Community Health Status Assessment: TJHD

Community Health Status Assessment: TJHD

Mobilizing for Action through Planning and Partnerships Community Health Improvement Plan Purpose: Improving Health in the Thomas Jefferson Health District The Thomas Jefferson Health District (TJHD) Virginias Planning District 10 Population: 234,702 Urban, suburban and rural environments 8% (19,302) live in rural census tracts Source: The Oak Hill Fund MAPP Model Source: Centers for Disease Control and Prevention; National Association of County and City Health Officials Big Picture of Community Health Compiles existing local data Trends Comparisons State Benchmarks MAPP 2 Health 2011-12 1. Locality CHA Councils Review, discuss and determine need for additional quantitative and qualitative data Prioritize health issues

Charlottesville-Albemarle Local government Schools Colleges Fluvanna Greene Louisa Community agencies Healthcare organizations Non-profits 2. TJHD MAPP 2 Health Leadership Council Decide health questions for TJHD phone survey Complete Community Health Improvement Plan for TJHD 1-2 reps per CHA locality council District-wide agencies serving TJHD Source: Thomas Jefferson Health District Nelson M2H Organizational Partners 2012 Creciendo Juntos/United Way Downtown Family Health Albemarle County Schools Care

ASG & CMHWC Emmanuel Christian Center Family & Consumer Blue Ridge Medical Center Sciences VA Cooperative (BRMC) Extension Service Albemarle County BRMC/Rural Health Outreach Program (RHOP) Charlottesville City Schools Charlottesville Free Clinic Fluvanna County Administrator Fluvanna County Health Department. Fluvanna County Public Schools Adult Education Charlottesville Department of Fluvanna County Schools Social Services Children, Youth and Family Fluvanna Department of Services Social Services Greene County Sheriff Greene County Transit and Early Education JABA JABA-Nelson Center

Martha Jefferson Hospital (MJH) MJH - Medical Group NCAE of ACE Nelson County Department of Social Services Smart Beginnings Stanardsville United Methodist Church State VICAP Counselor Thomas Jefferson Health District JAUNT Nelson County Health Department United Way Jefferson Area CHIP Nelson County Schools University of Virginia (UVA) Library Literary Board of Nelson County Louisa County Board of Supervisors Louisa County CSA

OK Collaborative Piedmont Housing Alliance Piedmont Virginia Community College UVA Curry School of Education UVA Department of Public Health Sciences UVA Emergency Department City of Charlottesville Greene Care Clinic Louisa County Department of Human Services Region Ten UVA School of Nursing Commission on Children and Families Greene County Administrator Louisa County Department. of Social Services

Regional Literacy Council Virginia Cooperative Extension Ride Share Virginia Department of Health Greene County Board of Louisa County Fire & EMS Supervisors Greene County Department Louisa Health and Community Dental Center of Social Services Wellness Community Mental Health and Greene County Health MACAA Wellness Coalition Department Community Action on Obesity Source: TJHD SARA Skyline CAP, Inc. M2H Steps and Timeline Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb '11 '11 '11 '11 '12 '12 '12 '12 '12 '12 '12 '12 '12 '12 '12 '12 13 13

Hold initial locality council meetings Continue locality CHA meetings Collect/present quantitative data Plan for qualitative research Conduct qualitative research Determine health priorities Write community profile(s) Hold TJHD M2H meetings Complete CHIP and M2H Report Disseminate profile and CHIP Source: Thomas Jefferson Health District Problem Importance Worksheet Complete a separate form for each health issue identified by the CHA Team Health Issue: ________________________________________________ Check the Appropriate Box for each item and record the score under subtotal 10 9 8 7 6 5 4 High

Magnitude/Impact How many people does the problem affect, actually or potentially, directly or indirectly? What is the cost to society and the economy? Seriousness of the Consequences What degree of disability or premature death occurs because of the problem? What are the potential burdens to the community, such as economic or social burdens? What happens if we do not address this problem? Feasibility of Correcting Is the problem amenable to interventions (i.e., is the intervention feasible scientifically as well as acceptable to the community?). What technology, knowledge, or resources are necessary to effect a change? Is the problem preventable? Can we affect this problem at the local level? Problem Importance Index (Sum of Subtotals) 3 2 1 Low Subtotal District Priority Issues 1. An increasing rate of obesity 2. Insufficient access to mental health and substance abuse services for segments of the population

