Mohave County Department of Public Health Annual Report 2012 Table of Contents Vision - Mission - Values - Strategic Priorities 03 Our Challenge 04 Board Members & Department Organization 05 Financial Information 06 Department Programs 07 Public Health Preparedness 08 Environmental Health 10 Nutrition and Health Promotion 14 Public Health Nursing 18 Senior Programs 22 Socioeconomic & Health Indicators 24 Patterns in Mortality 26 2 Our Vision To be recognized as the most innovative, efficient, and effective public health agency in the State of Arizona Our Mission To create and promote a safe and healthy community for our citizens and visitors Our Values Integrity, Quality ,Fiscal Responsibility Responsibility (Accountability), Timeliness, Professionalism Teamwork , Resourcefulness, Development Our Strategic Priorities    Be prepared to respond to emergencies Support excellent customer service Enhance our ability to provide the ten essential public health services  Provide effective public health communication  Reduce disease and disability 3 Our Challenge The Mohave County Department of Public Health (MCDPH) works to protect our communities from a range of public health threats that include tuberculosis, HIV/AIDS, sexually transmitted diseases and other communicable diseases, food borne outbreaks, naturally occurring emergencies, and tobacco related and chronic disease. During this fiscal year we started the process of assessing the health of our communities. We obtained a grant from the Arizona Department of Health Services to conduct the community health assessment and improvement process. This funding is allowing us to hold stakeholder meetings and conduct the health assessment throughout Mohave County. We have also partnered with Kingman Regional Medical Center to conduct the assessment in the Kingman region. After completion of the assessment, we will work with our stakeholders to conduct a Community Health Improvement Plan. MCDPH undertakes many activities in this challenge including: identifying health risks; detecting, investigating and preventing the spread of disease; promoting healthy lifestyles; preparing for and responding to public health emergencies; maintaining healthy communities through inspection and code enforcement; and informing the public on health issues. The many programs in public health span environmental health to family planning; senior meals to immunizations; and emergency preparedness to nutrition for women, infants, and children. We participate in disaster planning and facilitate the staffing of shelters in the event of a disaster. We process the county’s vital records for deaths and births, work with community groups for health projects, and educate the public regarding healthy behaviors such as nutrition and avoiding tobacco. We have three district offices located in Kingman, Bullhead City, and Lake Havasu City; operate a part time office in Colorado City and senior centers in Lake Havasu, Kingman and Golden Shores. We take our mission seriously - that of creating and promoting a safe and healthy community for our citizens and visitors. 4 Department Organization & Board of Health DIRECTOR Patty Mead ADMINISTRATION Jennifer McNally - Assistant Health Director Account Specialist - 2 Office Specialist - 2 SECRETARY Sue Frank ENVIRONMENTAL HEALTH Rachel Patterson - Manager PUBLIC HEALTH NURSING Christy Bronston - Manager Environmental Health Supervisor – 2 Office Supervisor - 1 Environmental Health Specialist I/II –8 Environmental Health Technician – 1 Permit Technicians – 4 Nursing Supervisor – 3 Nurse Midwife – 1 Office Assistant – 5 Public Health Specialist – 6 Public Health Nurse, RN – 8.5 Program Coordinator, RN - 1 Paraprofessional Temp – 1 Clerical Temp - 2 SENIOR PROGRAMS Rena Arnold - Senior Programs Coordinator NUTRITION & HEALTH PROMOTION Deborah Conter - Manager Community Nutrition Specialist Sr - 1 Community Health Education Spec Sr - 1 Community Health Education Spec I - 3 Community Health Education Spec II - 1 WIC Eligibility Worker - 8 Office Specialist - 1 Office Assistant Senior - 1 Office Assistant - 1 Temp WIC Breast Feeding Peer Counselor - 3 Site Supervisor – 2 Site Coordinator – 1 Senior Programs Assistant – 3 Cook - 3 Prep Cook - 2 Labor/Trades Temp - 3 BIOTERRORISM & EMERGENCY RESPONSE Bruce Leeming - Program Coordinator Epidemiologist - 1 Volunteer Coordinator - 1 Professional Temp/Planner - 1 Board of Health Phil Moon Gary Watson Robin Gordon JoAnn Unruh Steve Greely Doug Haslan Kathy Bruck Dr Dat Nguyen Vacant 5 Financial Information July 1, 2011 – June 30, 2012 Revenues Federal Grants AHCCCS Revenue Fees from Services State Grants & Contracts County General Funds Miscellaneous & Donations $2,341,898 43,542 1,613,598 743,001 1,515,694 253,337 Total Revenues $6,511,070 Expenditures Personnel Services $4,482,973 Operating Supplies 537,098 Other Charges/Services Capital Outlay Total Expenditures 1,088,533 144,023 6,252,627 6 Department Programs Health Administration HIV Prevention Environmental Health Oral Health Environmental Health Technology Fee WIC - Breast Feeding Peer Counseling Program Environmental Health Clean Up Public Health Policy Initiative County Nursing Health Start County Nutrition Teen Pregnancy Prevention TB Control Folic Acid Health Dept. Donations Child Fatality Review Tobacco Senior Volunteer Recognition Family Planning Title V Smoke Free Arizona Family Planning Title X Ryan White Family Planning Title X HIV Bioterrorism Arizona Nutrition Network (LIA) Homeland Security Women Infants & Children (WIC) Senior Programs - County Newborn Intensive Care Program Senior Programs - Kingman Sexually Transmitted Disease Senior Programs - Lake Havasu Immunizations Senior Programs - Golden Shores Commodities Supplemental Food Program 7 Public Health Preparedness Our program