2015 Community Health Needs Assessment

2015 Community Health Needs Assessment
Audrain
County
Health
Department
Audrain County Health Department
1130 S. Elmwood Drive
Mexico, MO 65265
2015
Community
Health
Needs
Assessment
Table of Contents
EXECUTIVE SUMMARY…… ...................................................................................................................................... ………………… 3
INTRODUCTION AND OBJECTIVES ................................................................................................................................................ 4
ABOUT AUDRAIN COUNTY HEALTH DEPARTMENT (ACHD) ......................................................................................................... 5
AUTHOR AND CONTRIBUTING MEMBERS .................................................................................................................................... 6
ACKNOWLEDGEMENTS ................................................................................................................................................................ 7
METHODOLOGY ........................................................................................................................................................................... 8
DESIGN OVERVIEW OF THE CHNA……………………………………………………………………………………………………………………………………..……9
DEMOGRAPHICS ......................................................................................................................................................................... 10
DEMOGRAPHIC & ACHD CHNA SURVEY FINDINGS .................................................................................................................... 13
ACHD SURVEY RESULTS .............................................................................................................................................................. 15
SURVEY RESPONDENT INFORMATION ....................................................................................................................................... 17
SECONDARY DATA ANALYSIS - CHSI OVERVIEW; CDC ................................................................................................................ 18
I.
PHYSICAL ENVIRONMENT ................................................................................................................................................... 19
II.
SOCIAL FACTORS….. ............................................................................................................................................................ 20
III. HEALTH CARE ACCESS & QUALITY ...................................................................................................................................... 24
IV.
HEALTH BEHAVIORS ............................................................................................................................................................ 26
V.
MORBIDITY ......................................................................................................................................................................... 29
VI.
MORTALITY ......................................................................................................................................................................... 34
SECONDARY DATA ANALYSIS –OVERVIEW; UW/PHI & ROBERT WOODS JOHNSON FDN...………………………………..………………..38
I.
STATE & CONTIGUOUS MULTI-COUNTY COMPARATIVE ANALYSIS ................................................................................ 40
SECONDARY DATA ANALYSIS –MISSOURI INFORMATION FOR COMMUNITY ASSESSMENT (MICA) …………..…………….……….42
SECONDARY DATA ANALYSIS –MISSOURI DEPARTMENT OF MENTAL HEALTH……………………………..………………..……………….….46
MEXICO POVERTY: CHILD ELIGIBILITY; FREE MEALS………………………………………………………………………………………………………………47
COMBINED SECONDARY ANALYSES – FINDINGS……………………………………….…………………………………………………………………………..48
FORCES OF CHANGE………………………………………………………………………………………………………………………………………………………………49
REFERENCES………………………………………………………………………………………………………………………………………………………………………….51
APPENDICES………………………………………………………………………………………………………………………………………………………………….…55-71
APPENDIX A: SURVEY RESPONDENT LETTER .............................................................................................................................. 55
APPENDIX B: ACHD CHNA SURVEY ............................................................................................................................................. 56
APPENDIX C: AUDRAIN COUNTY U.S. CENSUS TRACT ............................................................................................................... 60
APPENDIX D: CDC – CHSI AT-A-GLANCE SUMMARY; AUDRAIN COUNTY ................................................................................... 61
APPENDIX E: AMERICAN COMMUNITY SURVEY (ACS); 2009- 2013 ......................................................................................... 62
EXECUTIVE
SUMMARY
2015 Community Health Needs Assessment
Sandra M. Hewlett, MS, APRN, AOCN, FACHE
Administrator, Audrain County Health Department
To the Residents of Audrain County,
In 2014, the Audrain County Board of Health commissioned the Audrain
County Health Department (ACHD) to conduct a Community Health
Needs Assessment (CHNA) for Audrain County. The assessment was
designed to identify the most important health issues in the county using
scientifically valid health indicators and comparative information.
The assessment also identifies priority health issues where better
integration of public health and healthcare can improve access, quality,
and cost-effectiveness of services to residents of Audrain County. This
project represents ACHD’s efforts to share information that may lead to
improved health status and quality of care available to Audrain County
residents while building upon and strengthening existing infrastructure
of services and providers.
We are confident that local organizations and providers will find the
results of our CHNA to be helpful in planning how to improve the health
of our community. The CHNA will serve as a guide in expanding and
developing services to respond to the emerging health needs of our
community, in partnership with other local providers and agencies.
With the challenges facing today’s healthcare landscape, it is becoming
increasingly important to intervene and educate the public to:
Prevent. Promote. Protect. The primary goals of ACHD & public health.
Warm Regards,
Sandra M. Hewlett, MS, APRN, AOCN, FACHE
Administrator,
Audrain County Health Department
Introduction
Accountability &
Transparency
The Audrain County Health Department
promotes practices, policies, procedures,
and strategic document development
that helps bring positive changes
towards healthcare transparency and
accountability - important aspects of
patient-centered care1.
Figure 1
We strongly support public reporting
because it aids transparency, promotes
more informed patient choice, helps
improve quality, lowers the cost of care,
and increases provider accountability1.
Public reporting also provides a strong
motivation for county public health
departments, providers, healthcare
institutions, first responder
organizations, and local agencies to
collaboratively work together to
improve services within a community2.
To that end, a copy of the ACHD 2015
Community Health Needs Assessment is
available for the community at:
www.audraincountyhealth.org .
A community health needs assessment is one tool for stakeholders to evaluate the health needs
of our community and advocate for and create better health care delivery, coverage and
outcomes for all members in our community. The community health needs assessment process
includes significant input from numerous individuals and data repository sources. This range of
“voices” ensures that health in our community is viewed broadly and all encompassing. Beyond
traditional health indicators, the assessment looks at a myriad of other issues that can affect
health, such as transportation, poverty, education and the economy.
Objectives
The objectives for the 2015 Audrain County Health Department’s Community Health Needs
Assessment are as follows:
I.
II.
Develop a comprehensive baseline epidemiological profile of the population of Audrain
County, including specific sub-county regional (i.e., cities, towns) issues3;
Identify health factors, health outcomes, disparities, and service needs of Audrain County
based on the community health profiles and related information;
III.
Identify to the extent the data permits how health disparities and service needs differ
among sub-groups of the population (age and gender groups, racial, and ethnic
minorities);
IV.
Identify barriers in the health system and the community that, if addressed, would
improve population health, especially those identified as priority health issues;
V.
Begin to formulate recommendations on how to improve county priority service needs.
VI.
Integrate those recommendations in the follow-up ACHD strategic document entitled,
“Audrain County Health Department: 2015 Community Health Improvement Plan”.
The ACHD…
Audrain County Health Department (hereinafter referred to as ACHD) is a not-for-profit (501c-3)
public health department based in Mexico, Missouri. The ACHD proudly and diligently serves
the residents of Audrain County and remains committed to addressing their public health needs.
As a government-based public health department, the ACHD exists under RSMO §205.010-115,
County Health and Welfare Programs, providing numerous, multi-faceted public health programs
for the Audrain County community.
ACHD Mission Statement:
To protect and promote the public health and community well-being of the residents of Audrain
County.
ACHD Vision Statement:
That each individual, every family, and the community as a whole, attains the highest degree of
health achievable.
ACHD Values Statement:
The ACHD is committed to C.L.E.A.R. values:
Communication, Leadership, Excellence, Accountability, and Respect.
Public Health in Audrain County has a long and important history. In April 1961, the
citizens of Audrain County formed the Audrain City-County Health Unit (ACCHU). ACCHU
existed as a result of a cooperative agreement consisting of support provided by the Audrain
County Commission, Audrain Medical Center, the City of Mexico, and the City of
Vandalia under § 70.210 to of the Revised Statutes of the State of Missouri (RSMO).
The Compact Agreement allowed for the establishment of the City-County Health Unit of
Audrain County (dba) the Audrain City-County Health Unit. ACCHU began operations in April
1961 with a public health nurse, environmental sanitarian, and a part-time clerk typist. A
local book, “The Friend of Audrain – A History of Medicine in Audrain County” (Hodge,
1985), has interesting information about mid-1800’s public health in Audrain County5.
In November 2011, Audrain County voted and passed a ballot measure establishing a new
form of governance for Public Health. This measure allowed for the formation of the
Audrain County Health Center (dba) the ACHD under §§ 205.010 to 205.115 of the Revised
Statute, State of Missouri (RSMO). The ACHD officially began operations January 1, 2013
and exists under an elected Board of Health.
ACHD constantly assesses the health status, outcomes, resources, and unmet health needs of
county residents. In addition to basic public health services and environmental public health
programs related to food safety and sanitation, lodging, daycare inspections, and on-site sewage
system permitting, numerous ACHD services are offered under the following programs:
Maternal Child Health
Immunizations
Environmental Public Health
Emergency Preparedness
Communicable Disease
Blood Pressure & STD Testing
Foot Clinic
Breastfeeding Support
Women, Infants, & Children (WIC)
Car Seat Program
Safe Crib Program
Chronic Disease Education & Support
Thank you for reading the history of our health department. For more information or a copy of
this report, we welcome you to visit us at www.audraincountyhealth.org.
Author & Contributing Members
The 2015 Community Health Needs Assessment was researched and written by:
Sandra M. Hewlett, MS, APRN, AOCN, FACHE
Administrator,
Audrain County Health Department
Contributing CHNA efforts included the following individuals:
Katie Swaim, RN, BSN, CPN
ACHD
Communicable Disease Program Leader
Becky Wieberg, RN
ACHD
Clinic & WIC Services Coordinator
Brandi Meyers, LPN
ACHD
Immunization Program Leader
Kerry Patton, LPN
ACHD
Maternal Child Health Program Leader
Linda Spurling
ACHD
Accounting & Human Resources Manager
Carol Stuart
ACHD
Clinical & Marketing Support Staff Member
Kay Knipp
ACHD
WIC Support Staff
Emily Stotler
ACHD
Webmaster & Social Media
Sarah Palmer
ACHD
EPHS Support Staff
Dorothy Schafer
ACHD
Reception Support Staff
Becca Mickels
MO-DHSS
MICA Data Specialist, CHIR
Requested by:
Audrain County Board of Health:
Faye Fairchild, RN, MSN, CNE
AC BoH
Chairperson
Andrea Willer, FNP-BC
AC BoH
Secretary
Sharon Stowers, RN (Retired)
AC BoH
Treasurer
Clark Andelin, M.D.
AC BoH
Member
Kathleen Weaver, M.D.
AC BoH
Member
Copyright © 2015 by Sandra M. Hewlett, Administrator, Audrain County Health Department.
All rights reserved.
Reproduction or translation of any part of this work beyond that permitted by § 107 &/or § 108 of the 1976
U.S. Copyright Act without the permission of the copyright owner is unlawful. Requests for permission or
further information should be addressed to the Audrain County Department of Health.
Acknowledgements
We wish to recognize other agencies and resources that were used in completing the CHNA, including:
Central Missouri Community Action Needs Assessment: 2014
Central Missouri Community Action
Community Health Status Indicators (CHSI),
Centers for Disease Control & Prevention (CDC)
U.S. Department of Health & Senior Services
Community Toolbox – Needs Assessment,
Work Group for Community Health & Development
University of Kansas
Data MICA; Missouri Information for Community Assessment,
Community Health Improvement Resources (CHIR)
Missouri Department of Health & Senior Services (MO DHSS)
Community Profiles; MO DHSS
Community Health Improvement Resources (CHIR)
Missouri Department of Health & Senior Services (MO DHSS)
Data; Kids Count!
Annie E. Casey Foundation
University of Wisconsin, Institute of Public Health
Robert Wood Johnson Foundation
Priorities MICA; MO DHSS
Community Health Improvement Resources (CHIR)
Missouri Department of Health & Senior Services (MO DHSS)
2010 Dicennial Census; U.S. Census Bureau
2015 Estimated Census; U.S. Census Bureau
U.S. Department of Commerce
Methodology
The ACHD acknowledges the influence of social, cultural and environmental factors on health and
recognizes that such influences may have particularly deleterious effects when they occur during
critical periods over one’s life. In 2014, the Audrain County Board of Health commissioned a
comprehensive community health needs assessment. This report summarizes the health status of
our community and identifies priorities to address in partnership with others.
Audrain County Community Health Needs Assessment Survey (ACCHNAS)
The purpose of the ACCHNAS is to assess the health status of residents. Primary goals were to (a)
gather specific data on behavioral and lifestyle habits of the adult population; (b) gather data on the
prevalence of risk factors and disease conditions existing within the adult population; (c) compare,
where appropriate, health data of residents to previous health studies; and (d) compare, where
appropriate and available, health data of residents to state and national measurements.
The ACHD randomly selected approximately 1,208 individuals from various areas within Audrain
County to receive a 2015 CHNA Survey. The response rate from the survey was 264, or 21.9%.
The surveys were completed in paper format and could be returned in the mail to the ACHD, or
could be dropped off at four different and widely recognized Audrain County locations, including
(see Appendix A):
1.
2.
3.
4.
Drop-Off Site
C & R Market
ACHD
Martinsburg Bank & Trust
Vandalia City Hall
Location
Centralia, Missouri
Mexico, Missouri
Martinsburg, Missouri
Vandalia, Missouri
Secondary Data Analysis
This assessment used several nationally recognized and validated health databases to provide a
holistic picture of health in Audrain County (see Acknowledgements on preceding page) as well as
high-quality data and trends analyses. The Secondary Data Analysis is an objective, rigorous
adjunct to the primary data collection conducted in the Audrain County Community Health Needs
Assessment Survey. The report summarizes the distribution of health indicators and outcomes
among socioeconomic groups within Audrain County.
These state and national data repositories provide free data on more than 1,000 health indicators at
the state, national and county level. Data compiled from a variety of public, private, and
government sources allows users to map, rank, trend, or download information.
Finally, in addition to conducting a census decennially, the U.S. Census Bureau collects and
disseminates data across a variety of topics. Sources for this information include the Population
and Housing Census, National Health Interview Survey, Economic Census, The American
Community Survey, 2010 Current Population Survey, and the 2015 Population Estimates.
Design Overview of the CHNA
Two theoretical frames for public health planning guided the CHNA activities:
 Mobilizing for Action through Planning and Partnership (MAPP)
 PRECEDE- PROCEED Model.
MAPP was developed through a cooperative agreement between the National Association of County and
City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC).
The
MAPP framework is a community-wide strategic planning tool for improving community health and
helping communities prioritize public health issues and identify resources to address them. MAPP is
not an agency-focused assessment tool; rather, it is an interactive process that can improve the efficiency,
effectiveness, and ultimately, the performance of local public health systems.
