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2007

Valdez Community Needs Assessment

TABLE OF CONTENTS

Valdez Community Needs Assessment 2007 Applied Survey Research 1

Table of Contents Data Legend ___________________________________________________________________________ 3

Introduction, Methodology and Data Snapshots ___________________________________ 7 Introduction ___________________________________________________________________________ 8 Methodology __________________________________________________________________________ 10 Data Snapshots _______________________________________________________________________ 13

Demographics and Population ________________________________________________ 16 Population ____________________________________________________________________________ 17 Population – Ethnicity ___________________________________________________________________ 19 Population – Gender ____________________________________________________________________ 20 Population – Age ______________________________________________________________________ 21 Housing ______________________________________________________________________________ 22 Household Income _____________________________________________________________________ 24

Health Issues _____________________________________________________________ 25 Health Insurance Coverage ______________________________________________________________ 26 Youth Health Insurance _________________________________________________________________ 28 Medicaid and Denali KidCare Enrollment ____________________________________________________ 29 Dental Insurance / Oral Health ___________________________________________________________ 31 Health Care Costs ______________________________________________________________________ 33 Health Care Access and Utilization _________________________________________________________ 34 Delays in Care ________________________________________________________________________ 37 Valdez Health Care Satisfaction and Information _____________________________________________ 39 Adequate Prenatal Care _________________________________________________________________ 40 Tobacco and Alcohol Use During Pregnancy _________________________________________________ 41 Births _______________________________________________________________________________ 42 Teen Births ___________________________________________________________________________ 44 Low Birth Weight Babies ________________________________________________________________ 45 Mental Health Services __________________________________________________________________ 46 Physical Health ________________________________________________________________________ 48 Physical Activity – Adults ________________________________________________________________ 49 Tobacco Use __________________________________________________________________________ 50 Alcohol Consumption ___________________________________________________________________ 52 Youth Marijuana Use ___________________________________________________________________ 55 Youth Perception of Harm and Parental Approval of Tobacco, Alcohol and Drug Use _________________ 57 Unintentional Injury ____________________________________________________________________ 61 Suicide ______________________________________________________________________________ 62 Leading Causes of Death ________________________________________________________________ 64 Deaths Due to Cancer __________________________________________________________________ 66 People with Disabilities __________________________________________________________________ 67 Providence Valdez Medical Center – Hospital Data ____________________________________________ 69

Perception of Greatest Health Care Need in Valdez _______________________________ 70 Valdez Health Provider and Business Survey Comparison Questions __________________ 74

What Could Providers Do Differently _______________________________________________________ 75 Providence Valdez Medical Center Greatest Strengths and Improvements _________________________ 76

Valdez Health Provider Survey Results _________________________________________ 79 Unmet Health Care Needs _______________________________________________________________ 80 Barriers to Obtaining Health Care _________________________________________________________ 81 Referrals Outside of Valdez ______________________________________________________________ 82 Health Care Technology _________________________________________________________________ 84 Greatest Risks to the Valdez Health Care System _____________________________________________ 85 Health Care Information and Education ____________________________________________________ 86

Valdez Business Survey Results ______________________________________________ 88

TABLE OF CONTENTS


Employee Health Care __________________________________________________________________ 89 Workers’ Compensation _________________________________________________________________ 92 Hospital Information ____________________________________________________________________ 93 Additional Comments ___________________________________________________________________ 94

Appendices ______________________________________________________________ 95 Appendix I: Valdez Community Health Survey _______________________________________________ 96 Appendix II: General Survey Results _______________________________________________________ 98

TABLE OF FIGURES


Data Legend

Denotes a Valdez Community Health Survey question, 2007.

Denotes a Valdez Physician and Health Provider Survey question, 2007.

Denotes a Valdez Business Survey question, 2007.

Denotes a Youth Behavioral Risk Survey (YRBS) question, 1995, 1999, 2003, and 2005.

Denotes an American Drug and Alcohol Survey (ADAS) question, 2002-03 and 2006-07.

Table of Figures Figure 1: Population Estimates, City of Valdez and Alaska, 2000-2006 _____________________________ 17

Figure 2: Population Estimates, City of Valdez, 2000-2006 ______________________________________ 17

Figure 3: Population Estimates, Alaska, 2000-2006 ____________________________________________ 17

Figure 4: Total Population, City of Valdez, 2007 ______________________________________________ 17

Figure 5: Ethnic Distribution, City of Valdez, Alaska and the U.S., 2000 ____________________________ 19

Figure 6: Population by Gender, City of Valdez, Alaska and the U.S., 2000 _________________________ 20

Figure 7: Population by Age, City of Valdez, Alaska and the U.S., 2000 ____________________________ 21

Figure 8: Median Age, City of Valdez, Alaska and U.S., 2000 ____________________________________ 21

Figure 9: Types of Homes, City of Valdez, 2007 ______________________________________________ 22

Figure 10: Average Occupancy, by Dwelling Type, City of Valdez, 2007 ____________________________ 22

Figure 11: How much of your total household take-home pay goes to rent/housing costs? _________ 23

Figure 12: Which income range best describes your annual household income? __________________ 24

Figure 13: Do you have health insurance? ________________________________________________ 26

Figure 14: If you have health insurance, does it cover the following? __________________________ 26

Figure 15: If you have dependent children, do they have health insurance? _____________________ 28

Figure 16: Enrollment in Medicaid by Age, City of Valdez, 2005-2007 ______________________________ 29

Figure 17: Enrollment in Medicaid by Age, Alaska, 2005-2007 ____________________________________ 29

Figure 18: Enrollment in Denali KidCare, City of Valdez, 2005-2007 ________________________________ 30

Figure 19: Enrollment in Denali KidCare, Alaska, 2005-2007 _____________________________________ 30

Figure 20: If you have health insurance, do you have additional coverage for dental insurance? _____ 31

Figure 21: If you have dependent children, do they have dental insurance? _____________________ 31

Figure 22: How long has it been since you last visited a dentist, hygienist or orthodontist? _________ 32

Figure 23: In the last 12 months, what percent of your take-home pay went to health care costs? (Fill in the blank) __________________________________________________________________ 33

TABLE OF FIGURES


Figure 24: Have you needed health care in the last 12 months? ______________________________ 34

Figure 25: What is the primary reason for your most recent visit? (Read list and shade one) ________ 34

Figure 26: If you left Valdez to obtain health care, for what reasons did you go elsewhere? (Mark all that apply with an “Other (Specify) option) __________________________________________ 35

Figure 27: In the past year have you had an annual exam for preventive purposes such as a wellness screen or an age appropriate mammogram or a prostate exam? _________________________ 36

Figure 28: Do you use the emergency room for your main source of health care? ________________ 36

Figure 29: If you needed health care in the last 12 months, were you able to receive it? ___________ 37

Figure 30: What type of health care did you go without? (Mark all that apply with an “Other (Specify)” option) _______________________________________________________________________ 37

Figure 31: If you were unable to receive care, what was the reason? (Mark all that apply with an “Other (Specify)” option) _________________________________________________________ 38

Figure 32: Overall, how satisfied are you with your health care services in Valdez? _______________ 39

Figure 33: Where do you get your information about health care? (Mark all that apply with an “Other (Specify)” option) ______________________________________________________________ 39

Figure 34: Percentage of Women Receiving Prenatal Care in the First Trimester, Valdez-Cordova and Alaska, 2000-2005 ______________________________________________________________ 40

Figure 35: Percentage of Mothers Who Reported Drinking During Their Pregnancy, Valdez-Cordova, 2000-2005 _________________________________________________________________________ 41

Figure 36: Percentage of Mothers Who Reported Smoking During Their Pregnancy, Valdez-Cordova, 2000-2005 _________________________________________________________________________ 41

Figure 37: Birth Rate, All Ages, Valdez-Cordova and Alaska, 2000-2005 ____________________________ 42

Figure 38: Percentage of Births by Race, All Ages, Valdez-Cordova, 2000-2005 ______________________ 42

Figure 39: Percentage of Births by Race, All Ages, Alaska, 2000-2005 ______________________________ 42

Figure 40: Babies Born at Providence Valdez Medical Center, 2004-2006 ___________________________ 43

Figure 41: Percentage of Births by Teen Mothers Ages 19 and Under, Valdez-Cordova and Alaska, 2000-2005 _________________________________________________________________________ 44

Figure 42: Percentage of Babies Born at Low Birth Weight (<5.5 pounds), All Ages, Valdez-Cordova and Alaska, 2000-2005 ______________________________________________________________ 45

Figure 43: Have you needed mental health treatment in the last 12 months? ____________________ 46

Figure 44: If you needed mental health treatment in the last 12 months, were you able to receive it? 46

Figure 45: If no, why couldn’t you receive it? (Mark all that apply with an “Other (Specify)” option) __ 47

Figure 46: Would you say that in general your physical health (including physical illness and injury) is: 48

Figure 47: How many days per week do you engage in physical activity (such as brisk walking or gardening) for a combined total of 30 minutes or more? _____________________________ 49

Figure 48: Do you now smoke cigarettes or use smokeless tobacco? ___________________________ 50

Figure 49: Any Cigarette Use, Valdez Junior High and High School Students, 1995-2005 _____________ 50

Figure 50: Respondents’ Average Age of First Tobacco Use, Valdez Junior High and High School Students, 2006-2007 ____________________________________________________________ 50

TABLE OF FIGURES


Figure 51: Past 30-Day Tobacco Use by Respondents, Valdez Junior High and High School Students, 2002-2003 & 2006-2007 _________________________________________________________ 51

Figure 52: Considering all types of alcoholic beverages, during the past 30 days about how many times did you have more than 5 drinks on one occasion? (Fill in the blank) _________________ 52

Figure 53: Had Five or More Drinks Within a Couple of Hours in the Past 30 Days, High School Students, 1995-2005 ____________________________________________________________________ 52

Figure 54: Past 30-Day Alcohol Use, Valdez City School District, 2006-2007 _____________________ 53

Figure 55: Ever Used Alcohol, Valdez Junior High and High School Students, 1995-2005 ____________ 53

Figure 56: Student Respondents’ Average Age of First Alcohol Use, Valdez City Junior High and High School Students, 2006-2007 ______________________________________________________ 54

Figure 57: Ever Used Marijuana, Valdez Junior High School Students, 1995-2005 __________________ 55

Figure 58: Ever Used Marijuana, Valdez High School Students, 1995-2005 _______________________ 55

Figure 59: Past 30-Day Marijuana Use, Valdez Junior High and High School Students, 2006-2007 ____ 55

Figure 60: Student Respondents’ Average Age of First Marijuana Use, Valdez Junior High and High School Students, 2006-2007 ______________________________________________________ 56

Figure 61: Percent of Student Respondents Who Said Regular Tobacco Use Causes “Some Harm” or “A Lot of Harm,” Valdez Junior High and High School Students, 2006-2007 ___________________ 57

Figure 62: Percent of Student Respondents Who Said Their Parents Would Care “Some” or “A Lot” if They Used Tobacco, Valdez City Schools, 2006-2007 __________________________________ 57

Figure 63: Percent of Student Respondents Who Said Regular Alcohol Use Causes “Some Harm” or “A Lot of Harm,” Valdez Junior High and High School Students, 2006-2007 ___________________ 58

Figure 64: Percent of Student Respondents Who Said Their Parents Would Care “Some” or “A Lot” if They Used Alcohol, Valdez City Schools, 2006-2007 ___________________________________ 58

Figure 65: Percent of Student Respondents Who Said Regular Marijuana Use Causes “Some Harm” or “A Lot of Harm,” Valdez Junior High and High School Students, 2006-2007 _________________ 59

Figure 66: Percent of Student Respondents Who Said Their Parents Would Care “Some” or “A Lot” if They Used Marijuana, Valdez City Schools, 2006-2007 _________________________________ 59

Figure 67: Unintentional Injury, Number of Deaths, Valdez-Cordova, 2000-2005 _____________________ 61

Figure 68: Unintentional Injury, Number of Deaths, Alaska, 2000-2005 _____________________________ 61

Figure 69: Suicides, Valdez-Cordova and Alaska, 1999-2004 _____________________________________ 62

Figure 70: Suicidal Thoughts, Plans and Attempts Among Student Respondents, Valdez City Junior High and High School Students, 2005 ___________________________________________________ 62

Figure 71: Top Five Leading Causes of Death, Valdez-Cordova, 1999-2001 __________________________ 64

Figure 72: Top Five Leading Causes of Death, Valdez-Cordova, 2002-2004 __________________________ 65

Figure 73: Deaths Due to Cancer, Valdez-Cordova and Alaska, 2000-2005 __________________________ 66

Figure 74: People with Disabilities1, City of Valdez, 2000 ________________________________________ 67

Figure 75: Providence Valdez Medical Center Statistics __________________________________________ 69

Figure 76: What do you consider to be the greatest health care need in Valdez? (Fill in the blank/“please explain”) __________________________________________________________ 71

TABLE OF FIGURES


Figure 77: Thinking about the hospital, what are the areas that need the most improvement? (Fill in the blank/“please explain”) _____________________________________________________ 77

Figure 78: Do you think any of the following are barriers to residents obtaining health care in Valdez? (Mark all that apply with an “Other (Specify)” option) __________________________________ 81

Figure 79: Have you referred any of your patients to locations outside of Valdez for any of the following health care services? (Mark all that apply with an “Other (Specify)” option) _________ 82

Figure 80: What are the greatest risks to the health care system in Valdez? (Mark all that apply with an “Other (Specify)” option) ______________________________________________________ 85

Figure 81: How many employees do you currently have? (Fill in the blank) _____________________ 89

Figure 82: If you experience seasonal changes in the number of your employees, which months do you have the most employees? (Fill in the blank) _____________________________________ 89

Figure 83: Which of the following would be beneficial to your company? (Multiple choice) _________ 90

Figure 84: If you have a health plan, what type of coverage does the plan provide? (Multiple choice) 90

Figure 85: Do you feel that the hospital provides adequate information about services available? ____ 93

INTRODUCTION AND METHODOLOGY


Introduction, Methodology and Data Snapshots



Introduction City of Valdez, Alaska Valdez is located on the shore of Port Valdez, a deepwater fjord in the Prince William Sound which reaches 11 miles inland. The population of the City of Valdez is contained within 221.97 square miles of land area.1 The city is located five to six hours east of the City of Anchorage traveling by car along the Glen and Richardson Highways. Valdez is also accessible by water and air.2

In the summer, the area experiences a great inflow of tourists and seasonal workers. Additionally, since the 1970’s the city has been the southernmost terminus of the Trans-Alaska oil pipeline. 3 Major employers in Valdez include the Alyeska Pipeline Service Company, Alyeska associated contractors, government agencies, educational institutions, utility companies, the U.S. Coast Guard and tourism related businesses. 4

Providence Valdez Medical Center The Providence Valdez Medical Center provides a wide array of inpatient and outpatient health care services to the Valdez community. The Medical Center replaced an existing facility in January of 2005; this new facility is an 11 acute care/swing-bed facility. The hospital’s team of administrators, physicians, nurses and support staff is dedicated to delivering compassionate, quality care to all its patients.

The Providence Valdez Medical Center offers additional services to the community via the extended care and a behavioral health care centers. The Providence Valdez Extended Care Center is a 10-bed nursing home that is both state and Medicaid-licensed as well as federally certified. The Providence Valdez Behavior Health Center provides behavioral health services to patients of all ages.5

The Providence Health System in Valdez is also connected to Alaska’s largest medical center, the Anchorage based Providence Alaska Medical Center. This association formalizes and facilitates referral patterns for Valdez patients when the need for more specialized care arises.6 Map source: Pangaea Adventures, Retrieved September 20, 2007, from www.alaskasummer.com.

Photo: Providence Valdez Medical Center, 2007.

1 U.S. Census Bureau, Alaska by Place: Population, Housing Units, Area and Density, 2000. 2 Valdez Convention & Visitors Bureau (2007). History & Facts. Retrieved August 1, 2007, from http://www.valdezalaska.org/history/history.html. 3 Valdez Convention & Visitors Bureau (2007). A Short History of Valdez. Retrieved August 1, 2007, from http://www.valdezalaska.org/history/shortHistoryValdez.html. 4 City of Valdez, (2007). Business Links. Retrieved August 1, 2007, from http://www.ci.valdez.ak.us/business.html. 5 Providence Valdez Medical Center (2007). Welcome to Providence Health System in Valdez. Retrieved August 8, 2007, from http://www.providence.org/alaska/valdez/. 6 Providence Valdez Medical Center (2007). Providence Valdez Medical Center. Retrieved August 8, 2007, from http://www.providence.org/alaska/valdez/1medcenter.htm.



Introduction (con’t) Valdez Community Needs Assessment Project Overview The community assessment model provides a comprehensive view of the health issues in the City of Valdez based on credible primary and secondary data. This community assessment report is a baseline of the quality of health and health care in Valdez. It is also a tool for concerned community members to come together to review data and form a picture of where the city could be headed.

The goal of the 2007 Valdez Community Needs Assessment is to continually improve the quality of health and health care for city residents by:

• Giving community members the opportunity to share their personal experiences, insights and opinions on health and health care in Valdez;

• Raising public awareness of health needs, changing trends, emerging issues and community problems;

• Providing accurate, credible and valid information to health care providers; and

• Providing a baseline for the hospital to continue strategic planning in the future.

About the Researcher Applied Survey Research (ASR) is a nonprofit, social research firm dedicated to helping people build better communities by collecting meaningful data, facilitating information-based planning and developing custom strategies. The firm was founded on the principle that community improvement, sustainability and program success are closely tied to

assessment of needs, evaluation of community goals and the development of appropriate responses.

Contact:

Susan Brutschy or Kelly Pleskunas

P.O. Box 1927

Watsonville, CA 95077

Tel: 831-728-1356 - Fax: 831-728-3374 www.appliedsurveyresearch.org

A special thank you to all of the agencies who contributed data for this report. Cover and section photos: Kelly Pleskunas and The Providence Valdez Medical Center



Methodology Primary Data Measures of community progress depend upon consistent, reliable and scientifically accurate sources of data. One of the types of data gathered for this project is primary (original) data.

