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HomeMy WebLinkAbout04 April JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, Apri118, 2002 Board Members: Dan Titterness, Member- County Commissioner District #1 Glen Huntingford, Member - County CommÙ.rioner DÙ¡rid #2 Richard U/qjt, Member - County Commissioner District #3 GeoJfrry Masâ, Vice Chairman - Port Townsend City Counâl ]ill Buhler, Member - Hospital Commissioner District #2 Sheila U/esterman, Chairman - Citizen at LArge (City) Roberta Frissell, Member - Citizen at LArge (County) Staff Members.' Jean Baldwin, Nursing Services Director LArry FC!)', Environmental Health Diredor Thomas Locke, MD, Health qfJžcer Chairman Westerman called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exception of Vice Chairman Masci. APPROVAL OF AGENDA Larry Fay asked to add two information items under Old and New Business? Commissioner Wojt moved to approve the Agenda as revised. Commissioner Titterness seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Frissell asked that additional information be included under the Prenatal Risk Assessment Monitoring (PRAM) discussion related to the suggestion that the Board of Health be consulted regarding any major changes in Health Department policy or programs? Member Buhler moved to approve the minutes of March 21,2002 as corrected. Member Frissell seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT· None OLD BUSINESS AND INFORMATIONAL ITEMS Environmental Health Survey: Kellie Ragan pointed out that the on-site septic program survey developed by Staff is separate from the BRFSS survey. She reported that Staff is in the process of field- testing their survey, in which respondents are asked about their experience within the past 12 months and about their most recent contact in terms of courtesy, technical expertise, and overall satisfaction. Although it is modeled after the BRFSS study and is designed to be quantitative, because respondents are providing a lot of narrative, Dr. Hale is recommending Staff also record key words and themes. HEALTH BOARD MINUTES - April 18, 2002 Page: 2 Larry Fay said the survey was designed to evaluate the perceptions of those individuals who have used the on-site sewage program, including applicants, people with questions, and individuals who have participated in workshops. Staff is tracking contact names and information in order to provide the sample from which respondents are selected. The purpose of modeling it after the BRFSS survey is to be able to compare the data collected by each instrument. This survey will be part of an ongoing quality improvement program and is being tested in order to determine the amount of energy needed to collect this information. Chairman Westerman asked if this is a survey that might be used with Community Health and how long it might take to perfect the model? Jean Baldwin responded that while a less extensive survey is being done in two programs, another purpose of piloting this survey is to consider whether it might be used across other programs. The phone logs are also useful in assessing whether there is a need to improve the way staff dispenses information. The survey should be ready within a few weeks and preliminary results may be available by the next Board of Health meeting. Member Buhler asked whether the logs provide a representative sample of the entire area? Larry Fay said that the contacts collected over the period of a month should be representative. Chairman Westerman asked whether there is any distinction between commercial and residential contacts? Ms. Ragan explained that there is one question asking the respondent to specify whether they are a property owner, contractor, realtor, prospective buyer, business owner, designer, or engineer. Installer might also be added as a choice. Commissioner Wojt expressed concern about the kind of information being relayed in a 20-minute phone call. Mr. Fay said for those people who call the Department frequently, the logs might help Staff assess whether the Department is dealing with these people in the most effective manner. Chairman Westerman commented that a concern expressed during meetings of the Fee Review Advisory Committee was that people might be utilizing community development to design their projects. Some felt the need to establish a reasonable length of time for Staff to interact with citizens after which they should begin charging for their time. Letter to School Superintendents Washinu:ton State Healthv Youth Survey (2002): The Board recommends that the fact sheet, survey information and sample survey materials also be sent with the letter. To Member Buhler's question whether filling out the survey on-line could be an option, Ms. Ragan said it is currently designed in a hard copy format. She noted that the letter would be revised to clarify that the Principles of Effectiveness is a federally recognized model. There was support for Chairman Westerman to sign the letter on behalf of the Board with the minimal changes as discussed, including enclosures. Results on BRFSS Update 18-34 Year Olds: Jean Baldwin explained that the Board received a packet of data on two additional modules: Environmental Health and 18-34 Year Olds. She noted that while the Board had previously received the Basic Demographic Characteristics of Respondents and the Risk and HEALTH BOARD MINUTES - April 18, 2002 Page: 3 Predictive Behaviors BRFSS module, the versions in the latest packet are slightly modified to clean up the material. She asked for Board comments on the information presented. Chairman Westerman said she was surprised that while many in this group have dental insurance, few get dental cleanings. Jean Baldwin agreed that there does appear to be a disconnect in this data related to healthcare access, such as individuals having dental insurance but no health insurance. Also interesting to note are the behavioral risks. The data on guns, violence and smoking are much higher in this group and the rate of substance abuse and alcohol consumption in the past 30 days is, as expected, highest among 18-34 year olds both in the County and the State. She reminded the Board that only the most significant results have been reported and stated she does not feel the information presented is an exhaustive overview. Results on BRFSS Update Environmental Health Questions: Jean Baldwin explained that while there are some national pilot modules, the Centers for Disease Control have only recently begun collecting Environmental Health information. The only comparative data was from Kitsap County and a few other places around the country. This information is good baseline data and will be helpful in determining gaps in education. For example related to water testing, she noted 54% of Jefferson County adults reported their water has been tested within the last three years, compared with 71 % in Kitsap County. Also interesting was the information about fire and wood stove heat where 20% reported using wood stoves as their primary source of heat, compared to 5% in Kitsap County. While not surprising for a rural county, this data needs to be shared with the task force that works with kids safety because of air quality issues. Commissioner Huntingford mentioned that many people who are getting sick after the mandatory insulation packages and draft tightening are now suing because the building codes do not allow for adequate ventilation. Also, with the unavailability of natural gas, people use propane, electric and wood heat. Ms. Baldwin noted 15% are using propane as a primary source of heat. Larry Fay said because the Environmental Health component of BRFSS is new, the information is more of a qualitative evaluation. It provides an overview of what people think about the environment and what causes them problems, but is not based on environmental quality data. While the relatively high number of individual wells is not necessarily good or bad, it does raise the question whether the Department should be doing more education and encouraging testing of these wells. Residents in Kitsap County appear to test their water more frequently than residents of Jefferson. On the other hand, residents in Jefferson County have had their septic tanks pumped more recently, which may mean that public education programs are working. He added that while it was assumed that citizens were not aware that curbside pickup service was available, the survey does reflect knowledge and use of the service. The hauler, however, estimates reaching only about 30% of the potential market. Chairman Westerman said she was surprised that 17% of Jefferson County residents had never had their septic tanks inspected. Mr. Fay said he was more surprised that this figure was the same in both counties. HEALTH BOARD MINUTES - April 18, 2002 Page: 4 Member Frissell said she was disappointed that there was no follow-up question to the individuals who indicated that indoor pollution made them sick. She would like to have known what they believe it was that made them ill. Commissioner Huntingford agreed and asked how this correlates with other information such as kids with asthma. Ms. Baldwin said that unlike the previous results, the Data Steering Committee has not yet had a chance to examine this data for gaps. There might be issues that need more review. Member Frissell noted that a major source of indoor pollution is not mentioned and that is outgasing from carpet padding and particle board. She found it interesting that more individuals found air quality at home was worse than air quality at work. Mr. Fay believes that if we did a similar analysis of food-borne illness, we would find significant percentages originating in the home. He wondered if there was, short of a regulatory program, some way to get information to people to help reduce the frequency of such illnesses. He mentioned that industry is identified as a source of air quality concerns in Port Townsend while the sources out in the County were a combination of industry, trash or garbage burning. Chairman Westerman said some respondents may have been confused about the phrasing of the solid waste disposal question and considered their delivery of garbage to the transfer station as utilizing solid waste disposal services. She believes this question needs to be reworded, clarifying pick-up-at-your-door service. It will also be important to note now what additional questions may be needed, such as the age of the septic tank Existing Abatement Models: Larry Fay said he would report to the Board next month on his research into abatement models and sample ordinances from other county planning agencies. He hopes the Board could have a discussion at that meeting and decide whether or not to proceed and, if so, in what direction. While there are some very clear statutory authorities for municipalities, he has not found a model that is applicable to counties. Chairman Westerman asked whether there has been any progress on the Gaikowski property complaint on Egg and I Road? Mr. Fay said this would be the first case that will be pursued as a civil infraction. Mter learning the procedures, Staff will file the ticket with the court, which will deliver the notice and pursue a violation. Chairman Westerman expressed concern that without enforcement, these regulations are not particularly useful at protecting public health. Enforcement should be a priority. Mr. Fay said his interest and hope is that the Board can borrow pieces of processes from other counties to create a standardized and predictable enforcement framework. Commissioner Wojt asked about the Linda Sexton case, to which Mr. Fay responded that this issue would be better addressed through abatement rather than a civil infraction. HEALTH BOARD MINUTES - April 18, 2002 Page: 5 Review of Assessment Workgroups Access to Care. Childhood History of Violence. Concentration of Risk in Households with Children. and Substance Abuse: Member Frissell reported that the Data Steering Committee identified these four areas of concern for further investigation. They recommend that smaller workgroups review the data and consider expanding the survey to include other questions that address the unique issues in this community. She noted that a missing question related to access was how far people had to travel to see their provider. The high level of childhood history of violence is a concern. They also felt the need to examine the risk factors in households with children to determine effective preventive measures so as to both avert health problems and maximize the budgeted resources. The committee recommends continuing and committing to smaller work groups, as most members are willing to join smaller task forces. Jean Baldwin said the contract with the City was an attempt to identify community-wide issues that impact the law and justice community. Prior to the survey, Dr. Chris Hale and Staff had met with several individuals in the law and justice community about what they see as contributing factors. With results in hand, another meeting is necessary to discuss the findings, program implications, and how to share this information to make change. It is her desire that these committees would report back to the Board of Health. Chairman Westerman asked who would comprise the four workgroups and who would decide about representation? She suggested having a Health Board member on each workgroup. Ms. Baldwin said the approach has not yet been discussed, but the composition would need to extend well beyond the Data Steering Committee. More people from Jefferson General are needed to look at access issues. She noted that Member Masci expressed interest in working on Access and Member Frissell is interested in Concentration of Risk in Households with Children. Member Buhler expressed interest in Access and either the Childhood History of Violence or Substance Abuse. Jean Baldwin will join Kellie Ragan and Lisa McKenzie in staffing all groups. Also, Larry Fay would step in if they desire detail in Environmental Health. Member Frissell said Board members might also want to recommend individuals whom they feel might be helpful on the work groups. Chairman Westerman recommended involving others in the community in this process. Ms. Baldwin said that at this point, the goal is to get the data to the experts and incorporate other data sources. Education and outreach would follow. In the meantime, Staff will begin working on two of the workgroups and will try to produce a timeframe for the Board by the next meeting. Dr. Tom Locke said the access to healthcare issue overlaps with the Board's involvement in the Joint Board process. The work group would look at the available data. He commented that the deeper you look into access to healthcare, the more you realize how bad the data is and want to try to devise strategies for finding more information, such as from emergency rooms and other sources. HEALTH BOARD MINUTES - April 18, 2002 Page: 6 Washington State Bioterrorism Plan Jefferson County Impacts: Dr. Locke reported that last week the State submitted to the Federal Government its plan for spending the more than $18M of public health bioterrorism preparedness funds. The executive summary of the plan illustrates the different dimensions to be addressed under emergency preparedness. One of the most important elements of the process is to quickly identify and fill critical gaps before addressing other areas that, while substandard, provide some degree of response capability. Initial efforts under the work plan would focus on assessment and determining federal, state and local capabilities and gaps. A health emergency contingency plan specific to Jefferson County will then be developed which will mesh with regional, state and national plans. Although the County can borrow from the efforts and technical expertise of other levels, there is a need to develop a local response plan. The other challenge is merging the existing Emergency Management System with a health care system that was designed to provide care on a case-by-case basis instead of a more population-based approach. This is why public health has been pushed into the lead as the population-based part of the system, even if it only receives 1 % of the funding in 2002. Ninety-nine percent of the funding and most of the current infrastructure and resources are in the medical care sector. It would be a great opportunity for the medical care sector to benefit from more of a public health perspective on the management and prevention of communicable disease. Dr. Locke and Ms. Baldwin then talked about the levels of expected funding: $25K for all of Jefferson County, $2.8 billion from Health Resources and Services Administration (HRSA) shared between every hospital in Washington, and a considerable amount of federal funding, 75% of which is designated to go to local jurisdictions. Without an Emergency Preparedness infrastructure similar to the Centers for Disease Control, there is much discussion in the Office of Homeland Security about how best to disburse federal funds to state and local jurisdictions. Along with the $25K in funding, the plan requires collaboration with a regional response team, including Kitsap and Clallam Counties. The regional health district will be able to address issues that it could not have handled alone, such as the need for a regional epidemiologist. Dr. Locke said he believes the Board of Health's role in Emergency Preparedness will be broad. Planning activities mayor may not be popular on a local level, but there will be a need for support and to underscore their importance. There may also be controversial elements of local enforcement in which the Board of Health may be involved. He mentioned that old laws related to isolation, quarantine, and response to epidemics and extreme communicable disease threats have since lapsed, even though the authority still exists. He described the Model Emergency Powers Act, which was created after the September 11 tragedy as a guideline for states to tune up their emergency powers. Due to civil liberty concerns and fears of government power, only Utah succeeded in passing the act, which allows for a 10 day lag before actions come under court scrutiny. A more moderate approach, such as with the Tuberculosis regulations in this state, calls for a 72 hour lag. Some feel there should be no time lag, instead requiring court authorization before any action. Courts are now considering 24 hour court capabilities where judges would be on call in order to provide court orders. He advocates a minimum lag of 72 hours, which in some cases like Smallpox, would likely not be enough. HEALTH BOARD MINUTES - April 18, 2002 Page: 7 Ms. Baldwin noted that communicable disease is now not only a front burner issue, but one which calls for a completely new approach to surveillance, relationships to providers, and types of investigative properties. Dr. Locke said another item to come out of this system would be a switch from passive to active surveillance. The information stream will be useful in other realms because it will be a real-time monitoring of the health status of communities. Commissioner Wojt spoke in favor of better monitoring and an improved command structure so that earlier identification of an outbreak will reduce the number of individuals with whom we will be dealing. Dr. Locke agreed that the system has to be much more sensitive than it is now. To the extent you succeed with a sensitive surveillance system, you will find all kinds of things that you had been missing. A question by Commissioner Huntingford about the prioritization of transitory illnesses, led to the issue of antibiotic shelf life. A super antibiotic with a 3-5 year shelf life could be created, but if the germs mutate or the antibiotics are used inappropriately, antibiotic resistance can become a huge public health risk. Every time the country loses an antibiotic to a resistant strain we all become more vulnerable, making public education on this issue very important. Dr. Locke talked about the unusual respiratory outbreak that has occurred over the last month in western Washington and said it is not known why there were unusual levels of pneumonia. A more active surveillance system, more diagnostic testing and early treatment of sick individuals could have prevented the spread of a communicable bacterial infection. Considering lost work time, early detection saves lot of money. 