Community Health Needs Assessment for Cape Girardeau County

Transcription

Community Health Needs
Assessment
Cape Girardeau County, Missouri
This assessment will identify the health needs of the residents of Cape Girardeau County, Missouri, and
those needs will be prioritized and recommendations will be made for programs to be implemented to
meet those needs.
Community Health Needs Assessment – Cape Girardeau County, Missouri
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Table of Contents
LIST OF FIGURES..................................................................................................................................................... 5
LIST OF TABLES ...................................................................................................................................................... 6
EXECUTIVE SUMMARY ........................................................................................................................................... 8
KEY FINDINGS ...................................................................................................................................................... 10
PRIORITY NEEDS .................................................................................................................................................. 12
CHAPTER 1: COMMUNITY HEALTH NEEDS ASSESSMENT INTRODUCTION AND METHODS ................................... 13
COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIPTION .....................................................................................................13
COMMUNITY HEALTH NEEDS ASSESSMENT REQUIREMENTS ..................................................................................................13
IMPLEMENTATION STRATEGY REQUIREMENTS ....................................................................................................................14
COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS ...........................................................................................................15
Defining “Community” ........................................................................................................................................15
Identifying Partners and Individuals Representing the Broad Interests of the Community ................................15
Gather Available Data and Current Assessments ...............................................................................................16
Develop and Conduct Primary Research .............................................................................................................17
Aggregate Primary and Secondary Research ......................................................................................................17
Identify and Prioritize the Health Needs in the Community ................................................................................17
Develop and Implement a Strategy to Address the Identified Priority Health Issues ..........................................18
Widely Disseminate the CHNA ............................................................................................................................18
CHAPTER 2: COMMUNITY PROFILE ...................................................................................................................... 19
BACKGROUND INFORMATION FOR CAPE GIRARDEAU COUNTY ...............................................................................................19
City of Cape Girardeau ........................................................................................................................................19
City of Jackson .....................................................................................................................................................20
Smaller Cities and Towns in Cape Girardeau County ..........................................................................................20
DEMOGRAPHIC CHARACTERISTICS ....................................................................................................................................21
Population Growth ..............................................................................................................................................21
Race ....................................................................................................................................................................21
Ethnicity ..............................................................................................................................................................22
Age Distribution ..................................................................................................................................................22
Gender.................................................................................................................................................................23
Household/Family Configuration ........................................................................................................................24
Religion ...............................................................................................................................................................24
SOCIAL CHARACTERISTICS ...............................................................................................................................................25
Education ............................................................................................................................................................25
Language ............................................................................................................................................................27
Literacy................................................................................................................................................................28
Marital Status .....................................................................................................................................................28
ECONOMIC CHARACTERISTICS .........................................................................................................................................28
Income ................................................................................................................................................................28
Employment ........................................................................................................................................................29
Poverty Status .....................................................................................................................................................29
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Medicaid and Public Assistance Participation.....................................................................................................30
Hunger and Food Uncertainty .............................................................................................................................31
Women, Infants, and Children (WIC) Participation .............................................................................................31
Housing ...............................................................................................................................................................31
Transportation ....................................................................................................................................................32
ENVIRONMENT ............................................................................................................................................................32
Water Quality......................................................................................................................................................32
Air Quality ...........................................................................................................................................................33
Lead Poisoning ....................................................................................................................................................34
BUILT ENVIRONMENT....................................................................................................................................................34
Healthy Food Availability ....................................................................................................................................34
Recreational Activities Available .........................................................................................................................34
PUBLIC SAFETY.............................................................................................................................................................35
Crime Index .........................................................................................................................................................35
Juvenile Crime Rates ...........................................................................................................................................36
FAMILY AND DOMESTIC VIOLENCE ...................................................................................................................................36
Child Abuse and Neglect .....................................................................................................................................36
Child Out-of-Home Placement ............................................................................................................................37
Domestic Violence ...............................................................................................................................................37
HEALTH PROMOTION ....................................................................................................................................................38
Community Health Programs ..............................................................................................................................38
HEALTH CARE SYSTEM...................................................................................................................................................39
Access to Health Care..........................................................................................................................................39
Uninsured Population .........................................................................................................................................39
Health Care Providers .........................................................................................................................................39
Community Health Resources/Services ...............................................................................................................44
Emergency Services .............................................................................................................................................44
Long-Term Care Facilities ....................................................................................................................................46
CHAPTER 3: HEALTH OUTCOMES ......................................................................................................................... 48
MORTALITY .................................................................................................................................................................48
Leading Causes of Death .....................................................................................................................................48
Cancer .................................................................................................................................................................49
Chronic Disease ...................................................................................................................................................50
Years of Potential Life Lost ..................................................................................................................................51
Infant Mortality...................................................................................................................................................51
Motor Vehicle Accidents .....................................................................................................................................52
MORBIDITY .................................................................................................................................................................52
Obesity and Overweight......................................................................................................................................52
Diabetes ..............................................................................................................................................................52
Infectious Disease ...............................................................................................................................................53
Unintentional Injuries..........................................................................................................................................57
Health Status at Birth ..........................................................................................................................................60
HEALTH STATUS ...........................................................................................................................................................63
MENTAL HEALTH .........................................................................................................................................................63
PREVENTABLE HOSPITALIZATIONS ....................................................................................................................................64
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CHAPTER 4: HEALTH BEHAVIORS ......................................................................................................................... 65
DIET & EXERCISE ..........................................................................................................................................................65
TOBACCO USE .............................................................................................................................................................65
SUBSTANCE ABUSE .......................................................................................................................................................65
MATERNAL HEALTH ......................................................................................................................................................65
Prenatal Care ......................................................................................................................................................65
Smoking during Pregnancy .................................................................................................................................66
Breastfeeding ......................................................................................................................................................66
SEAT BELT USE ............................................................................................................................................................67
PREVENTION & SCREENING ............................................................................................................................................67
Preventative Practices.........................................................................................................................................68
Diabetes ..............................................................................................................................................................70
CHAPTER 5: HEALTH MEASURES .......................................................................................................................... 71
CHILD AND ADOLESCENT HEALTH ....................................................................................................................................71
Infant Immunization Rates..................................................................................................................................71
Causes of Death – Child.......................................................................................................................................71
Causes of Death - Adolescents ............................................................................................................................72
Teen Substance Abuse and Smoking ...................................................................................................................72
Teen Pregnancy ...................................................................................................................................................73
STDs in Teens ......................................................................................................................................................74
SENIOR HEALTH ...........................................................................................................................................................74
Missouri Senior Report ........................................................................................................................................74
CHAPTER 6: PRIMARY RESEARCH ......................................................................................................................... 76
FOCUS GROUPS ...........................................................................................................................................................76
Methodology .......................................................................................................................................................76
Question 1 - What do people in this community do to stay healthy? How do people get information about
health? ................................................................................................................................................................76
Question 2 - In this group’s opinion, what are the serious health problems in your community? What are some
of the causes of these problems? ........................................................................................................................77
Question 3 - What keeps people in your community from being healthy? .........................................................77
Question 4 - What could be done to solve these problems? ...............................................................................78
Question 5 - Is there any group not receiving enough health care? If so, why? ................................................79
Question 6 - Of all the issues we have talked about today, what issues do you think are the most important for
your community to address?...............................................................................................................................79
Checklist Exercise ................................................................................................................................................79
SURVEYS.....................................................................................................................................................................80
Survey Layout and Design ...................................................................................................................................80
Methodology .......................................................................................................................................................81
Participants .........................................................................................................................................................81
Access to Health Services ....................................................................................................................................84
Health Beliefs and Behaviors ..............................................................................................................................87
Health Issues .......................................................................................................................................................92
Community Health Concerns...............................................................................................................................94
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CHAPTER 7: SUMMARY OF FINDINGS ................................................................................................................ 100
USING THE DATA TO DETERMINE NEEDS .........................................................................................................................100
SECONDARY DATA ......................................................................................................................................................100
PRIMARY DATA ..........................................................................................................................................................101
CONCLUSION .............................................................................................................................................................102
APPENDIX A – SURVEY ........................................................................................................................................A-1
APPENDIX B - FOCUS GROUP QUESTIONS ........................................................................................................... B-1
APPENDIX C – FOCUS GROUP PARTICIPANT INFORMATION ............................................................................... C-1
APPENDIX D – SURVEY TRACKING DATABASE .................................................................................................... D-1
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List of Figures
FIGURE 1: POPULATIONS OF CAPE GIRARDEAU COUNTY CITIES/TOWNS/VILLAGES........................................................................20
FIGURE 2: CAPE GIRARDEAU COUNTY POPULATION ................................................................................................................21
FIGURE 3: RACE DISTRIBUTION OF CAPE GIRARDEAU COUNTY - 2010 ........................................................................................21
FIGURE 4: HISPANIC MAKEUP OF CAPE GIRARDEAU COUNTY VS. MISSOURI – 2010 .....................................................................22
FIGURE 5: AGE DISTRIBUTION FOR CAPE GIRARDEAU COUNTY COMPARED TO MISSOURI - 2010 ....................................................22
FIGURE 6: PERCENTAGE OF POPULATION – MALE VS. FEMALE – CAPE GIRARDEAU COUNTY VS. MISSOURI - 2010 .............................23
FIGURE 7: HOUSEHOLDS BY TYPE – CAPE GIRARDEAU COUNTY VS. MISSOURI – 2010 ..................................................................24
FIGURE 8: MEMBERSHIP BY RELIGIOUS CONGREGATION – 2010 – CAPE GIRARDEAU COUNTY........................................................24
FIGURE 9: EDUCATIONAL ATTAINMENT (POPULATION 25 YEARS AND OVER) – CAPE GIRARDEAU VS. MISSOURI - 2010 .......................25
FIGURE 10: HIGH SCHOOL DROPOUT RATES BY CAPE GIRARDEAU COUNTY SCHOOL DISTRICTS VS. MISSOURI ....................................26
FIGURE 11: DROPOUT RATES PER RACE/ETHNICITY FOR CAPE GIRARDEAU COUNTY SCHOOL DISTRICTS VS. MISSOURI - 2011 ..............26
FIGURE 12: DEMOGRAPHIC BREAKDOWN OF CAPE AND JACKSON SCHOOL DISTRICTS BY RACE VS. MISSOURI - 2011 ..........................27
FIGURE 13: LANGUAGE SPOKEN AT HOME – MISSOURI & CAPE GIRARDEAU COUNTY ...................................................................27
FIGURE 14: MARITAL STATUS (POPULATION 15 YEARS AND OVER) – CAPE GIRARDEAU COUNTY VS. MISSOURI - 2010 .......................28
FIGURE 15: CHANGE IN PER CAPITA INCOME FROM 2008 – 2009 – CAPE GIRARDEAU COUNTY VS. MISSOURI .................................28
FIGURE 16: UNEMPLOYMENT RATES FOR CAPE GIRARDEAU COUNTY VS. MISSOURI: 2006-2010 ...................................................29
FIGURE 17: MEDICAID PARTICIPATION BY RACE AND AGE FOR CAPE GIRARDEAU COUNTY AND MISSOURI - 2008 ..............................30
FIGURE 18: PERCENTAGE OF STUDENTS ENROLLED IN FREE/REDUCED LUNCH PROGRAM BY SCHOOL DISTRICT IN CAPE GIRARDEAU
COUNTY VS. MO .....................................................................................................................................................31
FIGURE 19: CHILD ABUSE & NEGLECT (RATE PER 1,000 CHILDREN) – CAPE GIRARDEAU COUNTY VS. MISSOURI ................................37
FIGURE 20: OUT-OF-HOME PLACEMENT ENTRIES (RATE PER 1,000 CHILDREN) – CAPE GIRARDEAU COUNTY VS. MISSOURI ................37
FIGURE 21: INFANT MORTALITY RATE – CAPE GIRARDEAU COUNTY VS. MISSOURI .......................................................................52
FIGURE 22: DEATH RATE BY UNINTENTIONAL INJURY TYPE (2007-2009) – CAPE GIRARDEAU COUNTY VS. MISSOURI........................58
FIGURE 23: ER VISITS RATE BY UNINTENTIONAL INJURY TYPE (2007-2009) – CAPE GIRARDEAU COUNTY VS. MISSOURI ....................58
FIGURE 24: HOSPITALIZATIONS RATE BY UNINTENTIONAL INJURY TYPE (2007-2009) – CAPE GIRARDEAU COUNTY VS. MISSOURI ........59
FIGURE 25: WORK INJURIES RATE – MACHINERY TYPE – CAPE GIRARDEAU COUNTY VS. MISSOURI .................................................59
FIGURE 26: LOW BIRTH WEIGHT PERCENT – CAPE GIRARDEAU COUNTY VS. MISSOURI .................................................................60
FIGURE 27: PRETERM BIRTHS (PERCENT OF TOTAL LIVE BIRTHS) – CAPE GIRARDEAU COUNTY VS. MISSOURI – 3 YEAR MOVING AVERAGE
............................................................................................................................................................................61
FIGURE 28: BIRTH DEFECTS RATE (PER 10,000 LIVE BIRTHS) – CAPE GIRARDEAU COUNTY VS. MISSOURI – 3 YEARS MOVING AVERAGE 62
FIGURE 29: PERCENTAGE OF MOTHERS THAT SMOKED DURING PREGNANCY – CAPE GIRARDEAU COUNTY VS. MISSOURI – 3 YEAR
MOVING AVERAGE...................................................................................................................................................66
FIGURE 30: RATE OF MOTHERS WHO BREASTFED THEIR BABIES SOMETIME DURING INFANCY – CAPE GIRARDEAU COUNTY VS. MISSOURI.67
FIGURE 31: UP-TO-DATE ON IMMUNIZATIONS (RATE PER 100 INFANTS) – WIC INFANT PARTICIPANTS – CAPE GIRARDEAU CO. &
MISSOURI ..............................................................................................................................................................71
FIGURE 32: BIRTHS TO TEENS (RATE PER 1,000 FEMALES AGES 15-19) – CAPE GIRARDEAU COUNTY VS. MISSOURI...........................73
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List of Tables
TABLE 1: ZIP CODES IN CAPE GIRARDEAU COUNTY..................................................................................................................20
TABLE 2: % BELOW POVERTY LEVEL BROKEN OUT BY EACH CITY IN CAPE GIRARDEAU COUNTY .......................................................29
TABLE 3: % BELOW POVERTY LEVEL BY OTHER CATEGORIES .....................................................................................................30
TABLE 4: PUBLIC DRINKING WATER SYSTEM VIOLATIONS CAPE GIRARDEAU COUNTY, 2006 - 2011 ................................................33
TABLE 5: OFFENSES AND ARRESTS BY CRIME TYPE IN CAPE GIRARDEAU COUNTY - 2009 ...............................................................36
TABLE 6: JUVENILE COURT REFERRALS - CAPE GIRARDEAU COUNTY VS. MISSOURI - 2009 .............................................................36
TABLE 7: DOMESTIC VIOLENCE INCIDENTS IN CAPE GIRARDEAU COUNTY - 2009 ..........................................................................38
TABLE 8: DENTISTS IN CAPE GIRARDEAU COUNTY THAT ACCEPT MO HEALTHNET (MEDICAID) .......................................................43
TABLE 9: OPTOMETRISTS IN CAPE GIRARDEAU COUNTY THAT ACCEPT MO HEALTHNET (MEDICAID) ...............................................44
TABLE 10: FIRE DEPARTMENTS IN CAPE GIRARDEAU COUNTY, MISSOURI & EMERGENCY MEDICAL RESPONSE AGENCIES.....................45
TABLE 11: LONG - TERM CARE FACILITIES IN CAPE GIRARDEAU COUNTY, MISSOURI......................................................................46
TABLE 12: LEADING CAUSE OF DEATH PROFILE 1999 - 2009 (RATES PER 100,000 POPULATION) - CAPE GIRARDEAU COUNTY VS.
MISSOURI ..............................................................................................................................................................48
TABLE 13: CAPE GIRARDEAU COUNTY, TOP TEN CANCER INCIDENCE SITES (2004-2008) .............................................................49
TABLE 14: CHRONIC DISEASE COMPARISON: CAPE GIRARDEAU COUNTY VS. MISSOURI .................................................................50
TABLE 15: NEW & LIVING HIV & AIDS CASES & RATES FOR CAPE GIRARDEAU COUNTY VS. MISSOURI, 2010 ..................................56
TABLE 16: PREVENTABLE HOSPITALIZATIONS 2009 - CAPE GIRARDEAU COUNTY VS. MISSOURI.......................................................64
TABLE 17: 2007 HEALTH & PREVENTATIVE PRACTICES - CAPE GIRARDEAU COUNTY VS. MISSOURI..................................................68
TABLE 18: CAUSES OF DEATH: AGES 1-14 ............................................................................................................................71
TABLE 19: CAUSES OF DEATH: AGES 15-19 ..........................................................................................................................72
TABLE 20: CURRENT SUBSTANCE USE FOR GRADES 6 -12 – CAPE GIRARDEAU COUNTY & MISSOURI ...............................................72
TABLE 21: SEXUALLY TRANSMITTED DISEASES: AGES 15-19 .....................................................................................................74
TABLE 22: QUALITY OF LIFE FOR SENIORS..............................................................................................................................75
TABLE 23: HEALTH AND WELLNESS FOR SENIORS....................................................................................................................75
TABLE 24: CAPE GIRARDEAU COUNTY RESULTS ......................................................................................................................80
TABLE 25: GENDER ...........................................................................................................................................................82
TABLE 26: YOUR RACE/ETHNICITY .......................................................................................................................................82
TABLE 27: AGE ................................................................................................................................................................82
TABLE 28: RACE/ETHNICITY OF CHILDREN LIVING AT HOME .....................................................................................................82
TABLE 29: MARITAL STATUS...............................................................................................................................................82
TABLE 30: EDUCATION LEVEL .............................................................................................................................................82
TABLE 31: ANNUAL HOUSEHOLD INCOME .............................................................................................................................82
TABLE 32: EMPLOYMENT STATUS ........................................................................................................................................83
TABLE 33: NUMBER OF PEOPLE CURRENTLY LIVING IN HOUSEHOLD ...........................................................................................83
TABLE 34: NUMBER OF ADULTS 65 AND OLDER CURRENTLY LIVING IN HOUSEHOLD .....................................................................83
TABLE 35: NUMBER OF CHILDREN UNDER 18 CURRENTLY LIVING IN HOUSEHOLD ........................................................................84
TABLE 36: WHAT KINDS OF INSURANCE DO YOU (AND/OR YOUR FAMILY) CURRENTLY HAVE?...........................................................84
TABLE 37: SELECT THE PREVENTIVE PROCEDURES YOU HAVE HAD IN THE LAST YEAR: ......................................................................85
TABLE 38: WHERE DO YOU GO FOR ROUTINE HEALTH CARE? .....................................................................................................86
TABLE 39: IF YOU ANSWERED SELDOM OR NEVER, WHY? ..........................................................................................................86
TABLE 40: WHAT SERVICES DO YOU SEEK OUTSIDE THE COUNTY? ...............................................................................................87
TABLE 41: WHY DO YOU TRAVEL OUTSIDE THE COUNTY? ..........................................................................................................87
TABLE 42: WHAT IS YOUR CURRENT HEALTH STATUS?..............................................................................................................87
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TABLE 43: SAFETY BEHAVIOR..............................................................................................................................................88
TABLE 44: HEALTHY LIFESTYLE BEHAVIORS ............................................................................................................................89
TABLE 45: SMOKE CIGARETTES ...........................................................................................................................................89
TABLE 46: HEALTHY LIFESTYLE BEHAVIORS ............................................................................................................................90
TABLE 47: HYGIENE/COMMUNICABLE DISEASE CONTROL ........................................................................................................90
TABLE 48: GET A FLU SHOT EACH YEAR .................................................................................................................................91
TABLE 49: HYGIENE/COMMUNICABLE DISEASE CONTROL ........................................................................................................91
TABLE 50: MENTAL HEALTH ISSUES AND BEHAVIORS...............................................................................................................91
TABLE 51: MENTAL HEALTH ISSUES AND BEHAVIORS...............................................................................................................92
TABLE 52: ENVIRONMENTAL/HOME SAFETY..........................................................................................................................92
TABLE 53: HEALTH ISSUES..................................................................................................................................................93
TABLE 54: PUBLIC SERVICES CONCERNS ................................................................................................................................95
TABLE 55: CRIME & VIOLENCE CONCERNS ............................................................................................................................95
TABLE 56: SAFETY BEHAVIORS ............................................................................................................................................96
TABLE 57: HEALTH BEHAVIORS ...........................................................................................................................................96
TABLE 58: HEALTH CARE & SUPPORT SERVICES CONCERNS ......................................................................................................97
TABLE 59: ENVIRONMENTAL PROTECTION CONCERNS .............................................................................................................97
TABLE 60: HEALTH CONDITIONS/ DISEASES CONCERNS ...........................................................................................................98
TABLE 61: MENTAL HEALTH CONCERNS ...............................................................................................................................98
TABLE 62: SOCIAL & ECONOMIC ISSUES CONCERNS ................................................................................................................99
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Executive Summary
The two not-for-profit hospitals in the city of Cape Girardeau, Missouri, SoutheastHEALTH and Saint
Francis Medical Center were partners in conducting this Community Health Needs Assessment (CHNA).
Community Health Needs Assessment Process and Requirements
A CHNA must be conducted every three years by not-for-profit hospitals in order to comply with federal
tax-exemption requirements under the Affordable Care Act. Following the CHNA, the hospital must
adopt an implementation strategy to meet the community health needs identified through the
assessment, and it must report how it is addressing the needs identified in the CHNA and provide a
description of needs that are not being addressed with the reasons why such needs are not being
addressed. The ultimate purpose of the CHNA is to improve community health.
The Community Health Needs Assessment process consists of the following steps:
1.
2.
3.
4.
5.
6.
7.
8.
Define the community served by the hospital facility
Identify the partners and individuals representing the broad interests of the community
Gather available data and current assessments
Develop and conduct primary research
Aggregate primary and secondary research
Identify and prioritize the health needs in your community
Develop and implement a strategy to address the identified priority health issues
Widely disseminate the CHNA
All steps were completed for this assessment except that the implementation strategy is not included.
That step will be completed separately by each hospital partner based on review of the CHNA.
Community Profile
Cape Girardeau County is located in southeast Missouri along the Mississippi River. The population of
the county is currently 75,674. Whites comprise 88.7% of the total population, with 7% comprised of
African Americans. The county has a higher percentage of the younger population, ages 15 – 24 than
does the state of Missouri. Nearly 86% of Cape Girardeau County residents 25 years and over have
graduated from high school, with 31.5% going on to receive a post-secondary degree. The
unemployment rate was 7.6% in 2010, which is considerably lower than Missouri’s 9.4%. Cape
Girardeau County has 14.2% of residents in poverty, with nearly 14% on Medicaid, 12% on Food Stamps,
and 15% uninsured. The city of Cape Girardeau offers an abundance of health care providers as well as
two medium-sized not-for-profit hospitals, a county health department, a federally qualified health
center, a free clinic, emergency services, and long-term care facilities. The community profile chapter
also includes social, economic, and environmental characteristics, information on public safety and
crime, and community health programs.
Health Outcomes
The Health Outcomes chapter contains information on mortality, including leading causes of death,
cancer incidence, chronic disease, infant mortality, and vehicle accidents, and on morbidity, including
obesity, diabetes, infectious disease, unintentional injuries, and health status at birth. The chapter also
contains information on mental health and preventable hospitalizations.
The leading causes of death in Cape Girardeau County are:
•
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Heart Disease
All Cancers (Malignant Neoplasms)
32%
21%
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Stroke/Other Cerebrovascular Disease
All Injuries and Poisonings
Chronic Lower Respiratory Disease
7%
5%
5%
Health Behaviors
The chapter on Health Behaviors is comprised of information on diet and exercise, tobacco use,
substance abuse, maternal health, and prevention and screening. In Cape Girardeau County, 28% of
residents are physically inactive, 72% eat less than five fruits and vegetables per day, and 18% smoke
cigarettes.
Health Measures
The chapter on Health Measures includes data regarding infant immunization rates, causes of death for
children and adolescents, teen substance abuse, teen pregnancy, STDs in teens, and the health of senior
citizens. The main causes of death for children and adolescents are unintentional injuries and motor
vehicle accidents; however, “all cancers” as a cause of death is higher in Cape Girardeau County than the
state of Missouri. Teen substance abuse is also a great concern as the percentage of substance use in
the past 30 days is higher for most substances in Cape Girardeau County than in Missouri.
Primary Research
Five focus groups were held in Cape Girardeau County and the questions asked can be found below.
Summaries of these focus groups are included in Chapter 6.
1. What do people in this community do to stay healthy? How do people get information about
health?
2. In this group’s opinion, what are the serious health problems in your community? What are
some of the causes of these problems?
3. What keeps people in your community from being healthy?
4. What could be done to solve these problems?
5. Is there any group not receiving enough health care? If so, why?
6. Of all the issues we have talked about today, what issues do you think are the most important
for your community to address?
118 surveys were completed by Cape Girardeau County residents. The survey was very extensive and
consisted of five different sections. The survey demographics were representative of Cape Girardeau
County’s population.
1. Multiple Choice: questions to collect information on demographics, health care access, health
status, and insurance.
2. Health Behaviors: questions to collect health behavior information.
3. Children’s Health Behaviors: questions to collect health behavior information about the
participants’ children if applicable.
4. Health Issues: questions the participants about having particular health issues.
5. Community Health Concerns: questions the participants to choose how much of a problem they
think particular issues are in their community.
Summary of Findings
The Summary of Findings chapter simply summarizes the needs determined by the assessment and how
those needs were determined.
