Mobilizing for Action through Planning and Partnerships Community

Mobilizing for Action through Planning and Partnerships Community Health Status Assessment: Nelson County A Compilation of Data that Reflects the Community’s Health

Section One: Who are we and what do we bring to the table? Demographics Socioeconomics Health Resource Availability

Demographics

Population Growth TJHD by Locality, 1990 -2010 100, 000 Number of Persons Living in Locality 98, 970 90, 000 80, 000 70, 000 68, 172 60, 000 50, 000 40, 475 40, 000 43, 475 33, 153 30, 000 25, 691 18, 403 20, 000 12, 429 10, 000 20, 235 12, 778 10, 297 15, 020 0 Albemarle (18%) Charlottesville Fluvanna (28%) Greene (21%) (8%) Louisa (29%) Locality (% Change 2000 -2010) 1990 Source: Weldon Cooper Center 2000 2010 Nelson (4%)

Percent Change in Population TJHD by Locality, TJHD, and Virginia 1990 -2010 1990 2000 2010 % Change 1990 -2000 %Change 2000 -2010 Albemarle 68, 172 84, 186 98, 970 23% 18% Charlottesville 40, 475 40, 099 43, 475 -1% 8% Fluvanna 12, 429 20, 047 25, 691 61% 28% Greene 10, 297 15, 244 18, 403 48% 21% Louisa 20, 235 25, 627 33, 153 26% 29% Nelson 12, 778 14, 445 15, 020 13% 4% TJHD 164, 476 199, 648 234, 712 21% 18% Virginia 6, 189, 317 7, 079, 030 8, 001, 024 14% 13% Source: Weldon Cooper Center and the Thomas Jefferson District Planning Commission

Age and Sex Distribution Nelson County, 2010 90. . . 85 to. . . 80 to. . . 75 to. . . 70 to. . . 65 to. . . 60 to. . . 55 to. . . 50 to. . . 45 to. . . 40 to. . . 35 to. . . 30 to. . . 25 to. . . 20 to. . . 15 to. . . 10 to. . . 5 to. . . Unde. . . 2, 000 1, 500 Source: U. S. Census Bureau 1, 000 500 Male 0 500 1, 000 Female 1, 500 2, 000

Age Distribution Nelson County, 2000, 2010 Number of Persons Living in Locality 6000 5, 124 5000 4, 280 4000 3, 692 3, 133 3000 3, 085 2, 892 2, 988 2, 420 2000 920 1000 931 0 < 18 yrs 18 -24 yrs 25 -44 yrs 45 -64 yrs Nelson 2000 Source: U. S. Census Bureau 2010 65+ yrs

Racial Composition Nelson County, 2010 Other Two or more races Asian 1. 5% 1. 7% 0. 5% Black 13. 1% White 83. 3% White Black Asian Other Two or more races • Other includes: American Indian, Alaska Native, Native Hawaiian, Pacific Islander, and some other race Source: U. S. Census Bureau

Percent of Population by Race TJHD by Locality, 1980 -2010 Percent of Population Albemarle County City of Charlottesville Fluvanna County Greene County Louisa County Nelson County Source: U. S. Census Bureau 1980 1990 2000 2010 Black 11% 10% 10% White 87% 86% 85% 81% Black 18% 21% 22% 19% White 81% 76% 70% 69% Black 29% 23% 18% 15% White 70% 77% 79% 81% Black 8% 6% 6% 6% White 92% 93% 91% 88% Black 33% 26% 22% 18% White 67% 74% 77% 78% Black 24% 19% 15% 13% White 76% 80% 83%

Percent Change in Hispanic Population Nelson County and Virginia, 2000 -2010 Percent of Total Persons Living in Locality that is Hispanic 9% 92% increase 8% 631, 825 7% 6% 5% 329, 540 4% 51% increase 3% 2% 459 1, 102 305 1% 0% Nelson 2000 Source: U. S. Census Bureau Virginia 2010

Limited English Proficient Student Enrollment Percent of Total Students Enrolled in Public Schools Nelson County, TJHD, and Virginia, 2002 -2012 12% 11% 10% 9% 8% 7. 2% 7% 6% 5% 4. 6% 4. 2% 4% 3% 2. 9% 2. 2% 2% 1% 1. 9% 0% 2002 -03 2003 -04 2004 -05 2005 -06 2006 -07 2007 -08 2008 -09 2009 -10 2010 -11 2011 -12 Nelson Source: Virginia Department of Education TJHD Virginia

SSI and Disabled OASDI Beneficiaries TJHD by Locality and Virginia, 2011 Total Number of Beneficiaries Total Population Percent of the Population Albemarle 2, 428 98, 970 2. 45% Charlottesville 1, 806 43, 475 4. 15% Fluvanna 899 25, 691 3. 50% Greene 725 18, 403 3. 94% Louisa 1, 850 33, 153 5. 58% Nelson 891 15, 020 5. 93% Virginia 355, 299 8, 001, 024 4. 44% Residents who received SSI (Supplemental Security Income) benefits, excluding those who also received OASDI (Old-Age, Survivors, and Disability Insurance) benefits to avoid duplication, PLUS persons classified as “Disabled” who received OASDI benefits. Source: U. S. Social Security Administration; U. S. Census Bureau

Percent of Supplemental Security Income (SSI) Recipients Nelson County, 2010 Nelson County 2. 4% *Measured as December 2010 recipients of SSI benefits divided by the total population Source: Weldon Cooper Center, County Health Rankings; U. S. Social Security Administration

Percent of Students Receiving Special Education Nelson County, 2006 -2010 Percent of Total Children Aged 19 and Under Living in Locality 11% 10% 9% 9. 78% 8. 61% 8% 7% 6% 5% 4% 3% 2% 1% 0% 2006 2007 2008 2009 Nelson Source: Virginia Department of Education; U. S. Census Bureau, Small Area Health Insurance Estimates 2010

On-Time* Graduation Rate Nelson County and Virginia, 2008 -2011 *The percentage of students in a cohort who earn a diploma within 4 years of entering high school **Cohort: Students who entered the ninth grade for the first time together and were scheduled to graduate 4 years later Source: Virginia Department of Education

Educational Attainment Charlottesville Metro Area, and Virginia, 2011 Percent of Total Persons Aged 25 and Over Living in Locality 100% 90% 88. 1% 87. 8% 80% 70% 60% 50% 44. 7% 40% 35. 1% 30% 21. 5% 14. 6% 10% 0% High School 2011 Bachelor's Degree 2011 Charlottesville Metro Area Source: American Community Survey Advanced Degree 2011 Virginia

Socioeconomics

Median Household Income Nelson County, Virginia, and U. S. , 2000 -2011 $75, 000 Annual Income in Dollars $70, 000 $65, 000 $61, 877 $60, 000 $55, 000 $50, 000 $45, 000 $50, 502 $46, 789 $41, 990 $46, 055 $40, 000 $35, 000 $37, 565 $30, 000 $25, 000 $20, 000 $15, 000 $10, 000 $5, 000 $0 2001 2002 2003 2004 2005 Nelson Source: U. S. Census Bureau, Small Area Income and Poverty Estimates 2006 Virginia 2007 2008 2009 U. S. 2010 2011

Percent of Persons in Poverty Nelson County, 2010 Nelson County 13. 1% Source: Weldon Cooper Center; U. S. Census Bureau, Small Area Income and Poverty Estimates

Percent of Persons in Poverty Nelson County, Virginia, and U. S. , 2000 -2011 Percent of Total Persons Living in Locality 30% 28% 26% 24% 22% 20% 18% 16% 15. 9% 14% 13. 6% 12% 11. 3% 11. 6% 10. 3% 8% 8. 9% 6% 4% 2% 0% 2000 2001 2002 2003 Nelson 2004 2005 2006 Virginia Source: U. S. Census Bureau, Small Area Income and Poverty Estimates 2007 2008 2009 U. S. 2010 2011

Percent of Children in Poverty Nelson County, Virginia, and U. S. , 2000 -2011 Percent of Total Children Aged 18 and Under Living in Locality 30% 28% 26% 24% 22. 5% 22% 20% 18% 21. 0% 16. 2% 16% 14% 12% 10% 15. 6% 14. 6% 12. 2% 8% 6% 4% 2% 0% 2000 2001 2002 2003 2004 2005 Nelson Source: U. S. Census Bureau, Small Area Income and Poverty Estimates 2006 Virginia 2007 2008 2009 U. S. 2010 2011

Percent of Students Eligible for Free/Reduced Lunch Nelson County, TJHD, and Virginia, 2005 -2012 Percent of Total Students Enrolled in Public Schools in Locality 60% 55. 2% 55% 50. 2% 50% 45% 42. 9% 39. 7% 40% 35% 30% 25% 32. 9% 36. 0% 30. 2% 20% 15% 10% 5% 0% 2005 -06 2006 -07 2007 -08 Nelson Source: Virginia Department of Education, School Nutrition Program 2008 -09 TJHD 2009 -10 2010 -11 Virginia 2011 -12

Number of Households Receiving Supplemental Nutrition Assistance Nelson County, 2001 -2011 1, 200 Number of Households Enrolled 1, 100 1, 099 1, 000 900 800 700 168% increase 600 500 410 300 200 100 0 2001 2002 2003 2004 2005 2006 Nelson Source: Virginia Department of Social Services 2007 2008 2009 2010 2011

Percent of Supplemental Nutrition Assistance Program (SNAP) Participants Nelson County, 2010 Nelson County 13. 7% *Measured as average monthly persons on SNAP divided by the total population Source: Weldon Cooper Center; Virginia Department of Social Services

Number of Homeless Persons TJHD, 2004 -2011 300 277 Number of Homeless Persons 250 235 200 150 129 100 50 18 35 0 2004 2005 2006 2007 Sheltered Source: Thomas Jefferson Area Coalition for the Homeless (TJACH) 2008 Unsheltered 2009 2010 2011

