COMMUNITY HEALTH ASSESSMENT TANEY COUNTY HEALTH

Transcription

COMMUNITY HEALTH ASSESSMENT
2011
T
Team work
A
Ambition to make life better
N
Neighbors helping neighbors
E
Effort to prevent disease and promote wellness
Y
Years of growth and accomplishments
TANEY COUNTY HEALTH DEPARTMENT
SCHOOLS
POLICE
Prevent. Promote. Protect.
CHAMBER
FIRE
OF
COMMERCE
TCAD
SKAGGS
GOVERNMENT
A Community of Partners
2011
Taney County Health Department
Community Health Assessment
______________________________________________________________________________
______________________________________________________________________________
“A Community of Partners”
Prepared and Written By:
Wennekota Tamara
Kimberly Foster
Robert Niezgoda
Cover Design:
Donna Gold
Kimberly Foster
Amanda Modayil
Kim Conway
i
Acknowledgement
The completion of this community assessment involved many individuals and organizations.
Sincere appreciation is given to the following community partners who were instrumental in
providing research, data, editing, and assistance. Thank you.
Bradleyville Public Schools
City of Branson
City of Branson Parks and Recreation
City of Branson Public Schools
City of Branson Public Works
City of Hollister
College of the Ozarks
Hollister Public Schools
James River Basin Foundation
Kirbyville Public Schools
Mark Twain Public Schools
Missouri Department of Agriculture
Missouri Department of Conservation
Missouri Department of Elementary and Secondary Education
Missouri Department of Health and Senior Services
Missouri Department of Mental Health
Missouri Department of Natural Resources
Missouri Department of Social Services
Missouri State Highway Patrol
Skaggs Community Foundation
Skaggs Community Health Center
Taneyville Public Schools
United States Corps of Engineers
United States Environmental Protection Agency
United States Department of Agriculture
White River Basin Foundation
ii
Methodology
The Taney County Health Department (TCHD) initiated a countywide Community Health
Assessment. This community health assessment will be used to help formulate our
community's future public health goals and outcomes. TCHD has chosen the health assessment
model, National Public Health Performance Standards Program (NPHPSP) as a framework to
provide a strategic approach to community health improvement by helping communities
identify and use existing resources, consider unique local conditions and needs and form
effective partnerships in action.
This process was a collaborative effort by the Taney County Health Department composed of
leaders and representatives from a broad array of city and county departments, health systems,
and community organizations.
Data for the 2011 Taney County Community Health Assessment was collected from a variety of
primary and secondary data sources. To ensure accuracy, data from sources were examined to
clarify reporting sources, data collection methods, and population or sample sizes. Every
reasonable effort was made to collect and present reliable, accurate information for
dissemination. Efforts were made to update the charts with the most recent information
available from the reporting agencies. Presented data that seemed to be misleading, or of
questionable quality, was compared to other sources to check for errors.
Rate calculations were based on the methods utilized by the Missouri Department of Health
and Senior Services and population estimates provided by the United States Census Bureau.
Efforts were made to review calculations to determine accuracy and reliability. The charts and
graphs presented in the chapters were developed using the data collected from the referenced
sources. Every effort was made to provide the reader with charts and graphs that provided as
much information as possible in an understandable format. When charts and graphs were
found to be unclear, efforts were made to clarify and reformat the information.
Every effort was made during the editing process to limit the possibility of errors in the
presentation of data and calculations. However, we are unable to prevent errors due to the
collection, compilation, and dissemination of data by reporting agencies. Data cited from
reporting agencies is provided with the understanding that data is only as reliable and valid as
the methodologies and processes employed to collect, evaluate, standardize, and report the
data. Additionally, reliability and validity of locally collected data was limited because of
collection procedures that limited randomization. Consequently, locally collected data should
be considered to be representative of the population groups sampled and cautiously
representative of the county as a whole. All of the information presented in this assessment
was reviewed and edited for accuracy. Any errors within this assessment are purely
unintentional and are deeply regretted. If an error is noted, please let us know; so that we may
identify, correct, or clarify the information.
iii
Table of Contents
Introduction
_______v
Summary
_______vi
Chapter 1: Demographic and Socioeconomic Issues
Chapter 2: Environmental Health Issues
__________________1
____________12
Chapter 3: Health Care Services
______32
Chapter 4: Communicable Disease Issues
____________43
Chapter 5: Chronic Diseases and Injuries
____________54
Chapter 6: Minority Health Issues
____________77
Chapter 7: Maternal and Child Health
______85
Chapter 8: Public Health Services
___________103
Chapter 9: Senior Health Issues
_____111
Chapter 10: Social Issues
_____124
Chapter 11: Youth Issues
_____138
Chapter 12: Community Resources_____________________________________152
Appendix A: Policy Changes Related to Public Health
Appendix B: Leading Causes of Death
Appendix C: Taney County Tobacco Use Assessment
iv
Introduction
Assessing the community’s health is an ongoing process that requires the regular and
systematic collection, assembly, analysis and dissemination of information regarding the health
needs of the community. This process is the foundation for improving and promoting the health
of community members through identification of the factors that affect the health of Taney
County residents and determining the availability of resources to adequately address health
issues.
The purpose of the 2011 assessment process is to provide a report to the community regarding
progress that has been made on previously identified priorities and to review current trends
that may require action to protect the health of the public. This valuable public health process
of ongoing community health assessment will help guide future programs and goals of local
public health. The many services that are provided by the Taney County Health department are
expected to increase in response to population and economic growth that is occurring in the
area. Additional services will also be added as new health concerns are identified and programs
are developed or expanded. This assessment has also helped the health department identify
priorities related to the community by providing the basis for discussion and action. The 2008
health assessment identified three priority areas that were presented to the community to
increase awareness and stimulate public health efforts. The priority areas focused on tobacco
use, obesity and child and family safety. From these priorities, community meetings and groups
met and early progress toward addressing these issues was observed.
The Taney County Health Department provides a variety of services that help protect residents
and visitors of Taney County. However, the department has recognized the necessity to further
strengthen and develop various collaborative efforts among community leaders, businesses,
hospitals, private practitioners, and schools etc, in order to identify the health status, needs,
strengths, health concerns, gaps and assets in the community. The Health Department
collaborates routinely on many projects with community partners to help the residents and
visitors of Taney County. Many community groups provide resources and partnerships with the
health department in order to address the public health issues in the county. Without these
partnerships, much of the progress in addressing public health concerns that has been achieved
in the county would not have been possible. The Taney county health department is
committed to building healthier communities in Taney County and “making a positive
difference”.
v
Key Findings: Community Health Assessment, 2011
The previous Community Health Assessment in 2008 identified Tobacco Use, Obesity and
Nutrition, and Child and Family Safety as the top three health priorities in Taney County. Data
from the recent community health assessment indicates that these issues continue to have a
disproportionate impact on the residents of Taney County.
The results of this assessment indicate that the evidence based health priorities for Taney
County should be:
1. Tobacco Use Prevention
2. Obesity, Nutrition, and Physical Activity
3. Alcohol and Substance Abuse
Other health priorities that need to be addressed include communicable disease prevention
and senior issues. Data from the Community Health Assessment indicated that enteric diseases
have such as salmonella and campylobacter have increased substantially since 2006 in Taney
County. This increase was seen with cases of Chlamydia while Gonorrhea have essentially
remained steady. The number of Syphilis cases also increased during same time period. These
trends are disturbing because they indicate behaviors in the community that may result in
exposure to serious diseases such as Hepatitis B and HIV. It is therefore necessary to focus
more educational efforts toward prevent risky sexual behaviors.
Data regarding seniors was also indicative of the need for increased interventions. The senior
population is increasing in number in Taney County. Seniors issues in Taney County were
identified as a priority issue because of the increasing number of seniors and the prevalence of
conditions that could potentially increase morbidity and mortality among this population. While
this is not one of the primary priorities of the Taney County Health Department, this priority
will be addressed as resources and opportunities are made available.
Increasing awareness of healthy lifestyles to prevent debilitating chronic diseases, such as
obesity and heart disease will continue. Collaboration between the Taney County Health
Department and community partners has provided some initial success by illustrating the
willingness among community members to participate in efforts addressing these problems.
Examples of local collaborative efforts include:
 Tobacco use prevention as well as efforts with the Alcohol and Drug Abuse
Prevention Team (ADAPT) Taney County have brought together health care
providers, elected officials, local public health, and other community organizations.
 School-based prevention programs to address tobacco use prevention among junior
high school students.
 Partnerships with schools to provide nutritional education for students
 Presentation of community health assessment data to community leaders and
elected officials to increase awareness and request input.
 Plans to reconvene community member focus groups to gather qualitative data
regarding community health issues, barriers accessing programs, and other issues.
vi
The health priorities identified through the community health assessment process have
impacted many residents of Taney County. Many other health problems such as diabetes,
heart disease, cancer, and stroke can be decreased in the county by addressing tobacco use and
overweight/obesity problems. Child and Family Safety issues will focus not only on abuse and
neglect, but will now include issues such as injury prevention.
The Taney County Health Department will continue to work with community partners to
strengthen or implement needed local programs and ordinances. Additionally, the community
health assessment process will continue as this updated information is provided to the
community to increase awareness, encourage discussion and gather feedback.
Chronic Disease Risk Factors
Many of the numerous deaths due to cancer, heart disease, stroke and other chronic diseases
that occur every year are the result of behaviors that negatively impact health. Healthy
Lifestyle changes can help prevent many chronic diseases. Early detection and treatment are
also important to help improve outcomes of these diseases. Table 1 provides information on
the behavioral risk factors that were identified among Taney County residents in 2007.
Taney County had a high percentage of respondents who reported having poor health, no
health insurance, smoking tobacco, overweight and obese people. Additionally, residents
reported low rates of having screening tests such as mammograms or breast exams.
vii
Table 1
Behavioral Risk Factor Survey-Taney County, 2007
Percent
Taney
Taney
Southwest
County
County
Region
2003
Health Status Reported Fair or Poor
19.0
18.0
18.9
No Health Insurance
21.0
22.7
17.2
No Leisure-Time Physical Activity
25.8
26.6
26.2
Current Smoker
34.4
36.5
24.9
Overweight (BMI >25-29.9)
41.8
32.6
37.0
Obese (BMI>30)
17.8
31.2
28.5
High Blood Pressure
High Cholesterol- Age 35 and Older
Asthma
Diabetes
No Mammogram or Breast Exam in Last YearWomen Age 40 and Older
Never Had a Pap Smear-Women Age 18 and Older
Never had a sigmoidoscopy or colonoscopy-Men
and Women age 50 and older
Missouri
United
States
16.8
14.7
25.3
23.2
35.7
29.1
15.1
14.5
23.0
19.7
36.7
26.3
20.1
30.5
11.3
6.1
19.0
23.3
7.2
9.1
19.8
22.6
7.5
8.6
19.6
20.2
8.5
9.3
--8.3
8.1
---
26.6
4.1
31.6
4.4
27.6
3.4
---
44.7
48.2
41.2
36.6
42.9
Source: Missouri Department of Health and Senior Services (MO DHSS), BRFSS, 2011
Table 2
Health Indicators-Taney County, 2000-2006
Rate Per 100,000
Taney
County
Stone
County
Barry
County
Lawrence
County
Missouri
203.0
176.9
204.2
199.1
201.0
Colon/rectum/anus cancer
16.2
14.3
21.9
18.2
19.8
Trachea/bronchus/lung cancer
67.9
58.6
67.7
66.3
62.8
Cancer Mortality
Prostate cancer
9.2
8.2
10.7
9.8
9.1
Breast cancer
13.2
13.0
10.9
12.6
15.0
Diabetes
13.1
17.9
20.8
18.1
24.9
Alzheimer's disease
14.6
24.2
18.1
20.2
20.7
Heart disease
251.0
225.3
285.8
235.3
253.6
Cerebrovascular disease
47.6
43.7
69.2
82.9
56.8
Atherosclerosis
19.7
@@
@@
@@
4.4
Pneumonia and Influenza
29.6
13.8
25.2
33.2
23.7
Chronic Liver Disease and Cirrhosis
8.9
10.8
8.7
@@
7.2
Kidney Disease
17.7
10.8
16.6
19.0
16.9
Motor Vehicle Accidents
25.2
35.2
40.6
35.7
19.7
Suicide
13.6
10.5
13.8
13.4
12.6
Source: Missouri Department of Health and Senior Services (MO DHSS), Missouri Information for Community Assessment (MICA), 2011
viii
Health Priorities for Taney County, 2011
Tobacco Use
Tobacco use prevention was identified as a priority for Taney County based on several health
indicators related to tobacco use. The Behavioral Risk Factor Surveillance Survey (BRFSS) from
2003 indicated that 34.4% of Taney County residents smoked tobacco. This rate increased to
36.5% in 2007 and was significantly higher than the Missouri rate of 23.2% and the national
rate (19.7%). Additionally, this was the highest rate of smoking reported by any county in the
State of Missouri. Data regarding new mothers who smoked tobacco was also higher than the
state average with 25.4% of new mothers smoking tobacco in Taney County. Other indicators
that were examined included Chronic Obstructive Pulmonary Disease, Heart Disease, Lung
Cancer, and Atherosclerosis. Research from the National Institutes of Health and the Centers
for Disease Control and Prevention indicate that these health consequences can be a result of
smoking tobacco, as well as exposure to environmental tobacco smoke, such as that from
cigarettes.
Figure 1
Source: MO DHSS, MICA, 2011
ix
Figure 2
If Taney County is to maintain or lower rates of heart disease, cancer, stroke, atherosclerosis,
and other chronic diseases related to tobacco use, it is important to initiate or broaden
programs aimed at decreasing tobacco use among residents.
Obesity, Nutrition and Physical Activity
Obesity and Overweight prevention was also identified as a priority for Taney County based on
several health indicators. The BRFSS report indicated that Taney County had a higher rate of
overweight residents (32.6%) with a BMI of 25 to 29.9 and (31.2%) obese BMI>30. Additionally,
the BRFSS indicated that a high percentage of residents were physically inactive as compared to
the state rate. Maternal and child health data from several sources also indicated that new
mothers and children were being reported as overweight and obese in the county more often.
This data indicated a high percentage of new mothers were 20% or more overweight (36.9%)
and approximately 24% of children receiving WIC services had a risk factor for being overweight
according to MO DHSS data.
Health indicators such as mortality rates for heart disease, atherosclerosis, high blood pressure,
and diabetes were also considered. The rate of deaths due to atherosclerosis was significantly
higher than the state rate while the other indicators were near the state rate or slightly lower.
The number of diabetes related emergency room visits for had increased from 2000 to 2009
compared to previous years.
x
According to National statistics from the CDC:
 Overweight children are more likely to develop childhood diabetes, hypertension and
lung problems.
 Overweight school age children are 50% more likely to become obese adults.
 Overweight adolescent are 70-80% more likely to become obese adults.
 Life expectancy for obese young adults is 5 to 20 years less than normal weight people.
 Obese adults have significantly higher rates of diabetes, heart disease, cancer, stroke,
hypertension and arthritis.
Figure 3
Table 3
Missouri 2007 Health and Preventative Practices Status Report
Indicator
Taney
SW Region
Physical Inactivity (%)
26.6
26.2
Overweight (BMI 25-29.9)
32.6
37.0
Obese (BMI >29.9)
31.2
28.5
Source: Missouri 2007 Health and Preventative Practices Status Report.
xi
Missouri
25.3
35.7
29.1
Table 4
WIC Infants Statistics, Rate Per 100 - Taney County and Missouri, 2000-2008
Taney
County
Missouri
Birth weight - low (less than 2500 grams and includes very low)
7.9
9.3
Birth weight - high (4000 grams or more)
7.6
7.2
Currently breast feeding - fully
62.3
46.3
Immunizations - up to date
85.4
72.1
Underweight for length - (less than or equal to 10th percentile)
4.7
13.7
Overweight for length - WIC (greater than or equal to 95th percentile)
5.2
4.9
At Risk of becoming overweight
13.3
9.3
Indicator
Figure 4
If Taney County is to maintain or lower rates of heart disease, high blood pressure, stroke,
atherosclerosis, diabetes, and other chronic diseases related to overweight and obesity issues,
it is important for Taney County residents to improve nutritional choices, increase physical
activity and increase awareness of the risks associated with unhealthy weight.
xii
Alcohol and Drug Abuse
The following tables and graphs highlight issues related to alcohol and drug abuse. Alcohol and
drug use related injuries, motor vehicle accident injuries and deaths, assault injuries, child
abuse and neglect, self-inflicted injuries, and domestic violence were all considered while
examining this issue. Taney County had high rates in several of these categories compared to
Missouri including motor vehicle accident injuries and deaths, alcohol and drug related injuries
especially among youth, self inflicted injuries and suicides among teens, fall injuries among
seniors, and injuries overall. In fact Drug and Alcohol related injuries have been increasing
overall since 2007 and have been higher than the state rate since that time as well. During this
same time period, motor vehicle injuries have remained higher than the state rate as well.
These indicators highlight the need for additional resources to be directed toward increasing
awareness of these issues in the community.
Table 5 illustrates the number of alcohol and drug related hospitalizations by Taney County
residents either through the ER or direct hospitalization from 2007 through 2009. Alcohol
related ER visits have increased by 21.43% from 2007-2009 while the ER visits for drug related
incidents decreased 9.15%.
Table 5
Alcohol and Drug Health Care Statistics-Taney County, 2007-2009
Alcohol
Drug
Year
Direct
Hospitalization
ER
ER
outpatient
Direct
Hospitalization
ER
ER
outpatient
2007
116
210
260
118
153
148
2008
113
232
279
125
162
196
2009
119
255
324
133
139
195
Percent
Change
2007-2009
2.58
21.43
24.62
12.7
-9.15
31.76
Source: Missouri Department of Mental Health, 2011
xiii
Figure 5
Source: MDHSS MICA, 2011
Figure 6
Source: MDHSS MICA, 2011
xiv
Table 6
Drug and Alcohol Overdose/Poisoning - Injuries, By Age Group, Rate Per 100,000 - Taney
County and Missouri, 2000-2009
Male
Female
All
10 -14
Taney
Missouri
County
128.7
64.4
116.6
150.5
122.9
106.4
15 - 17
Taney
Missouri
County
333.3
243.6
780.7
480.6
546.5
359.1
18 - 19
Taney County
Missouri
364.8
511.4
440.1
280.6
387.9
332.8
Table 7
Self Inflicted Injuries By Age Group, Rate Per 100,000 –
Taney County and Missouri, 2000-2009
10 - 14
Male
Female
All
Taney
County
21.5
101.0
59.6
Missouri
39.1
122.4
79.8
15 - 17
Taney
County
241.2
566.6
396.4
Figure 7
xv
Missouri
188.6
401.6
292.5
18 - 19
Taney
County
253.8
376.0
316.5
Missouri
222.2
324.8
272.2
Table 8
Motor Vehicle Occupant Injuries, By Age Group, Rate Per 100,000 –
10 -14
15 - 17
18 - 19
Taney
County
Missouri
Taney
County
Missouri
Taney County
Missouri
944.0
1,157.80
638.7
730.3
3,272.90
4,419.50
2,225.60
3,020.60
3,585.0
3,835.20
3,038.30
3,509.10
1,046.5
683.5
3,819.80
2,613.10
3,713.40
3,267.50
Table 9
Rate of Suicide Deaths Per 100,000 –
Taney
Missouri
Rate per 100,000
12.8
12.8
Number
63
8,211
Average Per Year
5.25
684.25
xvi
Table 10
High School Safe and Drug Free School Survey-Taney County, 2010
Age Group
How old were you
when you first:
Never
have
8 or
Younger
9
Smoked Marijuana?
85.0%
1.0%
Smoked a cigaretteeven a puff?
72.8%
Had more than
a sip or two of
beer, wine, or hard
liquor (for
example vodka,
whiskey, or gin)?
Used inhalants
56.9%
92.0%
10
11
12
13
14
15 or
Older
0.2%
1.0%
2.0%
1.4%
3.7
3.9
1.8
3.0%
1.9%
1.9%
4.4%
3.8%
5.4%
4.7%
2.1%
7.3%
2.4
3.7
2.0%
6.9%
10.6%
4.5%
1.4%
0.7%
1.0%
1.7%
0.4%
1.2%
0.9%
5.7%
0.6%
A local behavioral survey among high school students during the 2009-2010 school year
observed that 43.1% of students reported that they had used alcohol and 27.2% reported that
they had smoked cigarettes even if it was a puff. (Table 10)
These health indicators reveal that children and families in Taney County face several threats
that could lead to increased morbidity and mortality. By addressing some of these issues
through public health education and awareness efforts, the incidence of these problems can be
lowered in Taney County.
Other Areas of Concern
Communicable Disease Prevention
Communicable diseases will continuously threaten residents of Taney County. Ongoing efforts
by local health department staff and healthcare providers strive to identify, prevent further
spread, and treat those who are ill with communicable diseases. Sexually transmitted diseases
have decreased in Taney County compared to 2007. However, an increasing trend the past two
years is of concern and may indicate that a need exists for additional community education
regarding the prevention of sexually transmitted diseases.
xvii
Figure 8
Table 11
Chlamydia
Gonorrhea
Syphilis
2000
48
7
1
Number of Sexually Transmitted Diseases Reported-Taney County, 2000-2010
2001
2002
2003
2004
2005
2006 2007 2008 2009 2010 Average
53
74
74
84
75
88
109
47
53
59
69.45
13
11
22
22
20
23
23
6
6
2
14.09
0
0
0
0
2
1
4
2
1
0
1
xviii
Total
764
155
11
Figure 9
Confirmed and Probable Communicable Diseases-Taney County, 2006-2010
Condition
2006
2007
2008
2009
2010
5-Year Mean
CAMPYLOBACTERIOSIS
1
6
2
3
11
4.6
CRYPTOSPORIDIOSIS
0
0
0
0
4
0.8
E COLI SHIGA TOXIN POSITIVE
1
0
0
0
0
0.2
E. COLI O157 H7
0
0
1
1
0
0.4
GIARDIASIS
2
3
2
5
2
2.8
HAEMOPHILUS INFLUENZAE, INVASIVE
0
0
0
0
0
0
HEPATITIS A ACUTE
0
0
0
1
0
0.2
HEPATITIS B (PREGNANCY) PRENATAL
0
0
0
0
1
0.2
HEPATITIS B ACUTE
3
1
3
4
5
3.2
HEPATITIS B CHRONIC INFECTION
2
3
4
5
5
3.8
HEPATITIS C, CHRONIC INFECTION
45
53
62
53
37
50
LYME
1
4
0
0
0
1.0
MENINGOCOCCAL DISEASE
0
1
1
0
0
0.4
MUMPS
1
0
0
0
0
0.2
PERTUSSIS
0
0
0
2
0
0.2
ROCKY MOUNTAIN SPOTTED FEVER
9
9
6
9
13
9.2
SALMONELLOSIS
3
1
2
3
6
3.0
SHIGELLOSIS
STREP DISEASE, GROUP A INVASIVE
0
0
0
1
0
0
0
0
15
0
3
0.2
STREP PNEUMONIAE, DRUG-RESISTANT
0
1
1
0
1
0.4
TULAREMIA
0
1
0
0
0
0.2
VARICELLA (CHICKENPOX)
62
10
2
3
2
15.8
Source: Missouri Department of Health and Senior Services, 2011
xix
Figure 10
Figure 11
Other communicable disease threats to Taney County include norovirus. Norovirus causes a
sudden onset of vomiting and/or diarrhea with a combination of other symptoms. These
viruses are very contagious and spread easily from person-to-person. These viruses are a
particular threat to schools, long-term care facilities and local businesses that rely on tourism.
xx
Tick-borne diseases such as Tularemia, Lyme disease, Ehrlichiosis, Rocky Mountain spotted
fever continue to pose a threat to residents of Taney County. Over the past few years these
illnesses have steadily increased. Many reasons may account for this increase including better
laboratory tests, increased physician awareness, and an increase in the number of people
exposed to tick bites as they engage in outdoor activities.
Figure 12 provides the number of confirmed and probable cases of Rocky Mountain Spotted
Fever Cases Identified in Taney County from 2006 to 2010. During this time the numbers of
cases reported increased.
Figure 12
xxi
Table 12
Suspect, Probable and Confirmed Tick Borne DiseasesTaney County, 2010
Ehrlichiosis
6
Lyme Disease
0
Rocky Mountain Spotted Fever
15
Tularemia
0
Source: Taney County Health Department, 2011
Figure 13
Source: Taney County Health Department; *Includes Suspect, Probable and Confirmed Cases, 2011
Figure 13 provides an excellent example of the incidence of tick borne diseases by month of
diagnosis. Diseases caused by tick bites occur mainly during the summer months in Taney
County. However, these illnesses have been diagnosed during winter months and very early
spring as well. Regardless of the time of year, it is best to take precautions to avoid tick bites
whenever going outdoors where ticks may be.
The prevention of communicable diseases was determined to be an area of concern because of
the increase in the number of these conditions and the threat that they pose for further
morbidity and mortality in the population. Existing programs in the Taney County Health
Department will be utilized to offer educational opportunities for community members to
increase awareness and strengthen prevention efforts.
xxii
Senior Issues
The need for increased senior related programs and efforts was recognized in part because of
the increasing numbers of seniors in Taney County and the United States. Additional areas of
concern were identified as health indicators were examined for the senior population. This
analysis revealed that this population had increased mortality rates compared to the Missouri
rate for seniors including atherosclerosis, Liver disease, pneumonia and influenza, and suicide.
Seniors also had increased rates for injuries related to motor vehicle accidents,
poisonings/overdoses, machinery, hot weather, and overexertion.
Table 13
Mortality Rates Per 100,000 For Those Over 65 Years of Age-Taney County,
1999-2009
Taney County
Cause of Death
Missouri
Number
Rate
Rate
Cancer
798
1,013.0
1,112.40
Diabetes
56
71.1
141.8
Alzheimer’s Disease
106
134.6
182.0
994.9
1,339.3
1,656.8
Cerebrovascular disease (Stroke)
229
290.7
400.2
Atherosclerosis#
68
141.6
32.5
Pneumonia & influenza#
140
177.7
171.4
Liver Disease. Cirrhosis
22
27.9
22.4
Kidney
84
106.6
120.5
Motor Vehicle Accident
19
24.1
23.4
All other Accidents
54
68.6
88.5
Suicide
19
24.1
15.8
3,470
4,405.1
5,264.20
Heart Disease
Total all causes
Source: Missouri Department of Health and Senior Services, MICA, 2011
xxiii
Figure 14
Table 14
Injuries By Type For Those 65 Years of Age and Older, Rate Per 100,000 Taney County and Missouri, 1999-2009
Taney County
Missouri
Number
Rate
Rate
Total Injuries
6,244
7,926.6
8,578.4
Fall/Jump
3,650
4,633.6
5,389.3
Machinery
50
63.5
53.6
Motor Vehicle
519
658.9
582.9
Hot Weather
13
16.5
15.3
Over-exertion
364
462.1
362.8
Drugs/Alcohol
99
125.7
92.4
These senior issues were determined to be areas of concern and will become areas of focus as
programs are developed to address the main priority issues.
xxiv
Environmental Health Issues
Environmental health concerns for Taney County include water quality issues, sewage, and food
safety. Many of the issues with water quality and sewage are the result of increased
development in the county. As more development occurs increased demands will be placed on
existing infrastructure and water resources. Onsite wastewater treatment facilities continue to
be a concern. Improper operation and maintenance of these facilities could potentially
threaten local water resources.
Food borne illnesses are a high concern for Taney County. The many restaurants that depend
on the local tourism industry are required to have managers on duty who have attended food
safety classes. Additionally, local businesses are provided the opportunity to attend training
focused on the prevention of the spread of norovirus. Norovirus is very contagious and cause a
sudden onset of vomiting and diarrhea. Oftentimes ill visitors to the area may expose others to
the illness as they visit attractions, restaurants, theaters, and hotels. Because of this, the Taney
County Health Department directs substantial resources to the identification of these types of
illnesses and to the prevention of the spread of illnesses once identified
Table 15
Food Illness Complaints- 2006-2010
Percent
Change
Food illness complaints
2006
2007
2008
2009
2010
2009-2010
5-Year
Average
108
116
130
34
142
318%
106
xxv
Chapter 1
Demographics and Socioeconomic Conditions
Population
Figure 1.1 shows a comparison of Missouri Information for Community Assessment (MICA) data
from 2000 to 2009 with regard to the age distribution of the population in Taney County. This
graph shows an overall increase in the number of residents in the county, especially from 15
years old to about 55 to 64 years old where the county has experienced the highest increase.
Figure 1.1
Population Estimates
Table 1.1a illustrates the population estimate for Taney County and Missouri. The percent
change from 2000 to 2010 was 30.15% in Taney County which was higher than the state
average of 7.01%.
Table 1.1a
Population Estimate for Taney County and Missouri, 2010
Year
Taney
County
Missouri
2000
2010
Percent Change
2000-2010
39,703
51,675
30.15
5,596,692
5,988,927
7.01
Source: US Census, 2011
2
Table 1.2
Population Age Characteristics-Taney County and Missouri, 2010
Taney County
Missouri
Number
Percent
Percent
Under 5 years
6.1
3,175
6.5
5 to 9 years
5.8
3,012
6.5
10 to 14 years
6.3
3,279
6.6
15 to 19 years
6.8
3,489
7.1
20 to 24 years
6.8
3,537
6.9
25 to 34 years
11.6
5,960
12.9
35 to 44 years
11.9
6,156
12.5
45 to 54 years
13.8
7,105
14.8
55 to 59 years
6.6
3,396
6.5
60 to 64 years
6.6
3,416
5.6
65 to 74 years
10.6
5,499
4.3
75 to 84 years
5.4
2,779
4.6
85 years and over
1.7
872
1.9
Median age (years)
40.7
X
37.9
Figure 1.2 illustrates that Taney County has experienced a positive growth pattern in the last 15
years. Based on this graphical representation, it is evident that the population increase has
increased steadily since 1990. Since 1990, the population has increased by 22,462 residents or
87.8%.
