A Community of Partners - Taney County Health Department
Transcription
A Community of Partners - Taney County Health Department
Taney County Health Department MAPP Community Health Assessment THIS PAGE INTENTIONALLY LEFT BLANK 1 Taney County Health Department MAPP Community Health Assessment 2012 Taney County Health Department MAPP Community Health Assessment ______________________________________________________________________________ ______________________________________________________________________________ July 24, 2012 “A Community of Partners” Prepared and Written By: Kimberly Foster, MPH REHS Robert Niezgoda, MPH Wennekota Tamara, MPH-Intern Cover Design: Donna Gold Kimberly Foster Amanda Modayil Kim Conway 2 Taney County Health Department MAPP Community Health Assessment Contents INTRODUCTION ..................................................................................................................................................... 6 METHODOLOGY ..................................................................................................................................................... 7 PRIORITIES ............................................................................................................................................................. 8 TOP THREE PUBLIC HEALTH PROBLEMS ................................................................................................................. 9 VISION ................................................................................................................................................................. 12 VALUES ................................................................................................................................................................ 12 COMMUNITY HEALTH ASSESSMENT .................................................................................................................... 12 Demographic Characteristics ..............................................................................................................................12 Socioeconomic Characteristics ............................................................................................................................14 Behavioral Risk Factors .......................................................................................................................................17 Environmental Health Indicators ........................................................................................................................19 Housing Concerns................................................................................................................................................24 Agricultural Activities ..........................................................................................................................................26 Environmental Public Health Services .................................................................................................................27 Animal Control Services ......................................................................................................................................28 Health Resource Availability ...............................................................................................................................29 Communicable Disease .......................................................................................................................................30 Sexually Transmitted Diseases ............................................................................................................................30 Social and Mental Health ....................................................................................................................................31 Maternal and Child Health ..................................................................................................................................33 Senior Issues ........................................................................................................................................................34 Mortality .............................................................................................................................................................35 Community Resources Assessment .....................................................................................................................37 PHYSICAL ACTIVITY OPTIONS IN TANEY COUNTY ................................................................................................. 37 FORCES OF CHANGE ASSESSMENT ....................................................................................................................... 52 COMMUNITY THEMES AND STRENGTHS ASSESSMENT ........................................................................................ 55 LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT ...................................................................................................... 56 APPENDIX A ......................................................................................................................................................... 61 APPENDIX B ......................................................................................................................................................... 63 APPENDIX C ......................................................................................................................................................... 70 REFERENCES......................................................................................................................................................... 83 3 Taney County Health Department MAPP Community Health Assessment Acknowledgement MAPP membership 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 Hollister Parks and Recreation Department City of Branson Parks and Recreation Downhill Bikes City of Branson Public Works City of Hollister Ozarks Regional YMCA Branson RecPlex American Cancer Society; Relay For Life College of the Ozarks Hollister Public Schools Any Body’s Gym First Baptist Church Life Center James River Basin Foundation Anytime Fitness Kirbyville Public Schools Maples Training and Fitness Center Mark Twain Public Schools Curves For Women Missouri Department of Agriculture Missouri Department of Conservation Shape Shifters Pilates Branson Creek Golf Club Don Gardner Golf Course Missouri Department of Elementary and Secondary Education Missouri Department of Health and Senior Services Holiday Hills Golf Course Thousand Hills Golf Resort Payne Stewart Golf Club Missouri Department of Mental Health Point Royale Village Country Club Missouri Department of Natural Resources Murder Rock Country Club Missouri Department of Social Services Branson Public Schools My Neighbor’s Pantry Missouri State Highway Patrol Midwest Dance Revolution Skaggs Community Foundation Skaggs Regional Medical Center Music In Motion Skate World 4 Taney County Health Department MAPP Community Health Assessment Taney County Health Department Dogwood Lanes Taneyville Public Schools Ozark Mountain Trailblazers United States Corps of Engineers United States Environmental Protection Agency Branson Community Center Christian Action Ministries Ozarks Area Community Action Corporation United States Department of Agriculture White River Basin Foundation Older Adult Transportation System Veterans Affairs Outpatient Clinic Angel Food Ministry University of Missouri Extension Loaves and Fishes Forsyth Senior Friendship Center Meals on Wheels Boys and Girls Club Faith Community Health 5 Taney County Health Department MAPP Community Health Assessment 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. Beginning 2011, the Taney County Health Department (TCHD) engaged in an 18-month process to assess the health of the community. MAPP (Mobilizing Action through Planning and Partnerships) was chosen as the best practice for assessing the community. This health assessment is a community driven project involving health care providers, public health officials, stakeholders and the community at large. A coalition was formed through this process called the Community Health Improvement Coalition (CHIC). The intent was to mobilize and engage the community by conducting assessments, planning sessions, developing partnerships and developing an action plan to address the priorities identified. Taney County Health Department is continually organizing partnerships to address the issues by creating plans for change, implementing those plans and evaluating the outcome so that we know that the strategies that are put into place are creating a positive change which in turn will improve the health of our community. Objectives of the CHIC were to: o Complete comprehensive assessments to gather data on the health status of the community. o Define goals and strategies to address the priorities identified. o Take action to provide positive health outcomes. The health of the community process involved using four assessments which contained several components. 1. Community Health Assessment 2. Forces of Change Assessment 3. Community Strengths and Themes Assessment 4. Local Public Health Systems Assessment 6 Taney County Health Department MAPP Community Health Assessment Methodology The MAPP process was a collaborative effort facilitated by the Taney County Health Department which included leaders and representatives from a broad array of city and county departments, health systems, community organizations and the community at large. Data for the 2012 Taney County Community Health Assessment was collected from a variety of primary data sources, secondary data sources and four assessments. Existing databases containing local, state and national health and behavior data were used for comparison between communities where possible. Databases include Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Survey (YRBS), death certificate data, birth certificate data, hospital discharge data, and data, surveillance systems and statistical reports provided by the Missouri Department of Health and Senior Services. To ensure accuracy, data from sources were examined to clarify reporting sources, data collection methods, and population or sample sizes. In all sections of the Community Health Assessment, the most recent data available was used to compile this report. A nine page survey in English and in Spanish was made available through SurveyMonkey on the TCHD website as well as paper version for those who did not have access to a computer. Members of the Community Health Improvement Coalition (CHIC) as well as other partners were asked to distribute a link to the survey via email to their staff, friends, family, clients and coworkers. Members were also encouraged to provide a paper version of the survey for their contacts to fill out and return if necessary. The survey was made available to staff at the three health department locations and to clients to fill out before their appointments. The survey was made available for a total of four weeks. Approximately a week after the survey began, a reminder call was made to all CHIC members to complete the survey and distribute it to their staff. CHIC members were also asked to keep record of the number of surveys distributed and completed. The purpose of the community survey was to gather baseline data on demographics and health care access as well as to assess the community’s insight on what they considered to be community health priorities. The survey was also conducted to guide the coalition in creating our strategic plan to address the health needs of the community over the next five years. The survey resulted in 485 total responses. Only Taney County residents were able to complete this survey. If a respondent was not a Taney County resident, he or she would answer “NO” to the question, “Are You a Resident of Taney County?” and the survey would end for that participant. Of the total responses, 35 were not residents of Taney County and 450 were residents of Taney County. After determining the participants’ eligibility for the survey, they were directed to answer demographic information including weight, height, health care and health priority questions. It appeared that of the 450 residents, only 344 respondents answered questions two to twenty-four. Two of the 450 were eliminated due to incorrect zip codes. 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 of the Missouri Department of Health and Senior Services and on the 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 7 Taney County Health Department MAPP Community Health Assessment chapters were developed using the data collected from the referenced sources. Every effort was made to present 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 as 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 narrowed the ability for 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 notify us so that we may identify, correct, or clarify the information. Priorities Taney County Health Department and community partners have 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. The health priorities identified through the MAPP 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 following Health Priorities were identified through the MAPP process. 1. Unhealthy Body Weight due to poor nutrition 2. Tobacco, Alcohol and Drug Abuse 3. Child and Family Safety 8 Taney County Health Department MAPP Community Health Assessment Top Three Public Health Problems Unhealthy Body Weight due to poor nutrition Body Mass Index (BMI) in adults is defined as a ratio that is determined by height and weight. Between 25 and 29.9 is considered overweight and BMI of 30 or greater is considered obese. Developmental processes for adults and children are defined differently in regards to overweight and obese. According to the CDC, a child’s weight status is determined by using age and sex specific percentile for BMI instead of BMI categories used for adults. For children, overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex. Obese children are more likely to be obese as an adult than children who are not obese (CDC, 2012). Childhood obesity can have harmful effects on the body and can contribute to a variety of health risks such as high blood pressure, high cholesterol, glucose intolerance, diabetes, sleep apnea, asthma, joint problems, and most importantly it can have a social and psychological impact. Obese children and adolescents have a greater risk of discrimination and poor self-esteem which can go well into adulthood (CDC, 2012). Many factors contribute to obesity in children as well as adults, such as increased caloric intake with limited physical activity. Sugary drinks, less healthy options at schools, and lack of physical activity in most schools may contribute to the rise in obesity among children. At home, parents may find it cheaper to order dinner from a fast food restaurant than go to the grocery store and purchase fresh fruits, lean meats and vegetables to cook. The increased use of television viewing and electronic usage has increased through the years limiting activity of children and youth which can go into adulthood (CDC, 2012). Public Health Goals If diet and nutrition is not properly aligned with physical activity, weight may become an issue. Healthy People 2020 address diet/nutrition as well as physical activity in its goals and objectives. The goals of Healthy People 2020 are to improve access to healthy foods, especially for children, and to increase physical activity for all ages. The objective for Healthy People 2020 is to reduce the proportion of the population that is obese by 10% to 30.6% by 2020. Obesity, nutrition and overweight/obesity are listed as one of the Winnable Battles by the CDC, which advocates environmental and policy-level changes to facilitate healthy eating and physical activity levels (CDC, 2012). Tobacco, Alcohol and Drug Abuse Alcohol Alcohol in excess is the third leading cause of lifestyle death in the