Pasco County Health Department

PPAASSCCOO CCOOUUNNTTYY Community Health Profile Report

2005

Table of Contents

I. Description 1

II. Population Characteristics 2 Socioeconomic Profile / 4

III. Fertility 8

IV. Morbidity 9

V. Mortality 15 Infant Deaths / 17

VI. Health Behaviors and Risk Factors 19

VII. Health Care Resources and Health Care Utilization 27

VIII. Perceived Health Needs of Pasco County Residents 36

IX. Sample of Survey 39

X. References 40

XI. Appendices Index 41

1

Description

Pasco is the 13th largest county in the state of Florida with a population of 389,776 people.

Spread across 745 square miles, Pasco County makes up six municipalities – New Port Richey,

Port Richey, San Antonio, St. Leo, Zephyrhills and Dade City, the county seat. In addition,

nearby metropolitan areas such as Clearwater, St. Petersburg and Tampa are less than one hour

away.

Beautifully situated on the Gulf of Mexico in the Tampa Bay area, it is one of eight counties –

Citrus, Dixie, Hernando, Levy, Jefferson, Taylor and Wakulla – that make up the “Nature Coast.”

Surrounded with beautiful scenery, diving for scallops, swimming with manatees and visiting

historic museums are all a part of Florida’s “Nature Coast.”

Figure 1 - Pasco County Map Retrieved from http://pascocountyfl.net

2

Population Characteristics

With a marked 22.6 percent increase from 1990 to 2000, there has been a continuous increase

in the population of Pasco County in the past several decades (see Figure 2). Maintaining the

population growth is the increasing number of retirees relocating to the county. The county’s

population is predicted to reach 580,100 people by the year 2030. Twenty-seven percent of Pasco

County residents are 65 and older, while the state is comprised of 17.6 percent of this growing

population.

Since the elderly populations require very specific and distinct health services in addition to

the services provided for the normal pre-retiree population, this trend is a very important

marker for present and future health policies and services provided by the county. Although pre-

retirees may and do suffer from chronic illnesses, these cases are more prevalent in elderly

populations.

In addition to its high percentage of retirees, Pasco County’s pre-retiree group is also

experiencing a drastic growth, according to Guillermo Angulo, director of environmental health

for Pasco County Health Department. Due to the lack of available housing in the metropolitan

areas near Pasco County, more and more younger families are establishing their homes in Pasco.

Therefore, Pasco County’s health needs have changed. Now, the health department must begin

to address the health needs of the younger families moving into the area as well as continue their

services to elderly residents.

There is an estimated 99,372 families who make up the community along with a population

density of 462.9 people per square mile (see Figure 2). Pasco’s population density is nearly 1.6

times more than that of the state of Florida (University of Georgia Initiative on Poverty and the

Economy). From the 99,372 families, 12.62 percent have a female as a single parent.

Figure 2 - Pasco County Population Trends (1990-2000)

3

In 2003, Pasco County’s residents were predominantly white and made up 96 percent of the

population. Blacks made up 2.3 percent of the residents while the remaining 1.6 percent of the

population consisted of other minorities (see Figure 4). Although the amount of people from

Hispanic descent continues to grow, in 2000, Hispanics – regardless of race – made up 5.7

percent of the population (see Figure 5).

Figure 3 - Pasco County Population Age & Gender Demographics (2003)

Figure 4 - Pasco County Population Age & Gender Demographics (2003)

Figure 5 - Pasco County and State Hispanic Population Percentage (2000)

4

Socioeconomic Profile

Pasco County residents have better scores on socioeconomic indicators such as the total

population in poverty, the total number of families in poverty, and the total number of children

in poverty than the state of Florida. Also, the county has higher employment rates than the state

of Florida (see Figure 6).

High employment rates can be attributed to the top ten largest employers and manufacturers

in Pasco County including the District School Board of Pasco County, State of Florida

Government, the Community Hospital of New Port Richey, Pall Aeropower Corporation,

Zephyrhills Spring Water Company, and APAC-Southeast, Inc. (Pasco County Government,

2004). Due to the contributions of these organizations, per capita income in 2003 was $27,352.

However, the number of individuals with a high school diploma is still lower in the county

compared to the state average. Even though the number of individuals twenty-five years old and

older who has a high school diploma increased by nearly 10 percent in the last decade, Pasco

County is still behind the state’s score of 79.9 percent with a score of 77.6 percent, according to

CHARTS-the Community Health Assessment Resource Tools Set (Florida Department of

Health-Office of Planning, Evaluation and Data Analysis, 2003).

Figure 6 - Pasco County and State Socioeconomic Indicators (2000)

5

The University of Georgia has performed extensive work to provide quantitative values on

poverty in several states including Florida through their Initiative on Poverty and the Economy

project. According to the University of Georgia, there are only 22,581 individuals in Pasco

County who have attended college and received their Bachelor’s degree (see Figure 9). Therefore,

it follows that the largest employment by industry is retail, construction, manufacturing and

agriculture (Pasco County Government, 2004).

The median yearly household income in Pasco County is $32,969 (see Figure 8). Pasco

County consists of 147, 713 households, making up only 2.33 percent of the total number of

families in Florida (The University of Georgia Initiative on Poverty and the Economy, 2003).