conducts planning and preparedness activities for public health threats and emergencies. We work with local health care organizations, emergency management and public safety to build an integrated emergency response system to achieve response capabilities to protect residents and visitors of Mohave County and to better recover from disasters. Training, Exercises, and Response Conducting and participating in exercises is an important part of our ongoing preparedness activities. For two days in August we conducted a Receive, Storage and Staging (RSS) functional exercise as we combined all of our response assets into one location at our new warehouse. Health Department RSS staff and Medical Reserve Corps (MRC) Volunteers coordinated and executed the movement of Alternate Care Supplies (ACS) from the ACS warehouse and storage sites to the Warehouse Annex. A moving company was utilized to transport 33 pallets to the warehouse on the first day. MRC volunteers loaded a rental truck at three storage units and transported the supplies to the warehouse on the second day. Upon arrival, supplies were received, inventoried, and demarcated to the storage area. We participated in the state-wide Operation Vigilant Guard exercise in November, 2011. This exercise was a joint functional and full-scale exercise coordinated by the Arizona Division of Emergency Management, the Arizona National Guard through the VIGILANT GUARD Program, and the Arizona Department of Health Services. The exercise was designed to establish a learning environment for players to exercise emergency response procedures, plans, and policies related to an improvised nuclear device (IND) radiological incident. The Healthcare and Public Health Group participated on November 4, 2011 and focused on healthcare preparedness and response capabilities. This portion of the exercise focused on players and decision-makers at the Arizona Department of Health Services, county and tribal public health agencies, private and government sector hospitals, and community health centers. The scenario involved a 10 kiloton improvised nuclear device incident in the greater Phoenix metropolitan area and focused on the emergency response phases of the operation. In this scenario, participating hospitals and community health centers in all regions of the state were considered to be experiencing medical surge as a result of the incident in Phoenix. MCDPH was tasked with coordinating medical surge needs throughout the county, registering Phoenix area evacuees, and assisting in shelter needs for these individuals. 8 Planning Activities The Arizona Department of Homeland Security grant that we received in 2010 ends in September 2012. We plan to maintain this position through fiscal year 2013 with funding from our Public Health Preparedness grant that is being carried forward from fiscal year 2012. The planner has worked with all of the counties and hospitals in the Western Region (LaPaz, Mohave, and Yavapai) to develop a Medical Surge Program and response plan for the Western Region. Medical surge describes the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. The program has been delivered and presented to hospitals in Mohave County and will help to coordinate response activities throughout the county during a disaster. This program is nearing completion in LaPaz and Yavapai counties with the MOU process between the counties and hospitals remaining. The respective counties are working to complete this process in their own jurisdictions. During a disaster or emergency that overwhelms the capabilities of local hospitals, local health departments are responsible for coordinating alternate care facilities. We received funding from the Arizona Department of Homeland Security for medical surge equipment needs in the Western Region. The funding enables health departments in each county of the region to address critical functions should an Alternate Care Facility be opened to provide medical services to their population. We completed the supply portion of this grant which now enables us to open an alternate care site with up to 300 cots and other medical support supplies. The development of an alternate care supply cache for the county has been completed and enables counties to open an alternate care site to augment local hospitals for two - three days. Mohave county is one of five counties that have addressed this issue, and completed a program. An emergency response plan was developed for the Senior Program Division, Nutrition Centers. All of the Nutrition Center supervisors and employees have been trained on the plan which addresses functions and responsibilities during a disaster. Our Planner and Volunteer Coordinator presented the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program to Kingman Regional Medical Center. ESAR-VHP is a federal program created to provide support in establishing standardized volunteer registration programs for disasters. The program verifies health professionals' identification and credentials so they can respond more quickly when disaster strikes. By registering through ESAR-VHP, volunteer’s identities, licenses, credentials, accreditations, and hospital privileges are all verified in advance, saving valuable time in emergency situations. Medical Reserve Corps Medical Reserve Corps volunteers participated at emergency preparedness and community events during the year including: Winterfest Street Fair, Lake Havasu’s 30th Annual Home Show, Kingman Regional Medical Center’s Kids Day, Kingman Unified School District’s “Family Involvement Fair” and “Back to School Fair”, and "Havasu Stick'em" Health Fair and Immunization clinic. MRC volunteers also assisted Public Health Nursing during back to school immunization clinics. They also provided clerical assistance throughout the