U.S. resulting in approximately 79,000 deaths per year. Binge drinking is defined as four or more drinks per day for women and five or more drinks per day for men. Heavy drinking is defined as more than one drink per day for women on a single occasion and two or more for men (CDC, 2012). Excessive drinking can lead to immediate effects and harmful health conditions such as, unintentional injury, violence, risky sexual behavior, miscarriage, alcohol poisoning. Long term effects of alcohol 9 Taney County Health Department MAPP Community Health Assessment abuse can lead to liver disease, social problems, cardiovascular disease, cancer and other issues including pancreatitis and gastritis (CDC, 2012). Tobacco Tobacco, worldwide, causes more than 5 million deaths a year and will cause more than 8 million by 2030. In the U.S. tobacco use is responsible for about one in five deaths. For every person who dies from a smoking related illness, 20 more suffer with at least one illness from smoking (CDC, 2012). Smoking increases the risk of coronary artery disease, stroke, lung cancer and chronic obstructive pulmonary disease (COPD) (CDC, 2012). Drug Abuse Drug abuse is associated with many mental and physical health problems. It can disrupt relationships, employment and financial stability. Drug abuse can lead to hepatitis B, C, TB and STD’s. No single factor determines whether a person will become addicted to drugs. The overall risk for addiction is impacted by the biological makeup of the individual. It can be influenced by gender or ethnicity, developmental stage, and surrounding social environment (e.g., conditions at home, at school, and in the neighborhood) (CDC, 2012). Public Health Goals Healthy People 2020 addresses substance abuse in a ten year national plan for improving the lives and the health of Americans. The goal is to “reduce substance abuse to protect the health, safety and quality of life for all, especially children”. The Leading Health Indicators for Healthy People 2020 for substance abuse are: to reduce the proportion of adolescents reporting use of alcohol, marijuana or illicit drugs and reduce the proportion of people of all ages engaging in binge drinking (Healthy People 2020, 2012). Child and Family Safety Family Safety Any instance of physical or sexual violence, threats of violence or emotional abuse with a spouse or child is considered domestic abuse or Intimate Partner Violence (IPV). This type of violence can occur among heterosexual as well as homosexual couples and does not require sexual intimacy. Public health’s role is to “break the silence” of intimate partner violence. It must be aimed at reducing the occurrences through promotion of healthy, respectful, nonviolent relationships. Nearly 3 in 10 women and 1 in 10 men in the U.S. have experienced rape, physical violence and or stalking by a partner with IPV-related impact. IPV has resulted in 2,340 deaths in 2007, and of these 70% were female (CDC, 2012). Child Maltreatment A safe and stable environment among children and adults is a buffer against maltreatment or other adverse exposures during childhood. Unfortunately, not all children are exposed to positive relationships. Child maltreatment is a significant public health problem in the United States. In 2009, Child Protective Services confirmed more than 700,000 cases of abused or neglected children. These 10 Taney County Health Department MAPP Community Health Assessment confirmed cases, however, represent only a fraction of the true magnitude of the problem. Most cases are not reported, and child maltreatment remains a largely hidden problem. Some studies estimate that 1 in 8 U.S. children experience some form of child maltreatment (CDC, 2012). Child maltreatment can lead to a wide range of physical and emotional health problems. It can also lead to permanent physical disabilities and cognitive impairments. Not all injuries are visible that are a result of abuse. Victims of maltreatment may suffer long term anxiety and depression and possibly later in life have difficulty with relationships, abuse drugs and alcohol and possibly abuse those around them as well (CDC,2012). Public Health Goals The goals and objectives in Healthy People 2020 for Injury and Violence Prevention is reduction of intimate partner violence, sexual violence and exposure of children to violence. Prevention IVP will require changes at all levels of the community and society as a whole (Healthy People 2020, 2012). Goals and objectives for maltreatment are highly recognized by Healthy People 2020 and address the problem under Violence Prevention. First is to reduce all cases of child maltreatment and second, is to reduce the number of child deaths due to abuse and neglect (Healthy People 2020, 2012). 11 Taney County Health Department MAPP Community Health Assessment Vision T aney County is a community of healthy people living in a safe environment. Values We value improvement through teamwork, learning, and sharing of information. We strive to make a positive difference through education and communication; treating each other and those we serve with respect. Community Health Assessment Demographic Characteristics Taney County is located in Table 1 Southwest Missouri, 35 miles Demographics Taney County Missouri south of Springfield, Missouri and Population 51,675 5,988,927 is ranked 20 for overnight leisure Persons Under 18 Years Old 18.2 26.7 vacation destinations in the Persons 65 Years and older 17.7 14 country. Branson, Missouri is a Female 51.3 51 Class IV city with a permanent Male 48.7 49 population of approximately White 93.6 82.8 7,400 located in the west-central Black or African American 0.9 11.6 area of Taney County. The city of American Indian and Alaska Native 0.8 0.5 Branson includes approximately Native Hawaiian and Other Pacific 0.1 0.1 268 restaurants, 53 theaters, Islander three shopping malls, 207 Two or More Races 2.2 2.1 lodging facilities and three lakes. Hispanic or Latino (of any race) 4.8 3.5 Approximately eight million U.S. Census Bureau, 2010 guests per year visit this area, and 65% of those guests travel from outside a 300 mile radius. The average visitor stay is 2.4 days. Table 1 illustrates the diversity of Taney County those include Whites, Black or African American, Asians, American Indian and Alaska Native, Two or More Races as well as Hispanic or Latino. Compared to Missouri, Taney County has 1.3% more Hispanic and Latino. 17.7% of the population in Taney County is 65 Years and older and 18.2% are 19 years and younger. Respondents to the survey were distributed as follows, in percent: White 96.5; Two or more races 3; and Asian 0.6. 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 2). 12 Taney County Health Department MAPP Community Health Assessment Table 2 Percent of Population Classified as Rural and Urban, 2010 Total Population Urban Population Rural Population Taney County 51,675 50.0 50.0 Source: US Census, 2011 Missouri 5,988,927 73.1 26.9 69.4 Figure 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 Source: Missouri Department of Health and Senior Services, MICA, 2011 Figure 2 illustrates the age distribution of respondents to the health priority survey which resembles the age distribution according to the U.S. Census Bureau, 2010 of residents of Taney County. Respondents to the survey were over the age of 18. 13 Taney County Health Department MAPP Community Health Assessment Figure 2 Source: TCHD, 2012 Socioeconomic Characteristics The overall percent of all people below poverty level living in Taney County is significantly higher than the state and U.S. levels according to the U.S. Census Bureau for 2010. Taney County poverty rate in percent is 16.5% compared to Missouri poverty rate at 14.5% and 14.4% nationally (ACS, 2010). Taney County youth under the age of 18 living in poverty is 26.2% compared to 20.2% in Missouri and 20.1% in the U.S. (ACS, 2010). Table3 Percent Poverty Rate For The Population 25 Years and Over For Whom Poverty Status Is Determined By Educational Attainment Level-Taney County 2008-2010 Less than high school graduate High school graduate (includes equivalency) Some college or associate's degree TOTAL MALE FEMALE 25 22.3 28 16.6 14.1 18.8 8.5 8 8.9 Table 3 provides the poverty rate of the population 25 years of age and over for Bachelor's degree or 3 3.4 2.7 whom poverty status is determined by higher Missouri Department of educational attainment by gender. Source: Health and Senior Services, (MoDHSS) According to the data, female poverty levels are higher than males regardless of education obtained. As of 2010, 14% of Taney County Residents have less than a high school education compared to 13.9% Missouri and 14.4% in the U.S. (U.S. Census Bureau, 2010). The County Health Rankings (2011) place Taney County 99th in social and economic factors out of Missouri’s 115 counties. Table 4 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. 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 as illustrated in Figure 4.The median household income in Taney County is $39,405 which is lower that the state at $45,829 and the national median of $51,222. 14 Taney County Health Department MAPP Community Health Assessment Table 4 Social and Economic Profiles of Taney County and Missouri, 2006 and 2010 Taney County Missouri $1,355,815 $216,546,820 Personal income per capita, 2008 $28,680 $36,356 Civilian labor force, 2008 24,046 3,016,749 Unemployment rate, 2010 10.70% 8.70% Full-time and part-time employment by place of work, 2008 34,385 3,672,794 Full-time and part-time employment, net change 2000 to 2006 2,936 174,117 1,950 917,403 $28,247 279,133 147,421,561 $40,155 Personal income, 2008 (in thousands) Employment in government, 2008 Earnings, 2006 ($1000) Average earnings per job, 2006 Source: OSEDA, 2011 Socioeconomic and demographic characteristics have been shown to be important health indicators of health status. Understanding our population age distribution, race and ethnic composition as well as income characteristics is essential in identifying health needs which will aid in the planning of health programs. The most recent health insurance estimated show an uninsured rate of 15.5% in the U.S. Figure 4 details the unemployment rate by month for Taney County. January, 2011, unemployment rate of 22.4% represents US Census; 2008-2010 American Community Survey, 2011 businesses such as hotels and restaurants that are closed for the off season, forcing the establishments to lay off employees. 15 Taney County Health Department MAPP Community Health Assessment Figure 4 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 JUN JUL AUG SEP Month Source: Missouri Economic Research and Information Center, 2011 16 Taney County Health Department MAPP Community Health Assessment Behavioral Risk Factors Table 5 and Table 6 show adult as well as youth behavioral risk factors that significantly impact health outcomes. Many causes of death can be attributed to either tobacco use or obesity. Obesity rate for Taney County is in line with Missouri and the U.S. with percentages of 65, 65.8 and 64.5 respectively. According to the National Initiative for Children’s Healthcare Quality, “Obesity constitutes a grave threat to the health and well-being of our nation, as rates have risen dramatically over the past decades with particularly strong impact on diverse and disadvantaged communities. The US now has the highest rate of obesity among all developed nations. Unless industry, the public and the government work together to address Table 5 Southwest the issue, Missouri U.S. Region three in four 2010 BRFSS (Percentages) Americans will Overweight and/or Obesity, Adults over 18 years of age 65 65.8 64.5 become 27.2 51 50 overweight or Physical Activity among Adults * 39.3 41.8 obese by Alcohol Use among Youth 2020” (NICH, Tobacco Use among Adults 20.5 21.1 17.3 2012). Source: CDC, Behavioral Risk Factors *No Data Available Childhood obesity rates in Missouri are Table 6 15% to 20% (NICH, 2010 Youth Risk Behavior Surveillance-BRFSS 2012). Linked to (Percentages) obesity are sedentary Obesity lifestyles. 27.2% of Physical Inactivity residents in the Smoking Southwest region did Source: CDC, Youth Risk Behavior Surveillance not participate in any physical activity in the past 30 days, compared to 51% of Missouri. Missouri 14.4 26.7 9.3 U.S. 12 18.4 8.9 Another contributing factor to poor health is smoking and Behavioral Risk Factors Surveillance System (BRFSS) data show that 20.5% of adults in the southwest region currently smoke among adults ages 18 and above and 9.3% of Missouri residents’ youth ages 17 and below currently smoke. Out of 115 counties in Missouri, Taney County ranks 80 in health behaviors on the 2011 County Health Rankings. The BMI rates of the survey respondents to the survey revealed that 69% of the respondents were either overweight or obese along with 30% of them being in the normal BMI range and 1% being underweight, which is consistent with the BRFSS data provided. (Figure 5) 17 Taney County Health Department MAPP Community Health Assessment Figure 5 Source: Taney County Health Department (TCHD), 2012 BMI averages were further distributed by Taney County zip codes reported in the survey by four categories: Underweight, Normal, Overweight and Obese. The obese category had quite a few communities; Rockaway Beach’s BMI was the highest at 33 with seven other communities following closely. The overweight category (25-29.9) involved five communities with four of them at 28. There was only one community that had normal BMI distribution and that was Point Lookout. Point Lookout is considered a “college town”, an unincorporated community near Branson and Hollister where College of the Ozarks in located. The overall overweight/obesity rate is in line with Missouri average as well as the nation. 18 Taney County Health Department MAPP Community Health Assessment Environmental Health Indicators The physical environment impacts the lives of individuals and their quality of life. Clean air and water are some examples of factors that may influence health. However, access to recreational activities and healthy foods also impact health of the community. Physical activity can be affected if there are no sidewalks, bike lanes, trails, parks or fitness centers (Table 7). Taney County is ranked 19 out of 115 counties in physical environment. This includes air pollution, access to recreational facilities, limited access to healthy foods and percentage of fast food restaurants in Taney County. Table 7 Taney National Sixty-five percent of the BRFSS (Percentages) County Missouri Benchmark survey respondents considered access to Air pollution-particulate matter 0 0 0 exercise as either “most days 0 7 0 important” or Air pollution- ozone days 12 10 16 “extremely important” Access to recreational facilities .Other concerns Limited access to healthy foods 1% 8% 0% included: 34.6 % air Fast food restaurants 38% 47% 25% pollution, 73.6% clean County Health Rankings 2012 water/pollution and 47.4% mold among adults. For children, 74.1% access to exercise, 38.6% air pollution, 64% clean water/pollution and 41.1% mold. Regulated Facilities 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 8. 