The Well-Being of Everett - Cambridge Health Alliance
Transcription
The Well-Being of Everett - Cambridge Health Alliance
The Well-Being of Everett 2014 Health Assessment Report Authorization to reproduce this document in whole or in part is granted. While permission to reprint this publication is not necessary, the citation should be: The Well-Being of Everett, 2014 Health Assessment Report. For information on this publication or to request copies, contact 617-394-7632 or [email protected]. This publication and other resources are available on the Internet at www.challiance.org/EverettWellbeing2014 ©2014 Cambridge Health Alliance, Institute for Community Health. All rights reserved. The Well-Being of Everett 2014 Table of Contents 1. Letter from Mayor DeMaria Jr. and Patrick Wardell, CEO at Cambridge Health Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3. Summary of Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. City of Everett Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5. Social Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Economy, Housing and Employment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Built and Natural Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 17 23 30 34 6. Leading Health Indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 - Physical Activity and Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 - Tobacco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 - Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 - Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 - Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 - Sexual and Reproductive Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 - Maternal Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 - Chronic Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 - Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 - Access to Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7. Youth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 - Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 - Physical Activity and Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 - Tobacco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 - Substance Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 - Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 - Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 - Sexual and Reproductive Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 8. Data Sources and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 9. Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 10. Programs, Partners, and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 11. Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 - Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 - 10 Essential Public Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Everett Community Health Partnership Dear Everett Residents ECHP Mission To improve the health and quality of life of the people of Everett by creating opportunities for individuals, families and organizations to work collaboratively and strategically in addressing important challenges facing the community. ECHP Members (partial list) A Better Tomorrow Services, Inc. Boys and Girls Club of Everett Cambridge Health Alliance Eliot Community Human Services Everett Chamber of Commerce Everett Health, Human Services, Planning & Police Departments Everett Public Library Everett Public Schools Everett Substance Abuse Coalition For Kids Only Afterschool Grace Episcopal Church Hallmark Health Immaculate Conception Church Joint Committee for Children’s Health Care in Everett La Comunidad, Inc. Malden YMCA MGH Everett Family Care Medicine Mystic Valley Elder Services North Shore Evangelical Missionary Church Our Lady of Grace Church Portal To Hope Tri-City Community Action Program Whidden Memorial Hospital Zion Baptist Church The City of Everett, in partnership with the Cambridge Health Alliance and the Institute for Community Health and the other members of the Everett Community Health Partnership, have produced The 2014 Everett Health Assessment Report. The goal of this report is to inform the community about the health status of Everett and to provide a baseline for planning and improving the many crucial community health programs that serve the people of Everett. The 2014 Everett Health Assessment Report provides current information about key health indicators, such as physical fitness and nutrition, substance abuse, mental health, sexual behavior, violence, chronic illness, cancer and access to care. Additionally, the report provides information on social determinants of health that affect the community including education, employment, housing, the built and natural environment, and community-building resources. Each section of the report includes information on the many strengths and assets of Everett as well as recommendations for expanding and building on these existing resources to improve the community’s health. This year we have included a section dedicated to youth health and well-being as they represent the future of Everett. It is our hope that The 2014 Everett Health Assessment Report will be both accessible and provocative, and that it will increase the community’s curiosity about the health of all Everett residents. We welcome each member of the Everett community to join us in making Everett an even healthier and more vibrant city. Carlo DeMaria, Jr. Mayor, City of Everett Patrick Wardell, Chief Executive Officer, Cambridge Health Alliance The Well-Being of Everett • 2014 Health Assessment Report 1 Introduction What is the Well-Being of Everett Report? The Well-Being of Everett Report provides the reader with a summary of the health of our city. It compiles data related to public health from a variety of sources. It highlights the strengths and assets in our community, identifies areas of concern, and makes recommendations to help guide future work. Why Create the Well-Being of Everett Report? The Well-Being of Everett Report is intended to serve as a tool for local leaders, community agency members, directors and other stakeholders to continue to learn together about the public health issues of the community. It provides a baseline for planning and improving the many crucial community health programs that serve the people of Everett. It helps identify where we are making progress and where we have substantial gaps in health and well-being for vulnerable groups in Everett. Furthermore, it will help identify policy or programming opportunities to help address these gaps. The hope is that this book will facilitate a dialogue between agencies and residents, stimulating collaborative work toward making Everett a healthier city. Who Created the Well-Being of Everett Report? This Report is the result of contributions from across the City of Everett – from community members, agencies and service providers, to city and public school employees. The coordination of this effort was led by the Everett Community Health Partnership (ECHP) and the Institute of Community Health (ICH) at Cambridge Health Alliance, in collaboration with the City of Everett Health Department. A list of authors, partner organizations, and other contributors is featured in the acknowledgements section. 2 The Well-Being of Everett • 2014 Health Assessment Report Why is there a Section on the Social Determinants of Health? The Everett Community Health Partnership is committed to ensuring that everyone in Everett has access to good healthcare. We are equally committed to ensuring that everyone in Everett has access to other critical determinants of good health: a good education, a living wage job, healthy food, safe and affordable housing, a supportive built and natural environment and social inclusion and support. The need for policies and programs that address these societal level factors will require continued collective action by residents and community leaders. Well-Being of Everett Report User Guide: The Report is divided into four main chapters: 1) Demographics 2) Social Determinants of Health (Education, Housing, Economy and Employment, Built and Natural Environment and Community) 3) Leading Health Indicators and 4) Youth. Each section in the Social Determinants and Health Indicators chapters follows a similar format: introduction of the topic, data and data analysis, topical information, strengths and assets and recommendations for future collaborative action. The Report can be found on the websites of the Everett Health Department and the Everett Community Health Partnership at Cambridge Health Alliance. Summary of Recommendations SOCIAL DETERMINANTS OF HEALTH LEADING HEALTH INDICATORS – COMMUNITY-WIDE Education • Address the needs of out-of-school youth and other vulnerable youth populations to ensure access and support for high school completion. Physical Activity and Nutrition • Continue to expand public spaces for all residents to engage in physical activity. • Develop stronger systems of communication and support for non-English speaking parents to improve educational outcomes and high school completion rates for their children. • Offer media programming and education on healthy eating options, including recipes, shopping tips for low-cost meals and cooking demonstrations. Employment • Ensure that new development projects include provisions for creating good jobs at a living wage and job training for local residents. Tobacco • Increase access to information on smoking cessation resources in local businesses, city buildings and local media outlets including cable television. Housing • Ensure adequate representation of Everett’s diverse community (including renters) in discussions of the Housing Production Plan. Built and Natural Environment • Adhere to Complete Streets Resolution and accompanying Healthy Design Guide in all future planning projects to ensure that healthy and active transportation options are available to all. Community • Increase the number of intergenerational, interethnic and interracial community building projects. • Encourage and support mechanisms to increase representation of Everett’s diverse populations on City Council, Boards and Commissions. Substance Abuse • Develop support networks for parents, family members, and friends coping with their loved ones who are struggling with addiction and dealing with substance abuse disorders. • Advocate for increased funding for prevention and treatment services dedicated to substance abuse for all ages. Mental Health • Develop educational opportunities to reduce stigma associated with mental health issues and the importance of asking for help. • Expand access to mental health services at home in a cost-effective way, especially for adults who are homebound and seniors. Violence • Support and facilitate help-seeking where family violence occurs. Sexual Health and Reproduction • Develop a plan to reach out to the men having sex with men (MSM) population to increase awareness of testing and treatment services available in Everett. The Well-Being of Everett • 2014 Health Assessment Report 3 Maternal Child Health • Adopt supportive work policies for new and expecting families, family leave for part-time workers, personal days to attend prenatal doctor appointments and follow up postpartum appointments. Tobacco • Review and expand tobacco compliance efforts to reduce tobacco sales to minors. Chronic Disease • Expand community and health providers focus on understanding the factors impacting lung diseases in Everett. Substance Abuse • Increase information and outreach to middle school parents regarding the importance of talking to their children about alcohol and other drug use. • Increase primary care services for adults and children in Everett. • Fund a Wellness Program within the Health Department based on programs piloted by Energize Everett to increase fitness, nutrition and cooking programs throughout the city. Cancer • Organize community-wide efforts to educate Everett residents about cancer risk and encourage residents to take advantage of screening, early detection and potential curative treatment for common cancers. Access to Healthcare • Increase access to affordable dental/oral healthcare for all residents. LEADING HEALTH INDICATORS - YOUTH Physical Activity and Nutrition • Continue and expand Family Fitness Nights, which allows and encourages non-structured active play for youth and families in school gyms after hours. • Continue and expand schoolyard gardens to all Everett Public Schools, and work to incorporate produce into school meals in spring and fall. 4 The Well-Being of Everett • 2014 Health Assessment Report • Continue tobacco prevention education in the schools to raise awareness of the harm of tobacco products including e-cigarettes. Mental Health • Provide Youth Mental Health First Aid trainings to teach parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human service workers, and other caring citizens how to help adolescents who are experiencing mental health or addiction challenges, or are in crisis. Violence • Increase supportive programs and mentoring for adolescent girls who are at high risk of becoming victims of violence and abuse. • Increase funding for programs working with youth such as the Everett Boys and Girls Club, ROCA, For Kids Only Afterschool program, and the Joint Committee for Children’s Health Care to continue to support youth positively in their development. Sexual and Reproductive Health • Conduct outreach to Everett youth up to age 24 to increase awareness of services at the Teen Health Center at Everett High School including students at Pope John and the local charter schools. Demographics Based on the 2011 American Community Survey Estimate, the current population of Everett is 41,079, representing an 8% increase from the 2000 US Census level. With its residents living in 3.4 square miles, Everett is the fifth most densely populated city in Massachusetts with 12,082 people per square mile. The highest proportion of Everett residents (24.5%) is between 45 and 64 years old. This finding is similar to the data for Massachusetts overall. Between 2000 and 2011, the age groups that increased as a proportion of the total population number included children under 5 years old (5.9% to 6.7%) and adults aged 45 to 64 (24.5% to 27.4%), while proportion of adults aged 65 and older decreased between 2000 and 2011 (14.8% to 11.7%). Other age groups remained stable. Compared to Massachusetts, Everett has a younger resident population with a median of 35.6 years compared to 38.9 years in MA. More specifically, Everett has higher proportions of children under five, more adults age 25 to 34, and fewer adults 65 years old and over compared to MA. Furthermore, the birth rate among women age 20 to 29 in Everett is almost twice the state’s birth rate in this age group. For additional information on the youth of Everett, please see the Youth section of this report. BASED ON THE 2011 AMERICAN COMMUNITY SURVEY ESTIMATE, the current population of Everett is 41,079, representing an 8% increase from the 2000 US Census level. The Well-Being Well Being of Everett • 2014 Health Assessment Report 5 xx Age Distribution of Residents (2000 & 2011) Everett 2000 Percent of Population 100 90 80 70 60 50 40 30 20 10 0 Everett 2011 MA 2011 5.9 6.7 5.6 12.312.112.2 12.411.814.3 Under 5 Years 5 to 14 Years 15 to 24 Years 18.418.1 16.415.314.0 12.9 25 to 34 Years 24.5 19.9 35 to 44 Years 27.4 45 to 64 Years 14.8 11.713.7 65 Years or Older SOURCE: US Census, 2000; US Census ACS, 2007-2011 Functional Needs of Everett Residents age 65 or older Count Residents age 65 or older % 4,913 With any Disability 2,285 46.5% Hearing Difficulty 619 12.6% Vision Difficulty 268 5.5% Cognitive Difficulty 440 9.0% 1,624 33.1% 228 4.6% 1,047 21.3% Ambulatory Difficulty Self-Care Difficulty Independent Living Difficulty Source: US Census Bureau, American Community Survey, 2012 3-year Estimates Increasing Diversity Both the City of Everett itself and the Everett Public Schools have become markedly more diverse in the past decade. Between 2000 and 2011, the proportion of Black or African American and Hispanic or Latino residents in Everett have each doubled, while the non-Hispanic, White population has decreased from 75% to 62%. Compared to Massachusetts as a whole, Everett now has significantly higher proportions of Black or African American residents (13% vs. 6%) and Hispanic or Latino residents (18% vs. 9%), but fewer Asian residents (3% vs. 5%). 6 The Well-Being of Everett • 2014 Health Assessment Report Seniors Seniors remain a significant segment of Everett residents (over 10% of the population is age 65 or older). There are many dedicated resources and services available for Everett seniors to access. The Council on Aging, housed at the Connolly Center, offers social, economic and healthfocused activities to help seniors in Everett stay healthy and active. Mystic Valley Elder Services, based in Malden, also connects seniors and adults of all ages living with disabilities to services and resources that support their health, well-being, and independence. In Everett, nearly half of seniors (46.5%) live with some type of disability, so having programs and agencies, such as the Council on Aging and Mystic Valley Elder Services, dedicated to seniors is very important for the health of seniors, their families, and our community. Percent of Population 100 90 80 70 60 50 40 30 20 10 0 Race/Ethnicity of Residents (2000 & 2011) Everett 2000 76.9 75.2 Everett 2011 61.6 MA 2011 18.2 9.5 Hispanic or Latino White, Non Hispanic 13.2 9.3 6.1 6 Black or African American 3.2 5.3 3.3 6.3 3.9 2.4 Other+ Asian SOURCE: US Census, 2000; US Census ACS, 2007-2011 +Includes American Indian, Alaska Native, Native Hawaiian, Other Pacific Islander, Some Other Race and multiple races Public School Enrollment by Race/Ethnicity % of Everett Public School District % of MA 2009 2010 2011 2012 2013 2013 African American 15.8 16.6 18.2 18.1 18.7 8.6 Race/Ethnicity Asian 5.0 5.1 5.9 25.9 29.3 32.5 34.7 37 16.4 0.6 0.6 0.2 51.6 47.4 42.6 39.8 36.7 66.0 Native Hawaiian, Pacific Islander 0.1 0.1 0.1 0.1 0.1 0.1 Multi-Race, Non-Hispanic 0.6 0.9 1.0 1.6 1.8 2.7 Hispanic Native American White 5.4 5.1 0.6 5.1 0.6 0.6 SOURCE: Massachusetts Department of Elementary and Secondary Education, School and District Profiles • Additionally, Everett’s schools have become increasingly diverse with the largest growth in Hispanic, Brazilian and Haitian students. Changes in local, state, national and global economics tend to impact the student population shifts in the Everett schools. The Well-Being of Everett • 2014 Health Assessment Report 7 Percent of Foreign-Born Population 100 90 80 70 60 50 40 30 20 10 0 Region of Birth for Foreign-Born Residents (2000-2011) Everett 2000 72.7 Everett 2011 58.1 MA 2011 35.6 35.3 25.8 18.3 19.5 8.7 Latin America Central America 19.8 11.5 South America 28.7 24.3 12.4 Europe 13.1 6.9 7 7.5 8.1 Asia Africa 2 0.3 3.2 North America SOURCE: US Census, 2000; US Census ACS, 2007-2011 • The number of foreign-born residents in Everett has increased from 8,323 (22%) of the total population in 2000, to 14,794 (36%) of the total population in 2011. • In 2011, compared to Massachusetts, Everett has twice as many foreign-born residents from Latin America; nearly three times as many from South America, while substantially fewer from Asia and Europe. • Most foreign-born residents in Everett (72.7%) are from Latin America, reflecting an increase of 14% since 2000. The specific countries with the largest increases are Brazil, Peru and the Dominican Republic. The countries with the greatest percentage decrease were Italy, Columbia and Vietnam. xx 8 The Well-Being of Everett • 2014 Health Assessment Report Specific Origin of Hispanic or Latino Residents Everett 2000 Everett 2011 Count % Count % % Hispanic or Latino 3,617 9.5% 7,473 18.2% 9.3% Central American 1,201 3.2% 4,224 10.3% 1.6% Costa Rican 22 0.1% 0 0.0% 0.1% Guatemalan 127 0.3% 806 2.0% 0.6% Honduran 90 0.2% 498 1.2% 0.2% Nicaraguan 10 0.0% 0 0.0% 0.0% Panamanian 4 0.0% 0 0.0% 0.1% Salvadoran 888 2.3% 2,757 6.7% 0.6% Other Central American 60 0.2% 163 0.4% 0.0% South American 463 1.2% 1,003 2.4% 0.9% Argentinean 15 0.0% 12 0.0% 0.1% Bolivian 16 0.0% 48 0.1% 0.0% Chilean 8 0.0% 0 0.0% 0.1% Colombian 290 0.8% 160 0.4% 0.4% Ecuadorian 14 0.0% 83 0.2% 0.1% Peruvian 81 0.2% 542 1.3% 0.1% Uruguayan 3 0.0% 0 0.0% 0.0% Venezuelan 14 0.0% 16 0.0% 0.1% Other South American 22 0.1% 142 0.4% 0.0% Puerto Rican 542 1.4% 810 2.0% 4.0% Dominican Republic 79 0.2% 533 1.3% 1.6% 1,096 2.9% 445 1.1% 0.4% Mexican 186 0.5% 395 1.0% 0.6% Cuban 50 0.1% 63 0.2% 0.2% Other Hispanic or Latino MA 2011 SOURCE: Everett 2000 data based on year 2000 US Census Everett and MA 2011 data based on 2007 -2011 American Community Survey Estimates • The most substantial increases in population between 2000 and 2011 were with the number of Everett residents whose countries of origins were: El Salvador, Guatemala, Puerto Rico (territory), the Dominican Republic, Peru, Honduras and Mexico. The largest decrease was Columbia. The Well-Being of Everett • 2014 Health Assessment Report 9 Language Spoken at Home for Residents Age 5 and Older (2011) Arabic 1.3 0.4 Italian 2.6 0.7 French Creole 0.9 Portuguese Everett MA 6.3 12.8 2.9 15.8 Spanish 7.7 54.3 English Only 0 20 SOURCE: US Census ACS, 2007-2011 40 60 78.6 80 100 Percent • Everett is also linguistically diverse. Forty-six percent of residents speak a language other than or in addition to English, a much higher proportion than Massachusetts overall (79%). • The top 5 languages other than English spoken in Everett are Spanish (16%), Portuguese (13%), French Creole (6%), Italian (2.6%), and Arabic (1%). Public School Enrollment by First Language not English, Everett and MA (1994-2013) Everett MA 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 Percent of Students 100 90 80 70 60 50 40 30 20 10 0 School Year SOURCE: MA Department of Elementary and Secondary Education (ESE) • The proportion of Everett public school students whose first language is not English has increased steadily from 26% in 2000 to 50% in 2013 and is now substantially higher than the Massachusetts average. 10 xx The Well-Being of Everett • 2014 Health Assessment Report Disability Status of Everett Residents (2012) Count % Everett Residents 41,190 With any Disability 5,121 12.2% Hearing Difficulty 1270 3.0% Vision Difficulty 959 2.3% Cognitive Difficulty 2,108 5.0% Ambulatory Difficulty 3,083 7.4% 904 2.2% 1,844 4.4% Self-Care Difficulty Independent Living Difficulty Source: US Census Bureau, American Community Survey, 2012 3-year Estimates In Everett, 12.2% of the population is living with some sort of disability. The City works to comply with the Americans with Disabilities Act (ADA) regarding access to infrastructure such as buildings and streets, and the Everett Public Schools offer special education services for students from ages 3 to 21. Disability Disability is defined as a long-lasting physical, mental, or emotional condition. This condition can make it difficult for a person to perform basic activities such as walking, climbing stairs, self-care, learning or remembering. Individuals with disabilities may be less visible, undercounted, or underserved and therefore experience disadvantages in health and well-being compared with the general population. The potential for a lack of access to healthcare services and medical care may increase a person’s risk for various health and mental health conditions. The Well-Being of Everett • 2014 Health Assessment Report 11 Social Determinants of Health xx 12 The Well-Being of Everett • 2014 Health Assessment Report Social Determinants of Health The places where we live, learn, work, and play contribute to our overall health. People experience different life conditions depending on multiple factors such as income, age, race, and address. Health status is affected in positive or negative ways by these conditions and related behavioral choices. There has been increased attention given in recent years to the roles of the social determinants of health in preventing disease and supporting healthy communities. There is more to good health than lifestyle choices, genes and access to healthcare. Research shows that the social circumstances in which we are born, live and work—our jobs, schools, built space, transportation, even quality of civic life—get under the skin, influencing our behaviors, access to resources, chronic stress levels, and ultimately increasing or decreasing our chances for health. According to Dr. David Williams at Harvard School of Public Health, “Housing policy is health policy. Educational policy is health policy. Anti-violence policy is health policy. Neighborhood improvement policies are health policies. Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.” “EVERYTHING that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.” -Dr. David Williams The Well-Being of Everett • 2014 Health Assessment Report 13 The Health Impact Pyramid Increasing Population Impact Counseling & Education Increasing Individual Effort Needed Clinical Interventions Long-Lasting Protective Interventions Changing the Context to Make Individual’s Default Decisions Healthy Socioeconomic Factors SOURCE: Frieden, T.R. AM J Public Health 2010; 100:590-595, Copyright 2010 Americian Public Health Association SOURCE: Frieden, T. R. Am J Public Health 2010; 100:590-595 Copyright©2010 American Public Health Association The Centers for Disease Control and Prevention (CDC) illustrates how socioeconomic factors can impact an individual’s health through the Health Impact Pyramid above. The risk factors that most greatly impact a community and individual’s health can be lessened through policy, systems and environmental change interventions aimed at the social determinants of health, represented by 14 The Well-Being of Everett • 2014 Health Assessment Report the bottom two layers of the pyramid. Interventions aimed at these layers create more accessible and lasting healthy choices for individuals. Although the top three tiers of the pyramid are still important in managing good health, they require larger effort at the individual level to be effective. The following two versions of “Tips for Better Health” illustrate the difference between the conventional advice we usually hear on the best ways to stay healthy, and the social determinants approach to staying healthy. It showcases the need for developing and implementing policies addressing the social determinants of health to truly create a healthy community. Conventional 10 Tips for Better Health 1. Don’t smoke. If you can, stop. If you can’t, cut down. 6. Cover up in the sun, and protect children from sunburn. 2. Stay on a balanced diet with plenty of fruits and vegetables. 