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Key Findings
The following lists represent the key findings of this Community Health Needs Assessment by type of
need:
Health Needs
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Cancer (leading cause of death)
Diabetes (leading cause of death)
High Blood Pressure/Strokes (leading cause of death)
Heart Disease (leading cause of death)
Overweight Adults
Overweight Children
Mental Health – anxiety and depression, poor mental health days, mental health providers
Injuries/Poisonings (leading cause of death)
Chronic Lower Respiratory Disease (leading cause of death)
Alzheimer’s (leading cause of death)
Unintentional Injuries (leading cause of death)
Infectious Disease (Influenza)
High Cholesterol
Dental Health
Autism
Chronic Pain
Asthma/Respiratory Disorders (especially in children)
Sexually Transmitted Infections (especially in adolescents)
Allergies (especially food allergies in children)
Health Status at Birth - low birth weight, preterm births, birth defects
Preventable Hospitalizations - bacterial pneumonia and congenital syphilis
Cause of Death for Children and Adolescents - all cancers (Malignant Neoplasms)
Behavioral Needs
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Preventive Practices - women age 18 and older that never had a pap smear and no pap smear in
the last three years
Smoking
Alcohol/Drug Use
Poor Diet
No Exercise
Poor Lifestyle
Teen Substance Abuse - use of cigarettes, alcohol, prescription drugs, marijuana, heroin, bath
salts and binge drinking
Maternal Health –no prenatal care, living an unhealthy lifestyle, and smoking and using drugs
while pregnant
Eating Disorders
Community Needs
•
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Access to Specialists for Medicaid/Uninsured
Child Abuse and Neglect – including Child Out of Home Placement
Domestic Violence
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Health Care Affordability
Health Care Availability
Teen Pregnancy
Transportation (public)
Unemployment
Mosquitos
Job Availability
Job Security
Crime – theft offense rate
Juvenile Court Referrals – truancy and habitually absent from home
Property and Violent Crime committed against Senior Citizens
Housing Affordability
Racism
Child Care/Day Care
Murder or Intentional Injury
Secondhand Smoke
EMS called out for non-emergencies or repeat patients
High School Dropout Rate - Cape Girardeau School District 63 for Hispanics and Blacks
Food Stamps – received by a high percentage of Cape Girardeau County residents
Free/Reduced-Lunch Program - high percentage of Cape Girardeau School District 63 students
enrolled
Lack of Communication and Resources
Lack of Education and Awareness
Unsafe Neighborhoods
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Priority Needs
Prioritization Process
Members of the CHNA Team analyzed survey data, focus group data, and secondary data in the report
to prioritize the community health needs for each county. The priority needs were first identified by the
primary research or what the community finds most important. These high priority needs were then
validated by the secondary research – looking at the community’s statistics and trends against the
state’s statistics and trends.
Top 5 Priority Needs (and Associated Behavioral Needs)
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Cancer (Smoking)
Obesity (Diet and Exercise)
Chronic Disease
o Stroke (Healthy Lifestyle)
o Heart Disease (Smoking)
o Diabetes (Diet and Exercise)
o Chronic Respiratory Disease (Smoking)
Substance Abuse/Mental Health (Drug and Alcohol, Anxiety and Depression)
Health Care Affordability (Uninsured)
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Chapter 1: Community Health Needs Assessment Introduction and Methods
Community Health Needs Assessment Description
A community health needs assessment (CHNA) is a systematic process involving the community, to
identify and analyze community health needs and assets in order to prioritize these needs, and to plan
and act upon unmet community health needs.
Value of a Community Health Needs Assessment to the Community
 To share
the assessment
process and findings with the county residents and to educate local residents, health care
County
Background
Information
providers, and students regarding pressing health problems
To empower community members to act on issues of concern
To identify emerging issues, to provide data for deciding programmatic/organizational decisions, and to plan effective,
Population
Characteristics
Demographics
collaborative
interventionsand
to promote
better health
 To advocate for community change with politicians and other local decision-makers
 To promote collaboration and partnership among community members and groups
 To furnish a baseline by which to monitor changes
 To serve as a reference point and a historical perspective for future assessments
 To provide a resource for activities such as writing grant applications



To serve as a model for other counties who are planning an assessment
Source: North Carolina Public Health Community Health Assessment Guide Book
Community Health Needs Assessment Requirements
A CHNA must be conducted every three years by not-for-profit hospitals in order to comply with federal
tax-exemption requirements under the Affordable Care Act. The first CHNA must be completed by the
end of the first taxable year beginning after March 23, 2012. The CHNA must take into account input
from persons who represent the broad interests of the community served by the hospital facility,
including those with special knowledge of or expertise in public health; and it must be made widely
available to the public. Following the CHNA, the hospital must adopt an implementation strategy to
meet the community health needs identified through the assessment, and it must report how it is
addressing the needs identified in the CHNA and provide a description of needs that are not being
addressed with the reasons why such needs are not being addressed. The ultimate purpose of the
CHNA is to improve community health.
The documentation of the CHNA must include the following information:
1. A description of the community served by the hospital facility and how it was determined
2. A description of the process and methods used to conduct the assessment, including:
a. A description of the sources and dates of the data and other information used in the
assessment, including primary and secondary sources
b. The analytical methods applied to identify community health needs
c. Information gaps that affect the hospital’s ability to assess the community’s health
needs
d. If a hospital collaborates with other organizations in conducting a CHNA, the report
should then identify all of the community organizations that collaborated with the
hospital
e. If a hospital contracts with one or more third parties to assist in conducting a CHNA, the
report should also disclose the identity and qualifications of the third parties
Page 13
3. A description of the approach used to plan, develop, and conduct the assessment and how the
hospital organization took into account input from individuals who represent the broad interests
of the community served by the hospital facility, including:
a. A description of when and how the organization consulted with these individuals
(whether through meetings, focus groups, interviews, surveys, written correspondence,
etc.)
b. Community leaders who were consulted and/or collaborated in the planning and
implementation process
c. Justification of why data sources were used and selected
d. Justification of the approach for primary data collection
e. Explanation of successful and non-successful approaches to seek broad-based
community input, especially underserved or high-risk groups within the community
f. If the hospital takes into account input from an organization, the written report should
identify the organization and provide the name and title of at least one individual in that
organization who consulted with the hospital
g. Identification of any individual providing input who has special knowledge of or
expertise in public health and the report should list those people by name, title,
affiliation, and include a brief description of the individual’s special knowledge or
expertise
4. A prioritized description of all the community health needs identified through the CHNA, as well
as a description of the process and criteria used in prioritizing such health needs
a. Priorities identified through primary and secondary data
b. Other processes used to rank priorities
5. A description of the existing health care facilities and other resources within the community
available to meet the community health needs identified through the CHNA
Implementation Strategy Requirements
The IRS guidance specifies that the CHNA results must be used to develop an implementation strategy
that must be adopted by the hospital. The implementation strategy is defined as a written plan that
addresses each of the community health needs that were identified through the assessment. Each
hospital organization must meet the requirement to adopt an implementation strategy separately with
respect to each hospital facility it operates. The Treasury and IRS expect the implementation strategy
to:
1. Describe how the hospital facility plans to meet the health need; or
2. Identify the health need as one the hospital facility does not intend to meet and explains why
the hospital facility does not intend to meet the health need
In describing how a hospital facility plans to meet a health need identified through a CHNA, the
implementation strategy must tailor the description to the particular hospital facility, taking into
account its specific programs, resources, and priorities. The implementation strategy should also
describe any planned collaboration with governmental, non-profit, or other health care organizations,
including related organizations, in meeting the health need.
The IRS will allow hospital organizations to develop implementation strategies for their hospital facilities
in collaboration with other organizations, including related organizations, other hospital organizations,
for-profit and government hospitals, and state and local agencies, such as local health departments. If a
hospital does collaborate with other organizations in developing an implementation strategy, the
strategy should identify all the organizations with which the hospital collaborated.
Page 14
The implementation strategy is considered to be adopted on the date the implementation strategy is
approved by an authorized governing body of the hospital organization. The authorized governing body
means:
1. The governing body of the hospital organization (i.e. board of directors, board of trustees, or
equivalent controlling body)
2. A committee of the governing body, which may be comprised of any individuals permitted
under state law to serve on such committee, to the extent the committee is permitted by state
law to act on behalf of the governing body; or
3. To the extent permitted under state law, other parties authorized by the governing body of the
hospital organization to act on its behalf by following procedures specified by the governing
body in approving an implementation strategy
The hospital organization must adopt an implementation strategy to meet the community health needs
identified in a CHNA by the end of the same taxable year in which it conducts that CHNA.
Community Health Needs Assessment Process
The Community Health Needs Assessment process should consist of the following steps:
1. Define the community served by the hospital facility
2. Identify the partners and individuals representing the broad interests of the community
a. Individuals with special knowledge or expertise in public health
b. Federal, tribal, regional, state, or local health or other departments or agencies, with
current data or other information relevant to the health needs of the community served
by the hospital facility
c. Leaders, representatives, or members of medically underserved, low income and
minority populations, as well as populations with chronic disease needs
3. Gather available data and current assessments
4. Develop and conduct primary research
5. Aggregate primary and secondary research
6. Identify and prioritize the health needs in your community
7. Develop and implement a strategy to address the identified priority health issues
8. Widely disseminate the CHNA
Defining “Community”
The two not-for-profit hospitals in the city of Cape Girardeau, Missouri, SoutheastHEALTH and Saint
Francis Medical Center made the decision to define “community” as their primary service area, which
consists of four counties: Cape Girardeau, Bollinger, Scott, and Stoddard. The primary service area for
both hospitals is based on the number of inpatient discharges and outpatient visits by patients that
reside in each of these four counties. For SoutheastHEALTH, 75% of its patients are from these four
counties and for Saint Francis Medical Center, 68% of its patients are from these four counties. This
information is provided by the Hospital Industry Data Institute (HIDI) that is founded by the Missouri
Hospital Association. Since each county differs greatly from one another in terms of demographics,
health care providers, education, etc., four separate written assessment reports will be created and
made available to the public identifying specific needs per county.
Identifying Partners and Individuals Representing the Broad Interests of the Community
SoutheastHEALTH and Saint Francis Medical Center (“Community Health Needs Assessment Team”)
were partners in conducting this CHNA.
Page 15
The individuals representing the broad interests of Cape Girardeau County included involving people
from the following organizations when the primary research was conducted:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Cape Girardeau County Public Health Center
Cape Leaders Alliance
Cape Girardeau City Fire Department
Saint Francis Medical Center
SoutheastHEALTH
Samaritan Regional Health Clinic
City of Jackson
First Presbyterian Church
Jackson Chamber of Commerce
Jackson Family Care
Jackson R-2 Public School District
Jackson Senior Center
Oak Ridge R-VI School District
Community Caring Council
Cross Trails Medical Center
MERS/Goodwill
City of Cape Girardeau
The Salvation Army
SEMO Area Agency on Aging
United Way of Southeast Missouri
Cape Girardeau Police Department
Family Support Division
St. Vincent de Paul Catholic Church
Efforts were made to include at-risk, targeted populations and principle specialty areas that are served
by the hospital and present within the community, such as the medically underserved, low income
persons, minority groups, and those with chronic disease needs.
Gather Available Data and Current Assessments
Secondary data are existing data that are collected by someone else for a purpose other than the one
being pursued. Secondary research was obtained from various credible sources and is included in this
written assessment report. Some areas that were researched include demographics, the physical
environment, social factors, the economy, the transportation system, the education system, the health
care system, and public safety. The assessment also includes existing health status and public health
data. Examples of the data sources used are as follows:
•
•
•
•
•
•
•
•
U.S. Census Bureau
Missouri Department of Health and Senior Services
Missouri Department of Elementary and Secondary Education
Missouri Economic Research and Information Center (MERIC)
U.S. Bureau of Labor Statistics
Environmental Protection Agency
Centers for Disease Control and Prevention
University of Wisconsin’s County Health Rankings
Page 16
•
•
•
•
Missouri Department of Mental Health
Missouri State Highway Patrol
Annie E. Casey Foundation Kids Count Data Center
Other Local Websites
Develop and Conduct Primary Research
Primary data are data collected specifically for the purpose of answering project-specific questions.
Primary data should be collected after the collection and initial review of secondary data and should add
breadth, depth, and qualitative information to the secondary data. Primary research was obtained in
Cape Girardeau County through individual public surveys and focus groups.
Public Surveys
Surveys provide a flexible means of assessing a representative sample of the population to gather
information about attitudes and opinions, as well as measure behaviors and population characteristics.
The individual survey that was used was created by the Community Health Needs Assessment Team and
can be found in Appendix A. Advantages of surveying for individual responses include:
•
•
•
•
•
•
Obtaining direct feedback from clients, key informants and target populations about specific
issues
Developing public awareness problems
Building a consensus for solutions or actions
Comparing the self-reported incidence and prevalence with more objective data sources
Improving perception of quality of local health care services
Improving perception on the need of specific services either in existence or under consideration
Focus Groups
Group surveys in the form of focus groups were also conducted. A focus group is defined as people who
possess certain similar characteristics that are assembled as a group to participate in a focused
discussion to help understand the topic of interest. The questions asked in each focus group can be
found in Appendix B and a list of all focus group participants along with their experience, if any, can be
found in Appendix C. Data was collected from the focus groups primarily through note-taking. A writing
exercise was also handed out and completed regarding each participant’s top 5 serious issues.
Aggregate Primary and Secondary Research
An Access Database was created for the survey data to be entered and tracked. Screenshots of that
tracking database can be found in Appendix D. The Community Health Needs Assessment Team entered
the surveys into the CHNA Survey Tracking Database, which was a very tedious and time-consuming
process due to the amount of questions asked and data collected by the survey. Following the entry of
all surveys, the data was then exported from Access and manipulated into usable information in Excel.
The survey data will be presented and discussed in Chapter 6 – Primary Research of this report.
The information that was collected from the focus groups will also be presented and discussed in
Chapter 6 – Primary Research of this report.
Identify and Prioritize the Health Needs in the Community
From the analysis of this research, community needs were determined based on what the community
finds most important and by what the community is most lacking in that could have an impact on the
health of its citizens. These needs were primarily determined by the primary research – what the
Page 17
community finds most important – along with tying that information to what the secondary research
shows - looking at the community’s statistics and trends against the state’s statistics and trends.
Develop and Implement a Strategy to Address the Identified Priority Health Issues
The implementation strategy will be developed separately by each hospital partner involved in creating
this CHNA. Each hospital partner will decide what needs will be addressed and how those needs will be
addressed.
Widely Disseminate the CHNA
The CHNA is not considered “conducted” until the written report is made widely available to the public.
Fulfilling the “widely available” requirement requires the following:
1. Posting the CHNA on a website that clearly informs users that the document is available and
provides instructions for downloading.
2. The document is posted in a format that exactly reproduces the image of the report when
accessed, downloaded, viewed, and printed.
3. Allows individuals with Internet access to access, download, view, and print the report without
the use of special hardware or software.
4. The hospital or other organization distributing the report will provide the direct website address
to individuals who request a copy of the report.
5. The CHNA must remain widely available to the public until the next CHNA for that hospital is
conducted and made widely available.
Page 18
Chapter 2: Community Profile
Background Information for Cape Girardeau County
Cape Girardeau County was officially formed in 1812 and is located in southeast Missouri. The county
was named after Ensign Sieur Jean Baptiste Girardot, a French officer that developed a trading post on
the site of present day Cape Girardeau around 1733. The “cape” in the county name was after a rock
bluff overlooking the Mississippi River and is the world’s only inland cape. Part of the actual cape was
destroyed in the 1800s to make way for the railroads, yet a memorial “Cape Rock” sits at the top of the
bluff that was used as the trading post.
The county is bordered by the Mississippi River and
the state of Illinois to the east, Perry County to the
north, Scott County and a portion of Stoddard
County to the south, and Bollinger County to the
west. The land area of Cape Girardeau County is
579 square miles and the water area is 7.7 square
miles.
Interstate 55 is the major route running north and
south through the county. State highways also run
through the county connecting the smaller cities
and towns, such as highways 72, 34, 25, and 61.
The cities of Cape Girardeau and Jackson are the
largest cities in the county, but other smaller cities
in the county include: Delta, Gordonville, Oak Ridge,
Pocahontas, Whitewater, Allenville, Dutchtown, and
Old Appleton. The populations of these cities can
be found in Figure 1 along with the population
considered to be rural living outside of these cities.
Approximately 70% of residents live in the areas of
urban development, including the cities of Cape
Girardeau and Jackson along with a few other
smaller towns and villages. The population density
in 2010 was 129 people per square mile.
The largest city in the county is Cape Girardeau; however, the county seat is actually held by the
city of Jackson. Cape Girardeau is located along the Mississippi River in the southeastern part of
the county. Cape Girardeau became a river boom town when the steamboat arrived in 1835 and
was the busiest port between St. Louis and Memphis. After being occupied by Union forces during
the Civil War, Cape Girardeau saw continued growth with the establishment of public education in
1867, the introduction of rail services, and with advances in agriculture and industry. In 1873,
Southeast Missouri State University was founded as a teaching university. The city of Cape
Girardeau has evolved from a tiny trading post to a thriving, culturally rich community of almost
38,000 residents, serving as a regional hub for education, commerce, and medical care:
•
Education includes a public and private high school, many elementary schools, a university,
a college of nursing and health services, and several smaller trade schools/colleges.
Page 19
•
•
Commerce is available throughout with a variety of grocery stores, restaurants,
convenience stores, retail stores, and a large shopping mall.
Medical care services range from two medium-sized hospitals to long-term care facilities to
public health services to an abundance of specialists.
Figure 1: Populations of Cape Girardeau County Cities/Towns/Villages
37,941
Populations of Cape Girardeau County Cities/Towns/Villages*
22,369
13,758
438
Cape
Girardeau
city
Jackson city
Delta city
391
Gordonville
village
243
Oak Ridge
town
125
116
Whitewater
town
Allenville
village
114
94
85
Pocahontas Dutchtown
town
village
Old
Appleton
town
Rural
Source: U.S. Census Bureau, 2010 Census
*Populations for 2001 – 2009 are estimates by United States Census Bureau, 2010 is actual population based on the 2010 census
City of Jackson
The second largest city in the county is Jackson which is also the county seat. Jackson was incorporated
in 1814 and the first community in the nation to bear the name of President Andrew Jackson. Jackson is
located in the center of Cape Girardeau County and has a population of 13,758. The city of Jackson has
the largest school district in Cape Girardeau County with 4,664 students coming from a large
geographical portion of the county. Jackson offers a suitable amount of education, commerce, and
medical care as well.
Smaller Cities and Towns in Cape Girardeau County
The towns of Delta and Oak Ridge each host the other two school districts found in Cape Girardeau
County with 325 and 389 students, respectively. Neither of these towns offers much in regards to
commerce, but each has a few small businesses. Medical care is not available and must be sought out in
one of the larger cities close by. Gordonville has one of the higher populations of the smaller villages,
but does not have many businesses since it is relatively close to both cities of Jackson and Cape
Girardeau.
There are fifteen zip codes found in Cape Girardeau County and those are listed below:
Table 1: Zip Codes in Cape Girardeau County
Zip Code
City
Zip Code
City
Zip Code
City
63701
Cape Girardeau
63744
Delta
63766
Millersville
63702
Cape Girardeau
63745
Dutchtown
63769
Oak Ridge
63703
Cape Girardeau
63747
Friedheim
63770
Old Appleton
63739
Burfordville
63752
Gordonville
63779
Pocahontas
63743
Daisy
63755
Jackson
63785
Whitewater
Page 20
Demographic Characteristics
Population Growth
According to the U.S. Census Bureau:
•
•
•
In 2010, Cape Girardeau County had a population of 75,674.
The population has grown 10.00% since the year 2000, compared to 6.83% statewide.
Cape Girardeau County is the 16th largest county in the state of Missouri.
Figure 2: Cape Girardeau County Population
Cape Girardeau County Population
69,231
69,514
69,813
Year
2001
Year
2002
Year
2003
70,622
Year
2004
71,141
Year
2005
72,149
72,643
Year
2006
Year
2007
73,217
Year
2008
75,674
73,957
Year
2009
Year
2010
Source: U.S. Census Bureau, Population Estimates (http://censtats.census.gov/cgi-bin/usac/usatable.pl)
Race
•
•
The race distribution of Cape Girardeau County is not as diverse as the state of Missouri.
The percentage of the population that is white in Cape Girardeau County (88.7%) is considerably
higher than the Missouri percentage (82.8%) and the percentage of the population that is black
in Cape Girardeau County (7.0%) is considerably lower than the Missouri percentage (11.6%).
Figure 3: Race Distribution of Cape Girardeau County - 2010
Race Distribution - Cape Girardeau County
0.2%
7.0%
1.2%
White
0.9%
0.0%
1.8%
88.7%
Black or African
American
American Indian and
Alaska Native
Asian
Some Other Race
Native Hawaiian and
Other Pacific Islander
Two or More Races
Page 21
Ethnicity
• Figure 4 shows that the Hispanic population percentage in Cape Girardeau County is lower than
the state percentage.
Figure 4: Hispanic Makeup of Cape Girardeau County vs. Missouri – 2010
Hispanic Population of Cape Girardeau
County vs. Missouri - 2010
3.5%
2.0%
Cape Girardeau County
Missouri
Age Distribution
• Cape Girardeau County has a slightly younger population than the state with its median age
being 36.4, compared to 37.9 for Missouri.
• Cape Girardeau County has a higher percentage of 15-24 year olds than the state, due to the
student population of Southeast Missouri State University.
• In all other age groups, Cape Girardeau County and Missouri are closely matched, rarely
differing by more than 1%.
• 26.11% of the county’s population is 19 or younger.
• 14.32% of the county’s population is 65 or older.
Figure 5: Age Distribution for Cape Girardeau County Compared to Missouri - 2010
Age Distribution for Cape Girardeau County - 2010
Missouri
Cape Girardeau County has a higher percentage of the
younger population (ages 15-24) than Missouri
16%
Percent of Total Population
14%
12%
10%
8%
6%
4%
2%
0%
<5
5-14
15-19
20-24
25-34
35-44
45-54
Age Group
55-64
65-74
75-84
85+
Page 22
Gender
• The overall percentage of males in Cape Girardeau County is slightly lower than the percentage
of females.
• Looking at the percentage of males 65 and older compared to females 65 and older, there is a
much larger gap with an average of 16% more females than males.
• The percentage of the population that is male vs. female in Cape Girardeau County very closely
matches the average for the state of Missouri.
Figure 6: Percentage of Population – Male vs. Female – Cape Girardeau County vs. Missouri - 2010
Percentage of Population - Male vs. Female - Cape Girardeau County
vs. Missouri - 2010
48.4%
49.0%
51.6%
Missouri
Female
57.0%
51.0%
41.8%
Male
58.2%
43.0%
Male 65+
Female 65+
Page 23
Household/Family Configuration
• The household configuration for Cape Girardeau County closely matches the percentages for the
state of Missouri.
• Almost exactly half of the population is considered a husband-wife family, slightly higher than
the state percentage.
Figure 7: Households by Type – Cape Girardeau County vs. Missouri – 2010
Households by Type* - Cape Girardeau County vs. Missouri - 2010
49.8%
48.4%
Missouri
35.1%
4.1%
Husband-wife family
Male householder, no
wife present
12.3%
11.0%
4.6%
34.7%
Female householder,
no husband present
Nonfamily
households
*Husband-wife family includes those with own children under 18; Male householder, no wife present includes those with own children under 18;
Female householder, no husband present includes those with own children under 18; Non-family households include those living alone.
Religion
The following figure shows the membership by religious congregation in Cape Girardeau County.
Membership is counted as congregational adherents which include all full members, their children, and
others who regularly attend services. Nearly 77% of Cape Girardeau County’s population belongs to a
religious congregation.
Figure 8: Membership by Religious Congregation – 2010 – Cape Girardeau County
17,494
Membership by Religious Congregation - 2010 Cape Girardeau County
11545 11,162 10,823
9,952
6,989
4,178
1,717
787
636
150
113
101
27
Source: Association of Religion Data Archives
Page 24
Social Characteristics
Education
•
•
14.2% of Cape Girardeau County adults age 25 and older did not graduate from high school; this
is slightly higher than the state average of 13.9%.
The remaining 85.7% graduated from high school and 31.5% of those adults received a postsecondary degree, with a 2% higher average in the Bachelor’s degree category than the state.
Figure 9: Educational Attainment (Population 25 years and over) – Cape Girardeau vs. Missouri - 2010
Educational Attainment (Population 25 years and over) Cape Girardeau County vs. Missouri - 2010
33.9%
32.6%
Missouri
20.3%
22.0%
17.7%
8.7% 9.2%
5.5%
4.7%
Less than
9th grade
4.6%
9th to 12th
grade, no
diploma
High school
graduate
(includes
equivalency)
Some
college, no
degree
15.8%
9.2% 9.2%
6.6%
Associate's
degree
Bachelor's
degree
Graduate or
professional
degree
Figure 10 shows the high school dropout rates for Cape Girardeau County by school district.
•
•
•
In 2011, Delta did not have any dropouts.
All school districts except Cape Girardeau 63 had lower dropout rates than the state average.
Cape Girardeau 63 has a much higher dropout rate than any other school district and Missouri,
ranging from over 9% in 2008 to just over 5% in 2011. This school district is broken down by
race in Figure 11 to show what groups are included in the high dropout percentage.
Page 25
Figure 10: High School Dropout Rates by Cape Girardeau County School Districts vs. Missouri
High School Dropout Rates by Cape Girardeau County School District
vs. Missouri
MISSOURI
CAPE GIRARDEAU 63
DELTA R-V
JACKSON R-II
OAK RIDGE R-VI
10
9
8
7
6
5
4
3
2
1
0
Year 2008
Year 2009
Year 2010
Year 2011
Source: MO Dept. of Elementary and Secondary Education
Cape Girardeau 63 has a 13.3% dropout rate for the Hispanic population and an 8.3% dropout
rate for the black population causing the total dropout rate to be much higher than the state
and other Cape Girardeau County school districts.
•
Figure 11: Dropout Rates per Race/Ethnicity for Cape Girardeau County School Districts vs. Missouri - 2011
Dropout Rates per Race/Ethnicity for Cape Girardeau County School
Districts vs. Missouri - 2011
13.3
Black Dropout Rate 9-12 (%)
Hispanic Dropout Rate 9-12 (%)
White Dropout Rate 9-12 (%)
8.8
8.3
Total Dropout Rate 9-12 (%)
5.2
4.8
3.4
4.4
3.8
2.2
1.6 1.7
0
MISSOURI
CAPE GIRARDEAU 63
JACKSON R-II
0
0
0.9 0.9
OAK RIDGE R-VI
Page 26
•
Figure 12 shows the demographic breakdown by race for the Cape Girardeau 63 and Jackson R-II
school districts, and Missouri.
Figure 12: Demographic Breakdown of Cape and Jackson School Districts by Race vs. Missouri - 2011
Demographic Breakdown of Cape and Jackson School Districts by Race
vs. Missouri - 2011
MISSOURI
CAPE GIRARDEAU 63
JACKSON R-II
Cape Girardeau 63 has a significantly higher
percentage of black students than Missouri
and Jackson R-II in this comparison.
93.5
74.7
60.3
33.0
17.1
4.5
2.6
Black Percent
3.5
1.6
Hispanic Percent
White Percent
Language
As is shown below in Figure 13, Cape Girardeau County has a higher percentage of English being the only
language spoken at home than Missouri as a whole.
Figure 13: Language Spoken at Home – Missouri & Cape Girardeau County
Language Spoken at Home Missouri
Language Spoken at Home - Cape
Girardeau County
5.9%
96.4%
94.1%
Speak only English
Speak a language
other than English
3.6%
Of the 5.9% that speak a language
other than English, 61.9% speak
English "very well" and 38.1%
speak English less than "very well"
Source: U.S. Census Bureau, 2006-2010 American Community
Survey 5-Year Estimates
Speak only English
Speak a language
other than English
Of the 3.6% that speak a language
other than English, 59.6% speak
English "very well" and 40.4%
speak English less than "very well"
Source: U.S. Census Bureau, 2006-2010 American Community
Survey 5-Year Estimates
Page 27
Literacy
According to the National Center for Education Statistics’ 2003 Assessment of Adult Literacy, the
estimated percentage of those 16 and older considered to be lacking basic prose literacy skills in Cape
Girardeau County is 6%, compared to 7% for Missouri.
