Improving Community Health through Planning and Partnerships Louisa

Improving Community Health through Planning and Partnerships Louisa Community Health Council

Things to keep in mind… • Feel free to ask questions as we go along • We are presenting the most recent data we have • (From the past 4 – 5 years) • This is Section 2 data • In the next section in March we will cover: • Section 3: What is our Health Status?

Today • Updates from Section 2, Part 1 • Section 2, Part 2 • Health Behaviors • • • Tobacco Use Obesity Alcohol and Substance Use/Abuse Seat Belt & Safety Device use Mental / Behavioral Health Seat Belt & Safety Device use Immunization Health Screenings-Cancer & HIV Chronic Disease Management-Diabetes & Hypertension

Section Two: Strengths and Risks in Our Community Behavioral Risk Factors

Behavioral Risk Factors

CDC’s Behavioral Risk Factor Surveillance Survey (BRFSS) • A monthly randomized telephone health survey conducted by state health departments across the US • Asks standardized questions about adults’ health behaviors • Statewide results are periodically stratified and reported by health district

Why are sample sizes sometimes too small to report data at locality level for population health surveys such as BRFSS? Variable Total Sample Size Needed Cost Smoking Within 2. 5% 4, 200 $245, 00 Within 1. 5% 12, 138 $708, 050 Within 2. 5% 7, 998 $466, 550 Within 1. 5% 22, 488 $1, 311, 800 Within 2. 5% 288 $16, 800 Within 1. 5% 846 $49, 350 Obesity Mental Health Source: Yancey, Owen. The Demands and Limitations of Population health data for LHD’s. 2015. (Master’s Thesis)

Behavioral Risk Factors Tobacco Use

Adults Aged 20 Years and Older Who Smoke (Self-Reported), Three-Year Rolling 25% 22, 9% Averages, 2000 -13 20, 9% 20, 0% 18, 0% 20% 17, 9% 15, 8% 15, 3% 15% 17, 6% 10% Healthy People 2020 Goal = Reduce to 12% 5% 20 20 00 - 20 0 01 2 -2 20 00 02 3 -2 20 00 03 4 -2 20 00 04 5 -2 20 00 05 6 -2 20 00 06 7 -2 20 00 07 8 -2 20 00 08 9 -2 20 01 09 0 -2 20 01 10 1 -2 20 01 11 2 -2 01 3 0% TJHD Virginia Healthy People 2020 Source: Virginia Department of Health Behavioral Risk Factor Surveillance Survey 19, 6% 17, 0%

Adults Aged 18 Years and Older Who Have Ever Smoked at least 100 Cigarettes (Self. Reported), 2011 -12 80% 70% 68, 0% 60% 50% 46, 1% 43, 7% 44, 2% 40% 30% 20% 10% 0% 2011 -12 Fluvanna Louisa VA U. S. Source: Community Commons. Community Health Needs Assessment Report. (CC pulled this data from BRFSS with additional data analysis by CARES)

Adults Aged 18 Years and Older Who Have Ever Smoked at least 100 Cigarettes (Self. Reported) by Race and Ethnicity, 2011 -12 60% 50% 46% 49% 41% 40% 38% 40% 31% 36% 34% 30% 20% 10% 0% White (Non. Hispanic) Black (Non. Hispanic) Virginia Other Race (Non- Hispanic / Latino Hispanic) United States Source: Community Commons. Community Health Needs Assessment Report. (CC pulled this data from BRFSS with additional data analysis by CARES)

Percent of Smokers Who Tried To Quit in Virginia, 2001 -13 62% 61% 60% 2009 2013 60% 58% 56% 54% 52% 50% 48% 46% 2001 2005 Source: Virginia Department of Health Behavioral Risk Factor Surveillance System

Percent of Smokers with Quit Attempt in Past 12 Months(Self-Reported), 2011 -12 90% 79, 3% 80% 70% 60% 58, 4% 60, 0% VA U. S. 50% 40% 30% 20% 10% 0% 0, 0% Fluvanna Louisa Source: Community Commons. Community Health Needs Assessment Report. (CC pulled this data from BRFSS with additional data analysis by CARES)

Percent of Smokers with Quit Attempt in Past 12 Months(Self-Reported) by Race and Ethnicity, 2011 -12 80% 70% 60% 73% 69% 71% 53% 61% 62% 57% 66% 50% 40% 30% 20% 10% 0% White (Non. Hispanic) Black (Non. Hispanic) Virginia Other Race (Non- Hispanic / Latino Hispanic) United States Source: Community Commons. Community Health Needs Assessment Report. (CC pulled this data from BRFSS with additional data analysis by CARES)

Cigarette Expenditures, 2014 % of Food-at-Home Expenditures Average Expenditures (USD) TJHD 1. 5% $877. 76 VA 1. 4% $823. 43 U. S. 1. 6% $822. 70 Source: Community Commons. Community Health Needs Assessment Report. Nielsen, Nielsen Site. Reports. 2014. Source geography: Tract.

