cape girardeau county public health center community health

CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER
COMMUNITY HEALTH ASSESSMENT
Cape Girardeau County Public Health Center
Community Health Assessment 2012
1
Table of Contents
INTRODUCTION ................................................................................................................................... 5
DEMOGRAPHIC / EDUCATION / SOCIOECONOMIC INDICATORS..................................................... 5
Age Analysis ........................................................................................................................................ 5
Race/Ethnicity Analysis ......................................................................................................................... 6
Household Demographics ..................................................................................................................... 6
Education ............................................................................................................................................ 6
Socio-Economic Indicators .................................................................................................................... 7
Household Income ............................................................................................................................... 7
Poverty ............................................................................................................................................... 8
Unemployment .................................................................................................................................... 8
ENVIRONMENTAL HEALTH RISK INDICATORS .................................................................................10
Housing..............................................................................................................................................10
Blood Lead .........................................................................................................................................10
Hazardous Waste Sites ........................................................................................................................11
Waste Water / Sewage Risks……………………………………………………………………………………………..
11
Physical Environment ..........................................................................................................................11
PUBLIC SAFETY / DOMESTIC VIOLENCE ...........................................................................................12
Index Crime Rates...............................................................................................................................12
Juvenile Crime ....................................................................................................................................12
Illegal Drug Use / Alcohol Abuse...........................................................................................................13
Child Abuse & Neglect .........................................................................................................................14
Domestic Partner Violence ...................................................................................................................15
UNINTENDED INJURY ........................................................................................................................16
Types of Injuries .................................................................................................................................16
Traffic Accidents Contributed to Drug or Alcohol Use: .............................................................................17
Age Groups Most Involved in Traffic Accidents .......................................................................................17
Work Related Injuries ..........................................................................................................................17
MATERNAL and CHILD HELATH INDICATORS ...................................................................................17
Late Prenatal Care...............................................................................................................................17
Births to Teens ...................................................................................................................................17
Repeat Births under Age 20 .................................................................................................................18
2
Smoking During Pregnancy ..................................................................................................................19
Low Birth Weight ................................................................................................................................19
Infant Mortality ...................................................................................................................................20
Births To Mothers - No High School Diploma .........................................................................................20
Immunization Rates ............................................................................................................................20
Childhood Emergency Room Visits ........................................................................................................21
Childhood Hospitalizations ...................................................................................................................21
INFECTIOUS DISEASES ......................................................................................................................21
Sexually Transmitted Diseases .............................................................................................................22
Tuberculosis .......................................................................................................................................23
HIV / AIDS .........................................................................................................................................23
CHRONIC DISEASES AND RISK FACTORS .........................................................................................24
Behavioral Risk Factors ........................................................................................................................24
Tobacco Use .......................................................................................................................................24
Physical Activity ..................................................................................................................................24
Obesity ..............................................................................................................................................25
Preventable Hospitalizations .................................................................................................................26
Specific Chronic Diseases .....................................................................................................................26
Diabetes .............................................................................................................................................26
Screenings for Early Detection and Diagnosis of Diseases .......................................................................27
BEHAVIORAL / OCCUPATIONAL RISK FACTORS ...............................................................................28
LEADING CAUSES OF MORTALITY .....................................................................................................29
Average Life Expectancy ......................................................................................................................29
Rates of Premature Death ....................................................................................................................31
Risk Factors for Premature Death:
Cape Girardeau County, MO .......................................................31
COMMUNITY HEALTH IMPROVEMENT CAPACITY INDICATORS.......................................................32
Health Care Delivery System ................................................................................................................32
Health Care Coverage ..........................................................................................................................32
Mental Health Services ........................................................................................................................33
Dental Health Services .........................................................................................................................33
Transportation for Health Care Access ..................................................................................................34
Demand Response Vehicles..................................................................................................................34
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Fixed Route ........................................................................................................................................34
Service Contracts ................................................................................................................................35
Sight and Hearing Impaired Services ....................................................................................................35
COMMUNTIY HEALTH RESOURCE INDICATORS ................................................................................35
COUNTY HEALTH RANKING................................................................................................................35
SUMMARY OF SIGNIFICANT FINDINGS ............................................................................................36
PUBLIC HEALTH PRIORITIES .............................................................................................................36
DATA SOURCES ...................................................................................................................................37
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CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER
2012
COMMUNITY HEALTH ANALYSIS
INTRODUCTION: Every three years, the Health Center conducts an assessment of health
status indicators, fulfilling one of the Core Public Health Functions. The previous Community
Health Assessment reviewed data from 2006 / 2007 / 2008 and was compiled in 2009. The
2012 Community Health Assessment reviews data from 2009 / 2012/ and 2012 when
available. It also provides a comparison to the previous assessment per indicator when
indicated.
Data from several different sources was analyzed, including but not limited to: Missouri
Department of Health and Senior Services, Missouri Department of Social Services, Missouri
Department of Education, www.cassas.org, www.missourieconomy.org, US Census, EPA,
Missouri Department of Public Safety. A complete listing of the resources is included at the
end of this report.
Data was also reviewed from a nine county Regional Assessment conducted by East Missouri
Action Agency for the counties of Bollinger, Cape Girardeau, Iron, Madison, Perry, Reynolds,
St. Genevieve, St. Francois, and Washington. When available local data was also used for
comparisons.
INDICATORS










Demographics
Education
Socio-Economic
Environmental
Public Safety
Family/Domestic
Violence
 Unintended Injuries
Maternal & Child Health
Infectious Disease
Nutrition
Chronic Disease / Risk
Factors
 Mortality Rates
 Health Care Systems/
Community Resources
DEMOGRAPHIC / EDUCATION / SOCIOECONOMIC INDICATORS
Age Analysis:
The age distribution in Cape Girardeau County does not vary significantly from Missouri.
The most significant growth between 1990 and 2010 occurred in the following age groups:
45-64 year olds (2.86%), 65+ year olds (1.16%).
In 2007, 13.9% of the county’s population was 65 or over compared to 13.4% statewide.
The 2010 gender distribution is: Female 51.6%, and Male 48.4%. The gender distribution for
Missouri is Female 51.0% and Male 49.0%.
5
The regional assessment showed that overall population growth for the state of Missouri was
7%, Cape Girardeau County 10.6%, and St. Francois County 17.4%.
Age Distribution Comparison - 2010
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
0-4
5-9
10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75 +
Missouri
Cape Girardeau
Race/Ethnicity Analysis:
Data reflect a 277.7% increase (from 300 to 1,133) in the Hispanic/Latino population of Cape
Girardeau County from 1990-2010. Missouri’s increase in Hispanic and Latino population from
1990-2010 was 230.5%. These families may experience barriers in accessing care, due to a
number of environmental factors, including language, transportation, lack of insurance
coverage, lack of appropriate documentation. Missouri Kids Count indicates there were 27
children in 2002 with limited English proficiency and that number had increased to 82 in 2006
and is estimated at 62 in 2009.
Cape Girardeau County also experienced significant increase (271%) in the American
Indian/Alaska Native population from 99 individuals to 368, as well as an increase in Asian
Pacific Islanders (468 to 731).
