Community Health Data Analysis for St. Clair County

2008

A. Review of Health Status Indicators

Demographic/Education/Socioeconomic Indicators

Age Analysis

Age distribution, according to year 2000 demographics, for the under 5 to 44 year olds percentage rates for our county are lower than State. Our county rates for 45 year olds and older is higher than the State rates. St. Clair County has a population of 9,652.

According to the “MCDC Demographic Profile 3 Trend Report 1990 – 2000 for St. Clair County, MO 29185”:

Lowest population in the county is the 18-19 year olds with 165 of 9,652.

Highest population is our 35 – 44 year olds with 1,332 of 9,652.

According to the “Cultural Diversity by Sex – 2000 Census Percentages for St. Clair County”:

St. Clair County State

children 10.3 % 13%

adolescents 13.5% 14.4%

middle-aged 54.3% 59.1%

Our citizens in St. Clair County are lower in percentage than State in these categories.

St. Clair County State

65 year old and over 21.9% 13.3%

Our citizens are higher in percentage than State in this category.

No changes from 2005 report

Race/Ethnicity Analysis:

The majority of the county’s race is made up of 96% (9,268 of 9652) white non-Hispanic with a 4% (384 of 9652) minority population of people. No disparity in health status or barriers to accessing health care or preventative services have been experienced by race, ethnicity, immigrant, or refugee population groups.

American Indian/Alaska Native population has increased in St. Clair County by 34 people in 1990 to 83 people in 2000. Hispanic population has increased in St. Clair County from 58 people in 1990 to 149 people in 2000. The overall percentage of the population that is represented by special population groups has increased:

1990 2000

1.3% (107 of 8,378 people) 4.0% (384 of 9,380)

No changes found since 2005 data.

Other Demographic Features:

Low educational levels, family size and structure, and illiteracy contribute to increased health risks for some members of the community. Our county has shown improvement in education levels, thus decreasing illiteracy.

Education levels have improved in St. Clair County for 25 year olds without a diploma:

1990 2000

39.2% (2,326 of 5,933 people) 26.9% (1,853 of 6,876 people)

Those with High School or GED went from:

1990 2000

38.2% (2,269 of 5,933 people) 45.7% (3,141 of 6,876)

More persons have also attending college:

1990 2000

22.6% (1,338 of 5,933 people) 27.4% (1,882 of 6,876 people)

The percentage of annual dropout of total enrollment from the schools in St. Clair County compared to the State are as follows:

2004 2007

State 3.9% (10,354 students) 4.2% (11,796 students)

Appleton City 6.5% (10 students) 2.6 % (4 students)

Lakeland R-3 0.8% (1 student) 2.8 % (4 students)

Osceola 3.9% (8 students) 5.2 % (11 students)

Graduation Rate: 2004 2007

State 85.5% 85.8%

Appleton City 83.7% 90.2%

Lakeland 93.3% 73.9% (6 students over 4 year)

Osceola 87.3% 93.5% (4 students over 4 years)

All three county schools have a higher percent of increase in MSIP reading scores than State at the 3^rd grade level, but a higher percent of lower MSIP reading scores in the 7^th grade level for 2004.

3rd grade 7th grade

State 74.5% (48,063 Students) 62.0% (44,772 students)

Appleton City 88.5% (23 students) 59.4% (19 students)

Lakeland R-3 81.8% (18 students) 56.1% (23 students)

Osceola 83.3% (25 students) 61% (25 students)

MAP tests are now being done to replace MSIP.

MAP tests in 2007 in Communication Arts showed the following percent below basic.

3^rd grade 7^th grade

State 9.4 % 13.1 %

Appleton City 10.0 % 16.1 %

Lakeland R-3 10.0 % 8.5 %

Roscoe 0.0 % 0.0 %

Osceola 2.5 % 8.3 %

Single mother households have increased in St. Clair County:

1990 2000

3.9% (137 of 3,508 households) 5.3% (214 of 4,031 households)

Single parent family households have increased in St. Clair County:

1990 2000

14.6% (512 of 3,508 households) 20.8% (838 of 4031 households)

Divorced population has increased in St. Clair County:

1990 2000

6.8% (467 of 6,843 people) 11.1% (870 of 7,854 people)

The family structure is changing in our county, which will cause increased health risks.