Unemployment Rate Nelson County, TJHD, Virginia, and U. S. , 2000 -2011 Percent of Total Persons Aged 16 and Over Living in Locality 11% 10% 8. 9% 9% 8% 7% 6. 2% 6% 5% TJHD, 5. 5% Nelson, 5. 4% 4. 0% 4% 3% 2% 1% Virginia, 2. 3% Nelson, 2. 3% TJHD, 2. 1% 0% 2000 2001 2002 Nelson Source: Virginia Workforce Connection 2003 2004 TJHD 2005 2006 2007 Virginia 2008 2009 2010 United States 2011

Health Resource Availability

Sources of Health Insurance Virginia and U. S. , 2010 Employer; 55% Medicaid; 9% Individual; 5% Other Public; 1% Uninsured; 14% Other Public; 4% Employer; 49% Medicaid; 16% Individual; 5% Medicare; 12% Virginia Percentages may not sum to 100% due to rounding effects Source: Kaiser Family Foundation Uninsured ; 16% Medicare; 13% United States

Health Insurance Coverage by Age Virginia, 2010 -2011 Percent of Total Persons in Age Group Living in Locality 100% 94. 9% 90% 80% 70. 3% 67. 7% 61. 8% 60% 50% 40% 35. 4% 30% 18. 0% 20% 18. 8% 5. 9% 0. 8% 0% < 18 yrs 18 -64 Private Government Source: U. S. Census Bureau, Annual Social and Economic Supplement Not Covered 65+ yrs

Estimated Uninsured Persons, 18 -64 Nelson County, TJHD, and Virginia, 2005 -2010 Percent of Total Persons Aged 18 to 64 Living in Locality 35% 30% 25% 20% 15% 10% 5% 0% 2005 2006 2007 Nelson Source: U. S. Census Bureau, Small Area Health Insurance Estimates 2008 TJHD 2009 Virginia 2010

Estimated Uninsured Persons <19 Years Nelson County and Virginia, 2006 -2010 Percent of Persons Aged Less than 19 Years Living in Locality 18% 16% 15. 2% 14% 12. 8% 12% 10. 4% 7. 9% 8% 7. 0% 6% 4% 2% 0% 2006 2007 Nelson Source: U. S. Census Bureau, Small Area Health Insurance Estimates 2008 TJHD 2009 2010 Virginia

Medicaid Enrollment and Spending by Recipient Group Percent of Total Enrollment/Spending Virginia and U. S. , FY 2009 100% 90% 80% 15% 18% 45% 11% 10% 42% 70% 60% 16% 26% 50% 40% 30% 23% 20% 10% 55% 14% 49% 20% 25% 10% 21% 0% Enrollment 0. 95 M Spending $5. 55 B Virginia Children Source: Kaiser Family Foundation Enrollment 62. 59 M Spending $346 B United States Adults Elderly Disabled

Number of Primary Care Providers TJHD by Locality, 2011 Internal Family Pediatrics OB/GYN Geriatrics Medicine Albemarle/Charlottesville 65 39 67 27 8 Fluvanna 3 1 4 - 1 Greene - - 4 - - Louisa 1 1 8 - - Nelson - - 9 - - TJHD 69 41 92 27 9 Source: UVA Physician Directory; Martha Jefferson Hospital Physician Directory

Number of Charlottesville Free Clinic Medical Patients TJHD by Locality, FY 2012 3 26 0. 20% 1. 73% 95 91 58 6. 30% 6. 04% 3. 85% 610 103 40. 48% 6. 83% 521 34. 57% Albemarle Charlottesville Source: Charlottesville Free Clinic Fluvanna Greene Louisa Nelson Other Unknown

Number of Dental Service Providers TJHD by Locality, 2012 Dentists in General Practice, Oral Surgery and Pediatric Specialists Albemarle/Charlottesville 189 Fluvanna 11 Greene 8 Louisa 9 Nelson 10 Source: Community Dental Center; Denta. Quest; yellow pages

Number of Charlottesville Free Clinic Dental Patients TJHD by Locality, FY 2012 57 3 54 4 0. 16% 2. 88% 0. 21% 3. 04% 98 5. 23% 110 5. 87% 989 52. 80% 558 29. 79% Albemarle Charlottesville Source: Charlottesville Free Clinic Fluvanna Greene Louisa Nelson Other Unknown

Average Number of Community Dental Center Patients Served Per Month, FY 2010 -2012 Average Number of Patients Served Per Month 600 550 500 564 522 495 450 400 350 300 250 200 150 100 50 0 FY 2010 Source: Community Dental Center FY 2011 FY 2012

Medicaid/FAMIS Enrollees <19 Years Receiving Dental Services Nelson County and TJHD, FY 2007 - FY 2010 Percent of Total Pediatric Medicaid/FAMIS Enrollees Living in Locality 60% 50. 3% 50% 41. 8% 44. 2% 52. 3% 47. 2% 46. 4% 40% 30% 20% 10% 0% 2006 -2007 -2008 Nelson Source: Virginia Smiles for Children 2008 -2009 -2010 TJHD

Number of Licensed Mental Health Providers TJHD by Locality, 2011 Clinicians Practices Psychiatrists Licensed Therapists Total Practices Serving Youth Practices Accepting Medicaid Albemarle/ Charlottesville 24 115 66 7 35 Fluvanna 0 3 3 2 2 Greene 0 1 1 Louisa 2 16 4 2 2 Nelson 0 3 2 2 2 TJHD 26 135 73 11 39 Source: Mental Health America

Number of Region Ten Community Services Board Direct Service Staff TJHD by Locality, 2012 Number of Mental Health Direct Service Staff Albemarle/Charlottesville 161 Fluvanna 11 Greene 15 Louisa 14 Nelson 18 TJHD 219 All mental health direct service staff at Region Ten – anyone who provides mental health services, whether licensed or not Source: Region Ten

Number of Public Health Staff by Specialty TJHD by Locality, 2012 Number of Full-Time Equivalent Positions Local Health Department Public Health Nurses Environmental Health Specialists Nutritionists Clinicians Public Health Specialists Albemarle/ Charlottesville 10. 65 9. 00 3. 70 0. 70 4. 40 Fluvanna 2. 40 1. 47 0. 19 0. 11 0. 80 Greene 2. 45 1. 52 0. 29 0. 11 0. 80 Louisa 4. 85 2. 59 0. 63 0. 37 2. 00 Nelson 2. 15 1. 42 0. 19 0. 11 0. 80 TJHD 22. 50 16. 00 5. 00 1. 40 8. 80 Source: Thomas Jefferson Health District

Section Two: What are the strengths and risks in our community that contribute to health? Community Resources Community Safety Environmental Quality Health Behaviors

Community Resources

JAUNT Passengers Nelson County, FY 2008 -FY 2012 Number of Passengers (by place of origin) 20, 000 18, 508 16, 000 16, 018 14, 000 14, 037 12, 000 10, 000 8, 000 6, 000 4, 000 2, 000 0 FY 08 FY 09 FY 10 Nelson *Passengers are counted by trip and may be duplicated Source: Jaunt Ridership Report FY 11 FY 12

JAUNT Passengers by Type TJHD, FY 2008–FY 2012 350, 000 Number of Passengers 300, 000 93, 279 79, 322 84, 377 93, 819 96, 408 96, 110 98, 122 75, 353 82, 703 84, 080 81, 128 86, 606 FY 08 FY 09 FY 10 FY 11 FY 12 250, 000 67, 178 200, 000 150, 000 92, 196 100, 738 100, 000 50, 000 0 Medical Children and Youth Rural Routes Source: Jaunt Ridership Report Elderly and Disabled (nonmedical) Elderly Nutrition Services Other

Recreational Facilities TJHD by Locality and Virginia, 2009 Facilities per 100, 000 Persons Living in Locality 25 21. 3 20 National Benchmark 15 12. 6 11 10 9. 1 7. 8 6. 5 5. 4 5 0 Albemarle Charlottesville Source: County Health Rankings Fluvanna Greene Louisa Nelson Virginia

Food Stores by Type Nelson County, 2009 1 4 7 7 16 Grocery stores Supercenters & club stores Convenience stores Specialized food stores Fast-food restaurants Full-service restaurants Source: U. S. Department of Agriculture

Licensed Child Care Facilities TJHD by Locality, 2012 & le a l i v nn s a e e l luv ott mar l F r a e Ch Alb Number of children < 5 yrs old residing in locality 7, 832 Licensed Childcare Centers & Preschool Programs Number of Slots Available (Includes 1 mo to 5 yrs 3, 919 old and 6 -12 yrs old after school) Number of Facilities 1 mo to 1 yr old Number of those Facilities that Accept Ages 1 to 2 yrs old 2 to 4 yrs old 4 to 5 yrs old Family Day Homes Number of Slots Available (Includes 1 mo to 5 yrs old and 6 -12 yrs old after school) Number of Facilities 1 mo to 1 yr old Number of those Facilities that Accept Ages 1 to 2 yrs old 2 to 4 yrs old 4 to 5 yrs old Source: Virginia Department of Social Services ree ne G is ou a L n o els N 1, 592 1, 310 2, 029 727 279 434 381 393 54 19 6 23 6 4 2 2 7 1 1 3 2 12 1 7 4 7 5 2 174 44 0 76 12 1 3 - 4 2 2 - 0 - 7 7 - 1 1 -

Community Safety

Reported Crime Incident Rates Reported Group A Offenses* per 100, 000 Persons Living in Locality 14000 Nelson County and TJHD, 2000 -2011 13000 12000 110000 9000 8000 7000 6, 016. 59 6000 5000 4, 336. 80 3, 724. 50 2, 782. 93 3000 2000 1000 0 2001 2002 2003 2004 2005 2006 Nelson 2007 2008 2009 2010 2011 TJHD *Reported Group A Offenses; arson, assault, bribery, burglary, counterfeiting/forgery, destruction/damage/vandalism of property; drug/narcotic; embezzlement; extortion/blackmail; fraud; gambling; homicide; kidnapping/abduction; larceny/theft; motor vehicle theft; pornography/obscene material; prostitution; robbery; sex, forcible and non-forcible; stolen property; weapon law violations Source: Department of State Police, Virginia Uniform Crime Reporting Program

