declined over time in both Douglas County and Wisconsin, although Douglas County still reports about 8% more smoking mothers than the state as a whole. In 1995, 28% of births in Douglas County were to mothers who reported smoking during pregnancy. In 2003, 22% of births in Douglas County were to smoking mothers. 10% 15% 20% 25% 30% 1995 1996 1997 1998 1999 2000 2001 2002 2003 Percent of Births to Smoking Mothers Douglas County Wisconsin ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 42 Douglas County Health Assessment Summary Access to Primary and Preventative Health Services 24% of Douglas County adults that they needed medical care in the last year but did not receive or delayed getting care. 30% of Douglas County adults postponed dental work in the last year. ~70% of Douglas County women 65-74 years old had biennial mammography. 64% of WI adults at least 50 years old reported ever having a sigmoid/colonoscopy. 38% of Douglas County men had prostate exam in the last year. Adequate and Appropriate Nutrition 86% of Douglas County adults consumed less than 5 servings of fruits or vegetables a day. 26% of WI youth reported no servings of vegetables a day and 17% did not have fruit. About ¼ of WI youth reported having one can or bottle of non-diet soda a day. Alcohol and Other Substance Use and Addiction 26% of Douglas County adults reported binge drinking. 70% of binge drinking episodes in the U.S. are in adults over 25 years old. 49% of WI youth reported at least one alcoholic drink in the past month. ~10% of U.S. pregnant women consumed alcohol while pregnant, 4% binge drank. 8% of WI residents at least 12 years old used illicit drugs in the past year. 11% of WI residents at least 12 years old used marijuana, 5% used pain medications, 2% used cocaine, and used methamphetamines in the past year. 38% of WI high school students have ever used marijuana, 17% inhalants, 8% cocaine, 6% methamphetamines, and 3% have ever used heroin. Environmental and Occupational Health Hazards Douglas County Respiratory Hazard Index = 1.86 Fine Particulate Matter in Air = 8.4µg/m3 [2007 County Health Rank= 4] Ozone Level = 67ppb [2007 County Health Rank= 3] No nitrate levels in municipal or private water supplies identified above the Prevention Action Level [2007 County Health Rank= 1] 44% of houses built in Douglas County are at risk for lead (built prior to 1950). 1% of blood lead tests in Douglas County youth under 6 years old were positive for lead. Existing, Emerging, and Re-Emerging Communicable Diseases Top five most frequently reported communicable diseases in Douglas County from 2000-2005 were 1) Chlamydia, 2) Lyme disease, 3) Hepatitis C, 4) Gonorrhea, 5) Genital Herpes. 98% of WI youth in grades K-12 met statutory vaccination requirements. 74% of WI adults at least 65 years old received an influenza vaccination. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 43 High Risk Sexual Behaviors Three of the top five most frequently reported communicable diseases in Douglas County are sexually transmitted diseases. 40% of WI high school students reported ever having sex. 8% of births in Douglas County were to mothers less than 20 years old. 35% of WI women who had been pregnant in the last 5 years said the pregnancy was unintended. Intentional and Unintentional Injuries and Violence 13% of WI high school students rarely or never wore a seat belt. 14.4 average annual motor vehicle deaths in Douglas County per 100,000 population. 89% of WI high school students rarely or never wore a bicycle helmet. 12.5 deaths from falls per 100,000 population in WI (age-adjusted). 27.8 reports of child abuse or neglect per 1,000 children less than 18 years old in WI. 172 violent crime incidents/100,000 population in Douglas County [2007 County Health Rank= 57]. Mental Health and Mental Disorders ~26% of U.S. adults have a diagnosable mental disorder. Suicide was the 11th leading cause of death in the U.S. in 2005. 18% of WI high school students considered attempting suicide and 9% attempted suicide. 11% of Douglas County adults wanted mental health assistance but did not talk or delayed talking to someone. 25% of those Douglas County adults that did not talk or delayed talking to someone for mental health assistance did so because it cost too much, 18% insurance did not cover it, and 18% did not think it was serious enough. Overweight, Obesity, and Lack of Physical Activity 66% of Douglas County residents are overweight and 24% are obese. 27% of Douglas County adults feel they are overweight, 71% feel their weight is about average. ~30% of WI youth feel they are or very overweight. 53% of Douglas County residents are physically inactive. 60-67% of WI youth report physical activity. Social and Economic Factors that Influence Health 86% of Douglas County residents over25 years old have a high school degree; 18% have a bachelor’s degree or higher. 5% of Douglas County adults in the work force are unemployed. 