Percent of Households with Smokefree Rules (no smoking inside house)in Virginia, 1992 -2011 86% 90% 80% 70% 60% 50% 40% 39% 30% 20% 10% 0% 1992 -93 2010 -11 Source: Virginia Department of Health, Office of Family Health Services 2015 Report on Exposure to Secondhand Smoke in VA & the US

Youth & Tobacco

Percent of Youth Living in Households Where Smoking is Allowed in Virginia, 2013 High School Students 18% Middle School Students 17% Source: Virginia Department of Health, Office of Family Health Services 2015 Report on Exposure to Secondhand Smoke in VA & the US

High School Students (Grades 9 -12) Currently Using Tobacco(current cigarette use, current smokeless tobacco use, or current cigar use) , 2011 -13 Currently use tobacco (current cigarette use, current smokeless tobacco use, or current cigar use) 25% 20% US 23% US 22% VA 21% VA 18% 15% 10% 5% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Currently Using Tobacco by Gender (current cigarette use, current smokeless tobacco use, or current cigar use) , 2011 -13 30% US-Males 28% 25% VA-Males 24% 20% US-Females 19% 15% VA-Females 17% 10% US-Males 27% VA-Males 20% US-Females 18% VA-Females 15% 5% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Currently Smoking Cigarettes, 2011 -13 Currently smoke cigarettes (on at least 1 day during the 30 days before the survey) 20% US 18% US 16% 15% VA 15% 10% VA 11% 5% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Heavy Smokers, 2011 -13 Currently smoked cigarettes frequently (on 20 or more days during the 30 days before the survey) 7% US 6% 6% 5% VA 5% 4% 3% VA 4% 2% 1% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Ever Tried Smoking Cigarettes, 2011 -13 Ever tried cigarette smoking (even one or two puffs) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% US 45% US 41% VA 36% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Smoking Cigarette Before Age 13 Years, 2011 -13 Smoked a whole cigarette before age 13 years (for the first time) 12% 10% VA 11% US 10% US 9% 8% VA 8% 6% 4% 2% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Using Smokeless Tobacco, 2011 -13 Currently use smokeless tobacco (chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey) 9% 9% 9% 8% 8% 8% 7% 7% 7% US 9% VA 8% US 8% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Using Smokeless Tobacco by Gender, 2011 -13 16% 14% 12% Currently use smokeless tobacco (chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey) US-Males VA-Males 15% 14% VA-Males 13% US-Males 10% 13% 8% 6% 4% 2% US-Females VA-Females 2% 2% US-Females 3%VA-Females 3% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Using Cigars, 2011 -13 Currently use cigars (cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey) 14% US 13% 13% 12% VA 11% 11% 10% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

High School Students (Grades 9 -12) Using Cigars by Gender, 2011 -13 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Currently use cigars (cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey) US-Males 18% 17% VA-Males 15% VA-Females 9% US-Females 8% 2011 VA-Males 14% US-Females 9% VA-Females 8% 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey(YRBS)

Behavioral Risk Factors Obesity

Obesity Trends Among U. S. Adults 1985 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data 14% <10% 10%– Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 1990 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%– 14% Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 1995 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%– 14% 15%– 19% Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2000 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%– 14% 15%– 19% ≥ 20% Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2005 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data ≥ 30% <10% 10%– 14% 15%– 19% 20%– 24% 25%– 29% Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2010 (*BMI ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 29% ≥ 30% 10%– 14% 15%– 19% 20%– 24% 25%– Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2011 Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2012 Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2013 Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults 2014 Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults Differences by Racial/Ethnic Group. White (Non-Hispanic) 2012 -14 VA = 26% 95% CI = (25. 2, 26. 9) Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults Differences by Racial/Ethnic Group. Black (Non-Hispanic) 2012 -14 VA = 39% 95% CI = (36. 8, 41. 0) Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Obesity Trends Among U. S. Adults Differences by Racial/Ethnic Group. Hispanic 2012 -14 VA = 25% 95% CI = (21. 2, 28. 2) Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. ¶ Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention

Percentage of Adults Who are Obese 3 Year Rolling Averages, 2000 -13 35% 30, 6% 27, 7% 27, 9% 30% 25% 20% 15% 10% 5% 20 00 - 20 20 0 01 2 -2 20 003 02 -2 20 004 03 -2 20 005 04 -2 20 006 05 -2 20 007 06 -2 20 008 07 -2 20 009 08 -2 20 010 09 -2 20 010 11 -2 01 3 0% TJHD Virginia Healthy People 2020 Goal Source: Virginia Department of Health. Behavioral Risk Factor Surveillance Survey

Youth-Normal Body Composition (BMI 18. 5 -24. 9), School Years 2009 -10 to 2013 -14 Percent of Students in the Healthy Fitness Zone for Body Composition in VA, School Years 2009 -10 to 2013 -14 80% 71% 64% 67% 65% 64% 40% 59% 56% 55% 2012 -13 2013 -14 20% 0% 2009 -10 2010 -11 2011 -12 Boys Grades 4 -12 Girls Grades 4 -12 Source: Virginia Department of Education, Summary Fitness Reports