Violence Incidence Rates in Schools Nelson County, TJHD, and Virginia, 2007 -2011 Incidents per 1, 000 Students Enrolled in Public Schools in Locality 26 24 24. 95 22 20 18 16 14 15. 47 12. 73 12 10 8. 14 8 6 5. 03 3. 92 3. 46 2. 74 4 2 0 6. 67 5. 20 3. 85 6. 53 Altercations Battery against Student w/o Weapon 4. 34 5. 14 Bullying Nelson Source: Virginia Department of Education 3. 78 2. 66 2. 57 2. 64 2. 47 5. 54 0. 61 0. 36 Drug Fighting w/o Violations Injury 0. 35 Gang Activity TJHD 4. 82 1. 58 1. 00 0. 38 0. 96 Harassment Offensive Sexual Touching/ All 6. 08 1. 45 Other Weapons, and Explosive Devices Virginia Threat

Founded Child Abuse and Neglect Rates TJHD and Virginia, 2000 -2011 Founded Child Abuse and Neglect Reports per 1, 000 Children Aged 0 -17 Living in Locality 7 6 5 4 3. 03 2. 85 3 2. 47 2 1. 94 1 0 2000 -04 2001 -05 2002 -06 TJHD 2003 -07 2004 -08 2005 -09 2006 -10 Virginia *Five-year rolling averages of Rate of Abuse and Neglect per 1, 000 Children (Founded Investigations and Duplicated) Source: Virginia Department of Social Services 2007 -11

Adult Protective Service Reports per 1, 000 Adults Aged 18 and Over Living in Locality Reported Adult Abuse and Neglect Rates, TJHD and Virginia, 2008 -2011 12 11 10 9 8 7 6 5. 25 4. 96 5 4 3 2 2. 88 2. 41 1 0 2008 2009 TJHD Source: Virginia Department of Social Services 2010 Virginia 2011

Drug/Narcotic Arrest Rates Nelson County, TJHD, and Virginia, 2000 -2011 Drug/Narcotic Arrests per 100, 000 Persons Living in Locality 1200 1100 1000 900 800 700 595. 7 600 500 455. 4 495. 0 439. 2 300 200 318. 4 293. 1 100 0 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson TJHD Source: Department of State Police, Virginia Uniform Crime Reporting Program Virginia

Driving Under the Influence (DUI) Arrest Rates DUI Arrests per 100, 000 Persons Living in Locality Nelson County, TJHD, and Virginia, 2000 -2011 900 850 800 750 700 650 600 550 500 450 400 350 300 250 200 150 100 50 0 368. 0 Virginia, 352. 0 TJHD, 348. 4 251. 9 188. 2 120. 2 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson TJHD Source: Department of State Police, Virginia Uniform Crime Reporting Program Virginia

Environmental Quality

Air Quality Index Report Charlottesville, Fairfax, Richmond, and Virginia Beach 2011 Air Quality Rating (Number of days at each rating) Good Total Number of Unhealthy Days for Moderate for Monitored Sensitive Anyone Groups Charlottesville CBSA 330 (91%) 34 (9%) 0 (0%) 364 Fairfax CBSA 295 (82%) 54 (15%) 9 (2%) 2 (1%) 360 Richmond CBSA 283 (78%) 70 (19%) 11 (3%) 1 (0%) 365 Virginia Beach CBSA 276 (76%) 79 (21%) 10 (3%) 0 (0%) 365 *Cities are defined as Core Based Statistical Areas (CBSA) – Charlottesville CBSA includes Albemarle, Fluvanna, Greene, and Nelson Counties and the City of Charlottesville; Richmond CBSA includes the Amelia, Caroline, Charles City, Chesterfield, Cumberland, Dinwiddie, Goochland, Hanover, Henrico, King And Queen, King William, Louisa, New Kent, Powhatan, Prince George and Sussex Counties as well as the Cities of Colonial Heights, Hopewell, Petersburg and Richmond. Source: Environmental Protection Agency

Good and Impaired Streams in Watersheds Nelson County, 2008 Percent of Total Streams in Watershed 120% 100% 39 80% 59 33 28 60% 40% 117 78 20% 23 27 0% Maury Middle James - Buffalo Impaired Streams Source: Environmental Protection Agency Rivanna South Fork Shenandoah Good Streams

Watersheds that Drain Into Nelson County South Fork Shenandoah Rivanna Maury Nelson County Middle James - Buffalo Source: Environmental Protection Agency

Impaired Streams Nelson County, 2010 ork F th or N er iv R Tye Roc kfish o fal f u B er v i R Source: Thomas Jefferson District Planning Commission Rive r

Rivanna: Biological Health Scores Nelson County, 2006 -2009 3%; 3%6%; 6% 13%; 13% Very Good 22%; 22% Good Fair Poor Very Poor 56%; 56% Samples are scored per an index that reflects the composition and diversity of the array of captured organisms. Site health is assessed based on all scores generated during the assessment window Source: Stream. Watch

Lead Exposure: At-Risk Zip Codes* TJHD by Locality, 2011 Albemarle 22901 Charlottesville 22903 Fluvanna 23022 Greene 22935 (Dyke) Louisa 23024 Nelson 22931 22937 22943 (Covesville) (Esmont) (Greenwood) 22947 (Keswick) 22959 24590 (North Garden) (Scottsville) 23084 22938 22964 22969 22971 (Faber) (Piney River)(Schuyler) (Shipman) 24464 (Montebello) 24553 (Gladstone) *VDH identifies areas in Virginia at risk for lead exposure as those with more than 27% of homes built before 1950 and/or those with an increased prevalence of children with elevated blood lead levels (EBLL) Source: Virginia Department of Health, Lead Safe Virginia

Elevated Blood Lead Level Tests and Results in Children <72 Months of Age 100 2, 500 2, 402 90 2, 250 2, 153 1, 980 80 2, 000 1, 929 1, 852 70 1, 750 60 1, 500 50 1, 250 40 963 1, 052 1, 000 859 30 750 30 20 10 0 500 150 94 90 11 3 4 2005 127 9 2006 1 6 2007 Nelson Source: Virginia Department of Health, Lead Safe Virginia 198 113 2 3 2008 10 2009 TJHD 176 3 10 2010 195 3 250 8 2011 0 Number of Children <72 Months of Age Tested (Lines) Number of Tests Returning Positive (bars) Nelson County and TJHD, 2004 -2011

Health Behaviors

Leading vs. Actual Causes of Death Leading Causes of Death Heart Disease 37. 2% Cancer 23. 1% Deaths Attributable to Individual Risk Factors 467 Tobacco smoking 395 High blood pressure 216 Overweight-obesity (high BMI) Stroke 6. 3% Chronic Lower Respiratory Diseases 5. 1% Unintentional Injuries 4. 7% Diabetes 3. 1% Alzheimer's Disease 2. 8% Influenza and Pneumonia 2. 5% Physical inactivity 191 High blood glucose 190 113 High LDL cholesterol 102 High dietary salt Low dietary omega-3 fatty acids 84 High dietary trans fatty acids 82 64 Alcohol use Kidney Disease 1. 8% Septicemia 1. 4% -10% Low intake of fruits and vegetables Low dietary polyunsaturated fatty acids (PUFA) 30% Percentage of Total Deaths 58 15 0 500 Deaths (in thousands) Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLo. S Med 6(4): Heron, M. , Tejada-Vera, B. (2009). Deaths: Leading Causes for 2005. National Vital Statistics Reports. 58(8)

Self-Reported Adult Smokers Percent of Adults Aged 20 and Over Living in Locality TJHD and Virginia, 2000 -2010 25% 22. 9% 20% 18. 0% 17. 9% 17. 6% 15% Healthy People 2020 10% 5% 0% 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 TJHD Virginia Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey

Tobacco Facts Virginia, 2012 Virginia United States Adult Smoking Rank (1 st = low smoking rates) 31 st N/A Cigarette Tax (per pack) $0. 30 ($0. 35 local tax for Cville) $1. 46 Cigarette Tax Rank (1 st = high taxes) 50 th N/A FY 2012 Funding for State TC Programs (millions) $8. 4 $456. 7 Tobacco Prevention Spending % of CDC Target 8. 1% 12. 5% Tobacco Prevention Spending Rank (1 st =high spending rates) 30 th N/A Source: Campaign for Tobacco-Free Kids; City of Charlottesville City Treasurer Website

Physical Inactivity Estimated percent of adults aged 20 and over reporting no leisure time physical activity TJHD by Locality and Virginia, 2009 35% 30% 26% 25% 24% 22% 20% 19% 15% 10% 5% 0% Albemarle Charlottesville Fluvanna Greene Source: Behavioral Risk Factor Surveillance System; County Health Rankings Louisa Nelson Virginia *Numbers are self-reported

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

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

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: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

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: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

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% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System 25%– 29%

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% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System 25%–

Percentage of Adults Who Are Obese TJHD by Locality, 2009 Nelson County 26. 4% *Obese = Body Mass Index (BMI) ≥ 30, or ~ 30 lbs. overweight for 5’ 4” person **Body mass was derived from self-report of height and weight from adults 20 and Over. Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System

Percent of Adults Aged 20 and Over Living in Locality Percentage of Adults Who Are Obese TJHD and Virginia, 2000 -2010 35% 30% 27. 6% 25. 9% 25% 21. 6% 20% 21. 0% 15% 10% 5% 0% 2000 -2002 2001 -2003 2002 -2004 2003 -2005 TJHD 2004 -2006 2005 -2007 2006 -2008 Virginia Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey 2007 -2009 2008 -2010

