The Health of Jefferson County 2014 Community Health Assessment Prepared by: Siri Kushner, MPH CPH Presented: March 14, 2014 Updated: March 31, 2014

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1 The Health of 2014 Community Health Assessment Prepared by: Siri Kushner, MPH CPH Presented: March 14, 2014 Updated: March 31, 2014 Part III. Health Care Access Section A: Health Care Coverage 1 Population with health insurance 2 Health Benefit Exchange Enrollments 3 Adults Adequately Insured 4 Population with Medicare or Medicaid coverage 5 Adults with dental insurance coverage 6 Jefferson Healthcare charity care Section B: Health Care Access 1 Health Care Providers (new 3/31/14) 2 Physicians by type per 10,000 population 3 Health Professional Shortage Areas 4 Adults with a regular health care provider 5 Adults not getting needed medical care due to cost 6 Adults with a routine medical check up in past year 7 Youth with a routine medical check up in past year 8 School Based Health Clinic visits by month 9 DSHS Medical Assistance Utilization 10 DSHS Medical Assistance Utilization among Children (ages 0-17) 11 Adults with a dental visit in past year 12 Adults with a dental cleaning in past year 13 Youth with a routine dental visit in past year 14 Medicaid Dental Utilization Section C: Routine Preventive Health Care 1 Adults getting a flu shot in past year 2 Adults age 65+ ever getting a pneumonia vaccine 3 Immunization status of children at school entry 4 Immunization status at sixth grade (new 3/31/14) 5 Women age 50+ reporting having a mammogram in past 2 years Updated 8 The Health of March 2014

2 A1. Population with Health Insurance, Source: US Census, American Community Survey S2701 (Civilian, noninstitutionalized population) Nearly 9 in 10 and residents have health insurance. Insurance rates are highest in Brinnon and lower (worse) among young adults, males, individuals with lower education levels, individuals in the labor force but unemployed, and those living in poverty. 9 88% 86% 84% 82% 86.4% Rates by School District % insured Brinnon 9 Chimacum 85% Port Townsend 87% Queets 72% Quilcene 84% # population % % % 86.6% % 86.1% % Sub Group Rates Age Under % 19 to % 7 18 to % 65 and older % Male % 84% Female % 87% Educational Attainment (age 25+) Less than high school % 65% High School/GED % Some college/ Associate's degree % 86% Bachelor's degree or higher % 94% Employment Status (age 18+) Employed % 84% Unemployed % 54% Not in labor force % 88% Poverty Status Under 138% federal poverty thresho % 73% % federal poverty threshold % 20 of federal poverty threshold a % 91% Updated 9 The Health of March 2014

3 A2. Health Benefit Exchange Plan Enrollment, Sources: Choice Regional Health Network; WA Health Care Authority Between October 2013 and January 2014, nearly 8,000 residents signed up for health insurance through the Health Benefit Exchange. One-quarter of enrollments were for qualified health plans (non-subsidized), about half were Apple Health (subsidized) and another quarter were Medicaid renewals. far surpassed it's goal for Medicaid expansion enrollments by January 2014 (chart). October January 2014 Total Qualified Health Plans Apple Health Renewal % of total: 26% 46% 27% Updated 10 The Health of March 2014

4 A3. Adults Adequately Insured (not un or underinsured), Source: Behavioral Risk Factor Surveillance System Calculated variable: have insurance and cost barrier; do not have insurance and no cost barrier; do not have insurance and have cost barrier Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. Over 3 in 4 adults and about 3 in 4 WA adults are adequately insured meaning that they not only have insurance but have insurance that covers the cost of their medical needs. From to 2001 to , Jefferson and WA rates were statistically worse. In , Jefferson rates were statistically lower (worse) than WA for adults age 65+, adults with 4+ years of college, adults with incomes below $25,000 and adults with incomes above $50,000. Rates were lower (worse) for males, younger adults, adults with lower education and income levels % 74% (WA 05) (WA09) (WA 05) (WA09) % 75% 76% 78% 86% 79% 79% 74% * n too small for subgroup analysis Jefferson County range WA State gender male 71.4% % 77.9% female 81.7% % 79.7% age group * 65.2% % % 81.6% % % 95.9% jefferson sig lower education level high school or less 76.2% % 66.6% some college 71.1% % 78.4% 4+ years college 79.2% % 89.1% jefferson sig lower income level less than $25, % % 53.1% jefferson sig higher $25,000-50, % % 76. more than $50, % % 91. jefferson sig lower * number of respondents less than 30 therefore data cannot be reported Updated 11 The Health of March 2014

