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OWENSBORO-DAVIESS COUNTY HEALTH 2000 REPORT

View COMPILATION OF KEY FINDINGS & IMPRESSIONS-ISSUES

Contents

Acknowledgments

Executive Summary

Introduction

Demographics

Health Status

Disease Burden

Health Behaviors

Health Care Access

Health Insurance

Predictors of Health

Acknowledgments

The community health needs assessment for the Green River District was conducted by the staff of the Center for Health Services Management and Research of the University of Kentucky. Dr. Carol L. Ireson served as project director. Misook Chung, PhDC and James Schwar, MS were the research assistants.

The health needs assessment in this report is the first stage of a journey to improve the health status of the citizens of the Green River Area. The entire project was conducted under the auspices of the Public Life Foundation of Owensboro in partnership with the City of Owensboro, Daviess County, Hager Educational Foundation, Messenger-Inquirer, Owensboro Mercy Health Systems, Audubon Area community Services, Green river district Health Department, River Valley Behavioral Health, United Way of the Ohio Valley, Hancock, Henderson County, McLean County, Ohio County, Union County, Webster County, Ohio County Hospital, Yeager Foundation, Henderson Methodist Hospital, Methodist Hospital Union county, city of Henderson, The Gleaner, Preston Family Foundation, Henderson County School System. We wish to thank Mr. John Hager of the Public Life Foundation for providing his time, energy, and resources during the development and implementation of the project. We appreciate the time of the Health Council in providing overall direction for the project.

We also appreciate the input of the over 1800 citizens who answered the survey and thereby contributed to enhancing the quality of life for themselves and their neighbors.

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EXECUTIVE SUMMARY

The University of Kentucky Center for Health Services Management and Research conducted a comprehensive assessment of the health status, access to care, and health insurance coverage for the people in Daviess County. We used qualitative and quantitative methods including telephone surveys, personal interviews, and mailed questionnaires to gather information from citizens, physician, and other health care professionals. The core components of the assessment were an analysis of secondary health data and a random digit dial telephone survey of households conducted by the University of Louisville Urban Studies Institute. Our 1720 household sample for the seven county area compares favorably to the 2,397 interviews conducted for the statewide Kentucky Health Interview Survey. Nearly 40% of the respondents were from Daviess County. The survey consisted of 91 questions concerning health status, health promotion behaviors, access to health care, and affordability of health care. A mailed survey to area physicians and interviews with other health professionals provided data to enrich the assessment. The findings from the telephone survey agree reasonably well with information gathered from other surveys of the region and with the physician survey increasing the confidence in the information. The survey also gives new information about the region and provides a baseline for measuring progress toward the Healthy Kentucky 2010 objectives.

Health Insurance. The 9% of individuals in Daviess County without insurance at some time during the last year is higher than the GRADD, but lower than the 14% rate for Kentucky Thirty-three percent of the respondents had children under the age of 18 living in their household. Of the households with children, 83 or 36% were eligible for K-Chip coverage based on income and of those eligible, 17 (20%) were enrolled in K-Chip. Nearly 16% or 13 households with children had no insurance and the children were not enrolled in K-Chip. One-fourth (21%) of persons in the telephone survey indicated they could not afford needed medical care. The 21% included people with health insurance Twenty per cent could not afford medications, and 24% could not dental care. The physician respondents also reported that 21% of their patients go without needed care and cannot get needed medications because of cost.

Access to Care. The majority (78%) had access to a primary care provider, 92% have a place where they usually receive their medical care, and 77% had routine medical check-ups. The 22% without a primary care provider is lower than the state, despite the smaller ratio of PCPs to the population than statewide. Of the households with children, 75% had a primary care provider. The poor and uninsured did not have a usual source of care. A large percent (43%) visited the emergency room within the past year and 30% had 2 or more visits.

A large percent reported being satisfied with the total health services provided in their area with 94% rating it good, very good, or excellent. The uninsured and poor were less satisfied.

Health Status. The overall health status of the survey respondents was positive with respondents reporting higher physical health, mental health, role functioning, and health related quality of life than the average Kentucky resident reported on the Kentucky Health Survey. Those with less education and lower incomes had significantly lower health status scores in all areas.

