Community   Health  Profile   for  Mohave  County,   Arizona 2013 Acknowledgements      “The  most  powerful  factors  in  the  world  are  clear  ideas  in  the  minds  of  energetic  people  of  good  will.”                 —J.    Arthur  Thompson     This  Community  Health  Profile  for  Mohave  County,  Arizona  is  the  result  of  the  insights  and  input  from  hun-­‐ dreds  of  people  representing  a  broad  spectrum  of  community  interests  in  Mohave  County.    Many  thanks  to   representatives  of  the  following  organizations  who  serve  on  the  Mohave  County  Community  Health  Coalition   or  who  otherwise  contributed  to  this  report:         All  Women's  Medical  Center   American  Family  Insurance   Anotucci's   Arizona  Cooperative  Extension   Arizona  Youth  Partnership   AZ  Dept.  of  Economic  Security   AZ  Dept.  of  Fish  &  Game   AZ  Dept.  of  Health  Services   AZ  State  Office  of  Rural  Health   Boys  &  Girls  Club  of  the  Colorado  River   Bullhead  City  Chamber  Commerce   Bullhead  City  Dental   Bullhead  City  Elementary  School  Dist.   Bullhead  City  Fire  Dept.   Bullhead  City  Parks  &  Rec.   Bullhead  City  Police  Dept.   Bullhead  City  Senior  Programs   Bullhead  City  Transit   Bullhead  Health  Club   Bullhead  Regional  Economic  Develop-­‐ ment    Authority   Cameron  Broadcasting   Chloride  Chamber  of      Commerce   City  of  Bullhead     City  of  Kingman   City  of  Lake  Havasu   Colorado  River  Pediatrics   Cornerstone  Mission   Crossroads  Family  Dental   Dallman  &  Associates   Desert  Oasis  Medical  Center   Desert  Palms  Medical  Assoc.   Dolan  Springs  Chamber  of  Commerce   El  Palacio   Farm  Bureau  Financial   First  Things  First   Fluesche  Realty   Fort  Mohave  Tribal  Nation   Havasu  Community  Health  Foundation   Havasu  for  Youth   Havasu  Regional  Medical  Center   Havasu  Transit   Home  Depot   Hospital  District  Number  One  of  Moha-­‐ ve  County   Hualapai  Tribal  Nation   Indian  Health  Services   Interagency  of  Lake  Havasu   Kelley,  Moss,  &  Williams     Kenneth  Gregory  Law  Office   Kingman  Academy  of  Learning   Kingman  Daily  Miner     Kingman  Hospital  Inc.   Kingman  Area  Chamber  of  Commerce   Kingman  City  Council   Kingman  Fire  Department   Kingman  Police  Department   Kingman  Regional  Medical  Center   Kingman  Unified  School  District  #20   KJJJ  Radio   KRMC  Foundation   Lake  Havasu  Parks  &  Recreation   Lake  Havasu  Ministries   Lake  Havasu  Police  Dept.   Lake  Havasu  School  District   Lake  Havasu  City  Chamber  of  Com-­‐ merce   Legacy  Foundation   Maddog  Fitness   MAPPED   Meadview  Chamber  of  Commerce   Meals  on  Wheels   Mohave  County  Department  of  Public   Health       Mohave  County  Tobacco  Use  &  Chronic   Disease  Prevention  Program   Mohave  County  Board  of  Supervisors   Mohave  Accelerated  School   Mohave  Community  College   Mohave  County  Community  Develop-­‐ ment   Mohave  County  Community  Services   Mohave  County  Senior  Programs   Mohave  County  Sheriff's  Office   Mohave  County-­‐Children's  Action  Team   Mohave  Daily  News   Mohave  Mental  Health  Clinic,  Inc   Mohave  State  Bank   Mohave  Substance  Abuse  Treatment  &   Education  Partnership  (MSTEPP)   Nautical  Inn/London  Bridge  Resort   North  Country  Healthcare   Northern  Arizona  Univ.   Office  Express   Our  Town  Magazine   River  Medical   Riverside  Resorts   Sam's  Club   Shugrues   Southwest  Behavioral  Health     Telesis  Preparatory  Academy   Today's  News  Herald   University  of  Arizona   University  of  Nevada  Las  Vegas   U.S.  Bureau  of  Land  Management   U.S.  Bureau  of  Veteran  Affairs   Valley  View  Medical  Center   Western  Arizona  Council  of       Governments   Additionally,  special  thanks  to  the  Mohave  County  residents  who  took  the  time  to  participate  in  our  key   informant  interviews,  stakeholder  and  healthcare  provider  questionnaires,  and  in  the  Mohave  County   Community  Health  Survey.    The  energy,  dedication,  and  cooperation  of  the  hundreds  involved  in  this  effort   are  powerful  factors  for  improving  health  and  quality  of  life  issues  in  Mohave  County.         Authors     Teri  Williams   Mohave  County  Health  Improvement  Initiative  Co-­‐Leader,  Kingman  Regional  Medical  Center   Susan  Williams   Mohave  County  Health  Improvement  Initiative  Co-­‐Leader,  Mohave  County  Department  of  Public  Health   Ryan  Reiff   Mohave  County  Health  Improvement  Initiative  Consultant,  BKD  Associates           Table  of  Contents   Introduction ..................................................................................................................................................................... 1 Purpose  ..............................................................................................................................................................................................  1   Organization  Descriptions  ...........................................................................................................................................................  3   Community  Health  Assessment  Method  and  Process  .........................................................................................................  4 Mohave County Demographic, Socioeconomic, and Environmental Characteristics ...................7 Defined  Community  .......................................................................................................................................................................  7   Mohave  County  Population    .........................................................................................................................................................  8   Mohave  County  Educational  Statistics  ..................................................................................................................................  12   Mohave  County  Economic  Indicators  ....................................................................................................................................  14   Mohave  County  Physical  Environment  .................................................................................................................................  21   Health Resources in Mohave County ................................................................................................24 Acute  Care  Hospitals  ...................................................................................................................................................................  24   Primary  Care  Services  ................................................................................................................................................................  26   Federally  Qualified  Health  Centers  ........................................................................................................................................  28   Dental  Health  Services  ...............................................................................................................................................................  29   Mental  Health  and  Substance  Abuse  Treatment  Services  ..............................................................................................  30   Behavioral Risk Factors ......................................................................................................................33 Indicators  of  Unhealthy  Behaviors  among  Mohave  County  Adults  .............................................................................  34   Indicators  of  Unhealthy  Behaviors  among  Mohave  County  Youth  ..............................................................................  36   Mohave County Community Health Status .......................................................................................41 Mohave  County  Health  Rankings  ............................................................................................................................................  41   Leading  Causes  of  Death  in  Mohave  County  ........................................................................................................................  44   Chronic  Disease  in  Mohave  County  ........................................................................................................................................  49   Communicable  Disease  in  Mohave  County  ..........................................................................................................................  56   Maternal  and  Child  Health  ........................................................................................................................................................  57   Social  and  Mental  Health  ...........................................................................................................................................................  58   Community Input on Health Needs in Mohave County ....................................................................61 Key  Informant  Observations  ....................................................................................................................................................  61   Community  Stakeholder  Observations  .................................................................................................................................  66   Primary  Care  Provider  Observations  ....................................................................................................................................  68   General  Public  Observations  ....................................................................................................................................................  70 Conclusions and Next Steps ..............................................................................................................94 Appendices ..........................................................................................................................................97 Appendix  A:    Mohave  County  Community  Health  Coalition  Member  Organizations  ......................................................  98   Appendix  B:    Key  Informant  Interview  Protocol  ......................................................................................................................  99   Appendix  C:    Community  Stakeholder  Questionnaire  ..........................................................................................................  100   Appendix  D:    Primary  Care  Provider  Questionnaire  ............................................................................................................  102   Appendix  E:    Mohave  County  Community  Health  Survey  Questions  .................................................................................  103   Appendix  F:    References  ..............................................................................................................................................................  108                                                        Community  Health  Profile  for  Mohave  County,  2013   Introduction   This  Community  Health  Profile  documents  the  findings  of  a  formal  community  health   assessment  performed  in  Mohave  County,  Arizona.    In  general,  it  details  health  and   wellness  statistics  and  community  needs  for  health  services  in  Mohave  County   communities.     With  the  ultimate  goal  to  improve  health  and  quality  of  life  in  Mohave  County,  the   community  health  assessment  was  initiated  in  the  fall  of  2011  by  a  countywide  coalition  of   community  stakeholders  under  the  collaborative  leadership  of  the  Mohave  County   Department  of  Public  Health  and  Kingman  Regional  Medical  Center.  It  involved  a  wide-­‐ ranging  effort  to  gather  facts  and  statistics  regarding  health  and  quality  of  life  in  Mohave   County,  including  obtaining  insights  and  perspectives  from  county  residents.     The  health  assessment  was  a  first  in  our  area—  never  before  has  there  been  a   comprehensive  study  of  community  health  done  with  community  member  input  at  a  local   level.    Our  objective  was  to  provide  a  realistic  picture  of  the  health  needs  and  issues  unique   to  our  population,  geography,  and  economy  to  be  utilized  for  local  planning  and  for   creating  policies  and  programs  that  address  true  health  concerns  within  our  county.       The  community  health  assessment  is  the  first  part  of  a  two-­‐pronged  approach  for   improving  health  and  quality  of  life  in  Mohave  County.    With  the  publication  of  this   Community  Health  Profile,  the  community  coalition  will  use  the  data  and  information  herein   to  identify  and  address  priority  health  issues,  which  will  be  documented  in  a  second  report   called  a  Community  Health  Improvement  Plan  (CHIP).  The  CHIP  will  include  strategies  and   measures  for  acting  on  selected  community  health  issues.       The  Mohave  County  Health  Improvement  Initiative  will  be  an  ongoing  process,  which  will   involve  performing  a  community  health  assessment  and  developing  a  community  health   improvement  plan  every  three  years.     Purpose   The  purpose  of  this  Community  Health  Profile  is  to  provide  a  factual  basis  for  informing   community  decision-­‐making  regarding  health  and  quality  of  life  issues  in  Mohave  County.  It   is  one  part  of  an  overall  initiative  to  identify,  prioritize,  and  address  health  needs  to   ultimately  improve  health  and  quality  of  life  in  Mohave  County.       This  effort  was  first  prompted  by  separate  agency  requirements  (described  below)  for  the   Mohave  County  Department  of  Public  Health  (MCDPH)  and  for  Kingman  Regional  Medical   Center  (KRMC).  Therefore,  this  report  also  serves  to  document  both  entities’  compliance  to   their  respective  requirements.         Page  1                                                              Community  Health  Profile  for  Mohave  County,  2013   County  health  department  accreditation   Currently,  county  health  departments  throughout  Arizona  are  seeking  accreditation   through  the  Public  Health  Accreditation  Board.    As  part  of  the  accreditation  process,   MCDPH  is  required  to  conduct  a  community  health  assessment  and  develop  a  community   health  improvement  plan  for  Mohave  County.       The  Public  Health  accreditation  process  also  requires  the  health  department  to  identify   opportunities  for  improving  quality  and  performance  based  on  the  findings  of  the   CHA/CHIP.    Specifically,  the  accreditation  process  provides  a  means  for  the  health   department  to  improve  management,  develop  leadership,  and  improve  relationships  with   the  community.  The  process  challenges  the  health  department  to  reflect  on  their  current   business  practices  and  services  they  offer  to  the  public  and  to  determine  how  best  to   improve  and  stimulate  quality  performance.    It  also  promotes  greater  accountability  and   transparency  in  serving  the  county’s  citizens.       Non-­‐profit  hospital  compliance  with  the  Patient  Protection  and  Affordable  Care  Act   Non-­‐profit  hospitals  throughout  the  United  States  are  required  to  perform  a  community   health  assessment  in  compliance  with  the  Patient  Protection  and  Affordable  Care  Act   (KRMC  is  the  only  non-­‐profit  hospital  in  Mohave  County).         IRC  Section  501(r)  (a  byproduct  of  the  Affordable  Care  Act)  requires  health  care   organizations  to  assess  the  health  needs  of  their  communities  and  adopt  implementation   strategies  to  address  identified  needs.    Per  IRC  Section  501(r),  KRMC  must  do  the  following   to  comply  with  federal  tax-­‐exemption  requirements:          Conduct  a  community  health  assessment  every  three  years      Adopt  an  implementation  strategy  to  meet  the  community  health  needs  identified   through  the  assessment      Report  how  it  is  addressing  the  needs  identified  in  the  community  health   assessment  and  a  description  of  needs  not  being  addressed,  with  justification  as  to   why  such  needs  are  not  being  addressed     Since  both  MCDPH  and  KRMC  are  required  to  assess  health  in  the  community,  the  two   entities  used  the  opportunity  to  form  a  large  coalition  of  community  representatives  from   throughout  the  county  to  do  a  wider  ranging  assessment—  with  the  mutual  goal  of   ultimately  improving  health  and  quality  of  life  in  Mohave  County.    To  that  end,  this   document  will  serve  as  the  basis  for  prioritizing  community  health  needs  and  in  planning   to  meet  those  needs  with  the  support  of  many  organizations  and  public  service  agencies   throughout  Mohave  County.           Page  2                                                              Community  Health  Profile  for  Mohave  County,  2013   Organization  Descriptions   The  Mohave  County  Department  of  Public  Health  (MCDPH)  and  Kingman  Regional  Medical   Center  (KRMC)  are  co-­‐leading  the  ongoing  community  health  assessment  and  health   improvement  planning  process  for  Mohave  County.    Both  entities  share  project   management  responsibilities  and  costs.  Additionally,  there  were  many  community   organizations  and  outside  agencies  who  contributed  to  the  effort.    The  primary   organizations  involved  in  the  effort  are  listed  below.       Mohave  County  Department  of  Public  Health   With  the  mission  of  creating  a  safe  and  healthy  environment  for  Mohave  County  citizens,   the  Mohave  County  Department  of  Public  Health  (MCDPH)  serves  the  county’s  population   of  over  200,000  throughout  a  13,470-­‐square-­‐mile  area.  The  department  employs  over  100   public  health  professionals  in  six  divisions  including  Administration,  Bioterrorism  Defense   and  Emergency  Response,  Public  Health  Nursing,  Environmental  Health,  Senior  Programs,   and  Nutrition  &  Health  Promotion.         A  five  member  Board  of  Supervisors  has  authority  over  the  Mohave  County  Department  of   Public  Health,  while  a  local  eleven  member  Board  of  Health  functions  in  an  advisory  and   educational  capacity.    The  Department  serves  the  public  in  a  variety  of  public  health   services  including  senior  programs  in  Kingman,  Lake  Havasu  City,  Bullhead  City  and   Colorado  City.         Kingman  Regional  Medical  Center   Kingman  Regional  Medical  Center  (KRMC)  is  a  235-­‐bed  acute  care  hospital  located  in   Kingman,  Arizona.  With  the  mission  of  serving  the  community  with  commitment  and   compassion,  KRMC  is  the  only  nonprofit  medical  center  in  Mohave  County.    It  was   established  in  1982  by  a  voter  referendum  to  move  the  hospital  from  under  county  control   to  local  community  control.    The  referendum  created  Hospital  District  Number  One  of   Mohave  County,  which  is  governed  by  a  five-­‐member  District  Board.    The  hospital  district   encompasses  all  of  Mohave  County  with  the  exception  of  the  “strip”  area  north  of  the  Grand   Canyon  and  the  areas  within  the  school  district  boundaries  of  Bullhead  City  and  Lake   Havasu  City,  AZ.       In  1983,  Hospital  District  Number  One  of  Mohave  County  leased  the  hospital  and   equipment  to  Kingman  Hospital  Incorporated  (KHI)  —  a  local  non-­‐profit  organization   created  exclusively  to  oversee  hospital  operations.  The  11-­‐member  KHI  Board  of  Directors   is  comprised  of  local  citizens  who  serve  five-­‐year  terms.  Under  the  direction  of  the   community  board,  KRMC  has  grown  to  become  the  largest  medical  center  in  northwest   Arizona.  With  over  1,600  employees,  275  volunteers,  and  190  physicians/allied  health   professionals—  KRMC  is  capable  of  providing  highly  technical  and  specialized  healthcare   services  not  normally  available  in  similar-­‐size  communities.               Page  3                                                              Community  Health  Profile  for  Mohave  County,  2013   Mohave  County  Community  Health  Coalition   In  an  effort  to  coordinate  with  other  community  agencies  to  execute  the  community  health   assessment,  MCDPH  and  KRMC  formed  the  Mohave  County  Community  Health  Coalition,   which  includes  over  100  community  stakeholders  representing  community  interests   throughout  Mohave  County  (organizations  with  representatives  on  the  coalition  are  listed   in  Appendix  A).     The  role  of  each  coalition  member  is  to  contribute  insights  and  input  on  community  health   from  their  unique  perspective  as  related  to  their  role  in  the  community.    Coalition  members   also  serve  on  various  task  forces  and  committees  to  help  identify  and  evaluate  the  health   needs  of  the  community,  prioritize  those  needs,  and  develop  strategies  for  addressing  those   needs.     Arizona  Center  for  Rural  Health,  University  of  Arizona   Experts  from  the  Arizona  Center  for  Rural  Health  facilitated  our  community  coalition   meetings  and  provided  guidance  and  technical  assistance  throughout  the  community   health  assessment  process.    With  the  mission  to  promote  the  health  of  rural  and  medically   underserved  individuals,  families,  and  communities  through  service,  education,  and   research;  the  center  provides  flexible  and  innovative  resources  to  respond  to  the  needs  of   rural  constituents.    The  center  is  located  within  the  University  of  Arizona  Mel  and  Enid   Zuckerman  College  of  Public  Health.    In  addition  to  education  and  research,  the  Mel  Enid   Zuckerman  College  of  Public  Health  places  a  strong  focus  on  community  outreach,  practice,   and  service.     BKD,  LLP   KRMC  and  MCDPH  engaged  BKD,  LLP  to  conduct  the  formal  community  health  assessment.     BKD,  LLP  has  proven  experience  in  working  with  community  coalitions  in  the  community   health  assessment  and  improvement  process.    It  is  one  of  the  largest  CPA  and  advisory   firms  in  the  United  States,  with  approximately  2,000  partners  and  employees  in  30  offices.     BKD  serves  more  than  900  hospitals  and  health  care  systems  across  the  country.         Community  Health  Assessment  Method  and  Process   The  method  and  process  used  in  conducting  a  community  health  assessment  in  Mohave   County  was  influenced  by:      National  Association  of  City  and  County  Health  Officials  (NACCHO)  guidelines  for   conducting  a  community  health  assessment  and  developing  a  community  health   improvement  plan      Methodologies  suggested  by  the  Arizona  Center  for  Rural  Health,  University  of  Arizona      Public  Health  Accreditation  Board  guidelines  and  requirements  for  county  health   department  accreditation         Page  4                                                              Community  Health  Profile  for  Mohave  County,  2013    U.S.  Internal  Revenue  Service  (IRS)  guidelines  and  requirements  for  tax-­‐exempt  health   care  organization  compliance  with  IRC  Section  501(r)     The  Mohave  County  Community  Health  Improvement  Initiative  began  in  September,  2011   with  a  community  coalition  meeting  held  in  Kingman,  AZ.    The  meeting  involved  over  50   individuals  representing  city  and  county  government,  Indian  tribes,  healthcare,  education,   law  enforcement,  public  services,  business,  charities,  and  faith-­‐based  services  in  the   Kingman  area.    The  purpose  of  the  meeting  was  to  introduce  community  stakeholders  to   the  community  health  improvement  process  and  to  obtain  buy-­‐in  and  commitments  for   assisting  with  the  effort.     The  first  order  of  business  at  this  meeting  was  to  define  “community,”  in  terms  of  the   geographic  area  to  be  included  in  a  community  health  assessment.  Based  on  KRMC’s  and   MCDPH’s  service  areas  and  on  feedback  at  the  meeting,  the  decision  was  made  to  include   all  of  Mohave  County  in  the  assessment.    As  a  result,  similar  meetings  with  community   stakeholders  were  later  held  in  Lake  Havasu  City  and  Bullhead  City.         As  an  outcome  of  our  initial  community  coalition  meetings,  we  formed  four  task  forces   involving  key  representatives  of  our  local  communities:       Data  and  Information  Task  Force  to  compile  data  pertaining  to  health  in  Mohave  County   (demographic  information,  disease  statistics,  etc.)       Survey  Task  Force  to  develop  and  administer  a  survey  to  obtain  input  and  perspectives   from  county  residents  on  health  and  quality  of  life  in  their  community     Public  Relations  Task  Force  to  inform  the  public  and  community  organizations  of  the   initiative     Community  Resource  Task  Force  to  identify  community  resources  that  support  health   and  quality  of  life  in  Mohave  County     Community  members  on  the  above  task  forces  worked  throughout  2012  on  their   respective  aspects  of  the  community  health  assessment  process.    In  September,  2012,   stakeholders  from  all  Mohave  County  communities  convened  to  review  project  status  and   offer  further  input  on  the  process.     The  specific  steps  in  the  Mohave  County  community  health  assessment  were:     1.  Collected  and  analyzed  a  large  range  of  data  related  to  health  and  quality  of  life  within   Mohave  County  communities,  which  includes  demographic  and  socioeconomic   characteristics  and  health  statistics  utilizing  various  sources  (see  references  in   Appendix  F).    Information  on  the  leading  causes  of  death  and  morbidity  was  analyzed       Page  5                                                              Community  Health  Profile  for  Mohave  County,  2013   in  conjunction  with  health  outcomes  and  factors  reported  for  the  community  by   CountyHealthrankings.org  (see  page  41)         2.  Prepared  an  inventory  of  health  care  facilities  and  resources  in  Mohave  County  (see   page  24)     3.  Conducted  in-­‐depth  interviews  with  26  individuals  (key  informants)  representing:    a)   broad  interests  of  the  community,  b)  populations  of  need,  and  c)  persons  with   specialized  knowledge  in  public  health  (see  page  61)     4. Prepared  and  distributed  a  Community  Stakeholder  Questionnaire  to  community   representatives,  who  attended  the  county-­‐wide  stakeholder  meeting  in  September,   2012.    The  questionnaire  was  completed  by  46  community  stakeholders  (see  page  66)     5. Obtained  input  from  primary  care  providers  and  mental  health  professionals  on  the   leading  health  issues  they  are  seeing  in  the  community  (see  page  68)     6.  Developed  and  conducted  a  public  survey  to  obtain  input  and  perspectives  from   Mohave  County  residents  regarding  health,  quality  of  life,  and  needs  for  health-­‐related   services  in  their  respective  communities.    The  survey  period  started  December  1,  2012   and  ended  on  January  31,  2013.    The  survey  was  widely  publicized  throughout  Mohave   County.    An  electronic  version  was  available  on  both  MCDPH’s  and  KRMC’s  websites.     Hardcopy  surveys  were  available  at  all  public  libraries  within  the  county.    The  survey   was  completed  by  1,756  county  residents  (see  page  70)     7.  Compiled  all  results  and  findings  of  the  above  steps,  which  are  described  in  this   Community  Health  Profile  for  Mohave  County           Page  6                                                              Community  Health  Profile  for  Mohave  County,  2013     Mohave  County  Demographic   Socioeconomic,  &  Environmental   Characteristics     Defined  Community   In  performing  a  community  health  assessment,  community  is  defined  by  a  chosen   geographic  area.  Based  on  feedback  from  the  Mohave  County  Community  Health  Coalition   and  on  Mohave  County  Department  of  Public  Health’s  and  Kingman  Regional  Medical   Center’s  service  areas,  it  was  decided  to  include  the  entire  geographic  area  within  the   boundaries  of  Mohave  County  in  the  assessment.         Mohave  County  is  located  in  the  northwest  corner  of  Arizona.  In  terms  of  land  area,  it  is  the   fifth  largest  county  in  the  United  States,  covering  13,470  square  miles  (8,620,800  acres).    It   shares  borders  with  three  states—  California,  Nevada  and  Utah.    The  Grand  Canyon  and   Colorado  River  cross  Mohave  County  from  east  to  west,  dividing  it  into  two  geographic   regions—  the  Arizona  Strip  in  the  north  and  the  Mojave  Desert  in  the  south.  The  Colorado   River  bends  south  at  Hoover  Dam  and  forms  Mohave  County’s  western  border  with  Nevada   and  California.       Approximately  69%  of  the  land  (6  million  acres)  in  Mohave  County  is  federally  owned,   mostly  controlled  by  the  U.S.  Bureau  of  Land  Management.  Other  federal  lands  within  the   county  boundaries  include  part  of  Grand  Canyon  National  Park,  the  Grand  Canyon-­‐ Parashant  National  Monument,  Pipe  Spring  National  Monument,  Bill  Williams  National   Wildlife  Refuge,  Havasu  National  Wildlife  Refuge,  Lake  Mead  National  Recreation  Area,  and   Kaibab  National  Forest.       Other  land  ownership  in  Mohave  County  includes:  state–  6.9%,  county–  .1%;  and  tribal–   7%  (Hualapai,  Kaibab-­‐Paiute,  and  Fort  Mohave  Indian  Reservations).  Only  17%  of  the  land   (about  15,000  acres)  in  Mohave  County  is  under  private  ownership.     The  city  of  Kingman  (pop.  28,279)  is  the  county  seat  of  Mohave  County.  There  are  three   other  incorporated  cities  in  Mohave  County:  Lake  Havasu  City  (pop.  52,935),  Bullhead  City   (pop.  39,842),  and  Colorado  City  (pop.  6,085).    Unincorporated  communities  in  Mohave   County  include:  Beaver  Dam,  Chloride,  Dolan  Springs,  Fort  Mohave,  Golden  Shores,  Golden   Valley,  Grasshopper  Junction,  Hackberry,  Littlefield,  Meadview,  Mohave  Valley,  Oatman,   Peach  Springs,  Shipley,  Temple  Bar,  Topock,  Truxton,  Valentine,  White  Hills,  Wikieup,   Willow  Beach,  and  Yucca.     The  following  sections  describe  the  demographic,  socioeconomic,  environmental       Page  7                                                              Community  Health  Profile  for  Mohave  County,  2013   characteristics  of  Mohave  County.    Demographic  characteristics  include  measures  of  total   population  as  well  as  percent  of  total  population  by  age  group,  gender,  race  and  ethnicity.   Socioeconomic  characteristics  include  measures  that  have  been  shown  to  affect  health   status,  such  as  income,  education,  and  employment,  and  the  proportion  of  the  population   represented  by  various  levels  of  these  variables.     Zip  code  groupings   In  order  to  identify  geographic  areas  within  Mohave  County  for  the  community  health   assessment,  some  communities  close  to  an  incorporated  city  were  grouped  with  that  city.     Farther  outlying  communities  were  grouped  together.    These  zip  code  groupings  are  used   in  many  of  the  tables  contained  throughout  this  report.     Figure  1:  Zip  Code  Groupings  for  Mohave  County  Health  Assessment     Kingman                                                                      86401   Kingman                                                                      86409                        Kingman   Golden  Valley                                                  86413       Bullhead  City                                                    86442     Bullhead  City                                                      86429   Fort  Mohave                                                      86426                        Bullhead  City             Topock                                                                          86436   Mohave  Valley                                                86440     Lake  Havasu  City                                        86403   Lake  Havasu  City                                        86404                        Lake  Havasu  City   Lake  Havasu  City                                        86406     Dolan  Springs                                                    86441     Meadview                                                              86444   Willow  Beach                                                  86445     Wikieup                                                                      85360                    Outlying  Communities   Hackberry                                                              86411     Peach  Springs                                                  86434   Colorado  City                                                  86021     Littlefield                                                                  86432                           Mohave  County  Population   As  of  the  2010  census,  the  total  population  of  Mohave  County  is  estimated  at  204,  862,  with   a  population  density  of  14.96  people  per  square  mile.    Approximately  75%  of  the   population  lives  in  incorporated  towns/cities,  with  25%  in  unincorporated  areas.    The   largest  cities  are:  Lake  Havasu  City  (pop.  52,935),  Bullhead  City  (pop.  39,842)  and  Kingman   (pop.  28,279).                 