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Healthy Hall 2003 Community Assessment Summary Report

Assessment Findings - Health

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There are many ways to measure health within a community, including measures of personal health habits, access to care and occurrence of disease. In talking with the citizens of Hall County, the Healthy Hall community assessment attempted to measure many of these important indicators.

2003 SUMMARY
REPORT 
TABLE OF CONTENTS

 

These findings are divided into three sections:
Access to Care
Children's Health
Personal Health

Key Findings in This Section:

  • The study began with a personal assessment of health status, and then followed with questions about use of medical providers, and support for healthy practices such as age appropriate screenings and exercise.

  • Hall Countians view themselves as healthy.  Compared to Southerners overall, fewer Hall Countains feel their health is only fair or poor.

  • Access to physician care may be improving since the 1998 Healthy Hall study.  94% report seeing a doctor in the past three years.  82% report having a doctor the see regularly.

  • Where there is trouble accessing health care, lack of insurance and/or money are the primary reasons.  Over a tenth of Hall Countains studied (11%) report having no insurance. Latinos and those with lesser educations are far more likely to fall into this category. 

  • Latinos and Blacks continue to have more difficulty with access to health care than Whites in Hall County, though the gap has narrowed some since 1998.  

  • 90% of children under 18 have seen a doctor in the past year.  However, only 68% of children have seen a dentist in the last 12 months.   

  • There are significant improvement since 1998 for some health indicators among Latino women.  For example, 64% of the Latino women report performing a breast self-exam, compared to just 20% in 1998.  Further, 41% of Latino women over 40 report never having a mammogram, compared with 72% in 1998  

  • Use of tobacco seems to be declining.  23% report using tobacco on a regular basis now, compared with almost one-third five years ago.  There are indications smoking is declining even more among Hall County adults under 30.

Introduction 

Healthy Hall Members

Notes On Secondary Research

Hall County Survey Results

Who Responded To This Survey?

Assessment Findings:


Health


Safety & Security


Connections to the Community



Confidence in the Future
 

 

Access to Care


How would you rate your general state of health?

As a rule, Hall Countians consider themselves to be fairly healthy. In fact, almost 7 out of 10 rate their health as an 8, 9 or 10 on a 10-point scale (with 10 meaning excellent).  One in five (21%) said their health was excellent with, as might be expected, younger participants leading the way--30% of those 18 to 30 said their health was excellent, compared to only 7% of those aged 61 to 70. 

There also appears to be a relationship between education and personal assessments of health.  Those with college or graduate degrees are more likely to rate their personal health at the highest levels. One third (34%) of those with graduate degrees and 27.5% of those with college degrees rate their health as excellent, while 15% of those who did not finish high school and 19% of high school graduates rate their health at the highest level.  

Not surprisingly those who report that their weight is about right are more than twice as likely to rate their health highly than those who report being slightly overweight. However, cigarette smokers report their health quality being about the same as non-smokers (with mean of 7.32 for smokers and 7.96 for non-smokers).

In general, whites rate their health more highly than blacks, but Hispanics in Hall County rate their health the highest of all—a median of 8 on the 10 point scale--compared to 7.87 for whites and 6.64 for blacks.

There is a definite relationship between being active and feeling healthy.  Those who say they are active in the community are more likely to report better health, 8.32 on a 10-point scale versus 7.61 for those who say they are not active in the community.  Those who are employed rate their health more highly (a median of 8.27) than those who are not employed (6.98).  Of course some of these responding are unemployed for health and age reasons.

The highest levels of health are reported by those who earn the highest incomes.  Those in the study who earn more than $90,000 per year have a mean score 8.89 versus 6.71 for those who earn below $25,000 per year. 

 

 

How long has it been since you last visited a doctor?

Based on the survey results, it appears most Hall Countians can obtain access to a doctor when they want to go.  Of all respondents, 83.6% said they had seen a doctor within the past year.  An additional 10% reported seeing a doctor within the past 3 years.  Of course, simple access to a doctor does not mean all Hall Countians access care in the best way.  As can be seen below,12% of respondents said they would go to an emergency department if they needed care. 