Figure 1.2
Population Estimate-Taney County, 1990-2009
60,000
Number
50,000
40,000
30,000
20,000
10,000
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0
Year
3
Based on Table 1.3, Taney County showed a higher percentage of white population (97.9%)
than the state (84.86%). Similarly, both the county and the state display a predominant white
population in general.
Table 1.3
Population Percentages By Race or Ethnicity-Taney County, 2009
Taney County
Missouri
Total
Male
Female
Total
Male
White
97.9
46.61
49.61
84.86
41.39
Black/African-American
0.4
0.18
0.16
11.25
5.27
American Indian/Alaska Native
2.8
0.38
0.50
0.45
0.23
Asian
1.0
0.14
0.21
1.10
0.53
Native Hawaiian/Pacific
0.05
0.03
0.02
0.06
0.03
Islander
Other Race
1.4
0.43
0.31
0.82
0.45
Two or More Races
3.5
0.68
0.75
1.47
0.73
Hispanic or Latino
3.7
1.25
1.17
2.12
1.12
Female
43.47
5.98
0.22
0.57
0.03
0.37
0.74
1.00
The urban population in Taney County and Missouri showed an increase in the 2010 census.
The rural population in Taney County was higher than the state which shows 26.9% of the
Missouri population is rural (Table 1.4).
Table 1.4
Percent of Population Classified as Rural and Urban, 2010
Total Population
Urban Population
Rural Population
Taney County
51,675
50.0
50.0
Missouri
5,988,927
73.1
26.9
69.4
Table 1.5 compares children (0-17 years) living below poverty level in Taney County and
Missouri. Taney County percentages were higher than those of the state in 2000 and 2010.
Table 1.5
Children (0-17 years) In Poverty- Taney County, 2010
Percent
Year
2000
2010
Taney County
Missouri
17.6
26.2
15.3
21.0
Source: Bureau of the Census, Small Area Income and Poverty Estimates.
4
The overall percent of all people below poverty level is illustrated in table 1.6. The percent of
the population in the county who lived below poverty level was higher than the state rate in
2000 and 2008.
Table 1.6
All persons Below Poverty level, Taney County, 2010
Percent
Year
2000
2010
Taney County
Missouri
12.4
23.8
11.7
15.3
Source: Bureau of the Census, Small Area Income and Poverty Estimates.
County Income Pattern
Table 1.7 shows some social and economic profiles of Taney County and Missouri in 2006, 2008,
and 2010. According to the data, Taney County had a higher unemployment rate compared to
the state rate.
The county generated a total of $1,355,815,000 from personal income in 2008 and the per
capita income was $28,680 compared with $36,356 for Missouri.
Table 1.7
Social and Economic Profiles of Taney County and Missouri,
2006 and 2010
Personal income, 2008 (in thousands)
Personal income per capita, 2008
Civilian labor force, 2008
Unemployment rate, 2010
Full-time and part-time employment by place
of work, 2008
Full-time and part-time employment, net
change 2000 to 2006
Employment in government, 2008
Earnings, 2006 ($1000)
Average earnings per job, 2006
Source: OSEDA, 2011
5
Taney County
Missouri
$1,355,815
$216,546,820
$28,680
$36,356
24,046
10.7%
3,016,749
8.7%
34,385
3,672,794
2,936
174,117
1,950
279,133
917,403
147,421,561
$28,247
$40,155
Information regarding employment by industry is presented in Tables 1.8 and 1.9. The large
number of service industry and tourism related jobs also influences monthly unemployment
statistics as shown in Figure 1.3. In the winter (December through March), the unemployment
rate is higher compared to the rest of the year due to area businesses closing for the winter
season.
Table 1.8
Industry Employment
Taney County, 2010
Mining
Taney
County
Percent
Const
35
0.2
Manu
Transport.
& Warehousing
Utilities
683
3.0
391
1.7
2,255 538
9.8 2.3
Retail
Trade
Info
Fin &
insurance
Educ.,
services
Healthcare &
social
assistance.
559
2.4
1,614
7.0
2,145
9.3
3,787 492
16.4 2.1
Accom
Arts,
& food entertainment
service & recreation
Others
4,229
18.3
3,674
15.9
1,686
7.3
Table 1.9
Number of Establishments by Size, 2009
Employees
Taney County
Percent
1-4
5-9
10-19
20-49
963
52.7
360
19.7
242
13.2
164
9.0
County
50-99 100-249 250-499 500-999 1000+ Total
65
3.6
27
1.5
5
0.3
1
0.1
0
0.0
Figure 1.3
Unemployment Rate
Unemployment Rate By Month- Taney County,
January to September 2011
24%
22%
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
22.40%
8.50%
JAN
FEB
MAR
APR
MAY
Month
Source: Missouri Economic Research and Information Center, 2011
6
JUN
JUL
AUG
SEP
1,827
Housing
Housing characteristics in Taney County are shown in Table 1.10. In the year 2008, it was
reported that 775 new housing units were built in Taney County. This was a 3.1% increase.
Table 1.10
Annual Estimates of Housing Units for Taney County, Missouri:
April 1, 2000 to July 1, 2008
Year
July 1, 2008
July 1, 2007
July 1, 2006
July 1, 2005
July 1, 2004
July 1, 2003
July 1, 2002
July 1, 2001
April 1, 2000
Annual Estimate
Housing Units
25,468
24,693
23,381
22,440
21,741
21,200
20,805
20,377
19,688
Annual Change
Number
Percent
775
3.1
1312
5.6
941
4.2
699
3.2
541
2.6
395
1.9
428
2.1
689
3.5
Poverty
Table 1.11 provides a comparison between poverty levels in Taney County and Missouri. In
general, the percentage of the population living below 100% of the Federal Poverty Level in
Taney County is slightly higher than that of the state as a whole.
Table 1.11
Percent of Population At Federal Poverty Levels-Taney County and
Missouri, 2010
Taney County
Missouri
Total Population
Below 50 Percent of Poverty Level
51,675
5,988,927
6.4
19.4
26.8
33.8
24.4
31.6
36.9
34.4
6.0
22.0
7
Figure 1.4
Figure 1.4 provides a comparison of population percentages in Taney County and Missouri of
the population living below Federal Poverty Levels (FPL). Poverty by age groups is examined in
table 1.12 and table 1.13.
Table 1.12
Change in Poverty Characteristics-Taney County, 2000-2010
Individuals Below 100%
Federal Poverty Levels
Total
Children Under 18
2000
4,731
1,584
2010
7,982
2,886
Change
From 2000 to 2010
Number Percent
3,251
68.7
1,302
82.2
Percent of
Population
Living in
Poverty
1990 2010
11.9
16.5
22.4
26.2
Table 1.13 provides information regarding the poverty status of Taney County residents by age
group. Children under 5 years of age represented 15.3% of those living in poverty while they
represented 40.2% of the total population of the county in 2010. Those under 18 years of age
had a higher percentage of those living in poverty (36.2%) as compared to the general
population percentage (25.5%).
8
Table 1.13
Poverty Status By Age Group-Taney County, 2010
Income in 2010 below poverty level:
Under 5 years
5 years
6 to 11 years
12 to 17 years
Under 18 years
18 to 64 years
65 and Over
65 to 74 years
75 years and over
Number
7,982
1,221
46
708
421
2,886
4450
646
331
315
Percent
100.0%
15.3
0.6
8.9
5.3
36.2
55.8
8.1
4.1
3.9
Percent of the
Population Group
15.4%
40.2
25.5
7.2
Education
Figure 1.5 provides a comparison of the reported highest level of educational attainment by
gender among Taney County residents over 25 years of age. In 2010, a higher percentage of
females reported their highest level of education being high school graduate. However, the
percentage of females with a higher education was lower than that of their counterpart males.
About 18.5% of the population in Taney County reported being a college graduate or holding a
professional degree. (Table 1.4)
Figure 1.5
9
Table 1.14 shows a breakdown of educational attainment based on age and gender based on
the 2008-2010 American Community Survey three year estimate. Also in the table you will see
the population of 25 years of age and older show graduate and professional degree attainments
that no other age group shows.
Table 1.14
Educational Attainment-Taney County, Missouri, 2008-2010
Total
Subject
Estimate
Population 18 to 24 years
Male
Estimate
Female
Estimate
4,792
2,204
2,588
Less than high school graduate
14.00%
11.90%
15.80%
High school graduate (includes
equivalency)
23.60%
29.40%
18.60%
Some college or associate's degree
56.00%
53.40%
58.20%
Bachelor's degree or higher
6.40%
5.30%
7.40%
Population 25 years and over
34,702
16,782
17,920
Less than 9th grade
4.40%
5.50%
3.30%
9th to 12th grade, no diploma
9.70%
9.70%
9.70%
High school graduate (includes
equivalency)
35.80%
34.10%
37.40%
Some college, no degree
26.30%
25.70%
26.80%
Associate's degree
5.30%
4.70%
5.90%
Bachelor's degree
13.40%
14.60%
12.30%
Graduate or professional degree
5.10%
5.70%
4.60%
Percent high school graduate or higher
85.90%
84.70%
87.00%
Percent bachelor's degree or higher
18.50%
20.30%
16.90%
5,835
2,962
2,873
High school graduate or higher
91.20%
92.60%
89.80%
20.80%
17.90%
23.80%
6,027
2,999
3,028
84.10%
80.30%
87.90%
20.30%
22.30%
18.40%
13,861
6,658
7,203
88.50%
86.00%
90.70%
17.20%
19.40%
15.30%
8,979
4,163
4,816
79.70%
80.40%
79.10%
17.90%
22.10%
14.30%
Population 65 years and over
10
Table 1.15 provides information regarding the changes in reported educational attainment for
those over the age of 25 in Taney County between 2000 and 2010. The number of Taney
County residents that did not graduate from High School decreased by 9.9%, while the number
of people with a high school diploma or GED soared by 149% between 2000 and 2010.
Table 1.15
Educational Attainment For Those Over 25 Years of Age-Taney County, 2000-2010
Percent of
Change, 2000-2010 Population Age 25+
Less than 9th Grade
Grade 9 Through 12, No Diploma
HS Diploma/GED
Some College or Associates Degree
College Grad or Professional Degree
2000
1,251
3,735
4,986
7,695
3,998
2010 Number Percent
1,524
273
21.8
3,367
-368
-9.9
12,417 7,431
149.0
10,957 3,262
42.4
6,437 2,439
61.0
2000
4.7
13.9
18.6
28.7
14.9
2010
4.4
9.7
35.8
31.6
18.5
Table 1.16 provides the poverty rate of the population 25 years of age and over for whom
poverty status is determined by educational attainment by gender. According to the data
female poverty levels are higher than males regardless of education obtained.
Table 1.16
Percent Poverty Rate For The Population 25 Years and Over For Whom Poverty Status Is
Determined By Educational Attainment Level-Taney County 2008-2010
TOTAL
MALE
FEMALE
Less than high school graduate
25.00
22.30
28.00
High school graduate (includes equivalency)
16.60
14.10
18.80
Some college or associate's degree
8.50
8.00
8.90
3.00
3.40
2.70
Source: US Census; 2008-2010 American Community Survey, 2011
11
Chapter 2
Environmental Health Services
12
The Taney County Health Department celebrated the one year anniversary of the integration
with the City of Branson Health Department in February of 2008. Prior to this, the two
departments collaborated to provide citizens and visitors of Branson and Taney County a nonduplicated set of public health services. The two departments integrated in an effort to better
serve the community and utilize resources more efficiently and effectively.
The environmental services provided by the Taney County Health Department include
inspections of: food, lodging, swimming pools and spas, body art and massage facilities,
daycares, and animal acts. Additional environmental services include animal control and bite
investigations, nuisance compliance, well water testing, West Nile mosquito surveillance
programs, emergency preparedness, as well as handling threats or situations that may present
an imminent hazard to public health.
Area Growth
Taney County has an area of 632 square miles, with the majority of this land in natural forests
and woodlands.
Table 2.1
Taney County Geographical Statistics, 2011
Land Area (sq miles)
632
Water Area (sq miles)
19.1
Acreage
421,871
Population Density
76 people /sq mile
Percent of Lake Coverage
2.9%
Land Use for Roads and Highway
2.6%
Source: City-Data.Com; Accessed March 14, 2011.
The City of Branson has an incorporated area of 19 square miles, with 7,500 residents.
However, approximately eight million people visit the city annually.
Table 2.2
City of Branson Statistics, 2011
Incorporated Area (sq miles)
Resident Population
Guests Per Year (estimated)
Infrastructure Support for Daily Visitors
Source: City of Branson
13
Number
19
7,500
7,900,000
65,000
Table 2.3 provides a review of the change in active establishments in Taney County from 2009
to 2010. Active establishments are those facilities that are currently in operation or capable of
beginning operations.
Tables 2.4-2.8 provide a summary of inspections of Restaurants, Pools, Lodging facilities, Child
Day Care facilities, and Tattoo/massage establishments that occurred in 2010. For all
jurisdictions in 2010, the Health Department provided 215 routine lodging inspections, 1,121
routine food inspections, 32 routine childcare inspections and 1,023 routine pool inspections
for all jurisdictions.
Table 2.3
Active FacilitiesCity of Branson, Hollister, and Taney County
Total 2009
Total 2010
Percent Change
Childcare
32
32
0.00
Food
Temporary Events
629
89
645
97
2.54
9.00
Lodging
212
187
-11.79
Pools
397
391
-1.51
Tattoo/ Massage
28
27
-3.57
Table 2.4
Services Provided to Lodging Facilities
By Type of Service and Jurisdiction, 2010
Revisit
Routine
Inspections
Inspections
Total
Total, All Jurisdictions
(2010 Number)
215
235
450
Branson %
Hollister %
76.7
1.39
81.27
1.27
County %
21.86
17.44
Percent Change 20092010
-17.7
-25.1
Source: Taney County Health Department,2011
14
-20.8
Table 2.5
Services Provided to Food Establishments
Routine
Inspections
Revisit
Inspections
Total*
Total, All
Jurisdictions
(2010 Number)
1,121
495
1,616
Branson %
75.7
70.5
74.1
Hollister %
4.9
13.9
7.7
County %
Percent Change :
2009-2010
19.4
15.6
0.2
1.8
-17.9
-4.3
Table 2.6
Services Provided to Child Care Facilities
Revisit
Routine Inspections
Inspections
Total*
32
17
49
Branson %
25.0
35.3
28.6
Hollister %
County %
12.5
65.6
5.9
64.7
10.2
65.3
Percent Change
2009-2010
45.5
240
81.5
Total, All
Jurisdictions
(2010 Number)
Table 2.7
Services Provided to Tattoo/Massage Establishments
Routine
Revisit
Inspections Inspections
Total*
(2010 Number)
25
0
25
Branson %
93
0
93
Hollister %
7
0
7
County %
Percent Change
2009-2010
0
0
0
-21.88
-100
-26.47
15
Table 2.8
Services Provided For Pools
Routine Inspections
Revisit
Inspections
Total
1023
95.8
344
99.4
1367
96.7
0.3
3.9
0.0
0.6
0.2
3.1
4.9
-0.3
3.6
(2010 Number)
Branson %
Hollister %
County %
Percent Change
2009-2010
The Environmental Public Health Specialists with the Health Department also respond to foodborne illness complaints and outbreak investigations. Table 2.9 provides a review of the
number of food illness complaints that were conducted from 2006 to 2010. From 2009 to 2010
the number of food illness complaints increased by 318%, however from 2008 to 2009 the
number of complaints decreased from 130 to 34 (74%).
Table 2.9
Food Illness Complaints- 2006-2010
Percent
Change
Food illness complaints
2006
2007
2008
2009
2010
2009-2010
5-Year
Average
108
116
130
34
142
318%
106
Food borne illnesses are a high concern for Taney County. The many restaurants that depend
on the local tourism industry are required to have managers on duty who have attended food
safety classes. Additionally, local businesses are provided the opportunity to attend training
focused on the prevention of the spread of noroviruses. Noroviruses are very contagious and
cause a sudden onset of vomiting and diarrhea. Often, ill visitors to the area may expose others
to the illness as they visit attractions, restaurants, theaters, and hotels. Because of this, the
Taney County Health Department directs substantial resources to the identification of these
types of illnesses and to the prevention of the spread of illnesses once identified.
Water samples are routinely analyzed by the Health Department to determine levels of Total
Coliform and E.Coli that are present. The numbers of these tests are presented in Table 2.10.
From 2006 to 2010, the demand for public water tests increased by 35.82%, while private water
samples decreased by 28.48%.
16
Table 2.10
Water Testing Services- 2010
2006
2007
2008
2009
2010
Percent
Change
(20092010)
Water samples
collected
349
276
448
457
413
-9.63
388.6
Total Coliform present
63
89
96
109
74
-32.11
86.2
E-Coli present
Public water tests
performed
Private water tests
performed
4
6
16
20
20
0
13.2
277
183
151
134
182
35.82
185.4
72
93
297
323
231
-28.48
203.2
5-Year Average
Table 2.10b
Number of Housing Units By Type of Plumbing FacilitiesTaney County, 2009
Taney County, Missouri
Total:
19,623
Lack complete kitchen facilities
46
Lacking complete plumbing facilities
166
Source: US Census Bureau, 2011
Animal control services for the City of Branson are provided in Table 2.11. Some of these
services are also provided to areas outside of the City of Branson city limits through mutual aid
or other contractual agreements. During 2010, a total of 666 animal complaints were
investigated and 89 animal bites were reported.
Table 2.11
Animal Control Activities, 2010
Total
Complaints investigated
(animal)
Animal bites reported
Enforcements
Correction Notices
2009
2010
738
666
717
564
105
---
89
9
4
17
Percent
Change
-7.1
-21.3
-15.2
---
Table 2.12
Other Animal Control and Compliance Activities, 2010
Number
Wild animals collected
21
Transferred to Wildlife Agencies
6
Dogs Impounded
150
Dogs Adopted Out
69
Dogs Transferred to other facilities
63
Cats Impounded
160
Cats Adopted Out
40
Cats Transferred to other facilities
79
Dead Animal
14
Facility Inspection
15
Theater Inspections Involving Animals
6
Inspections
15
The total numbers of complaints to animal control increased are presented in Table 2.13 by
jurisdiction. Additionally, bite investigations averaged 90 per year for the past few years. Both
of these factors have resulted in increased man-hours worked by the Health Department
animal control officers. (Table 2.13)
Table 2.13
Number of Field Complaints By Jurisdiction, 2011
Jurisdiction
Branson
Taney County
Hollister*
Forsyth
Merriam Woods
Total
Total Number
Percent of Total
500
549
0
82
61
1,192
41.9
46.1
0.0
6.9
5.1
Source: Taney County Health Department, 2011; *Field complaints – officer assist only
Table 2.14 provides a summary of activities provided by the Taney County Health Department
regarding emerging disease surveillance. From 2006 to 2011 decreases were observed in
Mosquito pool testing and the collection. These activities were related to West Nile Virus
funding which has decreased substantially over the past few years. Further funding cuts are
expected for 2012.
18
Table 2.14
Emerging Disease Surveillance, 2006-2011
WNV and Mosquito
Activities
Mosquito Trap Nights
Mosquito Pools (50 each)
Tested
Complaints investigated
(Mosquito/vector)
2006
2007
2008
2009
2010
2011
% Change
(2006-2011)
104
106
-
-
-
-
-100.00
220
105
86
83
183
130
-40.91
22
-
-
11
7
4
-81.82
Regulated Facilities
In many cases, local businesses are required to report information to the state of Missouri.
However, in some cases, information is collected at the federal level.
Toxics Release Inventory data are reported by individual facilities via yearly reports to federal
EPA. The EPA converts these forms into an electronic database. A facility must report if the
facility:




Has 10 or more full-time employees, and
Manufactures or processes over 25,000 pounds of the approximately 600 designated
chemicals or 28 chemical categories specified in the regulations, or uses more than
10,000 pounds of any designated chemical or category, and
Engages in certain manufacturing operations in the industry groups specified in the U.S.
Government Standard Industrial Classification Codes (SIC) 20 through 39, or
Is a federal facility which are all now required to report per the August, 1995 Executive
Order signed by President Clinton.
EPA data regarding hazardous waste and regulated facilities in Taney County is listed in Table
2.16. A total of 456 facilities were registered with the EPA in 2010. This was an increase of 112
facilities since 2007 or a 32.56% increase.
According to the environmental protection agency, the following facts for Taney County were
noted:
o Facilities that produce and release air pollutants: 5
o Facilities that have reported toxic releases: 0
o Facilities that have reported hazardous waste activities: 12
 Number of CESQG’s: 4
 Number of Unspecified Universe:8
o Potential hazardous waste sites that are part of Superfund that exist: 1
 Number of Superfund: 1
o Facilities that generate hazardous waste from large quantity generators: 0
o Facilities issued permits to discharge to waters of the United States: 34
19
o Transient Non-Community Water Systems that do not consistently serve the same
people (e.g. rest stops, campgrounds, gas stations): 53
o Community Water Systems that serve the same people year-round (e.g. in homes or
businesses): 55
o Non-Transient Non-Community Water Systems that serve the same people, but not
year-round (e.g. schools that have their own water system): 9
Table 2.16
List of EPA-Regulated Facilities-Taney County, 2010
2010
Active or
Archived
Superfund
Reports
1
0
0
Air Releases
Reported
13
0
0
ZIP Code
65616
65614
65679
Forsyth
65653
21
27
11
0
9
0
0
Hollister
65672
38
64
36
1
8
0
5
Kirbyville
Kissee Mills
Merriam Woods
Point Lookout
65679
65680
65740
65726
7
9
6
0
0
0
1
4
2
3
4
1
3
2
0
2
0
0
0
0
0
1
0
0
0
1
0
1
Protem
65733
1
1
0
0
0
0
1
Ridgedale
Rockaway Beach
65739
65740
15
4
23
7
18
4
0
0
2
1
0
0
2
0
Taneyville
65759
4
4
2
1
0
0
1
Walnut Shade
Total
65771
5
10
0
0
0
0
0
344
456
268
3
74
1
25
City
Branson
Bradleyville
Cedar Creek
Total Permitted
Sites Discharges
Toxic
2010 to Water Releases
294
184
1
4
3
0
0
0
0
Hazardous
Waste
Handlers
53
0
0
Total
Sites
2007
236
4
0
Source: EPA, EnviroFacts Online Database, 2011
In 2010 a total of 25 air releases and 3 toxic releases were reported to the Environmental
Protection Agency. Additionally, a total of 74 hazardous waste handlers were located in Taney
County in 2010.
Map 2.1 provides information on the geographical locations of hazardous waste, water
discharges, air discharges, toxic releases, and waterways in Taney County for 2010.
These regulated facilities or documented releases can create potential negative health impacts
in the county. Exposure to toxic or hazardous chemicals can cause immediate health
consequences as well as possible long-term effects. Health impacts would depend on several
variables including, route of exposure, amount of the substance, and length of exposure.
20
Map 2.1
Source: EPA, EnviroMapper, 2011
Watershed and Drinking Water
Taney County crosses two watersheds, the Beaver Reservoir and Bull Shoals Lake. Information
regarding the identified impaired waterways in these two watersheds is provided in the
following maps and tables.


11010001: Beaver Reservoir; state(s): AR, MO
11010003: Bull Shoals Lake; state(s): AR, MO
21
Map 2.2
Source: EPA, 2011
Table 2.17
Impaired Waters Listed By Water bodyBull Shoals Watershed, 2010
Waterbody Name Waterbody Type Waters on List
Lake Taneycomo
Lake
1
Source: EPA, 2011
Table 2.18
Causes of Impairment-Bull Shoals Watershed, 2010
Impairment Name
Causes of Impairment Reported Percent of Reported
DISSOLVED OXYGEN
1
25.00
Source: EPA, 2011
22
Map 2.3
Source: EPA, 2011
Table 2.19
Impaired Waters Listed By Water bodyBeaver Reservoir, 2010
Waterbody Name Waterbody Type Waters on List
Table Rock Lake
Lake
1
Source: EPA, 2011
Table 2.20
Causes of Impairment-Beaver Reservoir Watershed, 2010
Impairment Name Causes of Impairment Reported Percent of Reported
Nutrients
1
Source: EPA, 2011
Water systems in Taney County are shown below in Tables 2.21-2.23. These tables show the
water system name and primary water source.
Community water systems are those water systems that serve the same people year-round, e.g.
in homes or businesses. A total of 38,818 people are served by these types of water systems in
Taney County.
23
Table 2.21
Community Water Systems-Taney County, 2011
Water System Name
County(s)
Served
BEAR CREEK WATER & SEWER
TANEY
BRANSON
TANEY
BRANSON CREEK DEVELOPMENT LLC
TANEY
BRANSON EAST APARTMENTS
TANEY
BRANSON VIEW ESTATES
TANEY
BULL CREEK VILLAGE
TANEY
CEDAR SHORES RANCH ESTATES
TANEY
CLEAR WATER ACRES SUBD
TANEY
COLLEGE OF THE OZARKS
TANEY
COUNTRY FARM ESTATES HOA INC
TANEY
DEER RUN APTS
TANEY
EMERALD POINTE SUBD
TANEY
FALL CREEK HEIGHTS SUBD
TANEY
FORSYTH
TANEY
GOBBLERS KNOB MOBILE HOME PARK
TANEY
HIDDEN RIDGE ESTATES MHP
TANEY
HIDEAWAY MHP
TANEY
HIGHLANDS SEWER & WATER ASSN INC
TANEY
HOLIDAY HILLS RESORT
TANEY
HOLLISTER
TANEY
LAKE TANEYCOMO ACRES SUBD
TANEY
LAKE TANEYCOMO WOODS
TANEY
LAKESIDE MOUNTAIN MANOR
TANEY
LAKEVIEW SUBD BLOCK C
TANEY
LONG CREEK CONDOMINIUMS
TANEY
LOOKOUT ACRES
TANEY
MEADOW RIDGE SUBDIVISION
TANEY
MEADOWOOD ESTATES SUBD
TANEY
MERRIAM WOODS VILLAGE OF
TANEY
MOORE BEND SUBD
TANEY
OAK BROOK ESTATES SUBD
TANEY
OAK GROVE TRAILER PARK
TANEY
OAKVIEW APARTMENTS
TANEY
OZARK PARK ESTATES
TANEY
PARADISE POINT RESORT LLC
TANEY
PERSIMMON RIDGE HOME OWNERS ASSN
TANEY
RIVERSIDE ESTATES
TANEY
ROCKAWAY BEACH
TANEY
ROLLING MEADOWS
TANEY
SAVANNAH PLACE THIRD ADDITION
TANEY
SPRING CREEK 2ND ADD
TANEY
SUMMIT RIDGE MOBIL HOME PARK
TANEY
SYCAMORE RIDGE SUBDIVISION
TANEY
TABLE ROCK HEIGHTS HOME OWNERS ASSN
TANEY
TANEY CO PWSD #1
TANEY
TANEY CO PWSD #2
TANEY
TANEY CO PWSD #2 WHITE RIVER VALLEY
TANEY
TANEY CO PWSD #3
TANEY
TANEY CO UTILITIES CORP #1
TANEY
TANEY CO UTILITIES CORP #2
TANEY
TANEYCOMO HIGHLANDS SUBD INC
TANEY
TRI STATE UTILITY CO
TANEY
TWILITE HOME SITES
TANEY
VALLEY VIEW VILLAGE SOUTH SUBD
TANEY
WALKER MOBILE HOME PARK
TANEY
WALL EYE HAVEN MHP
TANEY
WILDERNESS CLUB INC
TANEY
Source: EPA, Missouri Department of Natural Resources, 2011
Population
Served
54
9500
60
36
90
100
28
70
1200
52
32
313
28
1400
192
38
40
75
2065
3867
215
87
40
90
45
165
25
30
1500
28
25
77
25
130
132
45
400
720
125
25
35
150
25
40
1650
3210
300
1167
1500
137
25
7113
34
57
52
54
100
24
Primary Water Source Type
Groundwater
Surface_water
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Surface water
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
System Status
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Water System ID
MO5031241
MO5010096
MO5031223
MO5070611
MO5041212
MO5048161
MO5031398
MO5036191
MO5069033
MO5031294
MO5070683
MO5031148
MO5031149
MO5010285
MO5048286
MO5041129
MO5041419
MO5030690
MO5190947
MO5010374
MO5036198
MO5036012
MO5069068
MO5036268
MO5031498
MO5036114
MO5030915
MO5031126
MO5036152
MO5036117
MO5031481
MO5048178
MO5071460
MO5048271
MO5071269
MO5036275
MO5036210
MO5010697
MO5048344
MO5021379
MO5030391
MO5048030
MO5031437
MO5030442
MO5024599
MO5024600
MO5036019
MO5024602
MO5036180
MO5036223
MO5031159
MO5024601
MO5031277
MO5036227
MO5048992
MO5048214
MO5031102
Transient Non-Community Water Systems are water systems that do not consistently serve the
same people, such as those systems that supply rest stops, campgrounds, and gas stations.