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 o o Facilities that produce and release air pollutants: 5 Facilities that have reported toxic releases: 0 Facilities that have reported hazardous waste activities: 12 Number of CESQG’s: 4 19 Taney County Health Department MAPP Community Health Assessment o o o o o o Number of Unspecified Universe:8 Potential hazardous waste sites that are part of Superfund that exist: 1 Number of Superfund: 1 Facilities that generate hazardous waste from large quantity generators: 0 Facilities issued permits to discharge to waters of the United States: 34 Transient Non-Community Water Systems that do not consistently serve the same people (e.g. rest stops, campgrounds, gas stations): 53 Community Water Systems that serve the same people year-round (e.g. in homes or businesses): 55 Non-Transient Non-Community Water Systems that serve the same people, but not yearround (e.g. schools that have their own water system): 9 Table 8 List of EPA-Regulated Facilities-Taney County, 2010 2010 Total Sites Total Sites 2007 236 2010 294 Permitted Discharges to Water 184 Toxic Releases 1 Hazardous Waste Handlers 53 Active or Archived Superfund Reports 1 Air Releases Reported 13 City Branson ZIP Code 65616 Bradleyville 65614 4 4 3 0 0 0 0 Cedar Creek 65679 0 0 0 0 0 0 0 Forsyth 65653 21 27 11 0 9 0 0 Hollister 65672 38 64 36 1 8 0 5 Kirbyville 65679 7 9 6 0 0 0 1 Kissee Mills Merriam Woods 65680 4 4 2 0 0 0 1 65740 2 1 0 0 0 0 0 Point Lookout 65726 3 3 2 0 1 0 1 Protem 65733 1 1 0 0 0 0 1 Ridgedale 65739 15 23 18 0 2 0 2 Rockaway Beach 65740 4 7 4 0 1 0 0 Taneyville 65759 4 4 2 1 0 0 1 Walnut Shade 65771 5 10 0 0 0 0 0 344 456 268 3 74 1 25 Total 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 1 provides information on the geographical locations of hazardous waste, water discharges, air discharges, toxic releases, and waterways in Taney County for 2010. 20 Taney County Health Department MAPP Community Health Assessment 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. Map 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 Taney County Health Department MAPP Community Health Assessment Map 2 Source: EPA, 2011 Map 3 Source: EPA, 2011 Water systems in Taney County are shown below in Tables 2-3. 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. 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. 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. 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. 22 Taney County Health Department MAPP Community Health Assessment 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 9 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. The following tables give you numbers of homes hooked up to public sewer and the number and types of onsite wastewater treatment systems used by residents as well as the violations and complaints of those systems. Table 9 Sewer Systems in Taney County, 2007 Number Taney County Regional Sewer District City of Branson Forsyth 1,945 7,638 1,144 Hollister 1,530 Rockaway Beach 332 Total 12,589 Source: Taney County Regional Sewer District Taney County Planning and Zoning recently took over the responsibilities of Taney County Sewer District in regards to onsite wastewater treatment systems. Taney County Planning and Zoning now inspects new and existing onsite wastewater treatment systems, while complaints for failing systems will be investigated by the Taney County Sewer District and the Taney County Health Department. Table 10 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 11 Gravel and Pipe 49 Number and Type of Distribution and Soil Treatment Systems PermittedTaney County, 2007 Conventional Lateral Trench Systems Dilution Systems Large Expanded Pressure D-Box Dosed Low Diameter Polystyrene Network in 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 Source: Taney County Regional Sewer District, 2011 23 Taney County Health Department MAPP Community Health Assessment Housing Concerns Several environmental health concerns are related to housing including exposures to radon and lead. Increase of housing structures in Taney County have increased over the years. Table 12 illustrates the number of housing structures built from 1939 to 2005. With increased structures, problems may occur especially with the older homes. According to the 2000 Census, a total of 1,274 houses in Taney County were built prior to 1950. (Table 12) Additionally, those houses built prior to 1978, when lead paint was prohibited, may also have been painted with some lead paint. Table 12 Number of Housing Structures by Year Built- Taney County, 2009 Radon 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 Source: US Census, 2011 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. 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. 24 Taney County Health Department MAPP Community Health Assessment 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). 25 Taney County Health Department MAPP Community Health Assessment Agricultural Activities Information related to agricultural activities in Taney County is shown in Table 13 and 14. 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 the time of publication. Table 13 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 14 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 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 Table 15 preparedness, as well as handling threats or Taney County Geographical Statistics, 2011 situations that may present an imminent hazard Land Area (sq miles) 632 to public health. Water Area (sq miles) 19.1 Area Growth Taney County has an area of 632 square miles, 421,871 acres, with the majority of this land in natural forests and woodlands. Only 2.9% land use of Taney County is lake coverage and 2.6% being used for roads and highways (Table 15). Acreage Population Density 421,871 76 people /sq mile Percent of Lake Coverage Land Use for Roads and Highway 2.90% 2.60% Source: City-Data.Com; Accessed March 14, 2011 26 Taney County Health Department MAPP Community Health Assessment Environmental Public Health Services Table 16 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. Table 16 Tables 16 also provides 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. Active Facilities 2009-2010 City of Branson, Hollister, and Taney County Total Total Percent 2009 2010 Change Childcare 32 32 0 Food Temporary Events 629 645 2.54 89 97 9 Lodging 212 187 -11.79 The Taney County Health Department, Environmental 397 391 -1.51 Public Health Specialists also respond to food-borne Pools illness complaints and outbreak investigations. From Tattoo/ 28 27 -3.57 2009 to 2010 the number of food illness complaints Massage increased by 318%, however from 2008 to 2009 the Source: Taney County Health Department, 2011 number of complaints decreased from 130 to 34 (74%) (Table 17). Table 17 Food Illness Complaints- 2006-2010 Food illness complaints 2006 108 2007 116 2008 130 2009 34 2010 142 Percent Change 2009-2010 318% 5-Year Average 106 Source: Taney County Health Department, 2011 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 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%. 27 Taney County Health Department MAPP Community Health Assessment Animal Control Services Animal Control Services are providing services in the City of Branson as well as 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. During 2009, a total of 738 animal complaints and 105 animal bites were reported (TCHD, 2011). Animal control has been responsible for collecting both domestic and wild animals, as well as transferring certain wildlife to other appropriate agencies. Animal control is also involved in inspecting Table 18 theatres and issuing permits to facilities in Branson that perform Number of Field Complaints By with animals in their show. This responsibility ensures that the Jurisdiction, 2011 animals are properly cared for and maintained. In 2010, six theatres Total Percent Jurisdiction and 15 facility inspections were conducted within Branson. Number of Total The total number of complaints to animal control in 2011 is presented in Table 18 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 19 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 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. Branson 500 41.9 Taney County 549 46.1 Hollister* 0 0 Forsyth 82 6.9 Merriam Woods 61 5.1 Total 1,192 Source: Taney County Health Department, 2011; *Field complaints – officer assist only Table 19 Emerging Disease Surveillance, Taney County, 2006-2011 % Change 2006 2007 2008 2009 2010 2011 (2006-2011) Mosquito Trap Nights 104 106 - - - - -100 Mosquito Pools (50 each) Tested Complaints investigated (Mosquito/vector) 220 105 86 83 183 130 -40.91 22 - - 11 7 4 -81.82 WNV and Mosquito Activities Source: Taney County Health Department, 2011 28 Taney County Health Department MAPP Community Health Assessment Health Resource Availability Access to health care reduces death, disability and health inequities as well as improves quality of life for all citizens. Skaggs Regional Medical Center is a 165 licensed bed, community-owned and supported, healthcare facility dedicated to improving the health of all area residents. 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. Skaggs holds the highest national accreditation available for medical facilities from the Joint Commission on Accreditation of Healthcare Organizations and has earned the Gold Seal of Approval™ for its advanced inpatient diabetes care and is an Advanced Primary Stroke Center through the Joint Commission on Accreditation (SRMC, 2011) The Community Health Status Indicators project (2009) reports Taney County had a rate of 65.9 primary care physicians and a rate of 51.0 dentists per 100,000 population. The report also states that Taney County is not a health professional shortage area (U.S. Department of Health and Senior Services, 2009). Currently, there are three hospice care agencies, one professional home care facility, and one outpatient physical therapy clinic. 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, and three levels are provided by nursing homes in Taney County. Within the long term care facilities, there are one Alzheimer’s unit and one with ventilator care (MODHSS, 2012). Medicare beneficiaries in Taney County include 7,679 elderly (65+) and 1,620 disabled residents or 17.9% of the population. There are 11,212 Medicaid beneficiaries that total 21.6% of the population (U.S. Department of Health and Senior Services, 2009). Of the respondents to the community health survey, only 21.6% claimed they had trouble getting medical care, and not because of the lack of providers, but because of the cost of medical care and prescription medication regardless if they had insurance coverage or not (TCHD, 2012). Respondents were asked what issues they have in order to get care. Answers varied and included cost of medical care, prescription drugs are too expensive, not enough health insurance coverage, deductible too high, and no insurance coverage. Faith Community Health (FCH) 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. Registration 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. Veterans’ Affairs Outpatient Clinic administers primary care services for veterans in Branson and the surrounding area. The Veterans’ Affairs Outpatient Clinic includes a Behavioral Health service which offers individual or group counseling and programs such as Quit Smart Smoking Cessation. Branson Veterans Outpatient Clinic is a branch of Veterans Health Care System of the Ozarks which is based in Fayetteville, Arkansas. As part of their value system, the Outpatient Clinic focuses on quality, cost effectiveness, and healthy communities. Routine prescriptions may be processed through the mail or picked up at the facility. 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. 29 Taney County Health Department MAPP Community Health Assessment Communicable Disease 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. Table20 illustrates the trends in the county for Chlamydia, Gonorrhea and Syphilis cases. Taney County was ranked 89 out of 115 counties in Missouri in health factors, which included health behaviors such as sexually transmitted infections, clinical care, social and economic factors and physical environments (County Health Rankings, 2012). Table 20 Chlamydia Gonorrhea Syphilis Number of Sexually Transmitted Diseases Reported - Taney County 2000-2010 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Average 48 53 74 74 84 75 88 109 47 53 59 69.45 7 13 11 22 22 20 23 23 6 6 2 14.09 1 0 0 0 0 2 1 4 2 1 0 1 Source: MODHSS, 2012 Table 21 HIV and AIDS Cases, 2010 and Cumulative*-Taney County Taney County HIV AIDS HIV Diagnosed 2010 Cumulative* 4 29 1 Rate Per 100,000 45.3 69.1 2.4 SW HIV Region Cumulative* 451 770 62 Rate Per 100,000 40.4 122.8 5.6 Source: MODHSS, 2011 Immunizations Table 22 shows the percentage of 2 year olds that have been adequately immunized as assessed by Missouri Department of Health and Senior Services during quality assurance contract Table 22 monitoring in 2010. Immunization Statistics: Adequately ImmunizedThe Table 23 is a summary of selected vaccination series and the percent of children 2 years of age that were classified as being up-todate with their immunizations. Approximately 86% of children were adequately immunized for Polio and MMR. Taney County, 2010 Child’s Age: 2 Taney County 2005 2010 67.00% 73% Source: Missouri Department of Health and Senior Services, 2011 30 Total 764 155 11 Taney County Health Department MAPP Community Health Assessment Table 23 Percent of School Children Adequately Immunized, Grades K-12Taney County, 2008-2009 School Year Select Series/Antigens Percent Adequately Immunized Diphtheria/Pertussis/Tetanus Polio Measles Mumps 2 Dose 86.7 86.7 86.7 78.5 Mumps 1 Dose 93.2 Rubella 2 Dose 78.5 Rubella 1 Dose 93.3 Hepatitis B Varicella 86.7 74.5 Source: State of Missouri Immunization Assessment Survey Results, 2011 Social and Mental Health Social and mental factors affect the health of an individual and a community’s quality of life. These may be influenced by substance abuse and violence within the home and within the community. While the overall numbers of these incidents are currently relatively low in Taney County compared to other areas of the state and country, these issues will continue to increase along with population growth present in the county. 2010 adult BRFSS reported that eighty-two (81.9) percent of adults always or usually received the social and emotional support needed. Significantly more adults with annual household incomes of $75,000 and greater (54.2 percent) always received the support needed compared to those with incomes of less than $15,000 (40.2 percent). Ninety-four (93.7) percent of adults were very satisfied or satisfied with their life. Significantly more with annual household incomes of $75,000 or greater (54.7 percent) were very satisfied with their lives than those with incomes of less than $25,000. Fifteen (14.9) percent of adults had never been told by doctor or other health care provider that they had an anxiety disorder. Twenty-one (20.7) percent had never been told by a doctor or other health care provider that they had a depressive disorder. Adults experienced the following on more than three days over the past two weeks: 16.2 percent had little interest or pleasure in doing things; 12.7 percent felt down, depressed or hopeless; 27.0 percent had trouble falling asleep or staying asleep or sleeping too much; 37.8 percent felt tired or had little energy; 23.2 percent had a poor appetite or had eaten too much; 9.5 percent felt bad about themselves or that they were a failure or had let themselves or their family down; 10.7 percent had trouble concentrating on things, such as reading the newspaper or watching TV; 6.3 percent moved or spoke so slowly that other people could have noticed, or the opposite, being; so fidgety or restless that they were moving around a lot more than usual (MOBRFSS, 2010). 31 Taney County Health Department MAPP Community Health Assessment In Taney County, a total of 641 incidents of domestic violence were reported in 2010. The rate of domestic abuse reports was higher in Branson Table 24 than any other part of the Domestic Abuse Reports-Taney County, 2009-2010 county—164.1 per 10,000 Rate Per 10,000 population (Table 24). In general, Population domestic abuse reports were 2009 2010 2010 higher in 2010 compared to 2009 120 132 164.1 reports. Three year average for Branson aggravated assaults dominated Forsyth 15 20 117.4 the violent crime offenses totals 58 53 136.2 Hollister for 2010 in Taney County, and 2 5 84.9 was 247.3. Larceny theft was the Rockaway Beach largest criminal offense in 2010 Taney County Rural 374 431 141.4 with 1,413 cases with a 1,383 Village of Merriam 1 0 0 three year average. The total Woods property crime offenses for 2010 550 641 95 Total in Taney County were 1,887 and Source: Missouri State Highway Patrol, UCR, in line with the three year 2011 average of 1895.7 (Missouri State Highway Patrol, UCR, 2011). A greater issue is illegal substance use. Methamphetamine and marijuana use accounted for 22% of the individuals who were cited for treatment admissions. Of those who were not successful in seeking treatment, or never had the opportunity, 5% of deaths in Taney County were drug related and 5% were alcohol related. Figure 6 Source: Missouri Department of Mental Health, 2011 Suicide rates for Taney County are about the same rate for the state. 