Valdez Community Health Survey The central primary data were obtained from a self-administered written survey of Valdez residents ages 18 and older. In June of 2007, staff from Applied Survey Research (ASR), along with 15 trained community volunteers, went into the community and distributed surveys to adult residents, selected groups and organizations throughout the city. Self-administered surveys were conducted which averaged about five minutes in length. Overall, more than 300 surveys were collected at multiple different sites and community agencies. The intent of the survey was to measure the opinions, attitudes, desires and needs of the city’s residents. The Valdez Community Health Survey can be found in appendix I.

Valdez Physician & Health Provider Survey In July and August of 2007, ASR staff surveyed by telephone a total of ten health care providers who practice in Valdez. Of the ten providers, three were physicians in private practice associated with the Providence Valdez Medical Center; they are designated as “Physicians” throughout this report. The other seven providers represent a variety of health care practices and are referred to here as “Other Providers.”

Valdez Business Survey In July and August of 2007, ASR staff telephone surveyed 15 members of the Valdez business community. Individuals were selected from a variety of organizations in Valdez in an attempt to include businesses of diverse types and sizes.



Methodology (con’t) Secondary Data Secondary (pre-existing) data were collected from a variety of sources, including but not limited to: the U.S. Census Bureau; federal, state and local government agencies; health care institutions; and computerized sources through online databases and the Internet. Whenever local (City of Valdez) data was available, it was included. When local data was unavailable, regional data from the Valdez-Cordova Census Area was used.

Youth Risk Behavior Survey (YRBS) The Youth Risk Behavior Survey (YRBS) is a national survey developed by the Centers for Disease Control and Prevention’s (CDC’s) Division of Adolescent and School Health in collaboration with many departments of education and federal agencies. The results provide descriptive data on self-reported behaviors in a number of major risk categories. The survey does not attempt to answer the questions of why and how, but does address who, what, where and when. The YRBS is a component of a larger national effort to assess priority health risk behaviors that contribute to the leading causes of mortality, morbidity and social problems among youth and adults in the United States.7

The most recent YRBS in Valdez was conducted in 2005 and was taken by Valdez junior high (7th and 8th graders) and high school students (9th-12th graders). In 2005, a total of 96 surveys were administered at the George H. Gilson Junior High with a 70% response rate. Survey results were weighted8 to more accurately reflect the larger population. At the Valdez High School in 2005, 150 surveys were administered with a 59% response rate. This data was not weighted.

The YRBS was also administered in the Valdez City School District in 2003. In 2003, there were 94 junior high surveys administered with a 60% response rate and 129 high school surveys administered with a 44% response rate. Again the junior high data was weighted while the high school data was not.9

Previous to 2005 and 2003, the YRBS was conducted in Valdez in 1995 and 1999. Response rates and weighting information is unavailable for these years. The number of respondents who answered each YRBS question was not available for any survey year.

The American Drug and Alcohol Survey (ADAS) The American Drug and Alcohol Survey (ADAS) is an anonymous paper and pencil survey. It provides critical information to help school districts and communities understand the nature and extent of local substance use. The results of the survey can help one assess community needs, evaluate prevention programs, identify trends in substance use over time and provide the data required to write grant proposals and inspire others to get involved in substance use prevention.10 In Valdez, ADAS was completed by 7th to 12th graders during the 2002-2003 and 2006-2007 school years.

7 Alaska Epidemiology (2007). “Youth Risk Behavior Survey.” Retrieved August 9, 2007, from http://www.epi.hss.state.ak.us/pubs/yrbs/bkgrnd.htm. 8 Data weighting adjusts for discrepancies between demographic proportions within a sample and the population from which the sample was drawn; thus, data weighting makes sample data more representative of its larger population. 9 Valdez City School District, 2007. 10 Rocky Mountain Behavioral Science Institute (2003). “What is ADAS?” Retrieved August 9, 2007, from http://www.rmbsi.com/whatis.html.



Methodology (con’t) Behavior Risk Factor Surveillance System (BRFSS) The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly. BRFSS provides state-specific information about issues such as asthma, diabetes, health care access, alcohol use, hypertension, obesity, cancer screening, nutrition and physical activity, tobacco use, and more.

Federal, state, and local health officials and researchers use this information to track health risks, identify emerging problems, prevent disease, and improve treatment.11 BRFSS is used in this report to provide national and Alaska comparison data to Valdez specific data gathered by the Valdez Community Health Survey.

The State of Alaska Bureau of Vital Statistics The Alaska Bureau of Vital Statistics manages vital records for the State of Alaska which include birth, death, fetal death, divorce and marriage data and reports of adoption.12 The bureau’s statistics used in this report are available for the Valdez-Cordova Census Area only and not for the City of Valdez.

Healthy Alaskans 2010 Objectives Healthy Alaskans 2010 includes a set of health objectives for the state to achieve by 2010. This document reflects Alaska’s health-related goals and objectives that include health promotion, health protection, preventive services and access to care and public health infrastructure. People, communities, organizations and others can use these objectives to track changes in health status, identify changes that need to be made and to plan and develop programs to improve the health of Alaskans.13

11 National Center for Chronic Disease Prevention and Health Promotion (CDC). BRFSS: Turning Information into Health. Retrieved September 14, 2007, from http://www.cdc.gov/brfss/. 12 Alaska Division of Public Health, Bureau of Vital Statistics (2007). “Bureau of Vital Statistics.” Retrieved August 9, 2007, from http://www.hss.state.ak.us/dph/bvs/. 13 Alaska Division of Public Health (2007). Healthy Alaskans 2010, Retrieved August 24, 2007 from http://www.hss.state.ak.us/dph/targets/ha2010/default.htm.



Data Snapshots Demographics and Populations

In 2007, a local count certified by the Valdez City Council placed the Valdez population at 4,353.

Single family homes constituted the most frequent type of dwelling unit within the City of Valdez in 2007, but duplex homes, which were only 8% of all dwelling types, had the highest average occupancy (2.9) followed by single family homes (2.8) and mobile homes (2.5).

According to the U.S. Department of Housing and Urban Development, housing is affordable if it costs a household 30% or less of its annual income.14 More than half (58%) of Valdez respondents reported spending 33% or more of their household take home pay on housing.

Health and Dental Insurance Coverage At the time of the 2007 survey, nearly 13% of adult Valdez survey respondents and about 14%

of their dependent children did not have health insurance. In comparison, 19% of adults in Alaska and 17% of adults nationwide were without health coverage in 2006.

Nearly 9% of Valdez respondents and 16% of their dependent children did not have dental coverage in 2007. Additionally, 29% of adult respondents had not been to a dentist, hygienist or orthodontist within the last year. This compares to 31% on the national level in 2006.

The number of Denali KidCare and Medicaid enrollees decreased in both Valdez and Alaska after new identification requirements for federal insurance programs were implemented at the beginning of the 2007 Alaska fiscal year.

Health Care Costs Over half of respondents (55%) spent 1%-10% of their yearly take-home pay on health care costs

in the last year. An additional 19% of respondents spent 11%-20%. Thirteen percent (13%) spent over 20% while another 13% had no health care costs during that time.

Health Care Access and Utilization Valdez respondents reported a wide range of reasons for going outside of Valdez for health

care. The top six reasons included the following: they were referred to another provider (35%), they needed women’s health treatment (27%), they needed orthopedic (skeleton/bone) care (21%), they had other business to take care of in a larger city (17%), they needed cardiology specialty care (13%) and employer reimburses health care related travel costs (10%).

About four in ten respondents (39%) did not have an annual preventive exam in the past year.

In 2007, ten percent (10%) of Valdez respondents used the emergency room as their main source of care compared to 7% of Anchorage respondents surveyed in 2006.

In 2007, fifty individuals (18%) reported going without needed health care in the last year in Valdez. Of these, 38% went without specialty care, 35% did not receive care for a chronic condition, 31% lacked basic care/preventive care/annual exams and 29% went without prescribed medications.

The two main reasons respondents gave for not receiving needed care were that services were not available in Valdez (32%) and they didn’t have insurance/couldn’t afford it (32%).

Data Snapshots (con’t) 14 U.S. Department of Housing and Urban Development. Affordable Housing. Retrieved August 10, 2007, from http://www.hud.gov/offices/cpd/affordablehousing/index.cfm.



Valdez Health Care Satisfaction In 2007, the large majority (89%) of Valdez respondents were very or somewhat satisfied with

health care services in Valdez while 11% were not at all satisfied.

Sources of Health Care Information About three in four respondents (74%) receive health care information directly from their health

care provider. Friends and family (41%) and the internet (38%) were also popular sources of information in 2007.

Prenatal Care From 2000 to 2005, about 8 in 10 women consistently received prenatal care in the first trimester

of their pregnancy in Valdez-Cordova. In 2005, the percentage of women received prenatal care in the first trimester was 82% in Valdez-Cordova, 81% in Alaska and 73% nationwide.

Mental Health Services In 2007, just over 16% of Valdez survey respondents needed mental health treatment in the last

year. Of those individuals, 36% said that they were not able to receive treatment. The top reason for not receiving treatment was that respondents had no insurance/couldn’t afford it.

Tobacco Use In 2007, 21% adult respondents in Valdez smoked every day or some days. This percentage

compares to 24% of adult Alaskans and 20% of U.S. adults in 2006.

In 2005, 27% of junior high school students and 46% of high school students surveyed had used tobacco during their lifetime. Overall, males reported an earlier age of first use (12.2 years) than females (13.2 years). Of all grades surveyed, twelfth and eleventh graders reported smoking the most in the 30 days prior to the survey in 2006-2007.

Alcohol Use In 2007, 22% of adult Valdez respondents engaged in binge drinking in the 30 days prior to the

survey. According to BRFSS data, 17% of Alaskan adults engaged in binge drinking compared to 15% of U.S. adults in 2006.

The percentage of high school respondents who engaged in binge drinking in the 30 days prior to the survey decreased from 36% in 1995 to 32% in 2005. The national percentage for 2005 was 26%. Overall, male and female students reported similar use trends in 2006-2007 and had comparable average ages of first use (12 years 5 months and 12 years 7 months, respectively).

Youth Marijuana Use The percentage of Valdez junior high school students ever using marijuana decreased slightly

from 20% in 1995 to 19% in 2005. The percentage of high school students who ever used marijuana decreased more sharply from 45% in 1995 to 39% in 2005. In 2005, the national percentage for high school students was comparable at 38%.

During 2006-2007, male respondents reported using marijuana much more than females in the 30 days prior to the survey (22% compared to 15%) although both males and female students had a similar average age of first use (13 years 8 months and 13 years 7 months, respectively).



Data Snapshots (con’t) Perception of Greatest Health Care Need

Respondents to the Valdez Community Health Survey were asked to write in what they consider to be the greatest health care need in Valdez. The top five greatest needs that adult community respondents identified were the following: more specialty care, more doctors, pediatric care, lower costs/financial assistance for patients and female health care.

Physicians echoed the need for more practitioners and specialty care while Other Providers identified a need for health insurance, specialty care and provider coordination. The top three greatest needs of the business community were general care, emergency care and elderly care.

What Could Providers Do Differently Physicians responded that, overall, they were doing the best they could with the resources

available to improve health care in Valdez. Other Physicians felt that greater collaboration among providers would be beneficial. The large majority of business people responded that there was nothing that providers could be doing differently (71%).

Providence Valdez Medical Center Greatest Strengths and Improvements Both Other Providers and business respondents identified the quality of hospital staff as a great

strength of the hospital. Physicians highlighted the quality of staff and administrators as well as the physical facility.

All groups surveyed (community members, Physicians/Other Providers, and business people) felt that the Medical Center would be improved if workloads were lightened and staff changes were minimized. Increased staff training/coordination and diagnostic capabilities were also noted by Other Providers and business people as ways to improve the hospital.

Valdez Health Provider Survey Results All Physicians surveyed (3 respondents) identified affordability/insurance coverage as a

primary barrier to health care in Valdez. All Other Providers (7 respondents) reported knowledge of available services as a primary barrier.

The top six referral needs identified by Physicians were the following: orthopedic care, oncology treatment, prenatal care, substance abuse/alcohol treatment, mental health treatment and cardiology specialty care.

All Physicians felt that a lack of doctors was a risk to health care in Valdez. Six of seven Other Providers identified uninsured patients as a risk. Five of seven Other Providers also noted that not enough nurses and difficulty with insurance claims/coverage were risks.

Valdez Business Survey Results When asked what services would be beneficial to their company, all business people who

responded said flu shots. Eleven of 14 (79%) also reported that health education, employee health services and health risk assessments would be beneficial.

Ten of 15 businesses surveyed had a health plan for their employees. All ten carriers covered physical health. Nine out of ten covered dental health, vision and/or prescriptions. Long-term care and health risk assessments were the least covered services (4 of 10 carriers).

DEMOGRAPHICS AND POPULATION


Demographics and Population



Population Population changes help illustrate the changes communities experience. Reasons for population growth or decline are numerous although the economy often plays a large role in migration patterns. Figures 1-3 show population changes for Valdez and Alaska from 2000-2006 based on the U.S. Census Bureau’s population estimates.

In spring of 2007, the City of Valdez conducted a local population count which was derived from individual home counts and certified by the Valdez City Council on April 16, 2007. Data from this local count is presented in Figure 4.

Figure 1: Population Estimates, City of Valdez and Alaska, 2000-2006

2000 2001 2002 2003 2004 2005 2006

City of Valdez 4,063 4,052 4,069 4,033 4,034 4,020 3,996

Alaska 627,533 632,241 640,544 647,747 656,834 663,253 670,053

Figure 2: Population Estimates, City of Valdez, 2000-2006

3,9964,0204,0344,033

4,0694,0524,063

3,800

4,000

4,200

2000 2001 2002 2003 2004 2005 2006

Num

ber

Figure 3: Population Estimates, Alaska, 2000-2006

627,533632,241

640,544647,747

656,834663,253

670,053

600,000

625,000

650,000

675,000

2000 2001 2002 2003 2004 2005 2006

Num

ber

Source: Valdez data: U.S. Census Bureau, Population Estimates, Annual Estimates of the Population for Incorporated Places in Alaska, 2007. Alaska data: U.S. Census Bureau, Population Estimates, Annual Estimates of the Population for the United States, Regions and States and for Puerto Rico, 2007. Note: Census estimates are for July 1st of each year.

Figure 4: Total Population, City of Valdez, 2007

City of Valdez

4,353

Source: City of Valdez, Population Count for the City of Valdez, 2007.



Population (con’t) Data Summary According to the U.S. Census Bureau, the population of Alaska grew steadily from 2000 to 2006 from 627,533 to 670,053 (an increase of 7%). During the same time period, the population for Valdez was generally flat with a slight decline of two percent between 2000 and 2006 from 4,063 to 3,996.

In 2007, the local count certified by the Valdez City Council shows an increase in population for the city, placing the total population for the area at 4,353.



Population – Ethnicity Figure 5: Ethnic Distribution, City of Valdez, Alaska and the U.S., 2000

White Hispanic Asian African

American

American Indian/

Native Alaskan

Pacific Islander

Multi-Race

Valdez % 83.6% 4.0% 2.2% 0.4% 7.2% 0.4% 4.7%

Num. 3,375 160 88 17 290 18 191

Alaska % 69.3% 4.1% 4.0% 3.5% 15.6% 0.5% 5.4%

Num. 434,534 25,852 25,116 21,787 98,043 3,309 34,146

U.S. % 75.1% 12.5% 3.6% 12.3% 0.9% 0.1% 2.4% Source: U.S. Census Bureau, 2000 Fact Sheets, Valdez, Alaska and Alaska, 2007. Note: Number breakdowns not available for U.S. data.

New data not available

Data Summary The most recent year for which population data by ethnicity is available for the City of Valdez is 2000. In 2000, Valdez had a higher percentage of White residents than either Alaska or the U.S. (84%, 69% and 75%, respectively). Alaska had the greatest percentage of American Indians/Native Alaskans (16%) compared to Valdez (7%) and the U.S. (1%). Four percent (4%) of the population in Valdez and Alaska was Hispanic compared to 13% in the U.S. In addition, African Americans made up a larger percentage of the U.S. population (12%) than of the Alaskan or Valdez populations (4% and 0.4%, respectively).



Population – Gender Figure 6: Population by Gender, City of Valdez, Alaska and the U.S., 2000

51.9% 51.7% 49.1%48.1% 50.9%48.3%

0%

20%

40%

60%

80%

100%

Valdez Alaska U.S.

Perc

ent

Male Female

Source: U.S. Census Bureau, 2000 Fact Sheets, Valdez, Alaska and Alaska, 2007.


Data Summary The most recent year for which population data by gender is available for the City of Valdez is 2000. In 2000, 52% of both Valdez’s and Alaska’s population was male while 48% was female. In contrast, for the same year, the United States had a smaller percentage of males than females (49% and 51%, respectively).



Population – Age Figure 7: Population by Age, City of Valdez, Alaska and the U.S., 2000

7.4%

22.3%

3.5% 5.7%

66.8% 63.9%

7.6%

22.8%12.4%

74.3%

18.9%

6.8%

0%

20%

40%

60%

80%

100%

Under 5 Years 5-17 Years 18-64 Years 65 Years and Over

Perc

ent

City of Valdez Alaska U.S.

Figure 8: Median Age, City of Valdez, Alaska and U.S., 2000

35.432.4

35.3

0

10

20

30

40

Year

s of

Age

City of Valdez Alaska United States

Source: U.S. Census Bureau, Fact Sheets, Valdez, Alaska and Alaska, 2007.


Data Summary In 2000, the percentages of people under age five were was about seven percent (7%) for Valdez, Alaska and the United States. Valdez and Alaska had similar percentages of people ages 5 to 17 (22% and 23%, respectively). This age group made up a smaller percentage of the overall U.S. population (19%) during the same year. The population of those between the ages of 18 to 64 was greater for Valdez (67%) than Alaska (64%) by about three percent (3%) but less than the U.S. adult population (74%). The population for those ages 65 and older was slightly higher for Alaska (6%) than Valdez (4%); however, the U.S. had the highest percentage of those 65 and older in 2000 (12%).

Overall, the median age in Valdez (35.4) was higher than the median age for Alaska (32.4) and the United States (35.3).