According to the Five-Year Plan for the Prevention of Child Abuse, Neglect and Abandonment-

Pasco and Pinellas Counties 2005-2009, 82.4 percent of homes in Pasco County are owned by

the families who occupy the homes. In Pasco, the median value of homes is $79, 600. Mobile

homes are 25.16 percent of the homes in Pasco County (The University of Georgia Initiative on

Poverty and the Economy, 2003). The remainders of individuals or families who do not own

their homes pay an annual monthly rent of $552.72.

Figure 7 - Pasco County Residents’ Level of Education

6

The University of Georgia Initiative on Poverty and the Economy also provides information

on group-specific poverty rates that can be found in Pasco County. A total of 36, 201 persons are

living in poverty that accounts for a county poverty rate of 10.67 percent. According to the data,

10.17 percent of whites, 20.55 percent of African-Americans and 18.09 percent of Hispanics live

in poverty (see Figure 9). When looking at all of the individuals who are living in poverty in

Pasco County, the University of Georgia found that almost 90 percent are white. African-

Americans only contribute 3.65 percent to the entire poverty population while Hispanics

contribute 9.62 percent (see Figure 10).

Figure 8 - Pasco County Residents’ Yearly Household Income

Figure 9 – Group Specific Poverty Rates in Pasco County Group Specific Poverty Rates in Pasco County

10.17

20.55

18.09

0

5

10

15

20

25

White African-American Hispanic

Groups

Per

cen

tag

e

7

Pasco has 7,559 families living in poverty (The University of Georgia Initiative on Poverty and

the Economy). Although this number is alarming, the family poverty rate of 7.61 percent is lower

than the state of Florida’s rate of 9.04 percent. The poverty rate for children is 15.87 percent

while the elderly poverty rate, 7.66 percent, is one half of the child poverty rate.

Since the county’s residents are primarily white, only a small portion of the residents do not

speak English. Only 0.3 percent of the population experience English as a language barrier.

However, in spite of this low number, Pasco County Health Department programs and agencies

such as WIC are in need of medical translators as these services not only target the low income

white majority, but also Hispanic and Creole-speaking populations.

Figure 10 – Compositions of Impoverished Population in Pasco County by Race

8

Fertility

From the years 2001 to 2003, the yearly average number of births from Pasco County women

residents was 3,924 (see Figure 11). Pasco has one of the largest birth rates – 76th to 100th

percentiles – in the state of Florida. According to CHARTS, whites have the highest birth rates

followed by Hispanics then blacks (see Figure 11). However, blacks have the highest percentage

of births to unwed mothers followed by Hispanics then whites (see Figure 13). The total

percentage of births to un wed mothers in Pasco County is 34.8 percent of all births (see Figure

11).

Figure 11 – Total Births and Age-Specific Mother Births

Figure 12 – Births per 1,000 Women by Age & Race of Mother-Pasco County (2001-2003)

Figure 13 – Pasco County Births to Unwed Mothers by Race in Pasco County

9

Morbidity In order to assess the levels of morbidity in Pasco County, prevalence and incidence rates of

disease, injury and suicide were measured. Because of the large numbers of elderly people living

in Pasco County, morbidity levels due to coronary heart disease, stroke, congestive heart failure,

cancers and diabetes are extremely high (see Figure 14 below).

As will be mentioned in the Mortality section of this report, cancer is one of the leading causes

of death among Pasco County residents. To prevent residents from dying from cancer, it is

pertinent to begin with primary prevention – the “prevention of disease or mental disorders in

susceptible individuals or populations through [the] promotion of health, including mental

health, and specific protection, as in immunization, as distinguished from the prevention of

complications or after-effects of existing disease” (Children’s Environmental Health Project,

2000). A close examination of CHARTS data reveals that the incidences of breast and prostate

cancer are higher for the county than the state (see Figures 15 and 16). In addition, although the

incidence of cervical cancer has gone through some variations through the years, the county’s

rate is the same as Florida’s incidence rate (see Figure 17).

10

Figure 15 – Pasco County Breast Cancer Incidence Rates

Figure 17 – Pasco County Cervical Cancer Incidence Rates

Figure 16 – Pasco County Prostate Cancer Incidence Rates

11

Another measure of morbidity is the prevalence of sexually transmitted diseases within a

population (CHARTS). Pasco County consistently has lower rates of sexually transmitted

diseases such as syphilis, gonorrhea and chlamydia than the state of Florida. The total rate of

the aforementioned sexually transmitted diseases for the state of Florida is 229 percent higher

than the rates in Pasco County (see Figure 18 below).

Vaccine preventable diseases include hepatitis B, measles, mumps, rubella, pertussis and

tetanus. Obtaining the appropriate immunizations after birth or as needed can prevent the

incidence and decrease the prevalence of these diseases. Pasco County had a zero incidence rate

for the years 2001 to 2003 for measles, rubella and tetanus. However, the county had higher rates

of mumps – 0.1 per 100,000 individuals – compared to the zero per 100,000 individuals rate for

the state during those years (see Figure 19).

Figure 18 – Pasco County Prevalence of STDs, Vaccine Preventable Diseases, AIDS and other diseases

12

No measures of morbidity would be complete without examining the rates of AIDS

(Acquired Immune Deficiency Syndrome) and tuberculosis. During 2001 to 2003, Pasco County

had one of the lowest rates of tuberculosis in the state with a 3-year rate of two per 100,000.

AIDS 3-year rates were also significantly lower than the state – 11.3 per 100,000 people for Pasco

County compared to 30.2 per 100,000 for Florida (see Figure 20).