Marital Status
• Over half of the population that is 15 years and over was currently married, not separated in
2010.
• Almost 30% has never been married, slightly higher than the state average, due to the younger
population residing in Cape Girardeau County.
Figure 14: Marital Status (Population 15 years and over) – Cape Girardeau County vs. Missouri - 2010
51.8%
Marital Status (Population 15 years and over) Cape Girardeau County vs. Missouri - 2010
51.7%
Missouri
29.6% 28.3%
6.8%
Now married (not
separated)
6.5%
Widowed
10.2% 11.5%
Divorced
1.6% 2.0%
Separated
Never married
Economic Characteristics
Income
According to the U.S. Census Bureau, the median household income (in 2010 inflation-adjusted dollars)
in Cape Girardeau County is $44,479 compared to the state median of $46,262. The per capita income is
found in Figure 15 below. From 2008 to 2009, the per capita income has decreased in Cape Girardeau
County and in Missouri.
Figure 15: Change in Per Capita Income from 2008 – 2009 – Cape Girardeau County vs. Missouri
Change in Per Capita Income from 2008 - 2009 Cape Girardeau County vs. Missouri
$34,385
$34,282
$36,884
$36,181
2008 PCI
2009 PCI
-1.94%
-.3%
Missouri
Source: MERIC
Page 28
Employment
•
The unemployment rate in Cape Girardeau County has remained lower than the state rate in the
past five years and did not see as much of a jump in 2009 as the state of Missouri.
Figure 16: Unemployment Rates for Cape Girardeau County vs. Missouri: 2006-2010
Unemployment Rates for Cape Girardeau County vs. Missouri:
2006 - 2010
4.8
5
4.1
4.3
Year 2006
Year 2007
9.4
9.4
7.3
7.6
Year 2009
Year 2010
5.9
5.1
Year 2008
Missouri
Source: U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics
Poverty Status
According to the U.S. Census Bureau’s 2006 – 2010 American Community Survey, the percentage of
people below the poverty level in Cape Girardeau County for 2010 was 14.2% compared to the state
percentage of 14%. The tables below show the percentage below poverty level for each city, town, or
village in Cape Girardeau County and the percentage below poverty level for several other categories.
Table 2: % Below Poverty Level Broken Out by each City in Cape Girardeau County
Cape Girardeau County City
Dutchtown village
Cape Girardeau city
Pocahontas town
Old Appleton town
Allenville village
Delta city
Jackson city
Oak Ridge town
Gordonville village
Whitewater town
% Below Poverty Level
42.2%
19.8%
15.3%
11.5%
10.3%
9.7%
8.1%
6.5%
3.2%
0.0%
Source: U. S. Census Bureau, 2006 – 2010 American Community Survey
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Table 3: % Below Poverty Level by Other Categories
Category
Under 18 years
65 years and over
White
Black or African American
Hispanic or Latino origin (of any race)
Less than high school graduate
Unemployed
21.1%
7.6%
12.0%
40.9%
20.8%
18.3%
30.0%
Missouri
19.3%
9.3%
11.6%
28.0%
24.3%
25.2%
31.5%
Source: U. S. Census Bureau, 2006 – 2010 American Community Survey
Cape Girardeau County has a considerably higher poverty level than the state in the categories of:
•
•
Under 18 years
Black or African American
Medicaid and Public Assistance Participation
Medicaid
According to the Missouri Department of Health and Human Services, in 2008, 13.72% of Cape
Girardeau County residents were on Medicaid, which is slightly lower than the state rate of 14.50%.
Over 76% of those on Medicaid were white, 21% were black, and 53.15% were under age 18.
Figure 17: Medicaid Participation by Race and Age for Cape Girardeau County and Missouri - 2008
Missouri
Age Groups
Total Under 18
Total 18-64
65 and Over
TOTAL
Number
473,288
302,790
87,321
%
White
Cape Girardeau
AfricanAmerican
54.82%
5,339
35.07%
3,586
10.11%
863,399
Population - 2008
% of Medicaid Participation
Number
1,120
70.01%
26.22%
10,045
%
White
AfricanAmerican
76.07%
21.01%
53.15%
35.70%
11.15%
5,956,335
73,217
14.50%
13.72%
Source: Department of Health and Human Services, 2008.
Food Stamps
According to the U.S. Census Bureau’s 2006-2009 American Community Survey, 3,545 households or
11.97% in Cape Girardeau County were receiving food stamps. That was slightly higher than the state
percentage of 11.4%.
Free/Reduced-Lunch Program
Children from households with incomes less than 130 percent of poverty are eligible for free lunches;
those from households below 185 percent of poverty are eligible for reduced price lunches. The rate is
expressed as percent of total school enrollment. Figure 18 shows the percentage of students enrolled in
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the Free/Reduced Lunch program by school district – the percentage for Cape Girardeau 63 is much
higher than the state rate and much higher than all other school districts in Cape Girardeau County.
Figure 18: Percentage of Students Enrolled in Free/Reduced Lunch Program by School District in Cape Girardeau County vs. MO
Percentage of Students Enrolled in the Free/Reduced Lunch Program
by School District in Cape Girardeau County vs. Missouri
2008
65
60
55
50
45
40
35
30
25
20
15
10
5
0
2009
2010
2011
Cape Girardeau 63 had over 61% of its students
enrolled in the program in 2011 - much higher than
any other school district in the county and Missouri.
61.5
52.1
47.8
38.6
33.4
MISSOURI
CAPE
GIRARDEAU 63
DELTA R-V
JACKSON R-II
33.8
NELL HOLCOMB OAK RIDGE R-VI
R-IV
Hunger and Food Uncertainty
The Missouri Hunger Atlas from 2010 used three Need Indicators to determine the extent of food
insecurity and hunger in each Missouri County. For Percent Households Food Uncertain, Cape Girardeau
County has 12.4% compared to 15.8% for the state; Percent Households with Children Food Uncertain,
Cape Girardeau County has 16.6% compared to 23.4% for the state; and Percent Households Food
Uncertain with Hunger, Cape Girardeau County has 4.2% compared to 7.2% for the state.
Women, Infants, and Children (WIC) Participation
The Women, Infants, and Children (WIC) program provides federal grants to states for supplemental
food, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and nonbreastfeeding postpartum women, and to infants and children up to the age of five who are found to be
at a nutritional risk.
According to the Missouri Hunger Atlas, in 2008, Cape Girardeau County had 1,486 monthly participants
in the WIC program and 1,054 of those were infants and children (under the age of 5).
Housing
According to the U.S. Census Bureau, the majority of homes in Cape Girardeau County are single,
detached units (70.6%). Cape Girardeau County homes tend to be newer than the state as a whole, yet
are less expensive, and the county has a slightly higher percentage of those who rent their homes when
compared to the state.
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In Cape Girardeau County, 113 households lack complete plumbing facilities and 163 households lack
complete kitchen facilities. Also, another 1,107 households do not have any telephone service available.
Cape Girardeau County offers several housing resources for the homeless, abused, low-income, and for
those recovering from addiction and seeking treatment. Homeless shelters available include the Shelter
of Hope, Salvation Army, New Beginnings House of Refuge in the city of Cape Girardeau, and the Revival
Center in the city of Jackson. The Safe House for Women in the city of Cape Girardeau welcomes
women who have suffered from domestic violence. The Family Counseling Center, Mending Hearts
Recovery, and Vision House offer housing for women post-substance abuse treatment. The Gibson
Recovery Center and Teen Challenge offer housing for men post-substance abuse treatment. Several
options are available for low to moderate income seniors in the cities of Cape Girardeau and Jackson,
with some having handicap accessibility, and a few apartment complexes offer affordable housing
options for low to moderate income non-seniors.
Transportation
Several types of transportation services are available in Cape Girardeau County. The Cape Girardeau
Regional Airport is located approximately five miles from downtown Cape Girardeau and is easily
accessible from Interstate 55. The airport is a full-service airport and currently offers four daily flights to
Lambert International Airport in St. Louis for around $50. These short one-hour flights offer
convenience for passengers including parking, baggage claim, and security lines that are hassle-free.
Bus transportation is also available on local to national levels. The Cape Girardeau County Transit
Authority offers bus transportation around the city of Cape Girardeau on fixed routes. Southeast
Missouri State University also offers shuttle services on fixed routes around campus as well as a shuttle
bus that takes students off campus and to certain areas of the city. BART Transportation is based in
Jackson, Missouri, and has a total of 17 vans offering transportation to the St. Louis Airport from the
Cape Girardeau - Jackson area along with other areas in Illinois. The Greyhound Bus Line also has a stop
located in the city of Cape Girardeau and offers bus transportation on a national level.
The Cape Girardeau County Transit Authority also offers taxi services around the city of Cape Girardeau
in which individual passengers can request transportation from any location in Cape Girardeau at any
time for a fare.
Environment
Adequate environmental quality in terms of good air and water quality are prerequisites for good
health. Poor air or water quality can be particularly detrimental to the very young, the old, and those
with chronic health conditions.
Water Quality
According to the United States Environmental Protection Agency (EPA), a public water system is a
system that serves at least 25 people or services 15 or more connections at least 60 days per year.
There are three types of public water systems: a community water system is one that serves the same
people year-round, such as homes and businesses; a non-transient, non-community system serves the
same people, but not year-round, such as schools; and a transient, non-community system does not
consistently serve the same people, such as a campground or rest stop.
According to the EPA’s Safe Drinking Water Information System (SDWIS), Cape Girardeau County has 20
community water systems, three non-transient, non-community water systems, and five transient, noncommunity water systems. The SDWIS contains information about public water systems and their
violations of the EPA’s drinking water regulations. These statutes and accompanying regulations
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establish maximum contaminant levels (MCL), treatment techniques, and monitoring and reporting
requirements to ensure that water provided to customers is safe for human consumption.
During the past five years, 2006 – 2011, five community systems and two transient, non-community
water systems in Cape Girardeau County had health-based violations, where the amount of contaminant
exceeded safety standard (MCL) or the water was not treated properly. Those systems are listed in the
following table:
Table 4: Public Drinking Water System Violations Cape Girardeau County, 2006 - 2011
System Name
Type of Violation
Month/Year
CAPE GIRARDEAU CO PWSD 4
COLIFORM (TCR)**
SEPTEMBER 2007
CAPE PERRY CO PWSD 1 SOUTH
COLIFORM (TCR)**
JUNE 2006
MID AMERICAN TEEN CHALLENGE
COLIFORM (TCR)**
NOVEMBER 2008; DECEMBER 2008
PARKWOOD LAKE ESTATES
COLIFORM (TCR)**
MAY 2009; SEPTEMBER 2010; MAY
2011; JUNE 2011; JULY 2011
WESTLAKE MEADOWS SUBDIVISION
GROSS ALPHA, EXCL. RADON & U;
COMBINED RADIUM (-226 & -228)*;
COLIFORM (TCR)**
JANUARY 2006 - JUNE 2011 (44
violations)
CLASS ACT FAMILY FITNESS
COLIFORM (TCR)**
MAY 2010
RONS BUTCHER SHOP & GROCERY
COLIFORM (TCR)**
DECEMBER 2010
Source: U.S. EPA SDWIS
*Combined Radium 226/228: Some people who drink water containing radium 226 or 228 in excess of the Maximum Contaminant
Level over many years may have an increased risk of getting cancer.
**Total Coliform: Coliforms are bacteria that are naturally present in the environment and are used as an indicator that other,
potentially-harmful, bacteria may be present. Coliforms were found in more samples than allowed and this was a warning of potential
problems.
Air Quality
According to the County Health Rankings developed by the Robert Wood Johnson Foundation and the
University of Wisconsin Population Health Institute, air quality is represented by the population health
risks from ambient air pollution. Several pollutants, including ozone and fine particulate matter
(particulates less than 2.5 micrometers in diameter), can contribute to increased morbidity and
mortality. The County Health Rankings uses those two commonly measured pollutants to assess the
health risks of ambient air pollution, including the estimated number of days that a county’s air quality is
unhealthy for sensitive populations due to either one of those pollutants. The County Health Rankings
reports that Cape Girardeau County has an annual number of unhealthy air quality days due to fine
particulate matter equal to one and an annual number of unhealthy air quality days due to ozone equal
to zero. Cape Girardeau County is one of only 12 counties in the state of Missouri to have at least one
unhealthy air quality day due to fine particulate matter.
The negative consequences of ambient air pollution include decreased lung function, chronic bronchitis,
asthma, and other adverse pulmonary effects. Exposure to excess levels of ozone or fine particulate
matter are correlated with an increase in hospital emergency room visits and hospitalizations among
asthmatics and others with compromised respiratory function. Increases in these pollutants are
associated with greater risk of death due to cardiopulmonary and cardiovascular conditions and
ischemic heart disease. The clear impact that air quality has on human health and the importance the
EPA places on monitoring select pollutants shows that the air quality focus area is a critical one to
include among the County Health Rankings’ environmental measures.
Page 33
Lead Poisoning
Lead Poisoning is one of the most common and preventable environmental health problems today. The
primary lead hazard to children in Missouri is deteriorated lead-based paint. Lead-based paint was
banned for residential use nationwide in 1978 and any home built before 1978 may contain leaded
paint; however, the highest risk of lead exposure is found in homes built before 1950.
Fine particles of processed or recycled lead and/or lead dust become a health hazard when taken into
the body through inhalation (breathing) and/or ingestion (swallowing). Lead affects almost every organ
and system in the body and the effects are the same whether it is breathed or swallowed. Lead
damages the brain, central nervous system, kidneys and immune system. Lead in the human body is
most harmful to young children under the age of 6 and is especially detrimental to children less than 3
years of age due to their rapidly developing systems.
A blood test is used to determine blood levels and are measured and reported as micrograms of lead per
deciliter of whole blood (µg/dL). The 2010 Annual Report from the Missouri Childhood Lead Poisoning
Prevention Program of the Missouri Department of Health and Senior Services reports that of 661 total
tests done on children less than 6 years of age living in Cape Girardeau County, 650 had levels under 10,
8 had levels between 10-14.9, 1 had a level between 20-24.9, and 2 had levels between 25-44.9.
Children are considered to have elevated blood lead levels when the blood level is 10 µg/dL or greater.
So, 11 children under the age of 6 had elevated blood lead levels in Cape Girardeau County.
Built Environment
The built environment refers to human-made (versus natural-made) resources and infrastructure
designed to support human activity, such as buildings, roads, parks, and other amenities. The
characteristics of the built environment can affect the health of residents in multiple ways. As obesity
rates have increased over the past decades, interest in looking at local food and recreational
environments as potential contributors to obesity has also increased. The variety, price, and availability
of healthy foods in the local environment can play a role in whether those foods are consumed.
Additionally, the availability of recreational facilities can influence individuals’ and communities’ choices
to engage in physical activity. Better information on the availability of healthy food and recreational
facilities within the built environment will enable communities to take action to reduce the adverse
health outcomes associated with poor diet, lack of physical activity, and obesity.
Healthy Food Availability
University of Wisconsin Population Health Institute, Cape Girardeau County only has 1% of its residents
with limited access to healthy foods compared to 8% for the state. Limited access to healthy foods is
defined as the proportion of the population that is both living in poverty and do not live close to a
grocery store. Living close to a grocery store is defined as less than 10 miles in non-metro counties.
According to the Food Environment Atlas, Cape Girardeau County has ten grocery stores and four
farmer’s markets.
Also, according to the County Health Rankings, 43% of restaurants in Cape Girardeau County are fastfood establishments.
Recreational Activities Available
University of Wisconsin Population Health Institute, the rate of recreational activities available in Cape
Girardeau County is 11, which is the number of recreational facilities per 100,000 population. The rate
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for Missouri is 10, so Cape Girardeau County is right above the state rate. Recreational facilities are
defined as establishments 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.
The availability of recreational facilities can influence individuals’ and communities’ choices to engage in
physical activity. Proximity to places with recreational opportunities is associated with higher physical
activity levels, which in turn is associated with lower rates of adverse health outcomes associated with
poor diet, lack of physical activity, and obesity. Access to recreational facilities such as parks, sports
fields and facilities, biking trails, public pools, and playgrounds can be improved by locating them closer
to homes and schools, lowering costs to use the facilities, increasing hours of operation, and ensuring
access to people with various ability levels and limitations.
The City of Cape Girardeau Parks and Recreation Department offers many recreational activities to the
public. A large assortment of youth and adult sports leagues are available, such as baseball, softball,
volleyball, flag football, tennis, golf, and basketball. Other activities available include martial arts,
cheerleading, and art and cooking classes. Fitness classes are offered for Zumba, Yoga, Kickboxing, and
others. Swimming pools, bike lanes, and walking trails can be found in Cape Girardeau County for
physical activity as well. The Parks and Recreation Department also hosts a “Corporate Games” program
each year to get teams from businesses involved in some sporting competitions. Also, in Cape Girardeau
County, as many as 27 city parks, two county parks, and three community centers can be found offering
countless opportunities for residents to get out and about to enjoy some physical activity.
Public Safety
Crime Index
The Crime Index is the sum of eight major offenses and is used to measure the magnitude of crime in
the United States. Only eight major offenses are included in the Index because of their frequency of
occurrence and the fact they are most likely to be reported to law enforcement agencies. These Index
offenses include: murder, forcible rape, robbery, aggravated assault, burglary, theft, motor vehicle theft,
and arson. The first four make up the Violent Crime Index and the last four make up the Property Crime
Index. The following table shows the total number of offenses for each of those crimes in Cape
Girardeau County in 2009, as well as the number of arrests for those offenses, and the rate of offenses.
Also shown is the offense rate for Missouri to be compared to the county. Cape Girardeau County has a
higher offense rate than Missouri in the categories of forcible rape, aggravated assault, and theft.
Page 35
Table 5: Offenses and Arrests by Crime Type in Cape Girardeau County - 2009
Type of Offense
Violent Offenses Total:
Murder
Forcible Rape
Robbery
Aggravated Assault
Property Offenses Total:
Burglary
Theft
Motor Vehicle Theft
Arson
Total Offenses
# of Offenses # of Arrests
Offense Rate*
340
185
473.8
2
2
2.8
24
2
33.4
54
13
75.2
260
168
362.3
2832
570
3946.4
534
42
744.1
2221
522
3095.0
61
3
85.0
16
3
22.3
3172
755
4420.2
Missouri
Offense Rate*
521.0
7.1
28.6
131.3
354.0
3605.6
770.4
2485.0
307.5
42.7
4126.6
Source: Missouri State Highway Patrol’s 2009 Crime in Missouri report
*Offense Rate is per 100,000 population
Juvenile Crime Rates
The following table shows the number of juvenile court referrals in 2009 for Cape Girardeau County and
Missouri. Cape Girardeau County’s rate is considerably higher in the overall totals for law violation
offenses and status offenses, with the rates for truancy and being absent from home under status
offenses being higher than the state rate specifically.
Table 6: Juvenile Court Referrals - Cape Girardeau County vs. Missouri - 2009
Offense
Law Violation Offenses Total
Violent Offenses
Alcohol Offenses
Drug Offenses
Status Offenses Total
Truancy
Beyond Parental Control
Habitually Absent from Home
Injurious Behavior
# of Offenses
Rate*
849
11.2
114
23
24
217
2.9
108
27
66
16
1.5
0.3
0.3
1.4
0.4
0.9
0.2
Missouri
Rate*
5.4
1.6
0.2
0.4
2.4
0.6
0.5
0.5
0.7
Source: Missouri Department of Mental Health, Status Report 17th Edition
*Offense Rate is per 1,000 population
Family and Domestic Violence
Child Abuse and Neglect
The following figure shows the child abuse and neglect rates for Cape Girardeau County and Missouri for
the years 2004 – 2008. The rate for the county has been higher than the state rate since 2005.
Page 36
Figure 19: Child Abuse & Neglect (Rate per 1,000 children) – Cape Girardeau County vs. Missouri
Child Abuse & Neglect (Rate per 1,000 children) Cape Girardeau County vs. Missouri
41.6
41
40.5
34.7
34.9
33
Year 2004
Year 2005
Missouri
35.2
34.8
32.1
32.6
Year 2006
Year 2007
Year 2008
Source: Annie E. Casey Foundation Kids Count Data Center
Child Out-of-Home Placement
The following figure shows the out-of-home placement entries rate for Cape Girardeau County and
Missouri for the years 2004 – 2008. The rate for the county has been considerably higher than the state
rate since 2006 and while the state rate is trending downward, Cape Girardeau County’s rate is trending
upwards.
Figure 20: Out-of-Home Placement Entries (Rate per 1,000 children) – Cape Girardeau County vs. Missouri
Out-of-Home Placement Entries (Rate per 1,000 children) Cape Girardeau County vs. Missouri
Missouri
Linear (Cape Girardeau County)
5.5
5.2
4.8
5.2
4.8
4.5
3.9
Year 2004
Year 2005
4.1
Year 2006
3.8
3.8
Year 2007
Year 2008
Domestic Violence
Domestic violence incidents are reported whether or not an arrest is made and include any dispute
arising between spouses, former spouses, persons with children in common regardless of whether they
reside together, persons related by blood, persons related by marriage, non-married persons currently
Page 37
residing together, and non-married persons who have resided together in the past. Domestic violence
incidents are reported when an officer believes a dispute crosses an abuse threshold as indicated by
harassment, stalking, coercion, assault, sexual assault, battery, or unlawful imprisonment. Domestic
violence incidents are reported by the highest ranked relationship between victim and offender,
regardless of the number of persons or potential multiple relationships present during the incident. The
following table shows the domestic violence incidents in Cape Girardeau County for 2009 by the
victim/offender relationship. The Missouri rate for 2009 was 651.0 per 100,000 population, which is
higher than the Cape Girardeau County rate of 589.4.
Table 7: Domestic Violence Incidents in Cape Girardeau County - 2009
Victim/Offender Relationship
Spouses
Former Spouses
Couples w/Child(ren) in Common
Blood Relatives
People Related Through Marriage
People Who Live Together
People Who Lived Together in the Past
Total Domestic Violence Incidents
Rate per 100,000 population
93
28
49
57
7
153
36
423
589.4
Source: Missouri State Highway Patrol’s 2009 Crime in Missouri report
Health Promotion
Community Health Programs
The two community hospitals in Cape Girardeau County offer many health programs, classes, and
screening opportunities that are available to the public, with many being free of charge. Some of those
are as follows:
•
•
•
•
•
•
•
•
Support groups for breastfeeding, bariatric surgery, heart patients, cancer patients, and ostomy
patients, diabetes self-management and grief support
Classes for parenting and childbirth including breastfeeding, infant care, infant massage, car seat
installation, pregnancy and childbirth basics, infant and child CPR, and a sibling class to prepare
siblings for the arrival of a new baby
Screening opportunities for diabetes, colorectal cancer, blood pressure, metabolic syndrome,
abdominal aortic aneurysm, heart, and overall health
Fitness programs for adults and children
Smoking cessation programs
Camps for boys and girls that are interested in a health care profession
Asthma education
First-aid and CPR
Other programs available in the community provided by other community organizations include:
•
•
•
•
Alcoholics Anonymous
Parenting classes
Family skills classes
Grandparent support groups for grandparents acting as parents
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•
•
•
•
•
•
Parents without partners
Building strong families
Postponing sexual involvement
Puberty classes
Nutrition classes for how to eat healthy
Youth Substance Abuse Prevention
Health Care System
Access to Health Care
Access to health care is a broad concept that tries to capture accessibility to needed primary care, health
care specialists, and emergency treatment. While having health insurance is a crucial step toward
accessing the different aspects of the health care system, health insurance by itself does not ensure
access. It is also necessary to have comprehensive coverage, providers that accept the individual’s
health insurance, relatively close proximity of providers to patients, and primary care providers in the
community. There are additional barriers to access in some populations due to lack of transportation to
providers’ offices, lack of knowledge about preventive care, long waits to get an appointment, low
health literacy, and inability to pay the high-deductible of many insurance plans and/or co-pays for
receiving treatment.
Uninsured Population
The County Health Rankings created by the Robert Wood Johnson Foundation and the University of
Wisconsin’s Population Health Institute measures the uninsured population as the estimated percent of
the population under age 65 that has no health insurance coverage. Using 2009 data from the U.S.
Census Bureau, they determined that Cape Girardeau County has 15% of its population under age 65
uninsured, which is exactly the same as Missouri.
Health Care Providers
Hospitals
Southeast Hospital is located in the city of Cape Girardeau, Missouri, and is recognized as one of
Missouri’s leaders in the provision of health care services. It is a 266-bed medical center that serves
more than 640,000 people in 25 counties in southeast Missouri and southern Illinois. The hospital staffs
more than 200 physicians and has over 2,200 employees and offers a full continuum of health care and
wellness services designed to meet the needs of individuals, families, and businesses. Southeast ranks
high in a variety of quality measures such as patient satisfaction and clinical outcomes, as reported by
several nationally-recognized monitoring organizations and is also among only a handful of hospitals in
Missouri to achieve the Magnet Nursing Services Recognition Award. Some of the major service lines
found at Southeast include Oncology, Cardiovascular, Neurosciences, Women’s and Children’s,
Orthopedics, and Emergency Services. The 266 beds at Southeast Hospital are divided among 158
Med/Surg beds, 10 Pediatric beds, 13 Rehabilitation beds, 15 Neonatal Intensive Care Unit beds, 26
Intensive Care Unit beds, 29 Obstetrics beds, and 15 Psychiatric Unit beds.
Saint Francis Medical Center is also located in the city of Cape Girardeau, Missouri, and has become a
progressive, innovative regional tertiary care referral center in the last nine years that has nearly tripled
in size. It is a 280-bed facility that serves more than 650,000 people throughout Missouri, Illinois,
Kentucky, Tennessee, and Arkansas. Some of Saint Francis’ major service lines include Neurosciences,
Orthopedics, Family BirthPlace, Cardiovascular, Oncology, Rehabilitation, Trauma, and they had the
region’s first Level III Neonatal Intensive Care Unit. The hospital also offers urgent care centers and a
Page 39
fitness facility. Saint Francis Medical Center’s 280 beds are divided out into 176 Med/Surg beds, 8
Pediatric beds, 23 Rehabilitation beds, 25 Neonatal Intensive Care Unit beds, 32 Intensive Care Unit
beds, and 16 Obstetrics beds.
Landmark Hospital of Cape Girardeau is the premier Long Term Acute Care (LTAC) hospital of the fourstate area. This hospital has built a solid reputation for providing the very best patient care, and
excellent customer service. The hospital operates as a joint-venture between Landmark Holding of
Missouri, LLC, and Saint Francis Medical Center in Cape Girardeau. The facility has 30 single-occupancy
rooms, providing a more private, comfortable experience during the patient’s stay. A patient’s average
length of stay is about 27 days, depending on the patient’s level of acuity. Primary diagnoses include:
ventilator weaning, complex medical, and wound care. Most patients come to Landmark from a shortterm acute care hospital, and are discharged to home, skilled nursing, or rehab. Landmark Hospital has
developed strong relationships in the medical community, and works in partnership with other hospitals
and doctors. The care the hospital provides will continue to make a positive difference for critically ill
patients and their families.