3. Large and insufficient prenatal care and racial disparities in pregnancy outcomes 4. Tobacco use above the Healthy People 2020 goal Source: Thomas Jefferson Health District The Community Health Improvement Plan: MAPP 2 Health Community Health Issue #1: An Increasing Rate of Obesity Obesity Trends Among U.S. Adults 1985 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%14% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System Obesity Trends Among U.S. Adults 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%14%

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System Obesity Trends Among U.S. Adults 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%14% 15%19% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System Obesity Trends Among U.S. Adults 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%14% 15%19% 20% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System Obesity Trends Among U.S. Adults

2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%14% 15%19% 20%24% 25%29% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System 30% Obesity Trends Among U.S. Adults 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%14% 15%19% 20%24% 25%29%

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System 30% Percentage of Adults Who Are Obese Percent of Adults Aged 20 and Over Living in Locality 35% TJHD and Virginia, 2000-2010 30% 27.6% 25% 25.9% 21.6% 20%21.0% 15% 10% 5% 0% 2000-2002 2001-2003 2002-2004

2003-2005 2004-2006 2005-2007 2006-2008 -5% TJHD Virginia Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey 2007-2009 2008-2010 Percentage of Adults Who Are Obese TJHD by Locality, 2009 Greene County 30.5% Louisa County 31.7% Charlottesville 26.9% Albemarle County 27.1%

Nelson County 26.4% Fluvanna County 29.6% *Obese = Body Mass Index (BMI) 30, or ~ 30 lbs. overweight for 5 4 person **Body mass was derived from self-report of height and weight from adults 20 and Over. Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System Percentage of 5th Graders Who Are Overweight or Obese Albemarle and Charlottesville Public Schools, 1998-2011 Percent of Fifth Graders Enrolled in Public Schools in Locality 100% 90% 80% 70% 60% 50% 40% 30% 17.6% 19.3% 18.4%

18.3% 17.4% 18.2% 15.9% 16.9% 17.4% 15.9% 18.3% 1998 2003 2004 2007 2009 2010 2011 20% 10% 0%

18.4% 17.6% Obese Source: Community Action on Obesity 15.2% Overweight Percentage of 5th &10th Graders Who Are Overweight or Obese Percent of Fifth and Tenth Graders Enrolled in Public Schools in Locality Nelson County Public Schools, 2009-2011 100% 90% 80% 70% 60% 50% 40% 25.6% 32.8% 30% 26.1% 31.2%

29.9% 22.6% 20% 10% 25.0% 15.7% 20.3% 13.1% 14.9% 0% % Obese Source: Blue Ridge Medical Center % Overweight 17.5% Leading vs. Actual Causes of Death Leading Causes of Death Deaths Attributable to Individual Risk Factors 395 High blood pressure

23.1% Cancer 467 Tobacco smoking 37.2% Heart Disease 216 Overweight-obesity (high BMI) Stroke 6.3% Chronic Lower Respiratory Diseases5.1% Unintentional Injuries4.7% Diabetes3.1% 2.8% Alzheimer's Disease 2.5% Influenza and Pneumonia 1.8% Kidney Disease 0% 191 High blood glucose 190

High LDL cholesterol 113 High dietary salt 102 Low dietary omega-3 fatty acids 84 High dietary trans fatty acids 82 Alcohol use 64 Low intake of fruits and vegetables 58 1.4% Septicemia -10% Physical inactivity Low dietary polyunsaturated fatty acids (PUFA) 15 10% 20% 30%

Percentage of Total Deaths 0 100 200 300 400 500 Deaths (in thousands) Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 6(4): Heron, M., Tejada-Vera, B. (2009). Deaths: Leading Causes for 2005. National Vital Statistics Reports. 58(8) Percent of Adults Diagnosed with Diabetes (Self-Reported), TJHD and Virginia, 2000-2010 Percent of Total Adults Aged 20 and Over Living in Locality 10% 8.7% 9% 8% 7.8% 7% 6.1% 6% 5% 3.9% 4% 3%

2% 1% 0% 2000-2002 2001-2003 2002-2004 2003-2005 TJHD 2004-2006 2005-2007 2006-2008 Virginia Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance System 2007-2009 2008-2010 Estimated percent of adults aged 20 and over reporting no leisure time physical activity Physical Inactivity 35%

