Mohave County Department of Public Health Annual Report 2013 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 28 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 Accountability) Timeliness, Professionalism Teamwork , Resourcefulness, Staff Development Our Strategic Priorities    Be prepared to respond to emergencies Provide 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 With the ultimate goal to improve health and quality of life in Mohave County, a community health assessment was initiated in the fall of 2011 by a county-wide 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 via a public survey. 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. The objective was to provide a realistic picture of the health needs and issues unique to Mohave County’s population, geography and economy to be utilized for local planning and for creating policies and programs that address true health concerns within the county. To view the assessment on-line, go to: www.mohavecounty.us and click on Departments, Public Health, and Community Health Profile on the left side of the page. The community health assessment was the first part of a two-pronged approach for improving health and quality of life in Mohave County. With the completion of the health assessment the community coalition will use the data and information to identify and address priority health issues which will be documented in a second report called the Community Health Improvement Plan (CHIP). The CHIP will include strategies and measures for acting on selected community health issues. This will be an ongoing process, which will involve performing a community health assessment and developing a community health improvement plan every three years. This planning and working together as a community will encourage collaboration amongst community partners and will provide a more coordinated approach to current health issues. As it has always been, our mission is to create and promote 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 - 1 Site Supervisor – 1 Site Coordinator – 1 Senior Programs Assistant – 2 Cook - 1 Prep Cook - 1 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 Doug Haslan Sandra Sockwell Kathy Bruck JoAnn Unruh Dr Dat Nguyen Larry Carver Steve Greeley 5 Financial Information July 1, 2012 – June 30, 2013 Revenues Federal Grants $2,269,940 AHCCCS Revenue 39,065 Fees from Services 1,596,978 State Grants & Contracts County General Funds 777,679 1,285,644 Miscellaneous & Donations Total Revenues 156,165 $6,125,471 Expenditures Personnel Services $4,261,641 Operating Supplies 580,507 Other Charges/Services Capital Outlay Total Expenditures 1,161,654 90,179 6,093,981 6 Department Programs Health Administration HIV Prevention Environmental Health Sexually Transmitted Disease Environmental Health Technology Fee Immunizations Environmental Health Clean Up Health Start County Nursing Teen Pregnancy Prevention County Nutrition WIC - Breast Feeding Peer Counseling Program TB Control Commodities Supplemental Food Program Health Dept. Donations Healthy Arizona Policy Initiative Tobacco Child Fatality Review Family Planning Title V Senior Volunteer Recognition Family Planning Title X Smoke Free Arizona Family Planning Title X HIV Bioterrorism Arizona Nutrition Network Senior Programs - Kingman Women Infants & Children (WIC) Senior Programs - Lake Havasu Newborn Intensive Care Program Senior Programs - Golden Shores Ryan White 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. Exercises are an effective and cost-efficient way to validate our emergency plans, identify areas for improvement, and get feedback from the people who will be executing the plans. In February we participated in the Arizona Department of Health Services (ADHS) 2013 Strategic National Stockpile (SNS) full-scale exercise. Full-scale exercises are the most complex and include the actual deployment of personnel and equipment. They focus on implementing and analyzing the plans, policies, procedures, and cooperative agreements across multiple functional areas that require critical thinking, rapid problem solving, and effective responses by trained personnel in real time, stressful environments that closely mirror real incidents. The 2013 SNS Exercise utilized Health Department staff and Medical Reserve Corps (MRC) volunteers to demonstrate various SNS capabilities from the request processes to distribution and dispensing activities, in order to meet Medical Countermeasure Distribution and Dispensing Composite Measures established by the Centers for Disease Control and Prevention. We activated our Health Department Operations Center (HDOC), established and maintained communications with our stakeholders, requested medical assets from the State, received medical assets into our SNS Warehouse, conducted inventory, and coordinated dispensing these medical assets. In May we participated in the ADHS Patient Movement Functional Exercise which was designed to establish a learning environment for players to exercise emergency response plans, policies, and procedures as they pertained to patient movement capabilities in response to an extended power outage. This exercise was evidence of the growing public safety partnership between Federal, State, and local jurisdictions regarding the challengers an extended power outage presents to our Nation and communities. This exercise was one of many training opportunities leading up to the statewide full-scale exercise in November 2013. 