Housing Housing is a basic human need and its quality, cost and availability are a key component to an individual’s quality of life. Well-designed and maintained housing fosters a sense of community while location and type of housing contribute to community spirit and identity.15 According to the U.S. Department of Housing and Urban Development (HUD), housing is affordable as long as it costs a household 30% or less of its annual income. Spending more than 30% of one’s annual income on housing negatively impacts one’s ability to afford other basic needs such as health care and child care.16

Figure 9: Types of Homes, City of Valdez, 2007

732

556

222

1646

136

0

250

500

750

1000

1250

1500

1750

Single FamilyHomes

Mobile Homes Multi-Family Homes Duplex Homes Total

Num

ber

Source: City of Valdez, Population Count for the City of Valdez, 2007. Note: Other types of dwelling units in Valdez not shown above include the following: small boat harbor “live-aboards,” bed and breakfasts, RV’s, Hotels, the Senior Center, community college dorms, long-term care facilities, Coast Guard facilities and other vessels. 2007 counts are unavailable for these types of dwellings.

Figure 10: Average Occupancy, by Dwelling Type, City of Valdez, 2007

Dwelling Type Average

Occupancy Single Family Homes 2.8 Mobile Homes 2.5 Multi-Family Homes 1.8 Duplex Homes 2.9

Source: City of Valdez, Population Count for the City of Valdez, 2007.

15 The National Affordable Homes Agency. Why Housing is Important to Sustainable Development. Retrieved August 8, 2007, from http://www.housingcorp.gov.uk/server/show/nav.00100b004008002. 16 U.S. Department of Housing and Urban Development. Affordable Housing. Retrieved August 10, 2007, from http://www.hud.gov/offices/cpd/affordablehousing/index.cfm.

44.5% 33.8% 13.5% 8.3% 100%



Housing (con’t) Figure 11: How much of your total household take-home pay goes to rent/housing costs?

42.4%

57.6%

36.3%

19.1%

2.2%0%

20%

40%

60%

80%

100%

Less Than 33% More Than 33% 33% - 49% 50% - 74% 75% or More

Perc

ent

N=278 Source: Valdez Community Health Survey, 2007.

Data Summary In April of 2007, single family homes constituted the most frequent type of dwelling unit within the City of Valdez, comprising 44% of all dwelling types. Duplex homes, which made up 8% of all dwelling types, had the highest average occupancy at 2.9. This was followed by single family homes (2.8) and mobile homes (2.5).

In 2007, forty-two percent (42%) of Valdez respondents spent less than 33% of their total household take-home pay on housing costs. Thirty-six percent (36%) spent between 33% and 49% of their total household take home pay while 21% of respondents spent 50% or more of their net income on housing costs. Therefore, according to the U.S. Department of Housing and Urban Development’s definition of affordable housing, the majority of respondents to the Valdez Community Health Survey (58%) had housing that was not affordable in 2007.

2006 STATE OF ALASKA CENSUS DATA: 34% of Alaskan mortgage owners and 38% of Alaskan renters spent 30% or more of their household income on housing.



Household Income Figure 12: Which income range best describes your annual household income?

Annual Household Income

2007 Valdez

Less than $10,000 5.3%

$10,000 to $19,999 6.3%

$20,000 to $29,999 6.3%

$30,000 to $39,999 9.2%

$40,000 to $49,999 8.8%

$50,000 to $74,999 23.2%

$75,000 to $99,999 16.9%

$100,000 to $124,999 15.8%

Over $125,000 9.2%

Valdez N=284 Source: Valdez Community Health Survey, 2007.

Data Summary Five percent (5%) of the adult Valdez residents who completed the Valdez Community Health Survey made less than $10,000 per year. Twelve percent (12%) earned less than $19,000 while 18% made $29,000 or less per year. Another 18% earned between $30,000 and $49,000. Four in ten respondents (40.1%) had an annual income between $50,000 and $99,000 while one quarter (25%) made $100,000 or more per year.

HEALTH ISSUES


Health Issues

HEALTH ISSUES


Health Insurance Coverage Health insurance facilitates entry into the health care system. The uninsured report more problems getting care, are diagnosed at later stages of a disease and get less therapeutic care. They are sicker when hospitalized and are more likely to die during their stay. Moreover, families without health insurance often receive fewer preventive health screenings, immunizations or prenatal care and may avoid or delay medical treatment when problems arise. They also often lack a regular health care provider or clinic and are more likely to use emergency rooms as their primary source of medical treatment. 17 The financial burden of having no insurance is also great; almost 50% of personal bankruptcy filings are due to medical expenses. 18

Figure 13: Do you have health insurance?

Yes86.5%

No12.5%

Don't Know1.0%

N=311

Source: Valdez Community Health Survey, 2007.

Figure 14: If you have health insurance, does it cover the following?

84.2%

19.7%25.8%

79.3%94.6%

50.2%

0%

25%

50%

75%

100%

Prescriptions(Full or Partial)

N=261

Treatment forSubstance

Abuse N=253

Preventive Care/ Annual Exams

N=261

Long-Term CareN=248

In-Home HealthCare N=239

Vision CareN=253

Perc

ent


17 U.S. Department of Health and Human Services. Healthy People 2010. Retrieved August 5, 2004 from http://www.healthlypeople.gov/Document/html/uih/uih_bw/uih_4.htm#accesshealth. 18 United States Department of Health and Human Services, Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2005.

HEALTHY ALASKANS 2010 OBJECTIVE: Only 5% of Alaskans will be without health insurance coverage.

BRFSS 2006 STATE & NATIONAL DATA: Alaska: 81% with coverage.

U.S.: 83% with coverage.

HEALTH ISSUES


Health Insurance Coverage (con’t) Data Summary In 2007, the large majority of Valdez respondents (87%) had health insurance while about one in 10 respondents (13%) did not. This percentage does not yet meet the Healthy Alaskans 2010 Objective that only five percent (5%) of Alaskans will be without health insurance coverage. According to the 2006 BRFSS data, 81% of Alaskans and 83% of the nation had health coverage.19

Virtually all health insurance plans identified by survey respondents in Valdez covered prescriptions (95%). Most also covered preventive care/annual exams (79%) and vision care (84%) while half (50%) of health insurance plans covered treatment for substance abuse. Fewer respondents had coverage for long-term care (26%) and in-home care (20%).

19 Alaska Department of Health and Social Services, Health Risks in Alaska Among Adults, May 2007.

HEALTH ISSUES


Youth Health Insurance Figure 15: If you have dependent children, do they have health insurance?

86.1%

13.9%

0%

20%

40%

60%

80%

100%

Yes No

Perc

ent


Data Summary In 2007, the majority of dependent children in Valdez whose parents completed a survey were covered by health insurance (86%) although 14% of children were without coverage. The 2010 Healthy Alaskans Objective is that no child will be uninsured. Valdez is not yet meeting this goal. In comparison, according to the U.S. Census Bureau, 12% of U.S. children were without health coverage in 2006.20

20 U.S. Census Bureau (2007), Health Insurance Coverage: 2006. Retrieved September 9, 2007, from http://www.census.gov/hhes/www/hlthins/hlthin06/hlth06asc.html.

HEALTHY ALASKANS 2010 OBJECTIVE: 0% of Alaska children will be without health insurance coverage.

2006 U.S. CENSUS BUREAU STATISTIC: 11.7% of children under 18 years old were without health insurance in the U.S.

HEALTH ISSUES


Medicaid and Denali KidCare Enrollment The federal Medicaid program is available to low-income children and adults. Eligibility is based on narrowly defined categories such as medical need, resource level and proof of citizenship. Medicaid aims to offer low or no cost insurance to those who might otherwise be uninsured.

Denali KidCare is Alaska’s version of the State Children's Health Insurance Program (SCHIP). Denali KidCare provides health insurance specifically to children, teens and pregnant women. Denali KidCare enrollees have access to a full range of preventive and treatment services. Current eligibility is based on a 175% Federal Poverty Guidelines (FPG) threshold.21

At the start the 2007 Alaska Fiscal Year (July 2006), the Department of Health & Human Services issued more demanding federal citizenship guidelines for government insurance program eligibility. As of July 1, 2006, persons applying for Medicaid or SCHIP coverage and claiming to be U.S. citizens must document their citizenship and identity. This measure is intended to ensure that Medicaid beneficiaries are actually citizens without imposing undue burdens on them or the states.22 Due to this change in enrollment guidelines, data from previous years cannot be compared.

Please note that youth in Denali KidCare/SCHIP are included in the under age 19 Medicaid totals.

Figure 16: Enrollment in Medicaid by Age, City of Valdez, 2005-2007

286286337

168 170175

0

100

200

300

400

2005 2006 2007

Num

ber

Enro

lled

Under Age 19

Over Age 19

Figure 17: Enrollment in Medicaid by Age, Alaska, 2005-2007

83,03386,05686,458

45,570 46,11946,756

0

20,000

40,000

60,000

80,000

100,000

2005 2006 2007

Num

ber

Enro

lled

Under Age 19

Over Age 19

Source: Alaska Department of Health and Social Services, Medicaid Budget Group. MMIS/JUCE Data, 2007. Note: Counts are from the Alaska fiscal year which runs from July 1 to June 30. (2006 is 7/1/2005 to 6/30/2006.) *The 2007 Valdez population value is an estimate from the Valdez City Council while 2005 & 2006 population values are from the U.S. Census Bureau. **The 2007 Alaska population value is an estimate from the Alaska Department of Labor and Workforce Development while 2005 and 2006 data is from the U.S. Census Bureau.

21 Denali KidCare (2007). General Information. Retrieved July 23, 2007, from http://hss.state.ak.us/dhcs/DanliKidCare/gen_info.htm. 22 Center for Medicare and Medicaid Services, Department of Health & Human Services (2006). Medicaid Fact Sheet. Retrieved August 31, 2007, from http://www.ataporg.org/Citizenship.pdf.

Total population: 4,020* 3,996* 4,353*

Total population: 663,253** 670,053** 677,108**

HEALTH ISSUES


Medicaid and Denali KidCare Enrollment (con’t) Figure 18: Enrollment in Denali KidCare, City of Valdez, 2005-2007

47

7680

0

20

40

60

80

100

2005 2006 2007

Num

ber

Enro

lled

Figure 19: Enrollment in Denali KidCare, Alaska, 2005-2007

15,794

18,70918,676

14,000

15,000

16,000

17,000

18,000

19,000

2005 2006 2007

Num

ber

Enro

lled

Source: Alaska Department of Health and Social Services, Medicaid Budget Group. MMIS/JUCE data, 2007. Note: Counts are from the Alaska fiscal year which runs from July 1 to June 30. (2006 is 7/1/2005 to 6/30/2006.) *The 2007 Valdez population value is an estimate from the Valdez City Council while 2005 & 2006 population values are from the U.S. Census Bureau. **The 2007 Alaska population value is an estimate from the Alaska Department of Labor and Workforce Development while 2005 and 2006 data is from the U.S. Census Bureau.

Data Summary Since the federal enrollment guidelines changed at the beginning of the 2007 Alaska Fiscal year, fewer individuals have been enrolled in Medicaid and Denali KidCare (SCHIP) in both Valdez and Alaska. In Valdez, the decrease in enrollees was sharpest for the Denali KidCare program. For all of Alaska, the highest decrease was in the larger Medicaid program.

Total population: 663,253** 670,053** 677,108**

Total population: 4,020* 3,996* 4,353*

HEALTH ISSUES


Dental Insurance / Oral Health Regular dental visits—at least one visit per year—are important for preventing, diagnosing and treating oral diseases. Having dental insurance makes getting regular, adequate dental care easier. Further, recent research suggests that periodontal disease or gum disease can impact overall health; periodontal bacteria can enter the blood stream and infect major organs. This may contribute to the development of heart disease, increase the risk of stroke and increase a woman’s risk of having a preterm or low birth weight baby. 23

As of October 2007, there were two dentists currently practicing in the Valdez community.

Figure 20: If you have health insurance, do you have additional coverage for dental insurance?

89.5%

8.6%2.0%

0%

25%

50%

75%

100%

Yes No Don't Know

Perc

ent


Figure 21: If you have dependent children, do they have dental insurance?

84.0%

16.0%

0%

20%

40%

60%

80%

100%

Yes No

Perc

ent


23 American Academy of Periodontology, Mouth Body Connection, 2004.

HEALTH ISSUES


Dental Insurance / Oral Health (con’t) Figure 22: How long has it been since you last visited a dentist, hygienist or orthodontist?

50.5%

20.1%13.9% 9.9% 5.0% 0.7%

0%

20%

40%

60%

80%

100%

1 to 6 MonthsAgo

7 to 12 MonthsAgo

1 to 2 YearsAgo

2 to 5 YearsAgo

More than 5Years Ago

Don't Know

Perc

ent


Data Summary The majority of Valdez respondents, who had health insurance coverage, also had additional dental coverage (90%). The percentage for dependent children with dental coverage was slightly less at 84%.

Over 50% of Valdez respondents had visited a dentist, hygienist or orthodontist within the last six months while 20% had gone within the last 7 to 12 months and 71% had gone within the last year. According to BRFSS data, 68% of Alaskans visited a dentist, hygienist or orthodontist during the year prior to the 2006 survey. In Valdez, 14% had gone within the last one to two years while 15% had not visited a dentist, hygienist or orthodontist within the past two years. At the national level, 19% of respondents had not received dental treatment within the last one to two years. 24

24 Behavioral Risk Factor Surveillance System, Codebook Report, 2006.

2006 BRFSS U.S. DATA: 1 year: 67.5%

2 years: 11.7%

5 years: 9.0% Over five years: 9.9%

HEALTH ISSUES


Health Care Costs Health care costs, in addition to presenting a barrier to health care access, also impact individuals in a variety of other ways. For example, in 2005, nearly one-quarter (23%) of Americans reported having problems paying medical bills in the past year. Fifteen percent (15%) reported being contacted by a collection agency because of medical bills, 12% had used “all or most” of their savings because of medical costs and three percent (3%) had declared bankruptcy as a result of health care costs.25

Figure 23: In the last 12 months, what percent of your take-home pay went to health care costs? (Fill in the blank)

12.7%

36.3%

19.0% 19.0%

8.9%4.2%

0%

25%

50%

None 1% - 5% 6% - 10% 11% - 20% 21% - 30% 31% and Over

Perc

ent


Data Summary In 2007, over half (55%) of survey respondents spent 1-10% of their take-home pay on health care costs while 13% spent 21% or more. Thirteen percent (13%) of Valdez respondents did not spend any of their take-home pay on health care costs.

25 The USA Today/Kaiser Family Foundation/Harvard University Survey Project (2005). Health Care Costs Survey, Summary. Retrieved from http://www.kff.org/newsmedia/7371.cfm, August 27, 2007.

2006 BRFSS DATA: 13.3% of U.S. respondents reported that there was a time in the past 12 months when they needed to see a doctor but could not because of cost.

HEALTH ISSUES


Health Care Access and Utilization Timely medical visits help residents get appropriate preventive care and treatment for common and chronic conditions. People with a place to go for health care may be more likely to use it and to feel more comfortable accessing care. Regular and timely screenings can identify health conditions at their early stages when they are most easily treated and may also uncover potential risk factors for chronic diseases that can be managed with lifestyle changes. Further, early care of chronic conditions can reduce the impact of chronic diseases such as cancer, diabetes, heart disease or hypertension, which in turn can improve the quality of life for children and adults as they age. 26

Emergency room usage for primary care is often an indicator of a lack of access to care. Residents without health insurance or with limited provider choices often use the emergency room for their primary care as well as for emergencies.

Figure 24: Have you needed health care in the last 12 months?

No11%

Yes89%

N=311


Figure 25: What is the primary reason for your most recent visit? (Read list and shade one)

22.3%

5.2%

20.4%

3.3%

23.0%

0.7%

24.9%

0%

20%

40%

60%

Chronic(Ongoing)Problem

Preventive Care Acute (New)Problem

Emergency Care Women'sHealth/Prenatal

Care

PhysicalTherapy

Other

Perc

ent


26 U.S. Department of Health and Human Services, Administration on Aging (2004). Promoting Healthy Lifestyles—Health Screenings. Retrieved February 28, 2005, from http://www.aoa.gov/eldfam//Healthy_Lifestyles/Screenings/screenings.asp.

HEALTH ISSUES


Health Care Access and Utilization (con’t) Figure 26: If you left Valdez to obtain health care, for what reasons did you go elsewhere? (Mark all that apply with an “Other (Specify) option)

6.5%

0.5%

1.4%

1.9%

2.3%

2.3%

3.2%

4.2%

4.2%

5.6%

6.5%

6.9%

7.4%

7.9%

10.2%

13.0%

17.1%

20.8%

26.9%

34.7%

0% 25% 50% 75% 100%

Other

Needed Substance Abuse/ Alcohol Treatment

Alaska Native Medical Center

Diagnostic Purposes

Non-Specified Specialist

Needed Geriatric (Problems with Aging) Treatment

Always Use Care Elsewhere

Prefer Out-of-Town Health Care

Needed Mental Health Treatment

Needed Oncology (Cancer) Treatment

Needed Pediatric Care

Dental Care

Needed Diabetic Treatment

Vision Care

Employer Reimburses Travel Costs for Health Care

Needed Cardiology Specialty Care

Had Other Business to Take Care of in a Larger City

Needed Orthopedic (Skeleton/Bone) Care

Needed Women's Health Treatment

Referred to Another Provider by Your Family Doctor

Multiple response question with 216 respondents offering 396 responses. Source Valdez Community Health Survey, 2007.

HEALTH ISSUES


Health Care Access and Utilization (con’t) Figure 27: In the past year have you had an annual exam for preventive purposes such as a wellness screen or an age appropriate mammogram or a prostate exam?

No38.9%

Yes61.1%

N=296


Figure 28: Do you use the emergency room for your main source of health care?

No90.5%

Yes9.5%

N=305


Data Summary A large majority of Valdez respondents (89%) were in need of health care within the past 12 months yet the reasons for care varied. One quarter of respondents (25%) had chronic problems, 23% needed preventive care, 22% had an acute (new) problem and 20% needed emergency care. There are also a variety of reasons why Valdez respondents sought medical treatment outside Valdez. Over a third (35%) left because they were referred to another provider outside of Valdez by their family doctor. Over a quarter of respondents (27%) were in need of woman’s health treatment, 21% were in need of orthopedic care and 17% sought medical treatment outside of Valdez due to the convenience of having already been in another city. Seven percent (7%) of respondents either always obtain care elsewhere or prefer out of town care.