7. Make sure you practice safer sex. 3. Make sure you stay physically active and exercise at least 3 times a week. 4. Manage stress by, for example, talking things through and taking time to slow down, or planning relaxing getaways. 8. Don’t forget regular check-ups with your family doctor and get screenings for cancer. 9. Be safe on the roads: Follow the highway code and wear your seatbelt. 10.Learn the first-aid ABC: airways, breathing, circulation. 5. If you drink alcohol, do so in moderation. What Your Doctor Didn’t Tell You, or Social Determinant Tips for Better Health 1. Don’t be poor. If you can, stop. If you can’t, try not to be poor for long. 6. Take family vacations and all the benefits you are entitled to. 2. Live near good supermarkets and affordable fresh produce stores. 7. Make sure you have wealthy parents. 3. Live in a safe neighborhood with plenty of trees, parks and green space nearby. 4. Work in a rewarding and respected job with good compensation, benefits and control over your work. 5. If you work, don’t lose your job or get laid off. 8. Don’t live in damp low-quality housing, next to a busy road or near a polluting factory. 9. Be sure to own a car if you have to rely on neglected public transportation. 10.Learn how to fill in the complex housing benefit application forms before you become homeless and destitute. SOURCE: Adapted from Dave Gordon, University of Bristol, and Dennis Raphael, York University, from Unnatural Causes at www.UnnaturalCauses.org The Well-Being of Everett • 2014 Health Assessment Report 15 The Boston Public Health Commission’s Health of Boston 2010 divides the social determinants of health into three core areas: economic conditions, environmental and neighborhood conditions, and social conditions. quality experience higher rates of asthma. Lack of grocery stores that sell fresh produce and the lack of safe and affordable places to engage in physical activity contribute to poor diets, obesity, and diabetes. Economic conditions include employment, income, education, and wealth. Socioeconomic status has long been recognized as the single strongest predictor of health. Social conditions include neighborhood safety, social networks, social capital, and civic engagement. Social conditions such as exposure to racism and lack of neighborhood safety lead to chronic stress. Stress is directly linked to chronic disease, particularly hypertension and heart disease. Research has shown that supportive social networks can serve as a buffer to stress and depression, which in turn, protects against physical and mental illness. Physical environment and neighborhood conditions include food access, parks and open space, housing, air quality, liquor and tobacco advertisement, and transportation. These conditions work alone and with each other to affect health. Neighborhoods with poor air RESEARCH HAS SHOWN that supportive social networks can serve as a buffer to stress and depression, which in turn, protects against physical and mental illness. 16 The Well-Being of Everett • 2014 Health Assessment Report Education The Well-Being of Everett • 2014 Health Assessment Report 17 Education Percent of Population Over 25 Education is a key societal factor in supporting child and youth development, skill-building for future jobs and/or secondary education, and for supporting adults in job training or career development. Poverty in early life can negatively impact educational outcomes. Higher educational attainment is linked to higher future income. In a city with a large non-English speaking population, access to English language classes for adults is critical for educational and career development, as well as supporting the education of children and supporting parental engagement in all families. 100 90 80 70 60 50 40 30 20 10 0 Educational Attainment of Residents, aged 25 Years or Older (2000 & 2011) Everett 2000 Everett 2011 MA 2011 40.3 38.3 23.8 26.3 19.9 21.2 25.4 23.9 11.1 Less Than High School 22.1 10.1 11.3 High School Some College Graduate or Accociate’s or Equivalency Degree Bachelor’s Degree 11.6 3.4 3.8 Master’s Degree 1.2 1.4 5.0 Professional or Doctoral Degree SOURCE: US Census, 2000; US Census ACS, 2007-2011 • In general, the percentage of Everett residents with a Bachelor’s or higher degrees is lower than compared to Massachusetts overall. • In 2013, the percentage of graduates from the Everett Public Schools who planned to go to a 2-year or 4-year college after graduating high school has increased dramatically from 59% in 2007 to 80% in 2013. • The proportion of Everett public school students whose first language is not English has increased steadily from 26% in 2000 to 50% in 2013 and is now substantially higher than the Massachusetts average. (See the chart in the Demographics Section for Public School Enrollment by First Language not English). 18 The Well-Being of Everett • 2014 Health Assessment Report Everett Public Schools The Everett Public Schools consists of 9 public schools, pre-kindergarten through 12th grade, and enrolled nearly 7,000 students in the 2013-2014 school year. This represents a percentage increase of 31% since 2005-2006. There is a public charter school and two private schools in Everett. The city also maintains a membership affiliation with Shore Educational Collaborative, a special agency that provides services for children and adults with disabilities. Additional Characteristics of Everett’s public school population (K-12) • 79% of Everett public school children qualified for free and reduced cost lunches in the 2013-2014 school year compared to a statewide average of 37%. • Students in Everett exceeded the state rates for drop-out rates (3.3% compared to 2.2% in MA), but do better than the state for in-school suspensions (1.4% compared to 2.2% in MA). • The graduation rate from Everett High School is currently 86.5%, on par with the state graduation rate of 85%. • In 2012, Everett spent $12,261 per pupil for grades K-12, which is less than the state average of $13,636 per pupil. These funding levels are fairly consistent with communities surrounding Everett ($12,153 in Malden, $13,032 in Medford, $13,277 in Revere, and $16,506 in Somerville). • The student/teacher ratio in Everett is 13.5 to 1, nearly the same as Massachusetts which is 14.4 to 1. Strengths and Assets Stable Resident Base, with Transitory Segments The majority of our population has lived here for 5 or more years. However, from a community health perspective, if over onethird of the residents have been here for less than four years, community-wide campaigns may need to take into account this shifting segment of the overall population. Early Education • Tri-City Community Action Program, Inc. (Tri-CAP) provides comprehensive Head Start services for 55 Everett children, aged 3-5 years, and their families. School readiness is an integral part of the Head Start program that addresses cognitive, emotional, social and physical development. Parents receive encouragement and support to be active participants in their child’s/children’s education and learning, and in working with teachers and Family Service Workers to set goals for their children, themselves, and the household. • The Everett Coordinated Family and Community Engagement Program (CFCE) works on raising families’ awareness of the importance of high quality early education and care programs for children and promotes parent education, family engagement, early literacy and community resources for children and families. The Well-Being of Everett • 2014 Health Assessment Report 19 K-12 • The Parent Information Center is a registration center and clearinghouse for support services for new families entering the public school system. • Everett Public Schools offers free, half-day pre-kindergarten and full-day kindergarten education to all children enrolled at the Webster School and the Adams School. • Everett Public Schools has a partnership with Youth Harbors to support homeless or at-risk of becoming homeless youth. A case manager is available on site at the high school to assist youth in locating safe housing, applying for benefits including food stamps, health insurance, and providing job search assistance including resume building. • Everett Public Schools collaborates with Energize Everett in school gardens at the K-8 schools and Everett High School, and exercise programs at several K-8 schools. • Everett Public Schools, recognized by the New England Scholastic Band Association, has an award winning music program for students in grades 2-12 with the Everett High School Band, Percussion and Orchestra opportunities to enjoy and excel at musical endeavors. • Everett High School seniors can apply for more than 50 different local scholarships from area businesses, organizations, and non-profits to support their higher education plans. • The Parents Advisory Council, PAC, is an active group of parents working together with other parents, the schools and community to support the parents of Special Needs Students. • Everett Parent Teacher Organizations (PTO’s) are active at each of the K-8 public schools. • Everett offers families additional options for educating children K-12. Students may attend the Pioneer Charter School of Science, St. Anthony’s Parochial School and Pope John XXIII High School. 20 The Well-Being of Everett • 2014 Health Assessment Report After School • Everett Public Schools, in conjunction with Everett City Government, offers after school programming for 1st through 8th graders with the For Kids Only Afterschool program. Scholarships are offered with public school funds as well as city budgeted funds. Parents • For 20 years, Everett Public Schools has partnered with the Joint Committee for Children’s Health Care in Everett (JCCHCE) to collaborate on parent education and programming to support families including the Parent University All Day Conference and parent mini-workshops throughout the year. Adults • The Everett Adult Learning Center is an adult education program operated by the City of Everett which teaches 220 students to speak English as a second language (ESOL), citizenship, as well as how to access training programs, earn a GED or ADP, continue their education and get better jobs. The Everett Adult Learning Center has a waiting list of over 195 people. The program has a paid teaching and administrative staff, as well as a volunteer staff of one-to-one tutors. • There are several community-based organizations providing ESOL classes for adults & parents such as: La Comunidad, Inc., LUMA Inc., and A Better Tomorrow Services, Inc. • The Everett Public Libraries provide books and other resources in multiple languages. • Everett’s faith-based centers offer a range of health education programs and community forums to enrich the cultural, spiritual and educational opportunities for Everett residents. The Well-Being of Everett • 2014 Health Assessment Report 21 xx Recommendations • Address the needs of out-of-school youth and other vulnerable youth populations to ensure access and support for high school completion. Provide resources and services to ensure linkages for training and job opportunities that will support their full participation in society. • Develop stronger systems of communication and support for non-English speaking parents to improve educational outcomes and high school completion rates for their children. • Continue to work collaboratively to improve opportunities for early education and for all pre-school children in the city to be ready to start school. • Collaborate across various sectors in the city to strongly promote the strengths and diversity of educational options available to families with children. • In partnership with the Everett schools, strengthen efforts city-wide to support youth development and realization of their personal aspirations and goals in school, in the community and at home. • Continue to expand Adult Education offerings to reflect a wide range of interests and aspirations for Everett residents. • Increase access to English as a Second Language classes for adult newcomers to better meet the current demand. Please refer to the Youth Section for additional information on youth specific assets and recommendations. 22 The Well-Being of Everett • 2014 Health Assessment Report Economy, Employment and Housing The Well-Being of Everett • 2014 Health Assessment Report 23 Economy, Housing and Employment Everett is home to many small businesses, most with fewer than 10 employees, that provide employment in the city. The number of residents far outweighs the number of available local jobs, making commuting a daily reality for most residents. A significant portion of the local jobs, such as food services and retail, typically pay very low wages, requiring some residents to work several jobs to support their families. Median Household Income In Everett, the median household income increased from $40,661 in 2000 to $48,319 in 2011, which is a smaller increase than the state as a whole over the same time period (MA: $50,502 in 2000 to $65,981 in 2011). While there have been improvements for some, high utilization rates of local food pantries indicate that despite the improvements, there are still unmet basic needs. These households are forced to make choices between food or fuel and have no safety cushion of funds to tide them over in hard economic times. 24 The Well-Being of Everett • 2014 Health Assessment Report Income and Housing Indicators Everett 2000 Everett 2011 MA 2011 $40,661 $49,876 $19,845 $48,319 $58,045 $24,575 $65,981 $83,371 $35,051 Number of Occupied Housing Units Percent Owner-Occupied Percent Renter-Occupied 15,435 15,681 2,522,409 41.4% 58.6% 40.3% 59.7% 63.6% 36.4% Median House Value (Owner-Occupied Units) $178,800 $340,000 $343,500 Housing Units with a Mortgage Percent with costs 30% or more of Income Percent with costs 50% or more of Income 1,734 4,467 1,157,325 26.1% 57.9% 40.2% 10.0% 29.5% 15.6% 9,037 9,356 917,936 Income (Inflation Adjusted Dollars) Median Household Income Median Family Income Per capita income Renter-occupied Housing Units Percent with costs 30% to 49% of Income Percent with costs 50% or more of Income 20.2% 23.8% 23.3% 17.5% 28.1% 24.4% Median Gross Rent $729 $1,115 $1,037 SOURCE: Everett 2000 data based on year 2000 US Census Everett and MA 2011 data based on 2007-2011 American Community Survey Estimates A Healthy Community Means Affordable Housing A Healthy Community means citywide affordable housing in safe neighborhoods, free from discrimination. Affordable housing is critically important to the well-being and health of children and families. Without decent and affordable housing, families have trouble managing their daily lives and their children’s safety; health and development suffer. Families who pay more than they can afford for housing have too little left over for other necessities such as food, clothing and healthcare. They may not be able to pay for transportation and childcare, making it harder to go to work and school each day. Costly Housing There are 15,681 occupied housing units in Everett, 59% of which are renter-occupied (vs. 36% in Massachusetts). Of those who own their homes, 58% have a mortgage that equates to 30% or more of their household income (vs. 40% in MA.). Among renters, 28% of those who rent pay an amount equal to 50% or more of their household income for their monthly rent (vs. 24% in Massachusetts). The number of renters who now pay more than 50% of their income for rent has seen a percentage increase of 57% since 2000. The Well-Being of Everett • 2014 Health Assessment Report 25 xx Poverty Indicators Everett Everett MA 2011 2000 2011 Poverty Status of Individuals Under 100% of Poverty Level (Doing Poorly) 11.8% Between 100 to 200% of Poverty Level (Struggling) 16.4% Over 200% of Poverty Level (Doing OK) 71.8% Families Number of Families Percent of all Families in Poverty Percent of Female Headed Families in Poverty Percent of Female Headed Families with children in Poverty Children Number of Children (under 18 years of age) Percent of all Children in Poverty 11.6% 21.4% 67.0% 10.7% 12.9% 76.4% 9,610 9.2% 5.3% 9,885 9.5% 5.4% 1,603,940 7.6% 4.7% 4.6% 4.1% 4.1% 8,057 17.0% 8,935 1,405,216 14.3% 13.5% SOURCE: Everett 2000 data based on year 2000 US Census Everett and MA 2011 data based on 2007 -2011 American Community Survey Estimates Homeless Individuals and Families High rents and a limited range of housing options have resulted in homelessness for many families and individuals. On January 29, 2014, there were 365 people in the tri-cities (Everett, Malden and Medford) experiencing homelessness (Tri-City Community Action Program). Rise of Families in Poverty The number of Everett families in poverty increased slightly from 2000 to 2011, keeping the rate 25% higher than the state as a whole (9.5% in Everett vs. 7.6% in MA). However, the proportion of children under 18 years of age living in poverty has decreased in Everett from 17% in 2000 to 14% in 2011. Inequality Rising in United States According to the United Nations Development Program inequality rankings of 2009, the U.S. is highly unequal in terms of the gap between rich and poor, third among the world’s advanced economic countries below only Hong Kong and Singapore. A major shift has occurred over the past 30 years, so that between 1979 and 2007, 63.6% of pre-tax income growth in the U.S. went to the richest 10%, while the bottom 90% of the population collectively saw only 36.4% of the growth in income. 26 The Well-Being of Everett • 2014 Health Assessment Report Disability Linked to Poverty According to the US Census Bureau, in the United States in 2000, 8.7 million people with disabilities were poor - a substantially higher proportion (17.6%) than was found among people without disabilities (10.6%). The highest poverty rates in both cases were found among children aged 5 to 15. Young people with disabilities had a poverty rate of 25%, compared with 15.7% for those without disabilities. Annual Unemployment Rate (1990-2010) During the 1990s, unemployment in Massachusetts declined steadily, rose slightly in the early 2000s and increased sharply between 2008 and 2010. Unemployment rates in Everett were slightly higher, but had a similar trend and pattern compared with the state. Annual Unemployment Rate in Everett and MA (1990-2013) Everett MA 12 Percent 10 8 6 4 2 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 SOURCE: United States Department of Labor, Bureau of Labor Statistics The Well-Being of Everett • 2014 Health Assessment Report 27 xx Strengths and Assets (Employment): • Everett Master Planning Process: The City of Everett recently engaged the community in several master plans focusing on different parts of the city, such as the “Lower Broadway District Master Plan,” (better known as “The Line”), the “Everett Central Waterfront Municipal Harbor Plan, and the “Commercial Triangle,” (the commercial and residential areas around Revere Beach Parkway and Second Street). These Master Plans have included substantial input from various stakeholders, including residents and business owners, in order to bring these areas to their highest potential to spur private investment, create good, sustainable jobs, and benefit long-time, newly arrived, and future residents. These plans are available on the City of Everett website or through the Department of Planning and Development. • Tri-City Workforce Development Task Force is a coalition that advocates for jobs for local residents and training to help equip the local workforce for new community development projects so that they can afford increased housing costs that often accompany these projects. • The Everett Chamber of Commerce has been supporting businesses since it began in 1950 and now has 225 members. • Several community-based efforts work on job development and/or job training, with a particular focus on high school age students and young people. A partial listing includes the Everett High School’s Allied Health Academy, Everett Boys and Girls Club, Mayor’s Summer Jobs Program, Energize Everett, and opportunities for volunteering at the Cambridge Health Alliance, along with other larger businesses and/or organizations. Recommendations (Employment): • Ensure new development projects include provisions for creating good jobs at a living wage and job training for local residents. • Support anti-displacement strategies to protect vulnerable populations pending a casino development. • Increase local employment opportunities in the city for Everett youth. Strengths and Assets (Housing) • The City of Everett, with assistance from the Metropolitan Area Planning Council (MAPC), along with community input, is working to develop a Housing Production Plan that will guide housing development and help the City meet the state-mandated affordable housing target. This planning process will include discussions about local needs and demand, barriers to achieving housing affordability goals, successful strategies already in place on which Everett can build, and potential sites for new development. 28 The Well-Being of Everett • 2014 Health Assessment Report • The City of Everett offers assistance for housing rehabilitation and first-time home buyers. • Everett’s Fair Housing Committee meets to ensure compliance with the Fair Housing Act, which prohibits discrimination in housing and helps advocate for quality affordable housing. • Tri-City Community Action Program, Inc. (Tri-CAP) provides a number of services and resources for individuals and families needing housing assistance including housing search assistance, emergency financial assistance (when funds are available), and helping to resolve problems that could lead to homelessness. • Tri-CAP provides residents to apply for fuel assistance and legal services for people who are facing eviction, loss of a subsidy, or other housing problem. • Tri-CAP helps homeless individuals with transportation, clothing, benefits, mental health/ substance abuse counseling, access to healthcare resources, job search, housing search, and stabilization in housing. • Tri-CAP’s Housing Opportunities for People with AIDS (HOPWA) program provides housing search assistance and other support services. • The Tri-City Housing and Homelessness Task Force conducts an annual homeless census to capture current information on adults, families and youth impacted by homelessness. Recommendations (Housing): • Ensure adequate representation of Everett’s diverse community (including renters) in discussions of the Housing Production Plan. • Advocate for new housing development projects to include affordability below 60% of the Area Median Income, ensuring low to moderate income Everett residents will be able to access the new housing. • Ensure accessible housing by anticipating the needs of Everett’s current population with disabilities and aging baby boomers interested in aging in place. • Meet 10% affordable housing requirement of available housing as required by Massachusetts Affordable Housing Zoning Law, Chapter 40B. The Well-Being of Everett • 2014 Health Assessment Report 29 xx Built & Natural Environment 30 The Well-Being of Everett • 2014 Health Assessment Report Built & Natural Environment The built environment refers to human-made settings. These include the planned use, layout and design of a community such as streets, houses, playgrounds, schools, grocery stores, commercial and residential zones, and public transportation. Land Use Policy Tools: Zoning is the mechanism which brings planning, policy and legislative work together to determine the future character of a community through land-use planning. Zoning with a public health focus can promote and protect community features, such as mixed commercial-residential districts that encourage walking and biking, the preservation of open space, improved access to healthy food choices, and reduced exposure to pollution. Strengths and Assets • The City of Everett recently engaged the community in several master plans focusing on different parts of the city, such as the Lower Broadway District Master Plan and Urban Renewal Plan, the Everett Central Waterfront Municipal Harbor Plan, and will soon begin the Commercial Triangle Master Plan, which includes the commercial and residential areas around Revere Beach Parkway. These plans have included input from various stakeholders, such as residents and business owners, in order to elevate these areas to their highest potential to benefit long-time, newly arrived, and future residents. These plans are all available on the City of Everett website through the Department of Planning and Development. Transportation A healthy community includes reliable and safe access to all modes of transportation for everyone – pedestrians, bicyclists, motorists and transit riders of all ages and abilities – and encourages active and healthy transportation modes such as walking and bicycling. • The City of Everett has recently passed a Complete Streets Resolution, which recognizes the connection between transportation and health and ensures that all future transportation plans in the city make the street network better and safer for drivers, transit users, pedestrians, and bicyclists. • Everett has 8 bus routes that travel through the city and connect to three nearby Orange Line subway stations – Malden, Wellington and Sullivan. Public transportation is very important for Everett residents, as 22.4% of workers in Everett rely on public transportation to travel to work, and 18.2% of households in Everett do not have access to a vehicle. The Well-Being of Everett • 2014 Health Assessment Report 31 xx Recreation and Open Spaces • Everett strives to offer multiple recreational opportunities to its residents. There are approximately 58 acres of parkland in Everett, with at least one park in each of the six wards. Recent renovations of several parks and tot lots reaffirm commitment to offering youth and families safe, accessible spaces to play and socialize. Everett’s Recreation Department offers various low-cost activities to children and adults at two main facilities – the Recreation Center and the old Everett High School Field House. Recently, an elementary school opened one night a week for Family Fitness Nights in collaboration with Energize Everett. This successful activity has prompted the city to engage in a Joint Use Agreement with Everett Public Schools to allow usage of more school facilities after hours. • Everett is committed to protecting and expanding our natural resources by planting and maintaining trees, shrubs and flowers. In an urban setting such as Everett, trees play a vital role in energy conservation, noise and visual protection, beautification, as well as curb the urban heat affect and offsets urban pollution. The