5 A4. Population with Medicare or Medicaid Coverage and Source: US Census, American Community Survey , C27006, C27007 More than 9,000 residents are enrolled in Medicare coverage (nearly 1 in 3 persons). The Medicare enrollment rate is more than twice the rate. Nearly 5,000 Jefferson County residents are enrolled in Medicaid coverage (about 1 in 6 persons). The Medicaid enrollment rate is the same as. More females are enrolled in both Medicare and Medicaid in Jefferson and in Washington Medicare 9255 Medicaid % 14% 16% 16% Medicare Medicaid 0 Medicare Medicaid # Population % % Medicare % 14% Medicaid % 16% Medicare # Population % % Male % 13% Female % 15% Medicaid # Population % % Male % 15% Female % 17% Updated 12 The Health of March 2014

6 A5. Adults with dental insurance coverage, Source: Behavioral Risk Factor Surveillance System Question: Do you have any kind of insurance coverage that pays for some or all of your routine dental care, Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. Just over 1 in 2 adults has dental insurance coverage compared to nearly 2 in 3 adults in. Rates in are lower among females, older adults and adults with lower incomes. 9 % adults (WA09) % 53% (WA09) % 47% 53% 68% 68% 62% Gender male 58% female 49% Age % Age % Income <=$50,000 47% >$50,000 61% Updated 13 The Health of March 2014

7 A6. Jefferson Healthcare Charity Care Fiscal Year Ending During 2005 through 2010 Source: Department of Health, Center for Health Statistics, Hospital Data Charity care is defined in RCW as necessary hospital health care rendered to indigent people, when the people are unable to pay for the care, or to pay the deductibles or co-insurance amounts required by a third-party payer. A person in need of care is considered "indigent" if family income is at or below 200 percent of the federal poverty level. The basic distinction between bad debt and charity care in the health care setting can be made between uncollectible accounts arising from a patient s unwillingness to pay (bad debt) and those arising from a patient s inability to pay (charity care). For fiscal year ending during 2010, Jefferson Healthcare had the 11th highest rate of charity care as a percent of adjusted revenue of all WA hospitals. In 2008, it had the highest rate among rural WA hospitals (data not available for 2009 and 2010). Charity care dollars and as a % of adjusted revenue have been increasing over time. In 2009 and 2010, Jefferson Healthcare rank for charity care as % of total and adjusted revenue compared to all WA hospitals decreased. $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $0 Jefferson Healthcare Charity Care ($) Charity care % of adjusted revenue Jefferson Healthcare ranked % adjusted revenue among WA hospitals (1=highest) All WA hosp Rural hosp RANK * Jefferson Healthcare (Less) Medicare revenue (Less) Medicaid revenue Charity Care ($) Charity care % of total revenue Charity care % of adjusted revenue Total revenue 2005 $57,929,535 $27,221,454 $6,561,904 $1,507, % $64,313,789 $30,402,821 $7,180,604 $1,826, % 6.83% $66,943,427 $32,187,822 $8,184,890 $2,127, % 8.01% $77,777,161 $39,260,923 $10,244,651 $2,830, % 10.01% $99,643,589 $49,649,067 $13,594,905 $3,918, % 10.77% 9? 2010 $111,316,493 $55,270,339 $16,645,327 $4,243, % 10.77% 11? All WA hosp Rural hosp *1=highest For fiscal year 2010, compared to Jefferson Healthcare, hospitals (n=94) with higher Charity Care (n=10) as a % of total revenue/% of adjusted revenue: Hospital WA Region Charity care % of Charity care % of total revenue adjusted revenue Charity Care ($) Harborview Medical Center King County 13.09% 25.52% $186,733,000 Providence St. Joseph's Hospital East 7.45% 29.38% $2,971,431 Providence Centralia Hospital Southwest 5.27% 15.59% $22,579,090 Legacy Salmon Creek Hospital Southwest 5.04% 11.24% $22,171,861 Cascade Medical Center Central 4.59% 10.4 $513,351 Peace Health St. John Medical Center Southwest 4.57% 12.61% $22,998,163 Providence Regional Medical Center-Everett Puget Sound 4.41% 9.63% $62,589,372 Othello Community Hospital Eastern 4.07% 10.15% $1,381,864 Saint Clare Hospital Puget Sound 4.02% 8.42% $22,466,966 Valley General Hospital - Monroe Puget Sound 3.91% 6.91% $4,076,173 Jefferson Healthcare Puget Sound 3.81% 10.77% $4,243,525 Updated 14 The Health of March 2014