Over half of all Valdez adults (61%) have had an annual exam for preventive purposes.

Nearly ten percent (10%) of Valdez respondents use the emergency room as their main source of health care. In comparison, in 2006 seven percent (7%) of Anchorage respondents reported using the emergency room as their main source of health care.27

27 Applied Survey Research, Anchorage Community Assessment Project, Telephone Survey, 2006.

2006 BRFSS U.S. DATA: 69% of men had received a prostate-specific antigen test to check for prostate cancer in the last year.

2006 BRFSS U.S. DATA: 65% of women had a mammogram in the last year.

2006 ANCHORAGE DATA: 7.2% of respondents used the emergency room for their main source of health care.

HEALTH ISSUES


Delays in Care When residents need medical care, it is important to get care in a timely fashion. Delaying medical care can worsen problems and even be life threatening. It can also add to the cost of care to the patient. The high cost of medical care and being uninsured or underinsured can contribute to a delay in receiving medical care.

Figure 29: If you needed health care in the last 12 months, were you able to receive it?

No18.1%

Yes81.9%

N=277


Figure 30: What type of health care did you go without? (Mark all that apply with an “Other (Specify)” option)

8.3%

8.3%

8.3%

18.8%

29.2%

31.3%

31.3%

35.4%

37.5%

0% 25% 50% 75% 100%

Other

Mental Health (Counseling orOther Help)

Alternative (Homeopathic orAcupuncture)

Acute (New) Problem

Prescription Medications

Preventive Care/AnnualExams

Basic Care

Chronic (Ongoing) Problem

Specialist

Multiple response question with 48 respondents offering 100 responses. Source: Valdez Community Health Survey, 2007.

HEALTH ISSUES


Delays In Care (con’t) Figure 31: If you were unable to receive care, what was the reason? (Mark all that apply with an “Other (Specify)” option)

13.5%

2.7%

2.7%

5.4%

10.8%

10.8%

32.4%

32.4%

0% 25% 50% 75% 100%

Other

Waiting Lists

Couldn't Find Doctor/Provider to Accept Insurance

Couldn't Afford Copay

Insurance Wouldn't Cover It

Needed a Specialist

No Insurance/Couldn't Afford It

Services Not Available


Data Summary Of the adult Valdez population who were in need of health care within the past 12 months, 82% were able to receive care. The types of health care, which people were unable to receive were care from a specialist (38%), care for a chronic problem (35%), basic care (31%), preventive care/annual exams (31%) and prescription medications (29%). Of the 18% who were unable to receive care, reasons ranged from services not being available (32%), no insurance or unable to afford the expense (32%), in need of an unavailable specialist (11%) and insurance would not cover the needed procedure (11%).

HEALTH ISSUES


Valdez Health Care Satisfaction and Information Valdez community members ages 18 and older were surveyed on their satisfaction with health care services and the ways they learn about health care.

Figure 32: Overall, how satisfied are you with your health care services in Valdez?

41.6% 47.3%

11.1%

0%

25%

50%

75%

100%

Very Satisfied Somewhat Satisfied Not at all Satisfied

Perc

ent


Figure 33: Where do you get your information about health care? (Mark all that apply with an “Other (Specify)” option)

3.1%

2.1%

2.7%

5.5%

9.9%

15.1%

38.0%

40.8%

74.3%

0% 25% 50% 75% 100%

Other

Books

Work

Radio

Newspaper/Magazines

Television

Internet

Friends and Family (Word of Mouth)

Doctor/Provider


Data Summary The large majority of Valdez respondents (89%) were very satisfied or somewhat satisfied with health care services in Valdez. A large majority (74%) also reported that they receive health care information directly from a physician or another type of health care provider. Four in ten respondents (41%) get their health care information by word of mouth while over a third (38%) obtains health care information from the Internet. Media such as television (15%) and newspapers and magazines (10%) were also reported as health care resources in Valdez. The radio, work and books were least utilized.

HEALTH ISSUES


Adequate Prenatal Care Comprehensive prenatal care for the mother and fetus includes screening and treatment for medical conditions as well as identification and interventions for behavioral risk factors associated with poor birth outcomes. Adequate prenatal care is measured by the percentage of women who receive prenatal care in the first trimester of their pregnancy. According to a study by The National Public Health and Hospital Institute, financial barriers including cost of care were often reasons women did not get adequate prenatal care.28

Figure 34: Percentage of Women Receiving Prenatal Care in the First Trimester, Valdez-Cordova and Alaska, 2000-2005

81.7%82.1%

80.7%78.0%

87.0%

76.3%

80.5%

81.1%

80.1%

80.5%80.9%

80.6%

60%

70%

80%

90%

100%

2000 2001 2002 2003 2004 2005

Perc

ent

Valdez-Cordova Census Area Alaska

Source: The Alaska Bureau of Vital Statistics, Birth Profiles by Area of Mother’s Residence, Alaska and Valdez-Cordova Census Area, 2007.


Data Summary The percentage of women in Valdez-Cordova who received prenatal care within the first trimester of their pregnancy fluctuated between 2000 and 2005, spiking at 87% in 2003. During the same five-year period, Alaska was fairly consistent, remaining around 81%. In 2005, the percent of women receiving care in Valdez-Cordova was 82%; one percentage point higher than Alaska.

While a definite majority of women in Valdez-Cordova and Alaska received care in the first trimester in 2005, both areas were below The Healthy Alaskans 2010 goal of 85% of pregnant women receiving early and adequate prenatal care.

The most current data available for the United States reports that 73% of women in the U.S. started prenatal care in the first trimester of their pregnancy in 2004.29

28 The National Public Health and Hospital Institute, Barriers to Prenatal Care Study: A Survey of Women Who Deliver at Public Hospitals, 2003. 29 National Vital Statistics Reports, Volume 55, Number 1, 2006.

HEALTHY ALASKANS 2010 OBJECTIVE: 85% of pregnant women will receive early and adequate prenatal care.

HEALTH ISSUES


Tobacco and Alcohol Use During Pregnancy Tobacco and alcohol use by pregnant women has a number of serious consequences. Infants prenatally exposed to alcohol may develop a range of disorders known as fetal alcohol spectrum disorders.30 Furthermore, smoking tobacco during pregnancy is the single most preventable cause of illness and death among mothers and infants. Babies born to smokers are more likely to be born prematurely, with a low birth weight and have an increased risk of infant mortality.31

Figure 35: Percentage of Mothers Who Reported Drinking During Their Pregnancy, Valdez-Cordova, 2000-2005

Valdez-Cordova

2000

Valdez-Cordova

2001

Valdez-Cordova

2002

Valdez-Cordova

2003

Valdez-Cordova

2004

Valdez-Cordova

2005 Alaska

2005 Num. 5 5 5 4 2 3 219

Total Births 116 156 132 113 126 121 10,453 % 4.5% 3.2% 3.9% 3.6% 1.6% 2.5% 2.1%

Figure 36: Percentage of Mothers Who Reported Smoking During Their Pregnancy, Valdez-Cordova, 2000-2005

Valdez-Cordova

2000

Valdez-Cordova

2001

Valdez-Cordova

2002

Valdez-Cordova

2003

Valdez-Cordova

2004

Valdez-Cordova

2005 Alaska

2005 Num. 21 24 18 15 13 10 1,675

Total Births 116 156 132 113 126 121 10,453 % 18.8% 15.6% 14.0% 13.4% 10.3% 8.3% 16.1%

Source: The Alaska Bureau of Vital Statistics, Birth Profiles by Census Area of Mother’s Residence, Valdez-Cordova Census Area, 2007.


Data Summary Between 2000 and 2005, in Valdez-Cordova, the percentage of woman who drank and smoked during their pregnancy decreased. In 2000, five (5) women in Valdez-Cordova reported drinking during pregnancy; this number dropped to three (3) in 2005. The number of women reporting smoking during pregnancy dropped from 21 in 2000 to ten (10) in 2005.

Overall, in 2005 in Valdez-Cordova, ten women (8%) reported smoking and 3 (or 3%) reported drinking during pregnancy. At the state level during the same year, 16% of mothers reported smoking during pregnancy while two percent (2%) reported drinking. According to the most recent nationwide data available, 10% of women in the U.S. reported smoking during pregnancy in 2004.32

National data for alcohol use during pregnancy is unavailable.

30 Centers for Disease Control and Prevention (2007). Fetal Alcohol Spectrum Disorders. Retrieved August 8, 2007, from http://www.cdc.gov/ncbddd/fas/fasask.htm. 31 Centers for Disease Control and Prevention (2007). Tobacco Use and Pregnancy. Retrieved August 8, 2007, from http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/index.htm. 32 National Vital Statistics Reports, Volume 55, Number 1, 2006.

HEALTH ISSUES


Births The overall birth rate is an indicator of population growth. Areas with high birth rates can have a larger percentage of the population in younger age groups compared to areas with lower birth rates. Understanding this trend can help communities plan where to best allocate resources.

Please note when reviewing charts and graphs that there is Valdez-Cordova Census Area information as well as Valdez specific data because Valdez specific data is unavailable for certain categories.

Figure 37: Birth Rate, All Ages, Valdez-Cordova and Alaska, 2000-2005

13.1 10.9 12.6 12.011.415.5 15.815.715.615.9 15.515.8

0

10

20

2000 2001 2002 2003 2004 2005

Rate


Figure 38: Percentage of Births by Race, All Ages, Valdez-Cordova, 2000-2005

72.0% 75.2% 71.4% 67.8%68.1% 65.4%

27.3%20.6%17.7%24.1% 18.2%

26.3%

7.8% 8.3% 9.8% 7.1% 7.9% 5.0%

0%10%20%30%40%50%60%70%80%

2000 2001 2002 2003 2004 2005

Perc

ent

White Alaska Native Other

Figure 39: Percentage of Births by Race, All Ages, Alaska, 2000-2005

63.0% 63.3% 62.7% 61.5%63.1% 63.1%

25.9%24.9%24.4%24.6% 24.1%24.9%

12.3% 12.0% 12.8% 12.3% 12.4% 12.6%

0%10%20%

30%40%50%60%70%80%

2000 2001 2002 2003 2004 2005

Perc

ent

White Alaska Native Other

Source: The Alaska Bureau of Vital Statistics, Birth Profiles by Census Area of Mother’s Residence, Valdez-Cordova Census Area and Alaska, 2007. Note: Due to rounding, percentages may not add up to 100. Rates based on fewer than 20 occurrences are statistically unreliable and should be used with caution while rated based on fewer than 10 occurrences are not reported.


BIRTH RATE: The number of live births per 1,000 population.

HEALTH ISSUES


Births (con’t) Figure 40: Babies Born at Providence Valdez Medical Center, 2004-2006

27

38 38

0

10

20

30

40

2004 2005 2006

Num

ber

Source: Hospital Quality Report for Valdez Community Hospital, 2006.

Data Summary From 2000 to 2005 Alaska’s birth rate was consistently higher than that of Valdez-Cordova. In 2005, Valdez had a birth rate of 12.0 births per 1,000 women while Alaska had a rate of 15.8 births per 1,000 women.

In Valdez-Cordova, the majority of births were consistently to White mothers (65%-75%) from 2000 to 2005. The percentage of births to Alaska Native varied between 18% and 27%. The percentage of births to women of other races was ten percent (10%) or less over the same time period. In 2005, 68% of all Valdez-Cordova births were to White women, 27% were to Alaska Native women and five percent (5%) were to women of other races.

Data for the state illustrate the same historical birth trends that were present in Valdez-Cordova from 2000 to 2005; in Alaska over half of all births were to White mothers every year while about a quarter was to Alaska Natives. However, the percentage of births to women of other race was slighter higher in the state than in Valdez-Cordova for all years but 2001.

HEALTH ISSUES


Teen Births Teenage girls face a greater risk of delivering low birth weight babies than women of any other age. Additionally, babies born to teens have a higher risk of infant mortality.33 Teen mothers are also less likely to complete high school and go on to college than women who delay childbirth. In fact, only one-third of teen mothers receive a high school diploma while only 1.5% attain a college degree by the age of 30. 34 As a partial consequence of the interruption in a mother’s education, babies born to teen mothers are more likely to live in poverty.35

Figure 41: Percentage of Births by Teen Mothers Ages 19 and Under, Valdez-Cordova and Alaska, 2000-2005

7.6% 7.1%

9.5%

6.6%

12.1%10.9%

10.0%10.5%10.5%11.7%

10.9%10.7%

0%

5%

10%

15%

2000 2001 2002 2003 2004 2005

Perc

ent


Source: The Alaska Bureau of Vital Statistics, Birth Profiles by Census Area of Mother’s Residence, Alaska and Valdez-Cordova Census Area, 2007.


Data Summary In 2000 the percentage of births to teen mothers was very similar in Valdez-Cordova and Alaska (12.1% and 11.7%, respectively). However, after 2000 the percentage of births to teens decreased more sharply in Valdez-Cordova than in Alaska. For instance, in 2005, the percentage of teen births in Valdez-Cordova was 7% while the percentage in Alaska was 10%.

Numerically, Valdez-Cordova had the most teenage births in 2001 (17) while Alaska experienced its high in 2000 (1,173). Both Valdez-Cordova and Alaska had the fewest teenage births in 2005 (8 and 1,051, respectively).

33 Public Health Services of San Joaquin County, Public Health Counts, 2002. 34 Alan Guttmacher Institute, Facts in Brief, Teen Sex and Pregnancy, retrieved July 28, 2004 from http://sss.agi-usa.org/pubs/fb_teen_sex.html. 35 Public Health Services of San Joaquin County, Public Health Counts, 2002.

n=8

n=12

n=8

n=10

n=17

n=14

n=1,

051

n=1,

085

n=1,

065

n=1,

083

n=1,

071

n=1,

173

HEALTH ISSUES


Low Birth Weight Babies Low birth weight babies are those born at less than 5.5 pounds. The most common reason for low birth weight is premature birth, although the mother’s age, ethnicity, health can also be a factor. Infants born at low birth weight are at greater risk for complications including infections, breathing problems, neurological problems and Sudden Infant Death Syndrome. 36

Figure 42: Percentage of Babies Born at Low Birth Weight (<5.5 pounds), All Ages, Valdez-Cordova and Alaska, 2000-2005

Source: The Alaska Bureau of Vital Statistics, Birth Profiles by Census Area of Mother’s Residence, Alaska and Valdez-Cordova Census Area, 2007.


Data Summary The percentage of low birth weight babies born in Alaska was fairly consistent (about 6%) from 2000 to 2005. In Valdez-Cordova, the percentage fluctuated from four percent (4%) in 2000, to a high of ten percent (10%) in 2001 and then to a low of three percent (3%) in 2005. The Healthy Alaskans 2010 Objective is to have no more than 4% of infants born at a low birth weight. As of 2005, the percentage for Alaska was two percent above the objective while in Valdez-Cordova the goal was surpassed by one percent. However, one must consider this value with caution since the number of births is so small that the percentage for Valdez-Cordova has historically been volatile.

36 Lucile Packard Children’s Hospital (2005). High-Risk Newborn: Low Birthweight. Retrieved February 28, 2005, from http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/hrnewborn/lbw.html.

Year

All Races White Alaska Native

Alaska Valdez-Cordova Alaska

Valdez-Cordova Alaska

Valdez Cordova

2000

Num. 559 4 305 3 141 0

% 5.6% 3.5% 4.8% 3.8% 5.8% 0.0%

2001

Num. 564 16 322 14 145 1

% 5.7% 10.4% 5.1% 13.9% 5.9% 2.4%

2002

Num. 577 7 316 6 142 1

% 5.8% 5.3% 5.1% 6.3% 5.9% 4.2%

2003

Num. 593 5 357 5 149 0

% 5.9% 4.5% 5.6% 6.0% 6.1% 0.0%

2004

Num. 617 11 355 5 157 4

% 6.0% 8.9% 5.5% 5.7% 6.1% 15.4%

2005

Num. 630 3 367 3 136 0

% 6.0% 2.5% 5.7% 3.7% 5.1% 0.0%

HEALTHY ALASKANS 2010 OBJECTIVE: No more than 4% of infants will be born at low birth weight.

HEALTH ISSUES


Mental Health Services Mental health problems include depression, anxiety disorders and psychotic disorders. Health professionals are often the first to discuss and diagnose mental health issues. Moreover, timely and appropriate treatment can sometimes shorten the duration of symptoms or lessen the impact of a mental health illness. However, access to quality mental health services is difficult for many people, especially those with low-incomes. Compared to physical health coverage, private insurance is generally more restrictive in coverage of mental health illness. Public insurance programs such as Medicare and Medicaid also have limited mental health coverage.37

Figure 43: Have you needed mental health treatment in the last 12 months?

16.1%

83.9%

0%

20%

40%

60%

80%

100%

Yes No

Perc

ent


Figure 44: If you needed mental health treatment in the last 12 months, were you able to receive it?

No

36.2%Yes

63.8%

N=47


37 The Office of the Surgeon General, Mental Health: A Report of the Surgeon General, 1997.

HEALTH ISSUES


Mental Health Services (con’t) Figure 45: If no, why couldn’t you receive it? (Mark all that apply with an “Other (Specify)” option)

9.1%

27.3%

27.3%

36.4%

0% 25% 50% 75% 100%

Didn't Know Where To Go

Confidentiality Issues*

Services Not Available

No Insurance/Couldn'tAfford It

Multiple response question with 11 respondents offering 11 responses. Source: Valdez Community Health Survey, 2007. * Those who wrote in an answer in the “Other (Specify)” category indicated “confidentiality issues.”

Data Summary Fifty individuals (50 or 16%) reported that they were in need of mental health treatment within the last 12 months. Forty-seven of these 50 or 94% answered the follow-up question regarding mental health services. Over a third (36% or 17 individuals) were unable to receive such services. Reasons offered by respondents as to why they were unable to receive these services ranged from no insurance or unable to afford it (36% or 4 individuals) and did not know where to go to receive help (9% or 1 individual) to services were unavailable (27% or 3 individuals). Another 27% (or 3 individuals) suggested confidentiality issues as a reason why they were unable to receive mental health treatment.

HEALTH ISSUES


Physical Health Overall good physical health is a combination of many factors. Regular exercise, a healthy diet and regular health screenings can all help maintain good physical health. These factors contribute to greater well-being and can improve residents’ quality of life.