Percent of Students in the Healthy Fitness Zone for Body Composition (Normal BMI) by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to Girls 2013 -14 Boys Girls Grades 4 th-5 th Girls Middle School (Grades 6 -8) Girls High School (Grades 9 th-12 th) 20 09 -1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 20 09 - 1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 76% 80% 69% 68% 65% 73% 61% 58% 70%72% 59% 57% 60% 68% 60% 70% 66% 65% 67% 62% 58% 55% 50% 56% 54% 40% 30% 20% 10% 0% 0% Boys Grades 4 th-5 th Boys Middle School (Grades 6 -8) Boys High School (Grades 9 -12) Source: Virginia Department of Education, Summary Fitness Reports

Obesity-Physical Activity & Physical Fitness

Percent of Adults (Age 20+ Years) Reporting No Leisure Time Physical Activity, 2011 -14 32% 30% 28% 30% 22% 22% 2012 2013 2014 28% 29% 26% 24% 23% 22% 20% 18% 2011 Fluvanna Louisa Source: US County Healthy Rankings

Physical Activity-Youth, 2011 -13 Percent of High School Students (Grades 9 -12) who were NOT physically active at least 1 hour per day on 5 or more days in the past 7 days prior to survey, 2011 -13 70% 60% 50% 40% 65% 56% 54% 53% 51% 46% 44% 30% 20% 10% 0% 2011 VA Female 2013 VA Male VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Physical Activity-Youth, 2011 -13 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Percent of High School Students (Grades 9 -12) who played video/computer games OR used a computer (for something other than schoolwork) for 3 or more hours per day on an average school day, 2011 -13 41% 38% 29% 2011 2013 VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Physical Activity-Youth, 2011 -13 Percent of High School Students (Grades 9 -12) who watched TV for 3 or more hours per day on an average school day, 2011 -13 34% 33% 32% 31% 30% 29% 28% 27% 26% 25% 33% 32% 31% 30% 28% 28% 2011 VA Female 2013 VA Male VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Physical Activity-Youth, 2011 -13 Percent of High School Students (Grades 9 -12) who did NOT attend a PE class on at least 1 day in an average week they were in school, 2011 -13 60% 50% 40% 56% 53% 50% 48% 52% 48% 44% 43% 30% 20% 10% 0% 2011 VA Female 2013 VA Male VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Youth in the Healthy Fitness Zone for Abdominal Strength by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 100% 95% 89% 90% 87% 85% 87% 89% 87% Boys 88% 85% Girls 86% 83% 80% 2009 -10 2010 -11 2011 -12 2012 -13 2013 -14 Source: Virginia Department of Education, Summary Fitness Reports

Percent of Students in the Healthy Fitness Zone for Abdominal Strength by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 Girls Boys 100% 95% 88% 89% 89% 87% 90% 85%86% 85% 84% 85% 80% 83% 84% 80% 75% 78% 75% 92% 93% 91% 90% 86% 85% 83% 74% 79% Girls 6 th-8 th Boys 4 th-5 th Boys 9 th-12 th 14 13 - 20 13 12 - 20 12 11 - 20 11 10 - 20 09 20 14 13 - 20 13 12 - 20 12 11 - 20 11 10 - 0 20 -1 20 09 Girls 4 th-5 th Girls 9 th-12 th 10 70% Boys 6 th-8 th Source: Virginia Department of Education, Summary Fitness Reports

Youth in the Healthy Fitness Zone for Aerobic Endurance by Grade Level in Virginia, Grades 412, School Years 2009 -10 to 2013 -14 100% 80% 60% 75% 66% 67% 72% 71% 77% 76% 70% 68% Boys 40% Girls 20% 0% 2009 -10 2010 -11 2011 -12 2012 -13 2013 -14 Source: Virginia Department of Education, Summary Fitness Reports

Percent of Students in the Healthy Fitness Zone for Aerobic Endurance by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 Girls 9 th-12 th Girls 6 th-8 th Boys 4 th-5 th 14 20 13 - 13 20 12 - 11 - 20 09 -1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 Girls 4 th-5 th 12 0% 0% 20 20% 11 40% 74% 71% 80% 69% 66% 73% 67% 78% 77% 60% 76% 66% 68% 65% 61% 56% 53% 40% 57% 55% 49% 20 10 - 60% 10 80% 87% 85% 81% 87% 86% 20 09 - 100% Boys 6 th-8 th Source: Virginia Department of Education, Summary Fitness Reports

Youth in the Healthy Fitness Zone for Upper Body Strength by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 100% 80% 75% 78% 77% 74% 75% 73% 60% Boys Girls 40% 20% 0% 2009 -10 2010 -11 2011 -12 2012 -13 2013 -14 Source: Virginia Department of Education, Summary Fitness Reports