Page  8                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  2:    Mohave  County  Total  Population  &  Population  Density   Total  Popula-­‐ tion   Report  Area   Mohave  County,  Arizona   Population  Density     (Per  Square  Mile)   204,862   13,470.08   14.96   6,246,816   113,594.10   54.99   303,965,271   3,531,905.50   86.06   Arizona   United  States   Total  Land  Area   (Square  Miles)   Data  Source:  U.S.  Census  Bureau,  2010  American  Community  Survey.     Population  growth  from  2000  to  2010   This  indicator  reports  the  difference  in  population  counts  from  the  2000  census  population   estimate  to  the  2010  census  population  estimate.    This  is  relevant  because  a  positive  or   negative  shift  in  total  population  over  time  impacts  healthcare  providers  and  the  utilization   of  community  resources.       Figure  3:    Mohave  County  Population  Growth  from  2000  to  2010   Report  Area   Total  Population,     2010  Census   Mohave  County   Arizona   United  States   Total  Population,     2000  Census   Percent  Change  from   2000-­‐2010  Census   204,862   155,032   24.33%   6,392,017   5,130,632   24.59%   308,745,538   281,421,906   9.71%   Data  Sources:  U.S.  Census  Bureau,  2000  American  Community  Survey  and  U.S.  Census  Bureau,  2010  American  Community  Survey     Median  age  of  Mohave  County’s  population   Mohave  County’s  population  includes  a  significant  number  of  older  adults.    As  indicated  in   the  following  figure,  the  median  age  in  Mohave  County  is  46.30,  which  is  notably  high  in   comparison  to  state  and  national  population  statistics.  The  median  age  is  the  age  at  the   midpoint  of  the  population.  Half  of  the  population  is  older  than  the  median  age  and  half  of   the  population  is  younger.  The  median  age  is  often  used  to  describe  the  “age”  of  a  popula-­‐ tion.    This  is  relevant  because  the  age  of  a  population  indicates  the  potential  for  age-­‐specific   health  conditions  and  need  for  related  services.     Figure  4:  Mohave  County  Median  Age  Comparison   Report  Area   Median  Age   Mohave  County,  Arizona   46.30   Arizona   35.50   United  States   36.90   Data  Source:  U.S.  Census  Bureau,  2010  American  Community  Survey         Page  9                                                              Community  Health  Profile  for  Mohave  County,  2013     Figure  5:    Mohave  County  Median  Age  by  Zip  Code  Tract   Over  44.0   40.1  -­‐  44.0   36.1  -­‐  40.0   32.1  -­‐  36.0   Under  32.1                                                                                                                          Data  Source:  U.S.  Census  Bureau,  2010  American  Community  Survey       Mohave  County  population  by  gender   Mohave  County’s  population  includes  a  slightly  higher  number  of  males  than  females.    State   and  national  statistics  show  the  opposite,  with  a  slightly  higher  number  of  females  than   males.    This  is  relevant  because  the  gender  composition  of  a  community  can  indicate   relative  needs  for  gender-­‐specific  health  services.       Figure  6:  Mohave  County  Population  by  Gender   Report  Area   Mohave  County,  AZ   Arizona   United  States   Male   Female   %  Male   %  Female   99,877   99,300   50.14%   49.86%   3,108,234   3,138,582   49.76%   50.24%   149,398,720   154,566,544   49.15%   50.85%   Data  Source:  U.S.  Census  Bureau,  2010  American  Community  Survey       Projected  population  growth  in  Mohave  County  by  age  and  gender   Mohave  County’s  overall  population  is  projected  to  increase  slightly  by  4%  over  the  next   five  years.  The  projected  population  increase  for  all  of  Arizona  is  3%  and  for  the  United   States  is  4%.    Note  that  the  age  category  that  utilizes  healthcare  services  the  most,  65  years   and  over,  is  projected  to  increase  by  more  than  14  %.    This  increase  will  have  a  dramatic   impact  on  both  the  amount  and  type  of  healthcare  services  required  by  the  community.         Page   10                                                              Community  Health  Profile  for  Mohave  County,  2013   Mohave County Com m unity Health Profile Figure  7:    M ohave   County   Projected   Population   Growth   y  Age  &  Gender   Estim ated 2013 Population vs Projected 2018 Population Percent b Difference   Zip  Code  Grouping* Zip Code Grouping Under 15-44 45-64 65 years 15 years years years and over Total Male Fem ale Percent Difference Kingman Bullhead Lake Havasu City Outlying Communities 5.2% 4.3% -6.3% 13.5% 3.3% 3.2% 3.5% 6.1% 5.1% -6.8% 15.4% 4.3% 4.1% 4.6% 4.1% 4.1% -6.8% 13.0% 3.4% 3.4% 3.5% 9.5% 15.0% -0.8% 17.5% 10.4% 10.0% 10.8% Mohave C ounty 5.9% 5.5% -6.2% 14.2% 4.3% 4.1% 4.5% AZ 2013 Estimate d (1,000s) 851 1,746 1,163 600 4,360 2,140 2,219 AZ 2018 Proje cte d (1,000s) 876 1,724 1,181 695 4,476 2,199 2,277 PERC ENT DIFFERENC E 2.9% -1.3% 1.5% 15.8% 2.7% 2.8% 2.6% U.S. 2013 Estimate d (1,000s) 62,661 125,854 80,789 41,347 310,651 153,278 157,373 U.S. 2018 Proje cte d (1,000s) 65,357 125,839 83,934 47,902 323,032 159,466 163,566 PERC ENT DIFFERENC E 4.3% 0.0% 3.9% 15.9% 4.0% 4.0% 3.9% Data  Source:    The  Nielson  Company   Source: The Nielson*  Company Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)     Mohave  County  population  by  ethnicity  and  race   The  U.S.  Census  Bureau  uses  a  social  definition  of  ethnicity  and  race  rather  than  a  biologic,   anthropologic,  or  genetic  definition.  Census  categories  for  race  include:  white;  black  or   African  American;  American  Indian,  Alaska  Native,  Asian,  Native  Hawaiian  or  other  Pacific   Islander;  two  or  more  races;  or  some  other  race.    A  person’s  origin  (or  what  used  to  be   called  ethnicity)  is  either  Hispanic  or  non-­‐Hispanic.    People  who  identify  their  origin  as   Hispanic,  Latino,  or  Spanish  may  be  of  any  race.         Figure  8:    Mohave  County  Population  by  Ethnicity  &Race     Non-­‐Hispanic  Population  —  170,617     White                                                  159,378   Black                                                            1,715   American  Indian                3,793   Asian                                                            2,016   Pacific  Islander                              316   Some  Other  Race                        145   Two  or  more  Races        3,254     Hispanic  Population  —  29,569         Data  Source:  U.S.  Census  Bureau,  2010  American  Community   Survey               Page   11                                                                Community  Health  Profile  for  Mohave  County,  2013     Mohave  County  disabled  population   This  indicator  reports  the  percentage  of  the  total  civilian  non-­‐institutionalized  population   with  a  disability,  which  is  defined  as  a  health  condition  lasting  three  months  or  longer  that   limits  normal  daily  activities  (self  care,  work,  school,  etc.).  This  indicator  is  relevant   because  disabled  individuals  comprise  a  vulnerable  population  that  requires  targeted   services  and  outreach  by  providers.       Figure  9:  Percent  of  Mohave  County  Population  with  a  Disability   Report  Area   Mohave  County   Arizona   United  States   Total  Popula-­‐ tion  Consid-­‐ ered   197,320   Total  Popula-­‐ tion  with  a   Disability   Percent  Popu-­‐ lation  with  a   Disability   35,486   17.98%   6,240,052   715,833   11.47%   301,501,760   36,180,124   12%   Mohave  County   Arizona   United  States   Data  Source:  U.S.  Census  Bureau,  2008-­‐2010  American  Community  Survey  3-­‐Year  Estimates     Mohave  County  Educational  Statistics   Education  is  a  marker  for  an  array  of  opportunities  and  resources  that  can  lead  people  to   better  or  worse  health.    For  example,  limited  education  can  lead  to  limited  job  options,   lower  incomes,  and  greater  work-­‐related  stress,  which  can  limit  a  family's  chances  to  live  in   a  healthy  home  and  neighborhood  and  increasing  their  exposure  to  harmful  conditions  and   further  emotional  stresses  that  can  lead  to  illness.    In  contrast,  a  good  education  can  lay  the   foundation  for  a  healthy  life.    Better  educated  people  are  more  likely  to  have  jobs  that   provide  health  insurance  coverage,  to  be  more  knowledgeable  about  their  health,  and  to   have  more  time  to  attend  to  their  health.  Therefore,  education  statistics  are  included  in  this   report  as  important  indicator  of  community  health  in  Mohave  County.     Population  with  no  high  school  diploma   The  following  figure  shows  the  percentage  of  Mohave  County’s  population  aged  25  and   older  without  a  high  school  diploma  (or  equivalency).  This  indicator  is  relevant  because   low  levels  of  education  are  often  linked  to  poverty  and  poor  health.                             Page   12                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  10:    Percentage  of  Mohave  County  Population  with  No  High  School  Diploma   Total  Popula-­‐ tion     Report  Area   Mohave  County   143,120   24,390   17.04%   4,017,638   604,363   15.04%   199,726,656   29,898,482   14.97%   Arizona   United  States   Percent  Popula-­‐ tion  with  No   High  School  Di-­‐ ploma   Population  with   No  High  School   Diploma   Mohave  County     Arizona   United  States   Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.          Figure  11:       Percent  of  Mohave  County  Population  with  No  HS  Diploma  by  Zip  Code  Tract     .               Over  40.0%         30.1  -­‐  40.0%     20.1  -­‐  30.0%     10.1  -­‐  20.0%     Under  10.1%                                                                              Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates     Mohave  County  high  school  graduation  rate   The  following  figure  shows  the  percentage  of  students  in  Mohave  County  who  receive  their   high  school  diploma  within  four  years  of  starting  high  school.       Figure  12:    Mohave  County  On-­‐Time  High  School  Graduation  Rate   Report  Area   Average  Freshman   Enrollment   Diplomas  Issued   On-­‐Time  Graduation   Rate   Mohave  County   2,143   1,485   69.30   Arizona   85,984   62,374   72.50   United  States   4,024,345   3,039,015   75.50   Data  Source:  The  University  of  Wisconsin,  Population  Health  Institute,  County  Health  Rankings,  2012  and  the  U.S.  Department  of  Edu-­‐ cation,  National  Center  for  Education  Statistics  (NCES),  Common  Core  of  Data,  Public  School  Universe  Survey  Data,  2005-­‐06,  2006-­‐07   and  2007-­‐08           Page   13                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  13:  Average  Freshman  Graduate  Rate  in  Mohave  County,  AZ     Over  90.0%   85.1  -­‐  90.0%   80.1  -­‐  85.0%   75.1  -­‐  80.0%   Under  75.1%   Data  Source:  The  University  of  Wisconsin,  Population  Health  Institute,  County  Health  Rankings,  2012  and  the  U.S.  Department  of  Education,   National  Center  for  Education  Statistics  (NCES),  Common  Core  of  Data,  Public  School  Universe  Survey  Data,  2005-­‐06,  2006-­‐07  and  2007-­‐08.     Educational  attainment   Higher  levels  of  education  generally  lead  to  higher  wages,  less  unemployment  and  job  stability,   which  have  a  direct  influence  on  community  health.    The  following  figure  shows  that  the   number  of  people  with  a  college  degree  in  Mohave  County  is  more  than  two  times  lower  than   the  Arizona  average.   Mohave County Community Health Profile Community   Educational Attainment by Age - Total Population Figure  14:    Mohave  County   Educational  Attainment   2011 State/ County   Completing High School M ohave County Arizona United States 83.9% 85.2% 85.4% Bachelor's Degree or M ore M ohave County Arizona United States 12.2% 26.4% 28.2% Data  Source:  U.S.  Census  Bureau,  Quickfacts       Source: U.S. Census Bureau, Quickfacts   Mohave  County  Economic  Indicators   Economic  and  social  insecurity  are  often  associated  with  poor  health.    Poverty  and   unemployment  affect  access  to  care  and  a  community’s  ability  to  engage  in  healthy   behaviors.    Therefore,  adequate  economic  resources  provide  a  foundation  for  a  healthy   community.     Estimated  family  income  and  wealth  in  Mohave  County   The  following  table  presents  the  average  and  median  income  for  households  in  Mohave   County  communities.    Average  income  and  median  income  are  both  projected  to  decrease   by  approximately  8%  to  14%  between  2013  and  2018.       Page   14                                                              Community  Health  Profile  for  Mohave  County,  2013     Mohave County Com m unity Health Profile Figure  15:    Estimated   and   Projected   Average   Hand ousehold   ncome   in  Mohave  County   Estim ated Fam ily Incom e and Wealth for 2013 2018 w ith IPercent Difference Estim ated 2013 Avg. Projected 2018 Median Avg. Percent Difference Median Avg. Median   Household Household Household Household Household Household Zip  CZip ode  Code Grouping*   Grouping Incom e Incom e Incom e Incom e Incom e Incom e Kingman $ 41,071 $ 31,898 $ 37,365 $ 28,448 -9.0% -10.8% Bullhead City $ 42,973 $ 33,384 $ 39,038 $ 29,890 -9.2% -10.5% Lake Havasu City $ 45,736 $ 34,519 $ 41,269 $ 30,682 -9.8% -11.1% Outlying Communities $ 43,607 $ 28,504 $ 39,166 $ 25,481 -10.2% -10.6% Arizona $ 59,657 $ 44,169 $ 56,835 $ 41,516 -4.7% -6.0% United States $ 69,637 $ 49,297 $ 71,917 $ 49,815 3.3% 1.1% Data  Source:    The  Nielson  Company   Source: The Nielson Company *  Zip   code   groupings   include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)       Employment  by  major  industry   The  exhibit  below  summarizes   employment   by  mHealth ajor  industry   Mohave  County.    The   Mohave County Community Profilefor   Community majority  of  jobs  are  in  service-­‐producing   industries.   Employment by Major Industry   2010 Figure  16:    Employment  by  Industry  in  Mohave  County Mohave Major Industries County Goods-producing 5,557 Natural Resources and Mining % % 12.3% 14.7% 663 1.5% 1.4% Construction 2,144 4.8% 4.3% Manufacturing 2,751 6.1% 9.0% Service-providing 31,323 69.6% 68.4% 10,036 22.3% 19.1% 831 1.8% 2.1% Financial Activities 1,674 3.7% 5.8% Professional and Business Services 3,455 7.7% 13.1% Education and Health Services 8,029 17.8% 14.6% Leisure and Hospitality 5,817 12.9% 10.2% Other Services 1,481 3.3% 3.4% 654 1.5% 2.3% T rade, T ransportation, and Utilities Information Federal Government State Government 466 1.0% 3.6% Local Government 6,996 15.5% 11.0% 44,997 100.0% 100.0% T otal Employment Source: U.S. Department ofSource:   Census Data    The  Nielson  Company         US Page   15                                                                  Community  Health  Profile  for  Mohave  County,  2013     Leading  employers  in  Mohave  County   Major  employers  in  Mohave  County  with  more  than  50  full-­‐time  employees  include  the   following:   Figure  17:    Leading  Employers  in  Mohave  County     Mohave County   Top Em ployers Industry Classification Full-Tim e Em ployees Kingman Regional Medical Center Hospital 1,420   Wal-Mart Retail 1,227   County of Mohave County Services 1,078   Freeport-McMoran Mine Copper Ore Mining 805   Havasu Regional Medical Center Hospital 650 City of Lake Havasu City City  Services 615   Western AZ Regional Medical Center Hospital 740 MT C-Arizona State Prison Min.   Security Prison 464 Sterilite Corporation Household Plastics 425   City of Kingman City  Services 385 Sam's Club Retail 356   American Wookmark Corp Cabinets 335   Mohave Community College College 268 City of Bullhead City City  Services 328   Mineral Park Mine Molybedenum/Copper 313 London Bridge Resort Hotel/Resort 210   Shugrues Restaurant/Bar 200   River Medical Paramedics 150   Home Depot Home Improvement 342   Kmart Retail 125   Nautical Beachfront Resort Hotel 125   shop Laron Engineering Machine 112 JC Penny Retail 110   Smiths Grocery Store 109   New West Dental Ceramics Dental Implants 100   Lowes Home Improvement 196   Chemical Lime Company Lime Mining 93   Freight Central T rucking, Inc. Motor 90   Freight IWX Motor Freight Motor 89 McKee Foods Snack Foods 85   A&A Electronics & Assembly Electronics 84   Allied West Services Waste Management 81   T ru-Serv T rue Value Distribution 75   Cascades T issue Group Arizona Paper Products 73   News West Publishing Publishing 70   Store Food City Grocery 70 Bradley Ford Lincoln Mercury Auto   Sales 57 Campbell Redi-Mix Concrete 55   Praxair, Inc. Industrial Gases 55           Data  Source:    Mohave  County  Economic  Development     Page   16                                                              Community  Health  Profile  for  Mohave  County,  2013   Unemployment  in  Mohave  County   When  workers  are  unemployed,  they,  their  families,  and  the  community  lose.  Workers  and   their  families  lose  wages  and  employer-­‐provided  health  insurance.  In  addition,  the   purchasing  power  of  these  workers  is  lost,  which  can  lead  to  unemployment  for  yet  other   workers  in  the  community.    The  following  unemployment  rates  are  estimates  of  the   percent  of  the  labor  force  that  is  unemployed  based  on  the  number  of  people  filing  claims   for  unemployment  insurance  benefits  under  state  or  federal  programs.  Therefore,  the   unemployment  rate  does  not  count  people  who  are  still  jobless  when  their  benefits  run  out   or  those  who  are  not  eligible,  delay,  or  never  apply  for  benefits.  So,  the  unemployment  rate   is  not  a  complete  indicator  on  the  number  of  unemployed  in  our  community.       Figure  18:    Unemployment  Rate  in  Mohave  County  2008-­‐2012   Report  Area   2008   2009   2010       2011   2012   Mohave   County   8.9     11.1     11.4     11.3   9.7     Arizona   7.4     11.4     12.0     11.0     9.6     9.9     10.5     9.5     7.9     United  States   5.9     Data  Source:  Bureau  of  Labor  Statistics,  U.S.  Department  of  Labor       Population  below  200%  of  federal  poverty  level   This  indicator  reports  the  percentage  of  the  population  in  Mohave  County  whose   household  income  is  under  200%  of  the  federal  poverty  level  (FPL).  This  indicator  is   relevant  because  poverty  creates  barriers  to  accessing  health  services,  healthy  food,  and   other  necessities  that  contribute  to  a  healthy  lifestyle.       Figure  19:  Mohave  County  Population  Below  200%  FPL   Report  Area   Mohave  County   Arizona   United  States   Total  Population   (For  Whom  Poverty   Status  is  Determined)   Population  with  In-­‐ come  Below  200%  FPL   Percent  Population   with  Income  Below   200%  FPL   195,218   77,636   39.77%   6,110,304   2,137,786   34.99%   296,141,152   94,693,416   31.98%   Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.                     Page   17                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  20:    Mohave  County  Population  Below  200%  FPL  by  Zip  Code  Tract       Over  80.0%   60.1  -­‐  80.0%   40.1  -­‐  60.0%   20.1  -­‐  40.0%   Under  20.1%                                                                                      Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.       Mohave  County  Poverty  Rate  (<  100%  FPL)   Poverty  is  considered  a  key  driver  of  health  status.  This  indicator  reports  the  percentage  of   the  population  living  below  100%  of  the  Federal  Poverty  Level  (FPL).       Figure  21:  Mohave  County  Population  in  Poverty   Report  Area   Total  Population  in  Pov-­‐ erty   Mohave  County,  Arizona   Arizona   United  States   Percent  Population  in   Poverty   31,502   16.14%   933,113   15.27%   40,917,512   13.82%   Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.       Figure  22:    Mohave  County  Population  in  Poverty  by  Zip  Code  Tract   Over  40.0%   30.1  -­‐  40.0%   20.1  -­‐  30.0%   10.1  -­‐  20.0%   Under  10.1%                                                                                              Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.             Page   18                                                              Community  Health  Profile  for  Mohave  County,  2013   Children  in  poverty   This  indicator  reports  the  percentage  of  children  aged  0-­‐17  living  in  households  under   100%  of  the  Federal  Poverty  Level  (FPL).         Figure  23:      Mohave  County  Children  in  Poverty   Total  Popula-­‐ tion   (For  Whom   Poverty  Status   is  Determined)   Report  Area   Mohave  County   Arizona   United  States     41,726   Children  in   Poverty   Percent  Chil-­‐ dren  in  Pov-­‐ erty   10,300   24.68%   1,586,990   342,607   21.59%   72,850,296   13,980,497   19.19%   Mohave  County     Arizona   United  States   Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.   Figure  24:    Mohave  County  Children  in  Poverty  by  Zip  Code  Tract   Over  40.0%   30.1  -­‐  40.0%   20.1  -­‐  30.0%   10.1%  -­‐  20.0%   Under  10.1%                                                                                                    Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.         Supplemental  Nutrition  Assistance  Program  (SNAP)  recipients   This  indicator  reports  the  average  percentage  of  Mohave  County’s  population  receiving   Supplemental  Nutrition  Assistance  Program  (SNAP)  benefits,  otherwise  known  as  food   stamps.  This  indicator  is  relevant  because  it  assesses  vulnerable  populations  which  are   more  likely  to  have  multiple  health  access,  health  status,  and  social  support  needs;  when   combined  with  poverty  data,  providers  can  use  this  measure  to  identify  gaps  in  eligibility   and  enrollment.                   Page   19                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  25:  Percent  of  Mohave  County  Population  Receiving  SNAP  Benefits   Report  Area   Percent  Population   Receiving  SNAP  Bene-­‐ fits   Total  Population  Re-­‐ ceiving  SNAP  Benefits   Mohave  County   40,207   Arizona   United  States   20.64%   986,413   14.96%   38,701,176   12.60%   Mohave  County   Arizona   United  States   Data  Source:  U.S.  Census  Bureau,  2006-­‐2010  American  Community  Survey  5-­‐Year  Estimates.     Free  and  reduced-­‐price  school  lunch  eligibility   This  indicator  reports  the  percentage  of  public  school  students  eligible  for  free  or  reduced   price  lunches.    This  indicator  is  relevant  because  it  assesses  vulnerable  populations  which   are  more  likely  to  have  multiple  health  access,  health  status,  and  social  support  needs.     Additionally,  when  combined  with  poverty  data,  providers  can  use  this  measure  to  identify   gaps  in  eligibility  and  enrollment.       Figure  26:    Percent  of  Mohave  County  Children  Eligible  for  Free/Reduced-­‐Price  Lunch   Report  Area   Mohave  County   Arizona   United  States   Total  Student   Enrollment   Number   Free/Reduced   Price  Lunch  Eli-­‐ gible   Percent   Free/Reduced   Price  Lunch  Eli-­‐ gible   25,657   14,372   56.02%   1,081,223   493,622   45.65%   49,692,766   24,021,069   48.34%   Mohave  County   Arizona   United  States     Data  Source:  U.S.  Department  of  Education,  National  Center  for  Education  Statistics  (NCES),  Common  Core  of  Data,  Public  School  Universe   File,  2010-­‐2011.     Population  receiving  state  Medicaid  (AHCCCS)   This  indicator  from  the  U.S.  Census  Bureau  reports  the  percentage  of  the  population   enrolled  in  state  Medicaid  (called  the  Arizona  Health  Cost  Containment  System  or  AHCCCS)   as  of  the  last  census  in  2010.  The  data  below  does  not  reflect  Arizona’s  cuts  in  state   Medicaid  in  2011.    With  this  action,  150,000  Arizonans  subsequently  lost  their  healthcare   coverage,  with  another  80,000  estimated  to  lose  coverage  by  early  2014.    With  those  cuts,   the  actual  number  of  people  in  Mohave  County  enrolled  in  AHCCCS  is  likely  much  lower.                   Page   20                                                                Community  Health  Profile  for  Mohave  County,  2013   Figure  27:    Mohave  County  Population  Enrolled  in  AHCCCS  (2010)   Report  Area   Population   (for  whom  Insurance   Status  is  Determined)   Mohave  County   Arizona   United  States   Population  Receiving   Medicaid   Percent  Population  Re-­‐ ceiving  Medicaid   199,985   47,615   24.13%   6,240,052   1,180,572   18.92%   301,501,760   48,541,096   16.10%   Data  Source:  U.S.  Census  Bureau,  2008-­‐2010  American  Community  Survey  3-­‐Year  Estimates.     Uninsured  population   The  lack  of  health  insurance  is  considered  a  key  driver  of  health  status.  This  indicator  from   the  U.S.  Census  Bureau  shows  the  percentage  of  the  total  civilian  non-­‐institutionalized   population  in  Mohave  County  without  health  insurance  coverage  as  of  the  last  census  in   2010.    Therefore,  this  data  does  not  reflect  Arizona’s  cuts  in  state  Medicaid  in  2011   (described  above).    With  those  cuts,  the  actual  number  of  people  in  Mohave  County  without   health  insurance  is  likely  much  higher.     Figure  28:    Mohave  County  Population  without  Health  Insurance  (2010)   Report  Area   Mohave  County   Arizona   United  States   Number  Un-­‐ insured     Percent  Uninsured   31,287   15.86%   1,055,772   16.92%   45,368,296   15.05%   Mohave  County   Arizona   United  States                                                                  Data  Source:  U.S.  Census  Bureau,  2008-­‐2010  American  Community  Survey  3-­‐Year  Estimates.         Mohave  County  Physical  Environment   The  physical  environment  directly  impacts  health  and  quality  of  life.    A  safe,  clean   environment  that  provides  access  to  healthy  food  and  recreational  opportunities  is   important  to  maintaining  and  improving  community  health.     Air  quality  (Ozone)   This  indicator  reports  the  percentage  of  days  per  year  with  Ozone  (O3)  levels  above  the   National  Ambient  Air  Quality  Standard  of  75  parts  per  billion  (ppb).    Figures  are  calculated   using  data  collected  by  monitoring  stations  and  modeled  to  include  census  tracts  where  no   monitoring  stations  exist.    This  indicator  is  relevant  because  poor  air  quality  contributes  to   respiratory  issues  and  overall  poor  health.             Page   21                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  29:    Percentage  of  Days  Exceeding  O3  Emission  Standards  in  Mohave  County           Report  Area   Average  Daily   Ozone  Con-­‐ centration   Number  of   Days  Exceed-­‐ ing  Emissions   Standards   Percentage  of   Days  Exceed-­‐ ing  Emissions   Standards   Mohave  County   25.27   0   0%   Arizona   27.82   1.56   0.43%   United  States   24.82   2.92   0.80%     Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Environmental  Public  Health  Tracking  Network,  2008     Air  quality  (particulate  matter)   This  indicator  reports  the  percentage  of  days  with  particulate  matter  2.5  levels  above  the   National  Ambient  Air  Quality  Standard  (35  micrograms  per  cubic  meter)  per  year,   calculated  using  data  collected  by  monitoring  stations  and  modeled  to  include  counties   where  no  monitoring  stations  occur.    This  indicator  is  relevant  because  poor  air  quality   contributes  to  respiratory  issues  and  overall  poor  health.       Figure  30:   Percentage  of  Days  Exceeding  Air  Particulate  Matter  Standards  in  Mohave  County   Report  Area   Average  Daily   Ambient  Par-­‐ ticulate  Matter   2.5   Mohave  County   3.28   Arizona   United  States   Number  of   Days  Exceed-­‐ ing  Emissions   Standards   Percentage  of   Days  Exceed-­‐ ing  Emissions   Standards   0   0%   9.63   1.74   0.44%   10.72   4.07   1.16%   Mohave  County     Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Environmental  Public  Health  Tracking  Network,  2008     Grocery  store  access   This  indicator  reports  the  number  of  grocery  stores  in  Mohave  County  per  100,000  people.     Grocery  stores  are  defined  as  supermarkets  and  smaller  grocery  stores  primarily  engaged   in  retailing  a  general  line  of  food,  such  as  canned  and  frozen  foods;  fresh  fruits  and   vegetables;  and  fresh  and  prepared  meats,  fish,  and  poultry.    Included  are  delicatessen-­‐type   establishments.    Convenience  stores  and  large  general  merchandise  stores  that  also  retail   food,  such  as  supercenters  and  warehouse  club  stores  are  excluded.    This  indicator  is   relevant  because  it  provides  a  measure  of  healthy  food  access  and  environmental   influences  on  dietary  behaviors.               Page   22                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  31:   Grocery  Store  Establishments  in  Mohave  County  (per  100,000  pop.)   Report  Area   Mohave  County   Arizona   United  States   Total  Popula-­‐ tion,   2010  Census   Number  of  Es-­‐ tablishments   200,186   Establishment   Rate  (Per   100,000  Pop.)   20   9.99   6,392,017   849   13.28   308,745,538   67,342   21.81   Mohave  County     Arizona   United  States   Data  Source:  U.S.  Census  Bureau,  County  Business  Patterns,  2010     Population  living  in  food  deserts   This  indicator  reports  the  percentage  of  the  population  living  in  census  tracts  designated  as   food  deserts.    A  food  desert  is  defined  as  a  low-­‐income  census  tract  where  a  substantial   number  of  residents  have  limited  access  to  a  supermarket  or  large  grocery  store.    This   indicator  is  relevant  because  it  highlights  populations  and  geographies  facing  food   insecurity.       Figure  32:  Percent  of  Mohave  County  Population  Living  in  a  Food  Desert       Report  Area   Mohave  County   Arizona   United  States       155,032   Population   Living  in  a   Food  Deserts   Percent  Liv-­‐ ing  in  Food   Deserts   53,670   34.62%   5,130,632   700,631   13.66%   281,421,906   25,609,433   9.10%     Figure  33:    Percent  of  Mohave  County  Population  in  Food  Deserts  by  Zip  Code  Tract                         100%       75.1  -­‐  99.9%         50.1  -­‐  75.0%       25.1  -­‐  50.0%       Under  25.0%                                                                                                                Data  Source:  U.S.  Department  of  Agriculture,  Food  Desert  Locator,  2009       Mohave  County   Arizona   United  States Data  Source:  U.S.  Department  of  Agriculture,  Food  Desert  Locator,  2009       Total  Popu-­‐ lation   Page   23                                                              Community  Health  Profile  for  Mohave  County,  2013   Health  Resources  in  Mohave  County   The  availability  of  health  resources  is  a  critical  component  to  the  health  of  a  community’s   residents  and  a  measure  of  the  reliability  of  the  area’s  health  care  delivery  system.    An   adequate  number  of  health  care  facilities  and  health  care  providers  are  vital  for  sustaining   a  community’s  health  status.    Fewer  health  care  facilities  and  health  care  providers  can   impact  the  timely  delivery  of  services.    A  limited  supply  of  health  resources,  especially   providers,  results  in  the  limited  capacity  of  the  health  care  delivery  system  to  absorb   charity  and  indigent  care  as  there  are  fewer  providers  upon  which  to  distribute  the  burden   of  indigent  care.    This  section  addresses  the  availability  and  accessibility  of  health  care   resources  to  the  residents  of  Mohave  County,  Arizona.     Health  Professional  Shortage  Area   A  majority  of  Mohave  County’s  population  lives  in  a  geographic  area  designated  by  the   federal  government  as  a  “Health  Professional  Shortage  Area”  (HPSA).    An  HPSA  is  defined   as  having  a  shortage  of  primary  medical  care,  dental,  and  mental  health  professionals.    This   indicator  is  relevant  because  a  shortage  of  health  professionals  contributes  to  access  and   health  status  issues.     Figure  34:  Percent  of  Mohave  County  Population  in  Health  Professional  Shortage  Area   Report  Area   Mohave  County   Arizona   United  States   HPSA  Desig-­‐ nation  Popu-­‐ lation   67,461.75   Percent  of  Designated   Population  Under-­‐ served   Underserved   Population   47,861.83   70.95%   1,676,400.28   1,081,814.04   64.53%   52,826,822.65   32,117,352.05   60.80%   Mohave  County   Arizona   United  States Data  Source:  U.S.  Health  Resources  and  Services  Administration,  Health  Professional  Shortage  Area  File,  2012   Figure  35:    Mohave  County  Health  Professional  Shortage  Area  by  Zip  Code  Tract     Over  80.0%   70.1  -­‐  80.0%   60.1  -­‐  70.0%   50.1  -­‐  60.0%     Under  50.1%                                                      Data  Source:  U.S.  Health  Resources  and  Services  Administration,  Health  Professional  Shortage  Area  File,  2012     Page   24                                                                Community  Health  Profile  for  Mohave  County,  2013   Acute  Care  Hospitals   There  are  four  acute  care  hospitals  serving  the  residents  of  Mohave  County.    An  acute  care   hospital  is  where  people  can  be  treated  for  a  brief,  but  severe  episode  of  illness;  or  after  an   accident  or  other  trauma;  or  during  recovery  from  surgery.  Acute  care  is  given  by  medical   doctors  and  other  specialized  healthcare  personnel  using  sophisticated  medical  equipment   and  materials.    Acute  care  may  also  involve  intensive  or  emergency  care.  This  pattern  of   care  is  often  necessary  for  only  a  short  time,  unlike  chronic  care.  