Family Practice
According to the University of Wisconsin, Population Health Institute and Robert Wood Johnson
Foundation’s County Health Rankings, Cape Girardeau County has a primary care physician ratio of
832:1, whereas the state of Missouri has a ratio of 1,015:1.
Cape Girardeau County has many family practices that offer primary care. Some of the practices located
in Cape Girardeau and Jackson, Missouri, are listed below.
In Cape Girardeau, Missouri:
•
•
•
•
•
•
•
•
•
•
•
Southeast Primary Care
Cape Primary Care
Regional Primary Care
Riverside Family Practice
Cape Physician Associates
Cape Family Medical Clinic & Weight Loss Center
Cape Medical Group
Premier Family Physicians
Midwest Family Care
Cape Family Practice
Urgent Care:
o Doctors Express
o Immediate Convenient Care
o Cape Urgent Care
In Jackson, Missouri:
•
•
•
•
•
Jackson Primary Care
Heartland Family Physicians
Jackson Family Care
Jackson Medical Center
Urgent Care:
o Prompt Care
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Cross Trails Medical Center is the only federally qualified health center located in Cape Girardeau
County and is located in the city of Cape Girardeau. This facility has been providing patients with
affordable health care and dental services for over 14 years. Some of the services offered include:
•
•
•
•
•
•
•
Primary medical care – dental care – preventive health screenings and adult immunizations
Acute care for minor illness or injury – children’s care, including immunizations and well
child checks
Adolescent health – pediatrics – geriatrics – women’s health care, including family planning
and annual gynecology exams
Participation in Show Me Healthy Women program to assist women in obtaining necessary
exams
Full diabetes program, including education with a certified diabetes educator – laboratory
services (on-site) – X-ray services (on-site)
Mental health counseling referrals – patient medication assistance program – telehealth
(current dermatology – contract pharmacy program)
Emergency cases are referred to the nearest emergency room
A Rural Health Clinic can be found at the Cape Girardeau County Health Department located in the city
of Cape Girardeau. The clinic provides well and sick care by appointment, including childhood
immunizations and physical exams for children two weeks to 18 years of age. No emergency care is
given, but minor illnesses can be treated. River City Clinic is another available clinic located in
downtown Cape Girardeau.
Samaritan Regional Health Clinic is a free clinic located in Cape Girardeau, Missouri, that just opened in
2012 and serves individuals who do not have medical insurance and who are not eligible for Medicare or
Medicaid. This clinic is funded through donations and volunteers and is currently open two days per
week.
Mental Health
Foundation’s County Health Rankings, Cape Girardeau County has mental health provider ratio of
12,203:1, whereas the state of Missouri has a ratio of 9,561:1.
The Community Counseling Center in Cape Girardeau County is a not-for-profit behavioral health
organization that offers a full array of comprehensive mental health services for several counties in
southeast Missouri. They are dedicated to the treatment, support, and ultimate recovery of those
afflicted with mental illness. The Community Counseling Center has been accredited by the Commission
on Accreditation of Rehabilitation Facilities (CARF) and is certified by the Missouri Department of Mental
Health. Some of the programs offered include the following:
•
•
•
•
•
•
•
•
•
•
CRISIS INTERVENTION
PSYCHIATRIC SERVICES
OUTPATIENT COUNSELING SERVICES
COMMUNITY PSYCHIATRIC REHAB CENTER
ADULT TARGETED CASE MANAGEMENT
LOUIS E. MASTERMAN - GROUP HOME
PSYCHOSOCIAL REHABILITATION PROGRAM
CHILDREN’S TARGETED CASE MANAGEMENT
INTENSIVE IN-HOME SERVICES
FAMILY REUNIFICATION SERVICES
•
•
•
•
•
•
•
•
•
CHILDREN’S ALTERNATIVE SERVICES
CHILDREN’S INTENSIVE COMMUNITY
PSYCHIATRIC REHAB CENTER
HEALTHCARE HOME
PEER PHONE SUPPORT
APARTMENT LIVING PROGRAM
SUPPORTIVE COMMUNITY LIVING
EDUCATION
TRANSPORTATION
HOUSING
Page 41
•
•
•
•
•
•
CONSUMER EMPLOYMENT
CONSUMER ADVISORY BOARD
COMMUNITY OUTREACH
INTEGRATED DUAL DIAGNOSIS TREATMENT
DISEASE MANAGEMENT
COMMUNITY BASED SOLUTIONS
•
•
•
•
INTENSIVE RESIDENTIAL TREATMENT
SERVICES
EMERGENCY BEDS - LOU MASTERMAN
DAY TREATMENT (InSTEPP)
PROMOTING OLDER ADULT WELLBEING
Cottonwood Residential Treatment Center, located in the city of Cape Girardeau, is a residential
program designed to meet the emotional and mental health needs of children and adolescents (ages 6 17) who meet the criteria for severe emotional disturbance. Cottonwood also serves children who are
dually diagnosed with emotional disturbance and mental retardation. The center is located on the
campus of Southeast Missouri State University and provides employment and field experiences for many
of the University’s students. Education is provided on-site to the children through the Cape Girardeau
Public School system, as well as Therapeutic Recreation and Therapeutic Services. The purpose of
Therapeutic Recreation is to develop skills for a more independent lifestyle and successful transition to
community living and includes activities such as arts, crafts, basketball, and volleyball. Therapeutic
Services include Psychiatric evaluation and monitoring, individual therapy, recreation therapy, family
therapy, group therapy, Milieu therapy, case management, 24-hour crisis intervention, and nursing and
dietary assessment. Referrals to Cottonwood can either come from an Administrative Agent or the
State of Missouri Children’s Division and the admission criteria are as follows:
•
•
•
•
•
•
The child must be between the ages of 6 and 17
The child must have a serious psychiatric disorder as defined in Axis I of the Diagnostic and
Statistical Manual of Mental Disorders (if the child has only a diagnosis of conduct disorder,
mental retardation, developmental disorder, or substance abuse, they do not meet admission
criteria)
The child needs a supervised residential setting for treatment – a less restrictive environment is
unsuccessful or unsafe
The child must be able to independently accomplish activities of daily living (feeding, bathing
and toileting)
Cottonwood must be appropriate to meet the safety and treatment needs of the referred child
within the program
A discharge plan is identified with involved and responsible parties (parents, guardians,
Administrative Agent, etc.) providing needed assistance and support for discharge and aftercare
Southeast Hospital also offers a 15-bed psychiatric unit that is a locked unit and serves clients with a
mental illness. Common diagnoses treated on the psychiatric unit include disorders such as depression,
bipolar disorder, anxiety disorders, and psychosis. The unit is a voluntary unit serving adults on an
inpatient basis. The unit is staffed with a multidisciplinary team comprised of a medical director,
licensed clinical social workers, recreational therapists, and a nursing staff of RNs, LPNs, and Nurse
Assistants. The primary mission of the psychiatric unit is to provide a safe behavioral health care
environment and treatment to individuals in need of inpatient mental health services.
Page 42
Dental Services
Foundation’s County Health Rankings, Cape Girardeau County has a dentist ratio of 1,531:1, whereas the
state of Missouri has a ratio of 3,198:1.
Table 8 shows which dentists in the county accept MO HealthNet (Medicaid); there are 16 general
dentists, two dentists specializing in children’s teeth, and two oral surgeons. Six of the general dentists
are employed at Cross Trails Medical Center in the city of Cape Girardeau, which is a federally qualified
health center.
Table 8: Dentists in Cape Girardeau County that Accept MO HealthNet (Medicaid)
Name of Provider
ADEN, BYRON L., DDS
BEGLEY, RANDAL L., DDS
BEUSSINK, COURTNEY L., DDS
COTNER, DANNA P., DDS
EDWARDS, JONATHAN WADE, DDS
ETHERTON, ROBERT C., DMD
FALLERT, KEVIN R., DDS
FOX, JAMES L., DDS
FOX, ROBERT G., DDS
HABERKORN, ROBERT M., DDS
LEWIS, T. WAYNE, DDS
MERKLEY, PATRICIA J., DMD
ROHLFS, LOUIS H., DDS
RUOPP, JANET B., DDS
RUOPP, PATRICK R., DDS
SCHERRMAN, JAYNE F., DDS
SCHOOLMAN, STEVEN RONALD, DDS
SCHOOLMAN, STEVEN RONALD, DDS
SHEETS, SUSAN H., DDS
WILSON, LEIGH GARLAND, DDS
Specialty
DENTIST - GENERAL
ORAL SURGEON
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
DENTIST - GENERAL
PEDODONTIST
DENTIST - GENERAL
ORAL SURGEON
PEDODONTIST
DENTIST - GENERAL
Source: Missouri Department of Social Services, MO HealthNet Provider Search
Page 43
Optometry Services
Table 9 shows which optometrists in the county accept MO HealthNet (Medicaid); there are 18
optician/optometrists in total.
Table 9: Optometrists in Cape Girardeau County that Accept MO HealthNet (Medicaid)
Provider Name
BILLINGS, MICHAEL K., OD
BLANKENSHIP, TIMOTHY J., OD
BLIESE, DAVID R., OD
DETRING, KENNETH C., OD
EVANS, LAURA R., OD
FOSTER, AMY M., OD
FOWLER, CHRISTY M., OD
HAGER, LISA A., OD
HALL, JAMES T., OD
KIPPENBROCK, ROBERT L., OD
LEET, GREGORY S., OD
MCDONALD, JR, EUGENE F., OD
MCDOUGAL, SCOTT A., OD
SHEWMAKE, RACHEL A., OD
SMITH, JANET H., OD
THOMA, KORY, OD
TYHURST, KEITH N., OD
WOOD, RYNE CHRISTOPHER, OD
Source: Missouri Department of Social Services, MO HealthNet Provider Search
Specialty
OPTICIAN/OPTOMETRIST
Community Health Resources/Services
The Cape Girardeau County Health Department is also a great resource for public health,
environmental health, and disaster and emergency management information and other resources.
Emergency Services
Cape County Private Ambulance Service, Inc. (CCPA) has been providing Emergency Ambulance Service
to Cape Girardeau County, Missouri, since 1968. As a leader in the field of Emergency Medical Services,
emergency calls are handled by full time certified Emergency Medical Dispatchers (EMD) using Medical
Priority's EMD protocols. This provides the caller with life-saving and injury preventing pre-arrival
instructions, including phone instructions on critical life-saving maneuvers such as CPR, choking, serious
bleeding and others. Each emergency ambulance is equipped with cutting edge technology including 12
lead EKG and telemetry capability, leading emergency drugs, and staffed with Missouri Licensed and
National Registry certified Paramedics and Emergency Medical Technicians. CCPA also provides NonEmergency Medical Transportation within the Midwest region. Non-emergency transportation may be
provided using Advanced Life Support vehicles and crews if special or advanced services are required or
may be provided by Basic Life Support crews if appropriate.
Seven Fire Departments can be found in Cape Girardeau County located in several areas throughout the
county. The following table shows those locations as well as other information about those
departments. Firefighters have many responsibilities besides just putting out fires and one of those
responsibilities may be to provide emergency care for people involved in accidents and oftentimes,
firefighters are the first emergency personnel on the scene.
Page 44
Table 10: Fire Departments in Cape Girardeau County, Missouri & Emergency Medical Response Agencies
Type of Fire
Department:
# of Fire
Stations:
# of Career
Firefighters:
# of
Volunteer
Firefighters:
# of Paid
per Call
Firefighters:
NonFirefighting
Employees:
NonFirefighting
Volunteers:
Career
4
57
0
0
3
0
Fruitland Area Fire
Department
Volunteer
2
0
27
0
0
3
Fruitland, MO 63755
Millersville Fire Rescue
Department*
Volunteer
3
0
20
0
0
0
Volunteer
2
0
16
0
0
2
Volunteer
3
0
42
0
0
42
Jackson, MO 63755
Mostly
Volunteer
1
11
1
18
0
0
North Cape County Fire
District
Volunteer
1
0
19
0
0
0
Fire Department
Cape Girardeau Fire
Department*
Cape Girardeau, MO 63703
Millersville, MO 63766
Whitewater Fire Protection
District
Whitewater, MO 63785
East County Fire Protection
District*
Cape Girardeau, MO 637020691
Jackson Fire & Rescue*
Oak Ridge, MO 63769
*Licensed as an Emergency Medical Response Agency
Source: Fire Departments Network, Fire Department Listings by County
Source: Missouri Department of Health & Senior Services, Emergency Medical Services, Directories
ARCH Air Medical Service is a critical care air ambulance service that provides coverage for Cape
Girardeau County. ARCH has eight base locations in Missouri and three base locations in Illinois. The
service operates several rotary wing aircrafts and one fixed wing aircraft. The on-board flight team
includes a highly trained EMS Pilot, Critical Care Flight Nurse, and a Critical Care Flight Paramedic.
Southeast Hospital offers Emergency Services in its 17,800 square foot Emergency Department and is
among the regions finest in terms of experience, expertise, equipment, and facilities. The Emergency
Department includes:
•
•
•
•
An Acute Care Facility that is open and staffed 24/7, designated to care for patients with a wide
range of medical problems arising from illness or injury, and includes 22 treatment rooms in a
“center court” concept and one major treatment room with complete x-ray capabilities
The area’s first nationally accredited Chest Pain Center with the back-up of a nationally
recognized Heart Center
A nationally accredited Stroke Center
ERexpress, which is an area designated specifically for the diagnosis and treatment of minor
illnesses and injuries, minor lacerations, and splinting which may not require the full resources
of the acute emergency treatment area
Page 45
Saint Francis Medical Center also offers Emergency Services and is the region’s only state-designated
Level III Trauma Center. In early 2011, Saint Francis Medical Center completed a two-phase expansion
and renovation project and added almost 30,000 square feet to the original facility’s 11,600 square feet.
The new state-of-the-art facility offers 26 private treatment rooms, three trauma rooms, two triage
rooms, and a special procedures room for a total of 32 patient rooms. The Emergency and Trauma
Center features hospital-based, board certified emergency medicine physicians and trauma surgeons
who provide critical care 24 hours a day, seven days a week. Saint Francis Medical Center also has a
Convenient Care facility located within the Emergency and Trauma Center, which is a walk-in facility for
treating minor illnesses and injuries.
Long-Term Care Facilities
The following describes three types of Long-Term Care Facilities:
•
Residential care facilities (RCFs) refer to facilities that provide long-term care to adults or
children in a residential setting rather than the patient's home. People with disabilities,
mental health problems, or learning difficulties are often cared for at home by paid or
voluntary caregivers, such as family and friends, with additional support from home care
agencies.
•
Assisted living residences or assisted living facilities (ALFs) provide supervision or assistance
with activities of daily living (ADLs); coordination of services by outside health care providers;
and monitoring of resident activities to help to ensure their health, safety, and well-being.
•
Skilled nursing facilities (SNFs), nursing homes, or convalescent homes provide a place of
residence for people who require constant nursing care and have significant deficiencies with
activities of daily living. Residents include the elderly and younger adults with physical or
mental disabilities. Residents in a skilled nursing facility may also receive physical,
occupational, and other rehabilitative therapies following an accident or illness.
Table 11: Long - Term Care Facilities in Cape Girardeau County, Missouri
FACILITY NAME
LEVEL OF LICENSURE
CITY
AUBURN CREEK-ASSISTED LIVING BY AMERICARE
ASSISTED LIVING FACILITY OPTION 1
CAPE GIRARDEAU
CAPETOWN ASSISTED LIVING
CAPE GIRARDEAU
SKILLED NURSING FACILITY
CAPE GIRARDEAU
CHATEAU GIRARDEAU ASSISTED LIVING CENTER
CAPE GIRARDEAU
COUNTRY GARDENS
CAPE GIRARDEAU
FOUNTAINBLEAU LODGE
CAPE GIRARDEAU
FOUNTAINBLEAU LODGE
CAPE GIRARDEAU
RESIDENTIAL CARE FACILITY II
CAPE GIRARDEAU
HEARTLAND CARE AND REHABILITATION CENTER
CAPE GIRARDEAU
JACKSON MANOR NURSING HOME
JACKSON
RESIDENTIAL CARE FACILITY I
CAPE GIRARDEAU
CAPE GIRARDEAU
CAPE GIRARDEAU
CAPE GIRARDEAU
CAPE GIRARDEAU
CHATEAU GIRARDEAU
FREDERICK STREET MANOR
JEFFERSON MANOR
LIFE CARE CENTER OF CAPE GIRARDEAU
LOUIS E MASTERMAN CENTER
LUTHERAN HOME ASSISTED LIVING
LUTHERAN HOME, THE
Page 46
MAPLE CREST MANOR
CAPE GIRARDEAU
MONTICELLO HOUSE
JACKSON
MONTICELLO HOUSE
JACKSON
OAK RIDGE MANOR
OAK RIDGE
PARKWOOD MANOR
CAPE GIRARDEAU
RATLIFF CARE CENTER
CAPE GIRARDEAU
RESIDENTIAL CARE FACILITY I
CAPE GIRARDEAU
SPRIGG STREET MANOR
Source: Missouri Department of Health and Senior Services, Show Me Long Term Care in Missouri
Page 47
Chapter 3: Health Outcomes
Mortality
Leading Causes of Death
The leading causes of death in Cape Girardeau County based on 11-year data (1999 - 2009) from the
Missouri Department of Health and Senior Services are as follows:
•
Heart Disease
32%
• All Cancers (Malignant Neoplasms)
21%
• Stroke/Other Cerebrovascular Disease
7%
• All Injuries and Poisonings
5%
• Chronic Lower Respiratory Disease
5%
These five causes accounted for 70% of all Cape Girardeau County deaths in that time period. The table
below shows all leading causes of death in Cape Girardeau County and Missouri. The Cape Girardeau
County rate is higher than the state rate in heart disease, stroke/other cerebrovascular disease,
Alzheimer’s disease, and kidney disease.
Table 12: Leading Cause of Death Profile 1999 - 2009 (rates per 100,000 population) - Cape Girardeau County vs. Missouri
Cause of Death
All Causes
Heart Disease
Smoking-Attributable (estimated)
Lung Cancer
All Injuries and Poisonings
Chronic Lower Respiratory Disease
Alzheimer's Disease
Total Unintentional Injuries
Pneumonia and Influenza
Diabetes Mellitus
Kidney Disease (Nephritis and Nephrosis)
Breast Cancer
Motor Vehicle Accidents
Suicide
Alcohol/Drug-Induced
Septicemia
Firearm
Chronic Liver Disease and Cirrhosis
Homicide
Injury at Work
HIV/AIDS
Number
7596
2409
1587
1271
552
462
381
377
322
241
199
183
163
115
98
77
75
72
68
39
19
16
7
Rate
843.8
260.7
183.9
144.2
59
54.2
47.4
42.3
33.6
28.9
21.1
20.8
17.7
13.3
12.1
10.1
10.2
8.4
8.8
4.8
2.4
2
0.9
Compared to
Missouri Rate
Lower
Higher
Lower
Lower
Higher
Lower
Lower
Lower
Higher
Lower
Lower
Lower
Higher
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Lower
Equal
Lower
Missouri
Rate
871.5
245.6
197.7
152.2
54.9
61.4
67
48.7
21.9
45
23.1
23.8
17.2
14.6
18.6
12.8
16.4
11.5
12.7
7.3
7.1
2
2.3
Source: Missouri Department of Health and Senior Services, Community Data Profiles
Page 48
Cancer
The table below shows the top ten cancer incidence sites in Cape Girardeau County by all sexes and then
breaks out the top ten sites by males and females. While lung and bronchus cancer makes up the
greatest percentage among all sexes, when looking at males and females separately, breast cancer is the
most prevalent for females and prostate cancer is the most prevalent for males.
Table 13: Cape Girardeau County, Top Ten Cancer Incidence Sites (2004-2008)
All Sexes
Cancer Site
Lung and Bronchus
Female Breast
Prostate
Colon and Rectum
Thyroid
Urinary Bladder
Kidney and Renal Pelvis
Non-Hodgkin Lymphoma
Melanoma of the Skin
Oral Cavity and Pharynx
Cancer Site
Females
Female Breast
Lung and Bronchus
Colon and Rectum
Thyroid
Corpus and Uterus, NOS
Ovary
Pancreas
Cervix Uteri
Cancer Site
Males
Prostate
Lung and Bronchus
Colon and Rectum
Urinary Bladder
Kidney and Renal Pelvis
Oral Cavity and Pharynx
Leukemia
Liver and Intrahepatic Bile Duct
Percent
16.95
13.91
13.5
10.87
3.92
3.92
3.74
3.74
2.69
2.57
Percent
27.9
15.83
10.79
6.68
4.57
3.75
2.7
2.88
2.34
2.23
Percent
26.92
18.07
10.96
5.83
5.71
3.73
3.38
3.15
2.68
2.333
Source: Missouri Cancer Registry, Top Ten Cancer Incidence Sites (2004 - 2008)
Page 49
Chronic Disease
The table below shows a comparison of many chronic diseases for Cape Girardeau County and Missouri
and the deaths, hospitalizations, and ER visits caused by those chronic diseases. Cape Girardeau County
has worse rates than Missouri in only a few categories, which are highlighted in pink below.
Table 14: Chronic Disease Comparison: Cape Girardeau County vs. Missouri
Chronic Disease
# of Events Cape Girardeau
Cape Girardeau
Rate
2,409
4,904
4,211
260.7
121.7
11.6
245.6
152.38
12.95
1999-2009
2005-2009
2005-2009
1,741
1,539
68
189
38.4
0.2
170.32
55.25
0.82
1999-2009
2005-2009
2005-2009
552
1,275
193
59
30.7
0.5
54.92
30.37
0.79
1999-2009
2005-2009
1,587
1,456
183.9
36.7
197.7
39.07
1999-2009
2005-2009
193
192
21.8
4.7
19.39
4.89
1999-2009
193
21.8
19.25
1999-2009
2005-2009
462
185
54.2
4.6
61.41
5.18
1999-2009
2005-2009
115
77
13.3
1.9
14.55
2.2
Data Years
Missouri
Rate
Heart Disease
Deaths 1999-2009
Hospitalizations 2005-2009
ER Visits 2005-2009
Ischemic Heart Disease
Deaths
Hospitalizations
ER Visits
Deaths
Hospitalizations
ER Visits
Deaths
Hospitalizations
Colorectal Cancer
Deaths
Hospitalizations
Colon and Rectum Cancer (SEER)
Deaths
Lung Cancer (SEER)
Deaths
Hospitalizations
Breast Cancer
Deaths
Hospitalizations
Cervical Cancer
Deaths
Hospitalizations
Prostate Cancer
Deaths
Hospitalizations
1999-2009
2005-2009
1999-2009
2005-2009
14 1.7*
17 0.5*
95
171
1.41
0.79
10.6
4.2
9.1
2.78
Page 50
Diabetes Mellitus
Deaths 1999-2009
ER Visits 2005-2009
Chronic Obstructive Pulmonary Disease Excluding Asthma
Deaths 1999-2009
ER Visits 2005-2009
Asthma
Deaths 1999-2009
ER Visits 2005-2009
Smoking-Attributable (Estimated)
Deaths 1999-2009
Arthritis/Lupus
Deaths 1999-2009
ER Visits 2005-2009
183
523
530
20.8
13.8
1.5
23.78
17.32
1.7
368
778
1,638
41.2
19.3
4.6
47.38
23.22
5.41
7.2
2.3
1.3
13.41
5.12
1,271
144.3
152.23
25
1,564
5,333
2.8
39.8
14.9
3.55
41.01
8.67
9 1.1*
249
770
Source: Missouri Department of Health and Senior Services, County Level Study, Chronic Disease Comparison
Death rates are per year per 100,000 population and are age-adjusted to the U.S. 2000 standard population.
Hospitalization rates are per year per 10,000 population and are age-adjusted to the U.S. 2000 standard population.
ER Visit rates are per year per 1000 population and are age-adjusted to the U.S. 2000 standard population.
Years of Potential Life Lost
The County Health Rankings created by the Robert Wood Johnson Foundation and the University of
Wisconsin’s Population Health Institute measure premature death by the years of potential life lost
before age 75 (YPLL). Every death occurring before the age of 75 contributes to the total number of
years of potential life lost, so someone that dies at age 25 contributes 50 years of life lost to the
county’s YPLL.
According to the County Health Rankings, Cape Girardeau County had 6,938 years of potential life lost
before age 75 per 100,000 population in 2011, compared to 8,043 for the state of Missouri.
Infant Mortality
The figure below shows the infant mortality rate of Cape Girardeau County compared to the state of
Missouri. The state rate has remained fairly steady with a slight decrease over the ten-year period,
while the Cape Girardeau County rate has fluctuated up and down, trending downward overall.
Page 51
Figure 21: Infant Mortality Rate – Cape Girardeau County vs. Missouri
Infant Mortality Rate - Cape Girardeau County vs. Missouri
(per 1,000 live births)
Missouri
8.8
7.7
7.6
7.5
7.5
7.8
7.7
7.7
7.7
7.7
7.7
7.5
7.4
7.6
7.2
6.5
6.2
6.5
6.8
5.6
Year 1997 Year 1998 Year 1999 Year 2000 Year 2001 Year 2002 Year 2003 Year 2004 Year 2005 Year 2006
Motor Vehicle Accidents
According to the University of Wisconsin, Population Health Institute and the Robert Wood Johnson
Foundation’s County Health Rankings, Cape Girardeau County has a motor vehicle crash death rate per
100,000 of 13, compared to 19 in the state of Missouri.
Morbidity
Obesity and Overweight
Adult obesity is measured by those persons age 20 and older that have a body mass index (BMI) greater
than or equal to 30 kg/m2. According to the County Health Rankings developed by the Robert Wood
Johnson Foundation and the University of Wisconsin’s Population Health Institute, 28% of Cape
Girardeau County residents are obese compared to 31% of Missouri residents. Obesity is often the end
result of an overall energy imbalance due to poor diet and limited physical activity. Obesity increases
the risk for health conditions such as coronary heart disease, type 2 diabetes, cancer, hypertension,
dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, and
osteoarthritis.
Diabetes
According to the Centers for Disease Control and Prevention, diabetes is the leading cause of kidney
failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the United
States and it is also a major cause of heart disease and stroke. Other complications that can be caused
by diabetes include: hypertension, eye problems, kidney disease, nervous system disease, amputations,
dental disease, and complications of pregnancy.
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin
production, insulin action, or both. Diabetes can lead to serious complications and premature death, but
people with diabetes, working together with their support network and their health care providers, can
Page 52
take steps to control the disease and lower the risk of complications. There is more than one type of
diabetes:
•
Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenileonset diabetes. Type 1 diabetes develops when the body’s immune system destroys pancreatic
beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose.