Percent of Students in the Healthy Fitness Zone for Upper Body Strength by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 Boys Girls 100% 40% 20% 0% 0% 4 th-5 th 6 th-8 th 9 th-12 th 20 09 20 10 10 20 11 11 20 12 12 20 13 13 -1 4 79% 80% 78% 77% 74% 80% 76% 75% 78% 77% 75% 60% 73% 20 09 -1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 76% 75% 76% 74% 80% 75% 74% 60% 73% 72% 71% 70% 67% 4 th-5 th 6 th-8 th 9 th-12 th Source: Virginia Department of Education, Summary Fitness Reports

Youth in the Healthy Fitness Zone for Flexibility by Grade Level in Virginia, Grades 412, School Years 2009 -10 to 2013 -14 100% 85% 80% 79% 86% 84% 85% 83% 81% 2010 -11 2011 -12 2012 -13 2013 -14 60% 40% 20% 0% 2009 -10 Boys Girls Source: Virginia Department of Education, Summary Fitness Reports

Percent of Students in the Healthy Fitness Zone for Flexibility by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 100% 86% 88% 84% 85% 80% 81% 78% 79% 87% 81% 90% 84% 82% 83% 81% 80% 78% 70% 76% 70% 20 09 -1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 4 th-5 th 84% 82% 83% 80% 81% 78% 79% 80% 6 th-8 th 9 th-12 th 20 09 -1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 90% 4 th-5 th 6 th-8 th 9 th-12 th Source: Virginia Department of Education, Summary Fitness Reports

Youth in the Healthy Fitness Zone for Trunk Lift by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 2013 -14 100% 91% 90% 86% 90% 87% 88% 89% 86% 80% 89% 84% 70% 2009 -10 2010 -11 2011 -12 Boys 2012 -13 2013 -14 Girls Source: Virginia Department of Education, Summary Fitness Reports

Percent of Students in the Healthy Fitness Zone for Trunk Lift by Grade Level in Virginia, Grades 4 -12, School Years 2009 -10 to 201314 Girls 100% Boys 91% 90% 88% 90% 91% 89% 89% 91% 88% 90% 89% 87% 88% 84% 86% 85% 84% 80% 79% 70% 4 th-5 th 6 th-8 th 9 th-12 th 20 09 -1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 20 09 - 1 20 0 10 -1 20 1 11 -1 20 2 12 -1 20 3 13 -1 4 70% 4 th-5 th 6 th-8 th 9 th-12 th Source: Virginia Department of Education, Summary Fitness Reports

Obesity-Food & Diet

Soda Expenditures, 2014 % of Food-at-Home Expenditures Average Expenditures (USD) TJHD 4. 3% $252. 94 VA 4. 1% $238. 29 U. S. 4. 0% $236. 04 Source: Community Commons. Community Health Needs Assessment Report. Nielsen, Nielsen Site. Reports. 2014. Source geography: Tract.

Youth Drinking Soda, 2011 -13 Percent of High School Students (Grades 9 -12) who drank soda (at least 1 can/glass/bottle of soda) in the past 7 days prior to survey, 2011 -13 85% 80% 75% Percent of High School Students (Grades 9 -12) who drank soda (at least 1 can/glass/bottle of soda) in the past 7 days prior to survey by gender, 2011 -13 87% 79, 4% 79, 1% 77, 7% 72, 9% 82% 77% 70% 72% 65% 67% 60% 62% 2011 VA 2013 US 81, 4% 77, 2% 76, 3% 69, 5% 2011 VA Female 2013 VA Male Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Fruit and Vegetable Expenditures, 2014 % of Food-at-Home Expenditures Average Expenditures (USD) TJHD 12. 1% $714. 63 VA 12. 4% $729. 71 U. S. 12. 7% $744. 71 Source: Community Commons. Community Health Needs Assessment Report. Nielsen, Nielsen Site. Reports. 2014. Source geography: Tract.

Median Daily Number of Fruit & Vegetables Consumed in TJHD, 2011 -13 1, 8 1, 64 1, 6 1, 50 1, 4 1, 2 1, 13 1, 10 1 0, 8 0, 6 0, 4 0, 2 0 Fruit Vegetable 2011 2013 Source: Virginia Department of Health Behavioral Risk Factor Surveillance Survey

Percent Who Eat Less < 1 Fruit or Vegetable Daily in TJHD, 2011 -13 40% 36% 35% 30% 25% 22% 20% 15% 10% 5% 0% Fruit Vegetable 2011 2013 Source: Virginia Department of Health Behavioral Risk Factor Surveillance Survey

