Community Health Improvement Plan Mobilizing for Action through Planning and Partnerships

Community Health Improvement Plan

Mobilizing for Action through Planning and Partnerships

Purpose: Improving Health in the Thomas Jefferson Health

District

The Thomas Jefferson Health District(TJHD)

• Virginia’s Planning District 10• Population: 234,702

– Urban, suburban and rural environments– 8% (19,302) live in rural census tracts

Source: The Oak Hill Fund

Source: Centers for Disease Control and Prevention; National Association of County and City Health Officials

MAPP Model

Big Picture of Community Health

• Compiles existing local data

• Trends

• Comparisons– State– Benchmarks

1. Locality CHA Councils• Review, discuss and determine need for

additional quantitative and qualitative data• Prioritize health issues

Charlottesville-Albemarle Fluvanna Greene Louisa Nelson

2. TJHD MAPP 2 Health Leadership Council• Decide health questions for TJHD phone

survey • Complete Community Health Improvement

Plan for TJHD

• 1-2 reps per CHA locality council• District-wide agencies serving TJHD

• Local government• Schools• Colleges

• Community agencies

• Healthcare organizations• Non-profits

Source: Thomas Jefferson Health District

MAPP 2 Health 2011-12

M2H Organizational Partners2012

Source: TJHD

Albemarle County Creciendo Juntos/United Way Greene County Sheriff Martha Jefferson

Hospital (MJH) Smart Beginnings

Albemarle County Schools Downtown Family Health Care

Greene County Transit and Early Education MJH - Medical Group Stanardsville United

Methodist Church

ASG & CMHWC Emmanuel Christian Center JABA NCAE of ACE State VICAP Counselor

Blue Ridge Medical Center (BRMC)

Family & Consumer Sciences VA Cooperative

Extension ServiceJABA-Nelson Center

Nelson County Department of Social

Services

Thomas Jefferson Health District

BRMC/Rural Health Outreach Program (RHOP)

Fluvanna County Administrator JAUNT Nelson County Health

Department United Way

Charlottesville City Schools Fluvanna County Health Department. Jefferson Area CHIP Nelson County Schools University of Virginia (UVA)

Charlottesville Free Clinic Fluvanna County Public Schools Adult Education

Library Literary Board of Nelson County OK Collaborative UVA Curry School of

Education

Charlottesville Department of Social Services Fluvanna County Schools Louisa County Board of

SupervisorsPiedmont Housing

AllianceUVA Department of Public

Health Sciences

Children, Youth and Family Services

Fluvanna Department of Social Services Louisa County CSA Piedmont Virginia

Community College UVA Emergency Department

City of Charlottesville Greene Care ClinicLouisa County

Department of Human Services

Region Ten UVA School of Nursing

Commission on Children and Families

Greene County Administrator

Louisa County Department. of Social

Services

Regional Literacy Council

Virginia Cooperative Extension

Community Action on Obesity Greene County Board of Supervisors Louisa County Fire & EMS Ride Share Virginia Department of

Health

Community Dental Center Greene County Department of Social Services

Louisa Health and Wellness SARA

Community Mental Health and Wellness Coalition

Greene County Health Department MACAA Skyline CAP, Inc.

M2H Steps and Timeline

Sept '11

Oct '11

Nov '11

Dec '11

Jan '12

Feb '12

Mar '12

Apr '12

May '12

June '12

July '12

Aug '12

Sept '12

Oct '12

Nov '12

Dec '12

Jan ‘13

Feb ‘13

Hold initial locality council meetings

Continue locality CHA meetings

Collect/present quantitative data

Plan for qualitative research

Conduct qualitative research

Determine health priorities

Write community profile(s)

Hold TJHD M2H meetings

Complete CHIP and M2H Report

Disseminate profile and CHIP


Problem Importance WorksheetComplete a separate form for each health issue identified by the CHA Team

Health Issue: ________________________________________________

Check the Appropriate Box for each item and record the score under subtotal

10

High 9 8 7 6 5 4 3 2 1Low

Sub-total

Magnitude/ImpactHow many people does the problem affect, actually or potentially, directly or indirectly?

What is the cost to society and the economy?