Table 2.23
Transient Non-Community Water Systems-Taney Count, 2011
Water System Name
County(s)
Population
Primary Water Source Type
Served
Served
AMERICAS BEST CMPGRND
TANEY
450
Groundwater
ANDREWS LANDING & RV PARK
TANEY
80
Groundwater
BLUE HAVEN RESORT
TANEY
96
Groundwater
BRANSON AT EASE RV PARK
TANEY
20
Groundwater
BRANSON LOG HOMES
TANEY
25
Groundwater
BRANSON REC PLEX
TANEY
350
Groundwater
BRANSON STAGECOACH
TANEY
46
Groundwater
BRANSON VIEW CAMPGROUND
TANEY
75
Groundwater
CASA DE LUZ
TANEY
25
Groundwater
CEDAR JUNCTION GENERAL STORE
TANEY
25
Groundwater
CLEVENGER BRANCH MEMBERS CORP
TANEY
410
Groundwater
COOPER CREEK RESORT
TANEY
200
Groundwater
D MONACO LUXURY RESORT AND
TANEY
25
Groundwater
RESTAURANT
EDGEWATER BEACH RESORT
TANEY
30
Groundwater
EMPIRE DIST ELEC OZARK BEACH
TANEY
25
Groundwater
GATEWAY TO BRANSON
TANEY
25
Groundwater
HAPPY HOLLOW RESORT
TANEY
25
Groundwater
HITCH N POST GENERAL STORE
TANEY
40
Groundwater
KANAKUK KOUNTRY
TANEY
260
Groundwater
LAKE SHORE RESORT
TANEY
65
Groundwater
LAKE SHORE RESORT II
TANEY
45
Groundwater
LAZY VALLEY RESORT
TANEY
51
Groundwater
LILLEYS LANDING RESORT
TANEY
65
Groundwater under infl of
Surface water
MEADOWS OF EDEN
TANEY
25
Groundwater
PARKVIEW LODGE
TANEY
25
Groundwater
PINE VALLEY RESORT
TANEY
88
Groundwater
PIZZAS AND CREAM
TANEY
25
Groundwater
RAPID ROBERTS #104
TANEY
800
Groundwater
RAPID ROBERTS #121
TANEY
25
Groundwater
ROCK VIEW RESORT
TANEY
35
Groundwater
SCOOPS & MORE
TANEY
150
Groundwater
SENIOR FRIENDSHIP SITE
TANEY
148
Groundwater
SHEPHERD OF THE HILLS HATCHERY
TANEY
25
Groundwater
STONECROFT CONFERENCE CENTER
TANEY
45
Groundwater
TABLE ROCK LONG CREEK PARK 110
TANEY
135
Groundwater
TABLE ROCK POWER HOUSE 132
TANEY
75
Groundwater
TABLE ROCK RESIDENT OFFICE 133
TANEY
175
Groundwater
TABLE ROCK STATE PARK
TANEY
500
Groundwater
TABLEROCK INN
TANEY
185
Groundwater
TANEY CO PWSD # 2 SHOALS BEND
TANEY
188
Groundwater
TANEY COUNTY MEMORIAL POST #5168
TANEY
26
Groundwater
TANEYCOMO LAKEFRONT RESORT
TANEY
75
Groundwater
TANGLEWOOD LODGE
TANEY
55
Groundwater
THE DINNER BELL
TANEY
25
Groundwater
TRI LAKES MOOSE LODGE
TANEY
30
Groundwater
TROUT HOLLOW LODGE
TANEY
75
Groundwater
TWIN ISLAND RESORT
TANEY
30
Groundwater
VICKERY RESORT MOTEL
TANEY
36
Groundwater
WILD BILLS TRAVEL CENTER
TANEY
25
Groundwater
25
System
Status
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Water
System ID
MO5201414
MO5191687
MO5191016
MO5241250
MO5282768
MO5202738
MO5240231
MO5242442
MO5072790
MO5292355
MO5240145
MO5191022
MO5212783
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
MO5191004
MO5280562
MO5292590
MO5191013
MO5211978
MO5248292
MO5191757
MO5191015
MO5191029
MO5191989
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
Active
MO5282700
MO5191005
MO5191610
MO5212787
MO5258138
MO5292575
MO5191535
MO5211245
MO5218056
MO5142186
MO5271012
MO5111998
MO5111973
MO5110030
MO5120169
MO5211609
MO5031177
MO5218299
MO5191032
MO5191030
MO5212699
MO5242466
MO5191018
MO5191062
MO5191008
MO5292494
Non-Transient Non-Community Water Systems are those water systems that serve the same
people, but not year-round. These types of systems would include schools that have their own
water system. A total of 3,650 people are served by these types of water systems in Taney
County.
Table 2.22
Non-Transient Non-Community Water Systems-Taney County, 2011
Water System Name
County(s)
Served
TANEY
TANEY
TANEY
TANEY
TANEY
BIG CEDAR LODGE RESORT
BRADLEYVILLE R I SCHOOL
KANAKUK K KAUAI
KANAKUK KAMP NO 1
MARK TWAIN R VIII ELEM
SCHOOL
ROYAL OAK ENTERPRISES INC
TANEY
SHELTERWOOD
TANEY
SHEPHERD OF THE HILLS
TANEY
SWEET PEA DAY CARE
TANEY
Population
Served
375
245
360
440
80
Primary Water Source
Type
Groundwater
Groundwater
Groundwater
Groundwater
Groundwater
100
25
2000
25
Groundwater
Groundwater
Groundwater
Groundwater
System
Status
Active
Active
Active
Active
Active
Active
Active
Active
Active
Water System
ID
MO5191011
MO5171231
MO5242626
MO5248293
MO5171233
MO5180639
MO5071109
MO5211955
MO5282831
Waste Water and Sewage Disposal
The Taney County Regional Sewer District was formed under Missouri Revised Statutes Chapter
204 and was approved by voters in 1986. Currently the Sewer District has 1,945 customers on
the existing sewer lines. These customers are located mainly in rural areas of the county. The
sewer district also inspects all new septic systems in the county and addresses complaints in the
County outside of municipal areas. Currently, there are approximately 6,200 private onsite
wastewater treatment systems (OWTS) in Taney County. This number is approximate because
records of OWTS prior to 1998 are incomplete.
The largest municipal sewage system in the county is in the City of Branson with 7,638
customers as of July 2008. Branson has an ordinance regulating the amount of oil, grease and
fat allowed into the system from food service establishments. This ordinance requires a 1,000
gallon in-ground grease interceptor for every 250 seats of a food service establishment.
The municipalities of Forsyth, Hollister, and Rockaway Beach also have sewage systems for their
residents. However, there are still a few private septic tanks in each of the municipal areas.
Table 2.23 provides additional information regarding wastewater treatment systems.
Improperly maintained septic systems could result in contamination of water. Possible
gastrointestinal illnesses due to E. Coli or other bacteria may result if private wells become
contaminated with this runoff.
As the Taney County Sewer District and municipal sewer systems expand, the number of septic
tanks in the county will decrease. This will have a positive impact on the water quality in the
county.
26
Table 2.23
Customers on Sewer Systems-Taney County, 2008
Number
Taney County Regional Sewer District
1,945
City of Branson
7,638
Forsyth
1,144
Hollister
1,530
Rockaway Beach
332
Total
12,589
Source: Taney County Regional Sewer District
Table 2.24
Onsite Wastewater Treatment SystemsTaney County, 2007
Total Onsite Wastewater Treatment Systems
Malfunctioning OWTS Complaints
OWTS Violations
Systems Under Violation Notice Brought Into
Compliance Without Prosecution
Systems Under Violation Notice Brought Into
Compliance Through Prosecution
Number
6200
58
10
10
0
Source: Taney County Regional Sewer District
Table 2.25
Repair
Permits
61
Number of OWTS Permits Issued-Taney County, 2007
Replacement
New Permits
Total Permits
Multi-Family or business
Permits
permits, serving 20 or
more
0
149
333
2
Source: Taney County Regional Sewer District, 2011
Table 2.26
Number and Type of OWTS Permitted-Taney County, 2007
Temporary
Holding
Tanks
5
Septic
Tanks
111
NSF Standard 40
Aerobic treatment
Tank
69
27
Filter Treatment
Systems
(Foam)
1
Table 2.27
Gravel
and
Pipe
49
Number and Type of Distribution an Soil Treatment Systems PermittedTaney County, 2007
Conventional Lateral Trench Systems
Dilution Systems
Large
Expanded
Pressure
DDosed
Low
Diameter
Polystyrene
Network in
Box
D-Box
Pressure
Pipe
Bundle
Conventional
Pipe in Pea
Without
Lateral Trench
Gravel
Gravel
Lateral
Trench
39
88
1
12
2
1
Drip
Irrigation
Dispersal
2
Housing Concerns
Several environmental health concerns are related to housing including exposures to radon and
lead.
Radon
Radon (Rn) is a radioactive gas that occurs from the natural breakdown of uranium in the soil
and rocks. It is colorless, odorless, and tasteless. Radon is the second leading cause of lung
cancer in the nation and is classified as a “Class A” carcinogen according to EPA.
Radon becomes a risk indoors because as it continues to break down, it emits atomic particles
that enter the lungs and can alter the DNA increasing lung cancer risk. Radon can be tested
and measured (in picocuries per liter (pCi/L) of air) and there are estimated risks to health from
the exposure depending on the concentration.
The Missouri DHSS in conjunction with the EPA recommends that if the concentration of radon
is 4pCi/L or greater, then remediation should be done to lower risks. Smoking in conjunction
with radon exposure greatly increases the risk of cancer
It's never too late to reduce your risk of lung cancer. Don't wait to test and fix a radon problem.
If you are a smoker, stop smoking.
The following tables provide estimates on the risk of exposure to certain concentrations of
radon for smokers and non-smokers.
28
Radon
Level
20 pCi/L
10 pCi/L
8 pCi/L
4 pCi/L
2 pCi/L
1.3 pCi/L
0.4 pCi/L
Radon Risk If You Smoke
If 1,000 people who smoked were
The risk of cancer from
WHAT TO DO: Stop smoking
exposed to this level over a lifetime...
radon exposure compares and...
to...
About 260 people could get lung cancer
250 times the risk of
Fix your home
drowning
200 times the risk of dying Fix your home
in a home fire
30 times the risk of dying
Fix your home
in a fall
5 times the risk of dying in Fix your home
a car crash
Consider fixing between 2
from poison
and 4 pCi/L
(Average indoor radon
(Reducing radon levels below
level)
2 pCi/L is difficult)
(Average outdoor radon
level)
Note: If you are a former smoker, your risk may be lower.
Source: MO DHSS, 2011
Radon
Level
20 pCi/L
10 pCi/L
8 pCi/L
4 pCi/L
2 pCi/L
1.3 pCi/L
0.4 pCi/L
Radon Risk If You Have Never Smoked
If 1,000 people who never smoked were
The risk of cancer from
WHAT TO DO:
exposed to this level over a lifetime...
radon exposure compares
to...
35 times the risk of
Fix your home
drowning
Fix your home
in a home fire
4 times the risk of dying in
Fix your home
a fall
The risk of dying in a car
Fix your home
crash
The risk of dying from
Consider fixing between 2
poison
and 4 pCi/L
Less then 2 people could get lung cancer
(Average indoor radon
level)
(Average outdoor radon
level)
Note: If you are a former smoker, your risk may be higher.
Source: MO DHSS, 2011
29
Lead
Lead poisoning is one of the most common and preventable environmental health problems in
the United States. An estimated one million children have elevated blood lead levels of at least
10 micrograms per deciliter (10 µg/dl) in the U.S. According to 2003 Missouri blood lead testing
data, three thousand children under the age of six, were identified with elevated blood lead
levels in the state.
Lead is a shiny silver colored metal found naturally in the earth's crust. Lead has been used in
our society in a variety of ways including in paints, gasoline, and some vinyl products, such as
mini-blinds. Processed or recycled lead can become a health hazard. Fine particles of processed
or recycled lead and/or lead dust become a health hazard when they are taken into the body
through inhalation (breathing) and/or ingestion (swallowing).
According to the year 2000 Census, a total of 1,274 houses in Taney County were built prior to
1950. (Table 2.28) Additionally, those houses built prior to 1978, when lead paint was
prohibited, may also have been painted with some lead paint.
Table 2.28 provides information on when houses were built in Taney County.
Table 2.28
Number of Housing Structures by Year BuiltCounty, 2009
Total Housing Units
24,528
Built 2005 or later
1,314
Built 2000 to 2004
2,571
Built 1990 to 1999
8,790
Built 1980 to 1989
4,013
Built 1970 to 1979
3,420
Built 1960 to 1969
1,883
Built 1950 to 1959
1,105
Built 1940 to 1949
572
Built 1939 or earlier
860
30
Taney
Agricultural Activities
Information related to agricultural activities in Taney County is shown in Table 2.29 and 2.30.
These activities are important to monitor for possible health consequences associated with
runoff from these operations. Contamination of water sources used for swimming or private
wells has occurred in other areas. No updated census for cattle and calves since 2008 for Taney
County at time of publication.
Table 2.29
Cattle and Calves-Taney County, 2007-2008
Total
Beef Cows
22,000
13,500
20, 800
13,000
Year
2007
2008
Milk Cows
150
550
Source: United States Department of Agriculture (USDA), 2011
In the year 2010 a total of 704 tons of fertilizer were used in Taney County. This represents a
decrease of 6.05 percent as compared to the year 2007.
Table 2.30
Fertilizer Use, Taney County
Tons Used By Year
Percent Change
Year
1985
2000
2007
2010
1985-2000
2000-2007
2007-2010
Fertilizer
454
287
753
704
-36.8
162.4
-6.05
Nitrogen
55
16
57
6
-70.9
256.3
-89.5
P2O5
59
7
43
--
-88.1
514.3
-100
Potash
60
--
--
--
-100
--
--
Source: University of Missouri Annual Fertilizer Tonnage Report, 2011
31
Chapter 3
Health Care Services
32
Introduction
Health care service providers in Taney County are regional resources for residents in
surrounding counties in Missouri and Arkansas. Because of this, and Taney County’s increasing
population, it is important to identify the capacity of the delivery of current health care
services. Hospital capacity, skilled nursing, and physician characteristics will be examined to
develop a profile of the resources available in Taney County.
Nursing
The number of nurses by type of license in Taney County is presented in Table 3.1 for 2011.
Table 3.1
Nurses by License Type-Taney County, 2011
2006
2
1
1
10
5
1
1
155
223
399
Acute Care Nurse Practitioner
Adult Nurse Practitioner
Adult Psych/Mental Health CNS
Family Nurse Practitioner
Nurse Anesthetist
Pediatric Nurse Practitioner
Women's Health Nurse Practitioner
LPN
RN
Total
2011
3
1
2
13
7
1
1
171
345
544
% Change
50.0
0
100.0
30.0
40.0
0
0
10.3
54.7
36.3
Source: Missouri Division of Professional Registration, 2011
Hospital Services
Skaggs Regional Medical Center reported having 160 licensed beds in 2010 (Table 3.2). Table
3.3 also provides the occupancy rate and average length of stay for Skaggs Regional Medical
Center in Branson.
33
Table 3.2
Skaggs Regional Medical Center Rooms by Type, 2008 and 2010
2008
2010
Licensed Beds
160
160
Licensed Beds Occupancy Rate
160
66%
Average Length of Stay (Days)
3.5
4.2
Open Heart Surgery Rooms
1
1
Other Operating Rooms
6
6
Number of Airborne Infection Isolation Rooms
8
8
Number of Isolation Rooms
8
8
Delivery Rooms
3
3
Source: Skaggs Regional Medical Center, 2011
Table 3.3
Skaggs Regional Medical Center Beds by Type, 2011
Inpatient Service Area
Medical Surgical (Includes Swing)
Obstetric
Intensive Care (Mixed)
Other Special Care - Type: STEPDOWN
Alcohol/Chemical
Total Hospital
Licensed
Beds
32
14
14
Staffed
Beds
28
14
14
28
160
25
120
34
Occupancy Average Length*
Rate
of Stay
85%
5 Days
40%
2 Days
75%
-75%
66%
4 Days
-4.2 Days
Table 3.4
Utilization Statistics- Skaggs Regional Medical Center, 2010
Payroll Expenses
$53,400,000 Number of Open Heart Surgeries
- Adult
Non-Payroll Expenses
$130,100,000 Number of Open Heart Surgeries
- Ped
Total Expenses
$183,500,000 Number of Cardiac Caths
Procedures
Angioplasties
Outpatient Total
133,241
CT Scans Procedures
ESWL Totals (Lithotripsies)
Emergency Visits
41,019
Excimer Laser Procedures
Gamma Knife Procedures
Surgery Total
4,291
Hemodialysis Treatments
Inpatient
1,581
PET Procedures
Outpatient
2,710
Radiation Therapies
MRI Procedures
Open Heart Surgery Rooms
1
Births
Other Operating Rooms
6
OB Level
Number of Isolation Rooms
15
Newborn Days
Number of Airborne Infection
7
Delivery Rooms
Isolation Rooms
Negative Pressure Room (Air
All
LDRP Rooms
exchange 12 times/hour
Negative Pressure Room (Air
6-12
High Risk Infant Clinic
exchange 6 times/hours
High Risk Prenatal Clinic
94
0
763
374
14,278
31
73
0
530
326
4,023
2,602
616
2
2,014
3
0
0
0
Table 3.5
Health Care-Associated Infection Reporting-Skaggs Regional Medical Center
Number of
Hospital
Rate for
Statewide National
Hospital
Infection
Similar Sized
Rate
Rate
Infections
Rate
Hospital
Medical/Surgical
0
0.0
0.9
0.9
1.7
Surgical Site Infections
0
0.0
0.7
0.6
0.7
(Low Risk Group)
0
0.0
1.7
1.4
1.4
(Medium Risk Group)
0
0.0
3.8
3.0
2.4
(High Risk Groups)
Source: Missouri Department of Health, Health Care-Associated Infection Reporting, 2011
35
The US Department of Health and Human Services, Health Resources and Services
Administration have designated Taney County as a Health Professional Shortage area in regard
to Low Income access to healthcare and Mental Health Services.
Table 3.6
Health Promotion Services-Skaggs Regional Medical Center, 2010
Diabetes Screening
Diabetes Education
Arthritis Education
Weight Management
PSA Screening
Cholesterol Screening
Heart Health Education
Fitness/Exercise Program
Smoking Cessation Program
Osteoporosis Screening
Osteoporosis Education
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Source: Missouri Department of Health and Senior Services, Community Data Profiles, 2011
Table 3.7
Utilization Statistics-Skaggs Regional Medical Center, 2009
2007
2008
2009
Licensed Beds
177
165
165
Inpatient Days
28,668
26,777
24,200
Discharges
6,514
6,483
6,503
Average Length of Stay
4.4
4.1
3.7
Occupancy
44.4
44.5
40.2
Source: Missouri Department of Health and Senior Services, Community Data Profiles, 2011
36
Physicians
The number of total Active/Associate and Board Certified physicians by specialty at Skaggs
Regional Medical Center for the year 2010 are listed in Table 3.8.
Table 3.8
Physician Staffing By Specialty, Skaggs Regional Medical Center, 2010
Active/Associate
Board Certified
41
10
2
5
0
2
5
0
37
8
2
5
0
2
5
0
4
2
4
2
Orthopedic Surgery
Plastic Surgery
General Surgery
4
4
0
4
0
4
Thoracic Surgery
Other Surgical Specialties
Anesthesiology
Emergency Medicine
Nuclear Medicine
1
2
4
27
0
1
2
4
27
0
Pathology
Psychiatry
Physical Med & Rehab
Radiology
Other Specialties
Dental Specialties
Podiatric Specialties
Total
5
5
1
1
3
0
0
3
126
1
1
3
0
0
3
120
Physician Staffing
General Practice
General Internal Medicine
Pediatrics
Cardiology
Gastroenterology
Oncology
Neurology
Other Med Specialties
Obstetrics/Gynecology
Ophthalmology
37
Emergency Room Utilization
Table 3.9 provides information regarding Emergency Room utilization by condition for Taney
County residents. A comparison with state averages is also provided.
Table 3.9
Emergency Room Visit Profile for Taney County Residents-2010
16,919
189
139
27
204
103
34
24
638
249
140
1,794
687
412
897
Taney County
Age-Adjusted Rate
405.8
4.6
3.4
0.6
4.6
2.4
0.8
0.5
15.5
6.1
3.4
43.8
17.0
10.4
19.5
Significantly
Different
H
L
L
N/S
N/S
H
L
L
H
H
H
H
H
H
H
Age-Adjusted
State Rate
356.8
8.2
5.9
0.6
4.2
1.6
1.3
1.0
10.0
2.4
2.7
34.4
10.5
9.2
17.0
105
2.3
H
1.8
662
40
2,263
360
110
196
1,314
547
854
291
45
209
156
630
1,501
361
733
4,224
436
888
958
93
147
14.5
0.8
54.9
8.4
2.7
4.7
31.5
13.5
20.1
6.8
1.1
5.0
3.7
15.5
36.3
8.7
17.8
102.7
10.4
21.6
23.7
2.3
3.6
H
N/S
L
H
L
N/S
H
H
H
L
N/S
L
L
H
H
H
H
H
L
L
N/S
H
H
12.8
0.8
56.4
5.5
5.2
4.7
24.3
7.0
18.8
7.4
1.3
6.9
5.5
11.7
22.7
5.0
10.6
99.9
11.9
22.5
23.0
1.7
2.7
Numbers
All Diseases/Conditions
Infection
Viral Infections
Neoplasms (Cancer and Other Growths)
Nutritional/Metabolic/Immunity
Diabetes Mellitus
Blood and Blood-Forming
Anemia
Mental Disorders
Alcohol- and Substance-Related Mental Disorders
Anxiety-Related Disorders
Brain/Spinal Cord/Eyes/Ears
Headache/Migraine
Otitis Media and Related Conditions
Heart and Circulation
Hypertension
Heart Disease
Stroke/Other Cerebrovascular Disease
Respiratory (Throat and Lung)
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Digestive System
Teeth and Jaw Disorders
Kidneys/Bladder/Genitalia
Urinary Tract Infections
Pelvic Inflammatory Disorders (PID)
Pregnancy/Childbirth/Reproduction
Pregnancy Complications
Skin
Bone/Connective Tissue/Muscle
Arthritis and Related Joint Disorders
Back Problems
Injury and Poisoning
Fractures
Open Wounds
Sprains and Strains
Burns
Poisoning
All rates are per year per 1,000 population and are age-adjusted to the U.S. 2000 standard population. * Fewer than 20 events in numerator; rate is
unstable. Trends are available only if each 3-year period of the moving average has an average of 20 or more events.
38
Long-Term Care Facilities
Characteristics of long-term care facilities in Taney County are shown in the following tables. In
2010, there were seven licensed nursing homes in the county with 519 licensed beds. There
are four levels of care provided by nursing homes in the state of Missouri, three levels are
provided by nursing homes in Taney County.
o Residential Care Facility I (RCF I): provides shelter, board and protective oversight;
this may include keeping and distributing medications and providing care during
short-term illnesses or recuperation.
o Residential Care Facility II (RCF II): provides additional services including supervision
of diets and providing care during short-term illnesses or recuperation.
o Intermediate Care Facility (ICF): provides personal care, basic health and nursing
care services under the daily supervision of a licensed nurse and under the direction
of a licensed physician.
o Skilled Nursing Facility (SNF): provides, skilled nursing care and treatment services
commonly performed by or under the supervision of a registered professional nurse.
Individuals living in an SNF require twenty-four hour care and other nursing
functions requiring specialized judgment and skill.
Missouri Guide for Seniors, Choosing a Long-Term Care Facility
Table 3.10 presents the number of licensed beds and days of care for the year 2010. The
average occupancy rate and the number of Medicare/Medicaid beds for the year 2010 are also
shown.
Table 3.10
Characteristics of Long Term Care Facilities- Taney County, 2010
Total
Licensed
Beds
Medicare
Beds
Medicaid
Beds
Skilled Nursing Facility
3
350
Yes
Yes
Residential Care Facility I
2
47
No
No
Residential Care Facility II
2
122
No
No
Total
7
519
39
Table 3.11
Characteristics of Long Term Care Facilities- Taney County, 2010
Alzheimer’s Ventilator
Total
Unit
Care
Skilled Nursing
Facility
Residential
Care Facility I
Residential
Care Facility II
Total
Adult
Average
Average
Day
FT
PT Minimum Maximum
Care Staff Staff Charges
Charges
3
1
1
0
2
247
16
$3,145.33
2
0
0
0
0
0*
5*
$783*
2
0
0
0
0
11
11
$1,020.5
7
1
1
0
2
258
32
$2,043.33
Table 3.11 lists the number of Alzheimer’s Units, Ventilator Care and Adult Day Care available in
long-term care facilities in Taney County. It also provides the number of staff and average
charges for these facilities.
Medicaid and Other Pay Sources
Table 3.12 presents the number of people in Taney County enrolled in the Medicaid program as
of July 1, 2010. It indicates that 8,817 residents of Taney County under the age of 65 and 633
over the age of 65 were receiving Medicaid services. Approximately 20.07% of the population
under age 65 in Taney County was receiving Medicaid services in 2010.
Table 3.12
Medicaid Participation By Age for Taney County, 2010
2006 Medicaid
2010 Medicaid
Age Groups
Participants
Participants
Percent Change
Under 1
371
509
37.2
Total Under 19
4,698
5,966
27.0
Total Under 65
6,808
8,817
29.5
65 and Over
625
633
1.3
TOTAL
7,433
9,450
27.1
Percent of Population*
Under 65 receiving
Medicaid services
18.47%
20.07%
"Medicaid Participation" in these tables refers to people with a Medicaid card. This is an
unduplicated count of those participating in Medicaid as of July 1, 2010.
40
Table 3.13
Medicaid Participation By Age and Race For Taney County, 2010
Age Groups
Number
White
African-American
Under 1
509
463
7
1 to 4
1,548
1,472
25
5
326
311
4
6
301
286
5
7 to 9
868
820
6
10 to 14
1,090
1,317
18
15 to 17
725
690
7
18
214
199
5
Total Under 19
5,581
5,558
77
19
85
81
1
20
89
84
2
21
104
98
1
22 to 24
326
318
2
25 to 34
828
782
9
35 to 44
535
508
3
45 to 54
554
527
7
55 to 64
415
394
2
Total Under 65
8,517
8,350
104
65 and Over
633
619
1
Unknown
1
1
TOTAL
9,150
8,969
105
Percent of
Population* Under 65
20.07%
"Medicaid Participation" in these tables refers to people with a Medicaid card. This is
an unduplicated count of those participating in Medicaid as of July 1, 2010.
Table 3.13 provides a more detailed description of the age groups and racial categories
receiving Medicaid services. Approximately 20.07% of the population that is under 65 years of
age in Taney County was enrolled in Medicaid in 2010.
Days of care by pay source is illustrated in Table 3.14 with a slight total increase of all pay
sources for care.
41
Table 3.14
Days of Care By Pay Source-Taney County in 2008 and 2009
Medicare
Medicaid
Other Government
Workers Comp
Self pay/No Charge
Commercial
Other
Unknown
All Pay Sources
2008
2009
16,325
5,373
110
92
2,128
4,000
186
27
28,249
14,690
6,507
161
93
2,100
4,611
98
24
28,284
Percent
Change
2008-2009
-11.1
21.1
46.4
1.1
-1.3
15.3
-50.0
-11.1
0.1
Source: Missouri Department of Health and Senior Services; Rate per 10,000; Age Adjustment Uses 2000 Standard
Population.
42
Chapter 4
Communicable Diseases
43
Reportable Communicable Diseases
Table 4.1 shows the number of communicable diseases reported for residents of Taney County.
It is evident that chronic Hepatitis C affects more residents than any other communicable
disease with a 5 year average of 49 confirmed and probable cases reported per year.
Table 4.1
Confirmed and Probable Communicable Diseases-Taney County, 2006-2010
Condition
2006
2007
2008
2009
2010
5-Year
Mean
CAMPYLOBACTERIOSIS
1
6
2
3
11
4.6
CRYPTOSPORIDIOSIS
0
0
0
0
4
0.8
E COLI SHIGA TOXIN POSITIVE
1
0
0
0
0
0.2
E. COLI O157 H7
0
0
1
1
0
0.4
GIARDIASIS
2
3
2
5
2
2.8
HAEMOPHILUS INFLUENZAE, INVASIVE
0
0
0
0
0
0
HEPATITIS A ACUTE
0
0
0
1
0
0.2
HEPATITIS B (PREGNANCY) PRENATAL
0
0
0
0
1
0.2
HEPATITIS B ACUTE
3
1
3
4
5
3.2
HEPATITIS B CHRONIC INFECTION
2
3
4
5
5
3.8
HEPATITIS C, CHRONIC INFECTION
45
53
62
53
37
50
LYME
1
4
0
0
0
1.0
MENINGOCOCCAL DISEASE
0
1
1
0
0
0.4
MUMPS
1
0
0
0
0
0.2
PERTUSSIS
0
0
0
2
0
0.2
ROCKY MOUNTAIN SPOTTED FEVER
9
9
6
9
13
9.2
SALMONELLOSIS
3
1
2
3
6
3.0
SHIGELLOSIS
0
0
0
0
15
3
STREP DISEASE, GROUP A INVASIVE
0
1
0
0
0
0.2
STREP PNEUMONIAE, DRUG-RESISTANT
0
1
1
0
1
0.4
TULAREMIA
0
1
0
0
0
0.2
VARICELLA (CHICKENPOX)
62
10
2
3
2
15.8
Source: MOHSAIC, Crystal reports, 2011
44
Enteric Illnesses
Figure 4.1 shows the number for Campylobacter cases have increased since 2006 in Taney
County. The number of cases in 2010 in the County was more than double the average number
recorded in the last 5 years.
Figure 4.1
Fig. 4.2 demonstrates that the number of Salmonella cases experienced an increasing trend
from 2007 to 2010 in Taney County.
Figure 4.2
45
Fig. 4.3 reveals that more cases of Campylobacter were reported more than any other form of
enteric illness between the years of 2006-2010 in Taney County.
Figure 4.3
Hepatitis Illnesses
Figure 4.4 demonstrates that the number of Acute Hepatitis B cases experienced an increasing
trend between 2007 and 2010 in Taney County. The number of cases reported in 2010 was
marginally above the average number cases reported in the last five years, see Figure 4.4.
46
Figure 4.4
Fig. 4.5 illustrates that the number of Confirmed and Probable chronic Hepatitis C cases
increased between 2006 and 2008, but experienced a declining trend between 2008 and 2010
in Taney County. However, in 2010 the number of reported cases declined below the 5 year
average.
