Laughlin Memorial Hospital
Community Health Needs
Assessment Report
June 2016
Table of Contents
Introduction ......................................................................................... 1
Executive Summary .............................................................................. 1
Hospital Description ............................................................................. 3
Choosing the Community ..................................................................... 4
Defining the Community ...................................................................... 4
Stakeholder Input Process.................................................................... 6
Community Health Needs Assessment Committee (CHNAC)................ 6
Public Health Representation ............................................................... 8
Data Sources ........................................................................................ 8
Data Collection and Analysis ................................................................ 8
Data Analysis ........................................................................................ 11
Asset Inventory .................................................................................... 13
Data Summary ..................................................................................... 13
Priority Selection .................................................................................. 15
Next Steps ............................................................................................ 16
Attachments ........................................................................................ 17
Introduction
L
aughlin Memorial Hospital is committed to providing the highest quality
medical services and diagnostic medical equipment for our patients. This
follows the vision Dr. C.B. Laughlin had with the founding of Laughlin Clinic in
1939. This vision was to always strive to improve upon our ability to better serve the
most important people we know: our patients. This Community Health Needs
Assessment report is based on Laughlin Memorial Hospital’s involvement and
enrichment of those who live within Greene County, Tennessee. The primary service
area is shared by Takoma Regional Hospital and thus the Community Health Needs
Assessment was completed in cooperation with both local hospitals. The two primary
researchers for the Community Health Needs Assessment are Erin Stayton, Wellness
Director Laughlin Memorial Hospital and Bob Kamieneski, Wellness Director Takoma
Regional Hospital. This document focuses on Laughlin Memorial Hospital. No third
party was used to complete this Community Health Needs Assessment.
There are several reasons that Community Health Needs Assessments benefit a
community. First, many times there are adequate services within a community to meet
the needs of the underserved and underprivileged, however, these services often do not
work in harmony and the end result is that there may be duplication of services or a
lack of knowledge that the service actually exist. Secondly, there may be inadequate
transportation available for the services to meet the needs of those who need them
most. Thirdly, the assessment process is critical in bringing about unity in the
development of coalitions and partnerships that can bring about continuity to care in
meeting the demands of the underserved and underprivileged. The only way to
improve community health is to bring about a sense of community to those that live
within it. Finally, it is the right thing to do.
Executive Summary
The total population for Greene County, Tennessee is 68,679. For a further breakdown
of population by age cohort see Attachment 7, pgs. 34, 35. The total land area is 622.16
square miles making it one of the largest land area counties in the State of Tennessee.
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According to the data from the national, regional and county health rankings, tobacco,
diet (obesity) and lack of physical activity are still main concerns for the residents of
Greene County, Tennessee as they relate to their overall health status. The 2015-2018
Community Health Needs Assessment Committee felt that substance abuse should be
added to tobacco, nutrition and inactivity as the major health issues facing Greene
County. There was significant discussion by the community committee surrounding the
difficulty in identifying these top issues due to their relationship with one another. For
example, obesity is related to poor nutrition and cardiovascular disease and diabetes.
For a breakdown of the top ten health issues the committee listed as well as the top four
that were chosen to develop the Community Health Plan around see Attachment 4, pg. 31
and attachment 5, pg. 32. As you read through this document please keep in mind that
the two leading health determinants are lack of education and poverty. These two
health determinants are the basis of poor health choices thus leading to poor health.
In order for Laughlin Memorial Hospital to help the underserved and underprivileged,
and to understand the true health needs in Greene County, a Community Health Needs
Assessment was conducted. The Community Health Needs Assessment included
gathering data from reputable national and government sources that included the
CDC’s Behavioral Risk Factor Surveillance Survey, 2010 Census data, and America’s
Health Rankings (State and County) to name a few. The goals for Healthy People 20/20
were also considered see Attachment 11 pg. 67. A Community Health Survey was
developed to ascertain the true community needs as determined by objective data and
individual subjective opinion. The County Health Department played a significant role
in helping with the Community Health Needs Assessment Committee as well as
deciphering the data. It might be worthy to note that the local County Health
Department conducts a Community Health Needs Assessment on a regular basis.
The time frame that the Community Health Needs Assessment took place was during
the winter, spring and summer of 2016. All primary and secondary data was collected
during this time period. Primary data included focus groups, interviews and a health
survey questionnaire. There were 652 respondents to the community health survey.
Secondary data included hospital and community (Greene County, TN) health data and
demographics. Hospital data collected from the Tennessee Hospital Association on
Emergency Room admissions by diagnosis, payer mix and demographics was also
utilized in the health needs process see Attachment 9, pg. 65 and Attachment 10 pg. 66.
The Community Health Needs Assessment process included input from all socioeconomic strata. An intentional effort was made to be inclusive in securing a broad
introspection of the community health needs through various health and thought
leaders in Greene County. The information that was gleaned through these focus
groups, interviews and the questionnaire along with the national, state and county data
have provided us with ample evidence to begin formulating solutions in meeting the
health needs of Greene County residents.
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According to the America’s Health Rankings 2016 data, Greene County TN ranked 59th
in Health Outcomes and 45th Health Factors see Attachment 8, pg. 62. There are 95
counties in the State of Tennessee. The actual leading causes of death in Greene County
see Attachment 7, pg. 57 are: Tobacco, diet/activity patterns, alcohol, microbial agents,
motor vehicles, firearms, sexual behavior and illicit drugs. Tobacco leads the list at
18.1% and diet and activity patterns are second at 15.2%. The remaining causes are all
less than 4% see Attachment 7, pg. 57.
According to the 2016 County Health Rankings, Greene County fell near the middle of
the range in most health categories when comparing all 95 counties in the State of
Tennessee. Examples include, 47th in Mortality, 48th in Health Behaviors, 40th in Clinical
Care, 42nd in Social and Economic Factors and 53rd in the Physical Environment see
Attachment 8, pgs. 62, 63.
Tennessee’s state health ranking in 2016 is 43rd. In previous years, Tennessee has ranked
39th
in
2011
and
49th in
2005.
The
State
Health
Rankings
(Americashealthrankings.org/TN) show that the strengths of Tennessee are a high rate
of high school graduates, low prevalence of excessive drinking and a small disparity in
health status by education level. This is not necessarily true in northeast Tennessee as
will be seen later in this report. Challenges include; low immunization among
adolescent females for HPV, many poor mental health days and a high prevalence of
smoking. In the past year, physical inactivity decreased 28% from 37.2% to 26.8% of
adults. In the past 2 years, poor mental health days increased 20% from 4.0 to 4.8 days
in the previous 30 days. In the past 5 years, preventable hospitalizations decreased 26%
from 87.7 to 64.8 per 1,000 Medicare beneficiaries. In the past 10 years, cardiovascular
deaths decreased 22% from 382.3 to 299.0 per 100,000 of the population.
An assessment of all the available health resources in Greene County has made it
possible to utilize effective goals and objectives to develop a strategic plan that will be
used in the implementation of Laughlin Memorial Hospital’s Community Health Plan.
Both the Community Health Needs Assessment Committee and the Hospital Health
Needs Assessment Committee realize the challenges of moving entire communities in a
healthier direction but are determined to use their financial resources and human
capital wisely in accomplishing this task.
Hospital Description
Laughlin Memorial Hospital was established in 1939 when a large house was purchased
on North Main Street by Dr. C.B. Laughlin who converted it into a small hospital
named Laughlin Clinic. By the 1950s the hospital had grown to 99 beds. In 1978, a $3.6
million expansion brought the facility’s capacity up to 177 beds. In early 1995 the
hospital built a $24 million facility which created 140 beds. In 2001 the hospital
completed a $12 million expansion that included the new Laughlin Center for Women’s
Health. In July 2006 a third Medical Office Building and the Laughlin Center for
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Outpatient Care was completed which included an expanded same-day surgery
department, outpatient lab, cardiopulmonary, and radiology services. Over $8 million
in new equipment was also installed. Laughlin Memorial Hospital has a history of
providing the highest quality medical services and diagnostic medical equipment for
our patients and will continue to serve the community in the future.
Current services of Laughlin Memorial Hospital include: Emergency Services, Nuclear
Medicine, CT, MRI and Radiology Services, Radiation Oncology, In and Outpatient
Physical Rehabilitation Services, Surgical Services, Sleep Lab, Cardio-Pulmonary Care,
Wound Care, Diabetes Education, an Endoscopy Lab, Labor & Delivery/OB, Cardiac
Cath Lab, and Lab Services. Laughlin Memorial Hospital also has the Laughlin Center
for Women’s Health, the Laughlin Healthcare Center, Laughlin Home Health Agency
and Laughlin Healthcare Foundation. Along with those service lines Laughlin
Memorial Hospital has extensive Outpatient Primary Care and Specialty Services.
The economic impact of Laughlin Memorial Hospital on Greene County is significant.
Year end for December 2015, Laughlin Memorial Hospital employed 678 paid full-time;
the year-end gross payroll was $32,536,839 in wages.
Choosing the Community
Laughlin Memorial Hospital’s primary service area was chosen to represent the
community in which Laughlin Memorial Hospital serves and was the focal point of the
Community Health Needs Assessment. This is the area that Laughlin Memorial
Hospital would have the greatest impact in promoting health where health services are
in their greatest need. The data that has been collected came from the following zip
codes: 37745, 37616, 37809, 37743, 37744, 37641, 37818, and 37810.
Defining the Community
Greene County Tennessee is a rural area consisting of just over 622 square miles with a
population of 68,679 according to the 2010 government census. It is nestled against the
Smokey Mountains and Cherokee National Forest in the Northeast corner of the State of
Tennessee. The population change from 2000 to 2010 was 9.4% just behind the state’s
population change of 11.5%. Both show significant growth. Persons less than 5 years of
age made up 5.3% of the population with persons less than 18 years of age 21.2%,
persons 65 years and over 17.4%. Females made up 50.9 % of the Greene County
population.
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The makeup of the population of Greene County, Tennessee is 95% white Caucasian.
Blacks make up 2%, Hispanic or Latino 2.5% with persons reporting two or more races
1.2%. The unemployment rate for Greene County is 8.3% which is almost 43% higher
than the U.S. at 5.8%. The number of high school graduates 25+ years of age is 76.6%.
The number of residents 25+ years of age with a Bachelor’s degree is 14%. The
homeowner rate from 2006-2010 was 74.2%. Each of those homes had an average value
of $104,200. There were 28,134 households reported in 2010. The per capita income for
the 12 month 2010 period was $18,782. The median household income for 2006-2010
was $36,867. Persons below the poverty level during that same time period were 19.7%.
Records show that there were 1,154 private nonfarm business establishments in 2010
that employed 20,513. There was an 11% decrease in employment from 2000-2009 see
Attachment 7, pg. 36.
The primary population of Greene County, Tennessee is centered in the City of
Greeneville. According to the 2010 US Census the population of Greeneville was 15,062.
The population change in Greeneville was -.9% from 2000-2010. The main growth over
that time period was in the rural county areas. White persons make up 89.1% of the
Greeneville population, while Blacks make up 5.6% and Hispanics and Latinos make up
4.4%. There were about 2% that reported being more than one race.
The per capita money income in the past 12 months of 2010 was $19,982 with a median
household income of $33,210. The number of firms was reported to be 2,268 in the year
2007.