8 Planning Activities The Mohave County Department of Public Health (MCDPH) has maintained the emergency planner position by utilizing Bio-Terrorism grant funds to ensure the continuity of emergency planning efforts. The emergency planner has been working on establishing a radiological response plan/program to coincide with the State of Arizona's efforts in emergency response planning and exercises. This program has included the acquisition of radiological monitoring equipment to be able to monitor a large number of potential victims from a radiological type incident. Training through the local LEPC and Emergency Management is also in the planning stage. Our planner has been updating the relevant plans in preparation of the November 2013 state wide exercise which is a simulated state wide power outage lasting 2 weeks in the month of July. The MCDPH has been involved with the establishment of the Western Region Healthcare Coalition (WRHC), of which the emergency planner is the Chairman. Since this is a new planning coalition, the planner/chairman has also been working on the establishment of coalition By-Laws and necessary MOU's to ensure proper documentation of agreements for future emergency response planning between all member agencies of the WRHC. Medical Reserve Corps MRC volunteers received training on how to assist people with functional needs in general population shelters. They received additional training on Isolation & Quarantine, START Triage (Simple Triage And Rapid Treatment is a triage method used by first responders to quickly classify victims during a mass casualty incident), Winter Safety and Emergency Care, Epidemiological Investigation Overview, CPR- Continuous Chest Compression only (CCC), Disaster Medicine/Basic First Aid/START Triage; Heat Emergencies, MRC Integration within the Incident Command Structure, and NIMS Review. Medical Reserve Corps volunteers participated at emergency preparedness and community events during the year including the Lake Havasu City Winterfest Street Fair, Kingman Regional Medical Center’s Kids Day, and "Havasu Stick'em" Health Fair and Immunization clinic. Our volunteers also assisted Public Health Nursing during back to school immunization clinics along with providing clerical assistance throughout the year, including immunization follow-up phone calls. MRC volunteers participated in the ADHS 2013 Strategic National Stockpile Full-Scale Exercise February 21-22, 2013 and the Strategic National Stockpile (SNS) Full-Scale Exercise drill that was conducted on June 18, 2013. During the FY 2012 – 2013, the Mohave County MRC volunteers donated over 1,300 hours of service. 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. NEW PROGRAMS Hand Washing Sinks We received $2500 in funding from the Food and Drug Administration to purchase portable hand washing sinks to use for displaying proper hand washing techniques in food handler classes. The sinks have also been loaned to non-profit groups for use at temporary events and fundraisers. This helps organizers keep their costs down while fulfilling a need to keep our community safe through proper hand washing. For more information about this program feel free to contact any of our offices with inquiries. Credit Card Payments Environmental Health began accepting credit cards online and at the counter this year through Point and Pay, a company that the county contracted with to provide these services. This has been well received by our clients and members of the public as it provides a convenient way for them to call their payments in to our office or make last minute payments on their permits. The response has been overwhelmingly positive. New Food Handler Cards Due to fraudulent food handler cards being found on a regular basis in food establishments, the Division purchased ID card printers and software to increase security measures when issuing food handler cards. This program is designed to ensure food handlers are trained in proper food handling techniques so that food borne illness outbreaks can be avoided. Fraudulent food handler cards undermine the importance of the food handler training program. The new cards have security features including uniquely assigned food handler ID numbers, a bar code and a picture ID of the food handler. 