2002 Legislative Wrap-Up: Dr. Locke reported that the dominant theme in Olympia this session was filling the budget gap, making cuts and coming up with emergency financing strategies. Among the list of Public Health and Human Services bills that originated in the Senate, two that have potential interest to the Board concern donated food and drug offense sentencing. Two other bills that were closely tracked were the sale of hypodermic syringes and changes in the way state food codes are written and interpreted. The hypodermic needles bill dealt with vague language in Washington State law that said pharmacists can sell needles without a prescription, but they need to verify they are utilized for legitimate purposes. The bill that passed said pharmacists could sell as many syringes as they take back. Because of the major unintended consequence of diabetics having to redeem syringes in order to get additional ones, the Governor vetoed this portion of the bill. He noted that this bill does not replace the needle exchange programs, in which people are encouraged to exchange in order to get the dirty syringes out of circulation. With the prevalence of chronic Hepatitis C and an even higher incidence of HIV among IV drug users, the program creates an opportunity for treatment education and attempts to break the cycle of addiction. Dr. Locke reported that the bill on donated food took local Boards of Health out of the process when it comes to the interpretation of food safety rules and made the State Department of Health the sole interpreter of the State food code. At present, the local Health Department is the interpreter of the code HEALTH BOARD MINUTES - April 18, 2002 Page: 8 and could supplement the code by passing more stringent standards or adding language about suspension or revocation, appeals or administrative process. This bill passed with strong majority in the House and, although it was met with more resistance, it also passed the Senate. The Governor vetoed it in its entirety. In response to a question about the State Department of Health s interest in doing this, Mr. Fay explained that this was an industry-sponsored bill, with the restaurant association and major chains as supporters. The basic issue related to bare-hand contact policies. Many, but not all, counties now require people to wear protective gloves so restaurants that operate in multiple counties were looking for consistent, statewide rules. However, with the County doing inspections and interpreting the rules each day, it would not be practical for the State to be the sole interpreter of the rules. Environmental Health was glad the Governor vetoed this because the Department of Health is working on revising the state code. The committee had already suggested the use of the industry-recommended FDA food code as the model. He believes many of the industry's issues will be addressed in the next 18 months. Jean Baldwin reported that three DSHS funded programs that she had expected to be eliminated received last minute legislative support. The Department of Children Services was the main vendor that she felt would not have been served. Also in doubt were two contracts with the Department of Health that provide home visits for low risk families that have been screened for child abuse risk. It was decided that a nurse providing some education would release them from the DSHS system. The current caseload of nine families will continue to receive service. Ms. Baldwin noted that they are low risk to the Department of Child Protective Services, but high-risk community families. Contracts due to expire in July will be renewed and some of the expected cuts in DSHS were not as deep as anticipated. Chairman Westerman commented that it appears the bill reducing sentences for certain drug offenders is intended to save money and in turn those savings will be used for in-jail treatment. Staff agreed and said these savings would be applied only along the 1-5 corridor. Dr. Locke added that most health departments feel this is a step in the right direction a long overdue investment in treatment. Chairman Westerman thanked Staff for providing the Board with the letter from the Governor outlining his reasons for vetoing the food service rules. Joint Board Meeting: Dr. Locke said Staff is still working toward a date that would accommodate the schedules of the County and Hospital Commissioners. The Board will be notified as soon as a date is chosen. Drinkinu: Water Policy: Larry Fay said that at the next meeting he would provide an issue paper on the policy adopted in 1996, which requires individuals to connect to public water in a timely and reasonable manner when public water is available. This policy derived from the Coordinated Water System Plan and RCW 19.27.97. While the policy identifies timely, it does not identify reasonable. Recently, a situation has come up where reasonableness was in question and there was no mechanism for resolving whether or not the time, term and conditions of the permit were reasonable. HEALTH BOARD MINUTES - April 18, 2002 Page: 9 Chairman Westerman suggested consulting with the City or other counties for comparison. AGENDA CALENDAR / ADJOURN May Agenda Topics: Revisit BRFSS assessment; Drinking Water Policy and Existing Abatement Models. The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, May 16,2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH ?)~ 4v W It,~ \¡vV--- Sheila weB~ (Excused) Geoffrey Masci, Vice-Chairman &tin . hI ' ~'I /\ u er, etp e \ \ I / J' j. .. i" f ~/. ).'. / ~~~em~:r t ~J~ Roberta Frissell, Member JEFFERSON COUNTY BOARD OF HEALTH Thursday, April 18, 2002 2:30 - 4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of March 21, 2002 III. Public Comments IV. Old Business and Informational Items 1. Environmental Health Survey 2. Results on BRFSS Update - Environmental Health Questions - 18-34 Year Olds Health 3. Letter to School Superintendents - Washington State Healthy Youth Survey (2002) V. New Business 1. Review of Assessment Workgroups - Access to Care - Childhood History of Violence - Concentration of Risk in Households with Children 2. Washington State Bioterrorism Plan- Jefferson County Impacts 3. Legislative Wrap-Up 4. Joint Board Meeting with Jefferson General Hospital VI. Agenda Planning V. Adjourn Next Meetin~: May 16, 2002 2:30 PM - 4:30 PM Geoff/Roberta Tom Tom JEFFERSON COUNTY BOARD OF HEALTH ...~ MINUTES "'~ Thursday, March 21, 2002 Board Members.' Dan Titterness, Member - County Commissioner District #1 Glen Huntingfard, Member- County Commissioner Dist:rit.:t #2 Richard Wojt, Member· County Commissioner District #3 Geoffrey Masci, Vzce-Chairman - Part Townsend City Council Jill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Chairman - Citizen at Large (City) Roberta Frissell - Citizen at Large (County) Staff Members.' Jean Baldwin, Nursing Services Director Larry Fay, Environmental Health Director Thomas Locke, MD, Health Officer Chairman Westennan called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exception of Commissioner W ojt. APPROVAL OF AGENDA Member Masci moved to approve the Agenda. Commissioner Tittemess seconded.the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Masci moved to approve the minutes of February 21,2002 with one correction to page one, paragraph one, which should state "Chainnan Westerman called the meeting to order" rather than "Chairman Buhler." Member Buhler seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSNESS AND INFORMATIONAL ITEMS Complaint Response Procedure: Commissioner Titterness inquired about the status ofthe Complaint Response Procedure. Larry Fay said Risk Management is reviewing the document, with the County Prosecutor doing a final review. He agreed to follow-up with Deputy County Prosecutor David Alvarez. NEW BUSINESS 2002 Legislative Session Report - Bills. Backfill. Bonds And Bioterrorism: Dr. Tom Locke reported that a number of bills will have significant, but not immediate impacts dealing with changes in health care codes and the roles of local Boards of Health, and can be dealt with by the Board over time. Most surprising to report is that backfill funding will remain through June 2003. This means the County will not have to dismantle about 50% of communicable disease control capabilities in the State. Even though the State remains in crisis because funding will not continue past the end of the biennium, there will be additional time to come up with a more comprehensive, stable funding source for essential public health services. Local public health people are working hard on a federal bioterrorism plan to make Washington State eligible for $20 million a year in federal bioterrorism preparedness funds, the deadline of which is one month away. Commissioner Huntingford asked whether the $20M earmarked for Washington State would fill some of the other funding gaps? Dr. Locke explained that almost no federal money could be HEALTH BOARD MINUTES - March 21,2002 Page: 2 transferred or used to fund other areas of public health. Although it was originally thought that these funds would go to the State for distribution, the Federal guidelines are 80% local, 20% State and any state-wide plan has to have the consultation and endorsement oflocal health. Jefferson County Behavioral Risk Factor Surveillance System (BRFSS) Report: Jean Baldwin recognized that funding for this study came from the City and the Health Department. Dr. Chris Hale then provided background on the BRFSS, which is designed and carried out by the Centers for Disease Control. She explained how the survey was administered, noting the remarkably high success rate of 80% to the 170-question survey. After explaining how the data is organized, she summarized the findings under the following six message statements: 1. Adults in Jefferson County generally enjoy better health than the State average. · Life expectancy is consistently higher than Washington State -79 years as opposed to 77. · On the self-reported health status, Dr. Hale noted the FairIPoor response is high and comes from the 18-34 age range. She noted this is one of the first indicators that this age group looks different from the rest ofthe County - and not in a good way. · Of the first standard quality of life indicators, physical health looks similar to the State average and mental health looks better than the State. In terms of adult health, indicators look very good. 2. Adults in Jefferson County generally have as good or better access to health care as the State average. · Ninety percent of the adult population has some kind of health insurance. This varies dramatically by age, with the 18-34 year olds most often without health care coverage. · While 85% reported they have a person they go to for medical care, no question asked how far they have to travel to see that doctor. Commissioner Huntingford suggested that it might be interesting to review bridge closure information from the Department of Transportation to try to answer this question. · Eighty-eight percent indicated they had a place they could go if they were sick or needed health advice. · The percentage of those seeing a doctor in the past year for a routine check-up - 75% - was significantly higher than the State average of 68%: Vice-Chairman Masci noted that the remaining 25% are those who are served by public health. · Although 29% have been told they have high blood pressure, compared with the State average of 22%, when compared with age-specific rates there is no difference. · Sixty-seven percent reported they have used a home blood stool test kit, as opposed to 41 % of the State. · Seventy-two percent of the adults made a dental visit in the last year, compared with 67% of the State. The exception is the 18-34 year oIds. 3. In general, among Jefferson County adults, rates of behaviors that predict good health are higher, and rates of behaviors that predict poor health are lower. · In this County, only 16% of adults now smoke, which is significantly less than the State (21 %) or Kitsap County (23%). '. HEALTH BOARD MINUTES - March 21, 2002 Page: 3 · Twenty-nine percent consider themselves at risk for health problems related to being overweight as compared with 36% seen for the State. · Only 13% reported being at risk for health problems associated with physical inactivity, compared with 27% ofthe State. In line with the new guidelines to be physically active at least 5 days a week for at least 30 minutes a day, surprisingly, 87% ofthose who are physically active are active at that recommended rate. · Thirty- four percent of those considered heavy drinkers also currently smoke. There was also a strong association between heavy drinking and being overweight. 4. Jefferson County's drinking patterns are different from the State. · Sixty-eight percent consumed alcohol in the past 30 days, compared with 61 % in the State. · A larger proportion of men than women consumed alcohol. However, for both men and women, consumption was significantly higher than the State. · The more years of education, the more likely you are to drink alcohol. Jefferson County is extremely well educated. · When looking at alcohol consumption over the last 30 days, Jefferson County is very different ITom the State. Those consuming 1-5 days per month was 49% as opposed to 60% in the State, those consuming 6-10 days and 11-20 days were similar to the State percentages, but 24% said they consumed alcohol 20 days or more, compared with 8% of the State. Most ofthat 24% consumed alcohol 30 of the past 30 days. These rates are similar with European drinking patterns. · Of those respondents who drink, men drank 14 out of the last 30 days, and women drank 9.1 out of 30. The average number of drinks consumed per day was 1.7 - males drank an average of 2.0 drinks per day while women drank 1.5 drinks. · Seventeen percent of County adults were heavy drinkers, which is significantly lower than that for the State, 23 %. 5. County residents report higher rates of childhood abuse than the State average, and this abuse affects their adult functioning. Dr. Hale prefaced this data by saying that for some time there has been concern in the public health community about domestic violence and considerable concern about the life-long effects of children seeing violence. She noted that when asking about current experience with violence, the rates were so low the data was not usable. · The percentage of those saying they were punished violently was 9%, slightly higher than the State response of 7%. · Twelve percent reported being sexually abused before the age of 18, compared with 9% in the State. · To the question of whether they saw a parent or guardian abused, 11 % answered yes. · 25% reported having seen or experiencing physical or sexual abuse, compared with 20% in the State, which is statistically significant. · People younger than 65 were more likely to report abuse than 65 and older. HEALTH BOARD MINUTES - March 21,2002 Page: 4 · Those with four plus years of college reported being physically abused at lower rates than those with under 4 years. · Women in Jefferson County were more likely to report sexual abuse than men. 18% of women reported sexual abuse, compared with 14% in the State. · People with childhood histories of any abuse reported, on average, more days of poor health in the previous 30 days than people without such histories. Vice-Chairman Masci mentioned that these statistics can also become predictors of not only medical health needs, but law and justice needs. 6. Households with children younger than 18 have unusually dense concentrations of adults who reported health care access problems and who smoke, drink heavily, and themselves have childhood histories of abuse. Dr. Hale said the goals of Healthy People 2000 are "optimizing life expectancy, optimizing quality oflife and to reduce disparities." Populations that have been identified as being radically different ftom the rest of the population are households with children under the age of 18 and the 18-34 age group. In data yet to be analyzed, there are some indications that these groups are not only different ITom other citizens of the County, but are different than others ofthe same age groups in the State. Dr. Hale summarized the survey findings by saying households in Jefferson County with children under 18 are disproportionately likely to have adults in those households who have abuse histories. She noted the maternal child health indicators in Jefferson County remind her of Cowlitz County, which has some ofthe worse health rates in the State. She recognized the expense ofthe survey ($25,000 - $32 per respondent for data collection alone) and said the data should be useful over the next five years. She added the 18-34 age group information is expected within a week. Vice-Chainnan Masci commented that he believes the project was a good investment. Other data can now be compared with this fundamental database to make knowledge-based policy decisions. Dr. Hale mentioned that Kellie Regan is now trained to do an in-house study and could create a sub- base of questions. Member Frissell pointed to the need for data on the jail population and school age children. Jean Baldwin said the next projects listed on the Data Steering Committee report are the prenatal risk assessment survey of all county residents giving birth in 2002, a jail survey and school district survey. Dr. Hale added that the prenatal risk survey will be largely based on the survey of women who gave birth and include three questions of the respondent's childhood experience of abuse. Ms. Baldwin said that four out of five school districts will participate. She noted that the data from the survey can only be released on a county-wide basis. However, schools will have their data to release if they so choose. In response to questions ftom Commissioner Huntingford about the ages of children to be surveyed and whether students could opt out, Kellie Regan explained that the health needs survey is for 6th, 8th, 10th and 12th grades, and she believes it is a passive parental consent, which provides an opportunity to exempt the child. The Board was impressed with the depth of analysis and thanked Dr. Hale, Jean Baldwin and Kellie Regan for an incredible job. Vice-Chainnan Masci and Jean Baldwin then proposed convening a series of workgroups as a way of presenting this information to others in the community (e.g. law and justice, healthcare providers, HEALTH BOARD MINUTES - March 21, 2002 Page: 5 senior services). Chairman Westerman asked that Staff propose a list of workgroups, so the Board can discuss it at the next meeting. Chairman Westerman and Member Buhler talked about their personal experiences as respondents in the telephone survey. They said interviewers were friendly, professional, and nonjudgmental. Chairman Westerman commented that this is the first time since she has been on the Board there has been good, dependable information despite steadily dwindling resources. It is important to commit to continuing this process because the situation will get increasingly difficult and the number of those at risk groups is going to rise as resources go down. She encouraged the Commissioners to continue with this process, recognizing that as they make difficult decisions, it will be vital to have valid information with which to face difficult policy choices. Vice-Chairman Masci moved that the Board of Health request that the County Commissioners authorize expansion ofthis process to a jail survey, the structure and format of which would be recommended through a team of Jean Baldwin, Kellie Regan and Dr. Hale. Member Frissell seconded the motion. Dr. Hale said she has insisted that any data collection has to be vetted by an institutional review board. With the particular precautions around a jail population, such action would be absolutely necessary before they could get the work done. Vice-Chairman Masci noted that because the existing data is paid for, the cost for this small additional component would be minimal. Due to City/County policy making and the cost of criminal justice, he stressed the importance of making good decisions and having good data on which to make those decisions. The motion carried. Commissioners Huntingford and Titterness abstained. Vice-Chairman Masci moved that the Board send a letter to the four school districts encouraging them to participate in the health needs survey. Jill Buhler seconded the motion, which carried by a unanimous vote. Prenatal Risk Assessment Monitorin~ (PRAMS): Jean Baldwin reported that Staffhas met with both the hospital and the State and have come to agreement on the questions to be asked. The hospital's [mancial support of the assessment will be encouraged. On April 2, the Environmental Health customer satisfaction survey will begin and will include customers, realtors and designers. Regarding maternal child health, Staff is in the process