year, including immunization follow-up phone calls. The Mohave County MRC volunteers donated over 1,800 hours during the year. 9 Environmental Health Environmental Health is responsible for inspection of public places, enforcement of various environmental laws, response to public nuisances, and response to emergencies as part of the department Emergency Response Team. The division receives authority through delegation agreements with the Arizona Department of Environmental Quality (ADEQ), the Arizona Department of Health Services (ADHS), and local Mohave County Ordinances and operates in accordance with division policies and procedures. Specific areas of responsibility include; food safety, public & semi-public swimming pools, RV parks, hotels/motels, pet shops, grooming parlors and kennels, septic pumper trucks, refuse haulers, septic systems, public nuisance complaints, wells, Smokefree Arizona, campgrounds/children’s camps, and school buildings. Food handler education is offered as part of the food safety program. Accomplishments The National Association of County and City Health Officials (NACCHO) honored the Environmental Health Division’s nuisance program with a Model Practice Award. Mohave County was one of the submissions chosen out of 127 nationwide for this award. The division has created new procedures and legal forms, trained staff, and developed an ordinance allowing liens to be placed on properties requiring legal action on the part of the division. Funding for the program comes from lien payoffs and from a 50-cent surcharge per ton to the landfill fees. The objectives of the program include timely, efficient and legally sound responses to nuisance complaints in order to prevent health effects and collaboration with other county departments. Environmental Health forms and applications were posted on the Department website as well as all division ordinances. This provides the public with the ability to obtain necessary information without having to come in to the office. They are also able to print applications forms and have them completed prior to arrival at our offices. Due to a transition in computer systems, restaurant ratings had been unavailable on the county website. Environmental Health worked with the county IT Department to get the ratings back on-line. The public can again find ratings for all inspected food establishments in the county on the main page of the county website at www.mohavecounty.us. The revised web page provides more options for searching and is more user friendly. The search results for each establishment provide the rating, any violations noted at the time of inspection as well as the inspector notes. On-line restaurant ratings search Note: To limit your search to a particular Date, Establishment, Address, City, Rating, fill in one or more of the following: Start Date: End Date: Establishment: Address: City: Rating: 10 On-Site Wastewater Inspections On-Site Wastewater Permits Issued Food Service Annual Inspections 1400 1000 3000 1200 2500 750 1000 2000 800 500 1500 600 1000 400 250 500 200 0 0 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 07/08 FY 08/09 FY 09/10 FY 10/11 0 FY 11/12 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 In fiscal year 2012, the Division conducted 4,471 inspections in the various programs. While the number of annual food service permits has remained fairly constant, we have conducted 16% fewer inspections due to inspector vacancies throughout the fiscal year in the annual inspection program. Even with inspector vacancies, we have experienced an 18.4% increase in the number of food service inspections conducted annually form 2008 to 2012. Over the past five years, the number of septic permits issued has dropped and last year was no exception. From 2008 to 2012, we have experienced a 73.3% reduction in septic permits (from 953 to 254). Due to the reduction in permits, we experienced an 80% reduction in inspections during the same timeframe (from 1209 to 242). Nuisance complaints for land use have also continued to drop with a 33.5% reduction from 2008 to 2012 (from 739 to 491). 808 inspections were conducted in response to the complaints received with 18 cases taken to court (a 55% decrease in the number of court cases). In order to be fiscally responsible and ensure workload efficiencies, 5.5 inspector positions in the septic and nuisance complaint program have been frozen as individuals have resigned. As part of the public health nuisance complaint program, the division is statutorily required to respond to abate nuisances if they cannot be resolved by notification to the property owner. During fiscal year 2012, nuisance abatement was conducted at six properties for a cost of approximately $33,000. We received approximately $93,785 in lien payoffs and $3,137 in settlements; these were for liens placed prior to and including FY 12. A total of over $355,000 in liens remain against properties in Mohave County. Due to a significant reduction in the number of complaints received in the Smokefree Arizona program in 2011, the focus shifted to conducting more educational visits with businesses. The part-time employee who was hired as a result conducted 2,177 educational visits this fiscal year (a 53% increase from 2011). We visit places of business in Mohave County to explain the Smokefree rules, distribute signs, and answer any questions business owners may have. As a result of these educational efforts, the number of complaints from 2010 to 2012 has dropped 74% Smokefree Arizona complaints educational visits 2177 1028 800 650 188 FY 07/08 492 92 FY 08/09 122 FY 09/10 41 31 FY 10/11 FY 11/12 11 Environmental Health Statistics Food Service Temporary Permits Annual Permits Annual Inspections Food Handler Cards On-Site Wastewater Permits Issued Inspections Pools/Spas