With single parent households it is harder to provide money, time, and attention. For example, a person getting ill in a single parent household may have more time to wait to get to a doctor due to the parent not being able to get off from work for fear of loosing their job.

Economic Indicators:

St. Clair County has a median household income of $25,321 in 1999 compared to $22,525 in 1990, but the State rate $37,934. We have 680 households bringing in less than $10,000 a year and 843 households bringing in $15,000 - $24,999 a year. Our average annual wage/salary has gone from $13,356 in 1997 to $15,420 in 2000. Our average wage/salary of $15,420 for 2000 compares to State at $32,525.

We had 258 unemployed people out of 7,687 over the age of 16 in our county in 2000. No new jobs have become available, but our unemployment rate has gone from 7.3% in 1990 to 6.3% in 2000.

Our workforce by industry is lead by other industries 1,950 people out of 3,860 (50.5%). Our health care and social assistance ranks at 16.6% with 642 people out of 3,860. Our workforce by occupation is management, professional and related occupations 1,027 persons 26.6% rate. Although we haven’t added new industry to our county, our economy has remained about the same for 2000 as it was for 1990.

Our farming, fishing, and forestry workforce occupations are down significantly from 1990 with 480 employed persons at 15.1% dropping to 66 employed persons at 1.7% in.

Missouri Work Flow Data shows the flow from St. Clair County to other counties as 1,663 workers. Remaining in St. Clair are 2,015 workers. The workers flowing into St. Clair County from other counties is 494 workers.

The rate of children in poverty in our County has gone down from 29.8% in 1990 to 25.3% in 2000, but we are higher in percentage rate than the State (15.3%).

Transfer payments according to the Missouri State Census Data for unemployment insurance benefit payments and State employment insurance compensation is down. Government payments to individuals (retirement & disability insurance benefit, old age & retirement disability, and medical) and income maintenance benefit payments (Supplemental Security Income, family assistance, food stamps, and other income maintenance) are up.

No changes found since 2005 data.

Free/reduced lunch program participation has increased at three-of-four of our county schools Appleton City 58.2% in 2004 to 57.70% in 2007, Lakeland 57.7% in 2004 to 55.30% in 2007, Osceola 48.4% in 2004 to 51.10% in 2007, Roscoe 40.40% in 2004 to 59.40% in 2007 compared to State at 40.7% in 2004 to 41.1% in 2007.

Environmental Health Risk Indicators

Analysis of indicators related to housing:

The percentage of housing units in our county built before 1950 is 28.8% with 21.3% built before 1940. The average age of units is now 47.0. 579 units are less than 5 years old. 72 units lack complete plumbing facilities. 234 lack telephone service. 278 lack vehicle availability. Average household size is 2.34. 1,901 have moved in the last 5 years.

Out of the 5,205 housing units in 2000, 100% are rural. 4,040 are occupied, 3,210 are owned, 830 are rented, and 1,165 units are vacant. Single family units 3,529, 2-4 units 204, 5-19 units 39, 20+ units 14, 1,371 mobile homes.

No lead abatement or renovation projects have been undertaken in St. Clair County.

Children with elevated blood lead levels in 1998 were 9.3 and in 2002 they were 4.9 compared to State levels of 12.3 in 1998 and 5 in 2002. According to MCDC Demographic Profile 3 Trend Report 1990-2000 the population for children under 5 years old for 2000 was 514. In 2004 lead levels were preformed on 206 children with 4 children in our county that were found to have elevated blood levels. From January to October 2007 lead levels were performed on 153 children with 2 children in our county that were found to have elevated blood lead levels. These children with elevated blood lead levels are not living close to lead smelter/lead mine/ historic lead smelter. This year (2007) there was a recall of toys from China due to lead.

Analysis of indicators related to water supply:

Most of our county water systems use ground water as their primary water source and 2 sites are using purchased surface water. We did have a report in November 2004 of e-coli. in the water at Lowry City – boil order was not issued. The water had been treated with chlorine. Public water supplies are not naturally fluoridated and fluoride is not added to the water supply.

Many of the older rural homes in the area have failing septic systems. These generate valid complaints each year, which are dealt with before conditions result, which affect the health of members of the public.