National Arbor Day Foundation has recognized and designated the City of Everett as Tree City USA since 1996 for its dedication to planting and maintaining over 4,500 trees. • Everett has also recently supported further protection of the natural environment, as well as answering a well documented need for residents to grow their own food, by working with the Everett Community Growers (ECG) to open Everett’s first community garden on Florence Street. In collaboration with the city’s Department of Planning and Development, ECG is currently conducting an urban land inventory and assessment to identify spaces for urban agriculture for personal and commercial use. They are also compiling a report of best practices and recommendations for a zoning ordinance to support and encourage food growing and selling around the city. • The Northern Strand Community Trail is a multi-use trail that connects the communities of Everett, Malden, Revere, Saugus and Lynn. Everett was the first of these communities to pave the trail in 2012, and several other communities have followed 32 The Well-Being of Everett • 2014 Health Assessment Report Everett’s lead in recent months. The bicycle advocacy group, Bike to the Sea, has led this project for over 20 years, and encourages residents to become stewards of the trail in each community. • Many community groups and residents, led by organizations such as Tri-City Community Action Program and La Comunidad, Inc., around the Malden River watershed, have formed the Friends of Malden River to create awareness and encourage action of issues of environmental justice and water quality in the communities surrounding the Malden River. Recommendations • Adhere to Complete Streets Resolution and accompanying Healthy Design Guide in all future planning projects to ensure that healthy and active transportation options are available to all. • Ensure ongoing and future planning processes are accessible and welcoming for all Everett residents. • Representation of Everett’s diverse community should be a commitment from the city leadership so that all residents are represented on Boards and Commissions that make planning decisions. • Create and fund maintenance plan for Northern Strand Community Trail. • Continue and expand “free play” (non-program structured) spaces and opportunities for all Everett residents. • Support the expansion of spaces and opportunities for commercial agriculture so all residents have access to affordable, fresh, healthy food and the ability to generate revenue from agricultural products. • Support an expansion of the Friends of the Malden River and create a new coalition to assess and improve Everett’s air quality. See city website with Master Plan link: www.ci.everett.ma.us/Everett_files/commdevelop/ 120918%20LowerBroadwayPresentationFinal_Sept18.pdf The Well-Being of Everett • 2014 Health Assessment Report 33 xx Community 34 The Well-Being of Everett • 2014 Health Assessment Report Community Determinants of health include not only access to education, jobs, housing, and a safe physical environment, but social factors as well. Some of these elements are social supports and social networks, but also freedom from discrimination based on race, ethnicity, gender, age or sexual orientation. Community resources that facilitate health and personal growth may also include access to arts and cultural experiences, faith-based communities, open channels of communication, and opportunities to be civically engaged. The presence of social supports is linked to individual and community health outcomes, with related better health and lower mortality rates. In addition to helping reduce the negative impacts of stress, social networks provide support for individuals in coping with jobs, housing, childcare and other resources that influence socioeconomic impacts on health. Some of the sources of negative stressors, which can cause chronic stress, are driven by societal issues such as discrimination, racism, or other “isms” that impact status and access to fairness and justice in society. Health Disparities and Health Inequities: What’s the difference? The National Institute of Health defines health disparities as “differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” Health disparity equates with inequality related to differences between individuals or groups, whereas health inequity refers to underlying avoidable societal conditions that are unfair or unjust. Health inequities are socially produced, creating systemic differences in health between different socioeconomic populations. Healthy Community A healthy community, according to the World Health Organization, is “… one that is continually creating and improving those physical and social environments and expanding those community resources that enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.” Racism Race is a social construct, a biological myth that carries significant implications for health. Research related to health disparities, increasing the focus on social determinants of health, when controlled for social factors such as socioeconomic status and educational attainment indicated people of color experience worse health outcomes than whites. The chart that follows indicates some of the factors impacted by racism, as demonstrated in numerous studies. Ethnic health inequities also follow a similar pattern of poor health outcomes. The Well-Being of Everett • 2014 Health Assessment Report 35 xx Education Job Opportunity Food Assistance/ Food Environment Racism Socioeconomic Status Environmental Exposure Health Outcomes Health Behaviors Access to Health Services Safe & Affordable Housing Community Violence Health Equity Framework—Social Determinants of Health Inequities. SOURCE: Boston Public Health Commission Center for Health Equity and Social Justice Increasingly, there is growing recognition that the chronic stressors associated with racism threaten health. Racism can manifest as internalized, interpersonal or institutional – changing the day to day experiences of where people of color live, work, learn and play, impacting health across the full spectrum of life from maternal health to achieving average life expectancy. Anti-immigrant sentiments, which presently mirror past discrimination in earlier economic downturns, often present with subtle or even blatant racial undertones. Effective efforts to improve health outcomes increasingly need to take into consideration these issues in order to challenge deep-seeded health inequities. 36 The Well-Being of Everett • 2014 Health Assessment Report Strengths and Assets • Based on literature, participation in faith-based communities can be a critical social support for many people. Everett is home to many churches, one synagogue, and a mosque. Over the past decade, there have been significant changes in the religious demographics in both the White Protestant and Catholic churches. The immigrant-based faith communities have been growing and thriving, often sharing spaces with existing congregations or by outright purchase. In the past, the local faith community has met regularly to discuss shared concerns and issues impacting their populations. • Art, Culture and Social Activities – – – – – – – – – – – Everett Art Club Annual Spring and Fall City Cleanups Annual Cityfest Annual Everett Public Schools Homecoming Parade Friends of the Everett Libraries’ Annual Book Sale and Speaking Program Annual Citywide Independence Day Events Martin Luther King Day Celebration organized by Zion Baptist Church. Musical performances by Everett Public Schools Music Department Family Fitness Nights offered by Recreation Department and Energize Everett Annual Bike to the Sea Day Holiday activities of Office of Human Services • Places in our community where people gather informally, such as cafes, plazas, libraries and parks – – – – – – Parlin Library Shute Memorial Library Everett Farmers Market Various parks and tot lots Northern Strand Community Trail Independently owned coffee shops and bakeries • The Everett Community Growers brings together residents of diverse backgrounds under the common goal of achieving food justice by increasing access through food growing in the City of Everett. They began the city’s first community garden, the Florence Street Community Garden in 2012, and plan to secure more spaces around the city to grow food for both personal use and commercial use, hoping to alter city ordinances to allow selling of backyard and community garden produce. • One Everett is a coalition of residents of Everett, La Comunidad, Tri-CAP, Joint Committee for Children’s Health Care in Everett, Everett Community Health Partnership, Jobs With Justice, the Everett Teachers Association and Action for Regional Equity focused on increasing living-wage jobs for Everett residents and parent involvement in the Everett Public Schools. The Well-Being of Everett • 2014 Health Assessment Report 37 xx • The Multicultural Affairs Commission (MAC) was created in 2004 to directly tackle conflicts and create bridges between long-time residents and new immigrant groups. Among its many initiatives are a quarterly meeting with the Everett Police Department and members of the immigrant community and political forums hosting candidates for local and state elections. • Annual May 1st (May Day) International Workers Day Rally and March organized by various immigrant and labor rights organizations in Everett, East Boston, Chelsea and Revere. • La Comunidad, Inc. is a non-profit organization working to provide a better future to the Latino American Community in the City of Everett and surrounding areas. It is directed and operated by Latino staff members and volunteers, and is committed to educating and providing services in the following areas of interest: Immigration, Social Services, Education, Labor Rights, Community Organizing, and sharing public information. • A Better Tomorrow, a non-profit community organization, provides leadership and direction to immigrant families living in America, specializing in supporting recent Haitian immigrants. Some of their services include: bilingual parenting education, advocacy, case management, healthcare access, ESL, and computer applications skills. They also operate a food pantry on the 1st and 3rd month of each month from 4-6pm. • Latinos Unidos en Massachusetts (LUMA) is a non-profit community organization, based in Everett, which works for the rights of the immigrant community and promotes the Latin American culture. Recommendations • Increase the number of intergenerational, interethnic and interracial community building projects. • Encourage and support mechanisms to increase representation of Everett’s diverse populations on City Council, Boards and Commissions. • Increase community participation in Everett’s Multicultural Affairs Commission’s efforts to make Everett a welcoming community for immigrants. • Increase youth-led, community-wide events celebrating healthy behaviors. • Increase collaborative projects with faith-based community. 38 The Well-Being of Everett • 2014 Health Assessment Report Leading Health Indicators & Recommendations The Well-Being of Everett • 2014 Health Assessment Report 39 xx Adult Physical Activity & Nutrition Why is this important? Adequate physical activity and a healthy balanced diet can reduce the risk of many chronic health issues. There is a better chance of creating healthy habits when healthy choices are available and supported within the home and community. Exercise alone can decrease the chances of developing cardiovascular disease, type 2 Diabetes, metabolic syndrome, and certain types of cancers. It can also strengthen bones and muscles, improve mental health and mood, control weight, and increase chances of living longer. The Centers for Disease Control and Prevention (2012) state: Physical exercise is crucial for the well-being of children, adolescents, adults, and older adults. It is especially important for older adults considering the number of health problems which come with age. Physical activity in older adults can strengthen weakened muscles, reducing the risk of falls. A nutritious diet can decrease the risk of chronic diseases such as type 2 Diabetes, hypertension, and certain types of cancers. It can also reduce the risk of obesity and micronutrient deficiencies (i.e. the lack of essential vitamins which can lead to visual impairments and severe infections). Obesity continues to be a problem in the United States with 17% of children and 35.7% of adults considered to be obese. Based upon data from the 2008 5-City Behavioral Risk Factor Surveillance Survey, 69.1% of Everett adults reported they participated in physical activities during the past month. More specifically, 42.1% reported engaging in at least 30 minutes of moderate physical activity at least 5 days a week and 31.4% reported engaging in at least 20 minutes of vigorous physical activity at least 3 days a week. Citations The Centers for Disease Control and Prevention (CDC); Physical Activity (2012) www.cdc.gov/physicalactivity/index.html World Health Organization (WHO); Nutrition & Obesity, (2014). www.who.int/topics/en/ www.who.int/topics/en/ 40 The Well-Being of Everett • 2014 Health Assessment Report Obesity The World Health Organization affirms that obesity can lead to serious health problems, including but not limited to strokes, respiratory problems, osteoarthritis, coronary heart disease and sleep apnea. As of 2008, the medical costs of obesity in the United States totaled to approximately $147 billion. Strengths and Assets Physical Activity • The City of Everett has recently passed a Complete Streets Resolution, which recognizes the connection between transportation and health. The resolution ensures all future transportation plans in the city will make the street network better and safer for drivers, transit users, pedestrians, and bicyclists. • The Recreation Department offers various low-cost activities to children and adults at two main facilities – the Recreation Center and the old Everett High School Field House. Recently, an elementary school opened one night a week for Family Fitness Nights in collaboration with Energize Everett. • Seniors have access to various exercise and physical fitness programs at the Connolly Center. • Everett is part of the Northern Strand Community Trail, a multi-use trail that connects the communities of Everett, Malden, Revere, Saugus and Lynn. Everett was the first of these communities to pave the trail in 2012, and several other communities have followed Everett’s lead in recent months. Nutrition • The Everett Farmer’s Market runs in the summer and fall months and accepts SNAP, WIC and senior coupons. • Focusing on small markets and convenience stores, Energize Everett works with store-owners to sell more fresh food in neighborhoods throughout the city. • Healthy Vending – all municipal buildings including schools have healthy food options in vending machines. • For families in Everett in need of additional support to feed their families, there are two pantries available: Bread of Life located at 460 Broadway and A Better Tomorrow located at 3 Charlton St. • The Cambridge Health Alliance runs programming and educational sessions for seniors at the Connolly Center on healthy eating and diabetes control, in addition to other health and wellness topics such as brain, bone and heart health. • Increased visibility of Energize Everett’s social media outlets, including Facebook, Twitter and newsletters to promote and educate the community on healthy living. • Community gardens have increased access to fresh vegetables for residents. The Well-Being of Everett • 2014 Health Assessment Report 41 xx Recommendations Physical Activity • Continue to expand public spaces for all residents to engage in physical activity. • Support local businesses to provide opportunities for employees to participate in health and wellness programs. • Continue to expand physical fitness programs for seniors at the Connolly Center to fully engage all members. • Expand the number of secure bike racks throughout the city. Nutrition • Offer media programming and education on healthy eating options, including recipes, shopping tips for low-cost meals and cooking demonstrations. • Expand Healthy Markets in every ward. • Provide healthy and nutritious recipe information to expand awareness of healthy cooking options. • Demonstrate healthy eating alternatives at community-wide events. 42 The Well-Being of Everett • 2014 Health Assessment Report Adult Tobacco Why is this important? Tobacco use is the single most preventable cause of death and disease in the United States. According to Massachusetts Department of Health and Human Services, over 8,000 MA residents die each year from the effects of smoking. The use of tobacco products and secondhand smoke are directly related to chronic diseases, including emphysema, bronchitis, cancer, heart disease, pregnancy-related problems, and many other serious health problems. Despite the many risks of cigarette smoking, much of the potential harm can be decreased just by quitting. Citations The Centers for Disease Control and Prevention (CDC); Tobacco (2013) www.cdc.gov/tobacco/ Tobacco Tobacco kills more people each year than car accidents, AIDS, homicides, suicides and poisonings combined. Research indicates that 80% of adult smokers began smoking before the age of 18. What are Electronic Cigarettes? The emergence of electronic cigarettes, more commonly referred to as e-cigarettes, has gained national and local attention as a method of tobacco cessation to help people quit smoking. Additionally, it has garnered attention as a means to recruit new users to nicotine products, with a particular attention on young people, through the marketing of candy-flavored devices. The debate on the effectiveness and regulation of this product is currently ongoing with the Federal Drug Administration. Just what e-cigarettes are and what role they should play in helping people quit smoking depends very much on who you speak with about this topic. For more information on tobacco cessation, we encourage you to speak with your primary care provider or contact the tobacco quit line at 1-800-QUIT-NOW. Tobacco Use Based upon data from the 2008 5-City Behavioral Risk Factor Surveillance Survey, 29% of Everett adults reported they were current smokers, twice as many compared to Massachusetts (15%). Furthermore, nearly 10% of Everett adults reported they were heavy smokers (smoking more than 20 cigarettes a day). The Well-Being of Everett • 2014 Health Assessment Report 43 xx Smoking Cessation Based upon data from the 2008 5-City Behavioral Risk Factor Surveillance Survey, almost 56% of Everett smokers reported that in the prior 12 months they had stopped smoking for one day or longer because they were trying to quit, compared to 63% statewide. More than 80% of Everett smokers reported that a doctor, nurse or other health professional advised them not to smoke in the prior 12 months. Please refer to the Youth section for more information about tobacco use among youth. Strengths and Assets • The Six City Tobacco Control Collaborative is a joint project of the health departments of Cambridge, Chelsea, Everett, Revere, Somerville and Winthrop, through funding from the Massachusetts Department of Public Health. The goal is to develop, promote and enforce local tobacco control policies in all cities served. • Everett Board of Health, with the support of the Everett Community Health Partnership – Substance Abuse Coalition and TEASA (Teens in Everett Against Substance Abuse) youth members, banned the sale of tobacco products at Everett pharmacies in 2010. At the time, Everett was one of the first cities in Massachusetts to pass a city ordinance regarding the sale of cigarettes and other tobacco products. • Smoking cessation options have increased locally and statewide. Everett residents are utilizing the state-run cessation helpline (1-800-QUIT-NOW) to obtain information about quitting and the type of methods available to best fit personal needs. • All patients seen in the Cambridge Health Alliance, primary care and in-patient settings are screened for tobacco use. The medical provider determines in cooperation with the patient, resources and referrals to help reduce tobacco use. Recommendations • Increase access to information on smoking cessation resources in local businesses, city buildings and local media outlets, including cable television. • Increase availability of tobacco cessation programs and the different methods adults can use, with the support of a medical provider or on their own. • Cambridge Health Alliance runs the smoking cessation program, “Quit for Life”, which provides help for long-term smoking patients determined to quit smoking/tobacco use. Expansion of this program is needed in Everett. • Expand education efforts to adults and youth on the risks associated with secondhand smoke. • Increase awareness of cessation supports available through all health insurances, including Mass Health. Please refer to the Cancer and Chronic Disease sections for more information on health conditions. related to smoking. 44 The Well-Being of Everett • 2014 Health Assessment Report Adult Substance Abuse Why is this important? Substance abuse continues to be a critical public health problem impacting individuals, families, and communities. Approximately 23.9 million Americans over the age of 11 used illegal drugs or abused prescription medications in 2012 alone. In 2011, Eastern Massachusetts had the highest rate of emergency room visits caused by illegal drug use of any metropolitan region in the United States. Everett has been significantly affected by the widespread abuse of tobacco, alcohol, and illegal drugs, including prescription medications. Brain imaging shows that long-term drug use can change parts of the brain that are critical to judgment, decision-making, learning, memory, and behavior control (NIDA, 2012). Research continues to support that prevention is the most effective measure to reduce the onset of substance use or limit the development of problems connected to use and abuse. Prevention efforts can be directed to both the individual and the community. Changing conditions and policies can effectively reduce the availability of substances as well as the demand. Guidelines/Definitions for the following charts: Admissions into substance abuse programs through the state program, the Bureau of Substance Abuse Services, include the following services: • • • • • • Acute inpatient Post-detox treatment Residential treatment Outpatient treatment Opioid treatment Family treatment and other treatment programs Preventing Substance Abuse Preventing substance abuse is important because it impacts the whole community - individuals, families, businesses, local government, schools, law enforcement and more. Destructive consequences are related to lost work productivity, healthcare, and crime. Substance abuse and addiction can lead to severe and chronic health problems, mental health disorders, family disintegration, failure in school, relationship violence, increased crime, child abuse and neglect. The Well-Being of Everett • 2014 Health Assessment Report 45 xx Trend in Admissions to Substance Abuse Treatment (2000-2010) Crude Rate per 100,000 2500 2239.9 (N=831) 1872.5 (N=119,224) 2000 1500 1893.4 (N=721) 1589.9 (N=104,831) 1000 500 0 Everett MA 2000 2001 2002 2003 2004 2005 2006 2007 2009 2008 2010 Year SOURCE: Bureau of Substance Abuse Services, MADPH, Program Utilization Data on Substance Abuse Programs • Between 2006 and 2010 the rate of admissions to substance abuse treatment steadily increased in Everett from 1,690 per 100,000 to 2,239 per 100,000. The rate in Everett is currently 41% higher than the overall rate in Massachusetts. Admissions to Substance Abuse Treatment, by Age (2010) Age Adjusted Rate per 100,000 8000 7000 6757 6748 6000 Everett 5000 4526 4562 4009 4000 3356 3000 MA 3746 2666 2800 2460 2000 1000 0 589 1044 2175 2082 1676 1385 579 759 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 Years Years Years Years Years Years Years Years Years Age Group SOURCE: Bureau of Substance Abuse Services, MADPH, Program Utilization Data on Substance Abuse Programs; Data for other age groups not available or reported for Everett • In 2010, the age-adjusted rates of admissions to substance abuse treatment were highest among Everett residents age 20 to 29 year old. Rates in Everett were higher than rates in Massachusetts for most age groups except for 15-19 year olds and 55 to 59 year olds. • Across all age groups, males in Everett were more likely to be admitted into substance abuse treatment services compared to females (67% males vs. 33% females). Among 25 to 29 year olds specifically, 73% of admissions were males. 46 The Well-Being of Everett • 2014 Health Assessment Report Proper Disposal of Medications The misuse of non-prescribed medications is wide spread across Massachusetts and throughout the United States. Prescription drugs left unattended or forgotten in family medicine cabinets are one of the most accessible gateways to opiate and heroin abuse. In an effort to keep expired, unwanted, and unused medication out of the environment, Everett maintains two locations for residents to dispose of medications safely. Medication drop boxes are located at the Everett Police Department and the Health Department. In addition the city sponsors National Prescription Drug Take-Back Days throughout the year. Additional information can be found online at www.mass.gov/eohhs/gov/ departments/dph/programs/ substance-abuse/prevention/opioid-overdose-prevention.html Trend in Primary Substance Used Among Everett Residents EnteringSubstance Abuse Treatment (2000-2010) Crude Rate per 100,000 1600 Alcohol Cocaine Crack Heroin Marijuana 1400 1200 1000 800 1339.64 (N=497) 835.07 (N=318) 477.09 (N=177) 600 400 735.28 (N=280) 200 0 2001 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year SOURCE: Bureau of Substance Abuse Services, MADPH, Program Utilization Data on Substance Abuse Programs Data for Crack in some of the years is not available or reported for Everett • Heroin and alcohol were most often reported as the primary substances used among Everett residents entering substance abuse treatment. However, while alcohol has slightly declined and remained steady over the past 10 years, heroin as a primary substance has increased rather dramatically since 2003. Admissions to Substance Abuse Treatment for Heroin, by Age (2010) Age Adjusted Rate per 100,000 6000 5000 4914.5 4844.4 Everett MA 4000 2891.7 3000 2000 2481.6 1977.9 2328.7 1632.0 1077.3 1146.8 1000 0 763.3 862.6 515.1 465.5 316.5 40 to 44 35 to 39 45 to 49 50 to 54 Years Years Years Years Age Group SOURCE: Data for other age groups not available or reported for Everett Bureau of Substance Abuse Services, MADPH, Program Utilization Data on Substance Abuse Programs 20 to 24 Years 25 to 29 Years 30 to 34 Years • In 2010, substance abuse treatment admission rates for heroin were highest among Everett 20-29 year olds. The admission rates for heroin in Everett were substantially higher than Massachusetts for all age groups examined. The Well-Being of Everett • 2014 Health Assessment Report 47 xx Trend in Emergency Department Visits Related to Opioids (2002-2009) Age Adjusted Rate per 100,000 700 642.1 (N=254) Everett MA 600 500 400 330.5 (N=132) 300 200 100 0 244.2 (N=16,033) 153.6 (N=10,067) 2002 2003 2004 2005 2006 2007 2008 2009 Year SOURCE: Massachusetts Division of Health Care Finance and Policy, Uniform Hospital Discharge Data System (UHDDS) • A similar pattern of difference between Everett and Massachusetts is observed for opioid-related hospitalizations during the same time period. Trend in Opioid related Deaths (2002-2009) Age Adjusted Rate per 100,000 45 40 Everett MA 40.67 (N=15) 35 30 25 21.43 (N=8) 20 15 10 5 0 5.57 (N=363) 9.25( N=627) 2.91 (N=1) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year SOURCE: Registry of Vital records and Statistics, Research and Evaluation, Massachussetts Department of Public Health • Between 2002 and 2009, age-adjusted opioid-related death rates in Everett were generally higher than the state. • More recent data obtained from death record review in Everett for years 2010 through 2012 show a crude rate of 4.8 deaths per 100,000 residents in 2010; 14.2 deaths per 100,000 in 2011; and 9.4 deaths per 100,000 in 2012. 