Daniel Coulter, MPH Jean-Marie Kelly, MPH Community Health Needs - - PowerPoint PPT Presentation

Community Health Needs Assessment Findings & Selection of Health Priorities January 17, 2019

Daniel Coulter, MPH Jean-Marie Kelly, MPH

Community Health Needs Assessment (CHNA)- Purpose:

• Examination of the health status of Cecil County

residents to identify key health issues and assets available to address health issues.

• Provides the basis for the development of a

Community Health Improvement Plan (CHIP).

▫ This 3- year plan includes health priorities for the County and strategies to address health priorities.

Benefits of the CHNA & CHIP

• Comprehensive health information
• Justification of resource allocation
• Coordination and collaboration
• Strengthened partnerships
• Identified strengths and weaknesses
• Benchmark and baseline data for performance

improvement

Community Health Needs Assessment- Methods

• Community Health Survey

▫ Online survey open to all Cecil County adult residents ▫ Questions related to Demographics, Community Health, Quality of Life, and Access to Health Services

• Focus Groups

▫ Vulnerable populations in Cecil County.

• Key Informant Interviews
• Review of Secondary Data

▫ U.S. Census, MD Vital Statistics, MD SHIP, MD BRFSS, MD YRBS, County Health Rankings, etc.

Community Health Needs Assessment- Selection of Health Priorities

• Community Health Survey participants were asked to

select the 3 most important health issues in Cecil County.

• The top 15 identified health issues (selected by survey

respondents) are displayed on slide 11.

▫ Secondary data included in this presentation is organized related to these categories.

• Following the presentation of data, CHAC members will

be asked to vote on their top 3 priorities to be included in the CHIP for FY20- FY22. (Up to 5 will be included)

▫ This information will be reviewed by the CHNA steering committee to determine the final priorities.

Community Health Needs Assessment- Selection of Health Priorities

• Members should vote on health priorities based on:

▫ Size: Number of persons affected, taking into account variance from

benchmark data and targets.

▫ Seriousness: Degree to which the problem leads to death, disability,

and impairs one’s quality of life.

▫ Trends: Whether or not the health problem is getting better or worse

in the community over time.

▫ Equity: Degree to which specific groups are affected by a problem. ▫ Intervention: Any existing multi-level public health strategies proven

to be effective in addressing the problem.

▫ Feasibility: Ability of organization or individuals to reasonably

combat the problem given available resources. Related to the amount of control and knowledge (influence) organization(s) have on the issue.

▫ Value: The importance of the problem to the community (based on

Community Health Survey results).

▫ Consequences of Inaction: Risks associated with exacerbation of

problem if not addressed at the earliest opportunity.

▫ Social Determinant/ Root Cause: Whether or not a problem is a

root cause or social determinant of health that impacts one or more health issues.

Community Health Needs Assessment- Next Steps

• The CHNA steering committee will review the 5

priorities selected at this meeting and set final priorities to be addressed in the CHIP.

• An email will be sent out to the group

announcing final priorities and you will be invited to select one or more work groups to join and develop a strategic plan to address prioritized health issues.

• The CHNA and CHIP will be finalized by June

30, 2019 and we will begin work on the CHIP on July 1.

Community Health Survey Results- Demographics

A total of 1403 individuals completed the Community Health Survey.

Community Health Survey Results- Demographics

Gender Male 18.6% Female 81.2% Other 0.1% Race Alone or in Combination with One or More Other Race White 95.3% Black or African American 2.9% Asian 0.6% American Indian or Alaskan Native 1.2% Native Hawaiian or Other Pacific Islander 0.0% Some Other Race 2.1% Ethnicity Hispanic, Latino, or Spanish Origin 2.4% Marital Status Married 64.6% Divorced 15.6% Widowed 4.7% Separated 2.2% Never Married 13.0%

Community Health Survey Results- Demographics

Community Health Survey Results- Most Important Health Issues

Rank Health Issue % Respondents 1 Substance Abuse 75.3% 2 Mental Health 37.7% 3 Homelessness 32.9% 4 Access to Health Services 18.9% 5 Poverty 15.7% 6 Obesity 14.2% 7 Affordable Housing 13.9% 8 Child Abuse and Neglect 13.5% 9 Dental Health 10.9% 10 Cancer 10.7% 11 Violent Crime 7.9% 12 Unemployment 6.8% 13 Childhood Trauma 5.9% 14 Educational Attainment 5.6% 15 Diabetes 5.0%

*Survey respondents were asked to select their top 3 health issues.