Only among those who have never married is doctor use significantly lower.  Sixteen percent of those who have never been married have not seen a doctor in the last 5 years.

There are some differences in physician access based on race.  Among whites, 87% report seeing a doctor in the past year.  By comparison, 76.5% of Blacks and 72.5% of Hispanics reported the same.

 

18.4% of all Southern adults have not seen a doctor in 12 months.  This is only slightly higher than Hall County, where the percentage is 16.4.  Nationally, those least likely to have seen a doctor in the past year are low income and Latino —32%.

  In Hall County, 27.5% of Latino adults have not seen a doctor in the past year.

  Source:  NCHS National Health Survey

 


If you needed health care this week for any reason, are you confident you could get the care you need?

When asked if they were confident they could get care should they need a doctor for any reason this week, 91% said yes. Only 7% said no.  Those most likely to report a lack of confidence getting the care are younger--under age 40--and those reporting less than a high school education.  Further, 12% of Blacks and 14% of Latinos expressed doubt about getting care versus 4.5% of white respondents.

Where Hall Countians do worry about lack of access to care, insurance and money are the primary reasons, followed by concerns about wait times:

Are You Concerned About Getting Access To Needed Health Care Because Of . . .?

  • Lack of Insurance                                                    13.6%  (Percent Saying Yes)

  • Lack of Money                                                         13.6%

  • Too Long Wait To See A Doctor                              13.4%

  • Difficulties With Language                                           7.8%

  • Lack of Trust In Doctors/Hospitals                              5.0%

  • Unsure of Where To Go                                            4.6%

  • Transportation                                                           3.8%

Latinos and those who are younger, less educated and lower income are more likely to express concern about access to care due to economic reasons.  Predictably, those who expressed concerns about language are overwhelmingly Latino.  


How long since your last visit to a dentist?

Six of ten Hall Countians (61%) report seeing a dentist within the past year. An additional 19% report seeing a dentist in the past one to three years. Those most likely to report not seeing a dentist in the past five years are those with high school educations or less, those over age 70 and those who report their state of health as either being fair or poor.

There are differences in the races here:  65% of whites report seeing a dentist within the past year, compared to 51% of Latinos and 44% of blacks.

When asked if they are confident they could see a dentist this week if necessary for any reason, 81% of Hall Countians said they could get the needed care.  However, almost one in five (19%) expressed either a lack of confidence or said they did not know. 

Most who are unsure about getting dental care are those under age 30, those who are separated or divorced, those who have lived in Hall County less than 5 years and those with lower educational levels and incomes.   

Percentage Of Adults Reporting Seeing A Dentist In Past Year

  • All Adults 18-64           65.3%

  • Latino Adults                60.4%

  • Black Adults                 57.2%

  • White Adults                 69.4% 

  • Southern Adults           59.9%

Source: NCHS National Health Survey, 2000


How are most of your personal medical expenses paid?

Insurance Makes A Difference In Access To Care

Persons Who Needed Care, But Did Not Get It

Uninsured                       20%

Insured                             3%

 

Who Skipped Recommended
Treatments Or Care

Uninsured                        39%

Insured                           13%

 

Who Did Not Fill A Prescription

Uninsured                        30%

Insured                             12%

Source: Kasier Family Foundation, 2000

Over half of those surveyed (54%) report that their health insurance is provided through an employer.  An additional 9% report purchasing health insurance personally. One-quarter of those in the survey report being covered by Medicare, Medicaid or some type of government insurance program.  Just over one in ten (11%) report having no insurance at all. 

Those most likely to be uninsured are Latino (33%).  Similar percentages of Blacks and Whites are uninsured—5.9% of each group. These numbers represent minimal change from the 1998 Healthy Hall study, when 12.1% reported no health insurance. 

Those least likely to be covered by health insurance are young--29% of those aged 18-30 report having no health insurance.  By the time Hall Countians reach the next age cohort (31-40), their access to health insurance mirrors the county overall.  Among those 31-40, only 11.5% report having no health coverage. 