Youth Not Eating Fruits or Vegetables, 2011 -13 Percent of High School Students (Grades 9 -12) who did NOT eat vegetables in the past 7 days prior to survey, 2011 -13 Percent of High School Students (Grades 9 -12) who did NOT eat fruit or drink 100% fruit juice in the past 7 days prior to survey, 2011 -13 8% 8% 7, 1% 6, 2% 6% 6% 6, 4% 5, 7% 6, 7%6, 6% 2011 2013 5, 0% 4, 8% 4% 4% 2% 2% 0% 0% 2011 VA 2013 US VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Youth Not Eating Fruits or Vegetables by Gender, 2011 -13 Percent of High School Students (Grades 9 -12) who did NOT eat fruit or drink 100% fruit juice in the past 7 days prior to survey by gender, 2011 -13 10% 7, 8% 8% 6, 6% 6, 3% 5, 9% 6% Percent of High School Students (Grades 9 -12) who did NOT eat vegetables in the past 7 days prior to survey by gender, 2011 -13 10% 8, 0% 8% 6% 4, 8% 5, 3% 4% 4% 2% 2% 0% 0% 2011 VA Female 2013 VA Male Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Behavioral Risk Factors Alcohol & Substance Use/Abuse

Liquor Store Access Rate, Breweries, Wineries, and Liquor Stores per 100, 000 population 2008 -2013 Louisa Fluvanna 12 6 15 12 12 10 5 0 8 7 4 4 4 3 3 3 4 2008 2009 2010 2011 Fluvanna Louisa 6 6 2012 2013 Virginia Source: U. S. Census Bureau, County Business Patterns, 2008 -2013, using NAICS codes 312120, 312130, & 445310. U. S. Census Population Data

Liquor Store Access, Rates of each type per 100, 000 population 9 8 7 6 5 4 3 2 1 0 2013 8 8 6 6 0 0 6 4 4 4 3 3 3 0 0 0 2008 2009 2010 4 3 2011 2012 Fluvanna-Breweries Fluvanna Wineries Fluvanna-Liquor Stores Louisa-Breweries Louisa-Wineries Louisa-Liquor Stores 0 2013 Source: U. S. Census Bureau, County Business Patterns, 2008 -2013, using NAICS codes 312120, 312130, & 445310. U. S. Census Population Data

Driving Under the Influence (DUI), Arrest Rates per 100, 000 Population, 3 Year Averages, 2000 -13 600 500 400 335 253 300 200 100 382 347 330 250 233 236 301 269 174 199 149 158 20 00 -0 20 2 01 -0 20 3 02 -0 20 4 03 -0 20 5 04 -0 20 6 05 -0 20 7 06 -0 20 8 07 -0 20 9 08 -1 20 0 09 -1 20 1 10 -1 20 2 11 -1 3 0 Fluvanna Louisa Virginia Source: Crime in Virginia - Virginia State Police - Uniform Crime Reporting Program

Percent of Motor Vehicle Crashes that were Alcohol-Related by Place of Occurrence, 3 Year Averages, 2000 -13 13% 11% 10% 9% 9% 11, 1% 11% 10% 10% 6, 9% 20 00 -0 20 2 01 -0 20 3 02 -0 20 4 03 -0 20 5 04 -0 20 6 05 -0 20 7 06 -0 20 8 07 -0 20 9 08 -1 20 0 09 -1 20 1 10 -1 20 2 11 -1 3 14% 12% 10% 8% 6% 4% 2% 0% Fluvanna Louisa Virginia Source: Virginia Department of Motor Vehicles-Virginia Crash Facts

Percent of Motor Vehicle Fatalities that were Alcohol-Related by Place of Occurrence, 3 Year Averages, 2000 -13 60% 55% 50% 42% 40% 38, 9% 31, 9% 30% 20% 17% 10% 20 00 - 20 02 01 -0 20 3 02 20 04 03 20 05 04 20 06 05 -0 20 7 06 20 08 07 20 09 08 -1 20 0 09 20 11 10 20 12 11 -1 3 0% Fluvanna Louisa Virginia Source: Virginia Department of Motor Vehicles-Virginia Crash Facts

Alcohol Consumption Adults Drinking Excessively- Age-Adjusted Percentage, 2006 -12 100% 80% 60% 40% 21, 5% 16, 4% 16, 3% 16, 9% Louisa VA US 0% Fluvanna Source: Community Commons. Community Health Needs Assessment Report. Centers for Disease Control & Prevention, BRFSS, Accessed via the Health Indicators Warehouse, US Department of Health & Human Services. 2006 -12.

Alcohol Expenditures, 2014 % of Food-at-Home Expenditures Average Expenditures (USD) TJHD 18. 0% $ 1, 065. 72 VA 16. 6% $973. 12 U. S. 14. 3% $839. 54 Source: Community Commons. Community Health Needs Assessment Report. Nielsen, Nielsen Site. Reports. 2014. Source geography: Tract.