Community Health Survey Results- Perceived Health of Community and Personal Health

0.2%

Community Health Survey Results- Quality of Life

10.4% 15.3% 11.7% 16.5% 14.3% 12.1% 9.1% 5.4% 15.3% 8.1% 6.1% 12.1% 28.4% 30.0% 24.4% 31.0% 33.3% 30.7% 23.8% 15.6% 39.2% 27.3% 19.8% 32.3% 22.5% 23.4% 27.7% 30.0% 26.0% 24.4% 36.8% 34.9% 30.5% 34.3% 46.9% 35.9% 35.5% 28.8% 33.4% 21.0% 24.3% 30.6% 28.0% 39.2% 13.3% 28.4% 24.2% 18.4% 3.2% 2.5% 2.9% 1.6% 2.2% 2.3% 2.3% 4.8% 1.6% 2.0% 3.0% 1.3% I am satisfied with the quality of life in Cecil County. I am satisfied with the health care system in Cecil County. Cecil County is a good place to raise children. Cecil County is a good place to grow old. There is economic opportunity in Cecil County. Cecil County is a safe place to live. Cecil County has networks of support for individuals and families during times of stress and need. All individuals and groups have the opportunity to contribute to and participate in Cecil County’s quality of life. All Cecil County residents believe that they can make Cecil County a better place to live. Cecil County has many different resources that enhance quality of life. Community partners work well together. Cecil County residents feel responsible for their community and take pride in its accomplishments.

Quality of Life in Cecil County

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

Community Health Survey Results- Health Literacy

Community Health Survey Results- Primary Source for Health Information

Community Health Survey Results- Access to Health Services

5.1% 10.6% 11.9% 11.4% 7.6% 31.7% 36.2% 30.8% 13.2% 17.1% 28.4% 20.6% 18.0% 12.2% 29.3% 26.6% 22.3% 19.5% 22.2% 26.5% 22.0% 50.9% 69.9% 29.3% 29.7% 26.8% 44.6% 45.8% 31.1% 38.1% 15.2% 7.5% 8.2% 6.3% 12.9% 19.2% 9.8% 3.6% 7.4% 4.5% 2.9% 1.6% 1.2% 7.3% 3.5%

Cecil County residents are able to see a primary care provider (Family Doctor, Pediatrician, Nurse Practitioner, Physician… Cecil County residents are able to see a medical specialist when needed (e.g. heart, lung, skin, etc.). Cecil County residents are able to see a dentist when needed. There are enough providers accepting Medicaid (Medical Assistance) in Cecil County. There are enough bilingual (Spanish-speaking, etc.) providers in Cecil County. There are enough mental health providers for adults in Cecil County. There are enough mental health providers for children in Cecil County. There are enough substance use disorder treatment providers in Cecil County. Transportation for medical appointments is available to Cecil County residents when needed.

Access to Health Services in Cecil County

Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

Community Health Survey Results- Barriers to Accessing Health Services

Rank Most Significant Barriers % Respondents 1 Inability to Pay Out of Pocket Expenses 57.2% 2 Health Care Coverage Does Not Cover Needed Services 33.8% 3 Availability of Doctors or Other Providers/Appointments 30.4% 4 Time Limitations 25.9% 5 Basic Needs Not Met 25.6% 6 Lack of Transportation 22.9% 7 Lack of Dental Insurance 22.2% 8 Lack of Health Insurance 21.5% 9 Difficult to Understand/ Navigate Health Care System 18.7% 10 Lack of Trust in Medical Services 12.8%

*Survey respondents were asked to select their top 3 barriers.