Figure 4.5
47
Table 4.2 denotes the number and the rate of Hepatitis C cases in Taney County in 2009 and
2010. The rate of Hepatitis C decreased significantly from 2009 to 2010.
Table 4.2
Number and Rate of Hepatitis C Cases in Taney County, 2010
2009
Tested
Positive
2010
Number
Rate per 100,000
Number
Rate per 100,000
106
31
220.7
64.6
74
20
14.3
3.9
Percent
Change
-30.2
-35.5
Table 4.3
Mortality Rate Associated with Bacterial and Viral Infections-Taney County, 2005-2009
Cause of Death
Septicemia
AIDS/HIV
Taney County
Number
Rate Per 100,000
30
10.4
3
1.5
55
20.0
Missouri
Rate
11.8
2.0
20.7
Source: Taney County Health Department; 2011
@@ -indicates numbers are too small for calculations
Table 4.4
Hospital Discharges For Infections-Taney County, 2003-2008
Bacterial infection
Mycoses
Viral infection
Other infections- including parasitic
Immunizations and screening for infectious disease
Total for Selection
Taney County
Number
Rate
1,014
32.0
19
0.6
89
3.4
23
0.8
0
@.@
1,145
36.7
Missouri
Rate
13.8
0.7
5.7
0.7
0
20.9
Source: Taney County Health Department, 2011.
@@ -indicates numbers are too small for calculations
Sexually Transmitted Diseases
Sexually transmitted diseases have decreased in Taney County compared to 2007. However, an
increasing trend the past two years is of concern and may indicate that a need exists for
additional community education regarding the prevention of sexually transmitted diseases.
Figures 4.6-4.8 and Table 4.4 illustrate the trends in the county for Chlamydia, Gonorrhea and
Syphilis cases.
48
Figure 4.6
Figure 4.7
49
Figure 4.8
Table 4.5
Chlamydia
Gonorrhea
Syphilis
2000
48
7
1
Number of Sexually Transmitted Diseases Reported-Taney County, 2000-2010
2001
2002
2003
2004
2005
2006 2007 2008 2009 2010
53
74
74
84
75
88
109
47
53
59
13
11
22
22
20
23
23
6
6
2
0
0
0
0
2
1
4
2
1
0
Average
69.45
14.09
1
Total
764
155
11
Table 4.6
HIV and AIDS Cases, 2010 and Cumulative*-Taney County
Taney County
SW HIV Region
HIV
AIDS
HIV Diagnosed
2010
Cumulative*
4
29
1
Rate Per 100,000
45.3
69.1
2.4
Cumulative*
451
770
62
Source: Missouri Department of Health and Senior Services, 2011; *includes all cases, living and deceased.
50
Rate Per 100,000
40.4
122.8
5.6
Tick Borne Infections
Tick borne diseases reported in Taney County include Rocky Mountain spotted fever,
Ehrlichiosis, Lyme disease, Tularemia and Q-Fever. Figure 4.9 provides the number of
confirmed and probable cases of Rocky Mountain spotted fever identified in Taney County from
2006 to 2010. The number of reported cases increased between 2008 and 2010. The number of
Rocky Mountain spotted fever cases reported in 2010 was higher than the 5-year average.
Figure 4.9
Additional suspect cases of the various tick-borne diseases are reported and investigated as
well. These cases show many of the classic signs of the illnesses, but do not meet the case
definition to be classified as probable or confirmed cases.
Table 4.7
Suspect, Probable and Confirmed Tick Borne DiseasesTaney County, 2010
Ehrlichiosis
Lyme Disease
Rocky Mountain Spotted Fever
Tularemia
6
0
15
0
51
Figure 4.10
Source: Taney County Health Department 2011; *Includes Suspect, Probable and Confirmed Cases.
Figure 4.10 provides an excellent example of the incidence of tick borne diseases by month of
diagnosis. Diseases caused by tick bites occur mainly during the summer months in Taney
County. However, these illnesses have been diagnosed during winter months and very early
spring as well. Regardless of the time of year, it is best to take precautions to avoid tick bites
whenever going outdoors where ticks may be.
Immunizations
Table 4.8 shows the percentage of 2 year olds that have been adequately immunized as
assessed by DHSS during quality assurance contract monitoring in 2010.
Table 4.8
Immunization Statistics: Adequately ImmunizedTaney County, 2010
Child’s Age: 2
2005
67.0%
Taney County
52
2010
73%
Table 4.9 is a summary of selected vaccination series and the percent of children 2 years old
that were classified as being up-to-date with their immunizations. Approximately 86% of
children were adequately immunized for Polio and MMR.
Table 4.9
Percent of School Children Adequately Immunized, Grades K-12-Taney
County, 2008-2009 School Year
Select Series/Antigens
Percent Adequately Immunized
Diphtheria/Pertussis/Tetanus
Polio
Measles
Mumps 2 Dose
Mumps 1 Dose
Rubella 2 Dose
Rubella 1 Dose
Hepatitis B
Varicella
86.7
86.7
86.7
78.5
93.2
78.5
93.3
86.7
74.5
Source: State of Missouri Immunization Assessment Survey Results, 2011
53
Chapter 5
Chronic Disease and Injuries
54
Chronic Disease Mortality
Figure 5.1 demonstrates the mortality rates for all causes of death in Taney County and
Missouri. The graph shows that the mortality rate has been slightly lower in Taney County as
compared to Missouri.
Figure 5.1
Table 5.1
Number of Deaths, By Age For All Causes of DeathTaney County, 2000-2009
Age
All
Rate
Under 15
52
64.0
15 to 24
49
80.7
25 to 44
196
185.2
45 to 64
871
770.5
65 and Over
3,161
4,361.7
All Ages
4,330
835.2
Table 5.1 illustrates the number of deaths for the residents of Taney County by age. The
mortality rate in Taney County during the time period was 835.2 per 100,000 population.
55
Table 5.2 shows the profile of chronic diseases in Taney County, 1998-2008 in comparison to
the state age-adjusted rate. Taney County had several rates for hospitalizations and emergency
room visits that were higher than the state average.
Table 5.2
Chronic Disease Profile for Taney County Residents, 1998-2008
Age-Adjusted
Rate
Heart Disease
*
Hospitalizations
4,490
166.9
Emergency Room Visits
4,036
17.5
Ischemic Heart Disease
*
Hospitalizations
1,857
68.7
98
0.4
Stroke/Other Cerebrovascular Disease
*
Hospitalizations
856
31.3
253
0.9
All Cancers (Malignant Neoplasms)
*
Hospitalizations
1,089
40.5
Colorectal Cancer
*
Hospitalizations
139
5.1
Lung Cancer (SEER)
*
Hospitalizations
146
5.2
Breast Cancer
*
Hospitalizations
90
3.3
Cervical Cancer
*
Hospitalizations
32
1.5
Prostate Cancer
*
Hospitalizations
54
1.9
Diabetes Mellitus
*
Hospitalizations
346
14.7
446
2.0
Chronic Obstructive Pulmonary Disease (COPD) Excluding Asthma
Hospitalizations
384
13.8
2,085
9.3
Asthma
*
Hospitalizations
236
9.8
676
3.2
Arthritis/Lupus
*
Hospitalizations
1,226
45.8
2,392
11.2
Number of Events
Source: Missouri Department of Health and Senior Services, Community Data Profiles
Rates per 100,000 population and are Age Adjusted to the 2000 standard population
56
Significantly Age-Adjusted
Different
State Rate
H
H
160.6
12.9
H
L
60.5
0.9
N/S
N/S
31.3
0.8
N/S
40.4
N/S
5.1
N/S
5.4
H
2.4
H
0.8
L
2.7
L
H
17.5
1.7
L
H
22.9
5.2
L
L
13.5
5.2
H
H
40.5
8.6
Table 5.3 illustrates that heart disease accounted for the highest number of deaths from 2000
to 2009 for residents of Taney County with 1,232 deaths. Cancer accounted for the second
highest number of deaths during this period with 1,089 deaths, 358 of which were cancers of
the lung, bronchus and trachea.
Table 5.3
Number and Rate of Resident Deaths-Taney County and Missouri, 2000-2009
Age Group: Taney County
Under 15
Cause of Death
Number
15 to 24
Rate
Number
25 to 44
45 to 64
65 and over
Rate
Number
Rate
Number
Rate
Number
Rate
Taney
County
Rate
Missouri
Rate
All causes
52
64.0
49
80.7
196
185.2
871
770.5
3,161
4,361.7
835.2
865.0
Cancer
3
@@
1
@.@
28
26.5
314
277.8
743
1,025.2
200.8
196.8
Trachea/bronchus/lung
Cancer
0
@.@
0
@.@
7
6.6
113
100.0
238
328.4
64.1
61.4
Colon/rectum/anus
Cancer
0
@.@
0
@.@
3
@.@
30
26.5
60
82.8
17.6
29.1
0
@.@
0
@.@
4
3.8
25.7
38
52.4
13.3
14.5
0
@.@
0
@.@
1
@.@
29
2
@.@
48
66.2
9.6
8.9
Non-Hodgkin's
lymphoma
0
@.@
0
@.@
0
@.@
8
7.1
17
23.5
4.9
7.3
Leukemia
1
@.@
0
@.@
1
@.@
9
8.0
26
35.9
7.2
7.8
Diabetes
0
@.@
1
@.@
3
@.@
15
13.3
49
67.6
13.4
23.5
Alzheimer's Disease
Heart Disease
0
@.@
0
@.@
0
@.@
99
136.6
19.9
22.5
@.@
0
@.@
34
32.1
2
241
@.@
1
213.2
956
1319.1
236.5
240.5
0
@.@
0
@.@
26
24.6
164
145.1
352
485.7
103.3
75.3
0
@.@
0
@.@
2
@.@
28
24.8
205
282.9
44.5
53.8
0
@.@
0
@.@
0
@.@
1
@.@
70
96.6
14.0
3.9
0
@.@
0
@.@
5
4.7
27
23.9
20
27.6
10.2
7.2
Breast Cancer
Prostate Cancer
Acute Myocardial
Infarction
Cerebrovascular
Disease (Stroke)
Atherosclerosis#
Chronic liver disease &
cirrhosis
Source: Missouri Department of Health and Senior Services, Community Data Profile 2011. @@- indicates that numbers are too small for calculations.
57
Table 5.4 provides information on the number of deaths and mortality rates stratified by sex, in
Taney County from 2000 to 2009. During this period the top three leading causes of death
included heart disease, stroke and cancer. Other mortality rates that were higher than the
Missouri average included deaths due to Atherosclerosis, Chronic Liver Disease, Cancer, Motor
Vehicle Deaths, Kidney Disease and Pneumonia and Influenza.
Cause of Death
Table 5.4
Mortality Rates –Taney County, 2000-2009
Number
Rate Per 100,000
Male
Alzheimer’s
32
Atherosclerosis
28
Breast Cancer
0
Cancer
607
Cerebrovascular
95
Disease (Stroke)
Chronic Liver
40
Disease/Cirrhosis
Colon/Rectum/Anus
46
Cancer
Diabetes
39
Heart Disease
256
Kidney Disease
43
Leukemia
25
Motor Vehicle
75
Accidents
Pneumonia & Influenza
71
Prostate Cancer
51
Suicide
49
Trachea/Bronchus/Lung
208
Cancer
Total Deaths
2,295
Missouri
Female
Male
Female
Both Sexes
69
43
71
483
140
14.8
14.1
@@
249.5
41.5
22.0
13.4
24.6
163.8
45.7
19.9
14.0
13.3
200.8
44.5
Rate Per
100,000
20.7
3.9
14.5
196.8
53.8
12
16.6
4.4
10.2
7.2
47
19.3
16.1
17.6
29.1
29
576
51
12
29
16.8
290.1
19.7
11.4
36.3
10.1
188.3
17.4
4.0
13.4
13.4
236.5
18.1
7.2
24.5
23.5
240.5
17.4
7.8
18.5
63
0
9
150
34.4
22.9
22.6
81.5
20.4
0
4.3
50
26.1
9.6
12.8
64.1
22.7
8.9
12.9
61.4
2,035
1008.4
685.9
835.2
865.0
@@- indicates that numbers are too small for calculations.
58
Figure 5.2
Chronic Liver Disease Death Rates Per 100,000-Missouri, 2003-2008
Source: Missouri Department of Health and Human Services, 2011
Figure 5.2 illustrates the death rates of chronic liver disease by county in Missouri from 2003 to
2008. Taney County is among counties that have the highest death rates associated with
chronic liver disease.
59
Figure 5.3
Atherosclerosis deaths rates per 100,000 for those 65 and over-Missouri, 2003-2008
Figure 5.3 denotes the distribution of Atherosclerosis deaths rates per 100,000 for those 65 and
over by county in Missouri. Death rates associated with atherosclerosis in Taney County are
higher than state average.
60
Figure 5.4
Inpatient Hypertension Diagnosis, Rate Per 10,000-Missouri, 2008
Figure 5.4 depicts the rate of inpatient hypertension diagnosis in the state of Missouri in 2008.
The map shows that the rates in Taney County are higher than those in the surrounding
counties, including Stone, Christian, Douglas, and Ozark Counties.
Table 5.5 provides a comparison of the number of preventable hospitalizations of Taney County
residents by racial group and sex.
61
Table 5.5
Number of Preventable Hospitalizations By Race-Taney County,2000-2008
Number
All Races
Diagnosis
Asthma
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Dental Conditions
Diabetes
Hypertension
Nutritional Deficiencies
All Diagnoses
White
249
236
361
17
294
99
39
3,885
Black
2
1
2
1
2
0
0
22
261
237
370
18
296
99
44
4,039
Rate Per 10,000
Male Female Missouri
Total
6.1
9.3
12.9
6.0
5.4
9.4
13.2
5.8
10.7
0.8
0.3
0.8
10.8
8.4
10.3
3.6
2.1
2.5
1.1
1.3
0.7
112.0 121.1 140.5
Source: Missouri Department of Health and Senior Services, MICA
Figure 5.5 illustrates the cancer mortality rate in Taney County and Missouri between 1999 and
2009. The State has had a steady rate unlike the rates in Taney County, which has recorded a
higher mortality rate than the State average in 2001, and between 2004 and 2008. The current
trend shows that in 2009, the Taney County cancer mortality rate was slightly lower than that
of the state.
Figure 5.6 illustrates that the rate of Lung, Trachea and Bronchus cancer in Taney County and
Missouri. Taney County has recorded a higher rate of these forms of cancer on several
occasions in the last decade with the highest increase recorded between the years 2001-2003.
In the year 2009, the rate of this form of cancer has decreased above the state average.
Figure 5.5
62
Figure 5.6
Figure 5.7
Source: Community Data Profiles, 2011
63
The emergency room diagnosis of COPD has increased significantly in the past few years. Figure
5.7 illustrates the trend of three year averages for Taney County as compared to Missouri. The
rate in Taney County has been higher than the state rate for a few years since the year 2000.
Figure 5.8 illustrates the percent of deaths attributed to different forms of cancer in Taney
County from 1998 to 2008. The graph shows that lung/trachea/bronchus cancer accounted for
the highest percent of deaths with a staggering 33.3%. Ovarian cancer accounted for the
lowest percentage of 1.4%.
Figure 5.9 illustrates the rate of heart disease mortality in Taney County and Missouri. Since
1998, the mortality rates associated with heart disease in Taney County and in the state of
Missouri have experienced a downward trend. In 2008, the rates in Taney County were
significantly lower than the state rates.
Figure 5.8
64
Figure 5.9
Figure 5.10
Figure 5.10 illustrates the rate of Acute Myocardial Infarction in Taney County and Missouri.
The graph shows that the State has experienced a steady decrease in the rate of cases reported
unlike the haphazard rates recorded in Taney County. The graph reveals that the rates of cases
reported in Taney County are much higher than those of the state.
65
Figure 5.11 illustrates the mortality rate for cerebrovascular disease (Stroke) in Taney County.
There was an increase in the mortality rates in Taney County between 1998 and 2001 followed
by a steady decrease through 2008. The mortality rate for cerebrovascular disease (Stroke) in
Missouri experienced a steady decline overall.
Figure 5.11
Diabetes, Asthma, and Respiratory Diseases
Fig 5.12 Illustrates the emergency room diagnosis for diabetes and asthma in Taney County.
The graph shows that the number of cases diagnosed with asthma was higher than the number
diagnosed with diabetes between 2000 and 2009. However, the number of diabetes cases
diagnosed in the Emergency Room has been increasing in recent years.
66
Figure 5.12
Figure 5.13
Figure 5.13 displays hospital discharges of patients diagnosed with diabetes mellitus with
complications in Taney County and Missouri. The graph shows that Taney County has had lower
hospital discharges on average for patients diagnosed with diabetes mellitus compared to
Missouri.
67
Figure 5.14
Injuries
Injuries impact the life of people. They may result in economic hardships and disabilities that
affect quality of life and life expectancy. Table 5.6 shows the number of total injuries in 2009 by
zip code area in Taney County. The number of total injuries is higher in Branson, Hollister, and
Forsyth.
Table 5.6
Number of Total Injuries Requiring Medical Treatment By City-Taney County, 2009
Rockaway
Zip Code
Branson Forsyth Hollister
Bradleyville Kirbyville Protem Taneyville
Beach
Areas
Number of
2,481
509
1,089
51
41
278
36
97
Total
Injuries
The following charts and tables provide information on injuries that have occurred in Taney
County. Table 5.7 provides data on the leading causes of injuries.
68
Table 5.7
Type of Injury
Abuse/Neglect/Rape
Cut/Pierce
Fall/Jump
Fire/Burn
Firearm
Machinery
Motor Vehicle Traffic
Hot Weather
Dog Bites
Over-exertion
Poison/Overdose
Struck by/Against
All Injuries
Type of Injuries By Age Group and Gender-Taney County, 2000-2009
Taney County
Age Groups
Gender
Total
Male
Female
Under
15
25
45
65 and
15
to 24
to 44
to 64
Over
38.4
756.5
4,244.0
318.9
@@
14.7
636.7
@@
297.4
670.6
271.4
2,694.8
12,795.3
10.6
1399.9
2,641.1
371.9
19.7
72.6
3.424.2
25.7
83.1
1,982.0
495.9
3,149.1
16,903.5
23.3
1157.2
3132.9
330.9
29.3
83.6
2,180.8
32.7
104.3
2,306.6
506.6
2088.6
14,979.7
4.1
517.3
2252.8
143.6
@@
51.4
1,050.1
12.2
64.5
893.4
319.8
802.9
7,504.8
@@
285.6
4,633.6
52.0
8.9
63.5
599.2
16.5
44.4
462.1
137.1
486.2
7,926.6
17.3
854.5
3,336.3
256.6
14.1
57.0
1,577.9
18.7
127.4
1,374.5
368.6
1,888.9
12,310.8
7.4
1,141.9
3,135.0
296.1
23.3
102.8
1,526.9
27.4
138.0
1,395.7
329.7
2,365.3
13,180
Missouri
27.0
574.9
3,487.6
217.2
@@
14.3
1,627.5
10.6
115.6
1,352.1
405.2
1,415.3
11,403.3
Motor Vehicle Injuries and Deaths
Figure 5.15 demonstrates the motor vehicle accident deaths in Taney County between 2000
and 2009. The graph shows that the number of deaths resulting from motor vehicle accidents in
Taney County was lower than the average in 2009. From 2000 to 2001 the County recorded the
sharpest decrease in the number of accident deaths reported in Taney County.
Figure 5.15
69
Total
42.0
959.7
2,867.3
185.3
31.6
69.7
1,175.2
17.7
110.0
973.9
248.9
1,691.4
10,494.1
Figure 5.16
Figure 5.16 illustrates motor vehicle accident injuries for Taney County and Missouri from 2000
to 2009. The number of traffic-related accident injuries has experienced a downward trend in
Taney County and in Missouri as well. However, the rates in Taney County have been higher
than those in Missouri.
Figure 5.17
70
Figure 5.17 examines the rate of fall and jump injuries in Taney County and Missouri from 2000
to 2009. The graph shows that the prevalence rate of falls and injuries in Taney County was
higher than that in Missouri. Both the County and the State recorded about the same rate of
injuries in 2005. Between 2001 and 2005, Taney County recorded a steady decline in the rate of
fall and jump injuries followed by an overall increase through 2009.
Figure 5.18
Figure 5.18 depicts the number of fall and jump injuries stratified by age group and gender in
Taney County between 2000 through 2009. The graph indicates that females 65 years and over
had the highest number of injuries followed by males under 15 years old. The graph reveals
that females sustained more fall and jump injuries than males on average.
71
Figure 5.19
Fig 5.19 illustrates the prevalence rates of drug and alcohol related injuries in Taney County and
Missouri between 2000 through 2009. The graph shows that the rates of drug and alcohol
related injuries in Taney County were higher than those in Missouri. The graph demonstrates
that Missouri has had a steady increase in the rate of drug and alcohol related injuries. Taney
County has experienced an increasing trend in the rate of drug and alcohol related injuries since
2001. The rate of these injuries in Taney County (454 per 100,000) is significantly higher than
the state rate for 2009, 239 per 100,000.
Fig 5.20 demonstrates the rate of Over-exertion injuries in Taney County and Missouri. Taney
County has experienced a higher rate of these injuries compared to the State. There is an
overall declining trend in the rate of cases in the last four years in the County. Missouri’s rate of
over-exertion injuries has been consistent overall. The rate of these injuries in the County has
been consistently higher than the state rate since the year 2000.
72
Figure 5.20
Figure 5.21
Figure 5.21 illustrates the rates of over-exertion injuries in Taney County and Missouri between
2000 and 2009. The rates of over-exertion injuries associated with people 65 years and older in
Taney County followed a downward trend from 2000 to 2007, but increased drastically through
73
2009. The rates in Taney County were higher than the state’s rates between 2000 and 2005,
and between 2007 and 2009.
Figure 5.22
Figure 5.22 illustrates the trends of alcohol and drug injuries by gender in Taney County.
According to the graph, the rates of alcohol and drug related injury experienced an overall
upward trend for males and females. Generally, the graph depicts that females exhibit a
slightly higher rate of alcohol and drug related injuries than males. The widest gap was
recorded in 2005 when the rate of alcohol and drug related injuries for females were 502.5 per
100,000 compared to 190.6 per 100,000 for males.
Figure 5.23 denotes that the number of injuries recorded in males and females aged between
25 and 44 years old was higher than that in other age groups in Taney County between 2000
and 2009. Overall, females had a higher number of injuries associated with drug and alcohol
intake than males except for those less than 15 years old. Based on this graph, it is evident that
irrespective of gender identity, older people showed a progressive decrease in the number of
injuries as depicted by the shift in recorded level.
74
Figure 5.23
Table 5.8
Number of Assault Injuries By Race – Taney County, 1999-2009
American Indian/
Year White Black
Alaska Native
Other Unknown
1999 103
0
0
2
3
2000 143
2
0
0
3
2001 165
2
1
1
0
2002 131
2
1
1
0
2003 149
1
1
0
0
2004 187
2
1
2
1
2005 140
0
0
1
0
2006 117
2
1
1
0
2007 109
1
0
1
0
2008 103
4
0
0
0
2009 107
0
0
2
2
Table 5.8 presents information regarding the number of assault injuries by Race. Assault injuries
among the white population were highest in 2004 while the number was very low among
minorities. The rates for the assault injuries in the county by race were not obtainable due to
low numbers which could not yield stable rates.
75
Behavioral Risk Factors
Many of the numerous deaths due to cancer, diabetes, heart disease, stroke and other chronic
diseases that occur every year are the result of behaviors that negatively impact health.
Healthy Lifestyle changes can help prevent many chronic diseases. Early detection and
treatment are also important to help improve outcomes of these diseases. Table 5.9 provides
information on the behavioral risk factors that were identified among residents of Taney
County as compared to surrounding counties and the State of Missouri in 2008. An update to
the 2008 Study is scheduled for release in the spring of 2012.
Taney County had high percentages of respondents who reported smoking cigarettes, not
involved in leisure time physical activity, and being overweight or obese. Additionally, residents
reported low rates of having screening tests such as mammograms or breast exams. However,
Taney County residents reported consuming more fruits and vegetables per day than residents
in other counties.
Table 5.9
Health and Preventive Practices at the County and State Level, 2008
Counties
Taney Stone Christian Ozark Douglas Missouri
Current cigarette smoking
36.7
25.2
18.7
23.1
23.6
23.2
No leisure-time physical
activities
26.6
29.1
18.6
27.5
36.9
25.3
70.3
80.4
75.9
79.4
81.5
76.1
32.6
31.2
19
39.6
24.5
20.6
34.4
27.8
14.6
35.4
31
24.4
43.3
28.1
26.2
35.7
29.1
19.6
89
88.3
90.4
82.9
84.4
89.3
9.1
8.1
4.6
9.9
6.2
9.3
No Mammogram or Breast
Exam in Last Year-Women
Age 40 and Older
26.8
35.7
32.2
36.2
44.9
27.6
Never Had a Pap SmearWomen Age 18 and Older
22.2
23.3
3.5
2.9
25.8
3.4
Never had a sigmoidoscopy
or colonoscopy-Men and
Women age 50 and older
48.2
38.6
38.3
57.1
46.6
36.6
Less than 5 fruits and
vegetables per day
Overweight
Obese
High blood pressure
Ever had blood cholesterol
checked
Current diabetes
Source: Missouri Department of Health and Human Services, 2011. Rates are per 100.
76
Chapter 6
Minority Health Issues
77
Minority Health Issues
Figure 6.1 shows the racial and ethnic representation in the county. The white population
continued to be the predominant race. Slight increases were reported in 2010 among
Black/African American, Asian, and the Hispanic/Latino population as compared to the 2000
population.
Figure 6.1
Source U.S. Census Bureau, 2011
According to the 2010 Census, the percent of population living in poverty is illustrated in Figure
6.2. Hispanics/Latinos as well as American Indian/Alaskan natives represents approximately
30% of their Race or Ethnicity living below the Poverty level. The African/American population
is slightly under 30% of their group below the level of poverty in Taney County. Federal Poverty
Guidelines are used for determining financial eligibility for federal programs which are different
than the poverty thresholds. The thresholds are updated annually by the Census Bureau and
are used for analysis when preparing estimates of the number of Americans in poverty each
year. The Poverty Guidelines identify a person as living in poverty with a yearly net income of
$10,890 or below. A family of four would be considered as living in poverty with a yearly net
income of $22,350(MoDHSS, 2011).
78
Figure 6.2
Health Care
According to Figure 6.3, Hispanic/Latino and African American/Black have the highest number
of emergency visits in Taney County among minority groups. The trend of Hispanics/Latino
continued to increase through 2008 while Black/African Americans and other races declined
from 2007 to 2008. American Indian/Alaskan Natives as well as Asian/Native Hawaiian/Pacific
Islander stayed relatively stable during the years of 2000-2008.
79
Figure 6.3
Maternal and Child Health
Table 6.1 shows the maternal and child health indicators by race from 1999 to 2009. The overall
numbers of births among minority members was low compared to whites. The indicators
showing “mothers reporting to be 20% or more overweight” and “inadequate prenatal care”
were high among several of the groups. The percentage of mothers reporting to be unmarried
was also high among several of the groups, especially in the Black/African American
community. Overall, 39.0% of mothers reported being unmarried from 1999 to 2009.
80
Table 6.1
Maternal and Child Health Indicators by Race- Taney County, 1999 to 2009
Races
Indicator
Number of Live Births
Birth Weight: Low (less
than 2500 g)
Birth Weight: High
(greater than 4499 g)
Prenatal Care Beginning
First Trimester
Pre-natal Care
Inadequate
Prenatal Service
Utilization: Mother on
Food Stamps
Smoked During
Pregnancy: Yes
Birth Weight: Low (less
than 2500 g)- Medicaid
Births
Mother More Than 20%
Overweight
Marital Status: not
married
American
Indian/Alaskan
Native
White
Black/African
American
6,339
51
7.1
7.8
10.3
1.1
2.0
78.3
Asian/
Native
Hawaiian/
Pacific
Islander
74
Unknown
All
Races
49
6,580
8.1
2.0
7.1
5.1
1.4
0.0
1.1
68.2
84.6
60.8
34.7
77.8
18.2
18.4
20.5
31.4
35.5
18.6
27.0
30.6
44.7
19.2
16.3
27.0
26.4
15.7
25.6
17.6
12.2
26.0
7.1
7.8
10.3
8.1
2.0
7.1
35.2
36
47.4
22.9
38.5
35.2
38.8
60.8
38.5
18.9
59.2
39.0
39
Rates per 100
The death rates for the residents of Taney County by race were not provided due to the small
size of minority population. In table 6.2, the total numbers of deaths reported in Taney County
from 1999 to 2009 are shown by race and ethnicity. The numbers of deaths among the minority
population groups were significantly lower in the county because of lower population totals.
Consequently, the rate of deaths by race or ethnicity was not provided due to the state
confidentiality rule.
81
Table 6.2
Number of Deaths By Race and EthnicityTaney County, 1999 to 2009
Number of Deaths from
Race
All causes
White
Black/African-American
American Indian/Alaska Native
4,700
9
15
Asian/Native Hawaiian/Pacific Islander
Other races
Unknown
All races
11
0
5
4,740
Ethnicity
Hispanic
Non-Hispanic
30
4,740
Table 6.3 illustrates the number of deaths for the residents of Taney County by age. According
to the table, in general, the number of deaths increases with age, with the highest numbers
recorded among the residents aged 65 years and older and lowest for the age group less than
15 years.
Table 6.3
Number of Deaths By Age For All Causes of Death In
Taney County, 1999-2009
Age
Under 15
15 to 24
25 to 44
45 to 64
65 and Over
All Ages
African
American/Black
White
2
0
1
4
2
9
54
53
210
935
3,447
4,700
American
Indian/Alaskan
Native
0
0
1
2
12
15
82
Asian/Native
Hawaiian/Pacific
Islander
0
2
2
3
4
11
All
Hispanic
56
55
214
944
3,470
4,740
2
2
4
7
15
30
Table 6.4
Births By Mothers on Medicaid By Race-Taney County, 1999-2009
Medicaid Status
Number of Medicaid Births
Percent of Total Medicaid Births
Total Births By Race or Ethnicity
Percent of Group’s Total Births
Race
American
Asian/Native
Black/AfricanOther
All
White
Indian/Alaska Hawaiian/Pacific
Unknown
Hispanic
American
Races
Races
Native
Islander
4,118
32
29
45
23
36
4,283 341
96.2
0.8
0.7
1.1
0.5
0.8
100.0 7.96
6,339
51
39
74
28
49
6,580 447
76.3
65.0
62.8
74.4
60.8
82.1
73.5
65.1
Table 6.4 shows the number of births by mothers on Medicaid by race and ethnicity. Births by
white mothers in Taney County between 1999-2009 represented 96.2% of all Medicaid births
and 65% of total births for the white population. This compares to 62.8% of total births from
1999-2009 for the African-American category were on Medicaid. The highest percentage of
total births that were on Medicaid was the American Indian/Alaska Native which totaled 74.4%.