11% of Douglas County individuals, 8% of families, and 13% of children are below the poverty level. (Note: U.S. Census Bureau uses a set of money income thresholds that vary by family size and composition to detect who is poor. If the total income for a family or unrelated individual falls below the relevant poverty threshold, then the family or unrelated individual is classified as being "below the poverty level.") 8-12% of Douglas County residents are uninsured, 4-10% of children less than 18 years old are uninsured. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 44 Tobacco Use and Exposure 28% of Douglas County adults smoke cigarettes, 22% of WI adults smoke cigarettes. 45% of Douglas County adult smokers tried to quit in the past year, 21% are seriously thinking of quitting in the next 30 days. 23% of WI youth reported smoking in the past 30 days. 10% of WI youth obtained cigarettes from a store in 2005, 17% in 2003, and 21% in 2001. $17.3 million in health care costs were attributable to smoking in Douglas County, there was $13.1 million dollars in lost productivity were due to illness and premature death due to smoking. 980 years of potential life were lost from 2000-2004 due to smoking in Douglas County residents. Tobacco use is responsible for one-third of all cancer deaths each year. 22% of Douglas County mothers reported smoking during pregnancy, 17% in the WI Western Region, and 14% in WI. 9% of WI residents have asthma, which can be exasperated by cigarette smoke. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 45 Sources American Cancer Society. Wisconsin Cancer Facts and Figures, 2007, Available at: http://www.cancer.org/downloads/COM/WisconsinFF2007.pdf Athens JK, Taylor KW, Booske BC, Kempf AM, Remington PL. 2007 Wisconsin County Health Rankings Full Report, University of Wisconsin Population Health Institute. 2007. Campaign for Tobacco Free Kids, The Toll of Tobacco. The Toll of Tobacco in Wisconsin. Available at: http://www.tobaccofreekids.org/reports/settlements/toll.php?StateID=WI Centers for Disease Control and Prevention, Alcohol and Public Health. Quick Stats, Binge Drinking, Available at: http://www.cdc.gov/alcohol/quickstats/binge_drinking.htm Centers for Disease Control and Prevention, Alcohol and Public Health. QuickStats, General Information on Alcohol Use and Health, The Standard Measure of Alcohol, Available at: http://www.cdc.gov/alcohol/quickstats/general_info.htm Centers for Disease Control and Prevention. Alcohol Consumption Among Women Who Are Pregnant or Who Might Become Pregnant United States, 2002. MMWR. December 24, 2004; 53(50):1178-1181. Centers for Disease Control and Prevention, Fetal Alcohol Spectrum Disorders. Fetal Alcohol Information, Available at: Centers for Disease Control and Prevention. Notice to Readers: Surgeon General’s Advisory on Alcohol Use in Pregnancy. MMWR. March 11, 2005; 54(09):229. Centers for Disease Control and Prevention, Smoking and Tobacco Use. Fact Sheet, Health Effects of Cigarette Smoking. Available at: http://www.cdc.gov/tobacco/data_statistics/Factsheets/health_effects.htm Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance – United States, 2005. Surveillance Summaries, June 9, 2006. MMWR 2006;55(SS-5). Finch, M.D., Vezina, J.M., Kinney, A.M., Peterson, J.M.; Bridge to Health Collaborative (2005). Bridge to Health Survey 2005: Northeastern Minnesota and Northwestern Wisconsin Regional Health Status Survey, June 2006. Houtenville, Andrew J. 2007. "Disability Statistics in the United States." Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics Posted April 4, 2005. Available at: www.disabilitystatistics.org Jovaag AR, Palmersheim KA, Ullsvik JC, Kvale K, Umland MA &Wegner MV. Smoking During Pregnancy in Wisconsin and the United States: Trends and Patterns, 1999-2004. University of Wisconsin Comprehensive Cancer Center, Tobacco Surveillance and Evaluation Program. Madison, WI, 2006. Substance Abuse and Mental Health Service Administration, Office of Applied Studies. National Survey on Drug Use and Health, years 2004 and 2005. National Institutes of Health, National Institute of Mental Health. Health Information, Statistics. Available at: http://www.nimh.nih.gov/healthinformation/statisticsmenu.cfm National Institutes of Health, National Institute of Mental Health. Health Information, Suicide in the U.S.: Statistics and Prevention. Available at: http://www.nimh.nih.gov/publicat/harmsway.cfm ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 46 The National Organization on Disability, Statistics and Surveys. 2004 N.O.D./Harris Survey of Americans with Disabilities. Available at: Umland MA, Palmersheim KA, Ullsvik JC, Wegner MV. Burden of Tobacco in Wisconsin. University of Wisconsin Comprehensive Cancer Center. Madison, WI, February, 2006. United States Census Bureau., American FactFinder. Available at: http://www.factfinder.census.gov United States Census Bureau, Data Integration Division, Small Area Estimates Branch, Model-based Estimates of Counties and States. Wisconsin Health Insurance Coverage, 2005, Available at: http://www.census.gov/hhes/www/sahie/index.html United States Census Bureau, State and County QuickFacts. Available at: http://quickfacts.census.gov/qfd/states/00000.html Vila PM, Booske BC, Kempf AM, Athens JK, Remington PL. 2006 Wisconsin County Health Rankings Full Report, University of Wisconsin Population Health Institute. 