8 B1. Health Care Providers Source: Department of Health. Accessed at: hcareaccessreports.aspx Health Professional Survey Results Primary Care, 2011* Physicians (MD, DO) number Mid-Levels (PA-C, CNM-ARNP, LM, ARNP) rate per 10,000 population rate per 10,000 population FTE number Physicians Mid-levels FTE Physician and Mid-level survey responses (95% response rate: 20 physicians, 14 mid-levels): accept new private insurance patients accept Medicaid accept new Medicaid accept Medicare accept new Medicare accept sliding scale accept new sliding scale Identified specialty(ies): family practice 12 family practice 12 general practice 1 general practice 0 internal medicine 7 internal medicine 0 pediatrics 0 pediatrics 0 geriatrics 0 geriatrics 0 OB/gynecology 7 OB/gynecology 2 *Defined by HRSA. Exclude naturopathic doctors. Primary care includes family practice or general practice, general internal medicine, pediatrics, geriatrics, obstetricians/gynecology. Dental Care, 2010* Dentists (DDS, DMD) rate per 1,000 number population FTE Dentists Dental provider survey respondents ( response rate): accept new private insurance patients 6 Identified specialty(ies): accept Medicaid 5 general dentistry 8 accept new Medicaid 3 pediatric dentistry 0 accept self-pay 9 periodontics 0 accept new self-pay 7 oral surgery 0 accept sliding scale 0 endodontics 0 accept new sliding scale 0 orthodontics 0 prosthodontics 0 Updated 15 The Health of March 2014

9 B2. Physicians by Type per 10,000 Population and US Peer Counties Source: U.S. Department of Health and Human Services, Health Resources and Services Administration. Health Resources County Comparison Tool. Accessed at: For every 10,000 residents, has approximately: 8 Primary Care physicians. By specialist type, for every 10,000 residents, has: 6 General/family practice physicians and Dentists; 4 Pediatricians, 1 Internal Medicine and OB/Gyn physicians and less than 1 General Surgeon and Psychiatrist. Compared to national peer counties, has below the median rate of internal medicine, OB/Gyn, general surgeons, and psychiatrists. physicians per 10,000 population Primary care 6.4 General/family practice lowest peer rate highest peer rate 1.3 Internal medicine 4.2 Pediatricians 1.3 OB/Gynecologists General Surgeons Psychiatrists 6.0 Dentists National Peer Group* National Peer Group* number of physicians rate per 10,000 population Primary care General/family practice Internal medicine Pediatricians OB/Gynecologists General Surgeons Psychiatrists Specialists Lowest rate Highest rate rate per Lowest rate Highest rate per 10,000 per 10,000 number of 10,000 per 10,000 per 10,000 population population physicians population population population Dentists *National Peer Group based on United States counties with similar population size, density, poverty, age structure and frontier status. Peer counties for this report are those with relatively similar population age 65 and older. Updated 16 The Health of March 2014