Community Health Survey Results- Populations Not Being Adequately Served

Rank Population % Respondents 1 Uninsured/ Underinsured 43.7% 2 Homeless 43.1% 3 Low-Income/ Poor 41.9% 4 Seniors/ Aging/ Elderly 33.5% 5 Disabled 22.6% 6 Children/ Youth 20.5% 7 Young Adults 16.6% 8 None 14.4% 9 Other 11.1% 10 Black/ African American 7.1% 11 Hispanic/ Latino 5.9%

*Survey respondents were asked to select all that apply.

Community Health Survey Results- Resources or Services Missing in Cecil County

Rank Resource or Service % Respondents 1 Mental Health Services 50.2% 2 Free/ Low Cost Dental Care 46.8% 3 Substance Use Disorder Services 42.7% 4 Free/ Low Cost Medical Care 36.2% 5 Medical Specialists 31.0% 6 Transportation 29.9% 7 Prescription/ Medication Assistance 28.0% 8 Community and Family Outreach Programs 22.6% 9 Health Screenings 22.0% 10 Primary Care Providers 19.7% 11 Health Education 18.8% 12 Bilingual Services 11.7%

*Survey respondents were asked to select all that apply.

CHNA Focus Groups & Interviews- Key Themes

Substance Abuse- Alcohol Use and ED Visits for SUDs

• Percentage of Adults reporting excessive drinking in 2016

▫ Cecil County: 18% ▫ Maryland: 17%

 Source: County Health Rankings. Excessive Drinking, 2018.

1538.6 2121.9 2234.8 2057.6 2165.7 2133.2 1122.4 1237.5 1398.2 1474.6 1591.3 1940.5 2010 2011 2012 2013 2014 2016 ED Visits (per 100,000 population)

Rate of Emergency Department Visits Related to Substance Use Disorders*

Cecil Maryland

MD 2017 Goal: 1400.9 *Diagnoses include alcohol-related and drug related disorders

Source: Maryland Health Services Cost Review Commission (HSCRC), Research Level Statewide Outpatient Data Files.

Substance Abuse- Adolescents

Substance Use Among Cecil County and Maryland High School Students, 2016

Cecil County Maryland Percentage of students who currently drank alcohol (at least 1 drink on at least 1 day in the past 30 days) 31.1% 25.5% Percentage of students who currently were binge drinking (4-5 drinks in a row, within a couple of hours) on at least 1 day in the past 30 days 17.9% 13.0% Percentage of students who used marijuana one or more times during their life 34.8% 31.4% Percentage of students who used marijuana one or more times during the past 30 days 20.9% 18.4% Percentage of students who used any form of cocaine, including powder, crack, or freebase, one or more times during their life 4.6% 5.4% Percentage of students who used heroin one or more times during their life 2.7% 4.3% Percentage of students who have taken a prescription drug (ex. Oxycontin, Percocet, Vicodin, codeine, Adderall, Ritalin, or Xanax) without a doctor's prescription one or more times during their life. 13.3% 13.7%

Source: Maryland Youth Risk Behavior Survey, 2016

Substance Abuse- Drug-Induced Death Rate

21.6 21.2 27.4 29.5 26.5 27.9 30.5 39.8 12.9 12.1 11.9 12.3 13.3 15.2 17.7 24.1 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015 2014-2016 Deaths (per 100,000 population)

Drug-Induced Death Rate per 100,000 population

Cecil Maryland

Source: Maryland Department of Health, Vital Statistics Administration (VSA).

Substance Abuse- Overdose Deaths

25 10 24 24 28 25 26 29 32 30 59

10 20 30 40 50 60 70 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cecil County Drug- and Alcohol- Related Intoxication Deaths by Year, 2007-2017

Of the 59 deaths in 2017, 57 involved opioids, 44 involved fentanyl and 37 involved heroin.

