Assessment of Dauphin County, Pennsylvania PDF

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This paper includes a community assessment of Dauphin County PA...

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Community Assessment and Smoking in Dauphin County, Pennsylvania

Ryan Ward Pennsylvania College of Health Sciences IPC 501: Health Promotion and Disease Prevention Professor Mary Gibson October 24, 2021

Dauphin County Health Issues A community assessment of Dauphin County, Pennsylvania and its residents was performed, for which the findings demonstrated several benefits, but also many issues, related to the health of this community. The objective of this paper is to explore these benefits and issues that contribute to the current state of health in Dauphin County, Pennsylvania. This paper will also discuss in depth the high-risk behavior of smoking, a significant health issue found in this community. Additionally, several methods will be explored to address smoking in the community, including implementation of smoking cessation strategies and a marketing campaign outlined to combat this health problem in Dauphin County. Community Overview A number of variables including social, behavioral, biologic, etc., have been shown to have an effect on health-related outcomes. Dauphin County, Pennsylvania has much to offer its residents. However, some barriers to advancing the health of the community still remain. This section will provide an overview of the demographics and setting of Dauphin County, discuss community resources, and identify vulnerable populations that will help to set the stage to better define these assets and challenges. Setting: Located in South-Central Pennsylvania, Dauphin County, Pennsylvania’s 14th largest county by population, with an estimated 278,299 residents in July, 2019 (United States Census Bureau, n.d.). The county is 525.05 square land miles in size (United States Census Bureau, n.d). Per County Health Rankings and Roadmaps (2021a), 13.3% of Dauphin County residents reside in an area considered to be rural, which is more ‘urban’ when compared to the state average of Pennsylvania, which is 21.3% (County Health Rankings and Roadmaps, 2021a).

Demographics: The county has a population density according to the United State Census Bureau (n.d.) of 510.6 per square mile. Harrisburg, the capital city, is the county’s largest city by population. The female population of Dauphin County accounts for 51.5% of the population, which is similar to the State of Pennsylvania average of 51% (County Health Rankings and Roadmaps, 2021). Minors (below the age of 18) account for 22.5% of the population, while 17.4% of the population are 65 years or older (County Health Rankings and Roadmaps, 2021a). The majority of the population in Dauphin County are of Non-Hispanic White ethnicity, accounting for 64.5%. Non-Hispanic Blacks accounting for 17.4%. Followed by Hispanics and Asians with 9.9% and 5.3%, respectively. American Indian and Alaskan Native and Native Hawaiian/Pacific Islander accounting for less than 1% of the county’s population (County Health Rankings and Roadmaps, 2021a). Economic Factors: According to the County Health Rankings and Roadmaps (2021a), 4% of Dauphin County is unemployed, which is similar to the state unemployment rate of 4.4%. In 2019, the median household income in Dauphin County was $60,715, which is approximately $2,128 less than the state average for Pennsylvania (United States Census Bureau, n.d.). Of the inhabitants of Dauphin County, 66% aged 16 or older, are in the civilian labor force, with 62.6% of the labor force consisting of females (United States Census Bureau, n.d.). As of 2019, there were 6,850 employer establishments within Dauphin County with 151,385 individuals employed (United States Census Bureau, n.d.). The largest industries in Dauphin County include healthcare and social assistance, manufacturing, and retail trade, with the highest paying industries including utilities, management of companies and enterprises, and public administration (Data USA, 2021). According to the County Health Rankings and Roadmaps (2021a), 90% of individuals completed high school, and of those, 64% completed some college. Upon