TJHD by Locality and Virginia, 2009 30% 30% 26% 25% 25% 24% 24% 22% 20% 19% 15% 10% 5% 0% Albemarle Charlottesville Fluvanna

Greene Source: Behavioral Risk Factor Surveillance System; County Health Rankings Louisa Nelson Virginia *Numbers are self-reported F a c ilitie s p e r 1 0 0 ,0 0 0 P e rs o n s L iv in g in Recreational Facilities TJHD by Locality and Virginia, 2009 25 21.3 20 National Benchmark 15 12.6 11 10 9.1 7.8 6.5 5.4

5 0 Albemarle Charlottesville Source: County Health Rankings Fluvanna Greene Louisa Nelson Virginia Food Stores by Type TJHD, 2009 11 57 2 207 134 9 Grocery stores Specialized food stores

Farmers' markets Source: U.S. Department of Agriculture Supercenters & club stores Fast-food restaurants 141 Convenience stores Full-service restaurants Food Stores by Type TJHD by Locality, 2009 26 Number of Food Stores Available in Locality 24 23 22 20 18 16 16 14 12 10 9 11

10 11 9 8 7 9 7 6 4 3 3 4 4 4 2 0 1 0 0 Greene Source: U.S. Department of Agriculture 1 0 0

Fluvanna 2 4 3 0 2 0 Louisa Nelson 1 Food Stores by Type TJHD by Locality, 2009 120 110 Number of Food Stores Available in Locality 110 100 90 80 70

63 60 53 49 50 61 40 30 20 27 25 18 10 0 3 1 4 3 0

Albemarle Source: U.S. Department of Agriculture 0 Charlottesville Qualitative Data Thomas Jefferson Community Survey Obesity most frequently identified as the most important public health concern to which the district needs to give more attention Feedback during MAPP 2 Health Focus Groups Charlottesville and Albemarle: Lack of knowledge surrounding already existing programs. Fluvanna County: Parents do not have enough time and knowledge to prepare nutritious food for their families. Nelson County: Education is the key to ameliorating the problem. LEAD COALITION: Community Action on Obesity Goal 1 Decrease the percentage of persons who are overweight or obese in TJHD by promoting school and corporate wellness programs and by engaging residents in a Move2Health campaign. Objectives 1. By 2017, reduce the percentage of adults living in

TJHD who are physically inactive from 24% to 20%. 2. By 2017, stop the trend of the percentage of TJHD residents who are overweight or obese from increasing. Strategies 1.Encourage and support schools to implement comprehensive wellness policies. 2.Encourage and support employers to implement comprehensive wellness programs. 3.Organize and launch a district-wide Move2Health campaign to encourage TJHD residents to be more active. Community Health Issue #2: Insufficient Access to Mental Health and Substance Abuse Services Number* of Physically Unhealthy/Poor Mental Health Days Average Number of Poor Physical/Mental Health in the Last 30 Days (Self-reported) TJHD by Locality, TJHD and Virginia, 2004-2010 5 4.7 4.5 4 3.7 3.5

3 2.8 2.8 2.9 2.5 2 3.2 3.2 3.4 2.73 2.88 2.9 2.5 2.5 2.2 2.1 1.5 1.2 1 0.5 0

Albemarle Charlottesville Fluvanna Greene Louisa Nelson TJHD Average Virginia Average Number of Physically Unhealthy Days reported in past 30 days Average Number of Poor Mental Health Days reported in past 30 days National Benchmark for Physically Unhealthy Days National Benchmark for Poor Mental Health Days *Numbers are self-reported Source: County Health Rankings Hospital Discharge Rates for Neurotic Disorders, Personality Disorders, and other Nonpsychotic Mental Disorders TJHD and Virginia, 2000-2011 Hospital Discharges per 100,000 Persons Living in Locality 300 257.45

250 206.30 199.55 200 140.88 150 100 50 0 2000 2001 2002 2003 2004 2005 TJHD Source: VDH Data Warehouse; Virginia Hospital Information Systems 2006 2007

2008 VA 2009 2010 2011 Hospital Discharge Rates for Psychoses TJHD and Virginia, 2000-2011 Hospital Discharges per 100,000 Persons Living in Locality 800 677.19 700 600 586.01 563.09 500 400 418.60 300 200 100 0 2000