However,  most  acute  care   hospitals  also  provide  a  host  of  other  medical  services  for  people  with  chronic  health   conditions.    For  example:  surgical  services,  cancer  care,  physical  therapy  and  rehabilitation,   etc.     Havasu  Regional  Medical  Center   Havasu  Regional  Medical  Center  (HRMC  is  a  181-­‐bed  acute  care  facility  located  in  Lake   Havasu,  Arizona.    It  provides  24-­‐hour  emergency  service  with  full-­‐time  emergency   physicians  on  duty.    It  is  a  state-­‐certified  Level  IV  Trauma  Center.    The  facility  offers  a  full   complement  of  community  hospital  and  regional  referral  services  in  most  major  medical   disciplines.    More  than  100  physicians/allied  health  professionals  comprise  the  medical   staff  and  represent  a  broad  cross  section  of  specialty  areas.         Figure  36:    Location  of  Mohave   Kingman  Regional  Medical  Center   County’s  acute  care  hospitals   Kingman  Regional  Medical  Center  (KRMC)  is  a  non-­‐profit   235-­‐  bed  acute  care  hospital  located  in  Kingman,  Arizona.     With  over  190  physicians/allied  health  professionals,   KRMC  provides  a  full  range  of  health  and  wellness   services,  including  advanced  medical  programs  in   cardiology,  cancer,  rehabilitation,  wound  care,  home   health,  and  hospice  care.    KRMC  is  a  member  of  the  Mayo   Clinic  Care  Network  and  also  serves  as  a  teaching   hospital,  offering  physician  residency  training  in  family   practice  and  emergency  medicine  in  affiliation  with   Midwestern  University.    KRMC’s  emergency  department   is  a  state-­‐certified  Cardiac  Arrest  Center  and  Level  IV   Trauma  Center.     Valley  View  Medical  Center   Valley  View  Medical  Center  (VVMC)  is  a  90-­‐bed  acute  care  facility  located  in  Fort  Mohave,   Arizona.    It  provides  24-­‐hour  emergency  service  with  full-­‐time  emergency  physicians  on   duty.    It  offers  a  full  complement  of  community  and  regional  referral  services  in  all  of  the   major  medical  disciplines  with  a  medical  staff  that  represents  a  broad  cross  section  of   specialty  areas.     Western  Arizona  Regional  Medical  Center   Western  Arizona  Regional  Medical  Center  (WARMC)  is  a  139-­‐bed  acute  care  facility  located   in  Bullhead  City,  Arizona.    WARMC  services  include  an  intensive  care  unit;  inpatient  and       Page   25                                                              Community  Health  Profile  for  Mohave  County,  2013   outpatient  care;  diagnostic  imaging;  and  emergency,  medical  and  surgical  care.    It  also   offers  services  through  a  freestanding  surgery  center  and  wound  care  clinic.    More  than   110  physicians/allied  health  professionals  comprise  the  medical  staff  and  represent  a   broad  cross  section  of  specialty  areas.     Mohave County Community Health Profile Community Figure  37:    Summary   Mohave  Acute County   cute  Care  Hospitals Sum m ary o off  Short-Term CareA Hospitals Bed Annual Annual Patient Size Discharges Revenue (000's)     Havasu Regional M edical Center Kingman Regional M edical Center Valley View M edical Center Western AZ Regional M edical Center 101 Civic Center Lane, Lake Havasu City, AZ 86403 3269 Stockton Hill Road, Kingman, AZ 86409 5330 South Highway 95, Fort M ohave, AZ 86426 2735 Silver Creek Road, Bullhead City, AZ 86442 181 235 66 139 5,925 9,114 3,396 6,309 $ $ $ $ 442,262 783,537 245,731 643,620 Data   Source:  cost Costreportdata.com,   American  Hospital  Directory   *Information based on latest available Medicare report Source: Costreportdata.com   *  Information  based  on  latest  available  Medicare  cost  report   American Hospital Directory Primary  Care  Services   Primary  care  providers  include  doctors,  nurse  practitioners,  and  physician  assistants  in  the   following  disciplines:     Family  Medicine   Practitioners  of  family  medicine  provide  continuing  and  comprehensive  health  care  for   male  and  female  patients  of  all  ages,  from  newborns  to  the  elderly.     Geriatrics     Geriatrics  is  the  branch  of  medicine  that  focuses  on  health  care  of  the  elderly.  It  aims  to   promote  health  and  to  prevent  and  treat  diseases  and  disabilities  in  older  adults.     Internal  Medicine     Internists  are  experts  in  the  general  care  of  adults.  They  provide  routine  health   maintenance  and  preventive  care  as  well  as  diagnosis  and  treatment  of  many  medical   problems  that  affect  adults.     Pediatrics     Pediatricians  are  concerned  with  the  physical,  emotional,  and  social  health  of  children   from  birth  to  young  adulthood.  Care  encompasses  a  broad  spectrum  of  health  services   ranging  from  preventive  healthcare  to  the  diagnosis  and  treatment  of  acute  and  chronic   diseases  that  occur  in  children.     In  most  cases,  a  primary  care  provider  should  be  the  first  point  of  contact  for  a  person’s   healthcare.    These  professionals  can  diagnose  and  treat  many  medical  conditions  and   coordinate  healthcare  as  needed  among  other  medical  specialists.  Also  importantly,  a   primary  care  provider  is  the  professional  to  help  maintain  good  health.  They  provide  such   preventive  care  as  annual  checkups,  screenings,  routine  tests,  and  immunizations.  Rates  of   morbidity,  mortality,  and  emergency  hospitalizations  can  be  reduced  if  community   residents  are  able  to  access  primary  medical  services.           Page   26                                                              Community  Health  Profile  for  Mohave  County,  2013     Access  to  Primary  Care   The  following  figure  shows  the  number  of  primary  care  physicians  in  Mohave  County  per   100,000  people.    This  indicator  is  relevant  because  a  shortage  of  health  professionals   contributes  to  access  and  health  status  issues.       Figure  38:    Mohave  County  Primary  Care  Provider  Rate  (per  100,000  pop.)   Report  Area   Mohave  County   Arizona   United  States   Total  Primary  Care   Providers   Primary  Care  Provid-­‐ er  Rate  (Per  100,000   Pop.)   100   49.90   4,522   70.70   264,897   84.70   Mohave  County   Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010.     Lack  of  a  Consistent  Source  of  Primary  Care   The  following  figure  shows  the  percentage  of  adults  in  Mohave  County  aged  18  and  older   who  self-­‐report  that  they  do  not  have  at  least  one  person  who  they  think  of  as  their   personal  doctor  or  health  care  provider.    This  indicator  is  relevant  because  access  to   regular  primary  care  is  important  to  preventing  major  health  issues  and  emergency   department  visits.       Figure  39:    Mohave  County  Adults  without  a  Regular  Doctor   Report  Area   Mohave  County   Arizona   United  States   Number  Adults  Without   Any  Regular  Doctor   Percent  Adults  With-­‐ out  Any  Regular  Doc-­‐ tor   45,427   29.03%   1,114,776   24.06%   44,961,851.44   19.32%   Mohave  County   Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010     Preventable  Hospital  Events   The  following  figure  shows  the  discharge  rate  (per  1,000  Medicare  enrollees)  for  preventa-­‐ ble  conditions  (pneumonia,  dehydration,  asthma,  diabetes)  where  hospitalization  could   have  been  avoided  if  primary  care  resources  were  available  and  accessed  by  those  patients.                     Page   27                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  40:    Preventable  Hospital  Event  Discharge  Rate  (per  1,000  Medicare  Enrollees)   Report  Area   Total  Medicare  En-­‐ rollees   (Age  65-­‐75)   Mohave  County   Patient  Discharges   for  Preventable   Events   Discharge  Rate   for  Preventa-­‐ ble  Events   2,173   72.45   29,992   Arizona   United  States   415,410   23,759   57.19   53,239,865   4,053,740   76.14   Mohave  County   Arizona   United  States Data  Source:  Dartmouth  Atlas  of  Healthcare,  Selected  Measures  of  Primary  Care  Access  and  Quality,  2003-­‐2007       Federally  Qualified  Health  Centers   Federally  Qualified  Health  Centers  (FQHCs)  are  community  assets  that  provide  health  care   to  vulnerable  populations.  They  receive  extra  funding  from  the  federal  government  to   provide  low-­‐cost  preventive  and  primary  care  services  in  areas  designated  as  medically   underserved.   Federally  qualified  health  centers  play  a  crucial  role  during  tough  economic  times,   providing  affordable  health  services  for  millions  of  uninsured  and  newly  jobless  Americans.   FQHC’s  save  money  every  time  an  uninsured  patient  opts  for  an  exam  and  treatment  at  the   first  sign  of  a  health  issue  instead  of  waiting  until  a  costly  Emergency  Room  visit  is  the  only   option.  Health  centers  also  save  money  for  Americans  looking  for  work  whose  families   could  otherwise  face  poor  health  without  care,  or  piles  of  medical  debt.   There  are  four  federally  qualified  health  centers  providing  medical  services  in  Mohave   County.    However  there  are  no  FQHC’s  in  Mohave  County  who  provide  dental  or  mental   health  services.   Figure  41:    Federally  Qualified  Health  Centers  in  Mohave  County   Number  of  Federally   Qualified  Health  Centers   Report  Area   Mohave  County,  Arizona   4   Arizona   90   United  States   5,459          Data  Source:  U.S.  Health  Resources  and  Services  Administration,  Centers  for  Medicare  &  Medicaid  Services,  Provider  of  Service  File,  2011       North  Country  Healthcare     North  Country  Healthcare  is  a  private,  not  for  profit,  corporation  providing  high  quality,   cost-­‐effective  and  comprehensive  primary  and  preventive  care.  North  Country  operates   three  federally  qualified  health  centers  in  Mohave  County:           Page   28                                                                Community  Health  Profile  for  Mohave  County,  2013     North  Country  Healthcare  Kingman  Clinic   1510  Stockton  Hill  Rd   Kingman,  AZ  86401     North  Country  Healthcare  Bullhead  City  Clinic   2585  S  Miracle  Mile,  Suite  116   Bullhead  City,  AZ  86442     North  Country  Healthcare  Lake  Havasu  City  Clinic   2090  N  Smoketree  Ave   Lake  Havasu  City,  AZ  86403       Canyonlands  Healthcare  –  Beaver  Dam   Located  in  Littlefield,  Arizona,  Canyonlands  Healthcare  is  a  federally  qualified  health  center   providing  cost-­‐effective  and  comprehensive  primary  and  preventive  care  services  to  people   living  in  the  Colorado  Strip  area  in  north  Mohave  County.     Dental  Health  Services   There  are  an  estimated  150  independent-­‐practice  dentists  in  Mohave  County  cities  (the   exact  number  of  dentists  in  outlying  Mohave  County  communities  is  unavailable  at  this   time).       Figure  42:  Dental  Providers  in  Mohave  County  Cities     Provider  Type   Bullhead  City   Dentists   42   Kingman   45   Lake  Havasu,   City   47   Data  Source:  Mohave  County  Department  of  Public  Health   Although  Mohave  County  has  a  somewhat  adequate  number  of  dental  providers  for  the   population,  access  is  limited  for  many  Mohave  County  adults  who  do  not  have  dental   insurance,  including  many  on    Medicare  or  AHCCCS  (AHCCCS  does  not  cover  dental  for   anyone  over  21).    The  majority  of  dentists  in  Mohave  County  limit  their  practice  to  insured   or  self-­‐pay  patients.  There  are  no  dental  providers  who  offer  low-­‐cost  or  sliding-­‐fee   services  to  low-­‐income  patients,  such  as  through  a  Federally  Qualified  Health  Center   (FQHC)  dental  provider.         Dental  care  utilization  (adult)   The  lack  of  access  to  dental  care  in  Mohave  County  is  evident  in  the  percentage  of  adults   aged  18  and  older  who  self-­‐report  that  they  have  not  visited  a  dentist,  dental  hygienist,  or   dental  clinic  within  the  past  year.    This  indicator  is  relevant  because  engaging  in  preventive   behaviors  decreases  the  likelihood  of  developing  future  health  problems.    This  indicator   can  also  highlight  a  lack  of  access  to  preventive  care,  a  lack  of  health  knowledge,   insufficient  provider  outreach,  or  social  barriers  preventing  utilization  of  services.       Page   29                                                              Community  Health  Profile  for  Mohave  County,  2013     Figure  43:  Percent  Mohave  County  Adults  with  No  Dental  Exam   Report  Area   Mohave  County   Arizona   Total     Surveyed   Population   (Age  18  )   Number   Adults  with   No  Dental   Exam   156,485   4,633,315   United  States     Percent  Adults   with  No  Dental   Exam   69,557   44.45%   1,447,448   31.24%   232,747,222   70,151,188.94   30.14%     Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010.       Dental  health  status  in  Mohave  County   Low  utilization  of  dental  care  in  Mohave  County  is  also  evident  in  the  percentage  of  adults   age  18  and  older  who  self-­‐report  that  six  or  more  of  their  permanent  teeth  have  been   removed  due  to  tooth  decay,  gum  disease,  or  infection.    This  indicator  is  relevant  because  it   indicates  lack  of  access  to  dental  care  and/or  social  barriers  to  utilization  of  dental   services.     Figure  44:  Percent  Mohave  County  Adults  with  Poor  Dental  Health   Report  Area   Mohave  County   Arizona   United  States     Total  Popula-­‐ tion   (Age  18  )   156,485   Number  Adults   with  Poor  Den-­‐ tal  Health   Percent  Adults   with  Poor  Den-­‐ tal  Health   42,063   26.88%   4,633,315   612,988   13.23%   232,747,222   36,229,520   15.57%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010   Mental  Health  and  Substance  Abuse  Treatment  Services   Mental  health  is  critical  to  effectively  raising  children,  learning,  working,  and  being   productive  contributing  citizens.  Mental  health  providers  provide  care  to  help  people   overcome  mental  trauma,  depression,  anxiety,  mood  disorders,  addictive  behaviors,  and   other  mental  health  conditions.    Mohave  County  has  a  minimal  number  of  providers  to   serve  the  mental  health  needs  of  our  community.                   Page   30                                                                Community  Health  Profile  for  Mohave  County,  2013   Figure  45:    Mental  Health  Providers  in  Mohave  County   Provider  Type   Bullhead  City   Kingman   Lake   Havasu   City   Outlying   Communities   Psychiatrists  (Adult)   2   4   3   1   Psychiatrists  (Children)   0   0   0   0   Other  mental  health  professionals  (psycholo-­‐ gists,  counselors,  etc.)     6   11   7   *7   Inpatient  mental  health/detox  beds   0   14   0   0   Outpatient  mental  health/substance  abuse  clinic   5   3   2   *3   Inpatient  substance  abuse  treatment  center   0   0   0   0   Data  Source:    Substance  Abuse  and  Mental  Health  Services  Administration   *      Indicates  tribal  mental  health  resources     Mohave  Mental  Health   Mohave  Mental  Health  Clinic,  Inc.  (MMHC)  is  a  private,  not-­‐for-­‐profit  corporation  to  seek,   promote,  assist  and  contribute  to  the  improved  mental  health  of  the  individuals,  families,   and  communities  in  Mohave  County.  It  provides  a  mix  of  mental  health  and  substance   abuse  services  for  people  with  co-­‐occurring  mental  and  substance  abuse  disorders.    It   accepts  self  payment,  Medicaid,  Medicare,  and  private  health  insurance.    Additionally,   MMHC  provides  free  or  low-­‐cost  mental  health/substance  abuse  services  to  uninsured   individuals  eligible  for  Title  XIX/XXI  coverage.  Mohave  Mental  Health  is  under  subcontract   with  Northern  Arizona  Regional  Behavioral  Health  Authority  (NARBHA)  and  Arizona   Division  of  Health  Services  (ADHS)  and  funded  by  AHCCCS  (Arizona  Health  Care  Cost   Containment  System).         Mohave  Mental  Health  Clinic  Kingman     3505  Western  Ave   Kingman,  AZ  86409   Offering  outpatient  mental  health  and  substance  abuse  services  and  14  inpatient  mental  health/   detox  beds     Mohave  Mental  Health  Clinic  Lake  Havasu  City     2187  Swanson  Ave   Lake  Havasu  City,  AZ  86403     Offering  outpatient  mental  health  and  substance  abuse  services     Mohave  Mental  Health  Clinic  Bullhead  City     1145  Marina  Blvd   Bullhead  City,  AZ  86442   Offering  outpatient  mental  health  and  substance  abuse  services           Page   31                                                              Community  Health  Profile  for  Mohave  County,  2013   Southwest  Behavioral  Health  Clinics   Headquartered  in  Phoenix,  Southwest  Behavioral  Health  has  four  outpatient  clinics  in   Mohave  County.    Three  of  the  clinics  provide  mental  health  services  to  assist  families,   children,  adolescents,  and  adults  in  achieving  optimal  functioning  in  their  personal  lives   and  their  community.  Services  include  assistance  with  substance  abuse,  general  mental   health,  family  functioning,  crisis,  planning,  and  skill  building.    A  fourth  clinic  in  Bullhead   City  provides  outpatient  opiate  treatment,  which  includes  a  combination  of  medication   management  (methadone  and  suboxone  services)  coupled  with  counseling  and  community   support.   Southwest  Behavioral  Health  Kingman   2215  Hualapai  Mountain  Rd.,  #H   Kingman,  Arizona  86401     Southwest  Behavioral  Health  Lake  Havasu  City   1845  McCulloch  Boulevard,  #B-­‐1   Lake  Havasu  City,  Arizona  86403     Southwest  Behavioral  Health  Bullhead  City   2580  Highway  95,  #119   Bullhead  City,  Arizona  86442     Southwest  Behavioral  Health  Bullhead  City  (Opiate  Treatment  Program)   809  Hancock  Road,  #1   Bullhead  City,  Arizona  86442     Other  mental  health/substance  abuse  treatment  organizations  in  Mohave  County   The  following  organizations  offer  a  mix  of  outpatient  mental  health  and  substance  abuse   treatment  services  to  persons  with  co-­‐occurring  mental  and  substance  abuse  disorders,   DUI/DWI  offenders,  and  criminal  justice  clients.     ABC  Therapy  Inc.   1748  Highway  95,  Suite  14   Bullhead  City,  AZ    86442     Treatment  Assessment  Screening  Center,  Inc.    (TASC)   2364  Kingman  Ave.     Kingman,  AZ    86401     Westcare  Arizona   821  Hancock  Road,  Suite  2   Bullhead  City,  AZ  864442     In  addition  to  the  above  providers,  the  Hualapai  Tribal  Nation,  Fort  Mohave  Tribal  Nation,   and  Kaibab-­‐Paiute  Tribal  Nation  provide  mental  health  and  substance  abuse  treatment   programs  for  tribal  members.             Page   32                                                              Community  Health  Profile  for  Mohave  County,  2013   Behavioral  Risk  Factors   This  section  of  the  Mohave  County  Community  Health  Profile  includes  data  and  statistics  on   behaviors  and  risk  factors  that  are  believed  to  cause,  or  to  be  contributing  factors  to   injuries,  disease,  and  death  in  Mohave  County.     Healthy  people  are  among  a  community’s  most  essential  resources.  Good  health  can  be   defined  as  a  state  of  physical,  mental,  and  social  well-­‐being,  rather  than  the  absence  of   disease  or  infirmity.    According  to  Healthy  People  2020,  the  national  health  objectives   released  by  the  U.S.  Department  of  Health  and  Human  Services,  individual  health  is  closely   linked  to  community  health.    Community  health,  which  includes  both  the  physical  and   social  environment  in  which  individuals  live,  work,  and  play,  is  profoundly  affected  by  the   collective  behaviors,  attitudes,  and  beliefs  of  everyone  who  lives  in  the  community.         Numerous  factors  have  a  significant  impact  on  an  individual’s  health  status:  lifestyle  and   behavior,  human  biology,  environmental  and  socioeconomic  conditions,  as  well  as  access  to   adequate  and  appropriate  health  care  and  medical  services.    Studies  by  the  American   Society  of  Internal  Medicine  conclude  that  up  to  70  percent  of  an  individual’s  health  status   is  directly  attributable  to  personal  lifestyle  decisions  and  attitudes.    Persons  who  do  not   smoke,  who  drink  in  moderation  (if  at  all),  use  automobile  seat  belts  (car  seats  for  infants   and  small  children),  maintain  a  nutritious  low-­‐fat,  high-­‐fiber  diet,  reduce  excess  stress  in   daily  living,  and  exercise  regularly  have  a  significantly  greater  potential  of  avoiding   debilitating  diseases,  infirmities,  and  premature  death.     The  interrelationship  among  lifestyle/behavior,  personal  health  attitude,  and  poor  health   status  is  gaining  recognition  and  acceptance  by  both  the  general  public  and  health  care   providers.    Some  examples  of  lifestyle/behavior  and  related  health  care  problems  are   included  in  the  following  table.     Figure  46:    Behaviors  that  Contribute  to  Accidents,  Chronic  Disease,  and  Death   Lifestyle/Behavior   Primary  Disease  Factor     Smoking     Alcohol/  Drug  Abuse     Poor  Nutrition     Driving  at  Excessive  Speeds     Lack  of  Exercise     Uncontrolled  Stress   Lung  Cancer,  Cardiovascular  Disease,  Emphysema     Chronic  Bronchitis   Cirrhosis  of  Liver,  Motor  Vehicle  Crashes,   Unintentional  Injuries,  Malnutrition,  Suicide   Homicide,  Mental  Illness   Obesity,  Digestive  Disease,  Diabetes   Trauma,  Motor  Vehicle  Crashes   Cardiovascular  Disease,  Depression   Mental  Illness,  Alcohol/  Drug  Abuse,  Cardiovascular   Disease   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2003-­‐2009       Page   33                                                              Community  Health  Profile  for  Mohave  County,  2013   Indicators  of  Unhealthy  Behaviors  among  Mohave  County  Adults   The  following  statistics  cover  adult  lifestyle  choices  that  directly  affect  community  health.     High  rates  of  smoking,  alcohol  use,  and  obesity  are  certain  to  lead  to  debilitating  diseases,   infirmities,  and  premature  death  in  Mohave  County.         Fruit/vegetable  consumption   This  indicator  reports  the  percentage  of  Mohave  County  adults  aged  18  and  older  who  self-­‐ report  consuming  less  than  5  servings  of  fruits  and  vegetables  each  day.    This  indicator  is   relevant  because  unhealthy  eating  habits  may  cause  significant  health  issues,  such  as   obesity  and  diabetes.     Figure  47:    Percent  of  Mohave  County  Adults  Consuming  Few  Fruits  or  Vegetables   Report  Area   Mohave  County   Arizona   United  States   Total   Population   (Age  18  )   Population   Percent   Consuming  Few   Consuming  Few   Fruits  or   Fruits  or   Vegetables   Vegetables   150,033   120,026.40   80%   85,992   64,666   75.20%   111,821,887   84,891,309   75.92%   Mohave  County     Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2003-­‐2009       Physical  activity   This  indicator  reports  the  percentage  of  adults  aged  18  and  older  who  self-­‐report  minimum   physical  activity,  based  on  the  question:  “During  the  past  month,  other  than  your  regular  job,   did  you  participate  in  any  physical  activities  or  exercises  such  as  running,  calisthenics,  golf,   gardening,  or  walking  for  exercise?”    This  indicator  is  relevant  because  limited  physical   activity  can  cause  significant  health  issues,  such  as  obesity  and  poor  cardiovascular  health.     Figure  48:    Percent  of  Mohave  County  Adults  Who  Are  Physically  Inactive   Report  Area   Mohave  County   Arizona   United  States   Total   Population   (Age  18  )   150,033   Number   Physically   Inactive   Percent   Physically   Inactive   38,708.51   25.80%   85,992   18,746   21.80%   111,821,887   27,579,949   24.66%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2003-­‐2009       Page   34                                                                Community  Health  Profile  for  Mohave  County,  2013   Obesity   This  indicator  reports  the  percentage  of  adults  aged  18  and  older  who  self-­‐report  that  they   have  a  Body  Mass  Index  (BMI)  greater  than  30.0  (obese).    This  indicator  is  relevant  because   excess  weight  is  a  prevalent  problem  in  the  U.S.;  it  indicates  an  unhealthy  lifestyle  and  puts   individuals  at  risk  for  serious  health  issues,  such  as  diabetes  and  cardiovascular  disease.     Figure  49:    Percent  of  Mohave  County  Adults  Who  Are  Obese   Report  Area   Mohave  County,   Arizona   Arizona   United  States   Total  Population     (Age  20  )   143,666.67   Number  Obese   40,083   Percent  Obese   27.90%   4,680,888.96   1,165,468   24.90%   224,690,904.71   61,460,308   27.35%   Mohave  County   Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2009     Alcohol  consumption   This  indicator  reports  the  percentage  of  adults  aged  18  and  older  in  Mohave  County  who   self-­‐report  heavy  alcohol  consumption  (defined  as  more  than  two  drinks  per  day  for  men   and  one  drink  per  day  for  women).    This  is  relevant  because  heavy  alcohol  consumption  is   a  cause  of  significant  health  issues,  such  as  cirrhosis  of  the  liver,  cancers,  and  untreated   mental  and  behavioral  health  needs.       Figure  50:    Percent  of  Mohave  County  Adults  Who  Are  Heavy  Drinkers   Report  Area   Mohave  County,   Arizona   Arizona   United  States   Total  Population   (Age  18  )   150,033   Number  Heavy   Drinkers   30,156.63   Percent  Heavy   Drinkers   20.10%   85,992   14,791   17.20%   111,821,887   18,576,867   16.61%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2004-­‐2010       Tobacco  use   This  indicator  reports  the  percentage  of  adults  aged  18  and  older  who  self-­‐report  currently   smoking  cigarettes  some  days  or  every  day.    This  indicator  is  relevant  because  tobacco  use   is  linked  to  leading  causes  of  death  in  Mohave  County  which  are  cancer,  lower  respiratory   disease  (COPD),  and  cardiovascular  disease.                 Page   35                                                                Community  Health  Profile  for  Mohave  County,  2013     Figure  51:    Percent  of  Mohave  County  Adults  Who  Smoke  Cigarettes   Report  Area   Mohave  County   Arizona   United  States     Total   Population   (>Age  18  )   Number   Cigarette   Smokers   Percent   Cigarette   Smokers   150,033   42,609   28.40%   85,992   15,135   17.60%   111,821,887   21,551,350   19.27%   Mohave  County     Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2004-­‐2010   Indicators  of  Unhealthy  Behaviors  among  Mohave  County  Youth   The  following  charts  are  included  in  this  Community  Health  Profile  for  Mohave  County  as   indicators  of  the  health  and  well-­‐being  of  county  youth  and  of  the  overall  social  and  mental   health  of  our  community  as  a  whole.    They  are  excerpted  from  the  2012  Arizona  Youth   Survey,  Mohave  County  Summary  Report,  which  describes  substance  use,  antisocial   behavior,  delinquency,  and  the  level  of  risk  and  protective  factors  of  8th,  10th,  and  12th   grade  students  who  participated  in  a  survey  administered  by  the  Arizona  Criminal  Justice   Commission.  The  entire  report,  which  includes  further  data  (e.g.,  where  youth  are  obtaining   drugs/alcohol,  school  safety,  bullying,  etc.)  and  detailed  explanations  and  analyses  can  be   accessed  online  at  the  link  above.     The  youth  survey  is  done  bi-­‐annually  in  schools  throughout  Arizona.    The  latest  was   distributed  in  the  spring  of  2012,  with  62,817  students  throughout  the  state  participating.     Of  that,  2,485  students  in  Mohave  County  took  part  in  the  survey.  For  the  purpose  of   identifying  trends,  results  from  the  past  three  Mohave  County  surveys  are  presented  along   with  comparisons  to  state-­‐wide  results  (indicated  with  dots)  and  to  national  data   (indicated  with  diamonds).    The  national  data  is  from  either  the  Monitoring  the  Future   Survey  (MTF)  or  Bach  Harrison  Norm  (BH  Norm)  national  measures  (see  full  report  at   2012  Arizona  Youth  Survey,  Mohave  County  Summary  Report  for  more  information).       Substance  abuse  among  Mohave  County  youth   The  following  chart  indicates  alcohol,  tobacco  and  other  drug  (ATOD)  use  among  all  8th,   10th,  and  12th  grade  students  surveyed  in  Mohave  County  (a  breakdown  by  grade  is   available  in  the  full  summary  report  at  the  link  above).    Lifetime  use  is  a  measure  of  the   percentage  of  students  who  tried  the  particular  substance  at  least  once  in  their  lifetime  and   is  used  to  show  the  percentage  of  students  who  have  had  experience  with  a  particular   substance.  30-­‐day  use  is  a  measure  of  the  percentage  of  students  who  used  the  substance  at   least  once  in  the  30  days  prior  to  taking  the  survey  and  is  a  more  sensitive  indicator  of  the   level  of  current  use  of  the  substance.             Page   36                                                                Community  Health  Profile  for  Mohave  County,  2013       Figure  52:    Lifetime  &  30-­‐Day  Alcohol,  Tobacco,  and  Other  Drug  (ATOD)  Use   LIFETIME  &  30-­‐DAY  ATOD  USE   2012  Mohave  County,  All  Students  Surveyed   Lifetime  Use   30-­‐Day  Use   (Tried  substance  at  least  once)   100 (Used  substance  within  last  30  days)   90 80 70 Percentage (%) 60 50 40 30 20 10 0 Synthetic Drugs*† Over-the-Counter Drugs† Prescription Drugs† Prescription Sedatives† Prescription Stimulants Prescription Pain Relievers† Steroids State 2012 Other Club Drugs* Ecstasy Heroin** Methamphetamines Inhalants Cocaine Hallucinogens County 2012 Marijuana Chewing Tobacco Cigarettes Alcohol County 2010 Synthetic Drugs*† Over-the-Counter Drugs† Prescription Drugs† Prescription Sedatives† Prescription Stimulants Prescription Pain Relievers† Steroids Other Club Drugs* Ecstasy Heroin**     Methamphetamines Inhalants Cocaine Hallucinogens Marijuana Chewing Tobacco Cigarettes Alcohol County 2008 MTF 2011 **(Substance categories that were not measured and reported in survey administrations prior to 2012. **(Denotes a change in the question between administrations. Non-comparable data are omitted from charts. .† (No equivalent category for these substances in the Monitoring the Future survey. In the case of Prescription  Pain  Relievers, MTF does not have reliable data   for grades 8 and 10.                 Data  Source:  2012  Arizona  Youth  Survey,  Mohave  County  Summary  Report,     Used  with  permission,  Arizona  Criminal  Justice  Commission   Page   37                                                                Community  Health  Profile  for  Mohave  County,  2013   High-­‐risk  and  antisocial  behaviors  among  Mohave  County  youth   The  following  chart  indicates  behaviors  among  surveyed  youth  that  can  put  themselves  or   others  at  risk  of  life-­‐threatening  consequences.    Binge  Drinking  is  measured  as  having  five   or  more  drinks  in  a  row  during  the  two  weeks  prior  to  the  survey.  Drinking  and  driving  is   measured  by  youth  drinking  alcohol  and  driving,  or  riding  with  a  driver  who  had  been   drinking  alcohol  in  the  past  30  days.  Antisocial  behavior  is  a  measure  of  the  percentage  of   students  who  report  any  involvement  during  the  past  year  with  the  eight  antisocial   behaviors  listed  in  the  chart.     Figure  53:    High  Risk  &  Antisocial  Behaviors  among  Mohave  County  Youth   BINGE  DRINKING,  DRINKING  &  DRIVING,  &  ANTISOCIAL   BEHAVIOR   2012  Mohave  County,  All  Students  Surveyed   100 90 80 70 Percentage (%) 60 50 40 30 20 10 0 Data  Source:  2012  Arizona  Youth  Survey,  Mohave  County  Summary  Report,     Used  with  permission,  Arizona  Criminal  Justice  Commission       Carried a Handgun to School MTF 2011*/BH Norm 2012** **(National Comparison data for Binge  Drinking  category are Monitoring the Future values. **(National Comparison data for Drinking  &  Driving  and Antisocial  Behavior  category are Bach Harrison Norm values. Page   38   Carried a Handgun State 2012 Attacked Someone w/ Idea of Seriously Hurting Them County 2012 Been Arrested Stolen or Tried to Steal a Motor Vehicle Sold Illegal Drugs     County 2010 Suspended from School       Drunk or High at School       RIDE in a car driven by someone drinking alcohol? DRIVE a car when you had been drinking alcohol? 5 or more alcoholic drinks in a row in the past 2 weeks? County 2008                                                          Community  Health  Profile  for  Mohave  County,  2013   Youth  risk  profile   The  following  risk  profile  shows  aspects  of  surveyed  youths’  life  experiences  that  can   encourage  problem  behaviors.  Risk  factors  are  characteristics  of  school,  community,  family,   and  peer  environments  known  to  predict  increased  likelihood  of  drug  use,  delinquency,   school  dropout,  and  violent  behaviors  among  youth.     