12.8 Per 100,000 for the years of 1999-2009 with an average for Taney County of 5.25 per year and for Missouri, 684.25 per year. 32 Taney County Health Department MAPP Community Health Assessment Maternal and Child Health An important area to monitor and compare the health of individuals in the vulnerable population is infants and children. Birth data and outcomes are the focus of this category as well as mortality rates for infants and children. Maternal care is correlated with birth outcomes and this section will concentrate on maternal access to and/ or utilization of care. Table 25 Maternal, Infant and Child Health Taney County 2005-2009 Missouri 20052009 Birth Weight: Low (less than 2500 g) 239 Rate per 100 7.3 Education Status: Less Than 12 Years 771 23.7 18.1 Gestation: Preterm (less than 37 completed weeks) 383 11.8 13 Prenatal Care: Began First Trimester Prenatal Care: None Prenatal Service Utilization: Mother on Food Stamps| Prenatal Service Utilization: Mother on Medicaid Prenatal Service Utilization: Mother on WIC Smoked During Pregnancy: Yes Smoked During Pregnancy: Yes, 1 or More Packs Per Day Weight for Height (Overweight): Mother's BMI Between 25.0 and 29.9 Weight for Height (Obese): Mother's BMI 30 or Greater 2,581 80.7 86.7 12 0.4 0.7 1,002 31.7 26.2 2,163 68.4 47.7 2,018 63.8 43.1 849 26.1 17.7 91 2.8 2.5 676 21.7 23.7 667 21.5 23 Live Births 3,259 N/A N/A Indicator Number Rate per 100 8.1 Rates Per 100 Source: MoDHSS, 2011 Indicators for mothers on WIC between 2000 and 2008 are shown in Table 26. Comparison between Taney County Table 26 rates and the WIC Infants Statistics, Rate Per 100 - Taney County and Missouri, 2000-2008 state rates are Taney provided (Table Indicator County Missouri 26). According 7.9 9.3 to the table, the Birth weight - low (less than 2500 grams and includes very low) rate of breast Birth weight - high (4000 grams or more) 7.6 7.2 fed children is Currently breast feeding - fully 62.3 46.3 higher in Taney Immunizations - up to date 85.4 72.1 County 4.7 13.7 compared to Underweight for length - (less than or equal to 10th percentile) that of the state Overweight for length - WIC (greater than or equal to 95th percentile) 5.2 4.9 as a whole (62% At Risk of becoming overweight 13.3 9.3 vs. 46%). Likewise, up-to- Source: MoDHSS, MICA, 2012 date immunization rates are higher in the county. However, the rate of underweight for length infants in 33 Taney County Health Department MAPP Community Health Assessment Taney County is lower than the state rate. In addition, the rate of infants at risk of becoming overweight in Taney County is higher than the state rate. 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 27 outlines the demographics as it relates to different age groups within Taney Table 27 County. Population Estimate By Age Group - Taney County, 2009 Table 28 depicts the 85 and Total for population of older 45 - 54 55 - 64 65 - 74 75 - 84 Over Selection adults aged 45 years Taney old and over in County 6,419 6,135 4,977 2,550 916 20,997 Taney County in 2009. The Source: Missouri Department of Health and Senior Services, MICA, 2011 population is stratified by age and gender. The overall percentages were Table 28 47.5 percent male and 52.5 percent Population By Age and Gender -Taney County, 2009 female in 2009. By age group, the Total Total Percent Age Group Male Female percentages were 48.4 percent male 2008 2009 Change and 51.6 percent female in the 45-54 3,107 3,312 6,414 6,419 0.1 age group; 46.6 percent male, 53.4 45 - 54 2,860 3,275 6,031 6,135 1.7 percent female in the 55-64 age 55 - 64 2,314 2,663 4,769 4,977 4.4 group; 46.5 percent male, 53.5 65 - 74 percent female in the 65-74 age 75 - 84 1,134 1,416 2,472 2,550 3.2 group; 44.5 percent male, 55.5 85 and Over 357 559 889 916 3 percent female in the 75-84 age Total 9,772 11,225 20,575 20,997 2.1 group; and 39.0 percent male, 61.0 percent female in the 85 and over Source: Missouri Department of Health and Senior Services, MICA,2011 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 in 2009. 34 Taney County Health Department MAPP Community Health Assessment Mortality The leading causes of death in Taney County is heart disease, cancer, chronic lower respiratory diseases, stroke, Alzheimer’s disease, pneumonia and influenza, motor vehicle accidents, kidney disease, chronic liver disease and cirrhosis and septicemia (Table 29). Rates for heart disease, cancer, Alzheimer’s disease, motor vehicle accidents, chronic liver disease and cirrhosis are slightly higher than the state of Missouri rates. In health outcomes, which included mortality and morbidity, Taney County ranked 65 out of 115 counties. Table 29 Top Ten Leading Causes of Death in Taney County 2005-2009 Taney Numbers Total 2005 2006 2007 2008 2009 Number Heart Disease Cancer Chronic Lower Respiratory Diseases Stroke Alzheimer's Disease Pneumonia and Influenza Motor Vehicle Accidents Kidney Disease Chronic Liver Disease and cirrhosis Septicemia Taney Rate per 100,000 134 125 105 119 125 608 216.4 106 118 123 128 114 589 200.8 20 23 28 33 29 133 45.7 17 15 22 18 25 97 33.6 11 11 15 21 14 72 26.2 11 15 13 9 7 55 20 13 11 12 9 9 54 24 11 7 14 10 7 49 17.5 3 6 4 12 6 31 11.6 6 9 7 4 4 30 10.4 Missouri Rate per 100,000 216.3 191 50.1 48.2 25.4 20.7 17.3 17.9 7.2 11.8 Table 30 Chronic Disease (Crude Mortality Rate/100,000 Population 2009 Heart Disease Cancer Chronic Lower Respiratory Diseases Stroke Taney County Missouri 265.9 257.6 57.7 42.4 244 210.5 54.1 54.4 Source: DHSS MICA 2012 Table 31 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. 35 Taney County Health Department MAPP Community Health Assessment Table 31 Mortality Rates Per 100,000 For Those Over 65 Years of AgeTaney County, 1999-2009 Taney County Cause of Death Missouri Number Rate Rate Cancer 798 1,013.00 1,112.40 Diabetes 56 71.1 141.8 Alzheimer’s Disease 106 134.6 182 994.9 1,339.30 1,656.80 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 4,405.10 5,264.20 Heart Disease Total all causes Source: MoDHSS, 2012 36 Taney County Health Department MAPP Community Health Assessment Community Resources Assessment Community resources are important to consider when assessing a community. The individuals in the community use these resources as tools to 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 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. Branson North Park Branson North Park, fittingly located at the Branson North subdivision, offers a great playground area within the 1 acre park. Branson RecPlex The RecPlex is a great resource for physical activity in the community. It offers a wide range of activities, and is conveniently located past Wal-Mart Supercenter at 1500 Branson Hills Parkway in Branson, MO. 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 Adult Leagues Adult softball games are held at the RecPlex and Stockstill Park; 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 37 Taney County Health Department MAPP Community Health Assessment 7. 8. 9. Branson Bible Church Woodland Hills Church Army Basketball: Five divisions of adult basketball are offered at the Branson RecPlex, depending on desired competitive level. 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. 16 years and older Youth Sports and Leagues Baseball/Softball: Kids from all around Taney County are encouraged to join the summer league. Soccer: Nearly 500 youth participate annually in this fall program. Basketball: A great way for children to have fun, learn basketball skills and develop teamwork. Cheerleading: Open to girls 1st- 6th grade Volleyball: Fall league for girls 3rd- 8th grade Children’s Theater: Annual summer drama camp is held at Branson High School. Cantwell Park Cantwell Park is a beautiful park for the neighborhood which features not only playground equipment but also a lighted basketball court. 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. 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. Downing View Park This park in Hollister features a covered pavilion as well as playground equipment for small children. 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. 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. 38 Taney County Health Department MAPP Community Health Assessment 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. Murphy Park can be accessed off of Highway 76. 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. Sagers Park Sagers Park is a pleasant park which offers a basketball court, a playground, picnic tables as well as a covered pavilion. 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. Amenities at Stockstill Park include: 1/2 mile walking path surrounding the park Public Restrooms available A lighted soccer field and a skate park 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. Sponsored Runs/Walks Dash to the Splash: 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. 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 39 Taney County Health Department MAPP Community Health Assessment 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. 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. o Numerous age divisions: 15 & under, 16-19, 20-29, 30-39, 40-49, 50 & over 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. 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. 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 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. 40 Taney County Health Department MAPP Community Health Assessment Map 4 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. o Length: .6 mile 41 Taney County Health Department MAPP Community Health Assessment Hollister High School o Walking track open to the public when not in use for school functions. 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. 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. 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 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 Length: N/A Stockstill Park Walking Path The walking path itself is located within the 62 acre Stockstill Park. It is a figure eight-shaped path which wraps around two softball fields, two pavilions, and a large playground. Open from 6am – 11pm 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 o Length: .6 mile 42 Taney County Health Department MAPP Community Health Assessment 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 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 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 Map 5 Public Swimming Pools Branson Aquaplex: 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. 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. o Location: Branson RecPlex 43 Taney County Health Department MAPP Community Health Assessment Branson Waves Swim Team: 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. 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 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: 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 o o About 8 feet wide, paved, and 2.2 miles long Free to the public Open dawn to dusk. Pets allowed, but they must be on a leash. Fitness Facilities Any Body’s Gym: 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. 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 Anytime Fitness: 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 Cost for use of facility. 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 44 Taney County Health Department MAPP Community Health Assessment Curves for Women: 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. 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 Child care services: Not available First Baptist Church Life Center: 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. o Cost for use of facility. 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 Maples Training and Fitness Center: 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. o o o o Cost for use of facility. Financial Assistance: Based on need Age requirements: Must be 13 to work out without a parent, no age limit with a family Child care services: Monday – Friday 9am – 10am & 5pm – 7pm Ozarks Regional YMCA: 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. o Cost per month, fee rates for Individuals, Family, Student, Senior, and 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 Shape Shifters Pilates: 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. 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 Child care services: Not available 45 Taney County Health Department MAPP Community Health Assessment Skaggs Health and Fitness Center: 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. o o o o o Cost for joining and use of facility. Financial Assistance: Student discount available Age requirements: Under 18 need parent signature; Must be 16 to work out alone Child care services: Monday through Friday 8am–1pm; 4pm–8pm $2/day, $12/month 1500 Branson Hills Parkway, Branson Golf Courses Branson Creek Golf Club (Public, 18 holes): 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”. o o Cart and range balls included in the price 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. o No reservation required o Open year-round, 8 am – dusk o Golf Leagues, Clinics, and Tournaments are available. Holiday Hills Golf Course (Public, 18 holes): 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. Murder Rock Country Club (Semi Private/ Open to the Public, 18 holes): 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. o o Cart and range balls included in price Group Discounts available 46 Taney County Health Department MAPP Community Health Assessment Payne Stewart Golf Club (Public, 18 holes): 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. Pointe Royale Village Country Club (Resort/ Semi Public, 18 holes): 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. Thousand Hills Golf Resort (Open to Public, 18 holes): 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 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. Skating and Bowling Dogwood Lanes: 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. o Cost for individuals Skate World: 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. o Cost for individuals, Birthday Parties and Private Parties. Community Groups and Centers Branson Community Center: 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 o o o Wii Bowling League- six week league every fall, winter, spring and summer. Free Monthly ballroom dance, fourth Saturday of every month, 7-10 pm. Free 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 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. 47 Taney County Health Department MAPP Community Health Assessment Forsyth Senior Friendship Center: 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. o 8-ball Pool tables available for free play; treadmill and stationary bicycles also available. Ozark Mountain Trailblazers: 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. 