Permits Inspections Kennels/Grooming Permits Inspections Hotel & Motel Permits Inspections Trailer Parks Permits Inspections Campgrounds/Children’s Camps Permits Inspections School Buildings Permits Inspections Nuisance Complaints Number Received – land use Inspections – land use Number Received – annually permitted establishments Court hearings Septic Haulers Permits Inspections Refuse Haulers Permits Inspections Wells (recommendation of approvals given to ADWR) Notice of Intent approvals Smokefree Arizona (May—May reporting period) Complaints Inspections Educational Visits FY 10/11 FY 11/12 340 1330 2948 3239 428 1358 2475 4271 321 260 254 263 589 268 58 54 58 84 92 85 102 115 102 3 3 3 53 74 54 508 995 243 40 491 44 20 42 92 107 96 31 19 33 39 1393 32 242 532 31 87 106 3 61 808 305 18 18 70 38 2075 12 13 Nutrition & Health Promotion Special Supplemental Food Program for Women, Infants, and Children (WIC) & Breast Feeding Programs Helping Families With Proper Nutritional Choices WIC is a supplemental food assistance program for pregnant, breastfeeding and postpartum women, infants and children to age five. Benefits of the program include vouchers for specific nutritious foods, individual nutrition education and care plans, and referrals to health and social services. In 2012, our program served approximately 4,300 clients per month. This is down 200 participants per month from last year and can be attributed to families moving from the area and fewer babies being born. About half of Mohave County infants and twenty five percent of children to age five are served by WIC. From October 1, 2011 to September 31, 2012, WIC vouchers redeemed at local stores totaled $3,673,048. WIC is contributing to positive impacts on the health of babies born in Mohave County. Over the last two years, the rate of low birth weight babies has reduced 27% (from 7.0 to 5.1), the number of underweight children dropped by 1.2%, and the rate of childhood obesity has slowed but the number of overweight children has increased. Breastfeeding helps lower the risk of health problems for babies According to the Centers for Disease Control and Prevention, research shows that if 90 percent of mothers breastfed exclusively for 6 months, nearly 1,000 deaths among infants could be prevented. Breastfeeding rates have traditionally been low in Mohave County and we would like to move closer to the Healthy People 2020 goals of 81% of women breastfeeding their babies at birth, 60% of women breastfeeding their babies at 6 months of age, and 34% of women breastfeeding their babies at one year of age. Through our Breastfeeding Peer Counseling Program, classes are available to clients along with the services of a board certified Lactation Consultant and peer counselors in Kingman, Bullhead City and Lake Havasu City. A peer counselor is often the ideal advisor because she offers more credibility to the participant than a professional. Mohave County employs two part time peer counselors to work with pregnant and postpartum women interested in breastfeeding. Each pregnant woman entering the WIC program is offered the opportunity to attend a breastfeeding class. Counselors are also available by phone to assist with questions and problems new mothers may encounter. Breastfeeding statistics show an increase in the number of infants exclusively breastfed the first three months; the percentage doubled from 2006 to 2011. The number of babies in Mohave County who were breastfed for an entire year also increased by 2%. 14 Nutrition & Physical Activity Education The Nutrition Network (formerly LIA) Healthy Outcomes Folic Acid Program Nutrition education is important to shape food consumption in a positive way, to promote health, and to reduce disease. The Nutrition Network is funded by the USDA and was established to provide nutrition education to families who are eligible for the SNAP Program (food stamps). Folic acid is important because it can help prevent some major birth defects of a baby’s brain and spine by 50 - 70%. Since about 50% of pregnancies are unplanned, it is important that all women of childbearing age have sufficient folic acid in their body before they become pregnant and during pregnancy. The program provides nutrition education in local schools, SNAP and WIC offices. Curriculum includes: healthy breakfast and whole grains; Fruits and Veggies More Matters; My Plate, and Building Better Bones. We provided nutrition education to 6,600 children and their teachers during the year. This program provided education on the importance of folic acid and provided vitamins to women at WIC clinics and Nursing offices. The program has provided 3,000 bottles of vitamins to women of childbearing age. This grant ended in July, 2012 and the Arizona Department of Health Services will use funding for a social marketing campaign to target all women of childbearing age. We also provide food demonstrations to promote healthy meals and food choices. These demonstrations were given to approximately 500 people during the year. Commodity Supplemental Food Program (CSFP) Proper nutrition is key to a healthy life. Through this program we provide 350 nonperishable food boxes to income eligible women, children to age six, and seniors 60 and older in efforts to improve their health. There is great demand for this program and we are currently serving the maximum number of clients. Oral Health This goal of this grant was to provide more dental services to the underserved population in Mohave County. We contracted with a registered dental hygienist to educate local dental providers about teledentistry and Affiliated Practice. The Arizona Office of Oral Health did not receive funding for this program for 2013 so it ended in July, 2012. 