Youth & Alcohol

High School Students (Grades 9 -12)who have ever drank / currently drink alcohol, VA & the U. S. , 2011 -13 Ever had at least one drink of alcohol (on at least 1 day during their life) US 80% US 71% 66% 70% 60% 50% VA 61% 40% VA 55% 30% 20% 10% 0% 2011 2013 Currently drink alcohol (at least one drink of alcohol on at least 1 day during the 30 days before the survey) US 45% US 39% 40% 35% 30% VA 25% VA 31% 20% 27% 15% 10% 5% 0% 2011 2013 Source: Centers for Disease Control & Prevention. Youth Risk Behavior Surveillance System (YRBSS)

High School Students (Grades 9 -12) who report binge drinking, VA & the U. S. , 2011 -13 Had five or more drinks of alcohol in a row (within a couple of hours on at least 1 day during the 30 days before the survey) 25% US 22% US 21% 20% 15% VA 16% VA 15% 10% 5% 0% 2011 2013 Source: Centers for Disease Control & Prevention. Youth Risk Behavior Surveillance System (YRBSS)

High School Students (Grades 9 -12) who rode in vehicle with a driver who had been drinking, VA & the U. S. , 2011 -13 Rode with a driver who had been drinking alcohol (in a car or other vehicle one or more times during the 30 days before the survey) 30% 25% 20% 15% US 24% VA 20% US 22% VA 18% 10% 5% 0% 2011 2013 Source: Centers for Disease Control & Prevention. Youth Risk Behavior Surveillance System (YRBSS)

High School Students (Grades 9 -12) who Obtained Alcohol by Someone Giving it to them, VA & the U. S. , 2011 -13 Usually obtained the alcohol they drank by someone giving it to them (among students who currently drank alcohol) 45% VA 44% 43% 42% VA 41% US 42% 41% 40% US 40% 39% 38% 2011 2013 Source: Centers for Disease Control & Prevention. Youth Risk Behavior Surveillance System (YRBSS)

High School Students (Grades 9 -12) who drank alcohol before age 13 years, VA & the U. S. , 2011 -13 Drank alcohol before age 13 years (for the first time other than a few sips) 21% US 21% 20% 19% US 19% 18% VA 18% 2011 2013 17% Source: Centers for Disease Control & Prevention. Youth Risk Behavior Surveillance System (YRBSS)

Substance Use / Abuse

Drug/Narcotic Arrest Rate per 100, 000 Population Three Year Averages, 2000 -13 700 600 527 455 540 388 400 300 254 367 200 100 248 161 138 20 00 -0 20 2 01 -0 20 3 02 -0 20 4 03 -0 20 5 04 -0 20 6 05 -0 20 7 06 -0 20 8 07 -0 20 9 08 -1 20 0 09 -1 20 1 10 -1 20 2 11 -1 3 0 Fluvanna Louisa Virginia Source: Crime in Virginia - Virginia State Police - Uniform Crime Reporting Program

Percent of High School Students Ever Using Drugs by Type, VA & U. S. , 2013 32% Ever used marijuana 41% 16% 18% Ever took prescription drugs without a doctor's. . . 9% Ever used inhalants (sniffed glue, breathed th. . . 7% Ever used ecstasy Ever used cocaine (any form of cocaine, such. . . 6% Ever used methamphetamines 4% 3% Ever took steroids without a doctor's. . . 4% 3% Ever used heroin 4% 2% Ever injected any illegal drug (used a needle t. . . 4% 2% 0% VA US 20% Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS) 40%

High School Students Using Marijuana, VA & US, 2011 -13 45% 40% 35% 30% 25% 20% 15% 39, 9% 40, 7% 31, 9% 32, 1% 23, 4% 18, 0% 17, 9% 2011 2013 10% 5% 0% VA-Ever Used VA-Currently Use US-Ever Used US-Current Use Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

High School Students Using Prescription Drugs without Doctor's Prescription, VA & US, 2011 -13 45% 40% 35% 30% 25% 20, 7% 17, 8% 20% 15, 9% 15, 6% 10% 5% 0% 2011 2013 VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

High School Students Using Inhalents (sniffing glue, paints or sprays to get high), VA & US, 2011 -13 15% 11, 4% 10% 8, 9% 8, 8% 9, 9% 5% 0% 2011 2013 VA US Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Surveillance System (YRBSS)

Adult Mental/Behavioral Health

Days Mental Health was Not Good, 2012 -13 Mental Health in TJHD, 2012 -13 Percentage of TJHD Adult Respondents (%) During the past 30 days, how many days was your mental health not good? 80 70 67 60 50 40 30 20 17, 8 15, 2 10 0 0 1 to 7 8 to 30 Number of Days Mental Health Was Not Good Source: Centers for Disease Control & Prevention. Behavioral Risk Factor Surveillance System (BRFSS)

Youth Mental/Behavioral Health

Adolescent Mental Health- in High School Students (Grades 9 -12) Feeling Sad or Hopeless, 2011 -13 Felt sad or hopeless (almost every day for 2 or more weeks in a row so that they stopped doing some usual activities during the 12 months before the survey) 31% 30% 29% 28% 27% 26% 25% 24% 23% US 30% US 29% VA 26% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey (YRBS)