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Stakeholder Input Process
Those asked to give input on the current health status of Greene County, Tennessee
were asked because of their knowledge of the community, commitment to improving
social issues and because of their love and desire to improve the health of each member
of the Greene County community. Laughlin Memorial Hospital created a Community
Health Needs Assessment Committee (mainly external) to guide the need’s assessment
process. The names of those listed below in the Community Health Needs Assessment
Committee include the CEO of Laughlin Memorial Hospital (Chuck Whitfield) and the
Sr. Vice President of Physician Services and Marketing (Lyndon Gallimore) from
Takoma Regional Hospital, and those individuals and organizations who provided
input with regard to the medically underserved, low-income populations, minority
populations and populations with chronic disease needs. The specific organizations
representing the medically underserved, low-income and minority populations and
populations with chronic disease included: Frontier Health (Darlene Ousley), the
Greene County Food Bank (Carmen Ricker), Rural Resources (Sally Causey), Wesley
Heights (Willie Anderson), Tabernacle Soup Kitchen (Mary Goldman), The Hope
Center (Sharon Hodges and Mallory White), City and County School Systems (Jeanie
Woolsey and Valerie Walters respectively), The County Health Department (Lisa
Chapman), City Mayor (W. T. Daniels), County Mayor (David Crum) and
representatives from both hospitals see Next Page.
Community Health Needs Assessment Committee
The Community Health Needs Assessment Committee was made up of a cross section
of community leaders. The list of members is in the table below. These members
represent a key cog in the success of our community by helping to meet the needs of
current health-related issues in Greene County, TN. The broad spectrum of members
allowed the committee to view all aspects of Greene County health needs through the
eyes of those who see those needs on a daily basis. Members included health educators,
nurses and mental health professionals, city and county government servants,
community representation, hospital administrators and food bank and local food
distribution members. Each member had a passion to not only voice their positive
views but also their concerns as they related to Greene County health issues. The
Community Health Needs Assessment Committee met three times during the
assessment period, January through March 2016. The committee will meet in June for
document approval and again to review the Community Health Plan in the spring of
2017.
The Community Health Needs Assessment Committee discussed the primary and
secondary data in great detail. Each member shared their views on the data and
detailed ways to improve the health of our community as it related to the data. The top
ten health issues see Attachment 4, pg. 31 were identified and the top four see Attachment
5, pg. 32 were chosen as possible issues on which to focus the Community Health Plan
on.
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Community Health Needs Assessment Committee (CHNAC)
Contact Information Table
Name
Willie
Anderson
Sally
Causey
Lisa
Chapman
Pam
Chesser
David
Crum
W. T.
Daniels
Lyndon
Gallimore
Mary
Goldman
Sharon
Hodges,
Mallory
White
Darlene
Ousley
Carman
Ricker
Valerie
Walters
Chuck
Whitfield
Jeannie
Woolsey
Bob
Kamieneski
Erin
Stayton
Shaun
Street
Entity/Agency
Represented
Title
Minority
LowIncome
X
Public
Health
Wesley
Heights
Rural
Resources
Health
Department
Laughlin
Mem. Hosp.
County
Community
Member
Director
X
Health
Educator
Radiology
Oncology Dir.
County Mayor
X
X
X
X
City
City Mayor
X
X
X
Takoma
Regional
Hospital
Wesley
Heights
Sr. VP,
Physician Srvs
& Mktg
Director
Tabernacle
Soup Kitchen
Administrators
The Hope
Center
Frontier
Health
Food Bank of
Greeneville
Greeneville
County
Schools
Laughlin
Memorial
Hospital
Greeneville
City Schools
Takoma
Regional
Hospital
Laughlin
Memorial
Hospital
County
Health
Department
QI and
Wellness
Director
X
X
X
X
Other
X
X
Street Address
Phone & Email
142 N Sunset Street
Greeneville, TN
2870 Holly Creek Road
Greeneville, TN
810 W Church Street
Greeneville, TN
1420 Tusculum Blvd.
Greeneville, TN
214 N Cutler Street
Greeneville, TN
200 N College Street
Greeneville, TN
438 Vann Road
Greeneville, TN
423-416-3590
PO Box 112
Greeneville, TN
423-342-7006
423-278-0607
423-278-0607
423-787-5043
423-798-1766
423-639-7105
423-278-1759
X
X
X
X
X
314 Tusculum Blvd.
Greeneville, TN
423-638-5433
X
X
X
423-467-3704
X
X
X
PO Box 9054
Gray, TN
107 Cutler St.,
Greeneville, TN
993 Hal Henard Road
Greeneville, TN
423-638-1667
Health
Coordinator
X
CEO
X
1420 Tusculum Blvd.
Greeneville, TN
423-787-4000
Health
Coordinator
Wellness
Director
X
312 Floral Street
Greeneville, TN
401 Takoma Avenue
Greeneville, TN
423-823-2916
Wellness
Director
X
1420 Tusculum Blvd.
Greeneville, TN
423-787-5097
X
810 W Church Street
Greeneville, TN
423-798-1749
Director
X
X
X
423-638-1678
423-798-8414
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Public Health Representation
The Public Health Department of Greene County was intimately involved in the
community health needs assessment process. The County Health Department plays a
key role in our Community Health Needs Assessment due to the fact that they
undertake a community health needs assessment periodically and are well versed in the
process. The County Health Departments Director, Shawn Street and Health Educator,
Lisa Chapman played a key role in helping the Community Health Needs Assessment
Committee to understand the entire health needs assessment process. Mr. Street has an
extensive knowledge of community health issues. Ms. Chapman was instrumental in
helping both Laughlin Memorial Hospital and Takoma Regional Hospital administer
the Community Health Plan for the years 2012-2015. Without her help and expertise this
process would have been much more difficult to complete. Other health agencies
included Frontier Health (Crisis/Mental Health/Behavioral Addiction), the Hope
Center (Crisis Pregnancy/Resource Center), Rural Resources, City and County School
Systems and the local Food Bank and Soup Kitchen.
Data Sources
The data sources used in the research of the Community Health Needs Assessment can
be found in see Attachment 13, pg. 69. While the data was taken from the data sources
listed, the preponderance of data used for the survey came from the 2010 U. S. Census
Report, 2015 America’s Health Rankings, and the 2015 County Health Rankings and the
CDC’s 2015 Behavioral Risk Factor Surveillance Survey.
Data Collection
It would be impossible to include all Greene County health data, graphs, tables and
figures within the confines of this document. Therefore, the two main researches have
included those data points that are significant in leading to the major health issues of
Greene County residents as defined by the Community Health Needs Assessment
Committee and Laughlin Memorial Hospital. A significant portion of the data
presented in the analysis comes through the County and State Health Rankings
developed by the Robert Wood Johnson Foundation and widely accepted by
statisticians throughout the United States. The Foundation looks at a variety of
measures that affect the future health of communities, such as high school graduation
rates, poverty rates, access to healthy foods, rates of smoking, obesity, and teen births.
The Foundation looks at two distinct areas. First, Health Outcomes. Secondly, Health
Factors. Health Outcomes represent the overall health of a county. Health Factors, in the
County Health Rankings, represent what influences the health of a county. Health
Outcomes are defined by two areas of health. They are Length of Life and Quality of
Life. Health Factors include; health behaviors, clinical care, social and economic factors
and the physical environment. Both Health Outcomes and Health Factors are weighted
at 50% each. In the two maps below, Greene County is located in the northeast section
of TN and is represented by the letters GE.
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Primary and Secondary Data were collected for the purpose of the community Health
Needs Assessment process. A portion of the Primary Data see Attachment 1, pg. 18
consisted of an online Community Health Needs Assessment Survey by Survey Monkey
and hard copy questionnaire to over 652 community members see Attachment 2, pgs. 1928. There was an effort to reach all levels of the community social structure to ensure
that the underserved and underprivileged were included in the collection of health
data. A discussion of the survey results will appear near the end of this section.
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Secondary Data consisted of demographic and health data for Greene County, the State
of Tennessee and national data from the sources listed in Attachment 13 see pg. 68. The
information was shared with the Community Health Needs Assessment Committee so
that they could determine the community health needs based on government and
clinical data as well as empirical data. The entire Community Health Needs Assessment
process was a collaboration not only between the stakeholders, but was a joint effort
between Laughlin Memorial Hospital and Takoma Regional Hospital, the two hospitals
in Greene County, Tennessee. The Wellness Directors assigned to lead in this process
worked in unity to bring Greene County thought leaders together to ensure a successful
and useful project.
The discussion that follows deals with key health data for the Laughlin Memorial
Hospital service area and compares it to the State of Tennessee and the United States.
The four top health concerns on which the Community Health Plan will be developed
comes from this data. Unfortunately, as the reader will see, Tennessee is an unhealthy
state that is slowly improving in some areas while losing ground in other areas.
Data Analysis
Prior to discussing the analysis of data the reader must be reminded that the two main
health determinants that impact a community’s health status are the education level
and poverty levels of those communities. The information contained in this section is
taken from Attachment 7 see pgs. 34-60. The overall health for Greene County is
trending in the wrong direction. Tobacco use for those greater than 18 years of age is
30% in Greene County as compared to 22.8% for Tennessee and 18.1% for the United
States. The influence of tobacco as a cash crop for many years in Northeast Tennessee
still has negative residual effects upon its constituents. A cause and effect relationship
between tobacco and disease can clearly be seen by looking at the data. Lung Cancer
incidence per 100,000 is 93.9 in the county as compared to 78.2 in the state and 64.9 for
all Americans. Lung disease mortality per 100,000 is 71.4, 52.7 and 64.9 respectively for
Greene County, Tennessee and the U.S. These are huge disparities! Finally, smoking by
income level shows those with incomes less than $15K a year have a 38.2% smoking rate
as compared to 8.4% for those earning greater than $75K see Attachment 7, pg. 59. The
State of Tennessee ranks 46 out of 50 states see Attachment 7, pg. 58. Observation of
Attachment 7 pg. 57 shows that the number one actual leading cause of death is tobacco
use.
Obesity has increased from 32% in 2012 to 33.1% in 2016 for Greene County. The obesity
rate in Tennessee is 32.1% while the rate for obesity for the United States is 27.1%. The
trend for inactivity is also upward. 36.4% of Greene County residents are inactive as
compared to 31.4% of Tennesseans and 22.6% of all Americans. The number of
overweight, 35.5%, are basically the same for Greene County, Tennessee and the U. S.
These trends are bothersome in that they are so closely related to heart disease, cancer,
diabetes, hypertension and several other preventable lifestyle diseases.
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Cardiovascular disease mortality per 100,000 is 243.9 for Greene County, 209.2 for
Tennessee and 175 for the U.S. Heart disease prevalence for those greater than 18 years
of age is 11% in Greene County, 6.1% for Tennessee and 4.4% for the United States.
Again, these are huge disparities. Also supporting these disparities is the fact that
residents with high cholesterol levels for those 18 years of age and older is 47.14% in
Greene County vs 38.53% for the average American. It is best to not only look at single
data points but to look to see where one disease can have a profound impact upon
another. There is no question the relationship exists between poor nutrition and
inactivity upon diabetes, cardiovascular disease, cancer and heart disease.