POPULATION BY RACE
PERCENT CHANGE – INCREASE
Cape Girardeau County 1990-2009
277.7%
271.7%
300.0%
200.0%
100.0%
63.1%
56.2%
0.0%
0.0%
Hispanic or
Latino
Other or
Multiple Race
Asian/Pacific
Islander
American
Indian &…
Black or African
American
Household Demographics:
In 2000, there were a total of 27,031 households reported in the census data and this
increased to 29,309 by the 2010 census (an 8% increase in the total number of households).
Of those households, according to the 2010 census, 4,074 households (13.9%) in Cape
Girardeau County are “single parent” households (3,202 or 79% of single parent households
were listed as single mother), as compared to 11.8% in Missouri. This is an increase from the
2000 census when Cape Girardeau County had 2,103 (7.8%) single parent households and
Missouri had 9.1%.
Education:
2010 Census reflects the following: 48.7% of the Cape Girardeau County population over the
age of 25 had at most a high school diploma or equivalency, and 32.9% have a college or
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higher level degrees. Cape Girardeau County has a somewhat higher percentage of individuals
with college or advanced degrees when compared to the Missouri rate of 32.4%
High School Dropout Rates from 2007-2011 showed lower rates for Cape Girardeau County
than the state rates. A comparison of Cape Girardeau County School District Graduation Rates
reveals that Oak Ridge consistently has the highest rate, followed by Delta, Jackson, and Cape
Girardeau. This is the same as the previous assessment. On a nine county regional basis,
Iron County had the highest high school graduation rate (92.2%) and Perry County had the
lowest (75.2%), Cape Girardeau County ranked in-between those.
Cape Girardeau County
High School Graduation Rates - By District
2007-2011
District
2007
86.2
2008
86.0
2009
85.9
2010
85.9
2011
86.7
Cape Girardeau
77.6
74.6
78.2
78.4
76.9
Delta R-V
95.2
96.7
100
91.7
Jackson R-II
91.9
93.3
88.5
90.9
93.3
Oak Ridge R-VI
100
100
91.7
93.5
97.1
0
0
0
0
Missouri Average
Nell Holcomb R-IV
100
0K-8 only
Graduation Rate: (Graduates / (9-12 Cohort Dropouts + Graduates)) X 100
Source: Missouri Dept of Elementary and Secondary Education
Core Data As Submitted by Missouri Public Schools 12/11
http://www.dese.mo.gov/schooldata/
Graduation Rate Comparison
100.0
80.0
60.0
40.0
20.0
0.0
Missouri Average
Cape Girardeau
Delta R-V
Jackson R-II
Oak Ridge R-VI
Nell Holcomb R-IV
Socio-Economic Indicators:
The 2009 per capita income in Cape Girardeau County was $34,382 compared to Missouri’s at
$36,243. Cape Girardeau County has remained somewhat below (5%) state per capita
average since 1997. Both county and state per capita income have had a slight decrease since
2008-2009.
Household Income – 2010 population estimate data indicates median household income for
Cape Girardeau County at $32,001 - $38,000. 2008 average annual salary/wage for Cape
Girardeau County was $34,830-$43,473 as compared to the average of $41,050 for Missouri.
Cape Girardeau County in 2010 had 54.7% of households below $50,000 compared to Missouri
With 55%.
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Poverty – 2010 population estimates indicate that 15.2% of all persons in Cape Girardeau
County live in poverty as compared to the state rate of 15.3%.
By age groups: 5-17 yrs Cape Girardeau County = 16.5%, Missouri = 18.5%
Seniors in Cape Girardeau County = 7.1%, Missouri = 9.3%
There has been an increase across all age groups since the previous assessment.
People in Poverty - 2010
20.00%
18.00%
16.00%
14.00%
12.00%
All Ages
10.00%
Aged 5-17
8.00%
Seniors
6.00%
4.00%
2.00%
0.00%
Cape Girardeau
Missouri
From the regional assessment: Reynolds County had the highest rate at 25%, Perry County
had the lowest at 11.5%, and Cape Girardeau County was in the middle.
2009 Regional Poverty Rate
Poverty Rate
30
25
20
15
10
Poverty Rate
5
0
Unemployment: The annualized unemployment rate for Cape Girardeau County in 2011
was7.3% and the rate for Missouri was 8.8%. This is an increase for both the county and the
state from 2008 when Cape Girardeau County was at 5.6% and Missouri was at 6.0%. The
2010 Census data reflect that for Cape Girardeau County, more females than males were listed
as being unemployed. The Hispanic race had the highest unemployment rate.
8
Unemployment Rate Comparison
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
2007
2008
2009
Cape Girardeau
2010
2011
Missouri
The Regional assessment revealed that Reynolds had the highest unemployment rate at
14.65; Perry County had the lowest rate at 6.5%, with Cape Girardeau County (7.3%).
March 2011 Unemployment Rate
Regional
Unemployment Rate
16
14
12
10
8
6
4
2
0
Unemployment Rate
One other indicator in the review of poverty is the Percent of Students that are eligible for free
and reduced lunches. This was consistent with the findings from the previous assessment in
that Cape Girardeau District had the highest percent of students eligible. All districts, with the
exception of Oak Ridge, had increased percentage rates. Oak Ridge actually decreased
slightly.
PERCENT STUDENTS ELIGIBLE FOR
FREE &REDUCED LUNCH
Comparison of % Eligible for Free or Reduced Lunch
70
60
50
40
30
20
10
0
2007
Missouri Average
2008
Cape Girardeau
2009
Delta R-V
Jackson R-II
2010
Nell Holcomb R-IV
2011
Oak Ridge R-VI
The Regional Assessment also reviewed Home Foreclosure Rates and revealed that in the nine
county region, Reynolds County had the highest rate at 7.93%, Cape Girardeau County had
the lowest rate at 2.65%, and the state of Missouri was at 4.02%
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ENVIRONMENTAL HEALTH RISK INDICATORS
Housing:
The percentage of housing in Cape Girardeau County built before 1939, decreased from
12.8% in 2009 to 9.8% in 2011. Older housing is dispersed throughout the county. 39.2% of
all housing was built prior to 1970. The largest percentage of housing structures was built
from1970 to 1979. There is no knowledge of any asbestos or lead abatement projects
underway in the county.
Housing- By Year of Construction
Percent of Housing
18.0%
16.0%
14.0%
12.0%
Cape Girardeau
10.0%
8.0%
Missouri
6.0%
4.0%
2.0%
0.0%
Blood Lead:
Missouri Kids Count indicates that 1.3% of Cape Girardeau County children tested for lead
poisoning were found to have an elevated blood lead level. Primary data maintained by the
Cape Girardeau County Public Health Data indicate that in 2010, of the 1-6 year old
population, 13.9% (692) were screened for elevated blood lead – 11.8% screened in 2008. Of
those, only 1% had elevated readings – in 2006, 2% had elevated levels. During that same
time frame, 21.4% of all 1-6 year olds in Missouri were screened, with only 1% elevated.