10 B3. Health Professional Shortage Areas : as of 1/1/2014 Source: Department of Health, Rural Health Section; Health Professional Shortage Areas are determined based on the number of practicing providers in a given area. has a primary care geographic shortage designation in the West End, Port Townsend and Quilcene Bay areas; the West End also has a dental care shortage designation; and the whole county has a mental care shortage designation. With these designations, is eligible for specific Federal and State programs to increase health care access. Designation Type census tract area description # FTEs # short Primary care: Geographic with high needs West End CCD West End , , , Pt Townsend, Primary care: Geographic with high needs , Quilcene 7 2 Dental care: Geographic West End 0 3 Mental care (Psychiatrists): Geographic entire county 1 1 A "geographic" designation means that everyone in that area is identified as underserved and resources are considered overutilized. Shortage area and underserved area designations are used to establish eligibility for federal and state programs including: Federally Qualified Health Center, Rural Health Clinic, J-1 Visa Waiver Program, HSPA Medicare Bonus Payments, National Health Service Corps, among others. Updated 17 The Health of March 2014

11 B4. Adults with a regular health care provider, Source: Behavioral Risk Factor Surveillance System Question: Do you have one person you think of as your personal doctor or health care provider? (If "No" ask: Is there more than one, or is there no person who you think of as your personal doctor or health care provider?) Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. About 4 in 5 adults in and 3 in 4 report having at least one person they think of as personal doctor or regular health care provider. In rates are higher (better) among women, persons age 65+, more highly educated and insured. The Jefferson rate for persons with income $25,000-$50,000 was significantly higher than WA State. 9 % adults 7 81% 76% (WA 05) (WA09) (WA 05) (WA09) % 82% 82% 81% 79% 78% 78% 76% Jefferson County range WA State gender male 79.6% % 72.9% female 84.8% % 82.4% age group * 59.1% % % 83.5% % % 94.9% education level high school or less 74.4% % 68.4% some college 83.4% % years college 85.6% % 83.4% income level less than $25, % % 63.9% $25,000-50, % 78.5% Jefferson sig higher more than $50, % % insurance status insured 89.3% % uninsured 41.7% % * number of respondents less than 30 therefore data cannot be reported Updated 18 The Health of March 2014

12 B5. Adults not getting needed medical care due to cost, Source: Behavioral Risk Factor Surveillance System Question: Was there a time in (2001 used "during") the past 12 months when you needed to see a doctor but could not because of the cost? Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. About 1 in 7 adults in and 1 in 6 in report not getting needed medical care due to cost. In rates are higher (worse) among women, younger persons, persons with less education and lower incomes. 4 % adults % 14% (WA05) (WA09) (WA05) (WA09) % 15% 15% 14% % 8% 13% 13% 16% % * n too small for sub-group analysis. Jefferson County range WA State gender male * 12.6% female 17.7% % 14.3% age group * 19.4% % % 12.9% 65+ * 3.5% education level high school or less * 19. some college 18.4% % 14.8% 4+ years college 12.7% % 7.8% income level less than $25, % % 30.1% $25,000-50, % % 15.7% more than $50,000 * 5.9% Updated 19 The Health of March 2014

13 B6. Adults with routine medical check up in past year, Source: Behavioral Risk Factor Surveillance System Question: About how long has it been since you last visited a doctor for a routine checkup? A routine checkup is a general physical exam, not an exam for a specific injury, illness or condition. Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. Six in 10 adults and about 6 in 10 adults report a routine medical check up in the past 12 months. In , rates are lower among males, younger persons, persons with less education and income at or below $50, (WA 05) (WA09) % (WA 05) (WA09) % 67% 73% 58% 68% 66% 61% Gender male 45% female 71% Age n< % % Education Level high school education only 43% more than high school 65% Household Income <=$50,000 52% >$50,000 63% Updated 20 The Health of March 2014