Four assessments form the foundation of the MAPP process:
1. Community Themes and Strengths
2. Local Public Health System
3. Community Health Status
4. Forces of Change
Figure 2.
Figure 3.
Process is illustrated in Figure 2. Collectively, the four MAPP Assessments have several purposes
(MAPP, 2011):
• Reveals gaps between current circumstances and a community's vision;
• Provides information to identify the strategic issues to address to achieve the vision; and
• Serves as source of information from which strategic issues, strategies, and goals are built.
The PRECEDE-PROCEED Model is a comprehensive framework for planning population-based health
programs. It was developed by Lawrence Green and Marshall Kreuter in 1980, adapted in 1999 & 2004.
The PRECEDE-PROCEED frame uses an ecological and educational approach that respects context.
The assessment team followed the MAPP steps and elements of the PRECEDE-PROCEED model that
focus on Social Assessment, Situational Analysis and Epidemiological- Behavioral-Environmental
assessments as illustrated in Figure 3.
Demographics
Population data for Audrain County is based on the 2010 Decennial Census and 2014 Population
Estimates4 (U.S. Census Bureau, 2015a). Note that an asterisk (*) indicates a disparity or variance.
Population
Audrain County
Missouri
United States
Population Estimates, July 1, 2014
25,887
6,063,589
318,857,056
Population, Census, April 1, 2010
25,529
5,988,927
308,745,538
Age & Sex
Persons under 5 years, Census
6.8%
6.5%
6.5%
Persons under 18 years, Census
24.9%
23.8%
24.0%
Persons 65 and over, Census
*16.0%
14.0%
13.0%
Female persons, %, Census
53.8%
51.0%
50.8%
Male persons, %, Census
46.2%
49.0%
49.2%
*89.8%
82.8%
72.4%
Black or African American, %, Census
6.4%
11.6%
12.6%
American Indian and Alaska Native, %, Census
0.4%
0.5%
0.9%
Asian alone, %, Census
0.5%
1.6%
4.8%
0%
0.1%
0.2%
Two or More Races, %, Census
1.7%
2.1%
2.9%
Hispanic or Latino, %, Census
2.6%
3.5%
16.3%
Population Characteristics
Veterans, 2009 – 2013
1,954
479,828
21,263,779
Foreign born persons, %, 2009 – 2013
1.5%
3.9%
12.9%
Housing
Housing Units, Census
10,852
2,712,729
131,704,730
Owner-Occupied Rate, 2009 – 2013
74.2%
68.4%
64.9%
$90,500
$137,000
$176,700
Median Monthly Owner Costs; with Mortgage
$992
$1,227
$1,540
Median Monthly Owner Costs; without Mortgage
$346
$388
$452
Median Gross Rent, 2009 – 2013
$619
$727
$904
9,327
2,360,131
115,610,216
2.54
2.47
2.63
Living in Same House 1 Year Ago, %, 2009 – 2013
83.5%
83.8%
84.9%
Language Other than English Spoken in Home
*4.9%
6.1%
20.7%
Education
High School Graduate or Higher
84.3%
87.6%
86.0%
*13.1%
26.2%
28.8%
Race and Hispanic Origin
White alone, %, Census
Native Hawaiian & Pacific Islander, %, Census
Median Value, Owner-Occupied Housing, 20092013
Families & Living Arrangements
Households, 2009 – 2013
# of Persons per Household, 2009 – 2013
Bachelor’s Degree or Higher
Demographics continued…
Health & Economy
With a Disability, <65 years, %, 2009 – 2013
Audrain County
*11.8%
Missouri
10.1%
United States
8.4%
Persons Without Health Insurance, <65 Years, %
*16.8%
15.2%
15.3%
Percent of Population 16 Years+ in Labor Force
*57.9%
63.9%
63.8%
Income & Poverty
Median Household Income, 2009 - 2013
$43,013
$47,380
$53,046
Per Capita Income in Past 12 Months, 2009 – 2013
$19,687
$25,649
$28,155
Persons in Poverty, %
*19.7%
15.9%
14.5%
Mean Travel Time to Work, Minutes, Age 16+
21.1
23.1
25.5
Total Employer Establishments, 2013
553
150,290
7,488,353
6,778
2,355,336
118,266,253
Total Employment % Change, 2012 – 2013
*-0.1%
1.5%
2.0%
Total Non-Employer Establishments, 2012
1,393
394,685
22,735,915
Geography
Population Per Square Mile, 2010
*36.9
87.1
87.4
Land Area in Square Miles, 2010
692.24
68,741.52
3,351,905.43
Businesses & Transportation
Total Employment, 2013
Audrain County is bordered by:
 Monroe County (North) and Ralls County (Northeast)
 Boone County (Southwest) and Callaway County (South)
 Montgomery County (Southeast) and Pike County (East)
 Randolph County (Northwest)
Audrain County is located in Central Missouri; Mexico is the county seat. Per the 2010 U.S. Census
Tracts Reference Map, Audrain County Tracts (sub-county areas) include Tracts 9501through 9507.
These tracts encompass the cities, villages, unincorporated communities, and townships listed below:
Cities





Centralia (Predominantly in Boone County)
Farber
Laddonia
Mexico
Vandalia
Villages




Benton City
Martinsburg
Rush Hill
Vandiver
Unincorporated Communities


Rowena
Thompson
Townships
Audrain County is divided into eight townships:




Cuivre
Linn
Loutre
Prairie




Saling
Salt River
South Fork
Wilson
Multi-County Comparative Analysis
Randolph
County
Population
Population Estimates, July, 2014
Population, Census, April, 2010
Percent Change
Age and Sex
Persons < 5 years, %, July, 2013
Persons < 5 years, %, April, 2010
Persons <18 years, %, July, 2013
Persons <18 years, %, April, 2010
Persons 65 years+, %, July, 2013
Persons 65 years+, %, April, 2010
Females, %, July, 2013
Females, %, April, 2010
Housing
Building permits, 2013
Education
HS grad or higher, % age 25+, 2009-13
Bachelor's or higher, % age 25+, 2009-13
Health
With a disability, < 65 years, %, 2009-13
Persons with no health insurance, < 65, %
Income and Poverty
Persons in poverty, %
Total employer establishments, 2013
Total employment, % change, 2012-2013
Geography
Population per square mile, 2010
Monroe
County
Callaway
County
Cole
County
Boone
County
Audrain
County
25072
25414
-0.99
8707
8840
-0.98
44750
44332
0.99
76557
75990
1.01
172717
162642
1.06
25887
25529
1.04
5.9
6.3
22.5
23.1
15.1
14.2
47.9
47.7
5.2
6.1
22.6
23.3
20.2
18.6
49.7
50.0
5.7
5.9
21.8
22.6
13.8
12.3
48.9
48.6
6.2
6.6
23.1
23.6
13.6
12.3
49.5
49.5
6.0
6.2
20.6
21.1
10.1
9.3
51.6
51.5
6.3
6.8
23.4
24.9
16.5
16.0
54.6
53.8
14
24
46
224
1230
15
84.6
13.6
87.6
13.1
86.0
21.1
90.4
30.8
93.0
47.3
84.3
13.1
12.2
15.9
11.0
19.7
10.8
13.9
10.8
12.5
7.6
13.1
11.8
16.8
22.4
555
-6.8
15.7
197
3.8
13.8
745
5.7
13.7
2267
-1.8
19.8
4447
2.1
19.7
553
-0.1
52.7
13.6
53.1
193.0
237.3
36.9
(U.S. Census Bureau, 2015b)
County Services
There are an adequate number of public and private schools in Audrain County. Similarly, the fire,
law enforcement and emergency medical services in Audrain County meet the needs of its population.
Demographic Findings
The Audrain County Health Department, SSM-Audrain Medical Center, and the Arthur Center, a
federally qualified health center (FQHC) provide the main healthcare services in Audrain County.
However, Audrain County, like most Missouri counties, lacks an appropriate number of mental health
and dental care resources. In both instances, barriers to care exist, primarily of a financial, uninsured,
educational, and/or cultural nature. It should be noted that many Audrain County Hispanic and
African American residents have a delayed access or resistance to seek care.
Audrain County has the following notable disparities or variances (either positive or negative) as
compared to the six counties in the multi-county analysis listed above (U.S. Census Bureau, 2015):
 Second highest number of seniors in Census & 2013 estimates (16.5%); Monroe (20.2%).
 Second highest positive percent change in population (1.04%).
 Highest number of children under five years in Census & 2013 estimates (6.3%).
 Highest number of person <18 years in Census & 2013 estimates (23.4%).
 Highest percentage of females in Census & 2013 estimates (54.6%).
 Significantly higher percentage of residents living in poverty (19.7%).
 Lowest percentage of high school graduates, age 25+ (84.3%).
 Ties with Monroe County for lowest percentage of four-year college graduates (13.1%).
 Second highest percentage of residents <65 years who are disabled (11.8%)
 Second highest percentage of residents without health insurance (16.8%); Monroe (19.7%).
 Second lowest number of housing (building) permits issued, 2013 (15).
 Second lowest number of employers, 2013 (553).
 Third lowest percent, employment change (-0.1%), whereas three area counties have had
significant job growth: Callaway (5.7%), Monroe (3.8%), and Boone (2.1%).
 Audrain County has the second lowest population density per square mile (36.9); farm-driven.
Audrain County CHNA Survey Demographic Questions
What is your age group?
2015 Community Assessment
6.50%
1.90%
12.60%
Under 20
13.60%
20-29
13.10%
8.40%
30-39
40-49
50-59
60-69
12.10%
70-79
80 and above
17.30%
No Response
14.50%
Have you used any Audrain County Health Department services in the past two years?
2015 Community Assessment
8.90%
2.30%
44.40%
Yes
No
Not Sure
No Response
44.40%
Over the last year was there someone in your household, who wanted to see a physician,
dentist, the local public health agency (LPHA), or other health care provider but for some
reason did not go?
12.00%
10.00%
8.00%
6.00%
4.00%
Physician
2.00%
Dentist
0.00%
LPHA
Other Not Specified
Eye Doctor
CHNA Survey Results
IV. Community Health Assessment Comparative
Health Analysis
The following charts show the change of importance from the previous community health assessment surveys.
1. Children (Ages 1-9)
Weight and obesity
Lack of physical activities
Lack of social activities
Child abuse and neglect
Availability of childcare, babysitters, daycare
Car restraint use
1997
12%
31%
21%
24%
Chronic childhood illness (asthma, ear infections, allergies)
22%
Immunizations
28%
Access to a supplemental food program such as WIC
Availability of local allergy injections
Other (not specified)
2. Adolescents/Young Adults (Ages 10-20)
1997
Drug use/abuse
39%
Lack of parental supervision
Alcohol use/abuse
39%
Early or inappropriate sexual activity
Weight, obesity
17%
Behavioral or emotional problems(anger management, bullying) 31%
Lack of youth activities
Unintended pregnancy
39%
Tobacco use
28%
High school drop out rates
27%
Weight, anorexia/bulimia
Sexually transmitted diseases
32%
Suicide
28%
Car seat belt use
24%
Motor vehicle accidents
Immunizations
Availability of local allergy injections
Other (not specified)
3. Adults (Ages 21 and older)
1997
Drug use/abuse including synthetic and prescription
Weight, obesity
45%
Alcohol use/abuse
Tobacco use
Availabiltiy of family focused activities
Behavioral or emotional problems
21%
Stress
47%
Diabetes
38%
Availability of adult day care
18%
Vision or hearing loss
32%
Weight, anorexia, bulimia
Bone or joint disease
37%
Lung disease
39%
Heart disease, heart attack
58%
Cancer
57%
High blood pressure
52%
Stroke
52%
Availability of activities for senior citizens
Access to foot care
Availability of local allergy injections
Immunizations
Other (not specified)
-
2004
39%
55%
32%
41%
31%
44%
2004
68%
65%
59%
32%
52%
49%
49%
46%
32%
22%
50%
37%
30%
53%
2004
37%
46%
34%
31%
30%
48%
34%
19%
27%
14%
30%
29%
51%
51%
47%
43%
-
2007
44%
34%
29%
28%
25%
20%
7%
4%
2007
46%
46%
43%
41%
40%
39%
38%
36%
35%
25%
24%
23%
23%
19%
16%
6%
2007
40%
37%
37%
29%
29%
27%
25%
20%
19%
17%
17%
15%
14%
11%
10%
9%
8%
-
2015 (birth-9)
27%
25%
21%
18%
13%
10%
8%
9%
5%
9%
1%
2015
31%
29%
28%
34%
29%
53%
29%
32%
27%
28%
23%
24%
28%
21%
14%
14%
9%
3%
2015
29%
26%
22%
20%
23%
23%
23%
15%
13%
25%
10%
15%
11%
10%
14%
15%
21%
9%
8%
6%
1%
Community Health Assessment Comparative
Health Analysis - Continued
4. Pregnancy
Unintended Pregnancy
Transportation
Language Barriers
Access to postpartum support
Tobacco use during pregnancy
Availability of prenatal medical care
Drug use during pregnancy
Alcohol use during pregnancy
Access to nutrition education
Access to supplemental food program such as WIC
Availability of prenatal vitamins and/or folic acid
Access to breastfeeding support
Access to adequate diaper supply
5. General Concerns
Drug use and abuse
Alcohol use and abuse
Domestic violence
Prescriptions causing financial burdens
Family Relationship problems
Dental care
Parenting issues
Tobacco use
Transportation
Nutrition
Unemployment
Language barriers
Occupational accidents(including farming)
Motor vehicle accidents
Murder and violent acts
Infectious diseases(pneumonia, TB, hep A,B,C, STDs, AIDS)
Developmental and physical diabilities
Vision or hearing loss
Homelessness and sheltering
Availability of residential assistance during extreme weather
6. Environmental Health
Indoor air quality(mold, secondhand smoke, radon)
Disaster preparedness, bioterrorism, homeland security
Air pollution
Restaurant food
Animal vector control(vaccinations, rabies, stray animals)
Public motels/hotels
Rural sewage disposal
West nile virus/Mosquito control
Avian flu
Water supply
Lead exposure
Trash/waste/sharps/medication disposal
Influenza
Other (not specified)
1997
14%
14%
14%
15%
15%
1997
28%
28%
28%
22%
28%
23%
28%
34%
28%
36%
36%
38%
25%
32%
1997
33%
31%
30%
37%
29%
-
2004
49%
49%
45%
55%
50%
2004
49%
41%
44%
34%
29%
38%
36%
39%
23%
38%
30%
40%
29%
25%
2004
36%
22%
34%
21%
19%
38%
14%
19%
-
2007
31%
25%
24%
23%
21%
21%
19%
17%
16%
2007
43%
41%
37%
37%
33%
33%
32%
32%
25%
24%
24%
22%
21%
21%
20%
13%
12%
12%
2007
34%
37%
26%
22%
22%
20%
19%
18%
18%
17%
17%
17%
-
2015
15%
14%
13%
12%
19%
10%
17%
15%
9%
6%
7%
6%
7%
2015
28%
26%
30%
29%
24%
23%
22%
28%
23%
16%
25%
19%
14%
13%
21%
15%
19%
12%
23%
17%
2015
21%
15%
13%
7%
13%
7%
14%
11%
6%
9%
9%
7%
3%
Survey Respondent Time Requirement
The A u d r a i n County Community Health Needs Assessment Survey required respondents to
provide a great deal of information about themselves on a broad range of health topics. The ACHD
goal was to obtain accurate information about household members while limiting the time commitment
required of the respondent. The surveys were designed to be user-friendly, requiring check boxes for
responses and a readability level that met resident comprehension needs (see Appendix B). On
average, the surveys required approximately 20.2 minutes to complete.