Seriousness of the ConsequencesWhat degree of disability or premature death occurs because of the problem? What are the potential burdens to the community, such as

economic or social burdens? What happens if we do not address this problem?

Feasibility of Correcting

Is the problem amenable to interventions (i.e., is the intervention feasible scientifically as well

as acceptable to the community?). What technology, knowledge, or resources are

necessary to effect a change? Is the problem preventable? Can we affect this problem at the

local level?

Problem Importance Index (Sum of Subtotals)

District Priority Issues

1.An increasing rate of obesity

2. Insufficient access to mental health and substance abuse services for segments of the population

3.Large and insufficient prenatal care and racial disparities in pregnancy outcomes

4.Tobacco use above the Healthy People 2020 goal


The Community Health Improvement Plan:

MAPP 2 Health

Community Health Issue #1: An Increasing Rate of

Obesity

Obesity Trends Among U.S. Adults 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System


No Data <10% 10%–14%

Obesity Trends Among U.S. Adults1990


No Data <10% 10%–14% 15%–19%




No Data <10% 10%–14% 15%–19% ≥20%




No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%




No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%




Percentage of Adults Who Are Obese TJHD and Virginia, 2000-2010

Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey

2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010

-5%

0%

5%

10%

15%

20%

25%

30%

35%

21.6%

27.6%

21.0%

25.9%

TJHD Virginia

Pe

rce

nt

of

Ad

ults

Ag

ed

20

an

d O

ver

Liv

ing

in L

oca

l-ity

Percentage of Adults Who Are Obese TJHD by Locality, 2009

Greene County 30.5%

Albemarle County27.1%

Charlottesville26.9%

Fluvanna County29.6%

Nelson County26.4%

Louisa County31.7%

Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System

**Body mass was derived from self-report of height and weight from adults 20 and Over.

*Obese = Body Mass Index (BMI) ≥30, or ~ 30 lbs. overweight for 5’ 4” person

Percentage of 5th Graders Who Are Overweight or Obese

Albemarle and Charlottesville Public Schools, 1998-2011

Source: Community Action on Obesity

1998 2003 2004 2007 2009 2010 20110%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

17.4% 18.2% 15.9% 16.9% 17.4% 15.9% 18.3%

17.6% 17.6% 19.3% 18.4% 18.3%15.2%

18.4%

Overweight Obese

Pe

rce

nt

of

Fift

h G

rad

ers

En

rolle

d in

Pu

blic

S

cho

ols

in L

oca

lity

Percentage of 5th &10th Graders Who Are Overweight or Obese

Nelson County Public Schools, 2009-2011

Source: Blue Ridge Medical Center

5th 10th 5th 10th 5th 10th2008-2009 2009-2010 2010-2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

25.0%15.7%

20.3%13.1% 14.9% 17.5%

25.6%

32.8% 26.1%

22.6%

31.2% 29.9%

% Overweight % Obese

Pe

rce

nt

of

Fift

h a

nd

Te

nth

Gra

de

rs E

nro

lled

in

Pu

blic

Sch

oo

ls in

Lo

calit

y

Low dietary polyunsaturated fatty acids (PUFA)

Low intake of fruits and vegetables

Alcohol use

High dietary trans fatty acids

Low dietary omega-3 fatty acids

High dietary salt

High LDL cholesterol

High blood glucose

Physical inactivity

Overweight-obesity (high BMI)

High blood pressure

Tobacco smoking

0 100 200 300 400 500

15

58

64

82

84

102

113

190

191

216

395

467

Septicemia

Kidney Disease

Influenza and Pneumonia

Alzheimer's Disease

Diabetes

Unintentional Injuries

Chronic Lower Respiratory Diseases

Stroke

Cancer

Heart Disease

-10% 0% 10% 20% 30%

1.4%

1.8%

2.5%

2.8%

3.1%

4.7%

5.1%

6.3%

23.1%

37.2%

Percentage of Total Deaths Deaths (in thousands)

Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 6(4):Heron, M., Tejada-Vera, B. (2009). Deaths: Leading Causes for 2005. National Vital Statistics Reports. 58(8)

Leading Causes of Death Deaths Attributable to Individual Risk Factors

Leading vs. Actual Causes of Death

Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance System

Percent of Adults Diagnosed with Diabetes (Self-Reported), TJHD and Virginia, 2000-2010