Percentage of 5 th &10 th Graders Who Are Overweight or Obese Percent of Fifth and Tenth Graders Enrolled in Public Schools in Locality 100% Nelson County Public Schools, 2009 -2011 90% 80% 70% 60% 50% 40% 25. 6% 32. 8% 30% 26. 1% 31. 2% 29. 9% 22. 6% 20% 10% 25. 0% 15. 7% 20. 3% 13. 1% 14. 9% 17. 5% 10 th 5 th 10 th 0% 5 th 10 th 5 th 2008 -2009 -2010 % Overweight Source: Blue Ridge Medical Center 2010 -2011 % Obese

Virginia, 1987 -2011 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% National Average 81. 8% 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 92 19 91 19 19 90 19 89 19 19 19 88 32. 5% 87 Percent of Drivers and Passengers Using Seat Belts Seat Belt Usage Virginia Source: Virginia Department of Motor Vehicles, Highway Safety Office

Three Year Rolling Average Number of Hospitalizations from Motor/Other Vehicle Accidents With and Without Safety Device Usage, Nelson County, 2007 -2011 Number of Hospitalizations from MVAs 12 10. 7 10. 0 9. 7 10 10. 3 9. 7 8 8. 0 6 4 2 0 2007 -09 2008 -10 Nelson with SD 2009 -11 Nelson without SD *Safety Devices include air bags, child safety seats, helmets, and safety belts; note that the presence of a safety device does not necessarily imply that it was used (properly or otherwise). Similarly, "none" does not necessarily mean that safety device was not used Source: Virginia Department of Health, Office of Emergency Medical Services

Percentage of Adequately Immunized Kindergarteners TJHD, 2008 -2011 Percent of Kindergarteners Enrolled in Reporting Schools* 100% 95. 9% 95. 1% 95. 7% 94. 8% 93. 4% 94. 7% 84. 8% 80% 70% 60% 50% 40. 9% 30% 20% 10% 0% 2008 2009 Public School 2010 2011 Private School *Includes schools that submit student immunization survey results in the Fall of each year – approximately 30 public schools and 6 private schools (only 2 private schools reported in 2008) Source: Virginia Department of Health, Division of Immunization

Percentage of Adequately Immunized Sixth Graders TJHD, 2008 -2011 100% Percent of Sixth Graders Enrolled in Reporting Schools* 97. 5% 97. 0% 94. 9% 97. 8% 88. 4% 80% 81. 8% 78. 8% 70% 60% 50% 40% 30% 21. 4% 10% 0% 2008 2009 Public School 2010 2011 Private School *Includes schools that submit student immunization survey results in the Fall of each school year – approximately 10 public schools and approximately 8 private schools (only 2 private schools reported in 2008) Source: Virginia Department of Health, Division of Immunization

Section Three: What is our health status? Maternal and Child Health Leading Causes of Death Cancer Unintentional Injury Infectious Diseases Ambulatory Care Sensitive Conditions Mental Health

Maternal and Child Health

Live Birth Rates Live Births* per 1, 000 Total Persons Living in Locality Nelson County, TJHD, and Virginia, 1998 -2011 20 18 16 14 12 Virginia, 13. 9 Nelson, 13. 7 12. 9 10. 8 10 8 8. 3 6 4 2 0 1998 1999 2000 2001 2002 2003 2004 Nelson *Live Births Counted by Place of Residence Source: Virginia Department of Health, Division of Health Statistics 2005 TJHD 2006 2007 2008 2009 Virginia 2010 2011

Infant Deaths per 1, 000 Live Births by Place of Residence Infant Mortality Rates* TJHD and Virginia, 1999 -2011 22 20 18 16 14 12 10 7. 2 8 7. 0 6. 3 6 Healthy People 2020 4 2 0 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 TJHD *Deaths among infants <1 year of age Source: Virginia Department of Health, Division of Health Statistics 2004 -2008 2005 -2009 Virginia 2006 -2010 2007 -2011

Infant Mortality Rates* by Race TJHD, Virginia, and U. S. , 1999 -2011 Infant Deaths per 1, 000 Live Births by Place of Residence 22 20 18 17. 3 16 14 12 14. 9 13. 8 10 8 6 4 Virginia White, 5. 6 Healthy People 2020 Virginia White, 5. 4 TJHD White, 5. 7 TJHD White, 4. 5 2 0 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 2004 -2008 2005 -2009 2006 -2010 2007 -2011 TJHD Black Virginia Black U. S. Black *Deaths among infants <1 year of age Source: Virginia Department of Health, Division of Health Statistics TJHD White Virginia White U. S. White

Neonatal Death Rate* Infant Deaths per 1, 000 Live Births by Place of Residence TJHD and Virginia, 1999 -2011 22 20 18 16 14 12 10 8 6 4 5. 0 4. 7 Healthy People 2020 4. 4 4. 3 2 0 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 2004 -2008 2005 -2009 2006 -2010 2007 -2011 TJHD *Deaths among infants <28 days of age Source: Virginia Department of Health, Division of Health Statistics Virginia

Percentage of Preterm* Births Percent of Total Live Births by Place of Residence Nelson County, TJHD, West Central Perinatal Region and Virginia, 2001 -2010 13% Healthy People 2020 12% 11% 10% 9. 77% 9% 8. 59% 8% 10. 26% 10. 37% 8. 73% 8. 29% 8. 27% 7% 6% 6. 28% 5% 4% 3% 2% 1% 0% 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 Nelson TJHD *Percent of live births born less than 37 weeks gestation Source: Virginia Department of Health West Central Perinatal Region Virginia

Percentage of Low-Weight* Births Percent of Total Live Births by Place of Residence Nelson County, TJHD, Virginia, and U. S. , 1999 -2011 14% 13% 12% 11% 10% 9% Healthy People 2020 8. 9% 8. 2% 8% 7% 6% 5% Virginia, 7. 9% TJHD, 7. 6% Virginia, 7. 9% U. S. , 7. 5% TJHD, 7. 1% 5. 8% 4% 3% 2% 1% 0% 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson TJHD *Low Birth Weight = Live Births Weighing <2500 grams Source: Virginia Department of Health, Division of Health Statistics Virginia U. S.

Percentage of Low-Weight Births* by Race, Nelson County, TJHD, and Virginia, 1999 -2011 20% Percent of Total Live Births by Place of Residence 18% 16. 3% 16% 14% 13. 0% 12. 5% 12. 7% 12. 2% 10% 8% 6% Healthy People 2020 7. 6% 6. 5% 6. 1% Virginia White , 6. 8% Nelson White , 6. 1% TJHD White , 6. 0% Nelson Black , 5. 1% 4% 2% 0% 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson Black Nelson White TJHD Black TJHD White *Low Birth Weight = Live Births Weighing <2500 grams Source: Virginia Department of Health, Division of Health Statistics Virginia Black Virginia White

Teen Pregnancy Rates: Ages 10 -19 Pregnancies per 1, 000 Females Aged 10 to 19 65 Nelson County, TJHD, and Virginia, 2000 -2011 60 55 50 45 40 35 34. 9 30 25 20 29. 6 21. 3 23. 2 19. 1 15 15. 6 10 5 0 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 2009 -2011 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD Virginia

Teen Pregnancy Rates: Ages 15 -17 Nelson County, TJHD, and Virginia, 2000 -2011 Pregnancies per 1, 000 Females Aged 15 -17 70 65 60 55 50 45 40 Healthy People 2020 35 33. 4 30 31. 3 25 27. 6 19. 1 20 15 13. 3 10 9. 9 5 0 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 2009 -2011 Nelson TJHD Source: Virginia Department of Health, Division of Health Statistics Virginia

Teen Pregnancy Rates by Race: Ages 1019, Nelson County, TJHD, and Virginia, 2000 -2011 Pregnancies per 1, 000 Females Aged 10 to 19 75 70 65 60 55 50 48. 7 45 47. 5 40 35 30 25 20 41. 2 35. 1 31. 8 26. 2 23. 6 19. 4 19. 5 15 13. 8 10 Virginia White , 16. 7 Nelson Black , 16. 7 5 0 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson Black Nelson White TJHD Black TJHD White Source: Virginia Department of Health, Division of Health Statistics Virginia Black Virginia White

Induced Terminations per 1, 000 Women Aged 15 -44 Induced Termination Rates 32 Nelson County, TJHD and Virginia, 2003 -2011 30 28 26 24 22 20 18 16. 2 15. 1 16 14 12 10 12. 6 11. 7 12. 1 8 8. 8 6 4 2 0 2003 -2005 2004 -2006 2005 -2007 2006 -2008 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD 2007 -2009 2008 -2010 Virginia 2009 -2011

Percentage of Mothers Entering Prenatal Care in the 1 st Trimester Percent of Total Live Births to Mothers by Place of Residence Nelson County, TJHD and Virginia, 2000 -2010 100% 90% 83. 2% 84. 7% 80% 70% 60% Nelson, 81. 7% TJHD, 79. 3% TJHD, 77. 0% Nelson, 75. 6% Healthy People 2020 50% 40% 30% 20% 10% 0% 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 Nelson TJHD Percentage of Total Live Births with Prenatal Care Beginning in the First 13 Weeks Source: Virginia Department of Health, Division of Health Statistics Virginia

Percentage of Mothers Who had 10 or More Prenatal Care Visits Nelson County, TJHD, and Virginia, 1999 -2010 Percent of Total Live Births to Mothers by Place of Residence 100% 90% 82. 7% 77. 7% 80% 70% TJHD, 79. 8% 66. 0% Nelson, 79. 2% 60% 64. 0% 50% 40% 30% 20% 10% 0% 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD Virginia