With Highway 13 and 52 we have hazardous materials carried on trucks daily. In 2007 there was a hazardous substance event due to an anhydrous ammonia spill in Collins. We also have agricultural operations that use materials that may contribute to environmental health risks.

Public Safety/Domestic Violence

Analysis of indicators of public safety:

Reported for 2004/5: Crime rates for homicide for St. Clair County for 1/1/04 to 12/8/04 were 1; assault were 5 2^nd degree hand, 3 - 2^nd degree other, 1 - 2^nd degree vehicle, 6 – 3^rd degree injury, 37 – 3^rd degree assaults, 1 – law enforcement assault; juvenile crime were 1 missing, 8 runaway, and 2 child abuse, otherwise the report isn’t broken down into juvenile information; and violent crimes in our county were 1 attempted rape, 2 sexual assault, 1 stat. Rape, 9 unlawful use of weapon.

Reported for 2007 by the Sheriff’s Office: for 18 years old and older 187 assaults – 1 with firearms, 1 with knife, 17 other dangerous weapons, 12 aggravated assault, 20 other assaults, 0 homicides, 1 rape and 7 other sex offences, 23 burglaries, 17 thefts, 1 vehicle theft, 8 forgery/counterfeit, 34 fraud, 9 stolen property, 14 vandalism, and 3 weapons. Also 17 offences against family and children, 23 driving under the influence, 3 violations in liquor laws, 2 disorderly conduct, 142 other offences. For less than 18 years old - 1 aggravated assault, 3 burglaries, 2 larcenies, and 1 stolen property.

Problem with illegal drug use or alcohol abuse:

Reported in 2004/5: 33 possession illegal narcotics/drugs; 13 DWI for our county from 1/1/04 to 12/8/04.

In 2007 – 18 years and older 39 drug abuse violations, 27 sale/manufacturing, 24 marijuana, 3 other drugs, 12 in possession, 10 marijuana possession, 2 other dangerous drug possessions. For under 18 years old – 2 sales/manufacturing, 2 marijuana, 3 in possession of marijuana, 1 liquor.

Analysis of indicators related to abuse or neglect of vulnerable populations:

Reported in 2004/5: Indicators of maltreatment and neglect of elderly in 2003 there were 29 cases reported, and in 2004 there were 20 cases reported to the hotline on St. Clair County residents.

Indicators of maltreatment and neglect of children in 1998 was 37.4 in County compared to 22.4 in State (per 1000). In 2002 the rates were 50.8 in county compared to 44.3 in State (per 1000). DFS reported 14 reports on 27 children in October 2004, which is double what was reported last year. St. Clair County alternate care last November was 26. In 2004 only 3 foster families were registered in the County.

Domestic violence reports 2 women in 1997-1999 in St. Clair County area.

In the 2006 report from www.dss.mo.gov St. Clair County had 10 substantiated abuses reported, 2 unsubstantiated preventative services indicated, 36 unsubstantiated 55 family assessment services needed, 3 other unable to locate. All were below State percentages except the family assessment services. As of January 2008 there are 8 registered foster families.

Unintended Injury

Analysis of indicators related to injury:

The major types of injuries in St. Clair County are unintended injuries due to motor vehicle accidents, traffic related, and falls – in/out-patient. The age and population groups mainly involved for traffic in 2004 was the under 15 year olds (31 reported 1997 – 1999) and the 25-44 age groups (21 reported) of males. In 2005 the under 15 years old report was 15 reported and the 25-44 age groups (39 reported). The 45-64 age groups are 34 reported in 2005. For falls the highest incidents are 65 and older females (206 in 1997-1999) and in 2005 again it was 65 and older females (90).

The rate of injury related hospitalization has increased from 712 in 1994-2000 to 931.3 in 1996-2002 to 1,100 in 2005.

Analysis of indicators related to traffic safety:

The circumstances related to traffic safety use of seat belts and child safety seats unable to find statistical matter, but with 15 and under not driving and having a rate of 31 reported injuries in 1997-1999, this may be high due to not wearing seatbelts or not using child safety seats.

Drug and alcohol use has 13 incidents in the county in2004/5.

The age group most likely to be involved in traffic accidents in St. Clair County is 25-44 years of age.

No updates since 2005 assessment were found.

Analysis of injuries at work:

The incident of injury at work has increased from 3.6 in 1996-2002 to 4.8% in 1995-2005.