2001 2002 2003 2004 2005 TJHD Source: VDH Data Warehouse; Virginia Hospital Information Systems 2006 2007 2008 VA 2009 2010 2011 N u m b e r o f R e g io n T e n S e r v ic e s D e liv e r Number of Emergency Services Delivered by Region 10 Community Services Board by Type of Service 1996-2009

3000 2500 2306 2000 1453 1500 1000 1042 629 500 0 1996 1997 1998 1999 2000 2001 2002 Emergency Custody Order Evaluations Total Evaluations Wellness Recovery Center Referrals

Source: Region Ten Community Services Board 2003 2004 2005 2006 2007 2008 Temporary Detention Orders Issued Hospital Admissions 2009 Percent of Total Adults/Children Served through State Mental Health Agencies Percent of Persons Served though State Mental Health Agencies with Co-Occurring Mental Health and Substance Abuse Disorders, Virginia and U.S., 2010 35% 32.8% 30% 25% 20% 20.0%

15% 10% 7.6% 4.6% 5% 0% Virginia MH = Mental Health; AOD = Alcohol and Other Drug Source: Substance Abuse and Mental Health Services Administration US Qualitative Data Thomas Jefferson Community Survey Mental health issues identified by 20% of residents as the most important public health concern to which the district needs to give more attention Feedback during MAPP 2 Health Focus Groups A lack of access to mental health services was cited as a problem Stigma associated with mental health issues deters people from getting assistance LEAD COALITION: Community Mental Health & Wellness Coalition Goal 2

Decrease the number of poor mental health days among TJHD residents by increasing access to mental health services and decreasing stigmas and fear surrounding mental health issues. Objectives 1. By 2017, increase access to mental health services in TJHD by increasing the number of mental health service hours provided by Community mental Health and Wellness Coalition (CMHWC) member agencies. 2. By 2017, among TJHD residents decrease stigma and fears associated with mental health, as demonstrated through pre/post surveys from educational programs. Strategies 1. Establish a system to collect and track the number of CMHWC agencies service hours. 2. Promote the integration of behavioral health services into primary care settings. 3. Develop, conduct and promote culturally competent educational programs, such as Mental Health First Aid USA, to reduce stigma and fears that prevent individuals from seeking mental health services. Community Health Issue #3: Late and Insufficient Prenatal Care and Racial Disparities in Pregnancy Outcomes

Percentage of Mothers Entering Prenatal Care in the 1st Trimester Percent of Total Live Births to Mothers by Place of Residence TJHD and Virginia, 2000-2010 90% 84.7% 79.3% 80% 70% 83.2% 77.0% Healthy People 2020 60% 50% 40% 30% 20% 10% 0% 2000-2002 2001-2003 2002-2004 Albemarle

2003-2005 2004-2006 2005-2007 TJHD *Percentage of Total Live Births to mothers with Prenatal Care Beginning in the First 13 Weeks Source: Virginia Department of Health, Division of Health Statistics 2006-2008 2007-2009 Virginia 2008-2010 Percentage of Mothers Entering Prenatal Care in the 1st Trimester Percent of Total Live Births to Mothers by Place of Residence TJHD by Locality, 2000-2010 90% 81.8% 76.6% 80% 79.4% 75.0% 70%

60% 50% 40% 30% 20% 10% 0% 2000-2002 2001-2003 Albemarle 2002-2004 2003-2005 Charlottesville 2004-2006 Fluvanna 2005-2007 Greene *Percentage of Total Live Births to mothers with Prenatal Care Beginning in the First 13 Weeks Source: Virginia Department of Health, Division of Health Statistics 2006-2008 2007-2009

Louisa 2008-2010 Nelson Percentage of Mothers Who had 10 or More Prenatal Care Visits Percent of Total Live Births to Mothers by Place of Residence 100% TJHD and Virginia, 1999-2010 90% 82.7% 80% 79.8% 70% 77.7% 60% 66.0% 50% 40% 30% 20% 10% 0%

1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 TJHD Source: Virginia Department of Health, Division of Health Statistics Virginia Percentage of Mothers Who had 10 or More Prenatal Care Visits Percent of Total Live Births to Mothers by Place of Residence 100% TJHD by Locality, 1999-2010 90% 84.4% 79.8% 79.2% 80% 70% 64.1% 69.9% 64.0% 60% 50% 40% 30% 20% 10%