It is paramount in discussing health data to not only compare data by county, state and
country but to look at the root cause of disease. In 1985, in the International Journal of
Epidemiology, Geoffrey Rose coined the term, “Sick Individuals, Sick Populations”. An
example of this can be found in the diabetes data. Diabetes prevalence for Greene
County is 11.5%, for Tennessee’s 11.4% and for the U.S. 9.1%. While there doesn’t
appear to be a huge difference in the data across the board the numbers are still high
and because of the causal relationship between diabetes and heart disease we have to
consider diabetes at close to an epidemic state from the east to west coast.
Substance abuse is rampant in Northeast Tennessee. The drug poisoning mortality rate
was just over 20 per 10,000 in 2010. Hancock County was close to 40 per 10,000. Johnson
County was around 10 per 10,000 see Attachment 7, pg. 55. Greene County was third in
the number of substance abuse treatment admissions for youth ages 12-17 and adults in
2013 see Attachment 7, pg. 54. The number of Emergency Department admissions for
drug overdoses in Greene County from 2003-2012 jumped in 2006, from around 50 to
about 110 in 2007, where it has stayed fairly consistently through 2012. The only evident
reason may be the economy and unemployment.
It is worthy to note, that for the most part, the respondent’s results to the Community
Health Needs Assessment Survey see Attachment 2, pgs. 19-28 do in fact mimic the data
for Greene County. The majority of the respondents were between the ages of 30-69.
The majority were females and the annual income ranged from $25,000 to $74,999.
62.97% rated their overall health as good, while 13% rated their health excellent and .3%
very poor. Quality of life was rated 22.44% excellent, 65.87% good and 9.9% fair.
When asked in the Community Health Needs Assessment Survey which disease/
conditions do you believe are most common in Greene County, the respondents
answered in order: diabetes, obesity, substance abuse, cancer (all kinds), smoking,
hypertension, cardiovascular disease, lack of physical activity, poor nutrition and
mental health see Attachment 2, pg. 27. Health risks factors listed were: unemployment,
poverty, high number of uninsured and access to affordable health see Attachment 2, pg.
28. There is no question that positive changes in substance abuse, poor nutrition,
inactivity and the use of tobacco products are keys to improving the health status of
Greene County residents.
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Asset Inventory
The Asset Inventory see Attachment 3, pg. 29 lists ten health priorities in which the
Community Health Needs Assessment Committee decided deserved the highest
priority. The purpose of the asset inventory was to look at the current programs that are
offered by the community, the current programs the hospital offers and the potential
projects that could be developed in each health focus. The hospital currently teaches or
has available a variety of health programs that include; “The Biggest Loser” lifestyle
and weight loss program, the American Heart Association approved walking trail that
is 1.0 mile in length, Wellness Exercise Classes for employees and community members
and a variety of health programs. These classes are available for everyone including the
underserved and underprivileged at no or a nominal fee.
Laughlin Memorial Hospital is collaborating with Takoma Regional Hospital, the
Greene County Health Department and the University of Tennessee Extension, in
providing the Wesley Height’s Community, an underserved community, with health
programing aimed at reducing diabetes and cancer. The Wesley Heights area is not
defined by zip code(s) but rather by geographical location determined by local city
streets. In an interview with District Attorney General Cecil Mills, Jr. who lives in
Wesley Heights and is one of the spiritual leaders in the community, Mills stated that
there are approximately 11 churches and 1,700 residents that makeup the Wesley
Heights community. While there is no specific health data relating directly to this
community, it was the consensus of the Community Health Needs Assessment
Committee that the incidence of diabetes, heart disease, obesity and hypertension were
all well above the national, state and county norms for those selected diseases.
The Wesley Heights project is an ongoing multi-year initiative. Programming includes
healthy meals, physician, dietitian and health professional health lectures and other
activities. This has all been accomplished through the Diabetes Coalition made up of the
two local hospitals, the Greene County Health Department and the University of
Tennessee Extension.
Laughlin Memorial Hospital and Takoma Regional Hospital are also collaborating with
the Greene County Health Department in a Tobacco Coalition from State of Tennessee
grant funding to promote education on the negative impact of tobacco through
education, billboards, public service announcement and various other activities
targeting pregnant smoking mother’s, adults and teens.
Data Summary
The Priority Selection Report and Preliminary Data see Attachment 4, pg. 31, show the
Aggregated Priorities. The Defined Final Health Priorities selected see Attachment 5, pg.
32, and the Decision Tree see Attachment 6, pg. 33 under which those priorities were
scored and ranked. In each of the ten recognized health priorities the Decision Tree was
utilized to determine if the priority would become a top three community health needs
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project. The Decision Tree was used to walk the Community Health Needs Assessment
Committee through a process that determined if there were programs already available
to help meet the identified health needs in the community or whether it was feasible to
use the hospital resources to meet the identified health needs or both. The Decision Tree
also walked the committees through the process of determining whether they should
try to meet the health need by themselves, partner with an existing organization to meet
the health need or just support others in meeting the need.
As it relates to determining the top four health priorities the committee’s rationale was
as follows. The first health issue identified by the Community Health Needs
Assessment Committee was Accident mortality. While accident mortality per 100,000
was 50% greater than that for the United States the committee felt that the hospital
could do education in this area but that there are numerous health related organizations
that try to help people minimize accidents. The second health issue was dental care.
Again, dental health is very poor in Greene County see Attachment 7, pg. 50. The
problem doesn’t appear to be the number of dentist per population but the costs
involved in dental care or transportation. The Greene County Health Department
provides dental care so once again it wasn’t felt that the hospital resources should be
devoted to improving dental care. The third health issue that was identified is diabetes.
There is no question that diabetes is a national health issue. One of the priorities of the
2012-2015 Community Health Plan was diabetes. As a result, a Diabetes Coalition was
developed that was made up of the two local hospitals, the health department and the
University of Tennessee Extension Program. The Wesley Heights community has been
targeted to decrease the incidence of diabetes. This will continue to be a priority for the
2016-2018 cycle. The fourth health issue identified was poor nutrition/food insecurity.
The committee felt that both poor nutrition and inactivity were the basis of many of the
diseases in Greene County. Poor nutrition was selected as one of the top priorities to be
used to develop the Community Health Plan. The fifth health issue chosen was heart
disease/stroke. While this was high on the list it was not chosen for the Community
Health Plan due to the fact that if poor nutrition and inactivity could be overcome the
incidence of heart disease and stroke would be decreased.
The sixth health issue chosen, based on health data, was Inactivity. Inactivity was also
chosen as high priority and base for the Community Health Plan. The seventh health
issue was Obesity. This was not chosen in the top three this year by the Community
Health Needs Assessment Committee, not because it wasn’t important, but because the
committee felt that by attacking poor nutrition, food insecurity and inactivity the issue
of obesity would be confronted. The eight health issue identified was poverty. Because
there are a number of agencies that are available for the impoverished it was felt the
hospital’s resources could be better used. The ninth health issue was substance abuse,
drugs and alcohol. While this is a major issue and concern for health officials in Greene
County there are already agencies in existence that are available for this health issue.
The tenth health issue is tobacco use. Tobacco use was chosen as a top priority and will
continue to be part of the Community Health Plan. A tobacco coalition was developed
through a grant to the Green County Health Department by the State of Tennessee in
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2014. Both hospitals have joined in a coalition with the health department to reduce
tobacco use in Greene County.
Priority Selection
As stated in the previous section, it was challenging for the Community Health Needs
Assessment Committee to come up with the top ten health issues in Greene County.
Through the use of the decision tree see Attachment 6, pg. 34, the following three
priorities were chosen from the ten health issues on which to base the Community
Health Plan.
Defining the Final Priorities
The following top four health issues were determined by the CHNAC and Laughlin
Memorial Hospital to be the final priority issues for the Community Health Plan. The
committees determined that while cardiovascular, stroke and respiratory diseases are
prevalent in Greene County the root causes may be inactivity, poor nutrition and the
use of tobacco products. The committee’s determined through the Decision Tree that
Tobacco/Smoking, nutrition and inactivity and substance abuse were the top health
priorities for Greene County, Tennessee. Substance abuse was also determined to be a
priority issue for Greene County, Tennessee
Priority 1: Smoking and the use of tobacco products is a top priority of the Community
and Hospital Health Needs Assessment Committees. Greene County TN residents age
18+ have a 30.2% smoking rate as compared with a 22.8% State of Tennessee rate and a
national rate of 18.1%. The Healthy People 2020 goal is 12%. The use of tobacco
products has been promoted as a way of life for many years in Greene County because
tobacco has been a local crop and many families have made their living raising tobacco.
Priority 2: The second priority is inactivity. There is a strong relationship between
nutrition and inactivity as they relate to all the lifestyle diseases. Examples are heart
disease, obesity, diabetes, etc. Inactivity in the Laughlin Service area is 36. 3% as
compared to 31.4% and 22.6% respectively in Tennessee and the United States. The two
key health determinants related to many of these diseases are lack of education and
poverty.
Priority 3: The third top health priority as determined by the hospital and the CHNAC
is poor nutrition for both adults and children. The Community Health Needs
Assessment Committee struggled with choosing one cause over another because of
their close links and so it was determined that the approach will be to target nutrition
and inactivity in the fight against obesity. Over the past decade the State of Tennessee
has found itself in the top ten states in the country when it comes to obesity and
inactivity. Adult obesity (BMI >30) in Greene County is 35.4%, in the State of Tennessee
35.8% and the U.S. National Benchmark is 25%.
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Priority 4: Substance abuse was determined to be a high priority of the Community
Health Needs Assessment Committee. While there are agencies in Greene County that
provide help for those addicted to drugs and medications, the committee felt the
hospital could unify with Frontier health in providing education and information that
might minimize the use of illegal substances.
The Next Steps
The next step will be for Laughlin Memorial Hospital to develop the Community
Health Plan. The Community Health Plan will be completed by spring of 2017. The
Community Health Plan will then be implemented utilizing coalitions and various
health related agencies with the hopeful result of improving the health status of Greene
County residents. The ultimate goal will also be to improve the standing of Greene
County in the Robert Wood Johnson Foundation Community Health Rankings.