Disease Burden. The questions about health conditions were based on an analysis of the most common conditions in Kentucky and the most common diagnosis seen at the areas two largest health care facilities. Arthritis emerged as the most common chronic condition of the seven conditions we asked about with 30% of all ages combined reporting having physician-diagnosed arthritis. Hypertension affects more Daviess County residents (28%) than other Kentucky residents (24%). The cardiovascular death rate is the leading cause of death but the death rate is lower than the GRADD and the rest of the state. The number of respondents with diabetes (8.4%) was also higher than the GRADD and the state rate of 4.4%. Over 12% have asthma; the estimates for the state is 17%.

Cancer is the second leading cause of death. Eight percent or 51 people reported having had cancer. The cancer incidence for the major cancers including breast, cervical, prostate are lower than the rest of the state as are cancer deaths, except for the incidence of lung cancer. The mortality from lung cancer is lower than the GRADD but higher than the state. This finding for lung cancer likely indicates a lack of early diagnosis.

An area of concern was the high percentage (18%) of female respondents or members of the household (21%) who had low birth weight babies. This was significantly correlated with the high percentage (26%) of women who smoked during pregnancy. Education and income were not significant factors.

Health Behaviors. A very high percentage, (55%), of respondents had smoked, higher than the GRADD. The GRADD ranks third among the ADDs in the percentage of smokers. Smoking was related to being male but not education and income. Additionally, the number of pregnant women who smoked was very high. These finding suggest a need for intensive attention smoking cessation programs and prevention for all ages.

One of the most significant findings from the survey is the percentage of Daviess County residents who are overweight and obese. Those considered normal weight comprised only 42% as compared to the 32% of the Kentucky population, while a total of 58% were overweight (33%), and obese (25%). A very positive finding was the 36% (approaching the 2010 goal of 40%) who consumed the "Five-a-Day"--the nationally recommended number of servings of fruits and vegetables, 30% the recommended grains, and 32% the recommended red meat intake. Being female and lack of exercise, but not dietary habits were the most significant predictors of being overweight and obese. The 56% reporting physical activity either work or exercise 3 times per week, much higher than the state and national number, may be related to over reporting.

Potential Daviess County Priorities for Health Kentucky 2010:

Disease Burden

• Cancer Mortality
• Low Birth-weight Babies
• Hypertension
• Obesity

Health Behavior

• Smoking
• Mammograms
• Cervical Screening
• Exercise

Health Care Access

• Increase the numbers of primary care providers

Health Insurance

• Coverage for kids

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Owensboro/Daviess Survey 2000

A random digit dial telephone survey was conducted in the months of March, April, May and June of 2000 by the University of Louisville Urban Studies Institute. The random process was chosen to insure that the survey was representative of the population. The percent of people with a telephone in Owensboro/Daviess County is greater than the state percent as a whole. Studies from the Center for Disease Control in Atlanta found that random digit dial produces a higher response rate than other survey methods. They also found that those who are without a telephone this month had one last month or will have one next month indicating that this type survey indeed samples those without telephones.

The following describes the results of the survey questions, the relationships among the various issues related to health status, health care access, affordability, accessibility, and health insurance coverage:

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1. DEMOGRAPHICS

The 679 people who responded to the survey were predominately female, (68%) and white (95%); 4% were African-American, 1% multiracial and other representing less than one-percent each. The 1997 population in Daviess County was 52% female and 4.4% Black/African-American. The majority (61%) were married, 14% widowed, 15% divorced or separated and 10% single. Over one-third had children under 18 years living at home (GRAPH 1).

The majority of the respondents, 53%, worked full-time outside of the home, 10% worked part-time, 15% were retired and 23% were not employed. Those not employed outside the home included those who were disabled (3.8%), in school (1.8%), or keeping house (16%). Of those not employed outside the home only 1.5% considered themselves unemployed and looking for work.

Twenty percent had a college education, 29% had some college, 37% completed high school, and the remaining 13% had less than a high school education. On the whole women were more educated than men.

Nearly 11% of the respondents reported annual income of less than $10,000 with an additional 29% earning less than $30,000 (GRAPH 2). The median household income was $34,500 (GRAPH 3). The elderly reported less with 65% under than $10,000 per year.

Home ownership was high with nearly 76% owning their home. Less than half of the respondents (45%) had access to the Internet from home, 40% of the women and 54% of the men.

Table 1. Demographics of Survey

2. HEALTH STATUS

The questions concerning health status cover physical functioning, role functioning, pain experience, mental health, and current health perceptions and were worded the same as the questions asked on the Kentucky Health Survey. Questions were grouped and scored from 0 to 100, with 0 indicating worst health and 100 best health. Scores were analyzed for adult respondents, using groupings of young through middle adults (18 - 64) and older adults (65+); and for males and females. Comparisons also were made between income levels, education, access to health care, and insurance status.