Newcomers to Hall County, a group that includes a significant number of immigrants, are more likely to report not having health insurance.  For example, 26.5% of those who have lived in Hall County for less than 5 years, and 19.7% of those who have lived in Hall County from five years to 10 years, have no health insurance. Similarly, 33% of Latinos in the study have no insurance. 

Among Blacks & Whites, the percentage reporting no insurance is the same—5.9%.  The areas of the county where the greatest concentration of those without insurance live are Gainesville and Flowery Branch.

Three-fourths (75.5%) of those over age 70 report having Medicare supplemental insurance.  

"33.2 % of Georgians under age 65 have no health insurance.
In addition, 57.5% of Georgians under 65 were without insurance for at least six months from 2001--2002"

Source:  US Census Bureau

 


If you needed health care this week which of the following would you most likely do to find care?

Consistent with the county's relatively easy access to doctors, 72.5% of those in the study said they would go to a doctor in private practice if they needed health care this week. By comparison, 12% (about the same percentage as those uninsured) said they would go to the hospital emergency department.  An additional 7% said they would go to a doctor at a walk-in medical clinic. Only 3% of those in the study said they would go to the health department or a free clinic.

Where Would Hall County Go For Health Care?

  • Doctor In Private Practice                                        72.5%

  • Doctor At Hospital Emergency Room                      11.6%

  • Doctor At Walk-In Medical Clinic                                 7.4%

  • Doctor At A Free Clinic                                              2.0%

  • Doctor At Health Department                                     1.0%

Hispanics are more than three times more likely to go to the emergency department for care than their white neighbors in Hall County; 23.5% compared with 8%.  Among Black respondents, 15% said they would go to the emergency department.

Low income and related lack of insurance encourage use of the emergency department. Twenty-one percent earning less than $15,000 a year said they would go to emergency. In addition, 23% of those earning $15,000 to $25,000 per year also said they would use the emergency department as opposed to a private doctor.

# of Annual Visits to NGMC ER 83,080
# of Annual Visits to Quick Care 23.417
Source: Northeast Georgia Medical Center


Do you have a doctor that you see regularly that you consider to be your primary doctor?

More than 8 of 10 Hall Countians report having a personal doctor (82%). Those most likely to report not having a primary doctor match those who do not have insurance.  They are Latino (47%), the young (42%), those who have lived in Hall County for less than 5 years (37%), and those who report less than a high school education (33%).

Thirty-nine percent (39%) of those in the study said they are aware a doctor can be seen at the Good-News Health Center.  Further, 11% reported they have used services there at some time in the past.  Awareness seems to be highest among long-time county residents and those aged 61-70, indicating the Good News Clinic may be an important service to those who are older, but not yet covered by Medicare.  Awareness of Good News is somewhat lower among Latinos (34%) and highest among Blacks (47%).

Only 23% of those in the study said they were aware they could see a doctor at Med-Link Gainesville.  Awareness of the service seems to be highest among those in the African-American community (52%).  Fifteen percent of those in the study reported using medical services at Med-Link Gainesville. 

Far more Hall Countians are aware that they can see a doctor at the Hall County Health Department (56%), and 32.5% have used the service there.   Awareness of the Health Department as a resource for doctor care is highest among Blacks (62%) and Whites (59%) and somewhat lower among Latinos (44%).  However, Latinos are twice as likely to have seen a doctor at the

Health Department--51% say they have seen a doctor there, compared to 29.5% of Whites and 24% of Blacks.

CHILDREN'S HEALTH CARE

Of the 501 participating in the survey, 37%, report having children under the age of 18 living in their home.  Those with children were asked questions to help measure their access and experiences with the health care system.

 


Has your child/children been to a doctor or health care provider in the last year?

Ninety percent of those in the survey with children report that their children did see a health care provider within the past year.  Of the small number who reported otherwise, 57% of them are Hispanic. Overall, 13% of Hispanics in the survey said that their children did not get access to a doctor in the last year, compared with 7.5% overall. 

Are you aware of a state sponsored insurance program for children called PeachCare?
According to the 2000 Census, 5,519 children under age 18 are in families below the poverty level in Hall County.  Total Hall County PeachCare enrollment is 6,345.