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Attachments
Attachment 1: Community Health Needs Assessment Survey ................................ 18
Attachment 2: Community Health Needs Assessment Results .......................... 19-28
Attachment 3: Asset Inventory ................................................................................ 29
Attachment 4: Priority Selection Report (PSR) ........................................................ 31
Attachment 5: Final Priorities................................................................................... 32
Attachment 6: Decision Tree .................................................................................... 33
Attachment 7: Data Charts and Graphs .............................................................. 34-60
Attachment 8: County Health Rankings ................................................................... 61
Attachment 9: Laughlin Memorial Hospital ED Market Share by Payer ……………... 65
Attachment 10: Laughlin Memorial Hospital ED by Diagnosis ………………………………. 66
Attachment 11: Healthy People 20/20 Data .............................................................. 67
Attachment 12: Data Sheet Summary for CHNA 2015-2018 ..................................... 68
Attachment 13: Sources of Information..................................................................... 69
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Attachment 1: Community Health Needs Assessment Survey
1. What is your age?
19 & under 20-29
30-39
40-49
50-59
60-69
70 & over
2. What is your gender?
Male
Female
3. What is your annual average income?
$0-$24,900 $25-49,999
$50-74,999
$75-$99,999
$100,000 & up
4. How would you rate our community’s overall health status?
Excellent
Good
Fair
Poor
Very Poor
5. How would you rate your own health status?
Excellent
Good
Fair
Poor
Very Poor
6. How would you rate our community’s overall quality of life?
Excellent
Good
Fair
Poor
Very Poor
7. How would you rate your own quality of life?
Excellent
Good
Fair
Poor
Very Poor
8. How would you rate your own quality of life?
Excellent
Good
Fair
Poor
Very Poor
9. How well do our two (2) hospitals promote good health?
Excellent
Good
Fair
Poor
Very Poor
10. Which four (4) disease conditions do you believe are the most common in Greeneville/Greene County?
Asthma-children
High Blood Pressure
Poor Nutrition
Breast Cancer
Immunizations-adults
Respiratory Disease-adults
Cancer-all kinds
Immunizations-children
Smoking
Dental problems
Lack of physical activity
Substance Abuse-drugs
Diabetes
Mental Health Disorders
Substance Abuse-drugs
Heart Disease
Obesity
11. Which three (3) behavioral risk factors are the most common to our community?
Access to affordable health care
Inadequate transportation
Access to doctors
Lack of grocery stores
Access to fresh, health food
Lack of safe places for physical activity
High number of uninsured people
Poverty
Illiteracy
Unemployment
Wearing seatbelts
12. What do you see as the greatest health problem in our community?
13. What could our hospitals do BETTER to promote good health?
14. If you were in charge of improving health in our community, what would you do first?
15. Who else do you think we should ask these questions?
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Attachment 2: Community Health Needs Assessment Results
Total Responses: 652
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Attachment 3: Asset Inventory
Area of Focus Defined
by Primary/
Secondary data
Poverty
Uninsured/
Underinsured
Unemployed
Current
Community Programs
 Frontier Mental Health provides
services based on sliding scale
 Greene County Health Department
 Various job search companies
Current Hospital
Programs
 Medicaid
 Laughlin Memorial
Hospital Foundation
 TennCare
 YMCA programs
 Weight Watchers, other support
groups
 School health initiatives
 Boys & Girls Clubs
 City parks and recreation programs
 Various church programs
 Businesses employee wellness
programs
 Community workshops hosted by
hospital
 YMCA workshops
 American Diabetes Association
outreach & educational materials
 Health Department diabetes
program
 Fitness classes
 Dietetic counseling/
education
 Employee Wellness
Programs/incentives
 Walking Trail
Poor Nutrition
Education and
Food insecurity
 Roby Center health lectures
 YMCA monthly healthcare lectures
 Rural Resources
 Wellness Programs
 5-2-1-0 program for children
 Farmer’s Market
 Food Bank
 Healthy choices in
cafeteria/wellness
menu posted
 Dietitian counseling and
education
 CREATION Health
programs
Substance Abuse Issues
ETOH
NAS
Alcohol abuse
Tobacco/Smoking/
Respiratory
Disease/
Cancer
 Frontier Mental Health Services
 Greene County Health Department
 NAMI
 Inpatient program at
Laughlin Memorial
Hospital





 Tobacco cessation
classes “Quit Now”
 Smoking patches for
employees
 Screenings
 Education
Obesity
(adults with
a BMI >30)
Diabetes
TN Tobacco Quit Line
American Lung Association
American Cancer Society
Relay for Life
Health Department
 Bi-monthly diabetes
education program
open to the community
 Monthly support group
Potential Project
 Free health clinics
 Free health education
programs
 Work with community
partners to develop a better
system of secondary care
 Screenings and education in
low income neighborhoods,
such as Wesley Heights
 School programs
 CREATION Health seminars
and Information
 Business health initiatives
 Screenings and education
programs in low income
neighborhoods, such as
Wesley Heights
 Take the hospital diabetes
program out into the
community
 Diabetes Undone programs
 Educational events in low
income neighborhoods, such
as Wesley Heights
 Partner with school systems
to teach food and nutrition
 Teach nutrition to YMCA
and Boys & Girls Clubs
during summer months
 Physician education
programs on mental health
to teach them how to screen
patients
 Tobacco cessation classes
for local businesses
 Take Tobacco Cessation
classes out to the
community
 Develop incentive programs
to reduce the use of and the
cessation of tobacco
products
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Attachment 3: Asset Inventory continued
Area of Focus
Defined by Primary/
Secondary data
Inactivity
Current
Community Programs
 See Obesity section
Heart/Disease/
Stroke/Hypertension
 American Heart Association
 Walking tails










Current Hospital
Programs
“The Biggest Loser” programs
Walking programs
Incentive programs
Walking trails at two local
hospitals
Wellness programs
Cardiac rehab
Exercise classes
Walking trails
Support groups
Nutrition talks
Potential Project
 Health Fairs with emphasis
on moving
 Let’s Move Community
initiatives
 More walking trails
 Increase physical education
in schools at all levels
 Better sidewalks
 Fund raisers for American
Heart Association
 Health fairs
 Provide free blood pressure
clinics
 Community lectures on
prevention of CVD
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Lack of Adequate
Dental Care
Accident Mortality
 Health Department
 School-based dental prevention
program
 Fluoride in water system
 Laughlin Memorial Hospital
 Takoma Regional Hospital
 Poison Control Center
 Police Department
 Sheriff’s Office
 Emergency services
 Prom Promise
 Emergency Medical Services
 Drug Enforcement Center
 Teaching of proper oral
hygiene to local school
children and adults
 More free dental clinics
 Accident Prevention
Education programs
 Additional school programs
with emphasis on accidents
and mortality
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Attachment 4: Priority Selection Report (PSR) Preliminary Data
List the top 8-10 health priorities determined by Primary (local) Data collected from local
community/multi-hospital health assessments, interviews, surveys, etc.
1. Accident Mortality
6. Inactivity
2. Dental
7. Obesity
3. Diabetes
8. Poverty
4. Poor Nutrition/Food Insecurity
9. Substance Abuse/Drugs/Alcohol
5. Heart Disease/Stroke
10. Tobacco Use
List the 8-10 health priorities determined by Secondary Data from AHS, Health Department and other
publicly available sources.
1. Uninsured/Unemployed/Poverty
6. Smoking/Tobacco Use/Respiratory
2. Obesity
7. Cancer
3. Diabetes
8. Heart Disease/Hypertension
4. Poor Nutrition
9. Dental Care
5. Mental Health
10. Lack of Physical Activity
List the 8-10 health priorities determined by internal Hospital Data.
1. Integumentary System
6. Respiratory
2. Digestive System
7. Nose, mouth, pharynx
3. Misc. diagnosis
8. Nervous System and Sense Organ Disease
4. Cardiac System
9. Eye
5. Musculoskeletal
10. Ear
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Attachment 5: Final Priorities
The following top four health issues were determined by the CHNAC and Laughlin Memorial
Hospital to be the final priority issues for the Community Health Plan. The committees
determined, that while cardiovascular, stroke and respiratory diseases are prevalent in Greene
County, the root causes may be inactivity, poor nutrition and the use of tobacco products. The
committee’s determined through the Decision Tree that Tobacco/Smoking, nutrition and
inactivity and substance abuse were the top health priorities for Greene County, Tennessee.
Since there are agencies that deal directly with substance abuse the top three priorities are as
follows.
Priority 1. Smoking and the use of tobacco products is a top priority of the Community and
Hospital Health Needs Assessment Committees. Greene County TN residents age 18+ have a
30.2% smoking rate as compared with a 22.8% State of Tennessee rate and a national rate of
18.1%. The Healthy People 2020 goal is 12%. The use of tobacco products has been promoted
as a way of life for many years in Greene County because tobacco has been a local crop and
many families have made their living raising tobacco.
Priority 2. The second priority is inactivity. There is a strong relationship between nutrition
and inactivity as they relate to all the lifestyle disease. Examples are heart disease, obesity,
diabetes, etc. Inactivity in the Takoma Service area is 36. 3 per cent as compared to 31.4 per
cent and 22.6 per cent respectively in Tennessee and the United States. The two key health
determinants related to many of these diseases are lack of education and poverty.
Priority 3. The third top health priority as determined by the hospital and the CHNAC is poor
nutrition for both adults and children. The Community Health Needs Assessment Committee
struggled with choosing one cause over another because of their close links and so it was
determined that the approach will be to target nutrition and inactivity in the fight against
obesity in the County of Greeneville, TN. Over the past decade the State of Tennessee has
found itself in the top ten states in the country when it comes to obesity and inactivity. Adult
obesity (BMI >30) in Greene County is 35.4%, in the State of Tennessee 35.8% and the U.S.
National Benchmark is 25%. Both the HHNAC and the CHNAC believe that since there is such a
close relationship between
Priority 4. Substance abuse was determined to be a high priority of the Community Health
Needs Assessment Committee. While there are agencies in Greene County that provide help for
those addicted to drugs and medications, the committee felt the hospital could unify with
Frontier health in providing education and information that might minimize the use of illegal
substances.
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Attachment 6 – Decision Tree
Identified Need:
E.g., Low
Birthweight Babies
YES.
We provide
OB and/or
prenatal
services
What other groups
are working on this
need?
NO.
We do not
provide OB
and/or
prenatal
services.
What other groups
are working on this
need?
Many
Consider
collaborating with
others
Few
Seriously
consider this
as a Priority
Many
Hospital has
no role
Few
Encourage/support
others who are
meeting this need
Is the hospital able
to effectively meet
this need?
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Attachment 7: Data Charts & Graphs
Total Population of Greene County
Total Population
Total Land Area
(Square Miles)
Population Density
(Per Square Mile)
Laughlin (Service Area)
66,803
590
113.05
Greene County, TN
68,679
621.99
110.42
Hawkins County, TN
56,759
486.85
116.59
Washington County, TN
123,891
326.38
379.59
6,402,387
41,223.97
155.31
311,536,591
3,530,997.6
88.23
Report Area
Tennessee
United States
Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Total Population by Gender
Report Area
Male
Female
Percent Male
Percent Female
Laughlin (Service Area)
32,830
33,974
49.14%
50.86%
Greene County, TN
33,658
35,021
49.01%
50.99%
Hawkins County, TN
27,630
29,129
48.68%
51.32%
Washington County, TN
60,262
63,629
48.64%
51.36%
3,120,796
3,281,591
48.74%
51.26%
153,247,408
158,289,184
49.19%
50.81%
Tennessee
United States
Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
Total Population by Race Alone, Laughlin Service Area
Report Area
White Black
Asian
Native
American/
Alaska Native
Laughlin
(Service Area)
63,700 1,562
298
100
Native
Hawaiian /
Pacific Islander
Some Other
Race
Multiple
Races
17
485
641
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Change in Total Population
According to the U.S. Census Bureau Decennial Census, between 2000 and 2010 the population in the
report area grew by 5,755 persons, a change of 9.44%. A significant positive or negative shift in total
population over time impacts healthcare providers and the utilization of community resources.
Total
Population,
2000 Census
Total
Population,
2010 Census
Total Population
Change,
2000-2010
Percent Population
Change,
2000-2010
Laughlin (Service Area)
60,941
66,696
5,755
9.44%
Greene County, TN
62,909
68,831
5,922
9.41%
Hawkins County, TN
53,563
56,833
3,270
6.1%
Washington County, TN
107,198
122,979
15,781
14.72%
5,689,283
6,346,105
656,822
11.54%
280,421,907
307,745,539
27,323,632
9.74%
Report Area
Tennessee
United States
Data Source: US Census Bureau, Decennial Census. 2000 - 2010. Source geography: Tract
Population under Age 18
This indicator reports the percentage of population under age 18 in the designated geographic area. This
indicator is relevant because it is important to understand the percentage of youth in the community, as
this population has unique health needs which should be considered separately from other age groups.