2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-20100%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

3.9%

8.7%

6.1%

7.8%

TJHD Virginia

Pe

rce

nt

of

To

tal A

du

lts A

ge

d 2

0 a

nd

Ove

r L

ivin

g

in L

oca

lity

Physical InactivityTJHD by Locality and Virginia, 2009

Source: Behavioral Risk Factor Surveillance System; County Health Rankings *Numbers are self-reported

Albemarle Charlottesville Fluvanna Greene Louisa Nelson Virginia0%

5%

10%

15%

20%

25%

30%

35%

19%

26%

22%

24%

30%

25%24%

Est

ima

ted

pe

rce

nt

of

ad

ults

ag

ed

20

an

d o

ver

rep

ort

ing

no

le

isu

re t

ime

ph

ysic

al a

ctiv

ity

Recreational Facilities TJHD by Locality and Virginia, 2009

Source: County Health Rankings

Albemarle Charlottesville Fluvanna Greene Louisa Nelson Virginia0

5

10

15

20

25

12.6

21.3

7.8

5.4

9.1

6.5

11

Fa

cilit

ies

pe

r 1

00

,00

0 P

ers

on

s L

ivin

g in

Lo

cal-

ity

National Bench-mark

Food Stores by TypeTJHD, 2009

57

2

134

9

141

207

11

Grocery stores Supercenters & club stores Convenience stores

Specialized food stores Fast-food restaurants Full-service restaurants

Farmers' markets

Source: U.S. Department of Agriculture

Food Stores by TypeTJHD by Locality, 2009

0

2

4

6

8

10

12

14

16

18

20

22

24

26

3

0

9

0

4

9

0

3

0

10

1

3

11

44

1

23

2

11

9

2

4

0

16

0

7 7

1

Greene Fluvanna Louisa Nelson

Nu

mb

er

of

Fo

od

Sto

res

Ava

ilab

le in

Lo

calit

y


Food Stores by TypeTJHD by Locality, 2009


0

10

20

30

40

50

60

70

80

90

100

110

120

25

1

49

3

53

61

4

18

0

27

3

63

110

0

Albemarle Charlottesville

Nu

mb

er

of

Fo

od

Sto

res

Ava

ilab

le in

Lo

calit

y

Qualitative Data• Thomas Jefferson Community Survey

– Obesity most frequently identified as the most important public health concern to which the district needs to give more attention

• Feedback during MAPP 2 Health Focus Groups– Charlottesville and Albemarle: Lack of knowledge

surrounding already existing programs.– Fluvanna County: Parents do not have enough time and

knowledge to prepare nutritious food for their families.– Nelson County: Education is the key to ameliorating the

problem.

Goal 1

Decrease the percentage of persons who are overweight or obese in TJHD by promoting school and corporate wellness programs and by engaging residents in a Move2Health campaign.LE

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Objectives

1. By 2017, reduce the percentage of adults living in TJHD who are physically inactive from 24% to 20%.

2. By 2017, stop the trend of the percentage of TJHD residents who are overweight or obese from increasing.

Strategies

1.Encourage and support schools to implement comprehensive wellness policies.

2.Encourage and support employers to implement comprehensive wellness programs.

3.Organize and launch a district-wide Move2Health campaign to encourage TJHD residents to be more active.

Community Health Issue #2: Insufficient Access to Mental Health and Substance Abuse

Services

Average Number of Poor Physical/Mental Health in the Last 30 Days (Self-reported)

TJHD by Locality, TJHD and Virginia, 2004-2010

Source: County Health Rankings

*Numbers are self-reported

Albemarle Charlottesville Fluvanna Greene Louisa Nelson TJHD Average Virginia0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2.2

2.9

3.4

2.9

4.7

1.2

2.883.2

2.5 2.8

2.1

2.8

3.7

2.5 2.73

3.2

Average Number of Physically Unhealthy Days reported in past 30 daysAverage Number of Poor Mental Health Days reported in past 30 daysNational Benchmark for Physically Unhealthy DaysNational Benchmark for Poor Mental Health Days

Nu

mb

er*

of

Ph

ysic

ally

Un

he

alth

y/P

oo

r M

en

tal H

ea

lth D

ays

Hospital Discharge Rates for Neurotic Disorders, Personality Disorders, and other Nonpsychotic Mental Disorders