Figure  54:    Risk  Profile  of  Mohave  County  Youth   RISK  PROFILE   2012  Mohave  County,  All  Students  Surveyed   100 90 80 Percentage (%) of youth at risk 70 60 50 40 30 20 10 0 Students at High Risk* Gang Involvement State 2012 Rewards for Antisocial Behavior County 2012 Friend's Use of Drugs Interaction with Antisocial Peers Perceived Risk of Drug Use Attitudes Favorable to Drug Use Attitudes Favorable to Antisocial Behavior Early Initiation of Drug Use Early Initiation of Antisocial Behavior Rebelliousness Low Commitment to School County 2010 Academic Failure Parental Attitudes Favorable to Drug Use Parental Attitudes Favorable to Antisocial Behavior Family History of Antisocial Behavior Family Conflict Poor Family Management Perceived Availability of Handguns Perceived Availability of Drugs Laws & Norms Favorable to Drug Use Low Neighborhood Attachment County 2008 BH Norm 2012   **(High Risk youth are defined as the percentage of students who have more than a specified number of risk factors operating in their lives (8 th   grade: 8 or more risk factors, 10th &12th grades: 9 or more risk factors).   Data  Source:  2012  Arizona  Youth  Survey,  Mohave  County  Summary  Report,     Used  with  permission,  Arizona  Criminal  Justice  Commission         Page   39                                                                Community  Health  Profile  for  Mohave  County,  2013   Youth  protective  profile   The  following  protective  profile  shows  aspects  of  surveyed  youths’  life  experiences  that  can   prevent  problem  behaviors.  Protective  factors  exert  a  positive  influence  and  reduce  the   likelihood  that  adolescents  will  engage  in  problem  behaviors.  Protective  factors  identified   through  research  include  strong  bonding  to  family,  school,  community,  and  peers  in   addition  to  healthy  beliefs  and  clear  standards  for  behavior.     Figure  55:    Protective  Profile  of  Mohave  County  Youth   PROTECTIVE  PROFILE   2012  Mohave  County,  All  Students  Surveyed   100 90 Percentage (%) of youth with protection 80 70 60 50 40 30 20 10 0 BH Norm 2012   **(High Protection youth are defined as the percentage of students who have four or more protective factors operating in their lives. **(NOTE: Prior to the 2010 administration, this value was defined as the percentage of students who had five or more protective factors operating in their lives. In order to provide the best comparability across years, 2008 data were recalculated using the new definition. Data  Source:  2012  Arizona  Youth  Survey,  Mohave  County  Summary  Report,   Used  with  permission,  Arizona  Criminal  Justice  Commission       Students with High Protection* State 2012 Rewards for Prosocial Involvement Prosocial Involvement County 2012 Interaction with Prosocial Peers Belief in the Moral Order County 2010 Rewards for Prosocial Involvement   Opportunities for Prosocial Involvement     Rewards for Prosocial Involvement Opportunities for Prosocial Involvement Family Attachment Rewards for Prosocial Involvement County 2008 Page   40                                                                Community  Health  Profile  for  Mohave  County,  2013   Mohave  County  Community  Health  Status   This  section  of  the  Mohave  County  Community  Health  Profile  covers  data  and  statistics  that   indicate  the  health  status  of  Mohave  County’s  population.    Health  status  in  a  community  is   measured  in  terms  of  mortality  data  (rates  of  death  within  a  population)  and  morbidity   data  (rates  of  the  incidence  and  prevalence  of  disease).    Morbidity  may  be  represented  by   age-­‐adjusted  incidence  of  cancer  and  chronic  disease.    Mortality  may  be  represented  by   crude  rates  or  age-­‐adjusted  rates;  by  degree  of  premature  death  (Years  of  Productive  Life   Lost  or  YPLL);  and  by  cause  (disease  -­‐  cancer  and  non-­‐cancer  or  injury  -­‐  intentional,   unintentional).       Due  to  limited  morbidity  data,  this  health  status  report  relies  heavily  on  death  and  death   rate  statistics  for  leading  causes  of  death  in  Mohave  County  and  the  state  of  Arizona.    Such   information  provides  useful  indicators  of  health  status  trends,  which  permits  an   assessment  of  the  impact  of  changes  in  health  services  during  an  established  period  of  time.     Community  attention  and  health  care  resources  may  then  be  directed  to  those  areas  of   greatest  impact  and  concern.     Mohave  County  Health  Rankings   This  section  includes  information  from  County  Health  Rankings,  a  key  component  of  the   Mobilizing  Action  Toward  Community  Health  (MATCH)  project;  a  collaboration  between   the  Robert  Wood  Johnson  Foundation  and  the  University  of  Wisconsin  Population  Health   Institute.    The  County  Health  Rankings  model  is  grounded  in  the  belief  that  programs  and   policies  implemented  at  the  local,  state,  and  federal  levels  have  an  impact  on  a  variety  of   factors  that,  in  turn,  determine  the  health  outcomes  for  communities  across  the  nation.     The  model  provides  a  ranking  method  that  ranks  all  50  states  and  the  counties  within  each   state,  based  on  the  measurement  of  two  types  of  health  outcomes  for  each  county.    (A  more   detailed  discussion  about  the  ranking  system,  data  sources  and  measures,  data  quality  and   calculating  scores  and  ranks  can  be  found  at  the  County  Health  Rankings  website  at   www.countyhealthrankings.org).         The  following  tables,  from  County  Health  Rankings,  summarize  the  2012  rankings  for   Mohave  County.    All  counties  in  Arizona  were  ranked  according  to  the  exact  same  health   indicators.    The  number  in  the  last  column  indicates  Mohave  County’s  ranking  in   comparison  with  the  other  14  counties  in  Arizona  (1  to  15)—  the  lower  the  number  (1  or   2)  the  healthier  the  community  in  comparison  with  the  other  counties.  Each  measure   includes  a  confidence  interval  or  error  margin.    If  a  measure  is  above  the  state  average  and   the  state  average  is  beyond  the  error  margin  for  the  county,  then  further  investigation  is   recommended.                 Page   41                                                              Community  Health  Profile  for  Mohave  County,  2013   Health  outcome  rankings   A  number  of  different  health  factors  shape  a  community’s  health  outcomes.    The  following   table  includes  rankings  based  on  an  equal  weighting  of  one  length  of  life  (mortality)   measure  and  four  quality  of  life  (morbidity)  measures.    While  most  of  Mohave  County   health  outcomes  were  comparable  to  the  state  of  Arizona  (ranking  out  of  15  counties),  each   measure  was  significantly  below  national  benchmarks  with  opportunities  for   improvement.     Mohave County Community Health Profile Community Figure  56:   Mohave   County   Health   Outcome   Rankings   Mohave County Health Rankings - Health Outcomes (2012) (2012)   Mohave County Mortality Premature death - Years of potential life lost before age 75 per 100,000 population (age-adjusted) Morbidity Poor or fair health - Percent of adults reporting fair or poor health (age-adjusted) Poor physical health days - Average number of physically unhealthy days reported in past 30 days (ageadjusted) Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age-adjusted) Low birth weight - Percent of live births with low birth weight (<2500 grams) 10,374 Error Margin 9,860-10,887 National Benchmark 5,466 Rank (of 15) AZ 7,213 20% 18-23% 10% 15% 4.2 3.8-4.7 2.6 3.4 4.3 3.8-4.8 2.3 3.3 7.0% 6.6-7.4% 6% 7.0% Data  Source:  www.countyhealthrankings.org   11 12   Source: Countyhealthrankings.org   Health  factor  rankings   The  County  Health  Rankings  model  includes  four  types  of  health  factors:    health  behaviors,   clinical  care,  social  and  economic,  and  the  physical  environment.    The  following  table   summarizes  the  health  factors  for  Mohave  County  and  shows  that  Mohave  County  has   significant  room  for  improvement  in  the  following  areas:     Adult  smoking     Excessive  drinking   Sexually  transmitted  diseases  (STD’s)   Teen  birth  rate   Access  to  primary  care     Children  in  poverty   Inadequate  social  support   Violent  crime  rate                 Page   42                                                              Community  Health  Profile  for  Mohave  County,  2013     Mohave County Community Health Profile Community County Health - Health Factors (2012)(2012)   Figure  57:  Mohave Mohave   County   HRankings ealth  Outcome   Rankings   Mohave County Health Behaviors Adult smoking - Percent of adults that report smoking at least 100 cigarettes and that they currently smoke Adult obesity - Percent of adults that report a BM I >= 30 Physical inactivity - Percent of adults aged 20 and over reporting no leisure time physical activity Excessive drinking - Percent of adults that report excessive drinking in the past 30 days Motor vehicle crash death rate - M otor vehicle deaths per 100K population S exually transmitted infections - Chlamydia rate per 100K population Teen birth rate - Per 1,000 female population, ages 15-19 Clinical Care Uninsured adults - Percent of population under age 65 without health insurance Primary care physicians - Ratio of population to primary care physicians Preventable hospital stays - Hospitalization rate for ambulatory-care sensitive conditions per 1,000 M edicare enrollees Diabetic screening - Percent of diabetic M edicare enrollees that receive HbA1c screening Mammography screening - Percent of female M edicare enrollees that receive mammography screening 28.0% 27.0% 26-31% 24-30% 14% 25% 18.0% 25.0% 30.0% 28-33% 21% 20.0% 19.0% 16-21% 8% 17.0% 28.0 26-31 12 19.0 157.0 66.0 63-69 84 22 400.0 60.0 20.0% 18-22% 2,274:1 Rank (of 15) 11% 20.0% 631:1 1,427:1 67.0 64-70 49 52.0 81.0% 78-84% 89% 76.0% 64.0% 61-67% 74% 68.0% 9 69.0% 47.0% 76.0% 44-50% 11.2% Children in poverty - Percent of children under age 18 in poverty Inadequate social support - Percent of adults without social/emotional support Children in single-parent households - Percent of children that live in household headed by single parent Violent crime rate - Violent crime rate per 100,000 population Physical Environment Air pollution-particulate matter days - Annual number of unhealthy air quality days due to fine particulate matter Air pollution-ozone days - Annual number of unhealthy air quality days due to ozone Access to recreational facilities - Rate of recreational facilities per 100,000 population Limited access to healthy foods - Percent of population who are lowincome and do not live close to a grocery store Fast Food Restaurants - Percent of all restaurants that are fast-food establishments 68% 60.0% 5.4% 10.0% 34.0% 27-41% 13.0% 25.0% 25.0% 22-27% 14.0% 20.0% 36.0% 246.0 32-40% 20.0% 73.0 33.0% 466.0 4 - - 1 - - 29 7 16 7 6.0% 0% 9.0% 47.0% 25.0% 52.0% Data  Source:  www.countyhealthrankings.org   Page   43   AZ 9 Unemployment - Percent of population age 16+ unemployed but seeking work     National Benchmark 11 Social & Economic Factors High school graduation - Percent of ninth grade cohort that graduates in 4 years S ome college - Percent of adults aged 25-44 years with some postsecondary education Source: Countyhealthrankings.org Error Margin                                                            Community  Health  Profile  for  Mohave  County,  2013   Leading Causes of Death in Mohave County The  following  table  lists  the  leading  causes  of  death  for  Mohave  County  residents  and   compares  the  rates  to  the  state  of  Arizona  rates  per  100,000  people.    Although,  the  leading   causes  of  death  in  Mohave  County  are  the  same  as  the  leading  causes  in  Arizona,  the  rates   of  death  due  to  most  causes  are  much  higher  in  Mohave  County.   Figure  58:    Leading  Causes  of  Death  in  Mohave  County  (rate  per  100,000  pop.)     Arizona       Total,  All  Causes   738.5   212.6   161.9   127.9   32.1   163.8   41.2   14.4   2.9   48.8   46.0   13.7   12.2   12.1   1.3   36.3   26.7   17.3   14.5   11.3   10.1   8.5   6.4   6.0   5.0   1.5   14.8   16.5   15.1   Cardiovascular  disease            Diseases  of  the  heart            Coronary  heart  disease            Cerebrovascular  disease  (stroke)   Malignant  neoplasms  (Cancer)            Lung  cancer            Colorectal  cancer            Malignant  melanoma  of  skin   Chronic  lower  respiratory  diseases   Accident  (unintentional  injury)            Accidental  poisoning            Motor  vehicle  accident            Falls            Accidental  drowning   Alzheimer's  disease   Diabetes   Intentional  self-­‐harm  (suicide)   Chronic  liver  disease  and  cirrhosis   Primary  hypertension  (high  blood  pressure)   Influenza  and  pneumonia   Parkinson's  disease   Nephritis  (kidney  disease)   Assault  (homicide)   Septicemia  (blood  infection)   HIV  disease   Injury  by  firearms   Drug-­‐induced  deaths   Alcohol-­‐induced  deaths     Mohave     County     1209.5   401.7   350.8   282.9   31.4   305.4   96.8   25.9   5.0   100.3   51.4   17.5   14.0   8.5   19.3   27.9   29.9   31.9   19.0   9.0   18.0   10.5   15.0   3.5   10.5   2.0   18.0   26.9   15.0   Data  Source:  Arizona  Department  of  Health  Services,  Mohave  County  Department  of  Health,  2011   NOTE:    Rates  in  red  are  substantially  higher  than  the  Arizona  rate  for  cause  of  death.   Premature  death   This  indicator  reports  Years  of  Potential  Life  Lost  (YPLL)  before  age  75  per  100,000  people   in  Mohave  County  for  all  causes  of  death.  YPLL  is  calculated  by  subtracting  the  age  of  death   from  the  75  year  benchmark.    This  indicator  is  relevant  because  a  measure  of  premature   death  can  provide  a  unique  and  comprehensive  look  at  overall  health  status.           Page   44                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  59:    Premature  Death  Rate  in  Mohave  County     Annual   Premature   Deaths,   2006-­‐2008   Average   Total   Population,   2006-­‐2008   Average   Report  Area   Mohave  County   182,089   Arizona   United  States   Years  of   Potential  Life   Lost     (Rate  per   100,000  Pop.)   1,295   10,374   5,795,774   21,110   7,243   283,115,015   1,058,493   7,131   Mohave  County   Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Vital  Statistics  System,  2008-­‐2010  (As  Reported  in  the  2012  County  Health   Rankings).     Cardiovascular  disease   Cardiovascular  disease  is  the  leading  cause  of  death  worldwide.  It  involves  diseases  that   affect  the  cardiovascular  system,  which  includes  the  heart,  veins  and  arteries.   Cardiovascular  disease  is  usually  related  to  a  process  called  atherosclerosis,  which  is  when   a  substance  called  plaque  builds  up  in  the  walls  of  the  arteries  over  time.  The  buildup   narrows  the  arteries,  making  it  harder  for  blood  to  flow.  If  a  blood  clot  forms,  it  can  stop   blood  flow  to  the  heart  (heart  attack)  or  to  the  brain  (stroke),  which  kills  or  disables   millions  of  people  every  day.  Although  cardiovascular  disease  usually  affects  older  adults,   the  causes  of  cardiovascular  disease  (notably  atherosclerosis),  begin  in  early  life.     Therefore,  there  is  increased  emphasis  on  preventing  atherosclerosis  through  healthy   eating,  exercise,  and  not  smoking.     The  following  indicators  show  rates  of  death  due  to  heart  disease  and  stroke  in  Mohave   County  from  the  most  recent  statistics  from  the  U.S.  Centers  for  Disease  Control  (CDC).     Note  that  the  latest  statistics  (2011)  from  the  Arizona  Department  of  Health  Services  (see   page  44)  show  a  significantly  higher  death  rate  from  heart  disease  in  Mohave  County.    In   contrast,  the  state  statistics  show  a  slight  decrease  in  the  rate  of  death  from  stroke.     Figure  60:  Heart  Disease  Death  Rate  in  Mohave  County  (per  100,000  pop.)   Report  Area   Total   Population,     2006-­‐2010   Average   Mohave  County   HP  2020  Target   Death   Rate     199,178   496   249.22   170.76   6,242,471   8,107   129.87   126.31   303,844,430   432,552   142.36   134.65   Arizona   United  States   Crude   Death   Rate       Annual   Deaths               Mohave  County     HP  2020  Target   Note:   This  indicator   United   Statesi  s  compared  with  the   Healthy  People  2020  Target.   <=  100.8   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Center  for  Health  Statistics,  Underlying  Cause  of  Death,  2006-­‐2010.     Accessed  through  CDC  WONDER.       Page   45                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  61:  Stroke  Death  Rate  in  Mohave  County  (per  100,000  pop.)   Report  Area   Total   Population,     2006-­‐2010   Average   Mohave  County   199,178   Arizona   United  States   HP  2020  Target 112   Age-­‐ Adjusted   Death  Rate     56.33   39.96   6,242,471   2,158   34.57   34.08   303,844,430   133,107   43.81   41.78       Crude   Death   Rate       Annual   Deaths           <=  33.8   Mohave  County   HP  2020  Target   United  States   Note:  This  indicator  is  compared  with  the   Healthy  People  2020  Target.   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Center  for  Health  Statistics,  Underlying  Cause  of  Death,  2006-­‐2010.  .   Accessed  through  CDC  WONDER   Cancer   After  cardiovascular  disease,  malignant  neoplasm  (cancer)  is  the  second  leading  cause  of   death  in  Mohave  County.  Cancer  is  the  uncontrolled  growth  of  abnormal  cells  in  the  body   (called  malignant  cells).  Normal  cells  multiply  when  the  body  needs  them,  and  die  when   the  body  doesn't  need  them.  Cancer  appears  to  occur  when  the  growth  of  cells  in  the  body   is  out  of  control  and  cells  divide  too  quickly.  It  can  also  occur  when  cells  forget  how  to  die.   Cancer  can  develop  in  almost  any  organ  or  tissue,  such  as  the  lung,  colon,  breast,  skin,   bones,  or  nerve  tissue.    Although  the  cause  of  many  cancers  remains  unknown,  there  are   certain  substances  and  environmental  hazards  that  are  known  to  cause  certain  cancers.     For  example,  smoking  leads  to  lung  cancer,  drinking  excess  alcohol  can  lead  to  liver  or   pancreatic  cancer,  and  excessive  sunlight  exposure  can  lead  to  skin  cancer  (melanoma).     The  following  indicators  show  rates  of  death  due  to  all  cancers  in  Mohave  County  from  the   most  recent  statistics  from  the  U.S.  Centers  for  Disease  Control  (CDC).    Note  that  the  latest   statistics  (2011)  from  the  Arizona  Department  of  Health  Services  (see  page  44)  show  a   significantly  higher  death  rate  from  cancer  in  Mohave  County.         Figure  62:  Cancer  Death  Rate  in  Mohave  County  (per  100,000  pop.)   Total   Population,     2006-­‐2010   Average   Report  Area   Annual   Deaths   Crude  Death   Rate         Age-­‐Adjusted   Death  Rate     319.92   205.39   Mohave   County   199,178   Arizona   6,242,471   10,217   163.66   155.58   303,844,430   566,121   186.32   176.66   United  States   637     Mohave  County,  Arizona   HP  2020  Target   United  States Note:  This  indicator  is  compared  with  the   Healthy  People  2020  Target.   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Center  for  Health  Statistics,  Underlying  Cause  of  Death,  2006-­‐2010.     HP  2020  Target         <=  160.6         Page   46                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  63:  Cancer  Mortality  in  Mohave  County  by  Gender  (per  100,000  pop.)   Report  Area       Male   Female   Mohave   County   240.49   174.97   Arizona   186.16   132.07   United   States   215.04   150.05       Data  Source:  Centers  for  Disease  Control  and  Preven-­‐ tion,  National  Center  for  Health  Statistics,  Underlying   Cause  of  Death,  2006-­‐2010.  Accessed  through  CDC   WONDER       Chronic  lower  respiratory  diseases   Chronic  lower  respiratory  diseases  (CLRD)  are  the  fourth  leading  cause  of  death  in  the   United  States,  but  the  third  leading  cause  of  death  in  Mohave  County.  CLRD  comprises  three   major  diseases:  chronic  bronchitis,  emphysema,  and  asthma.  These  diseases  present  as   shortness  of  breath  caused  by  airway  obstruction.  Although  this  category  includes  asthma,   the  most  deadly  lower  respiratory  disease  is  chronic  obstructive  pulmonary  disease   (COPD).    Most  people  with  COPD  have  a  combination  of  both  chronic  bronchitis  and  em-­‐ physema.  COPD  is  almost  always  caused  by  smoking.  Over  time,  breathing  tobacco  smoke   irritates  the  airways  and  destroys  the  stretchy  fibers  in  the  lungs.  The  more  a  person   smokes,  the  more  likely  they  will  develop  COPD.    The  death  rate  from  COPD  in  Mohave   County  is  alarmingly  high  and  most  certainly  attributed  to  the  large  number  of  smokers  in   the  community  (see  page  35).  The  death  rate  from  COPD  is  likely  much  higher  because   COPD  is  often  cited  as  a  contributory,  not  underlying,  cause  of  death  on  death  certificates.   Figure  64:  COPD  Death  Rate  in  Mohave  County  (per  100,000  pop.)   Report  Area   Mohave  County   Arizona             Page   47       Death  Rate   100.3   48.8   Data  Source:  Mohave  County  Department  of  Public   Health                                                        Community  Health  Profile  for  Mohave  County,  2013   Pedestrian  motor  vehicle  death   This  indicator  reports  the  rate  of  pedestrians  killed  in  Mohave  County  by  motor  vehicles   per  100,000  population.  This  indicator  is  relevant  because  pedestrian-­‐motor  vehicle  crash   deaths  are  preventable  and  a  cause  of  premature  death.       Figure  65:  Pedestrian  Death  in  Mohave  County  (per  100,000  pop.)   Mohave  County   United  States   6   3.33   385   128   2   12,750   4,250   1.38       Average  Annual   Death  Rate     20   Arizona   HP  2020  Target Average   Annual   Deaths   Total  Deaths,   2008-­‐2010   Report  Area     <=  1.3   Mohave  County   HP  2020  Target   United  States   Note:  This  indicator  is  compared  with   the  Healthy  People  2020  Target.   Data  Source:  National  Highway  Traffic  Safety  Administration,  Fatality  Analysis  Reporting  System,  2008-­‐2010.     Motor  vehicle  crash  death   This  indicator  reports  the  rate  of  death  due  to  motor  vehicle  crashes  per  100,000   population,  which  include  collisions  with  another  motor  vehicle,  a  non-­‐motorist,  a  fixed   object,  and  a  non-­‐fixed  object,  an  overturn,  and  any  other  non-­‐collision.  This  indicator  is   relevant  because  motor  vehicle  crash  deaths  are  preventable  and  a  leading  cause  of   premature  death.    The  following  indicator  shows  rates  of  death  due  to  motor  vehicle   accidents  in  Mohave  County  from  the  most  recent  statistics  from  the  National  Highway   Safety  Administration.    Note  that  the  latest  statistics  (2011)  from  the  Arizona  Department   of  Health  Services  (see  page  44)  show  a  significantly  lower  death  rate  from  motor  vehicle   accidents  in  Mohave  County.         Figure  66:  Motor  Vehicle  Crash  Death  in  Mohave  County  (per  100,000  pop.)   Mohave  County   Arizona   United  States       144   48   23.98   2,471   823   12.80   103,048   34,349   11.13   Total  Deaths,   2008-­‐2010   Report  Area   HP  2020  Target Average   Annual  Deaths     Average   Annual  Death   Rate         <=  12.4   Page   48         Note:  This  indicator  is  compared  with  the   Healthy  People  2020  Target.   Data  Source:  National  Highway  Traffic  Safety  Administration,  Fatality  Analysis  Reporting  System,  2008-­‐2010.         Mohave  County   HP  2020  Target   United  States                                                        Community  Health  Profile  for  Mohave  County,  2013   The  following  table  indicates  specific  information  related  to  motor  vehicle  deaths  in   Mohave  County.    The  data  is  relevant  for  assessing  causes  and  formulating  public  policies   and  controls  to  help  prevent  motor  vehicle  accidents  and  related  deaths.     Figure  67:  Motor  Vehicle  Crash  Deaths  in  Mohave  County  by  Crash  Type   Fatalities  Per  100,000   Population   Fatalities   Fatality  Type   2007   2008   2009   2010   2011   2007   2008   2009   2010   2011   Total  Fatalities  (All  Crashes)*     52   57   42   48   39   26.03   28.49   21.03   23.81   19.27   (1)  Alcohol-­‐Impaired  (BAC=.08+)  Driving   Fatalities     17   18   8   11   6   8.51   (2)  Single  Vehicle  Crash  Fatalities     35   34   22   35   23   17.52   16.99   11.02   17.36   11.37   9.00   4.01   5.46   2.97   (3)  Large  Truck  Involved  Crash  Fatalities     4   9   5   3   4   2.00   4.50   2.50   1.49   1.98   (4)  Speeding  Involved  Crash  Fatalities     21   31   10   26   18   10.51   15.49   5.01   12.90   8.90   (5)  Rollover  Involved  Crash  Fatalities     25   24   25   24   14   12.52   12.00   12.52   11.91   6.92   (6)  Roadway  Departure  Involved  Crash   Fatalities     36   40   25   28   20   18.02   19.99   12.52   13.89   9.88   (7)  Intersection  (or  Intersection  Related)  Crash   Fatalities   5   3   6   3   7   2.50   1.50   3.00   1.49   3.46   Passenger  Car  Occupant  Fatalities     16   13   4   4   13   8.01   6.50   2.00   1.98   6.42   Light  Truck  Occupant  Fatalities     21   21   14   26   13   10.51   10.50   7.01   12.90   6.42   Motorcyclist  Fatalities     4   12   6   8   8   2.00   6.00   3.00   3.97   3.95   Pedestrian  Fatalities     4   7   5   8   2   2.00   3.50   2.50   3.97   0.99   Bicyclist  (or  Other  Cyclist)  Fatalities     2   0   2   0   0   1.00   0.00   1.00   0.00   0.00   Data  Source:  National  Highway  Traffic  Safety  Administration,  Fatality  Analysis  Reporting  System,  2008-­‐2010   Notes:*  A  fatality  can  be  in  more  than  one  category.  Therefore,  the  sum  of  individual  cells  will  not  equal  the  total    (1)  Crash  involved  at   least  one  driver  or  motorcycle  rider  with  blood  alcohol  level  of  .08  or  above  (2)  Crash  involved  only  one  vehicle  in  transport  (3)  Crash   involved  at  least  one  large  truck  (4)  Crash  involved  at  least  one  vehicle  speeding  (5)  Crash  involved  at  least  one  vehicle  that  rolled  over   (6)  Crash  involved  at  least  one  vehicle  that  departed  the  roadway  (FHWA  definition)  (7)  Crash  occurred  within  an  intersection  or  within   approach  to  an  intersection.     Chronic  Disease  in  Mohave  County   Chronic  disease  refers  to  long-­‐term  life-­‐threatening  health  conditions  that  require  medical   intervention  and  management.  Chronic  illness  affects  the  population  worldwide.  Chronic   disease  is  the  leading  cause  of  death  and  disability  in  the  United  States.  It  accounts  for  70%   of  all  deaths  in  the  U.S  or  1.7  million  people  each  year.  Although  chronic  diseases  are   among  the  most  common  and  costly  health  problems,  they  are  often  among  the  most   preventable.    Most  can  be  effectively  controlled,  especially  if  the  disease  is  diagnosed  in   early  stages  and  the  patient  receives  proper  medical  care  and  strictly  follows  their  doctor’s   instructions.     The  following  indicators  show  the  prevalence  or  incidence  of  specific  chronic  diseases  in   Mohave  County.    Also  included  (where  data  is  available  and  applicable)  are  local  statistics   regarding  early  screening  for  and  management  of  certain  chronic  diseases.           Page   49                                                              Community  Health  Profile  for  Mohave  County,  2013   Heart  disease  prevalence   This  indicator  reports  the  percentage  of  adults  aged  18  and  older  in  Mohave  County  who   have  ever  been  told  by  a  doctor  that  they  have  heart  disease.    This  indicator  is  relevant   because  heart  disease  is  the  leading  cause  of  death  in  Mohave  County  and  throughout  the   U.S.  (see  page  35).     Figure  68:  Percent  Adults  in  Mohave  County  with  Heart  Disease   Report  Area   Mohave  County   Arizona   United  States   Number   Adults  with   Heart   Disease   Total   Population   (>Age  18  )   Percent   Adults  with   Heart   Disease   156,485   10,562   6.75%   4,633,315   201,086   4.34%   232,747,222   9,911,760.85   4.26%   Mohave  County   Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010.       High  blood  pressure  (hypertension)   High  blood  pressure  (or  hypertension)  is  a  chronic medical  condition  in  which  the  blood   pressure  in  the  arteries  is  elevated.  This  requires  the  heart  to  work  harder  than  normal  to   circulate  blood  through  the  blood  vessels.  Hypertension  is  a  major  risk  factor  for  stroke,   heart  attack,  heart  failure,  aneurysms  of  the  arteries  (aortic  aneurysm),  peripheral  arterial   disease  and  chronic  kidney  disease.  Even  moderately  high  blood  pressure  is  associated   with  a  shortened  life  expectancy.  Dietary  and  lifestyle  changes  can  improve  blood  pressure   and  decrease  the  risk  of  associated  health  complications.  However,  drug  treatment  is  often   necessary  in  people  for  whom  lifestyle  changes  prove  ineffective  or  insufficient.  The   following  figure  shows  the  percentage  of  adults  aged  18  and  older  in  Mohave  County  who   self-­‐report  that  they  have  been  diagnosed  with  high  blood  pressure  but  are  not  taking   medication  as  prescribed  by  their  doctor  for  managing  the  condition.       Figure  69:  Percent  Adults  w/  High  Blood  Pressure  Not  Taking  Medication   Report  Area   Mohave  County   Arizona   United  States   Total   Population   (>Age  18  )   156,485   Number   Adults  Not   Taking  Blood   Pressure   Medication       Percent  Adults   Not  Taking   Medication   37,697   24.09%   4,633,315   1,097,169   23.68%   232,747,222   50,606,335.52   21.74%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010       Page   50                                                                Community  Health  Profile  for  Mohave  County,  2013   Diabetes  prevalence   This  indicator  shows  the  percentage  of  adults  aged  20  and  older  in  Mohave  County  who  have   been  diagnosed  with  diabetes.    Diabetes  is  a  condition  in  which  the  body  does  not  properly   process  food  for  energy.  According  to  the  American  Diabetes  Association,  8.7%  of  Americans   have  diabetes.  Of  those,  it  is  estimated  that  7  million  people  are  unaware  they  have  the   disease.  Diabetes  is  a  leading  cause  of  blindness,  kidney  failure,  amputations,  heart  failure,  and   stroke.  Many  forms  of  diabetes  exist,  the  most  common  are:  1)  Type  1,  which  results  when  the   body  loses  its  ability  to  produce  insulin  (a  hormone  that  delivers  glucose,  or  sugar,  to  the   body’s  cells  to  use  for  energy),  2)  Type  2  diabetes,  which  results  from  a  combination  of   resistance  to  insulin  and  insufficient  insulin  production,  and  3)  gestational  diabetes,  a  common   complication  of  pregnancy.    Over  90%  of  all  cases  of  diabetes  are  Type  2,  which  is  the  most   preventable.    Being  overweight,  physically  inactive  and  eating  the  wrong  foods  greatly   contribute  to  the  risk  of  developing  Type  2  diabetes.         Figure  70:  Percent  Adults  w/Diabetes  in  Mohave  County     Report  Area   Mohave  County   Arizona   United  States   Total   Population     (Age  >20  )   192,336.84   Percent  with   Diabetes   Population   with  Diabetes   18,272   9.50%   4,911,483.45   382,775   7.79%   239,583,791.97   21,015,523   8.77%     Mohave  County     Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Diabetes  Surveillance  System,  2009 Asthma  prevalence   This  indicator  reports  the  percentage  of  adults  aged  18  and  older  who  self-­‐report  that  they   have  ever  been  told  by  a  doctor,  nurse,  or  other  health  professional  that  they  had  asthma.     Asthma  is  a  chronic  lung  disease  that  inflames  and  narrows  the  airways.  In  the  United   States,  more  than  25  million  people  are  known  to  have  asthma,  of  these,  about  7  million  are   children.    Asthma  is  often  exacerbated  by  poor  environmental  conditions,  including  se-­‐ cond-­‐hand  smoke.  The  high  percentage  in  Mohave  County  may  also  be  a  reflection  of  the   number  of  people  with  respiratory  conditions  who  relocate  to  the  southwest  United  States.     Figure  71:  Percent  Adults  w/Asthma  in  Mohave  County     Report  Area   Mohave  County,   Arizona   Arizona   United  States   Total   Population   (>Age  18  )   156,485   Number   Adults  with   Asthma   Percent  Adults   with  Asthma   26,070   16.66%   4,633,315   692,681   14.95%   232,747,222   30,473,296.44   13.09%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010       Page   51                                                                Community  Health  Profile  for  Mohave  County,  2013   Breast  cancer  incidence   Breast  cancer  is  a  leading  cause  of  death  among  women  in  the  United  States,  with  one  in   eight  women  contracting  the  disease.  Breast  cancer  begins  when  cells  located  in  the  breast   start  to  grow  out  of  control.  In  time,  these  cancer  cells  can  invade  other  tissues  in  the  body,   something  that  normal  cells  cannot  do.    If  not  detected  and  treated  in  time,  breast  cancer   kills.  In  the  United  States,  one  woman  dies  of  breast  cancer  every  13  minutes.  This  indicator   reports  the  incidence  rate  (number  of  cases  per  100,000  women,  per  year)  with  breast   cancer  in  Mohave  County.         Figure  72:   Annual  Incidence  Rate  of  Breast  Cancer  among  Women  in  Mohave  County  (2009)   Report  Area   Mohave  County   Arizona   United  States   Total   Population,   ACS  2005-­‐ 2009   192,988   Annual   Incidence,     2005-­‐2009   Average   Annual   Incidence  Rate     (Per  100,000   Pop.)   185   95.80   6,324,865   6,749   106.70   301,461,536   367,783   122   Mohave  County   Arizona   United  States     Data  Source:  The  Centers  for  Disease  Control  and  Prevention,  and  the  National  Cancer  Institute:  State  Cancer  Profiles,  2005-­‐2009.     