Total Population
Population
Age 0-17
Percent Population
Age 0-17
Laughlin (Service Area)
66,803
13,965
20.9%
Greene County, TN
68,679
14,307
20.83%
Hawkins County, TN
56,759
12,468
21.97%
Washington County, TN
123,891
24,830
20.04%
6,402,387
1,492,753
23.32%
311,536,608
73,877,472
23.71%
Report Area
Tennessee
United States
Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography: Tract
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Unemployment Rate
Total unemployment in the report area for the current month was 2,375, or 8.3% of the civilian noninstitutionalized population age 16 and older (non-seasonally adjusted). This indicator is relevant
because unemployment creates financial instability and barriers to access including insurance coverage,
health services, healthy food, and other necessities that contribute to poor health status.
Number
Number
Unemployment
Report Area
Employed Unemployed
Rate
Laughlin (Service Area)
28,508
26,132
2,375
8.3
Greene County, TN
29,356
26,891
2,465
8.4
Hawkins County, TN
23,642
21,900
1,742
7.4
Washington County, TN
56,838
53,211
3,627
6.4
Tennessee
2,995,953
2,799,722
196,231
6.5
United States
157,349,384 148,197,942 9,151,442
5.8
Labor Force
Data Source: US Department of Labor, Bureau of Labor Statistics. 2015 - September. Source
geography: County
Unemployment Rate
Laughlin (8.3)
Tennessee (6.5)
United States (5.8)
Teen Births
This indicator reports the rate of total births to women age of 15-19 per 1,000 female population age 15-19.
This indicator is relevant because in many cases, teen parents have unique social, economic, and health
support services. Additionally, high rates of teen pregnancy may indicate the prevalence of unsafe sex practices.
Female
Population
Age 15-19
Births to
Mothers Age
15-19
Teen Birth Rate
(Per 1,000
Population)
Laughlin (Service Area)
2,077
98
47.3
Greene County, TN
Hawkins County, TN
2,138
1,756
102
90
47.9
51.1
4,194
214,184
139
10,067
33.1
47
10,736,677
392,962
36.6
Report Area
Washington County, TN
Tennessee
United States
Teen Birth Rate
(Per 1,000 Population)
Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers
for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC
WONDER. 2006-12. Source geography: County
Laughlin (47.3)
Tennessee (47)
United States (36.6)
Births to Women Age 15-19
Rate (per 1,000 Pop.) by Time Period, 2002-2008 through 2006-2012
Report Area
2002-2008 2003-2009 2004-2010 2005-2011 2006-2012
Greene County, TN
54.7
54.5
51.8
48.8
47.9
Hawkins County, TN
56.6
56.5
54.7
52.6
51.1
Washington County, TN
38.1
36.7
34.2
34
33.1
Tennessee
52.6
51.9
50.5
49
47
41
40.3
39.3
38
36.6
United States
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Accident Mortality
This indicator reports the rate of death due to unintentional injury (accident) per 100,000 population.
Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is
relevant because accidents are a leading cause of death in the U.S.
Report Area
Total
Population
Average Crude Death Age-Adjusted
Annual
Rate
Death Rate
Deaths, (Per 100,000 (Per 100,000
2007-2011 Population) Population)
Laughlin (Service Area)
66,681
46
68.25
64.38
Greene County, TN
68,800
47
68.9
65
Hawkins County, TN
56,749
38
66.61
67.6
Washington County, TN
123,933
57
45.99
42.5
6,401,540
3,462
54.07
52.9
311,430,373
124,733
40.05
38.6
Tennessee
United States
HP 2020 Target
<= 36.0
Unintentional Injury
(Accident) Mortality,
Age-Adjusted Death Rate
(Per 100,000 Population)
Laughlin (64.38)
Tennessee (52.9)
United States (38.6)
Data Source: Centers for Disease Control and Prevention, National Vital Statistics System.
Accessed via CDC WONDER. 2009-13. Source geography: County
Food Insecurity Rate
This indicator reports the estimated percentage of the population that experienced food insecurity
at some point during the report year. Food insecurity is the household-level economic and social
condition of limited or uncertain access to adequate food.
Total
Population
Food Insecure
Population, Total
Food Insecure
Population,
Percent
Laughlin (Service Area)
66,567
11,545
17.3%
Greene County, TN
68,679
11,950
17.4%
Hawkins County, TN
56,759
8,330
14.68%
Washington County, TN
123,891
19,400
15.66%
6,495,978
1,107,820
17.05%
320,750,757
48,770,990
15.21%
Report Area
Tennessee
United States
Data Source: Feeding America. 2013. Source geography: County
Percentage of the
Population with Food
Insecurity
Laughlin (17.3)
Tennessee (17.05)
United States (15.21)
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Poverty Rate (< 100% FPL)
Poverty is considered a key driver of health status.
Within the report area 22.1% or 14,386.35 individuals are living in households with income below the
Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access
including health services, healthy food, and other necessities that contribute to poor health status.
Population in
Poverty
Percent
Population in
Poverty
Report Area
Total Population
Laughlin (Service Area)
65,100.98
14,386.35
22.1%
Greene County, TN
66,941
14,750
22.03%
Hawkins County, TN
56,066
9,106
16.24%
Washington County, TN
119,709
21,952
18.34%
Tennessee
6,242,898
1,101,732
17.65%
United States
303,692,064
46,663,432
15.37%
Percent Population
in Poverty
Laughlin (22.1%)
Tennessee (17.65%)
United States (15.37%)
Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography:
Tract
Income Per Capita
This includes all reported income from wages and salaries as well as income from self-employment,
interest or dividends, public assistance, retirement, and other sources. The per capita income in this
report area is the average (mean) income computed for every man, woman, and child in the specified
area.
Total
Population
Total Income ($)
Per Capita
Income ($)
Greene County, TN
68,679
$1,359,910,656
$19,800
Hawkins County, TN
56,759
$1,172,732,928
$20,661
Washington County, TN
123,891
$3,141,312,768
$25,355
6,402,387
$156,274,638,848
$24,408
311,536,608
$8,771,308,355,584
$28,154
Report Area
Tennessee
United States
Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography:
Tract
Per Capita Income ($)
Tennessee (24,408)
United States (28,154)
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Population with No High School Diploma
Within the report area there are 9,436 persons aged 25 and older without a high school diploma (or
equivalency) or higher. This represents 20% of the total population aged 25 and older. This indicator is
relevant because educational attainment is linked to positive health outcomes (Freudenberg Ruglis, 2007).
Total
Population
Age 25
Report Area
Population Age Percent Population
25 with No High Age 25 with No High
School Diploma
School Diploma
Laughlin (Service Area)
47,281
9,436
20%
Greene County, TN
48,765
9,738
19.97%
Hawkins County, TN
40,208
7,608
18.92%
Washington County, TN
84,239
11,351
13.47%
4,292,718
669,914
15.61%
206,587,856
28,887,720
13.98%
Tennessee
United States
Data Source: US Census Bureau, American Community Survey. 2009-13. Source geography:
Tract
Percent Population Age 25
with No High School
Diploma
Laughlin (20%)
Tennessee (15.61%)
United States (13.98%)
Uninsured Population Age 18-64
The lack of health insurance is considered a key driver of health status.
This indicator reports the percentage of adults age 18 to 64 without health insurance coverage. This
indicator is relevant because lack of insurance is a primary barrier to healthcare access including regular
primary care, specialty care, and other health services that contributes to poor health status.
Percent
Percent Population Population
Population Population
w/out
w/out
w/Medical w/Medical Medical
Medical
Insurance Insurance Insurance Insurance
Report Area
Total
Population
Age 18-64
Greene
County, TN
40,331
31,667
78.52%
8,665
21.48%
Hawkins
County, TN
34,051
27,572
80.97%
6,479
19.03%
Washington
County, TN
76,729
62,263
81.15%
14,466
18.85%
Tennessee
3,942,367
3,149,371
79.89%
792,996
20.11%
79.56%
39,336,247
20.44%
United States 192,461,139 153,124,895
Percent Population Without
Medical Insurance
Tennessee (20.11%)
United States (20.44%)
Data Source: US Census Bureau, Small Area Health Insurance Estimates. 2013. Source
geography: County
40 | P a g e
Population with Low Food Access
This indicator reports the percentage of the population living in census tracts designated as food
deserts. A food desert is defined as a low-income census tract (where a substantial number or share of
residents has low access to a supermarket or large grocery store. This indicator is relevant because it
highlights populations and geographies facing food insecurity.
Total
Population
Population
with Low
Food Access
Percent
Population with
Low Food Access
Laughlin (Service Area)
66,695
15,058
22.58%
Greene County, TN
68,831
17,024
24.73%
Hawkins County, TN
56,833
10,528
18.52%
Washington County, TN
122,979
30,073
24.45%
6,346,105
1,738,898
27.4%
308,745,538
72,905,540
23.61%
Report Area
Tennessee
United States
Percent Population with
Low Food Access
Laughlin (22.58%)
Tennessee (27.4%)
United States (23.61%)
Data Source: US Department of Agriculture, Economic Research Service, USDA - Food
Access Research Atlas. 2010. Source geography: Tract
Access to Dentists
This indicator reports the number of dentists per 100,000 population. This indicator includes all dentists
- qualified as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed
by the state to practice dentistry and who are practicing within the scope of that license.
Total Population,
2013
Dentists,
2013
Dentists, Rate
per 100,000
Population
Laughlin (Service Area)
66,204
26
39.9
Greene County, TN
68,267
27
39.6
Hawkins County, TN
56,800
10
17.6
Washington County, TN
125,546
68
54.2
6,495,978
3,254
50.1
316,128,839
199,743
63.2
Report Area
Tennessee
United States
Dentists, Rate
per 100,000 Population
Laughlin (39.9)
Tennessee (50.1)
United States (63.2)
Data Source: US Department of Health Human Services, Health Resources and Services
Administration, Area Health Resource File. 2013. Source geography: County
41 | P a g e
Breast Cancer Screening (Mammogram)
This indicator reports the percentage of female Medicare enrollees, age 67-69, who have received one
or more mammograms in the past two years. This indicator is relevant because engaging in preventive
behaviors allows for early detection and treatment of health problems. This indicator can also highlight
a lack of access to preventive care, a lack of health knowledge, insufficient provider outreach, and/or
social barriers preventing utilization of services.
Female
Percent Female
Medicare
Medicare
Enrollees with Enrollees with
Mammogram Mammogram in
in Past 2 Years
Past 2 Years
Total
Medicare
Enrollees
Female
Medicare
Enrollees
Age 67-69
Laughlin
(Service Area)
7,089
590
365
61.9%
Greene County,
TN
7,343
611
378
61.9%
Hawkins
County, TN
4,020
364
226
62.4%
Washington
County, TN
11,875
1,027
652
63.6%
Tennessee
584,993
51,066
31,551
61.8%
53,131,712
4,402,782
2,772,990
63%
Report Area
United States
Percent Female Medicare
Enrollees with
Mammogram in
Past 2 Years
Laughlin (61.9%)
Tennessee (61.8%)
United States (63%)
Data Source: Dartmouth College Institute for Health Policy Clinical Practice, Dartmouth
Atlas of Health Care. 2012. Source geography: County
42 | P a g e
Lack of a Consistent Source of Primary Care
This indicator reports the percentage of adults aged 18 and older who self-report that they do not have
at least one person who they think of as their personal doctor or health care provider. This indicator is
relevant because access to regular primary care is important to preventing major health issues and
emergency department visits.