of a lengthy review of the Best Beginnings Project which in July will reach the end ofthe 3-year contract with the University of Colorado. There will be some chart review and evaluation of Family Planning to see ifit is filling the access need for those 1,300 served, the majority of whom are 18-34. Dr. Hale will be presenting the BRFSS data at a Substance Abuse Committee community training session for the public and professionals on April 30th looking at Methamphetamine treatment strategies. Chairman Westerman commented that the expanded Board is a perfect opportunity to de-politicize community and environmental health issues. Members Frissell and Buhler both spoke in favor of the County Commissioners using the Board as a resource. Commissioner Huntingford said his biggest fear with the expanded Health Board was that the County Commissioners would make decisions based on a broader knowledge of what is going on in Jefferson County. While the Board of Health may someday be upset that the County Commissioners did not listen fully to their recommendations, he believes the Board understands better the issues HEALTH BOARD MINUTES - March 21, 2002 Page: 6 with which the County Commissioners faced such as the difficult decisions about whether to layoff people or add new programs. He spoke in favor ofthe BRFSS as a good investment. Pull Tab: Commissioner Titterness reported that a representative group showed up at the County Commissioner hearing to speak on the issue and share their perspective. They commented that there was not enough profit to take the full amount of the tax allowed. The County Treasurer also researched the topic with another County and found that when the tax was implemented - about 40% who were in the business of pull tabs got out. The issue was sent back to Gary Rowe for a recommendation. Vice-Chairman Masci said the City Council has yet to discuss the matter. Chairman Westerman said although it is never easy to begin, it is something to consider if it provides a steady funding source for a program for a needy population. She said the Board could provide more support for the County Commissioners if desired. AGENDA PLANNING/ ADJOURN April Agenda Topic: Review the 18-34 year old BRFSS data. Joint Board Meeting: Dr. Locke explained that Staff is trying to schedule a joint meeting with the Hospital Commissioners. After the last meeting, the Board of Health was going to work on critical health services, deciding what are the essential services and looking at the data collected to see what information it provides. The Hospital was focused on patching gaps in health services. The biggest goal is to get organized for the next health summit. Staff will continue to try to coordinate a meeting. The meeting adjourned at 4:40 p.m. The next meeting will be held on Thursday, April 18, 2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chainnan Jill Buhler, Member Geoffrey Masci, Vice-Chainnan (Excused) Richard W ojt, Member Glen Huntingford, Member Roberta Frissell, Member Dan Tittemess, Member Documentation on BRFSS Update will be mailed the week of April 15, 2002 Or handed out at the board meeting - c?u ~ - ~e-£ 1/·17 tJ¿ Erin Lundgren BOCC Office PO Box 1220 Port Townsend W A 98368 April 16, 2002 r"""\ ¡Cd , oJ) In" í! ¡ (i t.~ TO: Board of Health APR 1 7 zuc,? FROM: Kellie Ragan SUBJECT: BRFSS Modules Enclosed are the following: · Basic Demographic Characteristics of Respondents · Environmental Health Module · 18-34 Year Olds · Revised Risk and Predictive Behavior BRFSS Module. The March 21,2002 version contained errors related Figure 7. Please recycle the March 21 version. Please contact Jean or myself if you need additional information. COMMUNITY HEALTH 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 SUBSTANCE ABUSE & PREVENTION 360/385-9400 April 16, 2002 Jefferson County 2001 BRFSS Basic Demographic Characteristics of Respondents Gender and Age. The 603 respondents to Jefferson County's 2001 Behavioral Risk Factor Survey System (BRFSS) questionnaire included 292 men (48.5%) and 311 women (51.5%). They ranged in age from 18 to 94 (Figure 1). The average (mean) age was 52.5 years, median age was 52, and modal age was 50. Based on the 2000 census, this is approximately the same distribution and average age as that seen in the county's population age 18+ (compare Figures 1 and 2). However, to be certain that the sample approximates the adult population, the sample was weighted to match age and gender to the county's 2001 projected population. All data in this report have been weighted. Respondents were grouped by age following the standard procedures of the Centers for Disease Control and Prevention (CDC) methodology, which splits BRFSS samples in three groups for small areas, 18-34,35-64, and 65+. For Jefferson County, 15.5% were 18-34, 58.2% were 35 to 64, and 25.9% were 65+. Three people refused to give their ages. Education. Eight respondents had completed only grade 8 or less, 34 had some high school (grades 9 to 11), and 146 had completed high school. Another 182 had one to three years' post-secondary education, and 229 had completed four years or more of college. Two people refused to answer the education question. For analysis, respondents were grouped as having a high school education or less (189 people, 31.3% of the sample (Figure 3), some post-secondary (182 people, 30.3% of the sample, and four or more years of college (229 people, 38.1 % of the sample). Educational attainment data from the 2000 census are not yet available, and so education levels of the sample cannot yet be compared with those of the adult population of the county but will be when they are available. 1 April 16, 2002 Marital status and presence of children. Most of the respondents were married (68.4%),12.3% were divorced, 5% were widowed, 1.4% were separated, 7.9% had never been married, and 4.7% were part of an unmarried couple. Two people refused to answer the question about marital status. It was not possible to make so detailed a comparison between the sample and the county, but when the comparison is between married couples and all others, more of the sample were in married couple households than in the county overall (68.6% vs. 53.6%, Figure 4). Four hundred and 23 people (70.3% of the sample) had no children younger than 18 living at home, and 179 (29.7%) did. When marital status and the presence of children are combined, the sample more closely approximates the county (Figure 5): 23% of the sample were married couples with children younger than 18 compared with 16.0% of the county, 45.6% of the sample are married couples without children compared with 37.6% of the county, 6.7% are other household types with children compared with 8.8% of the county, and 24.6% are other households without children compared with 37.6% of the county. Residence. Two hundred and ninety one people (48.2%) lived in the 98368 ZIP code. Three hundred and eleven (51.7%) respondents lived in all other ZIP codes. This is approximately what would be expected given the geographic distribution of the county's population. Income. Efforts to get useable information about income were unsuccessful because 34 people said they did not know their income (5.7%) and another 48 (8.0%) refused to answer no matter how the question was rephrased. Grouped education level was used in BRFSS analyses as a measure of socioeconomic standing; this is standard practice because non-response rates are typically so high when the question is income that it often cannot be used as a measure of economic well-being. The income distribution of respondents, like the education data, suggests they were rather well off. Among those who did respond, 48 (8.0% of the sample) said it was below $15,000, 85 (14.1 %) said it was $15,000 but less than $25,000,67 (11.0%) said it was $25,000 but less than 2 April 16, 2002 $35,000, 125 people (20.8% said it was $35,000 but less than $50,000, 112 people (18.5%) said it was $50,000 but less than $75,000, and 84 (13.9%) said it was $75,000 or more (Figure 6). Census 2000 income data for the county have not yet been released. Employment. When asked about their current occupation, 220 people (36.5%) said they were currently employed for wages and another 85 (14.0%) said they were self- employed. Twenty-nine people (4.8%) were unemployed but wanted to work, another 54 (9.0% described themselves as homemakers, 11 (1.9%) were students, 24 (3.9%) were unable to work, and 177 (29.4%) were retired. Work place and travel time. Only those currently working were asked about their place of employment and commuting times. Three-quarters of the sample worked in Jefferson County: 141 people (46.4%) worked in Port Townsend, and another 75 (24.6%) worked elsewhere in Jefferson County. Four people worked in Clallam County, 19 in Kitsap County, and 52 in other places. Thirteen people said their place of employment varied so much they could not name one place. Travel time to work ranged from one minute to eight hours. The nine people listing commutes of two hours or longer all worked in some kind of extraction industry. When that group was excluded from analysis, average (mean) commuting time one-way from home to work was 17.8 minutes, median was 10 minutes, and mode was 5 minutes. Again, detailed data from the 2000 census have not yet been released, and so it is not possible to determine how closely this information matches that for the general population of the county. Recent in-migration. Seventy-one percent of adults surveyed in the Jefferson County BRFSS had lived here five years ago, 5% lived in King County, 10% lived in another Washington County, 5% lived in California, and 9% lived in some other state or foreign country (Figure 7). The older the respondent, the more likely he or she was to have lived here five years ago: 63% of 18-34 year olds, 69% of those age 35-64, and 83% of 3 April 16, 2002 those age 65 and older had all lived here five or more years (Figure 8). More recent arrivals tended to have more education: 80% of those with a high school education or less had lived here at least five years as did 72% of those with some post-secondary education but only 64% of those who had completed at least four years of college (Figure 9). There were no statistically significant associations by gender or ZIP code of residence. 4 Draft 4/16/02 Jefferson County 2001 BRFSS Environmental Health The Environmental Health module focused several topics: outdoor and indoor air quality, ~is~omforts related to poor ~ir quality, source(s) of home heating, source(s) of home dnnkmg water, well water testmg, sewage disposal system, and solid waste disposal. Several questions have been omitted from analysis due to limited numbers of responses. Respondents were asked which of the following contribute to poor air quality: exhaust fumes, industry, trash or garbage burning, wood stoves, burning land-clearing debris, and agriculture dust. · Jefferson County adults overall reported that industry contributed to poor air quality (33%). This rate is significantly higher than Kitsap County (10%) (Figure1). · Jefferson County adults overall reported that trash or garbage burning contributed to poor air quality (12%). This rate is significantly lower than Kitsap County (19%) (Figure1 ). · Among the other contributors to poor air quality, there were no additional significant differences between Jefferson and Kitsap County respondents. · Twenty-five percent of ZIP Code 98368 respondents reported that transportation and 51 % reported that industry contributes to poor air quality as compared t015% and 16% respectively in all other ZIP Codes; these differences are significant (Figure 2). · Fifteen percent of all other ZIP code respondents reported that trash or garbage burning contributes to poor air quality as compared to 9% of ZIP code 98368 respondents; this difference is significant (Figure 2). · Nineteen percent of Jefferson County respondents reported discomfort (such as headaches, shortness of breath, breathing trouble or coughing) related to outdoor air quality (Figure 3). This is significantly higher (worse) than the 15% reported by Kitsap County residents. Jefferson County respondents reported differences of seasonal symptomatic experiences of discomfort (Figure 4). · During the summer months, 15% of Jefferson County adults reported experiencing symptoms of discomfort. This is significantly lower than Kitsap County (26%). · During the fall/winter months, 18% Jefferson County adults reported discomfort. This is significantly lower than Kitsap County (24%). · Year-around discomfort was reported by 22% of the Jefferson County adults. This is significantly higher Kitsap County (15%). · Occasional discomfort was reported by 20% of Jefferson County adults. This is significantly higher than the Kitsap County (8%). · Twenty-two percent of ZIP Code 98368 respondents reported that they had experienced discomfort from INDOOR air as compared to 15% of all other ZIP Codes; this difference is significant (Figure 6). 1 Draft 4/16/02 · Overall, there were no significant differences between Jefferson and Kitsap County respondents reporting on discomfort (such as headaches, shortness of breath, breathing trouble or coughing) related to indoor air quality (Figure 5). · However, 26% of Jefferson County respondents reported symptoms from indoor discomfort in the workplace/other as compared to 32% of Kitsap County adults (Figure 7). Additionally, 27% of Jefferson County adults reported symptoms related to indoor air discomfort in public buildings/other as compared to the Kitsap County rate of 31 %. Jefferson County rates are significantly lower (better) than Kitsap County. Respondents were asked to identify primary sources of heat for their homes. · Three percent of the Jefferson County adults reported natural gas the primary source of heat for their homes as compared to 24% in Kitsap County (Figure 8). · 6% percent of county adults reported oil as the primary source of home heat compared to 10% in Kitsap County (Figure 8). · 16% of county adults reported propane or propane-powered heat as the primary source of home heat as compared to 8% in Kitsap County (Figure 8). · and 20% of Jefferson County adults reported wood stoves as the primary source of heat for their homes as compared to 5% in Kitsap County (Figure 8). · All of the above differences are significant · ZIP Code 98368 respondents were significantly more likely to report the use electricity (59%) or propane/propane-powered/natural gas (28%) as a primary source of home heat as compared to all other ZIP Codes (50% and 22% respectively). Twenty-eight percent of those in all other ZIP codes reported use of wood heat as the primary source of home heat as compared to 13% in ZIP code 98368. This difference is significant (Figure 9). Jefferson County respondents were asked several questions about home drinking water. · Fifty-three percent of the Jefferson County respondents reported city/district as their home water supply. This is significantly lower than Kitsap County (66%) (Figure 10). · 29% of Jefferson County adults identified a private well as their home source of drinking water. This is significantly higher than Kitsap County (23%). 18% of Jefferson County adults identified a community system or other source as their home source of drinking water. This is significantly higher than Kitsap County (11 %). Eighty percent of ZIP code 98368 respondents reported city or district source as their home's source of drinking water (Figure 11). Conversely, 48% of all other ZIP codes reported a private well as their home's source of drinking water. These differences are significant · · 2 Draft 4/16/02 There were no significant differences between Jefferson and Kitsap responses to the question regarding if well water has ever been tested or whether well testing indicated the presence of contaminants (Figures 12 and 14). However, there were significant differences regarding well water testing. · 54% of Jefferson County adults reported that their water had been tested within the last 3 years. This is significantly lower than Kitsap County (71 %). · 46% of Jefferson County adults reported that their water had been tested greater than 3 years ago which is higher than the 29% of Kitsap respondents (Figure 13). Jefferson County respondents were also asked several questions about sewer/septic systems. · 40% of Jefferson County adults reported that they were on a municipal sewer system and 60% utilize septic tank/drain field systems as compared to 44% and 56% respectively in Kitsap County. These differences are significant (Figure 15). · 63% of Jefferson County adults reported that they had their septic tank pumped within the last 3 years and 7% reported their tank being pumped 4-5 years ago as compared to Kitsap County rates of 49% and 7% respectively (Figure 17). These differences are significant. · 64% of ZIP code 98368 respondents reported municipal sewer as their sewage disposal system; 80% of all other ZIP codes reported septic tank or drain field as their sewage disposal system. These differences are significant (Figure 16). The final environmental health module questions pertained to solid waste disposal. · 90% of Jefferson County adults reported a solid waste disposal service in their community as compared to 99% of Kitsap respondents (Figure 18). · 94% of Zip code 98368 reported knowing about a solid waste disposal service in their community as compared to 87% of all other ZIP codes (Figure 19). · 73% of Jefferson County respondents reported using the solid waste disposal service as compared to 87% of Kitsap County respondents (Figure 20). · 85% of ZIP code 98368 reported using a solid waste disposal service as compared to 60% of all other ZIP codes (Figure 21); this difference is significant. 3 DRAFT Figure 1. (Q26x1--Q26x7) Do any of the the following items contribute to poor air quality in your area? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Exhaust fumes Industry** Trash or garbage burning* Wood stoves Burning/land-clearing debris Agricultural dust Jefferson County 20% 33% 12% 30% 15% 3% Kitsap County 23% 10% 19% 29% 17% 4% Figure 1. Do any of the following items contribute to poor air quality in your area*. Jefferson County 2001 and Kitsap County 1998 BRFSS 100% Source: Jefferson County Department of Health & Human Services BRFSS. 2001 and Kitsap County BRFSS, 1998 900/0 80% . Jefferson County o Kitsap County I 70% 60% 50% 40% 33% 10%, 30% 20% 0% Exhaust fumes Industry** Trash or Wood stoves garbage burning* Burnin gfland- clearing debris Agricultural dust .. Jefferson County is significantly higher . Jefferson County is significantly lower 4/11/02 DRAFT Figure 2. (Q26x1--Q26x7) Do any of the the following items contribute to poor air quality in your area, by ZIP code*. Jefferson County 2001 BRFSS. The following contribute to poor air quality Transportation Exhaust** Industry* Trash or Garbage Burning** Wood Stoves Dust or Smoke from buring land clearing debris Agricultural Dust Jefferson County ZIP Code 98368 All other ZIP Codes 25% 15% 51% 16% 9% 15% NS NS NS NS NS NS Figure 2. Which of the following items contribute to poor air quality in your area, by ZIP code*. Jefferson County 2001 BRFSS Source: Jefferson County Department of Health & Human Services, 2001 BRFSS. I .ZIP Code 98368 100% 90% 80% 70% 60% 51% 50% 40% 30% 25% 20% 15% 10% 0% DAII other ZIP Codes I 16% 15% Transportation Exhaust** Industry* Trash or Garbage Burning** 'Difference is statiscically significant. p < .001 "Difference is statiscically significant, p < .05. 4/11/02 DRAFT Figure 3. (Q26x10) Have you experienced discomfort due to pollutants in the outside air such as headaches, shortness of breath, breathing trouble or coughing? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998 Jefferson County Percent Yes** 19% No 81% Kitsap County Percent 15% 85% Figure 3. Have you experienced discomfort due to pollutants in the outside air such as... *, Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998 . Jefferson County o Kitsap County 100% 90% 80% 70% 60% 50% 40% 30% 20% 19% 15% 10% 85% 0% Yes** .. Jefferson County is significanlly higher No 4111/02 DRAFT 4/11/02 Figure 4. (Q26x11) In which season do you experience these symptoms most often? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998 Spring Summer* Fall/Winter* Year -round** Occasionally** 100% 20% Jefferson County 25% 15% 18% 22% 20% Kitsap County 27% 26% 24% 15% 8% Figure 4. In which season do you experience symptoms of outdoor pollution most often*, Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. 