Breast  cancer  screening  (mammogram)  among    Medicare  enrollees   The  following  figure  shows  the  percentage  of  female  Medicare  enrollees  (age  55  or  older)   in  Mohave  County  who  have  received  one  or  more  mammograms  in  the  past  two  years   (this  data  does  not  include  uninsured  women  or  others  with  AHCCCS  or  private  insurance).   A  mammogram  is  a  low-­‐dose  X-­‐ray  of  the  breast.  It  can  show  an  extremely  small  tumor   before  a  woman  or  her  doctor  can  feel  it  in  a  breast  exam.  Early  detection  with   mammograms  saves  many  thousands  of  lives  each  year.         Figure  73:   Percent  of  Female  Medicare  Enrollees  Regularly  Screened  for  Breast  Cancer   Report  Area   Mohave  County   Arizona   United  States   Total  Female   Medicare   Enrollees   Number   Regularly   Screened   Percent   Regularly   Screened   2,738   1,691   61.76%   35,042   22,412   63.96%   4,203,461   2,660,626   63.30%   Mohave  County   Arizona   United  States Data  Source:  Dartmouth  Atlas  of  Healthcare,  Selected  Measures  of  Primary  Care  Access  and  Quality,  2003-­‐2007     Cervical  cancer  incidence   Cervical  cancer  is  a  type  of  cancer  that  occurs  in  the  cells  of  the  cervix  —  the  lower  part  of   the  uterus  that  connects  to  the  vagina.  Various  strains  of  a  sexually  transmitted  infection       Page   52                                                              Community  Health  Profile  for  Mohave  County,  2013   called  human  papillomavirus  (HPV)  cause  most  cases  of  cervical  cancer.  Cervical  cancer   used  to  be  the  leading  cause  of  cancer  death  for  women  in  the  United  States.  However,  in   the  past  40  years,  the  number  of  cases  of  cervical  cancer  and  the  number  of  deaths  from   cervical  cancer  have  decreased  significantly.  This  decline  is  largely  due  to  the  result  of   women  getting  regular  Pap  tests,  which  can  find  pre-­‐cancer  cells  before  they  turn  into   cancer.  This  indicator  reports  the  incidence  rate  (cases  per  100,000  women  per  year)  of   females  in  Mohave  County  with  cervical  cancer.       Figure  74:  Annual  Incidence  Rate  of  Cervical  Cancer  in  Mohave  County   Report  Area   Mohave  County   Arizona   United  States   HP  2020  Target   Annual   Incidence,     2005-­‐2009   Average   Total   Population     Annual   Incidence   Rate       192,988   21   10.80   6,324,865   443   7   301,461,536   24,117   8       <=  7.1     Mohave  County,  Arizona   HP  2020  Target   United  States Note:  This  indicator  is  compared  with  the   Healthy  People  2020  Target.   Data  Source:  The  Centers  for  Disease  Control  and  Prevention,  and  the  National  Cancer  Institute:  State  Cancer  Profiles,  2005-­‐2009     Cervical  Cancer  Screening  (Pap  test)   This  indicator  reports  the  percentage  of  women  in  Mohave  County  aged  18  and  older  who   self-­‐report  that  they  have  had  a  Pap  test  to  screen  for  cervical  cancer  in  the  past  three   years.    A  Pap  test  can  identify  potentially  precancerous  changes  in  cervical  cells  and  tissue.     Once  detected,  treatment  can  prevent  the  development  of  cancer.  In  the  United  States,  the   widespread  use  of  cervical  screening  programs  has  dramatically  reduced  the  incidence  of   invasive  cervical  cancer.     Figure  75:  Percent  of  Mohave  County  Women  Screened  for  Cervical  Cancer   Report  Area   Mohave  County   Arizona   United  States   Total   Population   (Women  >   Age  18  )   76,680   Est.   Population   Regularly   Screened   Percentage   Regularly   Screened   56,436   73.60%   2,339,406   1,857,870   79.42%   116,709,909   86,326,160   73.97%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2004-­‐2010       Colon  and  rectal  cancer  incidence   This  indicator  reports  the  age  adjusted  incidence  rate  (cases  per  100,000  people,  per  year)   of  colon  and  rectal  cancer  in  Mohave  County.    Colon  cancer  is  cancer  of  the  large  intestine       Page   53                                                              Community  Health  Profile  for  Mohave  County,  2013   (colon).  Rectal  cancer  is  cancer  in  the  last  6  inches  of  the  colon.  Together,  these  are  often   referred  to  as  colorectal  cancers.    After  lung  cancer,  colorectal  cancers  are  the  second   leading  cause  of  cancer  death  in  the  United  States.    According  to  the  American  Cancer   Society,  about  153,000  people  are  diagnosed  with  colorectal  cancer  each  year  and  over   50,000  people  die  of  the  disease  each  year.    Many  of  these  deaths  could  be  prevented  with   proper  screening  and  detection.     Figure  76:  Annual  Incidence  Rate  of  Colorectal  Cancer  in  Mohave  County     Report  Area   Mohave  County   Arizona   United  States   HP  2020  Target   Annual   Incidence,     2005-­‐2009   Average   Total   Population,     Annual   Incidence  Rate       192,988   83   43   6,324,865   2,309   36.50   301,461,536   121,188   40.20     Mohave  County   HP  2020  Target   United  States   Note:  This  indicator  is  compared  with  the     <=  38.6   Healthy  People  2020  Target.   Data  Source:  The  Centers  for  Disease  Control  and  Prevention,  and  the  National  Cancer  Institute:  State  Cancer  Profiles,  2005-­‐2009.     Colon  cancer  screening  (sigmoid  &  colonoscopy)   Colorectal  cancer  almost  always  begins  as  small,  non-­‐cancerous  clumps  of  cells  called   polyps,  which  can  be  detected  through  screening  tests.    At  this  stage,  people  usually  have  no   symptoms.    Screening  tests  (sigmoidoscopy  or  colonoscopy)  can  detect  polyps,  which  can   be  removed  before  they  become  cancerous.    The  American  Cancer  Society  recommends   that  adult  men  and  women  start  getting  tested  for  the  disease  at  age  50.  The  following   figure  shows  the  percentage  of  adult  men  aged  50  and  older  who  self-­‐report  that  they  have   ever  had  a  sigmoidoscopy  or  colonoscopy  (data  on  colorectal  cancer  screening  among   women  in  Mohave  County  is  unavailable  at  this  time).       Figure  77:  Percent  of  Mohave  County  Men  >50  Ever  Screened  for  Colon  Cancer     Report  Area   Mohave  County   Arizona   United  States             Total   Population     (Men  Aged   >50)   Number  Ever   Screened   Percent  Ever   Screened   39,929   18,647   46.70%   4,549,661   2,522,653   55.45%   119,567,203   61,919,221   51.79%   Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2004-­‐2010 Page   54                                                                Community  Health  Profile  for  Mohave  County,  2013   Lung  cancer  incidence   This  indicator  reports  the  age  adjusted  incidence  rate  (cases  per  100,000  population  per   year)  of  lung  cancer  in  Mohave  County.  Lung  cancer  arises  when  a  series  of  mutations  in   normal  lung  cells  cause  them  to  become  abnormal  and  grow  out  of  control.  These  changes   can  take  place  anywhere  from  the  windpipe  down  to  the  small  air  sacs  in  the  lungs  where   oxygen  exchange  takes  place.  Over  85%  of  lung  cancers  are  caused  by  smoking.  Once   uncommon,  the  surge  in  smoking  of  the  20th  century  has  contributed  to  a  tremendous  rise   in  the  incidence  of  lung  cancer.  Lung  cancer  is  the  leading  cause  of  cancer  death  in  men  and   the  second  leading  cause  of  cancer  death  in  women  in  Mohave  County.      The  incidence  rate   of  lung  cancer  in  our  region  is  alarmingly  high  and  most  certainly  attributed  to  the  large   number  of  smokers  in  the  community  (see  page  35).     Figure  78:  Annual  Incidence  Rate  of  Lung  Cancer  in  Mohave  County   Report  Area   Mohave  County   Arizona   United  States     Total   Population,   ACS  2005-­‐ 2009   Annual   Incidence,     2005-­‐2009   Average   192,988   Annual   Incidence  Rate       161   83.40   6,324,865   3,453   54.60   301,461,536   202,582   67.20     Mohave  County   Arizona   United  States Data  Source:  The  Centers  for  Disease  Control  and  Prevention,  and  the  National  Cancer  Institute:  State  Cancer  Profiles,  2005-­‐2009   Prostate  cancer  incidence   This  indicator  reports  the  incidence  rate  (cases  per  100,000  population,  per  year)  of  males   in  Mohave  County  with  prostate  cancer.  Prostate  cancer  only  occurs  in  men  and  forms  in   tissues  of  the  prostate  (a  gland  in  the  male  reproductive  system).  Cancer  screening  tests,   prostate-­‐specific  antigen  (PSA)  test  and  digital  rectal  exam,  can  help  identify  prostate   cancer  early  on,  when  treatment  is  most  effective.       Figure  79:  Annual  Incidence  Rate  of  Prostate  Cancer  in  Mohave  County   Report  Area   Mohave   County,  Arizona   Arizona   United  States         Total   Population,   ACS  2005-­‐2009   192,988   Annual   Incidence,     2005-­‐2009   Average   Annual   Incidence  Rate       211   109.30   6,324,865   7,469   118.10   301,461,536   456,412   151.40   Mohave  County   Arizona   United  States   Data  Source:  The  Centers  for  Disease  Control  and  Prevention,  and  the  National  Cancer  Institute:  State  Cancer  Profiles,  2005-­‐2009   Page   55                                                              Community  Health  Profile  for  Mohave  County,  2013   Communicable  Diseases  in  Mohave  County   Measures  within  this  category  include  diseases  that  are  contagious  or  infectious.    That  is,   they  are  usually  transmitted  through  person-­‐to-­‐person  contact  or  by  shared  use  of   contaminated  instruments/materials.  Many  of  these  diseases  can  be  prevented  through   vaccination  or  through  the  use  of  protective  measures,  such  as  condoms  for  the  prevention   of  sexually-­‐transmitted  diseases.     The  following  table  lists  all  common  communicable  diseases  in  the  United  States  and  lists   the  number  of  cases  diagnosed  in  Mohave  County  during  2012,  along  with  the  five-­‐year   case  averages  in  Mohave  County  for  each  disease  listed.      Counts  reflect  cases  confirmed  in   Mohave  County  residents  based  on  data  reported  to  the  Mohave  County  Department  of   Public  Health  or  through  the  Medical  Electronic  Disease  Surveillance  Intelligence  System   (MEDSIS)  at  the  Arizona  Department  of  Health  Resources.     Figure  80:  Cases  of  Infectious  Disease  in  Mohave  County  (2012)   DIAGNOSIS   Aseptic  meningitis  (viral  brain  inflammation)     Campylobacteriosis  (bacterial  infection-­‐  often  foodborne)   Chlamydia  infection  (sexually  transmitted  virus)   Coccidioidomycosis  (Valley  Fever)   Enterohemorrhagic  (E.  coli)   Giardia  (intestinal  infection  caused  by  waterborne  parasite)   Gonorrhea  (sexually  transmitted  virus)   Haemophilus  influenza  (bacterial  influenza)   Hepatitis  A  (viral  liver  infection  from  fecal  matter)   Hepatitis  B  (viral  liver  infection  from  infectious  body  fluids)   Hepatitis  C  (viral  liver  infection  from  blood  to  blood  contact)   Herpes  (sexually  transmitted  virus)   Influenza  (viral  flu)   Legionnaires’  disease  (lung  inflammation  from  inhaled  bacteria)   Lyme  disease    (bacterial  infection  transmitted  by  ticks)   Meningococcal  invasive  disease  (bacterial  brain  inflammation)   MRSA  (antibiotic-­‐resistant  bacterial  infection)   Pertussis  (whooping  cough)**   Respiratory  syncytial  virus    or  RSV  (viral  respiratory  infection)   Salmonella  (bacterial  infection-­‐  often  food  borne)   Shigellosis  (also  known  as  dysentery  from  food  borne  bacteria)   Streptococcal  (Strep)  Group  A  (invasive  bacterial  infection)   Streptococcal  (Strep)  Group  B  (in  infants  <  90  days)   Streptococcus  (Strep)  pneumoniae  (invasive  bacterial  lung  infection)   Syphilis  (sexually  transmitted  virus)   Tuberculosis,  active  disease  (airborne  bacterial  infection)   Vibrio  infection  (bacterial  infection  from  seafood  or  seawater)   West  Nile  virus  (mosquito-­‐borne  virus)   Case  Count   2012   5-­‐yr  Average   5   10   316   124   0   2   27   6   3   14   112   28   274   0   0   0   37   66   39   18   0   3   4   33   3   1   1   0   11   8   271   103   1   5   13   5   2   12   84   36   216   0   0   0   46   14   55   15   2   5   1   35   5   3   0   0           Data  Source:  Mohave  County  Department  of  Public  Health     **  2012  represents  an  outbreak  year  for  pertussis  in  Mohave  County;  the  4  year  average  f  or  pertussis  (excluding  2012)  is  one  case  per  year.     Pertussis  can  be  prevented  with  vaccination. Page   56                                                              Community  Health  Profile  for  Mohave  County,  2013   HIV  prevalence   This  indicator  reports  prevalence  rate  of  human  immunodeficiency  virus  (HIV)  per   100,000  people  in  Mohave  County.    This  indicator  is  relevant  because  HIV  is  a  life-­‐ threatening  communicable  disease  that  disproportionately  affects  minority  populations   and  may  also  indicate  the  prevalence  of  unsafe  sex  practices.       Figure  81:    Prevalence  of  HIV  in  Mohave  County   Report  Area   Total   Population   ACS  2005-­‐2009   Mohave  County   Arizona   United  States   Estimated   Population   with  HIV   192,988   HIV   Prevalence   Rate   165   85.40   6,324,865   13,883   219.50   297,679,913   994,491   334     Mohave  County   Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention  and  the  National  Center  for  HIV/AIDS,  Viral  Hepatitis,  STD,  and  TB   Prevention,  2008     Maternal  &  Child  Health   One  of  the  most  significant  indicators  for  monitoring  community  health  is  the  health  of  the   community’s  most  vulnerable  population:  infants  and  children.  This  category  focuses  on   birth  data  and  outcomes  as  well  as  mortality  data  for  infants.    Additionally,  the  number  of   births  to  teen  mothers  is  a  critical  indicator  of  increased  risk  for  both  mother  and  child.     Low  birth-­‐weight  infants   This  indicator  reports  the  percentage  of  total  births  that  were  low  birth  weight  (under   2500g  or  5  lbs.,  8  oz.).  This  indicator  is  relevant  because  low  birth  weight  infants  are  at   high  risk  for  health  problems.  This  indicator  can  also  highlight  the  existence  of  health   disparities  pertaining  to  access  to  prenatal  care  and  maternal  and  child  health.       Figure  82:    Percentage  of  Low  Birth-­‐Weight  Infants  in  Mohave  County   Report  Area   Mohave  County   Arizona   United  States           Total  Births   Number  Low   Birth  Weight   (<  2500g)   Percent  Low   Birth  Weight   16,511   1,150   6.97%   673,131   47,339   7.03%   29,126,451   2,359,843   8.10%   Mohave  County     Arizona   United  States Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Vital  Statistics  Systems,  2003-­‐2009.   Page   57                                                                Community  Health  Profile  for  Mohave  County,  2013     Infant  mortality   This  indicator  reports  the  rate  of  deaths  to  infants  less  than  one  year  of  age  per  1,000   births  in  Mohave  County.  This  indicator  is  relevant  because  high  rates  of  infant  mortality   indicate  the  existence  of  broader  issues  pertaining  to  access  to  prenatal  care  and  maternal   and  child  health.       Figure  83:    Infant  Mortality  Rate  in  Mohave  County  (per  1,000  Births)   Report  Area   Mohave  County   Arizona   United  States   HP  2020  Target Total  Infant   Deaths   Total  Births     Infant  Mortality   Rate     16,648   130   7.81   678,479   4,438   6.54   58,600,996   393,074   6.71       <=  6.0   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Vital  Statistics  System,  2003-­‐2009   Mohave  County     HP  2020  Target   United  States     Note:  This  indicator  is  compared  with   the  Healthy  People  2020  Target.       Teen  birthrate   This  indicator  reports  the  rate  of  total  births  to  teenage  women  in  Mohave  County  per   1,000  females,  age  15  -­‐  19.  This  indicator  is  relevant  because  in  many  cases,  teen  parents   have  unique  social,  economic,  and  health  support  services.  Additionally,  high  rates  of  teen   pregnancy  may  indicate  the  prevalence  of  unsafe  sex  practices.       Figure  84:    Teen  Birth  Rate  in  Mohave  County  to  Women  Age  15-­‐19  (per  1,000  Births)   Report  Area   Mohave   County   Arizona   United  States     Female   Population     Age  15  -­‐  19   38,047   Births  to   Mothers  Age   15  -­‐  19   Teen  Birth   Rate     2,454   64.50   1,433,853   83,737   58.40   72,071,117   2,969,330   41.20   Mohave  County     Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Vital  Statistics  Systems,  2003-­‐2009.  Accessed  through  the  Health   Indicators  Warehouse   Social  &  Mental  Health   This  category  represents  social  and  mental  factors  and  conditions  which  directly  or   indirectly  influence  overall  health  status  and  individual  and  community  quality  of  life.   Mental  health  conditions  and  overall  psychological  well-­‐being  and  safety  may  be  influenced   by  substance  abuse  and  violence  within  the  home  and  within  the  community.         Page   58                                                              Community  Health  Profile  for  Mohave  County,  2013   Adequate  social  or  emotional  support   This  indicator  reports  the  percentage  of  adults  in  Mohave  County  aged  18  and  older  who   self-­‐report  receiving  sufficient  social  and  emotional  support  all  or  most  of  the  time.  This   indicator  is  relevant  because  social  and  emotional  support  is  critical  for  navigating  the   challenges  of  daily  life  as  well  as  for  good  mental  health.  Social  and  emotional  support  is   also  linked  to  educational  achievement  and  economic  stability.       Figure  85:   Adults  in  Mohave  County  reporting  they  Receive  Adequate  Social/Emotional  Support   Surveyed   Population     (>Age  18  )   Report  Area   Mohave  County   Arizona   United  States   Adults   Reporting   Adequate   Support   Percent  Adults   Reporting   Adequate   Support   2,344   1,767   75.38%   37,174   29,739   80.00%   2,744,636   2,204,749   80.33%   Mohave  County     Arizona   United  States   Data  Source:  Centers  for  Disease  Control  and  Prevention,  Behavioral  Risk  Factor  Surveillance  System,  2006-­‐2010     Homicide  rate  in  Mohave  County   This  indicator  reports  the  rate  of  death  due  to  assault  (homicide)  per  100,000  people.  This   indicator  is  relevant  because  the  homicide  rate  is  a  measure  of  social  and  mental  health  and   a  leading  cause  of  premature  death.  The  following  indicator  shows  the  rate  of  death  due  to   homicide  in  Mohave  County  from  the  most  recent  statistics  from  the  U.S.  Centers  for   Disease  Control  (CDC).    Note  that  the  latest  statistics  (2011)  from  the  Arizona  Department   of  Health  Services  (see  page  44)  show  a  lower  death  rate  from  homicide  in  Mohave  County.         Figure  86:    Homicide  Rate  in  Mohave  County  (per  100,000  pop.)         Report  Area           Total   Annual   Population,     Deaths,     2006-­‐2010   2006-­‐2010   Average   Average   Crude     Homicide   Death  Rate       Age-­‐ Adjusted   Homicide   Death  Rate     Mohave   County   199,178   14   7.13   8.46   Arizona   6,242,471   471   7.55   7.62   United  States   303,844,430   17,564   5.78   5.81   HP  2020  Target         <=  5.5   Mohave  County   HP  2020  Target   United  States Note:  This  indicator  is  compared  with   the  Healthy  People  2020  Target.   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Center  for  Health  Statistics,  Underlying  Cause  of  Death,  2006-­‐2010.   Page   59                                                                Community  Health  Profile  for  Mohave  County,  2013   Suicide  rate  in  Mohave  County   This  indicator  reports  the  rate  of  death  due  to  intentional  self-­‐harm  (suicide)  per  100,000   people.  This  indicator  is  relevant  because  suicide  is  an  indicator  of  poor  mental  health.    It  is   estimated  that  as  much  of  90%  percent  of  all  suicide  cases  meet  criteria  for  a  psychiatric   disorder;  particularly  major  depression,  substance  abuse,  personality  disorders,  and   schizophrenia.  The  following  indicator  shows  the  rate  of  death  due  to  suicide  in  Mohave   County  from  the  most  recent  statistics  from  the  U.S.  Centers  for  Disease  Control  (CDC).     Note  that  the  latest  statistics  (2011)  from  the  Arizona  Department  of  Health  Services  (see   page  44)  show  a  significantly  higher  death  rate  from  suicide  in  Mohave  County.     Figure  87:    Suicide  Rate  in  Mohave  County  (per  100,000  pop.)   Report  Area   Total   Population,     2006-­‐2010   Average   Mohave  County   199,178   60   30.12   28.37   2,871,545   419   14.58   14.59   303,844,430   35,841   11.80   11.57   Arizona   United  States   HP  2020  Target             Annual   Suicides,     2006-­‐2010   Average     Crude   Suicide   Rate         Age-­‐Adjusted   Suicide  Rate     <=  10.2   Mohave  County     HP  2020  Target   United  States Note:  This  indicator  is  compared  with   the  Healthy  People  2020  Target.   Data  Source:  Centers  for  Disease  Control  and  Prevention,  National  Center  for  Health  Statistics,  Underlying  Cause  of  Death,  2006-­‐2010.     Page   60                                                                Community  Health  Profile  for  Mohave  County,  2013   Community  Input  on  Health  Needs  in   Mohave  County   Key  Informant  Observations   As  part  of  the  community  health  assessment  process,  members  of  the  Mohave  County   Community  Health  Coalition  conducted  interviews  with  individuals  (key  informants)  who   represent:    a)  broad  interests  of  the  community,  b)  populations  of  need,  and  c)  persons   with  specialized  knowledge  in  public  health.    The  purpose  of  the  interviews  was  to   ascertain  opinions  among  individuals  likely  to  be  knowledgeable  about  health  concerns  in   the  community.    This  section  includes  a  summary  or  those  opinions.     Methodology   Interviews  with  26  key  informants  were  conducted  in  the  fall  of  2012.  These  individuals   represented  the  following  community  sectors:          Social  Service  Agencies    Local  School  System  and  Community  College    Local  City  and  County  Government    Public  Health  Agencies    Industry    Faith  Community      Medical  Providers     All  interviews  were  conducted  using  a  standard  questionnaire  (see  Appendix  B).    The  key   informants  provided  comments  on  the  following  issues:      Health  and  quality  of  life  for  residents  of  the  community    Barriers  to  improving  health  and  quality  of  life  for  residents  in  the  community    Opinions  regarding  the  important  health  issues  that  affect  Mohave  County  residents   and  the  types  of  services  that  are  important  for  addressing  these  issues    Delineation  of  the  most  important  healthcare  issues  or  services  discussed  and   actions  necessary  for  addressing  those  issues.     Interview  data  was  initially  recorded  in  narrative  form  in  Microsoft  Word.    Themes  in  the   data  were  identified  and  representative  quotes  have  been  drawn  from  the  data  to  illustrate   the  themes.    Interviewees  were  assured  that  personal  identifiers  such  as  name  or   organizational  affiliations  would  not  be  connected  in  any  way  to  the  information  presented   in  this  report.    Therefore,  quotes  included  in  the  report  may  have  been  altered  slightly  to   preserve  confidentiality.     This  technique  does  not  provide  a  quantitative  analysis  of  the  leaders’  opinions,  but  reveals       Page   61                                                              Community  Health  Profile  for  Mohave  County,  2013   some  of  the  factors  affecting  the  views  and  sentiments  about  overall  health  and  quality  of   life  within  Mohave  County.       Interview  questions   The  interview  questions  for  each  key  informant  were  identical.    The  questions  on  the   interview  instrument  are  grouped  into  four  major  categories  for  discussion:     1. General  opinions  regarding  Health  and  Quality  of  Life  in  the  Community   2. Underserved  Populations  and  Communities  of  Need   3. Barriers   4. Most  important  health  and  quality  of  life  issues     A  summary  of  the  leaders’  responses  by  each  of  these  categories  follows.    Paraphrased   quotes  are  included  to  reflect  some  commonly  held  opinions  and  direct  quotes  are   employed  to  emphasize  strong  feelings  associated  with  the  statements.    This  section  of  the   report  summarizes  what  the  key  informants  said  without  assessing  the  credibility  of  their   comments.     General  opinions  regarding  health  and  quality  of  life  in  the  community   The  key  informants  were  asked  to  rate  the  health  and  quality  of  life  in  their  respective   community.    They  were  also  asked  to  provide  their  opinion  whether  the  health  and  quality   of  life  had  improved,  declined,  or  stayed  the  same  over  the  past  few  years.    Lastly,  key   informants  were  asked  to  provide  support  for  their  answers.       Interviewees  were  mixed  on  responses  on  whether  the  health  and  quality  of  life  had   improved,  declined  or  stayed  the  same  over  the  past  few  years.    38%  felt  there  has  been  a   decline,  38%  felt  things  have  stayed  the  same  and  24%  felt  that  there  has  been  an   improvement.    While  the  key  informants  were  split,  there  was  a  general  agreement  on  the   impact  the  economy  has  played  in  the  health  of  the  community.    Interviewees  continually   noted  that  the  health  needs  of  those  in  a  lower  socioeconomic  level  were  the  most  cause  for   concern.     Many  key  informants  mentioned  the  need  to  provide  additional  options  for  free  and   reduced  cost  clinics.    There  was  a  general  sense  that  lower  income  individuals  did  not  have   access  to  preventative  care  necessary  to  lead  healthy  lives.    The  lack  of  reduced  cost  dental   services  in  the  community  was  also  a  concern  that  was  raised  numerous  times.    The   indication  was  that  poor  dental  care  leads  to  other  physical  conditions  as  well  as  an  overall   lower  sense  of  self-­‐worth.     “People  can’t  afford  food,  homes  and  healthcare.    They  choose  food  and  shelter  first.”     “Lack  of  competition  for  physical  and  mental  health  providers.”     “Lots  of  good  energy  in  the  community.    Improvements  are  being  made.”       Page   62                                                              Community  Health  Profile  for  Mohave  County,  2013   Underserved  populations  and  communities  of  need   Key  informants  were  asked  to  provide  their  opinions  regarding  specific  populations  or   groups  of  people  whose  health  or  quality  of  life  may  not  be  as  good  as  others.    We  also   asked  the  key  informants  to  provide  their  opinions  as  to  why  they  thought  these   populations  were  underserved  or  in  need.    We  asked  each  key  informant  to  consider  the   specific  populations  they  serve  or  those  with  which  they  usually  work.         Respondents  felt  that  quality-­‐of-­‐life  and  health  are  greatly  impacted  by  socioeconomic   status.    Children  being  raised  in  households  with  fewer  financial  resources  were   considered  in  need  due  to  lack  of  access  to  services,  both  medical  and  dental.    Additionally,   healthy  nutrition  for  children  in  these  households  was  limited  due  to  the  cost  of  fruits  and   vegetables.    Persons  who  live  in  rural  areas  were  also  reported  in  this  category.     Transportation  was  felt  to  be  a  major  barrier  for  persons  living  in  rural  areas  with  few   financial  resources.         The  uninsured/underinsured  are  considered  to  have  issues  accessing  care.    Respondents   repeatedly  noted  additional  needs  for  resources  in  this  area.    69%  of  those  interviewed   indicated  that  there  are  not  enough  low  cost  providers  available  in  the  area.    Respondents   continually  noted  that  emergency  rooms  are  being  used  as  primary  care  providers  by   many.    27%  of  those  interviewed  also  brought  up  dental  care  as  a  major  issue  for  those   with  fewer  resources.    Indications  were  made  of  very  limited  availability  of  dental   resources  for  lower  income  individuals.     Many  key  informants  recognized  that  the  mentally  ill  experience  significant  health  issues   and  have  a  lower  quality  of  life  compared  to  the  rest  of  the  community.    An  overwhelming   sentiment  existed  among  the  key  informants  that  the  community  did  not  have  enough   mental  health  providers,  that  the  amount  of  time  to  get  into  see  mental  health  providers   was  too  long,  and  that  the  community  lacked  sufficient  inpatient  and  outpatient  mental   health  services.    35%  of  interviewees  felt  that  additional  behavioral  health  and  drug   detoxification  facilities  were  needed  in  the  community.     Barriers   The  key  informants  were  asked  what  barriers  or  problems  keep  community  residents  from   obtaining  necessary  health  services  in  their  community.    Responses  from  key  informants   include  lack  of  education  and  communication,  lack  of  low  cost  providers,  lack  of  behavioral   health  facilities,  lack  of  transportation,  and  general  decline  in  economic  conditions.         Lack  of  education  and  communication  surrounding  health  issues  and  the  availability  of   health  resources  is  seen  as  a  primary  barrier  to  health  services.    Respondents  indicated   that  children  through  adults  do  not  receive  the  education  they  need  on  how  to  lead  healthy   lifestyles.    Interviewees  indicated  that  the  lack  of  low  cost  primary  care  providers   continually  leads  individuals  to  receive  no  care  until  they  end  up  in  the  emergency  room.         Individuals  noted  that  there  is  an  alcohol  and  drug  abuse  issue  within  the  community.    39%       Page   63                                                              Community  Health  Profile  for  Mohave  County,  2013   of  those  interviewed  indicated  that  alcohol  and  drugs  are  a  problem.  Many  felt  that  the  lack   of  behavioral  health  facilities  in  the  community  contributed  to  individuals  self-­‐medicating   through  the  abuse  of  alcohol  and  drugs.     As  previously  noted,  people’s  attitudes  and  culture,  surrounding  health  and  lifestyle   choices,  are  seen  as  a  barrier.    Bad  habits  are  passed  down  from  generation  to  generation   and  there  are  not  enough  resources  to  bring  about  a  change.     “Money  is  being  spent  on  disaster  preparedness,  but     where  is  the  money  for  preventable  disease?”     Social  Services  Agency  representative  indicated  frequent  calls  of     “I  don’t  know  how  to  be  a  parent.”     “Health  care  resources  are  doing  damage  control.”     “It’s  a  combination  of  lack  of  education  and  just  not  caring.”     “Quality  of  social  opportunities  limits  the  ability  to  recruit  and  retain  [healthcare]  providers.”     Most  important  health  and  quality  of  life  issues   Key  informants  were  asked  to  provide  their  opinion  as  to  the  most  critical  health  and   quality  of  life  issues  facing  the  county.    The  issues  identified  most  frequently  were:  1)  lack   of  low-­‐cost  dental  and  health  providers;  2)  lack  of  education;  and  3)  poor  nutritional  habits.     “It’s  more  economical  to  buy  fast  food  and  snacks  than  fruits  and  vegetables.”     “Need  farmer’s  markets  and  other  resources  for  healthy  foods.”     “Taco  Bell  and  pizza  for  school  lunches”     “Difficult  to  change  habits  and  mindsets  unless  you  can  get  to  them  while  they  are  young”     “Some  families  can’t  afford  to  pay  $10  for  health  physical  so  they  can  play  sports.”     Key  Findings   A  summary  of  themes  and  key  findings  provided  by  the  key  informants  follows:      Information  and  education  on  health  issues  is  a  problem.    There  is  a  significant  need  to   inform,  educate,  and  counsel  specific  categories  of  the  community.      There  is  a  need  for  additional  low  cost  or  free  primary  care  providers  in  the   community.      The  ability  to  recruit  and  retain  providers  in  the  community  is  a  barrier  to  improving   the  quality  of  health  in  the  community.       Page   64                                                              Community  Health  Profile  for  Mohave  County,  2013          There  is  a  lack  of  access  for  mental  health  services  and  facilities,  particularly  inpatient   services  and  drug  detoxification  services.          Drug  and  alcohol  abuse  are  seen  as  a  health  and  quality  of  life  issue.          Transportation  may  be  an  issue  for  elderly,  single-­‐family  households  and  people  living   in  rural  unincorporated  areas.      There  is  a  severe  lack  of  affordable  dental  providers  in  the  county.      People’s  attitudes  and  choices  lead  to  poor  health.    Many  residents  are  apathetic   regarding  wellness  and  health.     