Report Area
Survey Population
(Adults Age 18 )
Total Adults
Percent Adults
Without Any
Without Any
Regular Doctor Regular Doctor
Laughlin (Service Area)
52,240
8,566
16.4%
Greene County, TN
54,178
8,917
16.46%
Hawkins County, TN
53,363
10,905
20.43%
Washington County, TN
77,555
10,130
13.06%
4,882,847
1,050,849
21.52%
236,884,668
52,290,932
22.07%
Tennessee
United States
Percent Adults Without
Any Regular Doctor
Laughlin (16.4%)
Tennessee (21.52%)
United States (22.07%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Additional data analysis by CARES. 2011-12. Source geography:
County
Preventable Hospital Events
This indicator reports the discharge rate (per 1,000 Medicare enrollees) for conditions that are
ambulatory care sensitive (ACS). ACS conditions include pneumonia, dehydration, asthma, diabetes, and
other conditions which could have been prevented if adequate primary care resources were available
and accessed by those patients. This indicator is relevant because analysis of ACS discharges allows
demonstrating a possible “return on investment” from interventions that reduce admissions (for
example, for uninsured or Medicaid patients) through better access to primary care resources.
Report Area
Ambulatory Care
Ambulatory
Total Medicare
Sensitive
Care Sensitive
Part A
Condition Hospital
Condition
Enrollees
Discharges
Discharge Rate
Laughlin (Service Area)
7,486
6,131
81.9
Greene County, TN
7,747
634
81.9
Hawkins County, TN
4,294
351
81.8
Washington County, TN
12,934
1,062
82.1
Tennessee
626,717
45,825
73.1
58,209,898
3,448,111
59.2
United States
Data Source: Dartmouth College Institute for Health Policy Clinical Practice, Dartmouth
Atlas of Health Care. 2012. Source geography: County
Preventable Hospital
Events, Age-Adjusted
Discharge Rate
(Per 1,000 Medicare
Enrollees)
Laughlin (81.9)
Tennessee (73.1)
United States (59.2)
43 | P a g e
Heavy Alcohol Consumption
This indicator reports the percentage of adults aged 18 and older who self-report heavy alcohol
consumption (defined as more than two drinks per day on average for men and one drink per day on
average for women). This indicator is relevant because current behaviors are determinants of future
health and this indicator may illustrate a cause of significant health issues, such as cirrhosis, cancers, and
untreated mental and behavioral health needs.
Estimated
Adults
Estimated
Drinking
Adults Drinking
Excessively
Excessively
(Crude %) (Age-Adjusted %)
Total
Population
Age 18
Estimated
Adults
Drinking
Excessively
Laughlin (Service
Area)
52,265
1,776
3.4%
7.3%
Greene
TN
53,934
1,780
3.3%
suppressed
Report Area
Estimated Adults Drinking
Excessively (Age-Adjusted
Percentage)
County,
Hawkins County,
TN
44,121
2,074
4.7%
suppressed
Washington
County, TN
96,744
6,482
6.7%
7.3%
Tennessee
4,806,514
447,006
9.3%
9.7%
232,556,016
38,248,349
16.4%
16.9%
United States
Laughlin (7.3%)
Tennessee (9.7%)
United States (16.9%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Accessed via the Health Indicators Warehouse. US Department of
Health Human Services, Health Indicators Warehouse. 2006-12. Source geography: County
44 | P a g e
Tobacco Usage - Current Smokers
In the report area an estimated 14,879.30, or 28.5% of adults age 18 or older self-report currently
smoking cigarettes some days or every day. This indicator is relevant because tobacco use is linked to
leading causes of death such as cancer and cardiovascular disease.
Percent
Percent
Population
Total Adults Population Smoking
Regularly
Smoking
Cigarettes
Smoking
Cigarettes
(AgeCigarettes
(Crude)
Adjusted)
Report Area
Total
Population
Age 18
Laughlin (Service Area)
52,265.35
14,879.30
28.5%
30%
Greene County, TN
53,934
15,425
28.6%
30.2%
Hawkins County, TN
44,121
11,560
26.2%
26%
Washington County, TN
96,744
23,315
24.1%
23.8%
4,806,514
1,086,272
22.6%
22.8%
232,556,016
41,491,223
17.8%
18.1%
Tennessee
United States
Percent Population
Smoking Cigarettes
(Age-Adjusted)
Laughlin (30%)
Tennessee (22.8%)
United States (18.1%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Accessed via the Health Indicators Warehouse. US Department of
Health Human Services, Health Indicators Warehouse. 2006-12. Source geography: County
Physical Inactivity (Adult)
Within the report area, 19,537 or 36.3% of adults aged 20 and older self-report no leisure time for activity,
based on the question: “During the past month, other than your regular job, did you participate in any
physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?” This
indicator is relevant because current behaviors are determinants of future health and this indicator may
illustrate a cause of significant health issues, such as obesity and poor cardiovascular health.
Total
Population
Age 20
Population with
no Leisure Time
Physical Activity
Percent Population
with no Leisure Time
Physical Activity
Laughlin (Service Area)
51,099
19,537
36.3%
Greene County, TN
52,708
20,240
36.4%
Hawkins County, TN
43,243
16,000
35.3%
Washington County, TN
96,012
31,300
31.6%
4,791,115
1,543,548
31.4%
231,341,061
53,415,737
22.6%
Report Area
Tennessee
United States
Data Source: Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion. 2012. Source geography: County
Percent Population
with no Leisure Time
Physical Activity
Laughlin (36.3%)
Tennessee (31.4%)
United States (22.6%)
45 | P a g e
Depression - Medicare Population
This indicator reports the percentage of the Medicare fee-for-service population with depression.
Total Medicare
Beneficiaries
Beneficiaries
with
Depression
Percent with
Depression
Laughlin (Service Area)
9,904
1,677
16.9%
Greene County, TN
10,263
1,737
16.9%
Hawkins County, TN
6,026
1,185
19.7%
Washington County, TN
16,141
2,744
17%
Tennessee
778,871
130,921
16.8%
34,126,305
5,271,176
15.4%
Report Area
United States
Data Source: Centers for Medicare and Medicaid Services. 2012. Source geography:
County
Percentage of Medicare
Beneficiaries with
Depression
Laughlin (16.9%)
Tennessee (16.8%)
United States (15.4%)
Heart Disease Mortality (All)
Within the report area the rate of death due to coronary heart disease per 100,000 population is 243.38.
Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant
because heart disease is a leading cause of death in the United States.
Report Area
Total
Population
AgeCrude
Adjusted
Average Death Rate Death Rate
Annual
(Per
(Per
Deaths,
100,000
100,000
2007-2011 Population) Population)
Laughlin (Service Area)
66,681
206
308.25
243.38
Greene County, TN
68,800
213
309.3
243.9
Hawkins County, TN
56,749
154
271.72
221.6
Washington County, TN
123,933
341
275.15
227.5
6,401,540
14,466
225.98
209.2
311,430,373
600,899
192.95
175
Tennessee
United States
Heart Disease Mortality,
Age-Adjusted Death Rate
(Per 100,000 Population)
Laughlin (243.38)
Tennessee (209.2)
United States (175)
Data Source: Centers for Disease Control and Prevention, National Vital Statistics System.
Accessed via CDC WONDER. 2009-13. Source geography: County
46 | P a g e
Heart Disease Prevalence
5,700, or 10.9% of adults aged 18 and older have ever been told by a doctor that they have coronary heart
disease or angina. This indicator is relevant because coronary heart disease is a leading cause of death in
the U.S. and is also related to high blood pressure, high cholesterol, and heart attacks.
Survey
Population
(Adults Age 18 )
Total Adults
with Heart
Disease
Percent Adults
with Heart
Disease
Laughlin (Service Area)
52,226
5,700
10.9%
Greene County, TN
54,179
5,944
11%
Hawkins County, TN
51,744
3,774
7.3%
Washington County, TN
76,913
6,843
8.9%
4,858,316
297,311
6.1%
236,406,904
10,407,185
4.4%
Report Area
Tennessee
United States
Percent Adults with
Heart Disease
Laughlin (10.9%)
Tennessee (6.1%)
United States (4.4%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Additional data analysis by CARES. 2011-12. Source geography:
County
High Blood Pressure Prevalence
17,530, or 33.54% of adults aged 18 and older have ever been told by a doctor that they have high blood
pressure or hypertension.
Report Area
Total Adults
Percent Adults
Total Population with High Blood with High Blood
(Age 18 )
Pressure
Pressure
Laughlin (Service Area)
52,265
17,530
33.54%
Greene County, TN
53,934
18,014
33.4%
Hawkins County, TN
44,121
17,251
39.1%
Washington County, TN
96,744
36,666
37.9%
4,806,514
1,614,989
33.6%
232,556,016
65,476,522
28.16%
Tennessee
United States
Percent Adults with
High Blood Pressure
Laughlin (33.54%)
Tennessee (33.6%)
United States (28.16%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Additional data analysis by CARES. 2006-12. Source geography:
County
47 | P a g e
High Cholesterol
This indicator reports the percentage of adults aged 18 and older who self-report that they have ever been
told by a doctor, nurse, or other health professional that they had high blood cholesterol.
Survey
Population
(Adults Age 18 )
Total Adults
with High
Cholesterol
Percent Adults
with High
Cholesterol
Laughlin (Service Area)
37,820
17,642
46.65%
Greene County, TN
38,822
18,302
47.14%
Hawkins County, TN
38,790
12,724
32.80%
Washington County, TN
81,426
27,072
33.25%
3,820,012
1,477,761
38.68%
180,861,326
69,662,357
38.52%
Report Area
Tennessee
United States
Percent Adults with
High Cholesterol
Laughlin (46.65%)
Tennessee (38.68%)
United States (38.52%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Additional data analysis by CARES. 2011-12. Source geography:
County
Infant Mortality
This indicator reports the rate of deaths to infants less than one year of age per 1,000 births. This indicator
is relevant because high rates of infant mortality indicate the existence of broader issues pertaining to
access to care and maternal and child health.
Total Births
Total Infant
Deaths
Infant Mortality
Rate (Per 1,000
Births)
Laughlin (Service Area)
3,439
16
4.7
Greene County, TN
3,540
16
4.6
Hawkins County, TN
3,060
19
6.3
Washington County, TN
6,900
61
8.8
416,345
3,414
8.2
20,913,535
136,369
6.5
Report Area
Tennessee
United States
HP 2020 Target
Infant Mortality Rate
(Per 1,000 Births)
Laughlin (4.7)
Tennessee (8.2)
United States (6.5)
<= 6.0
Data Source: Centers for Disease Control and Prevention, National Vital Statistics System.
Accessed via CDC WONDER. Centers for Disease Control and Prevention, Wide-Ranging
Online Data for Epidemiologic Research. 2006-10. Source geography: County
48 | P a g e
Low Birth Weight
This indicator reports the percentage of total births that are low birth weight (Under 2500g). This indicator
is relevant because low birth weight infants are at high risk for health problems. This indicator can also
highlight the existence of health disparities.