Figure 46: Would you say that in general your physical health (including physical illness and injury) is:

55.8%

17.5%

38.3%31.7%

9.9%2.6%

0%

25%

50%

75%

100%

Excellent orVery Good

Excellent Very Good Good Fair Poor

Perc

ent


Data Summary In 2007, over half (56%) of Valdez respondents reported that their physical health was excellent or very good. While this was a majority, it did not meet the Health Alaskans 2010 Objective that 75% of Alaskans will report that their general health as excellent or very good. The 2007 Valdez percentage was also slightly below the 2006 state percentage (59%) according to BRFSS data. However, in 2007 Valdez had a slightly higher percentage of respondents reporting excellent or very good health than the nation did in 2006 (55%).38 Additionally, just under a third (32%) of Valdez respondents reported their health to be in good condition and 13% reported their health to be in fair to poor condition in 2007.

38 Alaska Department of Health and Social Services, Health Risks in Alaska Among Adults, May 2007.

HEALTHY ALASKANS 2010 OBJECTIVE: 75% of Alaskans will report that their general health is excellent or very good.

HEALTH ISSUES


Physical Activity – Adults According to the Centers for Disease Control and Prevention (CDC), “Regular physical activity substantially reduces the risk of dying of coronary heart disease…and decreases the risk for stroke, colon cancer, diabetes and high blood pressure. It also helps to control weight, contributes to healthy bones, muscles and joints, reduces falls among older adults, helps to relieve the pain of arthritis, reduces symptoms of anxiety and depression and is associated with fewer hospitalizations, physician visits and medications.”39

Figure 47: How many days per week do you engage in physical activity (such as brisk walking or gardening) for a combined total of 30 minutes or more?

6.6%

29.5%33.4%

30.5%

0%

20%

40%

60%

None 1-2 Days 3-4 Days 5 or More Days

Perc

ent


Data Summary Thirty-one percent (31%) of the respondents to the Valdez Community Health Survey reported engaging in five or more days per week of physical activity. A third (33%) engaged in physical activity three to four days a week and 30% one to two days per week. Only seven percent (7%) of respondents reported engaging in no physical activity.

In 2006, residents in the Municipality of Anchorage, Alaska were asked about physical activity in a telephone survey. According to this 2006 data, a greater percentage of Anchorage respondents were inactive (9%) compared to Valdez respondents in 2007 (7%). However, a greater percentage of Anchorage respondents (47%) reported engaging in physical activity five or more times a week than Valdez respondents (31%).40

39 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Nutrition and Physical Activity, The Importance of Physical Activity, 2004. 40 Applied Survey Research, Anchorage Community Assessment Project, Telephone Survey, 2006.

2006 ANCHORAGE DATA: None: 8.7%

1-2 Days: 13.8%

3-4 Days: 30.9%

5 or More Days: 46.5%

N=398

HEALTH ISSUES


Tobacco Use Cigarette smoking is the most preventable cause of disease and death in the United States.41 Lung cancer is the most frequent cause of cancer deaths. Smoking is a huge risk factor in lung cancer and chronic lung diseases such as emphysema, heart disease and stroke. People who are exposed to environmental tobacco smoke are also more likely to develop heart disease and chronic lung diseases. Quitting smoking can improve overall health and reduce the risk of developing chronic diseases. 42

Figure 48: Do you now smoke cigarettes or use smokeless tobacco?

8.1%12.8%

79.2%

0%

50%

100%

Perc

ent

Smoke Every Day Smoke Some Days Do Not Smoke


Figure 49: Any Cigarette Use, Valdez Junior High and High School Students, 1995-2005

67.6%55.4%

27.1%30.9%39.3%44.9% 46.0% 54.3%

0%

50%

100%

1995 1999 2003 2005

Perc

ent

Valdez Junior High School Students Valdez High School Students U.S. High School Students

Source: Youth Risk Behavior Survey, 2005. Note: Valdez high school data is not available for 1999. Numbers of respondents are unknown.

New data unavailable.

Figure 50: Respondents’ Average Age of First Tobacco Use, Valdez Junior High and High School Students, 2006-2007

12.9 11.9 13.1 13.6 12.012.312.2Male

13.2Female

0

10

20

7th-12th Graders Males and Females, 7th-12th Graders

Year

s

7th Graders 8th Graders 9th Graders 10th Graders 11th Graders 12th Graders

Students grades 7-12: N =67; Males: N=31; Females: N=36. Source: The American Drug and Alcohol Survey, 2007.

41 Great Valley Center, The State of the Great Central Valley of California: Supporting the Economic, Social and Environmental Well-being of California’s Great Central Valley, 2003. 42 American Lung Association. Facts about Lung Cancer. Retrieved May 6, 2005, from http://www.lungusa.org.

HEALTHY ALASKANS 2010 OBJECTIVE: No more than 14% of adults ages 18 years and older will smoke cigarettes.

N=298

2006 BRFSS U.S. DATA: 32.6% smoke every day;

12.0% smoke some days.

HEALTH ISSUES


Tobacco Use (con’t) Figure 51: Past 30-Day Tobacco Use by Respondents, Valdez Junior High and High School Students, 2002-2003 & 2006-2007

2%

15%9%

20% 20%

6%

22%26%

22%17%

7%5%

0%

25%

50%

75%

100%

2002-2003 2006-2007

Perc

ent


2006-2007 students grades 7-12: N=242; N’s unavailable for 2002-2003 Source: The American Drug and Alcohol Survey, 2007.

Data Summary The majority of Valdez respondents did not smoke (79%). Thirteen percent (13%) of respondents smoked every day while eight percent (8%) smoked sometimes. The Healthy Alaskans 2010 Objective is to reduce the percentage of adults who smoke cigarettes to 14%. Valdez, at 21%, did not meet this goal. According to 2006 BRFSS data, 32.6% of U.S. respondents smoked every day while 12.0% smoked some days.43

Large percentages of Valdez junior high and high school students have tried smoking cigarettes. However, this percentage has been decreasing. The percentage of those who have ever tried smoking decreased among junior high school students from 45% in 1995 to 27% in 2005. Among high school students, the decrease was from 68% to 46% during the same time period. The national percentage for high school students was 54% in 2005.44

Among Valdez junior high and high school students, the average age of first tobacco use was between 12 and 14 years of age. The 2006-2007 data revealed that males, on average, had their first experience with tobacco at age 12 while for females, this occurred at age 13.

The number of 7th, 8th and 12th graders who reported smoking within the last 30 days decreased from 2002-2003 to 2006-2007. The only students who reported an increase in their 30-day tobacco use in 2006-2007 were 10th graders, who increased from 6% to 22%. In 2006-2007 both 9th and 12th graders met the Healthy Alaskans 2010 Objective that no more than 20% of high school students would have used tobacco in the last 30 days. Tenth and 11th graders were slightly above the goal at 22% each.

43 Behavioral Risk Factor Surveillance System, Codebook Report, 2006. 44 Centers for Disease Control and Prevention, Department of Health and Human Services, Youth Risk Behavior Surveillance—United States, 2005, 2006.

HEALTHY ALASKANS 2010 OBJECTIVE: No more than 20% of adolescents (grades 9-12) will have used any tobacco products in the 30 days prior to the survey.

HEALTH ISSUES


Alcohol Consumption In the United States, moderate drinking is usually defined as no more than two drinks per day for men and no more than one drink per day for women. Some research suggests that moderate drinking may be beneficial for the heart and circulatory system and may protect against type 2 diabetes. However, heavy drinking, often called binge drinking, which is defined as having five or more drinks on one occasion, is detrimental to health and is a major cause of preventable death in the nation. Binge drinking can damage the liver and heart and increase the chances of developing some cancers.45

Figure 52: Considering all types of alcoholic beverages, during the past 30 days about how many times did you have more than 5 drinks on one occasion? (Fill in the blank)

78.4%

1.4% 1.4%7.8% 3.5% 4.2% 3.4%

0%

25%

50%

75%

100%

Never 1 Time 2 Times 3 Times 4 Times 5 Times More than5 Times

Perc

ent


Figure 53: Had Five or More Drinks Within a Couple of Hours in the Past 30 Days, High School Students, 1995-2005

36.2%31.9%23.3% 25.5%

0%

50%

100%

1995 2003 2005

Perc

ent

Valdez High School Students U.S. High School Students

N’s are unknown Source: Youth Risk Behavior Survey, 2005.


45 Harvard School of Public Health, Nutrition Source: Alcohol, 2003.

HEALTHY ALASKANS 2010 OBJECTIVE: No more than 13% of adults ages 18 years and older will engage in binge drinking.

HEALTHY ALASKANS 2010 OBJECTIVE: No more than 30% of adolescents (grades 9-12) will engage in binge drinking 30 days prior to the survey.

HEALTH ISSUES


Alcohol Consumption (con’t) Figure 54: Past 30-Day Alcohol Use, Valdez City School District, 2006-2007

44%46%

8%

15%

30% Male

31%Female

38% 38%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


Perc

ent


Students grades 7-12: N=247; males: N=112; females: N=135 Source: The American Drug and Alcohol Survey, 2007.

Figure 55: Ever Used Alcohol, Valdez Junior High and High School Students, 1995-2005

34.7%

79.5%68.0% 67.2%

34.2%40.2%59.2%

74.3%

0%

25%

50%

75%

100%

1995 1999 2003 2005

Perc

ent


N’s are unknown. Source: Youth Risk Behavior Survey, 2005. Note: High school data is not available for 1999.


HEALTH ISSUES


Alcohol Consumption (con’t) Figure 56: Student Respondents’ Average Age of First Alcohol Use, Valdez City Junior High and High School Students, 2006-2007

11.7 11.113.0 13.3 14.3

10.2

12.4

Male

12.6

Female

0

5

10

15

20


Year

s



Data Summary The large majority (78%) of Valdez adults reported that they did not engage in binge drinking while 22% of adults had at least once in the 30 days prior to the 2007 survey. The Healthy Alaskans 2010 Objective is that no more than 13% of adults will binge drink. According to the data from the Valdez Community Health Survey, this goal has not been met. In comparison, in 2006, 17% of Alaskan adults and 15% of adults in the U.S. engaged in binge drinking.46

Among Valdez high school students, the percentage who engaged in binge drinking in the past 30 days decreased from 36% in 1995 to 32% in 2005. This 2005 binge drinking percentage is over the Healthy Alaskan 2010 Objective of 30%. The national high school percentage for the same year was 26%.47

Approximately one third of all respondents (7th-12th grade) in Valdez City Schools reported drinking within the last 30 days in 2006-2007 (30% of males and 31% of females). Tenth (10th) graders reported drinking the most (46%), followed by 9th, 11th and 12th graders (44%, 38% and 38%, respectively).

The percentage of Valdez students that have ever used alcohol decreased from 1995 to 2005. For junior high students, this percentage decreased from 59% to 34%; a net change of 25. For high school students, this percentage decreased from 80% to 67%; a net change of 13. In 2005, the percentage of U.S. high school students who had ever used alcohol was higher than Valdez at 74%.48

In 2006-2007, 12th graders reported an average age of first use of 14 years. Students in all lower grades reported earlier use. When comparing males to females (grades 7 to 12), the average age of first use for males was two months younger than for females (12.4 years and 12.6 years). The 2010 Healthy Alaskans Objective is to increase the average age of first use for high school students to 16.1 years. According to the 2006-2007 data, even the Valdez high school students with the oldest age of first use were about two years below this goal. 46 Alaska Department of Health and Social Services, Health Risks in Alaska Among Adults, May 2007. 47 Centers for Disease Control and Prevention, Department of Health and Human Services, Youth Risk Behavior Surveillance—United States, 2005, 2006. 48 Ibid.

HEALTHY ALASKANS 2010 OBJECTIVE: Increase the average age of first use of alcohol among adolescents grades 9-12 to 16.1 years.

HEALTH ISSUES


Youth Marijuana Use Figure 57: Ever Used Marijuana, Valdez Junior High School Students, 1995-2005

20.0%11.1%

18.7% 18.7%

0%

25%

50%

75%

100%

1995 1999 2003 2005

Perc

ent

Source: Youth Risk Behavior Survey, 2005. Note: N’s are unknown.


Figure 58: Ever Used Marijuana, Valdez High School Students, 1995-2005

47.5%38.8%45.0%

37.5%48.4%

38.4%40.2%

0%

25%

50%

75%

100%

1995 2003 2005

Perc

ent

Valdez High School Students Alaska High School Students U.S. High School Students

Source: Youth Risk Behavior Survey, 2005. Note: Valdez high school data is not available for 1999. State data is unavailable for 2005. U.S. unavailable for 1995. N’s are unknown.


Figure 59: Past 30-Day Marijuana Use, Valdez Junior High and High School Students, 2006-2007

18%

27%

0%

9%

22% Male 15%

Female

28%32%

0%

25%

50%


Perc

ent



HEALTH ISSUES


Youth Marijuana Use (con’t) Figure 60: Student Respondents’ Average Age of First Marijuana Use, Valdez Junior High and High School Students, 2006-2007

11.712.8 13.5 13.7

14.913.0

13.7Male

13.6Female

0

5

10

15

20


Year

s



Data Summary The percentage of students who had ever used marijuana decreased from 1995 to 2005. In 1995, the percentages of junior high and high school students who used marijuana were 20% and 45%, respectively. In 2005, these percentages dropped to 19% and 39%, respectively. In 2005, 38% of U.S. high school students had tried marijuana.49

In 2006-2007, 22% of males in grades 7 to 12 and 15% of females of the same grade had used marijuana at least once within the last 30 days. The percentage of 30-day use increases with age; 12th graders used marijuana the most (32%) while 7th graders reported zero marijuana use.

In 2006-2007, the average age of first time marijuana use ranged from 11 to 15 years of age. Both males and females had their first experience slightly before age 14 on average. Adolescents in grades 9-12 had an average age of first use that ranged from 12.8 for 9th graders to 14.9 years for 12th graders. Tenth and 11th graders reported first using marijuana around age 13 and a half. The Healthy Alaskans 2010 Objective is to increase the average age of first use to 17.4 years for high school students. According to the 2006-2007 data, this goal has not been met.

49 Centers for Disease Control and Prevention, Department of Health and Human Services, Youth Risk Behavior Surveillance—United States, 2005, 2006.

HEALTHY ALASKANS 2010 OBJECTIVE: Increase the average age of first use of marijuana among adolescents (grades 9-12) to 17.4 years.

HEALTH ISSUES


Youth Perception of Harm and Parental Approval of Tobacco, Alcohol and Drug Use Figure 61: Percent of Student Respondents Who Said Regular Tobacco Use Causes “Some Harm” or “A Lot of Harm,” Valdez Junior High and High School Students, 2006-2007

89% 93% 90%97% 93%91%

85%93%

0%

25%

50%

75%

100%


Perc

ent



Figure 62: Percent of Student Respondents Who Said Their Parents Would Care “Some” or “A Lot” if They Used Tobacco, Valdez City Schools, 2006-2007

94% 96% 97% 97%96%

88%88% 88%

0%

25%

50%

75%

100%


Perc

ent



HEALTH ISSUES


Youth Perception of Harm and Parental Approval of Tobacco, Alcohol and Drug Use (con’t) Figure 63: Percent of Student Respondents Who Said Regular Alcohol Use Causes “Some Harm” or “A Lot of Harm,” Valdez Junior High and High School Students, 2006-2007

89% 88%89% 79%Male

91%92%

Female

79% 79%

0%

25%

50%

75%

100%


Perc

ent



Figure 64: Percent of Student Respondents Who Said Their Parents Would Care “Some” or “A Lot” if They Used Alcohol, Valdez City Schools, 2006-2007

85% 84% 84%

68% 65%

96%77%Male

85%Female

0%

25%

50%

75%

100%


Perc

ent



HEALTH ISSUES


Youth Perception of Harm and Parental Approval of Tobacco, Alcohol and Drug Use (con’t) Figure 65: Percent of Student Respondents Who Said Regular Marijuana Use Causes “Some Harm” or “A Lot of Harm,” Valdez Junior High and High School Students, 2006-2007

89% 92% 88%

73%68%

98%

78%Male

91%Female

0%

25%

50%

75%

100%


Perc

ent



Figure 66: Percent of Student Respondents Who Said Their Parents Would Care “Some” or “A Lot” if They Used Marijuana, Valdez City Schools, 2006-2007

94% 96% 100%88%

72%

98%85%Male

97%Female

0%

25%

50%

75%

100%


Perc

ent


Students grades 7-12: N=240; males: N=108; female: N=132 Source: The American Drug and Alcohol Survey, 2007.

HEALTH ISSUES


Youth Perception of Harm and Parental Approval of Tobacco, Alcohol and Drug Use (con’t) Data Summary During the 2006-2007 school year, the majority of Valdez students surveyed believed that regular use of tobacco causes ‘some’ or ‘a lot of harm’ (between 85% and 97%) This perception was greatest among 10th grade students (97%). A greater percentage of females than males felt that tobacco was harmful (93% and 90% respectively). The majority of student respondents also believed that their parents would care ‘some’ or ‘a lot’ if they were using tobacco, ranging from 88% to 97%. Once again 10th grade students reported the highest percentage (97%). The difference between genders was even greater for this question; 97% of females said their parents would care ‘some’ or ‘a lot’ if they used tobacco compared to 88% of males.

The percentages were slightly lower for student beliefs concerning the harm of alcohol use. Seventy-nine (79%) to 91% of student respondents believed that alcohol use was harmful in 2006-2007. The range was wider among students who believed that their parents would care if they were using alcohol. Ninety-six percent (96%) of 7th graders believed that their parents would care. This percentage decreased consistently with age—65% of 12th graders reported that their parents would care if they used alcohol. Again, females felt their parents would care more than males (85% and 77%, respectively).

The data show that the belief that marijuana is harmful was held less among older students than among younger students in 2006-2007. Ninety-eight percent (98%) of 7th graders believed that regular marijuana use causes harm while only 68% of 12th graders reported having the same view. Females reported a much higher percentage of this belief than males; 91% in comparison to 78%. When asked whether or not they believe that their parents would care if they use marijuana, 100% of 10th graders said they would care ‘a lot’ or ‘some.’ Virtually all 7th and 9th graders responded the same (98% and 96%). Twelfth graders thought their parents would care the least (72%). Once again, the percentage was higher among females than males (97% in comparison to 85%).