Page   65                                                              Community  Health  Profile  for  Mohave  County,  2013   Community  Stakeholder  Observations   A  questionnaire  was  distributed  to  individuals  serving  on  the  Mohave  County  Community   Health  Coalition,  who  represent  broad  interests  of  the  community.    The  questionnaire  was   intended  to  supplement  the  key  informant  interviews  discussed  above.  Forty-­‐four   stakeholder  questionnaires  were  completed  and  returned.    A  copy  of  the  stakeholder   questionnaire  is  included  in  Appendix  C.       Assessment  of  the  general  health  of  the  community   Community  Stakeholders  were  asked  to  rate  the  general  health  of  the  community.    The   following  results  were  noted:                  0%  -­‐  Very  Healthy      9.09%  -­‐  Healthy   43.19%  -­‐  Somewhat  Healthy   45.45%  -­‐  Unhealthy        2.27%  -­‐  Very  Unhealthy     “I  don’t  think  most  people  understand  how  much  their   daily  choices  impact  their  overall  health.”     “Lots  of  disparity  in  this  area  –  sub-­‐communities  of  people  who  are  health  conscious.       As  a  whole,  communities  don’t  seem  healthy.”     “Depends  on  their  economic  condition!”     Factors  for  a  “healthy  community”   Stakeholders  were  asked  to  mark  the  three  most  important  factors  for  a  “Healthy   Community.”    The  following  responses  were  noted  the  most  often  by  respondents:                  18.12%  -­‐  Good  jobs  and  healthy  economy                    16.78%  -­‐  Access  for  quality  healthcare  services                    15.44%  -­‐  Healthy  behaviors  and  lifestyles                        9.04%  -­‐  Access  to  healthy  foods  (e.g.,  fresh  fruits  and  vegetables)                        8.05%  -­‐  Recreational  and  physical  activity  opportunities  (parks,  gyms,  etc.)                        7.38%  -­‐  Adequate  health  insurance     “Organic  foods  available  on  a  limited  and  costly  basis.    Way  too  much  fast  food.       Why  does  Kingman  need  3  McDonalds?    People  go  to  ER  because  they  can’t  get  in  with     primary  care  providers  in  a  timely  way.”     “Though  the  basis  for  a  quality  community  includes  healthcare,  strong  economy,  and     good  schools;  the  other  factors  listed  are  also  necessary.”     “Economic  growth  is  the  #1  way  to  get  people  out  of  poverty.    We  have  a  large     Medicare  and  Medicaid  population.”     Most  important  health  problems  in  the  community   Community  Stakeholders  were  asked  to  mark  the  three  most  important  “health  problems”       Page   66                                                              Community  Health  Profile  for  Mohave  County,  2013   in  the  community.    The  following  responses  were  noted  the  most  often  by  respondents:              20.14%  -­‐  Drug  addiction              14.39%  -­‐  Aging  problems  (e.g.,  arthritis,  osteoporosis,  etc.)              13.67%  -­‐  Mental  health  problems              11.51%  -­‐  Heart  disease  and  stroke                    6.47%  -­‐  Diabetes                    5.76%  -­‐  Alcoholism     “Motivating  behaviors  that  influence  controllable  risk  factors  would  result     in  better  quality  and  length  of  life.”     High-­‐risk  health  behaviors   Community  Stakeholders  were  asked  to  mark  the  three  most  important  “risky  behaviors”   in  the  community.    The  following  responses  were  noted  the  most  often  by  respondents:     22.22%  -­‐  Drug  abuse   17.04%  -­‐  Being  overweight   15.56%  -­‐  Alcohol  abuse   11.11%  -­‐  Not  seeking  preventive  care          9.63%  -­‐  Tobacco  use        8.15%  -­‐  Poor  eating  habits     “This  was  a  hard  choice  because  all  apply.    Lack  of  exercise  in  schools  has  inflated  the  Generation  X   leap  into  a  sedentary  lifestyle  thus  decreasing  overall  health.”     “All  are  risky,  some  just  more  than  others.”     Barriers  to  healthcare  access   Community  Stakeholders  were  asked  to  mark  the  three  most  important  barriers  to   accessing  healthcare  in  the  community.    The  following  responses  were  noted  the  most   often  by  respondents:       26.12%  -­‐  Economic  conditions  (unemployment,  poverty,  etc.)   16.42%  -­‐  Lack  of  health  insurance   11.94%  -­‐  Lack  of  affordable  healthcare  services   11.94%  -­‐  Low  health  literacy/education        8.21%  -­‐  Dysfunctional  home  life        5.22%  -­‐  Lack  of  transportation  to  healthcare  services   “Many  people  are  w/out  income.    We  have  North  Country  Healthcare  but  could  use  another  provider.”     “Lack  of  health  insurance  is  a  huge  driver,  especially  since  the  population  as  a     whole  is  unfamiliar  with  the  concept  of  a  community  health  center.”     “Doctors  keep  leaving  community.    No  rheumatologist,  no  diabetes  specialists,     no  residential  treatment,  no  integrated  health  care.           Page   67                                                              Community  Health  Profile  for  Mohave  County,  2013   Primary  Care  and  Mental  Health  Provider  Observations   A  questionnaire  was  distributed  to  a  number  of  primary  care  and  mental  health  providers   in  the  community.    The  intent  of  the  questionnaire  was  to  obtain  input  from  professionals   who  deal  directly  with  health  issues  in  the  community  on  a  daily  basis.    The  questionnaire   was  intended  to  supplement  the  key  informant  interviews.    Eighteen  questionnaires  were   completed  and  returned.    A  copy  of  the  questionnaire  is  included  in  the  Appendix  D.         Figure  89-­‐a:    Primary  Care  &  Mental  Health  Provider  Responses  (part  1)   Medical  Specialty   What  is  the  #1  health  problem   in  Mohave  County?   Pediatric  M.D.   Methamphetamine  addiction   Family  Practice  D.O.   Obesity   Family  Practice  D.O.   Obesity   Family  Nurse  Practitioner     Family  Nurse  Practitioner   Problems  associated  with  drug  abuse   Family  Nurse  Practitioner   Family  Practice  D.O.   Obesity   Lack  of  medical/dental  care,  obesi-­‐ ty/diabetes,  lack  of  availability  to  get   medications,  alcoholism   Family  Nurse  Practitioner   Cancer   Adult  Med.  Nurse  Practitioner   Community  Health-­‐  No  plan   Family  Practice  M.D.   Patients  without  medical  insurance   Obesity,  uncontrolled  diabetes-­‐2,   street  drugs-­‐  meth,  heroin,  psyche   problems   Ignorance,  lack  of  attention  to  per-­‐ sonal  health   Family  Practice  M.D.   Family  Practice  M.D.     Family  Practice  D.O.   Psychologist   Psychiatric  Spec.  Nurse  Practitioner   Psychiatric/Mental  Health  Nurse   Practitioner   Psychologist     Psychologist   COPD   Obesity   Obesity   Number  of  homeless  people  with  no   benefits   Acute  upper  respiratory  infections,   behavioral  problems   Obesity,  diabetes,  smoking,  illicit  drug   abuse,  mental  health   Hypertension,  diabetes  2,  COPD,  to-­‐ bacco  and  drug  abuse   Diabetes,  hypertension,  wounds,  drug   abuse  associated  issues   Diabetes,  hypertension,  COPD   Diabetes,  coronary  artery  disease,   hypertension,  depression,  chronic   pain   Diabetes,  dental  cavities,  COPD,  con-­‐ gestive  heart  failure,  psyche  condi-­‐ tions,  alcoholism   Diabetes,  COPD,  cancer,  hypertension,   obesity   Hypertension,  diabetes,  hyper-­‐ lipidemia,  obesity,  COPD,  kidney  dis-­‐ ease   Diabetes,  hypertension,  obesity,   COPD,  coronary  artery  disease,  non-­‐ alcoholic  fatty  liver  disease   Diabetes  2,  hypertension,  COPD,  psy-­‐ che  problems-­‐  lack  of  providers   Obesity,  diabetes,  COPD,  hypertension   Hypertension,  anxiety,  pain   Obesity  causing  diabetes,  raised  li-­‐ pids,  hypertension,  chronic  pain   Chronic  pain,  drug  abuse   Inappropriate  use  of  drugs   Chronic  pain,  dependency  to  pre-­‐ scribed  meds   Diabetes,  hypertension,  pain   Depression,  anxiety,  substance  abuse   problems   Not  enough  physicians  in  some  areas   Mood  disorders  and  substance  abuse             What  are  the  most  common   health  problems  you  see?   Page   68                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  89-­‐b:    Primary  Care  &  Mental  Health  Provider  Responses  (part  2)   Medical  Specialty   Pediatric  M.D.   Family  Practice  D.O.   Family  Practice  D.O.   Family  Nurse  Practitioner   What  chronic  diseases   do  you  feel  are  a  con-­‐ cern  in  our  area?   Mental  health  problems-­‐   no  child  psychiatrists   Mental  health,  obesity,   illicit  drug  usage,  alcohol-­‐ ism   COPD,  diabetes,  tobacco   abuse,  obesity,  alcohol   abuse   Diabetes,  hypertension,   COPD   What  communicable   diseases  do  you  feel   are  a  concern  in  our   area?   What  health  behaviors  do   you  feel  are  a  concern  in   our  area?   MRSA   Distrust  of  medical  communi-­‐ ty;  parents  against  vaccina-­‐ tions     Teaching  people  to  take  care   of  themselves  in  general   Hepatitis  C,  STD's-­‐  esp.:   Herpes  2   Family  Nurse  Practitioner   COPD,  diabetes   Drug  use/abuse  of  pre-­‐ scription  meds   STD's   Human  papillomavirus   (HPV),  Chlamydia,  drug   use,  abuse  of  prescription   pain  meds   STD's-­‐  human  papilloma-­‐ virus  (HPV),  Herpes,  MRSA   Family  Practice  D.O.   Family  Nurse  Practitioner   Obesity,  diabetes,  heart   disease,  access  to  mammo-­‐ grams   Diabetes,  COPD   STD's/  Hepatitis  B  &  C   MRSA,  Hepatitis  C   Family  Nurse  Practitioner   Adult  Med.  Nurse  Practi-­‐ tioner   Family  Practice  M.D.   Family  Practice  M.D.   Family  Practice  M.D.     Family  Practice  D.O.   Psychologist   Psychiatric  Spec.  Nurse   Practitioner   Psychiatric/Mental  Health   Nurse  Practitioner   Psychologist     Psychologist   Diabetes,  obesity   COPD,  diabetes,  hyperten-­‐ sion,  congestive  heart  fail-­‐ ure   Diabetes,  obesity,  hyper-­‐ tension,  COPD   Hepatitis  C,  MRSA   Smoking,  teen  pregnancy   Addictive/depression/bipolar-­‐   no  good  resources   STD's,  little  prevention  prac-­‐ ticed,  young  first  time  preg-­‐ nancies,  untreated  Hepatitis  C,   psyche  help  is  inadequate   Smoking,  substance  abuse   Pain  management,  prescrip-­‐ tion  drug  abuse,  tobac-­‐ co/alcohol  abuse   STD's   Non-­‐comprehensive  education   about  the  disease   STD's,  Hepatitis   Viral  &  respiratory  disease   spread,  sick  people  staying   at  work  or  school  because   of  punitive  threats  by  em-­‐ ployment   All  of  the  above   Diabetes  2,  chronic  pain   Obesity  causing  diabetes,   raised  lipids,  hypertension,   chronic  pain   Schizophrenia,  bipolar   disorder   Drug  dependency,  pre-­‐ scribed  medication  de-­‐ pendency,  alcohol   dependency   Obesity,  diabetes,  hyper-­‐ tension     Hepatitis  C     Poor  eating  habits,  no  exer-­‐ cise,  minimal  preventative   care   Hepatitis  C,  MRSA   Smoking  and  drug  abuse   Hepatitis  C,  Tuberculosis   Overuse  of  the  medical  system   Hepatitis       Substance  abuse   Diabetes,  schizophrenia   HIV,  Hepatitis  C   Chronic  pain  management   COPD,  diabetes           IV  drug  use,  risky  sexual  be-­‐ haviors   Non-­‐compliance  to  treatment   or  medication;  drug  abuse   Page   69       Poor  compliance  secondary  to   cost  of  health  care                                                          Community  Health  Profile  for  Mohave  County,  2013   General  Public  Observations   To  obtain  input  from  the  general  public  in  Mohave  County,  a  community  survey  was   conducted  by  the  Mohave  County  Community  Health  Coalition  under  the  direct   collaborative  leadership  of  Kingman  Regional  Medical  Center  (KRMC)  and  the  Mohave   County  Department  of  Public  Health  (MCDPH).    The  survey  was  available  to  the  public  from   December  3,  2012  through  January  31,  2013.     The  purpose  of  the  survey  was  to  obtain  broad  community  input  regarding  health  and   quality  of  life  issues  in  Mohave  County.    A  web-­‐based  survey  tool,  Question  Pro  was  utilized   to  conduct  an  electronic  survey,  which  was  available  on  both  KRMC’s  and  MCDPH’s   websites.    Paper  surveys,  which  were  identical  to  the  electronic  survey,  were  also   distributed  to  populations  who  may  not  have  access  to  the  internet.         1,756  surveys  were  completed  and  returned  and  were  comprised  of  1,415  electronic   surveys  and  341  paper  surveys.    Socio-­‐demographic  characteristics  such  as  age,  education,   income,  and  employment  status  were  fairly  comparable  to  the  most  recent  census  data.     Over  73%  of  the  survey  respondents  were  female,  which  is  more  than  the  50%  of  the   population  that  is  female  in  the  community.       The  survey  instrument  used  is  based  largely  on  the  Centers  for  Disease  Control  and   Prevention  (CDC)  Behavioral  Risk  Factor  Surveillance  System  (BRFSS),  as  well  as  various   other  public  health  surveys  and  customized  questions.    The  final  survey  instrument  was   developed  by  the  Mohave  County  Community  Health  Coalition  Survey  Taskforce  (see   Appendix  E  for  a  copy  of  the  survey  instrument).       The  actual  survey  was  quite  detailed  in  nature,  including  many  specific  questions  regarding   general  health,  satisfaction  with  specific  and  general  providers,  and  demographic   information.    The  figures  on  the  following  pages  include  a  compilation  of  the  survey  results   organized  by  survey  question  along  with  selected  comments  by  survey  respondents.                                 Page   70                                                              Community  Health  Profile  for  Mohave  County,  2013   How Would You Rate Your Personal Health Figure  90:  How  would  you  rate  your  personal  health?   Zip  Code  Grouping+   Zip Code Grouping Kingman Bullhead City Lake Havasu City Outly ing Communities All Other * Total Source: 70.00%   Total Ve ry Som e w hat Re s pons e s He althy He althy 933 210 397 57 159 13.61% 9.52% 14.11% 7.27% 11.40% 58.31% 61.90% 61.21% 59.65% 53.51% 1756 12.86% 59.15% Unhe althy Ve ry Unhe althy Unhe althy 24.12% 24.29% 22.67% 29.82% 30.70% 3.22% 3.81% 1.76% 1.82% 3.51% 0.75% 0.48% 0.25% 1.82% 0.88% 24.43% 2.92% 0.64%   Mohave County Community Health Survey * All other denotes individuals that did not provide a zip code. 60.00%   50.00%   40.00%   30.00%   20.00%   10.00%   0.00%   Kingman   Very  Healthy     Bullhead        City   Healthy   Lake  Havasu  City   Somewhat  Healthy   Outlying  CommuniTes   Unhealthy   Very  Unhealthy   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated   “As  I  am  a  healthy  85-­‐yr-­‐old  woman,  good  health  and  active,  I  cannot  speak  for  the  majority  of  our   population.  This  is  a  retirement/great-­‐place-­‐for-­‐kids  combination.  Lots  of  problems  with  jobs,   domestic  abuse,  alcohol/drug  use.  Not  present  in  our  household.  It  does  trouble  me  though.”   —    “As  I  get  older  I  am  finding  that  more  parts  of  my  body  are  getting  arthritis.  I  cannot  afford  to  go  to   five  different  doctors  to  take  care  of  my  shoulders,  back,  knees,  hips  and  feet  on  top  of  controlling  my   diabetes  and  high  blood  pressure.”     —   “When  you  are  my  age  (55)  and  not  well,  you  are  forgotten  about.  Can't  work,  living  on  disability,  yet   can't  get  help  from  any  state  or  federal  programs  to  see  a  doctor  that  might  be  able  to  help  me  live  a   longer  productive  life.  I  have  worked  since  I  was  15  1/2  yrs  old  and,  sad  but  true,  unless  you  have  kids   under  a  certain  age  or  are  not  born  here,  you  can't  get  help  when  you  need  it.  Just  get  papers  to  fill  out   and  the  run-­‐around  until  you  die....”         Page   71                                                                Community  Health  Profile  for  Mohave  County,  2013   How Would You Rate the General Health of Your Community Figure  91:  How  would  you  rate  the  general  health  of  your  community?   Zip  Code  Grouping+   Zip Code Grouping Total Very Som ew hat Responses Healthy 933 210 397 57 159 0.75% 0.48% 1.01% 0.00% 1.69% 1756 0.82% Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Healthy Very Unhealthy Unhealthy Unhealthy 16.18% 12.86% 38.54% 26.32% 22.03% 50.91% 59.05% 52.39% 54.39% 53.39% 26.69% 23.33% 7.05% 15.79% 20.34% 5.47% 4.29% 1.01% 3.51% 2.54% 21.69% 52.54% 20.93% 4.02% Source: Mohave County Community Health Survey 70.00%   * All other denotes individuals that did not provide a zip code. 60.00%   50.00%   40.00%   30.00%   20.00%   10.00%   0.00%   Kingman   Very  Healthy   Healthy   Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Somewhat  Unhealthy   Unhealthy   Very  Unhealthy   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)     *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated       “I  believe  that  our  community  needs  to  provide  healthy  choices  to  our  youth  and  parents  within  our   community.  Healthy  choices  begin  with  parents  teaching  children  how  to  be  healthy.  Our  community   needs  to  advocate  and  provide  unlimited  amount  of  outdoor  activities.  Let's  get  outside  and  move  and   abandon  the  convenience  of  fast  food!”   —   “People  in  my  community  need  exercise,  dietary,  and  drug  abuse  help.  There  needs  to  be  more  things  to   do  for  free,  because  people  in  this  city  are  very  poor.  It  shouldn't  cost  thousands  of  dollars  a  year  to  go   to  the  gym  or  learn  how  to  eat  better.”   —    “Many  people  in  the  community  have  no  real  access  to  health  care  due  to  their  economic   circumstances.  The  cuts  to  state  health  programs  have  left  many  adults  who  are  truly  disabled  and  do   not  have  dependent  children  in  desperate  need  of  medical  care  that  they  do  not  qualify  for.”   —    “Too  many  people  on  Medicaid  and  food  stamps  are  not  able  to  acquire  the  healthy  diet  they  need,   which  just  adds  to  the  health  problems  in  the  area.”       Page   72                                                              Community  Health  Profile  for  Mohave  County,  2013   When Was Your Last Health Checkup With a Doctor or Other Healthcare Provider? Figure  92:  When  was  your  last  health  checkup?   Never had Total Within last Within last Within last Betw een Over 5 a health Zip Code Grouping Responses 12 m onths 13-18 m onths 19-24 m onths 2-5 years years ago checkup 933 210 397 57 159 80.17% 82.38% 84.63% 78.95% 78.46% 6.11% 7.14% 4.79% 1.82% 6.92% 3.54% 2.38% 2.77% 3.64% 3.85% 4.93% 5.24% 5.54% 9.09% 4.62% 4.39% 2.38% 1.76% 7.27% 6.15% 0.86% 0.48% 0.50% 0.00% 0.00% 1756 81.30% 5.85% 3.24% 5.21% 3.76% 0.64% Zip  Code  Grouping+   Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Source: Mohave County Community Health Survey 90.00%   80.00%   * All other denotes individuals that did not provide a zip code. 70.00%   60.00%   50.00%   40.00%   30.00%   20.00%   10.00%   0.00%   Kingman   Bullhead  City   Last  12  months   Between  2-­‐5  years   Lake  Havasu  City   Last  13-­‐18  months   Over  6  years   Outlying  CommuniTes   Last  19-­‐24  months   Never   Data  Source:    Mohave  County  Community  Health  Survey,  2013     communities  listed  in  Figure  1  (page  8)   +  Zip  code  groupings  include  the  Mohave  County     a  zip  code  was  not  indicated   *  “All  Other”  includes  surveys  where     “I  go  to  the  doctor  only  when  absolutely  needed,  but  I  take  my  kids  often  for  their  checkups.  My   husband  hasn't  seen  a  doctor  in  many  years  due  to  no  insurance  and  high  costs.”   —   “Primary  healthcare  professional  refuses  to  treat  Medicare  patients  anymore.”    —   “For  some  reason,  if  you  are  sick,  there  is  no  place  to  go  to  but  the  emergency  room  at  the  hospital.  You   cannot  get  an  appointment  with  a  doctor  that  is  not  8  to  10  days  in  the  future.”    —   “I  do  not  go  to  the  doctor  because  I  cannot  afford  it  and  I'm  55yrs  old.  Wish  I  could  afford  health   insurance—  been  having  some  concerns  for  my  health.”   — “I  have  health  insurance  provided  by  my  employer  and  am  very  healthy,  but  I  find  myself  less  and  less   likely  to  see  the  doctor  and  get  labs,  etc.  because  the  cost  is  greatly  increasing.  My  deductable  and  co-­‐ pay  keep  increasing.  I  know  many  people  who  do  not  seek  care,  unless  emergent,  because  of  these   costs.”   —   “With  no  insurance,  I  often  have  to  go  to  the  ER  for  treatment  that  I  can’t  pay  for.”         Page   73                                                                Community  Health  Profile  for  Mohave  County,  2013   Have you received a dental checkup within the past year? Figure  93:  Have  you  received  a  dental  checkup  within  the  past  year?   Zip  Code  Grouping+   Zip Code Grouping Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Total Responses Yes No 933 210 397 57 159 68.92% 56.19% 71.79% 45.61% 63.49% 31.08% 43.81% 28.21% 54.39% 36.51% 1756 66.86% 33.14% Source: Mohave County Community Health Survey 80.00%   60.00%   * All other denotes individuals that did not provide a zip code. 40.00%   20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu   Outlying   City   CommuniTes   Yes     No     Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where     a  zip  code  was  not  indicated     I  see  so  many  people  with  major  dental  problems  missing  teeth  etc....low  income  people  can't  get  any   care.  Dentists  are  so  expensive.  Even  if  you  have  dental  insurance,  it  usually  covers  a  small  amount,  like   mine-­‐  $1500.00  per  year.  When  you  make  $11.00  per  hour,  you  don't  have  much  left  over  to  pay  for  the   dental  care  you  need.  And  they  won't  accept  payments,  and  if  you  have  poor  credit,  you  are  out  of  luck   and  toothless.  But  dental  care  is  so  important.”    —   “I’d  just  like  to  see  children  be  able  to  go  to  the  dentist  as  much  as  they  need  to.”     —   “Because  we  both  work,  pay  taxes,  but  our  children  are  grown;  we  have  no  access  to  even  mildly   affordable  insurance.  I  have  continuous  infections  in  my  mouth  due  to  lack  of  dental  care.”    —   “We  need  low  cost  or  sliding  scale  dental  services.  Dental  costs  in  our  community  are  outrageous.  Poor   dental  health  leads  to  medical  problems  and  deterioration  of  health.”     —   “I  cannot  afford  my  medical  bills,  so  I  let  my  teeth  just  get  worse.”     —   “I  cannot  afford  the  much  needed  dental  work  that  I  require  to  have  healthy  teeth.  There  is  not  enough   coverage  through  my  insurance.”           Page   74                                                              Community  Health  Profile  for  Mohave  County,  2013   Have you received a dental checkup within the past year? If no, why not? (please check all that apply) Figure   94:  If  you  haven’t  had  dental  checkup  within  the  past  year,  why?   Put off or Do not Zip  Code  Grouping+   Zip Code Grouping avoid seeking My health My deductible need Do not dental care insurance or dental have because I does not co-paym ent checkups a dentist hate going No insurance cover dental is too high Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 6.76% 6.20% 4.49% 9.30% 10.39% 17.02% 11.63% 16.03% 13.95% 15.58% 17.72% 24.03% 16.67% 8.89% 7.79% 16.32% 22.48% 21.79% 26.67% 19.48% 17.02% 10.85% 14.10% 16.28% 16.88% 11.42% 11.63% 15.38% 0.00% 12.99% 6.70% 15.67% 17.11% 19.14% 15.43% 11.72% Total Source: Mohave County Community Health Survey 30.00%   * All other denotes individuals that did not provide a zip code. 20.00%   10.00%   0.00%   Kingman   Bullhead  City   Do  not  need   Hate  going   Have you received a dental checkup w ithin the past year? Insurance  doesn't  cover   Lake  Havasu  City   If no, w hy not? Outlying   CommuniTes   No  denTst   No  insurance   (please check all that apply) (continued) DeducTble/co-­‐pay  too  high     Zip  Code  Grouping+   Zip Code Grouping Dentist Dentist's w ill not hours do Cannot Dentist Lack take m y not fit m y get tim e is too transportation insurance schedule off w ork far aw ay to dentist Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 6.76% 6.20% 4.49% 9.30% 10.39% 17.02% 11.63% 16.03% 13.95% 15.58% 17.72% 24.03% 16.67% 8.89% 7.79% 16.32% 22.48% 21.79% 26.67% 19.48% 17.02% 10.85% 14.10% 16.28% 16.88% 11.42% 11.63% 15.38% 0.00% 12.99% 2.87% 4.55% 2.99% 1.91% 0.84% 1.08% Total   No childcare   Source: Mohave County Community Health Survey 30.00%   * All other denotes individuals that did not provide a zip code. 20.00%   10.00%   0.00%   Kingman   +     Bullhead  City   Lake  Havasu  City   Outlying   DenTst  doesn't  take  insurance   CommuniTes   Hours  don't  fit  schedule   Can't  get  Tme  from  work   DenTst  too  far  away   Lack  transportaTon   No  childcare   Data  Source:    Mohave  County  Community  Health  Survey,  2013    Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated   Page   75                                                                Community  Health  Profile  for  Mohave  County,  2013   Are You Able to Get the Healthcare Services You Need in Your Community? Figure  98:  Are  you  able  to  get  the  healthcare  services  you  need  in  your  community?   Zip  Code  Grouping+   Zip Code Grouping Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Total Responses Yes No 933 210 397 57 159 60.13% 49.52% 56.17% 15.79% 49.15% 39.87% 50.48% 43.83% 84.21% 50.85% 1756 55.69% 44.31% Source: Mohave County Community Health Survey 100.00%   80.00%   * All other denotes individuals that did not provide a zip code. 60.00%   40.00%   20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu   Outlying   City   CommuniTes   Yes   No     Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)     *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated     “Help  those  of  us  that  have  needs  now,  before  we  get  weaker  and  can't  be  helped.  We  need  specialists,   even  if  they  come  to  town  a  few  times  a  month,  we  need  them  here.  Sick  people  can't  travel  to  them.”   —   “Can't  afford  co-­‐pay  for  proper  medicine,  so  I've  used  ‘hand-­‐me-­‐downs’  from  other  people  that  usually   is  not  the  dosage  given  by  doctor.”   —   “Our  community  has  little  to  no  healthcare  local  to  residents  with  a  high  majority  of  elderly,   unemployed,  under-­‐educated,  uninsured,  and  non-­‐mobile  people.  Most  have  to  travel  to  Needles,  Fort   Mohave  or  Lake  Havasu  for  medical  attention.”   —   “By  the  fact  that  for  any  little  thing,  they  tend  to  fly  you  to  Las  Vegas  at  a  cost  of  $28,000.00  to   you...that  says  it  all  about  the  lack  of  specialists  or  trauma  center  in  the  tri-­‐state  area.”   —   “We  need  better  specialists  in  our  area  that  our  local  doctors  trust,  so  that  we  don't  have  to  go  out  of   town  and  can  stay  locally,  instead  of  spending  so  much  money  on  transportation,  lodging,  and  food.”   —   “There  needs  to  be  more  availability  of  specialists  in  this  area.    As  of  right  now,  the  only   rheumatologist  is  in  Bullhead  City,  which  is  inconvenient  to  those  who  live  20-­‐30  minutes  away.  The   specialists  that  are  here  in  town  are  so  booked  out  that  it  takes  2-­‐6  months  (depending  on  the   specialty)  to  even  get  an  appointment  to  see  them.”       Page   76                                                              Community  Health  Profile  for  Mohave  County,  2013   Are You Able to Get the Healthcare Services You Need in Your Community? If no, why not? (check all that apply) Figure  99:  If  unable  to  get  the  healthcare  services  you  need  in  your  community,  why?     Zip  Code  Grouping+   Zip  Code  Grouping+   Zip Code Grouping Needed My health Healthcare services insurance provider's are not does not hours do co-paym ent provider language or afford locally cover w hat not fit m y is too w ill not take am from a insurance I need schedule high available No insurance My Local deductible or healthcare I speak a Too expensive different cannot m y insurance different culture prem ium s Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 23.72% 22.88% 18.66% 32.00% 25.38% 4.92% 7.21% 6.72% 4.80% 3.55% 6.50% 7.52% 9.54% 3.20% 8.63% 5.61% 4.39% 4.56% 1.60% 6.09% 8.66% 9.40% 13.23% 3.20% 10.66% 2.76% 3.13% 3.47% 0.80% 4.57% 0.20% 0.31% 0.22% 0.00% 0.00% 5.81% 9.72% 9.54% 8.00% 6.60% Total 21.70% 5.18% 6.86% 4.69% 9.03% 2.83% 0.18% 6.95% Source: Mohave County Community Health Survey 40.00%   * All other denotes individuals that did not provide a zip code. 20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Services  not  locally  available   No  insurance   Insurance  does  not  cover  Needed  Services   Provider's  hours  don't  fit  schedule   Are You Able to Get the Healthcare Services why not? (check all that apply) DeducTble/co-­‐pymt.   too  hYou igh   Need in Your Community? Provider  Ifdno, oesn't   take   my  ins.   Speak  different  language   Cannot  afford  insurance  costs   Couldn't pay for Zip  Code  Grouping+   Zip Code Grouping needed Could not Could not prescription get an get tim e Lack of Doctor is too m edicine appointm ent off w ork transportation far aw ay No specialist in m y No childcare com m unity Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 6.50% 5.64% 5.64% 4.00% 4.06% 9.35% 2.51% 5.64% 3.20% 6.60% 1.77% 0.94% 3.25% 0.80% 2.54% 2.07% 2.51% 0.65% 3.20% 2.54% 3.54% 6.58% 2.17% 17.60% 5.08% 0.39% 0.00% 0.65% 4.00% 1.52% 18.21% 17.24% 16.05% 14.29% 12.18% Total 5.45% 6.47% 1.86% 1.82% 4.38% 0.66% 15.77% Source: Mohave County Community Health Survey 40.00%   * All other denotes individuals that did not provide a zip code. 30.00%   20.00%   10.00%   0.00%   Kingman   Couldn't  pay  for  needed  Rx   Dr.  too  far  away   Bullhead  City   Lake  Havasu  City   Couldn't  get  appt.   No  childcare   Couldn't  get  Tme  off  work   No  local  specialist   Outlying  CommuniTes   Lack  transportaTon   Data  Source:    Mohave  County     Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)     *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated       Page   77                                                                Community  Health  Profile  for  Mohave  County,  2013   Do You Travel Outside of Your Community for Healthcare Services Figure  100:  Do  you  travel  outside  of  your  community  for  healthcare  services?   Zip   Code  Grouping+   Zip Code Grouping Total Responses Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Alw ays Som etim es Seldom Never 933 210 397 57 159 6.54% 14.29% 3.02% 64.91% 7.84% 45.66% 42.86% 38.79% 29.09% 52.94% 23.47% 20.00% 25.69% 5.45% 19.61% 24.33% 22.86% 32.49% 1.82% 19.61% 1756 8.71% 43.56% 22.72% 25.01% Source: Mohave County Community Health Survey 70.00%   60.00%   * All other denotes individuals that did not provide a zip code. 50.00%   40.00%   30.00%   20.00%   10.00%   0.00%   Kingman   Bullhead  City   Always   Lake  Havasu  City   SomeTmes   Seldom   Outlying  CommuniTes   Never   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)     *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated         “Husband  had  to  go  to  Flagstaff  to  see  urologist,  only  one  in  town  had  a  3-­‐month  wait.”   —   “Most  health  services  are  available  in  Kingman  if  one  has  transportation  and  the  means  to  pay  for   them.”    —    “We  need  an  adequate  mental  health  physician  who  also  treats  children.  I  have  to  take  my  challenged   child  out  of  state,  which  my  insurance  doesn't  cover.”    —   “We  need  more  specialized  doctors  in  this  area  so  people  do  not  need  to  be  flown  elsewhere  at  such   exorbitant  and  excessive  costs.”   —   “Son  premature–  need  specialists  in  Phoenix.”   —   “Insurance  dictates  who,  what,  when  and  where....local  providers  need  to  work  with  ANY  Insurance.   Patients  should  not  need  to  be  hospitalized  in  another  city  solely  because  of  who  their  employer   chooses  for  an  insurance  company.”         Page   78                                                              Community  Health  Profile  for  Mohave  County,  2013     Figure  1If01:   You Travel Outside of Your Community for Healthcare Services, Why? (check all that apply) If  you  travel  outside  of  your  community  for  healthcare,  why?  (Check  all  that  apply)   Not applicable, do not travel Zip  Code  Grouping+   Zip Code Grouping Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Services are Services not closer to m y Too difficult Local Quality of to get an doctors are outside m y available place of w ork care is appointm ent Recently not on m y com m unity in m y rather than better w ith a local m oved to insurance for healthcare com m unity m y hom e elsew here provider the area 10.08% 10.00% 11.34% 3.64% 3.14% 41.26% 43.81% 33.00% 77.19% 39.62% 0.86% 2.86% 1.51% 0.00% 2.52% 34.73% 33.33% 33.25% 23.64% 28.30% 13.08% 9.05% 8.06% 5.45% 10.06% 2.47% 3.33% 2.77% 0.00% 1.26% 5.04% 2.86% 3.27% 1.82% 2.52% 8.73% 37.36% 1.25% 30.51% 10.03% 2.25% 3.71% plan Source: Mohave County Community Health Survey 90.00%   * All other denotes individuals that did not provide a zip code. 80.00%   70.00%   60.00%   50.00%   40.00%   30.00%   20.00%   10.00%   0.00%   Kingman   Bullhead  City     Lake  Havasu  City   Outlying  CommuniTes   Services  not  available  locally   Services  closer  to  work   Quality  beber  elsewhere   Difficult  to  get  appt.  locally   Recently  moved  to  area   Local  Drs  not  on  ins.  Plan   Data  Source:    Mohave  County    Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated     “There  are  limited  resources  for  developmental  delay  in  toddlers,  there  are  no  clinics  offering  cognitive   behavioral  therapy  or  speech  therapy  for  disabled  children.  