Source: Maryland Department of Health. Unintentional Drug- and Alcohol- Related Intoxication Deaths in Maryland Annual Report, 2017.

Mental Health- Mentally Unhealthy Days & Adolescent Depression

• Average number of mentally unhealthy days

reported in past 30 days (age-adjusted), 2016:

▫ Cecil County: 4.2 ▫ Maryland: 3.5

 Source: County Health Rankings. Poor Mental Health Days, 2018.

Depression and Thoughts of Suicide Among High School Students, 2016

Cecil County Maryland Percentage of students who felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months 29.7% 29.9% Percentage of students who seriously considered attempting suicide during the past 12 months 16.9% 17.3% Source: Maryland Youth Risk Behavior Survey, 2016

Mental Health- ED Visits for Mental Health Disorders

7085.5 9974.8 10570.8 8901.6 5501.6 8684 2780.8 3211.2 3500.6 3318.5 3442.6 3796.7 2010 2011 2012 2013 2014 2016 ED Visits (per 100,000 population)

Rate: of Emergency Dept Visits Related to Mental Health Disorders*

Cecil Maryland

MD 2017 Goal: 3152.6

Diagnoses include disorders of: adjustment, anxiety, attention deficit, disruptive behavior, mood, personality, schizophrenia, psychotic, suicide, intentional self-inflicted injury, miscellaneous mental. Source: Maryland Health Services Cost Review Commission (HSCRC), Research Level Statewide Outpatient Data Files.

Mental Health- Alzheimer’s or Other Dementia Hospitalizations

314.1 264.5 204.2 199.3 136.5 291.1 267.8 247.6 221.6 194.1 2010 2011 2012 2013 2014 Hospitalizations (per 100,000 population)

Rate of Hospitalizations Related to Alzheimer's and Other Dementias

Cecil Maryland

MD 2017 Goal: 199.4

Source: Maryland Health Services Cost Review Commission (HSCRC), Research Level Statewide Outpatient Data Files.

Mental Health- Suicide SHIP Measure: Suicide Rate

Suicide rate per 100,000 population

2007- 2009 2008- 2010 2009- 2011 2010- 2012 2011- 2013 2012- 2014 2013- 2015 2014- 2016 Cecil 13.6 12.8 16.8 13.6 15.1 13.4 * * Maryland 8.9 8.7 8.9 8.8 9.0 9.2 9.1 9.2

HP 2020 Target: 10.2 MD 2017 Goal: 9.0 Source: Maryland DHMH Vital Statistics Administration (VSA) Reporting Threshold (*):Rate not reported if below threshold of 20.

Homelessness- 5 Year Point in Time Results

Source: 2014-2018 Cecil County Point In Time Survey. 195 191 167 193 129

50 100 150 200 250 2014 2015 2016 2017 2018

Point in Time Homeless Survey Counts, 2014- 2018

Homelessness- 2018 Point in Time Results

Source: 2018 PIT Survey

Gender Male 70% Female 29% Transgender 1% Race White 70% Black 26% Asian 1% American Indian or Alaskan Native 0% Native Hawaiian or Other Pacific Islander 0% Multiple Races 4% Ethnicity Hispanic, Latino, or Spanish Origin 1% Age Groups Children (Under 18) 18% Young Adults 18-24) 3% Adults (Over 24) 79%

Homelessness- 2018 Point in Time Results

Source: 2018 PIT Survey

Shelter Status Sheltered 68% Unsheltered 32% Subpopulations Chronically Homeless 21% HIV/AIDS 0% Homeless Youth 4% Serious Mental Illness 29% Substance Abuse Disorder 14% Veterans 42% Victims of Domestic Violence 7% Barriers to Housing * Alcohol/ Drug Use 2 Credit Issues 10 Criminal Background 13 No Income 34 Physical Disability 11

* Count based on 45 responses

Access to Health Services- Insurance Status

• From 2013-2017 an estimated 5.5% of Cecil County

residents were uninsured compared to 7.3% in Maryland. ▫ 73.9% of CC residents had private health insurance and 32.8% had public health insurance coverage.