Total Live Births
Low Weight
Births
(Under 2500g)
Low Weight
Births, Percent
of Total
Laughlin (Service Area)
19,054
1,669
8.76%
Greene County, TN
5,096
474
9.3%
Hawkins County, TN
4,424
394
8.9%
Washington County, TN
9,534
801
8.4%
579,117
53,279
9.2%
29,300,495
2,402,641
8.2%
Report Area
Tennessee
United States
HP 2020 Target
Percent Low Birth
Weight Births
Laughlin (8.76%)
Tennessee (9.2%)
United States (8.2%)
<= 7.8%
Data Source: US Department of Health Human Services, Health Indicators Warehouse.
Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via
CDC WONDER. 2006-12. Source geography: County
Lung Cancer Incidence
This indicator reports the age adjusted incidence rate (cases per 100,000 population per year) of colon and
rectum cancer adjusted to 2000 U.S. standard population age groups (Under age 1, 1-4, 5-9... 80-84, 85
and older). This indicator is relevant because cancer is a leading cause of death and it is important to
identify cancers separately to better target interventions.
Report Area
Total
Population
Average New Annual Incidence Rate
Cases per Year
(Per 100,000 Pop.)
Laughlin (Service Area)
66,471
83
93.41
Greene County, TN
68,617
87
93.9
Hawkins County, TN
56,694
73
99.6
Washington County, TN
121,458
107
73.3
6,297,991
5,487
78.2
306,603,776
212,768
64.9
Tennessee
United States
Data Source: National Institutes of Health, National Cancer Institute, Surveillance,
Epidemiology, and End Results Program. State Cancer Profiles. 2007-11. Source
geography: County
Annual Lung Cancer
Incidence Rate
(Per 100,000 Pop.)
Takoma (93.41)
Tennessee (78.2)
United States (64.9)
49 | P a g e
Lung Disease Mortality
This indicator reports the rate of death due to chronic lower respiratory disease per 100,000 population.
Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant
because lung disease is a leading cause of death in the United States.
Report Area
Total
Population
Average Crude Death Age-Adjusted
Annual
Rate
Death Rate
Deaths,
(Per 100,000 (Per 100,000
2007-2011 Population) Population)
Laughlin (Service Area)
66,681
63
93.74
70.76
Greene County, TN
68,800
65
94.77
71.4
Hawkins County, TN
56,749
39
69.43
53.6
Washington County, TN
123,933
75
60.36
50.3
6,401,540
3,662
57.21
52.7
311,430,373
142,214
45.66
42.2
Tennessee
United States
Lung Disease Mortality,
Age-Adjusted Death Rate
(Per 100,000 Population)
Laughlin (70.76)
Tennessee (52.7)
United States (42.2)
Data Source: Centers for Disease Control and Prevention, National Vital Statistics System.
Accessed via CDC WONDER. 2009-13. Source geography: County
Overweight (Adult)
35.5% of adults aged 18 and older self-report that they have a Body Mass Index (BMI) between 25.0 and
30.0 (overweight) in the report area. Excess weight may indicate an unhealthy lifestyle and puts
individuals at risk for further health issues.
Percent Adults Overweight
Survey
Population
(Adults Age 18 )
Total Adults
Overweight
Percent Adults
Overweight
Laughlin (Service Area)
49,774
17,665
35.5%
Greene County, TN
51,627
18,293
35.4%
Hawkins County, TN
51,141
18,146
35.5%
Washington County, TN
73,439
27,959
38.1%
4,624,095
1,653,372
35.8%
224,991,207
80,499,532
35.8%
Report Area
Tennessee
United States
Laughlin (35.5%)
Tennessee (35.8%)
United States (35.8%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Additional data analysis by CARES. 2011-12. Source geography:
County
50 | P a g e
Poor Dental Health
This indicator reports the percentage of adults age 18 and older who self-report that six or more of their
permanent teeth have been removed due to tooth decay, gum disease, or infection. This indicator is
relevant because it indicates lack of access to dental care and/or social barriers to utilization of dental
services.
Report Area
Total Adults with Percent Adults
Total Population
Poor Dental
with Poor Dental
(Age 18 )
Health
Health
Laughlin (Service Area)
51,854
14,243
27.5%
Greene County, TN
53,522
14,684
27.4%
Hawkins County, TN
43,790
15,595
35.6%
Washington County, TN
95,199
26,468
27.8%
4,806,514
1,144,599
23.8%
235,375,690
36,842,620
15.7%
Tennessee
United States
Percent Adults with Poor
Dental Health
Laughlin (27.5%)
Tennessee (23.8%)
United States (15.7%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Additional data analysis by CARES. 2006-10. Source geography:
County
Poor/Fair General Health
Within the report area 22.9% of adults age 18 and older self-report having poor or fair health in response
to the question "Would you say that in general your health is excellent, very good, good, fair, or poor?"
This indicator is relevant because it is a measure of general poor health status.
Report Area
Total
Population
Age 18
Estimated
Population
Agewith Poor or
Crude
Adjusted
Fair Health Percentage Percentage
Laughlin (Service Area)
52,265
11,987
22.9%
20.7%
Greene County, TN
53,934
12,405
23%
20.7%
Hawkins County, TN
44,121
12,486
28.3%
25.8%
Washington County, TN
96,744
19,446
20.1%
18.5%
4,806,514
990,142
20.6%
19.4%
232,556,016
37,766,703
16.2%
15.7%
Tennessee
United States
Percent Adults with
Poor or Fair Health
(Age-Adjusted)
Laughlin (20.7%)
Tennessee (19.4%)
United States (15.7%)
Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor
Surveillance System. Accessed via the Health Indicators Warehouse. US Department of
Health Human Services, Health Indicators Warehouse. 2006-12. Source geography: County
51 | P a g e
Years of Potential Life Lost
This indicator reports Years of Potential Life Lost (YPLL) before age 75 per 100,000 population for all
causes of death, age-adjusted to the 2000 standard. YPLL measures premature death and is calculated by
subtracting the age of death from the 75-year benchmark. This indicator is relevant because a measure of
premature death can provide a unique and comprehensive look at overall health status.
Total
Population,
2008-2010
Average
Total
Premature
Deaths, 20082010 Average
Laughlin (Service Area)
67,193
388
6,719
9,999
Greene County, TN
69,339
403
6,970
10,052
Hawkins County, TN
56,671
324
5,510
9,723
Washington County, TN
124,353
545
10,141
8,155
6,403,353
29,095
564,527
8,816
311,616,188
1,074,667
21,327,690
6,851
Report Area
Tennessee
United States
YPLL,
Total YPLL, Rate per
2008-2010 100,000
Average Population
Data Source: University of Wisconsin Population Health Institute, County Health Rankings.
Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via
CDC WONDER. 2008-10. Source geography: County
YPLL,
Rate per 100,000
Population
Laughlin (9,999)
Tennessee (8,816)
United States (6,851)
Stroke Mortality
Within the report area there are an estimated 48.6 deaths due to cerebrovascular disease (stroke) per
100,000 population. This is greater than the Healthy People 2020 target of less than or equal to 33.8.
Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant
because stroke is a leading cause of death in the United States.
Total
Population
Average
Annual
Deaths,
2007-2011
Crude Death
Rate
(Per 100,000
Population)
Age-Adjusted
Death Rate
(Per 100,000
Population)
Laughlin (Service Area)
66,681
41
61.5
48.6
Greene County, TN
68,800
43
61.9
48.8
Hawkins County, TN
56,749
26
45.1
36.9
Washington County, TN
123,933
62
49.7
41.5
6,401,540
3,171
49.5
46.8
311,430,373
128,955
41.4
37.9
Report Area
Tennessee
United States
HP 2020 Target
<= 33.8
Data Source: Centers for Disease Control and Prevention, National Vital Statistics System.
Accessed via CDC WONDER. 2009-13. Source geography: County
Stroke Mortality, AgeAdjusted Death Rate
(Per 100,000
Population)
Laughlin (48.6)
Tennessee (46.8)
United States (37.9)
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Prostate Cancer Incidence
This indicator reports the age adjusted incidence rate (cases per 100,000 population per year) of males
with prostate cancer adjusted to 2000 U.S. standard population age groups (Under age 1, 1-4, 5-9... 80-84,
85 and older). This indicator is relevant because cancer is a leading cause of death and it is important to
identify cancers separately to better target interventions.
Male Population
Average New
Cases per Year
Annual Incidence
Rate (Per 100,000
Population)
Laughlin (Service Area)
32,586
45
106.32
Greene County, TN
33,642
47
105.8
Hawkins County, TN
27,732
44
123.1
Washington County, TN
59,330
88
124.9
3,070,555
4,691
143.7
150,740,224
220,000
142.3
Report Area
Tennessee
United States
Data Source: National Institutes of Health, National Cancer Institute, Surveillance,
Epidemiology, and End Results Program.
State Cancer Profiles. 2007-11. Source geography: County
Annual Prostate Cancer
Incidence Rate
(Per 100,000 Population)
Laughlin (106.32)
Tennessee (143.7)
United States (142.3)
Suicide
This indicator reports the rate of death due to intentional self-harm (suicide) per 100,000 population.
Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are resummarized for report areas from county level data, only where data is available. This indicator is relevant
because suicide is an indicator of poor mental health.
AgeCrude Death
Adjusted
Rate
Death Rate
(Per 100,000 (Per 100,000
Population) Population)
Total
Population
Average
Annual
Deaths,
2007-2011
Laughlin (Service Area)
66,681
11
16.8
15.4
Greene County, TN
68,800
12
16.9
15.4
Hawkins County, TN
56,749
11
19.7
18.9
Washington County, TN
123,933
19
15.7
15.1
6,401,540
971
15.2
14.7
311,430,373
39,308
12.6
12.3
Report Area
Tennessee
United States
HP 2020 Target
Suicide, Age-Adjusted
Death Rate
(Per 100,000 Population)
Laughlin (15.4)
Tennessee (14.7)
United States (12.3)
<= 10.2
Data Source: Centers for Disease Control and Prevention, National Vital Statistics System.
Accessed via CDC WONDER. 2009-13. Source geography: County
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Diabetes Prevalence
This indicator reports the percentage of adults aged 20 and older who have ever been told by a doctor
that they have diabetes. This indicator is relevant because diabetes is a prevalent problem in the U.S.; it
may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.
Population
with
Diagnosed
Diabetes,
Age-Adjusted
Rate
Total
Population
Age 20
Population
with
Diagnosed
Diabetes
Population
with
Diagnosed
Diabetes,
Crude Rate
Laughlin (Service Area)
50,985
6,901
13.5
11.5%
Greene County, TN
52,588
7,152
13.6
11.5%
Hawkins County, TN
43,111
5,820
13.5
11.4%
Washington County, TN
95,894
10,836
11.3
10.2%
4,787,262
592,553
12.38
11.39%
9.85
9.11%
Report Area
Tennessee
United States
234,058,710 23,059,940
Percent Adults with
Diagnosed Diabetes
(Age-Adjusted)
Laughlin (11.5%)
Tennessee (11.39%)
United States (9.11%)
Data Source: Centers for Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion. 2012. Source geography: County
Obesity (Adult)
33.1% of adults aged 20 and older self-report that they have a Body Mass Index (BMI) greater than 30.0
(obese) in the report area. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for
further health issues.