10 Fiscal Year 2013 Statistics In fiscal year 2013, the Division conducted 4,522 inspections in the various programs. This year the overall number of inspections throughout all the programs increased by a small percentage. This year we also experienced an increase of 8.5% in the number of septic permits issued. 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. Nuisance complaints received this year dropped slightly from 491 to 481. However, inspections for this program increased by approximately 7% with 22 cases going to court. During fiscal year 2013, abatement was conducted on 7 properties at a cost of $14,833. We received approximately $30,464 in lien payoffs and $3,800 in settlements out of court. A total of over $431,000 in liens remain against previously abated properties in Mohave County. Legislative Changes In the past two years the State Legislature has enacted several new regulations that significantly affected the operations of the Division. Known as the regulatory bill of rights, these new provisions included issuance of inspection rights at the time of inspection, notification of permit processing on all applications and publication of licensing timeframes. The Division worked diligently toward meeting all requirements associated with this new legislation, including revision of several ordinances and has successfully implemented all changes required. 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 11/12 FY 12/13 428 1358 2475 4271 409 1356 2542 4315 254 242 278 268 532 265 58 31 62 85 87 87 271 424 40 102 102 106 102 3 3 3 54 61 54 491 808 305 18 481 42 18 42 96 70 95 19 33 32 38 2075 45 110 3 59 867 339 22 17 37 50 1549 12 13 Nutrition & Health Promotion Special Supplemental Food Program for Women, Infants, and Children (WIC) & Breast Feeding Programs For the past 38 years, the WIC program has had a positive impact on the health of low income pregnant, postpartum and breastfeeding women as well as infants and children up to the age of 5. WIC offers vouchers for specified healthy foods including low fat milk, whole grain bread, and fresh fruits and vegetables. Participants also receive guidance on choosing a healthy lifestyle for themselves and their families. In recent years, WIC has moved to an interactive form of counseling to “meet the family where they are” in making healthy lifestyle choices. In 2013, Mohave County WIC served approximately 3900 clients per month in the three sites of Kingman, Lake Havasu and Bullhead City. Caseload has dropped in recent years throughout the state of Arizona due in part to a declining birthrate and a decrease in population. Nevertheless, WIC continues to add to the local economy. Approximately $3,379,205 worth of WIC vouchers were redeemed in local stores in Mohave County. Nationally, WIC is tasked with the job of stemming the tide of childhood obesity. According to the Centers for Disease Control and Prevention (CDC), obesity now affects 17% of all children and adolescents in the United States - triple the rate from just one generation ago. The CDC cites the consequences of childhood obesity as:      Obese children are more likely to have - high blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD). Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes. Breathing problems, such as sleep apnea, and asthma. Joint problems and musculoskeletal discomfort. Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn). Using research based strategies, such as teaching parents infant hunger cues, portion sizes for toddlers and encouraging physical activity, we have made modest improvements. Dropping from an all time national high of 27.6% of overweight and obese 2 to 5 years olds in 2008 to 25.9% in 2011. The Mohave County rate is currently lower than the state of Arizona rate of 30%. 14 Nutrition & Physical Activity Education The Arizona Nutrition Network The Arizona Nutrition Network is funded by USDA to provide nutrition education to the SNAP (Food Stamps) eligible population. The mission of the AzNN program is to shape food consumption in a positive way, promote health, and reduce disease among all people living in Arizona In Mohave County, education is directed primarily to children from Kindergarten to 8 th grade. Nutrition educators go in to the classrooms and provide grade appropriate education that encourages consumption of low fat dairy, whole grain products, fruits and vegetables. Food demonstrations are also given at the local DES offices and to WIC participants. In FY 2012-2013, Mohave County partnered with Lake Havasu Unified School District and Bullhead City Elementary School District through subcontracts for the provision of nutrition education. In previous years, the Arizona Department of Health Services contracted with each agency individually. The subcontracts with the school districts have resulted in