Adolescent Mental Health-Depression in High School Students (Grades 9 -12) Feeling Sad or Hopeless by Gender, 2011 -13 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Felt sad or hopeless (almost every day for 2 or more weeks in a row so that they stopped doing some usual activities during the 12 months before the survey) US Female 39% 36% VA-Female 34% US-Male 22% VA-Male 17% 2011 US-Male 21% VA-Male 18% 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey (YRBS)

Adolescent Mental Health-Suicidal Thoughts in High School Students (Grades 9 -12), 2011 -13 Seriously considered attempting suicide (during the 12 months before the survey) 18% 17% VA 17% US 17% 16% US 16% 15% VA 15% 14% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey (YRBS)

Adolescent Mental Health-Suicidal Thoughts in High School Students (Grades 9 -12) by Gender, 2011 -13 25% 20% 15% 10% Seriously considered attempting suicide (during the 12 months before the survey) US Female VA-Female 22% US Female 19% US-Male 13% VA-Male 12% 5% VA-Female 19% US-Male 12% VA-Male 10% 0% 2011 2013 Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey (YRBS)

Adolescent Mental Health-Suicide Attempts in High School Students (Grades 9 -12), 2011 -13 Attempted suicide (one or more times during the 12 months before the survey) 12% VA 11% 10% 8% 6% VA 10% US 8% 2011 2013 4% 2% 0% Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey (YRBS)

Adolescent Mental Health-Suicide Attempts in High School Students (Grades 9 -12) by Gender, 2011 -13 14% 12% 10% 8% Attempted suicide (one or more times during the 12 months before the survey) VA-Female 12% VA-Female 10%US Female 11% 10% VA-Male 9% VA-Male 8% 6% 4% US-Male 6% US-Male 5% 2011 2013 2% 0% Source: Centers for Disease Control & Prevention (CDC). Youth Risk Behavior Survey (YRBS)

Seat Belt & Safety Device Use

Seat Belt Use, Percent of Passengers Using Seat Belts in VA & the U. S. , 1987 -2011 100% National Average 90% 85, 0% 81, 8% 80% 70% 60% 50% 40% 30% 20% 19 87 19 89 19 91 19 93 19 95 19 97 19 99 20 01 20 03 20 05 20 07 20 09 20 11 0% Virginia Natl Avg Source: Virginia Department of Motor Vehicles Highway Safety Office

Seat Belt Use Percent of Adults Who Always or Nearly Always Wear a Seat Belt when in Motor Vehicle (Self-Reported), 2011 -13 100% 98, 6% 98% 95, 0% 96% 94, 0% 94, 2% 93, 2% 90% 90, 2% 88% 86% 2011 2012 TJHD 2013 Virginia Source: Virginia Department of Health. Behavioral Risk Factor Surveillance Survey (BRFSS)

Number of hospitalizations from Motor & Other Vehicle Accidents without use of safety device (air bags, child car seats, bike helmets, seat belts), 1999 -2011 14 12 11 10 10 10 6 4 5 4 3 2 3 7 6 4 3 9 8 7 8 12 11 7 6 4 2 Fluvanna without SD 20 09 - 11 10 20 08 - 09 20 07 - 08 20 06 - 07 20 05 - 06 20 04 - 05 20 03 - 04 20 02 - 03 20 01 - 02 20 00 - 19 99 - 01 0 Louisa without SD Source: Virginia Department of Motor Vehicles Highway Safety Office

Immunizations

Immunizations Percent of Kindergarteners Immunized in Public & Private Schools in TJHD, 2008 -15 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 96% 95% 96% 85% 95% 93% 96% 95% 91% 90% 41% 2008 2009 2010 2011 Public School 2012 2013 2014 2015 Private School Source: Virginia Department of Health

Immunizations Percent of 6 th Graders Immunized in Public & Private Schools in TJHD, 2008 -15 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 97% 98% 95% 82% 89% 88% 98% 94% 89% 79% 92% 86% 67% 21% 2008 2009 2010 2011 Public School 2012 2013 2014 2015 Private School Source: Virginia Department of Health

Influenza Immunizations-Adults Percent of Adults Who Received a Flu Shot in the Past 12 Months, 2012 -13 50% 46% 44% 40% 42% 43% 2012 2013 30% 20% 10% 0% TJHD Virginia Source: Virginia Department of Health. Behavioral Risk Factor Surveillance System (BRFSS).

Tetanus Immunizations-Adults 80% 60% Percent of Adults Who Have Had a Tetanus Shot in the Past 10 Years 77, 1% 72, 8% 59, 6% 57, 7% 40% 20% 0% 2012 2013 TJHD Virginia Source: Virginia Department of Health. Behavioral Risk Factor Surveillance System (BRFSS).