There  are  no  pediatric  specialists,  you   have  to  transfer  to  the  children's  hospital  in  Phoenix,  which  puts  many  families  in  dire  poverty  and   forces  them  to  move  in  with  friends  or  parents.”   —   “I  go  to  Las  Vegas  where  more  doctors  are  participating  providers  in  my  insurance.”   —   “We  are  too  isolated  from  most  of  what  we  need.  We  lack  transportation  to  get  back  and  forth  to   Kingman  facilities  or  elsewhere.  We  need  more  healthcare  people  to  be  here  several  times  a  week—   nurse  practitioner,  dentist,  pharmacy,  etc.  To  be  young  and  drive,  okay,  but  to  be  old  and  not  able  to   drive,  bad.  Property  is  hard  to  sell  at  this  time.  Older  people  can't  survive  somewhere  else,  unless  they   sell  what  they  have.  So  we  all  just  hang  on  and  pray  for  the  best.”   —   “Veteran's  Affairs  treatment  requires  travel  to  Prescott.”       Page   79                                            Services                Community   Health   Profile   for  Mohave  County,  2013   Where Do You Go For    Healthcare (Please check all that apply) Figure  102:  Where  do  you  go  for  healthcare  services?  (Check  all  that  apply)   Zip  Code  Grouping+   Zip Code Grouping Health Hospital Com m unity Physician's Departm ent Em ergency Office Clinic Room Nurse Urgent or Clinic Low -cost Care at Work/ Clinic Clinic School Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 83.60% 89.52% 86.40% 56.14% 64.15% 4.82% 2.86% 3.53% 16.36% 3.14% 32.05% 30.48% 24.94% 40.00% 20.75% 4.18% 2.86% 3.53% 3.64% 3.77% 38.69% 37.62% 49.12% 21.05% 29.56% 2.14% 0.48% 6.05% 1.75% 0.63% Total 82.29% 4.50% 29.44% 3.82% 39.52% 2.68% Source: Mohave County Community Health Survey 100.00%   80.00%   * All other denotes individuals that did not provide a zip code. 60.00%   40.00%   20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Drs  Office   Low-­‐Cost  Clinic   Health  Dept.  Clinic   Urgent  Care  Clinic   Hospital  ER   Work/School  Clinic   Where Do You Go For Healthcare Services (Continued) Traditional Healer/ Zip  Code  Grouping+   Zip Code Grouping Chiropractor Dentist Do Not Alternative Have Eye Medicine Healthcare Doctor Provider Provider(s) Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 33.65% 22.86% 22.17% 12.73% 16.35% 62.92% 55.71% 59.95% 49.09% 43.40% 55.84% 54.76% 55.67% 52.73% 45.28% 5.14% 3.33% 6.80% 10.91% 4.40% 3.86% 2.86% 3.78% 9.09% 3.77% Total 27.51% 59.11% 54.56% 5.41% 3.87% Source: Mohave County Community Health Survey 100.00%   80.00%   * All other denotes individuals that did not provide a zip code. 60.00%   40.00%   20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Chiropractor   DenTst   Eye  Doctor   TradiTonal/AlternaTve  Medicine   Outlying   CommuniTes   No  Provider   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated       Page   80         Compared To All of Your How Would                  Healthcare                                      CExperiences, ommunity  Health   Profile  for  Mohave  County,  2013   You Rate the Quality of Healthcare in Your Community Figure  103:  How  would  you  rate  the  quality  of  healthcare  in  your  community?   Zip  Code  Grouping+   Zip Code Grouping Total Responses Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Excellent Good Fair Poor 933 210 397 57 159 7.82% 0.95% 4.53% 0.00% 6.03% 36.55% 24.29% 42.57% 27.27% 31.03% 43.84% 51.90% 42.57% 31.58% 42.24% 11.79% 22.86% 10.33% 43.64% 20.69% 1756 5.84% 35.73% 44.02% 14.42% Source: Mohave County Community Health Survey 60.00%   * All other denotes individuals that did not provide a zip code. 50.00%   40.00%   30.00%   20.00%   10.00%   0.00%   Kingman   Bullhead  City   Excellent     Good   Lake  Havasu  City   Fair   Outlying   CommuniTes   Poor   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated        “I  believe  that  the  healthcare  professionals  in  town,  generally  speaking,  have  too  many  patients  to   provide  ongoing  care.    It’s  a  one-­‐shot  deal  when  you  go  to  the  doctor;  no  appropriate  follow-­‐up  or   ongoing  care.    This  leads  to  mistakes  being  made  and  major  sicknesses  being  missed.”   —   “In  general,  people  with  life-­‐threatening  illnesses  can  receive  quality  healthcare.  For  anyone  who  is  not   dying  though,  they  are  pretty  much  on  their  own  in  this  town.    Physicians  are  triple  booked  and  don’t   have  time  for  patient  education.”   —   “There  are  too  many  needs  for  adequate  health  care  in  Mohave  County.    Unemployed  people,  low   income  people  who  were  dropped  from  AHCCCS  are  now  unable  to  afford  or  obtain  adequate  health   care.    This  puts  the  community  at  risk  of  losing  hospitals  if  the  hospitals  can’t  receive  payment.”   —   “We  need  more  specialists  and  quality  health  care  providers.  We  need  more  providers  interested  in   prevention  and  not  just  treatment.  I  am  looking  to  leave  this  area  because  of  the  lack  of  quality  care.”   —   “I  have  no  answers  as  to  how  to  achieve  the  perfect  community  in  regards  to  health  or  anything  else   for  that  matter.  I  just  know  there  is  definitely  needed  improvement  and  much  room  for  improvement   when  it  comes  to  healthcare.”           Page   81                                                              Community  Health  Profile  for  Mohave  County,  2013   What Do You Think Are The Three Most Im portant Health Problem s In Your Com m unity? (Please select only three) Figure  104a:  What  are  the  most  important  health  problems  in  your  community?   Zip  Code  Grouping+   Zip Code Grouping Aging Problem s Alcoholism Cancer Child Abuse/ Neglect Dental Problem s Dom estic Violence Diabetes Drug Addiction Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 8.76% 11.88% 15.51% 16.28% 12.87% 11.53% 7.87% 13.58% 15.12% 20.11% 5.20% 4.49% 6.32% 5.23% 4.02% 5.89% 5.78% 4.05% 3.49% 3.22% 5.38% 5.30% 2.36% 4.07% 3.49% 5.27% 4.98% 4.64% 4.65% 6.17% 3.82% 7.06% 4.97% 2.33% 3.75% 24.62% 22.31% 17.03% 14.53% 17.69% T otal 10.92% 11.93% 5.13% 5.01% 4.35% 4.98% 4.29% 21.06% Source: Mohave County Community Health Survey 25.00%   * All other denotes individuals that did not provide a zip code. 20.00%   15.00%   10.00%   5.00%   0.00%   Kingman   Aging  problems   Alcoholism   Bullhead  City   Cancer   Child  abuse/neglect   Lake  Havasu  City   Dental  problems   Diabetes     Outlying  CommuniTes   DomesTc  violence   Drug  addicTon   What Do You Think Are The Three Most Im portant Health Problem s In Your Com m unity? (continued) Exposure to Environm ental Zip  Code  Grouping+   Zip Code Grouping Hazards Firearm Related Injuries Heart Disease and Stroke High Blood Pressure HIV/AIDS Inadequate Health Services Hom icide Industrial Accidents/ Work Safety Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 0.47% 0.80% 0.25% 1.20% 1.34% 0.29% 0.32% 0.17% 0.00% 0.00% 4.55% 4.17% 7.00% 6.63% 5.90% 3.49% 4.01% 4.22% 7.23% 2.41% 0.44% 0.16% 0.00% 0.00% 0.00% 0.29% 0.32% 0.00% 0.00% 0.00% 5.67% 8.83% 8.52% 12.79% 7.51% 0.22% 0.16% 0.25% 0.00% 0.27% T otal 0.53% 0.23% 5.07% 3.65% 0.25% 0.19% 6.88% 0.21% Source: Mohave County Community Health Survey 25.00%   * All other denotes individuals that did not provide a zip code. 20.00%   15.00%   10.00%   5.00%   0.00%   Kingman         Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Environmental  hazards   Firearm  injuries   Heart  disease/stroke   High  blood  pressure   HIV/Aids   Homicide   Inadequate  healthcare   Work  safety   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated   Page   82                                                                Community  Health  Profile  for  Mohave  County,  2013   Figure  104b:       What Do You Think Are The Three Most Im portant Health Problem s In Your Com m unity? (continued) What  are  the  most  important  health  problems  in  your  community?  (Continued)   Infant Death Zip  Code  Grouping+   Zip Code Grouping Infectious Diseases Motor Vehicle Crash Injuries Rape/ Sexual Assualt Respiratory/ Lung Disease Sexually Transm itted Diseases Suicide Teenage Pregnancy Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 0.04% 0.00% 0.08% 0.00% 0.00% 1.16% 0.80% 0.42% 0.00% 0.80% 1.71% 3.21% 2.78% 1.74% 2.14% 0.44% 0.16% 0.17% 0.60% 0.00% 3.27% 2.41% 2.70% 0.60% 3.49% 1.09% 0.64% 1.18% 1.81% 0.54% 0.80% 0.96% 2.11% 0.60% 1.61% 5.60% 3.37% 1.69% 1.81% 2.68% T otal 0.04% 0.85% 2.11% 0.30% 2.87% 1.01% 1.14% 3.95% Source: Mohave County Community Health Survey 25.00%   * All other denotes individuals that did not provide a zip code. 20.00%   15.00%   10.00%   5.00%   0.00%   Kingman       Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Infant  death   InfecTous  disease   Motor  vehicle  accidents   Rape/sexual  assualt   Respiratory/lung  disease   Sexually  transmibed  disease   Suicide   Teen  pregnancy     Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated     Figure  105:  Mohave  County  Resident’s  Top  Rated  Community  Health  Problems 25.00%   20.00%   15.00%   10.00%   5.00%   0.00%   Kingman   Bullhead  City   Aging  Problems   Child  abuse/neglect   Heart  disease/stroke   Respiratory/lung  disease           Lake  Havasu  City   Alcoholism   Diabetes   High  blood  pressure   Teen  pregnancy   Data  Source:    Mohave  County  Community  Health  Survey,  2013   Page   83       Outlying  CommuniTes   Cancer   Drug  addicTon   Inadequate  healthcare                                                            Community  Health  Profile  for  Mohave  County,  2013   Which of the Follow ing Behaviors are Having the Greatest Im pact on Health in your Com m unity (please select only three) Figure  106:  What  behaviors  are  having  the  biggest  impact  on  community  health?   Alcohol Abuse Zip  Code  Grouping+   Zip Code Grouping Being Overw eight Dropping Out Of School Bullying Drug Abuse Lack of Exercise Not Getting Shots/ Im m unizations Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 11.94% 14.48% 15.99% 17.51% 16.27% 15.34% 14.03% 14.49% 15.82% 13.02% 2.57% 2.09% 2.08% 2.26% 1.18% 4.76% 3.88% 2.41% 3.95% 3.85% 21.88% 20.30% 17.15% 15.25% 23.37% 7.22% 10.00% 9.83% 10.73% 6.21% 1.00% 1.04% 1.33% 3.39% 1.48% T otal 13.48% 14.62% 2.26% 3.96% 20.16% 8.12% 1.18%   Source: Mohave County Community Health Survey 25.00%   * All other denotes individuals that did not provide a zip code. 20.00%   15.00%   10.00%   5.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Alcohol   buse   Being   overweight   Bullying   Dropping   Which of the Follow ingaBehaviors are Having the Greatest Im pact on Health in your Com m unity (please select only three) out  of  school   Drug  abuse   Zip  Code  Grouping+   Zip Code Grouping Lack  of  exercise   Not Seeking Preventative Medical or Dental Care Kingman Bullhead City Lake Havasu City Outlying Communities All Other * T otal Not Using Birth Control Not  gehng  immunizaTons   Not Using Seat Belts/ Child Safety Seats Poor Eating Habits Racism Tobacco Use Unsafe Sex Violence 8.90% 11.04% 11.16% 11.86% 11.54% 3.86% 2.24% 3.25% 2.26% 2.07% 0.64% 0.15% 0.75% 0.56% 0.30% 9.55% 7.46% 10.32% 9.60% 11.83% 0.75% 0.45% 0.50% 1.13% 0.30% 6.72% 6.42% 7.91% 2.82% 5.92% 2.25% 2.39% 1.33% 1.69% 0.89% 2.61% 4.03% 1.50% 1.13% 1.78% 9.83% 3.29% 0.57% 9.47% 0.63% 6.67% 1.92% 2.40% Source: Mohave County Community Health Survey 25.00%   * All other denotes individuals that did not provide a zip code. 15.00%   5.00%   -­‐5.00%             Kingman   Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Not  seeking  preventaTve  care   Not  using  birth  control   Not  using  safety  belts/child  restraints   Poor  eaTng  habits   Racism   Tobacco  use   Unsafe  sex   Violence   + Data  Source:    Mohave  County  Community  Health  Survey,  2013    Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated   Page   84                                                                Community  Health  Profile  for  Mohave  County,  2013   Figure  107:  Mohave  County  Resident’s  Top  Rated  Unhealthy  Behaviors   25.00%   20.00%   15.00%   10.00%   5.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Alcohol  abuse   Being  overweight   Drug  abuse   Lack  of  exercise   Not  seeking  preventaTve  care   Poor  eaTng  habits   Tobacco  use       Data  Source:    Mohave  County  Community  Health  Survey,  2013   “I  worry  about  children  not  getting  proper  care,  good  nutrition,  regular  exercise,  etc.  Also,  there  are   way  too  many  fat  people  here.  The  obesity  problem  needs  to  be  addressed.”     —   “People  in  my  community  need  exercise,  dietary,  and  drug  abuse  help.  There  needs  to  be  more  things  to   do  for  free,  because  people  in  this  city  are  very  poor.  It  shouldn't  cost  thousands  of  dollars  a  year  to  go   to  the  gym  or  learn  how  to  eat  better.”     —   “Suicide,  drug/alcohol  addiction,  and  domestic  violence  should  be  a  HUGE  concern  for  this  county.   Without  basic  needs  of  safety  and  sanity  being  met,  the  needs  such  as  proper  diet,  getting  to  the   dentist,  etc.  are  impossible  to  address.”     —   “Very  unhealthy  area  to  live  in.    Everyone  smokes.”   —   “We  really  need  to  focus  on  the  drug  problem  and  the  birth  control  problem.  So  many  children  are   born  into  drug  infested  homes  and  they  deserve  so  much  more.”   —   “I  have  never  seen  such  rampant  smoking  and  other  uses  of  tobacco  as  I  have  in  Mohave  County.   Likewise,  I  have  seen  a  proportionate  number  of  people  with  COPD,  cancer,  and  other  lung  diseases   that  are  related  to  smoking.   —   “People  don’t  eat  right  or  exercise.  Perhaps  this  is  related  to  a  lack  of  education  about  the  importance   of  these  things.”   —   “The  lack  of  education  in  the  area  is  responsible  for  a  lot  of  the  health  problems.    For  instance,  too   many  people  don’t  believe  in  flu  shots,  no  matter  how  bad  the  flu  season  is,  and  right  now  it’s  bad.    The   lack  of  an  informed  population  adds  greatly  to  the  poor  health  status  of  the  area.”         Page   85                                                                Community  Health  Profile  for  Mohave  County,  2013     Figure  What 108a:   Factors Would Most Im prove Health and Quality of Life in Your Com m unity? (Please select only three) What  would  most  improve  health  and  quality-­‐of-­‐life  in  your  community?   Access to quality healthcare services Zip  Code  Grouping+   Zip Code Grouping Access to healthy foods Adequate health insurance Arts and cultural events Affordable housing Clean Environm ent Good jobs and healthy econom y Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 9.83% 11.81% 12.96% 19.35% 14.40% 6.68% 7.18% 5.70% 10.22% 6.81% 7.45% 8.22% 10.42% 8.60% 9.42% 3.89% 3.82% 4.79% 2.15% 5.76% 3.74% 3.36% 3.03% 2.15% 1.31% 4.46% 3.94% 3.80% 3.23% 3.14% 13.57% 13.89% 15.00% 350.00% 13.35% T otal 11.19% 6.53% 8.25% 4.08% 3.27% 4.05% 13.64% Source: Mohave County Community Health Survey 20.00%   * All other denotes individuals that did not provide a zip code. 15.00%   10.00%   5.00%   0.00%   Kingman   Bullhead  City   Access  to  quality  care   Lake  Havasu  City   Access  to  healthy  food   Outlying  CommuniTes   Adequate  health  insurance   Affordable   housing   Arts   &  cQuality ulture   of Life in YourClean   What Factors Would Most Im prove Health and Come mnvironment   unity? (continued) Good schools Zip  Code  Grouping+   Zip Code Grouping Healthy behaviors and lifestyles Job training Low crim e/ Low level & higher safe of child education neighborhoods abuse/neglect Low adult death and disease rates Low infant deaths Kingman Bullhead City Lake Havasu City Outlying Communities All Other * 5.91% 4.28% 5.07% 3.89% 6.28% 8.76% 7.75% 7.75% 9.44% 9.95% 4.66% 4.17% 5.00% 5.56% 4.45% 6.80% 7.06% 6.34% 5.56% 4.71% 3.95% 4.28% 3.10% 1.67% 2.09% 1.37% 2.31% 1.06% 2.78% 0.79% 1.10% 1.27% 1.06% 1.11% 0.52% T otal 5.36% 8.33% 4.60% 6.45% 3.56% 1.41% 1.06% Source: Mohave County Community Health Survey 20.00%   * All other denotes individuals that did not provide a zip code. 15.00%   10.00%   5.00%   0.00%   Kingman             Bullhead  City   Lake  Havasu  City   Outlying  CommuniTes   Good  jobs  &  healthy  economy   Good  schools   Healthy  behaviors   Job  training  &  educaTon   Low  crime   Low  child  abuse/neglect   Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated   Page   86                                                                Community  Health  Profile  for  Mohave  County,  2013   What Factors Would Most Im prove Health and Quality of Life in Your Com m unity? (continued) Figure  108b:   What  would  most  improve  health  and  quality-­‐of-­‐life  in  your  community?  (Continued)   Zip  Code  Grouping+   Zip Code Grouping Religious or spiritual values Parks and recreation Stable fam ily life Good race relations Good place to raise kids Kingman Bullhead Cit y Lake Havasu Cit y Out lying Communit ies All Ot her * 3.45% 4.05% 2.75% 4.44% 2.62% 4.07% 3.94% 2.75% 1.67% 4.97% 4.90% 4.40% 5.00% 3.76% 4.45% 1.66% 1.39% 0.92% 1.67% 1.31% 3.74% 2.89% 3.52% 2.22% 3.66% T ot al 3.29% 3.67% 4.71% 1.41% 3.46% Source: Mohave County Community Health Survey 20.00%   * All other denotes individuals that did not provide a zip code. 15.00%   10.00%   5.00%   0.00%   Kingman   Low  death  &  disease  rates   Stable  family  life   Bullhead  City   Low  infant  death  rates   Good  race  relaTons   Lake  Havasu  City   Parks  &  recreaTon   Good  place  to  raise  children   Outlying  CommuniTes   Religious/spiritual  values     Data  Source:    Mohave  County  Community  Health  Survey,  2013      Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated       Figure  109:   Mohave  County  Resident’s  Top  Rated  Factors  for  Improving  Community  Health   + 20.00%   15.00%   10.00%   5.00%   0.00%   Kingman     Bullhead  City   Lake  Havasu  City   Access  to  quality  healthcare   Access  to  healthy  foods   Adequate  health  insurance   Good  jobs  &  healthy  economy   Healthy  behaviors   Low  crime   Data     Source:    Mohave  County  Community  Health  Survey,  2013         Outlying  CommuniTes   Page   87                                                                Community  Health  Profile  for  Mohave  County,  2013    “Our  community  fails  to  provide  an  overall  healthy  environment  for  the  residents  and  almost   promotes  unhealthy  practices.  We  have  no  healthy  restaurants  to  choose  from,  no  bike  lanes  to  ride  in,   etc.  The  city  is  dirty  and  littered,  giving  the  appearance  that  we  just  don’t  care  about  our  wellness  and   our  community  as  a  whole.”   —     “Not  enough  physical  activity  available  in  the  area.  Need  a  place  to  walk  in  winter  in  the  dark  —there   are  no  street  lights,  which  restrict  the  ability  to  exercise  before  or  after  work.”     —     “I  wish  there  was  more  for  us  young  athletic  people  to  do.  Like  an  aquatic  center,  rock  wall,  something   like  that.”   —     “Please,  please,  please  help  our  community  to  offer  healthy  nutritious  food  in  our  schools.  We  also  need   a  place  in  town  where  hungry  children  can  go  to  get  a  nutritious  meal,  there  is  no  place  where  our   underfed  or  starving  children  can  find  a  warm  healthy  meal  and  learn  about  how  to  keep  their  bodies   healthy  through  nutritious  food  and  exercise.  Please  help  us  make  the  children  in  our  community  to   become  healthier.”   —     “The  public  needs  to  know  of  the  available  services  that  are  free  to  the  general  public  so  that  they  can   take  advantage  of  them”     —     “Currently,  I  believe  there  is  a  need  for  the  state  to  include  pre-­‐existing  conditions  for  single  citizens.  In   our  community,  there  are  many  who  are  being  laid-­‐off  due  to  companies  closing,  leaving  them  without   insurance  and  on  unemployment.  Under  current  state  qualifications,  single  adults  do  not  qualify  for   state  Medicaid.”   —      “Affordable  housing  would  make  it  easier  to  afford  healthcare.”     —     “We  need  more  activities  for  children  and  young  adults,  possibly  a  family  fun  center.”   —     “Quality  of  life  may  be  enhanced  by  the  addition  of  a  weekly  community  farmer's  market  offering  fruits   and  vegetables  and  public  cooling  centers  in  July,  August,  and  September.”   —     “Mohave  County  is  in  dire  need  or  a  rehab  facility  for  drug  and  alcohol  abuse,  more  drug  awareness.”   —     “I  believe  more  needs  to  be  done  in  regards  to  mental  health.  It  is  not  easy  to  have  someone  who  needs   to  be  evaluated  actually  checked  out  by  a  certified  specialist.  Very  frustrating  and  it  puts  the   community  as  a  whole  at  risk.”               Page   88                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  110a:     Do  you  or  does  anyone  in  your  household  have  a  health  condition  lasting  3  months  or   longer  that  restricts  or  limits  necessary  daily  activities?           Total Zip Code Grouping + Responses Yes No Kingman 933 26.80% 73.20% Bullhead City 210 33.33% 66.67% Lake Havasu City 397 24.43% 75.57% Outlying Communities All Other * Total 57 42.11% 57.89% 159 38.99% 61.01% 1756 28.64% 71.36% 80.00%   60.00%   40.00%   20.00%   0.00%   Kingman   Bullhead  City   Yes   Lake  Havasu   City   Outlying   Communities   No     Figure  110b:  If  yes,  check  all  that  apply.     Total Responses Severe hearing loss or deafness Severe vision loss or blindness Immobility in or loss of one or more limbs Other condition that restricts mobility Condition that affects cognitive ablility Kingman 294 7.82% 2.38% 9.52% 63.27% 17.01% Bullhead City 77 11.69% 1.30% 9.09% 63.64% 14.29% Lake Havasu City 113 11.50% 3.54% 7.08% 59.29% 18.58% Outlying Communities 29 20.69% 6.90% 10.34% 51.72% 10.34% All Other* 50 12.00% 6.00% 4.00% 66.00% 12.00% Total 563 10.12% 3.02% 8.53% 62.17% 16.16% Zip Code + Grouping   Data  Source:    Mohave  County  Community  Health  Survey,  2013     communities  listed  in  Figure  1  (page  8)    Zip  code  groupings  include  the  Mohave  County   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated         respondents  who  indicated  they  have  a  disability  (defined  as   Note:    Figure  110b  represents  responses  from  28.64%  of  survey   a  health  condition  lasting  three  months  or  longer    that  restricts  or  limits  necessary  daily  activities).   +         Page   89                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  110b:  If  yes,  check  all  that  apply.   80.00%   60.00%   40.00%   20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Severe  Hearing  Loss  or  Deafness   Immobility  in  or  loss  of  one  or  more  limbs   CondiTon  that  affects  cogniTve  ability   Outlying  CommuniTes   Severe  Vision  Loss  or  Blindness   Other  condiTon  that  restricts  or  limits  movement       Figure  111:     Are  you  able  to  receive  appropriate  services  and  support  for  day  to  day  living?   Total Zip Code Grouping + Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total 100.00%   80.00%   60.00%   40.00%   20.00%   0.00%   Kingman   Responses Yes No 334 71.26% 28.74% 84 59.52% 40.48% 126 71.43% 28.57% 25 80.00% 20.00% 52 67.31% 32.69% 621 69.73% 30.27% Bullhead  City   Lake  Havasu  City   Yes           Outlying   CommuniTes   No       Data  Source:    Mohave  County  Community  Health  Survey,  2013    Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *    “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated     Note:    Figures  110b  and  111  represent  responses  from  28.64%  of  survey  respondents  who  indicated  they  have  a  disability   (defined  as  a  health  condition  lasting  three  months  or  longer  that  restricts  or  limits  necessary  daily  activities).   + Page   90                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  112:      Are  you  able  to  acquire  the  appropriate  assistive  devices  for  day  to  day  living?   Total Zip Code Grouping + Kingman Responses 72.26% 27.74% 79 62.03% 37.97% 111 66.67% 33.33% 24 62.50% 37.50% Outlying Communities All Other * Total 80.00%   60.00%   40.00%   20.00%   0.00%   Kingman   No 310 Bullhead City Lake Havasu City Yes 44 79.55% 20.45% 568 69.89% 30.11% Bullhead  City   Lake  Havasu  City   Yes   Outlying   CommuniTes   No       Figure  113:    Can  you  physically  access  healthcare  facilities  in  your  community?   Total Zip Code Grouping + Kingman Bullhead City Lake Havasu City Outlying Communities All Other * Total Responses Yes No 322 81.99% 18.01% 79 72.15% 27.85% 112 79.46% 20.54% 22 54.55% 45.45% 47 68.09% 31.91% 582 78.01% 21.99% 100.00%   80.00%   60.00%   40.00%   20.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Yes               No   Outlying   CommuniTes     Data  Source:    Mohave  County  Community  Health  Survey,  2013   +  Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated     Note:    Figures  112  and  113  represent  responses  from  28.64%  of  survey  respondents  who  indicated  they  have  a  disability   (defined  as  a  health  condition  lasting  three  months  or  longer  that  restricts  or  limits  necessary  daily  activities).   Page   91                                                              Community  Health  Profile  for  Mohave  County,  2013   Figure  114:  Can  you  physically  access  public  places  and  services  in  your  community?   Total Zip Code Grouping + Responses Kingman Bullhead City Yes No 318 83.33% 16.67% 77 80.52% 19.48% 114 78.95% 21.05% Outlying Communities 23 73.91% 26.09% All Other * 44 77.27% 22.73% 576 81.25% 18.75% Lake Havasu City Total 100.00%   50.00%   0.00%   Kingman   Bullhead  City   Yes   Lake  Havasu   City   Outlying   CommuniTes   No       Figure  115:     Are  you  able  to  receive  information  and  effectively  communicate  with  service   providers  in  your  community?   Total Zip Code Grouping + Kingman Bullhead City Responses Yes No 318 74.53% 25.47% 78 69.23% 30.77% 112 78.57% 21.43% Outlying Communities 26 57.69% 42.31% All Other * 47 65.96% 34.04% 581 73.15% 26.85% Lake Havasu City Total 100.00%   50.00%   0.00%   Kingman   Bullhead  City   Lake  Havasu  City   Yes   Outlying   CommuniTes   No     Data  Source:    Mohave  County  Community  Health  Survey,  2013    Zip  code  groupings  include  the  Mohave  County  communities  listed  in  Figure  1  (page  8)   *  “All  Other”  includes  surveys  where  a  zip  code  was  not  indicated     Note:    Figures  114  and  115  represent  responses  from  28.64%  of  survey  respondents  who  indicated  they  have  a  disability   (defined  as  a  health  condition  lasting  three  months  or  longer  that  restricts  or  limits  necessary  daily  activities).   +     Page   92                                                                Community  Health  Profile  for  Mohave  County,  2013   “Family  member  has  M.S.,  have  applied  several  times  for  disability  for  her  and  been  denied.    She  can't  afford  her  medication/treatment.  AHCCCS  only  covers  her  kids.  She  uses  the  emergency   room  for  herself.”     —   “There  are  assistance  devices  that  would  greatly  help  my  mom,  but  their  costs  exceed  what  I  can  afford   to  buy  on  the  very  low  salaries  offered  here  in  Mohave  County.”     —   “My  M.S.  has  caused  severe  neuropathy  in  legs  and  I  have  no  financial  support.”     —   “Unable  to  afford  hearing  aids.”     —   “Wife  has  cancer  and  heart  disease.  She  can’t  get  anywhere  without  someone  taking  her  and  caring  for   her.  I  can’t  do  it  all.  Insurance  won’t  pay  for  transportation  or  in-­‐home  care”       “Parking  not  conducive  to  access  public  events  and  if  there  are  ramps,  they  are  too  steep.    Stairs  limit   access.”     —   “I  feel  that  businesses,  banks,  and  doctors  do  not  listen  to  individuals  nor  take  into  account  their   mental  deficits  when  working  with  the  elderly.    They  do  not  check  prescriptions  and  businesses/banks   set  up  programs  that  are  not  reasonable  for  the  elderly  with  dementia.”   —   “Insurance  doesn’t  cover  assistive  devices,  so  borrow  from  friends  (miss  the  hospital’s  loan  closet  so   much  now  that  I  need  it).  Not  much  support  for  my  caregiver  or  mental  counseling  for  me.    Hoping   that  will  change  in  2013  by  increasing  my  insurance  premium  by  300%  over     what  I  was  paying  last  year”   —    “Mother  can’t  see  or  hear.    Only  one  eye  doctor  in  town  that  can  help  and  drops  are  too  expensive,   hearing  aid  too  expensive.”   —   “I’m  deaf  and  sign  language  interpreters  are  not  provided  most  of  the  time.  An  interpreter  is  almost   never  offered  to  me  and  even  when  I  ask  for  one,  I’m  usually  not  provided  with  one.”   —   “There  are  not  enough  handicapped  available  services  for  individuals  who  have  mobility  problems  and   not  enough  access  to  handicapped  parking  as  well  as  wheelchairs/motorized  carts  in  the  community   as  a  whole,  especially  businesses.”   —   “I  was  in  need  of  assistance  for  exterior  hand  rails  on  my  property  and  the  AZ  council  on  Aging  could   not  help  me  for  months…  I  needed  help  immediately  in  order  to  get  in/out  of  my  house.  There  are  no   groups  or  organizations  to  take  up  the  slack  when  federal/state/local  grant  funds  dry  up.”   —   “We  cannot  afford  daily  care  to  assist  at  home.  We  do  the  best  we  can.”   —   “There  needs  to  be  more  help  for  seniors  for  free/low  cost  programs  to  have  a  contractor  put  up  ramps   or  hand  rails,  etc.”           Page   93                                                                Community  Health  Profile  for  Mohave  County,  2013   Conclusions  &  Next  Steps   Mohave  County  has  a  number  of  strengths  that  contribute  to  a  healthy  lifestyle—clean  air   and  water,  abundant  outdoor  recreational  opportunities,  and  a  host  of  community  services   dedicated  to  the  health  and  wellbeing  of  our  residents.         Importantly,  our  strongest  asset  is  the  community  spirit  of  many  Mohave  County  citizens.   This  was  demonstrated  throughout  our  health  assessment  process  as  hundreds  of  people,   representing  a  broad  spectrum  of  community  interests,  came  together  in  a  joint  effort  to   make  this  assessment  possible.  It  was  also  demonstrated  in  the  passionate  responses  from   residents  participating  in  our  key  informant  interviews  and  public  health  survey.  In  short,   there  are  countless  individuals  and  organizations  with  a  deep  commitment  to  our   community  who  are  willing  to  work  toward  improvement.  Their  energy,  dedication,  and   cooperation  are  powerful  factors  in  addressing  health  and  quality  of  life  issues  in  Mohave   County.         Our  combined  effort  is  very  much  needed.  This  assessment  finds  that  far  too  many  of  our   residents  suffer  from  poor  physical  or  mental  health.  When  compared  to  state  and  national   statistics,  Mohave  County  ranks  poorly  in  most  health  indicators.  While  some  of  this  can  be   attributed  to  a  higher  than  average  population  of  senior  citizens  (who  naturally  have  more   chronic  health  conditions),  our  community  health  assessment  indicates  other  larger  causes:         1.  Poor  economic  conditions   Economic  insecurity  is  often  associated  with  poor  health.    Mohave  County’s  high  rates   of  poverty,  unemployment,  and  lack  of  educational  achievement  create  barriers  for   accessing  health  services,  healthy  food,  recreation,  and  other  necessities  that   contribute  to  a  healthy  lifestyle.       2.  Unhealthy  behaviors  and  attitudes   Our  lifestyle  decisions  and  attitudes  directly  affect  our  health.    Mohave  County’s  high   rates  of  smoking,  alcohol  and  substance  abuse,  lack  of  exercise,  and  obesity  are  certain   to  lead  to  debilitating  diseases,  infirmities,  and  premature  death.    Additionally,  these   behaviors  and  attitudes  are  passing  to  our  children,  as  indicated  in  Mohave  County’s   high  rates  of  underage  drinking  and  tobacco  use,  teen  substance  abuse,  teen   pregnancy,  and  youth  antisocial  behaviors.     3.  Restricted  access  to  primary  care  and  preventative  healthcare  services   Access  to  primary  care  and  preventative  health  services  is  vital  to  maintaining  good   health.  Due  to  a  number  of  barriers,  many  Mohave  County  residents  are  unable  or   unwilling  to  obtain  health  screenings,  routine  tests,  vaccinations,  dental  care,  and  other   preventative  healthcare  services.             Page   94                                                              Community  Health  Profile  for  Mohave  County,  2013       4.     The  lack  of  adequate  preventative  care  is  evident  in  our  health  rankings.  For  example:    High  hospitalization  rates  for  preventable  conditions    High  morbidity  and  mortality  rates  associated  with  certain  diseases  and  conditions   that  could  otherwise  be  prevented  or  managed  through  proper  healthcare    High  rate  of  cancer  death  due  to  late  diagnoses    High  rate  of  serious  dental  problems      High  rate  of  premature  death   Based  on  community  member  feedback  in  key  informant  interviews  and  the   community  health  survey,  barriers  to  obtaining  proper  healthcare  in  Mohave  County   include:      Financial  hardship  (interrelated  with  1  above)    Lack  of  health/dental  insurance  (interrelated  with  1  above)    Cultural  norms  and  attitudes  regarding  health  and  healthcare  (interrelated  with  2   above)    Lack  of  education  and  reliable  information  on  health  matters    Insufficient  number  of  primary  care  providers  and  physician  specialists  to  serve   our  population    Long  wait  times  (sometime  months)  to  see  a  primary  care  provider          Limited  number  of  low-­‐cost/sliding-­‐fee  health  providers  in  Mohave  County    No  low-­‐cost/sliding-­‐fee  dental  providers  in  Mohave  County   Lack  of  services  and  accommodations  for  disabled  and  homebound  persons      Geographic  isolation  and  lack  of  transportation      Restricted  access  to  mental  health  and  substance  abuse  services   Mental  health  is  critical  to  effectively  raising  children,  learning,  working,  and  being   productive  contributing  citizens.  