However, “Other Races” category represents 82.1% of total births were on Medicaid.
Table 6.5 represents the percent of inpatient hospital discharges by pay source stratified by
Race or Ethnicity.
Table 6.5
Percent of Inpatient Hospital Discharges By Pay Source and Race or EthnicityTaney County, 1999-2009
Medicare Medicaid
White
Black/African
American
American
Indian/Alaska
Native
Asian/Native
Hawaiian/Pacific
Islander
Other Races
Unknown
All Races
Hispanic
Other
Workers Self-pay/No
Commercial
Government Comp
Charge
%
%
%
%
0.5
0.7
8.4
19.8
Other
Unknown
%
1.3
%
0.1
All Pay
Sources
Number
54,492
%
51.0
%
18.2
16.6
36.8
0.0
1.2
23.3
20.9
1.2
0.0
163
28.0
36.0
0.0
0.0
22.0
10.0
4.0
0.0
50
16.9
39.8
0.0
0.0
13.3
24.1
6.0
0.0
83
22.5
31.1
51.2
31.0
25.5
18.6
1.0
0.5
0.5
1.3
0.5
0.7
15.7
13.0
8.7
24.5
26.2
19.9
3.8
8.3
1.4
0.0
1.2
1.2
902
408
56,098
8.9
50.4
0.2
1.4
26.8
10.9
1.2
0.2
514
83
Table 6.7
Birth Characteristics By Ethnicity-Taney County, 1999-2009
Hispanic
Indicator
Non-Hispanic
Number
Percent
Percent
Birth Spacing: Less Than 18 Months
29
10.6
12.8
Birth Weight: Low (less than 2500 g)
28
6.4
7.1
Birth Weight: Normal (2500-4499 g)
400
91.7
91.9
Birth Weight: High (greater than 4499 g)
8
1.8
1.1
188
43.1
22
Gestation: Low Birth Weight and Full Term
8
2.1
2.6
Gestation: Preterm (less than 37 completed weeks)
53
12.2
11.3
Gestation: Singleton Births Small For Gestational Age
33
7.8
9.3
Marital Status: Not Married
215
49.3
38.3
Method of Delivery: C-Section
127
29.1
28.7
2
2.9
5.8
Prenatal Care: Began First Trimester
299
69.4
79.5
Prenatal Care Adequacy (Missouri Index): Inadequate
120
28.1
17.9
Prenatal Service Utilization: Mother on Food Stamps|
68
16
27.7
Prenatal Service Utilization: Mother on Medicaid
333
78.2
65.4
Prenatal Service Utilization: Mother on WIC
350
82.2
61.6
Prior Live Births: Four or More
33
7.6
4.8
Prior Live Births: Mother Under Age 20
10
2.3
2.5
Smoked During Pregnancy: Yes
Unintended Delivery: Includes Live Births and Fetal Deaths
22
204
5.0
46.7
27.5
37.7
Weight Change: Gained Less Than 15 Pounds, Full Term Singleton Birth
41
11.2
9.7
Weight Change: Gained More Than 44 Pounds, Full Term Singleton Birth
40
10.9
19.4
Weight for Height: Mother Overweight 20% or More
143
35.0
35.3
Weight for Height: Mother Underweight More Than 15%
19
4.7
6.5
Weight for Height (Overweight): Mother's BMI Between 25.0 and 29.9
107
26.2
21.0
Weight for Height (Obese): Mother's BMI 30 or Greater
Live Births
70
436
17.2
20.9
Education Status: Less Than 12 Years
Method of Delivery: Vaginal Birth After C-Section
Table 6.7 provides a comparison of birth characteristics among Hispanic and Non-Hispanic births.
Hispanic mothers had better rates for many of the indicators as compared to the Non-Hispanic
population, such as smoking during pregnancy (5.0% versus 27.5%) and obesity (17.2%). However,
Hispanic mothers did have less favorable percentages in other important characteristics such as
inadequate prenatal care, overweight, and beginning prenatal care during the first trimester.
84
Chapter 7
Maternal and Child Health
85
Characteristics of Live Births
The number of live births in Taney County has increased dramatically from 2005 to 2009.
Previously, this rate had remained stable from 2000 to 2005 as shown in figure 7.1.
Figure 7.1
The rate of new mothers in Taney County and Missouri who reported having four or more prior
live births is shown in figure 7.2. Taney County rates have demonstrated an increasing,
although fluctuating, trend since the year 2000.
Figure 7.3 illustrates the trend of normal birth weight births in Taney County and Missouri
between 1999 and 2009. In general, the percentage of normal birth-weight births in Taney
County has been higher than the state average. The highest percentage reached in Taney
County was 95% in 2000, but since 2006 the County has been experiencing a downward trend.
In 2009, Taney County and Missouri normal birth-weight birth percentages were equal.
86
Figure 7.2
Figure 7.3
87
Figure 7.4
Figure 7.4 indicates that the rate of low birth weight in the state has remained about 8 percent
since 1999. The Taney County rate increased from 3 to 8.5 percent (2000 and 2004
respectively). In 2009, the county rate and the state rate were similar.
Figure 7.5
88
The rate of high birth weights in Missouri showed a decline from 1999 to 2005 and remained
constant afterward, while the county rate has fluctuated throughout the time period. In 2009,
the county rate was slightly lower than the state rate as indicated in figure 7.5.
Figure 7.6
Figure 7.6 showed no significant difference between the county and the state rate of mothers
reporting to be unmarried. The overall trend was upward for the county and the state rates. In
2009, approximately 46 out of every 100 births were to unmarried women.
The percent of pregnant women who began prenatal care in their first trimester in Taney
County and the state level between 1999 and 2009 is shown in figure 7.7. The state data
indicates a stable and higher rate than the county rate. However, in 2009 state rate was the
same as Missouri rate.
89
Table 7.7
Figure 7.8
Figure 7.8 denotes the percent of pregnant women receiving inadequate prenatal care in Taney
County. From 2002 to 2008 a downward trend has been observed. In 2009, the percent of
pregnant women receiving inadequate prenatal care in Taney County was lower than the state
rate (9.6% versus 11.5%).
Whereas the percent of women who gave birth having no prenatal care in Missouri declined
from 2000 through 2008, the county rates fluctuated and were lower than the state rates in
90
general, according to figure 7.9. The only time when the county rate was higher than the state
rate was in 2007. Both rates were less than or equal to one percent since 1999.
Figure 7.9
In figure 7.10, the rates of mothers who smoked during pregnancy in Taney County ranged
between 24 and 28 percent from 1999 to 2009. These rates were higher than the state average,
which were between 16 and 19 percent. The standard deviation (measure of variability) of the
percent of mothers who smoked during pregnancy in Taney County was higher than that of the
state (1.01 versus 0.47).
Figure 7.10
91
Figure 7.11 indicates that the rates of overweight (20% or more overweight for height) mothers
in Taney County were slightly lower than those of Missouri between 1999 and 2003 and from
2004 to 2009. The overall trends of the county rates and the state rates were upward.
Figure 7.11
Figure 7.12
92
In 2005, approximately 20 percent of mothers in both Taney County and Missouri had a weight
gain of more than 44 pounds during their pregnancy (Figure 7.12). In 2009, the rate in Taney
County was lower than that of the state.
Figure 7.13 shows that Taney County had experienced an overall declining trend between 1999
and 2004 in the rates of mothers who were underweight (more than 15 pounds underweight
for height). But since 2004, the trend line was moving upward. The graph also illustrates that
the state rates experienced an overall decreasing trend between 1999 and 2009.
Figure 7.13
Figure 7.14
93
Approximately 8.5 percent of mothers in Missouri had a weight gain of less than 15 pounds
during pregnancy from 1999 to 2009. On the other hand, Taney County had fluctuating rates
that peaked in 2004. Both regions had about 9 percent in 2009 as depicted in figure 7.14.
Figure 7.15 demonstrates the rate of births to mothers with less than 12 years of education in
Taney County and Missouri. The rate in Taney County was higher than the states rate since the
year 1999. The county rate was 24% in 2009, while the state percentage was 17.1.
Figure 7.15
Figure 7.16
94
Figure 7.16 illustrates pregnancy outcomes in Taney County from 1999 to 2009. The graph
denotes that the percent of live births is significantly high (over 92%). Less than seven percent
of pregnancies ended with an abortion.
Table 7.1 shows birth characteristics for mothers, stratified by years of education between 1999
and 2009. The table indicates behaviors and risk factors that vary according to level of
educational attainment. Mothers with less educational achievement ( especially less than 12
years) tend to have shorter birth spacing, lower birth weight, less prenatal care beginning first
trimester, more inadequate prenatal care, and smoke during pregnancy. In addition, the table
demonstrates that less educated mothers rely heavily on state assistance, including food
stamps, Medicaid, and utilization of WIC services.
Table 7.1
Birth Statistics to Mothers By Years of Education- Taney County, 1999-2009
Years of Education
Indicator
All
00-11
12
13-15
16 or
more
Number
Rate
Birth Spacing: Less Than 18 Months
17.7
11.5
13.8
8.0
443
12.7
8.7
7.3
5.5
6.2
423
7.0
90.8
91.8
92.6
92.1
5,541
91.8
0.6
0.9
1.9
1.7
70
1.2
67.8
42.8
22.8
7.9
2,350
38.9
69.8
77.8
83.8
91.0
4,718
79.2
Prenatal Care: Inadequate
26.1
18.5
15.2
8.9
1,063
18.1
Prenatal Service Utilization: Mother on Food
Stamps
Prenatal Service Utilization: Mother on
Medicaid
Prenatal Service Utilization: Mother on WIC
48.2
30.6
17.4
3.6
1,624
27.5
93.0
74.7
53.7
24.1
3,929
66.3
86.8
71.0
50.5
23.5
3,707
62.6
5.6
4.2
5.5
5.2
301
5.0
48.0
28.4
13.8
3.9
1,565
25.9
Weight for Height: Mother Underweight More
Than 15%
Weight for Height: Mother Overweight 20% or
More
9.6
6.1
4.9
4.6
373
6.4
31.3
38.2
38.4
31.0
2,055
35.4
Indicators for mothers on WIC between 2000 and 2008 are shown in Table 7.2. A comparison
between Taney County rates and the state rates is provided. According to the table, the rate of
breast fed children is higher in Taney County compared to that of the state as a whole (62% vs.
46%). Likewise, up-to-date immunization rates are higher in the county. However, the rate of
underweight for length infants in Taney County is lower than the state rate. In addition, the rate
95
of infants at risk of becoming overweight in Taney County is higher than the state rate
according to Table 7.2.
Table 7.2
WIC Infants Statistics, Rate Per 100 - Taney County and Missouri, 2000-2008
Indicator
Birth weight - low (less than 2500 grams and includes very low)
Birth weight - high (4000 grams or more)
Currently breast feeding - fully
Immunizations - up to date
Underweight for length - (less than or equal to 10th percentile)
Overweight for length - WIC (greater than or equal to 95th percentile)
At Risk of becoming overweight
Taney
County
7.9
7.6
62.3
85.4
4.7
5.2
13.3
Missouri
9.3
7.2
46.3
72.1
13.7
4.9
9.3
Source: Missouri Department f Health Senior Services, MICA, 2011
Table 7.3
Maternal and Child Health Characteristics of Medicaid Mothers,
Rate Per 100 - Taney County, 1999-2009
Indicator
Education Status: Less Than 12 Years
Gestation: Low Birth Weight and Full Term
Prenatal Care: Inadequate
Prior Live Births: Mother Under Age 20
Weight for Height: Mother Overweight 20% or More
Weight for Height: Mother Underweight More Than 15%
Medicaid
Mothers
7.7
91.3
1
33.2
2.9
53.5
74.1
22.2
5.8
3.1
34.9
35.9
7.2
All Mothers
7.1
91.8
1.1
23.4
2.6
39.0
78.8
18.6
5.0
2.5
26
35.2
6.4
Source: Missouri Department of Health Senior Services, MICA, 2011
Table 7.3 depicts the rates of maternal and child health characteristics of Medicaid mothers in
Taney County between 1999 and 2009.
Prenatal service utilization statistics are shown in Figures 7.17 through 7.19. In each service
area such as food stamps, Medicaid and WIC, the percentage of mothers utilizing these services
is higher than the state rate. The overall trends in all service areas were upward. In 2009, the
rate of mothers on Medicaid and the percent of mothers using the WIC services were similar
(figure 7.19).
96
Figure 7.17
Figure 7.18
97
Figure 7.19
Figure 7.20
The percentage of mothers who indicated that they plan to breast feed has increased steadily
in Taney County and Missouri from 2000 to 2008 (Table 7.20). During this time, the Taney
County Rate has been higher than the state rate.
98
Several pregnancy indicators are reviewed in the following figures for mothers who participate
in the Women, Infants, and Children program. Indicators measuring weight, the number of
prior live births, birth spacing, and smoking are shown.
Figure 7.21
Figure 7.22
99
Figure 7.23
Figure 7.24
100
Figure 7.25
Figure 7.26
The rate of WIC mothers who smoke in Taney County has been higher than the state rates for
those smoking three months prior to pregnancy and those reporting that they smoked in the
last seven days as well (Figures 7.25 and 7.26). WIC mothers also reported higher rates of
others smoking in the household. (Figure 7.27)
101
Figure 7.27
Figure 7.28
The rates of WIC Mothers employed at the time of postpartum visit, have been much higher in
Taney County than the state rates between 2000 and 2008.
102
Chapter 8
Local Public Health Services
103
Taney County Health Department Profile
Jim Berry, Administrator
Secondary
Address:
Phone:
Fax:
e-mail:
15479 Hwy. 160
P.O. Box 369
Forsyth, MO 65653
417/546-4725
417/546-4727
[email protected]
Toll Free #
Office Hrs:
1-888-707-4727
7:30 - 4:30
Toll Free #
Office Hrs:
Primary
Address:
Phone:
Fax:
e-mail:
320 Rinehart Road
Branson, MO 65616
417/334-4544 (Ph)
417/335-5727 (Fax)
8:00-4:30
Web Site: http://www.taneycohealth.org
Governing Body: Board
Advisory Board: Yes
Mill Tax Rate:$ 0.1404
Ordinances: Animal Control; Fee for Service; Prohibiting Accumulation of Waste Materials and Nuisance in County; 1999 National
Food Code (Countywide)
Primary Focus: Improve the health and environment of the community through leadership, education and coordination of services.
Board Chair:
Walt Stone
902 Canal Street
Branson, MO 65616
417-334-6704 417-230-5844 cell
County Commissioner:
Ron Houseman
P.O. Box 1086
Forsyth, MO 65653
417-546-7204
Services Offered:
Blood Pressure Screening
Child Car Seat Education
Children's Dental Clinic
Community Health Program Planning
Communicable Disease Testing and Follow-up
Disease Surveillance and Data Analysis
Emergency Response Planning
Comprehensive Environmental Health Services Including: Animal Control, Daycare, Lodging and Restaurant Inspections, Certified
Laboratory, Pool Monitoring and Vector Control
Family Planning
Immunizations for Children and Adults
Flu Shot Clinics
Lead Screening
MC+ Applications
Prenatal Case Management
Pregnancy Testing and Temporary Medicaid
Public Health Education
Resource Referrals
STD/HIV Testing and Counseling
School Health
Show Me Healthy Women
TB Testing
WIC
Contracts with DHSS:
Child Care Facility Inspection
Core Public Health Functions
Emergency Response
Maternal and Child Health (MCH)
Show-Me Healthy Women
WIC
Multi-county Agreements Relating to Public Health: None
Total Revenue (2009): $3,427,545.00
Local Contribution (2009): $1,510,581.00
# of Licensed Child Care Facilities: 58
Capacity: 1,260
# of Hospitals: 1
Population as of 7/01/10: 51,675
# of RHCs: 8
# of FQHCs: 0
Ratio of Physicians Per Population: 1:588
Ratio of RNs Per Population: 1:148
MO HealthNet Managed Care (Fee for Service or Captivated Rate): Fee for Service
104
The environmental services provided by the Taney County Health Department include: food,
lodging, pool, tattoo/massage, and daycare inspection programs; animal control; nuisance
compliance; well water testing; West Nile mosquito and bird surveillance programs; emergency
preparedness; as well as handling any threat or situation that may present an imminent hazard
to public health. The environmental health chapter, Chapter 2, of this assessment provides an
overview of the environmental health services provided in Taney County. The following tables
provide information on the other services provided by the Taney County Health Department.
Women, Infants and Children (WIC) Program
The Taney County Health Department provides many services that address maternal, child, and
family health activities. The following tables provide information on the services provided
during 2010.
The WIC services provided in Taney County decreased from 2009 to 2010, with the total
number of enrolled clients decreasing by 5.8%. This increase was a result of the number of
women and infants enrolling in the program. The number of women and infants enrolled in the
program fell by 9.8% and 15.3% respectfully.
Table 8.1
Women, Infants and Children (WIC) Program Activities
Taney County, 2010
WIC Clients Enrolled (total)
Women
Infants
Children
Average Monthly caseload
Average new clients each month
Average clients re-certified each month
Physician referrals from WIC Staff
2009
25,922
6,153
5,907
13,862
2,160
88
450
303
2010
24,407
5,585
5,006
13,816
2,034
85
472
409
Number
Change
-1,515
-568
-901
-46
-126
-3
22
106
Percent
Change
-5.8
-9.2
-15.3
-0.3
-5.8
-3.4
4.9
35.0
Dental Clinic Services for Children
In 2010 a total of 2,545 total dental visits were provided for children receiving Medicaid in
Taney County. During these visits, 279 extractions, 358 dental sealants, and 1,440 Fluoride
treatments were provided. (Table 8.2)
105
Table 8.2
Dental Clinic Services for Children
Taney County Health Department, 2010
Total Dental visits
Total Dental extractions
Total Dental Sealants
Visits to OACAC (early Headstart-exam & Fluoride)
Tubes of toothpaste supplied
Toothbrushes supplied
Oral Hygiene Instructions Given
Fluoride Treatments Given
2009
2010
2,458
226
169
6
1,391
1,391
1,398
1,391
2,545
279
358
6
1,456
1,456
1,456
1,440
Percent
Change
3.5
23.4
111.8
0.0
4.7
4.7
4.1
3.5
Nursing Activities
Many nursing activities are routinely provided by the Taney County Health Department. In
2010, nurses provided 869 blood pressure checks, 1,348 family planning visits, 520 pregnancy
tests, and filed 425 temporary Medicaid applications (Table 8.3).
Table 8.3
Nursing Activities-Taney County Health Department, 2010
2007
2010
Number
Change
Percent
Change
1,113
869
-244
-21.9
School Nursing Days
80
0
-80
-100
Number of People-Case management
137
103
-34
-24.8
1,380
1,348
-32
-2.3
Depo Provera
94
69
-87
-92.6
Pregnancy Tests
575
520
-55
-9.6
TEMP Medicaid Applications Filed
580
425
-155
-26.7
Blood Pressure Checks
Family Planning Visits
Providing vaccines and immunizations are an important public health service provided by the
Taney County Health Department for all residents of Taney County. A well-trained nursing staff
at the Forsyth and Branson offices provides these services. Between 2007 and 2010, the total
number of vaccines provided to children through the Vaccine For Children (VFC) program
increased from 1,543 to 3,737 or 142.2%. 3,560 adults and children were provided 6,353
vaccinations in Taney County for 2007.
106
Table 8.4
Vaccination Activities-Taney County Health Department, 2010
Vaccine for Children Program (Total Vaccinations)
Total Vaccinations, 18 years of age and under
Total Adults Vaccinated, 19 years of age and over
Total Adults and Children Vaccinated
Vaccinations Provided
Varicella
Pertussis
Tetanus
Influenza
Hepatitis B
Hepatitis A
MMR
Total of Above Vaccinations
2007
1,543
2,370
868
3,238
2010
3,737
7,292
877
3,560
Number
Change
2,194
4,922
9
108
Percent
Change
142.2
207.7
1.0
9.9
235
1,572
1,828
2,700
604
423
482
7,844
599
1,578
75
1,300
763
1,490
548
6,353
264
6
-1,753
-1400
159
1,067
66
-1,491
154.9
0.4
-95.9
-51.9
26.3
252.2
13.7
-19.0
Table 8.5
Adult Hepatitis Prevention Nursing Activities-Taney County, 2010
Adult Hepatitis A
Adult Hepatitis B
2007
358
127
2010
1490
763
Number Change
1,132
636
Percent Change
316.2
500.8
Communicable Disease Activities
Communicable disease activities provided by the Taney County Health Department are
summarized in Table 8.6. From 2009 to 2010, the total number of communicable diseases
investigated decreased from 188 to 150, a 20.2% decrease. During this same time period,
Tuberculosis services increased by 10.4%. (Table 8.6)
107
Table 8.6
Communicable Disease Activities-Taney County Health Department, 2010
Gastrointestinal illnesses reported (Campylobacter, Crypto,
Giardia, Hep A, Salmonella, E.Coli, Shigella)
Tick and Mosquito-borne illnesses reported (Ehrlichiosis, Lymelike illness, malaria, RMSF, tularemia, WNV)
Hepatitis B-Chronic, Acute, Prenatal (Confirmed, Probable,
Suspect)
Hepatitis C-Chronic, Acute (Confirmed, Probable, Suspect)
Influenza A, B and untyped
Pertussis (Confirmed, Probable, Suspect)
Varicella (Confirmed, Probable, Suspect)
Number
Change Percent Change
2009
2010
15
41
26
173.3
9
21
12
133.3
13
7
-6
-46.2
55
42
-13
-23.6
157
14
-143
-91.1
2
1
-1
-50.0
3
2
-1
-33.3
Total CD cases investigated (Confirmed, Probable, Suspect)
188
150
-38
-20.2
Tuberculosis Services
Clinical Laboratory Services
929
554
1026
669
97
115
10.4
20.8
Table 8.7
Sexually Transmitted Disease Services-Taney County, 2010
STD/HIV Testing and/or Treatment
HIV Testing
STD Treatments
STD tests administered (total)
STD positive tests (total)
Gonorrhea
Chlamydia
Syphilis
HIV
2009
532
-416
32
2
32
0
0
2010
550
512
38
0
38
2
0
Number
Change
18
-96
6
-2
6
2
0
Percent
Change
3.4
-23.1
18.8
-100
18.8
100
--
Community Health Education
Many activities provided by the Taney County Health Department are intended to increase
awareness in the community about health related issues so that behaviors can be changed to
prevent further illnesses. The Taney County Health Department coordinates many of these
activities with community partners through developing coalitions to focus on specific problems.
In 2006 many new programs were initiated including those addressing nutrition and tobacco
use prevention.
108
Table 8.8
Community Health Education-2010
2009
2010
Number
Change
Percent
Change
Community Health Presentations offered
14
4
-10
-71.4
Health Fairs Attended
Press Releases Issued
Live Media Interviews
2
25
3
2
37
3
0
12
0
0.0
48.0
0
Chronic Disease Newsletter Copies Distributed
250
0
-250
-100
150
113
-37
-24.7
475
417
-58
-12.2
150
113
-37
-24.7
--
21
21
--
--
1,870
1870
--
Child Car Seat Installation and Inspection Events
2
2
0
0
Child Car Seat Inspections
66
70
4
6.1
Number of People on Chronic Disease Newsletter
Distribution List
Communicable Disease Newsletter Copies
Distributed
Number of people on Communicable Disease
Newsletter Distribution List
Tobacco Prevention Presentations
Students Attending Tobacco Prevention
Presentations
Administrative Services
The Taney County Health Department provides many administrative services such as providing
certified copies of birth and death certificates. Over 2,000 certified copies of birth certificates
were provided in 2006. Other administrative services would include billing and providing other
types of documentation of public health records (Table 8.9).
Table 8.9
Administrative Services-Taney County Health Department, 2010
Certified copies of Birth
Certificates issued
Certified copies of Death
Certificates issued
2009
2010
Number
Change
Percent
Change
1,770
1,632
-138
-7.8
2,150
2,135
15
-0.7
Emergency Preparedness
The Taney County Health Departments is active partners with other emergency response
agencies in the community. Taney County Health Department is a member of the Local
Emergency Planning Committee (LEPC) and the Tri-lakes Emergency Health Planning Task Force
109
(TLEHPTF). These groups meet regularly to discuss issues, review plans, participate in exercises,
and provide updates regarding current activities.
In 2010, the Taney County general population shelter and alternative care site Full Scale
Exercise AFTERSHOCK was developed to test Taney County’s Mass Care (Sheltering, Feeding,
and Related Services) and Onsite Incident Management capabilities, as well as Stone County’s
Volunteer Management Capabilities. The exercise planning team was composed of numerous
and diverse agencies, including Branson Hilton and Convention Center, College of the Ozarks,
City of Branson Emergency Management, City of Branson Fire Department, City of Branson
Police, Missouri State Emergency Management Agency (SEMA), Taney County Ambulance
District, Taney County Emergency Management, Taney County Health Department, The
American Red Cross, Skaggs Regional Medical Center, Southwest Center for Independent Living,
Stone County Health Department, Western Taney County Fire Protection District. The exercise
planning team began meeting in December 2009 as part of the Tri-Lakes Emergency Task Force.
The exercise planning team discussed location to hold the exercise, volunteer role player
recruitment, agency participation, liability, public information needs, incident command
structure, volunteer reception center organization, personnel plans, lack of funding,
communications, security needs, objectives, exercise timeline, HSEEP requirements, EEGs and
TCLs, moving and storage of medical cache, use of role players with actual access and functional
needs, general population shelter registration process and interface with alternative care site
triage, safety considerations, shelter floor plan, controller and evaluator assignments, and
injects. Major barriers encountered during the exercise planning process included:
transportation for those with functional and access needs; funding for food items and
preparation for feeding operations; recruitment of role player volunteers; availability of
convention center and identification of alternative location; development of process for the
volunteer reception center; re-location of medical cache; liability considerations for exercise
participants and real event; staff availability and funding for staff time; and changing planning
requirements for access and functional needs populations
Table 8.10 provides additional information regarding emergency preparedness and response
activities.
Table 8.10
Emergency Response Activities-Taney County, 2010
Exercises
Trainings Provided
Outbreaks Investigated
Community Presentations on Disease Prevention
or Emergency Preparedness
2009
2
18
4
2010
4
7
5
Number Change
2
7
1
Percent Change
100
-61.1
25.0
29
16
-16
-44.8
110
Chapter 9
Senior Issues
111
Senior Issues
Taney County has a diversification of age typical of most areas in the Midwest that are a
combination of rural areas and small cities. Table 9.1 outlines the demographics as it relates to
different age groups within Taney County. Figure 9.1 below shows this same age diversification
in bar graph form.
Table 9.1
Population Estimate By Age Group - Taney County, 2009
Taney County
45 - 54
55 - 64
65 - 74
75 - 84
6,419
6,135
4,977
2,550
Figure 9.1
112
85 and Total for
Over Selection
916
20,997
Table 9.2
Population By Age and Gender -Taney County, 2009
Age Group
45 - 54
55 - 64
65 - 74
75 - 84
85 and Over
Total
Male
Female
Total
2008
Total
2009
3,107
2,860
2,314
1,134
357
9,772
3,312
3,275
2,663
1,416
559
11,225
6,414
6,031
4,769
2,472
889
20,575
6,419
6,135
4,977
2,550
916
20,997
Percent
Change
2008 to
2009
0.1
1.7
4.4
3.2
3.0
2.1
Table 9.2 depicts the population of older adults aged 45 years old and over in Taney County in
2009. The population is stratified by age and gender. The overall percentages were 47.5% male
and 52.5% female in 2009. By age group, the percentages were 48.4% male and 51.6% female
in the 45-54 age group; 46.6% male, 53.4% female in the 55-64 age group; 46.5% male, 53.5%
female in the 65-74 age group; 44.5% male, 55.5% female in the 75-84 age group; and 39.0%
male, 61.0% female in the 85 and over age group. The percentages of older female adults are
higher than those of their male counterparts in all age groups, especially in the last age group.
In addition, the table shows that the number of people in all age groups increased from 2008 to
2009. The 65-74 age group experienced the highest growth rate.
Chronic Disease
Figure 9.2 illustrates that the overall rates of cancer deaths for those 65 years old and over in
Taney County have been lower than those of the state between 1999 and 2011. From 2004 to
2006, the county rates stayed the same while the state rates showed a slight drop. The rates for
both Taney County and state remain high, between 870 per 100,000 and 1,160 per 100,000 for
the last decade.
113
Figure 9.2
Figure 9.3 illustrates the rates of Cancer Mortality for people 65 years old and over who lived in
Taney County compared to Missouri rates for the same age group between 1999 and 2009.
Colorectal carcinoma, lung cancer, and breast cancer were significantly lower for Taney County
residents compared to the higher rate for Missouri residents, while esophageal and pancreatic
cancers showed a marked increase for Taney County residents.