BLOOD LEAD TESTING
Percent of 1-6 year olds Tested and Percent Elevated
Tests
1.20%
25.00%
1.00%
20.00%
0.80%
Cape
Girardeau
15.00%
Cape
Girardeau
0.60%
Missouri
10.00%
Missouri
0.40%
5.00%
0.20%
0.00%
0.00%
2010
2010
The following map shows the areas in the county (by zip code) where those children tested
reside. The majority reside within the City of Cape Girardeau.
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Hazardous waste Sites: There are no hazardous waste sites in Cape Girardeau County.
Reports from the Missouri Department of Health and Senior Services indicate that there has
not been any hazardous substance release reports filed or request for environmental
consultations.
WATER SUPPLY: No hazardous waste sites
HAZARDOUS SUBSTANCE EVENTS: Per DHSS No hazardous substance
release reports
INDUSTRIAL / AGRICULTURAL: The County has several water bodies
(creeks/rivers) throughout the county as well as the Mississippi river
on it’s eastern boundary.
Cape & Jackson water systems are fluoridated
Waste Water / Sewage Risks
Potential Environmental Health risks associated with sewage disposal could include
Occupational, Toxicity, and Incineration Exposure. A review of all available data and literature
does not yield any reported evidence of health conditions directly related or caused by
exposure to sewage disposal.
Physical Environment
The County Health Rankings & Roadmaps (http://www.countyhealthrankings.org/roadmaps)
Report indicates that Cape Girardeau County had 6 “air pollution-particulate matter days” in
2005 compared to the state at 1. In 2007 Cape Girardeau had 1 such day compared to the
state’s 0 and that remained unchanged in 2009. They define the health risk of ambient air
pollution based on ozone and fine particulate matter and as “the number of days that a
county’s air quality is unhealthy for sensitive populations.”
This same report also identified “access to healthy foods” as a physical environment outcome.
In 2006, 25% of the population in Cape Girardeau County had adequate access compared to
the state at 35%. By 2009, the county was 36% and the state 47%. The National Benchmark
for this in 2010 was 54% and 92% in 2011. The measure was based on the percent
of residential Zip codes in a county with a healthy food outlet, defined as grocery stores or
produce stands/farmers’ markets
Another Physical Environment Outcome identified in this report was the percentage of Fast
Food Restaurants. In 2009, the report indicated that 43% of restaurants in Cape Girardeau
County were “fast food,’ compared to 47% for the state and 25% as the National Benchmark.
Fast food restaurants measures the proportion of restaurants in a county that are fast food
establishments.
On final area identified in the County Health Rankings and Roadmaps was “access to
recreational facilities. “This measure represents the number of recreational facilities per
100,000 population in a given county. Recreational facilities are defined as establishments
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primarily engaged in operating fitness and recreational sports facilities, featuring exercise and
other active physical fitness conditioning or recreational sports activities such as swimming,
skating, or racquet sports.” In 2009 Cape Girardeau County had a rate of 11 compared to the
state rate of 10 and a National Benchmark of 16.
PHYSICAL ENVIRONMENT FACTS
Access to Healthy
Foods 2008
Air Pollution
Particulate Matter
Days in 2007
Cape Girardeau = 36%
Missouri
= 47%
National Goal = 92%
Cape Girardeau = 1
Missouri
=0
Fast Food
Restaurants 2009
Access to Recreational
Facilities 2009
Cape Girardeau = 43%
Missouri
= 47%
National Goal = 25%
Cape Girardeau = 11
Missouri
= 10
National Goal = 16
PUBLIC SAFETY / DOMESTIC VIOLENCE
Index Crime Rates:
In 2011 the Missouri Highway Patrol Uniform Crime Reporting System reports a total of 3,176
crimes reported for Cape Girardeau County. In 2010, there were 3,502 crimes reported and in
2009, there were 3,172. Index Crimes are the eight crimes the FBI combines to produce its’
annual crime index. These offenses include: willful homicide, forcible rape, robbery, burglary,
aggravated assault, larceny over $50, motor vehicle theft, and arson. The Crime Index total is
the sum of these selected offenses used to measure crime rates and their fluctuations
reported to law enforcement. Of these eight offenses, the highest rates in Cape Girardeau
County are for Property Crimes, Larceny, Theft, and Burglary.
OFFENSES
3500
3000
2500
2000
1500
2009
1000
2010
500
2011
0
Juvenile Crime:
The number of referrals to juvenile courts in Missouri for acts that would be violations of the
Missouri Criminal Code if committed by an adult. The count represents separately disposed
court referrals, not individual youth. Rate is expressed per 1,000 youths ages ten through 17.
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The Juvenile law violation referral rate in Cape Girardeau County in 2008 was 128.2 per 1,000
juvenile’s age 10-17 years. According to Missouri Kids Count, 2010, the Missouri rate for the
same year was 55.2, reflecting a trend from 2004-2008 that Cape Girardeau County has a
higher Juvenile Crime Rate than the state. From 2007 to 2008 the county rate increased from
95.5 to 128.2 – a 34% increase.
Year
Missouri
Cape Girardeau
Health/Mental Health
Juvenile law violation rate per 1,000 teens 10-17
2004
61.4
74.3
2005
57.1
76.0
2006
58.0
69.4
2007
55.2
95.5
2008
55.2
128.2
Source: Office of Social and Economic Data Analysis - Missouri Census Data Center (OSEDA/MCDC) 12/11
http://oseda.missouri.edu/kidscount/
Juvenile law violation rate per 1,000 teens 10-17
Illegal Drug Use / Alcohol Abuse:
In 2006 there were 14 Methamphetamine laboratory incidents in Cape Girardeau County. By
2010, there were 66 incidents. This number is higher than a number of the surrounding
counties and other counties in the area. The Missouri Department of Health and Senior
Services Cause of Death profile does not indicate a high incidence of alcohol/drug attributable
deaths.
13
In 2010 the Southeast Missouri Youth Substance Abuse Prevention Coalition (located in Cape
Girardeau) survey Cape Girardeau youth to determine how teens gain access to alcohol,
tobacco, marijuana, and prescription drugs and what substances were being used. Of the
youth responding to the survey, they listed tobacco (30%), alcohol (29.6%), and marijuana
(18.2%) as the drugs of choice and easiest to obtain. Females and males equally were likely
to use and peers were listed as the primary point of access.
The County Health Rankings & Roadmaps data indicate that between 14-17% of the county
population reported binge or excessive drinking compared to a the state range of 16-17%.
Child Abuse & Neglect:
Child abuse and neglect: number of child abuse victims from reports classified as “probable
cause,” indicating that child abuse or neglect has occurred, and from children receiving family
assessments. Rate is expressed per 1,000 children.
The 2009 Missouri Child Abuse / Neglect data reflect a 32.0 rate per 1,000 for the county
compared to the rate for the entire state of 29.8. This has been the trend since 2006 – Cape
Girardeau County having a higher rate than the state. It does appear that since 2008, both
the county and the state rates are on a decline.