90% . Jefferson County o Kitsap County 80% 70% 60% 50% 40% 30% 10% 26% 0% Spring Summer* FallfWinter* Year-round** Occasionally** * Jefferson County is significantly lower ** Jefferson County is significantly higher DRAFT Figure 5. (Q26x12) Have you experienced discomfort from INDOOR air such as headaches, shortness of breath, breathing trouble or coughing? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Yes No Jefferson County Percent 18% 82% Kitsap County Percent 15% 85% Figure 5. Have you experienced discomfort from INDOOR air such as ..., Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. 100% . Jefferson County 90% o Kitsap County 85% 80% 70% 60% 50% 40% 30% 20% 18% 15% 10% 0% Yes No 4/11/02 DRAFT Figure 6. (Q26x12) Have you experienced discomfort from INDOOR air such as headaches, shortness of breath, breathing trouble or coughing, by ZIP Code*. Jefferson County 2001 BRFSS Have experienced discomfort Jefferson County ZIP Code 98368 All other ZIP Codes 22% 15% Figure 6. Have you experienced discomfort from INDOOR air such as headaches, shortness of breath, breathing trouble or coughing, by ZIP Code*. Jefferson County 2001 BRFSS Source: Jefferson County Department of Health & Human Services, 2001 BRFSS. .ZIP Code 98368 DAII other ZIP Codes 100% 90% 80% 70% 60% 50% 40% 30% 22% 20% 15% 10% 0% Have experienced discomfort *Difference is statiscically significant, p <.05 4/11/02 DRAFT Figure 7. (Q26x13) Where did these symptoms (of indoor pollution) occur? Kitsap County BRFSS, 1998 Jefferson County 48% 26% 27% Kitsap County 51% 32% 31% Home Workplace/office* Public building/Other* 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Figure 7. Where did you experience symptoms of indoor pollution*, Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. . Jefferson County 0 Kitsap County 51% 0% 32% Home Workplace/office* . Jefferson County is significantly lower 4/11/02 31% Public building/Other* DRAFT Figure 8. (Q26x14) What is the PRIMARY source of heat for your home, that is, the one you use most often? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Electricity Natural Gas* Oil* Propane/propane-powered heat** Wood buring stove** Jefferson County 54% 3% 6% 16% 20% Kitsap County 51% 24% 10% 5% 8% Figure 8. What is the PRIMARY source of heat for your home, that is, the one you use most often? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. 100% . Jefferson County o Kitsap County 90% 80% 70% 60% 24% 50% 40% 30% 20% 20% 10% 3% 0% Electricity Natural Gas* Oil* Propane/propa ne-powered heat** . Jefferson County is significantly lower Wood buring stove** .. Jefferson County is significantly higher 4/11/02 DRAFT 4/11/02 Figure 9. (Q26x14) What is the PRIMARY source of heat for your home, that is, the one you use most often? Jefferson County BRFSS, 2001. Jefferson County ZIP Code 98368 All other ZIP Codes 59% 50% 28% 22% 13% 28% Electricity Propane/propane-powered heat/natural gas Wood buring stove/other 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Figure 9. What is the PRIMARY source of heat for your home, that is, the one you use most often, by ZIP Code*. Jefferson County BRFSS, 2001. Source: Jefferson County Department of Health & Human Services BRFSS, 2001. .ZIP Code 98368 DAII other ZIP Codes 59% 50% 28% 28% 22% 13% Electricity Propanelpropane-powered Wood buring stove/other heat/natural gas *Difference is statiscically significant, p <.001 DRAFT Figure 10. (Q26x17) What is the source of your home's drinking water? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998 City/district supply* Private well** Community system/other** Jefferson Counl Percent 53% 29% 18% Kitsap County Percent 66% 23% 11% Figure 10. What is the source of your home's drinking water? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. 100% 90% 80% 70% 66% 60% 53% 50% 40% 30% 29% 23% 20% .Jefferson County o Kitsap County 0% 18% 10% 11% City/district supply* Private well** Community system/other** .. Jefferson County is significantly higher . Jefferson County is significantly lower 4/11/02 DRAFT Figure 11. (Q26x17) What is the source of your home's drinking water, by ZIP Code*. Jefferson County BRFSS, 2001. Jefferson County ZIP Code 98368 All other ZIP Codes 80% 28% 11% 24% 9% 48% City or District Supply Community System lather Private Well 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Figure 11. What is the source of your home's drinking water, by ZIP Code*. Jefferson County BRFSS, 2001. Source: Jefferson County Department of Health & Human Services BRFSS, 2001. 80% .ZIP Code 98368 D All other ZIP Codes 48% 28% 24% 11% 9% City or District Supply Community System lother -Difference is statiscically significant, p <.001 4/11/02 Private Well DRAFT Figure 12. (Q26x18) Has your well water ever been tested? Jefferson County BRFSS, 2001and Kitsap County BRFSS, 1998 Yes No 100% 40% 20% 4/11/02 90% 80% 70% 60% 50% 30% 10% 0% Jefferson County 92% 8% Kitsap County 92% 8% Figure 12. Has your well ever been tested? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. . Jefferson County o Kitsap County 92% 92% 8% 8% Yes No DRAFT Figure 13. (Q26x18) About how long has it been since (your well) was tested? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Jefferson County 54% 46% Kitsap County 71% 29% Within 3 years* Greater than 3 years ago** 80% 70% 60% 50% 40% 30% 20% 10% 0% Figure 13. How long has it been since your well was tested? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. 71 % .Jefferson County o Kitsap County 54% 46% 29% Within 3 years* ** Jefferson County is significantly higher Greater than 3 years ago** * Jefferson County is significantly lower 4/11/02 DRAFT Figure 14. (Q26x19) Did the results from well testing indicate the presence of any contaminants? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998 Yes No 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Jefferson County 7% 93% Kitsap County 7% 93% Figure 14. Did well testing show contaminants? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS. 2001 and Kitsap County BRFSS, 1998. . Jefferson County o Kitsap County 93% 93% 7% 7% 0% Yes No 4/11/02 DRAFT Figure 15. (Q26x20) What kind of sewage disposal system does your home use? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Municipal sewer* Septic tank/drain field** Jefferson County 40% 60% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4/11/02 Kitsap County 44% 56% Figure 15. What kind of sewage disposal system does your home have? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. . Jefferson County 44% Municipal sewer* ** Jefferson County is significantly higher D Kitsap County 60% 56% Septic tank/drain field** * Jefferson County is significantly lower DRAFT Figure 17. (Q26x20) What kind of sewage disposal system does your home use, by ZIP Code. Jefferson County BRFSS, 2001. Municipal Sewer Septic Tank or drain field ZIP Code 98368 64% 36% Jefferson County All other ZIP Codes 20% 80% Figure 16. What kind of sewage disposal system does your home use, by ZIP Code*. Jefferson County BRFSS, 2001. 100% Source: Jefferson County Department of Health & Human Services BRFSS, 2001. I .ZIP Code 98368 DAII other ZIP Codes I 90% 80% 80% 70% 64% 0% 36% 60% 50% 40% 20% 30% 20% 10% Municipal Sewer Septic Tank or drain field "Difference is statiscically significant, p <.001 4/11/02 DRAFT Figure 17. (Q26x21) When was the last time your septic tank was cleaned or pumped? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Within 3 years** 4-5 years ago* Over 5 years ago Never Jefferson County 63% 7% 13% 17% Kitsap County 49% 19% 14% 17% Figure 17. How long since your septic tank was cleaned/pumped? Jefferson County 2001 and Kitsap County 1998 BRFSS 100% Source: Jefferson County Department of Health & Human Services BRFSS. 2001 and Kitsap County BRFSS, 1998. 90% . Jefferson County o Kitsap County 80% 70% 63% 60% 50% 40% 30% 20% 19% 17% 17% 13% 14% 10% 7% 0% Within 3 years** 4-5 years ago* Over 5 years ago Never .. Jefferson County is significantly higher . Jefferson County is significantly lower 4/11/02 DRAFT Figure 18. (Q26x23) Is there a solid waste disposal service...in your community? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998. Yes* No** 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jefferson County 90% 10% Kitsap County 99% 1% Figure 18. Is there a solid waste disposal service in your community? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. 99% . Jefferson County o Kitsãp County 10% 1% Yes* No- .. Jefferson County is significantly higher . Jefferson County is significantly lower 4/11/02 DRAFT 4/11/02 Figure 19. (Q26x23» Is there a solid waste disposal service, such as..., by ZIP code*. Jefferson County BRFSS, 2001. Yes No 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% ZIP code 98368 94% 6% All other ZIP codes 87% 13% Figure 19. Is there a solid waste dispostal service, by ZIP code*. Jefferson County BRFSS, 2001. Source: Jefferson County Department of Health & Human Services BRFSS, 2001. .ZIP code 98368 DAII other ZIP codes 94% 0% 87% 13% Yes No Difference is significant, p<.05 DRAFT 4/11/02 Figure 20. (Q26x23) Do you use a solid waste disposal service, such as...? Jefferson County BRFSS, 2001 and Kitsap County BRFSS, 1998 100% 90% 87% 80% 73% 70% 60% 50% 40% 30% 27% 20% 10% 0% Yes Yes No Jefferson County 73% 27% Kitsap County 87% 13% Figure 20. Do you use a solid waste disposal service? Jefferson County 2001 and Kitsap County 1998 BRFSS Source: Jefferson County Department of Health & Human Services BRFSS, 2001 and Kitsap County BRFSS, 1998. .Jefferson County o Kitsap County 13% No DRAFT Figure 21. (Q26x24» Do you use a solid waste disposal service, such as..., by ZIP code·. Jefferson County BRFSS, 2001. 100% 90% 85% 80% 70% 60% 60% 50% 40% 30% 20% Yes No 10% 0% ZIP code 98368 85% 15% All other ZIP codes 60% 40% Figure 21. Do you use a solid waste disposal service, by ZIP code*. Jefferson County BRFSS, 2001. Source: Jefferson County Department of Health & Human Services BRFSS, 2001. .ZIP code 98368 DAII other ZIP codes 40% 15% Yes No Difference is significant. p<.05 4/11/02 4/16/2002 Jefferson County 2001 BRFSS Respondents age 18-34 years old Respondents who were 18 to 34 years old experienced significantly more health access problems than either older county residents or state residents age 18-34 but were less likely to keep firearms around their homes, to be overweight, or to be physically inactive than older people. . Respondents were asked their age. Ninety-three were 18 to 34 years old, or about 16% of the sample. . One finding of the BRFSS was that households including children younger than 18 had unusually dense concentrations of adults who reported health care access problems and who smoke, drink heavily, and themselves have childhood histories of abuse. The group which is the focus of this analysis, the 18-34 year olds, are not identical to respondents in households with children younger than 18: 178 households had children younger than 18, and in 50 of them (28%), the respondent was 18-34 years old. Of the 93 respondents age 18-34, 43 (46%) reported their households included children younger than 18 and 50 (54%) reported their households did not. · Eighty-nine percent of respondents age 18-34 said their general health was excellent, very good, or good (Figure 1). This rate is significantly lower than the state rate for that age group (93%), about the same as that reported for state and county residents age 35-64, and significantly higher than the rate among state and county residents age 65+. · Only 74% of county residents age 18-34 had any kind of health care coverage (Figure 2). This rate is significantly lower than the state rate for this age group (84%) and also significantly lower than the rate reported by county respondents age 35-64 (91%) or 65+ (99%). · Only two-thirds of county residents age 18-34 have a health care provider they usually go to (Figure 3), significantly lower than the rate for residents age 35-64 (85%) or 65+ (94%). Comparable state data will be available in the summer of 2002. · Only 74% of county residents age 18-34 have a particular place they usually go to get health care, significantly lower than people age 35-64 (89%) or people age 65+ (93%, Figure 4). Comparable state data will be available in the summer of 2002. 4/16/2002 · Respondents age 18-34 reported the significantly higher rates of dental insurance: 69% of them had dental insurance compared with 60% of people age 35-64 and only 29% of those age 65+. · However, 63% of county residents age 18-34 made a dental visit within the past year, significantly lower than the rate among people age 35-64 (76%) or 65+ (70%, Figure 7). · Only 59% of county residents age 18-34 had their teeth cleaned within the past year, significantly lower than the state rate in that age group, 68% (Figure 8). In both the county and state, rates of having teeth cleaned were significantly lower in this age group than in other age groups. · Twenty-one percent of country respondents age 18-34 keep guns in or· around their homes, a significantly lower rate than that in other age groups (Figure 9). Comparable state data will be available in the summer of 2002. · County residents age 18-34 had a significantly lower rate of being at risk for health problems from being overweight (16%) than the state average (31%, Figure 10). County rates of being at risk were significantly higher in other age groups but were significantly lower than the state average. · Smoking rates were significantly higher among county residents age 18-34 (28%) than among those age 35-64 (19%) or 65+ (5%, Figure 11). The county's age-specific rate is higher among those age 18-34 but lower among those in the two other age groups. . In every age group, significantly more county residents consumed alcohol within the previous 30 days (Figure 12). The rate is highest among people age 18-34 both in the county and in the state. In the county, people age 18-34 are significantly less likely to be physically inactive (Figure 13). Comparable state data will be available in the summer of 2002. . DRAFT Figure 1. (Q1X1) Self-reported health status is excellent, very good, or good Jefferson County 2001 and Washington State 2000 BRFSS, by age 18-34 years old* 35-64 years old 65+ years old 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Jefferson County 89% 87% 76% Washington State 93% 89% 77% Figure 1. Self-reported health status is excellent, very good, or good, by age*, Jefferson County 2001 and Washington 2000 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS, CDC website . Jefferson County 93% DWashington State 89% 76% 77% 18-34 years old* 35-64 years old 65+ years old *Among 18-34 year olds, county rate is significantly lower (worse) than state rate; in both state and county, rate in this age group is significantly lower than in other age groups 4/16/02 DRAFT Figure 2. (Q2X1) Have any kind of health care coverage, by age Jefferson County 2001 and Washington State 2000 BRFSS 18-34 years old 35-64 years old 65+ years old 100% 90% 80% 70% 60%, 500/. 40% 30% 20% 10% 0% Jefferson County 74% 91% 99% Washington State 84% 91% 99% Figure 2. Have any kind of health care coverage, byage*. Jefferson County 2001 and Washington 2000 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS - CDC website ¡_Jefferson County DWashington State I 99% 99% 91% 91% 84% 74% 18-34 years old 35-64 years old 65+ years old *Among 18-34 year aids, county rate is significantly lower (worse) than state rate; in both state and county, rate in this age group is significantly lower than in other age groups 4/16/02 DRAFT Figure 3. (Q2x6) Is there one doctor or health provider that you usually go to, by age Jefferson County 2001 BRFSS Is there one doctor or health provider that you usually go to, 18-34 years old 67% 35-64 years old 85% 65+ years old 94% Figure 3. Is there one doctor or health provider that you usually go to, by age*. Jefferson County 2001 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS 100% 94% 90% 85% 80% 70% 67% 60% 50% 40% 30% 20% 10% 0% 18-34 years old 35-64 years old 65+ years old *Rate among 18-34 year olds is significantly lower (worse) than rates in other age groups. 4/16/02 DRAFT Figure 4. (Q19x1) Is there one particular clinic, health center, doctor's office, or other place that you usually go if you are sick or need advice about your health, by age Jefferson County 2001 BRFSS 18-34 years old 35-64 years old 65+ years old Have one particular place you go to for care 74% 89% 93% Figure 4. Have one particular place you go to for care, by age*. Jefferson County 2001 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS 100% 93% 90% 89% 74% 80% 0% 70% 60% 50% 40% 30% 20% 10% 18-34 years old 35-64 years old 65+ years old *Rate among 18-34 year olds is significantly lower (worse) than rates in other age groups. 4/16/02 DRAFT Figure 5. (Q19x5) How long has it been since you last visited a doctor for a routine checkup, by age. Jefferson County 2001 BRFSS Jefferson County 64% 73% 84% Washington State 64% 66% 82% 18-34 years old 35-64 years old 65+ years old Figure 5. Had routine checkup in last year, by age*, Jefferson County 2001 and Washington State 2000 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS - CDC website 100% 90% 80% 70% 64% 64% 60% 50% 40% 30% 20% 10% 0% 84% 82% 73% 66% 18-34 years old 35-64 years old 65+ years old *In both the state and county, rates are significantly lower (worse) for 18-34 year aids and higher (best) for those 65+; rate among 35-64 year aids in county is significantly higher in county than in state.. 4/16/02 DRAFT Figure 7. (Q21x1) How long has it been since you last visited a dentist or a dental clinic for any reason, by age. Jefferson County 2001 BRFSS and Washington State 1999 BRFSS Jefferson County 63% 76% 70% Washington State 65% 70% 63% 18-34 years old 35-64 years old* 65+ years old* 100% Figure 7. Dental visit for any reason within the past year, by age*, Jefferson County 2001 and Washington State 1999 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washinç¡ton State data from CDC website . Jefferson County DWashington State 90% 80% 76% 70% 63% 70% 70% 65% 60% 50% 40% 30% 20% 10% 0% 18-34 years old 35-64 years old* 65+ years old* *In both the state and county, rates are significantly lower (worse) for 18-34 year aids. 4/16/02 DRAFT Figure 8. (Q21x3) Teeth were cleaned in past year by dentist or dental hygenist, by age, Jefferson County 2001 BRFSS and Washington State 1999 BRFSS 100% 90% 80% 70% 68% 60% 59% 50% 40% 30% 20% 10% 0% 18-34 years old* 35-64 years old 65+ years old* Jefferson County 59% 75% 72% Washington State 68% 76% 79% Figure 8. Had teeth cleaned within the past year, by age*, Jefferson County 2001 BRFSS and Washington 1999 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS, CDC website .Jefferson County DWashington State 79% 75% 76% 18-34 years old* 35·64 years old 65+ years old* 'Among 18-34 year olds and those 65+, county rates are significantly lower (worse) than state rate; in both state and county. rates among 18-34 year olds are significantly lower than in other age groups 4/16/02 DRAFT Figure 9. Are any firearms now kept in or around your home? Jefferson County 2001 BRFSS 18-34 years old* 35-64 years old* 65+ years old* Jefferson County 22% 42% 44% Washington State n/a n/a n/a Figure 9. Firearms are kept in or around home, by age*, Jefferson County 2001 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; 100% 90% 80% 70% 60% 50% 42% 44% 40% 30% 22% 20% 10% 0% 18-34 years old* 35-64 years old* 65+ years old* ·People age 18-34 have significantly lower rates than those in other age groups. 4/16/02 DRAFT Figure 10. (Q21x3) At risk of health problems from being overweight (modified BMI) by age, Jefferson County 2001 BRFSS and Washington State 2000 BRFSS 18-34 years old 35-64 years old 65+ years old Jefferson County 16% 31% 31% Washington State 31% 37% 39% Figure 10. At risk of health problems from being overweight, by age*, Jefferson County 2001 and Washington 2000 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS, CDC website 100% 90% 80% 70% 60% 50% 40% 31% 30% 20% 16% 10% 0% 37% 39% 18-34 years old 35-64 years old 65+ years old ·In each age group, the county rates are significantly lower (better) than state rate; in both state and county, rates among 18-34 year olds are significantly lower than in other age groups 4/16/02 DRAFT Figure 11. Currently smokes cigarettes, by age, Jefferson County 2001 BRFSS and Washington State 2000 BRFSS 18-34 years old 35-64 years old 65+ years old Jefferson County 28% 19% 5% Washington State 24% 22% 11% Figure 11. Current smoker, by age*, Jefferson County 2001 and Washington 2000 BRFSS Source: Jefferson County - Department of Health & Human Services. 