Overall, Daviess County respondents reported higher health related quality of life scores than those of the general Kentucky population from the Kentucky Health Survey (GRAPH 4). Over 81% of the respondents rated their health as good, very good, or excellent; 12% rated it as fair, and 7% reported poor health (GRAPH 5). There were no differences between men and women in health rating. Finally, the health perception score for all ages of 79.9 exceeded the 67.5 reported for the average Kentucky resident (GRAPH 6).

• Physical health. The average physical functioning score for all respondents was 87.9, higher than the 83.1 reported by Kentuckians as a whole. Women reported lower physical functioning scores than men

• Role functioning. The role functioning score 88.3 compared favorably to the 81.0 for the rest of the state.

• Mental health. The average mental health score of 79.9 was higher than the 74.9 for other Kentucky residents. As was true for other Kentucky residents, there were gender differences with men reporting higher mental health scores (81.4) than women (79.2), however the difference was not statistically significant. Those over 65 years had significantly lower mental health scores than those younger than 65.

In contrast to the findings from the Kentucky Health Survey for the whole state, there was no difference between Owensboro/Daviess men and women in role functioning, mental health or health perceptions. Education and income, on the contrary, made a significant difference in all indicators of health status; those with more education had better physical and mental health status, higher role functioning scores and viewed their health as better. The same was true for income; those with higher incomes had significantly higher scores in all indicators of health status.

For women the things that contributed significantly to positive health were diet, exercise, having mammograms, and pap smears, and higher income; having health insurance contributed but not as significantly. For men, diet, exercise, a higher income and having health insurance contributed significantly to positive health.

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3. DISEASE BURDEN

The questions about health conditions were based on an analysis of the most common conditions in Kentucky and the most common diagnosis seen at the areas two largest health care facilities, and the leading causes of death in the GRADD (GRAPH 7). The respondents were asked if a doctor or other health care provider had told them they had the following conditions. The results are compared to the goals for the Healthy People 2010 for Kentucky and the nation.

3.1 Heart Disease and Stroke

Objective of Kentucky Health 2010 (20.3): To decrease to at least 20% the proportion of adult Kentuckians with high blood pressure.

Over one fourth of the respondents, 26%, have been told that they have high blood pressure, higher than the 24.4% reported statewide (GRAPH 8). Hypertension is a risk factor for cardiovascular and cerebrovascular disease, the leading cause of death in the GRADD.

Objective of Kentucky Health 2010 (20.1): To reduce heart disease deaths to no more than 200 deaths per 100,000 people (age adjusted to the year 2000 standard population).

Thirteen percent (13%) reported a diagnosis of heart disease. According to the Kentucky Annual Vital Statistics Report, the age adjusted rate death of health disease in Daviess in 1997 was 210.1, lower than the GRADD rate of 223.1 and the Kentucky rate of 230.1. Over 40.3 % of the total deaths in Daviess County were from heart disease (31.1%) and cerebrovascular disease (9.25%) in 1997 (GRAPH 7a).

Table 2. Death by Heart Disease — Age adjusted rate

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

Objective of Kentucky Health 2010 (20.2): To reduce cerebrovascular death to no more than 35 deaths per 100,000 people (age-adjusted to the year 2000 standard population).

Four percent (4%) of Daviess County respondents have experienced a stroke compared to 3% of GRADD respondents. In 1997 cerebrovascular death rate in Daviess County was 59.6 per 100,000, similar to the GRADD (60.5), but higher than the Kentucky rate of 44.6.

Table 3. Death by Cerebrovascular disease - Age adjusted rate per 100,000 populations.

3.2 Respiratory Diseases

Objective of Kentucky Health 2010 (24.1): Reduce the asthma death rate to no more than 14 per million population.

Over 12% of the respondents reported a diagnosis of asthma. Although there is no statewide collection of asthma prevalence, the statewide estimate is 220,000 cases for the total population for an estimated rate of 17.76%. Medicaid data showed a 7% rate for Region 2 that includes Owensboro/Daviess County (GRAPH 9).

Nearly 9% of the respondents suffer from chronic lung disease. The mortality of chronic obstructive pulmonary disease in Daveiss County was the highest among the counties in GRADD in 1997. Eighteen percent had the flu this past year, more younger respondents than elderly; 14% have been diagnosed with pneumonia.