114
Figure 9.3
Table 9.3 provides a comparison of cancer mortality rates between Taney County and Missouri
from the year 1999 to 2009 for those 65 years of age or older. Overall, Taney County had a
lower rate of death due to cancer as compared to Missouri. (Table 9.3)
115
Table 9.3
Cancer Mortality Rates Per 100,000 For Those Over 65 Years of AgeTaney County 1999-2009
Taney County
Missouri
Cancer Site or Type
Number
Rate
Rate
Lip/ oral cavity/ pharynx
9
11.4
10.6
Esophagus
28
35.5
22.0
Stomach
12
15.2
17.9
Colon/rectum/anus
67
85.1
116.5
Liver and intrahepatic bile ducts
16
20.3
23.2
Pancreas
57
72.4
63
Larynx
8
10.2
6.4
Trachea/bronchus/lung
255
323.7
346.9
Skin
Breast
Cervix uteri
Uterus
Ovary
Prostate
Kidney and renal pelvis
Bladder
Meninges/brain/other parts of
central nervous system
Hodgkin's disease
Non-Hodgkin's lymphoma
Leukemia
Multiple myeloma and
immunoproliferative neoplasms
All other and unspecified
malignant neoplasms
Total for Selection
9
40
2
8
12
52
18
14
16
11.4
50.8
2.5
10.2
15.2
66.0
22.9
17.8
20.3
13.3
70.6
4.0
14.0
25.1
67.7
24.0
27.0
18.3
1
39
27
23
1.3
49.5
34.3
29.2
1.5
45.6
46.3
24.3
85
107.9
123.9
798
1,013.0
1,112.4
Table 9.4 provides a comparison of mortality rates for those over 65 years of age in Taney
County and Missouri. Taney County had higher mortality rates for atherosclerosis, pneumonia
and influenza, liver disease, and suicide deaths from 1999 to 2009. (Table 9.4)
116
Table 9.4
Mortality Rates Per 100,000 For Those Over 65 Years of AgeTaney County, 1999-2009
Taney County
Cause of Death
Cancer
Diabetes
Alzheimer’s Disease
Heart Disease
Cerebrovascular disease (Stroke)
Atherosclerosis#
Pneumonia & influenza#
Liver Disease. Cirrhosis
Kidney
Motor Vehicle Accident
All other Accidents
Suicide
Total all causes
Number
798
56
106
994.9
229
68
140
22
84
19
54
19
3,470
Missouri
Rate
1,013.0
71.1
134.6
1,339.3
290.7
141.6
177.7
27.9
106.6
24.1
68.6
24.1
4,405.1
Rate
1,112.4
141.8
182.0
1,656.8
400.2
32.5
171.4
22.4
120.5
23.4
88.5
15.8
5,264.2
Table 9.5 provides information on the number and rate of ER diagnoses of Taney County
residents whose ages range from 45 to 64 and 65 years old and over between 1999 and 2009.
The number and rate of patients diagnosed with Alcohol and substance-related mental
disorders, Diabetes, Affective disorders, Schizophrenia, and Anxiety were higher in the 45-64
age group, while Senility and organic mental disorders were higher in the 65 and older age
group.
Table 9.5
Emergency Room Diagnosis Taney County, 1999-2009
45 - 64
Rate Per
Number
1,000
114
0.9
155
1.3
Diagnosis
Diabetes mellitus without complication
Diabetes mellitus with complications
Alcohol and substance-related mental
disorders
Senility and organic mental disorders
Affective disorders
Schizophrenia and related disorders
Anxiety - somatoform - Dissociative - and
personality disorders
@. @ indicates numbers were too low for rate calculation
117
65 and Over
Rate Per
Number
1,000
76
1.0
104
0.9
618
5.0
39
0.5
27
121
23
0.2
1.0
0.2
87
16
6
1.1
0.2
0.1
385
3.1
141
1.8
Figure 9.4 demonstrates that heart disease mortality rates for those 65 years of age and over
had experienced a downward trend in Taney County and Missouri from 1999 to 2009. Taney
County rates were lower than those of the state. However, in 2005 they were similar.
Figure 9.4
Figure 9.5 shows that both the county and state death rates due to cerebral vascular disease for
those 65 years of age and over continued to fall from 2001 to 2006. Nevertheless, the county
rate was lower than the state rate during the time period 1999 through 2009.
Figure 9.5
118
Figure 9.6 demonstrates that the rate of pneumonia death for those 65 years and over in
Missouri was around 160 per 100,000, while the Taney county rate fluctuated from 71 to 300
per 100,000 from 2003 to 2005. The county rate was much lower than the state rate in 2009.
Figure 9.6
Injuries
The number and rate of injuries among those 65 years of age and older is provided in Table 9.6.
Compared to Missouri, Taney County had higher rates of injuries in five categories shown
below.
Table 9.6
Injuries By Type For Those 65 Years of Age and Older, Rate Per
100,000 - Taney County and Missouri, 1999-2009
Total Injuries
Fall/Jump
Taney County
Number
Rate
6,244
7,926.6
3,650
4,633.6
Missouri
Rate
8,578.4
5,389.3
Machinery
Motor Vehicle
50
519
63.5
658.9
53.6
582.9
Hot Weather
13
16.5
15.3
Over-exertion
Drugs/Alcohol
364
99
462.1
125.7
362.8
92.4
119
Table 9.6 illustrates that the rate of injuries per 100,000 in Taney County is lower for Fall/Jump
accidents, but higher for all other classifications of accidents compared to the total rate for the
state of Missouri.
Figure 9.7
Figure 9.7 shows the rate of total injuries per 100,000 for those 65 Years of age and older from
1999 through 2009 in Taney County and Missouri. Missouri rates were mostly flat, revolving
around 8,500 per 100,000, while Taney County rates fluctuated, ranging from 6,700 to 9,100
per 100,000. However, since 2004 Taney County rates have been steadily increased.
Figure 9.8
120
Figure 9.8 shows that the number of total injuries is generally about 25% to 55% higher for
females who are 65 years of age and older compared to males of the same age. In 2005 the
number of injuries for females 65 years of age and older was more than twice the number of
injuries for males of the same age.
Figure 9.9
Figure 9.9 illustrates the rate per 100,000 of fall and jump injuries by gender, between 1999
and 2009. The rates for both males and females 65 years of age and over fluctuated. However,
from 2005 through 2009 the rates for males steadily increased. In addition, the graph indicates
that females in the 65 year old group tend to experience more fall and jump injuries than their
male counterparts in Taney County. The rate of injuries for females in 2005 was nearly two and
a half times the rate for males of that same age group.
121
Figure 9.10
Figure 9.10 shows a decline of 56.5% in the rate of motor vehicle traffic injuries for males 65
years of age and over from 2002 to 2005 followed by an increasing trend thereafter. The rates
for females were unsteady and generally higher than those for males.
Figures 9.11 denotes that in general, the rates of motor vehicle accident injuries for those 65
years of age and over were higher for Taney County compared to the total state of Missouri
from 1999 to 2009. The rates were similar in 1999, 2003, 2007, and 2009. In 2002, Taney
County recorded the highest rate of motor vehicle accident injuries for those 65 years old and
over. However, the overall trend for both Taney County and the state is downward.
Figure 9.11
122
Figure 9.12 shows the rate of poison/overdose for residents 65 years old and over in Taney
County and Missouri. The graph illustrates that Taney County has a higher rate of these injuries
on average compared to the State. However, in 2006 the rate of poison/overdose for residents
over 65 Taney County dropped from 168 to 40 people per 100, 000, followed by a sharp
increase in 2007 to 193 people per 100,000.
Figure 9.12
Figure 9.13 shows that the rate of Over-exertion injuries reported for people over 65 years old
in Taney County is higher on average compared to the state average. From 2003 to 2006, it is
evident that the rates between the two regions have narrowed down to almost the same level
of injuries reported.
Figure 9.13
123
Chapter 10
Social Issues
124
Introduction
Issues such as crime, substance abuse, and domestic abuse affect the daily lives of many
residents of Taney County. While the overall numbers of these incidents are currently relatively
low compared to other areas of the state and country, these issues will continue to increase
along with population growth present in the county. Because of this, it is important to have an
understanding of the current situation and contributing issues during the development of
community programs.
Disabilities
The American Community Survey (ACS) produces population, demographic and housing unit
estimates. Data obtained was based on a sampling variability. The Census Bureau introduced a
new set of disability questions in the 2008 ACS questionnaire. Accordingly, comparisons of
disability data from 2008 or later with data from prior years are not recommended (U.S. Census
Bureau, 2011).
While the 2008-2010 American Community Survey (ACS) data generally reflect the December
2009 Office of Management and Budget (OMB) definitions of metropolitan and micropolitan
statistical areas; in certain instances the names, codes, and boundaries of the principal cities
shown in ACS tables may differ from the OMB definitions due to differences in the effective
dates of the geographic entities (U.S. Census Bureau, 2011).
Estimates of urban and rural population, housing units, and characteristics reflect boundaries of
urban areas defined based on Census 2000 data. Boundaries for urban areas have not been
updated since Census 2000. As a result, data for urban and rural areas from the ACS do not
necessarily reflect the results of ongoing urbanization (U.S. Census Bureau, 2011).
Persons in the community who have physical, sensory, mental, and/or self-care challenges
continue to confront many issues as they access services in the county. Tables 10.1 and 10.2
show disabilities by type and number of residents surveyed in Taney County. Over 4,300
people in Taney County, or 11.7% of the population according to the U.S. Census, reported
having one type of disability in the year 2000. Based on the ACS Survey 2008-2010 conducted,
there are approximately 3,445 people in Taney County who have a disability. Noted in Table
10.1 is the various disabilities stratified by employment status (U.S. Census Bureau, 2011).
125
Table 10.1
Employment Status By Disability Status and Type,
2008-2010, Estimates- Taney County, Missouri
Estimate
30,445
Total:
In the labor force:
22,979
With a disability:
With a hearing difficulty
With a vision difficulty
With a cognitive difficulty
With an ambulatory difficulty
With a self-care difficulty
With an independent living difficulty
No disability
Unemployed:
With a disability:
No disability
Not in labor force:
With a disability:
No disability
20,759
1,088
260
177
308
482
148
319
19,671
2,220
234
0
36
90
111
51
116
1,986
7,466
2,123
131
362
1,162
1,485
506
885
5,343
Employed:
126
Table 10.2
Disability By Type and Total Taney County 2008-2010
Number
Percent of
Surveyed
Population
(N=30,455)
3,445
11%
391
1%
575
2%
1560
5%
2078
705
7%
2%
1320
27000
4%
89%
With a disability:
With an independent living
difficulty
No disability
Source: US Census Bureau, ACS, 2011
Figure 10.1
Source: US Census Bureau, ACS, 2011
127
Figure 10.1 illustrates the percent of the population by type of disability for Taney County as
reported in ACS Survey conducted by the U.S. Census bureau. Approximately 11 percent of the
population sampled for Taney County reported having a disability.
Crime
Figure 10.2 and 10.3 give the number of domestic violence reports and the percent of reports
by relationship for Taney County from 2008 to 2010. In Taney County, a total of 638 incidents
of domestic violence were reported in 2010. Figure 10.2 shows that not married couples are
more likely to engage in domestic violence than married couples.
Figure 10.2
Source: Missouri State Highway Patrol, UCR, 2011
128
Figure 10.3
Table 10.3
Domestic Abuse Reports-Taney County, 2009-2010
Branson
Forsyth
Hollister
Rockaway Beach
Taney County Rural
Village of Merriam Woods
Total
2009
120
15
58
2
374
1
550
2010
132
20
53
5
431
0
641
Rate Per 10,000
Population
2010
164.1
117.4
136.2
84.9
141.4
0
95.0
Domestic abuse events reported in 2009 and 2010 are given in Table 10.3 by areas in Taney
County. The rate of domestic abuse reports was higher in Branson. In general, domestic abuse
reports were higher in 2010 compared to 2009 reports. Three year average for aggravated
assaults dominated the violent crime offenses totals for 2010 in Taney County, illustrated in
Table 10.4. Larceny theft was the largest criminal offense in 2010 with 1,413 cases with a 1,383
three year average. The total property crime offenses for 2010 in Taney County were 1,887 and
in line with the three year average of 1895.7. (Table 10.5)
129
Table 10.4
Violent Crime Offense Totals-Taney County, 2010
2010
1
14
2
22
218
257
Criminal Homicide
Forcible Rape
Attempted Rape
Robbery
Aggravated Assault
Total Violent Offenses
3 Year Average
0.3
15.0
1.7
16.0
247.3
280.3
Table 10.5
Property Crime Offense Totals-Taney County, 2010
2010
22
375
1,413
70
7
1,887
Robbery
Burglary
Larceny Theft
Motor Vehicle Theft
Arson
Total Property Offenses
3 Year Average
16.0
330.3
1,383
68
9.3
1,895.7
Registered Sex Offenders
The number of registered sex offenders in the county by city of residence is shown in Table
10.6. 133 registered sex offenders live in Taney County with a big proportion of registered sex
offenders live in Branson.
Table 10.6
Registered Sex Offenders By City of Residence-Taney County, October 2011
Total
Total
Branson
Cedar
Creek
Forsyth
Hollister
Kirbyville
Kissee
Mills
Merriam
Woods
Rockaway
beach
Taneyville
Other
133
57
1
17
17
6
5
7
10
2
11
Source: Missouri State Highway Patrol, Registered Sex Offender List, 2011
Alcohol and Drug Abuse
Table 10.7 illustrates the number of alcohol and drug related hospitalizations by Taney County
residents either through the ER or direct hospitalization from 2007 through 2009. Alcohol
related ER visits have risen 21.43% from 2007-2009 while the ER visits for drug related incidents
decreased by 9.15 percent.
130
Table 10.7
Alcohol and Drug Health Care Statistics-Taney County, 2007-2009
Alcohol
Drug
Year
Direct
ER
ER
Direct
ER
Hospitalization
outpatient Hospitalization
2007
116
210
260
118
153
2008
113
232
279
125
162
2009
119
255
324
133
139
Percent Change
2.58
21.43
24.62
12.7
-9.15
2007-2009
Figure 10.4
131
ER
outpatient
148
196
195
31.76
Figure 10.5
Figure 10.6
Source: Missouri Department of Mental Health, 2007Annual Status Report, 2011
132
Suicide
Information regarding suicides in Taney County is provided in the following tables and figures.
Table 10.8 provides data on the number and rate of suicides from 1999 to 2009 as compared to
the state rates. During this period of time, Taney County rate of suicidal deaths was equal to
the state rate. In Figure 10.9 the number of firearm related suicides is shown. In 2006 a total of
9 suicides were reported with 5 of those involving firearms.
Table 10.8
Rate of Suicide Deaths Per 100,000 –
Rate per 100,000
Number
Average Per Year
Taney
12.8
63
5.25
Missouri
12.8
8,211
684.25
Table 10.7 provides data on the rate of suicides in Taney County by age group. Taney County
has higher rates of suicide in all age groups when compared to the state of Missouri. (Table
10.9)
Figure 10.7
133
Table 10.9
Suicide Deaths By Age and Gender, Rate Per 100,000 – Taney County, 1999-2009
Age Group
Under 15 15 to 24
25 to 44
45 to 64
Over 65
All Ages
Male
0
21.5
28.1
24.1
44.9
22.3
Female
0
6.0
6.8
3.1
7.0
4.4
Both Sexes
0
12.1
17.2
13.1
24.1
12.8
Missouri
0.6
11.7
17.5
17.2
15.8
12.8
Both Sexes
Housing
Housing costs continue to be an issue in Taney County and Missouri. This problem places an
enormous burden on families and households in the community who are middle and low-wage
earners.
Missouri

In Missouri, the Fair Market Rent (FMR) for a two-bedroom apartment is $708. In order
to afford this level of rent and utilities, without paying more than 30% of income on
housing, a household must earn $2,360 monthly or $28,321 annually. Assuming a 40hour work week, 52 weeks per year, this level of income translates into a Housing Wage
of $13.62

In Missouri, a minimum wage worker earns an hourly wage of $7.25. In order to afford
the FMR for a two-bedroom apartment, a minimum wage earner must work 75 hours
per week, 52 weeks per year. Or, a household must include 1.9 minimum wage earner(s)
working 40 hours per week year-round in order to make the two bedroom FMR
affordable.

In Missouri, the estimated mean (average) wage for a renter is $11.36 an hour. In order
to afford the FMR for a two-bedroom apartment at this wage, a renter must work 48
hours per week, 52 weeks per year. Or, working 40 hours per week year-round, a
household must include 1.2 worker(s) earning the mean renter wage in order to make
the two-bedroom FMR affordable.

Monthly Supplemental Security Income (SSI) payments for an individual are $674 in
Missouri. If SSI represents an individual's sole source of income, $202 in monthly rent is
affordable, while the FMR for a one-bedroom is $579.
A unit is considered affordable if it costs no more than 30% of the renter's income
Source: National Low Income Housing Coalition, 2011. www.nlihc.org
134
The following tables provide information concerning the affordability of housing in Taney
County.
Table 10.10
Family Income and Housing-Taney County, Stone County and Missouri, 2011
2011 Annual Median Income (AMI)
Missouri
Taney
County
Stone
County
Annual
$61,841
Monthly 30% of AMI
$5,153
$18,552
Maximum Affordable* Monthly
Housing Cost By % of Family Area
Median Income
30%
50%
80%
100%
$464
$773
$1,237
$1,546
$49,700
$4,142
$14,910
$373
$621
$994
$1,243
$49,500
$4,125
$14,850
$371
$619
$990
$1,230
Source: National Low Income Housing Coalition, 2011
Table 10.11
Fair Market Rent (FMR) By Number of BedroomsTaney County, Stone County and Missouri, 2011
Number of
Bedrooms
Zero
One
Two
Three
Four
Taney County Stone County
$514
$401
$516
$467
$651
$617
$777
$809
$988
$890
Missouri
$514
$579
$708
$939
$1,015
Table 10.12
Renter Household and Income –
Taney County and Missouri, 2011
Estimated Median
Percent Needed to
Afford 2 BR FMR
Rent Affordable at
Median
% Renters Unable to
Afford 2 BR FMR
Taney
County
$31,918
$27,552
82%
103%
$798
$689
40%
49%
135
Missouri
Table 10.13
Income Needed to Afford Fair Market Rents - Taney County and Missouri, 2011
Percent of Family AMI By Number of Bedrooms
Annual Amount By Number of Bedrooms
Zero
One
Two
Three
Four
Zero
One
Two
Three
Four
Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom
Missouri
$20,549 $23,159 $28,321 $37,554 $40,580
33%
37%
46%
61%
66%
Taney County $20,560 $20,640 $26,040 $31,080 $39,520
41%
42%
52%
63%
80%
Table 10.14
Housing Wage For Fair Market Rents By Number of Bedrooms- Taney County and Missouri, 2011
Hourly Wage needed to Afford @ 40 hrs /Week
Housing Wage as % of Minimum Wage
Zero
One
Two
Three
Four
Zero
One
Two
Three
Four
Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom Bedroom
Missouri
Taney County
$9.88
$9.88
$11.13
$9.92
13.62
$12.52
$18.05
$14.94
$19.51
$19.00
136%
136%
154%
137%
Table 10.15
Work Hours/Week at Minimum Wage Needed to Afford
Fair Market Rent(FMR)Taney County and Missouri, 2011
Zero-Bedroom
One-Bedroom
Two-Bedroom
Three-Bedroom
Four-Bedroom
Taney County
55
55
69
82
105
136
Missouri
55
61
75
100
108
188%
173%
249%
206%
269%
262%
Homelessness
Taney County has experience an enormous growth in businesses, wealth, and resources in the
past couple of decades. However, despite these positive events, homelessness still occurs in
Taney County. The following tables and graphs provide information on the homeless counts
conducted by City of Branson to identify those who are experiencing homelessness in Taney
County. In 2010 a total of 398 individuals were identified as being homeless or living in weekly
rentals. In mid 2010 practice of counting population in weekly rentals ceases. See Figure 10.8
Figure 10.8
Source: City of Branson, 2011
137
Chapter 11
Youth Issues
138
Health Issues
Table 11.1 depicts the death rate for people under the age of 18 in Missouri and in Taney
County. The motor vehicle mortality rates for Taney County are much higher than the state
rates.
Table 11.1
Death Rate Per 100,000 For Those Under 20 Years of AgeTaney County and Missouri, 1999-2009
Total Deaths
Motor Vehicle Deaths
Taney
Taney
Missouri
Missouri
County
County
Under 15
63.3
70.9
7.9
4.2
15 - 17
44.0
65.6
@.@
29.1
18 - 19
77.6
105.1
@.@
46.0
Table 11.2 shows the rate of emergency room visits that detect mental health issues in
patients. Some diagnoses are related to substance or alcohol abuse, some to anxiety and
personality disorders, and others due to affective disorders. The rates of alcohol related mental
disorders associated with younger residents in Taney County were higher than those in the
state as a whole, while the rates of affective disorder were higher in Missouri.
Table 11.2
Rate of Mental Health Issues Diagnosed By Emergency Room VisitTaney County and Missouri, 1999-2009
Alcohol and Substance- Anxiety-SomatoformRelated Mental
Dissociative and
Affective Disorder
Disorders-ER Diagnosis, Personality Disorders
Taney
Taney
Taney
County
Missouri
County
Missouri
County Missouri
Under15
0.3
0.2
0.3
0.4
0.1
0.3
15 - 17
3.4
2.7
2.5
2.1
1.0
1.8
18 - 19
5.1
3.6
4.7
3.8
1.5
1.7
Source: Missouri Department of Health and Senior Services, MICA. Rates per 1,000, 2011
139
Teen Pregnancy
Table 11.3 indicates pregnancy related visits to the emergency room for Taney County and
Missouri. Reasons included childbirth and reproduction issues, spontaneous abortions and
pregnancy complications.
Table 11.3
Emergency Room Visits Due To PregnancyTaney County and Missouri, 1999-2009
Total PregnancyChildbirthReproduction Issues
Taney
Missouri
County
Under 15
0.1
0.1
15 – 17
10.7
10.0
18 – 19
26.9
34.0
Spontaneous
Abortion
Taney
County
0
0.4
1.7
Missouri
0.0
0.6
1.9
Complications
Resulting From
Pregnancy
Taney
Missouri
County
0.1
0.1
8.9
7.9
22.2
27.5
@. @ indicates number too small for rate calculation. Rates per 1,000
The graph shown in Figure 11.1 displays the percentage of teen pregnancies in Taney County
that resulted in abortions for the county from 1998 to 2009. 17% of teen pregnancies resulted
in abortions. A total of 29 births to mother under the age of 18 were recorded in Taney County
in 2009 with a five year average of 27.4 births to mother under the age of 18. Since 1990, the
percentage births to teens have demonstrated a downward trend in Taney County. (Figures
11.2 and 11.3) This trend is similar to national data.
Figure 11.1
140
Figure 11.2
Teen Births (Under 18 Years of Age) As Percent of Total BirthsTaney County 1990-2009
7.0
6.0
Percent
5.0
Under 18 Years
4.0
3.0
Linear (Under 18
Years)
2.0
1.0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0.0
Figure 11.3
Teen Births (18-19 Years of Age) As Percent of Total Births-Taney
County 1990-2009
16.0
14.0
12.0
Percent
10.0
8.0
18-19
6.0
Linear (1819)
4.0
2.0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0.0
141
Injuries
Injury data for those less than 20 years of age is presented in Tables 11.4 through 11.8. Data
from Taney County is compared to Missouri from the year 2000 to 2009. Taney County had
several rates that were higher than the state average including categories in overall injuries,
overdose/poisoning, and motor vehicle related injuries.
Table 11.4
Injuries By Age Group, Rate Per 100,000 - Taney County and Missouri, 2000-2009
10 -14
Male
Female
All
Taney
County
15,475.9
12,370.8
13,987.8
Missouri
15,469.1
10,858.1
13,217.2
15 - 17
Taney
Missouri
County
18,867.7
18,667.5
16,129.4
12,981.7
17,561.6
15,895.7
18 - 19
Taney
Missouri
County
19,797.0
17,825.8
14,453.3
13,176.9
17,054.0
15,562.1
Table 11.5
Rate of Assault Injuries By Age Group, Rate Per 100,000 –
Male
Female
All
10 -14
Taney
Missouri
County
236.0
415.0
139.9
258.4
189.9
338.5
15 - 17
Taney
Missouri
County
689.0
1,159.7
340.0
626.0
522.5
899.5
18 - 19
Taney
County
1,237.3
556.5
887.8
Missouri
1,552.9
797.2
1,185.0
Table 11.6
Drug and Alcohol Overdose/Poisoning - Injuries, By Age Group, Rate Per 100,000 Taney County and Missouri, 2000-2009
10 -14
15 - 17
18 - 19
Taney
Taney
Taney
Missouri
Missouri
Missouri
County
County
County
Male
128.7
64.4
333.3
243.6
364.8
280.6
Female
116.6
150.5
780.7
480.6
511.4
387.9
All
122.9
106.4
546.5
359.1
440.1
332.8
142
Figure 11.4
Figure 11.5
143
Table 11.7
Self Inflicted Injuries By Age Group, Rate Per 100,000 –
Male
Female
All
10 - 14
Taney
County Missouri
21.5
39.1
101.0
122.4
59.6
79.8
15 - 17
Taney
County Missouri
241.2
188.6
566.6
401.6
396.4
292.5
18 - 19
Taney
County Missouri
253.8
222.2
376.0
324.8
316.5
272.2
Table 11.8
Motor Vehicle Occupant Injuries, By Age Group, Rate Per 100,000 –
Male
Female
All
10 -14
15 - 17
Taney
Taney
Missouri
Missouri
County
County
944.0
638.7
3,272.90 2,225.60
1,157.80
730.3
4,419.50 3,020.60
1,046.5
683.5
3,819.80 2,613.10
144
18 - 19
Taney
Missouri
County
3,585.0
3,038.30
3,835.20 3,509.10
3,713.40 3,267.50
Behavioral Risk Factors
Tables 11.9 to 11.11 provide survey data conducted by the Taney County Health Department
between 2009 and 2011. This survey was conducted as part of a school program that required
parental consent to complete. The following survey results are limited by a lack of
randomization as only students who were granted permission from their parents participated.
While these results cannot reliably be applied to the entire population of students, they do
provide valuable data on some of the behaviors of students in the county.
Table 11.9
Percent of Junior High Students Answering “Yes” to Survey QuestionsTaney County, 2009-2011
In your
In the last In the last
Question
lifetime
year
30 days
Have you ever used alcohol other than for
25.7%
16.1%
5.4%
religious purposes?
Have you ever used marijuana?
8.6%
5.9%
3.6%
Have you ever “sniffed” glue, gas, sprays or
11.2%
7.3%
2.6%
anything like that to get high?
Have you ever smoked cigarettes?
18.0%
10.4%
5.6%
Have you ever used smokeless tobacco (chewing
4.9%
2.6%
1.1%
tobacco, snuff, etc)
Have you ever used illegal drugs (crack, cocaine,
3.6%
2.9%
1.9%
meth, etc) or prescription drugs illegally?
Table 11.10 shows the percent of junior high students that had been engaged in certain
behaviors based on a survey that was conducted from 2009 to 2011.
Table 11.10
Percent of Junior High Students Answering Questions-Taney County, 2009-2011
Questions
Yes
No
Have you and a boy/girl kissed, held hands, hugged, spent time
40.9%
58.3%
alone, put his/her hands under your clothing or laid down next to
each other in the last 30 days?
Have you ever had sexual intercourse?
7.3%
92.4%
145
Table 11.11 demonstrates the percent of junior high students who agreed or disagreed to
certain aspects about their attitudes, beliefs and opinions about specific issues.
Table 11.11
Percent of Junior High Students By Answer-Taney County, 2009-2011
Strongly
Agree
Disagree
Question
Agree
I have decided that I will smoke cigarettes.
I will be a better partner if I wait until
marriage before I have sex.
Having Sex at my age does not fit with the way
I want to live my life.
Smoking cigarettes fits the kind of life I would
like to live.
If I had the chance to have sex at my age, I
would definitely take it.
I have decided to limit how far I will go
sexually.
Strongly
Disagree
2.5%
57.1%
5.3%
29.4%
14.4%
10.3%
77.8%
3.1%
64.9%
24.7%
5.9%
4.6%
2.1%
3.3%
14.8%
79.8%
4.8%
8.3%
24.9%
61.9%
44.2%
41.3%
7.8%
6.6%
The Safe and Drug Free School survey conducted during the 2009-2010 school year was
completed by an area school district in conjunction with the Missouri Department of
Elementary and Secondary Education. These results from, junior high, and high school students
are summarized in the following tables.
Table 11.12
Think of your four best friends (the friends you feel closest to). In the past year (12 months),
how many of your best friends have:
None
1
2
3
4
Skip
TOTALS
Smoked cigarettes
50.1%
14.7%
8.5%
5.4%
21.0%
0.00%
100%
Tried beer, wine or hard
liquor (for example vodka,
whiskey, gin) when their
parents did not know about
it
Used marijuana
55.8%
11.9%
8.0%
6.1%
18.2%
0.00%
100%
70.1%
9.0%
6.2%
3.5%
10.7%
0.00%
100%
Used LSD, cocaine,
amphetamines, or other
illegal drugs
Sold illegal drugs
87.6%
6.9%
4.9%
2.0%
5.6%
0.00%
100%
80.0%
12.4%
3.5%
1.6%
2.5%
0.00%
100%
Source: Safe and Drug Free School Survey, 2010
146
Table 11.13
Age Group
How old were you
Never
8 or
9
10
11
12
13
14
when you first:
have Younger
Smoked Marijuana?
85.0%
1.0%
0.2% 1.0% 2.0% 1.4%
3.7
3.9
Smoked a cigarette72.8%
3.0%
1.9% 1.9% 4.4% 3.8%
5.4%
4.7%
even a puff?
Had more than
56.9%
7.3%
2.4
3.7
2.0%
5.7%
6.9% 10.6%
a sip or two of
beer, wine, or hard
liquor (for
example vodka,
whiskey or gin)?
Used inhalants
92.0% 1.7%
0.4%
1.2% 0.9% 0.6%
1.4%
0.7%
15 or
Older
1.8
2.1%
4.5%
1.0%
Table 11.14
High School Safe and Drug free School Survey-Taney County, 2010
How often in the past 3
months have you:
Never
Had pix or text that
embarrassed or hurt you
posted via the internet?
81.6%
11.5%
2.5%
1.9%
0.6%
0.9%
0.9%
Had embarrassing or hurtful
text or picture cell phone
messages sent about you?
Been made fun of?
80.7%
31.9%
10.4%
28.8%
2.8%
9.2%
2.8%
4.6%
0.9%
7.1%
0.3%
2.5%
2.1%
16%
1-2
3-5
6-9
10 - 19
20 - 29
30 or more
Table 11.15
High School Safe and Drug Free School Survey-Taney County, 2006-2007
What are the chances you would
Very
Pretty
Some
Little
None
Skips
be seen as cool if you:
good
good
chance chance or very
chance chance
little
chance
Smoked cigarettes?