▫ Source: U.S. Census Bureau, 2013-2017American Community Survey 5-Year Estimates

SHIP Measure: Uninsured Emergency Department Visits Percentage of persons without health (medical) insurance

2009 2010 2011 2012 2013 2014 2015 2016 Cecil 20.1 15.8 12.9 12.2 11.7 6.5 5.8 5.2 Maryland 19.6 17.1 15.8 15.7 15.2 11.0 10.7 10.1

MD 2017 Goal: 14.7 Source: Maryland Health Services Cost Review Commission (HSCRC), Research Level Statewide Outpatient Data Files

Access to Health Services- Primary Care

• In 2015 there were 37 primary care physicians in Cecil

County and a ratio of population to total primary care physicians of 2,770:1. The PCP ratio in MD was 1,140:1.

 Source: County Health Rankings. Primary Care Physicians, Cecil County, Maryland, 2018.

• In 2017 there were 47 non-physician primary care

providers in Cecil County.

 Source: County Health Rankings. Other Primary Care Providers, Cecil County, Maryland, 2018.

SHIP Measure: Persons with Usual Primary Care Provider Percentage of people who reported that they had a personal doctor or health care provider

2011 2012 2013 2014 2015 2016 Cecil 89.1 80.5 90.9 86.7 77.5 87.2 Maryland 83.0 83.4 79.4 82.6 85.2 84.8

MD 2017 Goal: 83.9 Source: Maryland Behavioral Risk Factor Surveillance System (BRFSS)

Access to Health Services- Primary Care

SHIP Measure: Adolescents Who Received a Wellness Checkup in the Last Year Percentage of adolescents (ages 13-20 years old) enrolled in Medicaid (320+ days) who received a wellness visit during the past year

2010 2011 2012 2013 2014 2015 2016 Cecil 47.6 47.2 47.0 49.8 49.4 52.8 47.7 Maryland 51.5 53.4 52.6 54.7 56.0 58.0 55.3

MD 2017 Goal 57.4 Source: Maryland Medicaid Service Utilization

Access to Health Services- Cost and Wait Times

• Adults who could not see a doctor due to cost in

past 12 months

▫ Cecil- 11.7% MD- 9.4%

 Source: MD BRFSS 2016

• Average time patients spent in the emergency

room before being seen by a doctor, 2017.

▫ Union Hospital: 26 minutes ▫ Average for Maryland Hospitals: 31 minutes

 Source: Center for Medicare and Medicaid Services, Timely and Effective Care Measures, last updated Oct 30, 2018.

Poverty- Population Below FPL

Source: U. S. Census Bureau, American Community Survey, 5-Year Estimates, 2013-2017.

9.4% 9.70% 14.6% 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% Cecil Maryland U.S.

Population Living Below Poverty Level, 2013-2017

Poverty- Educational Attainment

Source: U. S. Census Bureau, American Community Survey, 5-Year Estimates. 2013-2017

20.60% 8.00% 6.20% 3.00%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00%

Less than high school graduate High school graduate (includes equivalency) Some college, associate's degree Bachelor's degree or higher

Cecil County Adults Ages 25 and Older Living Below Poverty Level by Level of Education, 2013-2017

Poverty- Race/Ethnicity

Source: U. S. Census Bureau, American Community Survey, 5-Year Estimates, 2013-2017.

7.90% 18.90% 2.10% 18.30% 0.00% 13.40% 36.60% 21.60%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% White alone Black or African American alone American Indian and Alaska Native alone Asian alone Native Hawaiian and Other Pacific Islander alone Some other race alone Two or more races Hispanic

• r Latino
• rigin (of

any race)

Cecil County Population Living Below Poverty Level by Race/Ethnicity, 2013- 2017

Poverty- Families

• Cecil County families with a female householder

and no husband present are more likely to live in poverty (18.0%) than married couple families (2.7%).

• Among female householder families with

children the burden of poverty is even higher (27.4%). Source: U. S. Census Bureau, American Community Survey, 5-Year Estimates, 2013-2017.