15 Mohave County Tobacco Use and Chronic Disease Prevention Program Population Health Policy This is a new grant received this year that will focus on improvements in public health through policy changes in our community. The focus of the grant will be to work with community-based organizations and local decision makers to help them understand how they can improve the health of their communities by focusing on policy, systems and environmental change in the areas of schools, worksites, clinical care, community design and procurement. Chronic Disease Self Management Program This grant allows us to help county residents suffering from chronic conditions, or caring for family members with chronic disease, by offering the Stanford University’s Chronic Disease Self-Management Program. This is a community based program that offers six sessions to teach how to self-manage conditions through diet, physical activity, attitude and adhering to medication schedules. Self-management programs have been shown to decrease medical costs and provide the patient with a better quality of life. Coordinate School Health Program This grant program supports and offers technical assistance to local schools to help them identify their social and health challenges. It consists of eight interactive components that encourage participation from both community and school members. It systematically promotes a group effort to maintain the well-being of the school and community. Services are currently offered in Bullhead City and Lake Havasu City with Kingman targeted for 2013. Smoke Free Mommy and Me (SFM) This program targets pregnant women and moms with babies to age three who are trying to quit and struggling to stay quit. It addresses the health risks of smoking during pregnancy, avoiding postpartum relapse, and lifestyle changes that promote healthy families. SFM offers a wide variety of educational sessions in nutrition, physical activities, and feeding and caring for children. There is both group and individual cessation coaching for pregnant women, postpartum women, spouses and other family members. SFM offers diapers for incentives to stay quit. The program also supports and advances a collaborative relationship with ASHLine (Arizona Smokers Helpline), Mohave County healthcare providers, pregnancy centers, and family health programs. Mohave County has one of the highest rates of women who report smoking during pregnancy. Although our rates have gone down over the years, we continued to remain the highest in all of Arizona’s 15 counties according to the Arizona Department of Health Services. 52 clients enrolled in the program with 34 having quit dates. 16 Mohave County Youth Anti Tobacco Coalitions Kingman Youth Coalition Beating Up Teen Tobacco (KYCBUTT) at Kingman High School and Kingman Academy of Learning  Lake Havasu High School Youth Health Club  Bullhead City’s Fox Creek Junior High School and Bullhead Junior High School  The goal is to reduce the early onset of youth tobacco use and exposure to second hand smoke. The youth coalitions participate in executive officer elections and are recognized as an official school club. The Mohave County Tobacco Use and Chronic Disease Prevention Program co-sponsors the clubs with a school club teacher. The students provide peer led education to elementary and middle school students on the dangers of tobacco use and secondhand smoke. Students participate in community events and activities such as parades, health fairs and sports events. They also participate in fund raising activities to support the club. Other activities of the youth coalitions include: participation in the Arizona Attorney Generals Office merchant compliance checks and education; adopt-a-block to maintain and keep their cities trash free; educating the public and city officials on the concerns of tobacco use and exposure in the city ball fields and parks; and participate in an annual statewide leadership conference. Ten youths and two chaperones attended the statewide leadership conference. KYCBUTT Parade of Lights KYCBUTT Peer Education KYCBUTT at Kingman City Council Four to six youth participate in the STAND (Students Taking a New Direction) train-the-trainer program; they train other youth throughout the state on coalition development and community education. Mohave County Youth Coalitions continue to be a model program. The Kingman youth were successful in supporting the city’s one year smoke free zone pilot program which will cover three parks that include ball fields for signage and cigarette waste receptacles. Kingman High and Kingman Academy of Learning students were honored for their anti-tobacco educational actions. The Arizona Department of Health Services Bureau of Tobacco and Chronic Disease presented its first annual Most Valuable Partner Awards this year with Mohave County Tobacco Use Prevention Program and KYCBUTT receiving an Award of Excellence. Tobacco Education and Cessation Most Valuable Partner Award Businesses, healthcare providers, schools, and community members are educated on the hazards of tobacco use and exposure throughout the county. In schools, trained youth advocates offer peer to peer education to elementary and junior high schools. In the community both staff and youth advocates provide education through community health fairs, parades, and major events. On-going Stop Smoking classes are offered at Kingman Regional Medical Center through funding they provide to our program. Arizona Smokers’ hotline, telephone coaching and online quit services are offered to all Mohave County residents along with healthcare provider Ashline service trainings. 