HEALTH ISSUES


Unintentional Injury Unintentional injuries are injuries that can be classified as accidents. They may result from car accidents, falls and unintentional poisonings, among others. In many cases, these types of injuries—and the deaths resulting from them—are preventable.

Figure 67: Unintentional Injury, Number of Deaths, Valdez-Cordova, 2000-2005

Cause of Death 2000-2002 2003-2005

Motor vehicle accidents 9 7 Poisoning 3 1 Drowning and submersion 1 2 Falls 1 -- Water transport accidents 2 1 Suffocation and choking 1 -- All other unintentional causes 2 6 Total deaths 19 17

Population Data 2002 2005

Valdez-Cordova Census Area 9,979 9,923

Figure 68: Unintentional Injury, Number of Deaths, Alaska, 2000-2005

Cause of Death 2000-2002 2003-2005

Motor vehicle accidents 342 328 Poisoning 206 213 Drowning and submersion 76 74 Falls 54 -- Water transport accidents 44 56 Suffocation and choking 48 -- All other unintentional causes 263 277 Total deaths 1033 948

Population Data 2002 2005

Alaska 640,544 663,253 Source: The Alaska Bureau of Vital Statistics, Unintentional Injury Deaths for Valdez-Cordova, 2007. Note: -- signifies that this specific cause of death was not listed for the year range but may be included in the “All other unintentional causes” total. Population data is from the U.S. Census Bureau and is from July 1st of each year.

No new data available.

Data Summary In both Valdez and Alaska, the highest numbers of unintentional deaths each year were caused by motor vehicle accidents (7-9 deaths in Valdez and 342-328 deaths in Alaska). Poisoning, while contributing to far fewer deaths (1-3 in Valdez and 206-213 in Alaska), was also one of the top reasons for accidental death.

HEALTH ISSUES


Suicide Suicide is intentional self-harm resulting in death. Suicidal actions are often indicative of serious mental health problems and may signal other traumatic issues such as social isolation, discrimination and physical or substance abuse.

Figure 69: Suicides, Valdez-Cordova and Alaska, 1999-2004

Total population N’s unavailable. Source: The Alaska Bureau of Vital Statistics, Health Profiles for Valdez-Cordova, Alaska and the U.S., 2007.


Figure 70: Suicidal Thoughts, Plans and Attempts Among Student Respondents, Valdez City Junior High and High School Students, 2005

16.8%11.8%

8.4%

14.0% 12.6% 10.7%

16.9%13.0%

8.4%

0%

25%

Seriously Thought About Suicide Made a Plan Attempted Suicide

Perc

ent


N’s are unknown Source: Youth Risk Behavior Survey, 2005. Note: YRBS was not conducted at the Alaska state level in 2005. Please note that percentages may be misleading as the number of respondents may be very small.


6

10

7

0

5

10

1999-2001 2002-2004

Num

ber

All Suicides Teen Suicides

410

57 55

334

0

100

200

300

400

500

1999-2001 2002-2004

Num

ber

All Alaska Suicides All Alaska Teen Suicides


HEALTH ISSUES


Suicide (con’t) Data Summary In both Valdez and Alaska, teens comprise a small minority of the population who has committed suicide. In 2005, 17% of junior high school students seriously thought about suicide and 12% made a plan to commit suicide. Eight percent (8%) attempted suicide. With regards to high school students, 14% seriously thought about suicide, 13% made a plan and 11% attempted suicide.

During the same year, 17% of U.S. high school students had seriously thought about suicide. Thirteen percent (13%) made a suicide plan and 8% actually attempted suicide.50

Please note that Valdez percentages should be used with caution as the number of respondents may be very small.

50 Centers for Disease Control and Prevention, Department of Health and Human Services, Youth Risk Behavior Surveillance—United States, 2005, 2006.

HEALTH ISSUES


Leading Causes of Death Examining causes of death can provide a great deal of information about the health of the community. By knowing the common causes of death of residents, attention can be paid to the conditions that have the highest mortality rates.

Figure 71: Top Five Leading Causes of Death, Valdez-Cordova, 1999-2001

All Races Rank Deaths Alaska Rank

Malignant Neoplasms (Cancer) 1 42 1 Diseases of the Heart 2 28 2 Unintentional Injuries 3 23 3 Diabetes 4 10 7 Intentional Self-Harm 5 7 6

Total Deaths = 149

Caucasians Rank Deaths Alaska Rank

Malignant Neoplasms (Cancer) 1 32 1

Diseases of the Heart 2 20 2

Unintentional Injuries 3 16 3

Diabetes 4 10 7

Intentional Self-Harm 5 6 5

Chronic Lower Respiratory Diseases 5 6 6

Total Deaths = 114

Alaska Native Rank Deaths Alaska Rank




Cerebrovascular Diseases (Stroke) 4 4 5

(no 5th cause listed) -- --

Total Deaths = 33 Total population N’s unavailable Source: The Alaska Bureau of Vital Statistics, Top Five Leading Causes of Death for Valdez-Cordova, 1999-2001 and 2002-2004, 2007.


HEALTH ISSUES


Leading Causes of Death (con’t) Figure 72: Top Five Leading Causes of Death, Valdez-Cordova, 2002-2004

All Races Rank Deaths Alaska Rank

Malignant Neoplasms (Cancer) 1 42 1 Diseases of the Heart 2 30 2 Unintentional Injuries 3 12 3 Diabetes 4 9 7 Cerebrovascular Diseases (Stroke) 5 8 4 Chronic Lower Respiratory Diseases 5 8 5

Total Deaths = 142

Caucasians Rank Deaths Alaska Rank

Malignant Neoplasms(Cancer) 1 27 1



Cerebrovascular Diseases (Stroke) 4 6 4

Chronic Lower Respiratory Diseases 5 5 5

Total Deaths = 92

Alaska Native Rank Deaths Alaska Rank


Chronic Liver Disease and Cirrhosis 2 6 8

Diabetes 3 5 10



(no 5th cause listed) 5 --

Total Deaths = 46 Total population N’s unavailable Source: The Alaska Bureau of Vital Statistics, Top Five Leading Causes of Death for Valdez-Cordova, 2007.


Data Summary From 1999-2001 to 2002-2005 the leading causes of death, categorically, did not change. Cancer was the leading cause with diseases of the heart and unintentional injuries contributing to the next highest number of deaths. In Valdez-Cordova, cancer was also the top cause of death among Native Alaskans and Caucasians. However, in 2002-2004, chronic liver disease and cirrhosis was the second ranked cause of death for Alaskan Natives. This was a cause that did not rank among the top five causes of death previously for any race, neither was it a major cause of death for other races in 2002-2004.

HEALTH ISSUES


Deaths Due to Cancer While cancer was rarely seen in Alaska in the 1950’s, it was the state’s leading cause of death by the 1990’s. Cancer is still among the leading cause of death for Valdez residents. Additionally, cancer can be financially burdensome to the individual (breast cancer treatments can cost an average of $40,000 in Alaska), thus damaging their personal economic stability. 51

Figure 73: Deaths Due to Cancer, Valdez-Cordova and Alaska, 2000-2005

Cause of Death


2000-2002 2003-2005 2000-2002 2003-2005

All cancer 166 148 8,944 9,384 Trachea, bronchus and lung 17 11 599 653 All other and unspecified cancers 5 7 245 289 Colon, rectum and anus 3 4 211 184 Prostate 4 3 101 86 Lymphoid and hematopoietic 4 3 200 199

Leukemia 2 2 67 80

Breast 3 1 153 143

Non-Hodgkin’s lymphoma 2 1 85 71

Pancreas 1 1 113 115

Liver and intrahepatic bile ducts 0 0 71 88

Total population N’s unavailable Source: The Alaska Bureau of Vital Statistics, Cancer Deaths for Valdez-Cordova Census Area, 2007.

Data Summary In both Valdez-Cordova and Alaska and in both 2000-2002 and 2003-2005, trachea, bronchus and lung cancer were the most prevalent types of cancer causing death. Lymphoid and hematopoietic, breast and prostate cancers were also prevalent.

51 Alaska Department of Health and Social Services, Division of Public Health, Healthy Alaskans 2010, Volume 1: Targets for Improved Health, Chapter 22, 2002.

HEALTH ISSUES


People with Disabilities Obtaining and maintaining health insurance coverage and quality healthcare is a critical issue for everyone in the United States, but people with disabilities face additional barriers to receiving adequate healthcare. These barriers can range from physically inaccessible healthcare provider locations, to exam and diagnostic equipment that cannot be adjusted for a range of patient function, to a failure to modify office policies or practices to accommodate the communication and accommodation needs of patients with various disabilities.52

Figure 74: People with Disabilities1, City of Valdez, 2000

Valdez Males Females Both Sexes

With a disability ages 5 to 15 31 9 40



With a disability ages 65 and over 24 27 51

With a disability ages 5 and over 195 153 348

Total population ages 5 and over 1,914 1,798 3,712

Percent of population ages 5 and over with a disability 10.2% 8.5% 9.4%

Alaska Males Females Both Sexes

Percent of population ages 5 and over with a disability 15.8% 14.1% 14.9%

United States Males Females Both Sexes

Percent of population ages 5 and over with a disability 19.6% 19.1% 19.3% Source: U.S. Census Bureau, American FactFinder: Detailed Tables, Sex by Age by Types of Disability for the Civilian Non-institutionalized Population 5 years and Over, Valdez City, Alaska, 2007.

New data unavailable. 1 In the 2000 Census, individuals were classified as having a disability if any of the following three conditions was true: they were five years old and over and reported a long-lasting sensory, physical, mental or self-care disability; they were 16 years old and over and reported difficulty going outside the home because of a physical, mental, or emotional condition lasting six months or more; or they were 16 to 64 years old and reported difficulty working at a job or business because of a physical, mental, or emotional condition lasting six months or more. Note: Disability status was not tabulated for persons in institutions, people in the Armed Forces, and people under 5 years old. The percentage shown is calculated by dividing the number of persons with a disability by the number of civilian non-institutionalized persons 5 years old and over.

52 Disability Rights Education & Defense Fund (2007). Disability Healthcare Access Brief. Retrieved August 24, 2007, from http://www.dredf.org/healthcare/Access_Brief.pdf.

HEALTH ISSUES


People with Disabilities (con’t)

Data Summary In 2000, nine percent (9%) of Valdez residents of both sexes ages five and over had a disability. This compares to 15% of Alaskans and 19% of people in the U.S. with a disability. In Valdez, there were more males with a disability overall (10% or 195 males compared to 9% or 153 females) and in every age category except 65 and over. For individuals ages 65 and over, there were 27 females and 24 males with a disability.

PERCEPTION OF GREATEST HEALTH CARE NEED IN VALDEZ


Providence Valdez Medical Center – Hospital Data Figure 75: Providence Valdez Medical Center Statistics

Dimension 2004 2005 2006

Percent Change

04-06

Number of acute days (includes acute, OB and swing) 1,148* 765 1,015 -1

Number of patients who presented at the hospital 7,848 8,612 8,483 8.1%

Number of hours worked by visiting nurses 12,573 12,246 7,519 -40.2%

Number of patients visiting the emergency room 1,468 1,635 1,487 1.3% Number of patients admitted to the hospital after presenting at the emergency room 50 53 52 4.0%

Source: Providence Valdez Medical Center, PVMC Statistics, 2007. *This number was high in 2004 because there was no nursing home at the time A percent change has not been calculated since the addition of a nursing home after 2004 makes data incomparable.

Data Summary From 2004 to 2006 the number of patients presenting at the center increased by 8% from 7,848 to 8,483. The number of hours worked by visiting nurses decreased by 40%, dropping from 12,573 in 2004 to 7,519 in 2006. The number of patients who visited the emergency room and the number of patients admitted after presenting at the emergency room increased slightly during the same time period. In 2006 three percent (3%) of those who visited the emergency room were admitted to the hospital.



Perception of Greatest Health Care Need in Valdez



Greatest Health Care Need Respondents of all three Valdez surveys were asked what they considered to be the greatest health care need in their immediate community.

Valdez Community Health Survey

Figure 76: What do you consider to be the greatest health care need in Valdez? (Fill in the blank/“please explain”)

Responses Frequency Percent

More Specialist/Specialty Care 29 19.5%

More Doctors 26 17.4%

Lower Costs/Financial Assistance for Patients 16 10.7%

Pediatric Care/Pediatricians 16 10.7%

OBGYN/Female Health Care 12 8.1%

Vision Care 11 7.4%

Diagnostic Equipment (MRI, X-Ray) 10 6.7%

More Specialized Dental Care 9 6.0%

Elderly Care/Assisted Living 8 5.4%

Substance Use Rehab/Counseling 6 4.0%

Long-Term Care 6 4.0%

Mental Health Services/Counseling 5 3.4%

Surgical Care/Surgeons 4 2.7%

Uninsured Patients 4 2.7%

Privacy 4 2.7%

Additional Training for Health Care Workers 4 2.7%

Emergency Care 3 2.0%

Hospice Care 2 1.3%

Other 14 9.4% Multiple response open-ended question with 149 respondents offering 189 responses. Source: Valdez Community Health Survey, 2007. Note: 162 respondents left this question blank.



Greatest Health Care Need (con’t) Valdez Physician, Health Provider and Business Survey

What do you consider to be the greatest health care need in Valdez? (Fill in the blank/“please explain”)

Physicians (N=3):

One or two additional family doctors.

Expanded general practice so that a variety of services are consistently available—An anesthesiologist needs to be on hand so that doctors can provide consistent quality care and perform surgeries.

Valdez’s small population cannot support full-time specialists so referral care is complicated and often requires patients to travel several hours to Anchorage for treatment. To improve referral care, health care providers need to coordinate well to minimize the time and cost of outside care.

The hospital should prioritize retaining and properly training its staff.

Other Providers (N=6):

A large portion of the community is uninsured. (2 respondents)

Specialty clinic for community.

Health care providers, both those from Valdez and visiting professionals, need to work together to provide a fuller range of health care services.

The aging population of Valdez requires quality geriatric care.

People with disabilities need more health care support and greater financial assistance for medical procedures.

Expanded treatment for substance abuse.

Immigrant workers are underserved because of low-income levels and lack of insurance.

Business People (N=14):

General care such as immunizations, physicals and regular check-ups. (5 respondents)

Emergency care—the ability to handle large-scale emergencies. (4 respondents)

Elderly care. (2 respondents)

Screens for cancer—i.e. mammograms. (2 respondents)

More medical practitioners.

In-home care for patients restricted to their homes.

Counseling services for all ages.

Chronic disease management.

A large portion of the community is uninsured.



Greatest Health Care Need (con’t) Data Summary All three Valdez surveys included a question regarding health care needs in Valdez. The question was open-ended and thus required respondents to produce a written or oral response to the question, “What do you consider to be the greatest health care need in Valdez?” Please note that the question could be interpreted in multiple ways.

Community members who wrote in a response to this open-ended question believed the greatest local health care need was a need for more specialists and specialty care as well as more doctors (20% and 17%, respectively). Lower costs/financial assistance for patients was another top response to the question (11%).

Similarly, the three Physicians surveyed in the Valdez Provider Survey were most concerned about the need for additional general and specialty practitioners. One Physician stated that all Valdez health care providers need to coordinate to minimize the patients’ difficulty when they are receiving specialty care outside of Valdez. One Physician indicated that hospital staff training should be a priority.

Other Providers also highlighted the need for additional specialists. The need for providers to coordinate between themselves was reiterated. Additionally, Other Providers noted that the elderly, people with disabilities, people with substance abuse problems, the poor and the uninsured were all populations that need greater medical support.

In contrast to the respondents of the Valdez Community Health Survey and the Provider Survey, members of the business community felt the greatest need was general care (5 respondents) and emergency care (4 respondents). One business person identified a lack of providers as the greatest health care need.

Overall, all groups surveyed identified a need for specialty care. The need for elderly care and the problem of uninsured patients were identified by respondents of the Valdez Community Health Survey, business people and Other Providers. The ability to respond to emergencies well was identified as one of the greatest health care needs in Valdez by both community and business members.

VALDEZ PROVIDER AND BUSINESS SURVEY COMPARISON QUESTIONS


Valdez Health Provider and Business Survey Comparison Questions



What Could Providers Do Differently Is there anything that health providers could be doing differently to improve

health care in Valdez? (Fill in the blank/“please explain”)

Physicians (N=3):

Everything is dependent on time and resources; at any particular moment in time you could answer this question differently. At this moment, we need to put extra effort into recruiting additional full-time providers.

Of course, there are always a million things providers want to improve upon. If there were more providers, we would have more time to spend on improvements; we are always trying to improve.

Providers are doing as much as we possibly can at the moment given staffing, time and financial constraints.


Providers should collaborate more by sharing information, resources, concerns and support. We could provide a better quality of service with a high level of coordination and communication. (2 responses)

No, there is nothing providers could be doing differently. (2 respondents)

We need to focus on the dental care in our community.

We should create a way for people without insurance to receive immediate emergency care for a low flat fee.

There could be more community outreach on the part of providers.

More traveling specialists could be brought in—i.e. an internal medicine professional.


No, there is nothing providers could be doing differently. (10 respondents)

Decrease waiting lists and reduce provider overload by hiring more providers. (3 respondents)

Bring in a surgeon so that the need for Medi-Vac is decreased.

Providers could try to advertise their services more so that the entire community understands all of the health care that is provided in Valdez.

Data Summary All respondent groups mentioned that health care in Valdez could be improved by having more health providers. Other Providers reported that health providers could focus on collaboration, dental care, community outreach and serving the uninsured. The majority of business people (10) said that there was nothing providers needed to do to improve health care.



Providence Valdez Medical Center Greatest Strengths and Improvements

Thinking about the hospital, what are the areas of greatest strength? (Fill in the blank/“please explain”)

Physicians (N=3):

Knowing patients and integrating their care with the rest of their lives.

High level of generalism—all Valdez staff is familiar with a wide range of medical issues.

Individualized care.

Modern facility.

Caring nurses and doctors.

Effective administrator and assistant administrator.


The quality of hospital employees—attentive staff who have expanded their services and listened to the public. (4 respondents)

The long-term care. (3 respondents)

The physical structure. (2 respondents)

The rehabilitation and physical therapy department—revenue generators and allow patients to stay at home instead of going outside of Valdez for care.