Survey Respondent Bias
It must be acknowledged that the ACHD staff had an inordinately high number of respondent
“walk-ins” completing surveys at the ACHD. As a result, the 2015 Community Health Assessment
Survey of Audrain County identified the following Top Three concerns based upon the perceived needs
of community respondents.
1. Behavioral or emotional problems (anger management, bullying, etc.)*
2. Early or inappropriate sexual activity
3. Unintended pregnancy
These are the remaining concerns to distinguish the Top Ten concerns identified during the 2015
assessment. They are listed in no particular order. The secondary data analysis will be critical in
validating some of the top ten concerns.







Drug use/abuse including synthetic and prescription*
Domestic violence (child and /or adult)*
Prescriptions causing financial burdens*
Tobacco use
Weight, obesity
Lack of physical activities
Weight, anorexia, bulimia*
The heavy data collection on a similar characteristic-based subject group (ACHD clients) did skew some
of the survey top priority results. This inadvertently occurred as most ACHD clients tend to be female,
younger, healthier, and with issues in mind that reflect their age and those of their children. Asterisks (*)
noted above acknowledge findings that were identified by a preponderance of walk-in ACHD clients and
does not reflect findings in the three secondary analysis repositories, nor the Audrain County population
at large.
Secondary Data Analysis
I.
CDC: Community Health Status Indicators (CHSI)
The Centers for Disease Control’s (2015) Community Health Status Indicators Summary (CHSI)
Comparison Report (see Appendix D) provides an “at a glance” summary of how Audrain County
compares with peer counties on the full set of primary indicators. Indicators are presented as
Better, Moderate, or Worse in comparison with peer counties. Peer county values for each
indicator were ranked and then divided into quartiles.
CHSI 2015 was designed to complement other existing indicator applications including the Health
Rankings and Roadmaps. For example, CHSI 2015 includes indicator values for each county
benchmarked against similar “peer counties”, all U.S. counties, and Healthy People 2020 targets.
The Rankings resource of “What Works for Health”, includes research that has been reviewed and
rated on the effectiveness for a broad variety of strategies addressing health associated factors
including behaviors, clinical care, social and economic factors, and the physical environment.
Together, the Rankings and CHSI 2015 provide useful information for community health
assessment and improvement including:




A set of frequently recommended mortality, morbidity, and health determinant indicators
compared to a wide range of benchmarks.
Indicator values for subpopulations and census tract maps to assist with identification of
vulnerable populations and potential health disparities
Health status information integrated with info on health factors that influence health status.
Rated strategies for addressing priority focus areas.
CHSI 2015 Indicators and Definitions
Indicators in the Better category (green circle) fall into the most favorable quartile
compared to peers.
Indicators in the Moderate category (yellow diamond) fall into the middle two quartiles.
Indicators in the Worse category (red square) fall into the most unfavorable quartile.
Distribution Display: Bar charts allowing users to visually compare indicators for the selected
county to those of its peer counties. The display also shows median values for all U.S. counties
and Healthy People 2020 targets, where applicable.
Show Peer Counties Feature (bottom of the Distribution display): Allows users to examine
maps of the geographic distributions of each group of peer county categorized indicators.
Indicator Downloads: Indicator values for each group of peer counties can be downloaded for
further examination and analysis. For indicators that are based on estimated values, this feature
also allows users to examine the estimate and the associated margin of error (confidence interval).
Indicator Description: Each CHSI 2015 indicator is accompanied by information describing the
significance (importance) of the indicator, source and years of the data, methodology for creating
the indicator, and important limitations, where applicable.
Populations: Allows users to compare an indicator value for the entire population of a county
with sub-populations defined by sex, age groups, and race/ethnicity. This feature can be used to
assist with identifying potential health disparities that may warrant further attention.
Census Tract Maps: Help identify vulnerable populations and potential health disparities by
examining the geographic distribution of select social factor indicators within a county (by census
tract), where data are available.
Associated Indicators (AI): Indicators that are related to a primary indicator and may provide
additional valuable information. For example, the primary indicator for educational attainment is
on-time high school graduation rate. AIs include percent of adults without a high school diploma
and percent of adults with an associate level college degree or higher.
CHSI 2015 Topic and Indicator Selection Process
CHSI 2015 topic areas (e.g., leading causes of death, poverty), and final set of indicators (e.g., stroke
mortality rates, percent of the population whose income fall below the federal poverty level) were
selected through a deliberative process. The process for identifying health outcomes and potential
determinant topic areas consisted of a CDC staff review of the original CHSI and the CDC monograph,
Community Health Assessment for Population Health Improvement: Most Frequently Recommended
Health Metrics which identified topic areas to understand and improve community health. Next, a
qualitative review of the scientific literature was performed to better understand the potential
relationships between candidate health topic areas and population health outcomes. Finally, a
systematic review similar indicator initiative and available data sources was conducted. The indicator
initiatives reviewed included, but were not limited to:








The County Health Rankings and Roadmaps (www.countyhealthrankings.org)
United Health Foundation’s America’s Health Rankings (www.americashealthrankings.org)
State of the USA Health Indicators (www.stateoftheusa.org)
The Health Indicator’s Warehouse (www.healthindicators.gov)
Canadian Index of Wellness (www.atkinsonfoundation.ca/ciw)
Healthy People 2020 (www.healthypeople.gov)
National Prevention strategy
(www.surgeongeneral.gov/initiatives/prevention/strategy/report.pdf)
Annie E. Casey Foundation’s KIDS COUNT (datacenter.kidscount.org)
The results of these reviews were used to develop a set of CHSI indicators. Consistent with previous
versions of CHSI, the final set of indicators were required to meet the following criteria: the indicators
were considered important to public health, were actionable, were regularly reported, and were available
for at least two-thirds of U.S. counties. Additionally, all health factor indicators included in CHSI 2015
were required to be supported by a body of scientific literature establishing their association with
population health outcomes and identifying plausible mechanisms and pathways for those associations.
Final indicator selection was based on the synthesized scientific evidence; input from external advisors
and CDC subject matter experts; and consistency with similar indicator initiatives.
CHSI 2015 Health Indicators
Physical Environment
2. Annual average PM2.5 concentration (micrograms per cubic meter)
Annual average concentration of PM2.5 in Audrain County, MO is9:
10.9 (µg/m3)
Significance
Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and
cardiovascular systems. Progress has been made to reduce unhealthy air emissions, but approximately
127 million people still live in U.S. counties that exceed national air quality standards8.
Methodology
This measure represents the average daily amount of fine particulate matter in micrograms per cubic
meter (PM2.5) in a county. The monitoring data comes from the U.S. Environmental Protection Agency
(EPA) Air Quality System (AQS)9. When AQS data are available from multiple monitors for a given
county and day, the highest 8-h maximum (daily) ozone concentration among all the monitors is selected
for purposes of creating daily county level data.
3. Unhealthy PM2.5 days (days) – AI of # 1 above.
Number of days the air was rated unhealthy for PM2.5 in Audrain County, MO is9:
0.0 days
Significance
Acceptable PM2.5 results for Audrain County, Missouri; 2010 – 2012..
4. Unhealthy ozone days (days) – AI of # 1 above.
Number of days the air was rated unhealthy for ozone in Audrain County, MO is9:
0.0 days
Significance
Absence of unhealthy ozone days in Audrain County, Missouri; 2010 – 2012.
CHSI 2015 Health Indicators
Physical Environment (continued)
5. Living near highways (percent)
Percent of population living near a highway in Audrain County, MO is11:
2.1 %
Significance
Numerous studies have documented that concentrations of traffic-related pollutants are highest in the
near-road environment. A recent review determined that there is sufficient evidence of a causal
association between exposure to traffic-related air pollution and asthma exacerbation and suggestive
evidence of a causal association for onset of childhood asthma, non-asthma respiratory symptoms,
impaired lung function, all-cause mortality, cardiovascular mortality, and cardiovascular morbidity10.
Methodology
Percent of population living within 150 meters of a highway.
6. Schools located near highways (percent) – AI of #4 above.
Percent of schools located near a highway in Audrain County, MO is11:
42.9 %
Significance
As above. In Audrain County, chronic lower respiratory disease deaths are in the “Worse” category.
Methodology
This measure represents the percent of schools located within 150 meter of a highway. It was created by
the CDC using data from the National Center for Education Statistics (NCES) and road network data
from 2010, from NAVTEQ, a commercial company11.
CHSI 2015 Health Indicators
Social Factors
1. Children in single-parent households (percent)
Percent of children in single-parent households for Audrain County, MO is12:
28.1 %
Significance
Children living in nuclear families, or families consisting of two married adults who are the biological or
adoptive parents of all children in the family—were generally healthier, more likely to have access to
health care, and less likely to have definite or severe emotional or behavioral difficulties than children
living in nonnuclear families13.
Methodology
Percentage of all children in family households that live in households headed by a single parent (male
or female head of household with no spouse present).
2. Single-parent families (percent) – AI of # 1 above.
Percent of families with a single head of household for Audrain County, MO is12:
8.2 %
3. High housing costs (percent)
Percent of individuals with high housing costs in Audrain County, MO is12:
22.1 %
Significance
Affordability of housing is linked to the health and well-being of individuals and families14. When a
market lacks a sufficient supply of affordable housing, lower-income families are often forced to limit
expenditures for food, medical care, and other necessities in order to pay rent14. Audrain County does
well in providing affordable housing.
Methodology
This measure represents the percent of people that live in renter-occupied housing units or owneroccupied housing units with a mortgage and pay 30 percent or more of their household income on
housing costs. Monthly owner costs come from ACS data on mortgage, second mortgage and/or home
equity loans, real estate taxes, homeowners insurance, condo fee (if applicable), mobile home cost (if
applicable), utilities (electricity, gas, water and sewer, and other utilities). Monthly gross rent costs
come from ACS data on contract rent and utilities (electricity, gas, water and sewer, and other utilities).
CHSI 2015 Health Indicators
Social Factors (continued)
4. Inadequate social support (percent)
Percent of adults reporting inadequate social support in Audrain County, MO is15:
17.0 %
Significance
Social relationships are fundamental to emotional fulfillment, behavioral adjustment, and cognitive
function. Social isolation predicts morbidity & mortality from cancer, heart disease, and other causes16.
Methodology
Percent of adults 18 years & over who report not receiving sufficient social-emotional support; 2006 2012. Based on the BRFSS question "How often do you get the social & emotional support you need?"
5. On time high school graduation (percent)
The on time high school graduation rate for Audrain County, MO is17:
90.1 %
Significance
Education, employment, and health are linked. Without a good education, prospects for a stable and
rewarding job with good earnings decrease. Education is associated with living longer, experiencing
better health, and practicing health-promoting behaviors such as exercising regularly.
6. Associates level degree or higher (percent) – AI of # 5 above.
Percent of adults with an associate degree or higher in Audrain County, MO is 17:
19.1 %
7. No high school diploma (percent) – AI of # 5 above.
Percent of adults without a high school diploma in Audrain County, MO is17:
15.8 %
Significance
Audrain County has a poor post-high school education rate.
CHSI 2015 Health Indicators
Social Factors (continued)
8. Poverty (percent)
Percent of individuals living in poverty in Audrain County, MO is19:
20.3 %
Significance
Low-income and minority neighborhoods are less likely to have access to recreational facilities and fullservice grocery stores and more likely to have higher concentrations of retail outlets for tobacco,
alcohol, and fast foods18. Adolescents who grow up in neighborhoods characterized by concentrated
poverty are more likely to be a victim of violence; use tobacco, alcohol, and other substances; become
obese; and engage in risky sexual behavior18.
Methodology
Percent of individuals living in households with income below the Federal Poverty Level (FPL); 2012.
At the county level, SAIPE provides estimates on children ages 5-17 in families in poverty, children
under age 18 in poverty, all people in poverty, and median household income19.
9. Children in poverty (percent) – AI of # 8 above.
Percent of children living in poverty in Audrain County, MO is19:
29.4 %
Methodology
The percent of children under age 18 living in households with income below the Federal Poverty Line
(FPL); 2008 - 201219.
10. Older adults in poverty (percent) – AI of # 8 above.
Percent of older adults living in poverty in Audrain County, MO is:
12.2 %
Methodology
Percent of population aged 65 and older living below the Federal Poverty Line; 2008 – 201219.
CHSI 2015 Health Indicators
Social Factors (continued)
11. Unemployment (percent)
The unemployment rate for Audrain County, MO is20:
5.4 %
Significance
The association between unemployment and poor physical and mental health is well established.
Unemployed persons tend to have higher annual illness rates, lack health insurance and access to health
care, and have an increased risk for death21.
Methodology
Percent of the civilian labor force, age 16 and older, that is unemployed, but seeking work through
May, 201520.
12. Violent crime (rate per 100,000 persons)
The rate of violent crime for Audrain County, MO is22:
181.1 (per 100,000)
Significance
Witnessing or being a victim of violence (e.g., child maltreatment, youth violence, intimate partner and
sexual violence, bullying, elder abuse) are linked to lifelong negative physical, emotional, and social
consequences18.
Methodology
Annual rate of violent crimes including homicide, forcible rape, robbery, and aggravated assault, per
100,000 population; 2010 – 2012. The violent crime rate is calculated as the sum of murder, forcible
rape, robbery, and aggravated assaults over the three-year period divided by the aggregate population of
areas covered by agencies reporting crimes, and then multiply 100,00022.