2006. Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Environmental Health. Burden of Asthma in Wisconsin – 2004, PHHP 45055 (03/04). Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. Healthiest Wisconsin 2010: Annual Status Report, 2005 (PPH 0279), December 2006. Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. Life Expectancy by Sex and Age Group,2003-2005. Available at: http://dhfs.wisconsin.gov/stats/03-05life.htm Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH) data query system, Available at: http://wisconsin.gov/wish/ Wisconsin Department of Health and Human Services, Division of Public Health, Bureau of Health and Information Policy. Wisconsin Births and Infant Deaths, 2005, (PPH 5364-05), September 2006. Wisconsin Department of Health and Family Services, Division of Public Health, Wisconsin Diabetes Prevention and Control Program. The 2005 Burden of Diabetes in Wisconsin, December 2005. Wisconsin Department of Health and Family Services. Wisconsin Health Alert Network, Access Epidemiology site, February 2006. Wisconsin Department of Public Instruction. 2005 Wisconsin Youth Risk Behavior Survey, Trends, January 25, 2006. Wisconsin Department of Public Instruction, WINSS. Successful School Guide, Data Analysis, Available at: http://data.dpi.state.wi.us/data/ Wisconsin Department of Transportation. Wisconsin Traffic Crash Facts, years 2000-2005. Wisconsin Office of Justice Assistance. Crime and Arrests in Wisconsin Report, years 1997-2002. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 47 2008 Douglas County Physical Activity Survey Summary of Results Purpose A survey was administered to 3rd grade classes in Douglas County school districts in the fall of 2008. The goals of the survey were to: Assess the perceptions of the parents/guardians of the activity level of their child and themselves. Individuals participating in the survey will become conscious of their own physical activity levels. Use the baseline information collected in the survey to guide further planning for lineages with community-based activities, such as Fit City. Methods The survey was developed by the Overweight, Obesity, and Lack of Physical Activity Subcommittee and approved by the CHIP Steering Committee. Survey questions were modeled after questions from the National Behavior Risk Factor Survey and the Youth Risk Factor Behavior Survey. Three schools (one per school district in Douglas County) representing the demographic profile of Douglas County were targeted for participation in the survey. The three school districts were contacted by the Subcommittee to participate in the survey; two of the three school districts ultimately participated. Parents or guardians of the children in the two third grade classes completed the survey. Results The survey was completed by 23 parent/guardian – child sets. Nineteen (83%) parent/guardian – child sets completed all questions asked in the survey. Below please find the survey results for each question asked in the survey. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 48 Question 1: On average, how many days each week do you and your child exercise, dance or play sports? One parent/guardian response and 2 child responses were unanswered for this question and excluded from the analysis. Average Responses from Parent/Guardian for the Parent/Guardian and Child Activity Levels On average, between responses for the parent/guardian and child, respondents reported 4 days of exercise, dance or playing sports each week. 21% - all 7 days of the week 42% - less then 4 days 7% - 0 days physical activity Average Responses from Parent/Guardian for the Parent/Guardian Activity Levels When reviewing the average responses for parents/guardians, respondents reported 3 days of exercise, dance or playing sports each week. 5% - all 7 days of the week 59% - less then 4 days 9% - 0 days physical activity ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 49 Average Responses from Parent/Guardian for the Child Activity Levels When reviewing the average responses for children, parent/guardian respondents reported 5 days of exercise, dance or playing sports each week for their 3rd grade child. 38% - all 7 days of the week 24% - less then 4 days 5% - 0 days physical activity Question 2: On average, how many days each week do you and your child do exercises to strengthen or tone your muscles? Two child responses were unanswered for this question and excluded from the analysis. Average Responses from Parent/Guardian for the Parent/Guardian and Child Activity Levels On average, between responses for the parent/guardian and child, respondents reported 2 days of doing exercises to strengthen or tone muscles each week. 9% - all 7 days of the week 77% - less then 4 days 20% - 0 days physical activity ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 50 Average Responses from Parent/Guardian for the Parent/Guardian Activity Levels When reviewing the average responses for parents/guardians, respondents reported 2 days of doing exercises to strengthen or tone muscles each week. 8% - all 7 days of the week 78% - less then 4 days 21% - 0 days physical activity Average Responses from Parent/Guardian for the Child Activity Levels When reviewing the average responses for children, parent/guardian respondents reported 2 days of exercise, dance or playing sports each week for their 3rd grade child. 