48 The Well-Being of Everett • 2014 Health Assessment Report Strengths and Assets • Everett Community Health Partnership’s Substance Abuse Coalition (ECHP-SAC) has actively engaged community partners since 2002 to work on prevention strategies to reduce the incidence of substance use and abuse among Everett’s youth, and over time adults. • There are two prescription drop boxes available to residents for safe disposal of outdated medications or unused prescription drugs. One is located at the Everett Police Department lobby and is accessible 24 hours a day, 7 days a week. The second drop box is located at the Health Department in City Hall and is available during business hours. Properly disposed medications are less likely to get into the hands of the wrong person and seep into our water systems. • The Cambridge Health Alliance and Everett Board of Health continue to monitor admissions data related to substance abuse, helping to guide community prevention efforts. • Adults seeking treatment for opioid dependence may now receive care as part of a complete medication assisted treatment plan by their primary care provider. The Everett Family Health Center, additional providers at the Cambridge Health Alliance, and other providers in the region are trained and licensed to provide outpatient treatment dispensing office-based opioid treatment. • The Everett Outpatient Clinic, through Eliot Community Human Services, provides client-centered substance abuse counseling (individual, group, and family) and psychiatry. Treatment is developed collaboratively with the person served to address identified needs and incorporates their strengths, life goals, and preferences. • The Everett Outpatient Clinic at Eliot Human Community Services is now the exclusive provider for the Malden Drug Court and provides 24Q Evaluations (psychosocial summary and treatment recommendations), customized individual and group counseling, driver alcohol education for first and second offenders, as well as direct weekly consultation to the court and probation staff. • The Parents’ Action Committee of Everett (PACE) was formed in 2012 by a group of bilingual middle school parents who decided to take a stand to help prevent underage drinking. PACE’s mission is to provide Everett parents with tools and resources to empower them to candidly discuss the risks of alcohol with their children. A new campaign, the Power of 6, launched in 2013 at the Keverian School, will now be available to all parents within the Everett schools in the 2014-15 school year. The Well-Being of Everett • 2014 Health Assessment Report 49 xx • The Everett Police Department maintains a Special Investigations Unit to monitor illegal drug activity in the city and region, resulting in reducing and eliminating access to drugs. Everett residents are encouraged to report drug activity using the Drug Hot Line or the Drug Tips form available on the Department’s website. • ECHP-SAC’s youth group, Teens in Everett Against Substance Abuse (TEASA), now in its 9th year, continues to mobilize over 40 high school students each year to work in partnership with residents and community leadership on prevention efforts to educate youth, adults, parents, policy makers and local businesses on risks associated with substance use. • The Everett Police Department monitors alcohol sales to youth through compliance checks conducted throughout the year. • Regional approaches to addressing substance abuse and overdoses from opioids, including heroin, and reducing misuse of prescription drugs are a priority under the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services. Everett is a member of a newly formed partnership for prevention which includes the cities of Cambridge, Somerville and Watertown. Recommendations • Develop support networks for parents, family members, and friends who are coping with their loved ones who are struggling with addiction and dealing with substance abuse disorders. • Advocate for increased funding for prevention and treatment services dedicated to substance abuse for all ages. • Provide more treatment services for individuals seeking help with addiction disorders. • Promote the state-wide substance abuse treatment hotline to increase awareness of treatment resources and options for individuals and families managing substance abuse. • Expand awareness and educational opportunities for residents in Everett to recognize the signs and symptoms of substance abuse. Assist with referrals for treatment and support for family members and loved ones living with addiction. • Expand education and awareness of the effects of selling alcohol to minors. • Provide professional development and training such as Mental Health First Aid for city employees, youth workers, after school program staff, teachers and coaches with regard to recognizing signs and symptoms of substance use, and provide resources to help refer youth, adults and families for support. • Continue to practice safe monitoring of prescription drugs in the home, and utilize appropriate resources such as the prescription drop boxes in the community to properly dispose of unused or old prescriptions. 50 The Well-Being of Everett • 2014 Health Assessment Report Adult Mental Health Why is this important? An estimated 44 million Americans experience a mental health disorder during any given year. Mental health problems can affect anyone, regardless of age, sex, race, income, religion, or social status. One in every five Americans will experience a mental illness during their lifetime. Mental illness is so common in the United States that currently, more hospital beds are filled for psychiatric problems than for any other type of health problem. Humans live in a complex world, with everyone experiencing stress or emotional suffering at some point in their life. For many people, a mental health issue will arise requiring professional attention. Chronic, long-term mental illness can be highly debilitating and cause severe disruptions in everyday functioning, thinking, feeling, and relating to others. These disturbances can disrupt an individual’s ability to cope with everyday activities (DMH, 2014). There are several factors that contribute to the development of mental illness. Trauma and stress early in life can have serious psychological impact. Biological factors such as a genetic predisposition can also increase the risk of developing a mental illness. Mental Health Preventing the development of mental health problems and getting adequate professional treatment for existing mental health illnesses is crucial for well-being. It is important for people to learn and identify early signs, so support and treatment, if necessary, can be accessed. Trend in Mental Disorder Related Hospitalizations (2000-2009) Age Adjusted Rate per 100,000 1400 1293 (N=508) 1200 1114 (N=420) 1000 800 824 (N=53,827) 786 (N=53,395) 600 400 Everett MA 200 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year SOURCE: Massachusetts Division of Health Care Finance and Policy, Uniform Hospital Discharge Data System (UHDDS) • Between 2000 and 2009, the rate of mental disorder-related hospitalizations slightly decreased in Everett from 1,293 to 1,114 per 100,000. However the rate has continued to be substantially higher than the Massachusetts rate across the entire time period. The Well-Being of Everett • 2014 Health Assessment Report 51 xx Trend in Mental Disorder Related Hospitalizations, by Age Group (2003-2009) Age Specific Rate per 100,000 14000 13026 2003 12000 12261 11882 2005 2007 10000 10176 2009 8000 6000 4543 4000 2000 0 5350 4049 3224 968 963 Under 19 Years 561 20 to 64 Years Everett 664 Under 19 Years 65 Years or Older 20 to 64 Years MA 65 Years or Older SOURCE: Massachusetts Division of Health Care Finance and Policy, Uniform Hospital Discharge Data System (UHDDS) • Rates of mental health disorder-related hospitalizations are higher for Everett residents compared to Massachusetts across all age groups, except for those 65 years or older where the rate for Everett is slightly lower than Massachusetts. *Mental Disorders is a very broad category which includes the following conditions: dementias, drug/alcohol psychoses, schizophrenic or episodic mood disorders, alcohol dependence syndrome, drug dependence, disturbance of conduct, etc. (see the Data Definitions in the Appendix) for full detail. Age Specific Rate per 100,000 9000 Trend in Emergency Department Visits Related to Mental Disorders, by Age Group (2002-2009) 2003 8000 7890 2005 7000 2007 6000 2009 5000 5967 5194 4292 4000 2808 3000 2000 1804 1597 3746 1637 2982 2319 2086 1000 0 Under 19 Years 20 to 64 Years Everett 65 Years or Older Under 19 Years 20 to 64 Years MA SOURCE: Massachusetts Division of Health Care Finance and Policy, Uniform Hospital Discharge Data System (UHDDS) 52 The Well-Being of Everett • 2014 Health Assessment Report 65 Years or Older • The rate for mental disorder-related emergency room visits is higher for Everett residents compared to Massachusetts across all age groups. • The trend in emergency room visits is rising in all age groups for Everett and MA, though more sharply in Everett for those aged 20 or older. What is Alzheimer’s? Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. The symptoms usually develop slowly and worsen over time, becoming severe enough to interfere with daily routines. Alzheimer’s is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. Up to 5 percent of people with the disease have early onset Alzheimer’s (also known as early- or youngeronset), which often appears when someone is in their 40s or 50s. Alzheimer’s is the sixth leading cause of death in the United States. Alzheimer’s has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer’s treatments cannot stop the progression, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s, their families and caregivers. Trend in Alzheimer’s Deaths (2000-2010) 30 Everett MA Age Adjusted Rate per 100,000 26 25 21 20 19 15 10 5 0 5 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, Massachusetts Department of Health The Well-Being of Everett • 2014 Health Assessment Report 53 xx • The rate of death due to Alzheimer’s disease in Everett has dropped steadily since 2004 and is now substantially lower than Massachusetts. Depressed Mood in prior 30 days, Among Adults (age 18+) Everett (2008) 6% 27% All/Most Days Some/Few Days No Days 67% SOURCE: 5-City BRFSS 2008 Defined by question: During the last 30 days, how often have you felt so depressed that nothing could cheer you up? • In 2008, 6% of adults in Everett reported experiencing a depressed mood on most/all days during the prior 30 days. • This is a proportion similar to surrounding cities such as Chelsea (6.6%), but higher than Cambridge (1.2%) and Somerville (2.4%). 54 The Well-Being of Everett • 2014 Health Assessment Report Strengths and Assets • Cambridge Health Alliance provides a variety of clinical and professional expertise available to serve the mental health needs of the Everett community, including Whidden Hospital, which maintains an adult inpatient psychiatric unit, serving adults 18 and older, and a geriatric psychiatric unit, serving adults 55 and over. • The Everett Outpatient Clinic, through Eliot Community Human Services, provides person-centered counseling and psychopharmacological services across the life span. The approach is to match treatment with an individual’s strengths, dreams, and preferences as a means to restore hope and cultivate recovery. • Eliot Community Human Services’ Outpatient Clinic services include: Individual Counseling (including Substance Abuse); Certified Problem Gambling Counseling; Couples Counseling; Family Counseling; Specialized In-Home Psychiatry; Counseling and Peer Mentorship Services to Mystic Valley Elder Services Clients; Group Counseling (art therapy, trauma, anxiety and depression, anger management, and substance abuse); CSP (Case Management for recently hospitalized clients with Beacon, Neighborhood, Massachusetts Behavioral Health Partnership (MBHP), and Network Health Insurance); 24Q Substance Abuse Evaluation; Driver Alcohol Education Courses: First and Second Offender. • Eliot Community Human Services offers expertise in professional development and training on mental health and well-being topics for city programs, schools and local agencies. Opportunities in Everett have included: Trauma Informed Care, Motivational Interviewing, Understanding and Treating Substance Abuse Disorders, Person-Centered Treatment Planning and Practice. • The Mental Health First Aid training program has been offered to Everett residents and employees from local social service agencies and city-run programs. Attendees gain knowledge of signs, symptoms and risk factors of mental illnesses and addictions; identify multiple types of professional and self-help resources for individuals with a mental illness or addiction; and increase their confidence in and likelihood to help an individual in distress. Everett has two qualified trainees from the Cambridge Health Alliance and Eliot Community Human Services. • Mystic Valley Elder Services provides a range of services and programs to strengthen and support the well-being, dignity and independence of elders, adults living with disabilities, and caregivers residing in Everett. The Well-Being of Everett • 2014 Health Assessment Report 55 xx Recommendations • Develop educational opportunities to reduce stigma associated with mental health issues and the importance of asking for help. • Expand access to mental health services at home in a cost-effective way, especially for adults who are homebound and seniors. • Increase opportunities for Mental Health First Aid training in the community to increase understanding and appropriate referrals for adults needing behavioral health intervention or support. • Work to reduce social isolation for elders coping with loss and destigmatize issues of aging. • Strengthen services for adults and families who are survivors of major mental health stressors, such as loss of family members/loved ones, homelessness, suicide, natural disasters or violent crimes. 56 The Well-Being of Everett • 2014 Health Assessment Report Adult Violence Why is this important? Violence impacts both individuals and communities. Violent crime is linked to disability, mental health issues and increased medical costs, and may result in premature death or injury. Domestic or family violence includes parent/guardian abuse of children and intimate partner violence (IPV). Intimate partner violence includes acts of physical or sexual violence or abuse that occur between partners or spouses and can affect any age and any gender. IPV estimates rates among same-sex couples are similar to those of heterosexual couples. Elder abuse results in serious physical, sexual, or emotional injury or financial loss to an elder, 60 years old or older. Children exposed to violence are more likely to act out in school and have a greater potential for perpetrating violence in the future. While gang and gun-related violence remain a key area of concern in the U.S., other forms of violence, especially bullying and cyberbullying, have been the focus of increasing research and public attention. Sexual violence is a common and under-reported crime. Sexual violence includes rape, defined as non-consensual sexual penetration and sexual assault, defined as non-consensual sexual touching. In 2000, the U.S. Department of Justice estimated that 1 in 6 women and 1 in 33 men experienced an attempted or completed rape at some time in their lives. Locally, the Massachusetts Department of Public Health reports an estimated 17% of women and 6% of men have experienced sexual violence at some point in their lifetime. In Massachusetts, consent cannot legally be given if a person is under the age of 16, mentally disabled or incapacitated. Such violence can result in profound immediate and long-term consequences on survivors’ physical and mental health. What is Cyber-bullying/ cyber-harassment or cyber-stalking? Cyber-bullying is when a child, preteen or teen is tormented, threatened, harassed, humiliated, embarrassed or otherwise targeted by another child, preteen or teen using the Internet, interactive or digital technologies or mobile phones. If an adult engages in similar harmful behavior, it is considered cyber-harassment or cyber-stalking. It is a serious offense that can result in misdemeanor or federal criminal charges, depending on the severity of the crime. For more information, visit: www.stopcyberbulling.org The Well-Being of Everett • 2014 Health Assessment Report 57 xx Number of Calls Domestic Violence Calls in Everett, by Type (2011-2013) 200 180 160 140 120 100 80 60 40 20 0 173 177 162 2011 2012 2013 75 38 48 57 45 44 7 7 10 7 7 6 Restraining Domestic Abuse Child Domestic Abuse Domestic Abuse/Neglect or Neglect Verbal Assault & Order Violation Battery 2 0 1 Elderly Abuse SOURCE: Microsystems Crime Track, Everett Police Department • There were 568 domestic violence related calls for service received by the Everett police for the two- year period of 2011 and 2012, a 12% decrease from the two- year period of 2009 and 2010. The majority of the domestic violence calls were related to assault and battery (62%) followed by 209A-Restraining Order violations (17%). • In 2013, 298 total domestic violence related calls were received, a slight increase from 2012. Trend in Violent Crime Rate (2000-2012) Crimes per 100,000 Residents 900 800 851 Everett MA 700 600 557 500 400 300 200 100 0 459 475 467 405 313 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year SOURCE: MA State Police Reporting Unit. Data only includes offences known to law enforcement. 58 406 The Well-Being of Everett • 2014 Health Assessment Report • The violent crime rate in Everett rose above that of Masschussets in 2007 and remained higher until 2011. As of 2012, the violent crime rate in Everett is similar to Massachussetts. • In 2010, twenty-five cases of forcible rapes were reported, resulting in the highest number ever reported in Everett. * Violent Crime refers to homicide, forcible rape, robbery and aggravated assault. Everett Crime Prevention Meetings Trend in Property Crime Rate (2000-2012) Crimes per 100,000 Residents 4000 3624 3500 3000 2544 2366 2500 2000 Everett MA 2383 2348 2185 1500 1000 500 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year SOURCE: MA State Police Reporting Unit (2000-2012). Data only includes offences known to law enforcement. • Everett experienced a peak in property crime in 2008, after which the property crime rate has decline sharply to its current level of 2,366 crimes per 100,000 residents, comparable to the state rate. The Everett Police Department Crime Prevention meetings are held on the third Tuesday of every month at 7:00pm. The meetings are open to the public with open forum discussion where citizens have an opportunity to discuss issues and concerns with members of the Police Department. Contact the Everett Police Department for more information on the meetings. Also connect at www.facebook.com/ EverettPoliceMa The Well-Being of Everett • 2014 Health Assessment Report 59 xx Strengths and Assets • The Everett Violence Project (EVAP) is part of the Everett Police Department and provides services in support of law enforcement cases, including court advocacy, crisis intervention, safety planning and referrals. In 2012, thirty-three (33) cases were referred to EVAP’s partner program, Portal to Hope for their comprehensive services. • The Whidden Emergency Room and other CHA outpatient primary care and specialty staff screen all patients to assess for intimate partner violence. • There is a strong collaboration between the Police Department, the school system and city agencies around issues of injury and violence prevention, including a School Resource Officer at the high school, who regularly meets with parents to resolve conflicts with youth. • Portal to Hope is a non-profit organization committed to helping victims of domestic violence, sexual assault and stalking crimes. A variety of programs and services are offered to assist victims including: a 24-hour hotline, emergency shelter, legal aid for ensuring continued civil protections through the legal court system, job placement and housing assistance, which help victims rebuild their lives both personally and professionally, and youth programs designed to educate our children and help break the cycle of violence. Recommendations: • Support and facilitate help-seeking where family violence occurs. • Promote connectedness between family members and the community. • Work with Action for Regional Equity, La Comunidad, and other community leaders to expand the number of living wage jobs at Logan Airport and other large employers. • Strengthen the Restorative Justice program and increase community awareness about its services. • Increase the capacity of parents and/or caregivers to raise nonviolent youth. • Assure and promote alcohol and chemical dependency treatment for parents. • Expand community efforts to support individuals reintegrating from incarceration, including employment, housing, and referrals to appropriate health services. • Increase funding for Portal to Hope. Please refer to the Youth section for additional information on Violence. 60 The Well-Being of Everett • 2014 Health Assessment Report Adult Sexual Health and Reproduction Why is this important? The prevention and treatment of sexually transmitted infections (STIs) remains a health concern in the field of sexual and reproductive health. Untreated STIs can lead to long-term health issues, including pelvic inflammatory disease, infertility, and cancer. Untreated STIs during pregnancy can also lead to fetal and perinatal negative outcomes. In the United States, there are an estimated 19 million new diagnoses of STIs annually, with nearly half among those ages 15 to 24; the most common diagnosis being Chlamydia. In addition, it is estimated that approximately 1.1 million Americans are living with the human immunodeficiency virus (HIV) and that 1 out of 5 people are unaware that they have it (DHHS, 2013). In the United States, half of all pregnancies are unplanned. Of those 3.4 million unplanned pregnancies, approximately 305,000 are to girls aged 15 to 19 years old (National Campaign, 2012). U.S. teen pregnancy and birth rates have declined dramatically over the past twenty years and are now at historic lows; however the U.S. teen birth rates remain far higher than in other comparable countries and continue to cost the U.S. $12.5 billion dollars a year (Guttmacher, Unintended, 2013). Citations Guttmacher Institute; Contraceptive Needs and Services, 2010 (2013), www.guttmacher.org/pubs/win/contraceptive-needs-2010.pdf Guttmacher Institute; Unintended Pregnancy in the United States, (2013), www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html#13 National Campaign to Prevent Unplanned Pregnancy; National and State Data, (2013), thenationalcampaign.org/data/landing Family Planning Services Public funding for family planning services helps to prevent unintended pregnancies; for every $1 spent on family planning services, $5.68 in pregnancy related Medicaid expenditures is saved (Guttmacher, Contraceptive, 2013). Family planning funding also supports access to contraception, cancer screening and prevention, HIV and STI testing and treatment, pregnancy planning, screening for intimate partner violence, and referrals for prenatal care, substance abuse treatment, and primary care (DHHS, 2013). The Centers for Disease Control and Prevention (CDC); Pregnancy (2014), www.cdc.gov/pregnancy/The U.S. Department of Health and Human Services (DHHS); Healthy People, Reproductive Health (2013), healthypeople.gov/2020/LHI/ reproductiveHealth.aspx The Well-Being of Everett • 2014 Health Assessment Report 61 xx Trend in HIV/AIDS Prevalence (Existing Cases) (2000-2009) Crude Incidence Rate, per 100,000 450 400 350 300 250 398.9 (N=148) Everett MA 228.5 (N=87) 261.0 (N=17,208) 200 150 200.0 (N=12,734) 100 50 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year SOURCE: Bureau of Communicable Disease Control Registries, MADPH 2000-2009 • Everett’s HIV/AIDS prevalence rate (all existing cases) rose from 228.5 per 100,000 cases in 2000 to 399 cases per 100,000, while Massachusetts’ rate rose slightly from 200 to 261 per 100,000. • Generally HIV/AIDS prevalence increases with age for both MA and Everett. Percent of Prevalent Cases • As of 2012, 45.3% of residents living with HIV/AIDS in Everett were aged 50+. 100 90 80 70 60 50 40 30 20 10 0 Mode of Transmission for Prevalent HIV/AIDS Cases (as of December 2012) Everett MA 39.0 36.4 23.3 20.3 7.6 Male Sex with Injection Drug Use (IDU) Men (MSM) 11.0 4.1 14.3 3.4 MSM/IDU SOURCE: HIV/AIDS Surveillance Program, MADPH 15.1 8.7 Heterosexual Presumed Sex Heterosexual Sex 14.6 Unknown • As of 2012, 39% percent of residents living with HIV/AIDS in Everett were infected through males having sex with men; similar to the state overall. 