17 Public Health Nursing The division provides professional nursing services and programs for high risk populations. Many services are mandated in order to protect the health and safety of Mohave County residents and are free, regardless of household income. Communicable Disease Communicable disease reporting is the cornerstone of public health surveillance and disease control. It allows us to locate and prophylax or treat exposed contacts, ensure effective treatment and follow up of cases, and alert the health provider community as necessary. The goal is to interrupt the disease transmission and contain outbreaks. During the year we conducted 1,540 communicable disease investigations; not including Tuberculosis. The investigations included interviewing individuals, families and groups to identify exposure to disease and offering medications for treatment or prophylaxis when appropriate. HIV Testing and Counseling Funding for this program has been reduced 64.4% over the last decade; in 2003 we received $55,649 and today we receive $19,805 annually. Due to the current amount of funding, our program provides a “safety net” of service that allows those who have been exposed or concerned about exposure to be tested for a nominal fee. Rapid testing services have been utilized for the past two years which allows for results in approximately 20 minutes. For individuals who test positive on the rapid test, blood specimens are collected and submitted to the Arizona State Laboratory (ASL) for confirmation testing only. Results from ASL are typically provided within two weeks. Sexually Transmitted Disease Program Medical providers throughout Mohave County report cases of Gonorrhea, Chlamydia and Syphilis as required by Arizona Revised Statutes. Public Health Nurses contact clients to ensure completion of appropriate treatment and to refer contacts to local providers for testing, treatment and follow up. Tuberculosis (TB) Control and Treatment TB disease is caused by a bacterium called Mycobacterium tuberculosis that usually attack the lungs, but it can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. To combat this disease, we work with a TB Control Officer to provide one-on-one case management on every active TB case. H1N1 Hantavirus Pertussis Legionellosis Tuberculosis 18 Case management includes Direct Observed Therapy (DOT) by nursing personnel whereby personnel watch the TB patient actually take their medication. It is extremely important that people with TB disease take their medicine exactly as prescribed and that they finish the medicine. If they stop taking it too soon, they can become sick again and if they do not take it correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. During fiscal year 2012, the Nursing Division provided treatment and follow up to two active TB cases. These cases required 199 home visits for DOT and follow up of other complications related to the disease. The Centers for Disease Control and American Thoracic Society have recently changed recommendations related to the duration of treatment for active cases. The treatment regimen is now recommended for 9 - 12 months versus the previous 6-month regimen. Public health nurses also respond to suspect cases of TB that result in considerable staff time to rule out active disease. Suspect cases are investigated and often receive medications for several months until the disease can be ruled out. Maternal and Child Health Reproductive Health (RH) Reproductive health services are offered to both males and females in Bullhead City, Lake Havasu City, and Kingman. The program is funded by Title V with funds from the Arizona Department of Health Services, Title X funds through the Arizona Family Planning Council and in-kind support from Mohave County. In 2011, we served 1,419 unduplicated clients at 100% or below of the Federal Poverty Level. 1,413 of these client reported being uninsured which is a significant barrier to medical services. Although most of the clients served were between the ages of 15 - 44, 2.8% were 45 or older and 1.7% were 14 or younger. The program provided 279 syphilis, 441 gonorrhea, and 1144 chlamydia tests as well as 779 HIV screening tests. Over the past five years we have seen a 60.34% increase in the number of unduplicated clients in our clinics (from 885 to 1,419). As our demand for reproductive health services has increased, we have expanded services. We now offer two additional clinic days; one in Lake Havasu City and one Bullhead City. In order to ensure comprehensive services are provided to clients, the program coordinates with the STD, HIV, Health Start and Communicable Disease programs. We provide referrals to other county programs such as WIC, Smoking Cessation, and Community Development. As appropriate, we also refer clients to Mohave Mental Health, private physicians, Well Woman Health Check, Havasu Trust, and Community Health Centers. Newborn Intensive Care Program This home visitation program allows professional staff to visit high risk infants who have been in a newborn intensive care unit (NICU) unit for 72 hours or more following birth. It facilitates the transition of the child and family from the NICU to their home and community. Periodic monitoring of the child's medical and developmental needs identifies infants who would benefit from referral to other early intervention programs. Through these home visits, the family receives support and education as well as referral to appropriate community resources. 