No updates since 2005 assessment were found.

Maternal and Child Health Indicators

Analysis of maternal and child health indicators:

Our county in 2002 had about the same prenatal care beginning in the first trimester as State (County 82.9% to State 87.8%). In 2005 the prenatal care beginning in the first trimester for the County was 85% while State was 87.9%. The birth to teen's rate for 2002 is slightly higher in the county than State (County 4.6 to State 4.1). The birth to teen’s rate for 2001-2005 was 21.4% county to 29.2% State. Birth spacing (less than 18 months spacing) indicators show our county higher than State in 2002 (County 8.5 to State 6.1). In 2001-2005 birth spacing for County is 11.6% to State 11.1%. Mothers smoking during pregnancy had a higher count in our county compared to State in 2002 (County 33.3 and State 18.1) compared to 2005 29 County and 18.2 State. Births to women with less than a 12^th grade education in 2002 in our county were elevated over State (county 23.6 to State 19.2) and in 2005 (County 26.8 to State 18.6). Our county infant mortality was lower than State for 1993-2002 (County 5.4 to State 7.7) and for 2001-2005 (County 4.8 to State 7.6). Trend lines show that problems are beginning decreasing. Poor birth outcomes can be linked to poverty or low education levels, but could also be linked to prenatal care (delivery is out of county and so is prenatal care).

No race or special populations are experiencing higher rates of infant mortality, low birth weight, or poor birth outcomes.

Analyze indicators related to prenatal risks.

Smoking during pregnancy has been a high-risk 1^st priority in our county for over three years (county rate in 2004 was 33.3% compared to 18.1% for State). The rate in 2005 was 29% County compared to 18.2% State. While State seems to have gone up slightly, St. Clair County has begun to make a significant reduction in smoking during pregnancy. This is probably due to the program through MCH in working with WIC clients to reduce or stop smoking, and Girls on the Run program to teach life skills with that program. Improper weight gain of less than 15 pounds to term is a high-risk in 2004 for our county ranking 2^nd (County 11% and State 8.1%). In 2001-2005 the weight gain for less than 15 pounds for county was 12.0% compared to State 8.5%.

Teen pregnancy rated a 3^rd quintile in 2004 with the county having a rate of 27.8% to State at 33.7%. For 2001-2005 teen pregnancy was in the 4^th quintile with 21.4% County and 29.2% State.

Birth spacing rated 1^st in quintile in 2004 with our county having a rate of 14.9% to State at 10.8%. For the 2001-2005 in is in the 3^rd quintile with 11.6% County to 11.1 % State.

Late or no prenatal care for 2004 ranked 2^nd with county rate at 17.1% and State at 11.3%. For 2005 the county ranked in the 3^rd quintile with 13% county and 11.4 % State for late care.

Again these are not related to special populations.

Analyze indicators of child well being:

As of October 7, 2004 children age 2 that have completed their immunizations were only 42.86% in our county. This is down from 2000 when we had only 65.7% immunized by the age of 2. If the child comes to the health department for immunizations they are also receiving the routine physical through our rural health clinic. The problem is that they aren’t coming in for the immunizations and therefore aren’t receiving the physical.

Unintended injury and death rates among children in the community are showing unstable rate that cannot be rated with State at 7.2%. No leading causes are available and cannot be measured.

No changes in statistics are available since 2004/2005 assessment.

However, in talking with three of the school nurses in the county Lakeland School had 105 referrals of 415 students screened, Appleton City School had 56 referrals of the 128 screened, and Osceola School had 98 of their 556 screened that needed dental referral. Not all students at the schools have been screened. Miles for Smiles van comes to Lakeland and Osceola Schools twice a year, but haven’t been able to care for all those needing to be seen. Miles for Smiles does not see Roscoe School or Appleton City School.

Prevalence of Infectious Disease

Analysis of communicable disease rates:

Race and special populations are not a factor.

We haven’t seen any special outbreaks or extraordinary incidence of enteric disease since the last assessment in 2004/2005. Again, no significant outbreaks have occurred from 2005-2007.

Analysis of vaccine preventable disease:

No vaccine preventable disease cases were reported in 2004. There have been a few vaccine preventable Hepatitis B and Influenza A cases in the last three years.