0% 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 Albemarle Charlottesville Source: Virginia Department of Health, Division of Health Statistics Fluvanna Greene Louisa Nelson Infant Mortality Rates* Infant Deaths per 1,000 Live Births by Place of Residence 22 TJHD and Virginia,1999-2011 20 18 16 14 12 10 87.2 7.0

6 7.0 6.3 Healthy People 2020 4 2 0 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 TJHD *Deaths among infants <1year of age Source: Virginia Department of Health, Division of Health Statistics 2004-2008 2005-2009 Virginia 2006-2010 2007-2011

Infant Mortality Rates* by Race TJHD, Virginia, and U.S., 1999-2011 Infant Deaths per 1,000 Live Births by Place of Residence 22 20 17.3 18 16 14.9 14 13.8 12 13.8 10 8 Healthy People 2020 5.7 5.6 6 5.4 4.5 4 2 0

1999-2003 2000-2004 TJHD Black 2001-2005 Virginia Black 2002-2006 2003-2007 U.S. Black *Deaths among infants <1year of age Source: Virginia Department of Health, Division of Health Statistics 2004-2008 TJHD White 2005-2009 2006-2010 Virginia White 2007-2011 U.S. White Percentage of Low-Weight* Births

Percent of Total Live Births by Place of Residence 14% TJHD, Virginia, and U.S.,1999-2011 13% 12% 11% 10% Healthy People 2020 9% 7.9% 8% 7.9% 7.6% 7% 7.1% 6% 5% 4% 3% 2% 1% 0% 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 TJHD Virginia *Low Birth Weight = Live Births Weighing <2500 grams

Source: Virginia Department of Health, Division of Health Statistics United States HP Percentage of Low-Weight* Births TJHD by Locality,1999-2011 Percent of Total Live Births by Place of Residence 14% 13% 12% 11% 10% 8.9% 8.5% 9% 9.4% 8% 7% 6.2% 6% 6.6% 5% 5.8% 4%

3% 2% 1% 0% 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 Albemarle Charlottesville Fluvanna *Low Birth Weight = Live Births Weighing <2500 grams Source: Virginia Department of Health, Division of Health Statistics Greene Louisa Nelson Percentage of Low-Weight Births* by Race, TJHD and Virginia, 1999-2011 14% 13% 12% 11% 10% 9% 8%Healthy People 2020 P er c e

nt of T ot al Li v e Bi rt h s b y Pl a c e of R e si d e n c e 7% 6% 5% 4% 3% 2%

1% 0% 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 -1% TJHD Black Virginia Black *Low Birth Weight = Live Births Weighing <2500 grams Source: Virginia Department of Health, Division of Health Statistics TJHD White Virginia White Healthy People Percentage of Low-Weight Births* by Race, TJHD by Locality, 2005-2011 Three-year Rolling Averages, Low Birthweight births as a percentage of Live Births Albemarle Charlottesville Fluvanna Greene Louisa Nelson 2005-2007 2006-2008 2007-2009

2008-2010 2009-2011 White 6.3% 6.5% 6.4% 5.7% 5.0% Black 10.9% 9.7% 8.4% 10.3% 12.2% White 7.0% 6.9%

6.2% 5.4% 5.2% Black 13.7% 13.4% 15.0% 13.9% 14.3% White 7.5% 7.5% 7.0% 6.2% 6.5% Black 16.4%

18.4% 14.2% 13.4% 7.5% White 6.0% 8.6% 8.0% 8.0% 7.2% Black 25.6% 21.5% 17.0% 8.6% 8.6% White

9.0% 8.7% 8.6% 8.5% 8.3% Black 13.3% 12.0% 12.2% 15.0% 16.7% White 6.6% 6.4% 7.6% 6.2% 6.1%

Black 9.8% 5.1% 6.9% 6.5% 5.1% *Low Birth Weight = Live Births Weighing <2500 grams Source: Virginia Department of Health, Division of Health Statistics Reported Substance Exposed Infants* Number of Reported Substance Exposed Infants TJHD, FY1999-2011 24 22 22 20 18 16 14 12 10 8 6 4