TJHD and Virginia, 2000-2011

Source: VDH Data Warehouse; Virginia Hospital Information Systems

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

50

100

150

200

250

300

257.45

206.30199.55

140.88

TJHD VAHo

spita

l Dis

cha

rge

s p

er

10

0,0

00

Pe

rso

ns

Liv

ing

in L

oca

l-ity

Hospital Discharge Rates for PsychosesTJHD and Virginia, 2000-2011

Source: VDH Data Warehouse; Virginia Hospital Information Systems

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

100

200

300

400

500

600

700

800

677.19

418.60

586.01

563.09

TJHD VA

Ho

spita

l Dis

cha

rge

s p

er

10

0,0

00

Pe

rso

ns

Liv

ing

in L

oca

l-ity

Number of Emergency Services Delivered by Region 10 Community Services Board by Type of Service

1996-2009

Source: Region Ten Community Services Board

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

500

1000

1500

2000

2500

3000

1453

2306

1042

629

Emergency Custody Order Evaluations Temporary Detention Orders IssuedTotal Evaluations Hospital AdmissionsWellness Recovery Center Referrals

Nu

mb

er

of

Re

gio

n T

en

Se

rvic

es

De

live

red

Source: Substance Abuse and Mental Health Services Administration

Adults with a co-occuring MH and AOD disorder

Children with a co-occurring MH and AOD disorder

0%

5%

10%

15%

20%

25%

30%

35%32.8%

7.6%

20.0%

4.6%

Virginia US

Per

cent

of

Tot

al A

dult

s/C

hild

ren

Ser

ved

thro

ugh

Sta

te M

enta

l Hea

lth

Age

ncie

sPercent of Persons Served though State Mental

Health Agencies with Co-Occurring Mental Health and Substance Abuse Disorders, Virginia and U.S., 2010

MH = Mental Health; AOD = Alcohol and Other Drug

Qualitative Data• Thomas Jefferson Community Survey

– Mental health issues identified by 20% of residents as the most important public health concern to which the district needs to give more attention

• Feedback during MAPP 2 Health Focus Groups– A lack of access to mental health services was cited

as a problem– Stigma associated with mental health issues deters

people from getting assistance

Goal 2

Decrease the number of poor mental health days among TJHD residents by increasing access to mental health services and

decreasing stigmas and fear surrounding mental health issues.

LEA

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unity

Men

tal H

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&

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s C

oalit

ion

Objectives

1. By 2017, increase access to mental health services in TJHD by increasing the number of mental health service hours provided by Community mental Health and Wellness Coalition (CMHWC) member agencies.

2. By 2017, among TJHD residents decrease stigma and fears associated with mental health, as demonstrated through pre/post surveys from educational programs.

Strategies

1. Establish a system to collect and track the number of CMHWC agencies’ service hours.

2. Promote the integration of behavioral health services into primary care settings.

3. Develop, conduct and promote culturally competent educational programs, such as Mental Health First Aid USA, to reduce stigma and fears that prevent individuals from seeking mental health services.

Community Health Issue #3: Late and Insufficient Prenatal Care and Racial Disparities

in Pregnancy Outcomes

2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-20100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

79.3%

77.0%

84.7% 83.2%

TJHD Virginia

Healthy People 2020

Per

cent

of

Tot

al L

ive

Bir

ths

to M

othe

rs b

y P

lace

of

Res

iden

cePercentage of Mothers Entering Prenatal

Care in the 1st TrimesterTJHD and Virginia, 2000-2010

Source: Virginia Department of Health, Division of Health Statistics

*Percentage of Total Live Births to mothers with Prenatal Care Beginning in the First 13 Weeks

Percentage of Mothers Entering Prenatal Care in the 1st Trimester

TJHD by Locality, 2000-2010


2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-20100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Charlottesville; 76.6%


Louisa; 81.8% Louisa; 79.4%

Albemarle Charlottesville Fluvanna Greene Louisa Nelson

Per

cent

of T

otal

Liv

e B

irths

to M

othe

rs

by P

lace

of R

esid

ence

*Percentage of Total Live Births to mothers with Prenatal Care Beginning in the First 13 Weeks