CHILD ABUSE / FAMILY ASSESSMENT per 1,000
Child abuse/family assessment per 1,000
A comparison between Cape Girardeau, Bollinger, Perry, and St. Francois counties reveals that
Bollinger has the highest rate, followed by Perry, St. Francois, and then Cape Girardeau – at
least for 2010. The State of Missouri has a lower rate than all counties.
14
Regional Child abuse/family assessment per 1,000
Child abuse/family assessment per 1,000
Out of Home placements for children per 1,000 also run higher in Cape Girardeau County than
throughout the state. The rate for the County, however, started to decrease in 2008 and has
continued on that trend through 2010, while at the same time, the Missouri actually started an
increase in rates.
Out-of-home placements per 1,000
The Regional Assessment reflects numbers of homeless children ages 3-12th grade, by county
of residence. St. Francois County has the most (132), both Iron and St. Genevieve Counties
have 0 and Cape Girardeau County has 18. Statewide, there were 13,620 homeless children
reported in 2009.
HOMELESS CHILDREN
REGIONAL, 2006/2007
Homeless Children
Bollinger
Cape Girardeau
Iron
Madison
Perry
Reynolds
St. Genevieve
St. Francois
Washington Missouri
Domestic Partner Violence:
Domestic Violence Reports Filed
2008 there were 301 reports
2009 there were 423 reports
2010 there were 478 reports
Rate
419.4
589
666
Missouri
15
Rate
605
651
731.7
Comparison of population like counties:
Christian County had a rate of 655.9 in 2009
Cole County had a rate of 880 in 2009
Neighboring Counties: Bollinger was at 128, Scott was 1,527.3, and Stoddard was at 317.
UNINTENDED INJURY
Types of Injuries
From 1999-2009, the total deaths from unintentional injury rate for the county (28.9) were
lower than the state rate (44.97). Motor vehicle accidents and falls were the leading causes of
unintentional injury deaths.
Unintentional Injury Profile for Cape Girardeau County Residents
for Selected Indicators
Indicator Category: Deaths
Comparing neighboring counties, Cape Girardeau County had the lowest rate of deaths due to
unintentional injuries.
Unintentional Injury Profile
Deaths: Total Unintentional Injury
Missouri and Selected Counties/Cities
Seat Belt Use: The Missouri Highway Patrol 2010 Missouri Traffic Crashes Report ranks Cape
Girardeau County 108th among 115 counties in seatbelt usage (rank 1 being the worst).
Report indicates 96.5% usage by Cape Girardeau residents.
16
2010 Seat Belt Usage
Cape Gir
Missouri
Traffic Accidents Contributed to Drug or Alcohol Use: In 2008 there were 51 traffic
crashes in which alcohol was involved, with 1 fatality.
Age Groups Most Involved in Traffic Accidents:
Motor Vehicle injuries are highest among the 15-34 year old age group.
Work Related Injuries:
From 1999-2009, there were 16 incidents of work place death in Cape Girardeau County. Data
was not available for workplace injury incidents by county of occurrence.
MATERNAL and CHILD HELATH INDICATORS
Late Prenatal Care: The 2009 rate for 2nd / 3rd trimester entry into care was 8.7 compared
to the state rate of 12.9. The county rate is significantly lower than the state rate as indicated
in the following graph.
Prenatal Profile
Late Care (2nd/3rd Trimester)
Missouri and Selected Counties/Cities
Rate
Births to Teens: Actual rate values vary depending on which data sources are reviewed and
how they calculate the teen birth rate. The Missouri Department of Health and Senior Services
defines Births to Teens as “Resident live births to females in the given age group at the time
of delivery, and the percent this number is of total resident live births during the same time
period for the given geographic area.” Data from the Missouri Department of Health and
17
Senior Services Community Data Profiles are represented on the following graph and cove
three-year moving average rates:
Maternal Preconception/Family Planning Profile for Cape Girardeau County Residents
Births by Age of Mother: 15-17
The data indicate the Cape Girardeau County rate trend shows a statistically significant
decrease in the occurrence of births to teens in the 15-17 year old age group. In terms of
rates, from 2007-2009, the county rate was 2.9 compared to the state rate of 3.2. When
looking at actual numbers for the three year time period of 2007, 2008, and 2009, there were
62 births to teens in the 15-17 year old age group and 5 births to teens in the 10-14 year age
group (county rate of 0.2, state rate of 0.1). A review of specific populations for teen births,
from 2007-2009, has identified:
10-14 year old age group
75% Caucasian (40% Hispanic, 60% Non-Hispanic)
25% Black/African American
15-17 year old age group
75% Caucasian (10% Hispanic, 90% Non-Hispanic)
The following graph from Missouri Kids Count 2010 provides a year by year visual of teen
births (15-19 year olds) from 2005 -2009. Although these rates are calculated by the
individual year, the overall trend line is the same as for the three-year average graph.
Births to teenage mothers 15-19 (Per 1,000)
Repeat Births under Age 20: A three-year moving average rate for 2007-2009 indicates a
2.4 rate for Cape Girardeau County and a 2.2 rate for the state and is considered to be a nonsignificant trend.
18
Although the trend of teen births has declined over the past decade, addressing this indicator
remains a constant.
Smoking During Pregnancy: The 2009 rate for Cape Girardeau County was 19.9 compared
to the Missouri rate of 16.8. The county rate has been higher than the state rate for the past
12 years. A review of contiguous counties reveals that all have a higher rate than the state
rate.
Prenatal Profile
Mother Smoked During Pregnancy
Missouri and Selected Counties/Cities
Rate
Overall, the rates were highest in the 15-19 year old Caucasian group (32.1). The highest
prevalence rate in the African American population was among the 25-29 year old age group
and in the Hispanic population within the 20-24 year old age group. Between these three
population categories prevalence rates were highest in the Caucasian population.
Low Birth Weight: Cape Girardeau County rate trend shows a statistically significant
increase since 1991. It does not exceed the state rate.
Low Birth Weight
Three-Year Moving Average Rates
According to the 2007 Missouri Department of Health and Senior Services MICA Birth Data,
Cape Girardeau County had a Low Birth Rate (LBW) of8.2 compared to a 7.9 rate for Missouri.
19
The highest LBW Rate for Cape Girardeau County in 2007 was among the 15-17 year old age
group (18.5). Among the Caucasian population rates were highest in the 25-29 year olds,
among the African American population rates were highest among the 20-24 year old age
group.
Infant Mortality: Cape Girardeau County has approximately 1,000 births each year. During
the ten year time period of 1999-2009, the county had a total of 72 infant deaths. This
represents a rate of 7.2 compared to a state rate of 7.51. Missouri Kids Count 2010 lists this
as a “worse trend.”
Infant deaths per 1,000 births
Although data is not readily available by individual county, data from 2000 state vital statistics
lists the following as causes of infant deaths: infectious diseases, Nervous system diseases,
circulatory system, respiratory system diseases, perinatal conditions (leading cause),
congenital anomalies (2nd) SIDS, unintentional injuries, and homicide. The August 2009
Missouri Department of Health and Senior Services publication “Focus,” identifies “a reduction
in very small babies as the primary reason for the states’ decrease in infant deaths.”