The different departments seem to work well together.


Professional, friendly and knowledgeable staff. (6 respondents)

The close working relationship between the community and hospital. (3 respondents)

Physical therapy department. (2 respondents)

Dedication of hospital staff. (2 respondents)

The new facility. (2 respondents)

Senior facility.

CAT scan machine.

On-call 24-hours a day.

Medi-Vac service.

Accessibility.

Sonogram.

Association with the Anchorage Medical Center.

Birthing Center.



Providence Valdez Medical Center Greatest Strengths and Improvements (con’t) Figure 77: Thinking about the hospital, what are the areas that need the most improvement? (Fill in the blank/“please explain”)

Physicians (N=3):

Minimize staffing changes.

Train and retrain staff to make up for the fact that the population cannot support more specialists—make them generalists.

Increase overall feeling of trust and respect among providers and between the community and health care providers.

Hire more family practice doctors and nurses so that the workload for providers is more manageable.


Coordination of providers needs to be heightened. All providers, including nurses, visiting specialists and local doctors, should work together so that no one feels that their patients are being taken away by another professional. The focus would be on keeping people healthy.

The hospital needs to hire more staff—nurses, physical therapists, X-ray technicians, counselors etc. (2 respondents)

Purchase up-to-date equipment so that diagnostic needs that are currently met in Anchorage could be met locally.

The hospital should make sure that there is consistency in its leadership and nursing staff.

The hospital should provide health care to those without insurance.


More health providers. (6 respondents)

More full-time employees so that the number of visiting professionals decreases.

Purchase a MRI machine.

Hire a surgeon who could perform emergency procedures.

Expand type of services offered if possible.

The Valdez Medical Clinic should increase health insurance acceptance.

Strengthen counseling services.



Providence Valdez Medical Center Greatest Strengths and Improvements (con’t) Data Summary All respondent groups identified the quality of medical staff and the new facility as strengths of the Providence Valdez Medical Center. Other Providers noted that they felt the rehabilitation and physical therapy departments were particularly strong although all departments work well together in their opinion. Members of the business community also felt very positively about the physical therapy department while adding that they felt the senior care facility and the birthing center were also strengths of the hospital.

When asked about areas of the hospital that need improvement, the Physicians all focused their responses on staffing. Other Providers reported that consistent staffing and leadership would be beneficial. The Other Providers noted that increased coordination between area providers would improve health care in Valdez. Business people agreed that increasing the number of full-time staff would be an improvement. They also identified insurance acceptance, counseling services, surgery and diagnostic screenings as areas that could use improvement.

VALDEZ PROVIDER SURVEY RESULTS


Valdez Health Provider Survey Results



Unmet Health Care Needs Health care providers were asked whether they thought there were unmet health care needs for specific populations. In this question, the population of Valdez was broken down into the following sub-populations: young children, adolescent children, adult females, adult males, seniors, tourists and transient populations (e.g. seasonal workers). If respondents said that there were unmet health care needs for a certain population they were then asked to further describe the unmet need.

Please describe the unmet need: (Fill in the blank/“please explain”)

Physicians (N=3):

The “small town effect” is impacting all permanent residents—they may not want to see a provider who is a friend of the family or relative.

Limited health education for adolescent children.

Lack of insurance is a barrier to health care for all populations.

Transient populations such as seasonal workers sometimes have difficulty paying for non-work related health services because they only have coverage for work-related problems.


Young children only have access to a pediatrician on a quarterly basis. (2 respondents)

Adult females do not have access to local gynecological services. (2 respondents)

Lack of insurance is a barrier to health care for all populations.

A free clinic would benefit all populations.

Limited specialty care for all populations.

Expanded counseling and mental health services for adolescents.

Expanded family planning services for adolescents and adults.

Adult males seem to be the population that opts out of health insurance the most in Valdez.

People with diabetes are not having their needs met.

Transportation assistance to and from medical care for seniors

Seniors have trouble paying for their medications.

In the winter, all populations may be confined to Valdez and unable to reach medical care they need in Anchorage.

An electronic intensive care unit would benefit all populations.

Transient populations seem to be the least insured group.

Data Summary Both groups of providers said that lack of insurance is an overarching issue but especially for transient populations. Other Providers highlighted the unmet needs of women and infants for local gynecological and pediatric specialty care.



Barriers to Obtaining Health Care Figure 78: Do you think any of the following are barriers to residents obtaining health care in Valdez? (Mark all that apply with an “Other (Specify)” option)

66.7% 66.7%

33.3%28.6%

0.0%

33.3%

66.7%66.7%

33.3%

100.0%

14.3%

42.9%

28.6%

0.0%

42.9%

28.6%

71.4%

100.0%

0%

20%

40%

60%

80%

100%

Knowled

ge of A

vaila

ble Serv

ices

Afford

abilit

y/Ins

urance

Cov

erag

e

Acces

s/Tra

nspor

tation I

ssues

Confid

entia

lity

Langu

age D

iffer

ence

s

Waiting List

s

Availa

bility o

f Serv

ices

Qualit

yOth

er

Perc

ent

Physicians (N=3) Other Providers (N=7)

Multiple response question with 3 Physicians offering 14 responses and 7 Other Providers offering 25 responses. Source: Valdez Physician and Health Provider Survey, 2007.

Data Summary All three (3) Physicians surveyed identified “knowledge of available services” as a barrier to Valdez residents obtaining health care. In contrast, all seven (7) Other Providers felt that “affordability/insurance coverage” was a barrier. Physicians did not feel that “quality” was a barrier while Other Providers did not classify language differences as an obstacle to health care in Valdez. Most Physicians and Other Providers said that “access/transportation issues” were a difficulty to patients receiving care (2 out of 3 Physicians and 5 out of 7 Other Providers). Two out of the three Physicians also identified “language differences” and “confidentiality” as barriers. The Physicians and Other Providers surveyed recognized the great importance of privacy and make efforts to protect their patients’ confidentiality.



Referrals Outside of Valdez Figure 79: Have you referred any of your patients to locations outside of Valdez for any of the following health care services? (Mark all that apply with an “Other (Specify)” option)

0.0%

33.3%

33.3%

33.3%

33.3%

66.7%

66.7%

66.7%

66.7%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

20.0%

0.0%

0.0%

20.0%

0.0%

20.0%

20.0%

20.0%

20.0%

20.0%

20.0%

20.0%

20.0%

20.0%

0.0%

20.0%

66.7%

66.7%

0% 25% 50% 75% 100%

Other*

Pediatric Care

Nursing Home

Alzheimer's Unit

Geriatric Treatment

Preventive / Wellness Checkups

Women's Health Treatment

Diabetic Treatment

Hearing Aids

Occupational Health Injuries

Eye Care

Oncology Treatment

Orthopedic Care

Cardiology Specialty Care

Mental Health Treatment

Substance Abuse/Alcohol Treatment

Prenatal Care

Other Providers

Physicians

Multiple response question with 3 Physicians offering 34 responses and 5 Other Providers offering 17 responses. Source: Valdez Physician and Health Provider Survey, 2007. * The “Other” referral needs are presented on the next page.



Referrals Outside of Valdez (con’t) When Physicians and Other Providers identified that they had “Other” referral needs, they were asked to specify. These specified referral needs are shown below:

Other referral needs (“Other (Specify)”)

Physicians (N=3):

Pulmonology.

Gastroenterology.

Gastroneurology.

Neurology.

Surgery.

Sleep studies.

In-patient psychiatric treatment.

Ear, nose and throat doctor.

Pain specialist.

Endocrinology.


Oral surgery.

Hospitalization for mental health treatment.

Second opinions from specialists.

Neuropsychological testing.

Respiratory illness treatment.

Data Summary All Physicians (3 respondents) have referred patients outside of Valdez for the following types of care: cardiology specialty care, mental health treatment, substance abuse treatment, prenatal care, oncology treatment and orthopedic care. None referred patients outside of Valdez for pediatric care. None of the Other Providers with referral needs (5 respondents) had referred patients to a nursing home, an Alzheimer’s unit, substance abuse treatment or preventive/wellness checkups.



Health Care Technology Providence Valdez Medical Center currently has Upper Endoscopy, Colonoscopy, X-ray, Ultrasound and CAT Scan capabilities. 53

Is there any health care technology that would be beneficial in Valdez? (Fill in the blank/“please explain”)

Physicians (N=3):

We are currently trying to acquire a MRI machine.

Realistically, there is no technology that we would use enough to make it worth it. However, a fluoroscopy and a newer ventilator machine would be beneficial.

Electronic medical records with good readability and confidentiality would be helpful.

A low-cost knee and shoulder MRI machine would be very useful as it would cut down on referrals. The following would also be beneficial: a C-Arm, intensive care monitoring equipment, arterial monitoring equipment, intravenous monitoring equipment and tele-intensive care technology.


A shared electronic records system would really provide better service if everyone worked well together. This would ensure better continuity of care for patients going to providers in both Valdez and Anchorage.

A mammogram machine.

Data Summary Both Physicians and Other Providers identified a need for an electronic records system in Valdez. Two of the three physicians surveyed would like an MRI machine. A mammogram, fluoroscopy and newer respiratory machine were also mentioned.

53 Providence Valdez Medical Center (2007). Providence Valdez Medical Center. Retrieved August 8, 2007, from http://www.providence.org/alaska/valdez/1medcenter.htm.



Greatest Risks to the Valdez Health Care System Figure 80: What are the greatest risks to the health care system in Valdez? (Mark all that apply with an “Other (Specify)” option)

1

1

1

1

2

1

3

2

1

1

1

1

2

3

3

4

4

5

3

5

6

0 1 2 3 4 5 6 7 8

Other

Aging of Health Care Infrastructure

Not Enough Administrative/Support Staff

Lack of Appropriate Health Care Infrastructure

Not Enough Local Funding

Not Enough Equipment

Not Enough Trained Technicians

Not Enough Federal/State Funding

Seasonal Population Changes

Not Enough Specialist Expertise

Declining Population

Difficulty With Insurance Claims/Coverage

Not Enough Family Medicine Doctors

Not Enough Nurses

Uninsured Patients

Physicians (N=3) Other Providers (N=7)

Source: Valdez Physician and Health Provider Survey, 2007.

Data Summary All three Physicians stated that not enough family medicine doctors was the greatest risk to the health care system in Valdez while two out of the three Physicians identified a declining population and not enough nurses as a risk. Six of seven Other Providers indentified uninsured patients as a great risk. Another 5 responded that difficulty with insurance claims and coverage as well as not enough nurses were equally problematic for the health care system.



Health Care Information and Education Thinking about health care information and education in Valdez, what do you think is

effective? (Fill in the blank/“please specify”)

Physicians (N=3):

Provider-to-patient interactions within the office are where most effective health care education takes place. (2 respondents)

The Health Fair is highly popular and important to the community.

“No smoking” and “don’t drink and drive” radio notices.

Prenatal classes.


The Health Fair is great. (2 respondents)

The Community Resource book is really effective.

No health education is entirely effective; people will do what they want regardless.

Hospital advertising on the radio and TV.

Public health articles on health issues.

Online screenings for substance use.

The Public Health Nurse is a good resource.

Thinking about health care information and education in Valdez, what do you think needs improvement? (Fill in the blank/“please specify”)

Physicians (N=3):

The focus of school-based health education could be altered so that more time is spent on nutrition and birth control.

The community could have more information on the capabilities of a generalist provider versus a specialist.

There could be more public notices informing the community when specialists will be in Valdez.

Physicians could reinstate a health radio program.

An electronic medical system could be used to create local health statistics.



Health Care Information and Education (con’t) Other Providers (N=5):

Should be a way for people to have free or low-cost check-ups annually.

Could be more outreach to patients to educate them about certain disease states—high blood pressure, diet, diabetes.

At the moment, professional training is only available in Anchorage or in the lower 48. More training opportunities on a local level would be beneficial.

The lab has not delivered patients’ results reliably.

Could be more community involvement. Community groups and workshops are offered but there isn’t a high level of participation or engagement.

Data Summary Both Physicians and Other Providers mentioned that the Health Fair was an effective way of spreading health care information. Physicians noted that one-on-one provider-patient interactions were useful as well. Physicians and Other Providers surveyed all identified distinct health care information/education areas that could be improved upon.

VALDEZ BUSINESS SURVEY RESULTS


Valdez Business Survey Results



Employee Health Care

Figure 81: How many employees do you currently have? (Fill in the blank)

3

1 12

12

1

4

0

5

1 to 5 6 to 10 11 to 20 21 to 30 31 to 40 41 to 50 51 to 100 Over 100

Number of Employees

Num

ber

ofEm

ploy

ers

N=15 Source: Valdez Business Survey, 2007.

Figure 82: If you experience seasonal changes in the number of your employees, which months do you have the most employees? (Fill in the blank)

1 1 13

5 5

9 85

3 2 1

0

5

10

15

Janu

ary

Febru

ary

March

AprilMay

June Ju

ly

August

Septem

ber

Octobe

r

Novem

ber

Decem

ber

Num

ber

Multiple response question with 10 respondents offering 44 responses. Source: Valdez Business Survey, 2007.

If you require pre-employment health screens for your employees, what elements of

your screening process could the community hospital provide for you? (Fill in the blank/“please specify”)

Overall, business people who require pre-employment health screens (5 respondents) did not express a need for the hospital to provide pre-employment screening services other than those that the Providence Valdez Medical Center currently offers. However, one respondent did mention that drug screening services in general might be utilized by the community.



Employee Health Care (con’t)

Figure 83: Which of the following would be beneficial to your company? (Multiple choice)

100.0%78.6% 78.6% 78.6%

71.4%64.3%

50.0%42.9%

28.6%

0%20%40%60%80%

100%

Flu Shots

Health Education

Employee Health Services

Health Risk Assessments

Chronic Disease Management

Physical Therapy

OSHA Requirements

Pre-Employment Screens & Physicals Other

Perc

ent

Multiple response question with 14 respondent offering 83 responses. Source: Valdez Business Survey, 2007.

Are there any other services which would be beneficial to your company? (Fill in the blank/“please specify”) Four respondents identified additional services not listed in the multiple choice responses. There comments are shown below:

Immunizations and TB screening, as these are state requirements for some employees.

More access for the handicapped/elderly so that they can easily and cheaply get to appointments in both Valdez and Anchorage.

Access to specialty care as needed.

Rehabilitation services (substance abuse).

Figure 84: If you have a health plan, what type of coverage does the plan provide? (Multiple choice)

100.0%90.0% 90.0% 90.0%

80.0%70.0%

60.0%

40.0% 40.0%

0%

50%

100%

Physical HealthDental Health Vision

Prescriptions

Substance abuseMental Health

Wellness/Prevention

Health Risk Assessments

Long-Term Care

Perc

ent

Multiple response question with 10 respondents offering 66 responses. Source: Valdez Business Survey, 2007.



Employee Health Care (con’t)

Data Summary The 15 business people surveyed represented a range of company sizes. The greatest number of respondents (4) belonged to companies with over 100 employees while the next largest group of individuals surveyed (3) reported having a staff of five or fewer.

Ten business people, or 67%, responded that they experienced seasonal changes in the number of their employees. Nine of the ten respondents who experience seasonal changes said they had the most employees during the month of July. Eight respondents also had the highest number of employees throughout the month of August. Overall, Valdez business people reported that they have the most employees from May until the end of September.

All 14 individuals who responded identified flu shots as services that would be beneficial for their companies. Eleven of 14 individuals (79%) also identified health education, employee health services and health risk assessments as beneficial. Pre-employment screens and physicals were the least popular response (6 respondents or 43%).

Ten of the 15 business people surveyed reported that they had a health plan for their employees. Of the five (5) who did not have a plan, all were companies with four or fewer employees. Of the ten business health plans—which included plans from TRICARE, Primera, the National Telephone Cooperative Association, Risk and Benefit Management Services, New York Life, Blue Cross and self-insured plans—100% covered physical health. Dental health, vision and prescriptions were also among the health issues most covered (90% each) while health risk assessments and long-term care were the types of medical care least insured according to respondents (40% each).



Workers’ Compensation How could the health care system in Valdez help to meet your needs of zero

reportable workers compensation incidences? (Fill in the blank/“please specify”) Fifteen (15) members of the business community provided a response to the question “How could the health care system in Valdez help to meet your needs of zero reportable workers’ compensation incidences?” Five (5) gave suggestions of how the health care system could help; these suggestions are shown below:

Increase availability of preventive care.

Use print or radio advertising to “get the word out” about services available in this area.

Keep giving employers advice about how to make working conditions more health friendly.

Doctors could be more aware of what is a recordable prescription and substitute a recordable prescription for one that isn’t recordable.

Provide training for community employees.

Data Summary Most business people surveyed (67% or 10 out of 15) did not mention a way in which the health care system could help meet their needs of zero reportable workers’ compensation incidences. Of these ten, six (6) said that they felt that the safety measures already in place were adequate and three (3) reported that they did not know how the health care system could help and one (1) stated that the health care system could not help.

The five (5) respondents who did indentify possible means of assistance from the health care system all named distinct ways in which the system could help including enhanced awareness, training and preventive care.



Hospital Information Providence Valdez Medical Center posts the following list of available services at its website http://www.providence.org/alaska/valdez/1medcenter.htm:54

Figure 85: Do you feel that the hospital provides adequate information about services available?

100%

0%0%

20%

40%

60%

80%

100%

Yes No

Perc

ent

N=15 Source: Valdez Business Survey, 2007.

Data Summary All fifteen (15) business people surveyed felt that the hospital provides adequate information about services available.

54 Providence Valdez Medical Center (2007). Providence Valdez Medical Center. Retrieved August 8, 2007, from http://www.providence.org/alaska/valdez/1medcenter.htm.

Acute Care / Rehabilitation Hospital Service 24-hour Emergency Service X-ray 4-dimensional Ultrasound CAT Scan Acute Care/Swing bed Bone Densitometry Testing Medicare Swing Bed Rehabilitation Program Physical, Occupational Therapy Speech Language Pathology Back-to-Work Rehabilitation Programs Labor & Delivery Services

Laboratory Services - CLIA Certified Sigmoidoscopy Colonoscopy Cardiac Stress Test Non-Stress Test Extended Care Services Counseling Services Social Services Patient & Family Education Outpatient Health Clinics Employment Screening



Additional Comments Is there anything else you would like to add? (Fill in the blank/“please specify”)

Seven (7) of the individuals surveyed added a comment at the end of the Valdez Business Survey. These comments are shown below:

Public health reporting could be improved upon in our community. For example, when epidemics occur, the outside health officials who investigate should consider community input and share their findings publically.