Percentage of Mothers With <12 th Grade Education Nelson County and Virginia, 2002 -2010 Percent of Total Live Births to Mothers by Place of Residence 50% 45% 40% 35% 30% 25% 20% 15% 10% Virginia, 12% 14% Nelson, 12% 5% 0% 2002 2003 2004 2005 Nelson Source: Virginia Department of Health, Division of Health Statistics 2006 2007 2008 Virginia 2009 2010

Percentage of Mothers Who Smoke During Pregnancy Nelson County, TJHD, and Virginia, 1999 -2008 Percent of Total Live Births to Mothers by Place of Residence 50% 45% 40% 35% 30% 25% 20% 15. 6% 15. 3% 15% 10% 5% 9. 2% 7. 9% 8. 4% 6. 3% Healthy People 2020 0% 1999 -01 2000 -02 2001 -03 2002 -04 Nelson Source: Virginia Department of Health, Division of Health Statistics 2003 -05 TJHD 2004 -06 2005 -07 Virginia 2006 -08

Reported Substance Exposed Infants* Number of Reported Substance Exposed Infants TJHD, FY 1999 -2011 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 22 2 99 -00 00 -01 01 -02 02 -03 03 -04 04 -05 05 -06 TJHD 06 -07 07 -08 08 -09 09 -10 10 -11 *Newborn infants that may have been exposed to controlled substances prior to birth (as indicated by a positive drug toxicology of the mother with presence of a controlled substance or by the child being born dependent on a controlled substance and demonstrating withdrawal symptoms) or have a diagnosis of fetal alcohol syndrome Source: Virginia Department of Social Services

Leading Causes of Death

Mortality Rates Age-Adjusted Deaths per 100, 000 Persons Living in Locality Nelson County, TJHD, and Virginia, 1999 -2010 1, 200 1, 100 1, 000 956. 1 900 882. 9 800 857. 8 761. 7 747. 7 700 678. 5 600 500 400 300 200 100 0 1999 -2001 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD Virginia

Age-Adjusted Deaths per 100, 000 Persons Living in Locality Mortality Rates by Race 1, 400 Nelson County, TJHD, and Virginia, 2000 -2010 1, 300 1, 200 TJHD Black , 1093. 6 Virginia Black , 1083. 9 1, 100 1, 000 900 800 1277. 0 1173. 6 Virginia Black , 916. 0 1004. 2 TJHD Black , 896. 1 831. 5 812. 9 815. 2 728. 0 700 681. 8 600 500 400 300 200 100 0 2000 -02 2001 -03 2002 -04 Nelson Black 2003 -05 2004 -06 2005 -07 TJHD Black Source: Virginia Department of Health, Division of Health Statistics 2006 -08 2007 -09 2008 -10 Virginia Black

Five Leading Causes of Death TJHD and Virginia, 2010 1. Cancer 2. Heart Disease 3. Stroke 4. Chronic Respiratory Disease (Chronic Obstructive Pulmonary Disease (COPD) and Asthma) 5. Unintentional Injuries Source: Virginia Department of Health, Division of Health Statistics

Leading Causes of Death By Age Virginia, 2010 Youth/Teens <1 Year 1 -14 Years 15 -24 Years 6. 1% 11. 1% 7. 3% 32. 4% 24. 2% 0. 3% 48. 6% 60. 6% 3. 0% 12. 4% 6. 1% 0. 6% 5. 7% 1. 0% Source: Virginia Department of Health, Division of Health Statistics 80. 6%

Leading Causes of Death By Age Virginia, 2010 Adults 25 -39 Years 40 -59 Years 60 -64 Years 4. 2% 3. 5% 12. 2% 5. 5% 21. 4% 7. 4% 5. 4% 47. 0% 53. 2% 21. 3% 52. 5% 30. 4% 31. 9% 1. 1% 3. 0% Source: Virginia Department of Health, Division of Health Statistics

Leading Causes of Death By Age Virginia, 2010 65 and over 65 -74 Years 75 -84 Years 85 and over Years 4. 6% 3. 7% 2. 9% 9. 8% 8. 1% 11. 1% 6. 6% 9. 6% 39. 5% 22. 0% 14. 5% 50. 7% 30. 0% 36. 1% 50. 8% Source: Virginia Department of Health, Division of Health Statistics

Heart Disease Death Rates Nelson County, TJHD, and Virginia, 1999 -2010 Age-Adjusted Heart Disease Deaths per 100, 000 Persons Living in Locality 325 300 275 259. 5 250 225 200 243. 3 222. 6 176. 2 175 171. 6 150 148. 8 125 100 75 50 25 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD Virginia

Heart Disease Death Rates by Race Nelson County, TJHD, and Virginia, 2000 -2009 Age-Adjusted Heart Disease Deaths per 100, 000 Persons Living in Locality 325 300 297. 6 Virginia Black , 274. 5 Nelson White , 274. 1 275 250 225 200 255. 7 227. 4 216. 6 214. 0 202. 9 193. 0 178. 1 175 167. 0 150 149. 3 125 100 75 50 25 0 2000 -2004 2001 -2005 Nelson Black 2002 -2006 2003 -2007 TJHD Black Five-year rolling averages Source: Virginia Department of Health, Division of Health Statistics 2004 -2008 2005 -2009 Virginia Black

Stroke-Related Death Rates Nelson County, TJHD, and Virginia, 1999 -2010 Age-Adjusted Stroke-Related Deaths per 100, 000 Persons Living in Locality 120 110 100 90 80 70 60 78. 2 67. 2 Nelson, 45. 0 60. 8 50 TJHD, 44. 2 40 41. 9 30 20 10 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD Virginia

Age-Adjusted Stroke-Related Deaths per 100, 000 Persons Living in Locality Stroke-Related Death Rates by Race 120 TJHD and Virginia, 2000 -2009 110 100 90 87. 3 80 70 69. 5 60. 9 60 60. 1 52. 5 50 39. 9 40 39. 0 30 20 10 0 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 TJHD Black TJHD White Source: Virginia Department of Health, Division of Health Statistics Virginia Black Virginia White

Cancer-Related Death Rates Nelson County, TJHD, and Virginia, 1999 -2010 Age-Adjusted Cancer Deaths per 100, 000 Persons Living in Locality 300 275 250 225 214. 6 200 206. 9 175 183. 7 190. 4 TJHD, 179. 6 Virginia, 174. 5 150 125 100 75 50 25 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 Nelson Source: Virginia Department of Health, Division of Health Statistics TJHD Virginia

Cancer-Related Death Rates by Race Nelson County, TJHD, and Virginia, 2000 -2009 Age-Adjusted Cancer Deaths per 100, 000 Persons Living in Locality 300 275 250 225 200 175 249. 7 238. 0 225. 2 TJHD Black , 222. 1 220. 6 213. 7 Nelson White , 189. 8 189. 1 188. 2 176. 4 179. 0 171. 5 150 125 100 75 50 25 0 2000 -2004 Five-year rolling averages 2001 -2005 Nelson Black Nelson White 2002 -2006 2003 -2007 TJHD Black TJHD White Source: Virginia Department of Health, Division of Health Statistics 2004 -2008 2005 -2009 Virginia Black Virginia White

COPD-Related Death Rates Age-Adjusted COPD Deaths per 100, 000 Persons Living in Locality Nelson County, TJHD, and Virginia, 2000 -2010 65 60 55 50 45 40 43. 6 43. 3 42. 5 38. 6 40. 5 35 34. 9 30 25 20 15 10 5 0 1999 -02 2000 -03 2001 -04 2002 -05 Nelson Four-year rolling averages Source: Virginia Department of Health, Division of Health Statistics 2003 -06 TJHD 2004 -07 2005 -08 2006 -09 Virginia 2007 -10

COPD-Related Death Rates by Race TJHD and Virginia, 2000 -2009 Age-Adjusted COPD Deaths per 100, 000 Persons Living in Locality 65 60 55 50 46. 3 42. 6 45 40 44. 7 38. 1 39. 0 35 30 26. 3 31. 5 25 20 21. 2 15 10 5 0 2000 -03 2001 -04 TJHD Black 2002 -05 Virginia Black Source: Virginia Department of Health, Division of Health Statistics 2003 -06 2004 -07 TJHD White 2005 -08 2006 -09 Virginia White

Diabetes-Related Death Rates Nelson County, TJHD, and Virginia, 1999 -2010 Age-Adjusted Diabetes Deaths per 100, 000 Persons Living in Locality 55 50 45 40 37. 6 35 30 25 20 23. 7 Nelson, 20. 3 21. 1 Virginia, 20. 1 15 15. 7 10 5 0 1999 -03 2000 -04 2001 -05 2002 -06 Nelson Five-year rolling averages Source: Virginia Department of Health, Division of Health Statistics 2003 -07 TJHD 2004 -08 2005 -09 Virginia 2006 -10

Diabetes-Related Death Rates by Race TJHD and Virginia, 2000 -2009 Age-Adjusted Diabetes Deaths per 100, 000 Persons Living in Locality 55 50 47. 8 45 40 41. 5 38. 3 37. 9 35 30 25 20 15 Virginia White, 19. 7 16. 3 TJHD White, 19. 5 12. 5 10 5 0 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 TJHD Black Virginia Black Source: Virginia Department of Health, Division of Health Statistics TJHD White Virginia White

Unintentional Injury Death Rates TJHD and Virginia, 1999 -2010 Age-Adjusted Unintentional Injury Deaths per 100, 000 Persons Living in Locality 75 70 69. 6 65 60 55 51. 8 50 45 40 35 38. 4 TJHD, 33. 8 34. 5 30 Virginia, 34. 0 25 20 15 10 5 0 1999 -02 2000 -03 2001 -04 2002 -05 Nelson Four-year rolling averages Source: Virginia Department of Health, Division of Health Statistics 2003 -06 TJHD 2004 -07 2005 -08 2006 -09 Virginia 2007 -10