Figure 19 – Pasco County Prevalence of Reportable Vaccine Preventable Disease Cases

Figure 20 – Pasco County Reported Cases of AIDS, Hepatitis A, Meningitis and Tuberculosis

13

One of the fastest ways to determine the morbidity status of a population is to ask about

perceived health condition. The Behavioral Risk Factor Surveillance System (BRFSS) survey

executed this strategy when they interviewed 505 Pasco County residents. According to the

survey, 20.4 percent of the Pasco residents interviewed rated their health status as fair or poor

(see Figure 21 below).

The number of injuries and social and mental health indicators can also be utilized as

measures of morbidity, according to Health, United States, 2004: Chartbook on Trends in the

Health of Americans (Centers for Disease Control and Prevention, 2004). Therefore, these

variables are employed in this report. Although Pasco County has been given a decent ranking of

26th to 50th percentile for the number of alcohol-related motor vehicle crashes, this is one of the

most preventable causes of morbidity and mortality (see Figure 22). The Pasco County 3-year

rate of alcohol-related motor vehicle crashes and crashes resulting in injuries is consistently

higher than the state rate (see Figure 22).

Figure 21 – Pasco County Health Status

Figure 22 – Pasco County Alcohol Related Motor Vehicle Crashes

14

The effect from the lack of available mental health services through the Pasco County Health

Department is evident in the rates of suicide. Pasco County has one of the highest age-adjusted

suicide 3-year death rates – 3.5 cases per 100,000 (see Figure 23). The county also has

considerably higher rates for burglary, domestic violence, and alcohol-related motor vehicle

crashes than the state (see Figures 24 & 25).

Figure 25 – Social and Mental Health Indicators in Pasco County

Figure 23 – Pasco County Suicide Rate

Figure 24 – Pasco County Crime and Domestic Violence Rate

15

Mortality

CHARTS data has identified the major causes of mortality among Pasco County residents as

heart disease, cancer, chronic lower respiratory disease, motor vehicle crashes, diabetes,

cirrhosis, pneumonia, and HIV/AIDS (see Figure 26). Upon closer examination, it is noticeable

that races vary in disease specific mortality rates. Heart disease is the number one killer of

whites in Pasco County followed by cancer and chronic lower respiratory disease (see Figure

27).

Figure 26 – Major Cause of Death in Pasco County

Figure 27 – Age-Adjusted Death Rates in Pasco County for Whites

16

Instead of heart disease, cancer is the number one killer among black residents of Pasco

County. The mortality rate among black residents is 4.43 times more than whites due to

diabetes, 2.26 times more than whites due to stroke, 1.96 times more than whites due to

pneumonia or influenza, and 7.23 times more than wh ites due to HIV/AIDS (see Figure 28). The

only two mortality factors that white residents experience more deaths from than blacks are

cirrhosis ad motor vehicle crashes.

Figure 28 – Age-Adjusted Death Rates in Pasco County for Blacks

17

Infant Deaths

Neonatal and postneonatal deaths in Pasco County are consistently higher than the state

infant death rates. It is interesting to note that more infants of Hispanic descent die before they

are 27 days old. Hispanic babies who do survive past their 27th day are least likely to die

compared to other infants who are of white or black descent (see Figure 29). The postneonatal

death rate is only 0.7 per 1,000 infants for Hispanics (see Figure 30). Black infants who live past

their 27th day are more likely to die due to postneonatal conditions than white or Hispanic

babies.

Figure 29 – Infant Mortality Rates in Pasco County

Figure 30 – Infant Mortality Rate in Pasco County (Bar Graph)

18

One way to prevent prenatal mortality is to make sure pregnant mothers receive prenatal

care. In spite of the higher rates of prenatal mortality found in Pasco County, almost 90 percent

of mothers are receiving prenatal care within their first trimester (see Figure 31). A closer look at

the data reveals a disparity between white, Hispanic and black races. While 90.2 percent of

pregnant white mothers and 86.2 percent of pregnant Hispanic mothers receive prenatal care by

the first trimester, only 83.4 percent of Black mothers receive necessary prenatal care by the first

trimester (see Figure 31). However, 4.4 percent of pregnant black mothers obtain prenatal care

late in their pregnancy (see Figures 31 & 32). Therefore, this may be a causal factor of the high

rate of black childre n born with low birth weight.

Figure 31 – Prenatal Care in Pasco County

Figure 32 – Summary of Maternal and Child Health in Pasco County

19

Health Behaviors and Risk Factors

The Centers for Disease Control and Prevention implemented a yearly telephone survey in

1984 to gathe r information on the health behaviors and actions of 18 years old and older

individuals living in the United States (Florida Department of Health - BRFSS Report, 2002).

This annual survey has been coined the acronym BRFSS – Behavioral Risk Factor Surveillance

System Survey. CHARTS utilizes the BRFSS survey for its county-specific behavioral risk

factors. Some of the behavioral risk factors examined for Pasco County and Florida include

alcohol and tobacco use, lack of physical activity and nutrition – all of which are considered risk

factors for the development of diabetes, high cholesterol, hypertension and obesity. Regular

screenings for colorectal cancer, cholesterol, HIV/AIDS, breast cancer and cervical cancer are

considered healthy behaviors, and should be encouraged to curtail future mortality outcomes.

Health care access, including physician and dental visits, and flu shots, was measured for these

types of behaviors that are also preventive measure for developing diseases.