To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This
form of diabetes usually strikes children and young adults, although disease onset can occur at
any age. In adults, type 1 diabetes accounts for approximately 5% of all diagnosed cases of
diabetes. Risk factors for type 1 diabetes may be autoimmune, genetic, or environmental. There
is no known way to prevent type 1 diabetes. Several clinical trials for preventing type 1 diabetes
are currently in progress or are being planned.
•
Type 2 diabetes was previously called non–insulin-dependent diabetes mellitus (NIDDM) or
adult-onset diabetes. In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed
cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use
insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce
it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of
gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.
African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans
and Native Hawaiians or other Pacific Islanders are at particularly high risk for type 2 diabetes
and its complications. Type 2 diabetes in children and adolescents, although still rare, is being
diagnosed more frequently among American Indians, African Americans, Hispanic/Latino
Americans, and Asians/Pacific Islanders.
•
Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Gestational
diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and
American Indians. It is also more common among obese women and women with a family
history of diabetes. During pregnancy, gestational diabetes requires treatment to optimize
maternal blood glucose levels to lessen the risk of complications in the infant.
•
Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes
of youth), surgery, medications, infections, pancreatic disease, and other illnesses. Such types
of diabetes account for 1% to 5% of all diagnosed cases.
Foundation’s County Health Rankings, Cape Girardeau County has 10% of adults aged 20 and over that
have been diagnosed with diabetes, compared to 10% for the state.
Infectious Disease
Communicable Diseases
The Missouri Department of Health and Senior Services’ Bureau of Communicable Disease Control and
Prevention put out an Annual Communicable Disease Surveillance Report summarizing the different
communicable diseases reported across Missouri in 2009. The diseases that were reported in Cape
Girardeau County are described below.
Human ehrlichiosis and anaplasmosis are tick-borne diseases caused by several closely-related bacteria.
The bacterium is maintained in nature in parasite-host cycles involving ticks and mammals. Human
infections are usually the result of a bite from an infected tick. Ehrlichiosis can lead to life-threatening
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illness in otherwise healthy adults and children. People over the age of 40 and people undergoing
immunosuppressive therapy or with a preexisting immunosuppressive condition are especially
vulnerable to serious infections and hospitalization. Some infected people, however, never develop
symptoms, and others experience only mild symptoms that resolve without treatment. The greatest
challenge to health care providers is diagnosing ehrlichiosis early in the course of the illness, when
antibiotic therapy is most effective. There was one case of ehrlichiosis reported in Cape Girardeau
County in 2009 for a rate of .48 per 100,000 population, compared to 2.8 per 100,000 for Missouri.
Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to
severe illness, and at times can lead to death. There are three types of influenza viruses, types A, B and
C, with influenza A viruses being the most severe. Influenza is characterized by abrupt onset of fever,
often with chills or rigors, headache, malaise, diffuse myalgia, and nonproductive cough. Subsequently,
as symptoms progress, sore throat, nasal congestion, rhinitis, and cough become more prominent.
Influenza affects the health of a large number of people every year. Most people recover within a week,
but a cough and tiredness can linger for two weeks or longer. Dehydration, bronchitis, and bacterial
pneumonia, are examples of complications from flu. The flu can make chronic health problems worse.
For example, people with asthma may experience asthma attacks while they have the flu, and people
with chronic congestive heart failure may have worsening of this condition that is triggered by the flu.
Children may get sinus problems and ear infections as complications from the flu. Those persons 65
years and older, children under the age of two, and persons of any age with chronic medical conditions
are at highest risk for serious complications of flu. The influenza season is defined as the period
between week 40 (first week of October) of one year and week 20 (middle of May) of the next year. The
rate per 100,000 population in Cape Girardeau County was 1090.2 with a total case count of 793 for the
2009 – 2010 influenza season, compared to a rate of 517.1 per 100,000 for Missouri.
Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the
bacterium Bordetella pertussis. Pertussis is only found in humans and is spread from person to person.
People with pertussis usually spread the disease by coughing or sneezing while in close contact with
others, who then breathe in the pertussis bacteria. Pertussis can cause serious and sometimes lifethreatening complications in infants and young children, especially those who are not fully vaccinated.
Many infants who get pertussis are infected by older siblings, parents or caregivers who might not even
know they have the disease. The disease usually starts with cold-like symptoms and a mild cough or
fever. After one to two weeks, severe coughing can begin. Unlike the common cold, pertussis can
become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or
altogether absent. Infants may have a symptom known as "apnea." Apnea is a pause in the child’s
breathing pattern. Pertussis is most dangerous for infants. More than half of infants younger than one
year of age who get the disease must be hospitalized. Pertussis can cause violent and rapid coughing,
over and over, until the air is gone from the lungs and you are forced to inhale with a loud "whooping"
sound. This extreme coughing can cause you to throw up and be very tired. In teens and adults,
especially those who have been vaccinated, the "whoop" is often not there and the infection is generally
milder (less severe). Cape Girardeau County had two cases of pertussis in 2009 for a rate of .16 per
100,000 population, compared to 17.2 per 100,000 for Missouri.
Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most people infected
with Shigellosis develop diarrhea, fever, and stomach cramps starting a day or two after they are
exposed to the organism. Stools are frequent, loose to watery, of small volume, and often mucoid
and/or bloody. The diarrhea is usually self-limiting, resolving in five to seven days. Young children and
the elderly may be more severely affected, in some cases needing hospitalization. However, some
individuals who are infected may have no symptoms at all, but could still pass the Shigella bacteria to
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others. Cape Girardeau County had four cases of shigellosis for 2009 for a rate of .31 per 100,000
population, compared to 17.7 per 100,000 for Missouri.
Tuberculosis (TB) is a disease caused by the bacterium called Mycobacterium tuberculosis. The bacteria
can attack any part of your body, but it usually attacks the lungs. TB is spread through the air from one
person to another. The bacteria are expelled into the air when a person with TB disease of the lungs or
throat coughs, sneezes, speaks or sings. These bacteria can stay in the air for several hours, depending
on the environment. People who become infected with TB bacteria usually have had very close, day-today contact with someone who has TB disease (e.g. a family member, friend, or close co-worker). In
most people who become infected, the body is able to fight the bacteria to stop them from growing.
The bacteria become inactive, but they remain alive in the body and can become active later. This is
called latent TB infection (LTBI). These people do not have symptoms of TB disease, and they cannot
spread TB to others. According to the Missouri Department for Health and Senior Services Tuberculosis
Information Management System, Cape Girardeau County had one case of TB disease and 43 cases of
LTBI in 2010.
Hepatitis
Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can
range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.
Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from
contact with objects, food, or drinks contaminated by the feces or stool of an infected person. Cape
Girardeau County had zero reports of Hepatitis A in 2009.
Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. It can
range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B is
usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B
virus enters the body of someone who is not infected. This can happen through sexual contact with an
infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be
passed from an infected mother to her baby at birth. Hepatitis B can be either acute or chronic. Acute
Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is
exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection.
Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in
a person’s body. Chronic Hepatitis B is a serious disease that can result in long-term health problems,
and even death. Cape Girardeau County had one report of Hepatitis B Acute and two reports of
Hepatitis B, Chronic Infection in 2009.
Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can
range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is
usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone
who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles
or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began
in the United States, Hepatitis C was also commonly spread through blood transfusions and organ
transplants. Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a shortterm illness that occurs within the first six months after someone is exposed to the Hepatitis C virus. For
most people, acute infection leads to chronic infection. Chronic Hepatitis C is a serious disease that can
result in long-term health problems, or even death. There is no vaccine for Hepatitis C. The best way to
prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.
Cape Girardeau County had 114 cases of Hepatitis C, Chronic Infection reported in 2009.
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HIV/AIDS
HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency
syndrome, or AIDS. There are two types of HIV, HIV-1 and HIV-2. In the United States, unless otherwise
noted, the term “HIV” primarily refers to HIV-1. Both types of HIV damage a person’s body by
destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases.
Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a
week or two, but others have no symptoms at all. People living with HIV may appear and feel healthy
for several years. However, even if they feel healthy, HIV is still affecting their bodies. All people with
HIV should be seen on a regular basis by a health care provider experienced with treating HIV infection.
Many people with HIV, including those who feel healthy, can benefit greatly from current medications
used to treat HIV infection. These medications can limit or slow down the destruction of the immune
system, improve the health of people living with HIV, and may reduce their ability to transmit HIV.
Untreated early HIV infection is also associated with many diseases including cardiovascular disease,
kidney disease, liver disease, and cancer.
AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has
difficulty fighting diseases and certain cancers. Before the development of certain medications, people
with HIV could progress to AIDS in just a few years. Currently, people can live much longer - even
decades - with HIV before they develop AIDS. This is because of “highly active” combinations of
medications that were introduced in the mid-1990s.
The table below shows the total new and living cases and rates of HIV and AIDS in Cape Girardeau
County and Missouri for 2010. Cape Girardeau County has a much lower rate of HIV and AIDS than the
state of Missouri.
Table 15: New & Living HIV & AIDS Cases & Rates for Cape Girardeau County vs. Missouri, 2010
Case/Disease
New HIV Cases
Living HIV Cases
New AIDS Cases
Living AIDS Cases
Number
Rate
1
1.4
24
32.5
0
0
21
28.4
Missouri
Rate
7.5
84.9
2.3
96.5
Source: Missouri Department for Health and Senior Services’ HIV/AIDS Disease Surveillance System 2010 Epidemiologic Profile
Other Sexually Transmitted Diseases
Sexually transmitted diseases (STDs) is a term used to describe more than 20 different infections that
are transmitted through exchange of semen, blood, and other body fluids; or by direct contact with the
affected body areas of people with STDs. Sexually transmitted diseases are also called venereal diseases.
STDs can have very painful long-term consequences as well as immediate health problems. They can
cause:
•
•
•
•
•
birth defects
blindness
bone deformities
brain damage
cancer
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•
•
•
•
heart disease
infertility and other abnormalities of the reproductive system
mental retardation
death
Some of the most common sexually transmitted diseases are described below as defined by the Centers
for Disease Control and Prevention along with the number of cases reported in Cape Girardeau County
by the Missouri Department for Health and Senior Services’ HIV/AIDS Surveillance System STD by County
report.
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. It has often
been called "the great imitator" because so many of the signs and symptoms are indistinguishable from
those of other diseases. In 2011, Cape Girardeau County had six cases of Syphilis reported.
Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae, a bacterium that can
grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix
(opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra
(urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.
Gonorrhea is a very common infectious disease. In 2011, Cape Girardeau County had 62 cases of
Gonorrhea reported.
Chlamydia is a common sexually transmitted disease caused by the bacterium, Chlamydia trachomatis,
which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually
mild or absent, serious complications that cause irreversible damage, including infertility, can occur
"silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the
penis of an infected man. Chlamydia is the most frequently reported bacterial sexually transmitted
disease in the United States. Under-reporting is substantial because most people with chlamydia are
not aware of their infections and do not seek testing. Also, testing is not often done if patients are
treated for their symptoms. In 2011, Cape Girardeau County had 240 cases of Chlamydia reported.
Unintentional Injuries
An unintentional injury is one that is not inflicted by deliberate means. This category includes those
injuries and poisonings described as accidental, regardless of whether the injury was inflicted by oneself
or by another person. The following figures show the Death Rate, ER Visits Rate, and Hospitalizations
Rate for Cape Girardeau County and Missouri by type of unintentional injury. Cape Girardeau County’s
rate is either less than or equal to the state rate in every category and type except for falls in the
hospitalizations category. Falls and motor vehicle traffic are the largest causes of unintentional injuries.
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Figure 22: Death Rate by Unintentional Injury Type (2007-2009) – Cape Girardeau County vs. Missouri
Death Rate* by Unintentional Injury Type (2007-2009) Cape Girardeau County vs. Missouri
15.5
Missouri
11.6
10.2
8.6
5.2
0.5
1.2
Drowning
0.8
Fall
1.5
Fire/Burn
0.0 0.3
Firearm
0.9
1.6
1.4
Injury at Work Motor Vehicle
Poison:
Traffic**
Drugs/Alcohol
0.0 0.3
Poison:
Gas/Cleaner
Source: Community Data Profiles - Missouri Department of Health and Senior Services
*Death rates are per year per 100,000 population and are age-adjusted to the U.S. 2000 standard population.
Figure 23: ER Visits Rate by Unintentional Injury Type (2007-2009) – Cape Girardeau County vs. Missouri
ER Visits Rate* by Unintentional Injury Type (2007-2009) Cape Girardeau County vs. Missouri
Missouri
26.2
22.3
7.8
1.5 1.5
0.0 0.0
Drowning
Fall
Fire/Burn
9.2
0.5 0.7
0.1 0.1
Firearm
Motor Vehicle
Poison:
Traffic**
Drugs/Alcohol
0.2 0.2
Poison:
Gas/Cleaner
*ER Visits rates are per year per 1,000 population and are age-adjusted to the U.S. 2000 standard population.
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Figure 24: Hospitalizations Rate by Unintentional Injury Type (2007-2009) – Cape Girardeau County vs. Missouri
Hospitalizations Rate* by Unintentional Injury Type (2007-2009) - Cape
Girardeau County vs. Missouri
29.1
28.0
Missouri
7.5
1.1 1.3
0.0 0.1
Drowning
Fall
Fire/Burn
9.7
2.8 3.7
0.3 0.3
Firearm
Motor Vehicle
Poison:
Traffic**
Drugs/Alcohol
0.2 0.2
Poison:
Gas/Cleaner
*Hospitalization rates are per year per 10,000 population and are age-adjusted to the U.S. 2000 standard population.
Injuries at Work
The rate of work injuries has fluctuated greatly for Cape Girardeau County while Missouri’s rate has
been mostly trending down. Cape Girardeau County has had a much higher rate than the state from
year to year except for a drastic drop in 2001. The most common injury location for machinery-related
injuries is the wrists-hands which are at a much higher rate than all other injury locations.
Figure 25: Work Injuries Rate – Machinery Type – Cape Girardeau County vs. Missouri
Work Injuries Rate - Machinery Type - Cape Girardeau
County vs. Missouri
113.1
Missouri
100.8
88.8
89.5
78.2
88.6
74.0
80.2
86.9
70.0
68.9
69.3
63.8
59.7
71.5
70.1
57.8
56.0
67.0
45.8
Source: Missouri Department of Health and Senior Services, MICA, Injury
Rates per 100,000 population
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Health Status at Birth
Health status at birth can determine a child’s current and future morbidity — or whether or not a child
will have a “healthy start”.
Low Birth Weight
According to the University of Wisconsin’s Health Rankings, low birth weight (LBW) as a health outcome
represents two factors: maternal exposure to health risks and the infant’s current and future morbidity,
as well as premature mortality risk. From the perspective of maternal health outcomes, LBW indicates
maternal exposure to health risks in all categories of health factors, including her health behaviors,
access to health care, the social and economic environment the mother inhabits, and environmental
risks to which she is exposed. Modifiable maternal health behaviors — including weight gain, smoking,
and alcohol and substance use — account for more than 10% of the variation in birth weight. Maternal
smoking alone accounts for 7% of variation in birth weight. In terms of the infant’s health outcomes,
LBW serves as a predictor of premature mortality and/or morbidity over the life course. Gestational
age, which is correlated with birth weight, is inversely related to psychological distress. LBW children
have greater developmental and growth problems, are at higher risk of cardiovascular disease later in
life, and have a greater rate of respiratory conditions. LBW has also been associated with cognitive
development problems. Several authors find that LBW children have higher rates of sensorineural
impairments, such as cerebral palsy, and visual, auditory, and intellectual impairments.
The figure below shows the low birth weight percent of Cape Girardeau County compared to the state of
Missouri. From 1997 through 2004, Cape Girardeau County went from being significantly lower than the
state percentage to exactly equal and the percentage remained equal through 2006.
Figure 26: Low Birth Weight Percent – Cape Girardeau County vs. Missouri
Low Birth Weight Percent - Cape Girardeau County vs. Missouri
7.7%
7.7%
7.7%
7.8%
7.8%
7.9%
Missouri
8.0%
8.1%
8.1%
8.1%
8.1%
8.1%
8.1%
7.9%
7.7%
6.8%
6.9%
7.0%
7.1%
7.2%
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Pre-term Deliveries
Preterm birth is the birth of an infant prior to 37 weeks gestation. According to the CDC, preterm birth
is the most frequent cause of infant death and is the leading cause of long-term neurological disabilities
in children. A developing baby goes through important growth during the final weeks and months of
pregnancy and many organ systems, including the brain, lung, and liver, need the final weeks of
pregnancy to fully develop. Even infants born slightly preterm are at a greater risk than full-term
infants, but the earlier the delivery, the more likely the risk of serious disability or even death. Adverse
health outcomes related to preterm birth include cerebral palsy, developmental delay, and vision and
hearing impairment. Preterm births also may cause heavy emotional and economic burdens for
families.
Figure 27 shows the percent of preterm births in Cape Girardeau County compared to the state of
Missouri. The three-year moving average shows much fluctuation between Cape Girardeau County and
Missouri as the county was higher than the state about as many years as the state was higher than the
county. Both Cape Girardeau County and Missouri are trending upward.
Figure 27: Preterm Births (Percent of total live births) – Cape Girardeau County vs. Missouri – 3 Year Moving Average
Preterm Births (Percent of total live births) - Cape Girardeau County
vs. Missouri - 3 Year Moving Average
Missouri
Linear (Cape Girardeau County)
13.5
13.2
13.1
12.4
12.8
12.7
13.3
13.4
13.8
Linear (Missouri)
13.4
13.4
12.9
13.2
12.7
12.9
12.7
12.6
12.3
12.3
11.8
1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009
Source: Missouri Department of Health and Senior Services, Community Data Profiles, Infant Health
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Birth Defects
Major birth defects are conditions that cause structural changes in one or more parts of the body; are
present at birth; and have a serious, adverse effect on health, development, or functional ability.
According to the CDC, about one in every 33 babies is born with a birth defect and birth defects are a
leading cause of infant death, accounting for more than one of every five infant deaths. In addition,
babies born with birth defects have a greater chance of illness and long term disability than babies
without birth defects.
Figure 28 shows the rate of birth defects per 10,000 live births for Cape Girardeau County and Missouri.
The Cape Girardeau County rate has been higher than the state rate all years except for being close to
equal in the 2003-2005 range. For most years, Cape Girardeau County was considerably higher than
Missouri.
Figure 28: Birth Defects Rate (per 10,000 live births) – Cape Girardeau County vs. Missouri – 3 Years Moving Average
Birth Defects Rate (per 10,000 live births) - Cape Girardeau County
vs. Missouri - 3 Year Moving Average
806.3
Missouri
823.6
732.0
717.5
649.6
619.7
571.0
573.7
579.3
1999-2001
2000-2002
2001-2003
591.6
2002-2004
601.9
601.4
599.0
2003-2005
2004-2006
611.0
2005-2007
Source: Missouri Department of Health and Senior Services, Community Data Profiles, Infant Health
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Health Status
The County Health Rankings created by The Robert Wood Johnson Foundation and the University of
Wisconsin’s Population Health Institute has three measures for which a county’s health status can be
based on:
1. Poor or fair health
2. Poor physical health days
3. Poor mental health days
“Poor or fair health” is a self-reported health status that is a general measure of health-related quality of
life in a population. The measure is based on survey responses to the question: “In general, would you
say that your health is excellent, very good, good, fair, or poor?” The value reported in the County
Health Rankings is the percent of adult respondents who rate their health as “fair” or “poor.” For Cape
Girardeau County in 2011, the percentage of adults who rated their health as “fair” or “poor” was 14%,
which is just slightly lower than Missouri’s 16%.
The “poor physical health days” measure is based on responses to the question: “Thinking about your
physical health, which includes physical illness and injury, for how many days during the past 30 days
was your physical health not good?” The value reported is the average number of days a county’s adult
respondents report their physical health was not good. For Cape Girardeau County in 2011, the average
number of days that physical health was not good was 2.9 days, which is lower than the state average of
3.6 days.
The “poor mental health days” measure is based on responses to the question: “Thinking about your
mental health, which includes stress, depression, and problems with emotions, for how many days
during the past 30 days was your mental health not good?” The value reported is the average number
of days a county’s adult respondents report that their mental health was not good. For Cape Girardeau
County, the average number of days that mental health was not good was 4.3 days, which is higher than
the state average of 3.7 days.
Mental Health
Cape Girardeau County is not considered a mental health professional shortage area by the Health
Resources and Services Administration. According to the Behavioral Health Profile for Cape Girardeau
County created by the Missouri Department of Mental Health, in 2009, nine Cape Girardeau County
residents committed suicide. In 2010, 1,051 residents of Cape Girardeau County received treatment for
serious mental illness at publicly-funded facilities, with mood disorders being the most common
diagnosis category. Mood disorders include mania, major depression, and bipolar disorder. Anxiety and
psychotic disorders were the next most common diagnosis category. Anxiety disorders include panic,
obsessive-compulsive, post-traumatic stress disorders, and phobias. Psychotic disorders include
schizophrenia and delusional disorders. Individuals that struggle with a serious mental disorder are at a
higher risk for homicide, suicide, and accidents as well as chronic conditions including cardiovascular and
respiratory diseases and substance abuse disorders.
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Preventable Hospitalizations
Foundation’s County Health Rankings, Cape Girardeau County had a preventable hospital stay rate of 63
compared to 75 for the state of Missouri. Preventable hospital stays are measured as the hospital
discharge rate for ambulatory care-sensitive conditions per 1,000 Medicare enrollees.
The Missouri Department of Health and Senior Services Missouri Information for Community
Assessment rates the 22 diagnoses in the table below as preventable hospitalizations. Cape Girardeau
County has worse rates in only two diagnoses: bacterial pneumonia and congenital syphilis.
Table 16: Preventable Hospitalizations 2009 - Cape Girardeau County vs. Missouri
Diagnosis
Angina
Asthma
Cape Girardeau
Number
0
Missouri
Rate
Number
@
Rate
377
0.7
41
6.9
6,763
13.1
129
19.9
10,747
19.6
Cellulitis
67
10.9
7,366
13.9
Chronic obstructive pulmonary
77
11.1
7,049
11.7
1
0.2 @
11
0.0 @
Congestive heart failure
39
5.4
5,574
9.3
Convulsions
15
2.7 @
1,628
3.1
179
27
17,736
32.3
Bacterial pneumonia
Congenital syphilis
Dehydration - volume depletion
Dental conditions
3
0.5 @
550
1.1
Diabetes
59
8.6
5,954
11.2
Epilepsy
29
4.9
3,093
5.9
Failure to thrive
0
@
212
0.4
Gastroenteritis
17
2.7 @
2,124
4
Hypertension
9
1.4 @
1,435
2.6
Hypoglycemia
0
@
75
0.1
Immunization preventable
0
@
87
0.2
42
6.1
4,298
8
Nutritional deficiencies
0
@
1,545
2.7
Pelvic inflammatory disease
4
0.7 @
490
1
Severe ENT infections
7
1.1 @
915
1.8
Tuberculosis
0
@
49
0.1
718
110
78,078
142.9
Kidney/Urinary infection
Total for Selection
Source: Missouri Department of Health and Senior Services, MICA, Preventable Hospitalizations
Rates per 10,000, @ Rate considered unreliable - numerator less than 20
Page 64
Chapter 4: Health Behaviors
Diet & Exercise
Foundation’s County Health Rankings, Cape Girardeau County has 28% of its residents that are physically
inactive. Being physically inactive is measured by the estimated percent of adults aged 20 and over that
reported no leisure time physical inactivity.
According to the Missouri Department of Health and Senior Services’ 2007 Health and Preventative
Practices Profile, 72.4% of Cape Girardeau County residents reported eating less than five fruits and
vegetables per day.
Tobacco Use
Adult smoking prevalence is the estimated percent of the adult population that currently smokes every
day or “most days” and has smoked at least 100 cigarettes in their lifetime. According to the County
Health Rankings developed by the Robert Wood Johnson Foundation and the University of Wisconsin
Population Health Institute, 18% of Cape Girardeau County residents smoke cigarettes compared to 24%
of Missouri residents. Cigarette smoking is identified as a cause in multiple diseases including various
cancers, cardiovascular disease, respiratory conditions, low birth weight, and other adverse health
outcomes.
Substance Abuse
Substance abuse can have an impact on public safety, health care, crime, and public assistance.
According to the Behavioral Health Profile for Cape Girardeau County created by the Missouri
Department of Mental Health, in 2009, Cape Girardeau County had 72 alcohol-related traffic crashes.
This number was higher than 2008, which was at 53. Two of those 72 traffic crashes resulted in the loss
of life and 29 resulted in injuries. Also in 2009, Cape Girardeau County had 617 DUI arrests, 200 liquor
law violations, 383 drug arrests, and 52 methamphetamine lab seizures. In 2009, Cape Girardeau
County residents had a total of 540 alcohol-related and 462 drug-related hospitalizations and emergency
room visits. In 2010, 556 Cape Girardeau County residents were admitted to substance abuse treatment
at publicly-funded facilities.
Some adverse effects excessive drinking can have on health and health outcomes include alcohol
poisoning, hypertension, acute myocardial infarction, sexually transmitted infections, unintended
pregnancy, fetal alcohol syndrome, sudden infant death syndrome, suicide, interpersonal violence, as
well as motor vehicle crashes. According to the County Health Rankings developed by the Robert Wood
Johnson Foundation and the University of Wisconsin Population Health Institute, 14% of Cape Girardeau
County residents reported either binge drinking (consuming 4 drinks for women or 5 drinks for men on a
single occasion) or heavy drinking (consuming 1 drink for women or 2 drinks for men per day on
average) in the past 30 days, compared to 17% for Missouri.
Maternal Health
Prenatal Care
According to the Centers for Disease Control and Prevention, nearly one third of pregnant women will
have some kind of pregnancy-related complication. Those women who do not get adequate prenatal
care run the risk that such complications will go undetected or won't be dealt with soon enough, which,
in turn, can lead to potentially serious consequences for both the mother and her baby. According to
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the Prenatal Profile of the Missouri Department of Health and Senior Services, in 2009, Cape Girardeau
County had ten mothers that received no prenatal care, which is 1.1% of resident live births compared
to .8% for the state of Missouri. Another 8.7% of mothers received late prenatal care (in the 2nd or 3rd
trimester) and overall, 8.0% received inadequate prenatal care (<5 visits for a 37 week pregnancy or <8
for a pregnancy longer than 37 weeks).
Smoking during Pregnancy
Women who smoke during pregnancy put themselves and their unborn babies at risk for other health
problems. Dangers of smoking during pregnancy include:
•
•
•
•
•
•
Higher risk for miscarriage
Premature birth or low birth weight
Birth defects, such as cleft lip or cleft palate
Infant death
Problems with the placenta, which is the source of the baby’s food and oxygen during pregnancy
Higher risk for Sudden Infant Death Syndrome
The figure below shows the percentage of mothers that smoked during pregnancy in Cape Girardeau
County compared to the state. Cape Girardeau County has consistently remained above the state
percentage.