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

3.3 Arthritis

In the health history, arthritis is the most common chronic illness reported with 30% reporting this diagnosis. The Kentucky Health Interview survey also reported arthritis as the most common condition with a rate 16% for the state. Although there is not a Healthy Kentuckians 2010 related to arthritis, the number reporting problems with arthritis suggest that the burden of the disease is significant and will likely increase as the population ages. The elderly did not report a higher rate than respondents between 18 and 65 years did.

3.4 Diabetes

Objective of Kentucky Health 2010 (18.2): Slow the rise in the prevalence of diagnosed diabetes to no more than 7% of the population 18 years and older.

Over 8.4% of the survey respondents reported a diagnosis of diabetes, higher than the 8% for GRADD respondents. The 1995-1997 BRFSS indicated that 5.1% of the adult population in GRADD had been diagnosed with diabetes, higher than Kentucky rate of 4.5% (GRAPH 10).

Objective of Kentucky Health 2010 (18.3): Slow the rise in the diabetes death rate (diabetes as a primary/underlying cause) to no more than 28 per 100,000 persons.

The diabetes mortality rate of 27.5 for the Daviess is lower than the GRADD and state, meets the 2010 goal (GRAPH 11).

Table 5. Diabetes mortality - Crude rate (case number)

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

3.5 Cancer

Objective of Kentucky Health 2010(17.1): To reduce cancer deaths to a rate of no more than 220.7 per 100,000 people in Kentucky.

Cancer is the second leading cause of death in Daviess County. Nearly 8% of respondents, 51 people reported having had cancer. A total of 206 people, (23.5% of total deaths) died from the cancer in 1997 (GRAPH 12). The age adjusted cancer mortality rate was 182.2 in Daviess, lower than Kentucky rate of 188.5 and the GRADD rate of 192.7.

Table 6. Death from the cancer - Crude rate per 100,000 population (case number)

According to data from the Kentucky Cancer Registry, the age adjusted incidence rate in Daviess for all cancer sites in 1998 was 399.62 per 100,000 population, which is lower than the age adjusted rate for Kentucky (421. 8). A total of 453 cases of cancer were diagnosed in Daviess County in 1998. The sites with the highest indecencies were lung (91), breast (76), colorectal (50), and prostate (39) cancer.

Table 7. Cancer incidence rate in 1998

3.5.1 Lung Cancer

Objective of Kentucky Health 2010(17.2): To reduce lung cancer deaths to a rate of no more than 80.7 per 100,000 people in Kentucky.

Lung cancer deaths (89.2) are higher than those of the state (80.4) (GRAPH 13). According to the Kentucky Cancer registry, the total incident cases of lung cancer were 91 in Daviess during 1998, and male lung cancer cases accounted for 60.5% of total lung cancer cases. The age adjusted incidence rate of lung cancer per 100,000 was 86.41 (218 cases) in

1998. The crude incident rates of lung cancer in Daviess (99.85) were higher than the GRADD (88.16) in 1998. Lung cancer in men (111) accounted 22.2 % of the total male cancer cases.

Table 8. Death from lung cancer — Crude rate per 100,000 population (Case number)

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

3.5.2 Breast Cancer

Objective of Kentucky Health 2010(17.3): Reduce breast cancer deaths to a rate of no more than 22.5 per 100,000 women in Kentucky.

The breast cancer mortality rate in Daviess County (33.8) is higher than the State rate of 30.6 and significantly higher than the 2010 goal of 22.5.

Table 9. Death from breast cancer - Crude rate (case)

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

3.6. Maternal, Child Health

3.6.1 Infant Mortality

Objective of Kentucky Health 2010 (12.1): To reduce the infant mortality rates to no more than 6 per 1,000 live births.

In 1997, the Daviess County mortality rate was 4.0 per 1,000 live births, lower than Kentucky (7.2) and the GRADD (6.2) rate (GRAPH 14). However, the infant mortality rate for non-whites in Daviess County (14.1) is over twice that of Kentucky, and the second highest county among the GRADD counties.

Table 10. Infant mortality rate - Crude rate per 1,000 live birth (case number)

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

3.6.2 Teenage Pregnancy

Objective of Kentucky Health 2010 (11.6): To reduce pregnancies among females age 15-17 to no more than 45 per 1,000 adolescents.

Teenage mother (under age 19) is decreasing. However, during 1997, a total of 196 births were give by teen mothers. The percent of teenage mother in the total birth in Daviess (15.7%) were lower than the Kentucky (16.33%), and the GRADD (17.72%).