2001 BRFSS; Washington State 2000 BRFSS, CDC website 100% 90% 80% 70% 60% 50% 40% 30% 28% 24% 20% 10% 0% 22% 11% 18-34 years old 35-64 years old 65+ years old 'Among both county and state respondents, the rates among 18-34 year olds are significantly higher (worse); rates among county residents are higher among 18-34 year olds but lower in other age groups. 4/16/02 DRAFT Figure 12. Consumed alcohol within past 30 days, by age, Jefferson County 2001 BRFSS and Washington State 1999 BRFSS 18-34 years old 35-64 years old 65+ years old Jefferson County 73% 68% 65% Washington State 68% 62% 47% Figure 12. Consumed alcohol in past 30 days, by age*, Jefferson County 2001 and Washington 1999 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS, CDC website 68% 65% 62% 47% 100% 90% 80% 73% 70% 68% 60% 50% 40% 30% 20% 10% 0% 18-34 years old 35-64 years old 65+ years old *Age-specific alcohol consumption rates are significantly higher in the county than in the state. 4/16/02 DRAFT Figure 13. At risk of health problems from being physically inactive by age, Jefferson County 2001 BRFSS and Washington State 2000 BRFSS 18-34 years old 35-64 years old 65+ years old Jefferson County 7% 13% 16% Washington State Figure 13. At risk of health problems from being physically inactive, by age*, Jefferson County 2001 and Washington 2000 BRFSS Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS; Washington State 2000 BRFSS, CDC website 100% 90% 80% 70% 60% 50% 40% 30% 20% 16% 13% 10% 7% 0% 18-34 years old 35-64 years old 65+ years old "Rates among 18-34 year olds are significantly lower than in other age groups 4/16/02 DRAFT April 11, 2002 TO: Chimacum, Port Townsend Brinnon, and Quilcene School Superintendents FROM: Jefferson County Board of Health Sheila Westerman, Chair SUBJECT: 2002 Healthy Youth Survey This is a lette~ of encouragement for Chimacum, Port Townsend, Brinnon, and Quilcene Schools to participate in the 2002 Healthy Youth Survey (HYS). In a recent Board of Health meeting, members were informed of a unique opportunity that Jefferson County schools can take advantage of-the 2002 HYS. The 2002 HYS can provide useful assessment data. Survey results will tell districts about: · health risk behaviors of our community's youth in areas including nutrition, physical activity, violence, alcohol, tobacco and other drug use. · attitudes and opinions of youth-and research shows correlations between attitudes and risk behaviors. The 2002 HYS findings can · Identify and monitor factors that affect Jefferson County youth · Guide program and policy development in conjunction with the principles of effectiveness · Assist many local agencies with programs which focus on youth and families · Complement the current comprehensive county assessment process, which includes Behavioral Risk Factor Surveillance Survey (BRFSS), Census 2000, law and justice records, and vital statistics. In Jefferson County, Kellie Ragan of Jefferson County Health & Human Services is the contact for the 2002 HYS. She can provide additional details about the survey, its administration, the HYS instrument and data analysis. Please contact her at 360-385-9446 for additional information about the survey. In this time of shrinking dollars, we must take full advantage of the use of data to make responsible decisions. The 2002 HYS findings can provide a beacon to assist in responsible planning efforts. Therefore, we strongly encourage each district in our community to commit to a census survey, that is-survey each student in grades 6, 8, 10 and 12. In advance, thank you for your consideration of this effort. WASHINGTON STATE HEALTHY YOUTH SURVEY (2002) FACT SHEET February 2002 In fall 2002 the Office of Superintendent of Public Instruction (OSPI), the Department of Health (DOH), the Department of Social and Health Services' Division of Alcohol and Substance Abuse (DASA), and the Office of Community, Development (OCD) will conduct a survey to measure adolescent health behaviors and related risk and protective factors among Washington's Grade 6, 8, 10, and 12 students in public schools. This fact sheet answers important questions about the Healthy Youth Survey. Q: What is the focus of the Healthy Youth Survey? A: The focus of the Healthy Youth Survey is on health risk behaviors-such as violence and alcohol, tobacco and other drug use-that can result in injury and/or impede positive development among youth. The survey also includes questions about risk and protective factors, which are attitudes and opinions that research has shown to be correlated with these risk behaviors. Q. How does the Healthy Youth Survey compare to surveys that have been administered in the past? A. The Healthy Youth Survey combines two surveys used previously, the Washington State Survey of Adolescent Health Behavior (WSSAHB) and the Youth Risk Behavior Survey (YRBS). To accommodate a large number of items, the questionnaire for grades 8, 10 and 12 has two forms, A and B. The forms (A and B) will be interleaved before they are sent to the schools so that when they are passed out every other student will get a different form. Both forms have a "core" set of 32 items that are identical for the two forms. The last page on each form is a perforate answer sheet. Questions that are potentially sensitive have also been put on a perforated page (the second to last page), although they are important for planning and evaluation of programs that serve youth. Schools must make the decision to tear off the perforated page of questions before the survey is administered in the classroom. All students in grade 6 will receive a shorter questionnaire, form C. This form includes the perforated page of questions that schools may choose to tear off prior to survey administration. Q: Why is the survey conducted? Healthy Youth Survey (2002) November 2001 A: The purpose of the survey is to identify and monitor factors that affect the health of youth in Washington. Since similar surveys have been conducted across the state in 1988, 1989, 1990, 1992, 1995, 1998, 1999, and 2000, its results can be used to monitor how health behaviors change over time. The results can also be used to identify important areas of need for prevention programs. Q: Do all Washington students take the Healthy Youth Survey? A: No, only a sample of students in Grades 6,8, 10 and 12 take the survey. Schools are selected across the state to provide a representative sample of the entire student population at these grades. In all, about 125 schools and 20,000 students will participate-approximately 6 percent of the student population at these grade levels. Q: Does my school have to participate? A: Participation in the survey is voluntary. However, broad participation for all of the schools selected in the sample is needed to obtain accurate estimates of these behaviors. Q: Why should my school participate? A: This survey provides important information about adolescents in Washington, which can be used to guide policy and programs, and to focus attention on the needs of youth. Where numbers are adequate to protect privacy and provide accurate estimates, schools will be provided with a summary report of the results for their school, along with statewide totals for comparison. Schools will receive results for questions that have at least 15 valid responses per grade. This information is provided at no cost and is very useful in guiding prevention program planning and in fulfilling data requirements for programs led by county prevention coordinators, community mobilization coalitions, community public health and safety networks, and others. Schools decide whether to receive their results at the time the statewide results are released, or not at all. Q: Can my school participate if it is not selected for the sample? A: Yes, there is an opportunity for additional schools to participate and receive the results of the survey. The sponsoring agencies have agreed to cover the cost of piggybacking onto the survey, using DOH tobacco prevention dollars. A piggyback request form is available from RMC Research Corporation and must be completed for a school to participate as a piggyback. Q: Are sensitive questions asked? Healthy Youth Survey (2002) 2 November 2001 A: The survey questions measure key behaviors and some of the questions are sensitive. The survey includes questions related to unintentional and intentional injuries; physical activity and dietary behaviors; alcohol, tobacco, and other drug use; and related risk and protective factors. Unless questions in these topic areas are asked honestly and straightforwardly, we cannot know the degree to which Washington's youth engage in these health risk behaviors. The survey does not include questions about sexual behavior or education. Certain sensitive questions have been included on a separate page. Q: Is student participation voluntary? Are answers anonymous? A: Student participation is completely voluntary and anonymous and the administration procedures are designed to protect student privacy and anonymity. Students are not asked for their names or identification numbers when they complete the survey. When they finish the survey, students place their completed survey in a box or envelope with no personal identifiers. The box or envelope of completed surveys is then sealed and shipped to the contractor for optical scanning and analysis. Students may elect to participate in an alternative activity if they do not wish to complete the survey. Q: How is the survey coordinated at each school? A: Each participating school has a designated survey coordinator, and each school district or ESD has a central coordinator for the survey effort. These spokespersons and coordinators have additional information on the survey, its administration instructions, and uses of the results. Q: Can I review the survey? A: Yes, a copy of the survey is available in the office of each school. Q: How long does it take to fill out the survey? A: One class period is needed to complete the survey. All questions are self-report and no physical tests or exams are involved. Q: Do students answer the questions truthfully? A: Both national research and the experience in Washington indicate that the data collected are generally accurate when students are told of the importance of the information and that their responses are completely anonymous. Internal reliability checks help identify any surveys which have obviously been answered carelessly and these surveys are discarded from the sample. In addition, students always have the option Healthy Youth Survey (2002) 3 November 2001 of not answering questions to which they do not feel comfortable responding. Q: When is the survey conducted? When are results available? A: The survey will be administered during October 7-18, 2002. Results will be available in mid-February, 2003. Q: How will this information be used? A: Information from the Washington State Healthy Youth Survey can be used to meet a variety of needs at the community and state levels. The survey provides information that can be used to identify the importance of various problem behaviors. This information can be used as input for resource and policy decisions, such as targeting interventions. Those who receive the information may choose to share it with other community organizations. The items that were asked in previous years can be used to identify trends or changes in the patterns of behavior over time. The state-level data can be used to compare Washington results to other states that do similar surveys and to national results. Legitimate researchers and educational and health officials will have access to the data. At the state and federal levels, there are a variety of competing interests for limited resources. Results of this survey can be and have been used to provide evidence for the high priority of the important issues identified. Healthy Youth Survey (2002) 4 November 200 1 Washington State Healthy Youth Survey (2002) Rationale and Description of Survey Content The 2002 Washington State Healthy Youth Survey contains questions about behaviors that result in unintentional and intentional injury (e.g., seat belt use, fighting and weapon carrying); physical activity and dietary behaviors (e.g., fruit and vegetable consumption), alcohol, tobacco, and other drug use; and related risk and protective factors. Staff from the Office of Superintendent of Public Instruction (OSPI), the Department of Health (DOH), the Department of Social and Health Services' Division of Alcohol and Substance Abuse (DASA), and the Office of Community Development (OCD) have collaborated on the content of the survey. The survey has two forms for grades 8, 10 and i 2, Form A and Form B. Form A contains primarily questions from the Washington State Survey of Adolescent Health Behavior (WSSAHB). Form B contains primarily questions from the Youth Risk Behavior Survey (YRBS). Both Forms A and B contain a core set of 32 identical items. There is also a third form, Form C, for grade 6. Examples of questions below are on one or more of the forms. This document describes the importance and rationale for including each of these health behaviors on the survey and presents a few sample items from the survey relating to each behavior. Questions about family relationships, harassment, dating violence, and abuse history will be on a perforated page that can be torn off before survey administration, and this page is marked on the draft questionnaire. Examples of the questions are included below, but they are optional. Students are also free to not answer any question or questions, and both students and parents will have an opportunity to refuse participation. Core Items Some basic background information (e.g., age, grade level, ethnic group, etc.) is needed to ensure that the approximately 20,000 students participating in the state sample are generally representative of the statewide student population in these grades. In addition, it allows for examination of trends and differences in these behaviors among students of varying background characteristics. Healthy Youth Survey (2002) November 2002 Other core items measure cigarette smoking, drug and alcohol use, and physical fighting. Tobacco use is considered the most important preventable cause of death in the United States, and many smokers begin smoking in adolescence. Alcohol use contributes to motor vehicle crashes, which are the leading cause of death for 15-24 year olds. Both alcohol and drug use (especially heavy use) are associated with other problem behaviors in youth such as school failure and delinquency. After all deaths due to unintentional injury, suicide was the second and homicide the third leading cause of death among Washington youth aged 15-24 during 1996-1998. Data from the Healthy Youth Survey can be used in local and state prevention and intervention program planning. Also, data will be available to legitimate researchers and educational and health officials to use in improving our understanding of factors influencing adolescent health. All analyses are conducted without specific identification of individual students so that anonymity is maintained throughout the survey effort. In order to further protect student anonymity, reports will not be produced for schools with less than 15 valid surveys per grade. Sample items of this type include: What grade are you in? How old are you? Which race do you consider yourself to be? (???) During the past 30 days, on how many days did you smoke cigarettes? During the past 30 days, how many times did you carry a weapon such as a gun, knife or club on school property? Unintentional and Intentional Injury Behaviors Unintentional injury is the leading cause of death for Washington citizens ages 1- 44. Some of the target behaviors of interest in this survey are seat belt use, bicycle and motorcycle helmet use, and drinking and driving involvement. Intentional injury behaviors of interest include fighting, weapon carrying, and suicidal thoughts and feelings. The questions on feeling sad and suicidal are especially important to measure the effectiveness of suicide prevention programs. Suicide is the 2nd leading cause of death among 15-24 year olds. The questions on injury behaviors are drawn from the WSSAHB (Form A) and the YRBS (Form B); as noted earlier, some of these items are on the core. Healthy Youth Survey (2002) 2 November 2002 Reducing violent behaviors such as bullying, harassment, physical abuse, and dating violence is an important goal of state and local programs. Current federal and state goals for public health and education include the assurance of "safe and drug-free schools and communities" to promote student learning. This survey includes questions designed to determine the extent to which students engage in selected violent behaviors. Sample items of this type include: During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol? How often do kids at school threaten to hurt you physically? During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? Physical Activity and Dietary Behaviors Exercise and physical activity have both immediate and long-term benefits. Proper nutrition is essential for health and well-being. The combination of moderate physical activity and proper nutrition contributes to maintaining a - healthy weight. Questions from the YRBS are used to measure exercise and physical activity. Sample items of this type include: On how many of the past 7 days did you exercise or participate in physical activity for at least 20 minutes that made you sweat and breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities? During the past 7 days, how many times did you eat green salad? Alcohol, Tobacco, and Other Drug Use One of the target behaviors of interest in this survey is the extent to which students have used and are using alcohol, tobacco, and other drugs. Many of the same items that have been used in the previous statewide surveys will again be employed here. Asking these questions again allows for both local and statewide assessments of the changes in these patterns of use over time for Washington's students and provides important data-based direction for prevention efforts both locally and across the state. Healthy Youth Survey (2002) 3 November 2002 Sample items of this type include Have you ever smoked every day for 30 days? During the past 30 days, on how many days did you drink a glass, can or bottle of alcohol (beer, wine, wine coolers, hard liquor)? Risk and Protective Factors Research has provided a great deal of guidance on attitudinal and behavioral factors that place students at great risk for violence and substance use, and those that, on the positive side, provide protection against these unhealthy behaviors. The survey contains several items that assess the degree to which risk and protective factors occur in the students who have responded to the survey. They relate to the students themselves, their peers, their families, their schools, and the communities in which they live. These results highlight the important relationships that guide school prevention and intervention programs across the state. Sample items of this type include: How wrong do you think it is for someone your age to smoke marijuana? How interesting are most of your courses to you? How old were you when you first smoked a whole cigarette? How often do your parents tell you they're proud of you for something you've done? Access to school-based services Schools are increasingly seen as an important place for students to be able to access a variety of services. When schools do provide these services, students must also be aware that they are available. Therefore, the survey contains questions related to access to school-based services. Sample items of this type include: Does your school provide a counselor, intervention specialist, or other school staff member for students to discuss problems with alcohol, tobacco, or other drugs? Healthy Youth Survey (2002) 4 November 2002 If you had a question about alcohol, tobacco, or other drugs, which one of the following would you most likely go to for information? Healthy Youth Survey (2002) 5 November 2002 Executive Summary CDC Public Health Preparedness and Response for Bioterrorism Work Plan Purpose: The Washington State Department of Health (DOH) is submitting a work plan for approval to HHS for funding to develop capacity and infrastructure for public health preparedness and response to bioterrorism. The primary focus of this stage of funding is assessment and planning. Capacity building is proposed where planning has already been accomplished. The ultimate purpose of the work is to build a statewide system with state and local public health jurisdictions