Percentage of Mothers Who had 10 or More Prenatal Care Visits



1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

79.8%

66.0%

82.7%

77.7%

TJHD Virginia

Pe

rce

nt

of

To

tal L

ive

Bir

ths

to M

oth

ers

by

Pla

ce o

f R

esi

de

nce

Percentage of Mothers Who had 10 or More Prenatal Care Visits



1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Louisa; 79.8%

Louisa; 69.9%

Nelson; 79.2%

Nelson; 64.0%


Pe

rce

nt

of

To

tal L

ive

Bir

ths

to M

oth

ers

by

Pla

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f R

esi

de

nce

Infant Mortality Rates*TJHD and Virginia,1999-2011


*Deaths among infants <1year of age

1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-20110

2

4

6

8

10

12

14

16

18

20

22

7.06.3

7.2 7.0

TJHD Virginia

Healthy People 2020

Infa

nt

De

ath

s p

er

1,0

00

Liv

e B

irth

s b

y P

lace

of

Re

si-

de

nce

Infant Mortality Rates* by Race TJHD, Virginia, and U.S., 1999-2011


1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-20110

2

4

6

8

10

12

14

16

18

20

22

14.9

17.3

13.8

13.8

TJHD White 5.7

TJHD White 4.5

Virginia White; 5.6 Virginia White; 5.4

TJHD Black Virginia Black U.S. Black TJHD White Virginia White U.S. White

Healthy People 2020

Infa

nt D

eath

s pe

r 1,

000

Live

Birt

hs b

y P

lace

of

Res

iden

ce

*Deaths among infants <1year of age

Percentage of Low-Weight* BirthsTJHD, Virginia, and U.S.,1999-2011


*Low Birth Weight = Live Births Weighing <2500 grams

1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-110%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

13%

14%

7.1%7.6%

7.9%

Virginia 7.9%

TJHD Virginia United States

Healthy People 2020

Per

cent

of

Tot

al L

ive

Bir

ths

by P

lace

of

Res

iden

ce

Percentage of Low-Weight* BirthsTJHD by Locality,1999-2011


1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-110%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

13%

14%

Fluvanna 6.2%

Fluvanna 6.6%

Louisa 8.5%

Louisa 9.4%

Nelson 8.9%

Nelson 5.8%


Per

cent

of T

otal

Liv

e B

irths

by

Pla

ce o

f Res

iden

ce


Percentage of Low-Weight Births* by Race, TJHD and Virginia, 1999-2011


1999-01

2000-02

2001-03

2002-04

2003-05

2004-06

2005-07

2006-08

2007-09

2008-10

2009-11-1%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

13%

14%

TJHD Black Virginia Black TJHD White Virginia White

Pe

rce

nt

of

To

tal L

ive

Bir

ths

by

Pla

ce o

f R

esi

-d

en

ce

Healthy People 2020


Percentage of Low-Weight Births* by Race, TJHD by Locality, 2005-2011


Three-year Rolling Averages, Low Birthweight births as a percentage of Live Births

2005-2007 2006-2008 2007-2009 2008-2010 2009-2011

AlbemarleWhite 6.3% 6.5% 6.4% 5.7% 5.0%

Black 10.9% 9.7% 8.4% 10.3% 12.2%

CharlottesvilleWhite 7.0% 6.9% 6.2% 5.4% 5.2%

Black 13.7% 13.4% 15.0% 13.9% 14.3%

FluvannaWhite 7.5% 7.5% 7.0% 6.2% 6.5%

Black 16.4% 18.4% 14.2% 13.4% 7.5%

GreeneWhite 6.0% 8.6% 8.0% 8.0% 7.2%

Black 25.6% 21.5% 17.0% 8.6% 8.6%

LouisaWhite 9.0% 8.7% 8.6% 8.5% 8.3%

Black 13.3% 12.0% 12.2% 15.0% 16.7%

NelsonWhite 6.6% 6.4% 7.6% 6.2% 6.1%

Black 9.8% 5.1% 6.9% 6.5% 5.1%


Reported Substance Exposed Infants*TJHD, FY1999-2011

Source: Virginia Department of Social Services

99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-110

2

4

6

8

10

12

14

16

18

20

22

24

2

22

TJHD

Nu

mb

er

of

Re

po

rte

d S

ub

sta

nce

Exp

ose

d

Infa

nts

*Newborn infants that may have been exposed to controlled substances prior to birth (as indicated by a positive drug toxicology of the mother with presence of a controlled substance or by the child being born dependent on a controlled substance and demonstrating withdrawal symptoms) or have a diagnosis of fetal alcohol syndrome

Goal 3

Improve pregnancy outcomes in TJHD by increasing the percentage of women who plan pregnancies and receive adequate prenatal care; by targeting interventions towards vulnerable populations; and by promoting clinical smoking cessation interventions.