The BRFSS used random sampling when forming the study samples to ensure the

generalizability of the results (Florida Department of Health - BRFSS Report, 2002). However,

in spite of employing this measure, there were still certain behavioral risk factors where the data

were not available for the Hispanic and black populations. As mentioned before, a total of 505

Pasco County residents were interviewed.

According to CHARTS and the Behavioral Risk Factor Surveillance System survey data, 26

percent, of Pasco County residents are currently smoking. Contrary to data several decades ago,

BRFSS reported in 2002 that more women, 26.8 percent, smoke cigarettes than men, 25.1

percent. However, there are more non-Hispanic whites who make up the smoking population.

Although there is a great deal of smokers in the age group 18-44, most of the smokers consists of

the 45-64 age group (Florida Department of Health - BRFSS Report, 2002).

Socioeconomic status, including education, income level and lifestyle factors such as

smoking, has always been noted to play a big factor in one’s health. Education is shown to be

associated with less smoking. Only 19.4 percent of the people who have gone to college smoke

compared to 33.6 percent of smokers who did not finish their high school education. The 2003

BRFSS survey has shown that individuals in lower income brackets are more likely to smoke

than individuals whose income is $25,000 or more. Although 50 percent of Pasco County

smokers have tried to quit smoking in the last year, there is no available data on whe ther the

cessation has been maintained.

20

In addition, smoking during pregnancy has numerous unwanted outcomes for the fetus.

Presently, 18.6 percent of expectant mothers are smoking (Department of Children and Families,

Five-Year Plan for Prevention of Child Abuse, Neglect & Abandonment: Pasco and Pinellas

Counties 2005-2009, 2005). These rates are nearly two times the state average, according to Lisa

Sloan, a health educator consultant for Pasco County Health Department. With implemented

programs such as Quit Line; Baby and Me, Tobacco Free; and nicotine replacement programs,

these numbers are expected to decline soon.

Non-Hispanic white men make up the portion of the Pasco County residents that partake in

heavy or binge drinking. Also, the 18-45 years old group makes up most of the heavy drinkers

group at 29 percent of the county population. The socioeconomic status factors that were

characteristic of the smokers play the opposite role in the drinkers. The 2002 BRFSS survey

found that individuals who have attended college and have an income of $50,000 or more make

up most of Pasco County’s heavy or binge drinkers.

Screening is a secondary prevention method employed by public health to minimize the

incidence and adverse outcomes of disease such as diabetes, heart disease, dental caries,

influenza and sexually transmitted diseases. Since Pasco County is predominantly made up of

pre-retired and retired residents, the number of chronic illness cases is consistently higher than

the state’s cases (CHARTS). In response to the high number of cases, Pasco County Health

Department has employed various chronic disease prevention programs.

Higher socioeconomic status and income do not seem to have a positive correlation with

obtaining cholesterol screening (BRFSS). The BRFSS survey found that 97.3 percent of

individuals who did not graduate from high school and had a prior screening test have had their

cholesterol checked in the last two years; whereas, 91.1 percent of individuals who have attended

college have had their cholesterol checked in the last two years (see Figure 34). However,

Figure 33 – Summary of Maternal and Child Health in Pasco County

21

socioeconomic status is a risk factor for having a high blood cholesterol level since 51.5 percent

of individuals whose income is $24,999 or lower have been diagnosed with high cholesterol.

It is always surprising to see how the gender role plays a factor in health seeking behavior. It

has been said that women generally are more health conscious than men. The results of the

BRFSS survey (2002) support this accepted notion within the behavioral and social sciences

discipline. Although 34 percent of men have been told they have high cholesterol compared to 32

percent of women, more women than men – 83.8 percent to 78.9 percent, respectively – follow

physician’s orders to reduce their high cholesterol levels by taking high blood pressure

medication (see Figure 35).

During the last two decades, there has been a great increase in the number of people who are

obese and overweight in the United States (Centers for Disease Control and Prevention, 2004).

In spite of the 2010 Healthy People objective of decreasing the prevalence of obesity and

overweight in society, data has not shown an improvement. In Pasco County, 31.7 percent of the

individuals who participated in the BRFSS survey in 2003 were classified as obese and 32

percent were classified as overweight; therefore, more than half of the people randomly chosen

to participate were either obese or overweight.

Figure 34 – High Cholesterol Rates in Pasco County

Figure 35 – Hypertension Rates in Pasco County

22

A lack of physical activity and unhealthy eating habits are major contributors to obesity,

cardiovascular diseases and diabetes. Examining the eating habits and physical activeness of

Pasco County residents can explain the high rates of those pre viously mentioned chronic

illnesses in the county. Residents who did not eat the recommended five servings of fruits and

vegetables a day accounted for 76.5 percent of those individuals interviewed, and 56.9 percent of

residents did not have a moderate level of physical activity in their daily lives (see Figures 37 and

38).

Figure 37 – Nutrition Status of Pasco County Residents

Figure 36 – Obesity and Overweight Prevalence in Pasco County

Figure 38 – Physical Status of Pasco County Residents

23

Some risk factors for diabetes include old age, hypertension and obesity – which Pasco

County has higher rates that the state for all of these factors. Out of 504 Pasco County residents

interviewed, 12.4 percent have been diagnosed with diabetes (Florida Department of Health -

BRFSS survey, 2002) (see Figure 39).Pasco County is in the fourth quartile for these risk factors;

therefore, it has one of the highest rates in the state of Florida. In a population consisting of

older citizens, it is not surprising to find that the prevalence of diabetes is higher than the state’s

rate.