prepared for and able to respond to acts of bioterrorism, other outbreaks of infectious disease, public health threats and emergencies. Background - The challenge of preparing for and responding to a biological event is significant. Unlike the events of September 11,200 I or other acts of overt violence, infectious disease outbreaks are often difficult to identify early on. There is no explosion or outward sign. Instead there is an ever-increasing number of individuals showing up at clinics, emergency rooms and health care provider offices. The illnesses may be scattered geographically and occur in a number of different jurisdictions at once, depending on source and mechanism of initial infection. Without methods to rapidly detect this manifestation throughout the health system, an effective response cannot be mounted in a timely and coordinated fashion. The introduction of bioterroism agents adds another layer of complexity, due to the lack of experience with these infectious agents, and because unlike naturally occurring outbreaks, these are initiated by people who intend to cause harm. As such, the methods and nature of exposure are unpredictable and outside normal disease transmission routes. Approach - The proposed work plan will ensure system wide improvements through collaboration and coordination of state efforts with those of our key partners: local public health, hospitals, emergency management services, and health care providers. An effective system requires the rapid detection of illness by health care providers and labs, secure and dependable communication with public health disease investigators, and response plans to deliver necessary medicine or vaccines quickly. The system must provide clear health information to the public and technical assistance to the many different responders. Those responders all need appropriate and continuous training and education in the diseases of concern, and their individual roles in the overall system plan. Key partners in many areas, including local health, physicians, nurses, hospitals, emergency medical personnel, have been very involved in the work plan and are included in the proposed capacity development efforts. The Work Plan - The work plan lays out the framework for a public health system that recognizes certain critical centralized capacities, such as the state public health lab and the development and maintenance of a statewide information technology system. It increases the local capacity to detect and investigate diseases and coordinate a local response. Regional plans that link hospitals, local health and emergency responders do not currently exist and this work plan will allow the development of such plans. Finally, the work plan will build capacity in DOH to respond to a public health emergency, and to test and exercise the resultant response plans. The work plan is organized into six major focus areas with a number of CDC required critical capacities within each focus area: · Area A: Preparedness Planning and Readiness Assessment · Area B: Surveillance and Epidemiology Capacity · Area C: Laboratory Capacity - Biological Agents · Area E: Health Alert Network/Communications and Information Teclmology · Area F: Communicating Health Risk and Health Information Dissemination · Area G: Education and Training Timeframe and Funding - The timeframe covered in this work plan is from May 15, 2002 to Aug 30, 2003. This effort is primarily a needs assessment and planning phase. It is anticipated that there will be additional funding in future years to address needs that cannot be met during this funding cycle. Budget work sheets are provided following this narrative to summarize the distribution of funds within the focus areas and between local, regional and state entities. Preparedness Planning and Readiness Assessment - this area deals with the assessment of the state's emergency preparedness and responsiveness to a bioterrorist event, major infectious disease outbreak, or other public health emergency. The state work plan proposes action to address each of the critical capacities: Leadership - the agency will identify one key state public health official who will provide the strategic leadership for public health preparedness and planning. We will convene a state advisory committee to assist and advise the agency on the development and implementation of the work plan elements and ensure linkage of public health issues to other state eff0l1s related to emergency preparedness and terrorism response plans. We will collaborate with the University of Washington in leadership development around the public health competencies associated with planning and preparedness. An oversight steering group composed of key state, local, and hospital representatives will provide leadership and accountability. This group will meet regularly and monitor progress, accomplishments, barriers, and needs to alter approach. Assessment - The agency proposes a coordinated assessment of hospitals, local health, and emergency management systems to determine existing capacities and identify gaps for subsequent planning efforts at the state and local level. We will use existing information to help conduct this assessment. Included in the assessment work will be a review of the statutory and administrative codes under which public health actions would be taken in response to a biological emergency. A regional system will help coordinate local health jurisdictions in assessment and implementation. This approach ensures that every local jurisdiction will create basic capacity, while strengthening response systems by virtue of a regional plan. The regional framework will 2 include identification of a lead local health agency for each region, with that agency taking responsibility for providing assistance and guidance to the other agencies in the region. Preparedness and Response Planning - This critical capacity addresses the ability to exercise a comprehensive emergency management plan. The agency will meet this capacity by describing pre-event preparation, outlining the response to communicable disease emergencies, and highlighting the uniqueness of a biological event. The agency will define roles involved in managing mass casualty and fatality events so that our comprehensive emergency plan is consistent with the state emergency management plan. A senior public health official will be designated as lead coordinator. Each local health jurisdiction will produce a written plan around the public health functions they will perform during an emergency response. The local plans including county CEMP will be part of a coordinated regional and state plan. Federal Asset Coordination - This critical capacity addresses the agency's ability to coordinate with federal programs, most particularly the National Pharmaceutical Stockpile. We will develop plans for the receipt, storage, distribution and proper identification and training of individuals that will handle these pharmaceuticals during a time of emergency. National Pharmaceutical Stockpile - This critical capacity is intended to establish the ability to manage the delivery and distribution of a large "push package." These "push packages," which are part of the stockpile, contain medical supplies and pharmaceuticals that would be delivered to the state within I 2 hours of a request by the governor. Preparation includes local planning, training and exercises involving push package distribution plans. Surveillance and Epidemiology Capacity - This section of the work plan deals with the detection and response to disease outbreaks and consists of three critical capacities: Rapidly detect a terrorist event or disease outbreak through an efficient, mandatory reportable disease surveillance system - The work plan for this capacity is to increase available local and state disease surveillance staff. These people will work with key health care providers in identifying and reporting communicable diseases. DOH will develop and provide training on a secure, confidential system for local health agencies and health care providers. This will provide disease surveillance data through a Web-based system, known as Public Health Issues Management System (PHIMS). This will assure that local health jurisdictions can receive urgent disease reports from all parts of the state. We will pilot alternative disease surveillance strategies in selected regions, such as monitoring 911 calls or Emergency Room visits. A standard protocol will be developed and applied to regularly assess surveillance activities. Training will be developed and provided to disease reporters and public health staff to increase awareness of the importance of surveillance systems. Comprehensive and exercised epidemiological response plan - In order to meet this critical capacity, each region will designate an epidemiological response coordinator who will work with local public health in their regions to develop local and regional response plans. These plans will use secure information systems, will be linked to the broader public health and hospital emergency response plans, and will be strengthened by mutual aid agreements, and training plans. This effort will focus on routine training and exercise of developed plans. 3 Rapidly and effectively investigate and respond to a disease outbreak - We will develop standardized protocols for public health investigation and response. Public health investigation and response will be routinely assessed to identify improvements. After-hours response plans will be developed by all local health agencies to provide a rapid response to urgent public health issues. Current communication modes will be expanded to ensure that urgent messages can be delivered and received in an effective and timely manner. Communication tools, education, and protocols will be developed and presented to public health and veterinary professionals to improve animal disease surveillance. Laboratory Capacity - This focus area addresses the c1inicallaboratory capacity of the state to accurately and quickly identify a potentially infectious agent. It requires two critical capacities: I) establishing rapid laboratory response capability with enhanced public health laboratory security and infrastructure and 2) assuring adequate capacity by developing a coordinated system of lab services in the state. Rapid Service Response and Enhanced Infrastructure - This capacity will be met by increasing the number of trained microbiologists at the state Public Health Laboratories and investing in new technology. This will decrease the time it takes to identify potential pathogens using advanced DNA analysis. Establishing a secure electronic communication system will assist in transfer of information and test results between laboratories, with our neighboring states, and with CDC. We will increase our emphasis on safe handling of biological agents and specimens. We will establish plans with law enforcement agencies and hazardous material responders on sample collection, transport and chain of custody. Security at the state public health labs, including safe storage of equipment and samples or specimens sent to the lab, will be improved to ensure the safety of our staff and the public. The surge capacity issue will be addressed by enhancing two local public health laboratories (Spokane Regional Health District and Public Health - Seattle and King County) so that they can perform critical tests as needed, and test environmental samples as appropriate. We will establish agreements with other advanced microbiology laboratories at the University of Washington, Washington State University, and Madigan Hospital so that they can provide confirmatory testing should the public health laboratory system become overwhelmed. Assuring Adequate Laboratory Capacity - We will provide training and technical assistance to enhance the ability of private and public sector laboratories statewide to perform initial screening tests for microorganisms that may be associated with bioterrorism. We will establish an evaluation process, including proficiency testing and practice drills, to monitor the capability of laboratories around the state to correctly identify critical disease-causing microorganisms. The enhanced electronic communication system described previously will increase the ability of laboratories to share information. We will facilitate inter-lab agreements for mutual support and back up. Health Alert Network - This focus area addresses the need to move information and data quickly and securely in order to detect or respond to a bioterrorism or other public health event. It is composed of four critical capacities. 4 Communications and Secure Connections - During a public health emergency, it's crucial that providers and state and local health agencies share information quickly and securely. This capacity is intended to provide a secure system to exchange health information safely. We will work with local health to assure that 90 percent of the state's population lives in a health jurisdiction that is connected to this system. We will establish a secure Internet-based system for providing public health emergency information to public health officials, hospitals, laboratories, clinicians and local first responders. Authorized individuals will be listed in a directory that notes their level of access to the system. Emergency Communications - This capacity ensures that a variety of communication systems are available during an emergency. We will assess current systems available to local responders; identify the best methods within regions (including redundancy); distribute needed equipment; establish necessary policies and agreements; and conduct systems tests. There will be a strong focus on working with existing emergency management systems and operation centers. Protection of Data and Information Systems - This capacity focuses on the security of the information system. The work plan includes a review of state and local practices and policies on information technology security. That review will provide direction for consistency in systems and improving security. We will create a system of digital certificates to allow appropriate user access to a secure, Web-based information system, develop a secure machine-to-machine data transmission system. The system will be tested periodically to be sure it works. Secure Electronic Exchange of Public Health Information - This capacity addresses the need to automatically transmit clinical data from laboratories and health care facilities to public health agencies and disease investigators. We will assess existing capacity, find gaps and needs, and provide equipment, software, training or policies to fill those gaps. Once the capacity to exchange data is established, the data will be reviewed and analyzed by trained epidemiological investigators at the local and state level. On-going efforts include trend analysis (as data increases over time) and routine maintenance and quality control of the system. Risk Communication and Health Information Dissemination - This focus area draws attention to the capacity of the public health system to provide critical public health information during an emergency. It includes ongoing outreach to the general public and special populations on topics related to emergency preparation. Starting with an assessment of risk communication capacity on the local and system levels, the plan uses a mix of regional and system-wide resources to ensure public health system readiness. Newly created system resources-both centrally and regionally located-will work with regional public health emergency communications advisory committees that may be established as part of regional workgroups created under the "Preparedness Planning and Readiness Assessment" of this project. The majority of their efforts will focus on providing a coordinated system-wide resource for risk communication training, building a comprehensive library of materials for staff and the public, ensuring consistent public health messages, and supporting special community outreach efforts. The work plan contains an interim plan to address risk communication needs should something occur before the existing capacity is improved. This interim plan calls for DOH to activate an 5 Emergency Communications Strategy to provide support to the public health system through the DOH Communications Office. This emergency response plan includes activating an emergency call center, disseminating specific and general health information as necessary (to system partners and public) based on the nature of the emergency, and responding to inquiries from the media and general public. Education and Training - This focus area deals with a delivery system for education and training of public health officials, emergency responders, and health care providers. The plan proposes multiple learning strategies for training public health officials. Generally, these can be achieved with three factors: · Human Resources - state and local training coordinators throughout the regions. · Technology - build on existing community assets and enhance technology to offer other training options, including video conferencing and Web-based learning. · Barriers - identify and remove or reduce access barriers to learning opportunities, including subsidies to assist with travel and time away from work during training. Integration with Hospital Planning - The work plan for the CDC bioterrorism preparedness funding application is coordinated with the proposal to Health Resources and Services Administration for hospital planning. The Health Resources and Services Administration funding application is intended to upgrade the preparedness of hospitals in Washington, and their partners, to respond to bioterrorism. The primary focus of is assessment and planning. Ultimately, Washington will have a hospital system capable of responding to acts of bioterrorism, other outbreaks of infectious disease, public health threats and emergencies. It is important to coordinate these two applications, and examples of this coordination include: Needs Assessment - careful attention is made to coordinate the needs assessments required in both proposals. The existing emergency medical services regional councils will assist with linking hospital needs with those of first responders and including this information into local and regional preparedness planning related to developing their emergency response plans. Regional Preparedness Plans - the hospital plans to develop regional preparedness plans will include elements related to antibiotic and vaccine distribution and workforce development. The activities in the CDC work plan for National Pharmaceutical Stockpile planning, communication systems and training/education efforts clearly link to these proposed activities. It is proposed that exercises and drills be coordinated to test hospital and public health plans jointly. Establish Critical Benchmarks - The HRSA proposal contains several benchmarks that lead to coordination. In particular is the creation of the Hospital Bioterrorism Planning Committee, which will be linked to the larger DOH Bioterrorism Response Advisory Committee. A smaller project-focused Bioterrorism Response Steering Committee is planned under the leadership section of Focus Area A, and a hospital representative will be a member of that committee. Infrastructure - This element of the Health Resources and Services Administration proposal deals with the long-term maintenance of hospital plans within the state. The integration of the Health Resources and Services Administration plans with CDC and Metropolitan Medical Response System plans is noted. There is opportunity for coordination in the review of legal authorities and regulatory support structure around isolation procedures. 