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: 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 Front door Farm Market: 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. Forsyth Farmers’ Market: 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: 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 Food Pantries Angel Food Ministries 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. o A meal box feeds a family of four for about a week; No purchase limit on boxes 48 Taney County Health Department MAPP Community Health Assessment o o o o Different menu each month Absolutely no applications or qualifications necessary to purchase. Branson United Methodist Church Beacon of Hope Christian Action Ministries: 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. o Operates solely on donations from individuals, businesses, churches, clubs, and civic organizations Loaves and Fishes: 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. My Neighbor’s Pantry: My Neighbor’s Pantry is a charity food pantry which is committed to fighting hunger in Taney County. This pantry is a program of Gift of Hope, a charity organization aiming to benefit children and families in less than ideal circumstances 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. o $25 per year, but no child is turned away for financial reasons. 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. Information regarding the Free and Reduced meal program is available from area schools. Jesus Was Homeless: 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. 49 Taney County Health Department MAPP Community Health Assessment Meals on Wheels: 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. 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. 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 o Branson Office: 417 -334 – 4544; 320 Rinehart Road Forsyth Office: 417 -546 – 4725; 15479 State Highway 160 Breastfeeding Support: 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: 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. 50 Taney County Health Department MAPP Community Health Assessment 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 Ozarks Area Community Action Corporation: 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. o o 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. 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. OACAC Central Office is located in Springfield, Mo. Older Adult Transportation System (OATS): 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. o Approximately $6 Branson to Springfield; within Branson, Hollister, Forsyth area: $1-$3 o Call ahead and schedule a pick up time and route 51 Taney County Health Department MAPP Community Health Assessment Forces of Change Assessment The Forces of Change Assessment is one of four assessments conducted during the MAPP process. The assessment focuses on identification of external forces such as environmental, economic, legal and other issues that affect the way the community and its public health system operates During the Forces of Change Assessment, participants answered the following questions: "What is occurring or might occur that affects the health of our community or the local public health system?" and "What specific threats or opportunities are generated by these occurrences?" (NACCHO, 2012). Taney County conducted the Forces of Change Assessment in July 2012. During the Forces of Change Assessment over 10 Taney County community leaders and members identified trends, factors and events that impact our community. The Forces of Change Assessment resulted in a list that identifies key forces and their impacts. Category Environmental FORCES OF CHANGE ASSESSMENT FOR TANEY COUNTY Force Threats Posed Opportunities Created Access to sidewalks Climate / Environmental changes Lack of sidewalks limit the ability to safely travel by foot or by bicycle and discourages physical activity Potential increase in the number or severity of weather events; potential health consequences of deteriorating environment Recognize the need for more sidewalks to encourage walkability Increased awareness of environmental changes on health; greater understanding of the connection between environment and health; increased preparedness for emergencies, water conservations, energy conservation Potential for better food safety regulations and consumer education on safe food handling /practices; increased education at an early stage in our schools and homes; increase public awareness of related issues Food Safety Threats Increase in the number of food recalls due to the contamination of products; increase in foodborne illness Recession Business closures; Increased efficiencies; reduction unemployment and of duplication; collaboration underemployment; reduced tax revenue; declining values of investments; delay in economic recovery; reduced public and private capacities; reduction of benefits; bankruptcies, home foreclosures Economic 52 Taney County Health Department MAPP Community Health Assessment Category FORCES OF CHANGE ASSESSMENT FOR TANEY COUNTY Force Threats Posed Opportunities Created Housing Reduced real estate tax Investment in improving existing market decline revenues, resulting in more housing; lower tax burden; lower competition for limited real estate costs; allow for county resources; instability acquisition of properties to of neighborhood networks; increase affordable housing stock overcrowded housing Budget Potential for reduction in Development of creative nonreductions at entitlement programs and governmental solutions; local and state Medicaid; reduced local consolidation of programs; levels and state funding of social reduction of duplication of and health services programs/services programs; reduction of public employees; decreased funding for nonprofits Rising Increase of insurance co- Healthcare reform; employee healthcare costs pays, deductibles and wellness programs; increase denials; delay in diagnoses attention to prevention; greater and treatment; employers personal responsibility for reducing health benefits behaviors impacting health Job Loss Violence; increase in crime; Economic stimulus package; stress and broken families increase in technical skills; opportunity to explore new careers Legal Health Care Reform Uncertain impact of the affordable care program; impact on providers; political resistance; impact among those not covered under the Health Care Reform Expanded health care coverage; encourage public health work to be more population focused; increase focus on prevention and wellness Increasing senior population Increasing number of Seniors with disabilities are able disabilities; increasing costs to continue living in their homes; of services increase number of programs and service models Increased demand for Evaluate laws; strengthen resources and support enforcement prevention program services; greater demand expansion to build personal, for mental health services; family and community resilience decreased community safety Mental health problems; Increase awareness and programs domestic violence Social Abuse, neglect and violence Substance abuse 53 Taney County Health Department MAPP Community Health Assessment Category Ethical FORCES OF CHANGE ASSESSMENT FOR TANEY COUNTY Force Threats Posed Opportunities Created Social factors that affect health Disparities in health outcomes Systemic approach to along racial/ethnic/socio- address causes of health economic lines disparities through collaboration among diverse entities; support for population-based approaches to public health; community involvement 54 Taney County Health Department MAPP Community Health Assessment Community Themes and Strengths Assessment As part of the MAPP process, The Community Themes and Strengths Assessment answer the questions: "What is important to our community?" "How is quality of life perceived in our community?" and "What assets do we have that can be used to improve community health?" This assessment results in a strong understanding of community issues and concerns, perceptions about quality of life, and a map of community assets (NACCHO, 2012). An assessment on Community Themes and Strengths Assessment was conducted to gather perspectives from community members and identify problems that could be addressed in the community. Findings are as follows: Strengths: Parks and recreation Growing hospital Activities for younger children Competent fire and emergency personnel Strong partnerships between agencies Available networks of support Access to health care for the underinsured/uninsured Increase of restaurants who voluntarily are smoke free Weaknesses: Drug and alcohol abuse Need more specialized health care services Chronic diseases Poor diets Cancer Lack of public transportation Lack of sidewalks Unemployment Homelessness More options for underinsured/uninsured 55 Taney County Health Department MAPP Community Health Assessment Local Public Health System Assessment The Taney County public health system was assessed using the national Public Health Performance Standards Program (NPHPSP) developed by the CDC (2007) with other program partners. The purpose of this assessment was to identify our public health system strengths and weaknesses and decide upon improvement. Taney County Health Department is only part of many partners in the public health system. A one-day session with over 15 community partners completed the public health system instrument in February 2012. Results are as follows: INTRODUCTION The National Public Health Performance Standards Program (NPHPSP) assessments are intended to help users answer The NPHPSP is a collaborative effort of seven national partners: questions such as "What are the activities and capacities of our public Centers for Disease Control and Prevention, Office of Chief of Public Health Practice (CDC/OCPHP) health system?" and American Public Health Association (APHA) "How well are we Association of State and Territorial Health Officials (ASTHO) providing the Essential National Association of County and City Health Officials (NACCHO) Public Health Services in National Association of Local Boards of Health (NALBOH) our jurisdiction?" The National Network of Public Health Institutes (NNPHI) dialogue that occurs in Public Health Foundation (PHF) answering these questions can help to identify strengths and weaknesses and determine opportunities for improvement. The NPHPSP is a partnership effort to improve the practice of public health and the performance of public health systems. The NPHPSP assessment instruments guide state and local jurisdictions in evaluating their current performance against a set of optimal standards. Through these assessments, responding sites consider the activities of all public health system partners, thus addressing the activities of all public, private and voluntary entities that contribute to public health within the community. Three assessment instruments have been designed to assist state and local partners in assessing and improving their public health systems or boards of health. These instruments are the: State Public Health System Performance Assessment Instrument, Local Public Health System Performance Assessment Instrument, and Local Public Health Governance Performance Assessment Instrument. This report provides a summary of results from the NPHPSP Local Public Health System Assessment (OMB Control number 0920-0555, expiration date: August 31, 2013). The report, including the charts, graphs, and scores, are intended to help sites gain a good understanding of their performance and move on to the next step in strengthening their public system. 56 Taney County Health Department MAPP Community Health Assessment Calculating The Scores The NPHPSP assessment instruments are constructed using the Essential Public Health Services (EPHS) as a framework. Within the Local Instrument, each EPHS includes between 2-4 model standards that describe the key aspects of an optimally performing public health system. Each model standard is followed by assessment questions that serve as measures of performance. Each site's responses to these questions should indicate how well the model standard - which portrays the highest level of performance or "gold standard" - is being met. Sites responded to assessment questions using the following response options below. These same categories are used in this report to characterize levels of activity for Essential Services and model standards. NO ACTIVITY 0% or absolutely no activity. MINIMAL ACTIVITY Greater than zero, but no more than 25% of the activity described within the question is met. MODERATE ACTIVITY Greater than 25%, but no more than 50% of the activity described within the question is met. SIGNIFICANT ACTIVITY Greater than 50%, but no more than 75% of the activity described within the question is met. OPTIMAL ACTIVITY Greater than 75% of the activity described within the question is met. Using the responses to all of the assessment questions, a scoring process generates scores for each first-tier or "stem" question, model standard, Essential Service, and one overall score. The scoring methodology is available from CDC or can be accessed on-line at http://www.cdc.gov/nphpsp/conducting.html. Understanding data limitations Respondents to the self-assessment should understand what the performance scores represent and potential data limitations. All performance scores are a composite; stem question scores represent a composite of the stem question and sub-question responses; model standard scores are a composite of the question scores within that area, and so on. The responses to the questions within the assessment are based upon processes that utilize input from diverse system participants with different experiences and perspectives. The gathering of these inputs and the development of a response for each question incorporates an element of subjectivity, which can be minimized through the use of particular assessment methods. Additionally, while certain assessment methods are recommended, processes can differ among sites. The assessment methods are not fully standardized and these differences in administration of the self-assessment may introduce an element of measurement error. In addition, there are differences in knowledge 57 Taney County Health Department MAPP Community Health Assessment about the public health system among assessment participants. This may lead to some interpretation differences and issues for some questions, potentially introducing a degree of random non-sampling error. Because of the limitations noted, the results and recommendations associated with these reported data should be used for quality improvement purposes. More specifically, results should be utilized for guiding an overall public health infrastructure and performance improvement process for the public health system. These data represent the collective performance of all organizational participants in the assessment of the local public health system. The data and results should not be interpreted to reflect the capacity or performance of any single agency or organization. Presentation of results The NPHPSP has attempted to present results - through a variety of figures and tables - in a userfriendly and clear manner. Results are presented in a Microsoft Word document, which allows users to easily copy and paste or edit the report for their own customized purposes. Original responses to all questions are also available. For ease of use, many figures in tables use short titles to refer to Essential Services, model standards, and questions. If in doubt of the meaning, please refer to the full text in the assessment instruments. Sites may choose to complete two optional questionnaires - one which asks about priority of each model standard and the second which assesses the local health department's contribution to achieving the model standard. Sites that submit responses for these questionnaires will see the results included as an additional component of their reports. Recipients of the priority results section may find that the scatter plot figures include data points that overlap. This is unavoidable when presenting results that represent similar data; in these cases, sites may find that the table listing of results will more clearly show the results found in each quadrant. FINAL REMARKS The challenge of preventing illness and improving health is ongoing and complex. The ability to meet this challenge rests on the capacity and performance of public health systems. Through well equipped, high-performing public health systems, this challenge can be addressed. Public health performance standards are intended to guide the development of stronger public health systems capable of improving the health of populations. The development of high-performing public health systems will increase the likelihood that all citizens have access to a defined optimal level of public health services. Through periodic assessment guided by model performance standards, public health leaders can improve collaboration and integration among the many components of a public health system, and more effectively and efficiently use resources while improving health intervention services. 