Source: US Census Bureau,
Hall County Health Department

A large majority of those responding, 77% said they are aware of PeachCare, and 15% report the program covers their children.  Men are much less familiar with this program than women—29% of men, compared to only 15% of women, said they were not aware of PeachCare.

 

 


If your child needed health care this week which of the following would you most likely do to find care?

While 90% of adults said they would go to a doctor, a slightly lower percentage, 81%, said they would take their child to a private doctor should they need care this week. Only 5% said they would go to the hospital emergency department.  Eight percent said they would go to a walk-in medical clinic, health department or a free clinic such as the Good-News Clinic.  As with the adult responses, Latinos are more likely to respond with the hospital emergency department when asked where they would take their children for care.  


Where Would You Take Your Child If He/She Needed Care?

  • Doctor In Private Practice                         81.3%

  • Doctor At Hospital Emergency Room         5.3%

  • Doctor At Walk-In Medical Clinic                5.3%

  • Doctor At Health Department                      1.6%

  • Doctor At A Free Clinic                               1.1%

  A slightly higher percentage of children than adults (88% to 82%) have a regular doctor that parents consider to be their primary doctor.  Of the 10% who report not having a regular doctor for their children, the majority is Hispanic and half have been in Hall County for less than 5 years.  

 


Have you ever had difficulty getting health care for your child/children because of…?

Almost one in five respondents with children (18%) in the survey reported having difficulty getting health care for their children at some point in time due to economic factors--10% reported difficulty due to lack of insurance while an additional 9% reported difficulty due to a lack of money.  Issues of language and lack of trust, often indicators or cultural barriers, are far less important in children's health care than with adults.

Percent Of Parents Reporting Difficulty Getting Health Care For Children Because Of . . .

  • Lack of Insurance                                                    9.6%  (Percent Citing This Reason)

  • Lack of Money                                                         8.6%

  • Too Long Wait To See A Doctor                              5.3%

  • Unsure of Where To Go                                          2.7%

  • Difficulties With Language                                         2.1%

  • Lack of Trust In Doctors/Hospitals                            1.6%  

Nationwide, according to 2002Medicaid SCHIP Data, 6% of children under the age of six, and 15% of children aged 6-17 do not have health insurance coverage.

 


Has your child/children been to a dentist in the last year?

Most (68%) report that their children did see a dentist in the past year. However, almost 30% (29%) answered "no" to this question. Those most likely to report that their children did not see a dentist follow the typical access-to-care pattern.  They are the less educated and lower income respondents, and those who have been in Hall County for less than 5 years.

When asked why their children did not go to the dentist, the largest percentage (33%) reported that the child did not need to go. However, 16% said their child did not go to the dentist because they lacked either insurance or money for the service.

 

Personal Health


Do you consider yourself to be slightly overweight, very overweight, slightly underweight, very underweight or about the right weight?

Just under half of Hall Countians in the study (46%) consider themselves to be just about the right weight.  This compares with 39% who consider   themselves to be slightly overweight and 9% who say they are very overweight. By contrast, only 4% consider themselves to be slightly underweight and only 1% very underweight.  Women are somewhat more likely than men to view themselves as overweight (12% for women versus 4% for men).  Those aged 41-60 are more likely to see themselves as slightly overweight or very overweight.

Of those who say they are overweight, 39% also use tobacco.


Do you know what your cholesterol level is?

Only one-third of adults in the survey (33.5%) know their cholesterol level. Those least likely to know their cholesterol are those aged 18-30, which is not a surprise. However, 67% of those aged 41-50 do not know their cholesterol number either.  Among ethnic respondents 82% of African-Americans and 81% of Hispanics do not know their cholesterol number.

Of those who do know their cholesterol level, 71% report that it is less than 200. One in five (20%) report between 200 to 275.  Only 2% report their cholesterol level higher than 275.  Most physicians consider cholesterol above 200 to be an elevated risk for heart disease.  Cholesterol above 275 is considered to be very high risk.

 


How would you describe your level of physical fitness?

Just over half of Hall Countians (54.5%) see themselves as somewhat physically fit. Equal numbers (17%), see themselves as either very fit or somewhat unfit.  Those most likely to rate their level of fitness as poor are older adults, those in poor health and those with less than a high school education. 