a more efficient program due to a coordination of education efforts. During the past year, 5,900 students received a minimum 3 hours of nutrition education throughout the county. Commodity Supplemental Food Program (CSFP) CSFP continues to provide 350 boxes of nonperishable food to income eligible seniors, postpartum women and children 5 to 6 years of age. In order to streamline processes, the Mohave County Department of Public Health worked with the local food banks in Kingman, Lake Havasu, and Bullhead City to turn over the monthly distribution of the boxes to their organizations. This allows us to use staff time to determine eligibility and provide nutrition education for the recipients. This change made pick-up easier for participants and has resulted in a more efficient program. 15 Mohave County Tobacco Use and Chronic Disease Prevention Program Healthy Arizona Policy Initiative This grant focuses on improvements in public health through policy changes in our community. This is accomplished by working 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, and community design. This year, staff worked to create a community based special needs coalition with representation throughout Mohave County. The mission is to improve the health and quality of life for our special needs children, young adults and families. The coalition is developing a resource guide for services, a parent support network and a surveillance data system. Local businesses are benefiting from worksite wellness trainings to develop worksite programming and implement policy. Ongoing classes and technical assistance is provided to all businesses that enroll in the program. 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. According to the National Council on Aging, nearly 92% of older adults have at least one chronic condition, and 77% have at least two. 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, Lake Havasu City and Kingman. Tobacco Education and Cessation 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, middle schools, and 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. 16 Mohave Junior High School Science Fair BHC Walk Away from Drugs Educating County Employees and Visitors 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. Eight youths and two chaperones attended the statewide STAND leadership conference. 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. KYCBUTT is supporting the Kingman City Council with their Smoke Free Parks and Ball Field Pilot Program. Parks and Ball fields are now smokefree with designated smoking areas. They also have cigarette trash receptacles in all of the parks and ball fields 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 statewide Youth Advocate Coalition Awards this year to Mohave County’s Kingman Youth Coalition Beating Up Teen Tobacco (KYCBUTT) and the president of KYCBUTT, Brianna Brown, received the Most Valuable Person Award and the Youth Advocate of the Year Award. Educating Youth in the Classroom Centennial Park Cigarette Butt Clean Up KYCBUTT State Youth Advocate Coalition Award 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 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 investigated 2,720 communicable disease reports; 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 that is based on a sliding fee scale. HIV testing and counseling is provided utilizing the “same day” testing process. This process allows the client to obtain results of screening tests before leaving the office. Sexually Transmitted Disease Program Medical providers throughout Mohave County report cases of Gonorrhea, Chlamydia and Syphilis as required by Arizona Revised Statutes. Mohave County continues to experience a moderate level of sexually transmitted disease activity in comparison to other Arizona counties. In 2011, Mohave County ranked 8th in the state for the number of Syphilis cases and 14th in the state for the number of both Gonorrhea and Chlamydia cases. Ryan White Care Program This program allows clients who are positive for HIV/AIDS to receive medical care and medications to optimize and sustain quality of life. We have received these funds since 1996 as there were no other providers in the community who could or were interested in providing the services. Our role was to provide case management and facilitate clients receiving medical care; as such, clients were not receiving care here but at providers throughout the county and in Las Vegas. In order to ensure seamless services for the HIV positive patient, we collaborated with the funding agency for North County Health Care to assume responsibility of this primary care program. Effective March 1, 2013, North County received the grant and is providing services at their clinics in Kingman, Bullhead, and Lake Havasu. 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. 