14 B7. Youth reporting a medical visit in the past year (not for illness or injury) and Source: Healthy Youth Survey Note: Participation in the Healthy Youth Survey is voluntary. Data are not reported when the grade-level response rate is less than 4. Results represent students participating in the survey and likely represent all students in the grade level. Question text: When was the last time you saw a doctor or health care provider for a check-up or physical exam when you were not sick or injured? Not asked in This question was not asked on the 2012 survey. In 2010, half of 12th graders, 6 in 10 10th and 7 in 10 8th graders in reported a medical check-up in the past year. Rates are relatively unchanged over time and below WA State rates for all grades in recent years. male and female rates are similar th grade 12th grade 73% 10th grade 4 2 8th grade 12th grade 74% 7 63% 10th grade 8th grade 10th grade 12th grade 8th grade 10th grade 12th grade % 69% 63% 61% % 73% 63% 64% % 53% 57% 59% 54% % 51% 58% % 74% 7 63% 2012 FEMALE 8th 10th 12th % 67% % 61% 72% % 43% % 55% 46% % 53% 2012 MALE % 57% % 73% 38% % 53% % 54% 56% % 61% 48% 2012 Note: Jefferson 2002 and th grade sample too small to report Jefferson 8th by Gender FEMALE MALE Jefferson 10th by Gender FEMALE MALE Jefferson 12th by Gender FEMALE MALE Updated 21 The Health of March 2014

15 B8. Youth School Based Health Clinic Visits Chimacum and Port Townsend School Based Heath Clinics Source: School Based Health Clinic Patient Tracking Database On average, more than 130 students at Chimacum and Port Townsend high schools have used the School Based Health Clinic for medical care each school year. On average students make about 3 SBHC medical visits each year. 200 UNDUPLICATED STUDENTS 600 TOTAL VISITS Chimacum Port Townsend Chimacum Port Townsend UNDUPLICATED STUDENTS TOTAL VISITS school year Chimacum Port Townsend Chimacum Port Townsend Average Updated 22 The Health of March 2014

16 B9. DSHS Medical Assistance Utilization and Source: Department of Social and Health Services. Accessed at: Unduplicated number of clients served, category: "Medically Eligible Title 19 and Medically Eligible, not Title 19." Does not include mental health services, does include dental services. In , over 5,600 residents (19%) received DSHS medical assistance coverage. The Jefferson rate has been statistically unchanged over time while the WA rate has increased and had the highest number of individuals served. 2 Proportion of Population Using Medical Assistance Services 22% 19% 6000 Number of Clients Served number of clients % of total % of total served population $ per client population $ per client % $1,723 18% $2, % $1,774 19% $2, $1,855 2 $2, $2,153 2 $2, % $2,257 2 $2, % $2,097 2 $2, % $2,158 2 $2, % $2,501 19% $2, % $2,723 2 $2, % * 21% * % * 22% * % $3,271 22% * *data not available Updated 23 The Health of March 2014

17 B10. DSHS Medical Assistance Utilization among Children (ages 0-17) and Source: Department of Social and Health Services. Accessed at: Unduplicated number of clients served, category: "Medically Eligible Title 19 and Medically Eligible, not Title 19." Does not include mental health services, does include dental services. In , nearly of children (aged 0-17) received DSHS medical assistance coverage. The Jefferson rate has been consistently above the WA rate, both rates are statistically increasing overtime. The number and proportion of children served in is the highest of the years presented Proportion of Child (aged 0-17) Population Using Medical Assistance Services 59% 51% Number of Children (aged 0-17) Served number of clients served % of total child population $ per client % of total child population $ per client % $818 4 $1, % $915 42% $1, % $935 44% $1, % $1,062 43% $1, % $1,272 42% $1, % $1,043 42% $1, % $1,142 42% $1, % $1,565 43% $1, % $1,446 46% $1, % * 48% * % * * % * 51% * *data not available Updated 24 The Health of March 2014

18 B11. Adults having dental visit in the past year, Source: Behavioral Risk Factor Surveillance System Question: How long has it been since you last visited a dentist or a dental clinic for any reason? (Added in 2008: Include visits to dental specialists, such as orthodontists.) Two in three and 7 in 10 WA adults report a dental visit in the past year. Jefferson rates are down compared to 2001 and lower among females, younger adults and those with lower incomes % % 67% 7 66% % 7 gender male 73% female age group n< % % education level high school or less n<30 more than high school 7 income level less than $25,000 n<30 $25,000-50,000 63% more than $50,000 83% Updated 25 The Health of March 2014