Report Area
Percent Adults
Total Population Adults with BMI with BMI > 30.0
Age 20
> 30.0 (Obese)
(Obese)
Laughlin (Service Area)
51,166
16,878
33.1%
Greene County, TN
52,779
17,417
33.1%
Hawkins County, TN
43,293
14,936
34.8%
Washington County, TN
96,015
31,109
32.6%
4,792,789
1,542,526
32.1%
231,417,834
63,336,403
27.1%
Tennessee
United States
Percent Adults with
BMI > 30.0 (Obese)
Laughlin (33.1%)
Tennessee (32.1%)
United States (27.1%)
Data Source: Centers for Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion. 2012. Source geography: County
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United States Department of Health and Human Services (USDHHS), Centers for Disease Control and Prevention
(CDC) National Center for Health Statistics (NCHS), Compressed Mortality File (CMF) on DCD Wonder Outline
Database
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Tennessee Incident Based Reporting System; the American Community Survey, and the 2010 Census, United States
Census Bureau.
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Attachment 8: County Health Rankings
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Greene
County
Trend
(click
for info)
Error
Margin
Top US
Performers
Tennessee
Rank
(of 95)
Health Outcomes
59
Length of Life
57
Premature death
10,276
9,41711,134
5,200
8,696
Quality of Life
63
Poor or fair health
21%
17-26%
10%
19%
Poor physical health days
5.5
4.3-6.7
2.5
4.3
Poor mental health days
4.1
3.0-5.1
2.3
3.4
9.3%
8.5-10.1%
5.9%
9.2%
Low birth weight
Health Factors
41
Health Behaviors
38
Adult smoking
29%
22-36%
14%
23%
Adult obesity
32%
27-37%
25%
32%
Food environment index
7.1
8.4
6.9
Physical inactivity
36%
20%
30%
Access to exercise opportunities
44%
92%
70%
Excessive drinking
3%
10%
9%
Alcohol-impaired driving deaths
21%
14%
28%
Sexually transmitted infections
209
138
504
Teen births
48
20
47
31-42%
2-6%
44-51
Clinical Care
Uninsured
38
17%
16-19%
11%
16%
Primary care physicians
1,496:1
1,045:1
1,388:1
Dentists
2,528:1
1,377:1
1,996:1
Mental health providers
1,004:1
386:1
786:1
Preventable hospital stays
Diabetic monitoring
Mammography screening
82
75-89
41
73
83%
77-89%
90%
86%
61.9%
55.668.1%
70.7%
61.8%
Social & Economic Factors
High school graduation
55
95%
Some college
42.1%
Unemployment
10.6%
87%
38.246.0%
71.0%
57.7%
4.0%
8.2%
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Greene
County
Trend
(click
for info)
Error
Margin
Top US
Performers
Tennessee
Children in poverty
30%
23-36%
13%
27%
Income inequality
Children in single-parent
households
Social associations
4.3
3.9-4.7
3.7
4.8
33%
27-38%
20%
36%
11.2
22.0
11.5
Violent crime
385
59
621
Injury deaths
99
50
78
88-109
Physical Environment
Rank
(of 95)
9
Air pollution - particulate matter
13.1
9.5
13.8
Drinking water violations
7%
0%
4%
Severe housing problems
11%
10-13%
9%
15%
Driving alone to work
85%
83-88%
71%
84%
Long commute - driving alone
27%
25-30%
15%
32%
*90 percentiles, i.e., only 10% are better. Blank values reflect unreliable or missing data.
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Attachment 9: Laughlin Memorial Hospital ED Market Share by Payer
3rd Qtr 2014 through 2nd Qtr 2015
Facility
Visits
Total
Visits
363
1,153
BC/BS & BC Managed Care
3,188
6,097
Comm & Comm Managed Care
3,297
5,048
124
137
-
19
16
138
Medicare
6,757
13,747
Self-Pay
2,461
6,118
TennCare
5,799
14,055
Unknown
88
107
22,093
46,619
All Other
Cover Tennessee
Indigent/Free Care
Medicaid (not TennCare)
Grand Total
Data Source: Tennessee Hospital Association Health Information Network, Report Market Share and Changes by Payer.
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Attachment 10: Laughlin Memorial Hospital ED by Diagnosis
(Visits by Greene County residents)
3rd Qtr 2014 through 2nd Qtr 2015
Facility
Visits
Total
Visits
Market
Share
Total
Charges
Cardiovascular system OP
144
456
31.6%
$4,603,365
$31,968
Digestive system OP
487
902
54%
$9,539,402
$19,588
Ear OP
10
28
35.7%
$11,479
$1,148
Endocrine system OP
2
3
66.7%
$68,188
$34,094
Eye OP
29
63
46%
$36,841
$1,270
Female genital organs OP
14
29
48.3%
$74,498
$5,321
Hemic and lymphatic system OP
3
14
21.4%
$56,192
$18,731
675
1,490
45.3%
$1,346,538
$1,995
4
6
66.7%
$82,026
$20,506
Misc diag and therapeutic procs
766
2,015
38%
$6,118,325
$7,987
Musculoskeletal system OP
156
384
40.6%
$3,106,415
$19,913
Nervous system OP
14
76
18.4%
$126,531
$9,038
Nose, mouth, and pharynx OP
58
110
52.7%
$139,130
$2,399
Obstetrical procedures
9
15
60%
$76,005
$8,445
Respiratory System OP
66
129
51.2%
$1,809,657
$27,419
19,361
40,547
87.6%
$43,366,876
$2,240
295
352
83.8%
$3,016,482
$10,225
22,093
46,619
47.4%
$73,577,951
$3,330
DX Product Line
Integumentary system OP
Male genital organs OP
Unknown/No
Reported
Primary
Urinary system OP
Total
Proc
Average
Charges
Data Source: Tennessee Hospital Association Health Information Network, Report Market Share and Changes by
Procedure Product Line.
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Attachment 11: Healthy People 20/20 Data
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Attachment 12: Data Sheet Summary for CHNA 2015-2018
Unemployment rate
Teen Births (per 1,000)
Accident Mortality (per 100,000)
Food Insecurity
Poverty Rate (Key health determinant)
Income per capita
No HS Diploma (key health determinant)
Uninsured Population Age 18-64
Population with low food access
Access to dentist (dentist per 100,000)
Breast Cancer Screening (Mammograms)
Lack of consistent source of Primary Care
Preventable Hospital Events (per 1,000
Medicare enrollees)
Heavy Alcohol Consumption (>18 years)
Tobacco Usage (>18 years of age)
Physical Inactivity (Adult) (>20 years of age)
Depression – Medicare Population
Heart Disease Mortality (ALL) (per 100,000)
Heart Disease Prevalence (>18 years of age)
High Blood Pressure (>18 years of age)
High Cholesterol (>18 years of age)
Infant Mortality (per 1,000 births)
Low Birth Weight (Under 2,500 g)
Lung Cancer Incidence (per 100,000)
Lung Disease Mortality (per 100,000)
Overweight – Adult (>18 years of age)
Poor Dental Health (> 18 years of age)
Poor/Fair General Health (>18 years of age)
Years Potential Life Lost (<75 per (100,000)
Stroke Mortality (per 100,000)
Prostate Cancer Incidence (per 100,000)
Suicide (per 100,000)
Diabetes Prevalence (>20 years of age)
Obesity (>20 years of age)
Laughlin
Service
Area
8.3%
47.3
64.38
17.3%
22.1%
$19,800
20%
21.48%
22.58%
39.9
61.9%
16.4%
81.9
Greene
County
Tennessee
8.4%
6.5%
47.9
47
65
52.9
17.4
17.05
22.03
17.65%
$19,800 $24,408
19.97%
15.61%
21.48%
20.11%
24.73%
27.4%
39.6
50.1
61.9
61.8%
16.46%
21.52%
81.9
73.1
US
5.8%
36.6
38.6
15.21
15.37%
$28,154
13.98%
20.44%
23.61%
63.2
63%
22.07%
59.2
HP 20/20
Red
Red
Red
Red
Red
NA
Red
NA
Green
Red
Green
Green
Red
7.3%
30%
36.3%
16.9%
243.38
10.9%
33.54%
46.65%
4.7
8.76%
93.41
70.76
35.5%
27.5%
20.7%
9,999
48.6
106.32
15.4
11.5%
33.1%
7.3
30.2%
36.4
16.9%
243.9
11%
33.4%
47.14%
4.6
9.3%
93.9
71.4
35.4%
27.4%
20.7%
10,052
48.8
105.8
15.4
11.5%
33.1%
16.9%
18.1%
22.6%
15.4%
175
4.4%
28.16%
38.53%
6.5
8.2%
64.9
42.2
35.8%
15.7%
15.7%
6,851
37.9
142.3
12.3
9.11%
27.1%
Green
Red
Red
Red
Red
Red
Green
Red
Green
Green
Red
Red
Green
Red
Red
Red
Red
Green
Red
Red
Red
9.7%
22.8%
31.4%
16.8%
209.2
6.1%
33.6%
38.68%
8.2
9.2%
78.2
52.7
35.8%
23.8%
19.4%
8,816
46.8
143.7
14.7
11.39%
32.1%
Leading Causes of death in TN
1.
2.
3.
4.
5.
Heart Disease
Malignant Neoplasms (Cancer)
Chronic Lower Respiratory Disease
Accidents
Cerebrovascular Disease
6. Alzheimer’s Disease
7. Diabetes Mellitus
8. Influenza/pneumonia
9. Nephritis/neoplasms
10. Intentional self-harm (Suicide)
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Attachment 13: Sources of Information
The following is a list of the data sources utilized in the determination of the top ten health needs and
the final top three health needs of Greene County. While the data was taken from the data sources
listed below the preponderance of data used for the survey came from the 2010 U. S. Census Report,
2011 America’s Health Rankings, 2011 County Health Rankings and the CDC’s 2011 Behavioral Risk
Factor Surveillance Survey. In cases where no data is listed in Attachment 10, data was unavailable.
•
The 2010 US Census (www.census.gov/2010census/)
•
CDC’s Behavioral Risk Factor Surveillance Survey (www.cdc.gov/brfss)
•
America’s Health Rankings (www.americashealthrankings.org)
•
County Health Rankings (www.countyhealthrankings.org)
•
www.healthypeople.gov/
•
www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60 01.pdf
•
www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58 24.pdf
•
www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58 17.pdf
•
http://health.state.tn.us/statistics/PdfFiles/BehavioralRskSrvy_2009.pdf
•
http://www.eatwellplaymoretn.org/resources-and-tools/data-and-evidence/quick-facts.html
•
http://www.cdc.gov/nchs/nhds.htm
•
www.cdc.gove/nchs/data/nvsr58/nvsr58 19.pdf
•
http://205.207.175.93/HDI/TableViewer/tableView.aspx?ReportId=76
•
http://apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp?Year=2007&State=46
•
http://apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp?Year=2007&State=46
•
http://apps.nccd.cdc.gov/brfss/list.asp?cat=AC&yr=2008&qkey=7307&state=TN
•
http://apps.nccd.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf
•
http://apps.nccd.cdc.gov/BRFSS/list.asp?cat=TU&yr=2008&qkey=4396&state=All
•
Death Statistical System, Tennessee Department of health, Division of Health Statistics
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