18 Case management includes Direct Observed Therapy (DOT) whereby nursing 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 2013, the Nursing Division provided treatment and follow up to five active TB cases. Two of the cases were transferred in from other jurisdictions and treatment was completed. 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. There were 37 suspect cases during the fiscal year. TB skin testing is provided for screening purposes and is offered for a fee. Individuals with a positive skin test receive counseling, a chest x-ray, and free medication if necessary. During the year, there has been a national shortage of Tubersol solution used for TB skin testing. This shortage has affected daycare and healthcare providers as they require annual testing; testing has been delayed until the shortage is resolved. 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 2012, we served 1,491 unduplicated clients at 100% or below of the Federal Poverty Level. 1,275 of these clients reported being uninsured which is a significant barrier to receiving medical services. Although most of the clients served were between the ages of 15 - 44, 2.8% were 45 or older, and 1% were 14 or younger. The program provided 326 syphilis, 664 gonorrhea, and 1198 chlamydia tests as well as 712 HIV screening tests. Over the past six years we have seen a 68.5% increase in the number of unduplicated clients in our clinics (from 885 to 1,491). 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. During the fiscal year, 319 home visits were made to infants in the program. This is a 145% increase from the previous year 19 Teen Pregnancy Prevention Program Pregnancy during the teen years can change the lives and futures of the mother, father, child, and their families. Repeat teen births - two or more pregnancies ending in a live birth before age 20 - can limit the mother's ability to finish her education or get a job. Giving birth and raising a child during the teen years can carry high health, emotional, social, and financial costs for teen mothers and their children. Babies born from a repeat teen birth are often born too soon or too small. This can lead to more health problems for the baby.  Although teen birth rates have been falling for the last two decades, more than 365,000 teens aged 15 - 19 years gave birth in 2010. Of these births, 66,800 were repeat teen births,  57,200 were second births.  8,400 were third births.  1,200 were fourth or higher births. 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 1,612 students during the year. 40 35 Mohave County Pregnancy Rate for Females 19 and Under (per 1,000 females in the age group) 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 (VFC) program which is a federally funded immunization grant. During the fiscal year, we provided 11,126 vaccines to 5,959 children throughout Mohave County. A change was implemented by the grant this year in which individuals with insurance were not allowed to receive VFC immunizations. However, for some, their well child benefit runs out, they are unable to get an appointment with their physician and need immunizations for school or to ensure vaccines are received on time, or they aren’t able to pay their deductibles. To help with these issues, we purchased vaccine that can be used and their insurance billed. We entered a contract with The Arizona Partnership for Immunization (TAPI) to provide insurance billing of clients with private insurance. 20 FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13 207 248 367 306 24 88 130 319 1,234 1,323 1,453 1118 1485 1241 1540 2720 3,898 13,090 5,612 20,406 7,006 18,541 6,994 19,121 4929 13,822 4159 13,921 Td/Tdap 243 189 169 186 92 61 150 40 Hepatitis B Hepatitis A 305 171 336 132 359 66 325 73 292 72 206 30 201 32 241 15 140 59 71 59 Newborn Intensive Care Program Home visits Communicable Disease Disease investigations Childhood Immunization Program Children vaccinated Vaccinations given Adult Immunizations Program Twinrix Adacel 3735 3959 12,951 11,126 Varicella 25 43 17 41 24 69 56 37 MMR HPV 179 -- 147 1 115 4 201 44 85 21 118 3 84 2 69 2 Zostovax -- 10 155 157 63 26 3 3 Meningococcal -- 17 14 14 8 2 3 4 Influenza / H1N1 Pneumonia Tuberculosis Control 5,959 1,016 3,031 328 2,969 620 845 41 13,232 15 606 26 130 8 206 0 TB skin tests 1,149 1,207 1,657 1304 812 696 851 510 Latent TB infection 179 107 568 733 240 331 129 247 Active case visits Active case 291 7 321 3 113 4 407 3 303 3 120 4 199 2 281 5 Chest x-ray/clinics 162 139 322 305 70 69 55 80 Primary Reactor Visit Reproductive Health 60 59 164 114 37 45 30 45 Pregnancy Tests 316 708 710 869 756 680 623 763 New/Annual visits 971 889 1155 1263 1260 779 646 RH/HIV Tests Unduplicated clients Sexually Transmitted Disease Clinic visits HIV Counseling and Testing HIV tests HIV post counsel Health Start Visits Teen Pregnancy Unduplicated Students Ryan White Clients 885 1220 1376 1351 1419 1474 150 76 126 133 138 86 85 55 146 112 101 95 199 143 109 109 84 84 126 126 120 120 85 85 236 530 441 249 358 315 302 598 1962 2000 1792 1612 76 76 76 77 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 2013: 1st quarter $19.824.07 2nd quarter $15,443.91 3rd quarter $22,101.59 4th quarter $19,923.49 Total $77,293.06 Senior Programs Total Meals Served FY 11 was the last year with BHC meals 160000 150000 140000 130000 151758 143282 116647 100000 145590 110000 149543 120000 FY 09 FY 10 FY 11 FY 12 FY 13 22 Each of the centers continues to see a reduction in the number of congregate meals served over the past five years. 