Figure 29: Percentage of Mothers that Smoked During Pregnancy – Cape Girardeau County vs. Missouri – 3 Year Moving Average
Percentage of Mothers that Smoked During Pregnancy* - Cape
Girardeau County vs. Missouri - 3 Year Moving Average
Missouri
21.90%
20.80%
19.50%
18.50%
18.30%
21.00%
20.60%
18.20%
20.10%
19.30%
19.20%
18.10%
18.10%
19.90%
19.20%
18.10%
18.20%
18.10%
17.90%
17.40%
1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009
*Smoked during Pregnancy: Resident live births to mothers smoking during pregnancy and the percent this number is of total resident live births.
Breastfeeding
According to the Centers for Disease Control and Prevention, both babies and mothers gain many
benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect
infants from bacterial and viral infections. Women who breastfeed may also have lower rates of certain
breast and ovarian cancers. Also, a baby’s risk of becoming an overweight child goes down with each
month of breastfeeding.
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In a report completed by the Robert Wood Johnson Foundation and Trust for America’s Health, research
found many other benefits of breastfeeding for the child and the mother. For the child: reduced risk of
ear, skin, stomach and respiratory infections, diarrhea, sudden infant death syndrome, necrotizing
enterocolitis, and other bacterial and viral infections; and in the longer term, reduced risk of obesity,
type 1 and 2 diabetes, asthma, celiac disease, inflammatory bowel disease and childhood leukemia. For
the mother: quicker loss of pregnancy weight, prevention of postpartum bleeding and reduced risk of
breast cancer, ovarian cancer, type 2 diabetes and postpartum depression.
The following figure shows the rate of mothers with infants on the Women, Infants, and Children (WIC)
program who breastfed their babies sometime during infancy. Over the years 2000 - 2008, Cape
Girardeau County usually had a rate lower than the state rate, but was almost equal in 2004 and 2008
and has trended an increase throughout those years.
Figure 30: Rate of mothers who breastfed their babies sometime during infancy – Cape Girardeau County vs. Missouri
Rate of mothers who breastfed their babies sometime during
infancy - Cape Girardeau County vs. Missouri
Missouri
52.1
46.8
48.4
48.5
47.1
52.4
54.5
56.0
56.2
49.2
49.5
49.1
46.4
40.6
42.5
44.0
43.4
37.8
Year 2000
Year 2001
Year 2002
Year 2003
Year 2004
Year 2005
Year 2006
Year 2007
Year 2008
Source: Missouri Department of Health and Senior Services, MICA, WIC Infant
Seat Belt Use
According to the Missouri Department of Health and Senior Services’ Motor Vehicle Crash and
Outcomes Statistics, in 2008, 95.7% of Cape Girardeau County residents involved in a motor vehicle
crash reported wearing their seatbelts, which is slightly higher than the state percentage of 94.6%.
Strikingly, of all the motor vehicle crashes that resulted in a fatality from 2003-2008, seven out of ten of
those people killed were not wearing their seatbelts in Missouri and Cape Girardeau County.
Prevention & Screening
Health screenings are an important part of maintaining good health, especially as you get older. Many
deaths could be prevented if people got simple, regular health screenings as recommended by their
doctor. Health screenings can detect problems early, when chances for successful treatment are
greatest. For example, colon cancer is the most preventable type of cancer, but many times few
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symptoms occur early when it is most treatable. A routine exam can detect a colon polyp (growth)
before it becomes cancerous, and it can be easily removed. Heart disease is the leading cause of death
in Missouri, but people who routinely have their blood pressure and cholesterol checked, and treated if
necessary, improve their chances of preventing and controlling conditions that could cause a heart
attack. When a person gets the health screenings recommended, they are taking a simple but very
important step toward a better quality of life and quite possibly, a longer life.
Preventative Practices
The following table shows the weighted percent for Cape Girardeau County and Missouri for several
health and preventative practices. The percent for Cape Girardeau County is better than the state
percent in all areas except for women age 18 and older never having a pap smear done and not having a
pap smear done within the past three years.
Table 17: 2007 Health & Preventative Practices - Cape Girardeau County vs. Missouri
Indicator
Did not get medical care
Current cigarette smoking
No leisure-time physical activity
Less than 5 fruits and vegetables per day
Overweight (25.0 - 29.9 BMI)
Obese ( >= 30 BMI)
Current high blood pressure
Ever had blood cholesterol checked - age 35 and older
Has high cholesterol - age 35 and older
Never had a mammogram - women age 40 and older
No mammogram or clinical breast exam in last year women age 40 and older
Never had a pap smear - women age 18 and older
No pap smear in last 3 years - women age 18 and older
Never had a blood stool test - men and women age 50
and older
No blood stool test in last year - men and women age
50 and older
Never had a sigmoidoscopy or colonoscopy - men and
women age 50 and older
No sigmoidoscopy or colonoscopy in past 10 years men and women 50 and older
Cape Girardeau
County Weighted %*
5.2
19.9
21.6
72.4
35.0
26.5
18.3
93.6
17.3
3.2
Compared to
Missouri %
Better
Better
Better
Better
Better
Better
Better
Better
Better
Better
Missouri
Weighted %*
7.5
23.2
25.3
76.1
35.7
29.1
19.6
89.3
20.2
8.7
23.1
Better
27.6
6.0
24.6
Worse
Worse
3.4
19.5
51.9
Better
58.5
83.6
Better
87.1
36.1
Better
36.6
40.4
Better
40.4
Source: Missouri Department of Health and Senior Services, Community Health Profiles, Health and Preventative Practices
*Weighted Percent: The proportion (usually a percentage) of a population that has a defined risk factor, disease, or condition at a particular point in time.
The indicators are described as follows:
 Did not get medical care – among those who needed medical care but could not get it in the
past 12 months – due to cost of or no insurance, lack of transportation, or other reason
• Derived from "Yes" response to: "Was there a time in the past 12 months when you
needed medical care, but could not get it?" AND "What is the main reason you did not
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









get medical care? Would you say cost/no insurance, distance, office wasn't open when I
could get there, too long a wait for an appointment, too long a wait in waiting room, no
childcare, transportation, no access for people with disabilities, medical provider didn't
speak my language, or other?"
Current cigarette smoking
• Derived from "Yes" response to: “Have you smoked at least 100 cigarettes in your entire
life?” AND "Every day" or "some days" response to the following question: “Do you now
smoke cigarettes every day, some days, or not at all?”
No leisure time physical activity
• Derived from "No" response to the following question: “During the past 30 days, other
than your regular job, did you participate in any physical activities or exercise such as
running, calisthenics, golf, gardening, or walking for exercise?”
Less than 5 fruits and vegetables per day
• Derived by calculating number of fruits and vegetables eaten per day using the following
questions: “How often do you drink fruit juices such as orange, grapefruit or tomato?”
AND “Not counting juice, how often do you eat fruit?” AND “How often do you eat
green salad?” AND “How often do you eat potatoes not including French fries, fried
potatoes or potato chips?” AND “How often do you eat carrots?” AND “Not counting
carrots, potatoes or salad, how many servings of vegetables do you usually eat?”
Overweight (25.0 - 29.9 BMI)
• Derived by calculating BMI using responses to the following questions: “About how
much do you weigh without shoes?” AND “About how tall are you without shoes?”
Obese (>= 30 BMI)
• Derived by calculating BMI using responses to the following questions: “About how
much do you weigh without shoes?” AND “About how tall are you without shoes?”
Current High Blood Pressure (Among those that had ever had blood pressure checked)
• Derived from a response of any length of time to the question: "About how long has it
been since you last had your blood pressure checked?” AND "Yes" responses to the
following questions: “Have you ever been told by a doctor, nurse, or other health
professional that you have high blood pressure?” AND “Do you still have high blood
pressure?”
Ever had blood cholesterol checked - among age 35 and older
• Derived from "Yes" response from respondents age 35 and older to the following
question: “Have you ever had your blood cholesterol checked?”
Has high cholesterol - among age 35 and older who have had cholesterol checked
• Derived from "Yes" responses from respondents age 35 and older to the following
questions: “Blood cholesterol is a fatty substance found in the blood. Have you ever had
your blood cholesterol checked?” AND “Have you ever been told by a doctor, nurse, or
other health professional that your blood cholesterol is high?” AND “Do you still have
high blood cholesterol?”
Never had a mammogram - among women age 40 and older
• Derived from "No" response from women age 40 and older to the following question: “A
mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a
mammogram?”
No Mammogram or clinical breast exam in last year - among women age 40 and older
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•






Derived from a response of ">1 year" on the following questions: “How long has it been
since you had your last mammogram?” AND “How long has it been since your last breast
exam (clinical breast exam by a doctor or other health professional)?”
Never had a Pap Smear - among women 18 and older
• Derived from "No" response to the following question: “A Pap smear is a test for cancer
of the cervix. Have you ever had a Pap smear?”
No Pap smear in last 3 years - among women age 18 and older
• Derived from response of ">3 years" to the following question: “How long has it been
since you had your last Pap smear?”
Never had a blood stool test - among men and women age 50 and older
• Derived from "No" response to the following question: “A blood stool test is a test that
may use a special kit at home to determine whether the stool contains blood. Have you
ever had this test using a home kit?”
No blood stool test in last year - among men and women age 50 and older
• Derived from response of ">1 year" to the following question: “How long has it been
since you had your last blood stool test using a home kit?”
Never had a Sigmoidoscopy or Colonoscopy - among men and women age 50 and older
• Derived from "No" response to the following question: “Sigmoidoscopy and
colonoscopy are exams in which a tube is inserted in the rectum to view the bowel for
signs of cancer or other health problems. Have you ever had either of these exams?”
No Sigmoidoscopy or Colonoscopy in past 10 years among men and women age 50 and older
• Derived from response of ">10 years" to the following question: “How long has it been
since you had your last sigmoidoscopy or colonoscopy?”
Diabetes
Diabetic screening is calculated as the percent of diabetic Medicare patients whose blood sugar control
was screened in the past year using a test of their glycated hemoglobin (HbA1c) levels. According to the
County Health Rankings, 86% of Medicare enrollees in Cape Girardeau County received such diabetic
screening, compared to only 83% statewide. Evidence suggests that improvements in quality of care can
be seen through implementation of disease management programs that target multiple components of
chronic diseases. The use of HbA1c testing to measure glycated hemoglobin for long-term monitoring of
diabetes is widely accepted as one component of a comprehensive disease management program.
HbA1c testing is recommended for all patients with diabetes as part of the initial assessment after a
diabetes diagnosis, and then on a routine basis as a part of the patient’s comprehensive diabetes care
plan.
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Chapter 5: Health Measures
Child and Adolescent Health
Infant Immunization Rates
The up-to-date on immunizations rate for WIC infant participants in Cape Girardeau County has been
substantially higher than the Missouri rate for the years 2004 – 2008.
Figure 31: Up-to-Date on Immunizations (Rate per 100 Infants) – WIC Infant Participants – Cape Girardeau Co. & Missouri
Up-to-Date on Immunizations (Rate per 100 Infants) - WIC Infant
Participants - Cape Girardeau County & Missouri
Missouri
97.1
96.2
93.1
79.2
95.5
77.6
78.6
79.3
80.4
2005
2006
2007
2008
69
2004
Source: Missouri Department of Health and Senior Services, MICA, WIC Infant
Causes of Death – Child
According to the Missouri Department of Health and Senior Services’ Child Health Profile, Cape
Girardeau County has a slightly higher rate of death for Total Unintentional Injuries and Motor Vehicle
Deaths, and a considerably higher rate for All Cancers than the state of Missouri for children ages 1-14.
Table 18: Causes of Death: Ages 1-14
Deaths Ages 1-14
Data Years
All Causes
1999-2009
1999-2009
1999-2009
Motor Vehicle Deaths
All Cancers (Malignant Neoplasms) 1999-2009
1999-2009
Birth Defects
1999-2009
Homicide
1999-2009
Heart Disease
# of Events
27
12
6
5
2
1
0
Cape Girardeau County Rate
19.8
8.8*
4.4*
3.7*
1.5*
0.7*
0.0*
Missouri Rate
22.6
8.7
4.3
2.2
1.7
1.9
0.9
Source: Community Data Profiles - Missouri Department of Health and Senior Services, Child Health
* Fewer than 20 events in numerator; rate is unstable.
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Causes of Death - Adolescents
Girardeau County has lower rates of deaths for adolescents age 15-19 than the state of Missouri in all
categories except All Cancers.
Table 19: Causes of Death: Ages 15-19
Deaths Ages 15-19
All Causes
Motor Vehicle Deaths
Homicide
Suicide
Heart Disease
Data Years
1999-2009
1999-2009
1999-2009
1999-2009
1999-2009
1999-2009
1999-2009
# of Events
31
15
10
3
3
4
0
47.3
22.9*
15.3*
4.6*
4.6*
6.1*
0.0*
Missouri Rate
81.3
44.1
35.8
12.6
9.1
3.4
2
Teen Substance Abuse and Smoking
According to the Department of Mental Health’s Behavioral Profile from 2012, the availability of countylevel data on substance abuse is limited. However, the Missouri Student Survey that is administered to
6th through 12th grade students can provide estimates for youth in most counties.
In Cape Girardeau County:
•
•
•
58.5% of youth believe that it would be easy to get cigarettes and 49.9% have friends who
smoke.
61.1% of youth believe that it would be easy to get alcohol and 62.0% have friends who drink
alcohol.
19.4% of youth believe that it would be easy to get other drugs such as cocaine,
methamphetamine, and ecstasy.
The table below shows current substance use for grades 6 – 12 in Cape Girardeau County and Missouri.
30-day use of cigarettes, alcohol, binge drinking, marijuana, and OTC abuse is higher in Cape Girardeau
County than in the state.
Table 20: Current Substance Use for Grades 6 -12 – Cape Girardeau County & Missouri
Substance
Cigarettes
Alcohol
Binge*
Marijuana
Inhalants
Rx Abuse
OTC Abuse
30 Day Use - Cape Girardeau County
14.3%
20.3%
11.9%
10.2%
2.5%
4.9%
5.2%
30 Day Use - Missouri
13.7%
19.8%
11.4%
9.4%
3.0%
6.7%
4.8%
Source: Department of Mental Health, Behavioral Health Profile
* 5+ drinks on a single occasion
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Teen Pregnancy
Teen pregnancy can be associated with poor prenatal care and pre-term delivery. Pregnant teens are
more likely than older women to receive late or no prenatal care, have gestational hypertension and
anemia, and achieve poor maternal weight gain. They are also more likely to have a pre-term delivery
and low birth weight, which increases the risk of child developmental delay, illness, and mortality.
The prevention of teen pregnancy is very important as it brings substantial social and economic costs
through immediate and long-term impacts on teen parents and their children. According to the Centers
for Disease Control and Prevention:
•
•
•
Teen pregnancy accounts for nearly $11 billion per year in costs to U.S. taxpayers for increased
health care and foster care, increased incarceration rates among children of teen parents, and
lost tax revenue because of lower educational attainment and income among teen mothers.
Pregnancy and birth are significant contributors to high school drop-out rates among girls. Only
about 50% of teen mothers receive a high school diploma by 22 years of age, versus
approximately 90% of women who had not given birth during adolescence.
The children of teenage mothers are more likely to have lower school achievement and drop out
of high school, have more health problems, be incarcerated at some time during adolescence,
give birth as a teenager, and face unemployment as a young adult.
The following graph shows the Teen Birth Rate in Cape Girardeau County versus Missouri for the years
1999 – 2008. The Cape Girardeau County rate has always been lower than the state rate, but saw a
significant increase in 2008.
Figure 32: Births to Teens (Rate per 1,000 females ages 15-19) – Cape Girardeau County vs. Missouri
Births to Teens (Rate per 1,000 females ages 15-19) - Cape Girardeau
County vs. Missouri
49.8
48.6
Missouri
46.0
44.0
45.6
43.1
43.4
45.7
42.4
41.1
40.9
32.7
45.4
38.7
38.2
36.1
33.9
35.2
36.5
34.9
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STDs in Teens
Girardeau County has lower rates of Sexually Transmitted Diseases for 15 - 19 year olds than the state of
Missouri.
Table 21: Sexually Transmitted Diseases: Ages 15-19
STDs: Ages 15-19
Chlamydia
Gonorrhea
Syphilis
Data Years
2005-2009
2005-2009
2005-2009
# of Events
389
119
0
1,281.8
392.1*
0.0*
Missouri Rate
2,129.10
625.3
4.2
STD rates are per 100,000 residents age 15-19 using population estimates for the noted years.
Senior Health
Missouri Senior Report
The Missouri Department of Health and Senior Services and the University of Missouri Office of Social
and Economic Data Analysis (OSEDA) generated a Missouri Senior Report in 2009 to inform state and
local audiences about the contributions and needs of seniors in Missouri. Some of the findings from
that report are found below:
Cost Burdened by Housing. The U.S. Department of Housing and Urban Development considers families
who pay more than 30% of their income for housing as “cost burdened” since these families may have
more difficulty affording necessities such as food, clothing, transportation, and medical care. Housing
costs include mortgage or rent, taxes, insurance, and utilities. Seniors that are living on fixed incomes
are especially vulnerable to fluctuations in housing costs. Cape Girardeau County has 24.7% of its
seniors cost burdened by housing compared to 28.2% for Missouri.
Transportation. Transportation is necessary in order to obtain goods and services and to participate in
work and social activities. Whether seniors have the capacity to meet their transportation needs is
often measured by how many hold a valid driver’s license. Holding a valid driver’s license is especially
indicative in more rural areas where mass transit often doesn’t exist or isn’t as abundant. Cape
Girardeau County has 82.9% of its seniors with a valid driver’s license compared to 84.2% for the state.
Safety. This report measured safety by the rate of property and violent crimes per 1,000 persons in the
county. Seniors who are physically or psychologically vulnerable are at an increased risk of suffering
accidents and abuse within their own homes. The overall crime rate in a county combined with the
cases of abuse and neglect reported to the Missouri Department of Health and Senior Services’ Elder
Abuse and Neglect Hotline were used to determine the indexed rate per 1,000 persons. Cape Girardeau
County had a property and violent crime rate per 1,000 persons of 37.6 compared to 35.4 for the state.
Health Care Access. Health care access is essential for the overall well-being of seniors. Reliable,
convenient access to primary care increases the capacity of seniors to live independently. This report
measured the health care access for seniors as a rate of the number of primary care physicians per 1,000
seniors. Cape Girardeau County has 13.9 primary care physicians per 1,000 seniors compared to 13.1
for the state.
The Missouri Senior Report includes six measures that speak to the overall quality of life for seniors and
those statistics are found below in Table 25. Cape Girardeau County is very comparable to the state in
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most categories and notably has a higher average income of senior households and a much lower
percentage of seniors in poverty.
Table 22: Quality of Life for Seniors
Senior Owner-Occupied Housing, 2008
Seniors Living in Families, 2008
Median Value of All Owned Housing, 2008
Seniors in Poverty, 2008
Average Income of Senior Households, 2008
Seniors with a College Education, 2008
Cape Girardeau
85.1%
61.3%
$139,700
4.2%
$45,617
14.1%
Missouri
80.9%
62.6%
$141,500
9.3%
$44,665
16.4%
Source: Missouri Senior Report 2009, Missouri Department of Health and Senior Services and the Office of Social and Economic Data Analysis,
University of Missouri
1. Owner-Occupied Housing: Seniors’ housing needs are more likely to be met if they live in owneroccupied housing.
2. Seniors Living in Families: Family life enhances the senior population’s well-being. Seniors who
live alone are more likely to be socially isolated and at greater risk of accidental injury and
physical and mental illness.
3. Median Value of Owner-Occupied Housing: The ownership of a house represents a significant
asset for most seniors, and the relative value of housing is a useful indicator of both seniors’ and
community assets.
4. Seniors in Poverty: The proportion of seniors living in poverty is a direct measure of economic
need.
5. Average Income of Senior Households
6. Seniors with a College Education: Seniors with a higher education generally tend to fare better
on household and community wealth, and well-being.
The Missouri Senior Report includes seven measures that speak to the overall health and wellness for
seniors and those statistics are shown in Table 26 below. Cape Girardeau County is only slightly worse
than the state in obesity and high blood pressure.
Table 23: Health and Wellness for Seniors
No Exercise, 2007
No Sigmoidoscopy or Colonoscopy, 2007
High Blood Pressure, 2007
Obesity, 2007
Smoking, 2007
No Mammography, 2007
High Cholesterol, 2007
Cape Girardeau
30.1%
35.4%
40.7%
27.0%
9.0%
39.4%
14.6%
Missouri
38.5%
36.8%
40.1%
25.2%
10.8%
50.0%
25.1%
Source: Missouri Senior Report 2009, Missouri Department of Health and Senior Services and the Office of Social and Economic Data Analysis,
University of Missouri
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Chapter 6: Primary Research
Focus Groups
Methodology
Five focus groups were done for Cape Girardeau County on various dates and in various locations and in
total, forty-one participants took part.
The focus group process began with the Community Health Needs Assessment Team and/or some
community members compiling a list of potential participants and then inviting those participants to the
focus group via email, letter, phone call, or in person. Each event took approximately an hour and a half
and was held over lunch. Members of the Community Health Needs Assessment Team hosted the
event, with one member serving as moderator, another member as co-moderator taking notes on a flip
chart to make references for the group, and another member as the primary note-taker/recorder of the
entire event.
Materials that were provided to the group included a participant information form, a checklist exercise,
and a list of questions asked. The participant information form asked for each participant’s name,
company/organization, job title, credentials, education, affiliations, experience, and what makes them
an expert – not all forms were filled out completely, but some of the information collected can be found
in Appendix C. The checklist exercise asked the participants to choose their top five concerns from a list
the Community Health Needs Assessment Team created; the results of that exercise are provided in the
Checklist Exercise section following the question summaries ahead.
The questions asked by the moderator are listed below. Prompts were also used to get more detailed
answers from the groups and to help the group along if they were not providing much information. The
moderator did his best to ask all questions and to stay on track with the topics, but in some cases the
group wandered off track and not all questions were answered completely.
1. What do people in this community do to stay healthy? How do people get information about
health?
2. In this group’s opinion, what are the serious health problems in your community? What are
some of the causes of these problems?
6. Of all the issues we have talked about today, what issues do you think are the most important
for your community to address?
Each question is broken out into the following individual sections and includes a summary of all five
focus groups regarding the particular question.
Question 1 - What do people in this community do to stay healthy? How do people get
information about health?
According to the focus group participants, one of the most common ways to get exercise in the
community is simply to walk. People take advantage of the walking trails around town and some people
just walk out of necessity to get from place to place because of a lack of transportation. In the Jackson
area, people are even able to walk or jog at night because the area is so safe. Other people take part in
fitness clubs for exercise and some kids ride bikes, skateboard, and play sports such as basketball
(although this tends to be more for fun and recreation than for just getting exercise). In the rural areas
of Cape Girardeau County, many adolescents work on farms and get exercise in that way. Many of the
Page 76
rural schools also offer open gyms before and after school for the students to get in some physical
activity. Other ways people stay healthy in the community is by getting health, dental, and vision
screenings and by eating healthy food. Senior citizens are able to stay healthy by going to the senior
center for meals and for activities such as playing cards and bingo, quilting, and dances.
The community is able to get health information through health education provided by the hospitals,
schools, churches, and the county health department. Social media is also a main provider of health
education, including the Internet, TV, radio, and newspaper. Family, neighbors, and of course physicians
and nurses provide the community with health information, too.
Question 2 - In this group’s opinion, what are the serious health problems in your
community? What are some of the causes of these problems?
Some of the health conditions that were mentioned in the focus groups included diabetes and prediabetes, hypertension/high blood pressure, heart disease, adult and childhood obesity, cancer, high
cholesterol, dental health, autism, dementia, arthritis, and chronic pain. Mental health was also cited as
a problem and includes anxiety and depression. Some behavioral problems that were pointed out
include smoking, alcoholism for older males, substance abuse, and high risk pregnancies caused by
expectant mothers using drugs and smoking, getting no prenatal care, and living an unhealthy lifestyle
while pregnant. Some problems stated specific to adolescents include food allergies, asthma, STDs
including chlamydia and gonorrhea, and drug use – prescription drugs, marijuana, heroin, and bath salts.
Another very specific problem discussed was how often the Emergency Medical Services (EMS) get
called for non-emergencies, mainly due to the elderly’s inability to care for themselves following a
hospital discharge.
Causes that were mentioned for some of the health conditions include lack of exercise, being
overweight, smoking, poor diet, poor lifestyle, lack of motivation, lack of trust in health care, and lack of
education. More specifically, some of the dental issues can be caused by drug use, lack of fluoride in
water, and lack of education on how to brush properly. Childhood obesity can be caused by a lack of
exercise, lack of education on how to eat healthy and why exercise is important, and lack of support and
knowledge from the child’s parents on how to be healthy. STDs are more prominent with adolescents
because of their lack of concern and awareness about how serious the disease can be. The EMS issue
seems to occur because the elderly do not get the 24/7 care that is needed in their homes after being
discharged from the hospital and they are often unable to afford nursing home care.
Question 3 - What keeps people in your community from being healthy?
Finances are a recurring reason that keeps people from being healthy in the community. Low income
often leads to no insurance or Medicaid, which often leads to limited or no health care services. Some
people must sometimes choose between buying groceries and buying needed medications. When they
choose to buy food, they may end up sick or sicker since they cannot afford their medications, and then
they may not be able to work so they never seem to catch up financially. Another reason that relates to
finances is that people think healthy food is expensive, so they often go for the cheaper, less healthy
options, including fast food.
Being uninsured or underinsured can keep people from being healthy because it can lead to a lack of
preventive care since people often cannot afford co-pays or sliding scale fees and they often cannot
afford prescription drugs either. Also, even with Medicaid, access can become a problem since not all
doctors accept Medicaid, especially specialists and dentists. Psychiatry for all ages is another specialty
mentioned as difficult to access with Medicaid or without insurance. Not having insurance also takes
away the doctor/patient relationship since most uninsured do not have a regular primary care physician
Page 77
that they can go to for questions or that will tell the person what to do and what not to do regarding
their health and health conditions.
Other factors that keep people from being healthy include a lack of transportation – people are not
always able to get to a doctor or clinic when needed or to a fitness club or to a grocery store or
pharmacy or sports activity to keep them healthy.
Living stressful, busy lives is something else that keeps people from being healthy. This seems to be an
excuse of almost everyone for why they do not have time to exercise and eat healthy. Also, from living
stressful lives, kids are not always supervised and parents are not always as involved in their kids’ lives
to be able to teach them how to be healthy or to set a good example of how to be healthy. One other
thing mentioned was that women do not cook as often as they used to since they often work outside of
the home; therefore, those healthy home-cooked meals seem to becoming a thing of the past. One
participant stated “Life keeps people from being healthy – something more important always comes up”
and they are exactly right, as priorities are out of line and many people lack self-discipline.