2 2 0 99-00 00-01 01-02 02-03 03-04 04-05 05-06 TJHD 06-07 07-08 08-09 09-10 10-11 *Newborn infants that may have been exposed to controlled substances prior to birth (as indicated by a positive drug toxicology of the mother with presence of a controlled substance or by the child being born dependent on a controlled substance and demonstrating withdrawal symptoms) or have a diagnosis of fetal alcohol syndrome

Source: Virginia Department of Social Services LEAD COALITION: Improving Pregnancy Outcome Workgroup Goal 3 Improve pregnancy outcomes in TJHD by increasing the percentage of women who plan pregnancies and receive adequate prenatal care; by targeting interventions towards vulnerable populations; and by promoting clinical smoking cessation interventions. Objectives 1. By 2017, increase the percentage of pregnant women who receive 10 or more prenatal care visits from 66% to 75% of TJHD pregnant women. 2. By 2017, decrease the percentage of low birth weight black infants from 12.5% to 10% of TJHD black births. 3. By 2017, increase enrollment in Plan First, a Medicaid program that covers family planning services, in TJHD by 5%. Strategies 1. Conduct research to better understand why vulnerable populations of women are not receiving/accessing available prenatal care services. 2. Work with TJHD prenatal care providers to overcome barriers identified in research. 3. Increase awareness among vulnerable women of childbearing age

about the importance of taking steps to improve health before becoming pregnant and steps to take to improve the likelihood of having a healthy pregnancy. 4. Develop and/or promote peer-based health navigator services for vulnerable pregnant women. 5. Increase awareness among clinical providers and eligible populations about the availability of Plan First benefits Community Health Issue #4: Tobacco Use Above the Healthy People 2020 Goal P e r c e n t o f A d u lts A g e d 2 0 a n d O v e r L iv in g i Self-Reported Adult Smokers TJHD and Virginia, 2000-2010 25% 22.9% 20% 18.0% 17.9% 17.6% 15% Healthy People 2020 10% 5% 0%

2000-2002 2001-2003 2002-2004 2003-2005 TJHD 2004-2006 2005-2007 2006-2008 Virginia Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey 2007-2009 2008-2010 Percent of Total Live Births to Mothers by Place of Residence Percentage of Mothers Who Report Smoking during Pregnancy TJHD and Virginia, 1999-2010 50% 45% 40%

35% 30% 25% 20% 15% 9.2% 10% 8.4% 5% 0% 1 7.5% 6.2% Healthy People 2020 2 3 4 5 TJHD Source: Virginia Department of Health, Division of Health Statistics 6 Virginia 7

8 9 HP 10 Percentage of Mothers Who Report Smoking during Pregnancy TJHD by Locality, 1999-2010 Percent of Total Live Births to Mothers by Place of Residence 50% 45% 40% 35% 30% 25% 20% 15.3% 15% 15.5% 10% 5% 5.6% 0% 1999-01 2000-02 Albemarle

4.7% 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 Charlottesville Fluvanna Source: Virginia Department of Health, Division of Health Statistics Greene Louisa Nelson Tobacco Facts Virginia, 2012 Virginia United States Adult Smoking Rank (1st = low smoking rates) 31st N/A Cigarette Tax (per pack) $0.30 ($0.35 local tax for Cville)

$1.46 Cigarette Tax Rank (1st = high taxes) 50th N/A FY 2012 Funding for State TC Programs (millions) $8.4 $456.7 Tobacco Prevention Spending % of CDC Target 8.1% 12.5% Tobacco Prevention Spending Rank (1st =high spending rates) 30th N/A Source: Campaign for Tobacco-Free Kids; City of Charlottesville City Treasurer Website

LEAD COALITION: Tobacco Use Control Coalition Goal 4 Decrease the percent of persons who use tobacco in TJHD. Objectives 1. By 2017, decrease the percentage of adults who smoke from 18% to 16% of TJHD adults. 2. By 2017, decrease the percentage of pregnant women who report smoking during pregnancy from 7.5% to 6% of TJHD pregnant women. Strategies 1.Collect data to better understand the attitudes and behaviors that encourage young people to start smoking. 2.Evaluate current smoking cessation programs for effectiveness in decreasing tobacco use. 3.Develop and/or promote more smoking cessation classes for TJHD residents. 4.Educate clinical providers in TJHD about evidencebased patient interventions that were shown to increase tobacco cessation and promote their use. www.tjhd.org

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