CHSI 2015 Health Indicators
Healthcare Access and Quality
1. Cost barrier to care (percent)
Percent of adults who did not see a doctor due to cost in Audrain County, MO is15:
23.0 %
Significance
Access to comprehensive, quality health care services is important for the achievement of health equity
and for increasing the quality of a healthy life for everyone. Access to health services means the timely
use of personal health services to achieve the best health outcomes and encompasses four components8:
coverage, services, timeliness, and workforce. Barriers to services include: 1) Lack of availability, 2)
High cost, and 3) Lack of insurance coverage. These barriers to accessing health services diminish
quality of care and lead to delays in receiving appropriate care, the inability to get preventive services,
and hospitalizations that could have been prevented8.
Methodology
Percent of adults 18+ who needed to see a doctor but could not because of cost; 2006 – 201215. Based
on the BRFSS question: "Was there a time in the past 12 months when you needed to see a doctor but
could not because of cost?"
2. Older adult preventable hospitalizations
(rate per 1,000 Medicare enrollees age 65 years or older)
Older adult preventable hospitalizations rate for Audrain County, MO is7:
92.2 (per 1,000)
Significance
Preventable hospitalizations are admissions to a hospital for certain acute illnesses (e.g., diabetes) that
might not have required hospitalization had these conditions been managed successfully by primary care
providers in outpatient settings23. Hospitalization for diagnoses treatable in outpatient services suggests
that the quality of care provided in the outpatient setting was less than ideal23. U.S. median: 71.3.
Methodology
Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees7.
Ambulatory care-sensitive conditions include: convulsions, chronic obstructive pulmonary disease,
bacterial pneumonia, asthma, congestive heart failure, hypertension, angina, cellulitis, diabetes,
gastroenteritis, kidney/urinary Infection, and dehydration7. Rates are adjusted for age, sex and race
using the indirect method, using the U.S. Medicare population as the standard7.
CHSI 2015 Health Indicators
Healthcare Access and Quality (continued)
3. Primary care provider access (rate per 100,000 persons)
The primary care provider rate for Audrain County, MO is15:
78.2 (per 100,000)
Significance
Having a primary care provider (PCP) for routine care is very important. PCPs develop meaningful and
sustained relationships with patients and provide integrated services while practicing in the context of
family & community8. Having a PCP is associated with greater patient trust in the provider, good
patient-provider communication, and increased likelihood that patients will receive appropriate care8.
Methodology
Rate of Primary Care Providers per 100,000
The Health Resources and Services Administration compile physician data from the American Medical
Association Master File and from the Census Population Estimates program to report primary care
provider data at the county level15. Primary care physicians are those who identify as practicing general
practice, internal medicine, obstetrics and gynecology, or pediatrics15.
4. Dentists access (rate per 100,000 persons) – AI of # 3 above.
The dentist provider rate for Audrain County, MO is7:
23.5 (per 100,000)
Significance
Lack of access to dental care for all ages remains a public health challenge7. The poverty rate in
Audrain County makes this a significant outlier and resident concern.
5. Uninsured (percent)
Percent of the population without health insurance in Audrain County, MO is7:
18.4 %
Significance
Persons aged 18–64 years with no health insurance during the preceding year were seven times as likely
as those continuously insured to forgo needed health care because of cost. U.S. median is 17.7%7.
CHSI 2015 Health Indicators
Health Behaviors
1. Adult binge drinking (percent)
Percent of adults who report binge drinking in Audrain County, MO is7:
14.2 %
Significance
Excessive alcohol use, including underage drinking and binge drinking (drinking 5 or more drinks on an
occasion for men or 4 or more drinks on an occasion for women), can lead to increased risk of health
problems such as injuries, violence, liver diseases, and cancer. Approximately 80,000 deaths are
attributed annually to excessive drinking. Excessive drinking is the third leading lifestyle-related cause
of death in the United States. The U.S. median is 16.37.
Methodology
Percent of adults 18 years and over that report binge drinking. Based on the BRFSS question:
"Considering all types of alcoholic beverages, how many times during the past 30 days did you have [5
for men, 4 for women] or more drinks on an occasion?"7.
2. Adult female routine pap tests (percent)
Percent of women who report having routine pap tests in Audrain County, MO is7:
68.7 %
Significance
Less than half of older adults are up-to-date on a core set of clinical preventive services (e.g., cancer
screening and immunizations). U.S. median is 77.3%7.
Methodology
Percent of women age 18+ that report Pap test in the last 3 years. Based on the BRFSS questions: "A
Pap test is a test for cancer of the cervix. Have you ever had a Pap test? and " How long has it been since
you had your last Pap test?"7.
3. Adult physical inactivity (percent)
Percent of adults who report no leisure time physical activity in Audrain County, MO is 7:
27.8 %
Significance
More than 80 percent of adults do not meet the guidelines for both aerobic and muscle-strengthening
activities7. Regular physical activity can improve the health and quality of life of Americans of all ages,
regardless of the presence of a chronic disease or disability.
Methodology
Adults that report no leisure-time exercise in past month. Based on the BRFSS question: "During the
past month, other than your regular job, did you participate in any physical activities or exercises such as
running, calisthenics, golf, gardening, or walking for exercise?"7. The U.S. median is 25.9% and the
Healthy People 2020 target is 32.6%7.
4. Adult smoking (percent)
Percent of adults who report smoking cigarettes in Audrain County, MO is7:
31.3 %
Significance
Tobacco use is the single most preventable cause of death and disease in the United States. Each year,
approximately 443,000 Americans die from tobacco-related illnesses. For every person who dies from
tobacco use, 20 more people suffer with at least 1 serious tobacco-related illness. In addition, tobacco
use costs the U.S. $193 billion annually in direct medical expenses and lost productivity7. The U.S.
median is 21.7% and the Healthy People 2020 target is 12. Audrain County is one of the few remaining
counties that do not have a non-smoking ordinance in public venues and is well behind Missouri,
national, and HP 2020 goals.
Methodology
Percent of adults 18 years and over that report currently smoking cigarettes. Based on the BRFSS
question: "Do you now smoke cigarettes every day, some days, or not at all?" Persons are considered
smokers if they reported smoking every day or some days7.
5. Teen Births (rate per 1,000 females age 15-19 years)
The teen birth rate for Audrain County, MO is7:
49.6 (per 1,000)
Significance
Teen pregnancy and childbearing bring substantial social and economic costs through immediate and
long-term impacts on teen parents and their children.



In 2011, teen pregnancy and childbirth accounted for at least $9.4 billion in costs to U.S.
taxpayers for increased health care and foster care, increased incarceration rates among children
of teen parents, 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, versus
approximately 90% of women who had not given birth during adolescence.
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.
These effects remain for the teen mother and her child even after adjusting for those factors that
increased the teenager’s risk for pregnancy, such as growing up in poverty, having parents with low
levels of education, growing up in a single-parent family, and having poor performance in school. The
U.S. median is 42.1% and the HP 2020 target is 36.2%7. Audrain County’s teen pregnancy rate is
higher than most Missouri counties, the nation, and the HP goal.
By Age7
Aged 15-17 years
Aged 18-19 years
Audrain
23.0
96.3
Peer Median
18.7
77.2
Methodology
Rate per 1,000 of births to females 15-19 years of age7.
US Median
20.3
84.0
CHSI 2015 Health Indicators
Morbidity
1. Adult diabetes (percent)
Percent of adults living with diagnosed diabetes for Audrain County, MO is7:
11.2 %
Significance
Diabetes affects an estimated 23.6 million people in the United States and is the 7th leading cause of
death. Diabetes lowers life expectancy by up to 15 years and increases the risk of heart disease by 2 to 4
times. Diabetes is the leading cause of kidney failure, lower limb amputations, and adult-onset
blindness. In addition to these human costs, the estimated total financial cost of diabetes in the U.S. in
2007 was $174 billion, which includes the costs of medical care, disability, and premature death. The
U.S. median is 8.1%7.
Methodology
Percent of adults that report having been diagnosed as having diabetes. The prevalence of diagnosed
diabetes was estimated for adults age 20 and over, using data from CDC's Behavioral Risk Factor
Surveillance System (BRFSS), and data from the U.S. Census Bureau’s Population Estimates Program.
Respondents were considered to have diabetes if they responded "yes" to the question, "Has a doctor
ever told you that you have diabetes?"7.
2. Adult obesity (percent)
Percentage of adult obesity for Audrain County, MO is7:
32.0 %
Significance
Obesity is common, serious and costly. In 2009-2010, more than one-third of U.S. adults (35.7%) were
obese. The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars;
the medical costs for people who are obese were $1,429 higher than those of normal weight7.
Methodology
Percent of adults 20 years and over that report BMI >= 30, using the Behavioral Risk Factor
Surveillance System (BRFSS)7.
CHSI 2015 Health Indicators
Morbidity (continued)
3. Adult overall health status (percent)
Percent of adults reporting fair or poor health in Audrain County, MO is7:
21.6 %
Significance
Health-related quality of life (HRQOL) measures of perceived physical and mental health and function
have become an important component of health surveillance and are generally considered valid
indicators of service needs and intervention outcomes. Self-assessed health status also proved to be
more powerful predictor of mortality and morbidity than many objective measures of health7. The U.S.
median is 16.5%7.
Methodology
Percent of adults that report fair or poor health. Based on the BRFSS question : "Would you say that in
general your health is— Excellent, Very good, Good, Fair, Or Poor?"7.
4. Adult mentally unhealthy days (per person)
Average number of reported mentally unhealthy days per month
among adults in Audrain County, MO is7:
4.8 (per person)
Significance
Health-related quality of life (HRQOL) measures of perceived physical and mental health and function
have become an important component of health surveillance and are generally considered valid
indicators of service needs and intervention outcomes. Self-assessed health status also proved to be
more powerful predictor of mortality and morbidity than many objective measures of health7.
Methodology
Average number of reported mentally unhealthy days per month among adults 18 years and over.
Based on the BRFSS question "Now thinking about your mental health, which includes stress,
depression, and problems with emotions, for how many days during the past 30 days was your
mental health not good?"7.
5. Adult physically unhealthy days (per person)
Average number of reported physically unhealthy days per month
among adults in Audrain County, MO is7:
5.1 (per person)
Methodology
Average number of reported physically unhealthy days per month among adults 18 years+7. Based on
the BRFSS question: "Now thinking about your physical health, which includes physical illness &
injury, for how many days during the past 30 days was your physical health not good?"7.
6. Alzheimer's diseases/dementia (percent)
Percent of older adults living with Alzheimer's/dementia for Audrain County, MO is7:
10.7 %
Significance
Dementia is an umbrella term for a group of cognitive disorders typically characterized by memory
impairment, as well as marked difficulty in the domains of language, motor activity, object recognition,
and disturbance of executive function – the ability to plan, organize, and abstract. Most often, dementia
is an illness of older adults, which suggests that as successive cohorts of our population live longer, the
urgency to better address dementia increases. The likelihood of developing Alzheimer’s doubles about
every five years after age 65.
Methodology
Prevalence of Alzheimer's Disease and Dementia among Medicare fee-for-service Beneficiaries7.
7. Cancer (rate per 100,000 persons)
Age-adjusted cancer incidence rate for Audrain County, MO is7:
514.5 (per 100,000)
Significance
Advances in cancer research, detection, and treatment have resulted in a decline in both incidence and
death rates for all cancers. Among people who develop cancer, more than half will be alive in 5 years.
Yet, cancer remains a leading cause of death in the United States, second only to heart disease7. The
U.S. median is 457.6.
Methodology
Incidence rates of all cancer sites, all races, all ages. State Cancer Registry and the CDC's National
Program of Cancer Registries Cancer Surveillance System (NPCR-CSS). Retrieved from: National
Cancer Institute. State Cancer Profiles24.
Rate Icon
Description
Peer Median
HP 2020 Target
US Median
51.3
Colon & rectum cancer
51.5
38.6
46.8
147.4
Female breast cancer
115.5
41.0
115.6
93.2
Lung & bronchus cancer
78.0
NA
71.7
148.6
Male prostate cancer
134.3
NA
137.9
CHSI 2015 Health Indicators
Morbidity (continued)
8. Gonorrhea (rate per 100,000 persons)
The gonorrhea rate for Audrain County, MO is7:
129.1 (per 100,000)
Significance
The CDC estimates that there are approximately 19 million new sexually transmitted disease (STD)
infections each year—almost half of them among young people ages 15 to 24. The cost of STDs to the
U.S. health care system is estimated to about $15.9 billion annually. Untreated STDs can lead to serious
long-term health consequences, especially for adolescent girls and young women. CDC estimates that
undiagnosed and untreated STDs cause at least 24,000 women in the U.S. each year to become infertile7.
Audrain County has the highest gonorrhea rate in Missouri7. The U.S. median is only 30.5 cases per
100,0007. Audrain’s rate is greater than four times the national rate.
Methodology
Nationally notifiable STD surveillance data are collected and compiled from reports sent by the STD
control programs and health departments in all 50 states, the District of Columbia, selected cities, and
U.S. dependencies. Rates per 100,000 population were calculated for each STD7.
9. Chlamydia (rate per 100,000 persons) – AI of # 8 above.
The chlamydia rate for Audrain County, MO is7:
512.4 (per 100,000)
10. HIV (rate per 100,000 persons)
Rate of persons living with diagnosed HIV for Audrain County, MO is7:
154.4 (per 100,000)
Significance
Audrain County’s HIV rate is higher than the U.S. median of 105.5 cases/100,0007.
11. Syphilis (rate per 100,000 persons)
The syphilis rate for Audrain County, MO is7:
0.0 (per 100,000)
CHSI 2015 Health Indicators
Morbidity (continued)
12. Older adult asthma (percent)
Percent of older adults living with asthma for Audrain County, MO is25:
3.99 %
Significance
Currently, more than 23 million people have asthma in the U.S. The burden of respiratory diseases
affects individuals, families, schools, workplaces, neighborhoods, cities, and states. Annual health care
expenditures for asthma are estimated at $20.7 billion7.
13. Older adult depression (percent)
Percent of older adults living with depression for Audrain County, MO is25:
12.7 %
Significance
Depression is characterized by depressed or sad mood, diminished interest in activities which used to be
pleasurable, weight gain or loss, psychomotor agitation or retardation, fatigue, inappropriate guilt,
difficulties concentrating, as well as recurrent thoughts of death. But depression is more than a “bad
day”. APA criteria dictate that five or more of the above symptoms must be present for a period of at
least2 weeks. Depression falls within the spectrum of affective disorders & is an issue for many seniors.
14. Preterm births (percent)
Percentage of preterm births for Audrain County, MO is7:
12.1 %
Significance
In 2012, preterm birth affected more than 450,000 babies—1 of every 9 infants born in the U.S. Preterm
birth occurs before 37 weeks of pregnancy. Preterm-related causes of death accounts for 35% of all
infant deaths, more than any other single cause. Preterm birth is also a leading cause of long-term
neurological disabilities in children. U.S. Median is 12.1, HP 2020 Target: 11.4.