We haven’t had any mortality reported in St. Clair County from influenza since 2004. No reports of influenza deaths from January 2005 to December 2007. We had 7 reported influenza positive laboratory confirmed cases from January to March 2006. Only one reported Influenza A case in 2007. Of the 104 reported deaths in 2007 in St. Clair County 14 had pneumonia as a cause related to the death, but 7 were due to aspiration pneumonia. No deaths were from Influenza.

County childhood immunization rates for vaccine preventable disease are 49.07% of 2 year olds are complete with their immunizations as of December14, 2004 and is 51.30% as of May 31, 2006. In December 2007 the immunization rate for St. Clair County is up at 77% for 2 year olds. This increase is due to reminder cards being sent out as clients are due. We are continuing to increase these rates and at the same time work on reminding clients of needed healthy child checkups. We are going to begin entry of other physician’s immunizations from another clinic this year.

Prevalence of Chronic Disease Risk Factors

St. Clair County’s rate for adult tobacco use is 32.9 % in 2003 compared to 26.4% at State. St. Clair County MCH Performance measures show that in 1999 our county baseline was 29.7% of women reported smoking during pregnancy, compared to 19.0% of State. Physical inactivity is lower at county with 20.7% compared to State at 24%. Obesity, BMI > +30, in adults 18 and older for the county in 2003 was rated 25% compared to State at 23.4%. The county rate for percent of adults with high cholesterol is 37.5% compared to 37.1% for State. Prevalence for asthma is at 11.2% for county compared to 10.8% for State. These all contribute to increasing the county’s heart disease, lung cancer and other smoking related diseases.

There are no indicators available on obesity and inadequate diet by particular age groups, race, or special population for our county.

The most prevalent causes of hospitalization in our county seem to be due to heart disease 264.6% compared to State at 164.6%, which is consistent with risk behaviors.

A youth survey of 6^th-8^th graders was done at one of our schools in our county of 114 students. This survey had the following results: 42% of the students reported divorced and never married parents. 15.7% reported not being involved in extracurricular activities. 7% reported using tobacco beginning at the ages of 12-14. 23% reported using alcohol beginning at ages 10-13. 57% reported they could obtain drugs with 18% using drugs. 22% reported being sexually active and the highest level being at 6^th grade. 23% reported the need to exercise regularly. 27% felt they weren’t in the normal range with most feeling overweight. 32% reported needing more dairy and 53% needing more fruits and vegetables. 44.7% reported the need to see a dentist, and 37.7% needed a physical. 31.5% reported not using safety restraints (seat belts).

Our rates for women 50-64 with no mammogram or clinical breast exam in the last year are 57.3% for 2003 compared to State at 35.9%. Women 30-69 with no pap test in the last 3 years for 2003 in our county are 23.4% compared to State at 13.8%. Men and women >50 years who have never had a blood stool test is 63.9% in county compared to 57% in State, and who have never had a sigmoidoscopy or colonoscopy is 58.9% to States 49.2%. These services for mammogram, clinical breast exam, pap testing, blood stool testing and sigmoidoscopy or colonoscopy are available in our county at either the local clinics in Appleton City or Osceola or at one of the hospitals.

No changes in statistics since 2005.

Leading Causes of Mortality

Analysis of leading causes of mortality:

Mortality rates are higher in unintentional injuries and motor vehicle accidents. Total unintentional injuries for the county rate at 68.6% compared to State at 40.2%. Motor vehicle accidents rate at 45.7% compared to State at 20.1%. Both of these are ranking first in our county. Data does not show if this is related to lack of seatbelt use, or alcohol use as a contributing factor. All injuries and poisonings rate 94.5% in county with 64.1 % in State and it is also ranking first in our county. These are from 1999-2002 data.

Rates of mortality that are higher than the state rate are not consistent with behavioral risk factors for diseases. The rate of mortality is also not consistent with rates of screening tests for early detection, or other risk factors like high blood pressure or high cholesterol.

In 2005 of 131 deaths 34 were from Cancer, 32 from heart disease, 4 from pneumonia, and 12 from chronic lower respiratory disease. In 2007 of 104 deaths 44 were from heart disease, 25 from cancer, 7 pneumonia, and 28 miscellaneous/other. Heart disease and cancer continue to be our leading causes of death.