19 Teen Pregnancy Prevention Program According to the Centers for Disease Control and Prevention (CDC), in 2011, a total of 329,797 babies were born to women aged 15 - 19 years, for a live birth rate of 31.3 per 1,000 women in this age group. This is a record low for U.S. teens in this age group, and a drop of 8% from 2010. Birth rates fell 11% for women aged 15–17 years, and 7% for women aged 18–19 years. While reasons for the declines are not clear, teens seem to be less sexually active, and more of those who are sexually active seem to be using birth control than in previous years. The CDC also states that teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children:    In 2008, teen pregnancy and childbirth accounted for nearly $11 billion in costs to U.S. taxpayers for increased health care and foster care, and lost tax revenue because of lower educational attainment and income among teen mothers. Pregnancy and birth are significant contributors to high school drop out rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age. The children of teenage mothers are more likely to have lower school achievement and drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult. The Teen Pregnancy Prevention Program provides instruction for teens in local schools and the juvenile detention center and presents parent workshops at the Ft. Mojave Indian Social Service facility to provide them with the tools necessary to talk with their adolescent or teen about sex and reproductive health issues. The program provided education to 1,792 students during the year. Mohave County Pregnancy Rate for Females 19 and Under 40 (per 1,000 females in the age group) 35 30 25 20 15 Immunization Program Free immunizations are provided to children and adolescents seen during weekly immunization clinics. Immunizations provided include all vaccines recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. The vaccine is provided through the Vaccines for Children program which is a federally funded immunization grant. During the fiscal year, we provided 12,951 vaccines to 3,735 children throughout Mohave County. Childhood immunization clinics continue to experience large numbers of children requiring multiple vaccinations to enter school and/or daycare. Clinic numbers increase tremendously in the late summer as families prepare to send children back to school. On average, we see 65 - 85 children per day during these clinics. 20 FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 207 248 367 306 24 88 130 1,234 1,323 1,453 1118 1485 1241 1540 Children vaccinated 3,898 5,612 7,006 6,994 4929 4159 3735 Vaccinations given 13,090 20,406 18,541 19,121 13,822 13,921 12,951 Tetanus-Diphtheria 243 189 169 186 92 61 150 Hepatitis B 305 336 359 325 292 206 201 Hepatitis A 171 132 66 73 72 30 32 Twinrix na na na na na na 140 Varicella 25 43 17 41 24 69 56 MMR 179 147 115 201 85 118 84 HPV -- 1 4 44 21 3 2 Zostovax -- 10 155 157 63 26 3 Meningococcal -- 17 14 14 8 2 3 Influenza / H1N1 5,959 3,031 2,969 845 13,232 606 130 Pneumonia 1,016 328 620 41 15 26 8 1,149 1,207 1,657 1304 812 696 851 Latent TB infection 179 107 568 733 240 331 129 Active case visits 291 321 113 407 303 120 199 7 3 4 3 3 4 2 Chest x-ray/clinics 162 139 322 305 70 69 55 Primary Reactor Visit 60 59 164 114 37 45 30 Pregnancy Tests 316 708 710 869 756 680 623 New/Annual visits 971 889 1155 1263 RH/ HIV Tests (started FY 2012) na na Newborn Intensive Care Program Home visits Communicable Disease Disease investigations Childhood Immunization Program Adult Immunizations Program Tuberculosis Control TB skin tests Active case Reproductive Health Unduplicated clients na na na na 779 885 1220 1376 1351 1419 Sexually Transmitted Disease Clinic visits 150 76 126 133 138 86 85 HIV tests 146 101 199 109 84 126 120 HIV post counsel 112 95 143 109 84 126 120 236 530 441 249 358 315 302 1962 2000 1792 76 76 76 HIV Counseling and Testing Health Start Visits Teen Pregnancy Unduplicated Students Ryan White 21 Senior Programs Senior Programs provides congregate meals at senior center sites and home delivered meals via the “meals on wheels” program. The centers also provide support services, socialization, and education including: bridge, tax aide, legal aide, yoga, crafts, and exercise classes. Three senior centers were operated by Mohave County with sites in Golden Shores, Kingman and Lake Havasu City. Each Senior Center has a site council with a non-profit association established. They conduct numerous activities throughout the year to raise money to help support the operations at the senior centers. Revenues are used to help pay for program expenses such as utilities, food, office supplies, equipment and repairs and are considered in-kind donations. The total amount of in-kind received in FY 2012: 1st quarter $28,517.92 2nd quarter $32,116.81 3rd quarter $43,994.09 4th quarter $29,529.10 Total $134,157.92 Mohave County did not apply for WACOG funding for senior meals in the Bullhead service area as the City of Bullhead decided to apply for and take on this service. Due to their award from WACOG, the Mohave County award was reduced in FY 12; we started the year with $257,587. This reduction in funding and the reduction in general fund transfer the prior year affected our ability to provide the same number of meals as the previous year. Based on projected spending for the fiscal year, the county and WACOG implemented a cap on the number of clients for home delivered meals we were able to serve in the fourth quarter of the fiscal year. WACOG was able to provide an additional $26,470 in April, 2012 for home delivered meals which allowed us to add additional clients. They were also able to provide an additional $54,159 in June, 2012. Senior programs served a total of 143,282 meals during the fiscal year. 22 The Kingman, Golden Shores, and Lake Havasu centers saw a reduction in the number of congregate meals served by 12.5%, 10.1%, and 6.5% respectively compared to the previous fiscal year. 35000 30000 25000 20000 15000 10000 5000 0 1200 Congregate Meals Served 1000 Congregate Clients Served 800 600 400 200 0 Kingman Golden Shores Lake Havasu FY 08 582 144 1069 32563 FY 09 575 171 874 8544 30347 FY 10 332 114 711 12152 6896 28239 FY 11 257 147 705 10627 6199 26416 FY 12 238 132 604 FY 08 Kingman 21717 Golden Shores 7356 Lake Havasu 30479 FY 09 21783 8712 FY 10 16454 FY 11 FY 