Births To Mothers - No High School Diploma: The 2005-2009 rate for Cape Girardeau
County was 15.2 as compared to the Missouri rate of 18.1. The county rate is lower than the
state rate.
Overall, Cape Girardeau County has good birth outcomes. However, the County rates for
smoking during pregnancy are higher than the state rates.
Immunization Rates: Immunization rates for WIC participants in Cape Girardeau County
are comparable to Missouri WIC population rates. The most recent audit (Jan. 2012)
conducted by the Missouri Department of Health and Senior Services on the Immunization
program at Cape Girardeau County Public Center identified that the Center achieved a 76%
vaccination rate for clients receiving their immunizations through a Health Center clinic.
There are 8 VFC providers in the county.
20
WIC Infant Statistics for
Indicator: Immunizations - up to date
Year: 2008
Childhood Emergency Room Visits: Between 2001 and 2006 the 3 leading causes of
emergency room visit for children under the age of 15 were: Injury and Poisoning, Throat and
Lung, Brain-Spinal Cord, Eyes and Ears. No significant findings noted.
Childhood Hospitalizations: Between 2005 and 2009, the 3 leading causes of inpatient
hospitalization for children under age 15 were: Throat and Lung, Injury and Poisoning, and
Infections. No significant variance from Missouri data.
INFECTIOUS DISEASES
REPORTABLE CONDITION
ANAPLASMA PHAGOCYTOPHILUM
2009
2010
2011
1
0
ANIMAL BITES
67
11
5
CAMPYLOBACTERIOSIS
15
21
22
CRYPTOSPORIDIOSIS
5
3
3
E.COLI SHIGA TOXIN POSITIVE
3
2
2
E.COLI O157:H7
4
28
2
EHRLICHIA CHAFFEENISIS
3
4
GIARDIASIS
4
3
HAEMOPHILUS INFLUENZAE, INVASIVE
1
1
1
HEPATITIS A, ACUTE
3
5
13
HEPATITIS B, (PREGNANCY)
2
2
2
11
12
14
HEPATITIS B, ACUTE
HEPATITIS B, CHRONIC INFECTION
HEPATITIS C, ACUTE
2
5
3
2
1
8
0
0
5
150
62
80
INFLUENZA
4
0
0
LEGIONELLOSIS
0
2
0
LISTERIOSIS
1
0
0
LYME
5
5
MALARIA
1
0
MMENINGICOCCAL DISEASE
0
0
2
26
19
18
MUMPS
4
1
1
NON-NEUROINVASIVE WEST NILE
0
2
0
PERTUSSIS
3
2
Q FEVER
0
1
RABIS, ANIMAL
0
0
HEPATITIS C, CHRONIC INFECTION
MOTT
ROCKY MOUNTAIN SPOTTED FEVER
1
0
1
1
1
6
14
7
15
13
12
SHIGELLOSIS
4
20
2
STREP, GROUP A, INVASIVE
3
3
1
STREP PNEUMONAE
0
1
STREP PNEUMONAE, DRUG-RESISTANT
3
8
SALMONELLOSIS
TB DISEAE
3
8
2
1
43
44
45
TOXIC SHOCK SYNDROME
1
0
TULAREMIA
1
0
2
VARICELLA (CHICKENPOX)
1
2
10
YERSINIOSIS
0
1
0
TB INFECTION
0
The preceding chart displays the most frequently occurring communicable diseases for 2009,
2010, and 2011. No new and novel diseases occurring. Hepatitis C, chronic, continues to be
the most frequently reported communicable disease. Of particular interest is the number of
E.Coli 0157:H7 diagnosed cases in 2010. A total of 28 cases were diagnosed and investigated
that year. Tuberculosis infection (positive skin test) continues to be prevalent. Several
different sources are reviewed when determining actual disease occurrences and/or outbreaks.
These include, but are not limited to, Missouri Department of Health and Senior Services, Cape
Girardeau County Public Health Center report files, Crystal Reports, and reports from
surveillance sites within the county, i.e. School Health Surveillance Data from Cape Girardeau
School District.
21
Sexually Transmitted Diseases:
In 2011 (through Nov.) there were 58 cases of Gonorrhea, 5 Syphilis cases, and 231
Chlamydia cases reported for Cape Girardeau County residents. In 2010 those numbers were
71 Gonorrhea cases, 1 Syphilis case, and 262 Chlamydia cases. Need to monitor as this
appears to be a trend in increasing numbers.
CAPE GIRARDEAU COUNTY
350
300
250
2006
2007
200
2008
2009
150
2010
100
2011(Nov)
50
0
Chlamydia
Gonorrhea
Syphilis
As the above chart indicates, there was a peak of Chlamydia, Gonorrhea, and Syphilis in 2008.
Since that time, the rates have decreased, but only slightly. Syphilis has actually started ant
increased shift with 6 cases reported in 2011. Rate comparisons with the state for these are
as follows:
Chlamydia
Cape Girardeau Cases (Rates)
Missouri
2009
292 (399.0)
437.6
2010
262 (354.0)
435.1
2011
240
Gonorrhea
2009
2010
2011
Cape Girardeau Cases (Rates)
84 (109.8)
71 (96.0)
62
Missouri
115.0
119.6
Syphilis
2009
2010
2011
Cape Girardeau Cases (Rates)
1 (1.0)
1 (1.0)
6
Missouri
2.9
2.5
Primary data from the STD Clinic at Cape Girardeau County Public Health Center indicates the
following:
# Screened
# Treated
2009
208
90
2010
232
89
2011
246
105
22
Tuberculosis:
Cape Girardeau County has a slightly higher positive rate on PPD’s placed. TB Disease Rates
are slightly higher for the state than it is for the county. Primary data from the Cape
Girardeau County Public Health Center indicates the following: Of the Positive PPD’s identified,
about 1% are diagnosed as Active TB Disease
PPD’s Placed
Positive PPD’s
2009
986
18 (2%)
2010
1,062
14 (1%)
2011
1,159
11 (1%)
TUBERCULOSIS
TB DISEASE RATE
TB INFECTION
Positive PPD Reporting Rate
6
2006
2007
70%
5
60%
2008
2009
50%
2006
40%
2007
30%
3
2008
20%
2009
10%
2010
4
2
2010
0%
1
CAPE GIR
MO
0
CAPE GIR
MO
According to the Missouri Department of Health and Senior Services 2009 data, the county had
38 latent TB cases (52.3 rate) compared to a state rate of 57.7. In 2010 that number had
increased to 43 (59.2 rate) which surpassed the state rate of 46.5
In terms of TB Disease, there were 0 diagnosed cases in the county in 2009 and 80 (1.4 rate)
in the state. In 2010 the county had 1 case (1.4 rate) and the state had a 1.8 rate.
HIV / AIDS: The number of individuals living with HIV disease in Cape Girardeau County in
2009 = 50, 2010 = 45, and 2011 =50. These numbers are based on the individual’s residence
at time of the diagnosis. Within the newly diagnosed state wide, the largest percentage has
been in the men who have sex with men group, followed by the heterosexual contact. Ages of
those =that have been newly diagnosed has decreased in the 35-39 yr old age group and
increased in the 19-24 year old age group.