Unintentional Injury Death Rates by Race TJHD and Virginia, 2000 -2009 Age-Adjusted Deaths per 100, 000 Persons Living in Locality 75 70 65 60 53. 5 55 50 45 40 35 30 25 47. 8 39. 7 39. 9 VA White, 35. 9 38. 6 33. 4 TJHD White, 35. 3 20 15 10 5 0 2000 -03 TJHD Black 2001 -04 2002 -05 Virginia Black Four-year rolling averages Source: Virginia Department of Health, Division of Health Statistics 2003 -06 2004 -07 TJHD White 2005 -08 2006 -09 Virginia White

Age-Adjusted Deaths per 100, 000 Persons Living in Locality Suicide and Homicide Rates TJHD and Virginia, 1999 -2009 20 18 16 14. 49 14 Virginia Suicide, 11. 54 12 10 TJHD Suicide, 11. 41 11. 05 8 6. 12 6 4 4. 98 4. 60 2 2. 80 0 1999 -2001 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 TJHD Homicide Virginia Homicide Source: Virginia Department of Health, Virginia Online Injury Reporting System TJHD Suicide Virginia Suicide

Youth Suicide Rates • Suicide is the third leading cause of death for 10 -24 year-olds. • On average, two Virginia youths die each week from suicide. • The suicide rate is higher in males than the rate of females. • The White suicide rate is 2. 4 times higher than the Black suicide rate. Deaths per 100, 000 Persons Living in Locality TJHD and Virginia, 2004 -2008 10 8 6. 86 6 4. 39 4 2 0 TJHD Source: Virginia Department of Health, Office of Family Health Services Virginia

Cancer

Lung Cancer Incidence Rates Nelson County, TJHD, and Virginia, 1999 -2008 83. 64 80 75 69. 87 70 65 68. 40 64. 44 64. 43 61. 65 60 55 50 45 40 35 30 5 0 Nelson Source: Virginia Cancer Registry TJHD Virginia 2004 -2008 1999 -2003 10 2004 -2008 15 1999 -2003 20 2004 -2008 25 1999 -2003 Age-Adjusted Rate of Lung & Bronchus Cancer Cases per 100, 000 Persons Living in Locality 85

78. 06 73. 38 69. 06 69. 12 71. 73 68. 91 White TJHD Source: Virginia Cancer Registry 1999 -2003 2004 -2008 1999 -2003 Black 2004 -2008 64. 39 63. 31 2004 -2008 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 TJHD and Virginia, 1999 -2008 1999 -2003 Age-Adjusted Rate of Lung & Bronchus Cancer Cases per 100, 000 Persons Living in Locality Lung Cancer Incidence Rates by Race White Virginia

Lung Cancer Death Rates TJHD and Virginia, 1996 -2007 Age-Adjusted Rate of Lung Cancer Deaths per 100, 000 Persons Living in Locality 85 80 75 70 65 60. 7 60 55 50 54. 8 55. 2 52. 5 45 40 35 30 25 20 15 10 5 0 1996 -2000 1997 -2001 1998 -2002 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 TJHD Source: Virginia Department of Health, Division of Health Statistics Virginia

Breast Cancer Incidence Rates 200 180 140 127. 52 124. 5 124. 8 2004 -2008 144. 81 1999 -2003 146. 6 2004 -2008 160 106. 35 100 80 20 1999 -2003 40 2004 -2008 60 1999 -2003 Age-Adjusted Rate of Female Breast Cancer Cases per 100, 000 Females Living in Locality Nelson County, TJHD, and Virginia, 1999 -2008 0 Nelson Source: Virginia Cancer Registry TJHD Virginia

Breast Cancer Incidence Rates by Race TJHD and Virginia, 1999 -2008 147. 74 150 140 130 129. 15 133. 84 127. 06 125. 95 126. 59 124. 83 118. 13 120 110 100 90 80 70 60 2004 -2008 1999 -2003 2004 -2008 10 1999 -2003 20 2004 -2008 30 1999 -2003 40 2004 -2008 50 1999 -2003 Age-Adjusted Rate of Female Breast Cancer Cases per 100, 000 Females Living in Locality 160 0 Black White TJHD Source: Virginia Cancer Registry Black White Virginia

Breast Cancer Death Rates TJHD and Virginia, 1996 -2007 Age-Adjusted Rate of Breast Cancer Deaths per 100, 000 Persons Living in Locality 100 90 80 70 60 50 40 30 20 28. 8 25. 4 26. 6 20. 9 10 0 1996 -2000 1997 -2001 1998 -2002 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 TJHD Source: Virginia Department of Health, Division of Health Statistics Virginia

Prostate Cancer Incidence Rates Nelson County, TJHD, and Virginia, 1999 -2008 202. 11 200 175 165. 51 163. 15 165. 13 154. 94 160. 73 150 125 100 2004 -2008 1999 -2003 2004 -2008 25 1999 -2003 50 2004 -2008 75 1999 -2003 Age-Adjusted Rate of Prostate Cancer Cases per 100, 000 Males Living in Locality 225 0 Nelson Source: Virginia Cancer Registry TJHD Virginia

275 248. 15 250 225 242. 00 207. 16 202. 91 200 175 156. 68 148. 09 145. 10 145. 56 150 125 100 2004 -2008 1999 -2003 2004 -2008 25 1999 -2003 50 2004 -2008 75 1999 -2003 Age-Adjusted Rate of Prostate Cancer Cases per 100, 000 Males Living in Locality Prostate Cancer Incidence Rates by Race, TJHD and Virginia, 1999 -2008 0 Black Source: Virginia Cancer Registry White TJHD Black White Virginia

Age-Adjusted Rate of Prostate Cancer Deaths per 100, 000 Persons Living in Locality Prostate Cancer Death Rates 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 TJHD and Virginia, 1996 -2007 36. 8 TJHD, 27. 3 34. 2 Virginia, 26. 6 1996 -2000 1997 -2001 1998 -2002 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 TJHD Source: Virginia Department of Health, Division of Health Statistics Virginia

Colorectal Cancer Incidence Rates 70 66. 80 65 60 53. 08 55 50. 20 50 45. 14 44. 17 45 38. 20 40 35 30 25 2004 -2008 1999 -2003 5 2004 -2008 10 1999 -2003 15 2004 -2008 20 1999 -2003 Age-Adjusted Rate of Colorectal Cancer Cases per 100, 000 Persons Living in Locality Nelson County, TJHD, and Virginia, 1999 -2008 0 Nelson Source: Virginia Cancer Registry TJHD Virginia

70 67. 45 65 60. 97 59. 66 60 55. 02 55 50. 93 48. 57 50 45 43. 24 41. 66 40 35 30 25 2004 -2008 1999 -2003 5 2004 -2008 10 1999 -2003 15 2004 -2008 20 1999 -2003 Age-Adjusted Rate of Colorectal Cancer Cases per 100, 000 Persons Living in Locality Colorectal Cancer Incidence Rates by Race, TJHD and Virginia, 1999 -2008 0 Black White TJHD Source: Virginia Cancer Registry Black White Virginia

Colorectal Cancer Death Rates TJHD and Virginia, 1996 -2007 Age-Adjusted Rate of Colorectal Cancer Deaths per 100, 000 Persons Living in Locality 70 65 60 55 50 45 40 35 30 25 21. 4 17. 3 20 15 18. 9 15. 6 10 5 0 1996 -2000 1997 -2001 1998 -2002 1999 -2003 2000 -2004 2001 -2005 2002 -2006 2003 -2007 TJHD Source: Virginia Department of Health, Division of Health Statistics Virginia

Unintentional Injury

Percent of Hospitalizations due to Unintentional Injury by Cause Nelson County, 1999 -2009 Other/Unspecified; 20. 1% Bites/Stings; 2. 6% Poisoning; 4. 4% Struck by, against, 3. 0% Motor Vehicles/Other Transport Crashes; 22. 9% Source: Virginia Department of Health, Virginia Online Injury Reporting System Falls; 47. 0%

Hospitalizations due to Unintentional Injury by Cause and Age Group, Nelson County, 1999 -2009 0 -19 20 -64 65+ Number % Falls 14 15% 124 28% 318 73% Motor Vehicle/Other Transport Crashes 46 51% 144 32% 32 7% Struck by, against 10 11% 12 3% 7 2% Poisoning 2 2% 21 5% 20 5% Bites, Stings 4 4% 13 3% 8 2% Other/Unspecified 15 16% 131 29% 49 11% Source: Virginia Department of Health, Virginia Online Injury Reporting System

Reported Hospital Discharges for Injuries due to Falls per 100, 000 Persons Aged 65 and Over Living in Locality Rates of Hospitalizations due to Falls among Persons Aged 65+, Nelson County, TJHD, and Virginia, 1999 -2009 225 Nelson, 194. 51 Virginia, 193. 04 200 175 160. 99 168. 08 150 151. 86 125 100 115. 00 75 50 25 0 1999 -01 2000 -02 2001 -03 Nelson 2002 -04 2003 -05 TJHD Source: Virginia Online Injury Reporting System, Virginia Department of Health 2004 -06 2005 -07 2006 -08 Virginia 2007 -09

Rates of Unintentional Injury Deaths by Cause Nelson County, TJHD, and Virginia, 1999 -2009 Age-Adjusted Unintentional Injury Deaths per 100, 000 Persons Living in Locality 30 26. 81 25 20 17. 13 15 13. 04 9. 45 10 5. 82 5 5. 89 5. 54 5. 4 3. 56 2. 75 2. 32 0 Falls Transport Crashes Nelson 5. 5 4. 47 Suffocation 3. 71 3. 67 0. 960000001 1. 129999998 1. 06 Poisoning TJHD Source: Virginia Department of Health, Virginia Online Injury Reporting System Drowning 4. 66 1. 1 1. 22 Fire/Flame Virginia Other/Unspecified