Those most likely to report their level of fitness as excellent are, not surprisingly, aged 18 to 30.  This is, of course, the same group that is most likely to say their health is excellent, least likely to have health insurance and least likely to see a doctor.  There is no elixir like youth.

It is interesting to note that there is a link between economic status and physical fitness.  Those in the highest income levels, earning more than $90,000, are far more likely to report their level of fitness as being excellent than those in the next lowest income brackets. Among those earning more than $90,000 per year 28% report their level of fitness as excellent. By contrast, only 11% of those earning $75,000 to $90,000 per year, and 13% of those earning $60,000 to $75,000 per year, report their level of fitness as excellent.

Similarly, those earning more than $90,000 per year are more likely to report exercising regularly, at least three times per week.  This compares with only 10% of those earning $75,000 to $90,000. 

 


Within the last 5 years, have you used any form of complementary or alternative medicine?

Slightly less than 10% (9%) report using some form of complementary or alternative medicine. This is down substantially from Healthy Hall 1998 when almost 20% reported using such therapies. Those aged between 41 and 60 are most likely to be attracted to these therapies.  Further, those who are separated or divorced are more likely to use alternative therapies than those who are married.

Since alternative therapies are not usually paid by health insurance, one might expect the highest earners to use them.  However, those most likely to use alternative therapies are those who earn between $60,000 and $75,000 per year, the same group that exercises the least.  It may be that alternative therapies are seen as a shortcut to better health for those who feel they lack time to exercise.  

Complementary or alternative medicine is defined as any treatment that is outside of the traditional practice of medicine.  Treatments like acupuncture, massage and natural remedies are examples of complementary therapies.

 


Do you know how to perform a breast self-exam?  Do you perform a breast self-exam on a regular basis?

Most women in the study report knowing how to perform a breast self-exam--94% report that they know how and 67% report that they do it regularly. Performance of the breast self-exam is fairly uniform across all sub-groups in the survey, though significant percentages of women in key age groups say they do not examine their breasts regularly.  For example, 32% of women aged 41-50 and 27% of those 51-60 say they do not perform a breast self-exam with regularity.

It is important to note that 64% of the Hispanic women report performing a breast self-exam regularly in this new study.  This is changed considerably from the 1998 study when only 20% of Hispanic women reported performing a breast self-exam on a monthly basis.

 


Have you ever had a pap smear?  Have you had a pap smear in the past year?

A near unanimous majority--94% of all women--reported having had a pap smear, with 68% reported having had a pap smear within the past year. This is also up somewhat from the 1998 study when only 61% reported having had a pap smear within the past year. Almost half of those women in households earning less than $15,000 per year (49%) report not having had a pap smear within the past year.  Among Hispanic women, 10% report never having had a pap smear, compared with 3% Whites and 4% of Blacks.

 


Have you ever had a mammogram?  Have you had a mammogram in the past year?

Eight of ten women in the study (80%) report having had a mammogram at some point in their past.  This means that 20% report never having had a mammogram, which is substantially lower than the 1998 study when 35% reported never having had one. 

Those most likely to report never having aa mammogram are those aged 31to 40. Note: this question was not asked women under the age of 30.

In the 1998 study, Hispanic women were far more likely to never have had a mammogram than others in the study.   This is still true in 2003, but the numbers are improving.  In the 2003 study, 41% of Hispanic women reported never having had a mammogram, compared to 72% in the 1998 study.

Among women over age 30, 58.5% say they have had a mammogram in the past year, with the largest group being those under the age of 40.  However, 40% of women aged 41 to 50 did not have a mammogram within the past year. Further, 59% of Hispanic women did not have a mammogram in the past year.

 


Have you ever had a bone density scan for osteoporosis?

This question was only asked of those women over the age of 50. Of those responding, 52% reported that "yes" they had had a bone density scan for osteoporosis. Those most likely to report not having had a bone density scan are those who have lived in Hall County for less than 5 years (81%), Black women (76.5%), and Hispanics (75%), and those with less than a high school education (66%).

 


Have you ever had a prostate exam or PSA test? 