In 2009 there were 536 newly diagnosed and in 2010 there were 585 newly diagnosed
throughout the state. The age of individuals living with HIV has increased over time. Primary
data from the STD clinic at Cape Girardeau County Public Health Center indicates the following
number screened and positive:
Year
# Tested for HIV
# Positive
2009
190
1
2010
204
1
2011
188
7
23
CHRONIC DISEASES AND RISK FACTORS
Behavioral Risk Factors: Tobacco Use, Physical Inactivity, Obesity
Tobacco Use: The 2003- 2007 Health and Preventive Practices County Level Study
Comparison reflect 19.9% of Cape Girardeau County residents smoke and 23.3% Of
Missourians. In 2003, 20.9% of Cape Girardeau County residents smoked compared to the
Missouri rate of 28.7%. The percent of smokers in the county has decreased from 2003 to
2007, as it has statewide. In Cape Girardeau County, in 2007, there was an increase in the
percent of individuals who were using smokeless tobacco. Statewide, the percent of males
versus females that smoked was just about even (23.4% to 23.1%). 2007 was the last year
that the County Level Study was conducted.
TOBACCO USE
2003 / 2007 County Level Study
30.00%
25.00%
20.00%
2003
15.00%
2007
10.00%
5.00%
0.00%
Curremt
Smoker
Former
smoker
Smokeless
Tobacco
Physical Activity:
The 2003 Health and Preventive Practice Study Status Report indicated that 23.0% of Cape
Girardeau County residents are physically inactive. This decreased to 20.4% by the 2007
study. In 2003, the study reported that 27.9% of Cape Girardeau County residents reported
“No Leisure Time” and by 2007 the Study reported that 21.6% of county residents received
no leisure-time physical activity (a positive decrease in percents). The state rates were 23.5%
for physically inactive in 2007, 24.95% “No Leisure Time” in 2003 and 25.3% in 2007. Less
Cape Girardeau County residents are physically inactive and less report “No Leisure Time”
when compared to the state of Missouri.
PHYSICAL ACTIVITY
30.00%
25.00%
20.00%
2003
15.00%
2007
10.00%
2007
5.00%
0.00%
2003
Physically Inactive
No Leisure Time
24
Obesity:
The 2003 Health and Preventive Practices Status Report indicated that 30.6% of Cape
Girardeau County adults are overweight and 25.39% are obese. By 2007 the Study indicated
that 25.39% of adults were overweight and 26.5% of the residents were obese. Comparing
the overweight percent to that of Missouri in 2003 (35.86%) and obesity (24.93%), the county
had lower percentages of the adult population than the state. In 2007, the rates for Missouri
were 35.7% for overweight and 29.1% for obesity. Both the state and the county had an
increase in the percent of adults that were obese, however the county remains lower than the
state.
In January, 2012, staff from the Cape Girardeau County Public Health Center conducted a mail
survey of daycare providers in Cape Girardeau County, which was distributed to a random
sample of 10 providers in the county. Once the survey was completed, respondents were
asked to mail the form to the Health Center. The purpose of the survey was to identify what
level, if any, of nutrition policies and physical activity policies existed for children that attended
daycare. Eight providers (67%) responded with all eight reporting that they had nutrition
policies in place – 6 (75%) followed state guidelines and 2 (25%) established their own. In
regards to physical activity, 6 (75%) reported having physical activity/guidelines from 30
minutes to 1-2 hours a day and a total of 7 (88%) requested more information on developing
nutrition and physical activity guidelines.
OBESITY
35.00%
30.00%
25.00%
20.00%
2003
15.00%
2007
10.00%
2007
5.00%
0.00%
2003
Overweight
Obese
Obesity rates by age, gender, or race/ethnicity by individual county of residence are not
readily available or identifiable at the local, state, or national level. Data reviewed for this
assessment focused on data collected on WIC Prenatal, Infant, and Child participants. All data
reviewed was from the Missouri Department of Health and Senior Services 2008 MICA WIC
Prenatal, Infant, and Child reports. Those reports revealed the following:
Pre-Pregnancy Weight for Height – Obese:
Cape Girardeau County
= 28.4
Missouri
= 32.3
In the Caucasian population the rates were highest among the 35-39 year age group, in the
African American population the rates were highest among the 25-29 year age group and in
the Hispanic population rates were highest among the 20-24 year old age group.
25
Infants at Risk of Overweight:
Cape Girardeau County = 10.9
Missouri
= 9.2
Child at Risk of Overweight – Weight for Length (85th-95th percentile:
Cape Girardeau County = 19.0
Missouri
= 18.6
Preventable Hospitalizations:
Overall, rates of preventable hospitalization were lower for Cape Girardeau County than for
Missouri. From 2005 to 2009, there were 288 hospitalizations due to diabetes, 188 due to
heart failure, 207 hospitalizations due to asthma, and 286 for COPD. These are all related to
Chronic Disease. ER visits for these conditions were 11.6% for Heart Disease, 2.3% for
Asthma, and 4.6% for COPD, all of which were lower than the state rates.
ER visits were higher for Cape Girardeau County than the state for Respiratory (most
frequent), followed by Otitis Media, Eye Infections, Arthritis, and Allergic Reactions.
Preventable Hospitalizations
2005-2009
188
288
Diabetes
COPD
Asthma
207
Heart Failure
286
Specific Chronic Diseases
Diabetes: The 2003 and 2007 county level health profile shows slightly higher diabetes rates
for the county (7.6 in 2003 and 8.0 in 2007) than for the state (7.2 for 2007).
Missouri County Level Study 2007 - Health and Preventive Practices
Current diabetes
Diabetes regional profile for Cape Girardeau County shows higher rates for risk factor of obese
(31.8) and physical inactivity (29.2) as compared to the state rats of 24.5 and 21.9.
ER visits for Diabetes continues to increase and almost equals the state rate, as does the rate
for Hospitalizations for Diabetes.
26
DIABETES
Chronic Disease Profile for Cape
Girardeau County Residents
Hospitalizations: Diabetes Mellitus
Three-Year Moving Average Rates
Rate
Years
In the 2009 Community Health Assessment, the death rate for Diabetes actually exceeded the
state rate. The rate does appear to be decreasing slightly and is just barely less than the state
rate.
Deaths: Diabetes Mellitus
Three-Year Moving Average
Rates
Rate
Years
The following graph shows a comparison between Cape Girardeau County and the state in
regards to three key risk factors for Diabetes.
DIABETES RISK FACTORS - 2008
Diabetes Profile
Overweight with diabetes
Missouri and Selected
Counties/Cities
Diabetes Profile
Obesity with diabetes
Missouri and Selected
Counties/Cities
Diabetes Profile
Physical inactivity
with diabetes
Missouri and
Selected
Counties/Cities
Screenings for Early Detection and Diagnosis of Diseases:
A review (2003 & 2007 Health and Preventive Practices Studies) of selected screenings
indicates the following:
Cape Girardeau Co.