15. Low birth weight (percent)
Percentage of low birth weight deliveries for Audrain County, MO is7:
7.6 %
CHSI 2015 Health Indicators
Mortality
1. Alzheimer's disease deaths (rate per 100,000 persons)
The age adjusted Alzheimer's disease death rate for Audrain County, MO is7:
24.5 (per 100,000)
Significance
Alzheimer’s disease is the 6th leading cause of death among adults aged 18 years and older7. Estimates
vary, but experts suggest that up to 5.1 million Americans aged 65 years and older have Alzheimer’s
disease. These numbers are predicted to more than double by 2050.
Methodology
Alzheimer’s death rates are calculated as the number of deaths assigned to ICD-10 code G30 per
100,000 population, age adjusted to the 2000 standard population7.
2. Cancer deaths (rate per 100,000 persons)
The age adjusted cancer death rate for Audrain County, MO is7:
211.7 (per 100,000)
Significance
Cancer continues to be the second leading cause of death in the United States, accounting for more than
20% of all deaths in 2010. Advances in research, detection, and treatment have resulted in a decline in
incidence and death rates for all cancers. In people with cancer, half are expected to be alive in 5 years.
Methodology
Death rates are calculated as the number of deaths assigned to ICD-10 codes C00-C97 per 100,000
population, age adjusted to the 2000 standard population7.
3. Chronic kidney disease deaths (rate per 100,000 persons)
Age adjusted chronic kidney disease death rate for Audrain County, MO is:
19.9 (per 100,000)
Significance
Chronic kidney disease (CKD): 8th leading cause of death in the U.S. in 2010. More than 20 million,
aged 20 years or older in the U.S. have CKD. CKD is an important risk factor for cardiovascular disease,
including heart attacks, heart failure, heart rhythm disturbances, and strokes. CKD and end stage renal
disease (ESRD) are very costly to treat. Nearly 25% of the Medicare budget is used to treat people with
CKD and ESRD.
CHSI 2015 Health Indicators
Mortality (continued)
4. Chronic lower respiratory disease (CLRD) deaths (per 100,000 persons)
Age-adjusted chronic lower respiratory disease (CLRD) death rate for
Audrain County, MO is7:
71.8 (per 100,000)
Significance
Chronic lower respiratory diseases (CLRD) is the 3rd leading cause of death in the United States in
2010. Many of these adults have been diagnosed with chronic obstructive pulmonary disease (COPD the primary component of CLRD mortality). The burden of respiratory diseases affects individuals and
their families, schools, workplaces, neighborhoods, cities, and states. U.S. median is 49.6.
Methodology
CLRD death rates are calculated as the number of deaths assigned to ICD-10 codes J40-J47 per 100,000
population, age adjusted to the 2000 standard population.
5. Coronary heart disease deaths (rate per 100,000 persons)
Age adjusted coronary heart disease death rate for Audrain County, MO is7:
101.7 (per 100,000)
Significance
Together, heart disease and stroke are among the most widespread and costly health problems facing the
Nation today, accounting for more than $500 billion in health care expenditures and related expenses in
2010 alone. Audrain County’s rate is excellent as the U.S. median is 126.7 & HP 2020 Target is 103.4.
6. Diabetes deaths (rate per 100,000 persons)
The age adjusted diabetes death rate for Audrain County, MO is7:
30.4 (per 100,000)
Significance
Diabetes affects an estimated 23.6 million people in the U.S. and is the 7th leading cause of death.
Diabetes lowers life expectancy by up to 15 years and increases the risk of heart disease by 2 to 4 times.
Diabetes is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. The
estimated total financial cost of diabetes in the U.S. in 2007 was $174 billion, which includes the costs
of medical care, disability, and premature death.
CHSI 2015 Health Indicators
Mortality (continued)
7. Female life expectancy (years)
Female Life Expectancy for Audrain County, MO is7:
79.2 years
Significance
Between 2000 and 2007, life expectancies in more than 80% of United States counties fell in standing
against the average of the 10 nations with the best life expectancies in the world27.
8. Male life expectancy (years)
Male Life Expectancy for Audrain County, MO is7:
73.8 years
Significance
Similar to the national experience, Audrain County females live 5.4 years longer than males28.
Methodology
Life expectancy estimates were calculated using a mixed-effects Poisson statistical model with time,
geospatial, and covariate components and Gaussian Process Regression to estimate annual life
expectancy for U.S. counties28.
9. Motor vehicle deaths (rate per 100,000 persons)
Age adjusted motor vehicle traffic-related death rate for Audrain County, MO is7:
17.4 (per 100,000)
Significance
Motor vehicle crash-related injuries are the leading cause of death among younger people aged 5 to 34
years. Motor vehicle crash fatality rates are especially high in rural areas and for residents of tribal
lands, in part because of poor road maintenance, higher rates of alcohol impaired driving, lower rates of
seat belt and child safety seat use, and less access to emergency response and trauma care.
Methodology
Number of vehicle related deaths [ICD-10 codes V02-V04 (.1, .9), V09.2, V12-V14 (.3-.9), V19 (.4-.6),
V20-V28 (.3-.9), V29-V79 (.4-.9), V80 (.3-.5), V81.1, V82.1, V83-V86 (.0-.3), V87 (.0-.8), V89.2]7.
CHSI 2015 Health Indicators
Mortality (continued)
10. Unintentional injury (including motor vehicle) (rate per 100,000 persons)
Age adjusted unintentional injury (including motor vehicle) death rate
for Audrain County, MO is7:
47.1 (per 100,000)
Significance
Unintentional injuries were the 5th leading cause of death in the United States in 2010. Unintentional
injuries are the leading cause of death for Americans ages 1 to 44, as well as a leading cause of disability
for all ages, regardless of sex, race/ethnicity, or socioeconomic status. For children, motor vehicle and
bicycle accidents are leading causes of injury and death. In June, 2015, ACHD added car seat and safe
crib programs. A bicycle helmet program is in development.
11. Unintentional injury (excluding motor vehicle) (rate per 100,000 persons)
Age adjusted unintentional injury (excluding motor vehicle) death rate
for Audrain County, MO is7:
29.1 (per 100,000)
Significance
By gender, 28.1% of injuries involve females and 71.9% of injuries occur in males.
12. Stroke deaths (rate per 100,000 persons)
The age adjusted stroke death rate for Audrain County, MO is7:
48.7 (per 100,000)
Significance
Heart disease and stroke are among the most widespread and costly health problems facing the nation
today, accounting for more than $500 billion in health care expenditures and related expenses in 20107.
Audrain County’s stroke death rate is higher than the U.S. median is 46.0 and the HP 2020 target of
34.8.
Methodology
Stroke death rates are calculated as the number of deaths assigned to ICD-10 codes I60-I69 per 100,000
population, age adjusted to the 2000 standard population7.
II.
UW/PHI & RWJF: County Health Rankings
The Rankings are based on a model of population health that emphasizes the many factors that, if
improved, can help make communities healthier places to live, learn, work and play. Building on the
work of America's Health Rankings, the University of Wisconsin Population Health Institute, sponsored
by the Robert Woods Johnson Foundation, has used this model to rank the health of Wisconsin counties
every year since 200326.
The County Health Rankings measure the health of nearly all counties in the nation and rank them
within states. The Rankings are compiled using county-level measures from a variety of national and
state data sources. These measures are standardized and combined using scientifically-informed
weights26.
The following elements comprise the Rankings model:
Health Outcomes
Health outcomes in the County Health Rankings represent the health of a county. Two types of health
outcomes are measured:
1. How long people live (length of life); and H
2. How healthy people feel while alive (quality of life).
Length of Life (Mortality)
The Rankings examine mortality (or death) data to find out how long people live. More specifically, the
Rankings measure what are known as premature deaths (deaths before age 75).
Quality of Life (Morbidity)
Quality of life refers to how healthy people feel while alive. Specifically, the Rankings report on the
measures of their health-related quality of life (their overall health, physical health, and mental health)
and it also looks at birth outcomes.
Health Factors
Health factors in the County Health Rankings represent what influences the health of a county. Four
types of health factors are measured: health behaviors, clinical care, social and economic, and physical
environment factors. In turn, each of these factors is based on several measures. A fifth set of factors
that influence health (genetics and biology) is not included in the Rankings.
Health Behaviors
 Alcohol & Drug Use
 Diet & Exercise
 Sexual Activity
 Tobacco Use
Clinical Care
 Access to Care
 Quality of Care
Social and Economic Factors
 Community Safety
 Education
 Employment
 Family & Social Support
 Income
Physical Environment
 Air & Water Quality
 Housing & Transit
A multi-county analysis that compares Audrain County to its seven contiguous neighboring counties and
the State of Missouri metrics follows.
Monroe Montgomery Pike
(MR)
(MY)
(PI)
Ralls
(RS)
Randolph Audrain Callaway Boone
(RO)
(AU)
(CW)
(BO)
Health
Outcomes
28
30
49
75
65
48
67
7
Length of Life
5
20
26
78
41
23
35
6
5,538
6,844
7,094
9,072
7,709
6,984
7,440
5,591
89
60
86
61
83
87
93
20
19%
15%
21%
22%
17%
11%
3.9
3.4
5.2
5.1
3.7
2.7
5.1
4.8
3.9
4.0
Missouri
Premature
death
7,714
Quality of Life
Poor or fair
health
16%
21%
Poor physical
health days
3.7
4.4
Poor mental
health days
3.8
3.1
Low birthweight
8.0%
9.4%
7.2%
8.5%
7.9%
7.1%
7.6%
9.9%
7.4%
Health Factors
52
68
84
20
56
57
46
3
Health
Behaviors
48
82
87
30
59
66
78
1
3.8
4.8
Adult smoking
23%
26%
28%
27%
21%
27%
29%
30%
18%
Adult obesity
31%
32%
33%
34%
35%
32%
31%
34%
24%
Food
environment
index
7.0
7.7
7.3
6.8
8.2
6.8
7.1
7.8
6.3
Physical
inactivity
26%
29%
28%
29%
28%
28%
29%
30%
21%
Access to
exercise
opportunities
77%
45%
41%
50%
32%
61%
75%
65%
74%
Excessive
drinking
17%
21%
21%
18%
17%
15%
18%
15%
Alcoholimpaired driving
deaths
35%
45%
35%
29%
15%
19%
26%
38%
49%
STDs
462
92
242
307
282
399
511
262
659
Teen births
40
30
50
44
33
50
50
30
20
49
75
87
71
46
36
24
2
18%
19%
16%
17%
18%
15%
15%
Clinical Care
Uninsured
16%
20%
Primary care
physicians
1,439:1
2,901:1 3,999:1
3,713:1 5,139:1
1,689:1
1,423:1 2,606:1
986:1
Dentists
1,920:1
4,387:1 5,983:1
3,734:1 10,192:1 2,771:1
3,666:1 4,929:1
1,691:1
Mental health
providers
632:1
8,774:1 2,393:1
2,667:1 3,397:1
597:1
344:1
1,313:1
562:1
Missouri
Monroe Montgomery Pike
(MR)
(MY)
(PI)
Ralls
(RS)
Randolph Audrain Callaway Boone
(RO)
(AU)
(CW)
(BO)
Preventable
hospital stays
65
55
72
87
76
77
82
66
45
Diabetic
monitoring
86%
87%
84%
84%
85%
85%
85%
87%
86%
Mammography
screening
62.2%
63.0%
53.1%
58.2%
54.5%
55.6%
65.6%
61.4%
71.4%
62
57
75
14
64
67
49
10
Social &
Economic
Factors
High school
graduation
86%
93%
92%
84%
88%
90%
83%
82%
86%
Some college
63.8%
45.0%
49.8%
36.3%
50.8%
48.9%
48.7%
54.6%
78.6%
Unemployment
6.5%
7.3%
7.0%
5.9%
5.0%
6.5%
5.8%
5.8%
4.5%
Children in
poverty
22%
27%
23%
27%
17%
29%
33%
20%
17%
Income
inequality
4.6
3.5
4.4
4.7
3.1
4.6
3.7
4.1
5.4
Children in
single-parent
households
34%
25%
35%
35%
27%
40%
33%
29%
30%
Social
associations
11.9
17.2
16.7
19.4
7.8
15.8
13.7
11.1
11.7
Violent crime
452
257
136
179
88
151
181
266
408
Injury deaths
74
92
89
72
65
66
72
79
51
27
51
95
21
49
34
55
64
Physical
Environment
Air pollution particulate
matter
10.2
10.3
10.8
11.0
10.6
10.0
10.4
10.4
10.2
Drinking water
violations
4%
0%
2%
27%
0%
0%
7%
0%
0%
Severe housing
problems
14%
9%
10%
13%
9%
13%
10%
12%
18%
Driving alone to
work
81%
79%
79%
79%
78%
83%
79%
82%
78%
Long commute 30%
driving alone
41%
39%
27%
28%
23%
23%
26%
17%
(University of Wisconsin, Public Health Institute & Robert Wood Johnson Foundation, 2015).
III.
MICA
Child Health Update, Ages 1 – 14: Injury, ER Visits29
(MO DHSS, MICA, 2014).
Child Health Update, Ages 15 – 19: Death, Suicide30
(MO DHSS, MICA, 2014).
Leading Cause of Death Profile: Lung Cancer31
(MO DHSS, MICA, 2015).
Leading Cause of Death Profile: Chronic Lower Respiratory Disease32
(MO DHSS, MICA, 2015).
Leading Cause of Death Profile: Diabetes Mellitus33
(MO DHSS, MICA, 2015).
Leading Cause of Death Profile: Smoking34
(MO DHSS, MICA, 2015).
Leading Cause of Death Profile: COPD35
(MO DHSS, MICA, 2014).
Women’s Health Profile: Cervical Cancer36
(MO DHSS, MICA, 2014).
Mental Health, Substance Abuse, & Crime39
(MO Department of Mental Health, 2015).
Mexico – Child Eligibility for Free Meals40
PUBLIC RELEASE
Mexico School District announced its revised free and reduced price policy for school children unable to pay the full price of meals served in schools under
the National School Lunch Program and the School Breakfast Program.