Oral health indicators such as visiting the dentist, 63.5 percent, and the teeth cleanings in the

last year, 66.1 percent, are lower for Pasco County residents than the state that has 70.2 percent

and 70.5 percent, respectively (see Figure 40). These lower percentages could be attributed to

the lack of available dentists within the Pasco County Health Department among other factors.

There is one public health dental clinic in the county with one full time dentist, Dr. Ray Anel.

This dental clinic services Medicaid, Healthy Start, Ryan White clients and other Pasco County

residents. Education and yearly income seem to be highly correlated with these oral health

indicators because 46.6 percent of individuals who did not graduate from high school have not

visited the dentist within the last year; whereas, 68.2 percent of the persons who attended

college have visited the dentist within the last year (Florida Department of Health – BRFSS

survey, 2002).

Figure 39 – Diabetes in Pasco County

Figure 40 – Pasco County Oral Health Status

24

According to the BRFSS survey, more Pasco County residents have had a pneumonia and flu

shot – 33.6 percent and 32.4 percent, respectively – than the state of Florida, 22.7 percent and

26.2 percent, respectively (see Figure 41). These vaccinations have been utilized more by men

than women; however, more women, 1.6 percent, have utilized flu shots provided by the Pasco

County Health Department than men, 0.6 percent. This may result from Pasco County Health

Department having more services for women and children than men, according to Cynthia

Street, senior community health nurse supervisor at Pasco County Health Department.

Consequently, women are more exposed to and are used to receiving public health services such

as flu shots from the health department than men.

Although there is data available on the persons obtaining screening tests for colorectal cancer

in Pasco County, the only data available refers to non-Hispanic males and females (Florida

Department of Health – BRFSS survey, 2002). Therefore, these values are not representative of

the residents of Pasco County as a whole. Nevertheless, 43.8 percent of the individuals who were

queried about receiving a colorectal screening in the last two years were men and 41.8 percent of

all the people interviewed received a colorectal screening test in the last two years – a

percentage significantly higher than the state’s percentage of 33.5 percent (see Figure 42). Pasco

County is in the fourth quartile – 76th to 100th percentile – for this behavioral indicator.

Figure 42 – Colorectal Screening Rates in Pasco County

Figure 41 – Adult Pneumonia/Influenza Vaccinations Rates in Pasco County

25

The best way to detect the incidence of breast and cervical cancer is through mammograms

and Pap smears. These screening tools can make a difference between life and death of these two

cancers. However, in spite of these medical advancements, only 82.4 percent of women 40 years

old and older have had Pap smears and only 77.6 percent have had a mammogram in the last two

years (Florida Department of Health – BRFSS survey, 2002) (see Figure 43). Also, the data

shows that the majority of these screening test are being utilized primarily by women who have

attended college, and who are married or living together wi th their partners.

The following table shows the percentage of people who have been tested for HIV – Human

Immunodeficiency Virus (see Figure 44). Being tested for HIV is one of the best ways to limit

transmission to others and a way to assure a better outcome by early intervention.

A lack of appropriate prenatal care has adverse affects on infants. Fetuses that are not

properly taken care of during pregnancy can be born prematurely and severely underweight.

Infants born to black mothers experience more cases of being born underweight than white or

Hispanic babies (see Figure 45). A recommended safety guard for having a health baby is proper

spacing between births. Only 37.8 percent of Pasco County mothers in 2002 properly spaced

their pregnancies compared to 36.3 percent of mothers in the state of Florida, according to the

Figure 44 – HIV Testing Rates among Pasco County Residents under 65 Years Old

Figure 43 – Pap Smear and Mammogram Rates Among Pasco County Women

26

Five-Year Plan for Prevention of Child Abuse, Neglect and Abandonment – Pasco and Pinellas

Counties: 2005-2009 (2005).

Another child health factor that should be considered when looking at risk factors is the rate

of child abuse within the county. Data from the Florida’s Children: Needs Assessment

2003/2004 indicates the child maltreatment rate is 10.4 percent for Pasco County children (Five-

Year Plan for Prevention of Child Abuse, Neglect and Abandonment – Pasco and Pinellas

Counties: 2005-2009 (2005). The rate for child maltreatment in Pasco County is significantly

lower than Pinellas’ County rate of 25.4 percent. Pinellas County has a higher reabusement rate

of 9.2 percent while 8.5 percent of children who have ever been abused in Pasco County will

experience reabusement within six months.

The Five-Year Plan for Prevention of Child Abuse, Neglect and Abandonment – Pasco and

Pinellas Counties: 2005-2009 also extended the weight data to children. According to their

findings, 4.2 percent of Pasco County children are in the lowest 5th percentile for their height to

weight ratio. Again, this height to weight indicator for child health is better for Pasco County

than Pinellas County that has 6.6 percent of children in the lowest 5th percentile for height to

weight ratio.

Figure 45 – Low Birth Weight in Pasco County

27

Health Care Resources and Health Care Utilization

Pasco County is in the 50th and below percentile for the number of dentists, family

physicians, obstetricians, gynecologists and pediatricians employed in the county (Florida

Department of Health-Office of Planning, Evaluation and Data Analysis, 2003). In 2002, there

were 26.6 dentists per 100,000 individuals in the county compared to 51.9 dentists per 100,000

individual for the state (see Figures 46 and 47). This can be an explanation of why the number of

people who have visited a dentist for a teeth cleaning is lower than the state average (Florida

Department of Health – BRFSS survey, 2002).