Missouri
Ever Had Cholesterol Checked
2003
77.7%
85.7%
2007
92.2%
89.29%
Never had a Mammogram
2003
2007
17.35%
4.5%
12.8%
8.74%
Never had a Pap Smear
2003
2007
3.81%
5.39%
4.18%
3.41%
27
Never had a Blood Stool Test
2003
2007
55.89%
53.41%
56.37%
58.49%
Never had a Colonoscopy
2003
2007
59.48%
37.3%
48.24%
36.59%
As indicated from this data and the following map, Cape Girardeau County has a higher rate
for women age 18 and older who have not had a Pap smear test in the past three years. This
could indicate that women are not receiving screenings as often as recommended.
Missouri County Level Study 2007 - Health and Preventive Practices
No pap smear in last 3 years - women age 18 and older
BEHAVIORAL / OCCUPATIONAL RISK FACTORS
The following Table details the leading industry / employment in the county.
Type of Employment
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
Type of Employment
0.00%
28
In analyzing potential contributing factors for leading health problems, occupational risks were
reviewed. 34.8% of the workforce was in management, business or sciences, 22.5% were in
sales and office occupations, 17.5% were in service occupations, 12.8% were in production /
transportation, and 12.3% were in natural resources (agriculture, construction, maintenance).
Health risks associated with these leading types of occupation could include: Decreased
activity while on the job (lack of physical activity and reduced leisure or physical activity time),
reduced or limited access to nutritional meals during the work day (place of work may not
offer food on-site or limited choices).
LEADING CAUSES OF MORTALITY
Average Life Expectancy: According to the Community Health Status Indicators, CHSI
2009, from the US Department of Health & Human Services, Cape Girardeau County has a life
expectancy of 77.2 years, which is slightly higher than the median of 76.5 years for all US
counties. The graph below displays this as well as the range among peer counties (74.9-79.3
years).
AVERAGE LIFE EXPECTANCY1
Overall, Cape Girardeau County had a lower death rate (740.4) for 2009 than did Missouri
(801.8) However, in the under 15 year old age group, Cape Girardeau County had an overall
higher death rate (96.5 with 13 deaths) compared to Missouri (66.7) for that same age group.
Cape Girardeau County has significantly higher death rates from the following diseases:
Heart Disease at 260.7 compared to state rate of 245.6. Although the incidence has
decreased slightly, it is the leading cause of death for Cape Girardeau County.
29
Leading Cause of Death Profile for Cape Girardeau County Residents
Mortality Rates: Heart Disease
Three-Year Moving Average Rates
Rate
Years
Stroke at 59.0 compared to state rate of 54.9. Overall the incidence has declined but it is
higher than the state rate.
CHRONIC DISEASE
Deaths: Stroke/Other Cerebrovascular
Disease
Three-Year Moving Average Rates
Rate
Years
Alzheimer’s at 33.6 compared to state rate of 21.9. Appears to be an increasing trend and
continues to be above the state rate.
Leading Cause of Death Profile for Cape
Girardeau County Residents
Deaths: Alzheimer's Disease
Three-Year Moving Average Rates
Rate
Years
Comparing to contiguous counties, Heart Disease is the leading cause of death with Cape
Girardeau County ranking the highest. All four surrounding counties have cancer then stroke
30
as their second and third causes of death. Both Perry and Stoddard Counties rank higher than
the state for deaths due to Alzheimer’s and Perry is higher than Cape Girardeau County.
Leading Cause of Death Profile for
Mortality Rates: Heart Disease
Missouri and Selected Counties/Cities
Rates of Premature Death
Risk Factors for Premature Death:
Cape Girardeau County, MO
The rates that are higher than the state rates are consistent with the Behavioral Risk Factors
of Increased Rate for Obesity, Increased Rated for Smoking, and Increased Rate for Physical
Inactivity. Specific populations /age groups that have higher rates of death due to Heart
Disease are the 65 years and older (1430.2 Rate compared to state rate of1335.2 in same age
group of), followed by the 45-64 year old, the 24-44 year old, and the less than 15 year old
(7.4) age groups. Although in the less than 15 year old age group there was only 1 death due
31
to heart disease, the rate of 7.4 was higher than the state rate of 1.4 for that same age group.
The following table details the rates for the leading causes of death in each age group.
LEADING CAUSES OF DEATH: RATE BY AGE GROUP
HEART DISEASE
CGCo
<15 yrs
15-24yrs
25-44yrs
45-64yrs
>65yrs
7.4
0
11.9
144
1430.2
MO
STROKE
CGCo
1.4
0
21.4
157.2
1336.2
0
0
0
4
291.7
ALZHEIMERS
MO
0
0
0
22.4
316.9
CGCo
0
0
0
0
305.2
MO
0
0
0
1
207.1
COMMUNITY HEALTH IMPROVEMENT CAPACITY INDICATORS
Health Care Delivery System:
Cape Girardeau County has three hospitals; Saint Francis Medical Center, Southeast Health,
and Landmark, a Federally Qualified Health Care Center (Crosstrails), numerous Rural Health
designated clinics. The County Health Rankings & Roadmaps indicates that Cape Girardeau
County has a Primary Care Provider Rate of 122 (2010) state was at 95, 832:1 in 2011 state
was at 1,015:1.
Emergency services are available in the County. There are 22 Long Term care facilities in the
county.
There are a number of Primary Care physicians providing services in Cape Girardeau County.
No shortage noted at this time. Missouri Health Net provides a listing of health care providers
that are Medicaid participants. Although the number is significant, acceptance into these
practices may be limited by the number accepted at given times.
Health Care Coverage:
There are many working people without health insurance coverage and the 2007 Health and
Preventive Practices County Level Study indicate that 14.9% of Cape Girardeau County adults
have NO coverage compared to 14.72% for the state.
32
HEALTH CARE COVERAGE
% of Residents Without Health Care
Coverage
Cape Girardeau
Missouri
11.60%
15%
2003
15%
12.30%
2009
2009
15%
2003
2007
2007
14.72%
The County Health Rankings & Roadmaps indicated that in 2009, 15% of adults in Cape
Girardeau County were uninsured, 15% in Missouri, and the National Benchmark was 11%.
Mental Health Services:
Assessment of Mental Health services is much the same as three years ago.
MENTAL HEALTH SERVICES
Only six psychiatric physicians at community
clinic
Only one private psychiatric physician
No services for children when Medicaid is lost
No inpatient beds for children
Children in crisis must go to St. Louis
Bootheel Counseling does not accept Medicaid nor Cape Girardeau County referrals. These
individuals are referred to Community Counseling in Cape Girardeau
Dental Health Services:
DENTAL SERVICES SURVEY
Dental
Providers
(38 Surveyed)
44
(4 Outside of
Cape
Girardeau
County)
New Patients New Patients
& Medicaid
& Previous
Medicaid
6
4
Pediatric
New Patients &
Restricted
Medicaid
1
Children Under
16 years with a
Disability or
Hadicap
1
Survey Date: April, 2012 through phone interviews
The Federally Qualified Health Care Center reports at least a 3 month waiting time for
an appointment for individuals and the dental services are so full that access must be
limited to individuals who are blind, handicapped, or pregnant women.