Rates of Motor Vehicle Accidents Nelson County, TJHD, and Virginia, 2000 -2011 Motor Vehicle Accidents per 100, 000 Persons Living in Locality 3, 500 3, 250 3, 000 2, 750 2, 500 2, 250 2, 000 1, 750 2317. 64 2025. 78 2046. 23 2010. 26 1659. 47 1, 500 1471. 82 1, 250 1, 000 750 500 250 0 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson *Crashes are by place of occurrence Source: Virginia Department of Motor Vehicles TJHD Virginia

Motor Vehicle Crash Fatality Rates Nelson, TJHD, and Virginia, 2000 -2011 Motor Vehicle Crash Fatalities per 100, 000 Persons Living in Locality 50 45 40 35 30. 74 30. 31 30 25 19. 98 20 15 16. 20 12. 73 10. 38 10 5 0 2000 -04 2001 -05 2002 -06 Nelson Five Year Averages Source: Virginia Department of Motor Vehicles 2003 -07 2004 -08 TJHD 2005 -09 2006 -10 Virginia 2007 -11

Percent of Alcohol-Related Motor Vehicle Crashes, Nelson, TJHD, and Virginia, 2000 -2011 Percent of Total Motor Vehicle Crashes by Place of Occurrence 20% 18% 16% 14% 12% 10% 8% 11. 3% 9. 2% 8. 1% 8. 5% 7. 9% 7. 4% 6% 4% 2% 0% 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 Nelson Source: Virginia Department of Motor Vehicles TJHD Virginia

Percent of Alcohol-Related Motor Vehicle Crash Fatalities, TJHD and Virginia, 2000 -2011 90% 80% 70% 60% 50% 44. 5% 37. 0% 40% 38. 3% 33. 0% 20% 10% 0% v Percent of Total Motor Vehicle Crash Fatalities in which Alcohol was Involved -- by Place of Occurrence 100% 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 TJHD Source: Virginia Department of Motor Vehicles Virginia

Infectious Diseases

Rates of Reportable Communicable Diseases, TJHD and Virginia, 2000 -2010 Communicable Disease TJHD Virginia Average Number of Cases Average Rate Per 100, 000* Chlamydia 559 260. 2 23, 406 306. 7 Gonorrhea 134 62. 3 8, 723 119. 3 Pertussis 56 26. 3 246 3. 3 Salmonellosis 35 16. 3 1, 186 15. 8 Giardiasis 33 15. 5 489 6. 5 Chicken Pox 25 11. 7 1, 079 14. 3 Campylobacteriosis 21 9. 8 687 9. 2 Lyme Disease 20 9. 1 514 6. 7 *Population data based on U. S. Census Data for TJHD and State of Virginia (2000 -2010) Source: Virginia Department of Health, Division of Surveillance and Investigation

Reported Cases of Chlamydia per 100, 000 Persons Living in Locality Chlamydia Incidence Rates 425 Nelson County, TJHD, and Virginia, 1997 -2010 400 397. 7 375 350 325 300 280. 7 275 250 225 219. 6 200 175 150 Nelson, 167. 5 Virginia, 189. 3 Nelson, 189. 2 125 100 75 50 25 0 1997 -99 1998 -00 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 Nelson TJHD Source: Virginia Department of Health, Division of Disease Prevention Virginia

Reported Cases of Gonorrhea per 100, 000 Persons Living in Locality Gonorrhea Incidence Rates 160 Nelson County, TJHD, and Virginia, 1997 -2010 140 134. 4 120 109. 4 100 94. 3 80 68. 6 60 45. 5 40 28. 2 20 0 1997 -99 1998 -00 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 Nelson TJHD Source: Virginia Department of Health, Division of Disease Prevention Virginia

Reported Cases of HIV/AIDS per 100, 000 Persons Living in Locality HIV and AIDS Incidence Rates 16 TJHD and Virginia, 1997 -2009 15. 1 15 14 13. 5 13. 4 13 12 11 10 10. 2 8. 9 9 8 8. 2 7 6. 1 6 5. 9 5 4 3 2 1 0 1997 -99 1998 -00 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 TJHD HIV TJHD AIDS Source: Virginia Department of Health, Division of Disease Prevention Virginia HIV Virginia AIDS

Syphilis (early) Incidence Rates Reported Cases of Syphilis per 100, 000 Persons Living in Locality TJHD and Virginia, 1999 -2010 8 6. 8 7 6 5 4. 1 4 2. 8 3 2 1 0. 5 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Pertussis per 100, 000 Persons Living in Locality Pertussis Incidence Rates TJHD, and Virginia, 1999 -2010 50 45 40 35 30 25 20 16. 4 20. 4 15 10 5 3. 5 2. 2 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Chicken Pox per 100, 000 Persons Living in Locality Chicken Pox Incidence Rates TJHD and Virginia, 1999 -2010 30 25 20 16. 3 15 12. 7 12. 1 10 5 2. 1 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Hepatitis B per 100, 000 Persons Living in Locality Hepatitis B Incidence Rates TJHD and Virginia, 1999 -2010 4. 0 3. 5 3. 0 2. 5 2. 0 2. 4 2. 3 1. 5 Healthy People 2020 1. 4 1. 0 0. 5 0. 4 0. 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Salmonellosis Incidence Rates Reported Cases of Salmonellosis per 100, 000 Persons Living in Locality TJHD and Virginia, 1999 -2010 22 20 18. 5 18 16 17. 4 14. 9 14 14. 0 12 10 Healthy People 2020 8 6 4 2 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Campylobacteriosis Incidence Rates Reported Cases of Campylobacteriosis per 100, 000 Persons Living in Locality TJHD and Virginia, 1999 -2010 18 16 14. 2 14 11. 7 12 10 8. 5 9. 5 8 6 4 2 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of E. Coli O 157: H 7 per 100, 000 Persons Living in Locality E. Coli O 157: H 7 Incidence Rates TJHD and Virginia, 1999 -2010 4. 0 3. 5 3. 4 3. 0 2. 7 2. 5 2. 3 2. 0 1. 5 1. 0 Healthy People 2020 0. 5 0. 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Giardiasis per 100, 000 Persons Living in Locality Giardiasis Incidence Rates TJHD and Virginia, 1999 -2010 28 26 24 22 20 18 17. 8 16 14 12. 8 12 10 8 6. 3 6 6. 2 4 2 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Legionellosis per 100, 000 Persons Living in Locality Legionellosis Incidence Rates TJHD and Virginia, 1999 -2010 3. 5 3. 0 2. 5 2. 0 2. 1 1. 93 1. 87 1. 5 0. 9 1. 0 0. 5 0. 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Disease Prevention Virginia

Reported Cases of Lyme Disease per 100, 000 Persons Living in Locality Lyme Disease Incidence Rates TJHD and Virginia, 1999 -2010 30 25. 3 25 20 15 13. 2 10 5 Virginia, 2. 0 0 TJHD, 1. 7 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Spotted Fever Rickettsiosis per 100, 000 Persons Living in Locality Spotted Fever Rickettsiosis Incidence Rates, TJHD and Virginia, 1999 -2010 5. 0 4. 4 4. 5 4. 0 3. 5 3. 0 2. 5 2. 0 1. 5 1. 0 0. 5 0. 0 0. 3 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Surveillance and Investigation Virginia

Reported Cases of Tuberculosis per 100, 000 Persons Living in Locality Tuberculosis Incidence Rates TJHD and Virginia, 1999 -2010 5. 0 4. 5 4. 4 4. 0 3. 6 3. 5 3. 0 2. 9 2. 5 2. 0 1. 8 1. 5 1. 0 Healthy People 2020 0. 5 0. 0 1999 -01 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 TJHD Source: Virginia Department of Health, Division of Disease Prevention Virginia

Ambulatory Care-Sensitive Conditions

Percent of Adults Diagnosed with Diabetes (Self-Reported), TJHD and Virginia, 2000 -2010 Percent of Total Adults Aged 20 and Over Living in Locality 10% 8. 7% 9% 8% 7% 6. 1% 6% 5% 4% 3. 9% 3% 2% 1% 0% 2000 -2002 2001 -2003 2002 -2004 2003 -2005 2004 -2006 2005 -2007 2006 -2008 2007 -2009 2008 -2010 TJHD Virginia Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance System

Hospital Discharge Rates for Diabetes Age-Adjusted Hospital Discharges for Diabetes per 10, 000 Persons Living in Locality TJHD and Virginia, 2000 -2011 34 32 30 28 26 24 22 20 18 16 14 17. 01 TJHD, 15. 83 Virginia, 15. 46 14. 82 12 10 8 6 4 2 0 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 TJHD Source: VDH Data Warehouse; Virginia Hospital Information Systems Virginia

Hospital Discharge Rates for Diabetes Age-Adjusted Hospital Discharges for Diabetes per 10, 000 Persons Living in Locality TJHD by Locality, 2000 -2010 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 24. 65 23. 84 2000 -02 2001 -03 Albemarle 2002 -04 2003 -05 Charlottesville Source: Virginia Hospital Information Systems 2004 -06 Fluvanna 2005 -07 Greene 2006 -08 Louisa 2007 -09 2008 -10 Nelson

Hospital Discharge Rates for Asthma Nelson County, TJHD, and Virginia, 2000 -2010 Age-Adjusted Hospital Discharges for Asthma per 10, 000 Persons Living in Locality 22 20 18. 80 18 16 14 16. 50 15. 85 14. 99 12. 66 12 11. 94 10 8 6 4 2 0 2000 -02 2001 -03 2002 -04 Nelson Source: Virginia Hospital Information Systems 2003 -05 2004 -06 TJHD 2005 -07 2006 -08 2007 -09 Virginia 2008 -10

Age-Adjusted Hospital Discharges for Hypertension per 10, 000 Persons Living in Locality Hospital Discharge Rates for Hypertension, TJHD and Virginia, 2000 -2011 10 9 8 7 6 5 4 3 2 TJHD, 2. 69 TJHD, 2. 68 Virginia, 2. 64 1 0 2000 -02 2001 -03 2002 -04 2003 -05 2004 -06 2005 -07 2006 -08 2007 -09 2008 -10 2009 -11 TJHD Source: VDH Data Warehouse; Virginia Hospital Information Systems Virginia