Poverty- ALICE

• ALICE is an acronym for Asset Limited, Income

Constrained, Employed – households that earn more than the Federal Poverty Level, but less than the basic cost of living for the county. ▫ 30% of Cecil County households met this criteria in 2016, compared to 28% in Maryland.

 Source: United Way ALICE Report. ALICE in Cecil County 2016 Point in Time Data.

Obesity- Prevalence

SHIP Measure: Adults Who Are Not Overweight or Obese Adults who are not overweight or obese

2011 2012 2013 2014 2015 2016 Cecil 25.0 29.7 31.6 33.6 44.4 26.8 Maryland 35.6 36.2 35.8 35.1 35.0 35.4

HP 2020 Target: 33.9 MD 2017 Goal: 36.6 Source: Maryland DHMH Behavioral Risk Factor Surveillance System (BRFSS)

SHIP Measure: Adolescents Who Have Obesity Percentage of adolescent public high school students who are obese

2010 2013

2014 2016

Cecil 12.1 13.2

14.1 16.3

Maryland 11.7 11.0

11.5 12.6 HP 2020 Target: 16.1 MD 2017 Goal: 10.7 Source: Maryland Youth Risk Behavior Survey (YRBS)

Obesity- Physical Activity

• Percentage of population with adequate access

to locations for physical activity, 2016:

▫ Cecil County: 79% ▫ Maryland:93%

 Source: County Health Rankings. Access to Exercise Opportunities, 2018.

SHIP Measure: Increase Physical Activity Percentage of adults reporting adequate amounts of physical activity

2011 2012 2013 2015 Cecil 55.2 49.7 39.1 50.5 Maryland 48.7 51.8 48.0 52.9

HP 2020 Target: 47.9 MD 2017 Goal: 50.4 Source: Maryland DHMH Behavioral Risk Factor Surveillance System (BRFSS)

Obesity- Physical Activity

Physical Activity Among Public High School Students, 2016

Cecil County Maryland Percentage of students who were physically active at least 60 minutes per day on 5 or more days (in any kind of physical activity that increased their heart rate and made them breathe hard some of the time during the 7 days before the survey)

35.1% 35.2%

Percentage of students who did not participate in at least 60 minutes of physical activity on at least 1 day (in any kind of physical activity that increased their heart rate and made them breathe hard some of the time during the 7 days before the survey)

17.6% 21.6%

Percentage of students who were physically active at least 60 minutes per day on all 7 days (in any kind of physical activity that increased their heart rate and made them breathe hard some of the time during the 7 days before the survey

17.3% 17.9%

Source: Maryland Youth Risk Behavior Survey, 2016

Obesity- Nutrition

Nutrition Among Public High School Students, 2016

Cecil County Maryland

Percentage of students who ate fruit or drank 100% fruit juices one or more times per day (such as orange juice, apple juice, or grape juice, during the 7 days before the survey) 50.5% 53.9% Percentage of students who ate vegetables one or more times per day (green salad, potatoes [excluding French fries, fried potatoes, or potato chips], carrots, or other vegetables, during the 7 days before the survey) 59.1% 57.4%

Source: Maryland Youth Risk Behavior Survey, 2016

Affordable Housing

39.3 46.8 61.3 56.9 62 71.8 77.2 40.2 48.1 52.8 53.1 46.1 48.2 48.1 10 20 30 40 50 60 70 80 90

2010 2011 2012 2013 2014 2015 2016

Prcentage of Housing Units that are Affordable on the Median Teacher's Salary

Cecil Maryland

MD 2017 Goal: 54.4

Source: Maryland Department of Planning (MDP)

Child Abuse and Neglect

SHIP Measure: Child Maltreatment Rate Rate of children who are maltreated per 1,000 population under the age of 18

2011 2012 2013 2014 2015 2016 Cecil 18.4 20.1 16.5 16.8 10.6 10.1 Maryland 9.3 10.2 9.2 9.9 7.3 6.6

HP 2020 Target: 8.5 MD 2017 Goal: 8.3 Source: Maryland Department of Human Resources (DHR)

Dental Health- Provider Availability and ED Visit Rate

• In 2016 there were 41 dentists in Cecil County and a

ratio of population to total dentists of 2,500:1. The dentist ratio in MD was 1,320:1.