Table 11. Percent of births to teen mothers

	Kentucky	Green River	Daviess
1995	17.2	19.1	16.6
1996	17.0	17.8	16.3
1997	16.3	17.7	15.7

3.6.3 Low Birth Weight Babies

Objective of Kentucky Health 2010 (12.12): To reduce the incidence of low birth weight to no more than 5% (baseline 6.4%), very low birth weight to no more than 1% (baseline: 1.3% white and 3.0% nonwhite), and reduce the incidence of premature birth to no more than 7.6% (baseline: 6.1% white and 9.1% nonwhite) of all live births.

Low birth weight infants are infants weighing less than 2500 grams or about 5 1/2 pounds. Low birth weight infants are less likely to survive and at higher risk of disability if they live. Overall, 18% of the respondents who had given birth reported they had a baby weighing less than 5 1/2 pounds at birth. Of those 93% received prenatal care while pregnant. Another 21% reported that a female member of their household had a baby weighing less than 5 1/2 pounds and 97% of those had prenatal care. Nearly 40% of mothers of low birth-weight babies had a high school education and 25% had some college. Having a low birth-weight baby was not related to income. Nearly one-third earned less than $20,000 annually, but slightly more, 36% was in households with incomes between $40,000 and $80,000. More of those having a low birth-weight baby had insurance at the time of the survey, however their insurance status at the time of the pregnancy is not known.

In Daviess County, the incidence rate of low birth weight is decreasing. The low birth weight rate was 7.7 per 100 live birth similar to the state rate (7.8%), but lower than the GRADD rate (8.6%) during 1997 (GRAPH 15).

The rate of low birth weight is very high for the teen mother. In 1997, the incident rate of low birth weight by teen mother of total birth was 9.69, higher than Kentucky (9.4%), but lower than the GRADD rate (10.7 %).

	Kentucky	GRADD	Daviess	Hancock	Henderson	McLean	Ohio	Union	Webster
1994	7.7	9.3	9.5	10.9	9.9	5.1	7.2	9.6	9.6
1995	7.6	8.8	8.7	7.4	9.9	11.2	8.4	6.8	9
1996	7.9	8.8	8.6	6.1	10.8	12.5	8.3	8.9	4.7
1997	7.8	8.6	7.7	8.9	8.6	11.5	11.6	10	7.3

Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

Objective of Kentucky Health 2010 (3.4): Reduce cigarette smoking among pregnant women to a prevalence of no more than 20 percent.

Of those females having a low birth weight baby, 26% smoked while pregnant. Another 21% reported that a female member of their household had a baby weighing less than 5 1/2 pounds at birth and of those 21% smoked while pregnant. Smoking during pregnancy was the most significant risk factor for having low birth-weight infants (GRAPH 15a).

3.7 Mental Health

Nearly 10%, two-thirds women, reported that they needed to talk with a mental health professional within the last year. There is no state data related to need for mental health care. However, approximately 20% of the U.S. population are affected by mental illness during a given year and depression is the most common disorder.

One percent reported that they or a member of their family had attempted suicide in the last year. The state age adjusted death rate of suicide is 11.7 per 100,000.

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4. HEALTH BEHAVIORS

In this section the health habits, behaviors, and risk factors of illness are analyzed.

Heart disease and cancer are the leading causes of death in the Daviess County and the following Kentucky Health 2010 objectives relate to health habits, behaviors, and risk factors that contribute to a reduction in the rate by 2010.

4.1 Blood Pressure

Ninety-one percent (91%) reported getting their blood pressure checked within the last year; this did not differ by sex. Twenty-six (26%) of those had high blood pressure. There is not a state 2010 goal related to monitoring blood pressure.

4.2 Cholesterol Screening

Objective of Kentucky Health 2010 (20.4): To increase to at least 85% the proportion of adults who have had their blood cholesterol checked within the preceding five years.

Seventy-five percent (75%) had their cholesterol checked within the last 2 years and 85.6% in the last 5 years meeting the Healthy Kentucky 2010 goal.

4.3 Smoking

Objective of Kentucky Health 2010 (3.1): Reduce the proportion of adults (18 and older) who use tobacco products.

Fifty-five percent (55%) have smoked at least 100 cigarettes in their life, higher than the GRADD at 54%. The BFRSS reports 34.5 adults age 18 and older in the GRADD smoke, higher than the state rate of 30.1% and third among all Kentucky districts. Those who smoked were predominantly male and 69% had a high school or college education. Less than 2% use smokeless tobacco (GRAPH 16).