58 Taney County Health Department MAPP Community Health Assessment Performance Assessment Instrument Results How well did the system perform the ten Essential Public Health Services (EPHS)? Table 1: Summary of performance scores by Essential Public Health Service (EPHS) EPHS 1 Monitor Health Status To Identify Community Health Problems 2 Diagnose And Investigate Health Problems and Health Hazards 3 Inform, Educate, And Empower People about Health Issues 4 Mobilize Community Partnerships to Identify and Solve Health Problems 5 Develop Policies and Plans that Support Individual and Community Health Efforts 6 Enforce Laws and Regulations that Protect Health and Ensure Safety 7 Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable 8 Assure a Competent Public and Personal Health Care Workforce 9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services 10 Research for New Insights and Innovative Solutions to Health Problems Overall Performance Score Score 68 96 87 85 94 99 66 92 78 80 85 Table 1 (above) provides a quick overview of the system's performance in each of the 10 Essential Public Health Services (EPHS). Each EPHS score is a composite value determined by the scores given to those activities that contribute to each Essential Service. These scores range from a minimum value of 0% (no activity is performed pursuant to the standards) to a maximum of 100% (all activities associated with the standards are performed at optimal levels). Figure 1 (below) displays performance scores for each Essential Service along with an overall score that indicates the average performance level across all 10 Essential Services. The range bars show the minimum and maximum values of responses within the Essential Service and an overall score. 59 Taney County Health Department MAPP Community Health Assessment Figure 1: Summary of EPHS performance scores and overall score (with range) 60 Taney County Health Department MAPP Community Health Assessment Appendix A Policy Changes 61 Taney County Health Department MAPP Community Health Assessment Taney County Health Department 2012 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 62 Taney County Health Department MAPP Community Health Assessment Appendix B Taney County Tobacco Use Assessment 63 Taney County Health Department MAPP Community Health 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 smokingrelated 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. 64 Taney County Health Department MAPP Community Health Assessment 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, long65 Taney County Health Department MAPP Community Health Assessment 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. 66 Taney County Health Department MAPP Community Health Assessment 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 to determine 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. 67 Taney County Health Department MAPP Community Health Assessment 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 o o o 63% under the age of 18, 26% between the ages of 18-21, 7% between the ages of 31-44 and 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. 68 Taney County Health Department MAPP Community Health Assessment 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. 69 Taney County Health Department MAPP Community Health Assessment Appendix C Health Care Services-Taney County 70 Taney County Health Department MAPP Community Health Assessment 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 1 for 2011. Table 1 Nurses by License Type-Taney County, 2011 2006 2011 % Change Acute Care Nurse Practitioner 2 3 50 Adult Nurse Practitioner 1 1 0 Adult Psych/Mental Health CNS 1 2 100 Family Nurse Practitioner 10 13 30 Nurse Anesthetist 5 7 40 Pediatric Nurse Practitioner 1 1 0 Women's Health Nurse Practitioner 1 1 0 LPN 155 171 10.3 RN 223 345 54.7 Total 399 544 36.3 Source: Missouri Division of Professional Registration, 2011 Hospital Services Skaggs Regional Medical Center reported having 160 licensed beds in 2010 (Table 2). Table 3 also provides the occupancy rate and average length of stay for Skaggs Regional Medical Center in Branson. 71 Taney County Health Department MAPP Community Health Assessment Table 2 Skaggs Regional Medical Center Rooms by Type, 2008 and 2010 2008 160 2010 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 Licensed Beds Source: Skaggs Regional Medical Center, 2011 Table 3 Skaggs Regional Medical Center Beds by Type, 2011 Licensed Staffed Occupancy Average Length* Inpatient Service Area Beds Beds Rate of Stay Medical Surgical (Includes Swing) 32 28 85% 5 Days Obstetric 14 14 40% 2 Days Intensive Care (Mixed) 14 14 75% -- Other Special Care Type: STEPDOWN 28 25 75% 4 Days - - - -- 160 120 66% 4.2 Days Alcohol/Chemical Total Hospital Source: Skaggs Regional Medical Center, 2011 72 Taney County Health Department MAPP Community Health Assessment Table 4 Utilization Statistics- Skaggs Regional Medical Center, 2010 Payroll Expenses $53,400,000 Number of Open Heart Surgeries - Adult 94 Non-Payroll Expenses $130,100,000 Number of Open Heart Surgeries - Ped 0 Total Expenses $183,500,000 Number of Cardiac Caths Procedures Angioplasties Outpatient Total 133,241 CT Scans Procedures 763 374 14,278 ESWL Totals (Lithotripsies) 31 Excimer Laser Procedures 73 Gamma Knife Procedures 0 4,291 Hemodialysis Treatments 530 Inpatient 1,581 PET Procedures 326 Outpatient 2,710 Radiation Therapies 4,023 MRI Procedures 2,602 Emergency Visits Surgery Total 41,019 Open Heart Surgery Rooms 1 Births Other Operating Rooms 6 OB Level Number of Isolation Rooms 15 Newborn Days 2,014 Number of Airborne Infection Isolation Rooms Negative Pressure Room (Air exchange 12 times/hour Negative Pressure Room (Air exchange 6 times/hours 7 Delivery Rooms 3 All LDRP Rooms 0 High Risk Infant Clinic 0 High Risk Prenatal Clinic 0 12-Jun 616 2 Source: Skaggs Regional Medical Center, 2011 73 Taney County Health Department MAPP Community Health Assessment Table 5 Health Care-Associated Infection Reporting-Skaggs Regional Medical Center Number of Hospital Infections Hospital Infection Rate Medical/Surgical 0 0 Rate for Similar Sized Hospital 0.9 Surgical Site Infections (Low Risk Group) 0 0 Surgical Site Infections (Medium Risk Group) 0 Surgical Site Infections (High Risk Groups) 0 Statewide Rate National Rate 0.9 1.7 0.7 0.6 0.7 0 1.7 1.4 1.4 0 3.8 3 2.4 Source: Missouri Department of Health, Health Care-Associated Infection Reporting, 2011 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 6 Health Promotion Services-Skaggs Regional Medical Center, 2010 Diabetes Screening Yes Diabetes Education Yes Arthritis Education Yes Weight Management PSA Screening Yes Cholesterol Screening Yes Heart Health Education Yes Fitness/Exercise Program Yes Smoking Cessation Program Yes Osteoporosis Screening Yes Osteoporosis Education Yes Source: Missouri Department of Health and Senior Services, Community Data Profiles, 74 Taney County Health Department MAPP Community Health Assessment Table 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 75 Taney County Health Department MAPP Community Health Assessment 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 8. Table 8 Physician Staffing By Specialty, Skaggs Regional Medical Center, 2010 Physician Staffing Active/Associate 41 Board Certified 37 General Internal Medicine 10 8 Pediatrics 2 2 Cardiology 5 5 Gastroenterology 0 0 Oncology 2 2 Neurology 5 5 Other Med Specialties 0 0 Obstetrics/Gynecology 4 4 Ophthalmology 2 2 Orthopedic Surgery 4 4 Plastic Surgery 0 0 General Surgery 4 4 Thoracic Surgery 1 1 Other Surgical Specialties 2 2 Anesthesiology 4 4 Emergency Medicine 27 27 Nuclear Medicine 0 0 Pathology 5 5 Psychiatry 1 1 Physical Med & Rehab 1 1 Radiology 3 3 Other Specialties 0 0 Dental Specialties 0 0 Podiatric Specialties 3 3 126 120 General Practice Total Source: Skaggs Regional Medical Center, 2011 76 Taney County Health Department MAPP Community Health Assessment Emergency Room Utilization Table 9 provides information regarding Emergency Room utilization by condition for Taney County residents. A comparison with state averages is also provided. Table 9 Emergency Room Visit Profile for Taney County Residents-2010 Taney County Numbers AgeAdjusted Rate Significantly Different AgeAdjusted State Rate 16,919 405.8 H 356.8 189 4.6 L 8.2 139 3.4 L 5.9 Neoplasms (Cancer and Other Growths) 27 0.6 N/S 0.6 Nutritional/Metabolic/Immunity 204 4.6 N/S 4.2 103 2.4 H 1.6 34 0.8 L 1.3 24 0.5 L 1 638 15.5 H 10 Alcohol- and SubstanceRelated Mental Disorders 249 6.1 H 2.4 Anxiety-Related Disorders 140 3.4 H 2.7 1,794 43.8 H 34.4 Headache/Migraine 687 17 H 10.5 Otitis Media and Related Conditions 412 10.4 H 9.2 897 19.5 H 17 Hypertension 105 2.3 H 1.8 Heart Disease 662 14.5 H 12.8 Stroke/Other Cerebrovascular Disease 40 0.8 N/S 0.8 2,263 54.9 L 56.4 Chronic Obstructive Pulmonary Disease (COPD) 360 8.4 H 5.5 Asthma 110 2.7 L 5.2 All Diseases/Conditions Infection Viral Infections Diabetes Mellitus Blood and Blood-Forming Anemia Mental Disorders Brain/Spinal Cord/Eyes/Ears Heart and Circulation Respiratory (Throat and Lung) 77 Taney County Health Department MAPP Community Health Assessment 196 4.7 N/S 4.7 1,314 31.5 H 24.3 547 13.5 H 7 854 20.1 H 18.8 Urinary Tract Infections 291 6.8 L 7.4 Pelvic Inflammatory Disorders (PID) 45 1.1 N/S 1.3 209 5 L 6.9 156 3.7 L 5.5 630 15.5 H 11.7 1,501 36.3 H 22.7 Arthritis and Related Joint Disorders 361 8.7 H 5 Back Problems 733 17.8 H 10.6 4,224 102.7 H 99.9 Fractures 436 10.4 L 11.9 Open Wounds 888 21.6 L 22.5 Sprains and Strains 958 23.7 N/S 23 Burns 93 2.3 H 1.7 Pneumonia and Influenza Digestive System Teeth and Jaw Disorders Kidneys/Bladder/Genitalia Pregnancy/Childbirth/Reproduction Pregnancy Complications Skin Bone/Connective Tissue/Muscle Injury and Poisoning 147 3.6 H 2.7 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. 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 o o 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. Residential Care Facility II (RCF II): provides additional services including supervision of diets and providing care during short-term illnesses or recuperation. 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. Skilled Nursing Facility (SNF): provides, skilled nursing care and treatment services commonly performed by or under the supervision of a registered professional nurse. 78 Taney County Health Department MAPP Community Health Assessment 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 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 10 Characteristics of Long Term Care Facilities- Taney County, 2010 Licensed Medicare Medicaid Beds Beds Beds Total 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 Source: Missouri Department of Health and Senior Services, 2011 Table 11 Characteristics of Long Term Care Facilities- Taney County, 2010 Alzheimer’s Ventilator Total Unit Care Skilled Nursing Facility Residential Care Facility I Adult Day Care FT Staff PT Staff Average Average Minimum Maximum Charges Charges 3 1 1 0 2 247 16 $3,145.33 2 0 0 0 0 0* 5* $783* Residential Care Facility II 2 0 0 0 0 11 11 $1,020.50 Total 7 1 1 0 2 258 32 $2,043.33 Source: Missouri Department of Health and Senior Services, 2011 79 Taney County Health Department MAPP Community Health Assessment Table 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 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 12 Medicaid Participation By Age for Taney County, 2010 2006 Medicaid Participants 371 2010 Medicaid Participants 509 Percent Change 37.2 Total Under 19 4,698 5,966 27 Total Under 65 6,808 8,817 29.5 625 633 1.3 7,433 9,450 27.1 18.47% 20.07% Age Groups Under 1 65 and Over TOTAL Percent of Population* Under 65 receiving Medicaid services "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. Source: Missouri Department of Health and Senior Services, 2011 80 Taney County Health Department MAPP Community Health Assessment Table 13 Medicaid Participation By Age and Race For Taney County, 2010 Number White AfricanAmerican 509 463 7 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 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 8,517 8,350 104 633 619 1 1 1 9,150 8,969 Age Groups Under 1 1 to 4 Total Under 19 Total Under 65 65 and Over Unknown TOTAL Percent of Population* Under 65 105 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. Source: Missouri Department of Health and Senior Services, 2011 Table 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 14 with a slight total increase of all pay sources for care. 81 Taney County Health Department MAPP Community Health Assessment Table 14 Days of Care By Pay Source-Taney County in 2008 and 2009 Percent Change 2008 2009 2008-2009 Medicare 16,325 14,690 -11.1 Medicaid 5,373 6,507 21.1 Other Government 110 161 46.4 Workers Comp 92 93 1.1 Self pay/No Charge 2,128 2,100 -1.3 Commercial 4,000 4,611 15.3 Other 186 98 -50 Unknown 27 24 -11.1 28,249 28,284 0.1 All Pay Sources Source: Missouri Department of Health and Senior Services; Rate per 10,000; Age Adjustment Uses 2000 Standard Population. 82 Taney County Health Department MAPP Community Health Assessment 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. (2012, June 3). State & County QuickFacts. Retrieved from U.S. Census Bureau: http://quickfacts.census.gov/qfd/states/29/29213.html 83 Contact: Jean Mueller Taney County Health Department 320 Rinehart Road Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] FOR IMMEDIATE RELEASE February 4, 2013 Health Focus for February is Good Oral Hygiene To help kick-off National Children’s Dental Health Month, the Taney County Health Department is addressing the most common chronic disease of children by encouraging enrollment in the Children’s Dental Clinic. Preventative and emergency dental care are available to Taney County children ages 18 and under with active Medicaid and women in Taney County with active Medicaid for pregnant women. Dr. Chyrelle Blount is the Division Dentist at the Taney County Health Department Children’s Dental Clinic. “Untreated tooth decay can cause pain, and possible infections which could lead to problems with eating, speaking, and learning,” Dr. Blount said. “Children who start good habits at an early age learn the importance of taking care of their teeth and gums.” The Centers for Disease Control and Prevention reports that, although tooth decay is largely preventable, it remains the most common chronic disease of children aged 6 to 11 years at 25 percent, and adolescents aged 12 to 19 years at 59 percent. Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years at an average of 15 percent. Parents and caregivers can help encourage good oral health by: Encouraging a well-balanced diet that limits sugar and starchy foods. If these foods are included in the daily diet, eating them with a meal and not as a snack produces extra saliva to help rinse the food out of the mouth. Using fluoride toothpaste protects children’s teeth (for children less than seven years old, use only a pea-sized amount on their toothbrush). Asking a dentist or doctor about how to protect child's teeth with dental sealants and fluoridated drinking water. Brushing teeth twice daily. Parents may need to help younger children with this. Flossing teeth daily. You'll need to floss for your children until they are around four years old. Scheduling regular dental checkups every six months. The Children’s Dental Division of the Taney County Health Department provides preventive dental care which includes exams, cleanings, x-rays, sealants, and a fluoride varnish. As well as restoration, space maintainers, stainless steel crowns, root canals, and extractions. Recent original research released from the Centers for Disease Control and Prevention has led to an increasing awareness of the overall health effects of poor dental hygiene. Particular attention has been paid to the possible role of gum diseases in coronary heart disease. The study suggests that improving dental health may reduce the risk of heart disease, a finding which has significant public health implications because of the high rate this disease. “The first step in preventing bacteria buildup and infection is to know the meaning of good oral hygiene,” Dr. Blount said. “Good oral hygiene results in a mouth that looks and smells healthy. This means your teeth are clean and free of debris, gums are pink and do not hurt or bleed when you brush or floss, and bad breath is not a constant problem.” To learn more, visit the Taney County Health Department website at www.taneycohealth.org . Please contact a staff member at (417) 546-4725 ext. 311 or [email protected] for more information or to schedule an appointment. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] FOR IMMEDIATE RELEASE February 27, 2013 ASPCA Grant Funding Provides Care for Animals During Disasters Branson, MO—The Taney County Health Department is a recent recipient of a $12,100 grant from the American Society for the Prevention of Cruelty of Animals (ASPCA). The grant funds will allow for the expansion of animal control emergency response efforts. “The Taney County Health Department Animal Control Division is honored to be working with ASPCA to develop a local and regional animal emergency response program,” said Eric Hansen, Animal Control Officer. Hansen said, “Following the 2012 Leap Day tornado that struck Branson and neighboring communities, it became apparent that coordination of services among emergency response partners was needed to ensure the care and safety of animals.” When a disaster occurs, pets are often separated from their owners resulting in a stressful situation for both the owner and pet. In response to the Leap Day tornado, the ASPCA collaborated with Pet Smart Charities and donated animal care kits to the community. The kits included dog crates, pet cages, feeding bowls, leashes, cat litter boxes and food. Taney County Health Department Animal Control Officers coordinated distribution of over 175 care kits to area residents following the tornado disaster. The kits allowed families the option of keeping their pets with them and provided shelter and care needed during their transition. The amount of storage needed for the remaining animal care kits in stock after the recovery efforts ended was significant. As a result, grant funding was sought through ASPCA to resolve this issue and develop a plan for assisting future local and regional emergency response activities. The funding will allow for the purchase of a 28 ft. enclosed trailer for equipment storage and immediate deployment in response to a disaster. “Developing strong partnerships that have planned and trained for response to a large scale disaster involving animals is important,” said Hansen. “The ASPCA grant will provide the necessary resources to begin the process that will ensure the safety and care of animals during a disaster.” For more information about the ASPCA visit their website at www.aspca.org or the Taney County Health Department website at www.taneycohealth.org or call Eric Hansen at (417) 334-4544 ext. 230. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release May 14, 2013 Animal Shelter Staff Attend Workshop Pefinder an online database for adoptable pets recently conducted a one-day workshop in Branson. Darcy Potter and Ashlee Sanchez represented the Taney County Health Department Animal Control Shelter at the training sponsored by PETCO and hosted by the Shepherd of the Hills Humane Society. The workshop provided information to improve adoption rates for shelter animals including, on-line marketing, networking with other adoption programs and training dogs for adoptability. Petfinder.com is the largest online, searchable database of animals that need permanent homes, with over 375,000 animals listed. Visit Petfinder.com to view animals that are available for adoption at the Taney County Animal Control Shelter. The Taney County Animal Control Shelter located at 255 Critter Trail, Hollister, Missouri and is open to the public Monday through Saturday 10:00 am to 2:00 pm. For more information about pet adoptions visit the Taney County Health Department website at taneycohealth.org or call (417) 332-0172. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] FOR IMMEDIATE RELEASE May 16, 2013 Dog Safety: National Dog Bite Prevention Week The Taney County Health Department continues its tradition of calling attention to one of the nation's most commonly reported public health problems: dog attacks and bites. Dog bites can range from a relatively painless nip to a fatal mauling. A public service campaign known as National Dog Bite Prevention Week® takes place May 19-25 and offers safety tips for pet owners to responsibly reduce the more than 4.7 million dog bite injuries that occur each year. “The Taney County Health Department urges all families to start early in educating children about safety around dogs, even if you don't own a dog,“ Jeff McRoy, Animal Control Officer says."Any animal can bite if it is frightened or feels threatened, even the family pet. Unfortunately, children are the most common victims," says McRoy. Each year, an estimated 4.7 million people are victims of a dog bites, and more than half are children younger than 14 years old, according to the American Academy of Pediatrics. Dog bites are a largely preventable public health problem, and adults and children can learn to reduce their chances of being bitten. Before you bring a dog into your household: Learn what breed of dogs is the best fit for your household and spend time with a dog before buying or adopting it. If a child seems frightened by dogs, wait before bringing the dog home. If you decide to bring a dog into your home: Never leave infants or young children alone with a dog. Avoid highly excitable games like wrestling or tug-of-war. Immediately seek professional advice from veterinarians or animal control officers if the dog develops aggressive behaviors. To help prevent children from being bitten by dogs, teach the following basic safety tips and review them regularly: Do not approach an unfamiliar dog. Do not run from a dog or scream. Remain motionless, "be still like a tree," when approached by an unfamiliar dog. Avoid direct eye contact with a dog. Do not disturb a dog that is sleeping, eating, chewing on a toy, or caring for puppies. If a dog or other animal bites you: Try not to panic. Immediately wash the wound thoroughly with soap and water. Contact your physician for additional care and advice. Report the bite to your local law enforcement agency. Be prepared to tell the animal control officer everything you know about the animal, including the owner's name and address. If you do not know the animal’s owner try to get the following information; a description of the animal including color, size, or breed, where the incident occurred, have you seen the. animal before, and if you know where the animal is located now. Visit the Taney County Health Department website at taneycohealth.org or call either location at (417) 334-4544 or (417) 546-4725 for more information about dog bite prevention. ### Contact: Kara Miller ADAPT Coalition Phone: (417) 334-4544 ext. 225 Email: [email protected] For Immediate Release May 16, 2013 ADAPT Coalition and IMAX Sponsor After-Prom Event The Taney County Alcohol and Drug Abuse Prevention Team (ADAPT), along with the Branson IMAX Theater, recently sponsored an after-prom event for all Taney County high schools. Students and prom attendees from Bradleyville, Branson, Forsyth, and Hollister attended this alcohol-free and drug-free event where they were treated to snacks and a movie at the Branson IMAX Theater, on Shepherd of the Hills Expressway, in Branson. Approximately 407 students enjoyed these four separate events, one for each school’s prom. The Taney County ADAPT coalition was formed in 2008 with the mission to reduce and prevent youth substance abuse in our community. The Branson IMAX Theater and ADAPT have proudly collaborated for the last five years to sponsor the after-prom event and plan to continue to work together to promote a safe and fun, substance-free event for the students of Taney County. For more information about the ADAPT coalition please visit the Taney County Health Department website at taneycohealth.org/Community Health/Community Coalitions. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release May 21, 2013 Health Department Offers Shingles Vaccine The Taney County Health Department will conduct a special clinic for Shingles vaccine on Monday, June 3, from 8:00 am to noon at both Taney County Health Department locations Branson-320 Rinehart Road and Forsyth- 15479 US Highway 160. The Taney County Senior Citizen’s Service Fund allocated funds to offer free Shingles (Zostavax) vaccine to Taney County residents 60 years of age and older. According to the Centers for Disease Control (CDC), an estimated one million cases of Shingles occurs each year in the United States. One in three people will get Shingles during their lifetime. Shingles is a painful localized skin rash that often has blisters caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. Anyone who has had chickenpox can develop Shingles. In many cases, it causes pain that has been described as sharp, shooting and throbbing. The CDC recommends the one-time vaccination to reduce the risk of Shingles and its associated pain in people 60 years of age or older. The Taney County Senior Citizen’s Service Fund allocated $16,000 to the Taney County Health Department to purchase and administer the vaccine. Due to the cost of the vaccine there is a very limited supply available and will be offered on a first come, first serve basis. Those interested in getting the Shingles vaccine will need to follow these guidelines: 60 years of age or older Provide proof of Taney County residency Provide a doctor’s order ( people with some medical conditions should not get the vaccine) For more information about the upcoming clinic please contact the Taney County Health Department at either location, Branson (417) 334-4544 ext. 590, Forsyth (417) 546-4725 ext. 690 or visit our website at taneycohealth.org. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release July 11, 2013 Health Department Offers Free Tdap Vaccinations The Taney County Health Department (TCHD) will offer free Tdap (tetanus, diphtheria, and pertussis) vaccinations during a mass vaccination clinic in partnership with the Missouri Department of Health and Senior Services. The clinic will be held Tuesday, July 30 from 8:00 am to 4:00 pm at the Branson and Forsyth health department locations. Children 11 years old or older and adults are eligible to receive a Tdap vaccination. The Missouri Department of Health and Senior Services is providing Tdap vaccine on a one-time basis to local health departments to train staff and educate the public how a mass vaccination clinic would work in the event of an emergency. The Taney County Health Department will have 500 doses of Tdap vaccine to offer the community at no cost, regardless of insurance coverage. No appointments are required for this clinic and vaccine will be available on a first come, first serve basis. “We encourage everyone, children and adults, to take advantage of this one- time event to receive a Tdap vaccination at no cost,” says clinical director Pam Priest. The Tdap vaccination protects against tetanus, diphtheria, and pertussis. Tetanus, commonly called lockjaw, is present in the soil and enters the body through cuts, scratches, or wounds. Adults should receive a booster dose of tetanus every five years. Pertussis, also known as whooping cough, is a contagious disease that causes severe coughing spells and difficulty breathing. It is a very serious illness for children under one year of age. The Centers for Disease Control (CDC) recommends a booster dose of Tdap for everyone 11 years old through adulthood especially those who are in close contact with young children. This includes parents, siblings, grandparents, childcare providers and anyone who needs a booster shot. For information, contact the Taney County Health Department at (417) 334-4544 Branson (320 Rinehart Road), (417) 546-4725 Forsyth (15479 State Hwy 160) or visit the TCHD website at www.taneycohealth.org . ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release July 19, 2013 Taney County Health Department Celebrates World Breastfeeding Week BREASTFEEDING SUPPORT: CLOSE TO MOTHERS Even when mothers are able to get off to a good start with breastfeeding, all too often in the weeks or months after delivery there is a sharp decline in breastfeeding rates. This is a time when a community support system for nursing mothers is essential. The week of August 1-7 is designated as World Breastfeeding Week (WBW). Breastfeeding advocates in over 174 countries worldwide will be celebrating the WBW theme 'BREASTFEEDING SUPPORT: CLOSE TO MOTHERS’, highlighting breastfeeding peer counselors. Peer counselors provide support through personal experience and training with a focus on education and encouragement to nursing mothers. The Taney County Health Department, Women’s, Infant, and Children (WIC) program, has participated in the Breastfeeding Peer Counselor program for 15 years and currently has two peer counselors on staff. “We consider the peer counseling program an important part of the success for mothers who choose to breastfeed their children,” says Tammy Drake, WIC Division Manager. “The counselors have personal experience and training to encourage mothers to reach and maintain their breastfeeding goals.” To celebrate World Breastfeeding Week, the Taney County Health Department will be hosting a family event at Stockstill Park to raise awareness about the benefits of breastfeeding. The event will include a walk around the park on August 8 from 6:00-7:30 pm with activities and refreshments. For information about breastfeeding peer counseling and support groups visit our website at www.taneycohealth.org or call the Taney County Health Department at (417) 334-4544 (Branson) or (417)-546-4725 (Forsyth). ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release July 30, 2013 Branson, MO—The Missouri Department of Health and Senior Services released information July 26, 2013 regarding a confirmed case of Cyclospora in Taney County and Kansas City. Nationwide, the Centers for Disease Control (CDC) has been notified of over 350 cases of this illness. “The case identified in Taney County is most likely connected to out of state travel based on local investigation findings and not from any local source. There haven’t been any reports of illness from Cyclospora linked to a Taney County source,” said Kim Foster, Taney County Health Department epidemiologist. Foster stated, “The best way to prevent this type of illness is to thoroughly wash fruits and vegetables before eating and always wash your hands before preparing food or eating.” Cyclospora is a parasite that causes intestinal infection called cyclosporiasis; sometimes referred to as a stomach illness. The most likely way a person will become ill with Cyclospora is through contaminated food or water. Cyclospora needs time (days to weeks) after being passed in a bowel movement to become infectious to another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. The CDC has yet to narrow down which specific food item is spreading the illness; however, the parasite is commonly found in fresh produce. The Missouri Department of Health and Senior Services is currently working with the CDC and other agencies to investigate whether or not the two cases reported in Missouri are linked to cases in other states. Symptoms for Cyclospora include diarrhea, loss of appetite, stomach cramps, bloating, nausea, and fatigue. Symptoms usually begin about one week after becoming infected and last from a few days to a month or longer. Sometimes the symptoms may go away and return one or more times. If you have symptoms, contact your health care provider. At this time, the source of illness has not been confirmed. Individuals are encouraged to follow good hand washing techniques and contact their healthcare provider if they become ill with any symptoms related to this illness. For more information about Cyclospora please visit the Taney County Health Department website at www.taneycohealth.org and click on the CDC link or call the Branson location at (417) 334-4544 or Forsyth location at (417) 546-4725. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release August 15, 2013 Tetanus shots available for individuals assisting in flood cleanup The Taney County Health Department will continue to offer tetanus shots for those affected by the recent flood. Individuals who live in the flood area, those assisting with cleanup, or volunteers are eligible for a tetanus shot at no cost. Shots are available at either Taney County Health Department location during normal business hours --8:00 am to 4:00 pm Monday through Friday, no appointments necessary. Office locations: Branson—320 Rinehart Road (417) 334-4544 Forsyth – 15479 US Hwy 160 (417) 546-4725 Children under age 18 must be accompanied by an adult. Special arrangements could be made to provide tetanus shots at your location for groups of 10 or more individuals assisting with flood cleanup. For more information about arranging an onsite clinic, please contact Jean Mueller at 334-4544 ext 224. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release August 30, 2013 Protect Yourself from Tick and Mosquito Bites Due to the heavier than normal rainfall in the last several weeks, mosquitoes and ticks are on the rise in the area. “The increase in ticks and mosquitoes in our area is not a serious health concern, but we want everyone to take the necessary precautions to prevent bites,” said Kim Foster, Taney County Health Department epidemiologist. Using an insect repellent is a simple way to prevent insect bites. “There are several types of repellents available, the most important step is to choose one and use it,” said Foster. Repel ticks by using an insect repellent that contains DEET or permethrin. Products containing permethrin should be only be used to treat clothing or gear, such as boots, pants, socks or tents. Use repellents that contain at least 20% DEET, but not more than 30% for children, on exposed skin. Wearing light colored clothing, long sleeve shirts, long pants and socks while outdoors can help prevent both tick and mosquito bites. Ticks can be carried into the house on clothing and pets, so both should be checked carefully to eliminate ticks. Conduct a body check after being outdoors in a potentially tick-infested area by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body. Carefully remove any ticks you find on your body. To remove an attached tick, use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Pull upward with steady, even pressure; do not twist or jerk the tick. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water. Mark the date you removed the tick on a calendar. If you develop a rash or fever within several weeks of removing the tick, see your doctor. Be sure to inform the doctor about the recent tick bite and the date it was removed. Mosquito bites occur more often at peak hours between dusk and dawn, use extra care during this time of time or stay indoors. Help reduce the number of mosquitoes around your home by emptying standing water from flowerpots, gutters, buckets, pool covers, pet water dishes, discarded tires, and birdbaths on a regular basis. Visit the Taney County Health Department website at taneycohealth.org for more information or call (417) 334-4544 or (417) 546-4725. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release September 19, 2013 Flu Vaccination Clinic Scheduled The Taney County Health Department will host community flu clinics on October 1, 2013 for individuals who are in the following categories over age 65, Medicare recipients, or have a chronic illness. Flu season can start as early as October, which is why health agencies recommend getting the vaccine as early as possible. The walk-in clinics will be held at both Taney County Health Department locations on Tuesday, October 1 from 8:30 a.m to 4:00 p.m. The offices are located at 15479 US Hwy 160, Forsyth and 320 Rinehart Road, Branson. The health department will offer the Fluzone High-Dose vaccine to adults 65 years and older. The highdose flu vaccine generates a stronger immune response and offers greater protection for those most at risk for complications from influenza. There is no out- of- pocket expense to Medicare recipients. The Centers for Disease Control (CDC) recommend an annual flu shot for anyone age 6 months and older. It is especially important for people of all ages with a chronic disease, such as diabetes, heart disease, or asthma, to get a flu shot. Protection against the flu begins about two weeks after vaccination making it important to take action as soon as possible. “The health department will have flu vaccine available for individuals who do not have Medicare, including children age 6 months and older, “said Pam Priest, Taney County Health Department Clinical Division Manager. “This year we have the option to provide vaccine to children and adults with private insurance.” Contact the Taney County Health Department at (417) 546-4725 Forsyth location or (417) 334-4544 Branson location for more information about fees and vaccine availability or visit our website at www.taneycohealth.org . ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release October 2, 2013 Health Department Director Honored Jim Berry, Taney County Health Department Director, received the W. Scott Johnson Award at the 2013 Missouri Public Health Association Annual Conference recently held in Columbia, Missouri. The W. Scott Johnson Award is the most prestigious award presented by the Missouri Public Health Association and given to an individual for distinguished service to public health in Missouri. The award is in commemoration of the skills, integrity, leadership, and devotion to duty, which characterized the life of W. Scott Johnson. Berry joined the Taney County Health Department as director in 1996 following more than 30 years of hospital management. During his 17 years of service and leadership, he has developed the Taney County Health Department to be one of the most professional and successful public health departments in the state of Missouri. He is a recognized leader in the state of Missouri having served as a member of the Missouri Board of Health, Missouri Institute for Community Health, Missouri Public Health Association, Missouri Hospital Association, and Missouri Association of Local Public Health Agencies. Berry currently serves on the Cox Medical Center Branson Board of Trustees and Faith Community Health Board of Directors. Jim Berry will retire in December 2013 after a successful career in healthcare and public health spanning 51 years. ### Bert Malone, Missouri Public Health Association Board of Directors, & Jim Berry, TCHD Director Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release October 3, 2013 WIC Services Continue in Taney County Regardless of the ongoing federal government shutdown, the Taney County Women’s, Infants, and Children (WIC) program is operating as normal. WIC services are continuing as usual and issued checks can be used at local grocery stores. WIC clinics at both Taney County Health Department locations are open for business and no appointments have been cancelled. WIC is a federally funded program administered by state and local health departments. The Missouri Department of Health & Senior Services has informed local public health departments funding is available to continue operations through the month of October. WIC participants should check for any program changes and updates at the Taney County Health Department website and Facebook page. For more information, contact the Taney County Health Department at Branson (417) 334-4544 ext. 590 or Forsyth (417) 546-4725 ext. 321 or visit our website at www.taneycohealth.org. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release October 11, 2013 Free Dog Adoption Event Did you know that black dogs are generally the last to be adopted? A black dog is more often passed over for adoption in favor of other dogs. Those involved in animal welfare refer to this as “Black Dog Syndrome”. It is a mystery why dark-colored dogs are adopted less frequently. Shelters everywhere say it is real, but since there is no practical problem with black fur, such as a link to poor health, they can only guess at the reasons, such as: Black dogs are difficult to see in their crates at the shelter. Black dogs do not photograph as well as those with lighter coats and their facial expressions are not shown as well. Many larger dog breeds have dark-colored coats and few owners select larger breeds. In order to educate the community about this issue, during the month of October, the Taney County Animal Control Shelter is offering free adoptions for all black dogs. The waived adoption fee includes microchipping, spay or neuter, heartworm test, and preventative and selected vaccinations including rabies. "When people are considering adoption, they shouldn't just look at what the dog looks like or the color,” says Sherry Simpson Animal Control supervisor."They should find the best personality match for their family." Black dogs make great pets and are as loyal and lovable as any other dog in the shelter. Visit the Taney County Animal Control Center at 255 Critter Trail in Hollister between the hours of 10:00 and 2:00 p.m. Monday through Saturday. To learn more, visit the Taney County Health Department website at www.taneycohealth.org Animal Control and Adoption tab or call the Center at (417) 332-0172 ext. 401. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release October 17, 2013 Taney County Health Department Director Selected The Taney County Health Department Board of Trustees selected Robert Niezgoda as health department director, effective December 28, 2013. He will be replacing Jim Berry who has held this position for the last 17 years. Niezgoda has served as health department assistant director since 2009. He joined the department in 2004 as the epidemiology specialist and served as the emergency response planner since 2006. Niezgoda received his master’s degree in public health from Southwest Missouri State University in 2004. He currently serves as a Missouri Public Health Association and Missouri Institute for Community Health board member and a member of the Missouri State University, Masters of Public Health Program Professional Advisory Committee. “We had several quality candidates whom we interviewed but Robert demonstrated extensive experience in a variety of the emerging public health focus areas as well as a vision for where the Taney County Health Department needs to develop in the future. The Board is confident in Robert Niezgoda’s leadership abilities to move us in that direction,” said Sonya Hayter, chair of the Taney County Health Department search committee. Niezgoda resides in Forsyth with his wife Selina. Robert Niezgoda Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] For Immediate Release December 4, 2013 Home for the Holidays Pet Adoption and Fostering Event In an effort to reduce the number of animals that will be homeless for the holidays, the Taney County Animal Control Shelter is offering a reduced adoption fee that will run through December 31. The reduced adoption fee for a dog or cat is $40. The fee includes spay/neutering, routine vaccinations, microchip and heartworm test for adults dogs. “We are hoping that people considering adding a furry family member to their household during the holidays will consider adopting a shelter animal,” said Sherry Simpson, TCHD Animal Control Division Manager. “Supporting the Home for the Holidays adoption program is a win-win for everyone.” Another way to support the Home for the Holidays event is to become a foster home for pets during the holidays. “We would like to find temporary homes for adoptable pets during the holiday season,” said Simpson. The goal would be for animals to be placed in foster homes beginning on December 21. The shelter’s own holiday wish list includes donations of blankets, towels, treats, and dog and cat toys. People interested in making this Christmas a happy holiday for a pet in need or who want more information about becoming a foster home should contact the Taney County Animal Control Shelter. The shelter is located at 255 Critter Trail in Hollister and open to the public Monday-Saturday 10:00 am to 2:00 pm. To view animals available for adoption or for more information, go to http://taneycohealth.org/animal_adoptions.php or call (417) 332-0172. ### Contact: Jean Mueller Taney County Health Department 320 Rinehart Road, Branson, MO 65616 Phone: (417) 334-4544 ext. 224 Cell: (417) 230-0725 Email: [email protected] FOR IMMEDIATE RELEASE December 20, 2013 Women, Infants and Children (WIC) Contract Renewed The Taney County Health Department has signed a contract to continue providing WIC (Women, Infants and Children) services for the fiscal year 2014 with the Missouri Department of Health and Senior Services. The purpose of this contract is to provide funds to support the delivery of services and benefits of the WIC Program to eligible participants. Under terms of the contract, the Taney County Health Department can serve 1,994 people who are eligible for WIC services every month. During the 2013 contract year, approximately 1,955 participants received WIC benefits each month in Taney County. WIC, a supplemental food program , provides at no cost to the participant, nutrition education, breastfeeding support, referrals to other health and social services, and checks for nutritious supplemental foods to pregnant, breastfeeding and postpartum women, infants and children up to age five. WIC participants are those who meet income guidelines and are determined by health professionals to be at nutritional risk. WIC supplemental food packages are specifically chosen to provide foods high in protein, iron, calcium, and Vitamins A and C. Eligible women and children receive fortified milk, eggs, cereal, whole wheat bread, tortillas or brown rice, fruits and vegetables and canned or dried beans or peanut butter. Although WIC recommends breastfeeding, infants receive supplemental iron fortified formula when needed, and infant cereal and baby food at the appropriate age. Participants are issued checks to buy these foods at authorized local retail stores. The Taney County Health Department receives $18,656 additional funding to provide the Breastfeeding Peer Counseling Program. Peer Counselors are available to educate women about the advantages of breastfeeding, and to offer support and encouragement. The Taney County WIC program has been recognized as a “Breastfeeding Friendly WIC Clinic” for the second consecutive year. With this designation comes a $23,000 grant that covers the cost of staff time to provide breastfeeding support and education. “The goal of the WIC program is to improve the health and nutrition of those who are eligible for the service by providing quality nutrition education and supplemental nutritious foods,” said Tammy Drake, WIC Division Manager. WIC services are provided at both Taney County Health Department locations. Those interested in applying for WIC or in need of more information should contact the Taney County Health Department at the Forsyth location at (417) 546-4725 ext. 321 or at the Branson location at (417) 334-4544 ext. 214 or visit our website at www.taneycohealth.org. "This institution is an equal opportunity provider." ###