 Source: County Health Rankings. Dentists, Cecil County, Maryland, 2018

SHIP Measure: Emergency Department Visit Rate for Dental Care Emergency department visit rate related to dental problems (per 100,000 population)

2008 2009 2010 2011 2012 2013 2014 2016 Cecil 1574.0 1995.8 1728.5 1690.1 1683.2 1690.1 1525.3 1069.3 Maryland 724.8 746.4 767.5 789.6 816.7 809.0 779.7 585.7

MD 2017 Goal: 792.8 Source: Maryland Health Services Cost Review Commission (HSCRC), Research Level Statewide Outpatient Data Files

Dental Health- Children and Adolescents

• In 2016, 78.4%of Cecil County HS students reported seeing a

dentist in the past year compared to 76.6% in Maryland.

▫ Disparities exist by race/ethnicity in Cecil County.

 White students-81.8%; Hispanic/Latino students- 67.5% Black students- 58.0%

• In 2016, 1.9% of Cecil County HS students reported having

never seen a dentist compared to 2.7% in Maryland.

 White students-1.1%; Hispanic/Latino students- 5.1% Black students- 6.4%

Source: Maryland Youth Risk Behavior Survey, 2016.

Number of Permanent Teeth Removed Among Adults Age 18+

None 1 to 5 6 or more, but not all All Cecil 57.5% 26.7%

13.2% 2.7%

Maryland 58.8% 30.1%

9.1% 3.1%

Dental Health- Adults

Cancer- Mortality Rate

220.2 206 196.7 188.4 189.4 185.9 186.4 184.3 192.3 179.3 176.8 171.4 166.8 163.8 162 159.3 157.4 154.5

50 100 150 200 250 Rrate per 100,000 population

Age-Adjusted Mortality Rate from Cancer, Cecil County and Maryland

Cecil Maryland HP 2020 Target MD 2017 Goal

160.6

Source: Maryland Department of Health, Vital Statistics Administration.

147.4

Cancer- Incidence and Deaths From Select Causes

• From 2011-2015, the age-adjusted incidence rate of cancer in Cecil County was

504.8 per 100,000 population, compared to 446.2 per 100,000 population in Maryland.

• Cecil County had the second highest incidence of Cancer among Maryland

Counties.

 Source: National Cancer Institute. Incidence Rate Report for Maryland by County, All Cancer Sites, 2011-2015.

• In 2017, there were 234 total deaths due to cancer in Cecil County.
• Number of deaths from select cancers, 2017:

▫ Trachea, Bronchus and Lung: 72 ▫ Colon, Rectum and Anus: 22 ▫ Urinary Tract: 14 ▫ Pancreas: 11 ▫ Breast: 11 ▫ Cervix, Uteri, Corpus Uteri and Ovary: 10 ▫ Leukemia: 8 ▫ Non Hodgkin’s Lymphoma: 7 ▫ Prostate: 7 ▫ Stomach: 2 ▫ Other: 64

 Source: Maryland Department of Health. Maryland Vital Statistics Annual Report, 2017.

Cancer- Tobacco Use

• Among Cecil County adults, approximately 19%

were current smokers in 2016, compared to 14% in Maryland.

 Source: County Health Rankings. Adult Smoking, 2018.

• Among public high school students in Cecil

County 26.6% reported using any tobacco product (including electronic vapor products) in 2016, compared to 21.6% in Maryland.

 Source: Maryland Youth Risk Behavior Survey, 2016.

Violent Crime

Unemployment

• From 2013-2017 , the unemployment rate in Cecil County was at

5.8%, compared to 6.1% in Maryland.