4.4 Mammograms

Objective of Kentucky Health 2010 (17.5): To increase to at least 85% the proportion of women ages 40 and older who have ever received a CBE and mammogram, and to at least 85% those ages 50 and older who have received a CBE and mammogram within the preceding one to two years.

Overall 67% of all women, compared to 65% in the GRADD in Survey 2000, reported having a mammogram within the last two years. This was related to income and having insurance and insurance type, but not education. The uninsured and those with Medicaid were less likely to have regular mammograms. More women over age 65 (84%) reported getting a mammogram within the last two years (GRAPH 17).

4.5 Cervical Screening

Objective of Kentucky Health 2010 (17.6): To increase to at least 95% the proportion of women ages 18 and older who have ever received a Pap test, and to at least 85% those who received a Pap test within the preceding one to three years.

Seventy-eight percent (78%) of women got a Pap smear in the preceding one to three years exceeding the state of 75.4%; and 97% of respondents had received a Pap test in their lifetime. The uninsured were less likely to get annual pap smears. Only 67% of elderly women had and pap test within the preceding 3 years (GRAPH 18).

4.6 Colorectal Screening

Objective of Kentucky Health 2010 (17.7): To reduce colorectal cancer deaths to no more than 23.5 per 100,000 people in Kentucky.

The survey respondents were asked about rectal or prostate exams. Nearly one half (49%) of all men and two-thirds, 64.3% of those over 65 had a prostate exam in the last year.

4.7 Immunizations and Infectious Diseases

Objective of Kentucky Health 2010 (22.12): Increase the rate of influenza immunization coverage for non-institutionalized adults 65 years of age or older to 75%.

Seventy-two percent (72)% of adults over 65 received flu shots in the last 12 months, well on the way to the 2010 goal. Over 43% of all respondents received a flu shot during the last fall or winter (GRAPH 19).

4.8 Physical Activity and Fitness

Objective of Kentucky Health 2010 (1.1): To reduce overweight to a prevalence of no more than 25% among Kentuckians ages 18 and over increase to at least 50% the prevalence of healthy weight (defined as a body mass index (BMI) greater than 19.0 and less than 25.0) among all people aged 20 and older.

Body mass index (BMI) is a calculation of height in inches divided by weight squared. A BMI less than 25 is considered normal; between 25 and 30 is overweight; and greater than 30 is obese. Those considered normal weight comprised 42%, while 33% were overweight, and 25% obese. Obesity significantly affected physical functioning ability. Being overweight was related to being female and lack of exercise but not to positive dietary habits. Positive dietary habits were defined as eating 5 or more fruits, vegetables, and grains; avoiding fast food; and a low fat and red meat intake (GRAPH 20).

Objective of Kentucky Health 2010 (1.2): To increase to at least 50% the proportion of Kentuckians ages 18 and over who engage regularly in physical activity for at least 20 minutes 3 or more times per week.

The number engaging in physical activity was very positive with 56% reporting they exercised at least times per week for 20 minutes, lower than the GRADD of 60% but. There was no difference between men and women. This number is much higher than that reported in the 1997 BRFSS that found 27% of the GRADD population meeting the physical activity goal. The rate for the state is 32.3% and for 15% the US as a whole is for the adult population raising concern about over reporting of exercise. The difference may be related to the fact that the question included exercise or work (GRAPH 21).

4.9 Nutrition

Objective of Kentucky Health 2010 (2.5): Increase to at least 40% the proportion of age 2 and older that meet the dietary guidelines’ minimum average daily goal of at least five servings of vegetables and fruits.

A healthy diet includes 5 or more servings of fruits and vegetables, 3-4 servings of grains or pasta, low intakes of fat and red meat. The 36% consuming the recommended amount of fruits and vegetables was much higher than the 16% GRADD as a whole. Thirty-two percent, (32%) consumed the recommended grains and 38% the recommended amount of red meat. Only 28% ate at fast food restaurants more than out 1-2 times per week. Women were more likely to eat the recommended amount of fruits and vegetables, red meat and fat, and to avoid eating fast food frequently (GRAPH 22).

4.10 Injury/Violence Prevention

Objective of Kentucky Health 2010 (7.13): Increase use of safety belts to 93% of motor vehicle occupants.

Three fourths (75.4%) use seatbelts all of the time; women use them more than men. Those who drank were more likely to not use seatbelts. The 1997 BRFSS data show that only 61.1% of individuals in GRADD report using a seat belt at all time (GRAPH 23).