Local education officials have adopted the following family-size income criteria for determining eligibility:
Household
Size
1
2
3
4
5
6
7
8
Each add’l
member
Maximum Household Income
Eligible for Free Meals
Annually
Monthly
Weekly
$15,301
$1,276
$295
20,709
1,726
399
26,117
2,177
503
31,525
2,628
607
36,933
3,078
711
42,341
3,529
815
47,749
3,980
919
53,157
4,430
1,023
+ 5,408
+ 451
+ 104
Maximum Household Income
Eligible for Reduced Price Meals
Annually
Monthly
Weekly
$21,775
$1,815
$419
29,471
2,456
567
37,167
3,098
715
44,863
3,739
863
52,559
4,380
1,011
60,255
5,022
1,159
67,951
5,663
1,307
75,647
6,304
1,455
+ 7,696
+ 642
+ 148
Children from families whose current income is at or below those shown are eligible for free or reduced price meals. Applications are available at the school
office. To apply, fill out a Free and Reduced Price School Meals Family Application and return it to the school. The information provided on the application
is confidential and will be used only for the purpose of determining eligibility. Applications may be submitted any time during the school year. A complete
application is required as a condition of eligibility. A complete application includes: (1) household income from all sources or Food Stamp/TANF case
number, (2) names of all household members, and (3) the signature and last four digits of social security number or indication of no social security number
of adult household member signing the application. School officials may verify current income at any time during the school year.
Foster children may be eligible regardless of the income of the household with whom they reside.
If a family member becomes unemployed or if family size changes, the family should contact the school to file a new application. Such changes may make
the children of the family eligible for these benefits.
Households will be notified of their children’s eligibility status for free or reduced price meals. If any children were not listed on the eligibility notice for
families receiving SNAP, TANF or FDPIR, the household should contact the school to have free meal benefits extended to those children.
If any child(ren) was not listed on the eligibility notice, the household should contact the LEA or school to have free meal benefits extended to that
child(ren).
Under the provisions of the policy, the Food Service Director will review the applications and determine eligibility. If a parent is dissatisfied with the ruling of
the determining official, they may wish to discuss the decision with the hearing official on an informal basis or he/she may make a request either orally or in
writing to the Superintendent of Schools, Mr. Kevin Freeman.
Hearing procedures are outlined in the policy. A complete copy of the policy is on file in each school and in the central office where any interested party
may review it.
Non-discrimination Statement: The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment
on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or
parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in
employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment
activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form (PDF), found
online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter
containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director,
Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected]
Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 8456136 (Spanish). USDA is an equal opportunity provider and employer.
Combined Data Repository Findings: CHSI, the Rankings, & MICA
A broad range of personal, social, economic, and environmental factors that influence health status are
known as determinants of health. These factors are interrelated and determine both population and
individual health outcomes. The county obesity rate is higher than the State average. Similarly, the
county’s smoking rate (31.3%) is higher than the U.S (21.2%) & state (23%) rates. Consequently, the
incidence of diabetes, heart disease, stroke, lung and oral cancers, and chronic upper respiratory diseases
is higher than the norm.
STDs are also one of the most critical health challenges facing Audrain County today. Audrain’s HIV
prevalence rate (154.5 per 100,000 persons) is significantly higher than the U.S. rate (105.5 per 100,000
persons). Audrain’s Gonorrhea rate is significantly higher than the U.S. median (30.5/100,000 persons).
The Audrain County Chlamydia rate (512.4 cases per 100,000 persons) is also significantly higher than
both Missouri and U.S. rates.
Top Five Causes of Morbidity38
Top Five Causes of Mortality38
1. Cancer
1. Heart Disease
2. Heart Disease
2. Cancer
3. COPD
3. COPD; Chronic Lower Respiratory Diseases
4. Stroke
4. Stroke
5. Diabetes Mellitus
5. Unintentional Injuries
Top Five Causes of Inpatient Hospitalizations38 Top Five Causes of Emergency Room Visits38
1. Heart & Circulation
1. Injury & Poisoning
2. Heart Disease
2. Respiratory, Throat & Lung
3. Reproduction: Pregnancy; Birth
3. Symptoms & Ill-Defined Conditions
4. Respiratory, Throat & Lung
4. Respiratory Infections
5. Digestive System
5. Brain/Spinal Cord/Eyes/Ears
Audrain County: Ranking Against 115 Counties in the State of Missouri:
Health Outcomes Ranking:
48th
Health Factors Ranking:
57th
Preventable Hospital Stays: 88th overall and 2nd highest compared to the other 6 contiguous counties.
Access to comprehensive, quality health care services is important for the achievement of health equity
and for increasing the quality of life for everyone. There are four components of access to care:
coverage, services, timeliness, and workforce (Healthy People 2020–Access to Health Services). Rising
health care costs cause policy makers to be concerned about emergency room (ER) visits, which are
often more expensive than primary provider treatment. Preventable hospitalizations are hospitalizations
that better primary care could have prevented.41 The preventable hospitalization rate is significantly
higher than most of the 115 Missouri counties; ranking 88th.
Combined Data Repository Findings: CHSI, the Rankings, & MICA
Mental health is a critical component of overall health and quality of life and should be addressed with
the priority that is given to physical health. Mental illness has been associated with the development and
outcomes of several physical ailments and is regularly associated with health risk behaviors such as
substance abuse, tobacco use, and physical inactivity. Moreover, depression has been found to be a risk
factor for multiple chronic diseases–hypertension, cardiovascular disease, and diabetes–and can
negatively impact these conditions. Audrain County findings include 4.8 mentally unhealthy days/month
– higher than the State and U.S. norm.
Bullying is a form of violence that occurs among children and youth. Bullying can lead to social and
emotional distress, injuries and even death. Persons who are victims of bullying have escalated risks for
mental health issues such as anxiety and depression. Although ACHD respondents identified bullying as
an area of concern, all regions of the state have approximately the same rate of victims of bullying, with
no statistical differences between the regions.
The ACHD CHNA offers a comprehensive review of all of the organizations and entities that
contribute to the public’s health. The assessment answers questions related to the activities,
competencies and capacities of the system and how essential public health services are performed in the
state. The public health system consists of not just the health department, but other government and
non- government entities as illustrated below.
Forces of Change Impact
• The economic downturn and budget cuts in both the state and the U.S. adversely affect services to
the most vulnerable populations and undermine past achievements.
• Some lawmakers do not understand or appreciate the value of public health and some
policies in the state confound and perpetuate growing economic gaps, leading to “haves
and have-nots”.
• Organizations are engaged in competition for limited resources to meet their respective
missions, and such an environment inhibits collaborative partnerships.
• The impact of the Affordable Care Act continues to unfold.
• The lack of Medicaid expansion in Missouri has created a gap in service for some.
• Many Audrain County residents are uninsured. The Kaiser Family Foundation has identified
several key facts related to the uninsured in the U.S.:
• More than half of people under the age of 65 receive health coverage as an employment
benefit, consequently the loss of a job leads to the loss of insurance.
• Most people without health coverage are in working families and have low incomes through
low paying and part-time jobs.
• Adults make up a disproportionate share of the uninsured population because they are less
likely than children to be eligible for Medicaid.
• While the majority of uninsured people are White non-Hispanic, racial/ethnic minorities
are at especially high risk of being uninsured.
• Health insurance is a deciding factor in whether and when people get necessary
medical care, where they get their care, and ultimately, how healthy they are.
• For many uninsured people, the costs of health insurance and medical care compete
with other essential needs.
The Patient Protection and Affordable Care Act of 2010 has the potential to decrease the
number of uninsured in several ways:
• Expanding the Medicaid program (states must agree & approve; MO has not).
• Building on employer-based coverage using requirements and incentives
• Providing premium subsidies & health exchanges to make private insurance affordable.
Missouri Forces of Change That May
Missouri Current Assets that May
Impact Strategies to Respond to the
Uninsured Issue
Facilitate the Strategies to Respond
to the Uninsured Issue
Antigovernment sentiments
Innovative initiatives from national
Fewer factories and jobs with
benefits
and state foundations
Recession
Implementation of the Affordable Care
Increasing disparities in wealth and
economic opportunities
Act of 2010
Government regulations that restrict
business
advocacy
Aging population
Increased push for living wages
State and federal legislative
State Medicaid Program
Federally Qualified Health Centers
Hospitals and the MHA
References
1. O’Malley, P.O., Rainford, J., & Thompson, A. (2009). Transparency during public health
emergencies: From rhetoric to reality. Bulletin of the World Health Organization, 87,
p. 614-618. doi: 10.2471/BLT.08.056689
2. Washington Advocates for patient Safety. (2015). Transparency and accountability.
Retrieved from http://www.washingtonadvocatesforpatientsafety.org/transparency-andaccountability/.
3. Central MO Community Action. (2014). Central MO Community Action: 2014 community
assessment. Retrieved from http://www.showmeaction.org/public/csbg/2014na.pdf.
4. U.S. Census Bureau, U.S. Department of Commerce (2015a). 2010 Decennial census
data. Retrieved from http://www.census.gov/quickfacts/table/PST045214/29007,29,00.
5. Hodge, L. (1985). The Friend of Audrain – A History of Medicine in Audrain County.
Mexico, MO: Audrain Medical Center.
6. U.S. Census Bureau. (2010). 2010 Census Tracts: Audrain County. Retrieved from
http://www2.census.gov/geo/maps/dc10map/tract/st29_mo/c29007_audrain/DC10CT
_C29007_001.pdf
6. U.S. Census Bureau, U.S. Department of Commerce (2015b). Multi-county comparative analysis
data. Retrieved from http://www.census.gov/quickfacts.
7. Centers for Disease Control & Prevention, U.S. Department of Health & Human Services. (2015).
Community health status indicators: Audrain County. Retrieved from
http://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/MO/Audrain/
8. U.S. Department of Health and Human Services, Office of Disease Prevention and Health
Promotion. Healthy People 2020. Washington, DC. Retrieved from
http://www.healthypeople.gov.
9. Centers for Disease Control and Prevention (2015). National Environmental Public Health
Tracking Network. Retrieved from www.cdc.gov/ephtracking.
10. Boehmer, T., et al. (2013). Residential proximity to major highways - United States, 2010.
MMWR. Surveillance summaries, 62, Suppl. 3: p. 46-50.
11. Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry
(CDC/ATSDR). Geospatial Research, Analysis and Services Program (GRASP); 2010-2012.
12. American Community Survey (2015). Retrieved from www.census.gov/acs/www/.
13. Blackwell D.L. (2010). Family structure and children’s health in the United States: Findings
from the National Health Interview Survey, 2001–2007. National Center for Health Statistics.
References (continued)
Vital Health Stat. 10(246). Retrieved from http://www.cdc.gov.nchs/data/series/sr_10
/sr10_246.pdf.
14. Freeman, L. (2002). America’s affordable housing crisis: A contract unfulfilled. American Journal
of Public Health, 92, p. 709–712. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles
/PMC1447149/.
15. Behavioral Risk Factor Surveillance System (BRFSS). (2015). Retrieved from Centers for Disease
Control and Prevention, National Center for Health Statistics. Health Indicators Warehouse.
16. Hawkley, L. , & Cacioppo, J. (2003). Loneliness and pathways to disease. Brain, Behavior, and
Immunity, 17 Suppl 1: S98-105.
17. U.S. Department of Education (EDFacts) (2015). On time high school graduation rate: Audrain
County. Retrieved from https://explore.data.gov/Education/Adjusted-Cohort-Graduation-Rates
-at-the-LEA-level-/gnfw-qmug.
18. National Prevention Council, National Prevention Strategy, U.S. Department of Health and Human
Services, Office of the Surgeon General. (2011). Retrieved from http://www.surgeongeneral.
gov/initiatives/prevention/strategy/report.pdf.
19. U.S. Census Bureau (2012). Small Area Income and Poverty Estimates (SAIPE). Retrieved from
http://www.census.gov/.
20. Bureau of Labor Statistics. (2015). Local area unemployment statistics. Retrieved from
http://data.bls.gov/map/MapToolServlet.
21. Centers for Disease Control and Prevention. (2013). Unemployment: U.S. 2006 & 2010. MMWR,
3(62), (Suppl 3): p. 27-31. Retrieved from http://www.cdc.gov/mmwr/pdf/other/su6203.pdf.
22. United States Department of Justice, Federal Bureau of Investigation. (2014). Uniform crime
reporting program data: County-level detailed arrest and offense data, 2012. ICPSR35019-v1.
Ann Arbor, MI: Inter-University Consortium for Political and Social Research, 2014-06-12.
http://doi.org/10.3886/ICPSR35019.v1.
23. Centers for Disease Control and Prevention. (2013). Potentially preventable hospitalizations: U.S.
MMWR, 62(Sup 3), p.139-143. Retrieved from http://www.cdc.gov/mmwr/pdf/other/su6203.pdf.
24. National Cancer Institute, Missouri Cancer Registry. (2015). State Cancer Profiles and the CDC
National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS).
25. Centers for Medicare and Medicaid Services. (2015). Medicare Chronic Conditions Dashboard:
County Level. Retrieved from http://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends- and-Reports/Dashboard/Chronic-Conditions-County/CC
_County_Dashboard.html.
References (continued)
26. University of Wisconsin, Public Health Institute & Robert Wood Johnson Foundation. (2015).
County health ranking. Retrieved fromhttp://www.countyhealthrankings.org/app/missouri/2015/
compare/snapshot?counties=137%2B139%2B163%2B173%2B175%2B007%2B027%2B019.
27. Kulkarni, S., et al. (2011). "Falling behind: Life expectancy in U.S. counties from 2000- 2007 in an
international context.". Population Health Metrics, 9(1), p. 16-16. Retrieved from
http://www.pophealthmetrics.com/content/11/1/8.
28. Wang. H., Schumacher, A. E., Levitz, C. E., Mokdad, A. H., & Murray, C. J. L. (2013). Left
behind: Widening disparities for males and females in U.S. county life expectancy, 1985-2010.
Population Health Metrics, 11, p. 8.
29. Missouri Department of Health & Senior Services. (2014). Data MICA: ER Visits, Injury,
Ages 1 – 14. Retrieved from
http://health.mo.gov/data/mica/ASPsChildHealth/trend.php?county=007&code=051135.
30. Missouri Department of Health & Senior Services. (2014). Data MICA: Death, Suicide,
Ages 15 – 19. Retrieved from
http://health.mo.gov/data/mica/ASPsChildHealth/displaybar.php?typ=C&county=007&caus%5B
%5D=081132&colrbw=0.
31. Missouri Department of Health & Senior Services. (2015). Lung Cancer. Retrieved from
http://health.mo.gov/data/mica/ASPsDeath/displaybar.php?typ=R&code=011014&cnty%5B%5
D=007&colrbw=0.
32. Missouri Department of Health & Senior Services. (2015). CLRD. Retrieved from
http://health.mo.gov/data/mica/ASPsDeath/displaybar.php?typ=R&code=011040&cnty%5B%5
D=007&colrbw=0.
33. Missouri Department of Health & Senior Services. (2015). Diabetes Mellitus. Retrieved from
http://health.mo.gov/data/mica/ASPsDeath/displaybar.php?typ=R&code=011052&cnty%5B%5
D=007&colrbw=0.