With the growing population, not only from the individuals retiring in the area but also from

families relocating into the area due to the lack of housing available in nearby metropolitan

areas, there needs to be an increase in the number of health practitioners in Pasco County. The

county has lower rates than the state in the number of practitioners whether they are family

practitioners, pediatricians or internists (Florida Department of Health-Office of Planning,

Evaluation and Data Analysis, 2003). There are only two obstetricians/gyne-cologists per

100,000 people in Pasco County compared to 8.6 per 100,000 for the state (see Figures 46 and

47). The lack of available obstetricians and gynecologists in the county could be an explanation

of why 1,515 of 3,924 births were delivered in Pasco County hospital facilities such as East Pasco

Medical Center or Pasco Regional Medical Center (ACHA -Agency for Health Care

Administration, 2003). The remaining 2,409 deliveries may be occurring in nearby county

hospitals such as Tampa General Hospital or Suncoast Hospital.

Figure 46 – Pasco County Health Providers

28

There are a total of 1,087 beds found in five hospitals within Pasco County which are

Community Hospital in New Port Richey, East Pasco Medical Center in Zephyrhills, Morton

Plant North Bay Hospital in New Port Richey, Pasco Regional Medical Center in Dade City, and

Regional Medical Center Bayonet Point in Hudson. As Pasco County falls behind the number of

health practitioners serving 100,000 individuals when compared to the state, it is also below the

state number relating to the number of hospital beds, acute care beds and specialty beds per

100,000 individuals. However, Pasco County does have more nursing home beds, 533 per 100,000

individuals, available than the state (see Figure 48).

Figure 47 – Health Care Providers in Pasco County per 100,000 Residents

Figure 48 – Total Number of Hospital, Acute Care, Specialty and Nursing Home Beds in Pasco County

29

Pasco County Health Department (PCHD) has one of the state’s lowest numbers of public

health department full-time employees. It is in the lowest 25th percentile with only 53.4 FTEs

per 100,000 compared to the state’s 61.4 FTEs per 100,000. Also, the PCHD spends almost $1

million less per 100,000 residents than the state (see Figure 50).

One aspect of the BRFSS survey is to determine the accessibility of health care by the

citizens. The percentage of individuals in Pasco County who did not have health care coverage –

17.7 percent – was lower than the state average of 18.7 percent. However, on average there were

more individuals who did not have a personal health care provider in the state, 23.9 percent,

than Pasco County, 22.7 percent (see Figure 51). According to A Profile of Uninsured Floridians

Findings from the 2004 Florida Health Insurance Study (2004), 5.6 percent of Pasco County residents

under the age of 65 are without health insurance.

Figure 49 – Pasco County Health Facilities’ Capacity for Service

Figure 50 – Pasco County Health Department Profile

30

Out of these five hospitals, the Regional Medical Center Bayonet Point in Hudson provides

the greatest number of services to the residents of Pasco (Agency for Health Care

Administration-AHCA, 2003). For hospitalization, Regional Medical Center Bayonet Point had

a total of 13,620, Community Hospital in New Port Richey received 13,307, and Morton Plant

North Bay Hospital serviced only 4,036 hospitalizations in 2003. The Regional Medical Center

Bayonet Point in Hudson also charged the highest amount – almost $5,000 – for an average

charge per day. On the other hand, Morton Plant North Bay Hospital had an average charge of

$3,343 per day (see Figure 52).

Figure 51 – Pasco County Health Care Coverage and Access

31

There are many facilities that provide outpatient care to the residents of Pasco. However, the

following facilities listed on the table are accredited by the Agency for Health Care

Administration (Agency for Health Care Administration-AHCA, 2005). The biggest providers

for outpatient services are the hospitals and Pasco Regional Medical Center provides the largest

number of services (see Figure 53 above). It is also the facility providing the most number of

services for Medicare patients while East Pasco Medical Center provides the highest number of

services to Medicaid patients (see Figures 54 and 55).

32

33

Pasco County residents utilize different hospitals for inpatient and outpatient services due to

the major causes of mortality discussed previously. The Community Hospital in New Port

Richey receives the most hospitalizations due to heart failure; whereas, more people utilize

Regional Medical Center Bayonet Point for coronary bypass with catheterizations (Agency for

Health Care Administration-ACHA, 2005). Based on the data from ACHA, there is not a single

hospital that dominates services provided to patients who are suffering from various heart

related diseases and conditions (see Figure 56).

Contrary to the hospital utilization for heart related conditions, there is a definite hospital

that dominates in providing hospitalization services due to respiratory related conditions such

as asthma, bronchitis, chronic obstructive pulmonary disease, respiratory failure, pulmonary

edema, pneumonia and pleurisy. Community Hospital in New Port Richey is most utilized for

these conditions, and it is the most utilized facility for diabetes care, cirrhosis and HIV (see

Figures 57, 58, 59, and 60).

Figure 57

34

Figure 58

Figure 60

Figure 59

35

There are three hospitals in Pasco County that offer obstetric services – Community Hospital

in New Port Richey, East Pasco Medical Center and Pasco Regional Medical Center. Of these

three hospitals, Community Hospital in New Port Richey provides the most vaginal and

cesarean deliveries paid by regular health care insurance and Medicaid (see Figure 61).