19 B12. Adults having dental cleaning in the past year, Source: Behavioral Risk Factor Surveillance System Question: How long has it been since you had your teeth cleaned by a dentist or dental hygienist? Fewer than 2 in 3 adults report a dental cleaning in the past year, slightly below Washington State (68%). Jefferson rates are down compared to 2001 and lower among females, younger adults and those with lower incomes % 62% % 66% 66% 62% 68% 69% 7 68% gender male 67% female 58% age group n< % education level high school or less n<30 more than high school 67% income level less than $25,000 n<30 $25,000-50,000 57% more than $50,000 Updated 26 The Health of March 2014

20 B13. Youth reporting a dental visit in the past year and Source: Healthy Youth Survey Note: Participation in the Healthy Youth Survey is voluntary. Data are not reported when the grade-level response rate is less than 4. Results represent students participating in the survey and likely represent all students in the grade level. Question text: When was the last time you saw a dentist for a check-up, exam, teeth cleaning, or other dental work? Between 7 in 10 12th graders and 8 in 10 8th and 10th graders in report a dental check-up in the past year. Rates are relatively unchanged over time and below WA State rates for all grades in recent years. Jefferson County male and female rates are similar th grade 12th grade 10th grade 78% 68% 9 7 8th grade 10th grade 12th grade 85% 83% 79% 8th grade 10th grade 12th grade 8th grade 10th grade 12th grade % 7 75% 74% % 72% 75% 72% 75% 74% % 74% 73% 72% 71% % 63% 65% 74% 71% 71% % 73% 73% 83% 82% 77% % 68% 85% 83% 79% FEMALE 8th 10th 12th % 78% % 77% 77% % % 62% 68% % 67% % 72% 75% MALE % 69% % 64% 66% % 59% % 65% 63% % 67% 79% % 84% 59% Note: Jefferson 2002 and th grade sample too small to report Jefferson 8th by Gender FEMALE MALE Jefferson 10th by Gender FEMALE MALE Jefferson 12th by Gender FEMALE MALE Updated 27 The Health of March 2014

21 B14. Medicaid Dental Utilization and Source: WA State Health Care Authority. Accessed at: NOTE: Includes services paid through December Totals subject to change as claims are paid. Client age for majority of year (age as of 12/31). OF THE TOTAL POPULATION: In , over 1,300 residents (4%) used Medicaid dental services. The number of individuals served in is down compared to the previous two years in Jefferson and WA. Proportion of Population Using Dental Assistance Services Number of Clients 1 8% 4% number of clients served % of total population number of clients served % of total population % % % % % % % % OF THE TOTAL ELIGIBLE POPULATION: About 1 in 4 eligible residents used Medicaid dental services compared to 2 in 5 eligible Washington residents. In both Jefferson and Washington, the rate of eligibles using services has gone down from to By age group, the highest proportion of eligibles using services are children ages 2-14; about half of eligibles of that age group use services Proportion of Total Eligible Population Using Dental Services 39% 26% % Eligible Jefferson Population Using Dental Services by Age Group AGE 0-1 AGE 2-5 AGE 6-14 AGE AGE AGE 21+ Updated 28 The Health of March 2014

22 TOTAL number of clients served number eligible use rate (%) $ per client use rate (%) $ per client % $394 41% $ % $430 43% $ % $395 41% $ % $400 39% $444 AGE 0-1 number of clients served number eligible use rate (%) $ per client use rate (%) $ per client % $83 23% $ % $147 26% $ % $142 3 $ % $101 32% $226 AGE $391 57% $ $434 $ % $410 62% $ % $426 63% $514 AGE % $323 58% $ % $381 61% $ % $357 62% $ % $338 63% $426 AGE % $466 46% $ $735 49% $ % $717 49% $ % $758 $586 AGE % $639 3 $ % $469 32% $ % $495 29% $ % $769 29% $542 AGE % $488 29% $ % $445 29% $ % $366 21% $ % $301 12% $344 Updated 29 The Health of March 2014