4.11 Substance Abuse

Objective of Kentucky Health 2010 (26.12): Reduce alcohol consumption in Kentucky to an annual average of no more than 2 gallons of ethanol per person.

Objective of Kentucky Health 2010 (26.19): Reduce by half the proportion of persons who report having driven a vehicle, or riding with a driver who had been drinking, during the past month.

Forty-two percent (42%) reporting having at least one drink in the last month and 31% of those consumed more than two drinks when they drank. Only 2% admitted driving when they had drunk too much.

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5. HEALTH CARE ACCESS

Objective of Kentucky Health 2010 (10.6): Increase to at least 90 percent the proportion of people who have a specific source of ongoing primary care.

5.1 Usual Source of Care

Most of the respondents (92%) have a place where they usually receive their medical care and women were more likely to have a usual source of care than men (GRAPH 24). The site of care was most often a physician's office (80%) or clinic (13%), while 5% go to an emergency room or urgent treatment center, and 2% some other place (GRAPH 25). The poor used an emergency room or urgent treatment center as their only source of care. Of those without a usual source of care, 29% felt they did not need medical care, 23% were uninsured, 11% could not afford care and 6% did not believe in doctors. Those without a usual source of care considered themselves to be less healthy than those with a source of care. Having access to health care was related to income, insurance status, and gender but not race (GRAPH 25a).

The majority (77%) had routine medical check-ups and women were more likely to get them than men. Most (89%) have their check-ups at a physician's office, or clinic/health center (8%). Less than 1%, most often women, get their routine check-ups at an emergency room or urgent treatment center. Nearly 90% of all respondents and 92% of the elderly had a routine check-up within the last year.

Overall, those with a chronic illness, except for those with asthma, were more likely to have a usual source of care, a primary care provider, and get routine medical check-ups. This finding indicates a need for increased community wide attention to asthma. Those who had pneumonia or a stroke did not necessarily have a primary care provider.

Those with a usual source of care and routine medical check-ups were more likely to have their blood pressure monitored, cholesterol checked, get mammograms, pap smears, flu shots, and prostate exams. The same was true for those having a primary care provider except for pap smears indicating that those without a PCP get pap smears elsewhere. Having a usual source of care, routine medical check-ups, and a primary provider did not affect smoking behavior.

If the respondents needed to see a doctor during regular office hours the majority went to a physician's office (77%) or a clinic (8%). Nearly 4% however went to an emergency room for care during regular office hours. When the need arose to see a doctor after regular office hours, 79% go the emergency room and another 17% go to an UTC. Fifty-six percent of respondents or family members did not visit the emergency room in the last year, but 26% of respondents had 2 or more ER visits.

5.2 Primary Care Provider

Over three-fourths (78%) of the respondents, significantly more women than men, had a primary care provider. Having a PCP did not differ on the basis of race. The 22% without a PCP is lower than the state figure of 28.9%, but higher than the 17.1% for the US as a whole (GRAPH 25b). According to the Kentucky Board of Medical Licensure the GRADD has 64 PCPs per 100,000 compared to 78 for Kentucky. The Kentucky Cabinet for Health Services Primary Care Branch reports 41.6 PCPs for the GRADD compared to 56.3 for the state. Daviess County has 42.5 PCPs for 91,000 inhabitants or a rate of 46.7 per 100,000, higher than the GRADD but lower than the state.

Getting an appointment with their PCP required an average of 12 days but could wait as long as 90 days (GRAPH 26). Those with Medicaid, Medicare, and the uninsured waited longer for an appointment than those with private insurance. Once they had an appointment, the wait in the physician averaged 20 minutes and could be as long as 90 minutes (GRAPH 26a). Less than 19% of those who had to wait were dissatisfied with the wait, and this did not differ on the basis of insurance status. Only 18% had changed doctors in the last 2 years, 17% because the provider moved and 20% because they were dissatisfied.

The majority (74%), but not the uninsured, felt that their primary care providers spent as much time with them as they needed. The majority 82% also felt their physician involved them in medical decisions; women were more involved than men were. Most (87%) reported that their physician treated them with respect regardless of insurance status (GRAPH 27).

Nearly one-fourth, (21%), of the respondents reported that during the last year they or a family member needed to see a physician but did not because of the costs. Those who did not see a physician when they needed were more likely to be female, uninsured, and have incomes below the poverty level.