10% - all 7 days of the week 76% - less then 4 days 19% - 0 days physical activity ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 51 Question 3: During the past 12 months, on how many sports teams did you and your child play? Include all school, church and/or community teams. Two parent/guardian responses were unanswered for this question and excluded from the analysis. Average Responses from Parent/Guardian for the Parent/Guardian and Child Sports Team Participation On average, between responses for the parent/guardian and child, respondents reported playing on 1-2 sports teams in the past 12 months. 55% - 1-2 sports teams 11% - 3 or more teams 32% - 0 teams Average Responses from Parent/Guardian for the Parent/Guardian Sports Team Participation When reviewing the average responses for parents/ guardians, the majority of respondents reported not playing on any sports teams in the past 12 months. 33% - 1-2 sports team 10% - 3 or more teams 57% - 0 teams ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 52 Average Responses from Parent/Guardian for the Child Sports Team Participation When reviewing the average responses for children, parent/ guardian respondents reported playing on 1-2 sports teams in the past 12 months. 74% - 1-2 sports teams 13% - 3 or more teams 9% - 0 teams Question 4: In an average week, how many days does your child have physical education classes at school? All 23 parent/guardian-child sets responded to this question and were included in the analysis. Average Responses from Parent/Guardian for the Child Frequency of Physical Education Classes at School When reviewing the average responses, parent/guardian respondents reported 2 days of physical education class each week for their 3rd grade child. 83% - 2 days of physical education classes each week 13% - 3 days 0% - 4 days 0% - 5 days 4% - unsure how many days of classes each week ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 53 Question 5: On how many of the past 5 school days was your child able to go outside for recess? One parent/guardian-child set did not responded to this question and was excluded from the analysis. Average Responses from Parent/Guardian for the Child Going Outdoors for Recess When reviewing the average responses, parent/ guardian respondents reported 5 days of outdoor recess for their child in the past 5 schools days. 9% - 3 days outdoor recess in past 5 school days 10% - 4 days outdoor recess 76% - 5 days outdoor recess 5% - unsure how many days of outdoor recess in the past 5 school days Question 6: On how many of the past 5 school days did your child engage in physical activity after school hours? Include days played on team sports. One parent/guardian-child set did not responded to this question and was excluded from the analysis. Average Responses from Parent/Guardian for the Child Frequency of Physical Activity After School When reviewing the average responses, the majority of parent/guardian respondents reported 4 days of physical activity after school for their 3rd grade child. 14% - 2 days of physical activity after school each week 23% - 3 days 9% - 4 days 54% - 5 days ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 54 Question 7: On an average weekend day, how many minutes do you and your child engage in physical activity? All 23 parent/guardian-child sets responded to this question and were included in the analysis. Average Responses from Parent/Guardian for the Parent/Guardian and Child Time Frequency of Weekend Physical Activity On average, between responses for the parent/guardian and child, respondents reported 45 minutes of physical activity on an average weekend day. 17% - 15 minutes of physical activity 28% - 30 minutes 24% - 45 minutes 46% - 60 minutes or more Average Responses from Parent/Guardian for the Parent/Guardian Time Frequency of Weekend Physical Activity On average, parent/ guardian respondents reported they had 45 minutes of physical activity on an average weekend day. 4% - 15 minutes of physical activity 26% - 30 minutes 30% - 45 minutes 39% - 60 minutes or more ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 55 Average Responses from Parent/Guardian for the Child Time Frequency of Weekend Physical Activity On average, parent/guardian respondents reported their child had 45 minutes of physical activity on an average weekend day. 30% - 15 minutes of physical activity 30% - 30 minutes 17% - 45 minutes 52% - 60 minutes or more Question 8: On