23 C1. Adults getting annual flu shot, Source: Behavioral Risk Factor Surveillance System Question: A flu shot is an influenza vaccine injected into your arm. During the past 12 months, have you had a flu shot? Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. About 2 in 5 and adults reported getting a flu shot in the past year. The Jefferson rate is lower among males, younger persons, persons with less education, and lower incomes. 4 41% 38% (WA 05) (WA09) (WA 05) (WA09) % 38% 41% 26% 4 38% gender male 35% female 46% age group n< % % education level high school or less n<30 more than high school 44% income level <=$50,000 3 more than $50,000 63% insurance status insured 43% Updated 30 The Health of March 2014

24 C2. Adults age 65 and older ever getting pneumonia vaccine, Source: Behavioral Risk Factor Surveillance System Question: A pneumonia shot or pneumococcal vaccine is usually given only once or twice in a person's lifetime and is different from the flu shot. Have you ever had a pneumonia shot? Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. Over 7 in 10 Jefferson and adults age 65+ reported ever getting a pneumonia vaccine % 71% (WA 05) (WA09) (WA 05) (WA09) % 71% 71% 67% 71% 74% gender male n<30 female 79% education level high school or less n<30 more than high school 73% income level <=$50,000 n<30 more than $50,000 n<30 insurance status insured 73% Updated 31 The Health of March 2014

25 C3. Immunization Status at School Entry (Kindergarten or First Grade) and Data Source: WA DOH Immunization Program/CHILD Profile School and Childcare Assessment Database Note: This is parent reported data and is not verified with health care providers. In the most recent period, about 48% of children starting kindergarten/first grade in had completed their recommended immunizations; 33% were missing some immunizations (non-compliant or conditional), and 12% were exempt for personal, medical or religious reasons. The rate of children exempt and non-compliant has been consistently much higher than. Jefferson rates of immunization for all vaccines are lower than (7 compared to 9) Complete Exempt Conditional Non-Compliant to to % 32% 12% 1% Compared to Jefferson County WA State Jefferson County WA State 81% 82% 88% 81% 89% 87% 87% 85% 85% 73% 75% 79% 83% 83% 85% 86% 57% 66% 64% 53% 48% 48% to to COMPLETE % EXEMPT 18% 15% 16% 14% 16% 9% % 9% 1 3% 4% 4% 4% 5% 6% 6% 8% 6% 6% 5% 5% to to Jefferson County WA State 12% 11% to % 6% 3% 1% 2% 1% 2% 2% 1% 2% 2% 2% 2% 3% 2% 2% 1% 2% 1% 2% to CONDITIONAL Jefferson County WA State NON-COMPLIANT 2 18% 27% 19% 5% 7% 6% 9% 4% 6% 7% 1% 7% 8% to to Total 3 31% 37% 32% 19% 11% 9% 1 9% 8% Updated 32 The Health of March 2014

26 Enrolled For School Complete Exempt Conditional Non-Compliant Entry* # % # % # % # % to % 78 12% to % % 39 7% % 1 9% % 9% 1% 18% % 19% 5% 1% % 15% 1% 27% % 14% 2% 19% % 2% % 16% 31% % 16% 2% 19% % 1 6% 37% % 12% 1% 32% WA State to , ,535 81% 7,414 3% 27,868 11% 12,513 5% to , ,014 88% 9,044 4% 6,610 3% 13,023 6% ,671 89% 4% 2% 4% ,759 87% 4% 2% 6% ,594 87% 5% 2% 7% ,085 85% 6% 2% 7% ,752 85% 6% 2% 8% ,278 79% 8% 3% 11% ,443 83% 6% 2% 9% ,593 83% 6% 1% ,867 85% 5% 2% 9% ,624 86% 5% 2% 8% Updated 33 The Health of March 2014