Video games and TV are things that draw people inside and keep them there which keep them from
going outside and taking part in physical activity. Unsafe neighborhoods are another thing that keeps
people inside. Some people do not feel safe or comfortable to be outside and those people will not
send their kids out to play either.
Lack of education and awareness was brought up numerous times in all five focus groups. Oftentimes,
people do not know what programs and services are available in their communities. An example of this
came up in one of the focus groups, in which the group was representative of one of Cape Girardeau’s
low-income areas, having no idea that a free clinic was now available in Cape Girardeau and that there
was a federally-qualified health center available also that primarily takes Medicaid patients. This proved
how the community has a strong lack of communication about available resources. Lack of education
can also lead to misconceptions about health care as one participant described how they know many
people that are afraid of doctors and hospitals because of stories they heard from people they know
about bad experiences they had, so now those people have a negative connotation about those
facilities. Recognizing symptoms of health conditions can also be difficult for anyone and then
navigating through health conditions can be difficult as well so people need to know where to go for
help and need basic education about symptoms of common health conditions.
Question 4 - What could be done to solve these problems?
One of the most common recommendations that were made to solve many of these problems was
simply to provide basic health education to the community – to explain why healthy habits are needed.
Another piece of education is to marry the people to the resources so that everyone knows where to go
to find the information they need and people need to know who they can contact at the hospitals and
clinics when they need help. Someone mentioned that education needs to come from all directions,
including schools, churches, health care facilities, employers and other businesses.
In the low income areas, it was suggested that the health educators go to the people in those low
income areas that need to be educated instead of expecting those people to come to the educator in a
place outside of their “comfort zone”. This will help establish a relationship with the low income areas
and start building up trust. Also, some other good ways to reach this group are to provide health
information on TV and the radio, through churches and schools, and by handing out flyers and informing
them that the information included is very important so that they will read it. Training and educating
church leaders to become health leaders is another option so that when people in those areas get sick,
they have someone to turn to for help and advice.
Page 78
Other suggestions included having employers establish wellness programs that provide incentives to
achieve better health, having schools mandate more physical activity and Life Skills classes, and having
hospitals offer more free screenings at a health fair and scholarship programs to their owned fitness
facilities. Collaboration between the health department, hospitals, schools, churches, and other not-forprofit organizations was also mentioned. Building Community Gardens was suggested as a way for the
community to access healthy food and more organized activities were suggested to increase physical
activity. These could both help combat the obesity epidemic that is occurring.
Some other recommendations made were for the community to start offering assessments for mental
health problems and for the hospitals to work on their transitions of care so that patients are not
discharged to their homes before they are capable of taking care of themselves. One last good idea
cited was to do a well-check on adults like they do for children. Adults need to know what types of
preventive tests they should have by what age and how often so they do not miss out on what could be
critical life-saving preventive measures.
Question 5 - Is there any group not receiving enough health care? If so, why?
A few groups mentioned by the participants of the focus groups as not receiving enough health care
include the following:
•
•
•
•
•
•
•
•
•
•
River Corridor (geographic area)
Low income areas
Single moms – some have Medicaid for their children, but not for themselves
Youth – those with generational issues
Uninsured – some just barely miss the Medicaid requirements
Part-time workers that are unable to get insurance
Hispanic population – especially those that are undocumented
Senior Citizens – many are on a fixed income
Rural areas
Mentally ill
Question 6 - Of all the issues we have talked about today, what issues do you think are the
most important for your community to address?
This question did not get answered in all five focus groups due to time constraints. However, when it
did get answered, some of the most important issues mentioned were:
•
•
•
•
•
Healthy Lifestyles
Obesity
Making sure people have a primary care physician or regular walk-in clinic
Health care affordability
Education and awareness
Checklist Exercise
The table below summarizes the Checklist Exercise that was handed out in all five focus groups held in
Cape Girardeau County. The concerns are ranked from the highest concern to the lowest. Alcohol/Drug
Use and Health Care Affordability were tied for first as the greatest concern. Overweight Adults, Mental
Illness, and Overweight Children rounded up the top five concerns.
Page 79
Table 24: Cape Girardeau County Results
Concern
Alcohol/Drug Use
Overweight Adults
Mental Illness
Overweight Children
Smoking/Smokeless Tobacco
Teen Pregnancy
Eating Disorders
Allergies
Health Facilities
Clean Water/Water Pollution
Sexually Transmitted Infections
Child Abuse
Domestic Violence
Prenatal Health
Highway Safety
Infant Health
Mosquitoes
Childhood Immunization Rates*
Dental/Dentures Affordability*
Group 1
6
6
6
5
4
4
3
1
1
0
0
0
0
0
0
0
0
0
0
0
Group 2
8
6
6
5
4
3
2
2
1
1
0
0
0
1
1
0
0
0
0
0
Group 3
4
3
5
1
5
5
1
1
2
1
2
2
0
0
0
1
0
0
0
0
Group 4
6
6
3
6
3
2
3
3
0
1
0
0
0
1
0
0
0
0
0
0
1
1
Group 5
3
6
3
3
2
0
2
3
4
2
2
2
3
1
1
1
2
1
1
0
Total
27
27
23
20
18
14
11
10
8
5
4
4
3
3
2
2
2
1
1
0
1
1
*Concern added in by focus group participant. These were not included on original list provided.
Surveys
Survey Layout and Design
The Community Health Needs Assessment Survey was a questionnaire-style, self-administered survey,
available only to those participants that a hospital-hired intern came into contact with at certain
locations. Since the survey was only completed on paper, data entry was necessary to track, and then
extract the data to be in a usable format.
The survey was designed to collect data on health beliefs, health behaviors, access to and utilization of
health care services, and concerns about community health issues. The survey consists of five different
sections:
1. Multiple Choice: There are 32 questions that are multiple choice with part of the questions
asking demographic information about the participant and their household and the remaining
questions centering on health care access, health status, and insurance.
2. Health Behaviors: This section lists 24 behaviors and asks the participants to mark how often
they do this behavior, with options of “Almost Always”, “Sometimes”, “Never”, or “N/A”.
Page 80
3. Children’s Health Behaviors: This section lists 17 behaviors and asks the participants to mark
how often any children living in their home do this behavior, with the same options as listed
above. Many of the behaviors listed are the same or similar to the Health Behaviors Section.
4. Health Issues: This section lists 27 health problems or diseases and asks the participant if they
have ever been diagnosed by a doctor with any of those problems or diseases. If the participant
chooses “Yes”, they are then supposed to check “I see a doctor” if they see a doctor, “I am
taking medications or getting treatment” if they are taking medications or getting treatment,
and “I feel the disease is well managed” if they feel as such.
5. Community Health Concerns: This section lists 56 community issues and the participants are
asked to choose how much of a problem they think each issue is in their county, with options of
“Serious Problem”, “Moderate Problem”, “Not a Problem”, or “Not Sure”.
Methodology
A total of 118 surveys were completed by Cape Girardeau County residents, with a few surveys having
some unanswered questions. An actual response number was determined for each question and the
percentage of each answer was calculated based on the number of responses. The survey sample was
not a random sample, but more of a targeted sample to ensure that certain populations were surveyed.
Also, some of the questions asked in the survey had an option of choosing multiple answers, which
means that not all of the questions have answers that are mutually-exclusive, so some of the total
percentages will not add up to 100 percent. When an answer of “Does Not Apply” or “N/A” was chosen,
those answers were excluded from calculating the percentages also since the question did not apply to
the survey participant.
The process for conducting these surveys involved an intern hired by one of the partnering hospitals
who then traveled to different locations throughout the county, including community businesses,
organizations, and health care facilities, asking participants face-to-face to complete the survey. The
intern did not verbally ask the questions to the participants, but did offer help if the participant had
questions about the survey.
Participants
Key Characteristics
•
•
•
•
•
•
•
69% are women
A mere 7% are a race other than White or Black
45% are single/not married
64.35% have at least some college, while 9.57% did not finish high school
Almost 62% have a household income less than $25,000
72% are employed at least part-time, 10% are at least part-time students, and 11% are
considered unemployed
51% live in households with three or more members
Details
The tables and graphs below show certain demographic characteristics of the survey participants in
Cape Girardeau County, including the survey takers gender, marital status, age, education level,
race/ethnicity, employment status, household income, and household size and age of members. The
number of responses ranged from 60 to 118 and the percentages of each demographic category are also
listed.
Page 81
Table 25: Gender
Table 26: Your Race/Ethnicity
Female
Male
69.03%
30.97%
N=113
Table 27: Age
18-24
25-44
45-64
65+
33.05%
29.66%
22.03%
15.25%
N=118
White or Caucasian
Black/African American
Hispanic
70.69%
22.41%
1.72%
Asian or Pacific Islander
Native American
Other
2 or more races
1.72%
0.86%
0.86%
1.72%
N=116
Table 28: Race/Ethnicity of Children Living at Home
Table 29: Marital Status
Single/Not Married
Married
Divorced
Living with Partner
Widowed
Other
White or Caucasian
Black/African American
Hispanic
Asian or Pacific Islander
Native American
Other
2 or more races
44.83%
34.48%
9.48%
3.45%
6.90%
0.86%
N=116
N=60
Table 30: Education Level
Table 31: Annual Household Income
Did not finish high school
High school graduate/GED
Some college
College graduate
9.57%
26.09%
46.09%
18.26%
Less than $5,000
$5,000-$14,999
$15,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000 or higher
N=115
63.33%
25.00%
0.00%
1.67%
1.67%
0.00%
8.33%
10.78%
28.43%
22.55%
16.67%
10.78%
7.84%
2.94%
N=102
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Table 32: Employment Status
Employed Full-Time
Employed Full-Time
Employed Full-time, Full-time Student
Employed Full-time, Part-time Student
Employed Full-time, Employed Part-time, Full-time Student
Employed Part-Time
Employed Part-Time
Employed Part-time, Full-time Student
Employed Part-time, Part-time Student
Unemployed due to disability or illness, Employed Part-time
Full-time Student
Full-time Student
Employed Full-time, Full-time Student
Employed Part-time, Full-time Student
Part-time Student
Employed Part-time, Part-time Student
Employed Full-time, Part-time Student
Unemployed
Unemployed
Unemployed due to disability or illness
Unemployed less than one year
Unemployed more than one year
Unemployed due to disability or illness, Employed Part-time
Full-time Homemaker
Retired
64.66%
90.67%
4.00%
4.00%
1.33%
7.76%
44.44%
22.22%
11.11%
11.11%
11.11%
6.90%
25.00%
37.50%
25.00%
12.50%
3.45%
25.00%
75.00%
11.21%
15.38%
53.85%
7.69%
15.38%
7.69%
3.45%
12.93%
*Please note, percentages do not add up to 100% because of the option to select multiple answers to the question.
N=116
Table 33: Number of People Currently Living in Household
1-2
3-5
6+
48.28%
45.69%
6.03%
Table 34: Number of Adults 65 and Older Currently Living in Household
0
1-2
3-5
78.95%
20.18%
0.88%
Page 83
Table 35: Number of Children Under 18 Currently Living in Household
0
1-2
3-5
54.31%
31.90%
13.79%
Number of People Living in Household: N=116; Number of Adults 65 and Older Living in Household: N = 114; Number of
Children Under 18 Currently Living in Household: N = 116
Access to Health Services
Insurance, Utilization, and Access to Care
Individual and Family Insurance
Nearly 70% of survey respondents have health insurance with 36% also having dental insurance and 28%
also having vision insurance along with health insurance. Of the 30% that do not have insurance, 29%
are black and 54% are white. Also, of those without health insurance, a significant 80% have an annual
household income of less than $25,000.
Table 36: What kinds of insurance do you (and/or your family) currently have?
Health
Health
Health, Vision
Dental, Health
Dental, Health, Vision
Dental
Dental, Health
Vision
Health, Vision
Do not have insurance
69.57%
46.25%
2.50%
13.75%
37.50%
35.65%
26.83%
73.17%
27.83%
6.25%
93.75%
30.43%
N=115
Of those with health insurance, 40% have a government health insurance plan (Medicaid, Medicare,
VA/CHAMPUS) and 40% have employer-provided health insurance.
Of those households without health insurance, 12% have all adults without insurance, 27% have at least
one adult without insurance, and 14% have the entire family without insurance. Over 44% were not
sure who was not covered by insurance in their household.
Health Services Utilization
It appears that most survey participants have sufficient access to medical services as 74% had a routine
doctor’s visit within the last 12 months. An additional 7% had a routine doctor’s visit within 13-24
months. Of the participants that had a routine doctor’s visit in the past 12 months, 76% of those were
female and only 24% were male. In the 65 and older age group, nearly 90% had a routine doctor’s visit
within the past 12 months.
Page 84
Preventive Services
Adult Preventive Procedures
The following table shows the preventive procedures the participants had in the last year. Some
procedures are broken down by age and certain procedures only apply to a particular gender. Nearly
77% of women over 45 have had a mammogram in the past year and nearly 69% of women over 18
have had a pap smear within the last year. Over half the participants had a dental exam and nearly a
quarter of them had an STD screening in the last year. Higher percentage differences can be noticed
between the general age group and the 45+ age group in the glaucoma test, blood pressure check, flu
shot, cholesterol screen, cardiovascular screen, and blood sugar check.
Table 37: Select the preventive procedures you have had in the last year:
Mammogram
Pap smear
Females 45+
76.92%
General
Age 45+
14.74%
26.32%
General
Age 45+
70.53%
86.84%
Glaucoma test
Blood pressure check
Flu shot
General
Age 45+
Prostate cancer PSA blood screen
Males 45+
Cholesterol screen
General
Age 45+
Cardiovascular screening
General
Age 45+
Bone density test
General
Age 45+
42.11%
55.26%
25.00%
31.58%
60.53%
11.58%
21.05%
6.32%
13.16%
Females 18+
Blood sugar check
General
Age 45+
Skin cancer screening
General
Age 45+
Colon/rectal exam
General
Age 45+
Prostate cancer digital screen
Males 45+
Hearing screening
General
Age 45+
Vision screening
General
Age 45+
Dental exam
General
STD screening
General
68.57%
40.00%
60.53%
7.37%
7.89%
8.42%
15.79%
25.00%
6.32%
7.89%
53.68%
55.26%
51.58%
22.11%
General Population N = 95; All Age 45+ N = 38; Males 45+ N = 8; Females 18+ N = 70; Females 45+ N = 26
Childhood Immunizations
Of the 54 responses by those having children currently living in their home, over 96% of the children are
current on immunizations, with only 3.7% not being current.
Page 85
Type of Provider for Routine Health Care
For individual participants and their children, the physician’s office is the most predominant source for
seeking routine medical care. Interestingly for adults, the hospital emergency room is the second most
predominant source for seeking routine medical care, greatly ahead of urgent care centers, and also a
very common source for children as well as it is the third most predominant source.
Table 38: Where do you go for routine health care?
Physician's office
Hospital emergency room
Urgent care center
Health department clinic
Community clinic
Chiropractor
Other
Dentist
Eye doctor
You
67.83%
14.78%
9.57%
8.70%
6.09%
3.48%
2.61%
25.22%
23.48%
Children
84.31%
15.69%
3.92%
17.65%
3.92%
0.00%
0.00%
19.61%
11.76%
You: N = 115; Children: N = 51
Access to Health Providers
When the survey participants were asked about how often they are able to see a doctor when needed,
nearly 61% answered always, 19% answered sometimes, and 20% answered seldom or never. Those
that answered seldom or never were then asked why they were not able to see a doctor when needed
and those reasons are shown in the table below. Over 91% of those respondents that are never or
seldom able to see a doctor when needed is due to a lack of insurance.
Table 39: If you answered seldom or never, why?
Couldn't get appointment
Lack of transportation
No insurance
Too expensive/cannot afford
4.35%
8.70%
91.30%
47.83%
N = 23
Seeking Care Outside the County
When asked how often the survey participants travel outside of the county for health care, a
considerable 70% answered never. The remaining 30% was broken out with 5% answering always, 17%
answering sometimes, and 8% answering seldom. For those that did not answer “never”, follow up
questions were asked about why they seek services outside the county and for what services they seek.
Tables 40 and 41 below display that information. Nearly 71% of those that seek healthcare outside the
county are looking for medical/doctor appointments and 29% are looking for dental appointments. The
two greatest reasons for participants traveling outside the county for healthcare is because the services
are not available in the county and because they feel they can find better quality elsewhere.
Page 86
Table 40: What services do you seek outside the county?
Dental appointments
Hospitalization
Laboratory and other tests
Medical/doctor appointments
Outpatient treatment
Vision appointments
X-rays
Other
N/A
29.03%
12.90%
9.68%
70.97%
16.13%
6.45%
9.68%
16.13%
3.23%
31 Table 41: Why do you travel outside the county?
Better quality elsewhere 35.48%
Closer to work/home 9.68%
Local doctors not covered by insurance 12.90%
Recently moved to this county 12.90%
Services not available in my county 41.94%
Too hard to get appointment with local doctor 6.45%
Other 25.81%
N/A 3.23%
N = 31
Health Beliefs and Behaviors
Health Status
When survey participants were asked to rate their own health, nearly as many rated their health as fair
or poor (28.45%) as rated their health as very good or excellent (31.03%). Table 42 shows all health
status percentages. Interestingly, exactly half of those who rated their health as fair or poor have an
annual household income of less than $15,000 and another 18% are in the household income range of
$15,000-$24,999.
Table 42: What is your current health status?
Poor
Fair
Good
Very good
Excellent
4.31%
24.14%
40.52%
22.41%
8.62%
N = 116
Survey participants were also asked how many days they have been too sick to work or carry out usual
activities in the past 30 days. 19% were sick 1-2 days and only 7% were sick 3 or more days, leaving 74%
that were not too sick in the past 30 days to work or carry out usual activities.
Sources of Health Information
“Doctors, nurses, and pharmacists” was the most frequent response as a source where the participants
obtain health-related information, with nearly 76% of participants choosing that source. “Friends or
family” and the “Internet” come in second and third, with 43% and 41% respectively.
Again, “doctors and nurses” are the person/place that the participants feel is most responsible for
providing health-related information with 72% of participants choosing that answer. “Yourself” and
“hospitals” both tied in second at 29% and the “Internet” came in third with 22%. Surprisingly, the
“Health Department” came in after these other resources as a place that provides health information.
Safety
Exactly 80% of the individual respondents indicated that they “almost always” wear their seatbelt, with
an additional 17.39% indicating that they “sometimes” wear their seatbelt, leaving only 2.61%
Page 87
responding that they “never” wear their seatbelt. Regarding children using a seatbelt, car seat, or
booster seat as recommended, 92.45% answered “almost always”. No disparities were found across the
different demographics.
The “almost always” percentages for the individual respondents aren’t quite as high for driving the
posted speed limit or wearing a helmet when riding a motorcycle, ATV, scooter as they were for wearing
seatbelts. 66.35% of respondents said they “almost always” drive the posted speed limit with another
29.81% answering “sometimes”, leaving only 3.85% responding that they “never” drive the posted
speed limit. 65.12% of respondents said they “almost always” wear a helmet when riding a motorcycle,
ATV, or scooter with another 20.93% answering “sometimes”, leaving a higher 13.95% that “never”
wear a helmet. Regarding children wearing a helmet when riding a motorcycle, ATV, or scooter, 74%
responded with “almost always”, leaving 26% wearing a helmet only “sometimes” or “never”. When
riding a bicycle, rollerblading, or skateboarding, 69% responded with “almost always”, leaving 31%
wearing a helmet only “sometimes” or “never”. No disparities were found across the different
demographics.
Table 43: Safety Behavior
Individual
Wear a helmet when riding a motorcycle, ATV, scooter
Drive the posted speed limit
Wear a seat belt
Children
Wear a helmet when riding a motorcycle, ATV, or scooter
Wear a helmet when riding a
bicycle/rollerblading/skateboarding
Use seat belt, car seats, and booster seats as recommended
Almost
Always
Sometimes
Never
Responses
65.12%
66.35%
80.00%
20.93%
29.81%
17.39%
13.95%
3.85%
2.61%
43
115
115
74.07%
14.81%
11.11%
27
69.23%
92.45%
20.51%
5.66%
10.26%
1.89%
39
53
Healthy Lifestyle
For the individuals’ responses regarding healthy lifestyle behaviors, some positive findings are that
nearly 98% “never” chew tobacco, 89% “never” drive after drinking alcoholic drinks or using drugs, and
nearly 92% “never” use illegal drugs. In addition, 70% “almost always” or “sometimes” apply sunscreen
before planned time outside, 86% “almost always” or “sometimes” eat at least five servings of fruits and
vegetables each day, 80% “almost always” or “sometimes” get enough sleep each night, and 70%
“almost always” or “sometimes” exercise at a moderate pace at least 30 minutes per day, five days per
week.
On the negative side, over 47% are “almost always” or “sometimes” exposed to secondhand smoke at
home or work, 78% “almost always” or “sometimes” eat fast food more than once a week, and 37%
“almost always” or “sometimes” smoke cigarettes.
Page 88
Table 44: Healthy Lifestyle Behaviors - Individual
Individual
Apply sunscreen before planned time outside
Are exposed to secondhand smoke in your home or work
Chew tobacco
Consume more than 3 alcoholic drinks/day (female), 5/day
(male)
Drive after drinking alcoholic drinks or using drugs
Eat at least 5 servings of fruits and vegetables each day
Eat fast food more than once a week
Get enough sleep each night (7-9 hours)
Smoke cigarettes
Take vitamin pills or supplements daily
Use illegal drugs (marijuana, cocaine, meth, etc)
You exercise at a moderate pace at least 30 min/day, 5
days/week
Almost
Always
Sometimes
Never
Responses
18.81%
18.27%
0.00%
51.49%
28.85%
2.02%
29.70%
52.88%
97.98%
101
104
99
3.88%
0.00%
13.79%
18.92%
28.95%
24.27%
31.53%
2.04%
19.42%
10.89%
72.41%
59.46%
50.88%
12.62%
32.43%
6.12%
76.70%
89.11%
13.79%
21.62%
20.18%
63.11%
36.04%
91.84%
103
101
116
111
114
103
111
98
20.87%
49.57%
29.57%
115
One disparity noticed was between household income and the percentage of those who smoke. Overall,
for those that have a household income of less than $25,000, nearly 26% “almost always” smoke
cigarettes compared to 14% of those with a household income greater than $50,000. Also, for those
that “sometimes” smoke cigarettes, the less than $25,000 group is 14% compared to 5% for the greater
than $50,000 group. For those that “never” smoke cigarettes, the less than $25,000 group is only 60%
compared to 82% for the greater than $50,000 group. This disparity is also found with those exposed to
secondhand smoke in the home or at work.
Table 45: Smoke Cigarettes
Almost Always
Household Income
Number
%
Less than $5,000
2
22.22%
$5,000-$14,999
6
23.08%
$15,000-$24,999
7
30.43%
$25,000-$49,999
5
41.67%
$50,000-$74,999
1
9.09%
$75,000-$99,999
2
25.00%
$100,000 or higher
0.00%
Grand Total
23
Sometimes
Number
%
1
11.11%
3
11.54%
4
17.39%
2
16.67%
1
9.09%
0.00%
0.00%
11
Never
Number
%
6
66.67%
17
65.38%
12
52.17%
5
41.67%
9
81.82%
6
75.00%
3
100.00%
58
Responses
9
26
23
12
11
8
3
92
For the individuals’ responses regarding their children’s healthy lifestyle behaviors, some positive
findings are that 87.5% “almost always” or “sometimes” apply sunscreen before planned time outside,
94% “almost always” or “sometimes” eat at least five servings of fruits and vegetables each day, 96%
“almost always” or “sometimes” get enough sleep each night, 96% “almost always” or “sometimes”
participate in at least one hour of physical activity each day, and 84% “almost always” or “sometimes”
are limited to two hours or less per day of TV, computer, and video game time.
Page 89
On the negative side, over 33% are “almost always” or “sometimes” exposed to secondhand smoke in
the home, 73% “almost always” or “sometimes” eat fast food more than once a week, and 85% “almost
always” or “sometimes” drink soda and/or sugar sweetened drinks.
Table 46: Healthy Lifestyle Behaviors - Children
Children
Apply sunscreen before planned time outside
Are exposed to secondhand smoke in the home
Are limited to 2 hours or less/day of TV, computer, video
games
Drink soda and/or sugar sweetened drinks
Eat at least 5 servings of fruits and vegetables each day
Eat fast food more than once a week
Get enough sleep each night (7-9 hours)
Participate in at least 1 hour of physical activity each day
Take vitamin pills or supplements daily
Almost
Always
Sometimes
Never
Responses
39.58%
8.89%
47.92%
24.44%
12.50%
66.67%
48
45
41.18%
23.08%
33.33%
9.62%
73.21%
69.81%
34.88%
43.14%
61.54%
61.11%
63.46%
23.21%
26.42%
34.88%
15.69%
15.38%
5.56%
26.92%
3.57%
3.77%
30.23%
51
52
54
52
56
53
43
One disparity noticed was between household income and the percentage of children exposed to
secondhand smoke in the home. Of the children exposed to secondhand smoke “almost always”, 2 out
of 3 (67%) of those children are in a household with income less than $25,000 and of those children
exposed to secondhand smoke “sometimes”, 80% (8 out of 10) of those children are in a household with
income less than $25,000.
Hygiene/Communicable Disease Control
Over 40% of the individual survey participants “never” get a flu shot each year and nearly 20% “never”
practice safe sex using either a condom or other barrier method.
Table 47: Hygiene/Communicable Disease Control - Individual
Almost
Always
Sometimes
Never
Responses
Individual
Get a flu shot each year
Practice safe sex (use condom or other barrier method)
Wash hands with soap and water after using the restroom
Wash hands with soap and water before preparing/eating meals
34.82%
48.28%
86.84%
81.74%
25.00%
32.18%
10.53%
16.52%
40.18%
19.54%
2.63%
1.74%
112
87
114
115
It appears as though lower household income plays a part in why some participants don’t get a flu shot
each year. 50% of those participants with an annual income less than $25,000 “never” get a flu shot
each year, while 50% of those participants with income greater than $50,000 “almost always” get a flu
shot each year. It also appears that the percentage of participants that “almost always” get a flu shot
each year increases with age as is shown in the following table.
Page 90
Table 48: Get a flu shot each year
Age
18-24
25-44
45-64
65+
Almost Always
13.51%
34.29%
47.83%
64.71%
Responses
37
35
23
17
It appears as though lower household income also plays a part in never practicing safe sex. Nearly 32%
of participants with a household income less than $25,000 answered “never” when asked if they
practice safe sex, compared to 18% of those with a household income greater than $50,000. Another
disparity is shown for practicing safe sex by race. Almost 23% of whites answered “never” when asked if
they practice safe sex with an additional 35% only “sometimes” practicing safe sex.
Nearly 39% of the survey participants’ children “never” practice safe sex using either a condom or other
barrier method and 25% of their children “never” get a flu shot each year.