LEA

D C

OA

LIT

ION

:Im

prov

ing

Pre

gnan

cy O

utco

me

Wor

kgro

up

Objectives

1. By 2017, increase the percentage of pregnant women who receive 10 or more prenatal care visits from 66% to 75% of TJHD pregnant women.

2. By 2017, decrease the percentage of low birth weight black infants from 12.5% to 10% of TJHD black births.

3. By 2017, increase enrollment in Plan First, a Medicaid program that covers family planning services, in TJHD by 5%.

Strategies

1. Conduct research to better understand why vulnerable populations of women are not receiving/accessing available prenatal care services.

2. Work with TJHD prenatal care providers to overcome barriers identified in research.

3. Increase awareness among vulnerable women of childbearing age about the importance of taking steps to improve health before becoming pregnant and steps to take to improve the likelihood of having a healthy pregnancy.

4. Develop and/or promote peer-based health navigator services for vulnerable pregnant women.

5. Increase awareness among clinical providers and eligible populations about the availability of Plan First benefits

Community Health Issue #4: Tobacco Use Above the

Healthy People 2020 Goal

Self-Reported Adult SmokersTJHD and Virginia, 2000-2010

2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-20100%

5%

10%

15%

20%

25%

17.6% 17.9%

22.9%

18.0%

TJHD Virginia

Pe

rce

nt

of

Ad

ults

Ag

ed

20

an

d O

ver

Liv

ing

in

Lo

calit

y

Healthy People 2020

Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey

Percentage of Mothers Who Report Smoking during Pregnancy



1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-100%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

9.2%7.5%

8.4%

6.2%

TJHD Virginia

Healthy People 2020

Pe

rce

nt

of

To

tal L

ive

Bir

ths

to M

oth

ers

by

Pla

ce

of

Re

sid

en

ce

Percentage of Mothers Who Report Smoking during Pregnancy



1999-01 2000-02 2001-03

2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-100%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

5.6%4.7%

15.3% 15.5%


Pe

rce

nt

of

To

tal L

ive

Bir

ths

to M

oth

ers

by

Pla

ce o

f R

esi

de

nce

Tobacco Facts Virginia, 2012

Virginia United States

Adult Smoking Rank(1st = low smoking rates)

31st N/A

Cigarette Tax(per pack)

$0.30($0.35 local tax for Cville)

$1.46

Cigarette Tax Rank(1st = high taxes)

50th N/A

FY 2012 Funding for State TC Programs(millions)

$8.4 $456.7

Tobacco Prevention Spending % of CDC Target

8.1% 12.5%

Tobacco Prevention Spending Rank(1st =high spending rates)

30th N/A

Source: Campaign for Tobacco-Free Kids; City of Charlottesville City Treasurer Website

Goal 4

Decrease the percent of persons who use tobacco in TJHD.

LEA

D C

OA

LIT

ION

:To

bacc

o U

se C

ontr

ol C

oalit

ion

Objectives

1. By 2017, decrease the percentage of adults who smoke from 18% to 16% of TJHD adults.

2. By 2017, decrease the percentage of pregnant women who report smoking during pregnancy from 7.5% to 6% of TJHD pregnant women.

Strategies

1.Collect data to better understand the attitudes and behaviors that encourage young people to start smoking.

2.Evaluate current smoking cessation programs for effectiveness in decreasing tobacco use.

3.Develop and/or promote more smoking cessation classes for TJHD residents.

4.Educate clinical providers in TJHD about evidence-based patient interventions that were shown to increase tobacco cessation and promote their use.

www.tjhd.org

Documents

Community Health Improvement Plan Mobilizing for Action through Planning and Partnerships