6 Data Collection - One critical capacity in the CDC proposal is the development of a secure information system through which we can send and receive clinical data and important public health information. That information system will serve to assist hospitals with the transfer of critical data (bed counts and availability) as well as provide reports on the progress made in filling the gaps identified in the needs assessments. Integration with Metropolitan Medical Response System - Three cities in Washington (Seattle, Tacoma and Spokane) are designated planning areas under the Metropolitan Medical Response System plan guidance. The plan for Seattle is completed. Tacoma and Spokane are in the process of developing plans. When these plans are available, they will be reviewed along with the Portland, Oregon plan. They will be integrated into the regional and statewide planning efforts. Integration with Tribes and Federal Facilities - There are 29 Federally recognized Tribes in Washington. However, few have significant health care facilities that might serve as an asset during a biological event or infectious disease outbreak. Communications have been initiated with Tribal health care organizations to seek representation on the Bioterrorism Response Advisory Committee, but the primary communication with Tribal communities is the need to be engaged at the local and regional planning level, through integration in the local emergency response plans. There are several major federal facilities in Washington, including V A Hospital and several military health care facilities. We will have representatives from these facilities on the state advisory committee. Conclusion - This federal funding application process is the beginning of a long-term responsibility that will continue to evolve. Much of the work in the application is built on the foundation DOH established in more than two years of previous bioterrorism response planning. Our broad, system-based approach to the previous work on bioterrorism and public health emergency response has been extended to this application. 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(l) "0 I C "0 o -- '- m c:: ~ :J <D ~ ~ ~w ~. 1:5 0 o ~ '" It> N o o N r CD CO (/) (l) -- < CD (j) CD (/) (/) o :J ESSB 6588 Page 1 of I April 4, 2002 To the Honorable President and Members, The Senate of the State of Washington Ladies and Gentlemen: I am returning herewith, without my approval, Engrossed Substitute Senate Bill No. 6588 entitled: "AN ACT Relating to food service rules;" Substitute Senate Bill No. 6588 would have provided sole rulemaking authority to the State Board of Health for food service rules, and it would have made the state Department of Health the exclusive authority to interpret the rules. I support the development of a statewide food code that will protect all the citizens of the state, as well as provide more uniform standards for restaurants and other food handlers. However, such an effort must leave enough flexibility for local health jurisdictions to make adjustments to accommodate their unique circumstances. It is not necessary to diminish the existing powers or duties of local health authorities in order to gain a greater level of uniformity across our state. It is my understanding that the State Board of Health is already working to revise our state's food code. I encourage local health authorities to work with the regulated community and the state to make sure the new rules provide uniformity wherever practical, and are comprehensive enough to address unique local circumstances. I would like to see a state code that allows for narrow or limited deviations, and can be readily adopted by local jurisdictions. While this bill attempted to allow a local health board to adopt temporary deviations from the state rules, to respond to emergencies that "threatens the public health or safety," it is unclear what constitutes an emergency for this purpose. This bill is too restrictive oflocal health authorities. For these reasons, I have vetoed Engrossed Substitute Senate Bill No. 6588 in its entirety. Respectfully submitted, Gary Locke Governor http://www.governor.wa.gov/02Ieg/veto/6588.htm 4/9/02 Jefferson County Health and Human Services MARCH ~ APRIL 2002 NEWS ARTICLES 1. "County, environmentalists settle", P.T. LEADER, March 13,2002. 2. "Panel looks past need for doctors", Peninsula Daily News, March 15, 2002. 3. "Saddler: Elected officials got me fired", P.T. LEADER, March 20,2002 4. "Read-aloud project still open", P.T. LEADER, March 20,2002. 5. "Hadlock auto repair shop is EnviroStars winner", P.T. LEADER, March 20,2002 6. "Jefferson residents in good health" (2 pages), Peninsula Daily News, March 24,2002 7. "County's health survey: Most of us in good shape", P.T. LEADER, March 27,2002 8. "Deputies await test results in meth bust", Peninsula Daily News, March 27, 2002 9. "PA syringe-trade locale moving to new location; Jefferson program to continue at _ health department", Peninsula Daily News, April 4, 2002. I O. "'Critical access' may help hospital", Peninsula Daily News, April 4, 2002. 11. "State targets water use: New meter rules", Peninsula Daily News, April 5, 2002 12. "Panel formed to keep water fresh in wells", Peninsula Daily News, April 9, 2002 13. "Hospitals ready for new state contraception law", Peninsula Daily News, April 9, 2002. 1 County; environmentalists settle Jefferson County has agreed to address several environmental issues in the coming year under a negotiated settlement with the Washington Environmental Council (WEC). The council had appealed nu- merous provisions of the county's Unified Development . C?d~ per:!aining ÌO¡, ~,9,9.dp'~~s, wildlife and wetlands. The agreement, finalized March 5, settles a lawsuit which had been brought by WEC alleg- ing that the county had failed to follow provisions of the law which require the county to pro- tect salmon habitat and other critical areas from the harmful impacts of development and other activities. "'This agreement is a real win for both the environment and the county." said Jerry Gorsline, WEC policy associate. "It shows that environmentalists and local rpy: LEADer( "3 ;('?,) -0 '2- government officials engaged in constructive dialogue can produce creative solutions that protect the environment and address the concerns of local government." County Civil Deputy Pros- ecuting Attorney David Alvarez agreed: "I tlùnk it's a good com- o . :efq~.sSj Jf¡ ~~'f.~o :U~I.~~ Pf¥Ceed with what we wanted to do any- way. It stops the legal process so we can focus on science and data gathering." The agreement calls for Jefferson County to initiate a project to identify and map flood hazard areas and river meander patterns of the maj'oreastem county rivers, followed by an update of its regulations to bet- ter protect fish and wildlife in the floodplain. The county will also follow a policy developed by the state Department of Ecology for replacing wetlands that are dis- turbed by new development. It will develop a process for classi- fying and protecting state prior- ityand locåliy important specie~ and "their habitat, using:a land- scape-based approach where possible. Beginning with Chimacum Creek, the county will initiate a ,collaboratiyÿ. !stakehol,~r..effort to . develop 0 a. systematic, vt;)lun- tary watershed-based program to address the impacts of agricul- ture on salmon habitat. If the voluntary approach is not imple- mented within two years, the county will adopt new regula- tions to address the impacts of agriculture on fish and wildlife habitat. "This settlement will benefit all residents of the county," said County Administrator Charles Saddler. "Not only will it im- prove fish and wil.dlife habitat, but' it also will reduce risks to public health, public safety and the property damage resulting from development in areas prone to flooding. hazards." . Gorsline said the environmen- tal council's dispute with Jefferson County focused on methods to achieve the county's stated goals to protect and en- o)1~5~y;~tlands,. pShand wildlife habitat. "We have a lot of work to do to implement this agreement." said Dave Christensen, county natural resources division man- ager. "We're looking forward to working with WEC to put this on the ground. We actually began down this pathway last year, when we obtained state funding to iden- tify the best remaining salmon habitat in eastern Jefferson County. Our next projects will include wildlife habitat mapping and improving knowledge of flood hazard areas." Panel looks past need for d'octors Study finds funding key to health care By JIM MANDERS i 'i\.;'~·;U,.·\ DAILY NEWS ¡'here are "' \[ju,~h doctors l[) serve the Pon Angeles and Sequim ureas, but peo- ple older than Ii;; who use .\Iedicare or .\Iedicaid often dun't have Morris access to physi- CllinS because <If the low reimbursement rates paid through government I nSlI rance programs. That's one of the conclusions reached by a committee study- ing access issues as part of United Way's Healthy Commu- nities Initiative. Judith Morris, director of the Healthy Communities pro- ¡.;ram, said 22 percent of the peuple in Port Angeles and Sl'quim areas are covered by .\1t'dicare or Medicaid insur- ance programs. Those government-funded insurance programs reimburse ubout 50 cents on each billed dullar, causing many doctors to limit the number of Medicare and Medicaid patients they can accept. Morris, who has led the access program since its incep- lIun two years ago, said the cummittee includes health care professionals, social service providers and business owners. I t started meeting after Rep. .'<orm Dicks, D-Bremerton, held a health care forum on the Olympic Peninsula to obtain i,ackground on issues facing l'lullam County residents. Health care interest "We realized there was a deep and widespread interest in r1ealth care," Morris said. .. Problems surfaced in a variety uf ways, and we decided to take the Issues in our hands with the mum focus on access." The main issue was barriers I 0 heal th -care access because of the low reimbursement rate. \Iurris said some committee ",,,mbers focused their energy 'JI, efforts to increase reim- !)LlI',ement rates but have been : rust rated because the policy- mukers are based in Olympia und Washington, D.G One of the accomplishments <If the committee is to secure a it'deral government designation uf Port Angeles and Sequim as !dW I ncome areas, Morris said. "We realized there was a deep (lnd widespread ¡merest in health care. Problems surfaced in a variety of ways, and we ~decided·to take the issues in our hands with [he main focus on access." JUDITH MORRIS Healthy Communities There is an incorrect percep- tion that most people in Sequim are rich. As a result of the federal des- ignation, the area qualifies for rural health clinic status which allows clinics that meet certain criteria to receive higher reim- bursement for Medicare and Medicaid patients. Children's Clinic Peninsula Children's Clinic in Port Angeles is one of the clinics to receive the designa- tion, according to Morris. "It's a short-term, quick fix," Morris said, noting that boost- ing reimbursement rates is the only long-term solution. She said higher reimburse- ment rates will have an effect on taxpayers who foot the bills for the programs. Helping people with access to physicians is only part of the committee's focus, Morris said. "We want to make sure there's no 'wrong door' for peo- ple to walk through," Morris said, explaining that people should be able to get pointed in the right direction or obtain accurate information on finding a physician. Morris said the business community is involved with the committee to the extent that companies thinking about relo- cating take a hard look at edu- cation and health care systems. "A strong health care system keeps money in the commu- nity," Morris said. Not serious enough While physician access is a problem in central Clallam County it isn't serious enough to qualif'y the area for a federal medical clinic, Morris said. "It's a very complex and comprehensive process," Mor- ris said. "You have to be med· ically undersized and we're not sure we're going to qualif'y." Morris thinks the commit- tee's strength is in the approach being taken to solve the wide range of access issues. "We're not unique in the problems we face be we are unique in how we approach them," Morris said. ~ 3-15' -0 L O.!,. "O.c UVJ ~Ull) ~.g ~g,oo £] ~lu< g & ~ £ .§ IŠ ~ ~ .9.0 .... \:Ï ~ 0 ~ [l, '-I- .~~ ..; £o":g ~ ] J! p,; If'"f d :a~ "O,,:J . ~ ~ 8 ~ ~ ~ " õ .,; .¡ £ c ....- ~ "'.$ £,,'~: ~ ~ V') ò ð! õj ;a Š £ ,,'õ"6b U) § £ £.s .~ ~;= ~ ? ~ OJ 8'¡i 'E.!:!. ..c:,s f~ ¡i > å=o ~2.!:!~]u..c:~ .. ~ 2 lS "'.= '.~ :s £.." "'...... 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Õ. - ~ .::: 0 c. ca 1-0 U 0 .... ~ u ~b~Bu;o~~~~~~~u~~~9E·e"~u~'~~~~#·~ =~~ ~t·6ê~,ge]]~~¡;¡~~t!;J.Èj~.s~Gi.c~~:-g~.È~~~E~'E c t,) o¡;;;¡ CO _ ~ C'O ..0 ~ b 8. = " '" 8 c:: OJ ~ ~ ('IõI N G) ~ {'Q: u 0.. ¡...; 'ë u ...-S 8þ.5~;:; ~.: "~i3 .~~"g_:>2 õj ~.:,.'- HlS ~ ¡::;,,~-S ~ ~.g·6--ê c - . a "0 . õ' 13 ... ~ .. ",..¡:: >-. 1:; lii ~ = = /5.," " ¡;¡ ..,c, 0 81~ "",!.s~a::~ ~B] ~~lii~8~~2~~~£~~~.s ~6.. tf Read- aloud 'project still open A free study, funded by the University of Washington and åimed at delivering infonna- tion to parents about building reading readiness in young children, still has openings for interested parents. ColleenHeubner, assistant professor at· UW, . said the "Hear and Say' Reading for , Toddlers" projéct has enrolled about 75 Jefferson County parents but still has room for many more. The project, sponsored jointly by UW and Jefferson County Health and Human Services De- partment, looks at different ways of transmitting infor- mation about thesignifi- cance of reading aloud to parents of 2-, and 3~year~0Id children. Parents receive im instructional video and two children's books as a thank- you for participating. The program is open to all , Jefferson County residents who live with young children; , gratldparents and foster par- ents are also encouraged to participate. Heubner and other read- "ing specialists have as- sembled research that shows , that reading aloud to tod" dlers builds reading readi- ness in preschoolers and prepares them for school. To learn more, or to enroll in the project, call 379-4471. 3 -'2.0-02.. rp/T LEAD5R ,.- ':> Hadlock auto repair shop is EnviroStars winner By Philip L. Watness Leader Staff Writer Reto Filli has an abiding sense of stewardship from seeing as a youth the waterways of his na- tive Switzerland polluted beyond usefulness. So when Filii and his wife, lana, planned the new Circle & Square Automotive Repair shop II1 Port Hadlock. they went to extraordinary lengths to ensure anything and everything that could be recycled would be re- cycled. right down to the metal and oil inside oil filters. That environmental steward- shIp led to the Governor's Award that recognized "green" busi- nesses like the Fillis'. It comes as no surprise, then, that Circle & Square will be the inaugural business for the EnviroStars Program in Jefferson County. The automotive shop re- ceives its five-star rating as the program is kicked off at noon Thursday, March 21, by the 1 efferson County Environmental Health Department. "What they've done is shown a facility-wide commitment to the environment from the get- go," said Pat Pearson of the Puget Soundkeeper Alliance. "They really looked at the environment when they were building this buildlI1g. Other auto repair shops do the same things, but they probably didn't have to go to this length." Pearson coordinates the EnviroStars Program in the six participating counties. She said the program sets the bar pretty high, requiring businesses to go beyond recycling waste to Reto and Jana Filii, owners of Circle & Square automotive repair shop in Port Hadlock, stand near a machine that pumps used antifreeze out of automobile radiators so it can be recycled. Submitted photo helping educate other companies. That's another reason why Circle & Square was an ideal business to launch the local pro- gram, Pearson said. "Five-star winners need to show they're leaders in their community," she said. "They must educate customers or work with local colleges to help edu- cate others. They often hoS! open houses tò share what they d·o." Jefferson County Environ- mental Health specialist Melinda Bower said the Fillis' success could help convince others to do similar environmentally friendly things. Filii explained that his auto- motive shop recycles brake fluid, transmission fluid and oil, burn- ing much of it to heat the build- ing. Mechanics use a machine to pump radiators dry in order to make sure not a drop of anti- freeze meanders away. The same machine pumps new fluid into the radiators. Another method of keeping oil and grit from enter- ing the environment is a washdown bay in which the waste- water is collected and filtered. ~ "The mentality I grew up with makes it very hard for me to 9-;¿ø-o~ throw anything away," Filii saId. "It's the right thing to do in the long run. I hope to maybe help other businesses get exposed to the idea that a business can still be profitable [despite recycling] and also do the right thing." Molly Pearson, county envi- ronmental health educator. said the EnviroStars Program will be offered to other small businesses handling environmentally hann- ful products. Those could include print shops, dry-cleaning facili- ties and even dental offices. "The award goes to small gen- erators which sometimes use ex- tremely hazardous chemicals," Molly Pearson said. Businesses in Jefferson County that participate in the program will benefit from join- ing such large counties as King. Pierce and Snohomish because they pay for the lion's share of the advertising costs which ben- efit all six counties. Whatcom and Kitsap counties are the other two participants. "The whole idea is to help businesses reduce hazardous waste, tell the public who's do- ing a good job and encourage consumers to shop at those busi- nesses," Pat Pearson said. The local program is funded with approximately $5,000 avail- able through two matching grants from the Washington State De- partment of Ecology. / ~ Jefferson residents in g09d health Survey shows. above-average habits, lifespan plans and policies for health care. The survey asked randomly selected residents a series of 170 questions during 25-minute tele- phone interviews conducted from April through December. "In terms of adult health, the news is really good," said epidemiol- ogist Dr. Christine Hale, a Seattle- based consultant who analyzed the numbers and presented her findings to the county Board of Health. BY STUART ELLIOTr PENINSULA DAILY NEWS ~- Jefferson County residents smoke less, exercise more and live longer than other adults in Washington Better than state average state, a yearlong survey of county residents shows. ''Jefferson County lQoks betteà Preliminary results of a survey of than Washington state, and Wash~ 600 residents conducted last year ington state looks really good" com- show the county faring well in terms pared to the rest of the country, she of a number of key health indicators said. from frequency of routine physical Continuing a trend that has held exams to a lower level of binge drink- steady for at least the past 20 years, ing. life expectancy in Jefferson County The positive results were par- was higher than life expectancy tially offset by findings that those in statewide. lower income groups _ including For 1995 through 1999, life family households in Jefferson, expectancy in Jefferson county was County and those in the 18 to 34 age: ,,7!;} years, co,inparedwith 77 years for group - had less access to health'" thesti\te,;' Bale:~.ai4·; care and were more likely to smoke Despite åppare'nt problems to and drink heavily. accessing health care, a greater per- The $25,000 Behavioral Risk Fac- centage of local residents reported tor Surveillance. System survey was. they. ha4,.a .r~gular health care commíssioned by Jefferson County provIder ana a check-up during the ,,~d the city of Port Townsend in an 'last year. -effort to get hard data to help shape TURN TO HEALTH! A6 (; -:LV ~ð d-- PENINSULA DAILY NEWS Health: Jefferson survey CONTINUED FROM Al "Drinking alcohol is a nor- mative activity in Jefferson County. It's done in the European pattern here - it's moderate, it's low and it's steady." DR. CHRISTINE HALE analyst Seventy-five percent of Jef- ferson county adults had a rou- tine physical in the last 12 months, compared to the state rate of 68 percent. Approximately 90 percent of people in Jefferson County have health insurance. And 85 percent of county residents reported they have a doctor or health care provider where they could go to get treatment. That's slightly higher than the state average of 83 percent. "Unfortunately, the survey didn't ask 'how far do you travel?," Hale said. "You might have access, but it might be two hours away," added Jean Baldwin, Jefferson County Community Health director. anthrax, is smoke cigarettes." Exercise encouraging Results concerning exercise were also encouraging, Hale said. Only 13 percent of Jefferson County residents reported themselves as physically inac- tive, meaning they did not exercise three times a week for 20 minutes at a time or engage in physically demanding work. Family household adults That number was less than half the statewide average of The generally rosy health 27 percent. care picture was also slightly The report also found Jef- marred when one looked