Source: U. S. Census Bureau, American Community Survey, 5-Year Estimates, 2013-2017. 4 3.8 4.6 4.6 4.5 3.9 3.9 4.5 4.4 4.2 3.9 3.8 3.5 4.4 4.3 5.4 5.4 5.2 4.3 4.2 4.8 5.1 4.9 4.2 4.1 3.8

1 2 3 4 5 6 Unemployment rate (%)

Unemployment Rate by Month, Cecil County and Maryland, Nov. 2017- Nov. 2018

Maryland Cecil County

Source: U.S. Department of Labor, Bureau of Labor Statistics. Local Area Unemployment Statistics (LAUS) . Publisher: MD Office of Workforce Information & Performance. Release Date January 3, 2019

Childhood Trauma- ACEs

34.7% 46.8% 18.6% 40.2% 35.7% 24.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

0 ACEs 1 to 2 ACES 3 to 8 ACEs

Prevalence of Adverse Childhood Experiences (ACES) Among Adults, 2015

Cecil County Maryland

Source: Maryland Behavioral Risk Factor Surveillance System, 2015

Childhood Trauma- ACEs

Source: Maryland Behavioral Risk Factor Surveillance System, 2015

Prevalence of Adverse Childhood Experiences (ACEs) among Adults, 2015

Cecil County Maryland Household Mental Illness 15.8% 15.0% Household Substance Abuse 25.4% 24.9% Incarcerated Household Member * 7.6% Parental Separation or Divorce 19.9% 27.5% Intimate Partner Violence * 17.4% Emotional Abuse 38.3% 31.2% Physical Abuse * 16.9% Sexual Abuse * 11.1%

*Data suppressed due to denominator < 50

Educational Attainment- Adults Age 25 and Older

Educational Attainment- School Readiness & Graduation Rates

SHIP Measure: Students Entering Kindergarten Ready to Learn Percentage of students who enter Kindergarten ready to learn

2014 2015 2016 Cecil 42 44 35 Maryland 47 45 43

Source: Maryland State Department of Education (MSDE)

SHIP Measure: High School Graduation Rate Percentage of students who graduate high school in four years

2012 2013 2014 2015 2016 2017 2018 Cecil 84.1 86.7 88.6 87.8 90.7 90.5 90.5 Maryland 83.6 85.0 86.4 87.0 87.6 87.7 87.7

HP 2020 Target: 82.4 MD 2017 Goal: 95.0 Source: Maryland State Department of Education (MSDE)

Educational Attainment- Graduation by Race/Ethnicity

Source: Maryland State Department of Education. Maryland Report Card, 2018.

Diabetes- Prevalence

• Adults with prediabetes (excludes people with

reported diabetes), 2017

▫ Cecil County: 8.9% ▫ Maryland: 11.7%

 Source: Maryland Behavioral Risk Factor Surveillance System, 2017.

Adults with Diabetes

2011 2012 2014 2015 2016 2017 Cecil

11.7% 7.7% 12.5% 8.7% 10.4% 10.5%

Maryland

10.2% 10.2% 10.2% 10.4% 10.2% 10.0%

Source: Maryland Behavioral Risk Factor Surveillance System (BRFSS).

Diabetes- Mortality

Source: Maryland Department of Health, Vital Statistics Administration. 19.4 15.8 18 17.3 23 19.6 19.2 19 19.2 19.4

2011-2013 2012-2014 2013-2015 2014-2016 2015-2017

Age-Adjusted Death Rate due to Diabetes (per 100,000 population)

Cecil Maryland

Diabetes- Emergency Department Utilization

Source: Maryland Health Services Cost Review Commission (HSCRC), Research Level Statewide Outpatient Data Files.

185.4 214.4 212 215.8 250.2 284.9 177.3 180.9 194.8 192.1 204 222.9 2010 2011 2012 2013 2014 2016 ED Visits (per 100,000 population)

Rate of Emergency Department Visits due to Diabetes per 100,000 Population

Cecil Maryland

MD 2017 Goal: 186.3