54.7% in Kingman, 36.6% in Golden Shores, and 25% in Lake Havasu. However, during that time the General fund support was reduced (in July 2010) by 50% which equaled a $250,000 reduction to the program. 35000 Congregate Clients Served Congregate Meals Served 1000 900 30000 800 25000 700 600 20000 500 15000 400 10000 300 200 5000 0 FY 09 FY 10 FY 11 FY 12 FY 13 100 0 Kingman Golden Shores Lake Havasu FY 09 575 171 874 30347 28239 FY 10 332 114 711 FY 11 257 147 705 6199 26416 FY 12 238 132 604 5525 24428 FY 13 173 69 481 Kingman 21783 Golden Shores 8712 Lake Havasu 32563 16454 12152 8544 6896 10627 9863 Over the past five years the number of homebound meals served in Kingman has fluctuated greatly with the highest number of meals served in FY 11. In FY 13, Kingman provided 9.2% more meals than FY 09. Golden Shores has remained fairly consistent in the number of homebound meals served. Lake Havasu has experienced an overall reduction in the number of homebound meals served with a 26.9% reduction over the past five years. The number of homebound clients served in FY 13 was: Homebound Meals S erved 50000 Kingman 233 Golden Shores 38 Lake Havasu 258 40000 30000 There was an error in the report of homebound clients served in prior fiscal years, therefore there is no chart available for prior year comparisons. 20000 10000 0 Kin gman Golden Shores Lake Havasu FY 09 FY 10 33575 5212 47698 42180 5481 42584 FY 11 52282 5314 46875 FY 12 50461 6117 43462 FY 13 36649 5333 34849 23 Socioeconomic* and Health Indicators Mohave County Population from Office of Employment & Population Statistics, AzDOA Bullhead City Colorado City 39,495 4,813 Kingman 28,476 Lake Havasu City 52,908 Unincorporated 77,900 203,592 Total 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, 272 Cuban and 3,816 Other. Household Income (in 2010 inflation-adjusted dollars) US Census 2010 Age Distribution from Arizona Vital Statistics 60,000 50,000 20.00% 40,000 18.00% 16.00% 14.00% 12.00% 30,000 10.00% 8.00% 6.00% 20,000 0 to age 14 15 - 19 1 20 - 44 2.00% 0.00% 49,396 59,279 49,155 12,024 10,000 33,219 4.00% 45 - 64 65+ 0 0 ,0 0 1 $ < 0 0 ,0 0 1 $ * Socioeconomic statistics are from the 2010 US Census unless otherwise noted. 9 9 9 , 4 1 $ 0 0 ,0 5 1 $ 9 9 9 , 4 2 $ 0 0 ,0 5 2 $ 9 9 9 , 4 3 $ 0 0 ,0 5 3 $ 9 9 9 , 9 4 $ 0 0 ,0 0 5 $ 9 9 9 , 4 7 $ 0 0 ,0 5 7 $ 9 9 9 , 9 9 $ 0 0 ,0 0 0 1 $ 9 9 9 , 9 4 1 $ 0 0 ,0 0 5 1 $ 9 9 9 , 9 9 1 $ 0 0 ,0 0 0 2 $ e r o m r o 24 Health Insurance Census data presents a “civilian noninstitutionalized population” of 198,223 in the county. 83.4 % of these individuals had health insurance coverage and 16.6% did not. Population 18 - 64 in Labor Force There are 77,987 county individuals ages 18 - 64 in the labor force. The chart on the right represents the employed and unemployed individuals in the labor force with and without insurance coverage: 70000 60000 50000 40000 30000 20000 10000 0 Employed = 66,700 with health insurance Unemployed = 11,287 no health insurance Education There are 44,841 county residents 3 years of age or older and enrolled in school. Enrollment Percentage of Population (n = 44,841) nursery school, preschool 6.30% kindergarten 4.50% elementary school (1- 8) 40.70% high school (9 - 12) 21.40% college or graduate school 27.00% The population of the county age 25 and older is 145,074 and the educational attainment of these individuals is depicted in the chart below. Educational Attainment population 25 and older n = 145,074 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 25 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 24.5% and the birth rate has declined 24.1%. Birth Rate Total Births per 1,000 popoulation 12 2400 2300 11 2301 2200 2220 2100 11.2 10.9 10 2000 2022 1900 10.1 9.8 9 1962 1800 8.5 1736 1700 2008 2009 2010 2011 8 2012 2008 2009 2010 2011 2012 While the number of births to unwed mothers had declined over the past five years by 18.3%, the rate of births to unwed mothers has increased by 8.2%. The number of teen births, as well as the rate of teen births, has decreased significantly over the past five years; 35% and 32.2% respectively. Characteristics of Mothers 2008 2009 2010 2011 2012 50 40 18.5 18.4 25.6 24 27.3 55.7 51.8 48.2 