2.5%
7.5%
20.0% 17.5%
52.5%
0.00%
Began drinking alcoholic
10.0%
17.5%
20.0% 10.0%
42.5%
0.00%
beverages regularly, that is, at
least once or twice a month?
Smoked marijuana?
2.5%
12.5%
20.0% 17.5%
47.5%
0.00%
147
Totals
100%
100%
100%
Table 11.16
Junior High School Safe and Drug Free School SurveyTaney County, 2010
None
1
2
3
4
Skip
TOTALS
Smoked cigarettes
68.7%
10.7%
4.9%
3.9%
11.8%
0.00%
100%
liquor (for example
vodka, whiskey, gin)
when their parents did
not know about it
Used marijuana
59.7%
11.9%
8.4%
5.5%
14.7%
0.00%
100%
77.4%
9.4%
3.5%
3.1%
6.6%
0.00%
100%
Used LSD, cocaine,
illegal drugs
Sold illegal drugs
90.7%
4.5%
2.2%
1.1%
1.6%
0.00%
100%
85.6%
9.4%
2.3%
1.5%
1.2%
0.00%
100%
Table 11.17
How old were you
when you first:
Smoked Marijuana?
Smoked a cigaretteeven a puff?
Had more than
a sip or two of
beer, wine, or hard
liquor (for
example vodka,
whiskey or gin)?
Used inhalants
Junior High School Safe and Drug Free School SurveyTaney County, 2010
Age Group
Never
8 or
9
10
11
12
13
have
Younger
90.1%
0.6%
0.2%
0.6%
1.3%
0.4%
2.9%
14
15
3.2%
0.6%
78.3%
4.4%
1.7%
1.9%
3.8%
2.7%
3.5%
3.1%
0.6%
69.0%
4.5%
2.3%
3.5%
1.9%
6.2%
4.3%
6.8%
1.4%
94.4%
1.3%
0.4%
0.6%
0.8%
0.8%
0.8%
0.4%
0.4%
148
Table 11.18
Junior High School Safe and Drug free School Survey-Taney County, 2010
How often in the past 3
months have you:
Never
Had pix or text that
embarrassed or hurt you
posted via the internet?
87.5%
6.9%
2.3%
0.8%
1.3%
0.6%
0.6%
Had embarrassing or hurtful
text or picture cell phone
messages sent about you?
Been made fun of?
72.4%
27.8%
10.2%
31.5%
3.8%
13.6%
2.7%
7.5%
2.9%
5.0%
3.5%
4.2%
4.6%
10.4%
1-2
3-5
6-9
10 - 19
20 - 29
30 or more
Table 11.19
Junior High School Safe and Drug Free School SurveyTaney County, 2006-2007
What are the chances you
Very
Pretty
Some
Little
None
would be seen as cool if you:
good
good
chance chance
or very
chance chance
little
chance
Smoked cigarettes?
5.45%
1.82%
3.64% 20.0%
69.09%
beverages regularly, that is, at
least once or twice a month?
Smoked marijuana?
Skips
Totals
0.00%
100%
5.45%
00.00%
7.27%
21.82%
65.45%
0.00%
100%
5.45%
1.82%
3.64%
16.36%
72.73%
0.00%
100%
149
Table 11.20
Intermediate School Safe and Drug Free School SurveyTaney County, 2006-2007
None
1
2
3
4
Skip
TOTALS
Smoked cigarettes
94.44%
2.78%
1.39%
0.46%
0.46%
0.46%
100%
liquor (for example
vodka, whiskey, gin)
when their parents did
not know about it
Used marijuana
89.35%
8.33%
0.93%
0.46%
0.46%
0.46%
100%
95.83%
1.39%
0.93%
0.93%
0.46%
0.46%
100%
Used LSD, cocaine,
illegal drugs
Sold illegal drugs
96.76%
2.31%
0.46%
00.00%
00.00%
0.46%
100%
97.69%
0.93%
0.46%
00.00%
00.00%
0.93%
100%
12
13
0.46%
00.00%
Table 11.21
Intermediate School Safe and Drug Free School SurveyTaney County, 2006-2007
Age Group
How old were you when
Never
8 or
9
10
11
you first:
have Younger
99.07% 00.00% 00.00% 00.00% 0.46%
Smoked Marijuana?
Smoked a Cigarette-even a
puff?
Had more than
a sip or two of
beer, wine, or hard liquor
(for example vodka,
Whiskey, or gin)?
Began drinking
Alcoholic beverages
regularly, that is, at least
once or twice a month?
90.74%
1.85%
1.39%
2.31%
1.85%
1.39%
00.00%
87.50%
4.17%
0.93%
0.93%
3.70%
2.31%
00.00%
98.61%
00.00%
00.00%
00.00%
00.00%
0.46%
0.46%
150
Table 11.22
Junior High School Safe and Drug Free School Survey-Taney County, 2006-2007
What are the chances you
Very
Pretty
Some
Little
None
Skips
would be seen as cool if
good
good
chance chance or very
you:
chance chance
little
chance
0.93%
0.93%
4.63%
9.26%
84.26%
0.00%
Smoked cigarettes?
beverages regularly, that is,
at least once or twice a
month?
Smoked marijuana?
Totals
100%
0.46%
1.85%
3.24%
7.41%
86.57%
0.46%
100%
2.31%
0.46%
2.78%
4.63%
89.35%
0.46%
100%
151
Chapter 12
Community Resources Assessment
152
Community Resources
Introduction
Community resources are important to consider when assessing a community. These resources
will be the tools that will assist the community and individuals address the health issues that
are identified. Resources could include programs, facilities, or organizations that are available
and accessible free, low cost or at higher costs. The following resources were identified during
the assessment process in conjunction with a number of community partners.
Physical Activity Options in Taney County
Many options for physical activity are available in Taney County; some of them are free of
charge and some require a fee to use. The options range anywhere from walking trails
throughout the community to fitness facilities to golf courses.
Public Parks and Recreation Centers
-
For information regarding parks in the area call:
o Branson Parks and Recreation Department: 417-335-2368
o Hollister Parks and Recreation Department: 417-336-0843
ALEXANDER PARK
- A great 6 acre park that offers nice playground equipment, a tennis court, a
pavilion with picnic tables, public bathrooms, and two youth ball fields. These
fields are often used for youth sports such as baseball, softball, and soccer. (1)
o 901 Hawthorne Street
Branson, MO 65616
BRANSON NORTH PARK
- Branson North Park, fittingly located at the Branson North subdivision, offers a
great playground area within the 1 acre park. (1)
o Woodbridge and Westwood Street
Branson, MO 65616
BRANSON RECPLEX
The RecPlex is a great resource for physical activity in the community. It offers such a
wide range of options to do in order to get up and get active. This facility is located
up the road past Wal-Mart Supercenter at 1500 Branson Hills Parkway in Branson,
MO. (5)
153
The RecPlex offers the following features:
 4 Baseball/Softball
Fields
 1 Full Size
Soccer Field
 A Playground
 Pavilions Available for
Rent ($15/4hrs; $25/8hrs)
 1 Mile Walking Loop
Around the Complex
 Fitness Center
(Skaggs)
 2 Indoor
Basketball Courts
 2 Indoor Volleyball
Courts
 1/12 Mile Indoor
Walking Track
 Lounge and
Concessions
 Game Room
 Community Rooms
Costs and Fees:
o low per visit to use the basketball courts or indoor walking track
o One-year pass is available for individual household members with lower fees for
additional household members;
o The fields outside are free and on a first come first serve basis unless league play
is scheduled
1. Adult Leagues
- Adult softball games are held at the RecPlex and Stockstill Park; visit
http://www.bransonparksandrecreation.com/adult_softball.htm for more
information
 16 years and older; Men, Co-ed, and Church teams
 Churches or church organizations involved in the Church League include:
1. Tri-Lakes Christian Church
2. Promise Keepers
3. Branson First Baptist
4. Victor Baptist
5. Sanctuary of Hope
6. Exciting First
7. Branson Bible Church
8. Woodland Hills
9. Church Army
*Fees Subject to Change*
-
Basketball: Five divisions of adult basketball are offered at the Branson RecPlex,
depending on desired competitive level
 For information on basketball leagues, levels, and prices visit:
http://www.bransonparksandrecreation.com/adult_basketball.htm
-
Volleyball: A six-on-six Co-ed recreational league is offered at the RecPlex in two
10-week sessions; First session starts in October, Second session in January
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

16 years and older
For more details visit:
http://www.bransonparksandrecreation.com/adult_volleyball.htm
2. Youth Sports and Leagues
- Baseball/Softball: Kids from all around Taney County are encouraged to join the
summer league
 For more details and information visit:
http://www.bransonparksandrecreation.com/youth_bb.htm
-
Soccer – Nearly 500 youth participate annually in this fall program
 For details visit:
http://www.bransonparksandrecreation.com/youth_soccer.htm
-
Basketball: A great way for children to have fun, learn basketball skills and
develop teamwork
 http://www.bransonparksandrecreation.com/youth_basketball.htm
-
Cheerleading: Open to girls 1st- 6th grade
 http://www.bransonparksandrecreation.com/youth_cheerleading.htm
Volleyball: Fall league for girls 3rd- 8th grade
 http://www.bransonparksandrecreation.com/youth_volleyball.htm
-
-
Children’s Theater: Annual summer drama camp held at Branson High School
 Call 336-4255 or visit:
http://www.bransonparksandrecreation.com/youth_workshop.htm
CANTWELL PARK
Cantwell Park is a beautiful park for the neighborhood which features not only
playground equipment but also a lighted basketball court. (1)
o At the intersection of Sunshine Street and Mockingbird Lane; Branson
CAUDILL PARK
This 5-acre park contains a picnic area as well as a gazebo. Future plans exist which call
for the construction of walking and running trails throughout the wooded areas of the
park. (1)
o 792 Caudill Way, Branson
CEDAR STEPS
Cedar Steps is an interesting park because it features 229 steps with 33 landings. These
landings offer a fitness option as well as beautiful views and landscaping. (2)
o Positioned on the BB Highway at the East end of St. James Street Bridge in
Hollister
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DOWNING VIEW PARK
This park in Hollister features a covered pavilion as well as playground equipment for
small children. (2)
o Esplanade Street overlooking Downing Street, Hollister
EISERMAN PARK
Eiserman Park is found at the same location as the Branson Community Center and the
Don Gardner Par 3 golf Course. This park includes a playground area and a covered
pavilion. Picnic tables are also on location nearby (1)
o 201 Compton Drive, Branson
JOHN NYGARD MEMORIAL PARK
A neighborhood park located on the corner of 5th and Long Street that contains a
playground for kids and benches dispersed throughout the premises. (1)
o 500 South 5th Street, Branson
MURPHY PARK
Murphy Park is a neighborhood park that offers a basketball court, a sand volleyball
court, a playground, and two pavilions including picnic tables. (1) Murphy Park can be
accessed off of Highway 76
o Neihardt Avenue, Branson
PARNELL PARK
Parnell Park offers two tennis courts as well as a playground. It is located at the end of
the Parnell Circle in the same neighborhood as the Don Gardner Par 3 Golf Course. (1)
o 699 Parnell Circle, Branson
SAGERS PARK
Sagers Park is a pleasant park which offers a basketball court, a playground, picnic tables
as well as a covered pavilion. (2)
o Found at the corner of First and Elm Streets in Hollister, MO 65672
STOCKSTILL PARK
Stockstill Park is a large 62 acre recreational area which features two softball fields, six
tennis courts, two playgrounds, and four separate pavilions. Softball, tennis, and youth
baseball and softball leagues are often hosted here throughout the year. (1)
 For tennis information about lessons and costs visit:
http://www.bransonparksandrecreation.com/tennis.htm


For information about softball leagues, rules, and fees visit:
http://www.bransonparksandrecreation.com/adult_softball.htm
For more information about youth baseball and softball visit:
http://www.bransonparksandrecreation.com/youth_bb.htm
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-
Amenities at Stockstill Park include:
 1/2 mile walking path surrounding the park
 Public Restrooms available
 A lighted soccer field and a skate park
o 625 Stockstill Lane
Branson, MO 65616
SUNSET PARK
Set on the banks of Lake Taneycomo, this park features a Frisbee golf course and a
beautiful walking trail going around the outskirts of the course. Frisbee golf is free, but
tournaments are hosted occasionally which require a fee. (1)
o 859 Sunset Road, Branson
Sponsored Runs/Walks
DASH TO THE SPLASH: 417-334-0131
Dash to the Splash is a 5K run sponsored by White Water Park, The Caring People, and
numerous other sponsors. The event was just started two years ago, and has been a
success. All proceeds go to The Caring People, an organization which reaches out to
single mothers.
http://www.dashtothesplash.com/
o Event Start Location: White Water Theme Park, Highway 76 & Pat Nash Drive
Branson
THE FIRECRACKER 5000 1 MILE WALK/RUN, 5K, 10K
The firecracker road race is a race along the Branson Landing and the surrounding area.
It is in its 10th year of operation and all proceeds go to the American Heart Association.
Fees: $15-$20
FREEDOM RUN OF THE OZARKS
Freedom Run of the Ozarks is a newly organized run with the option of running a 5K,
10K, or half-marathon course. The course is along Table Rock Lakeshore Trail.
Registration: Adults - $20; Children 12 and under - $10. All proceeds go towards the
Table Rock Freedom Center
RELAY FOR LIFE: TANEY AND STONE COUNTIES
Relay for Life is 24 hour walk/run fundraiser to celebrate those who have battled cancer,
remember loved ones lost, and fight back against the disease itself. Teams of people
camp out at the chosen site for that year, whether it is a local high school, park, or
fairground, and take turns walking or running around a track. (7)
o Form a team and register, $10 per person fee
o Updates on locations and times can be found at:
http://main.acsevents.org/site/TR?pg=entry&fr_id=23893
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RUN FROM THE COUCH 5K RUN/WALK
This 5K walk/run is sponsored by the Junior Auxiliary of Taney County and is
organized in order to promote and encourage fitness in the community. Any age
group is eligible to participate in this event. (1)
o Numerous age divisions: 15 & under, 16-19, 20-29, 30-39, 40-49, 50 & over
o Location: Branson RecPlex
o Cost: $18 - $20
o Registration form at http://www.bransonparksandrecreation.com
RUN TO THE LIGHTS 5K WALK/RUN
Run to the Lights is an annual walk/run in its 5th year, sponsored by Skaggs Regional
Medical Center, Elite Automotive Group and Silver Dollar City. It occurs during the
holiday season, so everyone can enjoy the lights and sounds of Christmas. Post-race
refreshments are also included. Proceeds benefit The Caring People, an organization
which reaches out to single mothers.
o http://thecaringpeople.org/NewsEvents/Events/tabid/361/Default.aspx
TANGER OUTLET 5K WALK/RUN
Tanger Outlets 5K walk/run is a newly organized event in the community. It aims to
ensure families participate in fitness activities to stay healthy. Proceeds from the
registration fees will benefit the Breast Cancer Foundation of the Ozarks.
o Registration fee: $25
o www.tangeroutlet.com/race
Walking Trails
Hiking is a free or low cost opportunity to exercise while enjoying the weather and scenery of
Taney County. If you are going hiking please remember to observe some safe hiking practices.
Make sure you are comfortable and wear weather appropriate clothing. A proper fitting pair of
shoes is important to prevent blisters and other discomfort. Normal tennis shoes will suffice for
the paved trails, but it is recommended to wear hiking shoes when hiking on the natural trails.
Bring water and maybe some nutritious snacks, this will make the hike more enjoyable. Before
leaving, make sure someone knows where you are going and approximately when you will be
back. Take your cell phone with you in case of an emergency.
BRANSON CEDAR RIDGE CAMPUS
Walking track open to the public (23)
o 396 Cedar Ridge Dr, Branson
BRANSON RECPLEX
A popular walking and biking destination for residents of the Branson area, the
RecPlex offers a paved path that encircles the 42 acre facility. An outdoor restroom
is located near the trail, as well as drinking fountains located at various points along
the trail. Open 6am – 11pm (5)
o Location: 1500 Branson Hills Parkway, Branson
158
o No Cost for the trail
o Length: 1 mile
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CHAD A FUQUA MEMORIAL PARK
Chad A. Fuqua Memorial Park was built in memory of Chad A. Fuqua, former Director of
Hollister’s Park Department. Commemorative and memorial bricks, placed there to
honor loved ones, lie along the sides of the walking trail. (2)
o Location: North side of Hollister Town Hall
o Length: .6 mile
HOLLISTER HIGH SCHOOL
o Walking track open to the public when not in use for school functions. (22)
LAKESIDE FOREST WILDERNESS AREA
Lakeside Forest Wilderness Area is a great place to enjoy nature along its two woodland
trails that wind throughout the Lakeside Forest. The area is Open daily from 7am – 7pm
during summer and 7am – 5pm during winter. (1)
o Location: Fall Creek Road, just two blocks south of W. Highway 76 not far from Dixie
Stampede in Branson, MO.
o Closed Thanksgiving, Christmas and New Year’s Day
 Trail 1 – A 1/2 mile (one way) trail offers an aerobic exercise with its 315 stone
steps. This trail winds through woodlands, and offers a great view of the White
River Valley and Lake Taneycomo. Mostly level terrain, but the steps section may
require some agility.
 Trail 2 – This 1.3 mile trail is more family friendly because it is level and is ideal
for those desiring a leisurely walk. Also, a picnic area is located about halfway
down the trail.
NORTH BEACH PARK
North Beach Park is more than just a walking trail; this path includes two fishing docks,
picnic tables, barbeque grills, and horseshoe pits (1)
o Location: Branson Landing Boulevard. On the banks of Lake Taneycomo connecting
to the Branson Landing boardwalk
o Length: 3/4 mile
RUTH AND PAUL HENNING CONSERVATION AREA
A beautiful place to hike with varying types of trails. Anything from a paved trail leading
to an excellent view of the White River Hills, to rugged trails which will certainly give you
a good workout. Gates are opened at daylight and closed at dark. Pets must be on leash
o Location: West side of Branson on Highway 76 (1)
o Length: Varying lengths of trails, from .4 miles all the way to 3.4 miles
SHADOW ROCK STATE PARK
Shadow Rock State Park is a great park surrounded by Ozark Hills right on Lake
Taneycomo. It has several tennis courts, wide open spaces, and a number of hiking trails
throughout the park.
o Location: US Highway 160 and Highway 76, Forsyth
160
o Length: N/A
STOCKSTILL PARK WALKING PATH
The walking path itself is located within the 62 acre Stockstill Park. It is a figure eightshaped path which wraps around two softball fields, two pavilions, and a large
playground. Open from 6am – 11pm (1)
o Location: 625 Stockstill Lane, Branson
o Length: 1/2 mile
SUNSET PARK WALKING PATH
This park is set on the banks of Lake Taneycomo. The lighted and paved path stretches
along the perimeter of a 9-hole Frisbee golf course which is located at the center of the
park. Open 6am – 11pm (1)
o Location: 859 Sunset Road, Branson
o Length: .6 mile
TABLE ROCK LAKESHORE TRAIL
This Lakeshore Trail feature a great 8 foot wide, paved walking path which provides a
terrific view of Table Rock Lake at all points along the trail. It is a perfect trail for any age
and ability. Open from dawn to dusk; and pets are allowed but they must be on a leash.
o Location: Runs from the Dewey Short Visitors’ Center next to Table Rock Dam, along
the lake, and down to Table Rock State Park near the Marina. (1)
o Length: About 2.2 miles
WOODS TRAIL
Woods Trail is the newest trail opened by the city of Branson. It is a beautiful nature
trail through the trees and is great for any age (1)
o Trailhead: Roark Valley Road next to the entrance of The Woods Development
o Length: 2/3 mile trail through the woods ending at a natural waterfall
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Public Swimming Pools
BRANSON AQUAPLEX: 417-335-2368
The Branson AquaPlex features a full size swimming pool along with many fun water
slides. It is a great aquatic park which the whole family can enjoy. Group rates are
available as well as birthday packages and private party rentals. (5)
o Pool open Memorial Day to Labor Day
o Lap Swim- $2; MWF 7-10 pm; Ages 18 and up.
o Daily Admission to Aquaplex is $4 youth (3-17) and $5 adult (18 & up)
o Open 12pm - 7pm Monday – Saturday, 12pm - 6pm on Sunday
o August 2-15 open from 12pm - 6pm everyday
o Aug 16 – Sept 6 from 12pm - 6pm Weekends only.
BRANSON WAVES SWIM TEAM: 417-335-2368
o The Branson AquaPlex offers a summer program which consists of competitive
swimming for kids ages 5-17. The swim team participates in the Tri-State Swim
Conference which is made up of summer and year-round swim teams from
surrounding states. (5)
o In order to be eligible, kids must to be able to swim the length of the pool (25 yards)
on their own
o Registration Fee: $25
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o Practices start in May after school and continue through the summer Monday-Friday
from 7:00 am to 9:30 am.
Bike routes
Downhill Bikes: 417-335-4455
Downhill Bikes is a great bike shop in Branson which can supply you with all your
bicycling needs and also lend out information about bike trails in the Tri-Lakes area.
TABLE ROCK LAKESHORE TRAIL
Lakeshore Trail is a great trail for walking and riding, and is suitable for any age and
ability. It runs from the Dewey Short Visitors’ Center next to Table Rock Dam, along the
lake through the Branson Belle parking lot, and down to Table Rock State Park near the
marina. At any point along the trail, a great view of Table Rock Lake can be seen
o About 8 feet wide, paved, and 2.2 miles long (3)
o Free to the public
o Open dawn to dusk. Pets allowed, but they must be on a leash.
o Check out http://www.downhillbikes.biz/ for a look at more bike routes in
Branson, Hollister, and Forsyth
Fitness Facilities
ANY BODY’S GYM: 417-339-2639
Any Body’s Gym is a unique facility in that there is no joining fee. A punch card is
scanned each visit to the gym. It is not your typical fitness facility because it features
intense workouts which are only 4 minutes long. (8)
o Cost for use of facility.
o Financial Assistance: Not available
o Age requirements: Must be 18 to work out without a parent
o Child care services: Not available since it is a 4 minute workout
o 4200 E State Highway 76, Kirbyville
ANYTIME FITNESS: 417-239-0078
Anytime Fitness is a fitness facility which focuses on helping people adopt a healthy
lifestyle through physical activity and fitness. They offer personal training programs to
help you achieve your fitness goals, and are open 24 hours a day 7 days a week for your
convenience.
o Financial Assistance: Not available
o Age requirements: 14 years old with parent; Must be 16 to exercise without a
parent
o Child care services: Not available
o 554 Gretna Rd., Branson
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CURVES FOR WOMEN: 417-335-5115
Curves for Women offers 30 minute workouts involving complete cardio and strength
training workouts. They also offer several nutritional programs such as weight
management classes, meal plans, and a complete line of vitamins and supplements. (12)
o Cost for use of facility and joining facility.
o Financial Assistance: Available, call for more information
o Age requirements: Must be 13 years old; 16 is the preferred age
o 827 West Main Street # 204, Branson
FIRST BAPTIST CHURCH LIFE CENTER: 417-334-5423
Life Center is a great fitness facility operated by First Baptist Church which features
many amenities such as a gymnasium, a weight and cardio room, a walking track, and a
children’s room. Church involvement is not required to use the facilities. (9)
o Financial Assistance: Not Available
o Age Requirements: 13 years old; parent must be present if younger than 13 yrs old
o Child care services: Children’s room for 3-8 years old
o 400 S. Sunshine St., Branson
MAPLES TRAINING AND FITNESS CENTER: 417-239-1199
Maples Training and Fitness Center is a 24 hour a day facility which offers fitness
equipment for any style of exercise and various fitness classes. Every elliptical and
treadmill comes with its own television and personal DVD player. Along with the fitness
portion, Maples also offers popular supplements and a wide selection of vitamins. (11)
o Financial Assistance: Based on need
o Age requirements: Must be 13 to work out without a parent, no age limit with a
family
o Child care services: Monday – Friday 9am – 10am & 5pm – 7pm
o 1000 Pat Nash Drive, Branson
OZARKS REGIONAL YMCA: 417-332-1909
The Ozarks Regional YMCA is a well known organization within the community. It is a
viable option of health and fitness for all ages. The YMCA offers a variety of classes and
programs such as Aerobics, Boot Camp, Zumba dance, Gymnastics, and many more. (4)
o Cost per month, fee rates for Individuals, Family, Student, Senior, Senior Couple.
o Financial Assistance: Application for financial assistance available at
www.orymca.org
o Age requirements: None
o Free child care is available to members during workouts for up to two hours. Child
care is available 8:30am – 11:30am and 4:30pm – 7:30pm
o 175 Industrial Park Dr., Hollister
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SHAPE SHIFTERS PILATES: 417-336-3600
Shape Shifters Pilates aims to increase people’s level of fitness through Pilates training
such as flexibility and core strength. Shape Shifters is great for anyone coming back from
an injury, such as athletes who want to regain balance and flexibility, or senior citizens
who want to improve back strength and posture. (13)
o Costs for use of facility.
o Age Requirements: No strict regulations; young kids up to professional athletes and
senior citizens; Very individualized, personal training
o 2700 Green Mountain Drive, Branson
SKAGGS HEALTH AND FITNESS CENTER: 417-348-0060
Skaggs Fitness Center is located on the upper level of the Branson RecPlex. They offer a
variety of classes for people of all fitness levels as well as other programs such as
nutritional consultation and personal training. (6)
o Cost for joining and use of facility.
o Financial Assistance: Student discount available
o Age requirements: Under 18 need parent signature; Must be 16 to work out alone
o Child care services: Monday through Friday 8am–1pm; 4pm–8pm $2/day,
$12/month
o 1500 Branson Hills Parkway, Branson
Golf Courses
BRANSON CREEK GOLF CLUB (Public, 18 holes): 417-339-4653
Branson Creek Golf Club is a beautiful course which offers a
large range of services including golf instruction, a practice
facility, beverage carts, rental shoes and clubs, on course
player assistance, and group arrangements. Branson Creek has been rated #1 by Golf
Magazine and Golf Digest in the “Top Public Courses in Missouri”. (14)
o http://bransoncreekgolf.com/
o 1001 Branson Creek Boulevard, Hollister
o Cart and range balls included in the price
o Special arrangements for groups available
DON GARDNER PAR 3 GOLF COURSE (9 holes, Municipal)
Don Gardner Par 3 Course is operated by Branson Parks and Recreation Department.
This course is suitable for all ages and skill levels. (15)
o No reservation required
o Open year-round, 8 am – dusk
o Golf Leagues, Clinics, and Tournaments are available. For more information visit
http://www.bransonparksandrecreation.com/golf.htm
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HOLIDAY HILLS GOLF COURSE (Public, 18 holes): 417-334-4838
Holiday Hills Golf Course is a beautiful 18-hole facility which is designed for entry level
golfers, but still presents a challenge to even highly skilled players. The course also
offers a restaurant and lounge as well as a fully stocked Golf Shop. Each golf cart is
equipped with a new ProLink GPS System which enables the player to view distances,
order food and beverages, view sales by and communicate with the Pro Shop, and view
the leader board while playing in tournaments put on by Holiday Hills. (16)
o 2380 East State Highway 76, Branson
o http://holidayhills.com/
MURDER ROCK COUNTRY CLUB (Semi Private/ Open to the Public, 18 holes): 417-332-3259
John Daly’s Murder Rock Golf and Country Club is a semi-private golf club which offers
many amenities such as a community clubhouse with dining, a pro shop, fitness room,
tennis, and swimming. The golf course is set on the magnificent landscape of the Ozark
Mountains and provides beautifully placed greens which offer great views of the
surrounding area. (20)
o Cart and range balls included in price
o Group Discounts available
o http://www.murderrock.com/
o 1250 Golf Club Drive, Hollister
PAYNE STEWART GOLF CLUB (Public, 18 holes): 417-337-2963
The Payne Stewart Golf Club is a course constructed in honor of golf legend Payne
Stewart. It was ranked one of the Top 40 new course layouts in 2009 by Golf Week
magazine. Each hole is interwoven with a story of Stewart’s life and golf experiences
throughout his career. The Golf Club also features a clubhouse which includes a full
menu of food items. Annual membership with the Payne Stewart Golf Club includes full
use of all the golf, tennis, swimming, and social amenities which it has to offer. (18)
o http://www.paynestewartgolfclub.com/
o 100 North Payne Stewart Drive, Branson
POINTE ROYALE VILLAGE COUNTRY CLUB (Resort/ Semi Public, 18 holes): 1-800-962-4710
Pointe Royale Village Country Club offers nightly rental condominium housing,
swimming, tennis, an exercise center, lakeside trout fishing, and of course a premier golf
course. The course is newly renovated and presents a challenge for players, yet it still
features tees for all levels of play. A fully stocked Pro Shop is available along with a
restaurant in the Pointe Royale club house. (19)
o http://pointeroyale.com/golf/index.html
o 1000 Point Royale Drive, Branson
THOUSAND HILLS GOLF RESORT (Open to Public, 18 holes): 417-336-5873
Thousand Hills Golf Resort is a popular course because of its ability to cater to golfers of
every skill level. The course features three separate sets of tees which ensure
challenging yet fair play for every golfer at every skill level. Thousand Hills Golf Course
was rated 4 stars by Golf Digest magazine in 2009 and voted Best of the Ozarks for
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Branson Golf Courses by readers of the Springfield News-Leader. The golf resort is part
of the full service Resort which offers discounts to their nightly rental guests. (17)
o http://www.thousandhills.com/branson-golf
o 245 South Wildwood Drive, Branson
Skating and Bowling
DOGWOOD LANES: 417-336-2695
Dogwood Lanes Bowling Alley offers a full deli. While not the most strenuous of physical
activity, it is a good option to get out and do something fun. (28)
o 2126 East State Highway 76, Branson
o Cost for individuals
SKATE WORLD: 417-334-1630
Skate World is a great option for group gatherings or families who are looking for fun
and physical activity. It features a large skating arena, full snack bar, free Wi-Fi Internet,
and a selection of arcade games. (27)
o Cost for individuals, Birthday Parties and Private Parties.
o 100 Truman Drive, Branson
Community Groups and Centers
BRANSON COMMUNITY CENTER: 417-337-8510
The Branson Community Center is used for a plethora of activities such as a senior lunch
program, dancing, crafts, card playing, club meetings, bingo activities, and Wii games.
o Wii Bowling League- six week league every fall, winter, spring and summer. Free
o Monthly ballroom dance, fourth Saturday of every month, 7-10 pm. Free
o Branson Senior Center offers lunch daily Mon-Fri 11:30 a.m. - 12:30 p.m.
o $3 suggested donation ages 60+; and $5 for anyone under 60
o Guest speakers come to the Senior Center once a month after lunch to speak on the
topics of health and nutrition. They also occasionally bring in local entertainers to
perform during the lunch hour. (30)
FORSYTH SENIOR FRIENDSHIP CENTER: 417-546-6100
o The Forsyth Senior Friendship Center offers a variety of activities free of charge to
seniors including Yoga, Line dance, Pinochle, and other activities during weekday
afternoons. (42)
o 8-ball Pool tables available for free play; treadmill and stationary bicycles also
available
o 13879 US Highway 160, Forsyth
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OZARK MOUNTAIN TRAILBLAZERS: 417-844-5834
Ozark Mountain Trailblazers is a group of outdoor enthusiasts, whose members enjoy
hiking and backpacking through the natural areas of southwest Missouri and northern
Arkansas. The group offers professional guide services, outdoor education and training,
gear and trail reviews and expedition adventures. (29)
o http://hikingtheozarks.com/
Food and Nutrition Resources in Taney County
Apart from all the normal supermarkets in Taney County, there are many resources which can
be utilized relating to options for less expensive food and healthy choices.