5.3 Medications

During the last year 18% of the respondents could not afford to fill their prescriptions, compared to 20% for the GRADD. Women, the uninsured, and those in poverty level were less likely to get the medications they needed.

5.4 Oral Health Care

Objective of Kentucky Health 2010 (9.9): Increase to at least 70% the proportion of adults aged 18 and older using the oral health care system each year.

Sixty-seven (67%) percent of respondents used the oral health care system in the last year and 79% had visited a dentist within the last two years. Over 13% had not visited a dentist for more than 5 years. Dental care visits were directly related to income, with 21% of the respondents having no dental care in the last two years and 24% not getting dental care when they needed it. Women did not differ from men in access to dental care. Those who did not see a dentist when needed made up 24% of the respondents, higher than the 21% who did not get needed medical care. When asked the reason, they consistently cited lack of money as the primary reason. Income was related to oral health care, those with lower incomes did not get dental care when needed.

5.5 Alternative Therapies

Only 16% of respondents use alternative therapies and those who do see a massage a chiropractor, 39%, therapist, 35%, or a herbalist, 21%.

5.6 Source of Health Care Information

Overall 59% of respondents, predominately women, get their health care information from a health care professional, followed by friends and family members, television, and magazines. Men were more likely to use television as the second most common source.

5.7 Satisfaction with Health Care

Overall satisfaction with all of the health care received was high with 94% rating it good, very good, or excellent. The uninsured and those below poverty level were less satisfied (GRAPH 28).

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6. HEALTH INSURANCE

Eight per cent (8%) reporting having no insurance coverage of any type and 9% were without insurance at sometime during the last year. Fewer residents of Daviess County were uninsured than the state rate of 14.1% and the U.S. at 16.3%. The uninsured were predominantly women. Women were more likely to be employed in part-time jobs that usually do not offer employer sponsored insurance coverage. Of those without insurance at some time during the last year, 40% could not afford to pay for insurance and an additional 21% lacked coverage because they lost or changed jobs. Significantly more of those living in poverty lack insurance and fail to get needed care. When those below the poverty level do get care they are unable to pay their medical bills and their credit is affected. Credit problems related to medical costs affected 18%, primarily those with annual incomes under $40,000. Nearly one-half of those living in poverty were elderly (37%) or uninsured (12%). This is very significant for the elderly because they require more medications and lack prescription drug coverage (GRAPH 29).

Table 13. Type of health insurance coverage

	Frequency	Percent
Your employer	708	41.45
Someone else’s employer	322	18.85
A plan that you or someone else buys on your own	61	3.57
Medicare	349	20.43
Medicaid or medical assistance	70	4.10
The military, CHAMPUS, TriCare or the VA	18	1.05
Some other source	44	2.58
No Coverage	136	7.96
TOTAL	1708	100

The majority of those who were insured (83%) felt that it was easy to the information that they needed from their health plan except for those with Medicaid.

Objective of Kentucky Health 2010 (10.1): Reduce to zero the proportion of children and adults without health care coverage.

Thirty-three percent (33%) of the 697 respondents or 230 households had children under the age of 18 living in their household. Of the households with children, 83 or 36% were eligible for K-Chip coverage based on income and of those eligible, 17 (20%) were enrolled in K-Chip. Of the eligible who did not have K-Chip, 53 or 80% had another source of insurance, but .13 or 16% of the children in eligible households had no insurance coverage.

Objective of Kentucky Health 2010 (10.6a): Increase to least 95 percent the proportion of children 18 years and under and who have a specific source of primary care.

Of the 230 households with children, 75% had a primary care provider.

Objective of Kentucky Health 2010 (10.7): Reduce to no more than 7 %, the proportion of individual/families who report that they did not obtain all of the health care that they needed.

Nearly one-fourth, (21%), of the respondents reported that there was a time during the last year when they needed to see a physician but did not because of the costs (GRAPHS 30 and 31). Those who did not see a physician when they needed were more likely to be female, uninsured, and have incomes below the poverty level.

During the last year 20% of the respondents could not afford to fill their prescriptions. Women, the uninsured, and those in poverty level were less likely to get the medications they needed.

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7. PREDICTORS OF HEALTH

A model for positive health was tested. All of the factors influencing health, exercise, diet, screening for risks, income, and insurance, were analyzed statistically to determine which factors influenced positive health for women and men. For women the things that contributed significantly to positive health were diet, exercise, having mammograms, and pap smears; higher income contributed but not as significantly. For men, exercise, having health insurance, and a higher income contributed significantly to positive health.

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