10 48.2 30 51.5 215 275 211 309 331 *per 100 live births **per 1000 females 19 or under 60 20 967 974 1017 1069 2008 2009 2010 2011 2012 1184 1400 1200 1000 800 600 400 200 0 Characteristics of Mothers 0 rate of births to unwed rate of births to mothers mothers* 19 or under** births to unwed mothers births to mothers 19 or under The number of low birthweight babies has decreased over the past five years (26.2%), while the rate has remained relatively constant with only a 1.6% reduction in the past five years. The number of fetal deaths has not fluctuated by more than 6 over the past five years; however the rate of fetal deaths has increased 76.9% over that period of time. Characteristics of Newborns Characteristics of Newborns 2008 2009 2010 2011 140 120 100 2008 2009 2010 2011 2012 7 6 low birthweight babies fetal deaths low birthweight babies rate* 6.9 3.9 4 5.1 0 6.3 6 5.1 7 6.1 12 10 1 8 9 0 14 104 100 2 141 40 136 3 141 4 60 6.1 5 80 20 *rates per 100 live births 8 fetal death rate* 26 The total number of alcohol abuse related inpatient discharges and ER visits in the county has steadily increased over the past five years by 42%. While the number of inpatient discharges has remained fairly consistent (5% variance from 2006 to 2010); the number of ER visits has dramatically increased - 97.41% over the same time period. The number of alcohol abuse related visits among males and females has remained consistent with two-thirds of the visits male and one-third female. Alcohol Abuse Related Inpatient Discharges & ER Visits Alcohol Abuse Related Inpatient Discharges & ER Visits 1900 2000 2006 1800 2007 2008 1400 2009 1300 1200 2010 1100 900 800 700 600 0 888 1080 1358 1728 1753 200 500 1042 1088 1038 1099 987 400 # Female 1500 1600 1000 # Male 1700 Inpatient Discharges ER Visits 300 100 The total number of amphetamine related inpatient discharges and ER visits in the county has declined over the past five years by 21.77%. Inpatient discharge numbers have declined by 44.35% over the past five years. ER visit numbers were experiencing a decline (2008 had a 47% reduction compared to 2006), but then began to rise to their previous level. The greatest number of inpatient discharges and ER visits were in the 20 - 44 and 45 - 64 year old age groups; with 61.34% and 32.99% of the total respectively. In 2010, inpatient discharges and ER visits for individuals under 15 = 0%, 15 - 19 = 5.05%, and 65+ = 2.53%. Amphetamine Related Inpatient Discharges & ER Visits by Age Amphetamine Related Inpatient Discharges & ER Visits 350 2007 300 2009 2008 2010 250 350 300 250 100 100 0 Inpatient Discharges 208 260 150 266 210 141 150 150 128 200 230 230 156 200 50 ER Visits 2006 2007 2008 2009 2010 50 0 110 109 82 119 128 2006 338 282 187 218 238 400 20 - 44 years 45 - 64 years 27 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. There were 2,482 deaths in Mohave County in calendar year 2012 and staff issued 15,604 certified copies of death certificates during the fiscal year We began providing certified copies of birth certificates in November, 2011. Fiscal year 2013 was our first full year and staff issued 1,653 certified copies of birth certificates. In addition to certified copies, staff register all home births and births occurring in facilities that are not on the state vital record system. Court ordered paternities and Acknowledgement of Paternities are also processed for Mohave County births. Number of Deaths Death Rate per 10,000 of population 2500 124 2450 122 2400 120 2350 118 116 2300 114 2250 112 2482 2011 2012 122.2 2424 2010 120.9 2368 2009 106 118.3 2260 2008 108 110.5 2461 2150 120.1 110 2200 2008 2009 2010 2011 2012 104 2100 Of the 2,482 deaths in Mohave County in 2012, the top ten causes of death were: number % of total deaths major cardiovascular diseases 820 33.0% Malignant neoplasms 588 23.7% Chronic lower respiratory diseases 212 8.5% Accidents 94 3.8% Intentional self harm 62 2.5% Diabetes 60 2.4% chronic liver disease & cirrhosis 53 2.1% Alzheimer's disease 49 2.0% nephritis, nephrotic syndrome & nephrosis 47 1.9% symptoms, signs, abnormal findings 40 1.6% 28 Of the 588 deaths related to malignant neoplasms in the county, the top five types were: 1. 2. 3. 4. 5. Trachea, bronchus, lung Colon, rectum, anus All other and unspecified Lymphoid, hematopoietic & related tissue Pancreas Top Five Causes of Death 2012 - Males percentage is of total male deaths =1,433 93 7% 31% 11% 9.5% 6.9% 6.1% Top Ten Causes of Death 2012 - Females percentage is of total female deaths = 1,049 41 61 4% 6% 39 62 3% 5% 443 33% 356 27% Malignant Neoplasms Major Cardiovascular Diseases Chronic Lower Respiratory Diseases Accidents Suicide 90 9% 303 29% 254 25% Major Cardiovascular Diseases Malignant Neoplasms Chronic Lower Respiratory Diseases Accidents Alzheimer's Disease 29 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 30