62 The Well-Being of Everett • 2014 Health Assessment Report Trend in Chlamydia Incidence (New Cases) among Everett Residents, by Age Group (2000-2010) Age Adjusted Rate per 100,000 3000 15 to 19 Years 20 to 25 Years 25 to 29 Years 30 Years or Older 2500 2000 2436 1526 1500 1000 500 0 1022 1008 741 237 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year SOURCE: Bureau of Communicable Disease Control Registries, MADPH *Rates for age 30+ are estimates only and data were not available for 2000-2005 • Between 2000 and 2010, the Chylamdia incidence rate increased steadily for both Everett (165 to 451 cases per 100,000) and MA (158 to 324 cases per 100,000). • When examined by age, the Chylamdia incidence rate in Everett showed a four fold increase among 20 to 25 year olds, a three fold increase among 15 to 19 year olds and almost doubled among 25 to 29 year olds between the years 2000 and 2010. Crude incidence Rate per 100,000 Trend in Hepatitis C Incidence (New Cases) (2000-2012) 250 Everett MA 200 162 (N=69) 150 100 50 0 86 (N=33) 113 (N=7515) 63 (N=3987) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year SOURCE: Bureau of Communicable Disease Control Registries, Epidemiology Program, MADPH Crude rate calculated using US Census 2000-2012 population estimates • Since 2005, the rate of new cases of Hepatitis C in Everett has increased and remained higher than the Massachusetts rate. The Well-Being of Everett • 2014 Health Assessment Report 63 xx Strengths and Assets • Cambridge Health Alliance operates the Everett Family Health Center on Broadway. Open Monday through Friday, the health center offers comprehensive primary care services, HIV testing services, and reproductive health services. Services include access to low or no cost reproductive care, HIV testing and counseling, and STI testing and treatment. • Cambridge Health Alliance has a Hepatitis C clinic and offers a Hepatitis C testing/counseling hotline. Services are provided in a variety of languages, including French, Haitian Creole, Portuguese and Spanish. Additionally, CHA has a clinic that offers primary care, HIV specialty care and obstetrics and gynecological services. Recommendations • Develop a plan to reach out to the men having sex with men (MSM) population to increase awareness of testing and treatment services available in Everett. • Increase awareness and visibility of the Cambridge Health Alliance bilingual Integrated Counseling, Testing and Referral (ICTR) services at Everett Family Health Center during the hours of 9 AM-5 PM, Monday through Friday, that include comprehensive HIV, Hepatitis C, and STI testing, including access to confidential low or no cost STI treatment. • Host HIV testing events, such as during World AIDS Day and National Testing Day, to increase HIV testing. • Develop a plan to increase awareness of lesbian/gay/bisexual/transgender (LGBT) health and to address that community’s health needs. 64 The Well-Being of Everett • 2014 Health Assessment Report Maternal and Child Health Why is this important? Adequate care for an unborn child begins before conception with a mother’s healthy lifestyle and good nutrition. Prenatal care, defined as care while the baby is in the womb, is highly important for a child’s well-being as it prevents a multitude of health problems after birth. An ideal pregnancy would be one in which the mother maintains a healthy diet with minimal stress, refrains from drugs, alcohol, and other harmful toxins, and has a full-term pregnancy (approximately 9 months). An ideal birth would include a healthy delivery of the baby followed by caretaking in a stable, positive environment that supports the physical and emotional needs of the mother and baby (CDC, 2012). Pregnancy and childbirth are life-changing events which impact the physical, mental, emotional, and socioeconomic needs of the pregnant woman and her family. Prenatal providers and counselors list nausea and loss of appetite as the two most commonly observed physical complaints in pregnant clients. Other concerns may center on financial needs, including housing to properly care for and raise a child. Once the baby is born, a new mother may need support and education on feeding the baby, including breastfeeding. Citations The Centers for Disease Control and Prevention (CDC); Reproductive Health (2012), www.cdc.gov/reproductivehealth/DRH/index.htm What is WIC? The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides federally-funded clinics for low-income, nutritionallyat-risk, pregnant women, new mothers, and children up to five years of age. WIC, which serves 53% of all infants born in the United States, supplies clients with supplemental foods, healthcare referrals, and nutrition education (USDA, 2014). United States Department of Agriculture (USDA); Women, Infants, and Children (WIC) (2014), www.fns.usda.gov/wic/women-infants-and-children-wic The Well-Being of Everett • 2014 Health Assessment Report 65 xx Trend in Birth Rate by Age of Mother (2000 - 2010) 2000 160 2002 Age Specific Rate Per 1,000 140 128.5 133.8 2004 120 100 80 101.3 85.8 79.3 2006 109.7 112.8 100.4 97.1 91.6 2008 90.7 86.8 78.6 2010 2010 MA 63.4 60 40 23.0 20 0 35 Years and Older 30 to 34 Years 20 to 29 Years 35.3 38.4 35.0 35.6 27.5 26.0 Everett SOURCE: Source: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MADPH • Between 2000 and 2009, the birth rate among women age 20 to 29 years steadily increased and was much higher compared to Massachusetts. However, a sharp drop in the birth rate for this age group in Everett occurred in 2010. • The birth rate among women age 30 to 34 years show a steady increase between 2004 and 2010, approaching the rate seen at the state level for this age group. Adequate Prenatal Care* Received, by Race (3-year average; 2008-2010) 84.4 84.5 82.5 74.5 Percent of Total Births 100 90 80 70 60 50 40 30 20 10 0 White, NonHispanic 74.2 Black, NonHispanic 76.5 Hispanic Everett MA 82.4 81.9 Asian / Pacific Islander, Non-Hispanic SOURCE: Source: Registry of Vital Records and Staistics, Bureau of Health Statistics, Research and Evaluation, MADPH; *Adequate care = care begun by month 4 and 80% or more of the expected visits received, based upon the Kotelchuck scale. • During the time period 2008 to 2010, the proportion of Everett mothers receiving adequate prenatal care did not differ significantly by race compared to the state. Generally the proportion receiving adequate prenatal care was lower for Black, non-Hispanic women compared to White, non-Hispanic women in Everett and Massachusetts. 66 The Well-Being of Everett • 2014 Health Assessment Report 30 Trend in Low Birth Weight (2000-2010) Everett MA Percent of Total Births 25 20 15 10 5 0 7.8 (N=5,650) 7.0 (N=5,711) 6.7 (N=42) 6.1 (N=30) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year SOURCE: Registry of Vital Records and Staistics, Bureau of Health Statistics, Research and Evaluation, MADPH; Low Birth Weight is defined by weight less than 2,500 grams • Since 2000, the proportion of low birth weight among Everett residents has remained steady and similar to Masschussetts overall. Why is Breastfeeding Important? The health benefits of breastfeeding include increased infant protection from infections and illnesses, decreased risk of breast and ovarian cancers for mothers and decreased risk of obesity in children who are breastfed for at least six months. A study published in the Journal of the American Dietetic Association suggests economic benefits include a savings of between $1,200 and $1,500 on infant formula in the first year alone. www.breastfeedingmadesimple.com/EconomicsofBF.pdf Over the past decade, the rate of mothers initiating or intending to breastfeed after childbirth has increased among White, non-Hispanic mothers (65% in 2000 and 78% in 2010) and Asian mothers (60% in 2000 and 86% in 2010). The rate among Black, non-Hispanic and Hispanic mothers has historically been high (approximately 87% for both groups in 2000) and has remained steady through 2010 (Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH). The Well-Being of Everett • 2014 Health Assessment Report 67 xx Strengths and Assets • Everett’s Women, Infants and Children (WIC) Program, overseen by Hallmark Health Systems, is conveniently located at Everett City Hall. WIC services are provided to pregnant, breastfeeding and postpartum women, and to infants and children up to age five. They provide personalized nutrition consultations, breastfeeding support, referrals to our community’s healthcare services, and vouchers for free, nutritious food tailored to supplement the dietary needs of participants. • In addition to the Everett location, Everett residents are able to receive services at additional locations in the North Suburban WIC Program of Hallmark Health. They offer a variety of resources and support services to strengthen families. A partial listing of programs open to income-eligible Everett participants include: breastfeeding classes, breastfeeding peer counseling, parenting support programs, farmer’s market coupons, prenatal exercise and nutrition, mobile food market, free clothing store, and family support coordinator program to help WIC families coordinate services such as SWAP, childcare, ESL, Mass Health and fuel assistance. • The Joint Committee for Children’s Health Care is available to assist pregnant woman and new parents with health insurance, referrals to parenting groups, and other resources addressing issues that arise with the arrival of a newborn child. Recommendations • Adopt supportive work policies for new and expecting families, family leave for part- time workers, personal days to attend prenatal doctor appointments, and follow up postpartum appointments. • Provide supportive breastfeeding policies at work places. 68 The Well-Being of Everett • 2014 Health Assessment Report Chronic Disease Why is this important? Chronic diseases—such as heart disease, cancer, and diabetes— are the leading causes of death and disability in the United States. Annually, chronic diseases account for 70% of all deaths, with heart disease, cancer, and stroke making up 50% of all U.S. deaths. Furthermore, these diseases cause major limitations in daily living for almost 1 out of 10 Americans. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Reducing poverty and racism, as well as adopting healthy behaviors, such as eating nutritious foods, being physically active and avoiding tobacco use can prevent or control the devastating effects of these diseases. Not only can chronic diseases be debilitating and fatal, they are also responsible for high levels of medical spending. The total amount of public and private spending on healthcare in Massachusetts is $60 billion per year. Much of that is due to the rise of chronic diseases. For example, diabetes has increased by 40% in only one decade. Type 2 Diabetes was once unheard of, but is now the most common type of diabetes in Massachusetts. Leading Causes of Death (3-year average; 2008-2010) 155 150 Heart Disease 48 Lung Cancer 44 Mental Disorders, All 73 53 Everett 29 29 Chronic Lower Respiratory Disease, Other MA 17 21 Pneumonia and Influenza Cerebrovascular Disease 20 20 18 13 16 15 16 10 16 Breast Cancer (Female) Poisoning, All Colorectal Cancer Septicemia 0 32 50 100 150 200 250 Age adjusted Rate per 100,000 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MADPH The Well-Being of Everett • 2014 Health Assessment Report 69 xx • The leading causes of death between 2008 and 2010 in Everett and throughout Massachusetts included heart disease, lung cancer and mental disorders. • The Everett rates were much higher than Massachusetts for lung cancer and mental disorders while heart disease was slightly lower in Everett than Massachusetts. Leading Causes of Hospitalizations (3-year average; 2007-2009) 2594 Childbirth and Pregnancy Related 1982 Diabetes Mellitus Related 2093 COPD Related 1537 1585 Circulatory System Diseases 780 Mental Disorders 3533 2430 2397 Everett MA 1150 1046 1118 913 1034 Digestive System Diseases Asthma Related Genitourinary Diseases 334 Alcohol / Substance Related Musculoskeletal Diseases 284 Opioid Injuries 0 542 568 521 604 509 495 1000 2000 3000 Age adjusted Rate per 100,000 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MADPH • The leading causes of hospitalizations occuring between 2007 and 2009 for both Everett and Massachusetts included childbirth and pregnancy, diabetes and chronic obstructive pulmonary disease (COPD). Each of these rates was higher for Everett than Massachusetts. • Everett also had higher rates of hospitalization for mental disorders, asthma, and opioid-related injuries. • 26% of Everett adults reported having been told they have high blood pressure (2008 BRFSS). • 30% of Everett adults reported having been told they have high cholesterol (2008 BRFSS). • Childbirth and pregnancy related hospitalizations have been included in the Leading Causes of Hospitalizations chart. This includes mothers who gave birth, as well as women hospitalized for pregnancy and childbirth-related conditions. 70 The Well-Being of Everett • 2014 Health Assessment Report 4000 Age Specific Rate per 100,000 14,000 Diabetes Related Hospitalizations, by Age Group (2009) 12,000 Everett 10,000 MA 12,140 10,937 8,093 8,000 6,070 6,000 4,000 3,282 2,096 2,000 0 332 1,150 185 15 to 29 years 667 30 to 44 years 45 to 59 years 60 to 74 years 75 years or older Age Group SOURCE: Uniform Hospital Discharge Dataset System (UHDDS), Massachusetts Division of Health Care Finance and Policy. • Diabetes-related hospitalizations among Everett residents in 2009 were higher than the rates in Massachusetts for all age groups from 15 to 74 years old. • Massachusetts had a higher rate among those age 75 years or older. • Data reflects a total of 1,010 hospital discharges related to diabetes among Everett residents in 2009. • 10% of Everett adults reported having been told they have diabetes (2008 BRFSS). The Well-Being of Everett • 2014 Health Assessment Report 71 xx Age Adjusted Rate per 100,000 4,500 Trend in Emergency Department Visits Related to COPD (2002-2009) Everett MA 4,000 3,500 3907.9 (N=1,430) 3,000 2,500 2,000 1851.4 (N=709) 2037.8 (N=133,315) 1,500 1,000 1457.5 (N=93,909) 500 0 2002 2003 2004 2005 2006 Year 2007 2008 2009 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH • The rate of emergency department visits related to chronic obstructive pulmonary disease (COPD) has increased sharply since 2006 in Everett and is now substantially higher than Massachusetts. • This trend is observed among all age groups, however the sharpest increases are observed among residents in the younger age groups under age 45. • The group with the highest rate is 15 to 29 year olds with an agespecific rate of 5,451.8 per 100,000 individuals in Everett for 2009 compared to Massachusetts at 3907.9 per 100,000 individuals. 72 The Well-Being of Everett • 2014 Health Assessment Report Age Specific Rate per 100,000 6000 Emergency Department Visits Related to Asthma, by Age Group (2009) 5053.8 5000 4000 Everett 4121.6 MA 3451.3 3000 1967.9 1886.6 2000 1593.3 1638.6 857.5 1000 0 Under 15 years 14 to 29 years 30 to 44 years 45 years or older SOURCE: Massachusetts Division of Health Care Finance and Policy, Uniform Hospital Discharge • Age-specific rates of emergency room visits related to asthma for Everett residents were much higher than Massachusetts for all age groups in 2009. The age groups most affected were individuals under 30 years of age. • 14% of Everett adults reported having been told they have asthma at some point in their lives (2008 BRFSS). • 10% of Everett adults reported they currently have asthma (2008 BRFSS). Trend in Emergency Department Visits for Acute Respiratory Infection (2002-2009) 4,000 3806.9 Age Adjusted Rate per 100,000 3,500 3316.2 3,000 2,500 2419.1 2,000 1,500 2087.6 1963.4 1843.4 1,000 Everett MA 500 0 2002 2003 2004 2005 2006 2007 2008 2009 Year SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH • The rate of emergency room visits for acute respiratory infections among Everett residents was markedly higher than Massachusetts between the years of 2002 and 2009. The Well-Being of Everett • 2014 Health Assessment Report 73 xx • Data from the Everett Health Department show increasing cases of latent Tuberculosis (TB) among Everett residents: 160 cases in 2011, 198 cases in 2012 and 210 cases in 2013. Tuberculosis is a disease caused by a germ called Mycobacterium tuberculosis which is spread from person to person through the air. People with latent TB are infected with M. tuberculosis, but do not have the TB disease. Persons with latent TB are not infectious and cannot spread TB infection to others. Trend in Emergency Department Visits Related to Falls (2002-2009) 4144.9 Age Adjusted Rate per 100,000 4,500 4,000 3,000 2,500 3018.6 2904.5 2720.5 2,000 1,500 Everett MA 1,000 500 0 2002 2003 2004 2005 2006 2007 2008 Year SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH • The rates of emergency department visits related to falls were higher than Massachusetts from 2002 through 2009 and the trend in Everett is increasing. • For 2007 through 2009, falls were the second leading cause of emergency room visits among Everett residents age 65 years and over. 74 The Well-Being of Everett • 2014 Health Assessment Report 2009 Strengths and Assets • The Everett Health Department provides communicable disease investigation and surveillance, organizes immunization clinics, oversees public health and school nurses, provides health and sanitary inspections, and plans public health roles in emergency preparedness. • The Cambridge Health Alliance’s older adult health education program, in collaboration with the Everett Foundation, provides weekly aerobic, strength and yoga classes, informational and screening sessions at the Connolly Center and other locations in Everett. • Screening for blood pressure, diabetes, and cholesterol control are provided along with health information including nutritional counseling. • The Cambridge Health Alliance’s Everett Family Health Center has been selected by the National Committee for Quality Assurance with the highest designation of Level 3 Medical Home. Recommendations • Expand community and health providers focus on understanding the factors impacting lung diseases in Everett. • Increase primary care services for adults and children in Everett. • Fund a Wellness Program within the Health Department based on programs piloted by Energize Everett to increase fitness, nutrition, and cooking programs throughout the city. • Expand cancer screening and education. • Expand pre-diabetes screening and education. • Increase access to affordable dental care for adults and children in Everett. • Create more opportunities for community residents of all ages to volunteer in the city and in community organizations to support health and wellness activities impacting Everett’s well-being. • Address health disparities and the social determinants of health in health policies and programs. • Increase access and expand awareness of support services for families managing chronic diseases of family members. The Well-Being of Everett • 2014 Health Assessment Report 75 xx Cancer Why is this important? In 2014, there will be an estimated 1,665,540 new cancer cases diagnosed and 585,720 cancer deaths in the United States. Cancer remains the second most common cause of death in the U.S. after cardiovascular disease (heart attack and stroke), accounting for nearly 1 of every 4 deaths. One in three individuals in America will develop some form of cancer in their lifetime; every family in America will be touched by cancer. Great progress has been made in recent years in the fight against cancer in terms of screening and early detection, improved treatments, and significantly more cures. Many forms of childhood leukemia, testicular cancer, cervical cancer, breast cancer and colon cancer can be completely cured through early detection and state-of-the art treatment. We can have an important impact on the well-being of Everett by providing public education about risk factors, ensuring the availability of screening for early cancer detection, and providing state-of-the art treatment in our excellent, local and Greater Boston-area hospitals and treatment centers. Public health data shows that Everett has higher rates of specific cancers, particularly lung and colon, than the state of Massachusetts. In the case of colon cancer, screening is known to decrease mortality. For lung cancer, prevention is key. There is work to do to reduce smoking rates, which remain high in Everett. Leading Cancer Deaths (5-year average; 2006-2010) 50 Lung Prostate 16 Colorectal Breast (Female) 11 12 Pancreas 8 Ovary 6 Liver 4 Stomach Leukemia 5 5 Lymphoma, Non Hodgkin 5 5 4 5 4 3 4 4 3 3 3 Esophagus Bladder Kidney Brain/Central Nervous System Multiple Myeloma 0 20 18 Everett 21 17 MA 9 8 7 6 10 20 30 40 50 Age adjusted Rate per 100,000 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MADPH 76 65 23 The Well-Being of Everett • 2014 Health Assessment Report 60 70 • The leading causes of cancer deaths between 2006 and 2010 for Everett residents included lung, prostate and colorectal cancers. While for Massachusetts, the top three causes of cancer deaths were lung, prostate, and breast cancers. • The age-adjusted death rates for lung, colorectal, ovarian, liver, stomach, and kidney cancers were also higher than for Massachusetts. Leading Cancer Incidences (5-year average; 2006-2010) Prostate 114 Breast, invasive (female) 72 Lung 49 Colorectal Breast, non-invasive (female) 30 26 Uterus Thyroid Melanoma / Skin Kidney 7 Ovary Pancreas Leukemia 83 Everett 55 MA 20 23 17 16 23 15 16 15 Lymphoma, Non Hodgkin Stomach 47 47 111 164 135 14 13 12 13 11 12 11 7 10 Liver 0 50 100 150 200 Age adjusted Rate per 100,000 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MADPH • The leading new cancer cases (termed incidence) between 2004 and 2008 for both Massachusetts and Everett included prostate, breast and lung cancer. • The state rates were much higher for both prostate and breast cancer compared to Everett. However, incidence rates for lung cancer, colorectal, non-Hodgkin lymphoma, stomach and liver cancer were all higher in Everett than Massachusetts. Lung Cancer Lung cancer is the leading cause of death from cancer for Everett residents with an average of approximately 37 deaths per year. The rate of death to lung cancer is dramatically higher in Everett compared to Massachusetts. Over the 5-year period 2006 to 2010, the age-adjusted rate was much higher (nearly 30% higher) than Massachusetts. The Well-Being of Everett • 2014 Health Assessment Report 77 xx Trend in Lung Cancer Incidence (1995-2009) 140 115.55 (N=48) 100 74.8(N=29) 80 60 69.95 (N=5,151) 69.6 (N=4,241) 40 09 20 20 07 20 06 20 05 20 04 20 03 20 01 02 20 20 00 20 99 19 98 97 19 19 19 19 0 96 20 08 Everett MA 95 Age Adjusted Rate per 100,000 120 SOURCE: The Massachusetts Cancer Registry, Bureau of Health Statistics, Research and Evaluation MADPH Trend in Female Breast Cancer Incidence (1995-2009) 200 172.9 (N=35) 160 135.93 (N=5,447) 140 145.1 (N=4,832) 120 132.9 (N=29) 100 80 60 Everett MA 40 09 20 08 20 07 20 06 20 05 20 4 20 0 03 20 02 20 01 20 00 20 99 19 98 19 97 19 96 19 0 95 20 19 Age Adjusted Rate per 100,000 180 SOURCE: The Massachusetts Cancer Registry, Bureau of Health Statistics, Research and Evaluation MADPH • The rate of new cases of breast cancer in Everett has generally been lower than Massachusetts since 2000. • The overall trend in breast cancer incidence since 1995 appears to be slightly decreasing for both Everett and Massachusetts. 78 The Well-Being of Everett • 2014 Health Assessment Report Cancer Screening Prevention mammography is a method of screening shown to reduce breast cancer mortality by approximately 20-25% over 10 years among woman aged 40 years and older. • Data from the 2008 5-City Behavioral Risk Factor Surveillance Survey showed that 84% of Everett women ages 40 and older reported having a mammogram in the prior 2 years and 82% of Everett women reported having a Pap smear test in the prior 3 years. In terms of colorectal cancer, 60% of deaths could be prevented if people, 50 years and older, were regularly screened by testing for occult (hidden) blood in stool, in addition to routinely scheduled colonoscopies. Removing precancerous polyps or abnormal growths, identified during a fecal occult blood test (sigmoidoscopy or colonoscopy) can prevent colorectal cancer. • Data from the 2008 5-City Behavioral Risk Factor Surveillance Survey showed that 39% of Everett adults ages 50 and older reported having a blood stool test at some time in their life and 61% of Everett adults ages 50 and older reported having a colonoscopy within the last 10 years. Sigmoidoscopy vs. Colonoscopy A sigmoidoscopy can be used as a screening procedure to determine if a full colonoscopy is necessary. It is done in many instances in conjunction with a fecal occult blood test (FOBT), which can detect the formation of cancerous cells throughout the colon. It has been shown that up to 50% of polyps and other findings can be missed with a sigmoidoscopy; thus, there has been a trend towards performing a colonoscopy rather than sigmoidoscopy. The Well-Being of Everett • 2014 Health Assessment Report 79 xx Strengths and Assets • The American College of Surgeons Commission on Cancer recognizes the Cambridge Health Alliance (CHA) as a Community Hospital Cancer Program for its high-quality cancer care. In order to achieve this, CHA is surveyed every three years to evaluate the cancer care provided in 36 specific compliance areas. • In 2010, five CHA primary care sites were selected for Massachusetts’ new Patient-Centered Medical Home Initiative and two of those were recognized with the highest designation of Level 3 Medical Homes by the National Committee for Quality Assurance. • CHA provides access to uninsured and language services for those with limited English proficiency for all cancer screenings. Cambridge Health Alliance Cancer Services: • Cambridge Breast Center - open access for mammography, diagnosis and treatment including the Whidden Hospital location in Everett. • Coordinated team approach to cancer care for all common cancers (e.g. breast, colon, skin, cervix, testicular, prostate). • Everett residents, including youth, consistently participate in community and regional cancer awareness walks and fundraising efforts to support research as well as families coping with cancer. Recommendations • Organize community-wide efforts to educate Everett residents about cancer risk and encourage residents to take advantage of screening, early detection and potential curative treatment for common cancers. • Increase awareness of support networks for individuals and families managing cancer. • Organize public forum to present health data and priorities for action, including cancer. 