comparison of persons in poverty (percent), Dauphin County sits at 11.3%, which is mildly better than the State of Pennsylvania average of 12% (U.S. Census Bureau, n.d.). Additionally, 8.8% of dauphin county residents under the age of 65 are handicapped or have a disability, which is less than the state average of 9.8% (U.S. Census Bureau, n.d.) Vulnerabilities: In Dauphin County, 32% of children live in single-parent households and 18% of children live in poverty, both of which are higher than the State of Pennsylvania average by 6% and 1%, respectively, with 8% of the county having limited access to healthy foods (County Health Rankings and Roadmaps, 2021a). Reading and math scores are below the state average by 0.2 points per subject and high school graduation rates are 5% less than the State of Pennsylvania average (County Health Rankings and Roadmaps, 2021a). Violent crime is significantly worse at 403 per 100,000 population when compared to the Pennsylvania average of 315 (County Health Rankings and Roadmaps, 2021a). Teen births are increased in Dauphin County at 25/1,000 births when compared to the Pennsylvania state average of 17 and Unites States average of 12 (County Health Rankings and Roadmaps, 2021a). According to the U.S. Census Bureau (n.d.) 7.7% of the population of Dauphin County was foreign born and 2% of the population of Dauphin County is not proficient in English, which is equivalent to the average of the State of Pennsylvania (County Health Rankings and Roadmaps, 2021a). According to County Health Rankings and Roadmaps (2021a), 60% of children are eligible for free or reduced lunch, which is 9% higher (51%) than that of the State of Pennsylvania Average. Partners: Dauphin County is home to many large businesses, including the Commonwealth of Pennsylvania, Tyco Electronics/AMP, Hershey Foods, Hershey Amusement Park/Hershey Entertainment, and multiple healthcare organizations, including Penn State Health, UPMC, and Capital Blue Cross (Dauphin County, 2020c). Dauphin County has 13

YMCA/YWCA locations spanning the county (County Office, 2021). Harrisburg is home to the Central Pennsylvania chapter of the American Red Cross, where one can take courses in CPR and first-aid (American Red Cross, 2021). Tri-County Community Action is a program offered in Dauphin and surrounding counties to help the community with budgeting, homeownership, financial literacy education, child and youth development, and much more (Tri-County Community Action, 2021). Dauphin County does not have a county-based or municipal-based health department (Pennsylvania Department of Health (DOH), 2021). The search for religious organizations in Dauphin County did not yield much except for the Pennsylvania Council of Churches; However, it did produce several places of worship practicing different faiths. Education: The high school graduation rate in Dauphin County, Pennsylvania, is 90%, 1% lower than the State of Pennsylvania average, and 4% lower than top U.S. performers (County Health Rankings and Roadmaps, 2021a). Sixty-four percent of adult Dauphin County residents have some college education, which is 2% lower than the State of Pennsylvania average and 9% lower than top U.S. performers (County Health Rankings and Roadmaps, 2021a). According to the National Center for Educational Statistics (NCES) (n.d), Dauphin County is home to several private and public colleges/universities and technical schools including Harrisburg Area Community College, Messiah College, Harrisburg University of Science and Technology, and branch campuses of both Penn State and Widener Universities. Transportation: Dauphin County offers its residents a variety of transportation methods. Capital Area Transit (CAT) provides a fixed route bus service, free to persons ages 65 and older, Monday through Saturday (Dauphin County, 2020a). For those elderly individuals who cannot use the fixed-route bus system or live in an area not serviced by community-based transportation programs, the Capital Area Transit paratransit division offers a Share-A-Ride Transportation

service (Dauphin County, 2020a). Riders with disabilities under 65 may also utilize this service and qualify for the discount rate under the Americans with Disabilities Act. The Share-A-Ride Transportation service is also available to veterans for rides to and from the Veterans Affairs Hospital in Camp Hill, PA. During the fiscal year 2018-2019, CAT provided more than 2.2 million trips for those within the local community (Capital Area Transit, 2020a). Dauphin County contains a number of both state and federal highways that run through its borders. Interstate 76, the Pennsylvania Turnpike, running east and west, spans the entire way across the lower borders of the county. Other notable and well-traveled routes include Pennsylvania State routes 81, 83, and 283, and U.S. routes 22 and 322 (Google Maps, n.d.). Additionally, 25% of Dauphin County residents who commute in their car alone have a long commute to work (defined as having to commute longer than 30 minutes), significantly less than the state average of 38%. Of those individuals commuting to work, 79% commute alone, which is 3% higher than the State of Pennsylvania Average of 76% (County Health Rankings and Roadmaps, 2021a). Recreation: Dauphin County offers many available activities and attractions. The county is home to Hershey Park Amusement Park and Chocolate World (Visit Hershey and Harrisburg, 2021). The county is home to professional baseball, soccer, and hockey teams. Venues in the Hershey and Harrisburg areas offer a wide variety of performances. Dauphin County has a county library system with eight branches spread throughout the county (Dauphin County Library System, 2018). The Dauphin County Park System offers eight areas, including parks, gardens, and a conservancy (Dauphin County, 2020d). Health Access: Dauphin County offers several hospitals to care for its community. Penn State Health Milton S. Hershey Medical Center is one of the region’s largest hospitals. Dauphin