Hospital Discharge Rates for COPD Age-Adjusted Hospital Discharges for COPD per 10, 000 Persons Living in Locality Nelson County, TJHD, and Virginia, 2000 -2010 30 26. 10 25 23. 30 22. 49 20 21. 52 18. 18 17. 69 15 10 5 0 2000 -02 2001 -03 2002 -04 Nelson Source: Virginia Hospital Information Systems 2003 -05 2004 -06 TJHD 2005 -07 2006 -08 2007 -09 Virginia 2008 -10

Mental Health Indicators

Average Number of Poor Physical/Mental Health in the Last 30 Days (Self-reported) Number* of Physically Unhealthy/Poor Mental Health Days TJHD by Locality, TJHD and Virginia, 2004 -2010 5 4. 7 4. 5 4 3. 5 2. 9 3 2. 9 2. 8 2. 5 2 3. 7 2. 2 3. 2 2. 88 2. 5 3. 2 2. 73 2. 1 1. 5 1. 2 1 0. 5 0 Albemarle Charlottesville Fluvanna Greene Louisa Nelson TJHD Average Virginia Average Number of Physically Unhealthy Days reported in past 30 days Average Number of Poor Mental Health Days reported in past 30 days National Benchmark for Physically Unhealthy Days *Numbers are self-reported Source: County Health Rankings

Region Ten Community Services Board’s Most Frequent Diagnosed Disorders, 2011 Percent of Total Region Ten Patients Served 30% 25% 20% 15% 12% 11% 9% 10% 7% 5% 0% 7% 3% Mood Disorders Attention Deficit & Alcohol-Related Schizophrenia & Disruptive Disorder Other Pyschotic Behavior Disorders Source: Region Ten Community Services Board Adjustment Disorder 2% Anxiety Disorders Cocaine-Related Cannabis-Related Disorder

Number of Emergency Services Delivered by Region 10 Community Services Board by Type of Service 1996 -2009 Number of Region Ten Services Delivered 3000 2500 2306 2000 1500 1000 1453 1042 629 500 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Emergency Custody Order Evaluations Temporary Detention Orders Issued Total Evaluations Hospital Admissions Source: Region Ten Community Services Board

Percent of Total Adults/Children Served through State Mental Health Agencies Percent of Persons Served though State Mental Health Agencies with Co-Occurring Mental Health and Substance Abuse Disorders, Virginia and U. S. , 2010 35% 32. 8% 30% 25% 20. 0% 15% 10% 7. 6% 4. 6% 5% 0% Adults with a co-occuring MH and AOD disorder Virginia MH = Mental Health; AOD = Alcohol and Other Drug Source: Substance Abuse and Mental Health Services Administration Children with a co-occurring MH and AOD disorder US

Percent of Total Adults/Children Served through State Mental Health Agencies Percent of Persons Served though State Mental Health Agencies with Co-Occurring Severe Mental Health and Substance Abuse Disorder, Virginia and U. S. , 2010 35% 31. 8% 30% 25% 24. 4% 20% 15% 8. 7% 10% 7. 9% 5% 0% Adults with a SMI and a substance abuse disorder Virginia Children with a SMI and a substance abuse disorder US Adults with a serious mental illness (SMI) are Persons 18 years and Over who, “at any time during a given year, had a diagnosable mental, behavioral, or emotional disorder without the benefit of treatment or other support services … that has resulted in functional impairment which substantially interferes with or limits one or more major life activities. …" Source: Substance Abuse and Mental Health Services Administration

Hospital Discharge Rates for Psychoses Hospital Discharges per 100, 000 Persons Living in Locality TJHD and Virginia, 2000 -2011 800 700 677. 19 600 563. 09 586. 01 500 418. 60 300 200 100 0 2001 2002 2003 2004 2005 TJHD Source: VDH Data Warehouse; Virginia Hospital Information Systems 2006 2007 2008 VA 2009 2010 2011

Hospital Discharges per 100, 000 Persons Living in Locality Hospital Discharge Rates for Neurotic Disorders, Personality Disorders, and other Nonpsychotic Mental Disorders TJHD and Virginia, 2000 -2011 300 257. 45 250 206. 30 199. 55 200 140. 88 150 100 50 0 2001 2002 2003 2004 2005 TJHD Source: VDH Data Warehouse; Virginia Hospital Information Systems 2006 2007 2008 VA 2009 2010 2011

Section Four: What are community members’ perceptions of health in their communities? Thomas Jefferson Area Community Survey MAPP 2 Health Focus Groups Louisa County Qualitative Data

Thomas Jefferson Area Community Survey

Thomas Jefferson Area Community Survey (TJACS) • • TJHD, 2012 Conducted by the UVA Center for Survey Research (CSR) Conducted in January 2012 Survey of 1, 098 individuals living in Charlottesville City and Albemarle, Nelson, Fluvanna, Greene, and Louisa Counties Conducted through a Random Digit Dial (RDD) sample of landline and cell-phone numbers – Also included a random sample of directory-listed landline households Source: UVA Center for Survey Research

Question 1: Thinking about Nelson County, which of the following services is most difficult to get care from? Counselors for Urgent Medical Doctors Dentists Mental Health or Care Hospitals Substance Abuse Facilities Nelson TJHD 7. 7% 9. 8% 17. 6% 27. 3% 37. 6% 11. 3% 13. 4% 20. 7% 17. 9% 14. 9% 19. 7% Insists No Problems • Open-ended response: “All of them. I live in Nelson County and it would take an hour to come get me if something ever happened to me. ” Source: UVA Center for Survey Research

Question 2: Thinking about Nelson County, what is the biggest difficulty people have in getting health services? Problems with cost, insurance or Medicaid Distance or Transportation Not enough doctors, Language or dentists or cultural counselors difficulties Nelson 45. 2% 41. 8% 6. 7% 6. 3% TJHD 59. 4% 20. 4% 11. 0% 2. 2% • Open-ended response: “People in Nelson County have a lack of education to reach out and use resources which are available. It's an old cultural thing – people don't have perspective or don't care and are uneducated. ” Source: UVA Center for Survey Research

Question 3: Which of the following public health concerns is the most important for Nelson County to give more attention to? Smoking Weight and Alcohol/ obesity drug use Infant Death Mental Health Nelson 3. 8% 43. 1% 40. 7% 0. 0% 12. 4% TJHD 7. 8% 36. 0% 32. 7% 3. 1% 20. 3% Source: UVA Center for Survey Research

MAPP 2 Health Focus Groups

Focus Group Demographics Nelson County, 2012 Attendees Number Percent 15 100. 0% 1 6. 7% 14 93. 3% 11 73. 3% 4 26. 7% 0 0. 0% 15 100. 0% 0 0. 0% 1 6. 7% 6 40. 0% 7 46. 7% 0 0. 0% Gender Male Female Race White Other Ethnicity Hispanic or Latino Not Hispanic or Latino Age 18 -27 28 -37 38 -47 48 -57 58 -67 68 -77 Unknown

Focus Group Demographics Nelson County, 2012 Number Percent Married 6 40. 0% Widowed 2 13. 3% Divorced 4 26. 7% Never Married 2 13. 3% No Answer 1 6. 7% Employed 7 46. 7% Retired 4 26. 7% Unemployed 3 20. 0% Disabled/ Unable to Work 1 6. 7% No Answer 0 0. 0% Marital Status Employment status

Focus Group Demographics Nelson County, 2012 Number Percent Less than eighth grade 1 6. 7% High school diploma or GED 2 13. 3% College degree (4 years or less of college) 8 53. 3% Advanced degree 4 26. 7% No Answer 0 0. 0% < $15, 000 5 33. 3% $15, 000–$29, 000 2 13. 3% $30, 000–$44, 000 0 0. 0% $45, 000–$59, 000 1 6. 7% $60, 000–$74, 000 2 13. 3% $75, 000–$89, 000 1 6. 7% >$90, 000 1 6. 7% No answer 3 20. 0% Education Completed Income

Focus Group Health Care Characteristics Nelson County, 2012 Number Percent 2 13. 3% 7 46. 7% 4 26. 7% 3 20. 0% 2 13. 3% 0 0. 0% Medical Insurance None Medicare Medicaid Private Employment-based Other No Answer On average, how many times each month do you use health care services (doctor, dentist, hospital, etc)? 1 - 4 5 -9 10 -14 15 or more Other: 1 -4/year Never No Answer 9 60. 0% 1 6. 7% 0 0. 0% 5 33. 3% 0 0. 0%

Focus Group Health Care Characteristics Nelson County, 2012 Number Percent Do you have any of the following conditions? Check all that apply: Smoking 1 6. 7% Diabetes 3 20. 0% Heart Disease 0 0. 0% Cancer 1 6. 7% Asthma 1 6. 7% High Blood Pressure 5 33. 3% Other 2 13. 3%

Nelson County Focus Group Results 2012 • Weight and Obesity – This issue can be ameliorated through education • Nutritional education has helped before • Participants only knew of one rural health class available to the community – Poverty contributes to this problem – people purchase foods that are cheaper rather than healthier – A lack of walking trails/sidewalks is a barrier to becoming fit within the community

Nelson County Focus Group Results 2012 • Transportation – Participants reported being unable to use resources offered, mainly due to limits to their use • e. g. , solely for medical appointments, always booked, not enough time, and not enough volunteers – One solution suggested was a more informal system in which community residents would be able to carpool, and those with cars could offer to take those without

Nelson County Focus Group Results 2012 • Alcohol and Drug Use – It is a cultural issue: parents are enabling their children – making it a generational problem – and alcoholism is culturally engrained in the population – The problem may be due to a lack of activities available for community members to be involved in – Though people are more educated about the issue, drinking and driving is a major concern in the community