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
Source: Thomas Jefferson Health District
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
Source: Thomas Jefferson Health District
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
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends Among U.S. Adults1990
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System
No Data <10% 10%–14% 15%–19%
Obesity Trends Among U.S. Adults1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System
No Data <10% 10%–14% 15%–19% ≥20%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends Among U.S. Adults2000
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends Among U.S. Adults2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends Among U.S. Adults2010
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System
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
Source: U.S. Department of Agriculture
Food Stores by TypeTJHD by Locality, 2009
Source: U.S. Department of Agriculture
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
AD
CO
ALI
TIO
N:
Com
mun
ity A
ctio
n on
Obe
sity
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
D C
OA
LIT
ION
: C
omm
unity
Men
tal H
ealth
&
Wel
lnes
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
Source: Virginia Department of Health, Division of Health Statistics
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%
Charlottesville; 75.0%
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
TJHD and Virginia, 1999-2010
Source: Virginia Department of Health, Division of Health Statistics
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
TJHD by Locality, 1999-2010
Source: Virginia Department of Health, Division of Health Statistics
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%
Charlottesville; 84.4%
Charlottesville; 64.1%
Louisa; 79.8%
Louisa; 69.9%
Nelson; 79.2%
Nelson; 64.0%
Albemarle Charlottesville Fluvanna Greene Louisa Nelson
Pe
rce
nt
of
To
tal L
ive
Bir
ths
to M
oth
ers
by
Pla
ce o
f R
esi
de
nce
Infant Mortality Rates*TJHD and Virginia,1999-2011
Source: Virginia Department of Health, Division of Health Statistics
*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
Source: Virginia Department of Health, Division of Health Statistics
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
Source: Virginia Department of Health, Division of Health Statistics
*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
Source: Virginia Department of Health, Division of Health Statistics
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%
Albemarle Charlottesville Fluvanna Greene Louisa Nelson
Per
cent
of T
otal
Liv
e B
irths
by
Pla
ce o
f Res
iden
ce
*Low Birth Weight = Live Births Weighing <2500 grams
Percentage of Low-Weight Births* by Race, TJHD and Virginia, 1999-2011
Source: Virginia Department of Health, Division of Health Statistics
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
*Low Birth Weight = Live Births Weighing <2500 grams
Percentage of Low-Weight Births* by Race, TJHD by Locality, 2005-2011
Source: Virginia Department of Health, Division of Health Statistics
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%
*Low Birth Weight = Live Births Weighing <2500 grams
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
TJHD and Virginia, 1999-2010
Source: Virginia Department of Health, Division of Health Statistics
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
TJHD by Locality, 1999-2010
Source: Virginia Department of Health, Division of Health Statistics
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%
Albemarle Charlottesville Fluvanna Greene Louisa Nelson
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