Farmers’ Markets
BRANSON FARMERS’ MARKET: 417-593-6247
The Branson Farmers’ Market is a great option for buying fresh produce and helping to
support local farmers.
o Saturdays: 7a.m.-12p.m. May 9-October
o 114 West Pacific, Branson
FRONT DOOR FARM MARKET: 417-546-5112
Front Door Farm Market is working towards becoming a small scale sustainable farm
with all natural beef, pork, and chickens that have been given no steroids as well as over
an acre of garden. The aim is to supply several families in the area with a healthier and
all natural option for a good portion of their food needs.
o 565 Max Creek Road, Taneyville
FORSYTH FARMERS’ MARKET I
Located in the parking lot on Main Street across from the Taney County Judicial Center
in Forsyth. Open every Tuesday, Thursday, and Saturday during season, 7 am until sold
out.
FORSYTH FARMERS’ MARKET II
Located at Forsyth Veterans of Foreign Wars Post north of Forsyth on State Highway H
just north of US Highway 160 in Forsyth. Open every Friday and Saturday during season,
7 am until sold out.
ROCKAWAY BEACH FARMERS’ MARKET: 417-546-2744
Rockaway Beach Farmers’ Market features a delicious full line of products grown
organically from the region. Open Saturdays from 7a.m.-3p.m, April- October
o 2536 State Highway 176, Rockaway Beach
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Food Pantries
ANGEL FOOD MINISTRY
Angel Food Ministries is dedicated to providing food relief and financial support to the
community. Many different food options are available with a different price for each
compilation box of food, with the average price of a box being $24. The food can be
ordered online or in person, and picked up at the host site. (32)
o A meal box feeds a family of four for about a week; No purchase limit on boxes
o Different menu each month
o Absolutely no applications or qualifications necessary to purchase.
o Branson United Methodist Church: 417-230-7201
o 1208 W. 76 Country Blvd, Branson
o Beacon of Hope: 417-561-8206
o Highway 76, Rockaway Beach
CHRISTIAN ACTION MINISTRIES: 417-334-1157
Christian Action Ministries is a non-denominational local organization dedicated to
distributing hundreds of pounds of food and grocery products in Christ's name to hungry
and needy people in the community. CAM provides
emergency assistance with up to 3 days of food. (31)
o Operates solely on donations from individuals,
businesses, churches, clubs, and civic organizations
o 202-B Vaughn, Branson
LOAVES AND FISHES: 417-335-4599
Loaves and Fishes aims to serve the working poor, families, homeless, and seniors
during winter months by providing them with no cost hot meals. Various locations are
used as sites for serving the meals (33)
o P.O. Box 6224, Branson
MY NEIGHBOR’S PANTRY: 417-251-0260
My Neighbor’s Pantry is a charity food pantry which is committed to fighting hunger in
Taney County. (24) This pantry is a program of Gift of Hope, a charity organization
aiming to benefit children and families in less than ideal circumstances
o 10275 E Hwy 76, Forsyth
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Food Programs
BOYS AND GIRLS CLUB
The Boys and Girls Club provides after school programs for kids 6-18. Not only do they
have after school programs, but they are also open all day
(7:30am – 6:30pm) during the summer months and offer
various programs for the summer. A hot meal is served
each day during the after school program, and during the
summer months, breakfast, lunch, and a snack are all
served. (35)
o $25 per year, but no child is turned away for financial reasons.
o Branson location: 417-336-2420
 1460 Bee Creek Road, Branson
o Forsyth location: 417-546-6299
 501 Panther Road, Forsyth
FREE AND REDUCED MEAL PROGRAMS
In 2008, 52.7% of students in Taney County schools were enrolled in the Free and
Reduced Breakfast and/or Lunch Program. Children from households with income less
than 130% of poverty are eligible for free lunches, and children from households with
income below 185% of poverty are eligible for reduced price breakfast/lunches. (22)
Information regarding the Free and Reduced meal program is available from area
schools.
JESUS WAS HOMELESS: 417-294-1300
Jesus Was Homeless is a nonprofit Christian organization which is dedicated to helping
people who are in need. They provide and deliver sack lunches to the weekly stay
motels and the homeless people who live and work in Branson and the surrounding
area.
o 176 Summerbrooke Lane, Branson
MEALS ON WHEELS: 417-335-4801
Meals on Wheels is a nationwide food program, but is locally served by the Community
Center to homebound senior citizens who cannot purchase or prepare their own food.
Eligibility is determined by medical need and financial need but overall, ability to pay
does not matter. (34)
SNACKS IN PACKS (SIP)
Snack in Packs, sponsored by the Junior Auxiliary of Taney County, is a special food
program for children Kindergarten and 1st grades at Hollister Elementary School. The
program was designed to provide food and snacks for the weekend for eligible children.
Each Friday, the child receives a bag packed with healthy snacks to help meet food
needs during weekend. (22)
o Contact Hollister Elementary School for further details: 243-4000
170
SUMMER FOOD SERVICE PROGRAM
The Summer Food Service Program assures that eligible children have access to
nutritious meals during the summer months. Children up to the age of 18 are eligible if
their family income is less than or equal to 185% of the Federal Poverty Guidelines.
Adults over the age of 18 are eligible if they have been determined by the state
educational agency to have a disability and participated in a school-based program for
the disabled during the school year.
o Several different locations in Taney County
o Taneyville R-II: 417-546-5803
o Bradleyville R-1 School: 417-796-2288
o Forsyth Elementary School: 417-546-6384
o Lake Taneycomo Elks: 417-546-6299
o Kirbyville Elementary School: 417-334-2757
o Hollister Elementary School: 417-243-4025
o Branson High School: 417-334-6541
o Branson Primary School: 417-334-6541
o Branson Branch: 417-335-2089
WOMEN, INFANTS, AND CHILDREN (WIC):
WIC is a nutrition program which helps mothers and young children eat well and stay
healthy. The program is for women who are pregnant, breast feeding, or who have
young children under the age of 5. It is operated locally through the Taney County
Health Department. The WIC Program provides checks to buy healthy foods, offers
health education and personal nutrition counseling, and referrals to other health
programs for the family. Qualifications and other information can be found at:
http://taneycohealth.org/wic.php
o BRANSON OFFICE: 417 -334 – 4544; 320 Rinehart Road
o FORSYTH OFFICE: 417 -546 – 4725; 15479 State Highway 160
BREASTFEEDING SUPPORT: 417-334-4544
o A Certified Breast feeding educator is available at the Taney County Health
Department to answer all your questions about breast feeding at no cost.
Other Resources
MASTER GARDENERS OF THE OZARKS: 417-546-4431
Master Gardeners of the Ozarks is a gardening enthusiast group which aims to improve
the quality of life and enhance the economy and environment through horticulture
education. The group offers a volunteer program as well as gardening workshops and
various gardening events. (41) The volunteer programs consist of involvement in one on
one teaching, the speaker’s bureau, community beautification projects, children’s
garden and hosting conferences and workshops
o Office Location: University of Missouri Extension, 122 Felkins Avenue, Forsyth
171
OZARKS AREA COMMUNITY ACTION CORPORATION: 417-862-4314
Ozarks Area Community Action Corporation is a non-profit agency which works towards
alleviating the causes and conditions of poverty in several counties the Ozarks area,
including Taney County. They offer several programs in order to meet the needs of
people in the Ozarks. (37)
o Foster Grandparents- For low-income senior citizens, 55 yrs or older. Receive an
hourly stipend for time spent with at-risk children in the community through local
agencies such as public schools, Head Start classes, Youth Community Centers, and
Day Care centers.
o Neighborhood Centers- Offers Family Support, Emergency Assistance, Targeted
Coaching, School Readiness Fairs, Workshops, and Community Projects. Exists for
those in need of services. Meet with a Family Resource Specialist and discuss the
current situation. You will be referred to specific OACAC community programs for
further help.
o OACAC Central Office, 215 S. Barnes Ave., Springfield
OLDER ADULT TRANSPORTATION SYSTEM (OATS): 417-887-9272
o OATS is a nonprofit public transportation system that serves people across Missouri,
including Taney County. It serves to transport people so they can get to work,
doctors appointments, or necessary shopping such as the grocery store or food
pantry. (38)
o Approximately $6 Branson to Springfield; within Branson, Hollister, Forsyth area: $1$3
o Call ahead and schedule a pick up time and route
Health Care Resources
FAITH COMMUNITY HEALTH: 417-336-9355
Faith Community Health provides healthcare for the working uninsured. Through a
partnership with the Ozark Mountain Family YMCA, patients can participate in the
Healthy Lifestyles Program. This program includes classes which focus on nutrition,
fitness, relationships, faith, etc. Sign up for Faith Community Health is available at
Ozarks Regional YMCA. (36) (4) Services include medical and pharmacy services with
future plans for optometry and dental services. Client fees are based on a sliding scale
for visits to FCH, including access to prescribed classes at the YMCA. Eligible clients must
prove income at or below 200% of the federal poverty guidelines, and proof of
employment status within last 6 months in Stone or Taney counties.
o Appointments are required
o 610 South Sixth Street, Branson
VETERANS AFFAIRS OUTPATIENT CLINIC: 417-243-2300
o Veterans’ Affairs Outpatient Clinic administers primary care services for veterans in
Branson and the surrounding area. Included with all the normal primary care
services, Behavioral Health services offers individual or group counseling, and
programs such as Quit Smart Smoking Cessation. Branson Veterans Outpatient Clinic
172
is a branch of Veterans Health Care System of the Ozarks which is based in
Fayetteville, Arkansas. As parts of their value system, the Outpatient Clinic focuses
on quality, cost effectiveness, and healthy communities. (39)
o Routine prescriptions are processed through the mail
o There is a possibility of a number of co-pays as a result of treatment; the clinic will
file claims with the patient’s insurance company.
o http://www.fayettevillear.va.gov/visitors/branson.asp
o 5571 N Gretna Road
Branson, MO 65616
SKAGGS REGIONAL MEDICAL CENTER EDUCATION: 417-335-7453
Health Education classes for diabetes, health disease and other conditions meet
regularly on certain days of the month. These classes are aimed toward benefitting
patients and their families with useful information relayed through various topics and
presentations. (40)
o Location: Skaggs Regional Medical Center, 251 Skaggs Rd., Branson
o Visit http://www.skaggs.net/body.cfm?id=195 to view a monthly calendar of Skaggs’
events such as free blood pressure screenings, childbirth classes, diabetes education,
or various support groups
173
Special Thanks To Our Partners Who Provided Information for This Report:
1. Branson Parks and Recreation Department
2. Hollister Parks and Recreation Department
3. Downhill Bikes
4. Ozarks Regional YMCA
5. Branson RecPlex
6. Skaggs Health and Fitness Center
7. American Cancer Society; Relay For Life
8. Any Body’s Gym
9. First Baptist Church Life Center
10. Anytime Fitness
11. Maples Training and Fitness Center
12. Curves For Women
13. Shape Shifters Pilates
14. Branson Creek Golf Club
15. Don Gardner Golf Course
16. Holiday Hills Golf Course
17. Thousand Hills Golf Resort
18. Payne Stewart Golf Club
19. Point Royale Village Country Club
20. Murder Rock Country Club
21. Department of Elementary and Secondary Education
22. Hollister Public Schools
23. Branson Public Schools
24. My Neighbor’s Pantry
25. Midwest Dance Revolution
26. Music In Motion
27. Skate World
28. Dogwood Lanes
29. Ozark Mountain Trailblazers
30. Branson Community Center
31. Christian Action Ministries
32. Angel Food Ministry
33. Loaves and Fishes
34. Meals on Wheels
35. Boys and Girls Club
36. Faith Community Health
37. Ozarks Area Community Action Corporation
38. Older Adult Transportation System
39. Veterans Affairs Outpatient Clinic
40. Skaggs Regional Medical Center
41. University of Missouri Extension
42. Forsyth Senior Friendship Center
174
Appendix A:
Policy Changes
2011 Community Health Assessment:
Public Policy Changes
Year
20052006
2006
Agency
Schools
Rule Change
Model School Wellness Program required by Missouri State Law
Schools
2006
Schools
2006
Taney County
Health
Department
Schools
Requires school districts to grant authorization to pupils for the
possession and self-administration of medications for the
treatment of asthma and anaphylaxis.
Allows school nurses to keep on hand and administer
epinephrine auto syringes to students who the nurse believes is
having an anaphylactic reaction.
County Food Code Ordinance Enacted
2007
2006
Ongoing
2007
2008
City of Branson
Park Board
TCHD
Skaggs
City of Branson
Park Board
City of Forsyth
TCHD
TCHD
2007
2008
Missouri
City of Branson
Annually
MO DHSS
Taney County
Park Board
2008
2006
Ongoing
Beginning July 1, 2008, every child enrolled in kindergarten or
first grade shall receive comprehensive vision examinations by a
state licensed optometrist or physician and before the
completion of first and third grade, school districts must conduct
and eye screen for each student.
Rec-Plex Facility opened.
Tobacco Free Campus Policy Implemented
Tobacco Free Campus
Walking Trails constructed for the community
Walking Trails constructed for the community.
Ordinance for adoption of 1999 Food Code
Integration of Environmental Health Services and TCHD
Approved
MC+ changes to Missouri Health Net approved to begin in 2008
Liquor Law Ordinance Changes for City of Branson to tighten sale
and consumption of alcohol beverages in Branson
Communicable Disease Reporting Rule Changes
Taney County Park Board Established
Appendix B
Leading Causes of Death
Leading Cause of Death Profile for Taney County Residents, 1999-2009
Number
of Events
4740
AgeAdjusted
Rate
841.1
Significantly
Different
L
Ranking
4
AgeAdjusted
State
Rate
871.5
1346
237.9
N/S
4
245.6
1176
199.2
N/S
3
197.7
384
63.3
N/S
2
61.4
77
13.4
N/S
3
14.6
Stroke/Other
Cerebrovascular Disease
Chronic Lower Respiratory
Disease
Total Unintentional
Injuries
Motor
Vehicle
Accidents
Diabetes Mellitus
Alzheimer's Disease
261
45.5
L
5
54.9
263
44.5
N/S
4
48.7
253
52.1
H
3
45
117
25.1
H
4
18.6
148
79
108
26.3
14.2
19.6
N/S
L
N/S
2
5
3
23.1
23.8
21.9
Kidney Disease (Nephritis
and Nephrosis)
Suicide
Septicemia
Chronic Liver Disease and
Cirrhosis
Homicide
HIV/AIDS
Smoking-Attributable
(estimated)
Alcohol/Drug-Induced
All Injuries and Poisonings
Firearm
Injury at
Work
100
17.6
N/S
3
17.2
63
56
12.8
9.5
N/S
N/S
4
4
12.8
11.5
56
10.2
H
7.3
24
6
5.4
1.4*
N/S
N/S
7.1
2.3
936
159.4
N/S
3
152.2
74
353
50
15.7
72.8
9.9
N/S
N/S
N/S
2
3
4
16.4
67
12.7
9
1.8*
N/S
All Causes
Heart
Disease
All Cancers (Malignant
Neoplasms)
Lung Cancer
Breast
Cancer
2
Source: Missouri Department of Health and Senior Services, Community Data Profile; All rates are per year per 100,000 population and are ageadjusted to the U.S. 2000 standard population.
Heart disease mortality has demonstrated a decreasing trend for the past several years.
Medical and pharmaceutical advances have decrease mortality for this condition. However,
high use of tobacco products, decreasing physical activity, and increasing rates of residents who
are overweight and obesity in the community may eventually contribute to increased mortality
from heart disease and lung cancer.
Percent of Missouri Adults with Risk Factors, 2010
Overweight
Obese
No Leisure Time Physical Activity
Binge Drinking (Men)
Current Cigarette Smoking
Ate 5 or more servings of fruit and
vegetables per day
Fair or Poor General Health Status
No Health Care Coverage
Binge Drinking (Women)
34.4
31.4
27.2
21.5
21.1
19.9
16.4
15.0
10.1
Source: MODHSS, Behavioral Risk Factor Surveillance System (BRFSS), 2011
Appendix C
Taney County Tobacco Use Assessment
2011 Tobacco Use Assessment
Introduction
Taney County consists of 632.14 square miles of land and 19.12 square miles of water and is
located in the southwest corner of Missouri in the heart of Ozark country. Taney County was
organized on January 6, 1837 and was named after a Chief Justice of the United States Supreme
Court, Roger B. Taney (Taney County Missouri, 2011).
Total resident population is approximately 51,675 according to the 2010 census which has
increased 30.2% since 2000 (U.S. Census Bureau, 2011). The population diversity is
approximately 93.6% white, 0.9% Black, 4.8% Hispanic and the remaining 0.7% consists of other
ethnic groups. The population is young with a median age of 21.9 years for both males and
females. There are a larger number of females compared to males in Taney County, 51.5% and
48.5%, respectively (U.S. Census Bureau, 2011).
The 2009 median income for a household in Taney County according to the 2010 US Census was
$37,319. The per capita income for the county in the past 12 months (2005-2009) was $20,855
and about 15.8% of the population is living below the poverty level (U.S. Census Bureau, 2011).
Of adults 25 years of age and older in Taney County, 86.2% possesses a high school diploma or
higher while 20.4% holds a bachelor's degree or higher as their highest educational attainment
(U.S. Census Bureau, 2011).
Background
Tobacco use is the leading cause of death in the Unites States with an estimated 443,000
deaths each year which includes approximately 49,000 non-smokers exposed to secondhand
smoke. Smoking tobacco has been associated with an increased risk of stroke, heart disease,
chronic obstructive pulmonary disease, and several other forms of cancer. Smokeless tobacco
has also been associated with an increased risk of oral cancer, pancreatic cancer, and
cardiovascular disease (CDC, 2011).
The economic costs of smoking are staggering. It is estimated that smoking is related to over
one-tenth of the total hospital and medical expenses in the United States, with the combined
cost of smoking-related sickness and decreased productivity (lost work output and
absenteeism) raising this total into the billions of dollars. In addition, the health risk to
nonsmokers (e.g., passive smoking) may also be significant, especially if there is a preexisting
cardiovascular or pulmonary condition (CDC, 2011).
The Taney County Health Department’s (TCHD) primary focus has always been to increase
awareness and educate the community on the harmful effects of tobacco use and second-hand
smoke. In 2006, the department received a Maternal and Child Health Grant from the Missouri
Department of Health and Senior Services (DHSS) which allowed the health department the
ability to hire a health educator to teach tobacco awareness in schools. Through student lead
anti-tobacco groups in Branson and Forsyth Junior High Schools, the DreamOn (BJHS) and TATU
(FJHS) clubs empower local youth to take action to reduce tobacco use and exposure to
secondhand smoke. For the last 5 years, members of these clubs have worked to educate
themselves , their peers and community about tobacco use. They have participated in Red
Ribbon Week, the Great American Smoke-out, and Kick Butts Day as well as participating in
Relay for Life. These students have also participated in radio interviews and developed PSA’s.
In 2007, the department initiated the Breathe Easy Coalition. This coalition began with
representatives from TCHD’s board, Skaggs Regional Medical Center, the American Heart
Association, American Lung Association, American Cancer Society, and community leaders from
Branson, Forsyth and Hollister. In 2009, the coalition changed its name to Smoke-free Taney
County and has recently joined the Alcohol and Drug Abuse Prevention Team(ADAPT) as a
subcommittee.
Since Taney County has the highest rate of smoking (36.5%) according to 2007 Missouri County
Level Study of having the tobacco users within the state of Missouri, we decided to conduct a
tobacco use survey to assess the prevalence of smokers, age distribution, education obtained
among smokers and if they would like to receive education on tobacco cessation.
County Level Study 2007
A Missouri county level study (CLS) was conducted on tobacco use in 2007. The Missouri
Foundation for Health (MFH) contracted with the University of Missouri-Columbia Health and
Behavioral Risk Research Center (UMC HBRRC) to conduct interviews with 400 adults in 112
counties and 800 adults each in Jackson and St. Louis Counties and the City of St. Louis. A total
of 47,200 Missouri adults were randomly called on landline telephones and an additional 5,000
were called on cell telephones. The 2007 CLS involved interviews with 49,513 Missouri adults
and was supported by a grant from MFH. The 2003 CLS involved interviews with approximately
15,000 adults. Because of the lower number of responses in smaller counties, the 2003 study
combined data from two or three counties. UMC HBBRC conducted the interviews in 2003 and
2007. Macro International conducted the primary data analysis in 2007 and a special
comparison analysis of the 2003 and 2007 studies (Missouri County-Level Study, 2007).
Currently a 2011 study is being conducted. Calls began in January 2011 and will continue
through December 2011. MFH contracted with Macro International to conduct the primary
data analysis. Missouri Department of Health and Senior Services (DHSS) staff was responsible
for the study design and will monitor data quality and consult with MFH on interpreting and
reporting results. The 2011 CLS results will be posted on the DHSS Community Data Profiles
web site where 2007 results and a comparison analysis of 2003 and 2007 may be found
(Missouri County-Level Study, 2007).
Results from the 2007 County Level Study:
Taney County 381 interviewed
 36.5% currently smoked
 2.9% used smokeless tobacco
 22.5% were former smokers
Missouri, 49,019 interviewed
 23.2% currently smoked
 3.9% used smokeless tobacco
 25.1 were former smokers
Limitations to the 2007 study:
The findings of the 2007 study are subject to at least three limitations. First, the CLS did not
collect information from institutionalized persons, thereby excluding persons residing in nursing
homes, long-term care, and correctional facilities. Second, as a self-report survey, the CLS is
subject to recall bias. Third, the CLS did not include persons residing in households without
telephones and those households that use cell phones only.
August 2011, Taney County Health Department developed and implemented an anonymous
online survey of residents of Taney County for three consecutive weeks using websites of the
City of Branson, the Taney County Health Department, and Community Partnership of the
Ozarks.
Methodology
Study Design
A cross-sectional, anonymous questionnaire survey
Assessment of Tobacco Use among Taney County Residents
Needs assessments are conducted during the planning phase of any program to isolate the
target population, determine what variables are contributing to increased tobacco use
compared to other counties in Missouri, and what actions can be implemented to decrease
tobacco use in our community. The information collected from the tobacco use assessment has
driven a needs assessment for the population in the community, and helped establish which
course should be taken to maximize efficacy.
An important step in addressing tobacco use and dependence is by screening residents of
Taney County for tobacco use. A questionnaire was developed by Taney County Health
Department to collect and analyze data on the tobacco prevalence and also to find out if the
respondents were aware of second and third hand smoke. The anonymous questionnaire
about tobacco use was uploaded to the Taney County Health Department, the City of Branson,
and Community Partnership of the Ozarks websites for a period of three weeks. Only residents
of Taney County were asked to respond to the survey. Mass emails went out to community
partners for participation in the survey and to forward onto others to increase participation.
The goal was to have at least 1000 responses to the survey; however, at the close of the survey,
we received a total of 282 responses. Any respondents who did not reside in Taney County
were excluded from the results making the total of viable responses to 270.
Purpose and Scope: The purpose and scope of the needs assessment is to gather data from
residents in the local community to determine their opinions and comprehension of tobacco
use. Demographic and behavioral statistics were collected from self-report surveys and used to
determine individual and community knowledge and actions as it pertains to tobacco use.
Overall goal of the assessment:
 Prevalence of tobacco use in Taney County
 Age distribution of current tobacco users
 Education obtained from tobacco users
 Assess respondents’ knowledge of second and third hand smoke
Gathering Data: Primary data was collected from residents in the community via survey
administration and asked residents to complete an original self-report online questionnaire.
Considerable effort was made to ensure accurate reporting; however, self-reporting
respondents may have provided inaccurate information because the respondent was unaware
of relevant information or did not wish to reveal information that was requested.
Analyzing Data:
This full-report will be made available to all stakeholders in the community in the public domain
via the Taney County Health Department website upon compilation of the primary data.
Identifying the Intervention Focus:
Based on the primary and secondary data collected and analyzed, by providing community
education to Taney County residents the primary goal will be to educate them on the dangers
of tobacco use and offer different ideas and methods to safely and effectively quit smoking or
using smokeless tobacco. Area to focus on: Behavioral changes and health education in
addition to providing resources to assist the community in their process which will enable
individuals to change their habits, decrease possible health issues and live a longer life.
Results
Tobacco Use Prevalence
• 10% of the participants surveyed regularly use tobacco products, 27% were regular
users at one time but have quit, and 63% never used regularly. Missouri data from the
2010 Behavioral Risk Factor Surveillance Survey (BRFSS) estimate that the smoking rate
among Missouri residents is around 21.1% (BRFSS, 2010).
• Although rates of tobacco use are low overall, significantly more females use regularly
than males (85% vs.15%).
 The overall adult smoking prevalence was significantly higher among adults ages 46-55
than among adults ages 65 and older. 42% of the participants that use tobacco have an
education of at least an associate’s degree.
 18% of non-smokers shared a household with a family member who currently smokes
and 37% of smokers live with other family members that smoke besides themselves.
 Survey findings indicate that 50% of smokers and 82% of non-smokers supported laws
making restaurants smoke-free.
 The smoking prevalence among adults decreased with increasing education level. Adults
who had some post secondary education have the highest smoking prevalence (40%)
among all educational attainment groups.
 Starting age of Taney County smokers who responded to the survey:
o 63% under the age of 18,
o 26% between the ages of 18-21,
o 7% between the ages of 31-44 and
o 4% between the ages 45-60.
The Need for Intervention
Cessation of tobacco use can greatly improve the physical health consequences of tobacco use,
help reduce the financial burden from the purchase of tobacco, increase self-esteem, and
reduce tobacco user’s feelings of stigma.
• According to the survey, 48% of Taney County residents who regularly use tobacco
would either like to quit, maybe would quit or are unsure they would quit within the
next 12 months.
• 79% of current tobacco users indicated that they tried to quit in the past but were
unsuccessful. 65% of current users tried to quit “Cold Turkey”, with nicotine
replacement therapy used far less often. 44% of tobacco users surveyed that they have
tried to quit tobacco “more than three times.
Limitations
The study had some limitations: smoking status was by anonymous self-report and the survey
was cross-sectional. Therefore, some Taney County residents may have under reported their
tobacco use. Because the study was carried out on three website locations with a press release
that was conveyed along with mass emails to our community partners to disseminate to their
staff, residents were not interviewed personally. Taney County Health Department did not
collect information from institutionalized persons, thereby excluding persons residing in nursing
homes, long-term care, and correctional facilities. Taney County Health Department did not
include persons residing in households without internet access.
Conclusion
Tobacco use in any form (smoking or smokeless) is prevalent among Taney County Residents.
Cigarette smoking was the most popular form of tobacco use. Female Taney County residents
were more likely to use tobacco. Targeted adult intervention strategies by counseling and
education are necessary. Enforcement of regulations on sale and advertisements of tobacco
products may also be useful. Legislations on use of tobacco products need to be enforced to
decrease availability, accessibility and affordability of tobacco products by instituting a no
smoking policy in public places. Policies to bring about changes in acceptability of tobacco use
(social norms) among adults may also help to curb the tobacco use among Taney County
residents. A reassessment of the county will need to be conducted after the intervention of
health education and policy change to compare results and see if there has been a decrease
related to policy change.
References
BRFSS. (2010). BRFSS. Retrieved from Missouri Department of Health and Senior Services:
http://health.mo.gov/data/brfss/2010datareport.pdf
CDC. (2011, March 8). Smoking & Tobacco Use. Retrieved from Center for Disease Control and
Prevention: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm
MICA. (2007). Tobacco Cessation for Missouri Adults. Retrieved from Missouri Department of
Health and Senior Services:
http://health.mo.gov/data/mica/County_level_study/header.php?cnty=929&profile_ty
pe=3&chkBox=C
Missouri County-Level Study. (2007). Missouri County-Level Study. Retrieved October 24, 2011,
from Missouri Department of Health and Senior Services:
http://health.mo.gov/data/cls/index.php
Taney County Missouri. (2011). History of Taney County. Retrieved from Taney County,
Missouri: http://www.co.taney.mo.us/cgi-bin/County/index.cgi?section=history
U.S. Census Bureau. (2011, June 3). State & County QuickFacts. Retrieved from U.S. Census
Bureau: http://quickfacts.census.gov/qfd/states/29/29213.html

COMMUNITY HEALTH ASSESSMENT TANEY COUNTY HEALTH

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