Mohave  County  residents  face  a  number  of  barriers  in   obtaining  proper  care  for  stress,  mental  trauma,  depression,  anxiety,  mood  disorders,   addictive  behaviors,  and  other  mental  health  conditions.  In  Mohave  County,  barriers  to   mental  and  emotional  well-­‐being  include:      Lack  of  education  and  reliable  information  regarding  mental  health    Financial  hardship  (interrelated  with  1  above)    Cultural  norms,  behaviors,  and  attitudes  (interrelated  with  2  above)    Poor  parenting  and  dysfunctional  family  life  (interrelated  with  2  above)    Poor  physical  health  (interrelated  with  3  above)    A  severe  shortage  of  psychiatrists,  psychologists,  and  other  mental  health   professionals  in  Mohave  County    A  very  limited  number  of  inpatient  facilities  for  severe  mental  illness  and   drug/alcohol  detoxification  (only  14  beds  for  all  of  Mohave  County)    No  inpatient  facilities  in  Mohave  County  for  drug/alcohol  rehabilitation,  which   Page   95                                                              Community  Health  Profile  for  Mohave  County,  2013   severely  limits  effective  family  therapies  and  follow-­‐up  for  those  who  go  elsewhere   for  inpatient  rehabilitation.       As  a  result  of  these  and  other  barriers  to  mental  health/substance  abuse  services,   many  residents  with  mental  issues  may  self-­‐medicate  through  the  use  of  drugs  and   alcohol,  which  in-­‐turn  results  in  even  higher  rates  of  substance  abuse  and  dependence.   Sadly,  Mohave  County’s  extremely  high  suicide  rate  also  indicates  a  critical  need  for   more  comprehensive  mental  health  services  in  our  community.     Next  steps   Healthy  people  are  among  a  community’s  most  essential  resources.  Therefore,  improving   community  health,  improves  quality  of  life  for  all  of  us.  This  is  a  daunting  task.    In  all  reality,   there  is  only  so  much  that  can  be  done  from  a  community  standpoint  because  good  health   is  a  personal  responsibility  and  a  result  of  personal  choices.  However,  as  a  community,  we   can  work  together  to  address  certain  barriers  to  good  health  that  are  under  our  control.         In  the  next  phase  of  our  health  improvement  initiative,  our  county-­‐wide  coalition  will  use   the  data  and  information  in  this  report  to  identify  and  prioritize  the  health  issues  we  are   able  to  address.  We  will  next  develop  a  Community  Health  Improvement  Plan  (CHIP),   which  will  include  strategies  and  measures  for  how,  as  a  community,  we  can  act  on  those   issues.  This  effort  is  especially  important  during  tough  economic  times.    With  the  many   community  organizations  that  have  come  together  on  this  initiative,  together  we  can  more   effectively  leverage  and  direct  limited  resources  on  key  community  health  issues.           Once  developed,  we  will  publish  the  CHIP  and  continue  to  gather  public  feedback  and   perspectives.    In  three  years,  we  will  conduct  another  community  health  assessment  to   measure  our  progress  and  to  identify  emerging  health  issues  and  other  priorities.    We  plan   to  continue  this  process  indefinitely—  with  the  ultimate  goal  of  improving  health  and   quality  of  life  in  Mohave  County.             Page   96                                                              Community  Health  Profile  for  Mohave  County,  2013   APPENDICES       Page   97                                                              Community  Health  Profile  for  Mohave  County,  2013   Appendix  A   Mohave  County  Community  Health  Coalition  Member  Organizations     All  Women's  Medical  Center   American  Family  Insurance   Anotucci's   Arizona  Cooperative  Extension   Arizona  Youth  Partnership   AZ  Dept.  of  Economic  Security   AZ  Dept.  of  Fish  &  Game   AZ  Dept.  of  Health  Services   AZ  State  Office  of  Rural  Health   Boys  &  Girls  Club  of  the  Colora-­‐ do  River   Bullhead  City  Chamber  Com-­‐ merce   Bullhead  City  Dental   Bullhead  City  Elementary   School  Dist.   Bullhead  City  Fire  Dept.   Bullhead  City  Parks  &  Rec.   Bullhead  City  Police  Dept.   Bullhead  City  Senior  Programs   Bullhead  City  Transit   Bullhead  Health  Club   Bullhead  Regional  Economic   Development  Authority   Cameron  Broadcasting   Chloride  Chamber  of      Com-­‐ merce   City  of  Bullhead     City  of  Kingman   City  of  Lake  Havasu   Colorado  River  Pediatrics   Cornerstone  Mission   Crossroads  Family  Dental   Dallman  &  Associates   Desert  Oasis  Medical  Center   Desert  Palms  Medical  Assoc.   Dolan  Springs  Chamber  of   Commerce   El  Palacio   Farm  Bureau  Financial   First  Things  First   Fluesche  Realty   Fort  Mohave  Tribal  Nation   Havasu  Community  Health   Foundation   Havasu  for  Youth   Havasu  Regional  Medical  Cen-­‐ ter   Havasu  Transit       Home  Depot   Hospital  District  Number  One   of  Mohave  County   Hualapai  Tribal  Nation   Indian  Health  Services   Interagency  of  Lake  Havasu   Kelley,  Moss,  &  Williams     Kenneth  Gregory  Law  Office   Kingman  Academy  of  Learning   Kingman  Daily  Miner     Kingman  Hospital  Inc.   Kingman  Area  Chamber  of   Commerce   Kingman  City  Council   Kingman  Fire  Department   Kingman  Police  Department   Kingman  Regional  Medical   Center   Kingman  Unified  School  Dis-­‐ trict  #20   KJJJ  Radio   KRMC  Foundation   Lake  Havasu  Parks  &  Rec.   Lake  Havasu  Ministries   Lake  Havasu  Police  Dept.   Lake  Havasu  School  District   Lake  Havasu  City  Chamber  of   Commerce   Legacy  Foundation   Maddog  Fitness   MAPPED   Mohave  County  Department  of   Public  Health   Mohave  County  Tobacco  Use  &   Chronic  Disease  Prevention   Program   Meadview  Chamber  of  Com-­‐ merce   Meals  on  Wheels   Mohave  County  Board  of  Su-­‐ pervisors   Mohave  Accelerated  School   Mohave  Community  College   Mohave  County  Community   Development   Mohave  County  Community   Services   Mohave  County  Senior  Pro-­‐ grams   Page   98       Mohave  County  Sheriff's  Office   Mohave  County-­‐Children's  Ac-­‐ tion  Team   Mohave  Daily  News   Mohave  Mental  Health  Clinic,   Inc   Mohave  State  Bank   Mohave  Substance  Abuse   Treatment  &  Education   Partnership  (MSTEPP)   Nautical  Inn/London  Bridge   Resort   North  Country  Healthcare   Northern  Arizona  Univ.   Office  Express   Our  Town  Magazine   River  Medical   Riverside  Resorts   Sam's  Club   Shugrues   Southwest  Behavioral  Health     Telesis  Preparatory  Academy   Today's  News  Herald   Univ.  of  Arizona   Univ.  of  Nevada  Las  Vegas   U.S.  Bureau  of  Land  Mgmt.     U.S.  Bureau  of  Veteran  Affairs   Valley  View  Medical  Center   Western  Arizona  Council  of   Governments                                                                                        Community  Health  Profile  for  Mohave  County,  2013   Appendix  B Key  Informant  Interview  Protocol     Introduction:  Good  morning/afternoon.    My  name  is  [interviewer’s  name].  Thank  you  for  taking  time  out   of  your  busy  day  to  speak  with  me.    I’ll  try  to  keep  our  time  to  approximately  30  minutes.  The  Mohave   County  Department  of  Public  Health  and  Kingman  Regional  Medical  Center  is  gathering  local  data  as  part  of   developing  a  plan  to  improve  health  and  quality  of  life  in  Mohave  County.    Community  input  is  essential  to   this  process.    A  combination  of  surveys  and  key  informant  interviews  are  being  used  to  engage  community   members.    You  have  been  selected  for  a  key  informant  interview  because  of  your  knowledge,  insight,  and   familiarity  with  the  community.    The  themes  that  emerge  from  these  interviews  will  be  summarized  and   made  available  to  the  public;  however,  individual  interviews  will  be  kept  strictly  confidential.     To  get  us  started,  can  you  tell  me  briefly  about  the  work  that  you  and  your  organization  do  in  the   community?  ________________________________________________________________________________________________________     Thank  you.    Next  I’ll  be  asking  you  a  series  of  questions  about  health  and  quality  of  life  in  Mohave  County.     As  you  consider  these  questions,  keep  in  mind  the  broad  definition  of  health  adopted  by  the  World  Health   Organization:  'Health  is  a  state  of  complete  physical,  mental  and  social  well-­‐being  and  not  merely  the   absence  of  disease  or  infirmity,'  while  sharing  the  local  perspectives  you  have  from  your  current  position   and  from  experiences  in  this  community.     Questions:   1. In  general,  how  would  you  rate  health  and  quality  of  life  in  Mohave  County?   2. In  your  opinion,  has  health  and  quality  of  life  in  Mohave  County  improved,  stayed  the  same,  or   declined  over  the  past  few  years?         3. (Based  on  answer  from  previous  question),  why  do  you  think  it  has  improved,  declined,  or  stayed  the   same?   4. (Based  on  answer  from  question  2),  what  other  factors  are  impacting  health  and  quality  of  life?   5. Are  there  people  or  groups  of  people  in  Mohave  County  whose  health  or  quality  of  life  may  not  be  as   good  as  others?   a.  Who  are  these  persons  or  groups?   b.  Why  do  you  think  their  health/quality  of  life  is  not  as  good  as  others?   6.            What  barriers,  if  any,  exist  to  improving  health  and  quality  of  life  in  Mohave  County?   7. In  your  opinion,  what  are  the  most  critical  health  and  quality  of  life  issues  in  Mohave  County?   8. What  needs  to  be  done  to  address  these  issues?   9. In  your  opinion,  what  else  will  improve  health  and  quality  of  life  in  Mohave  County?   10. Is  there  someone  (who)  you  would  recommend  as  a  “key  informant”  for  this  assessment?     Close:  Thanks  so  much  for  sharing  your  concerns  and  perspectives  on  these  issues.  The  information  you   have  provided  will  contribute  to  develop  a  better  understanding  about  factors  impacting  health  and  quality   of  life  in  Mohave  County.    Before  we  conclude  the  interview,       Is  there  anything  you  would  like  to  add?   As  a  reminder,  summary  results  will  be  made  available  by  the  Kingman  Regional  Medical  Center  and   Mohave  County  Department  of  Public  Health  and  used  to  develop  a  community-­‐wide  health  improvement   plan.             Page   99                                                                                            Community  Health  Profile  for  Mohave  County,  2013   Appendix  C   Community  Stakeholder  Questionnaire   Name: __________________________________________Title: _____________________________ Organization: ______________________________________________ Phone : _________________ City: ______________________________________________ Zip Code: ______________________ 1. How would you rate the general health of your community?” ___Very unhealthy ___Unhealthy ___Somewhat healthy ___Healthy ___Very healthy If you would like to elaborate, please explain here (if you require more space, use back of page): 2. In the following list, what do you think are the three most important factors for a “Healthy Community?” (Those factors which most improve health and quality of life in a community)Check only three: ___Access to quality healthcare services ___Low crime / safe neighborhoods ___Access to healthy foods (e.g., fresh fruits & vegetables) ___Low level of child abuse/neglect ___Adequate health insurance ___Low death and disease rates among adults ___Affordable housing ___Low infant deaths ___Arts and cultural events ___Recreational and physical activity opportunities (parks, ___Clean environment gyms, bike paths, etc.) ___Good jobs and healthy economy ___Religious/spiritual values ___Good schools ___ Strong family life ___Healthy behaviors and lifestyles ___ Other___________________________ ___Job training & higher education You may explain your answers here (if you require more space, use back of page): ________________________________________________________________________________ 3. In the following list, what do you think are the three most important “health problems” in your community? (Those problems which have the greatest impact on overall community health.) Check only three: ___Aging problems (e.g., arthritis, osteoporosis, etc.) ___Alcoholism ___Cancer ___Child abuse / neglect ___Dental problems ___Diabetes ___Domestic Violence ___Drug Addiction ___Exposure to environmental hazards ___Heart disease and stroke ___High blood pressure ___IV / AIDS ___Homicide ___Industrial accidents ___Infant Death ___Infectious diseases (e.g., flu, hepatitis, whooping cough, etc.) ___Mental health problems ___Motor vehicle crash injuries ___Rape / sexual assault ___Respiratory / lung disease ___Sexually Transmitted Diseases (STDs) ___Suicide ___Teen pregnancy ___Other _______________ You may explain your answers here (if you require more space, use back of page): ________________________________________________________________________________ 4. In the following list, what do you think are the three most important “risky behaviors” in your community? (Behaviors that have the greatest impact on overall community health.) Check only three: ___Alcohol abuse ___Being overweight ___Criminal behavior ___Dropping out of school ___Drug abuse ___Lack of exercise ___Poor eating habits ___Not seeking preventive care (immunizations, regular checkups, etc.) ___Not using birth control ___Not using seat belts / child safety seats ___Tobacco use ___Unsafe sex ___Other_________________________ You may explain your answers here (if you require more space, use back of page): ________________________________________________________________________________     Page   100                                                                                            Community  Health  Profile  for  Mohave  County,  2013   5. In the following list, what do you think are the three most important barriers to accessing healthcare in your community? (Obstacles that prevent community members from receiving proper healthcare) Check only three ___Dysfunctional home life ___Economic conditions (unemployment, poverty, etc.) ___Geography (rural location) ___Inadequate healthcare facilities & services to meet public need ___Insufficient public information/communications ___Lack of accommodations & accessibility for elderly/disabled persons ___Lack of affordable healthcare services ___Lack of health insurance ___Lack of transportation to healthcare services ___Local culture (beliefs, values, & attitudes relating to healthcare) ___Low health literacy/education ___Outdated medical technologies & facilities ___Public policy (federal, state, county, and/or city laws ®ulations as related to healthcare) ___ Shortage of healthcare providers (e.g., nurses, primary care doctors, physician specialists, etc.) ___Other___________________________ You may explain your answers here (if you require more space, use back of page): ________________________________________________________________________________ 6. Are you interested in participating in a more in-depth interview about health in our community (approximately 30 minutes)? [ ] Yes [ ] No If yes, when is the best time to contact you? [ ] Morning [ ] Afternoon [ ] Evening 7. Are you interested in participating on our community survey committee? [ ] Yes [ ] No Thank you for your participation and involvement in the Mohave County Health Improvement Initiative!         Page   101                                                                                            Community  Health  Profile  for  Mohave  County,  2013   Appendix  D   Primary  Care  Provider  Questionnaire   Name: _____________________________________________________________ Specialty: __________________________________ Degree: _________________ 1. What, in your opinion, is the #1 health problem in Mohave County? 2. What are the most common health problems you see in your practice? 3. What chronic diseases do you feel are a concern in our area? 4. What communicable diseases do you feel are a concern in our area? 5. What health behaviors do you feel are a concern in our area? 6. May we contact you for more in-depth information? [ ] No [ ] Yes Phone: ______ *  A  community  health  assessment  (CHA)  is  a  process  that  engages  local  community  partners  to  systematically  collect  and   analyze  qualitative  and  quantitative  health-­‐related  data  from  a  variety  of  sources  within  our  community.  The  findings  of  the   CHA  are  presented  in  the  form  of  a  community  health  profile  to  inform  community  decision-­‐making  and  for  prioritizing  and   addressing  local  health  problems.             Page   102                                                                                            Community  Health  Profile  for  Mohave  County,  2013   Appendix  E   Mohave  County  Community  Health  Survey   Your input is important! With this survey, we are seeking your opinions and perspectives regarding health, quality of life, and needs for health-related services in your community. There is nothing in this survey that asks for your personal identity. Your answers will be combined with others according to zip code to help us identify health needs and concerns in your community. The survey should take about15-20 minutes to complete. Thank you in advance for your participation. Please  complete  this  survey  only  once.   1. Zip  code  where  you  live:  ______________     2. How  would  you  rate  the  general  health  of  your  community?   oVery  healthy          oHealthy          oSomewhat  unhealthy          oUnhealthy          oVery  unhealthy     3. What  factors  would  most  improve  health  and  quality  of  life  in  your  community?  (Please  select  only  three)   o  Access  to  quality  healthcare  services   o  Healthy  behaviors  and  lifestyles   o  Access  to  healthy  foods  (fresh  fruit  &  vegetables)   o  Job  training  &  higher  education   o  Adequate  health  insurance   o  Low  crime/safe  neighborhoods   o  Affordable  housing      o  Low  level  of  child  abuse/neglect   o  Arts  and  cultural  events    o  Low  adult  death  and  disease  rates   o  Clean  environment   o  Low  infant  deaths   o  Good  jobs  and  healthy  economy      o  Parks  and  recreation   o  Good  schools    o  Religious  or  spiritual  values   o  Good  race  relations   o  Stable  family  life   o  Good  place  to  raise  kids    o  Other___________________________         4. What  do  you  think  are  the  three  most  important  health  problems  in  your  community?  (Please  select  only  three)   o Aging  problems  (e.g.,    arthritis,  hearing/vision  loss)   o Homicide   o Alcoholism   o Inadequate  health  services   o Cancer   o Industrial  accidents/work  safety   o Child  abuse/neglect   o Infant  death   o Dental  problems   o Infectious  diseases  (e.g.:  TB,  hepatitis)   o Diabetes   o Motor  vehicle  crash  injuries   o Domestic  violence   o Rape/sexual  assault   o Drug  addiction   o Respiratory/lung  disease   o Exposure  to  environmental  hazards   o Sexually  transmitted  diseases   o Firearm-­‐related  injuries   o Suicide   o Heart  disease  and  stroke   o Teenage  pregnancy   o High  blood  pressure   o Other_____________________   o HIV/AIDS     5.    Which  of  the  following  behaviors  are  having  the  greatest  impact  on  health  in  your  community?  (Please  select  only  three)   o  Alcohol  abuse   o  Not  using  birth  control   o  Not  using  seat  belts/child  safety  seats   o  Being  overweight   o  Poor  eating  habits   o  Bullying   o  Racism   o  Dropping  out  of  school   o  Tobacco  use   o  Drug  abuse     oUnsafe  sex   o  Lack  of  exercise     oViolence   o  Not  getting  shots/immunizations   o  Other__________________________   o  Not  seeking  preventative  medical  or  dental  care       Page   103                                                                                            Community  Health  Profile  for  Mohave  County,  2013       6. How  would  you  rate  the  quality  of  healthcare  in  your  community?   o    Excellent      o  Good      o  Fair    o    Poor     7. Are  you  able  to  get  the  healthcare  services  you  need  in  your  community?        o    Yes    o    No   If  no,  why  not?  (Please  check  all  that  apply)   o    Needed  services  are  not  locally  available   o Couldn’t  pay  for  needed  prescription  medi-­‐ o    No  insurance   cine   o    My  health  insurance  does  not  cover  what  I  need   o Could  not  get  an  appointment   o    Healthcare  provider’s  hours  do  not  fit  my  schedule   o Could  not  get  time  off  from  work   o    My  deductible  or  co-­‐payment  is  too  high   o Lack  of  transportation   o    Local  healthcare  provider  will  not  take  my  insurance   o Doctor  is  too  far  away   o    I  speak  a  different  language  or  am  from  a  different  cul-­‐ o No  childcare   ture   o No  specialist  in  my  community                  o    Too  expensive/cannot  afford  insurance  premiums   o Other______________________     8. Where  do  you  go  for  healthcare  services?  (Please  check  all  that  apply)   o  Physician’s  office   o  Chiropractor   o  Health  department  clinic    o  Dentist   o  Hospital  emergency  room    o  Eye  doctor   o  Community  low-­‐cost  clinic    o  Traditional  healer/alternative  medicine  provider   o  Urgent  care  clinic    o  Do  not  have  healthcare  provider(s)     o  Nurse  or  clinic  at  work/school    o  Other____________________________       9. Do  you  travel  outside  your  community  for  healthcare  services?   oAlways     o  Sometimes     o  Seldom    o    Never     10. If  you  travel  outside  of  your  community  for  healthcare  services,  why?  (Please  check  all  that  apply)   o  Not  applicable,  do  not  travel  outside  my  community  for   o  Too  difficult  to  get  an  appointment  with  a  local   healthcare   doctor/healthcare  provider   o  Services  not  available  in  my  community             o  Local  doctors  are  not  on  my  insurance  plan   o  Services  are  closer  to  my  place  of  work  rather  than  my  home   oRecently  moved  to  the  area     o  Quality  of  care  is  better  elsewhere   o  Other____________________     11. In  the  following  list,  what  do  you  think  are  the  three  most  important  barriers  that  prevent  community  members   from  receiving  the  healthcare  they  need?  (Please  select  only  three)   o    Dysfunctional  home  life   o    Lack  of  transportation  to  healthcare  services   o    Economic  conditions  (unemployment,  poverty,  etc.)   o    Local  culture  (beliefs,  values,  &  attitudes)     o    Geography  (rural  location)   relating  to  health  and  healthcare   o    Inadequate  healthcare  facilities  &  services  to  meet  public   o    Low  health  literacy/  education   need   o    Outdated  medical  technologies  &  facilities   o    Insufficient  public  information  and  communications  about   o    Public  policy  (federal,  state,  county,  and/or  city   health  matters   laws&  regulations  related  to  health  and  healthcare)   o    Lack  of  accommodations  &  accessibility  for  elderly/disabled     o    Shortage  of  healthcare  providers  (e.g.,  nurses,     persons   primary  care  doctors,  physician  specialists,   o    Lack  of  affordable  healthcare  services   o    Other___________________   o    Lack  of  healthcare  insurance           Page   104                                                                                            Community  Health  Profile  for  Mohave  County,  2013   12. How  would  you  rate  your  personal  health?   oVery  Healthy          oHealthy          oSomewhat  Unhealthy          oUnhealthy          oVery  Unhealthy     13. When  was  your  last  check-­‐up  with  a  doctor  or  other  healthcare  provider?   oWithin  last  12  months   oBetween  2  -­‐  5  years   oWithin  last  13  -­‐  18  months   oOver  5  years  ago     oWithin  last  19  -­‐  24  months   oNever  had  a  check-­‐up       14. Have  you  received  a  dental  checkup  within  the  past  year?    o  Yes        o    No   If  no,  why  not?  (Please  check  all  that  apply)   o    Do  not  need  dental  checkups   o    Dentist  will  not  take  my  insurance   o    Do  not  have  a  dentist   o    Dentist’s  hours  do  not  fit  my  schedule   o    Put  off  or  avoid  seeking  dental  care  because  I  hate  going   o    Cannot  get  time  off  work   to  the  dentist   o    Dentist  is  too  far  away   o    No  insurance   o    Lack  transportation  to  dentist   o    My  health  insurance  does  not  cover  dental   o    No  childcare     o    My  deductible  or  co-­‐payment  is  too  high   o    Other:    _________________________     15. Do  you  or  does  anyone  in  your  household  have  a  health  condition  lasting  3  months  or  longer  that  restricts  or  limits   necessary  daily  activities  (e.g.,  work,  self-­‐care,  household  chores,  etc.)?        oYes      oNo   If  yes,  please  check  all  that  apply:   o    Severe  hearing  loss  or  deafness   o    Other  condition  that  restricts  or  limits  walking,   o    Severe  vision  loss  or  blindness   reaching,  lifting,  or  carrying   oImmobility  in  or  loss  of  one  or  more  limbs  (hands,  feet,   o    An  emotional  or  mental  condition  that  affects   arms,  or  legs)   learning,  remembering,  or  concentrating   o    Other:    __________________________     16. If  you  or  a  member  of  your  household  has  a  disability  as  described  above,              Yes            No   are  you  (or  they)  able  to:  (Please  check  yes  or  no)   A.  Receive  the  appropriate  services  and  support  needed  for  day-­‐to-­‐day  living?   o    o   o   o   C.    Physically  access  healthcare  facilities  in  your  community?   o   o   D.    Physically  access  public  places  and  services  in  your  community?   E. Receive  information  and  effectively  communicate  with  service  providers            in  your  community  (e.g.,  healthcare  providers,  teachers,  law  enforcement,          bank  tellers,  etc.)?   o   o   o   o   B.    Acquire  the  appropriate  assistive  devices  (e.g.,  wheelchair,  prosthetics,                    hearing  aids,  etc.)  needed  for  daily  functioning?       If  you  answered  no  to  any  of  the  above,  please  use  this  space  to  describe  your  circumstances:  ___________________     17. Where  do  you  get  most  of  your  health-­‐related  information?    (Please  check  all  that  apply)   o    Family/friends   o    School   o    Doctor/Nurse/Pharmacist   o    Internet   o    Newspaper/Magazine/Television/Radio   o    Public  library   o    Health  help  line  (telephone)   o    Hospital   o    Health  department   o    Other  _______________________   o    Church         Page   105                                                                                            Community  Health  Profile  for  Mohave  County,  2013   18. Who  is  your  most  trusted  source  of  health  information?    (Please  check  one)   o    Church/faith   o    Public  library   o    Doctors   o    Employer   o    Nurses   o    Internet   o    Hospital   o    Yourself   o    Health  department   o    Other__________________________   o    Family/friends     19. How   many   hours   per   month   do   you   volunteer   in   your   community   (e.g.,   schools,   community   organizations,   churches,   hospitals,  etc.)?   o  Less  than  1  hour   o  1  –  5  hours     o  6  –  10  hours   o  11  or  more  hours           o  Do  not  volunteer   oOther_________________________     20. Age:      ounder  18    o18-­‐25      o26-­‐39      o40-­‐54        o55-­‐64      o65-­‐74      o75  or  over     21. Household  income:    o  Less  than  $10,000  o$10,000  to  $19,999  o$20,000  to  $39,999o$40,000  to  $59,999  o$60,000  to  $79,999  o$70,000  to  $89,999    oOver  $90,000     22. Sex:      oMale      oFemale       23. Ethnic  group  you  most  identify  with:   oAfrican  American/Black   oNative  American    oAsian/Pacific  Islander     oWhite/Caucasian            oHispanic/Latino   oOther  _________________     24. Marital  Status:   o  Married   o  Widow/Widower          o  Single   o  Divorced     25. Education:   oHigh  school  diploma     oAssociates  degree   oGED   oBachelors’  degree       oNo  HS  diploma  or  GED     oGraduate  degree     oSome  college   oOther____________     26. What  type  of  health  insurance  do  you  have?  (Please  check  all  that  apply)   oNone     oMedicaid  (AHCCCS)   oIndividual  plan  (not  provided  by  employer)   oMedicare     oEmployer-­‐provided  plan   oVeterans  Administration   oIndian  Health  Services   oOther  ________________     27. Where  did  you  get  this  survey?     oNewspaper   oChurch   oPersonal  contact   oCommunity  meeting   oSchool   oHospital   oWorkplace   oInternet   oOther:  ____________________   oLibrary     oMohave  County  facility           Page   106                                                                                            Community  Health  Profile  for  Mohave  County,  2013   Please  use  the  following  space  to  add  any  additional  comments  regarding  health,  quality  of  life,  and  needs  for   health-­‐related  services  in  your  community  (use  back  of  this  page  if  necessary):     ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________   Thank  you  very  much  for  your  response!   This  survey  is  part  of  a  county-­‐wide  health  assessment  being  conducted  by  the  Mohave  County  Department  of   Public  Health  and  Kingman  Regional  Medical  Center  in  partnership  with  numerous  other  public  and  private   organizations  throughout  Mohave  County.  The  assessment  will  provide  a  realistic  picture  of  the  health  needs   and  issues  unique  to  our  population,  geography,  and  economy.  In  turn,  this  will  allow  for  better  planning  and   policies  that  address  true  health  concerns  and  needs  in  Mohave  County  communities.           For  more  information,  please  visit  the  Mohave  County  website  at  www.mohavecounty.us  or  Kingman  Regional   Medical  Center’s  website  at  www.azkrmc.com  or  contact:       Susan  Williams,  Mohave  County  Department  of  Public  Health:     928-­‐753-­‐0794  ext.  4165     Teri  Williams,  Kingman  Regional  Medical  Center:     928-­‐681-­‐5061                 Page   107                                                                                            Community  Health  Profile  for  Mohave  County,  2013   Appendix  F       References   2012.1 Nielson Demographic Update, The Nielson Company, April 2011 Regional Economic Conditions (RECON). 2006-2010, Federal Deposit Insurance Corporation, 8 Dec. 2011 United States Department of Labor: Bureau of Labor Statistics. 2010. U.S. Department of Census. 8 Nov. 2011 . 2011 Poverty and Median Income Estimates – Counties, U.S. Census Bureau, Small Areas Estimate Branch, November 2012. 2010 Poverty and Median Income Estimates – Counties, U.S. Census Bureau, Small Areas Estimate Branch, December 2011. 2010 Health Insurance Coverage Status for Counties and States: Interactive Tables. U.S. Census Bureau, Small Area Health Insurance Estimates. 13 Jan. 2012 . County Health Rankings: Mobilizing Action Toward Community Health. 2011. Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. 30 Nov. 2012 . Community Health Status Indicators: CHSI 2009. U.S. Department of Health & Human Services. 8 Nov. 2012 . HealthyPeople.gov. 2011. U.S. Department of Health and Human Services. 30 Nov. 2012 . http://www.cityofkingman.gov/pages/about/community.asp U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimate U.S. Census Bureau, 2000 Census of Population and Housing The University of Wisconsin, Population Health Institute, County Health Rankings, 2012 U.S. Department of Education, National Center for Education Statistics, Common Core of Data, Public School Universe Survey Data, 2005-2006, 2006-2007, 2007-2008 and 2010-2011 Mohave County Economic Development U.S. Census Bureau, Small Area Income and Poverty Estimates, 2009 U.S. Census Bureau, 2008-2010 American Community Survey 3-Year Estimates and 2006-2010 5-Year Estimates U.S. Health Resources and Services Administration, Health Professional Shortage Area File, 2012 Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010 U.S. Health Resources and Services Administration, Centers for Medicare & Medicaid Services, Provider of Service File, 2011 Centers for Disease Control and Prevention, National Vital Statistics System, 2008-2010 Dartmouth Atlas of Healthcare, Selected Measures of Primary Care Access and Quality, 2003-2007     Page   108                                                                                            Community  Health  Profile  for  Mohave  County,  2013   National Highway Traffic Safety Administration, Fatality Analysis Reporting System, 2008-2010 Centers for Disease Control and Prevention, National Center for Health Statistics, Underlying Cause of Death, 2006-2010 Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2005-2009 Centers for Disease Control and Prevention, National Diabetes Surveillance System, 2009 Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 2008 and 2009 Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, 2008 U.S. Census Bureau, County Business Patterns, 2010 U.S. Department of Agriculture, Food Desert Locator, 2009     Page   109