12 The number of home delivered meals in Kingman and Lake Havasu decreased 3.5% and 7.3% respectively compared to the previous fiscal year. The number of home delivered meals in Golden Shores increased 15% compared to the previous fiscal year. 50000 400 350 300 250 200 150 100 50 0 Homebound Meals Served 40000 30000 20000 10000 0 Homebound Clients Served FY 08 Kingman 261 Golden Shores 61 Lake Havasu 323 47698 FY 09 234 62 352 5481 42584 FY 10 200 30 139 52282 5314 46875 FY 11 189 22 168 50461 6117 43462 FY 12 140 24 133 FY 08 Kingman 37214 Golden Shores 5735 Lake Havasu 42360 FY 09 33575 5212 FY 10 42180 FY 11 FY 12 23 Socioeconomic* and Health Indicators Mohave County Population from Office of Employment & Population Statistics, AzDOA Bullhead City Colorado City 39,348 4,794 Kingman 28,029 Lake Havasu City 52,406 Unincorporated 75,840 200,417 Total 2011 Age Distribution <1 - 14 15 - 19 20 - 44 46712 60292 47753 11719 33941 from Arizona Vital Statistics 45 - 64 65+ Of the total county population, 194,693 individuals reported they were of one race and 5,493 reported they were of two or more races. Those who reported one race were:       White Black or African American American Indian & Alaskan Native Asian Native Hawaiian & other Pacific Islander Some Other Race 173,878 1,882 4,500 2,103 341 11,989 29,569 individuals reported they were Hispanic or Latino. Of these, 24,760 were Mexican, 721 Puerto Rican, and 272 Cuban and 3,816 Other. * Socioeconomic statistics are from the 2010 US Census unless otherwise noted. 24 Health Indicators The total number of births and the birth rate in Mohave County have continued to decline over the past five years. The number of births has declined 19.5% and the birth rate has declined 19.8%. Birth Rate Total Births 13 2500 2400 per 1,000 population 12 2439 2300 2200 11 2301 11.2 2220 2100 2022 1900 1800 2008 10.9 10 2000 2007 12.1 2009 2010 10.1 9 1962 9.8 8 2007 2011 2008 2009 2010 2011 While the number of births to unwed mothers had declined over the past five years, the rate of births to unwed mothers has increased; 11.6% and 9.7% respectively. The number of teen births, as well as the rate of teen births, has decreased significantly over the past five years; 43% and 40.8% respectively. Characteristics of Mothers Characteristics of Mothers *per 100 live births **per 1000 females 19 or under 2007 1400 2008 1200 2009 1000 2010 800 2011 600 2008 50 2009 40 2010 30 2011 370 331 309 275 211 births to mothers 19 or under 31.1 27.3 25.6 24 18.4 1150 1184 1069 974 1017 births to unwed mothers 0 10 47.2 51.5 48.2 48.2 51.8 20 400 200 2007 60 rate of births to unwed mothers* rate of births to mothers 19 or under** 0 The number and rate of low birthweight babies has decreased significantly over the past five years; 44.4% and 31.1% respectively. Although the overall numbers are low, the number and rate of fetal death were decreasing but they experienced an increase last year. 7 2007 6 2008 5 2009 low birthweight babies fetal mortality 0.54 0.54 0.39 0.72 5.1 6.1 7 6.1 2 0.92 2011 3 1 -20 2010 4 7.4 12 9 17 100 141 136 141 180 80 18 2007 2008 2009 2010 2011 130 30 *rates per 100 live births 8 11 180 Characteristics of Newborns Characteristics of Newborns 0 low birthweight babies fetal mortality rate* rate* 25 Patterns in Mortality Vital Records The Administration Division provides certified copies of death certificates for deaths that occurred from 2008 to present. We provide services to all county funeral homes for deaths that occurred in the county and provide mail and walk-in service to individuals who need certified copies of death certificates for deaths that occurred in Arizona. There were 2,424 deaths in Mohave County in calendar year 2011 and staff processed 16,613 certified copies of death certificates. Death Rate Number of Deaths per 10,000 population 2500 130 2400 120 2300 110 2200 100 2100 90 2000 1900 2007 deaths 2153 2008 2461 2009 2260 2010 2368 2011 2424 80 death rate 2007 2008 2009 2010 2011 107 120.1 110.5 118.3 120.9 Of the 2,424 deaths in Mohave County in 2011, the top ten causes of death were: major cardiovascular diseases malignant neoplasm chronic lower respiratory diseases accidents intentional self harm diabetes Alzheimer's disease chronic liver disease & cirrhosis influenza & pneumonia nephritis, nephrotic syndrome & nephrosis number 788 601 195 96 64 59 55 38 35 29 % of total deaths 33% 25% 8% 4% 3% 2% 2% 2% 1% 1% 26 Of the 601 deaths related to malignant neoplasms in the county, the top five types were: 1. 2. 3. 4. 5. Trachea, bronchus, lung All other and unspecified Colon, rectum, anus Pancreas Prostate 31% 9.8% 8.5% 6.3% 6.2% The top three causes of death of males and females in the county were the same: major cardiovascular disease, malignant neoplasm, and chronic lower respiratory diseases. Top Ten Causes of Death 2010 - Males percentage is of total male deaths =1,322 24 2% 62 5% 21 2% Top Ten Causes of Death 2010 - Females percentage is of total female deaths = 1,102 16 2% 20 1% 41 4% 443 33% 21 2% 61 6% 90 9% 356 27% Malignant Neoplasms Major Cardiovascular Diseases Chronic Lower Respiratory Diseases Accidents Suicide Diabetes other diseases of respiratory system Chronic Liver Disease & Cirrhosis Alzheimer's disease 12 1% 18 2% 31 382% 39 3% 3% 93 7% 14 1% 303 29% 254 25% Major Cardiovascular Diseases Malignant Neoplasms Chronic Lower Respiratory Diseases Total Accidents Alzheimer's Disease Diabetes Signs, symptoms, abnormal findings Suicide influenza & pneumonia Chronic liver disease & cirrhosis 27 Mohave County Department of Public Health  700 W. Beale Street  P.O. Box 7000  Kingman, AZ 86402 Phone 928-753-0743  Fax 928-718-5547  Emergency Info 866-409-4099  www.HealthELinks.com Prepared by: Reviewed by: Jennifer McNally, Assistant Health Director Patty Mead, Health Director 28