80 The Well-Being of Everett • 2014 Health Assessment Report Access to Healthcare Why is this important? Access to healthcare is critical to maintaining overall physical, social and mental health and aids in the prevention and treatment of disease and disability. Everett broadly defines access to healthcare to include financial, physical, cultural, and linguistic accessibility. Healthcare must be affordable to be financially accessible. Financial accessibility is enhanced when a healthcare institution and local physicians and dentists accept a wide variety of insurance, assist patients in applying for coverage and when there is no other option, provide free or reduced priced care. Physical accessibility includes being accessible to people with limited mobility. Cultural and linguistic respect and inclusiveness ease the way for people who are less able or less likely to use existing health services. Additionally, access to healthcare also includes availability of emergency services. However, the basic tenet of the access to healthcare concept is a focus on decreasing the need for emergency room visits through preventive medical, dental, nutrition and mental health care. Access to regular medical and dental checkups and the financial support to sustain relationships with primary care providers and pay prescriptions are critical steps to accessing preventive care throughout life for all residents. Percent of Residents Overall Rate of Health Insurance Coverage, by Type (2010-2012) 100 90 80 70 60 50 40 30 20 10 0 Access Access to healthcare refers to the presence or absence of various barriers to seeking or receiving healthcare, including oral and mental health care. Access to healthcare is essential for increasing quality of life, length of life, and eliminating disparities in health status. Everett MA 95.8 88.1 75.3 50.6 45.6 32.6 Any Health Insurance Coverage Public Health Insurance Coverge Private Health Insurance Coverage SOURCE: US Census ACS, 2010-2012 The Well-Being of Everett • 2014 Health Assessment Report 81 xx • A lower proportion of Everett residents have health insurance (88%) than Massachusetts overall (96%). • Among those that do have health insurance, the type of coverage is more likely to be public vs. private health insurance among Everett residents. • Data from the 2008 5-City Behavioral Risk Factor Surveillance Survey show 78% of Everett adults reported having visited a doctor for a routine checkup in the prior year and 64% reported having visited a dentist within the prior year. • The 2008 data also show that 14% of Everett adults were not able to afford medical care when they needed it at some point in the prior year. Of these persons, the top three types of care they most often mentioned not being able to afford were 1) dental care, 2) doctor appointments, and 3) prescription medications. (Note: the 2008 BRFSS survey was conducted during the early years of MA health insurance reform). Oral Health in America: A Report of the Surgeon General (2000) This report found that the interdependence of oral health and general health and well-being is widely underestimated. In addition to a lack of awareness of the importance of oral health among the public, this report found a significant disparity between racial and socioeconomic groups in regards to oral health and ensuing overall health issues. 82 The Well-Being of Everett • 2014 Health Assessment Report What If Someone Does Not Have Insurance Coverage? The Health Safety Net is a program for Massachusetts residents who are not eligible for health insurance or cannot afford to buy it. To be eligible, one must be uninsured or underinsured, with no access to affordable health coverage. Additionally, people of any income with large medical bills they cannot pay are also eligible. Citizenship or immigration status does not affect eligibility; however one must be a resident of Massachusetts. Strengths and Assets Outreach and Education • Helping uninsured residents enroll in insurance plans is the foundation for improving access to health services. The Joint Committee for Children’s Health Care in Everett (JCCHCE) has performed this function since 1994, with a multilingual telephone helpline and team of outreach workers to assist Everett residents apply for Mass Health and other state funded health insurance programs. • Cambridge Health Alliance provides enrollment in health insurance for patients seen at the Whidden Hospital and the Everett Family Health Center. Services are available in multiple languages. • Community-based human service organizations such as La Comunidad Inc., A Better Tomorrow Services Inc., and Tri-City Community Action Program Inc, work with clients to connect them to healthcare services and local providers. • Parent education is available under the Parent University programs organized by JCCHCE in partnership with Everett Public Schools, CHA, Hallmark Health, Eliot Community Human Services, and other providers, offering workshops to guide parents on a range of parenting issues. • Everett Public Library maintains a collection of resources and information on disease prevention and management. Healthcare Services City of Everett – Everett Health Department • Public health nurses work to assure residents of Everett have access to services including vaccinations and management of reportable communicable diseases. 650 flu vaccines were provided over the course of the last 12 months. • Data from the 2008 5- City Behavioral Risk Factor Surveillance Survey show 78% of Everett adults ages 65 and older reported having a flu vaccine in the prior year and 76% reported having a pneumonia vaccination at sometime in their life. • School nurses from the Everett Health Department provide support and services in public school settings to assure students are ready to learn. Cambridge Health Alliance • Anna May Powers Health Center (at Keverian School): Mental health services. • Teen Health Center (at Everett High School): Primary care, confidential reproductive healthcare, and mental healthcare. • Everett and Revere Family Health Center: Primary care (adult, adolescent, pediatrics, OB/GYN), confidential testing and counseling; Specialty Care (cardiology, pulmonology, gastroenterology, endocrinology, nephrology, sports medicine and orthopedics, podiatry); Other services: nutrition, diabetes education, mental health services, lab testing. The Well-Being of Everett • 2014 Health Assessment Report 83 xx • Malden Health Center: Primary care for all ages, women’s health, sports medicine, x-ray, ultrasound, lab testing, special programs for diabetes and asthma. • Whidden Memorial Hospital’s expanded services: — — — — — — Emergency Department Diagnostic Radiology Department of Surgery & Orthopedics Specialty Suites Medicine Specialty & Hospitalist Programs Breast Center Medical/Surgical beds Primary Care and Community Care: • Hallmark Health: Community Health Education program, Healthy Families and Everett WIC programs. • MGH Everett Family Care: Primary care (adult, adolescent, pediatrics, OB/GYN). • Eliot Community Human Services: Mental health services for children, youth and adults including outreach, emergency services and outpatient medication programs. Recommendations • Increase access to dental/oral healthcare for all residents. • Enrich and enhance citywide campaign to inform residents of available insurance options and assist residents to access healthcare services, with particular emphasis on newcomers to Everett, including immigrants. • Restore dental screenings for children. • Expand primary care services in Everett. • Increase collaboration on outreach with Literacy Program and Multicultural Affairs Commission. • Outreach directly with all faith-based sites and communities. • Identify needs and provide education on available healthcare options for low-income residents and undocumented immigrants. 84 The Well-Being of Everett • 2014 Health Assessment Report Youth The Well-Being of Everett • 2014 Health Assessment Report 85 xx Youth Introduction This section provides current information about key youth health indicators such as tobacco, substance abuse, mental health, violence, physical activity and nutrition, and sexual and reproductive health. The report includes substantial data obtained through the Everett Student Health Survey, commonly referred to as the Youth Risk Behavior Survey. Bi-annually since 2003, the Cambridge Health Alliance, in partnership with the Everett Public Schools, has administered the anonymous survey to students in grades 6th-12th. The data has been instrumental in supporting school and community-based health and wellness education and program development. There are many exciting collaborations and innovative programs taking place in Everett that THERE ARE MANY EXCITING COLLABORATIONS and innovative programs taking place in Everett that value youth input; positioning our city to become a leader in health promotion, youth leadership, prevention and more. 86 The Well-Being of Everett • 2014 Health Assessment Report value youth input, positioning our city to become a leader in health promotion, youth leadership, prevention and more. Everett’s youth are the future leaders of Everett and beyond. Investing in their development and well-being positively directly impacts the economic, social and political assets of a community. Without effective support for children and youth, negative outcomes such as school drop-out, poor labor market entry, risky sexual behaviors, substance abuse, crime and violence are bound to have an impact. We hope that this section allows you to reflect on the youth of Everett and how you, your organization and the leadership of the city can influence the quality of life and opportunity for its young residents. Youth Physical Activity and Nutrition Why is this important? Adequate physical activity and a healthy balanced diet can reduce the risk of many chronic health issues. For children and adolescents, regular exercise can improve bone health, cardiovascular and muscular fitness, decrease body fat, and improve educational outcomes. A nutritious diet can decrease the risk of chronic diseases such as type 2 Diabetes, hypertension, and certain types of cancers. Furthermore, it reduces the risk of obesity. Obesity continues to be a problem in the United States with 17% of children considered to be obese. The World Health Organization affirms that obesity can lead to serious health problems, including but not limited to strokes, respiratory problems, osteoarthritis, coronary heart disease and sleep apnea. As of 2008, the medical costs of obesity in the United States totaled to approximately $147 billion. Self Perceived Weight Status • In 2013, about 50% of Everett middle school students describe their weight as ‘about the right weight’, while 34% students describe themselves as ‘slightly’ or ‘very’ overweight. Screen Time • Between 2005 and 2013, the proportion of middle school students with TVs in their bedrooms declined slightly, from 80.9% to 73.8%. • Between 2005 and 2013, the proportion of students who watch 3+ hours of TV on an average school day slightly declined from 55.7% to 49.4% in middle school and 40.7% to 36.1% in high school, but remains higher than the state overall (27%). • In 2013, Everett middle and high school students played more computer/video games on an average school day compared to Massachusetts overall (52% Middle School and 40% High School compared to 28% and 32% statewide in Middle and High school). Source: Everett Student Health Survey 2013 The Well-Being of Everett • 2014 Health Assessment Report 87 Physical Activity • In 2013, 32% of Everett Middle School students and 33% of Everett High School students reported they achieved 60 or more minutes of physical activity for at least 5 of the prior 7 days. • In 2013, 58% of Everett Middle School students and 50% of Everett High School students reported playing on at least 1 sports team in the prior 12 months. • In 2013, 48% of Everett Middle School students and 47% of Everett High School students reported walking to school on most days of the week. Nutrition • In 2013, almost one-third of Everett High School students and 40% of Everett Middle School students reported eating breakfast every day in the prior week. • In 2013, 24% of Everett High School students and 26% of Everett Middle School students reported eating fruit or drinking 100% fruit juice one time in the prior day. • In 2013, 25% of Everett High School students and 25% of Everett Middle School students reported eating vegetables one time in the prior day. • In 2013, 1/3 of Everett High School students and 25% of Everett Middle School students reported not drinking any sweetened drinks in the prior day. Source: Everett Student Health Survey 2013 88 The Well-Being of Everett • 2014 Health Assessment Report Strengths and Assets Physical Activity • The Everett High School Fitness Center is open for students and teachers after school until 3:30. Physical Education and Health classes use the fitness center every period of the school day as well. • Physical Education, Health, and classroom teachers have been trained in Project Adventure activities and workshops such as “Creating Healthy Habits,” “Portable Adventure” and other trainings, including how to use the high and low elements courses at each school and the climbing walls. Teachers use these trainings and the curriculum in their classes and in several after school clubs. • Four of the K-8 schools and the Everett High School maintain exercise climbing walls used in physical education and health classes. • Students in grades 5-8 participate in the Boston Athletic Association Relay Challenge held the weekend before the Boston Marathon. • New activities such as yoga, crew and lacrosse teams are available at the high school and yoga classes are provided at the Parlin Library for middle school age children. Nutrition • Everett Public Schools received a MCAS grant to build and expand the schoolyard gardens at the high school, Keverian and Parlin schools. The program uses the STEM training/Kids Consortium Service Learning model to work in the gardens and create healthy food throughout the spring and summer. • The Everett High School Culinary Arts Program, along with the Health Education Department, filmed healthy cooking classes that are available for viewing on the Everett Schools TV station. • The K-8 schools practice recess before lunch where available, and many schools have found this change to be very beneficial. • The Everett High School Allied Health Academy participates in the School Breakfast Public Service Announcement contest through the Department of Education. • The Child Nutrition Outreach Program (CNOP) works to increase participation in two underutilized federal child nutrition programs, the National School Breakfast Program and the Summer Food Service Program. Funded by the Massachusetts Department of Elementary and Secondary Education (DESE) and administered by Project Bread, CNOP has been supporting school nutrition directors, superintendents, principals, and other school personnel since 1994. • The Everett High School Green Club develops schoolyard gardens as well as city gardens with the Everett Community Growers, helping to expand community gardens throughout the city. The Well-Being of Everett • 2014 Health Assessment Report 89 xx Recommendations Physical Activity: • Continue and expand Family Fitness Nights, which allows and encourages non-structured active play for youth and families in school gyms after hours. • Continue to expand programming for new physical and recreation activities at the schools and in the community. • Create and fund maintenance plan for Northern Strand Community Trail, and work to create better access to existing recreational facilities along the Trail. • Actively apply Complete Street guidelines when repairing roads to encourage bike and pedestrian street use. • Install more bike racks and safe storage options for bicycles throughout the city, including schools, to encourage biking. Nutrition: • Continue and expand schoolyard gardens to all Everett Public Schools, and work to incorporate produce into school meals in spring and fall. • Encourage students to examine their food environment and take action to create more healthful retail outlets by participating in Energize Everett’s Healthy Market Program. 90 The Well-Being of Everett • 2014 Health Assessment Report Youth Tobacco Why is this important? Tobacco contains nicotine, a highly addictive drug, causing many young people to progress from smoking occasionally to smoking every day. Nearly all tobacco use begins prior to age 18. Each day in the United States, over 3,800 young people under 18 years of age smoke their first cigarette, and over 1,000 youth under age 18 become daily cigarette smokers. The vast majority of Americans who begin daily smoking during adolescence are addicted to nicotine by young adulthood. (www.surgeongeneral.gov/library/reports/preventing-youth-tobaccouse/exec-summary.pdf) Young people start smoking for many reasons – social, physical and environmental influences. In 2011, cigarette companies spent $8.37 billion on advertising and promotional expenses in the United States alone; up from $8.05 billion in 2010.(1) The five major U.S. smokeless tobacco manufacturers spent $451.7 million on smokeless tobacco advertising and promotion in 2011 an increase from $442.2 million spent in 2010.(2) CDC resources: 1. Federal Trade Commission. Cigarette Report for 2011. [PDF–386 KB] Washington: Federal Trade Commission, 2013 [accessed 2013 June 20]. 2. Federal Trade Commission. Smokeless Tobacco Report for 2011.[PDF–180.59 KB] Washington: Federal Trade Commission, 2013 [accessed 2013 June 20]. Tobacco Tobacco use is the single most preventable cause of death and disease in the United States. Preventing children and youth from tobacco use has a significant and long-lasting impact on the health of everyone. In children, secondhand smoke can cause asthma, respiratory infections, ear infections, and Sudden Infant Death Syndrome (SIDS). For additional information on tobacco, please refer to the Adult Tobacco section. Prevention is critical to ensure young people stay tobacco-free. The Well-Being of Everett • 2014 Health Assessment Report 91 xx Percent of Students 100 90 80 70 60 50 40 30 20 10 0 Trend in Cigarette Use Among Everett Middle and High School Students (2005-2013) 2005 2007 2009 2011 47.3 2013 24.8 19.9 7.3 Middle School, Ever 5.5 18.2 6.2 1.9 Middle School, Past 30 Days High School, Ever High School, Past 30 Days SOURCE: Everett Student Health Survey • Currently, 2% of middle school students and 6% of high school students report having used cigarettes in the prior 30 days. • Lifetime and 30-day cigarette use has continued to decrease since 2005 among Everett middle school and high school students. • In 2013, 58% of middle school students and 61% of high school students believe people are at great risk for harming themselves by smoking one or more packs of cigarettes daily. 92 The Well-Being of Everett • 2014 Health Assessment Report Strengths and Assets • Teens in Everett Against Substance Abuse (TEASA), has been an active member of the 84.org, a state-wide youth movement initiative in Massachusetts encouraging teens to focus on positive, healthy lifestyles rather than smoking. • TEASA youth members meet with legislative leaders at the State House yearly to raise awareness of the tobacco industry’s tactics and advertising to recruit young smokers. • In 2014, TEASA successfully worked with the Board of Health to raise the purchasing age of e-cigarettes to 18. In 2010, youth leaders advocated to ban the sale of tobacco products in local pharmacies. • TEASA provides educational and outreach events in the schools and community to raise awareness of the risks associated with tobacco use, including newer products that are designed to reach new smokers. Examples include: candy flavored cigarillos, chewing tobacco and smokeless tobacco products containing many of the same carcinogens that are found in cigarettes. • Youth participate in national initiatives such as the Great American Smoke Out, World No Tobacco Day, and Kick Butts Day. Recommendations • Review and expand tobacco compliance efforts to reduce tobacco sales to minors. • Continue tobacco prevention education in the schools to raise awareness of the harm of tobacco products including e-cigarettes. • Include smokeless tobacco products in tobacco use prevention throughout the schools and community-run youth programming. • Increase access to tobacco cessation programs for youth already smoking. The Well-Being of Everett • 2014 Health Assessment Report 93 xx Youth Substance Use Why is this important? Adolescent substance use and addiction is a national public health problem impacting communities across the nation, including Everett. Exposure to alcohol, marijuana and other substances may interfere with adolescent brain development leading to adverse lifetime consequences. Drug and alcohol use can increase other risk behaviors, leading to injury, violence, victimization, sexually transmitted diseases, teen pregnancy, suicide and poor educational performance and completion. Youth are bombarded with mixed messages from the media, peers, family dynamics, and other places. Prevention efforts targeting the environment as well as individuals are effective in changing behaviors and health outcomes. Addressing social norms and perceived harm of substance use are critical in the implementation of prevention programs. Research shows prevention efforts improve school attendance, graduation rates, and reduce violence and mental health disorders, among other positive outcomes. Prevention programs that use a skills-based approach have demonstrated improving youth and community health outcomes. Binge Drinking Binge drinking is defined by the National Institute on Alcohol Abuse and Alcoholism as a pattern of drinking that brings alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. Alcohol use by persons under age 21 years is a major public health problem. Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs. Research indicates youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years. www.cdc.gov/alcohol/ fact-sheets/underagedrinking.htm 94 The Well-Being of Everett • 2014 Health Assessment Report Percent of Students 100 90 80 70 60 50 40 30 20 10 0 Trend in Alcohol Use Among High School Students (2003-2013) 66.7 68 2003 2013 2005 MA 2007 53.7 2009 2011 40 37.9 23.3 22.7 19.2 11 Alcohol, Ever Alcohol, Current SOURCE: Everett HS Survey, 2003-2013; MA YRBS, 2011 Early Initiation (before age 13) 11.3 22 Binge drinking, past 30 days • Between 2003 and 2013, alcohol use has decreased among Everett High School students and is now substantially lower than Massachusetts as a whole. • In 2013, high school girls were more likely to report lifetime alcohol use (57.2%) compared with boys (50.6%) and slightly more likely to report use within prior 30 days of the survey (24.5% vs. 22.2%). No difference in binge drinking was seen by gender. • Among Middle School students, in 2013, middle school girls were more likely to report lifetime alcohol use (18.4%) compared with boys (14.6%) and more likely to report use within prior 30 days of the survey (5.9% vs. 3.9%). The Well-Being of Everett • 2014 Health Assessment Report 95 xx Usual Source of Alcohol Among Everett High School Students Who Reported Drinking Alcohol (2013) I get it from friends my own age 18.8 Older friends give it to me 18.4 I ask someone of legal age to buy it for me 17.5 6.8 My parents give it to me Older brothers/sisters give it to me 5.7 Take it from my/friend's parents without them knowing 5.9 1.1 I buy it myself at a store/tavern/bar Other 25.9 0 20 SOURCE: Everett HS Survey 2013 40 60 Percent of Students • Among high school students who reported ever consuming alcohol, 48% of them report obtaining it by asking someone older to give or buy it for them. • Among middle school students who reported ever consuming alcohol, 35% of them report obtaining it by asking someone older to give or buy it for them. 96 The Well-Being of Everett • 2014 Health Assessment Report 80 100 Percent of Students 100 90 80 70 60 50 40 30 20 10 0 Trend in Marijuana Use Among High School Students (2003 - 2013) 2003 2013 2005 MA 2007 2009 35.7 38.3 37.6 38.7 43.1 2011 31.9 34.2 17.2 20.9 22.0 23.6 27.9 17.1 19.9 Marijuana Past 30 Days Marijuana Ever High School SOURCE: Everett MS and HS Surveys, 2003-2013; MA YRBS, 2011 • Marijuana use, lifetime and 30-day use, among Everett High School students was slowly rising from 2003 to 2009 after which the rate had dropped somewhat and is now below the rate of Massachusetts overall. Similar trends were observed among Everett Middle School students. • Currently, about 34% of high school students report ever trying marijuana, while 20% report using marijuana in the prior 30 days. The Well-Being of Everett • 2014 Health Assessment Report 97 xx High School trends in other illicit drugs, percent of students 2003 2005 2007 2009 2011 2013 MA, 2011 Ecstasy, Ever 10.3 8.4 10.2 5.6 1.9 2.3 5.8 Inhalants, Ever 7.4 9.0 11.0 7.9 7.1 5.0 n/a Cocaine, Ever 7.3 6.9 6.5 5.2 1.8 1.7 5.0 Methamphetamines, Ever 2.3 1.8 1.6 1.0 0.2 0.3 2.7 Heroin, Ever 1.8 1.6 0.8 0.8 0.0 0.3 2.1 Other Types of Illegal Drugs*, Ever 7.7 6.1 4.8 4.3 2.3 2.6 n/a *Other illegal drugs include: LSD, PCP, mushrooms, Ketamine, Rohypnol, or GHB • The rates of lifetime use for other illicit drugs, including ecstasy, inhalants, cocaine, methamphetamines and heroin have decline dramatically for high school students since 2007 and are currently lower than the state rates. • Overall, use of other illicit drugs among middle school students was low in 2013, less than 0.5%. The exception being inhalant use, which was reported by 8.5% of middle school students in 2013, down from 14.5% in 2005. • While only 31% of high school students thought it would be very risky to drink one or two drinks daily and 19% believed it would be very risky to smoke marijuana once or twice a week, 65% believed it would be very harmful to take prescription medications not prescribed to them. • Data related to non-medical use of prescription drugs show that in 2013, 2.1% of high school students had tried to get high using someone else’s prescription medication. A further 4.4% of high school students had tried to get high using over-the-counter medications. These rates represent a steady decrease in such use since 2003. • Use of oxycontin without a prescription was reported by 1.6% of high school students in 2013 while less than 1% reported using steroids without a prescription. Source: Everett Student Health Survey 2013 98 The Well-Being of Everett • 2014 Health Assessment Report Percent of Students Percent of Everett Students Identifying Substances as “Very Easy” or “Sort of Easy” to Obtain, by Grade (2013) 100 90 80 70 60 50 40 30 20.9 20 10 0 72.8 70.6 64.4 6th 11th 7th 12th 8th 9th 10th 37.5 19.7 13.2 8.7 Cigarettes Alcohol SOURCE: Everett HS Survey, 2003-2013; MA YRBS, 2011 Marijuana Prescription drugs not prescribed to you • In 2013, the perception that substances were ‘very easy’ or ‘sort of easy’ to obtain increased with grade level, regardless of type of substance. • In 2005, nearly half (46%) of high school and middle school students lived with someone who smoked cigarettes. This has declined to about 30% for both groups in 2013. • Similarly, the rate of high school and middle school students living with someone that uses illegal drugs (other than marijuana) has declined from about 6% in 2005 to under 2% in 2013. • Overall, the trend in the percent of students who reported having someone living in their household using substances was similar for Everett middle and high school students. • Currently, 14% of high school students and 10% of middle school students report that they live with someone they think drinks too much alcohol. In addition, 12% of high school students and 5% of middle school students report marijuana use by someone they live with. The Well-Being of Everett • 2014 Health Assessment Report 99 xx Strengths and Assets • Everett’s youth group, Teens in Everett Against Substance Abuse (TEASA), now in its 9th year, continues to mobilize over 40 high school students each year to work in partnership with residents and community leaders on prevention efforts to educate youth, adults, parents, policy makers and local businesses on risks associated with substance use. • TEASA has organized local educational and awareness events such as Kick Butts Day, Great American Smoke Out, alcohol prevention rally for Alcohol Awareness Month, debates on medical marijuana, presented survey data on tobacco products sold in Everett, and presented the findings of the bi-annual Youth Risk Behavioral Survey to students at the high school and at community meetings. • Everett Public Schools continue to implement Project Northland, a nationally recognized science-based substance abuse curriculum, for students in 6th - 8th grades with positive results. • The Everett Police Department conducts alcohol compliance checks to monitor sales to minors throughout the year. Recommendations • Increase information and outreach to middle school parents regarding the importance of talking to their children about alcohol and other drug use. • Expand the substance abuse educational curriculum in all grades throughout all Everett schools to ensure that children and youth are learning about the impact of alcohol and other drugs on their developing bodies. • Prescription drug abuse has become a national epidemic. Continue to provide awareness and education to children and youth on the harm of using prescription drugs without the guidance of a medical professional. • Increase availability of early prevention information to help parents, teachers and others working with youth to recognize the signs and symptoms of early drug use. • Provide support for youth at the schools and in the community who are struggling with substance use dependency. Refer students to treatment and recovery programs to help them complete high school and work towards a balanced life of sobriety and post-high school career development. • Continue to provide prevention resources and opportunities for youth leadership in the area of substance abuse prevention. 