27 Exempt by Exemption Status Beginning school year, schools reported counts of students claiming each exemption type WA State Medical 1% 1% Personal/Philosophical 11% 3% Religious Religious Membership 0.1% Immunization Rates by Vaccine: Compared to % 92% 7 92% 7 91% WA State 68% 92% 69% 93% DTaP/Td** Pertussis Polio MMR*** Hep B DTaP/Td** Pertussis Polio Measles Mumps Rubella MMR*** Hep B Varicella**** to % 87% 92% 92% 92% 65% to % 88% 92% 92% % 88% 85% % % 84% 92% 91% 92% % 81% 88% 91% 91% 83% % 72% 76% 7 76% 76% % 81% 82% 79% 79% 78% 81% 78% % 75% 76% 74% 74% 74% 79% 61% % 73% 85% 71% 7 79% 61% % 81% 81% 81% 81% 82% 78% 72% % 68% 69% 68% 68% 68% 73% 66% % % 69% 61% WA State to % 95% 97% 97% 97% 84% to % 93% 92% 95% 95% 95% % 93% 91% 96% 96% 95% % 92% 96% 96% 96% 94% % 91% 94% 95% 95% 93% % 92% 92% 9 95% 95% 93% 93% % 91% 92% 91% 91% 91% 93% 93% % 9 91% 91% 91% 91% 93% 84% % 91% 92% 95% 92% 92% 93% 89% % 9 92% 91% 91% 91% 93% 91% % 91% 91% 92% 92% 92% 93% 91% % 92% 91% 92% 93% 9 Updated 34 The Health of March 2014

28 Definitions: Complete: Exempt: Conditional: Non-compliant: Immunization series is complete. Child is legally excused from being immunized because of family's personal or religious beliefs or for medical reasons. Child who has begun, but the immunizations required for the age of the child are not complete. The child can be admitted to school or child care with the understanding that the appropriate immunizations series will be completed on schedule. Out of Compliance: A child without a Certificate of Immunization Status Form, signed by a parent/guardian, or a child who has not received immunizations required for his/her age and who is not exempt. ** Beginning in SY , Pertussis is reported separately from DT/Td. *** SY , Measles, Mumps, Rubella reported as MMR combination. **** SY is first year Varicella is required. Updated 35 The Health of March 2014

29 C4. Immunization Status at Sixth Grade and Data Source: WA DOH Immunization Program/CHILD Profile School and Childcare Assessment Database In , fewer than 1 in 4 sixth graders had completed their recommended immunizations; over half were missing some immunizations (non-compliant or conditional), and 1 in 5 were exempt for personal, medical or religious reasons. The rate of children exempt and non-compliant is much higher than. Jefferson rates of immunization for all vaccines are lower than Washington State. Compared to COMPLETE 82% 1 CONDITIONAL 22% % 1% WA State WA State EXEMPT NON-COMPLIANT 55% % % WA State WA State Complete Exempt Conditional Non-Compliant Enrolled # % # % # % # % % % % WA State ,856 82% 6% 1% 11% Exempt by Exemption Status Beginning school year, schools reported counts of students claiming each exemption type WA State Medical 1% 1% Personal/Philosophical 18% 5% Religious 1% 0.4% Religious Membership 0.03% Immunization Rates by Vaccine: Compared to WA State 85% 86% 85% 96% 85% 96% 83% 96% % 27% 0. DTaP/Td Pertussis Polio MMR Hep B DTaP/Td Pertussis Polio Measles Mumps Rubella MMR Hep B Varicella % 27% 85% 85% 83% 81% WA State % 86% 96% 96% 96% 96% Definitions: Complete: Exempt: Conditional: Non-compliant: Immunization series is complete. Child is legally excused from being immunized because of family's personal or religious beliefs or for medical reasons. Child who has begun, but the immunizations required for the age of the child are not complete. The child can be admitted to school or child care with the understanding that the appropriate immunizations series will be completed on schedule. Out of Compliance: A child without a Certificate of Immunization Status Form, signed by a parent/guardian, or a child who has not received immunizations required for his/her age and who is not exempt. Updated 36 The Health of March 2014

30 C5. Preventive cancer screening: Women age 50+ receiving a mammogram in past 2 years, Source: Behavioral Risk Factor Surveillance System Question: A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? How long has it been since you had your last mammogram? Note: Starting with 2011, BRFSS results cannot be compared historically due to changes in the survey methodology. About 3 in 4 women age 50+ in and report having a routine mammogram in the past 2 years. Rates are higher among older women and women with more education and insurance % 74% % 84% 74% 78% 83% 76% age group % % education level high school or less n<30 more than high school income level <=$50,000 71% >$50,000 73% insured 79% Updated 37 The Health of March 2014