B. Community Health Improvement Capacity Indicators

Health Care System Indicators

Analysis of the Community’s Health Care System:

Reported in 2004/5: Our healthcare provider rate in 2002 was 1:877 compared to States 1:407. We need more healthcare providers in our county. We have 9 doctors. We do have 4 Nurse Practitioners and a Nurse midwife. By 2007 we have seen a loss of the nurse midwife, but now have 12 doctors and 5 nurse practitioners.

We have a barrier of being a rural county and therefore transportation is a problem to get to a doctor. Ellett Hospital has begun transportation services to their doctors in Appleton City.

Adequate access to emergency services through Sac-Osage Hospital and Ellett Memorial Hospital is available. Acute care is available through Sac-Osage Hospital. Access to long-term care is available through Truman Lake (a skilled nursing facility), Appleton City Manor (an intermediate care facility), and Country Side Estates (a residential care facility.

In 2003 16.6% of the county lacked health insurance coverage, compared to 12.31% of State. There doesn’t seem to be any particular segment of the population without health insurance.

Only 2 dentists in the county give dental health care. Mental health has to be serviced from outside of the county. A grant is being worked on to possibly start a mental health and dental facilities in the St. Clair County Health Center basement.

There are 12 primary care providers in our county. All of these physicians accept Medicaid.

Medicaid participating dentists are available to our community.

There are no populations that are not served due to language-specific or culturally knowledgeable service providers.

Resources are available to provide transportation for health care access such as the OATS bus and Medicaid transportation, but it is not adequate for the county population.

Resources are available through On My Owns, Inc. which has moved to Collins and DFS to accommodate those needing sight and hearing impaired services or other assisting technology.

The health care resource gaps in our community are more doctors, more dentists, transportation, respite care, and pharmacy.

Community Health Resource Indicators

Analysis of health resources that are available to address leading causes of mortality, especially premature deaths, and risk factors that contribute to leading health problems in the community:

Presently we have available in our community: a physician for chemotherapy, recreation due to the lake, a swimming pool in Osceola, senior nutrition sites, WIC, On My Own, Inc., First Steps, Pathways, Parents as Teachers, School nurses that are present daily, Cancer Society activities, Community Betterment Coalition, GED Classes, Medicaid Transportation, Oats bus, Doctors, Dentists, Nurse Practitioners, Health Coalition/CHART, and 2 Hospitals.

The St. Clair County Health Center has two nurse practitioners that are part of the Rural Health Clinic. The Health Center assesses the community on a three-year basis and updates that assessment yearly. They provide guidance for a Maternal Child Health task force to work on reducing smoking in pregnancy. The St. Clair County Health Center has provided a facilitator for the local C.H.A.R.T. and Regional C.H.A.R.T in 2004. Without this facilitator the local C.H.A.R.T. would have ceased functioning. The Health Center also provides Home Health in the county that would otherwise not be available. They provide immunizations through the Vaccine for Children Program through State to keep vaccine preventable diseases from occurring.

We need an orthopedic doctor, drug/alcohol/tobacco treatment/classes, and summer feeding sites, respite care, and pharmacy.

Community Health Assessment Summary of Findings

For St. Clair County

A) Review of community health status indicators, including primary and secondary data, reveals the following problems:

Smoking in pregnancy, childhood immunization rate is low, tobacco/alcohol/drug use, heart disease, need for better nutrition and exercise, pharmacy/dental/ medical – orthopedic for falls and obstetrical for pregnancy, mental health care, transportation, and respite care.

B) Review of Behavioral Risk Factor Surveillance System County Level Data reveals the following problems: in 2004/5 Physical inactivity is lower than the State, Current smokers are higher than State, Overweight with BMI 25-29.9 is lower than State, and Obese (BMI > 30) is higher than State. In 2007 no changes in physical activity, but the smoking in pregnancy has been decreased and in some cases stopped due to our WIC department working through MCH and WIC with clients during their visits.

C) The 3 most significant problems affecting the health status of the population within the jurisdiction of the local public health agency are (public health priorities):

1) Education on harmful behaviors, smoking, sexual activity, and parent skills.

2) Maternal Child Health on parent skills, immunizations, child wellness, and

childbirth facilities.

3) Medical Services for dental, mental health (smoking and drug treatment

services), pharmacy, and transportation.