County has access to Pediatric specialty care, cancer specialists, psychiatric, and rehabilitation hospitals as a result of Penn State Health (Penn State Health, 2021b). UPMC of Central Pennsylvania also offers two hospitals in Dauphin County in addition to a psychiatric hospital in which they are partners with Penn State Health (UPMC, 2021). Additionally, Dauphin County offers free or income-based health clinics, including Beacon Clinic for Health and Hope and Mission of Mercy Health Clinic, which provides medical and dental services to underprivileged community members (National Association of Free and Charitable Clinics, 2016). In Dauphin County, the ratio of residents to primary care physicians is 930:1, which is considerably better than the State of Pennsylvania average of 1,230:1 (County Health Rankings and Roadmaps, 2021a). Dauphin County’s ratio of residents to mental health providers, 420:1, is less than the state average of 450:1 (County Health Rankings and Roadmaps, 2021a). A personal barrier to obtaining health care is a lack of health insurance. Eight percent of Dauphin County adults do not carry health insurance (County Health Rankings and Roadmaps, 2021a). Five percent of children are uninsured, which is one percent more than the state average (County Health Rankings and Roadmaps, 2021a). Moving focus towards public health and primary and secondary prevention, 53% of Dauphin County Medicare enrollees received their flu shot in 2018, identical to the state average (County Health Rankings and Roadmaps, 2021a). Forty-five percent of Medicare-enrolled females (aged 65-74) received mammography screenings, similar to the state average of 45% (County Health Rankings and Roadmaps, 2021a). Problem – Ischemic Heart Disease The health issue/behavior chosen to discuss in the next section of this community assessment is smoking. This was a major health issue identified while reviewing data for

Dauphin County, Pennsylvania as a result of its increased prevalence likely related to it’s increased incidence of risk factors Overview of Community Health Issues: Dauphin County is ranked 37th out of 67 counties in Pennsylvania for overall health outcomes and 20th for overall health factors (County Health Rankings and Roadmaps, 2021a). Dauphin county has several health issues affecting its residents, which fall into mostly high and low middle quartile ranges on both a state and national scale. The most common noncommunicable diseases (NCD) affecting residents of Dauphin County include ischemic heart disease, injury deaths, tracheal, bronchus, lung cancer, diabetes, urogenital, blood and endocrine diseases, and cirrhosis and other chronic liver diseases (Community Health Status Indicators, 2016). Additionally, teen births and sexually transmitted infections are also major health issues affecting Dauphin County. Nonetheless, ischemic heart disease, the most prevalent noncommunicable disease in Dauphin County, will be the primary focus moving forward. Targeted Health Issue and Priority: Ischemic heart disease was selected as it is a significant health issue in Dauphin County and the United States, alike. There are numerous risk factors that contribute to the development of heart disease, which include physical inactivity, obesity, smoking, hypertension, high cholesterol, poor diet, and excessive alcohol intake, (CDC, 2019) for which many of these risk factors are present in Dauphin County. Magnitude of the Issue: Ischemic heart disease is responsible for about 659,000 deaths, or 1 in 4 deaths, each year (CDC, 2021). Ischemic heart disease is a notable health issue in Dauphin County. Data from Community Health Status Indicators (2016) reveals that ischemic heart disease is more prevalent in Dauphin County when compared to state and national averages. Data from County Health Rankings and Roadmaps (2021a), reveals that 20% of the

adult population in Dauphin County are current smokers and 33% of the population are obese, both of which are risk factors for ischemic heart disease (County Health Rankings and Roadmaps, 2021a). Additionally, in the United Sates, heart disease is the leading cause of death for both men and women, as well as individuals of most racial and ethnic groups (CDC, 2021). Etiology: By utilizing the Determinants of Health framework provided by Healthy People 2020, several risk factors were identified contributing to the selected health problem of ischemic heart disease. Social Factors: A healthy diet is essential in preventing ischemic heart disease (CDC, 2019). Data presented from County Health Rankings and Roadmaps (2021a) reveals that 8% of Dauphin County’s population has limited access to healthy foods, compared to a state average of only 5% and four times greater than top U.S. performers at 2%. Psychosocial risk factors such as stress also contribute to the development of heart disease. Frequent physical and/or mental stress plagues 12% and 15% of Dauphin County residents, respectively (County Health Rankings and Roadmaps, 2021a). Stress may lead to the development of poor health behaviors including smoking, overeating, and a poor diet (American Heart Association, 2021), which are prevalent risk factors found in Dauphin County. Addressing physical factors, 14% of dauphin county residents experience severe housing problems, which include overcrowding, insufficient plumbing or kitchen facilities, or high costs. Severe housing problems can be associated with a low socioeconomic status, for which there is correlation for a higher incidence of heart disease in this population (Schultz et al., 2018). Biology and Genetics: Factors such as age, gender, and genetics can affect the development of heart disease. According to the American Heart Association (2021) your risk for heart disease increases as you age. As you age the chance of developing risk factors for heart