100 The Well-Being of Everett • 2014 Health Assessment Report Youth Mental Health Why is this important? Emotional health is a vital part of overall health and well-being. A person’s emotional health, including thoughts and feelings, influence his or her ability to lead a satisfying and productive life. The mental health of a community depends on the opportunities its members have to experience safe, caring and secure environments in families, schools, work settings and community life. For adolescents, this period of time can be a challenging developmental stage with episodes of confusion, wonder and discovery. Self-esteem and peer relations are critical aspects for youth development. Understanding and supporting the needs of all youth are critical to launching self-assured and positive members of society who are healthy in mind, spirit and body. Percent of Students 100 90 80 70 60 50 40 30 20 10 0 Depression and Self Harm in prior 12 Months, Among Middle and High School Students (2003 & 2013) Everett 2003 Everett 2013 MA 2011 25.6 28.6 19.5 26.3 25.2 15 13.3 9.1 13 12.6 Definition of Self-Harm Self-harm and self-injury are defined as intentional harm or injury of one’s self, usually done without suicidal intentions. The most common forms of self-harm include cutting, burning, scratching, hair pulling, preventing wounds from healing or other similar behaviors. Tattoos and body piercings are not considered non-suicidal self-injury, unless they are created with the specific intention to self-harm. 18 0 Middle School High School Depressed* High School Middle School Hurt Self on Purpose+ SOURCE: Everett HS Survey, 2003-2013; MA YRBS, 2011 *Described as feeling “so sad and hopeless almost every day for two weeks or more in a row that you stopped doing some usualactivities”; +Includes cutting, burning or bruising • Between 2003 and 2013, the percent of students feeling symptoms of depression declined to about 20% of middle school students and 26% of high school students. However, these rates are higher than for Massachusetts overall. • Self-harm was lower among Everett High School and Middle School students compared to the state and middle school data suggest a decline in this behavior between 2003 and 2013. The Well-Being of Everett • 2014 Health Assessment Report 101 xx Everett 2003 Everett 2013 Percent of Students 100 90 80 70 60 50 40 30 20 10 0 Suicidal Ideation in prior 12 Months, among Middle and High School Students (2003 & 2013) MA 2011 14.9 10.8 12.2 7 Middle School 13.3 9.7 3.4 High School Seriously Considered Suicide 3.1 6.7 4 4.6 6.8 High School Middle School Attempted Suicide SOURCE: Everett HS Survey, 2003-2013; MA YRBS, 2011 • Everett Middle School students have a higher rate of suicidal ideation (11%) compared to the state (7%) as well as compared to Everett High School students (10%). However the rates of ideation have declined since 2003 for both middle and high school students. • Attempted suicide was reported by 3% of middle school students and nearly 5% of high school students, both lower proportions than the state. Percent of Students 100 90 80 70 60 50 40 30 20 10 0 Percent of Everett Middle and High School students that have an adult to talk to about their problems (2013) Middle School 75.1 54.4 55.5 40.7 29.1 School Adult Family Adult SOURCE: Everett HS Survey, 2003-2013; MA YRBS, 2011 102 High School 67.5 The Well-Being of Everett • 2014 Health Assessment Report Non-Family/School Adult • In 2013, over half of Everett Middle and High School students report having an adult at school to talk to, while 75% of middle school and 68% of high school students report having an adult in their family to talk to about their problems. • In 2013, the proportion of students describing their lives as ‘somewhat’ or ‘very’ stressful increased with school grade, with 34% of 6th graders feeling somewhat or very stressed and 65% of 12th graders feeling somewhat or very stressed. • In 2013, 66% of Everett High School and 45% of Everett Middle School students worried ‘often’ or ‘everyday’ about school issues. • Approximately 42% of Everett High School students and 33% of Everett Middle School students worried ‘often’ or ‘everyday’ about social, appearance, or family issues. • When examined by gender, girls were more likely to worry than boys for all issues whether they were in high or middle school. Strengths and Assets • Everett Public Schools has expanded school-based initiatives to promote mental health. These initiatives help students cope with common issues, support healthy development, and improve educational outcomes. By integrating resources into a comprehensive continuum of support promoting healthy and positive youth development, it allows for early intervention and provides assistance to those with more chronic and severe problems. • The Everett Public Schools have a total of eight school adjustment counselors and school social workers in the district. There is one person located in each elementary school and one at the high school for a total of four licensed clinical social workers and four licensed adjustment counselors. • Everett High School has one full-time licensed clinical social worker to assist students who may benefit from counseling, assistance and/or referrals. • Close collaboration between primary care providers, school guidance counselors, school nurses, and social service providers allows for effective referrals to clinical settings with expertise in child/ youth/adolescent mental health needs. • The Cambridge Health Alliance provides a range of clinical and professional expertise to serve the mental health needs of children and their families in Everett. The Anna May Powers Health Center at the Keverian School and the Teen Health Center at Everett High School provide counseling and other mental health services from a staff social worker, psychologist and psychiatrist. Staff has bilingual capacity in Spanish. Other languages are available utilizing interpreter services. • Eliot Community Human Services provides child, youth and family centered behavioral healthcare for children and their families. A new Youth and Family Clinic opens in June 2014, and will provide trauma-focused individual, family, and group treatment utilizing multi-sensory and expressive art interventions. The Well-Being of Everett • 2014 Health Assessment Report 103 xx • The Joint Committee for Children’s Health Care in Everett conducts Parent University, an annual educational forum focusing on the stress of parenting, as well as childhood behavioral health topics. • The Everett Youth Networkers, a collaboration of over 20 youth advocates and service providers, are dedicated to creating opportunities for youth development impacting social and emotional well-being. Opportunities in the community are forged to support youth in making positive life choices by promoting structured activities, civic engagement, employment resources and healthy recreational opportunities. These collective efforts are important in the social and behavioral development of Everett’s youth. • The Builders Club offers 7th and 8th graders community service projects in partnership with the Kiwanis Club. For high school students, the Key Club offers opportunities for volunteering and community services hours. Recommendations • Provide Youth Mental Health First Aid trainings to empower parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human service workers, and other caring citizens how to help adolescents who are experiencing mental health or addiction challenges, or are in crisis. • Expand opportunities for youth to be involved in mentorship programs with local businesses, community leaders, and schools. • Strengthen services for children and youth who are survivors of major mental health stressors such as homelessness, trauma, suicide, natural disasters and violent crimes. • Strategize across the community to reach youth who are at-risk or have dropped out of school. • Develop social norm messaging to reduce stigma associated with mental health for high school and middle school aged youth. • Provide culturally competent information including education and resources on mental health issues to help reduce stigma and cultural differences regarding well-being. • Increase early education and outreach for mental health issues to vulnerable youth. • Increase the ability of the community to help youth and families with mental health concerns by increasing knowledge and access of available resources. 104 The Well-Being of Everett • 2014 Health Assessment Report Youth Violence Why is this important? Youth violence refers to harmful behaviors that can start early and continue into young adulthood. The young person can be a victim, an offender, or a witness to the violence. Youth violence includes various behaviors. Some acts of violence can cause emotional and psychological harm while others can lead to serious physical injury or even death (Center for Disease Control and Prevention). Each year, millions of children and adolescents in the United States are exposed to violence in their homes, schools, and communities as both victims and witnesses. Even if they are not physically present, children may be affected by intentional harm done by another. Children react to exposure to violence in different ways, and many children show remarkable resilience. Children who are exposed to violence often experience lasting physical, mental, and emotional stress and may be more prone to engaging in violent relationships including dating violence, delinquency, further victimization, and involvement with the child welfare and juvenile justice systems. Children exposed to violence are more likely to act out in school and have greater potential for perpetrating violence in the future, continuing the cycle of violence into the next generation. The ultimate goal is to stop youth violence before it starts. Cyber Bullying Cyber bullying is when electronic technology such as cell phones, computers, or other digital technology via social media sites, text messages, online chats or websites is used (Facebook, Instagram, Twitter or other platforms) to torment, threaten, harass, humiliate, embarrass or otherwise target another person. Bullying is unwanted, aggressive behavior that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. (www.stopbullying.gov) The Well-Being of Everett • 2014 Health Assessment Report 105 xx Trend in Experience of Bullying in Prior 12 Months (2005-2013) 100 2005 2007 Percent of Students 80 2009 2011 60 2013 40 36 31 33 40 41 MA 2011 36 20 16 0 17 16 Middle School 19 18 18 High School SOURCE: Everett MS and HS Surveys, 2005-2013; MA YRBS, 2011 • Bullying has increased slightly between 2005 and 2013 and currently exceeds the Massachussets rate among middle school students. • Bullying is twice as common among middle school students compared to high school students in Everett. Trend in Experience of Violence in Prior 12 Months Among Everett High School Students (2007-2013) 2007 2009 Percent of Students 100 90 80 70 60 50 40 30 20 10 0 2011 2013 27.2 16.7 5.4 3.3 10.2 5.6 8.6 6.2 19 10.7 9.4 5.1 Carried a Engaged in Hurt physically Witnessed Received verbal Sexually weapon physical fight or sexually by violence in or emotional harassed in family school on school abuse from a date or on school property someone in property someone you family were giong out with SOURCE: Everett MS and HS Surveys, 2005-2013; MA YRBS, 2011 • Since 2007, the rate for all indicators of violence have decreased among Everett High School students. • High school girls (7.3%) were more likely to report being sexually harrassed in school than boys (3.1%) in 2013. A higher proportion of girls (9.7%) were more likely to report being hurt physically or sexually by a date or someone they were going out with. 106 The Well-Being of Everett • 2014 Health Assessment Report Strengths and Assets • The Everett Public Schools have a conflict resolution and mediation program at the K-8 schools that is available for all students and staff to use. • Portal to Hope, a local organization that provides services to victims of sexual assault and domestic violence, provides class presentations and information sessions at the high school to increase awareness and access to their services and supports available to children, youth and families. • The Everett Police Department has a full-time school resource officer located at the high school who develops relationships with students and staff to ensure that the health and safety of all allows for a productive learning environment. • The City of Everett has been awarded funding from the Senator Charles E. Shannon Community Safety Initiative, a state grant program administered by the Executive Office of Public Safety and Security (EOPSS), to “support regional and multi-disciplinary approaches to combat gang violence through coordinated programs for prevention and intervention.” • Everett Public Schools use Second Step, Open Circle and Core Values programs for K-8 schools to develop social competence and violence prevention. Everett High School uses the Michigan Model Curriculum for Violence Prevention and skills-based lessons from www.healthteacher.com. • Bullying prevention and intervention plans are being implemented through the Everett High School Bullying and Cyber Bullying MARC curriculum. The Massachusetts Aggression Reduction Center also provides presentations on cyber safety to each school in the district. • The Brain Injury Association of Massachusetts (BIA-MA) provides education programs to students on brain injury, drugs, alcohol and violence prevention. • Everett High School provides a variety of violence prevention programs, including Northeastern University’s Mentors in Violence Prevention and the Samaritans Preventing Self Harm programs. • Grace Episcopal Church and the Everett Police work together with youth to implement a Restorative Justice Program. Recommendations • Increase supportive programs and mentoring for adolescent girls who are at high risk of becoming victims of violence and abuse. • Increase funding for programs working with youth such as the Everett Boys and Girls Club, For Kids Only Afterschool program, the Joint Committee for Children’s Health Care to continue to support youth in their development. • Implement a mediation program at the high school. • Increase number of resource officers to better reach middle school aged youth. • Expand the number of youth jobs in summer and year round. The Well-Being of Everett • 2014 Health Assessment Report 107 xx Youth Sexual and Reproductive Health Why is this important? Sexual and reproductive health education is an important part of overall health education of teenagers. Sexual and reproductive health education includes knowledge of emotional and physiological body changes during puberty. This knowledge is becoming increasingly important as youth today are entering puberty earlier in life and are often unaware of the changes happening to their bodies. Sexual and reproductive health education provides a framework for youth to learn about healthy vs. unhealthy relationships and community resources on this topic. According to the Centers for Disease Control, 9.4% of high school students report being hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend (CDC, 2011). In the United States, youth who identify as lesbian, gay, bisexual, transgender (LGBT) are twice as likely as their peers to have been physically assaulted, kicked, or shoved at school. Nearly half of youth who identify as LBGT feel they do not “fit in” in their community, as opposed to only 16% of non-LGBT youth. Additionally, 4 out of 10 LGBT youth say the community in which they live is not accepting of LGBT people (HRC, 2012). Sexual and reproductive health education provides a platform for youth to learn about sexuality. The prevention and treatment of sexually transmitted infections (STIs) remains a health concern in the field of sexual and reproductive health. Untreated STIs can lead to long-term health issues, including pelvic inflammatory disease, infertility, and cancer. In the United States, there are an estimated 19 million new diagnoses of STIs annually, with nearly half among those ages 15 to 24 and with the most common diagnosis of Chlamydia. In the United States, half of all pregnancies are unplanned. Of those 3.4 million unplanned pregnancies, approximately 305,000 (National Campaign, 2012) are to girls ages 15 to 19 years old. U.S. teen pregnancy and birth rates have declined dramatically over the past twenty years and are now at historic lows; however the U.S. teen birth rates remain far higher than in other comparable countries and continue to cost the U.S. $12.5 billion dollars a year (Guttmacher, Unintended, 2013). Public funding for family planning services helps to prevent unintended pregnancies; for every $1 spent on family planning services, $5.68 in pregnancy related Medicaid expenditures is saved 108 The Well-Being of Everett • 2014 Health Assessment Report (Guttmacher, Contraceptive, 2013). Furthermore, family planning funding supports access to contraception, cancer screening and prevention, HIV and STI testing and treatment, pregnancy planning, screening for intimate partner violence, and referrals for prenatal care, substance abuse treatment, and primary care (DHHS, 2013). Citations Guttmacher Institute; Contraceptive Needs and Services, 2010 (2013), www. guttmacher.org/pubs/win/contraceptive-needs-2010.pdf Guttmacher Institute; Unintended Pregnancy in the United States, (2013), www. guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html#13 National Campaign to Prevent Unplanned Pregnancy; National and State Data, (2013), thenationalcampaign.org/data/landing The Centers for Disease Control and Prevention (CDC); Pregnancy (2014), www.cdc. gov/pregnancy/ The Centers for Disease Control and Prevention (CDC); Teen Dating Violence, (2011), www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence. html The Human Rights Campaign (HRC); Growing Up LGBT In America, (2012), www.hrc. org/youth/about-the-survey Percent of Students The U.S. Department of Health and Human Services (DHHS); Healthy People, Reproductive Health (2013), healthypeople.gov/2020/LHI/reproductiveHealth.aspx 100 90 80 70 60 50 40 30 20 10 0 Trend in Sexual Behaviors Among High School Students (2005-2013) 2005 2007 73.9 53.3 47.9 50.6 45.5 45.6 68.3 71.9 73.2 72.1 2009 2011 58 2013 42 MA 2011 17.4 18.8 Sexual Intercourse, Ever Condom Use, Last Intercourse* 23 22.4 12.8 15 Alcohol or Drugs Used, Last Intercourse* *Among students reporting ever having had intercourse. SOURCE: Everett MS and HS Surveys, 2005-2013; MA YRBS, 2011 The Well-Being of Everett • 2014 Health Assessment Report 109 xx • In 2013, 46% of Everett High School students reported every having had sexual intercourse, which represents a decline since 2009. The proportion of students reporting condom use during last intercourse has remained steady over the years, with approximately 72% of sexually active students reporting condom use. • A sharp decline in the proportion of sexually active high school students who used alcohol or drugs during last intercourse has occurred since 2009. • In 2013, among middle school students, 8% reported ever having had sexual intercourse and 68% of sexually active used a condom. Method Used to Prevent Pregnancy During Last Intercourse Among Everett High School Students (2013) Condoms 58.9 Birth control pills 20.5 Depo-Provera 5.6 Withdrawal 2.5 Some other method 3.9 Not sure 1.9 No method used 6.8 0 20 40 60 Percent of Students Among students reporting ever having had intercourse SOURCE: Everett HS Survey 2013 • In 2013, among sexually active Everett High School students, more than half reported using condoms and about 20% used birth control pills as the method used to prevent pregnancy during last intercourse. On the other hand, about 15% relied on unsafe/unreliable methods or no prevention method at all. 110 The Well-Being of Everett • 2014 Health Assessment Report 80 100 45 Age Specific Rate Per 1,000 40 Trend in Teen Birth Rate, Age 15 to 19 Years (2003-2010) 40.6 39.6 35 32.4 33.0 22.2 21.7 Everett MA 40.6 34.9 34.9 30 25 20 23.0 21.3 22.0 24.3 20.1 19.6 15 17.2 10 5 0 2003 2004 2005 2006 2007 2008 2009 2010 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH • Between 2003 and 2010, the teen birth rate was higher in Everett than Massachusetts; however, a downward trend is evident for both Everett and Massachusetts with a particularly sharp drop in Everett after 2009. The Well-Being of Everett • 2014 Health Assessment Report 111 xx Strengths and Assets • Cambridge Health Alliance (CHA) operates the Everett Teen Health Center on the campus of Everett High School. Open during the school year, this confidential and comprehensive clinic offers primary healthcare, reproductive health education and counseling. Clients, up to age 24, receive many services at low or no cost and being an Everett High School student is not a requirement to receive care. • Cambridge Health Alliance runs two programs at Everett High School: Empowering Youth in our Community (EYC), a health elective and Helping Hands at Work (HHW), an after-school service-learning club. Both were developed to increase knowledge of health issues facing the Everett community as well as to teach important skills such as decision-making, communication, pregnancy and STI prevention, and goal setting. • Sexual health education is required of all Everett High School students. This includes information on abstinence, HIV/AIDS, STIs, reproduction, puberty, and pregnancy prevention. These classes are supplemented by presentations from the Everett Teen Health Center about sexual health and contraception. In addition, reproductive health is taught in the Everett middle schools, including basic sexual health education on abstinence, puberty, anatomy, pregnancy prevention, and STIs. • All Everett High School freshmen students receive a tour of the Everett Teen Health Center and overview of services provided during health class. Recommendations • Conduct outreach to Everett youth up to age 24 to increase awareness of services at the Teen Health Center at Everett High School including students at Pope John and the local charter schools. • Increase awareness of low or no-cost Chlamydia testing and treatment services available at the Everett Teen Health Center for those aged 19 to 24 and younger. • Evaluate prenatal care access for low-income and vulnerable populations. • Develop a plan to increase awareness of LGBT health topics and to address the community health needs. 