Table 49: Hygiene/Communicable Disease Control - Children
Almost
Always Sometimes
Never
Responses
Children
Practice safe sex (use condom or other barrier method)
Get a flu shot each year
Wash hands with soap and water before eating meals
Wash hands with soap and water after using the restroom
55.56%
51.02%
69.81%
70.00%
38.89%
24.49%
5.66%
4.00%
18
49
53
50
5.56%
24.49%
24.53%
26.00%
There appears to be a disparity between the children that are “never” practicing safe sex and their race.
62.5% of the children of a black survey participant “never” practice safe sex.
Individual and Family Mental Health Issues and Behaviors
Nearly 90% of survey participants feel stressed out either “almost always” or “sometimes”, yet in spite
of that stress level, over 98% of participants feel happy about their life “almost always” or “sometimes”.
Another 63% feel lonely "almost always” or “sometimes” and 43% worry about losing their job “almost
always” or “sometimes”.
Table 50: Mental Health Issues and Behaviors - Individual
Almost
Always
Sometimes
Never
Responses
Individual
Feel stressed out
Feel lonely
Worry about losing your job
Feel safe in your community
Feel happy about your life
17.39%
9.73%
4.04%
67.86%
56.03%
72.17%
53.10%
39.39%
29.46%
42.24%
10.43%
37.17%
56.57%
2.68%
1.72%
115
113
99
112
116
One disparity was found between those who worry about losing their job and household income.
Nearly 53% of participants with a household income less than $25,000 worry about losing their job
Page 91
“almost always” or “sometimes”, while only 38% of those with an income greater than $50,000 worry
about losing their job “sometimes”.
82.5% of the survey participants answered “almost always” for their children feeling safe in school and
0% answered “never”.
Table 51: Mental Health Issues and Behaviors - Children
Almost
Always
Sometimes
Never
Responses
Children
Feel safe in school
82.50%
17.50%
0.00%
40
Home Environmental Safety
Regarding the environment and home safety, 82% of respondents reported having more than one
working smoke detector, yet only 51% have a fire extinguisher, only 39% have a carbon monoxide
detector, and only 3.54% reported having a radon test completed in their home. For emergencies, only
38% have a family fire safety/evacuation plan, 33% of children know how to dial 911 and know their
home address and phone number, and only 14% of households keep the poison control number by the
phone. Most homes (95%) have their trash removed weekly, but only 35% have curbside recycling.
Table 52: Environmental/Home Safety
Trash removed weekly
Food put back in fridge w/in 2 hrs
More than one working smoke detector
Internet access
Have one or more fire extinguishers
Carbon monoxide detector
Family fire safety plan/evacuation plan
Have one or more types of exercise equipment
Curbside recycling
Children know how to dial 911 for emergencies
Children know home address and phone number
Poison control number by phone
Radon test been completed in home
Pets
Primary source of drinking water is well or cistern
Septic tank
Provide care for older adult
Children under 13 unsupervised in non-school hours
Present in Home
94.69%
90.27%
82.30%
61.95%
51.33%
38.94%
38.05%
36.28%
34.51%
32.74%
32.74%
14.16%
3.54%
42.48%
23.89%
21.24%
2.65%
1.77%
Absent in Home
5.31%
9.73%
17.70%
38.05%
48.67%
61.06%
61.95%
63.72%
65.49%
67.26%
67.26%
85.84%
96.46%
57.52%
76.11%
78.76%
97.35%
98.23%
N = 113
Health Issues
The Health Issues section of the survey included a list of 27 diseases and health problems and the survey
asked the participants if they have ever been diagnosed by a doctor with any of those diseases or health
problems. If the participant selected “Yes”, then they were to select “I am taking medications or getting
Page 92
treatment” if they are taking medications or getting treatment, “I feel the disease is well managed” if
they feel as such, and/or “I see a doctor” if they indeed see a doctor for their condition.
The results of that section are shown in the table below. High blood pressure was the most commonly
diagnosed health problem at 26%; and of those that were diagnosed with high blood pressure, 72% are
receiving medications or getting treatment, only 34% feel it is well managed, and only 31% are seeing a
doctor for the condition. The next most common health conditions include sinus problems, eye
disorders, migraine headaches, and arthritis.
Table 53: Health Issues
Disease/Health Problem
High Blood Pressure
Sinus Problems
Eye Disorders
Migraine Headaches
Arthritis
Diabetes
High Cholesterol
Asthma
Obesity
Heart Disease
Dental Health Problems
Mental Disorders
Hearing Disorders
Kidney Disease
Respiratory/Lung Disease
Stroke
Glaucoma
Memory Loss
Cancer
Liver Disease
Hepatitis
Tuberculosis
Epilepsy
Lupus
Sickle Cell Anemia
Gonorrhea
HIV/AIDS
No
73.87%
74.77%
78.70%
81.48%
81.82%
82.14%
83.49%
83.64%
88.79%
89.91%
90.65%
90.83%
91.59%
94.34%
95.37%
95.41%
96.23%
97.20%
97.20%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
Yes
26.13%
25.23%
21.30%
18.52%
18.18%
17.86%
16.51%
16.36%
11.21%
10.09%
9.35%
9.17%
8.41%
5.66%
4.63%
4.59%
3.77%
2.80%
2.80%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Receiving Medications
or Treatment
72.41%
48.15%
30.43%
40.00%
25.00%
55.00%
72.22%
44.44%
16.67%
54.55%
0.00%
30.00%
11.11%
33.33%
40.00%
20.00%
50.00%
0.00%
33.33%
Well
Managed
34.48%
29.63%
30.43%
35.00%
15.00%
40.00%
50.00%
38.89%
0.00%
27.27%
10.00%
30.00%
11.11%
33.33%
40.00%
40.00%
25.00%
0.00%
33.33%
Seeing a
Doctor
31.03%
22.22%
39.13%
15.00%
30.00%
65.00%
33.33%
5.56%
25.00%
9.09%
0.00%
20.00%
22.22%
50.00%
20.00%
60.00%
0.00%
0.00%
66.67%
Responses
111
107
108
108
110
112
109
110
107
109
107
109
107
106
108
109
106
107
107
106
106
106
105
106
106
106
105
Page 93
Community Health Concerns
A list of 56 health, safety, and environmental issues that might be found throughout the community was
included in the Community Health Concerns section of the survey and the participants were asked to
select whether they feel the issue is a serious problem, moderate problem, not a problem, or if they
were not sure. The 28 issues below are of the greatest concern as more than 50% of the survey
participants felt the issue was a moderate to serious problem:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Allergies (87.88%)
Overweight Adults (81.82%)
Teen Pregnancy (78.48%)
Overweight Children (78.41%)
Unemployment (77.66%)
Mosquitos (77.53%)
Job Availability (77.32%)
Alcohol/Drug Use (77.23%)
Job Security (76.09%)
Crime (75.79%)
Health Care Affordability (73.26%)
Domestic Violence (72.09%)
Housing Affordability (68.60%)
Cancer (67.47%)
Smoking (65.91%)
Public Transportation (62.50%)
Child Abuse (62.16%)
High Blood Pressure/Strokes (61.19%)
Eating Disorders (59.52%)
Racism (57.30%)
Sexually Transmitted Infections (55.74%)
Heart Disease (55.71%)
Child Care/Day Care (54.22%)
Murder or Intentional Injury (52.63%)
Secondhand Smoke (51.16%)
Health Care Availability (51.16%)
Mental Illness (50.68%)
Asthma/Respiratory Disorders (50.67%)
Each health, safety, and environmental issue was divided into nine categories for purposes of analysis
and discussion:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Public Services
Crime and Violence
Safety Behaviors
Health Behaviors
Health Care and Support Services
Environmental Protection
Health Condition/Disease
Mental Health
Social and Economic Issues
Page 94
Public Services
Public transportation was the only concern from the Public Services category that was included in the
top concerns from the survey, ranked 16th. 62.5% of participants feel that transportation is a moderate
to serious problem in Cape Girardeau County. Law enforcement, recreation opportunities, and school
systems seem to only be moderate problems and fire protection seems satisfactory for the survey
participants.
Table 54: Public Services Concerns
Fire Protection
Law Enforcement
Recreation Opportunities
School Systems
Moderate to
Serious Problem
Number
%
15
20.00%
40
45.45%
39
46.43%
39
45.35%
55
62.50%
Not a Problem
Number
60
48
45
47
33
%
80.00%
54.55%
53.57%
54.65%
37.50%
Responses*
Not Sure**
75
88
84
86
88
33
19
24
22
22
*Response numbers do not include surveys that are Not Sure; percentages of Moderate to Serious Problem and Not a Problem
are based on only those responses where the participant chose Moderate, Serious, or Not a Problem
**For reference only. These numbers were not used in calculating the percentages of Moderate to Serious and Not a Problem
Crime and Violence
The Crime and Violence category has five concerns that are in the top issues. Crime overall ranked 10th
with nearly 76% participants feeling as though it is a moderate to serious problem. Domestic violence
ranked 12th with 72% of participants feeling it is a moderate to serious problem. Child abuse ranked 17th
and over 62% felt it is a moderate to serious problem. Racism ranked 20th on the top concerns list with
57% of participants feeling it is a moderate to serious problem. Lastly, murder or intentional injury
made the top list, which ranked 24th at 52.63%. The other three concerns, elder abuse, gang activity,
and school violence seem to only be moderate problems, with larger numbers of responses being “Not
Sure”.
Table 55: Crime & Violence Concerns
Child Abuse
Crime
Domestic Violence
Elder Abuse
Gang Activity
Racism
School Violence
Moderate to
Serious Problem
Number
%
46
62.16%
72
75.79%
62
72.09%
27
40.30%
37
48.68%
40
52.63%
51
57.30%
32
41.03%
Not a Problem
Number
28
23
24
40
39
36
38
46
%
37.84%
24.21%
27.91%
59.70%
51.32%
47.37%
42.70%
58.97%
Responses*
Not Sure**
74
95
86
67
76
76
89
78
36
14
22
41
33
32
20
30
Page 95
Safety Behaviors
None of the Safety Behaviors below ranked in the top concerns of the survey participants. Firearms and
highway safety appear to be mild concerns, but did not fall towards the top of the concern list.
Farming accidents had a high number of responses that were “Not Sure” so there is not much
awareness about this issue to know if it is a real concern.
Table 56: Safety Behaviors
Farming Accidents
Firearms
Highway Safety
Pedestrian Safety
Moderate to
Serious Problem
Number
%
21
31.82%
36
45.00%
34
45.33%
27
34.18%
Not a Problem
Number
45
44
41
52
%
68.18%
55.00%
54.67%
65.82%
Responses*
Not Sure**
66
80
75
79
43
29
33
29
Health Behaviors
Four out of the five Health Behaviors below made the list of top concerns. Overweight adults ranked in
second place with nearly 82% of participants feeling it is a moderate to serious problem. Teen
pregnancy came in third with 78.48% that felt it is a moderate to serious problem, and when just taking
the serious problem percentage into consideration, teen pregnancy actually ranks the highest with
nearly 46% of the participants feeling it is a serious problem. Overweight children is ranked 4th on the
list of top concerns with a moderate to serious problem percentage of 78.41%, which is almost equal to
the teen pregnancy percentage. Lastly, smoking is ranked 15th on the top list with nearly 66% of
participants feeling it is a moderate to serious problem. Many of the participants responded as “Not
Sure” regarding smokeless tobacco, unsure if it is a concern.
Table 57: Health Behaviors
Overweight Adults
Overweight Children
Smokeless Tobacco
Smoking
Teen Pregnancy
Moderate to
Serious Problem
Number
%
72
81.82%
69
78.41%
30
44.78%
58
65.91%
62
78.48%
Not a Problem
Number
16
19
37
30
17
%
18.18%
21.59%
55.22%
34.09%
21.52%
Responses*
Not Sure**
88
88
67
88
79
21
21
42
21
29
Healthcare and Support Services
Three of the Healthcare and Support Services concerns are on the top concern list. Health care
affordability, which ranked 13th had 73.26% of participants that felt it was a moderate to serious
problem. Child Care/Day Care is ranked 23rd and health care availability is ranked 26th on the list of top
concerns. Most of the other concerns are mild concerns, but the participants seem mostly satisfied with
ambulance services.
Page 96
Table 58: Health Care & Support
Services Concerns
Ambulance Services
Child Care/Day Care
Elder Day Care
Emergency Preparedness
Nursing Home Care
Services for the Disabled
Moderate to
Serious Problem
Number
%
23
28.40%
45
54.22%
24
38.71%
24
31.58%
63
73.26%
44
51.16%
31
45.59%
30
42.86%
Not a Problem
Number
58
38
38
52
23
42
37
40
%
71.60%
45.78%
61.29%
68.42%
26.74%
48.84%
54.41%
57.14%
Responses*
Not Sure**
81
83
62
76
86
86
68
70
29
28
46
33
23
22
40
39
Environmental Protection
One Environmental Protection concern that is on the top concern list is mosquitos, which is ranked quite
high in 6th place. Nearly 78% of survey participants felt that mosquitos are a moderate to serious
problem. Secondhand smoke is also on the top concern list where it ranked 25th with 51.16% of
participants that felt it is a moderate to serious problem. The remaining five environmental concerns
rank very low, within the bottom six on the list of 56 issues; however, radon gas and sewage treatment
had a high number of responses that were “Not Sure”.
Table 59: Environmental Protection
Concerns
Animal Control
Clean Water/Water Pollution
Mosquitos
Radon Gas
Secondhand Smoke
Sewage Treatment
Trash/Solid Waste Management
Moderate to
Serious Problem
Number
%
23
27.38%
22
26.51%
69
77.53%
14
25.93%
44
51.16%
19
28.36%
20
26.67%
Not a Problem
Number
61
61
20
40
42
48
55
%
72.62%
73.49%
22.47%
74.07%
48.84%
71.64%
73.33%
Responses*
Not Sure**
84
83
89
54
86
67
75
26
26
20
53
23
41
33
Health Conditions/Diseases
Seven of the top concerns fall in the Health Conditions/Diseases category. Allergies ranked the highest
on the top concern list with nearly 88% of participants feeling it is a moderate to serious problem;
however, when looking at the moderate and serious responses separately, participants classified it more
as moderate, than serious. Cancer is ranked 14th on the top list with a combined moderate to serious
percentage of 67.47%. High blood pressure/strokes and eating disorders are both ranked towards the
bottom of the list, ranking 19th at 61.19% and 20th at 59.52%, respectively. Sexually transmitted
infections and heart disease are moderate to serious problems, as they ranked 21 and 22, respectively,
on the list of concerns. Asthma and respiratory disorders round up the list ranking at the bottom in 28th
place with 50.67% of participants that felt it is a moderate to serious problem. HIV/AIDS received the
Page 97
second highest number of responses that were “Not Sure” so participants are not certain how serious a
problem it is. A large majority of participants feel that infant health and prenatal health are not
problems.
Table 60: Health Conditions/
Diseases Concerns
Allergies
Asthma/Respiratory Disorders
Cancer
Eating Disorders
Heart Disease
High Blood Pressure/Strokes
HIV/AIDS
Infant Health
Infectious Disease
Prenatal Health
Sexually Transmitted Infections
Moderate to
Serious Problem
Number
%
87
87.88%
38
50.67%
56
67.47%
50
59.52%
39
55.71%
41
61.19%
29
49.15%
25
36.76%
22
36.67%
24
32.88%
34
55.74%
Not a Problem
Number
12
37
27
34
31
26
30
43
38
49
27
%
12.12%
49.33%
32.53%
40.48%
44.29%
38.81%
50.85%
63.24%
63.33%
67.12%
44.26%
Responses*
Not Sure**
99
75
83
84
70
67
59
68
60
73
61
12
33
25
27
38
39
49
38
47
34
47
Mental Health
Two mental health concerns made the top list. Alcohol/drug use, ranked in 8th place with over 77% of
survey participants that felt it is a moderate to serious problem. Mental Illness overall ranked 27th on
the top concern list at 50.68%. Suicide seems to be a mild problem, but also received a high number of
“Not Sure” responses.
Table 61: Mental Health Concerns
Alcohol/Drug Use
Mental Illness
Suicide
Moderate to
Serious Problem
Number
%
78
77.23%
37
50.68%
30
47.62%
Not a Problem
Number
23
36
33
%
22.77%
49.32%
52.38%
Responses*
Not Sure**
101
73
63
9
34
44
Social and Economic Issues
Four of the top concerns fall in the Social and Economic Issues category. Unemployment is ranked 5th
on the top concern list with nearly 78% of participants feeling it is a moderate to serious problem. Job
availability is ranked 7th with a combined moderate to serious percentage of 77.32%. Job security and
housing affordability are both ranked towards the top of the list, ranking 9th at 76.09% and 13th at
68.60%, respectively. For this assessment, gambling did not rank very high on the list of concerns;
however, a casino just opened in the fall of 2012 in the city of Cape Girardeau, so it may be interesting
to see if this changes for the next assessment.
Page 98
Table 62: Social & Economic Issues
Concerns
Gambling
Job Availability
Job Security
Unemployment
Moderate to
Serious Problem
Number
%
30
37.97%
59
68.60%
75
77.32%
70
76.09%
73
77.66%
Not a Problem
Number
49
27
22
22
21
%
62.03%
31.40%
22.68%
23.91%
22.34%
Responses*
Not Sure**
79
86
97
92
94
29
23
12
17
16
Page 99
Chapter 7: Summary of Findings
Using the Data to Determine Needs
The secondary data is used to compare Cape Girardeau County to Missouri by examining quantitative
data such as percentages, rates, and trends. If Cape Girardeau County ranks worse than the state or a
negative trend is occurring, then a need is presented. The primary data is qualitative and takes in
consideration the thoughts and opinions of people in the community. If a consensus arises about a
concern, then a need is established.
Secondary Data
After a review of the secondary research found in chapters 2 - 5, it can be determined that Cape
Girardeau County does remarkably well compared to the state of Missouri in many areas; however,
there are some areas that should be of concern. The following describes the findings from the
secondary data.
In the Education category, Cape Girardeau School District 63 in Cape Girardeau County has a higher high
school dropout rate than the state, 5.2% versus 3.4%. More specifically by race/ethnicity, 13.3% of
Hispanics and 8.3% of blacks dropped out at Cape Girardeau School District 63 in 2011, compared to
3.8% of whites.
Even though the rate of Unemployment in Cape Girardeau County is lower than the state rate, the rate
has been continuously trending upwards since 2006.
In the Public Assistance Participation category, there is a slightly higher percentage of people in Cape
Girardeau County that are on Food Stamps (11.97%) when compared to the state (11.4%). Also, again
when just looking at Cape Girardeau School District 63, there is a much higher percentage of students
enrolled in the Free/Reduced Lunch Program (61.5%) than compared to the state (47.8%) or any other
school district in the county.
Under Public Safety, the theft offense rate is higher for Cape Girardeau County than the state of
Missouri, 3,095 versus 2,485 per 100,000 population. Also, for juvenile crime rates, truancy and those
that are habitually absent from home are higher for Cape Girardeau County than Missouri.
In the Family and Domestic Violence category, the child abuse and neglect rate is higher in Cape
Girardeau County than the state overall; however, the rate has been trending downward 2004 – 2008.
The child out of home placement rate is considerably higher in Cape Girardeau County than the state
overall, at 5.2 versus 3.8 per 1,000 children.
For Mental Health, the provider ratio in Cape Girardeau County is 12,203:1 which is considerably higher
than the state’s ratio of 9,561:1. Also, the number of “poor mental health days” is higher in Cape
Girardeau County at 4.3, compared to 3.7 for the state.
The Leading Causes of Death in Cape Girardeau County are Heart Disease, All Cancers, Stroke/Other
Cerebrovascular Disease, All Injuries/Poisonings, and Chronic Lower Respiratory Disease, which
accounted for 70% of all deaths 1999 – 2009. Of all leading causes of death, Cape Girardeau County has
rates worse than the state in Heart Disease, Stroke/Cerebrovascular Disease, Alzheimer’s, and Kidney
Disease.
Cape Girardeau County has worse rates than the state in the Chronic Disease category for Colorectal
Cancer deaths, Cervical Cancer deaths, Prostate Cancer deaths and hospitalizations, and Arthritis/Lupus
ER visits.
Page 100
Cape Girardeau County has a higher rate of influenza in the infectious disease category. The rate per
100,000 population was 1,090.2 for the county, compared to a rate of 517.1 per 100,000 for Missouri.
In the Unintentional Injuries category, the hospitalization rate for Falls in Cape Girardeau County is
slightly higher than Missouri. Also, the work injuries rate is considerably higher in the county than for
the state; however, the rate has been trending downward 2000 – 2009.
Under the Health Status at Birth category, low birth weight has been increasing 1997 – 2006 and was
last equal to the state at 8.1%. Preterm births in Cape Girardeau County have also been trending
upwards 1998 – 2009 and were last nearly equal the state at 12.6%. The birth defects rate in Cape
Girardeau County has almost always been significantly higher than the state 1999 – 2007 and was last at
823.6 per 10,000 live births versus 611.0 per 10,000 live births for the state.
Overall in Preventable Hospitalizations, Cape Girardeau County does very well. There are only two
diagnoses where the Cape Girardeau County rate just barely falls above the state rate: bacterial
pneumonia and congenital syphilis.
In the Maternal Health category, Cape Girardeau County has a slightly higher percentage of resident live
births where no prenatal care was received, 1.1%, compared to .8% for the state. Cape Girardeau
County also has had a higher percentage of mothers that smoked during pregnancy since 1998-2000
(moving average), and was at 19.2% of resident live births 2007-2009 (moving average), compared to
17.4% for Missouri.
The residents of Cape Girardeau County do very well compared to the state in most Preventive
Practices, except for women that are age 18 and older getting pap smears. 6% of women age 18 and
older in Cape Girardeau County have never had a pap smear compared to 3.4% in Missouri and 24.6% of
women age 18 and older in Cape Girardeau County have not had a pap smear in the last three years
compared to 19.5% for the state.
Specific to Child and Adolescent Health, the causes of death for children and causes of death for
adolescents show Cape Girardeau County having a higher rate of death than the state in the all cancers
(malignant neoplasms) cause for both groups. Also, teen substance use in the last 30 days is higher in
Cape Girardeau County for cigarettes, alcohol, binge drinking, marijuana, and over-the-counter drugs
than the state. The teen pregnancy rate is lower in Cape Girardeau County than for the state; however,
the births to teens rate is trending upwards for Cape Girardeau County while trending downwards for
the state.
For Senior Health, safety is a greater concern in Cape Girardeau County as the property and violent
crime rate per 1,000 persons was higher than the state at 37.6 compared to 35.4.
Primary Data
After a review of the primary research results found in chapter 6, it can be determined that Cape
Girardeau County has many areas of concern. The following lists the findings from the primary data,
including the community surveys, focus groups, and checklist exercise completed at the focus groups.
The issues were determined as a concern if the focus group participants were in agreement about the
issue and/or if more than 50% of survey participants classified the issue as a moderate to serious
problem.
Health Problems determined by the primary research:
•
•
•
Diabetes & Pre-Diabetes
High Blood Pressure/Strokes
Heart Disease
Page 101
• Overweight Adults
• Overweight Children
• Cancer
• High Cholesterol
• Dental Health
• Autism
• Chronic Pain
• Mental Health – Anxiety and Depression
• Asthma/Respiratory Disorders (especially in children)
• Sexually Transmitted Infections (especially in adolescents)
• Allergies (especially food allergies in children)
Behavioral Problems determined by the primary research:
• Smoking
• Alcohol/Drug Use
• Poor Diet & No Exercise
• Poor Lifestyle
• High-Risk Pregnancies – because of no prenatal care, living an unhealthy lifestyle, and drug use
• Drug Use with Adolescents
• Eating Disorders
Community Problems determined by the primary research:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
EMS called out for non-emergencies or repeat patients
Child Abuse
Domestic Violence
Health Facilities
Teen Pregnancy
Unemployment
Mosquitos
Job Availability
Job Security
Crime
Racism
Child Care/Day Care
Secondhand Smoke
Lack of Communication and Resources
Conclusion
This Community Health Needs Assessment is the product of a completed process of finding secondary
data, performing primary research, and presenting those findings. This compiled information will allow
the partnering hospitals to create an implementation strategy designed to meet some particular needs
that are specific to the Cape Girardeau County community.
Page 102
Appendix A – Survey
Page A-1
Page A-2
Page A-3
Page A-4
Appendix B - Focus Group Questions
Community Health Needs Assessment Focus Group Questions
1. What do people in this community do to stay healthy? How do people get
information about health?
2. In this group’s opinion, what are the serious health problems in your community?
What are some of the causes of these problems?
6. Of all the issues we have talked about today, what issues do you think are the
most important for your community to address?
B-1
Appendix C – Focus Group Participant Information
Cape Girardeau City Fire Department
•
Battalion Chief: 29 years working in fire
service
Cross Trails Medical Center
•
Cape Girardeau County Public Health Center
•
Assistant Director: 23 years working in
public health
Department of Health & Senior Services
•
Cape Girardeau Police Department
•
Captain
Cape Leaders Alliance
•
•
•
Board Members
Director
Chairman/Pastor
Chaffee Nursing Center
•
Outreach Coordinator/Social Work
•
Assistant City Manager
Mayor: 20 years in government
Fire Chief: 13 years working as a
firefighter/EMT
Community Caring Council
•
•
Health Coordinator
Community Coordinator: 10 years
working in community development
Adult Protective Community Supervisor:
15 years working with
elderly/disabled/children
Family Support Division
•
Eligibility Specialist Supervisor
First Presbyterian Church
•
Pastor
Jackson Chamber of Commerce
•
Executive Director
Jackson Family Care
•
City of Jackson
•
•
Case Manager: 4 years working with
uninsured and underserved at a
Federally Qualified Health Center
Physician: 34 years working in health
care
Jackson R-2 Public School District
•
Director of Communications/Director of
Foundation
Jackson Senior Center
•
President of the Board
Life Skills/Touch Point Autism Services
•
Autism Specialist
C-1
Love in the Name of Christ of Southeast
Missouri
•
Executive Director
SoutheastHEALTH
•
•
MERS/Goodwill
•
WIA Youth Case Management
Oak Ridge R-VI School District
•
School Nurse: 14 years working in
nursing
Saint Francis Medical Center
•
•
RN, Manager Emergency Services: 25
years working in nursing
Assistant Manager - Social Services: 9
years working in hospital social work
Samaritan Regional Health Clinic
•
CEO: 30 years working as a hospital ICU
nurse
SEMO Area Agency on Aging
Director, Emergency Services
Director, Case Management/Social
Services: 25 years working in health
care
St. Vincent de Paul Catholic Church
•
Coordinator of Christian Service
Success by 6, United Way of Southeast MO
•
SB6 Coordinator
The Bridge Community Outreach in South Cape
for La Croix United Methodist Church
The Salvation Army
•
Major
United Way of Southeast Missouri
•
•
•
Director of First Call for Help
LIFE Initiative Coordinator
Executive Director
Page C-2
Appendix D – Survey Tracking Database
D-1
Page D-2
Page D-3
Page D-4
Page D-5

Community Health Needs Assessment for Cape Girardeau County

Transcription

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