disease also increase, for which the CDC (2019) reports that 47% of Americans have at least 1 of 3 key risk factors for smoking. The CDC (2019) also suggests a genetic component, likely affecting blood pressure, specifically hypertension, that contributes to the development of heart disease. Pertaining to risk factors of age and gender, 17.4% of Dauphin County is over the age of 65 and 51.5% of the population are female. Individual behaviors: There are several individual behaviors that contribute to the development of ischemic heart disease. Significant factors include smoking, physical inactivity, obesity, and excessive alcohol consumption (CDC, 2019). In Dauphin County smoking, physical inactivity, and obesity rates are all increased when compared to the State of Pennsylvania averages (County Health Rankings and Roadmaps, 2021a). Health Services: Seven percent of Dauphin County residents under the age of 65 are uninsured, which is identical to the state average, but increased from U.S. top performers at 6% (County Health Rankings and Roadmaps, 2021). As discussed previously, the absence of health insurance can be a personal barrier to obtaining healthcare. An individual who is uninsured may not seek treatment to prevent or manage existing heart disease. However, Dauphin County offers community aids for smoking cessation that could potentially decrease risk factors associated with heart disease (Harrisburg Area YMCA, 2021). The county also offers a 930:1 ratio of primary care physicians to patients (County Health Rankings and Roadmaps, 2021a). Policymaking: Policymaking falls under one of the categories of Determinants of Health offered by Healthy People 2020 (2021a). Policies introduced at the local, state, and federal level will have a direct impact on both individual and population health (Healthy People 2020, 2021a). Healthy People 2020 offers multiple objectives that directly affect risk factors that contribute to the development of heart disease. For example, Healthy People 2020 pushes for an increase of

the tobacco tax, as well as an increase in the minimum age for tobacco sales (Healthy People 2020, 2021b) Recommendations Risk Factor: After evaluating several risk factors contributing to ischemic heart disease, it appears the health-risk behavior of smoking has been identified as one of the most modifiable risks. According to the American College of Cardiology (2019), 1in 3 deaths related to heart disease is correlated with smoking or second-hand smoke exposure. Smoking damages the structure and function of blood vessels, which increases the risk of atherosclerosis of vessels (National Institutes of Health, n.d.). Higher rates of tobacco use typically correlate with a higher prevalence of heart disease (Roy et al., 2017). Recommendation: Heart health screenings including screening for tobacco and secondhand smoke exposure are evidence-based recommendations to help prevent heart disease (American Heart Association, 2019). Arnett et al., 2019, provides evidence that cessation treatments including counseling and medications to current smokers should be encouraged. The Class of Recommendation (COR) for this specific recommendation is strong, or class I, which translates to the highest certainty of the five classes (Arnett et al., 2019). This intervention would be classified as a “downstream factor”, as it “directly involves and individual and can potentially be altered by individual interventions” (Riegelman & Kirkwood, 2019, p. 87). Cultural Considerations: Cultural considerations should be addressed prior to implementation of evidenced-based recommendations to reduce ischemic heart disease in this community. Purnell’s Model of Cultural Competence would be helpful to address cultural factors in order to specify recommendations for implementation. Domains from Purnell’s Model that could be utilized to address heart disease include nutrition; with a focus on common foods, high-

risk behaviors; specifically, tobacco, alcohol, and recreational drug use, overview/heritage and communication; with a focus on level of educational attainment and contextual use of educational information provided; and healthcare practices addressing barriers to healthcare, as well as common healthcare practices and responsibility for health (Purnell, 2002). Implementation Implementatio...