at ferson County residents drink family households, defined as more frequently than others in households with children the state, but not to excess. under 18 years of age, Hale Jefferson County residents said. are three times more likely to Only 65 percent of adults in drink 20 or more days a family households had a rou- month. tine checkup during the last Twenty-four percent of year, compared to 74 percent of county residents reported all adults in Jefferson County. drinking on 20 or more days of Hale said that could be a 30 day period, compared to attributed to lower income lev. only 8 percent statewide. els, though the study wasn't But "binge" drinking is not successful in obtaining a reli- prevalent _ only 17 percent of able measure of income. Jefferson County adults drank Adults in Jefferson County more than five drinks at one in family households were also time during the past 30 days, less likely to go to a dentist compared to 23 percent because of the cost, Hale said. statewide. "The highest rates of Hale said alcohol consump- poverty nationwide come in tion is strongly tied to educa- households" where the chil- dren are under 18, Hale said. tion, pointing out that educa- tion levels in Jefferson County County residents were also are extremely high. more likely to have higher The more education, the blood pressure than the rest of the state _ 29 percent more likely one will drink, reported having high blood Hale said. pressure here, compared to 22 "Drinking alcohol is a nor- percent statewide. mative activity in Jefferson "A diagnosis of higher blood County," she said. "It's done in pressure becomes more com- ~~e European p~ttern here-;- man as a population ages," It s mO,?erate, It s low and It s Hale said. "We have twice as' ste~dy. many people over 65" than the Now, I unde~stand why the statë average, she said. . cheap French wme goes out 0t Good news also came in Jef- the Food Co-Op so fast, ferson County residents' quipped Baldwin. responses concerning smoking Bmge drmkmg, ~s well as and exercise. smokmg, were higher for Only 16 percent of adults adults in family househol~s in smoked cigarettes in 2001, sig- Jefferson County, Hale said. nificantly lower than the statewide rate of 21 percent. Hale referred a national benchmark that aims to cut smokers to 13 percent of the population by 2010. "We're just about there," she said. "The single worst thing you can do to your health. short of inhaling While 17 percent of all adults in Jefferson County are heavy drinkers, 28 percent of adults in family households fall in this category. More smoking Adults in family households also smoked more - 24 per- cent smoke compared to 16 percent of all county adults. Specific on the 18 to 34 age group will be released in the next month along with other survey results. Hale said she expects simi- lar findings to the data released on adults in family households. "These are the two biggest risk groups," she said. "They are the two groups where the health reported is different than the rest of the popula- tion." Board of Health members - including hospital commis- sioners, Port Townsend City Council members and Jeffer- son County commissioners _ who listened to Hale's presen- tation Thursday said the sur- vey will be useful in making future policy decisions. "Since I've been on the board, we've heard anecdotal, and clinical information, but this is the first time we've had data we can depend on," board member Sheila Westerman said. Commingling the data Board member and City Council member Geoff Masci said the data could be commin- gled with already collected information. "This was commissioned to help us discover where we should put our money or not put our.money," Masci said. "I think this was a good invest- ment." Over the next month, board subcommittees will likely be formed to analyze data in depth, focusing on topics like substance abuse or needs of low-income families or senior citizens. The telephone survey, con- ducted by Seattle-based Gilmore Research, was based on questions developed by the U.S. Center for Disease Con- trol and Prevention in the mid- 1980s. March 27,2002 7 >TLeader.com * Visitor Info Website: Olympic.Peninsula.com Vol. 113 No. 12 County's health survey: Most of us in good shape By Janet Huck Leader Staff Writer "Jefferson County adults enjoy better health than the residents of Washington state, which has one of the best health rates in the United States," said Hale. The epidemiologist was commis- sioned by the Jefferson County Depart- ment of Health and Human Resources to analyze the data from the Behavioral Risk Factor Surveillance System, a ques- tionnaire developed by the Centers of Disease Control. From April I to Dec. 31,2001,603 randomly selected resi- dents in Jefferson County were asked 170 questions about their health status, access to health care providers, knowl- edge of blood pressure. physical activ- ity, oral health and family violence. Answering the telephone questionnaire took about 20 minutes. The 292 male and 311 female re- spondents ranged in age from 18 to 94, with an average age of 52.5. It was a highly educated group. with 229 having completed four or more years of college. Sixty-eight percent were married. More than 70 percent re- ported they had lived here five years See SURVEY, Page A 10 The news is good, really good, said University of Washington epidemiolo- gist Christian Hale, who analyzed the data from an extensive health survey of Jefferson County adults. Overall, the adults of Jefferson County exercise regularly. consume al- cohol responsibly, get regular medical checkups. smoke tobacco in small num- bers, and live nearly a maximum pos- sible life expectancy. Survey: Above state average Continued from Page A 1 ago. The most recent arrivals tended to have more education. Although some people didn't give usable information about Income. 22 percent of those who did reported annual income of less than $25,000 and 33 percent of more than $50,000. Big contrast However, the health news wasn't nearly as glowing for adults ages 18 to 34 with at least one child living at home. The survey mdicates they have higher rales of alcohol consumption and tobacco use, and experience some type of abuse. Hale is look- Ing at the statistics for all adults III this age range, who she said look different from other Jefferson County adults and dif- ferent from their peers statewide. "We have identified two groups whose health is radically differen!." said Hale. "Something different is going on in families \VJlh kids than with the nice. rosy picture of adult health in the rest of the counl)'! The contrast tS so sharp." Hale didn't have an immediate explanation of the contrast except to say that the natIOn's highest poveny rates are in households ""Jlh children under 18. Some of the younger adults in Jefferson County had multiple nsk factors. Among those who currently smoke, 34 percent re- ported heavy alcohol consump- tion within the previous 30 days, Comparison between Jefferson County adults as a whole and parents with children younger than 18 A: All Jefferson County adults B: Adults with children below age 18 Had a recent medical routine checkup A: 74% B: 65% Could not afford a dentist A: 42% B: 68% Regularly smoked cigarettes A: 16% B: 24% Consumed five or more alcoholic drinks daily A:17% B: 28% Experienced physical abuse in childhood A: 9% B: 15% Source: Behavioral Risk Factor Surveillance System, Jefferson County Board of Health twice the average use in Jefferson County. Of these respondents. 27 per- cent reported being overweight and also admitted to heavy alco- hol use within the last 30 days - 60 percent above the average use in county adults. And among those who were overweight, 18 percent were physically inactive, almost 40 percent above the county's average inactivity level among adults. The drinking patterns of Jefferson County adults as a whole differ from statewide pat- lerns. About 68 percent con- sumed at least one alcoholic drink in the last 30 days, signifi- cantly higher than the state rate of 61 percent. Though county . residents reported drinking at a steady rate. they drank a moder- ately low amount. "It's done in a European pal- tern here - it's moderate, it's low and it's steady," Hale said. "They drank about one to two drinks a day, which is exactly at the level that is protective of health." Yet Hale expressed concern that even responsible alcoholic consumption may model behav- ior for younger people. Abuse too There was one other outstandmg anomaly in the study. County resl· dents report higher rates of abuse in childhood than the state and national averages, and this abuse affects their functioning as adults. Overall, 25 percent - one in four - of the respondents reponed al least one abusive experience In childhood. a level above the state rate of 20 percent. The definition of abuse included having been punched. kicked. choked or receIV- ing a more senous physical pun- ishment from a parent or guardian. Those who reported child· hood histories of abuse revealed significantly more days of poor physical and mental health in the previous 30 days than people without abusive life histories. "You are looking at post-trau- matic syndrome with impaired relationships and dysfunctional families," said Hale, who is con- cerned that the abused adults could repeat family patterns In their own homes. Hale and other health officials hope this data will help policy makers shape plans and policies in Jefferson County. "Since I've been on the board (of health], we've heard anec- dotal and clinical mfom1atlOn. but this is the first Itme we had data we can depend on," said Sheila Westerman. Jefferson County Board of Health chair. f Deputies await test· results in meth bust By STUART ELLIOTI' PENINSULA DAlLY NEWS QUILCENE - Jefferson County Sheriffs Office investigators are hopeful an analysis of fingerprints obtained at an outdoor methamphet- amine lab will lead to a suspect and an arrest. Fingerprints have been sent to the Washington State Patrol crime lab in Olympia, Undersheriff Ken Sukert said. "Although no arrests have been made, we are hopeful fingerprint evi- dence recovered at the scene will aid with the identification" of a suspect Sukert said Tuesday. ' The analysis of the fingerprints could take three weeks to complete. The fingerprints were obtained from a methamphetamine lab found on timberlands in the East Quilcene Road area Thursday by detectives acting on a tip. Jefferson County Department of Environmental Health workers posted the Quilcene site Friday to keep people away from potentially hazardous materials there, Environ- mental Health Director Larry Fay said. The owners of the timberlands will be required to clean up the site Fay said. ' Evidence collected indicates those who used the lab were using the anhydrous ammonia/lithium metal process, or "Nazi" method of manu- facturing methamphetami~e, investi- gators said. Sukert said the lab was "moder- ate" in size and may have had the potential to produce as much as a half pound of methamphetamine, based on chemicals found at the site. TURN TO METH/A2 Meth: Quilcene CONTINUED FROM Al Seized items include a gas- powered generator, propane cylinders containing ammo- nia, fans, coffee filters, a propane heating mantle, muratic acid, solvents, lithium battery cases, and other items· consistently found at metham- phetamine labs, Sukert said. Lead investigator Det. Dave Miller said the lab may have been in' the woods near the intersection of McDonald and Gustavesen roads for one or two weeks. The lab, the second found in the Quilcene area in the last three months, was inactive at the time it was seized by law enforcement officials. The lab was much smaller than the "superlab" between Port Angeles and Joyce seized by law enforcement officials in January. That lab produced as much as 200 pounds of methamphet- amine in three months. Last week's seizure follows the discovery of a metham- phetamine lab on the Coyle Peninsula in December. Phillip Maki Jr., 40, and his wife, Rosanne, 39, are charged with manufacture of a con- trolled substance after police allegedly discovered a methamphetamine lab while responding to a domestic vio- lence complaint. The MaIds are scheduled to be tried May 13 in Jefferson County Superior Court. Sukert said only about 10 methamphetamine labs have been seized in Jefferson County in the last decade. While methamphetamine lab seizures in Jefferson County have been few and far between, Sukert said he is aware of a trend of labs mov- ing to more rural areas from Pierce and King counties as law enforcement agents seize sites there. The largest methampheta- mine lab discovered in Jeffer- son County was found in the Port Hadlock area in 1990, Sukert said. It contained $20,000 worth of lab equipment and was capable of producing up to 250 pounds of methamphetamine, Sukert said. 3-)..1r{);)- 1 PA syringe-trade locale moving to new location Jefferson program to continue at health department By JIM MANDERS PENINSULA DAILY NEWS There will be no syringe exchange this evening in Port Angeles but the program will open i~ a new location next week, according to Clallam County Health Department officials. The address of the new loca- tion is available by calling 360- 417-2412. The Port Angeles exchange is open from 6 p.m. to 8 p.m. Tuesdays. The only syringe exchange location in Clallam County is in Port Angeles. Health departments in Clal- lam and Jefferson county sponsor the program, known as Peninsula Syringe Exchange, which provides clean equipment for people who inject drugs into their bloodstreams. People using the program in Jefferson County can go to the health department at 615 Sheridan St. between 10 a.m. and noon Mondays and 3-4:30 L/-?- -ð d- p.m. Thursdays, according to health educator Kelly Ragan. If people need to make an exchange at a different time, they can do so by calling 360- 385-9446. More than 2,500 syringes have been exchanged in 127 transactions involving 29 clients in Jefferson County since the program started in September 2000. . The number of syringe exchanges in Clallam County was not immediately available. But a Peninsula Daily News story published March 31, 2001, reported 550 transac- tions involving 30 clients dur- ing the first six months of the program. "We do a one-for-one exchange, whether it's one or 100," Ragan said. The syringe exchange isn't held at the Clallam County Courthouse, 223 E. FourthSt., Port Angeles, because the Sheriff's Department is in the same building with the health department, unlike in Jeffer- son County. Opposed to exchange One person spoke out against the exchange program during a Jefferson County public hearing before the pro- gram started, she said. The idea that people use drugs is often hard for the gen. eral public to understand, but she said the exchange program is important. . 'Shoot safely' "If people are going to shoot drugs they need to shoot safely," Ragan said. "It might be hard for people to hear, bu t it's about public health," Encouraging safe . use of drugs goes beyond replacing used syringes. Both health departments provide sterile equipment such as, bleach, towels, cotton ánd ties, in an effort to keep dis- eases from spreading, Prophylactics are also pro- vided to help prevent sexually transmitted diseases. ID 'Critical access' may help hospital Jefferson officials weigh options in atmosphere of declining revenues BY JENNJFER JACKSON PENINSULA DNLY NEWS PORT TOWNSEND - Jef- ferson General Hospital offi- cials met Wednesday to hear about a program that could serve as a life raft for rural hos- pitals sinking in what health administrators call "the perfect storm." The metaphor describes the precarious position of small hospitals buffeted by rising insurance and other costs while facing increased cuts in Medicare and Medicaid reim- bursements. "Independent primary care is no longer sustainable in our community," hospital Adminis- trator Vic Dirksen said. 'We have to look at options for sus- tainability." One option is acceptance in the Critical Access Hospital program, said Bev Court of the state Department of Health and Welfare. Court outlined the federal program implemented in 1997 for hospital officials Wednesday. The critical access program provides rural hospitals reim- bursement of services for Medicare and Medicaid patients on the basis of cost instead of a fee schedule. ~])¡J tf~ L( - 0 '2- Small hospitals are unable to survive financially because they lack volume and lack economies of scale, Court said. "This could provide a safe harbor for rural hospitals who would be thrown into financial chaos by draconian cuts in Medicare," Court said. Medicare cut protection Rural hospitals are protecte<} from cuts in Medicare reim- bursements, but that protec- tion will be withdrawn in July of 2003, Court said. "We will lose $500,000 to $1 million if we are no longer pro- tected," Dirksen said. "We're talking significant dollars." For a hospital to qualify as a critical access care . center, it must have no more than 15 acute care patients at a time and a limit of 25 beds. Jefferson General Hospital is licensed for 43 beds, but has only 37 beds available. The hos- pital averages between 10 and 12 in-patients daily. Court said the hospital will have to look at how often occu- pancy rates spike during the year as part of the analysis in deciding to apply for the pro- gram. The hospital can apply for a state grant to fund the financial analysis. Critical designations Eighteen rural hospitals in Washington state have been certified with critical access sta- tus since the program started. Of those, 50 percent had aver- age daily census of eight or fewer patients, and 25 percent had three or less, Court sai¡j. Nine more, including Forks Community Hospital and Jef- ferson General, are considering the move. "You are what I would call folks on the edge," Court said. 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",.~ S o ~ ~ ..g ·ð ~ Jj ~:§ 0 8..ê æ CIJ~::r:: ~- ~ ~ p 1a~ >.-:5 <: .Éj ~ ;§ 'é)1! ~ lJ g;,$' 8 +-'.~ 8 ~........... ~+-,Q)Q)+>¡ï¡E-t0Q) '~",",<:::<':':¡-Q)~ ';:"':;:::Q)~~+-' .......<.:.;jl-<<+.< E-t~I...!<:b~¡~ ~:i~~~~t~!il~oQ)¡::'~~æij~~~r£J~RI~];::I&~! .... .¡..> .... ¡::,-,. ¡::...c: 00 a¡ ·c..., a:I Ul Q) "" ¡¡:¡ a:s -.... ( ) ¡:; "" Ul 00 ..... ..... ..... +> ::j 00 .90 +-' 00 -:5 .Éj -E. . :> >, 0 ...c:: o..r:: aJ 0 00 0 ~ ;> ttJ' """ +-' (Ij 0. >'..D ;::I u ~ C1.)ri ~z c:3 0< ~¡::¡ ~~ ~~ >oZ ~æ Panel formed to keep water fresh in wells First meeting on salt problem set for Friday / By STUART ELLIOTI' PENINSULA DAlLY NEWS Jefferson County has formed a citizens committee to help develop a solution to saltwater intrusion into private water wells. And the committee begins its quest at its first meeting Friday. The nine-member committee was formed for a program to monitor seawater seepage after the Western Washington Growth Management Hearings Board rapped the county in January. Commissioners had earlier rejected staff recommendations on how to deal with the problem, and decided to seek input from the pub- lic on the issue. New rules on saltwater intrusion must be in place by Aug. 11, said county Natural Resources Manager Dave Christiansen. The issue largely revolves around the ·sháring of ·reSOUrCes;" and whether a well drawing water will contribute to saltwater contamina- tion of a nearby well.. The issue includes to what extent Jefferson County is charged with Ý-?-o 2- PDtJ preventing groundwater degrada- tion under the state Growth Man- agement Act. . The citizens group will hold the first of four meetings at 10 a.m. Fri- day at the Jefferson County Library,- 620 Cedar Ave., Port Hadlock. Membership listed Group members are Paul Heinzinger and Rita Kepner of Mar- rowstone Island; David Sullivan and Dick Broders of Discovery Bay; Com- missioner Wayne King of Public Utility District No.1; Tom McNerny of the Jefferson County Planning Commission; Dana Roberts of the Water Resource Inventory Area No. 17 Planning Unit; Joe Baisch of Brinnon; and Colette Kostelec of Port Townsend. The hearings board ruling was the result of a complaint fùed by the Olympic Environmental Council and the Shine Community Action Council. Commissioners earlier rejected three options proposed by staff as a response to the ruling. One option included requiring applicants in critical seawater intru- sion areas to submit a certification from a licensed geologist. A second option would have included installing a flow meter as a condition for issuing a building permit. Under a third option, Jefferson County would manage water resources completely. /2- ,~ co - c o .- .... c. (1) (.) CO I- ...., C o (.) 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