A bus from Valdez to Anchorage once or twice a month for people who aren’t able to get care in Valdez would be great.

Health care in Valdez has come so far recently and the providers and administrators do a great job.

Employers could work more closely with the hospital and encourage their employees to “go local.” The hospital could also create focus groups for businesses to make them more aware of the services the hospital could provide their employees.

All of my experiences with the medical center have been very good; all of my kids were born in the hospital.

For the size of our town, we are doing really well in terms of health care.

Overall, the health care system is attempting to provide services that are necessary and providers are willing to accommodate the community and provide for its need in both winter and summer.

APPENDICES


Appendices

APPENDICES


Appendix I: Valdez Community Health Survey

1. Have you needed health care in the last 12 months?

3a. If no, why couldn't you receive it? (Mark all that apply)

Skip to question 4

YesNo

3b. What type of health care did you go without? (Mark all that apply)

Basic carePreventive care/ annual examsMental Health (counseling or other help)SpecialistAlternative (homeopathic or acupuncture)Chronic (ongoing) problemAcute (new) problemPrescription medicationsOther (Specify): ___________________

4. Do you have health insurance?

Skip to question 7

Yes

No

Don't know

Continue with question 5

5. Does your health insurance cover: 5a. Prescriptions?

Yes No Don't know

Yes No Don't know

5b. Treatment for substance abuse? (alcohol / drugs, etc.)

Yes No Don't know

Valdez Confidential Community Health Survey

9. Have you needed mental health treatment (counseling or other help) in the last 12 months?

YesNo

Continue with question 9a

Skip to question 10

Valdez residents only please

3. If you needed health care during the past 12 months, were you able to receive it?

Skip to question 4Yes

No Continue with questions 3a and 3b

9a. If you needed mental health treatment (counseling or other help), were you able to receive it?

Continue with question 9b

Skip to question 10

5c. Preventive care / annual exams?

8a. If you have dependent children, do they havedental insurance?

Yes No No children

8. If you have dependent children, do they havehealth insurance?

Yes No No children

Skip to question 7

6. Do you also have additional coverage for: 6a. Long-term care?

(nursing home) Yes No Don't know

6b. Dental care? Yes No Don't know

9b. If no, why couldn't you receive it? (Mark all that apply)

10. If you left Valdez to obtain health care elsewherewas it because: (Mark all that apply)

Needed diabetic treatmentNeeded geriatric(problems with aging) treatmentNeeded cardiology specialty careNeeded mental health treatmentNeeded substance abuse/alcohol treatmentNeeded pediatric careNeeded women's health treatmentNeeded oncology (cancer) treatmentNeeded orthopedic (skeletal/bone) careEmployer reimburses travel costs for health careYou have other business to take care of in a larger cityReferred to another provider by your family doctorOther (specify): _______________________

2. What was the primary reason for your most recentvisit? (Read list and shade one)

Emergency careAcute (new) problemChronic (ongoing) problemPreventive careOther (Specify): __________________

YesNo

No insurance/couldn't afford itInsurance wouldn't cover itCouldn't afford copayCouldn't find doctor/provider to accept insuranceTransportation issuesUnable to communicate due to

Didn't know where to goUnable to understand phone instructions

Waiting listsServices not availableProvider will not accept Medicare/MedicaidOther(Specify): _____________________

to make an appointment

language differences

Yes No Don't know

6d. Vision care? Yes No Don't know

6c. Home health?

7. Do you use the emergency room for your main source of health care? This would be for illness as well as for emergencies.

Yes No

Thank you for taking the time to complete this very important survey. Providence Valdez Medical Center isinterested in your health care needs and would like to get your opinions in order to make improvements tothe health care system in Valdez. This survey is anonymous and we will not ask for your name.

Continue with question 2

A. Are you a full time resident or part time resident?Full time resident Part time resident

No insurance/couldn't afford itInsurance wouldn't cover itCouldn't afford copayCouldn't find doctor/provider to accept insuranceTransportation issuesUnable to communicate due to

Didn't know where to goUnable to understand phone instructions

Waiting listsServices not availableProvider will not accept Medicare/MedicaidOther(Specify): _____________________

to make an appointment

language differences

5733100201

APPENDICES


Appendix I: Valdez Community Health Survey (con’t)

12. Do you now smoke cigarettes or use smokeless tobacco?

Every day Some days Not at all

21. How much of your total household take-homepay (income after taxes) goes to rent/housingcosts? Housing costs are considered any type ofpayment having to do with housing, such as rentor mortgage payments, and utilities.

Less than 33%Between 33% - 49%Between 50% - 74%75% or more

17. In the last 12 months did you or your familyhave to go without basic needs such as food,child care, health care, or clothing?

Skip to question 18

Yes

No

Continue with question 17a

17a. What did you go without? (Mark all that apply)Health careDental carePrescriptionsClothingChild care

FoodChoosing food we wantedRent / housingHeat/fuel/utilitiesOther (Specify): _________

CaucasianHispanic/LatinoAlaskan Native/Native AmericanAfrican AmericanFilipinoPacific IslanderAsianMulti-ethnicOther

24. Which income range best describes your annual household income?

Less than $10,000$10,000 to $19,999$20,000 to $29,999$30,000 to $39,999$40,000 to $49,999

$50,000 to $59,999$60,000 to $74,999$75,000 to $99,999$100,000 to $124,999$125,000 or more

25. What is the highest level of education you have completed?

No high school diplomaHigh school diploma or GEDSome college, no degreeAA degreeFour year college degreeMaster's degree or higher

27. Are you: Male Female

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY

23. Which of the following best describes yourrace / ethnic group? (Mark one response)

11. How long has it been since you last visited a dentist, hygienist, or orthodontist?

Have never visited1 to 6 months ago7 to 12 months agoMore than one year, up to 2 years agoMore than 2 years, up to 5 years agoMore than 5 years agoDon't know

26. What year were you born? __________

19. What do you consider to be the greatest health care need in Valdez? Please explain.

20. Overall, how satisfied are you with your health careservices in Valdez?

Very satisfiedSomewhat satisfiedNot at all satisfied

13. The definition of a drink of alcohol is 1 can or bottle of beer, or 1 glass of wine, or 1 can or bottle of wine cooler, or 1 cocktail, or 1 shot of liquor. Considering all types of alcoholic beverages, during the past 30 days about how many times did you have 5 or more drinks on an occasion? An occasion is considered about 2 hours.

_______ Number of times (Office use)

14. Would you say that, in general, your physical health(including physical illness and injury) is:

ExcellentVery goodGoodFairPoor

15. How many days per week do you engage in physicalactivity (such as brisk walking or gardening) for acombined total of 30 minutes or more?

None1 - 2 days3 - 4 days5 or more days

16. In the past year have you had an annual exam forpreventive purposes such as a wellness screen or an

age appropriate mammogram or a prostate exam?YesNo

22. In the last 12 months what percent of your takehome pay went to health care costs? (Health care costs are considered doctor or provider visits, hospital, copay and health insurance)

____________ %(Office use)

(Office use)

18. Where do you get information about health care?Doctor/providerInternetTelevisionInserts in the newspaper/magazinesFriends and family members (word of mouth)RadioOther (Please specify) _______________________

6806100203

APPENDICES


Appendix II: General Survey Results Valdez Community Health Survey

A. Are you a full time resident or part time resident?

Response Frequency Percent Full time resident 296 97.0% Part time resident 9 3.0% Total 305 100.0%

1. Have you needed health care in the last 12 months?

Response Frequency Percent Yes 277 89.1% No 34 10.9% Total 311 100.0%

2. What was the primary reason for your most recent visit? (Read list and shade one)

Response Frequency Percent Chronic (ongoing) problem 67 24.9% Preventive care 62 23.0% Acute (new) problem 60 22.3% Emergency care 55 20.4% Women’s health / prenatal care 9 3.3% Physical therapy 2 0.7% Other 14 5.2% Total 269 100.0%

3. If you needed health care during the past 12 months, were you able to receive it?


APPENDICES


Appendix II: General Survey Results (con’t) 3a. If no, why couldn't you receive it? (Mark all that apply)

Response Frequency Percent No insurance/couldn't afford it 12 32.4% Services not available 12 32.4% Insurance wouldn't cover it 4 10.8% Needed a specialist 4 10.8% Couldn't afford copay 2 5.4% Couldn't find doctor/provider to accept insurance

1 2.7%

Waiting lists 1 2.7% Other 5 13.5% Multiple response question with 37 respondents offering 41 responses.

3b. What type of health care did you go without? (Mark all that apply)

Response Frequency Percent Specialist 18 37.5% Chronic (ongoing) problem 17 35.4% Basic care 15 31.3% Preventive care/ annual exams 15 31.3% Prescription medications 14 29.2% Acute (new) problem 9 18.8% Mental Health (counseling or other help) 4 8.3% Alternative (homeopathic or acupuncture) 4 8.3% Other 4 8.3% Multiple response question with 48 respondents offering 100 responses.

4. Do you have health insurance?

Response Frequency Percent Yes 269 86.5% No 39 12.5% Don't know 3 1.0% Total 311 100.0%

APPENDICES


Appendix II: General Survey Results (con’t) 5a. Does your health insurance cover prescriptions?


5b. Does your health insurance cover treatment for substance abuse? (alcohol / drugs, etc.)


5c. Does your health insurance cover preventive care / annual exams?


6a. Do you also have additional coverage for long-term care? (nursing home)


6b. Do you also have additional coverage for dental care?


APPENDICES


Appendix II: General Survey Results (con’t) 6c. Do you also have additional coverage for home health?


6d. Do you also have additional coverage for vision care?


7. Do you use the emergency room for your main source of health care? This would be for illness as well as for emergencies.


8. If you have dependent children, do they have health insurance?


8a. If you have dependent children, do they have dental insurance?

Response Frequency Percent Yes 142 50.5% No 27 9.6% No children 112 39.9% Total 281 100.0%

APPENDICES


Appendix II: General Survey Results (con’t) 9. Have you needed mental health treatment (counseling or other help) in the last 12 months?


9a. If you needed mental health treatment (counseling or other help), were you able to receive it? (Mark all that apply)


9b. If no, why couldn't you receive it? (Mark all that apply with an “Other (Specify)” option)

Response Frequency Percent No insurance / couldn't afford it 4 36.4% Services not available 3 27.3% Confidentiality issues* 3 27.3% Didn't know where to go 1 9.1% Multiple response question with 11 respondents offering 11 responses. * Those who wrote in an answer in the “Other (Specify)” category indicated “confidentiality issues.”

APPENDICES


Appendix II: General Survey Results (con’t) 10. If you left Valdez to obtain health care elsewhere was it because: (Mark all that apply)

Response Frequency Percent Referred to another provider by your family doctor 75 34.7% Needed women's health treatment 58 26.9% Needed orthopedic (skeleton / bone) care 45 20.8% You have other business to take care of in a larger city 37 17.1% Needed cardiology specialty care 28 13.0% Employer reimburses travel costs for health care 22 10.2% Vision care 17 7.9% Needed diabetic treatment 16 7.4% Dental care 15 6.9% Needed pediatric care 14 6.5% Needed oncology (cancer) treatment 12 5.6% Needed mental health treatment 9 4.2% Prefer out-of-town health care 9 4.2% Always use care elsewhere 7 3.2% Needed geriatric (problems with aging) treatment 5 2.3% Non specified specialist 5 2.3% Diagnostic purposes 4 1.9% Alaska native medical center 3 1.4% Needed substance abuse / alcohol treatment 1 0.5% Other 14 6.5% Multiple response question with 216 respondents offering 396 responses.

11. How long has it been since you last visited a dentist, hygienist or orthodontist?

Response Frequency Percent 1 to 6 months ago 153 50.5% 7 to 12 months ago 61 20.1% More than one year, up to 2 years ago 42 13.9% More than 2 years, up to 5 years ago 30 9.9% More than 5 years ago 15 5.0% Don't know 2 0.7% Total 303 100.0%

APPENDICES


Appendix II: General Survey Results (con’t) 12. Do you now smoke cigarettes or use smokeless tobacco?

Response Frequency Percent Every day 38 12.8% Some days 24 8.1% Not at all 236 79.2% Total 298 100.0%

13. The definition of a drink of alcohol is 1 can or bottle of beer, or 1 glass of wine, or 1 can or bottle of wine cooler, or 1 cocktail, or 1 shot of liquor. Considering all types of alcoholic beverages, during the past 30 days about how many times did you have 5 or more drinks on an occasion? An occasion is considered about 2 hours. (List the number of times)

Response Frequency Percent 0 222 78.4% 1 22 7.8% 2 10 3.5% 3 12 4.2% 4 4 1.4% 5 4 1.4% 6 - 10 occasions 6 2.2% More than 10 occasions 3 1.2% Total 283 100.0%

14. Would you say that, in general, your physical health (including physical illness and injury) is:

Response Frequency Percent Excellent 53 17.5% Very good 116 38.3% Good 96 31.7% Fair 30 9.9% Poor 8 2.6% Total 303 100.0%

APPENDICES


Appendix II: General Survey Results (con’t) 15. How many days per week do you engage in physical activity (such as brisk walking or gardening) for a combined total of 30 minutes or more?

Response Frequency Percent None 20 6.6% 1 - 2 days 90 29.5% 3 - 4 days 102 33.4% 5 or more days 93 30.5% Total 305 100.0%

16. In the past year have you had annual exam for preventive purposes such as a wellness screen or an age appropriate mammogram or a prostate exam?


17. In the past 12 months did you or your family have to go without basic needs such as food, child care, health care, or clothing?


17a. What did you go without? (Mark all that apply)

Response Frequency Percent Dental care 14 56.0% Health care 13 52.0% Choosing food we wanted 8 32.0% Prescriptions 6 24.0% Rent / Housing 5 20.0% Clothing 4 16.0% Food 3 12.0% Heat / Fuel / Utilities 3 12.0% Child care 1 4.0% Other 1 4.0% Multiple response question with 25 respondents offering 58 responses.

APPENDICES


Appendix II: General Survey Results (con’t) 18. Where do you get information about health care? (Mark all that apply)

Response Frequency Percent Doctor / Provider 217 74.3% Friends and family members (word or mouth) 119 40.8% Internet 111 38.0% Television 44 15.1% Inserts in the newspaper / magazines 29 9.9% Radio 16 5.5% Work 8 2.7% Books 6 2.1% Other 9 3.1% Multiple response question with 292 respondents offering 559 responses.

19. What do you consider to be the greatest health care need in Valdez? (Fill in the blank)

Response Responses Percent More specialist/specialty care 29 19.5% More doctors 26 17.4% Pediatric care/pediatrician 16 10.7% Lower costs/financial assistance for patients 16 10.7% OBGYN/female health care 12 8.1% Vision care 11 7.4% Diagnostic equipment (MRI, X-ray) 10 6.7% More specialized dental care 9 6.0% Elderly care/assisted living 8 5.4% Substance use rehab/counseling 6 4.0% Long term care 6 4.0% Mental health services/counseling 5 3.4% Surgical care/surgeons 4 2.7% Uninsured patients 4 2.7% Privacy 4 2.7% Additional training for health care workers 4 2.7% Emergency care 3 2.0% Hospice care 2 1.3% Other 14 9.4% Multiple response question with 149 respondents offering 189 responses.

APPENDICES


Appendix II: General Survey Results (con’t) 20. Overall, how satisfied are you with your health care services in Valdez?

Response Frequency Percent Very satisfied 124 41.6% Somewhat satisfied 141 47.3% Not at all satisfied 33 11.1% Total 298 100.0%

21. How much of your total household take-home pay (income after taxes) goes to rent / housing costs? Housing costs are considered any type of payment having to do with housing, such as rent or mortgage payments, and utilities.

Response Frequency Percent Less than 33% 118 42.4% Between 33% - 49% 101 36.3% Between 50% - 74% 53 19.1% 75% or more 6 2.2% Total 278 100.0%

22 .In the past 12 months what percent of your take-home pay went to health care costs? (Health care costs are considered doctor or provider visits, hospital, copay and health insurance) (Fill in the blank)

Response Frequency Percent None 30 12.7% 1% - 5% 86 36.3% 6% - 10% 45 19.0% 11% - 20% 45 19.0% 21% - 30% 21 8.9% 31% and over 10 4.2% Total 237 100.0%

APPENDICES


Appendix II: General Survey Results (con’t) 23. Which of the following best describes your race / ethnic group?

Response Frequency Percent Caucasian 257 85.7% Alaskan Native/Native American 15 5.0% Hispanic/Latino 6 2.0% Multi-ethnic 6 2.0% African American 4 1.3% Pacific Islander 3 1.0% Asian 3 1.0% Filipino 1 0.3% Other 5 1.7% Total 300 100.0%

24. Which income range best describes your annual household income?

Response Frequency Percent Less than $10,000 15 5.3% $10,000 to $19,999 18 6.3% $20,000 to $29,999 18 6.3% $30,000 to $39,999 26 9.2% $40,000 to $49,999 25 8.8% $50,000 to $59,999 30 10.6% $60,000 to $74,999 33 11.6% $75,000 to $99,999 48 16.9% $100,000 to $124,999 45 15.8% $125,000 or more 26 9.2% Total 284 100.0%

APPENDICES


Appendix II: General Survey Results (con’t) 25. What is the highest level of education you have completed?

Response Frequency Percent No high school diploma 7 2.3% High school diploma or GED 43 14.3% Some college, no degree 127 42.2% AA degree 37 12.3% Four year college degree 54 17.9% Master's degree or higher 33 11.0% Total 301 100.0%

26. Age

Response Frequency Percent 18 - 21 years 11 3.8% 22 - 30 years 31 10.8% 31 - 40 years 59 20.6% 41 - 50 years 78 27.2% 51 - 60 years 69 24.0% 61 - 70 years 31 10.8% 71 years or more 8 2.8% Total 287 100.0%

27. Are you:

Response Frequency Percent Male 100 33.7% Female 197 66.3% Total 297 100.0%

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