112 The Well-Being of Everett • 2014 Health Assessment Report Data Sources and Definitions US Census Data American Community Survey Decennial Census What is It? Continuous demographic survey Count of the population Data Average characteristics OVER TIME How Often Every 1 year (more timely) Counts characteristics for a SPECIFIC DATE Every 10 years (less timely) Households 11 million households per 5 years 18 million households per 1 year Sampling Error Higher Error Lower Error Accuracy Less Accurate More Accurate Content Extensive and detailed demographic, Only Age, Sex, Race, Hispanic Ethnicity, economic and housing data and Household Relationships The Massachusetts Community Health Information Profile (MassCHIP), developed by the Massachusetts Department of Public Health, provides access to community and state level health status, health outcome, program utilization, and demographic data sets. The Institute for Community Health led the 5-City Behavioral Risk Factor Surveillance Survey (BRFSS) in 2008. It was a health-related telephone survey that collected data on health-related risk behaviors, chronic health conditions, and use of preventive services of Everett adults 18 years or older. The other cities included in the survey were Cambridge, Chelsea, Revere and Somerville. The Massachusetts Youth Risk Behavior Survey (YRBS) collects data on health risk behaviors among Everett public school students, alternating years between middle school (grades 6-8) and high school (9-12). Data collected include behaviors that contribute to unintentional injuries and violence, sexual behaviors, alcohol and other drug use, tobacco use, dietary behaviors, and physical activity. In Everett, the survey is also referred to as the Everett Student Health Survey. Bureau of Labor and Statistics, U.S. Department of Labor is the principal Federal agency responsible for measuring labor market activity, working conditions, and price changes in the economy to support public and private decision-making since 1884. Massachusetts Division of Health Care Finance and Policy, Uniform Hospital Discharge Data System (UHDDS) provides definitions for acute care hospitals to report inpatient data elements in a standardized manner, and collects data on hospital discharges and emergency visits. Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, Massachusetts Department of Health collects, processes, corrects and issues copies of birth, death and marriage records that occur in Massachusetts. The Well-Being of Everett • 2014 Health Assessment Report 113 xx Bureau of Substance Abuse Services (BSAS) oversees the substance abuse and gambling prevention and treatment services in the Commonwealth. Responsibilities include: licensing programs and counselors; funding and monitoring prevention and treatment services; providing access to treatment for the indigent and uninsured; developing and implementing policies and programs; and tracking substance abuse trends in the state. The Massachusetts Department of Elementary and Secondary Education (ESE) collects a variety of data from schools and districts in the state, some of which is published as a School or District Profile. Free Lunch: Gross income limit - 130% FPL Reduced Lunch: Gross income limit - 185% FPL High Needs: Calculated based on the number of high needs students, divided by the adjusted enrollment. A student is high needs if he or she is designated as either low income, or ELL, or former ELL, or a student with disabilities. A former ELL student is a student not currently an ELL, but had been at some point in the two previous academic years. Special Education: Indicates the percent of enrollment who have an Individualized Education Program (IEP). Definitions Count is the number of people in the population with the characteristic of interest. Percentage or Proportion is the count of people with the characteristic of interest divided by the total number of people in the population. An age-specific rate is the count of people or events in a particular age group divided by the total number of people in that age group and standardized to a population size of 1,000. The crude rate is the total number of people or events divided by the total number of people in the population and standardized to a population size of 100,000 people. If the event is related to age then a crude rate is misleading when comparing between areas with different age distributions (see age-adjusted rate). The age-adjusted rate is a weighted average of the age specific rates for an event of interest that is then standardized to a population size of 100,000. Useful when comparing rates between diverse populations. 114 The Well-Being of Everett • 2014 Health Assessment Report ICD 9 Code Definitions Chronic Disease Section Circulatory System Disease Includes: • • • • • • • • • (390–392) Acute Rheumatic Fever (393–398) Chronic rheumatic heart disease (401–405) Hypertensive disease (410–414) Ischemic heart disease (415–417) Diseases of pulmonary circulation (420–429) Other forms of heart disease (430–438) Cerebrovascular disease (440–448) Diseases of arteries, arterioles, and capillaries (451–459) Diseases of veins and lymphatics, and other diseases of circulatory system COPD Includes: • • • • • • • • • • • • (490) Bronchitis, not specified as acute or chronic (491) Chronic bronchitis (492) Emphysema (492.0) Emphysematous bleb (492.8) Other emphysema (493) Asthma (493.0) Extrinsic asthma (493.1) Intrinsic asthma (493.2) Chronic obstructive asthma (494) Bronchiectasis (495) Extrinsic allergic alveolitis (496) Chronic airway obstruction, not elsewhere classified Digestive System Diseases Include: • • • • (520-529) Diseases of oral cavity, salivary glands, and jaws (530-537) Diseases of the esophagus, stomach and duodenum (540-543) Diseases of appendix (555-558) Noninfective inflammation of • • • the colon (560-569) Other diseases of intestines and perioneum (570-573) Diseases of liver (574-579) Disorders of gallbladder, biliary tract and pancreas Genitourinary System Diseases Include: • • • • • • (580–589) Nephritis, nephrotic syndrome, and nephrosis (590–599) Other diseases of urinary system (600–608) Diseases of male genital organs (610–611) Disorders of breast (614–616) Inflammatory disease of female pelvic organs (617–629) Other disorders of female genital tract Heart Disease Includes: • • • • • • (410-414) Coronary heart disease (428) Heart failure (410-414) Ischemic heart disease (429) Major cardiovascular disease (410) Acute myocardial infarction NOT: hypertension, atheroscelerosis; cerebrovascular disease Musculoskeletal System Diseases Include: • • • • • (710-719) Arthropathies and joint disorders (includes rheumatoid arthritis) (710) Systemic connective tissue disorders (includes lupus, sclerosis) (720-724) Dorsopathies (injuries to the spine) (729) Soft tissue disorders (muscles, tendons) (730-739) Osteopathies, chondropathis (includes osteoporosis, fractures, stress fractures) The Well-Being of Everett • 2014 Health Assessment Report 115 xx Nervous System Diseases Include: • • • • • • • • (320-327) Inflammatory Diseases Of The Central Nervous System (330-337) Hereditary And Degenerative Diseases Of The Central Nervous System (338-338) Pain (339-339) Other Headache Syndromes (340-349) Other Disorders Of The Central Nervous System (350-359) Disorders Of The Peripheral Nervous System (360-379) Disorders Of The Eye And Adnexa (380-389) Diseases Of The Ear And Mastoid Process Poisonings Include: 116 • • • • • • • • Unintentional poisoning Poisionings that may be accidental Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics (X61) Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified (X62) Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified (X63) Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system (X64) Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances (X65) Intentional self-poisoning by and exposure to alcohol • (X66) Intentional self-poisoning by and The Well-Being of Everett • 2014 Health Assessment Report • • • • • • • • • • • exposure to organic solvents and halogenated hydrocarbons and their vapours (X67) Intentional self-poisoning by and exposure to other gases and vapours (X68) Intentional self-poisoning by and exposure to pesticides (X69) Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances (X85) Assault by drugs, medicaments and biological substances (X86) Assault by corrosive substance (X87) Assault by pesticides (X88) Assault by gases and vapours (X89) Assault by other specified chemicals and noxious substances (X90) Assault by unspecified chemical or noxious substance (Y10) Undetermined intent (Y35.2) Legal intervention involving gas Mental Health Section Mental Health-Related Disorders Include: Organic psychotic conditions • • • • • (290) Dementias (291) Alcoholic psychoses (292) Drug psychoses (293) Transient organic psychotic conditions (294) Other organic psychotic conditions Other psychoses • • • • • (295) Schizophrenic disorders (296) Episodic mood disorders (297) Paranoid states (298) Other nonorganic psychoses (299) Psychoses with origin specific to childhood Neurotic disorders • (300) Neurotic disorders • • Personality disorders (301) Personality disorders Psychosexual disorders • (302) Psychosexual disorders Psychoactive substance • • • (303) Alcohol dependence syndrome (304) Drug dependence (305) Nondependent abuse of drugs Other (primarily adult onset) • • • • • • (306) Physiological malfunction arising from mental factors (307) Special symptoms or syndromes, not elsewhere classified (308) Acute reaction to stress (309) Adjustment reaction (310) Specific nonpsychotic mental disorders following organic brain damage (311) Depressive disorder, not elsewhere classified Mental disorders diagnosed in childhood • • (312) Disturbance of conduct, not elsewhere classified (313) Disturbance of emotions specific to childhood and adolescence Violence Forcible rape: defined by the FBI’s Uniform Crime Reporting (UCR) Program is the carnal knowledge of a female forcibly and against her will. Attempts or assaults to commit rape by force or threat of force are also included; however, statutory rape (without force) and other sex offenses are excluded. Substance Abuse Substance Abuse Treatment Admissions are admissions into substance abuse treatment programs administered by the Bureau of Substance Abuse Services (BSAS). Their services include prevention services, residential • • • (314) Hyperkinetic syndrome of childhood (315) Specific delays in development (316) Psychic factors Mental retardation • • • (317) Mild mental retardation (318) Other specified mental retardation (319) Unspecified mental retardation Suicide and self-inflicted injury • • • (E950) Suicide and self-inflicted poisoning by solid or liquid substances (E951) Suicide and self-inflicted poisoning by gases in domestic use (E952) Suicide and self-inflicted poisoning by other gases and vapors • • • • • • • (E953) Suicide and self-inflicted injury by hanging, strangulation, and suffocation (E954) Suicide and self-inflicted injury by submersion (drowning) (E955) Suicide and self-inflicted injury by firearms, air guns and explosives (E956) Suicide and self-inflicted injury by cutting and piercing instrument (E957) Suicide and self-inflicted injury by jumping from high places (E958) Suicide and self-inflicted injury by other and unspecified means (E959) Late effects of self-inflicted injury treatment under 30 days (short-term acute treatment), residential treatment over 30 days, ambulatory services (counseling and treatment), aftercare/recovery support, homeless services, and education and treatment alternative sentencing programs convicted of driving under the influence. www.mass.gov/eohhs/gov/ departments/dph/programs/substance-abuse/ providers/substance-abuse-services.html Opioid-related Hospitalizations and ED visits: underlying cause is non-fatal opioid-related associated with opioid abuse, dependence, and/ or poisoning (overdose). The Well-Being of Everett • 2014 Health Assessment Report 117 xx Acknowledgements Authors and Contributors: (Alphabetical order based on last name) Devan Cody Jackie Coogan Alba Cruz-Davis Linda Cundiff James Errickson Kristin French Marzie Galazka Nicole Graffam Jean Granick Lindsey Grant Loretta Kemp Jodi Lava Jaime Lederer Carolyn Lightburn Bob Marra Chief Steven Mazzie Sylvia L. N-Olivares John Obremski Kathleen O’Brien Dan O’Leary Elaine Silva Valerie Spain Jamie Stein Dr. Tom Stella Melissa Trzepacz Keith Wales Kelly Warner Cambridge Health Alliance Joint Committee for Children’s Health Care in Everett Joint Committee for Children’s Health Care in Everett/City of Everett Cambridge Health Alliance Department of Planning and Development, City of Everett Everett Community Health Partnership Department of Planning and Development, City of Everett Joint Committee for Children’s Health Care in Everett Everett Community Health Partnership, Cambridge Health Alliance Eliot Human Services Tri-City Community Action Agency, Inc. Everett Public Schools Everett Community Health Partnership, Cambridge Health Alliance City of Everett, Human Services Everett Community Health Partnership, Cambridge Health Alliance Everett Police Department City of Everett, Adult Learning Center Everett Public Schools Everett Community Health Partnership, Cambridge Health Alliance Mystic Valley Elder Services Everett Health Department Everett Health Department Cambridge Health Alliance Everett Public Schools Everett Police Department Eliot Human Services Cambridge Health Alliance Data compilation and summarization by the Institute for Community Health: Lisa Arsenault Grace Chan Blessing Dube Reann Gibson Kelly Washburn 118 The Well-Being of Everett • 2014 Health Assessment Report A special acknowledgement and appreciation to our neighboring partners in Somerville and Malden, Lisa Brukilacchio and Renee CammarataHamilton, respectively, for their support and recommendations for The Well-Being of Everett 2014 Report. Photography provided by: Cambridge Health Alliance, Everett Public Schools, Colin Barr, and Jean Granick. Programs, Partners and Resources Partners providing support for community health activities in Everett: Partner Action for Regional Equity A Better Tomorrow Services Inc. Boys and Girls Club of Middlesex County – Everett Clubhouse Cambridge Health Alliance Website www.action4equity.org www.abticharity.org Telephone see website 617-381-0300 www.kidsclubs.org 857-363-2611 617-389-6270 617-394-7702 or 617-665-1305 Eliot Community Human Services Everett Chamber of Commerce www.challiance.org www.challiance.org/Locations/ EverettFamilyHealthCenter.aspx www.challiance.org/Locations/ EverettTeenHealthCenter.aspx www.eliotchs.org www.everettmachamber.com Everett Public Library www.noblenet.org/everett City of Everett www.cityofeverett.com cityofeverett.com/Everett_files/ commdevelop/index.htm www. energizeeverett.org cityofeverett.com/Everett_files/health/index. htm cityofeverett.com/Everett_files/human%20 services/index.htm www. everettpolicema.com www.everett.k12.ma.us www.everettrec.com www.facebook.com/ Everettcommunitygrowers Everett Family Health Center Everett Teen Health Center Community Planning and Development Energize Everett Health Department Human Services and Literacy Programs Police Department Public Schools Recreation Department Everett Community Growers Everett Community Health Partnership Substance Abuse Coalition For Kids Only Afterschool Grace Episcopal Church Hallmark Health Immaculate Conception Church Joint Committee for Children’s Health Care La Communidad, Inc. Malden YMCA MGH Everett Family Care Metro Mayors Shannon Grant Community Safety Initiative Mystic Valley Elder Services North Shore Evangelical Missionary Church Our Lady of Grace Portal to Hope Tri-City Community Action Program, Inc. Whidden Memorial Hospital Zion Baptist Church www.makethedifferenceE.org www.fkoafterschool.org www.graceepiscopal www. churcheverett.org www.hallmarkhealth.org www.parishesonline.com/iceverett www.jcchce.org www.lacomunidadinc.org www.ymcamalden.org www2.massgeneral.org/primarycareweb/ primary_everett_hours.htm www.mass.gov/eopss/funding-and-training/ justice-and-prev/grants/shannon-csi/ shannon-csi-grant-overview-and-annualreports.html www.mves.org www. nsemc.org www. ologp.net www.portaltohope.org www. tri-cap.org www.challiance.org/Locations/ WhiddenHospitalCampus.aspx www.zionchurchministries.com 617-843-0700 781-388-6200 617-387-9100 617-394-2300 (Parlin) & 617-394-2308 (Shute) 617-389-2100 617-394-2245 617-389-2120 617-394-2255 617-394-2260 617-389-2120 617-394-2400 617-394-2390 617-394-7632 617-591-6927 or 617-591-6808 978-740-5437 617-387-7526 781-979-3000 781-389-5660 617-394-2414 617-387-9996 781-324-7680 617- 394-7500 see website 781-324-7705 781-420-0416 617-884-0030 781-338-7678 781-322-4190 617-389-6270 617-389-8357 * The list above is intended to include a sampling of resources beyond the local programs and community partners. The list is not comprehensive. The Well-Being of Everett • 2014 Health Assessment Report 119 xx Appendix Tables • According to the US Census 2011 American Community Survey, Everett’s population size is 41,079 residents; an 8% increase compared to the 2000 Census. Everett 2000 Everett 2011 MA 2011 38,037 41,079 6,512,227 Under 5 Years 5.9% 6.7% 5.6% 5 to 14 Years 12.3% 12.1% 12.2% 15 to 24 Years 12.4% 11.8% 14.3% 25 to 34 Years 18.4% 18.1% 12.9% 35 to 44 Years 16.4% 15.3% 14.0% 45 to 64 Years 19.9% 24.5% 27.4% 65 and Older 14.8% 11.7% 13.7% 35.6 35.6 38.9 Not Hispanic or Latino 90.5% 81.8% 90.7% White Alone, Not Hispanic or Latino 75.2% 61.6% 76.9% Black or African American Alone 6.0% 13.2% 6.1% Asian Alone 3.2% 3.3% 5.3% Other† 6.3% 3.9% 2.4% Hispanic or Latino (any race) 9.5% 18.2% 9.3% Total Households 15,435 15,681 2,522,409 Households with individuals under 18 years 30.2% 33.3% 31.6% Households with individuals age 65 or older 26.8% 22.9% 25.1% Householder age 65 or older living alone 11.8% 10.5% 10.7% Demographics Population Count Age Median Age (in years) Race 120 The Well-Being of Everett • 2014 Health Assessment Report Everett 2000 Everett 2011 MA 2011 Educational Attainment (Age 25 Years & Over) 26,399 28,542 4,419,291 Less Than High School 23.8% 19.9% 11.1% High School Graduate (Includes Equivalency) 40.3% 38.3% 26.3% Some college 21.2% 25.4% 23.9% Bachelor’s degree 10.1% 11.3% 22.1% Master’s degree 3.4% 3.8% 11.6% Professional school degree 0.9% 0.9% 2.7% Doctorate degree 0.3% 0.5% 2.2% Native Born 78.1% 64.0% 85.3% Foreign Born 21.9% 36.0% 14.7% Foreign-Born Population 8,323 14,794 957,402 Europe 19.8% 12.4% 24.3% Asia 13.1% 6.9% 28.7% Africa 7.0% 7.5% 8.1% Americas 60.1% 73.0% 38.6% -Latin America 58.1% 72.7% 35.3% --Central America 18.3% 19.4% 8.7% --South America 25.8% 35.6% 11.5% -Northern America 2.0% 0.3% 3.2% Demographics Nativity Place of Birth For the Foreign-Born Population DATA SOURCES AND NOTES: Everett 2000 data based on year 2000 US Census Everett and MA 2011 data based on 2007 -2011 American Community Survey Estimates †Other includes 'American Indian and Alaska Native Alone,' 'Native Hawaiian and Other Pacific Islander Alone,' 'Some Other Race Alone,' and 'Two or More Races' The Well-Being of Everett • 2014 Health Assessment Report 121 xx Top 20 Causes of Death (3-year average 2008-2010) Everett Cause of Death Count (N=892) Massachusetts Percent Ageof all Adjusted Count Causes Rate Per (N=157,676) of Death 100,000 Percent of all Causes of Death AgeAdjusted Rate Per 100,000 Heart Disease 201 22.5 149.6 37,069 23.5 155.0 Lung Cancer 91 10.2 72.6 10,663 6.8 48.4 Mental Disorders, All 75 8.4 52.6 11,081 7.0 44.3 Chronic Lower Respiratory Disease, Other 40 4.5 29.5 6,703 4.3 29.4 Pneumonia and Influenza 30 3.4 21.4 4,219 2.7 17.4 Cerebrovascular Disease 28 3.1 20.4 7,692 4.9 32.0 Breast Cancer (Female) 13 1.5 18.0 2,657 1.7 20.8 Poisoning, All 19 2.1 16.2 2,647 1.7 13.1 Colorectal Cancer 20 2.2 16.2 3,457 2.2 15.1 Septicemia 22 2.5 15.9 2,293 1.5 9.9 Nephritis, Nephrosis 20 2.2 14.4 4,020 2.6 17.1 Renal Failure 20 2.2 14.4 3,744 2.4 15.9 Prostate Cancer 7 0.8 13.5 1,867 1.2 21.6 Pancreas Cancer 17 1.9 12.8 2,520 1.6 11.2 Opioid Injuries 13 1.5 11.0 1,776 1.1 8.9 Diabetes Mellitus 13 1.5 10.1 3,103 2.0 13.6 Chronic Liver Disease 12 1.4 10.0 1,742 1.1 7.8 Alzheimer’s Disease 13 1.5 9.6 5,289 3.4 21.0 Liver Cancer 12 1.4 9.6 1,401 0.9 6.2 Homicide 9 1.0 7.5 552 0.4 2.8 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, Massachusetts Department of Health 122 The Well-Being of Everett • 2014 Health Assessment Report Top 20 Causes of Hospitalization (3-year average 2007-2009) Everett Massachusetts Cause of Hospitalization Count (N=16,460) Percent of all Hospitalizations Ageadjusted Rate per 100,000 Childbirth, Pregnancy, Puerperium 2,084 12.7 3533.5 239,818 10.0 2594.0 Diabetes Mellitus Related 3,015 18.3 2430.3 429,888 17.8 1982.3 COPD Related 2,922 17.8 2397.2 444,403 18.5 2092.9 Circulatory System Diseases 2,007 12.2 1584.9 339,156 14.1 1536.8 Mental Disorders 1,309 8.0 1149.6 156,944 6.5 779.7 Digestive System Diseases 1,333 8.1 1118.4 220,619 9.2 1046.4 Asthma Related 1,185 7.2 1033.7 185,915 7.7 913.2 Genitourinary Diseases 706 4.3 567.5 116,186 4.8 541.5 Alcohol / Substance Related 601 3.7 520.9 67,820 2.8 333.8 Musculoskeletal Diseases 623 3.8 508.6 129,420 5.4 604.2 Opioid 579 3.5 494.9 56,506 2.4 284.3 Falls 528 3.2 407.1 87,115 3.6 389.1 Infectious & Parasitic 475 2.9 391.7 72,783 3.0 341.7 Pneumonia and Influenza 430 2.6 354.2 72,901 3.0 342.4 Bacterial Pneumonia 385 2.3 315.7 64,337 2.7 300.7 Skin Diseases 315 1.9 271.4 41,961 1.7 201.4 Nervous System Diseases 274 1.7 234.0 48,074 2.0 229.9 Bronchitis / Chronic & Unspecified 280 1.7 223.3 41,870 1.7 192.2 Blood Diseases 147 0.9 120.0 25,188 1.1 120.6 Acute Respiratory Infections 122 0.7 115.4 14,854 0.6 80.7 Percent Count of all (N=2,409,215) Hospitalizations Ageadjusted Rate per 100,000 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, Massachusetts Department of Health The Well-Being of Everett • 2014 Health Assessment Report 123 xx Top 10 Causes of Hospitalizations, Ages 15-29 years (3-year average; 2007-2009) Everett Massachusetts Percent of all Causes Percent of all Causes Childbirth, Pregnancy, Puerperium 55.47 46.02 Mental Disorders 14.72 14.56 Opioid Injuries 8.81 7.16 COPD Related 7.59 9.88 Asthma Related 7.31 9.48 Alcohol / Substance Related 6.27 5.66 Digestive System Diseases 4.91 7.65 Diabetes Mellitus Related 3 2.89 Genitourinary Diseases 2.45 2.55 Skin Diseases 2.04 1.67 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH Top 10 Causes of Hospitalizations, Ages 65 years or older (3-year average; 2007-2009) Everett Massachusetts Percent of all Causes Percent of all Causes Diabetes Mellitus Related 31.53 28.25 COPD Related 27.6 26.06 Circulatory System Diseases 23.35 25.09 Digestive System Diseases 8.95 9.65 Falls 6.7 6.72 Genitourinary Diseases 6.68 6.94 Musculoskeletal Diseases 5.75 6.72 Pneumonia and Influenza 4.27 4.67 Asthma Related 4.25 5.59 Bacterial Pneumonia 3.92 4.2 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH 124 The Well-Being of Everett • 2014 Health Assessment Report Top 20 Causes of Emergency Department Visits (3-year average; 2007-2009) Everett Massachusetts Count (N=16,460) Age Adjusted Rate per 100,000 Age Count Adjusted (N=2,409,215) Rate per 100,000 Musculoskeletal Diseases 4,250 5572.4 563,937 2817.4 Falls 3,728 3813.8 561,121 2872.3 Nervous System Diseases 3,442 3475.6 375,615 1985.3 Acute Respiratory Infections 3,364 3235.9 365,416 1966.9 COPD Related 2,963 3055.5 367,257 1888.1 Mental Disorders 2,834 2648.5 365,293 1850.9 Skin Diseases 2,742 2526.4 327,193 1672.3 Digestive System Diseases 2,635 2447.0 352,534 1818.5 Asthma Related 2,549 2436.0 251,810 1332.1 Injuries - Struck by, against Genitourinary Diseases Injuries - Overexertion Childbirth, Pregnancy, Puerperium Diabetes Mellitus Related Infectious & Parasitic Injuries - Cut/Pierce Alcohol / Substance Related Traumatic Brain Injuries Circulatory System Diseases Pneumonia and Influenza 2,476 2,216 1,118 2394.7 2180.2 2008.3 344,027 292,524 245,290 1841.4 1476.4 1274.2 2,150 1948.9 102,720 1074.9 2,167 1,642 1,664 1,392 1,354 726 607 1825.9 1556.9 1500.1 1227.2 1214.0 605.8 568.2 263,217 181,680 207,844 152,495 165,032 112,471 82,274 1237.7 984.0 1069.8 758.5 855.2 528.1 437.5 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH The Well-Being of Everett • 2014 Health Assessment Report 125 xx Top Causes of Emergency Department Visits, Ages 15 to 20 years (3-year average 2007-2009) Everett Massachusetts Percent of all Causes Percent of all Causes Musculoskeletal Diseases 8.4 6.1 Acute Respiratory Infections 5.7 5.6 Genitourinary Diseases 5.5 5.5 Injuries - Struck by, against 5.1 6.4 Mental Disorders 4.9 5.9 COPD Related 4.8 4.4 Skin Diseases 4.7 4.8 Injuries - Motor Vehicle Related 4.6 4.6 Injuries - Falls 4.5 4.8 Digestive System Diseases 4.3 5.8 Asthma Related 4.3 3.6 Nervous System Diseases 4.3 4.4 Childbirth, Pregnancy, Puerperium 4.2 3.7 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH 126 The Well-Being of Everett • 2014 Health Assessment Report Top Causes of Emergency Department Visits, Age 65 years or older (3-year average 2007-2009) Everett Massachusetts Percent of all Causes Percent of all Causes Diabetes Mellitus Related 14.2 11.9 Falls 13.8 14.4 Musculoskeletal Diseases 11.5 9.2 COPD Related 7.1 9.4 Nervous System Diseases 5.1 3.4 Circulatory System Diseases 4.4 5.9 Skin Diseases 4.4 4.3 Digestive System Diseases 4.2 4.3 Traumatic Brain Injuries 4.2 3.4 Genitourinary Diseases 3.7 5.0 Mental Disorders, All 3.4 2.4 Asthma Related 2.3 1.8 Acute Infections 2.0 2.2 SOURCE: Registry of Vital Records and Statistics, Bureau of Health Statistics, Research and Evaluation, MDPH The Well-Being of Everett • 2014 Health Assessment Report 127 xx The 10 Essential Public Health Services Public Health is a population based approach to promote health and prevent disease in order to reduce the burden of printable illness and injury. Public Health efforts at their best help reduce overall health costs and are essential in creating high quality of like for everyone who live in the United States. The motto most community used to describe Public Health Efforts is “Prevent, Promote and Protect.” The 10 Essential Public Health Services listed below can be defined as a consensus statement that defines Public Health within the context of a larger health system. Public Health efforts are models of partnership: In Massachusetts, the 10 Essential Services are provided to our residents through the combined efforts of local and state public health entities 1. Diagnose and investigate health problems and health hazards in the community. 2. Inform, educate, and empower people about health issues. 3. Mobilize community partnerships and action to identify and solve health problems. 4. Develop policies and plans that support individual and community health efforts. 5. Enforce laws and regulations that protect health and ensure safety. 6. Link people to needed personal health services and assure the provision of healthcare when otherwise unavailable. 7. Assure competent public and personal healthcare workforce. 8. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 9. Research for new insights and innovative solutions to health problems. SOURCE: www.cdc.gov/nphpsp/ essentialservices.html 128 The Well-Being of Everett • 2014 Health Assessment Report
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