Figure 61

36

Perceived Health Needs of Pasco County Residents

Three tools were utilized to determine the perceived health needs of the Pasco County

Community – the Suncoast Health Council survey, Pasco County Community Assessment and

interviews of various Pasco County Health Department employees.

According to Suncoast Health Council survey results, 34.15 percent of the people interviewed

thought the residents of Pasco County were in good health. Only one out of the 41 people

interviewed rated their knowledge of health care issues with the county as “excellent.” Also,

only one person of the interviewed group stated that they were very knowledgeable of the

affordable health care services made available to the Pasco County residents.

In addition, the interviewees rated which health care services are difficult to obtain in Pasco

County. They believed mental health services to be the hardest to obtain followed by dental

care. Prescription and other medical supplies were also difficult to obtain followed by

alternative forms of health therapy such as acupuncture and herbal medicines, then convenient

walk-in clinics. Of the residents in Pasco County, the people who participated in the survey

thought the group who has the greatest difficulty of obtaining care are those who do not have

health care insurance. They believed the state government has the responsibility of addressing

the problems associated with the accessibility and rising cost of health care. Also, Pasco County

residents believed one of the ways to solve the problems related to health care is to offer more

affordable health care coverage.

A group of dietetic interns from the Pasco County Health Department performed the Pasco

County Community Assessment. The assessment revealed incongruence in the perceived health

needs between the community members and community leaders. According to the results of the

community survey, Pasco County residents believe the five most pressing health care issues are

heart disease, obesity, cancer, diabetes and sexually transmitted diseases. However, the

community leaders thought the top four health care issues are a lack of health care,

cardiovascular diseases, obesity and hepatitis C.

Lastly, nine interviews of different Pasco County Health Department full-time employees

were performed. Although nine interviews does not provide this study with enough power to be

statistically significant, the results are still of great value. The questions asked during the

interviews were all open-ended allowing for the greatest information to be gathered without

setting some limitations on answers.

37

According to the interviewees, the following are some barriers to accessing services provided

by the Pasco County Health Department.

Ø Language – A significant number of Pasco County Health Department clients speak Spanish and Creole. Although a translator is provided whenever possible for clients,

there have been instances when a translator was not available for clients who speak Arabic and some African languages.

Ø Transportation – A lack of tra nsportation limits the accessibility of services provided. Even

though there is a public transportation system in Pasco County, the routes are extremely limited and the wait times are very long. Some clients have had to walk two hours to receive services from Pasco County Health Department clinics.

Ø Space Limitations – Due to the inadequate space in clinics, there is a limitation on the

number of patients that can be seen in a given day to provide necessary services. When the clients can make it to the clinics for their appointments, there is usually a long wait to be seen since there is not enough space to facilitate faster service.

Ø Insufficient Practitioners – The lack of available practitioners who are willing to work for the

health department limits the amount of patients that can be seen in a day also. Therefore, there is a long wait list to see a physician. Moreover, there are only three full-time practitioners, two part-time practitioners, and four practicing advance registered nurse practitioners for the entire Pasco County Health Department.

Ø Lack of Marketing – Adequate marketing is not in place to help inform the residents of Pasco

County of the available services provided by the county health department.

Although special accommodations are provided to patients whenever possible and available,

the Pasco County Health Department’s main accommodation is language translators.

Translators are available for Spanish, Creole, Arabic and Bosnian, and its need is often assessed

when appointments are scheduled. If a translator is required for a visit, special arrangements are

made to ensure that there will be a translator available. Also, Pasco County residents who

qualify for Healthy Start can receive house calls to assure that clients are receiving the assistance

they need.

In addition, changes to the clinic hours have been made in order to make services at health

clinics more accessible. The Pasco County health clinic on Little Road in New Port Richey has

extended its working hours form 7 a.m. to 6 p.m. to make it easier for clients to access these

services for those who work during a normal 9 a.m. to 5 p.m. day. Walk-ins are also serviced for

those who have a flexible work schedule; however the time is limited on when care can be

received.

38

Also, the interviewees assessed how well their program was doing. The majority of the

individuals interviewed scored themselves below a nine on a scale of one being the worst and 10

being the best. Below is a list of areas that can be improved in order to increase the employees’

scores of their services:

Ø Increase Employees – Employees interviewed emphasized the need to increase employment. With the burgeoning growth of Pasco County, there needs to be a simultaneous growth within the Pasco County Health Department to keep up with the growing health needs and demand for services from residents.

Ø Establish Customer Service Training – Training on customer service methods such as the

proper way to answer the phone and speak with clients seeking services should be implemented. Within a short amount of time at the Pasco County Health Department, a significant need for this training was noticed. For instance, during a visit to one of the clinics, a client was crying because she was insulted by an employee after explaining that she did not have any money for the service fee. The employee told the client that she didn’t have any money for her health, but she had money to spend on cigarettes. Because of this incident, this individual will probably never return to the health department to obtain needed health care that they might not be able to receive elsewhere.

Ø Increase the Number of Providers and Hours of Availability – Currently, there are three full-time

practitioners, two part-time practitioners and four advanced registered nurse practitioners working for the Pasco County Health Department. With more practitioners available, the health needs of the Pasco County residents will be met easier. If the hours of availability are also increased, more individuals needing the services will be able to obtain them.

Ø Grant Writers – Professional grant writers should be employed by the health department to

increase the amount of money flowing into the department so more necessary programs and services can be provided.