34. Missouri Department of Health & Senior Services. (2015). Smoking. Retrieved from
http://health.mo.gov/data/mica/ASPsDeath/displaybar.php?typ=R&code=011156&cnty%5B%5
D=007&colrbw=0.
35. Missouri Department of Health & Senior Services. (2014). Chronic disease comparisons: COPD.
Retrieved from
http://health.mo.gov/data/mica/ASPsChronicDisease/displaybar.php?typ=R&code=031211&cnty
%5B%5D=007&colrbw=0.
36. Missouri Department of Health & Senior Services. (2014). Cervical cancer: Retrieved from
References (continued)
http://health.mo.gov/data/mica/ASPsWomensHealth/displaybar.php?typ=R&code=042302&cnty
%5B%5D=007&colrbw=0.
37. Missouri Census Data Center. (2015). ACS Profiles [dataset application]. Retrieved from
http://census.missouri.edu/acs/profiles/.
38. Missouri Department of Health & Senior Services. (2014). Community Data Profiles; MICA.
Retrieved from http://health.mo.gov/data/CommunityDataProfiles/.
39. Missouri Department of Mental Health. (2015). Audrain County: Mental health, substance abuse,
and crime. Retrieved from http://dmh.mo.gov/ada/countylinks/docs/indicator-audrain.pdf.
40. Mexico School District. (2015). Public Release: National School Lunch Program & the School
Breakfast Program. Emailed to Administrator from MSD.
41. Moy, E., Barrett, M., & Ho, K. (2011). Potentially Preventable Hospitalizations-United
States, 2004-2007. Morbidity and Mortality Weekly, (60)01, p.80-83.
Appendix A. Audrain County CHNA Respondent Letter
Appendix B. Audrain County CHNA Survey
Audrain County Health Department
Community Health Assessment
2015
PLEASE ANSWER ALL THE QUESTIONS ON THIS QUESTIONNAIRE
1. Are the following health concerns for children birth to
Check one choice for each topic
9 being addressed to your satisfaction?
YES
NO
UNKNOWN
Access to a supplemental food program such as WIC
□
□
□
Availability of childcare, babysitters, daycare
□
□
□
Child abuse/neglect
□
□
□
Car restraint use
□
□
□
Immunizations
□
□
□
Chronic childhood illness (asthma, ear infections,
□
□
□
allergies)
Weight, obesity
□
□
□
Lack of physical activities
□
□
□
Lack of social activities
□
□
□
Availability of local allergy injections
□
□
□
Other________________________________________
□
□
□
2. Are the following health concerns for children ages 10
Check one choice for each topic
to 20 being addressed to your satisfaction?
YES
NO
UNKNOWN
Alcohol use/ abuse
□
□
□
Drug use/ abuse
□
□
□
Unintended pregnancy
□
□
□
Early or inappropriate sexual activity
□
□
□
Behavioral or emotional problems (anger management,
□
□
□
bullying, etc.)
□
□
□
Sexually transmitted diseases
□
□
□
Tobacco Use
□
□
□
Motor vehicle accidents
□
□
□
Suicide
□
□
□
High school drop out rates
□
□
□
Vehicle seat belt use
□
□
□
Weight, obesity
□
□
□
Weight, anorexia, bulimia
□
□
□
Lack of youth activities
□
□
□
Lack of parental supervision
□
□
□
Immunizations
□
□
□
Availability of local allergy injections
□
□
□
Other________________________________________
□
□
□
3. Are the following health concerns for ages 21 and older
Check one choice for each topic
being addressed to your satisfaction?
YES
NO
UNKNOWN
Cancer
□
□
□
Alcohol use/ abuse
□
□
□
Drug use/ abuse including synthetic and prescription
□
□
□
Diabetes
Tobacco Use
Lung disease
Heart disease, heart attack
Stroke
High blood pressure
Weight, obesity
Weight, anorexia, bulimia
Stress
Behavioral or emotional problems
Vision or hearing loss
Bone or joint disease
Availability of activities for senior citizens
Availability of family focused activities
Access to foot care
Availability of local allergy injections
Immunizations
Other________________________________________
4. Are the following concerns before during and after
pregnancy being addressed to your satisfaction?
Alcohol use during pregnancy
Drug use during pregnancy
Tobacco use during pregnancy
Availability of prenatal medical care
Unintended pregnancy
Language barriers
Transportation
Access to post-partum support
Access to nutrition education
Access to a supplemental food program such as WIC
Availability of prenatal vitamins and/or folic acid
Access to breastfeeding support
Access to adequate diaper supply
5. Are the following general concerns being addressed to
your satisfaction?
Motor vehicle accidents
Occupational accidents (including farming)
Domestic violence (child and/or adult)
Murder and or other violent acts
Infectious diseases (pneumonia, TB, hepatitis A,B, C,
sexually transmitted, AIDS, etc.)
Nutrition
Alcohol use/abuse
Drug use/abuse
Tobacco use
Dental Care
Developmental and physical disabilities
□
□
□
□
□
□
□
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□
Check one choice for each topic
YES
NO
UNKNOWN
□
□
□
□
□
□
□
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Check one choice for each topic
YES
NO
UNKNOWN
□
□
□
□
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□
□
Vision or hearing loss
Family relationship problems
Parenting issues to include parenting classes
Language barriers
Transportation
Prescriptions causing financial burdens
Unemployment
Homelessness and sheltering
Availability of residential assistance during extreme
weather
6. Are the following environmental health concerns
being addressed to your satisfaction?
Air pollution
Indoor air quality (mold, secondhand smoke, radon, etc.)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
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Check one choice for each topic
YES
NO
UNKNOWN
□
□
□
□
□
□
□
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□
□
Rural sewage disposal
Lead exposure
West Nile Virus/ Mosquito control
Trash/waste/sharps/medication disposal
Food establishment safety and sanitation
Water supply
Disaster preparedness, bioterrorism, homeland security
Animal vector control (vaccinations, rabies, stray animals)
Influenza
Public motels/hotels (lodging)
Other________________________________________
7. Please answer the following nutrition and exercise related
Check one choice for each topic where applicable
questions.
YES
NO
UNKNOWN
If employed, does your work place have incentives for exercising?
□
□
□
Do you read nutrition labels to help you decide what to eat or drink?
□
□
□
How many times per week do you get take out or fast food?
□ Never
□ 1-2 ti mes □ 3-4 ti mes □ 5-6 times
□ 7 or more
How often do you exercise per week?
□ Never □ 1-2 times □ 3-4 times □ 5-6 times
□ 7 or more
How do you perceive your weight?
What kind of physical activities do you do on most days?
□Swimming□ Cleaning □Yardwork □ Gym
□ Bike Riding
Which beverage do you consume the most of daily?
□ Water □ Soda □ Juice
□ Tea
□ Coffee
On a scale of 1-5, how willing are you to make changes in
your lifestyle to live healthier?
□ Normal
□ Underweight □ Overweight
□ None
□ Walking
□ Playing with children
□ Alcohol
□1
□4
□2
□5
□ Running
□ Other
□3
8. Over the last year was there someone in your household who wanted to see a physician, dentist, the local
public health agency (LPHA), or other health care provider but for some reason did not go? Check all that apply.
Location
Cost
No insurance
Physician
Dentist
LPHA
OTHER
□
□
□
□
□
□
□
□
□
□
□
□
If other specify
Transportation
□
□
□
□
Inconvenient hours
□
□
□
□
Insurance would not
□
□
□
□
cover the service
Language barriers
□
□
□
□
Other_______________
□
□
□
□
9. Have you used any Audrain County Health Department services in the past two years?
Yes
No
Not Sure
□
□
□
Information About You
1. Your sex
Male
Female
2. Race
White
Black or African-American
Asian
American Indian or Alaskan Native
3. What is your zip code?
□
□
□
□
□
□
Native Hawaiian or Pacific
Islander
Two or more races
Hispanic or Latino
□
□
□
___________
4. Please identify your age group.
□
Under 20
□
20-29
□
30-39
□
40-49
□
□
□
□
50-59
60-69
70-79
80 and above
Dear Public Health Patrons,
This information will help direct Public Health in Audrain County and will assist in allowing the Audrain
County Health Department to continue to provide the high quality of care and customer service you have
have been used to for over 50 years.
Public Health in Audrain County is everyone's business. However, very few of us take the time to really
think about it. For example, have you ever eaten at a local restaurant? If you have, then you have used
Public Health services. Public Health is in the business of preventative medicine…that's why you usually
hear very little from us. It doesn’t mean that we're not doing our job; it's just the nature of the business.
If you do hear from us, it's usually a major issue, such as an outbreak of Pertussis (whooping cough) or a
foodborne illness.
Public Health provides many essential programs in the community and supports many more critical
programs. Besides partnering with local, state, national, and global organizations; Public Health is involved
with a multitude of issues from Communicable Disease Surveillance, Birth and Death Certificates, and
Women, Infant, Children (WIC) programs to Disaster Preparedness, Immunization services, Blood Pressure
Screenings, Flu Clinics, and Environmental Public Health Services.
We appreciate your support, because Public Health is here for you…to Prevent, Promote and Protect.
THANK YOU!
Appendix C: 2010 U. S. Census Tracts: Audrain County, Missouri
(U.S. Census Bureau, U.S. Department of Commerce, 2010).
Appendix D: CDC CHSI, 2015.
APPENDIX E: American Community Survey, 2015.
ACS Profile Report37: 2009-2013 - Audrain County, Missouri (05000US29007)
Demographic - D1. AGE
Variable
Universe: Total population
Audrain County, Missouri
Number
Total population
Percent
25,584
Under 5 years
1,705
6.7
5 to 9 years
1,696
6.6
10 to 14 years
1,715
6.7
15 to 19 years
1,678
6.6
20 to 24 years
1,482
5.8
25 to 34 years
3,370
13.2
35 to 44 years
3,103
12.1
45 to 54 years
3,541
13.8
55 to 59 years
1,684
6.6
60 to 64 years
1,473
5.8
65 to 74 years
2,121
8.3
75 to 84 years
1,386
5.4
85 years and over
630
2.5
Median age in years
38.8
5 years and over
23,879
93.3
15 years and over
20,468
80.0
6,227
24.3
18 years and over
19,357
75.7
21 years and over
18,408
72.0
25 years and over
17,308
67.7
62 years and over
4,963
19.4
65 years and over
4,137
16.2
Number
Percent
Under 18 years
D2. AGE AND SEX
Universe: Total population
Variable
Audrain County, Missouri
Total population
25,584
Male
11,803
46.1
Males 18 years and over
8,409
71.2
Males 65 years and over
1,700
14.4
Female
13,781
53.9
Females 18 years and over
10,948
79.4
Females 65 years and over
2,437
17.7
Number
Percent
D3. RACE
Universe: Total population
Variable
Audrain County, Missouri
Total population
25,584
One race
24,923
97.4
White alone
22,962
89.8
1,534
6.0
American Indian and Alaska Native
51
0.2
Asian
80
0.3
Black or African American
Native Hawaiian and Other Pacific Islander
-
Some other race
296
Two or more races
661
1.2
2.6
White (alone or in combination)
23,583
92.2
Black (alone or in combination)
1,987
7.8
American Indian (alone or in combination)
177
0.7
Asian (alone or in combination)
179
0.7
Native Hawaiian (alone or in combination)
-
Some other race (alone or in combination)
319
1.2
D4. HISPANIC OR LATINO (ANY RACE)
Universe: Total population
Variable
Audrain County, Missouri
Number
Total population
Percent
25,584
Hispanic or Latino of any race
681
2.7
Not Hispanic or Latino
24,903
97.3
White alone
22,611
88.4
1,533
6.0
American Indian and Alaska Native alone
34
0.1
Asian alone
80
0.3
Black or African American alone
Native Hawaiian and Other Pacific Islander alone
-
ECONOMIC
E1. HOUSEHOLD INCOME AND BENEFITS
Universe: Total households
Variable
Audrain County, Missouri
Number
Total households
Percent
9,327
Less than $10,000
577
$10,000 to $14,999
654
7.0
$15,000 to $24,999
1,336
14.3
$25,000 to $34,999
1,179
12.6
$35,000 to $49,999
1,512
16.2
$50,000 to $74,999
2,107
22.6
$75,000 to $99,999
1,195
12.8
$100,000 to $149,999
568
6.1
$150,000 to $199,999
97
1.0
102
1.1
$200,000 or more
Median household income
$43,013
Mean household income
$52,396
With earnings
6,883
Mean household earnings
6.2
73.8
$52,081
With social security
3,467
Mean household social security income
37.2
$17,235
With retirement income
1,802
Mean household retirement income
19.3
$15,227
With supplemental security income
513
Mean household supplemental security income
5.5
$8,819
With cash public assistance income
246
2.6
Mean household cash public assistance income
$4,147
With food stamp benefits in the past 12 months
1,247
13.4
E2. FAMILY INCOME AN D BENEFITS
Universe: Family households
Variable
Audrain County, Missouri
Number
Percent
Family households
6,430
68.9
Less than $10,000
338
5.3
$10,000 to $14,999
246
3.8
$15,000 to $24,999
690
10.7
$25,000 to $34,999
614
9.5
$35,000 to $49,999
1,036
16.1
$50,000 to $74,999
1,743
27.1
$75,000 to $99,999
1,071
16.7
$100,000 to $149,999
522
8.1
$150,000 to $199,999
84
1.3
$200,000 or more
86
1.3
Median family income
$53,564
Mean family income
$60,370
E3. OTHER INCOME MEASURES
Universe: Various
Variable
Audrain County, Missouri
Number
Per-capita income
Percent
$19,687
Nonfamily households
2,897
Median nonfamily income
$25,979
Mean nonfamily income
$32,141
31.1
All full-time workers
8,028
All male full-time workers
4,424
55.1
All female full-time workers
3,604
44.9
Median earnings for workers
$25,828
Median earnings for male full-time, year-round workers
$39,809
Median earnings for female full-time, year-round workers
$29,433
E4. POVERTY STATUS OVER THE LAST 12 MONTHS