33
In April, 2012, staff of the Cape Girardeau County Public Health Center conducted, by phone,
the survey of dental care providers in Cape Girardeau County. Dentists were identified by
listings in the local phone registry and by those known to be practicing in Cape Girardeau
County. Staff interviewed the dentists and/or their appropriate staff, asking the [re-identified
questions. The purpose of the survey was to determine which providers were accepting New
Patients (private pay and Medicaid), accepting pediatric patients (private pay & Medicaid) and
accepting children less than 16 years of age with a disability or handicap and the waiting time
for an appointment.
Cross Trails Medical Center has dental offices located in Cape Girardeau, Advance, and Marble
Hill. They do accept Medicaid and provide a sliding fee for those individuals without insurance
coverage.
A child with Medicaid needing immediate care can get an appointment in approximately 3-4
weeks. A regular check-up with cleaning would be a wait of approximately 2-3 months. SEMO
Health Network provides dental services to anyone regardless of county of residence. They
accept Medicaid and offer a sliding fee for those individuals without insurance coverage.
Transportation for Health Care Access:
OATS and non-emergency medical transportation (primarily for MC+) is available. It is
important to note that each of these services is available on a scheduled basis only.
Cape Girardeau Transit Authority (CTA) provides the following types of services:
Demand Response Vehicles
Part of the CGCTA fleet is comprised of Demand Response Vehicles, often referred to as Taxi
services. These are transit services in which individual passengers can request transportation
from one specific location to another specific location at a certain time. Vehicles providing
Taxi service do not follow a fixed route, but rather travel throughout the community
transporting passengers according to their specific requests. Taxi services are offered for a
fare. Taxi Services are available 24 hours a day, 6 1/2 days a week, including holidays.
Fixed Route
Deviated Fixed Routes are a hybrid type transportation that combines Demand Response and
Fixed Route principles. Deviated Fixed Route vehicles follow a designated fixed route. CGCTA
has implemented two bus routes within the City of Cape that are designed to coordinate
transportation to specific locations within the city throughout the day, such as
hospitals/doctors’ offices, grocery stores, and shopping areas. The buses are in operation
Monday through Friday from 6am to 6pm and Saturday from 9am to 6pm.
Courier Services
The CGCTA provides a courier service to local businesses. Proceeds from this entity go directly
to raising local match for our government grants.
34
Service Contracts
The CGCTA is a subcontractor for other state and local programs.
Cape County Private Ambulance provides emergency response and transport.
fire districts also do emergency response.
Several local
Sight and Hearing Impaired Services:
SB40 Board provides residential and other related services to individuals with mental
retardation or developmental disabilities.
The Community Health Assessment completed by East Missouri Action Agency identified, from
Focus Groups a surveys, five areas of primary importance. Each of these choices can be tied
back to another issue area. Those areas included: “no money or insurance for medical care,”
“no resources to pay for auto repair, licensing, insurance,” “no food or money to purchase
food,” “no emergency resources to help pay rent,” and “unaware of resources other than
EMAA to help with crisis situations.”
COMMUNTIY HEALTH RESOURCE INDICATORS
Analysis of Health Resources to Address Leading Causes of Mortality & Risk
Factors:
Recreational Opportunities: Conservation walking and hiking trails are available throughout
the county. Both the cities of Cape Girardeau and Jackson have parks, lakes, swimming pool,
and gym facilities (some are limited use due to membership fees).
The Cape Girardeau County Public Health Center provides health education to all clients.
Additionally, blood pressure checks are provided at no cost. Southeast Missouri Food Bank
distributes food at various sites throughout the county.
COUNTY HEALTH RANKING
A component of the Mobilizing Action toward Community Health (MATCH) project ranks the
health of counties and indicates that much of what affects health occurs outside of the
doctor’s office. This confirms the critical role that factors such as education, jobs, income, and
environment play in how healthy people are and how long the will live. This ranking is
published by the University of Wisconsin Population Health Institute and Robert Wood Johnson
Foundation and review a variety of health measures similar to this Community Health
Assessment (health behaviors, clinical care, social and economic, physical environment). High
ranking begins at 1 and is considered to be the “healthiest.” The most recent publication
ranks Cape Girardeau County as “15” on those measures and “24” on overall health outcomes.
(http://www.countyhealthrankings.org/#app/missouri/2012/rankings/outcomes/overall)
35
SUMMARY OF SIGNIFICANT FINDINGS
 Significant Larger Senior Population
 Increasing Hispanic / Latino Population
 Increased Risk of Smoking in County / Higher rate of Smoking During Pregnancy
 Juvenile Law Violation Rates higher than the state
 Higher Rates of Death due to:
o Heart Disease, Stroke, Alzheimer’s
 Women 18 and Older Not Seeking Pap Test as Recommended
 Higher Rates of Overweight / Obesity / Physical Inactivity
Diabetes Risk Factors
 Immunization Rates Lower than the state rates for 2 year olds
PUBLIC HEALTH PRIORITIES
In May, 2012, Health Center staff, a group of Community Stakeholders, and attending
members of the Board of Trustees, identified the three most significant problems affecting the
health status of the population:
1. Obesity Rate
2. Increased rate of Smoking in County / Higher Rate of Smoking During
Pregnancy
3. Immunization Rates
Community Partners were also asked for input on the Health Centers Strategic Plan
The following recommendations were also made:
 Attempt smoking cessation activities at the Junior and Senior High
levels
 Encourage clients who utilize services at the Health Center to
participate in wellness programs that their employers might provide
 Create a pool of interpreters for the community
 Address Bed Bug issues on a community level
36
DATA SOURCES
www.oseda.missouri.edu
www.oseda.missouri.edu/kidscount
www.dhss.mo.gov
www.dese.mo.gov
www.casas.org/lit
www.census.gov/hhes/
www.saipe
www.missourieconomy.org
www.bea.gov/bea/regional/reis
www.epa.gov/safewater
www.dhss.mo.gov/oralhealth/waterfluoridation
www.dps.missouri.gov/MSHPWeb/SAC
http://mcdc2.missouri.edcu/kidscount
www.dmh.mo.gov/ada
www.dhss.mo.gov/immunizationMICA
Cape Girardeau County Public Health Center
Communicable Disease Logs
STD Clinic Logs
Communicable Disease Clinic Logs
Rural Health Clinic Reports
www.dhss.mo.gov/BRFSS
www.dhss.mo.gov/WIC
www.dhss.mo.gov/PrimaryCareRuralHealth
Community Needs Assessment – Lower East Central – East Missouri Action Agency
SEMO Youth Substance Abuse & Prevention
County Health Rankings & Roadmaps (http://www.countyhealthrankings.org/roadmaps)
Dental Care Providers Survey
Daycare Providers Survey
Cape Girardeau Public School District, School Health Surveillance
Cape Girardeau City Council Bill No. 11-08
US Department of Health & Human Services, Community Health Status Indicators, CHSI, 2009:
(http://www.communityhealth.hhs.gov/SummaryMeasuresOfHealth.aspx?GeogCD=29031&Pee
rStrat=19&state=Missouri&county=Cape Girardeau)
37