Immunizations Adults Percent of Adults Aged 65 years and older who have received pneumonia vaccine, 2006 -12 100% 80% 66, 3% 67, 2% 70, 1% 67, 5% Louisa TJHD VA US 60% 40% 20% 0% Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention, Behavioral Risk Factor Surveillance System (BRFSS). Accessed via the Health Indicators Warehouse. US Department of Health & Human Services. 2006 -12. Source geography: County

Cancer & HIV Screening Behaviors

Cancer Screenings-Colon Percent of Adults Age 50+ Years Who Have Ever Had a Sigmoidoscopy or Colonoscopy 100% 80% 69% 60% 67% 61% 53% 40% 20% 0% 2006 -12 Fluvanna Louisa VA US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention, Behavioral Risk Factor Surveillance System (BRFSS). Accessed via the Health Indicators Warehouse. US Department of Health & Human Services. 2006 -12. Source geography: County

Cancer Screenings-Mammograms Percent of Female Medicare Enrollees Aged 6769 Years Who Have Had a Mammogram in the Past 2 Years 100% 80% 76% 68% 60% 67% 76% 70% 67% 66% 67% 63% 2009 2010 2011 Louisa Fluvanna 69% 66% 63% 2012 40% 20% 0% 2008 VA Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care. 2008 -12. Source geography: County

Cancer Screenings-PAP Percent of Adult Women Age 18+ Years Who Have Had a PAP test in the past 3 years 100% 92% 87% 82% 78, 5% 80% 60% 40% 20% 0% 2006 -12 Fluvanna Louisa VA US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention, Behavioral Risk Factor Surveillance System (BRFSS). Accessed via the Health Indicators Warehouse. US Department of Health & Human Services. 2006 -12. Source geography: County

Cancer Screenings-PSA Percent of Adult Males Age 40 Years and Older Who have had a PSA Test n the Past 2 Years, 2012 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 45, 3% 46, 5% 42, 3% 2012 Nothwestern Region of VA VA US Source: Virginia Department of Health. Centers for Disease Control & Prevention, Behavioral Risk Factor Surveillance System (BRFSS).

HIV Screenings Percent of Adults Aged 18 -70 Years Who Have Never Been Screened for HIV (Self-Reported), 2011 -12 100% 80% 68% 64% 60% 63% 58% 40% 20% 0% 2011 -12 Fluvanna Louisa VA US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention, Behavioral Risk Factor Surveillance System (BRFSS). Accessed via the Health Indicators Warehouse. US Department of Health & Human Services. 2006 -12. Source geography: County

HIV Screenings Percent of Adults Aged 18 -70 Years Who Have Never Been Screened for HIV by Race & Ethnicity, 2011 -12 100% 80% 63% 68% 60% 57% 40% 39% 40% 68% 20% 0% White (Non. Hispanic) Black (Non. Hispanic) VA Other Race (Non- Hispanic or Latino Hispanic) US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention, Behavioral Risk Factor Surveillance System (BRFSS). Accessed via the Health Indicators Warehouse. US Department of Health & Human Services. 2006 -12. Source geography: County

Managing Chronic Disease. Diabetes & Hypertension

Managing Diabetes, 2008 -12 Percent of Medicare Beneficiearies with Diabetes with Annual Hemoglobin A 1 c Test 100% 90% 80% 91% 89% 88% 92% 89% 90% 91% 86% 85% 87% 2008 2009 2010 2011 2012 Louisa Fluvanna 70% 60% 50% VA Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care. 2012. Source geography: County

Managing Hypertension, 2006 -10 Percent of Adults with Hypertension who are NOT taking Hypertension medication, 2006 -10 25% 21, 7% 19, 7% 20% 15% 10, 4% 10% 5% 0% TJHD VA US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention (CDC). Behavioral Risk Factor Surveillance System. Additional Data analysis by CARES. 2006 -10. Source geography: county

Medical Care Utilization. Primary Care & Dental

Lack of a Consistent Source of Primary Care Percent of Adults Age 18 Years and Older Who Do NOT Have a Primary Care Doctor or Health Care Provider (Self-Report), 2011 -12 25% 22, 5% 20% 15% 22, 1% 18, 0% 11, 9% 10% 5% 0% 2011 -12 Fluvanna Louisa VA US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention (CDC). Behavioral Risk Factor Surveillance System. Additional Data analysis by CARES. 2006 -10. Source geography: county

Dental Care Utilization, 2006 -10 Percent of Adults Age 18 Years and Older Who Have NOT Had a Dental Exam within the Past Year, 2006 -10 56, 0% 60% 50% 40% 30, 2% 30% 24, 4% 17, 4% 10% 0% 2006 -10 Fluvanna Louisa VA US Source: Community Commons Community Health Needs Assessment for TJHD localities-Clinical Care Report. Centers for Disease Control & Prevention (CDC). Behavioral Risk Factor Surveillance System. Additional Data analysis by CARES. 2006 -10. Source geography: county

Questions ? Contact Info: Jillian Regan, MPH Jillian. Regan@vdh. virginia. gov