Another variable addressed in the survey is the unmet needs of the Pasco County residents.

According to the public health employees who were interviewed, the following needs were

unmet:

§ Affordable health insurance § Dental clinics – Only one dental clinic exists in the health department. § Mental health services § Options for primary care services § Services for men – The only service provided exclusively for men at the Pasco County

Health Department is a vasectomy.

39

Survey Questions for Service Providers in Pasco County

Name: _______________________________________________________________________________________________ Title: ________________________________________________________________________________________________ Address: ____________________________________________________________________________________________

Phone Number: __________________________ Name of Agency/Program: __________________________

1. What are the services provided by your agency or program? 2. What are some of the barriers for citizens in Pasco County to accessing these services? 3. What are some special accommodations that you provide for citizens who require special services in Pasco County (e.g. language/cultural barriers or transportation issues)? 4. Please rate your agency or program on how well you are doing to meet the needs of the client given your limited resources. Please give reasons for rating. 5. What could you do to improve? 6. What are the major health concerns of citizens in Pasco County? 7. What are some of the needs of citizens in Pasco County that are not being addressed? 8. What do you think needs to be done to address the needs that are not being provided?

40

References

Agency for Health Care Administration. (2003). Health Stat. Retrieved June 10, 2005 from www.floridahealthstat.com.

Anderson, C., Bartos, S., Enrique, E., Ferguson, L., Gray, M., Rhodes, R. (2005). Pasco County Community Assessment Group Project.

Children’s Environmental Health Project. (2000). What is Primary Prevention? Retrieved May 25, 2005 from http://www.cape.ca/children/prev.html.

Department of Children and Families. (2005). Prevention of Child Abuse, Neglect & Abandonment: Pasco and Pinellas Counties 2005-2009 .

Florida Department of Health-Office of Planning, Evaluation and Data Analysis. (2003). Community Health Assessment Resource Tool Set: County Health Profile Report-Pasco County. Retrieved May 20, 2005 from http://www.floridacharts.com/charts/chart.aspx.

Florida Department of Health, Bureau of Epidemiology. (2002). The Prevalence of Major Behavioral Risk Factors in Pasco County – A Report from the 2002 County Behavioral Risk Factor Surveillance System (BRFSS) Survey.

Florida Department of Health, Bureau of Epidemiology. (2003). County Behavioral Risk Factor Surveillance System Health Care Access Among Hispanics in Florida: A Report from the 2002 County Behavioral Risk Factor Surveillance System (BRFSS) Survey.

Pasco County Government – Growth Management Department. (2004). Pasco 2004-2005 Profile.

Retrieved May 25, 2005 from http://pascocountyfl.net. Suncoast Health Council. (2005). Key Informant State Findings. The Centers for Disease Control and Prevention. (2004). Health, United States, 2004:

Chartbook on Trends in the Health of Americans with Special Feature on Drugs. Retrieved June 10, 2005 from www.cdc.gov.

The University of Georgia Initiative on Poverty and the Economy. (2003) Interactive Poverty Statistics. Retrieved June 15, 2005 from http://www.poverty.uga.edu/stats/stats.php.

University of Florida – Department of Health Services Research, Management and Policy.

(2005). A Profile of Uninsured Floridians Findings from the 2004 Florida Health Insurance Study.

41

Appendices Index – Additional Resources

A. 2004 National Healthcare Quality Report

B. A Profile of Uninsured Floridians - Findings from the 2004 Florida Health Insurance Study

C. Behavioral Risk Factor Surveillance System a. HIV/AIDS Prevention Among Non-Hispanic Blacks and Hispanics, 18- to 64-

Year Olds in Florida: 2002 Florida County BRFSS Findings b. Prevalence of Fair or Poor Health Status c. Health care Access, Health-related Behaviors, and Chronic Conditions Among

Adults in Florida d. Health Care Access Among Non-Hispanic Blacks in Florida e. Overweight and Related Risk Factors among Non-Hispanic Blacks in Florida f. Overweight and Related Factors among Hispanics in Florida g. Health Care Access among Hispanics in Florida h. Prevalence of Major Behavioral Risk Factors in Pasco County

D. Comprehensive Health Assessment Resource Tools Set (CHARTS-2003)

E. Consumer Health Data enables users to access information on the most common diagnoses and procedures in Florida hospitals or ambulatory surgery (outpatient) centers.

F. Five-Year Plan for the Prevention of Child Abuse, Neglect & Abandonment Pasco and Pinellas Counties 2005-2009

G. Health Care Access Among Hispanics in Florida: Findings from 2002 Florida County BRFSS

H. Key Informant Findings- Statewide: Suncoast Health Council Survey Results

I. Pasco County Community Assessment Group Project

J. Pasco County Demographics- Tables and Graphs used in the Pasco County Community Health Profile Report

a. Births to Unwed Mothers b. Causes of Mortality Among Whites c. Causes of Mortality Among Blacks d. Composition of Impoverished Population in Pasco County e. Deliveries in Pasco County Hospitals f. Group Specific Poverty Rates g. Hospitalizations Due to Cirrhosis h. Hospitalizations Due to Diabetes i. Hospitalizations Due to HIV j. Hospitalizations Due to Respiratory-Related Conditions k. Hospitalizations Due to Heart Disease and Heart Surgery l. Levels of Education in Pasco County m. Pasco County Household Income

K. Comprehensive Health Assessment Resource Tools Set (CHARTS-2004)