Universe: Persons for whom poverty status is determined
Variable
Audrain County, Missouri
Number
Persons for whom poverty status is determined
Percent
23,823
Persons below poverty
4,049
Persons under 18 for whom poverty status is determined
6,126
Persons under 18 in poverty
1,576
Persons aged 18 to 64 for whom poverty status is
determined
17.0
25.7
13,770
Persons aged 18 to 64 in poverty
2,069
Persons over 65 for whom poverty status is determined
3,927
Persons over 65 in poverty
Persons in families for whom poverty status is
determined
15.0
404
10.3
19,652
82.5
Unrelated individuals for whom poverty status is
determined
4,171
Persons in families in poverty
2,782
14.2
Unrelated persons in poverty 15 years and over
1,267
30.4
Poverty ratio under 0.5
1,797
7.5
Poverty ratio in 0.5 to 0.99
2,252
9.5
Poverty ratio in 1 to 2
4,915
20.6
14,859
62.4
Number
Percent
Poverty ratio in 2 and over
E5. EMPLOYMENT STATU S
Universe: Population 16 years and over
Variable
Audrain County, Missouri
Population 16 years and over
20,185
In labor force
11,698
58.0
Civilian labor force
11,690
57.9
Employed civilians
10,774
92.2
916
7.8
Unemployed civilians
In military
8
Not in labor force
8,487
42.0
11,284
55.9
Females in labor force
5,738
28.4
Females in civilian labor force
5,738
28.4
Employed females
5,304
92.4
Number
Percent
Females 16 years and over
E6. CHILDREN WITH ALL PARENTS WORKING
Universe: Own children under 18 years in families and subfamilies
Variable
Audrain County, Missouri
(Own) children under 6
1,944
All parents working
1,471
(Own) children aged 6 to 17
3,872
All parents working
2,867
75.7
74.0
E7. COMMUTING TO WOR K
Universe: Workers 16 years and over
Variable
Audrain County, Missouri
Number
Workers 16 years and over
10,684
Workers 16+ who commute to work
Percent
10,228
95.7
Car, truck, or van; drove alone
8,486
79.4
Car, truck, or van; carpooled
1,131
10.6
63
0.6
Walked to work
243
2.3
Other means of commuting
305
2.9
Worked at home
456
4.3
Mean travel time to work in minutes
21.1
Public transportation (excluding taxicab)
E8. WORKERS BY OCCUP ATION
Universe: Civilian employed population 16 years and over
Variable
Audrain County, Missouri
Number
Civilian employed population 16 years and over
Percent
10,774
Management, professional, and related occupations
2,753
25.6
Service occupations
2,137
19.8
Number
2,510
Percent
23.3
Variable
Audrain County, Missouri
Sales and office occupations
Farming, fishing, and forestry occupations
105
1.0
Construction, extraction, maintenance and repair
occupations
1,033
9.6
Production, transportation, and material moving
occupations
2,236
20.8
Number
Percent
E9. WORKERS BY INDUS TRY
Universe: Civilian employed population 16 years and over
Variable
Audrain County, Missouri
Civilian employed population 16 years and over
10,774
Agriculture, forestry, fishing and hunting, and mining
456
Construction
546
5.1
1,811
16.8
Manufacturing
Wholesale trade
4.2
248
2.3
1,711
15.9
Transportation and warehousing, and utilities
657
6.1
Information
157
1.5
Finance and insurance, and real estate and rental and
leasing
386
3.6
Retail trade
Professional, scientific, management, and administrative
393
3.6
2,647
24.6
Arts, entertainment, and recreation, and accommodation,
and food services
638
5.9
Other services, except public administration
546
5.1
Public administration
578
5.4
Number
Percent
Educational services, and health care, and social
assistance
E10. CLASS OF WORKER
Universe: Civilian employed population 16 years and over
Variable
Civilian employed population 16 years and over
Audrain County, Missouri
10,774
Private wage and salary workers
8,259
76.7
Government workers
1,727
16.0
759
7.0
29
0.3
Self-employed workers in own not incorporated business
Unpaid family workers
SOCIAL
S1. HOUSEHOLDS BY TYPE
Universe: Total households
Variable
Audrain County, Missouri
Number
Percent
Total households
9,327
Family households
6,430
68.9
With own children under 18 years
2,623
28.1
Married-couple families
5,049
54.1
With own children under 18 years
1,707
18.3
Male householder, no wife present
394
4.2
With own children under 18 years
293
3.1
Female householder, no husband present
987
10.6
With own children under 18 years
623
6.7
Nonfamily households
2,897
31.1
Householder living alone
2,480
26.6
65 years and over living alone
1,161
12.4
Households with one or more people under 18 years
2,940
31.5
Households with one or more people 65 years and over
2,796
30.0
Average household size
2.54
Average family size
3.06
S2. PERSONS BY HOUSEHOLD TYPE / GROUP QUARTER S
Universe: Total population
Variable
Audrain County, Missouri
Number
Percent
Total population
25,584
Household population
23,698
92.6
Living in family households
20,272
85.5
Living in nonfamily households
3,426
14.5
Living alone
2,480
26.6
Living in group quarters
1,886
7.4
Number
Percent
23,698
92.6
Householder
9,327
39.4
Spouse
5,052
21.3
Child
7,085
29.9
Other relatives
1,085
4.6
Nonrelatives
1,149
4.8
599
2.5
S3. RELATIONSHIP
Universe: Household population
Variable
Audrain County, Missouri
Household population
Unmarried partner
Unmarried-partner HHs per 1000
64
S4. MARITAL STATUS
Universe: Population 15 years and over
Variable
Audrain County, Missouri
Number
Persons 15 years and over
Never married
Now married, except separated
Separated
Percent
20,468
5,231
25.6
10,768
52.6
461
2.3
Widowed
1,462
7.1
Divorced, and not currently married
2,546
12.4
S5. FERTILITY
Universe: Women 15 to 50 years old who gave birth in the past 12 months
Variable
Audrain County, Missouri
Number
Percent
Women 35 to 50 years
25
6.7
Per 1,000 unmarried women
32
Per 1,000 women 15 to 50 years
57
Per 1,000 women 15 to 19 years
3
Per 1,000 women 20 to 34 years
117
Per 1,000 women 35 to 50 years
9
S6. GRANDPARENTS AS CAREGIVERS
Universe: Population 30 years and over
Variable
Audrain County, Missouri
Number
Grandparents living with own grandchildren under 18
years
405
Responsible for grandchildren
Percent
210
51.9
Less than 1 year
33
15.7
1 or 2 years
97
46.2
3 or 4 years
48
22.9
5 or more years
32
15.2
Number
Percent
S7. SCHOOL ENROLLMEN T
Universe: Population 3 years and over
Variable
Audrain County, Missouri
Population 3 years and over
24,541
Population 3 years and over enrolled in school
5,706
23.3
In nursery school, preschool
386
6.8
In kindergarten
341
6.0
In elementary school, grades 1-8
2,745
48.1
In high school, grades 9-12
1,581
27.7
653
11.4
Number
Percent
In college or graduate school
S8. EDUCATIONAL ATTAINMENT
Universe: Population 25 years and over
Variable
Audrain County, Missouri
Population 25 years and over
17,308
Less than 9th grade
877
5.1
9th to 12th grade, no diploma
1,836
10.6
High school graduate (includes equivalency)
7,920
45.8
Some college, no degree
3,316
19.2
Associates degree
1,094
6.3
Bachelors degree
1,405
8.1
Graduate or professional degree
High school graduate or higher
Bachelor degree or higher
860
5.0
14,595
84.3
2,265
13.1
Number
Percent
19,349
100.0
1,954
10.1
S9. VETERAN STATUS
Universe: Civilian population 18 years and over
Variable
Civilian population 18 years and over
Civilian veterans
Audrain County, Missouri
S10A. DISABLED BY AGE
Universe: Civilian noninstitutionalized population
Variable
Audrain County, Missouri
Number
Civilian noninstitutionalized persons
Percent
23,914
With a disability
3,702
15.5
Under 18
6,213
26.0
With a disability
186
3.0
13,774
57.6
With a disability
2,173
15.8
65 years and over
3,927
16.4
With a disability
1,343
34.2
Number
Percent
18 to 64 years
S11. RESIDENCE 1 YEA R AGO
Universe: Population 1 year and over
Variable
Audrain County, Missouri
Population 1 year and over
25,312
Same house
21,133
83.5
Different house in the U.S.
4,170
16.5
Same county, different house
1,773
7.0
Different county
2,397
9.5
Different county, same state
1,897
7.5
500
2.0
Different state
Lived abroad 1 year ago
9
S12. PLACE OF BIRTH AND CITIZENSHIP STAT US
Universe: Total population
Variable
Audrain County, Missouri
Number
Percent
Total population
25,584
U.S. native
25,198
98.5
Born in United States
25,099
98.1
Born in state of current residence
20,062
78.4
5,037
19.7
99
0.4
Born in different state than current residence
Born in Puerto Rico, U.S. Island areas, or born abroad to
American parents
Foreign born
386
1.5
Naturalized U.S. citizen
155
40.2
Not a U.S. citizen
231
59.8
Number
Percent
S13. YEAR OF ENTRY
Universe: Population born outside the United States
Variable
Audrain County, Missouri
Population born outside the United States
Native, born outside U.S.
485
1.9
99
20.4
Entered U.S. 2000 or later
5
5.1
Entered U.S. before 2000
94
94.9
Foreign born
386
1.5
Entered U.S. 2000 or later
140
36.3
Entered U.S. before 2000
246
63.7
S14. WORLD REGION OF BIRTH OF FOREIGN BORN
Universe: Foreign-born population, excluding population born at sea
Variable
Audrain County, Missouri
Number
Percent
386
1.5
Europe
71
18.4
Asia
80
20.7
Africa
14
3.6
Foreign-born population, excluding population born at
sea
Oceania
-
Latin and Central America (includes Mexico)
221
Northern America
57.3
-
S15. LANGUAGE SPOKEN AT HOME
Universe: Population 5 years and over
Variable
Audrain County, Missouri
Number
Percent
Population 5 years and over
23,879
93.3
English only
22,701
95.1
1,178
4.9
Speaks English less than "very well"
490
2.1
Speak Spanish
675
2.8
Speaks English less than "very well"
247
1.0
Number
Percent
Language other than English
HOUSING
H1. HOUSING OCCUPANCY AND TENURE
Universe: Housing units
Variable
Audrain County, Missouri
Total housing units
10,822
Occupied housing units
9,327
86.2
Owner-occupied
6,917
74.2
Renter-occupied
2,410
25.8
Average household size of owner-occupied unit
2.60
Average household size of renter-occupied unit
2.37
Vacant housing units
1,495
13.8
For sale
142
9.5
For rent
318
21.3
83
5.6
For seasonal, recreational, or occasional use
Total owner units
7,059
Homeowner vacancy rate
2.0
Total rental units
2,728
Rental vacancy rate
11.7
People living in owned homes
17,985
70.3
People living in rental homes
5,713
22.3
Number
Percent
H2. UNITS IN STRUCTURE
Universe: Housing units
Variable
Audrain County, Missouri
Total housing units
10,822
Single-family units
8,908
82.3
Single unit, detached
8,779
81.1
Single unit, attached
129
1.2
Duplexes
370
3.4
3 or 4 units
359
3.3
5 to 9 units
240
2.2
10 to 19 units
61
0.6
20 or more units
71
0.7
813
7.5
Mobile home
Boat, RV, van, etc.
-
Mobile homes per 1000 HUs
75
H3. YEAR STRUCTURE B UILT
Universe: Housing units
Variable
Audrain County, Missouri
Number
Total housing units
Percent
10,822
Built 2010 or later
9
Built 2000 to 2009
950
8.8
Built 1990 to 1999
1,420
13.1
Built 1980 to 1989
1,003
9.3
Built 1970 to 1979
1,678
15.5
Built 1960 to 1969
1,626
15.0
Built 1950 to 1959
1,620
15.0
Built 1940 to 1949
697
6.4
1,819
16.8
Number
Percent
Built 1939 or earlier
0.1
H4. YEAR HOUSEHOLDER MOVED INTO UNIT
Universe: Occupied housing units
Variable
Audrain County, Missouri
Occupied housing units
9,327
Moved in 2010 or later
1,442
15.5
Moved in 2000 to 2009
4,007
43.0
Moved in 1990 to 1999
1,661
17.8
Moved in 1980 to 1989
877
9.4
Moved in 1970 to 1979
746
8.0
Moved in 1969 or earlier
594
6.4
Number
Percent
H5. VEHICLES AVAILABLE
Universe: Occupied housing units
Variable
Audrain County, Missouri
Occupied housing units
9,327
No vehicles available
596
6.4
1 vehicle available
2,653
28.4
2 vehicles available
3,916
42.0
3 or more vehicles available
2,162
23.2
Number
Percent
H6. HOUSE HEATING FUEL
Universe: Occupied housing units
Variable
Audrain County, Missouri
Occupied housing units
9,327
Utility gas
4,200
45.0
Bottled, tank, or LP gas
1,058
11.3
Electricity
3,515
37.7
Fuel oil, kerosene, etc.
Coal or coke
Wood
493
5.3
8
0.1
Other fuel
20
0.2
No fuel used
33
0.4
Solar energy
H7. SELECTED CHARACTERISTICS
Universe: Occupied housing units
Variable
Audrain County, Missouri
Number
Occupied housing units
Percent
9,327
Lacking complete plumbing facilities
111
1.2
Lacking complete kitchen facilities
163
1.7
No telephone service available
378
4.1
Number
Percent
H8. OCCUPANTS PER ROOM
Universe: Occupied housing units
Variable
Audrain County, Missouri
Occupied housing units
9,327
1.00 or less
9,240
99.1
1.01 to 1.50
55
0.6
1.51 or more
32
0.3
Number
Percent
H9. HOME VALUES
Universe: Owner-occupied units
Variable
Audrain County, Missouri
Owner-occupied units
6,917
Less than $50,000
1,323
19.1
$50,000 to $99,999
2,597
37.5
$100,000 to $149,999
1,367
19.8
$150,000 to $199,999
716
10.4
$200,000 to $299,999
543
7.9
$300,000 to $499,999
234
3.4
$500,000 to $999,999
102
1.5
$1,000,000 or more
35
0.5
Median home value
$90,500
Average home value
$118,639
H10. SELECTED MONTHL Y OWNER COSTS
Universe: Owner-occupied units
Variable
Audrain County, Missouri
Number
Percent
Owner-occupied units
6,917
Housing units with a mortgage
3,787
54.7
891
23.5
Owner costs 30% or more of HH income
Median owner costs
$992
Housing units without a mortgage
3,130
45.3
383
12.2
Nonmortgage owner costs 30% or more of HH income
Median owner costs
$346
H11. GROSS RENT
Universe: Renter-occupied units
Variable
Audrain County, Missouri
Number
Percent
Renter-occupied units
2,410
Paying cash rent
2,142
88.9
268
11.1
Paying no cash rent
Median rent
Average gross rent
$619
-
Gross rent 30% or more of HH income
820
34.0
Gross rent of $750 or more
594
24.6
Generated: Sun, 05 Jul 2015 21:48:50 -0500 by Sandra Hewlett, Administrator, ACHD.
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