an average school day, how much time do you and your child spend watching TV, playing video games or on the computer? All 23 parent/guardian-child sets responded to this question and were included in the analysis. Average Responses from Parent/Guardian for the Parent/Guardian and Child School Day Sedentary Time On average, between responses for the parent/guardian and child, respondents reported 2 hours spent watching TV, playing video games or on the computer on an average school day. 10% - 30 minutes 34% - 1 hour 33% - 2 hours 13% - 3 hours 10% - 4 or more hours ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 56 Average Responses from Parent/Guardian for the Parent/Guardian School Day Sedentary Time When reviewing the average responses for parents/guardians, respondents reported 2 hours spent watching TV, playing video games or on the computer on an average school day. 17% - 30 minutes 22% - 1 hour 31% - 2 hours 17% - 3 hours 13% - 4 or more hours Average Responses from Parent/Guardian for the Child School Day Sedentary Time When reviewing the average responses for children, parent/guardian respondents reported 1 hour spent watching TV, playing video games or on the computer on an average school day. 50% - 1 hour 38% - 2 hours 6% - 3 hours 6% - 4 or more hours ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 57 Question 9: On an average weekend day, how much time do your and your child spend watching TV, playing video games or on the computer? All 23 parent/guardian-child sets responded to this question and were included in the analysis. Average Responses from Parent/Guardian for the Parent/Guardian and Child Weekend Sedentary Time On average, between responses for the parent/guardian and child, respondents reported 3 hours spent watching TV, playing video games or on the computer on an average weekend day. 4% - 30 minutes 15% - 1 hour 35% - 2 hours 22% - 3 hours 24% - 4 or more hours Average Responses from Parent/Guardian for the Parent/Guardian Weekend Sedentary Time When reviewing the average responses for parents/ guardians, respondents reported 2 hours spent watching TV, playing video games or on the computer on an average weekend day. 4% - 30 minutes 18% - 1 hour 35% - 2 hours 17% - 3 hours 26% - 4 or more hours ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 58 Average Responses from Parent/Guardian for the Child Weekend Sedentary Time When reviewing the average responses for children, parent/guardian respondents reported 3 hours spent watching TV, playing video games or on the computer on an average school day. 4% - 30 minutes 13% - 1 hour 35% - 2 hours 26% - 3 hours 22% - 4 or more hours Question 10: Does your family regularly participate in a physical activity together such as hiking, biking, baseball, swimming, etc.? All 23 parent/guardian-child sets responded to this question and were included in the analysis. Average Responses from Parent/Guardian for Phyical Activity Together as a Family When reviewing the average responses, the majority of parent/guardian respondents reported that their family regularly participated in a physical activity together. 87% - Yes 13% - No Conclusions Children were more like to have 7 days of physical activity per week, while parents/guardians were more likely to have 5 days. Almost 2/3 of parent/guardians reported they had less than 4 days of physical activity per week while ¼ of children had less than 4 days of physical activity. The majority of children were reported to have 2 days of exercise to strengthen or tone muscles per week while parents/guardians reported just 1 day. For both parents and children, over ¾ reported having less than 4 days of exercise to strengthen or tone muscles per week. ---PAGE BREAK--- Douglas County Community Health Improvement Plan 2008-2012 2011 Update Page 59 The majority of both parents/guardians and children responses reported playing on 1-2 teams in the past 12 months. While just 1/10 of children did not play on a sports team, almost 2/3 of parents/guardians did not. The majority of parents/guardians reported that their 3rd grade child had two days of physical education class at school during an average week. Four or five days of physical education class was not reported by any respondents. Three-fourths of parents/guardians reported that their child was able to go outside for recess on all 5 of the past 5 school days. Over half of the parents/guardians reported that their 3rd grade child participated in physical activity after school hours in the past 5 school days. On average, response for parents/guardians and children reported they had 45 minutes of physical activity on an average weekend day. The average response for time spent parents/guardians watching TV, playing video games or on the computer on an average school day was 2 hours while children averaged 1 hour. On an average weekend day, parents/guardians reported an average 2 hours spend watching TV, playing videos fames or on the computer while children averaged 3 hours. 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