Among the men over age 50 responding, 82% report having had a prostate exam or PSA test. Those most likely to report never having had such an exam are Hispanics (67%) and those who earn less than $15,000 per year (60%). 

 


Have you ever had a colonoscopy?

This question was asked of both men and women, but only of those over the age of 50 reported having had a colonoscopy. Among the women, those most likely to have never had a colonoscopy are those who are married (63%) with those children at home (85%). These patterns are similar among men, where 71% of those who are married report never having had a colonoscopy.  Indicative of poor health habits among some men, it is interesting to note that 83% of the men over 50 who use tobacco on a regular basis, also report never having had a colonoscopy.  Further, 72% of men over 50 who smoke have never had a prostate exam.

 


Have you ever felt the need to access counseling services for mental or emotional health reasons?

Only 13.4% of those in the study reported feeling the need to access counseling services for these reasons. Those more likely to report needing such services are those who have experienced separation or divorce (26%). Women and those at mid-life (aged 41 to 50) are more likely to report needing such services than men or those in other age groupings.

 


Have you ever had difficulty getting needed counseling services for any of the following reasons?

Only 13% of those in the survey reported difficulty getting needed care.  Lack of money is a primary reason, followed closely by issues of discomfort, confusion or embarrassment.

Primary Reasons For Lack Of Access To Mental Health Care

  • Lack of Money                                                         17.9%

  • Lack of Insurance                                                      9.0%

  • Felt Uncomfortable Getting Help                                 9.0%

  • Didn't Know Where To Go                                         7.5%

  • Felt Ashamed                                                             7.5%  

Americans Who Had Problems Getting Needed Mental Health Care
Uninsured 13%
Insured 4%

Source: Kaiser Family Foundation, 2000

For information on mental health services available in Hall County, contact Laurelwood at 770-531-3800.

 


Within the past year, have you used tobacco products on a regular basis?

Just over one in five in the study (22.8%) reported using tobacco on a regular basis.  This is significantly less than the 1998 study when almost one-third of respondents reported using tobacco on a regular basis. Those most likely to smoke are male (28.8%) and under the age of 50.

As seen in the 1998 study, there is a relationship between education and tobacco use.  For example, 88% of those with bachelors degrees and 96% of those with graduate degrees report they do not use tobacco, while 26% of high school drop outs and 32% of those with high school diplomas only report they do.

Tobacco use appears to be down among Hall County's youngest adults.  In the 1998 survey, 54% of those 18-25 said they did not use tobacco at all.  The age groupings are different in 2003, but among those age 18-30, 70% say they use no tobacco.

 


Within the past year, have you consumed more than three alcoholic beverages in a single day?

This question was designed to reveal a willingness to consume alcohol to the point of possible intoxication.  When asked about alcoholic beverage consumption, 16% of those in the survey said they have consumed more than three alcoholic beverages in a day. 83% of those responding said they have not. 

Those more highly educated are most likely to report consuming more than three alcoholic beverages in a single day.   For example, 25% of those with bachelors degrees and 21% of those with graduate degrees report consuming more than three alcoholic beverages in a single day, compared with only 5% of those with less than a high school education and 17% of those with a high school degree only. 

Higher income earners are also more likely to drink more than three alcoholic beverages in a single day--40% of those earning more than $90,000 per year reported doing so. 

 


In the past year have you used marijuana?  Used a drug other than a prescription or over-the-counter drug?  Operated a vehicle after using alcohol or a drug?

A very small percentage (2%) reported using marijuana in the past year. By comparison, 7% reported using a drug other than a prescription or over-the-counter medication, and 6% reported consuming intoxicants prior to operating a vehicle.

These are relatively small numbers of respondents reporting what are essentially illegal activities.  Taken at face value, these data could be good news, or they could mean some respondents were reluctant to admit to potentially illegal activity to an unknown interviewer.

The results are somewhat similar to 1998, however, when 9.6 of those surveyed said someone in their family used illegal drugs in the past two years.

 

Healthy Hall: A Community Partnership
c/o 1250 Limestone Parkway | Suite 115 | Gainesville, GA 30501  |  770-533-8099  | fax:770-533-8124