pa. state health assessment 2016 update...2016/12/02 · pennsylvania state health assessment 2016...

Pennsylvania State Health Assessment 2016 Update

Bureau of Health Planning Division of Plan Development 2 December 2016

Table of Contents Introduction ........................................................................................................................................................... 5

Acknowledgements ............................................................................................................................................... 5

Priority Issue 1: Obesity, Physical Inactivity and Nutrition (OPIN) .......................................................................... 6

Obesity and Overweight ........................................................................................................................................ 7

Figure 1: Obesity in Pennsylvania adults by demographic, Behavioral Risk Factor Surveillance System

(BRFSS), 2015 ..................................................................................................................................................... 7

Figure 2: Obesity in Pennsylvania adults by year, Behavioral Risk Factor Surveillance System, (BRFSS), 2011–

2015 .................................................................................................................................................................. 8

Map 1: Overweight and obese adults in Pennsylvania by region, Behavioral Risk Factor Surveillance System

(BRFSS), 2015 ..................................................................................................................................................... 9

Figure 3: Overweight and obesity in Pennsylvania youth by two-year comparison, Youth Risk Behavior Survey

(YRBS), 2009 and 2015 ..................................................................................................................................... 10

Figure 4: Pennsylvania adults with and without obesity reporting fair or poor general health by year,

Behavioral Risk Factor Surveillance System (BRFSS), 2011–2015 ..................................................................... 11

Physical Inactivity ................................................................................................................................................ 12

Figure 5: Pennsylvania adults reporting no leisure time physical activity in the past month by demographic,

Behavioral Risk Factor Surveillance System (BRFSS), 2015 ............................................................................... 12

Figure 6: Pennsylvania adults reporting no leisure time physical activity in the past month by year, Behavioral

Risk Factor Surveillance System (BRFSS), 2011–2015 ....................................................................................... 13

Map 2: Participated in no leisure time physical activity in the past month among Pennsylvania adults by

region, Behavioral Risk Factor Surveillance System (BRFSS), 2013-2015 .......................................................... 14

Figure 7: Pennsylvania adolescents who were physically active by year and school grade, Youth Risk Behavior

Survey (YRBS), 2009 and 2015 ......................................................................................................................... 15

Figure 8: Pennsylvania adolescents who were physically active by demographic, Youth Risk Behavior Survey

(YRBS), 2015 .................................................................................................................................................... 16

Nutrition .............................................................................................................................................................. 17

Figure 9: Pennsylvania adults who consume at least five servings of fruits and/or vegetables every day by

demographic, Behavioral Risk Factor Surveillance System (BRFSS), 2015 ........................................................ 17

Figure 10: Pennsylvania adults who consume at least five servings of fruits and/or vegetables every day by

year, Behavioral Risk Factor Surveillance System (BRFSS), 2011–2015 ............................................................ 18

Priority Issue 2: Primary Care and Preventive Services (PCPS) ............................................................................. 19

Access to Primary Care ........................................................................................................................................ 20

Table 1: Federally designated geographic and population Health Professional Shortage Areas (HPSA),

Pennsylvania, 2015 and 2016........................................................................................................................... 20

Figure 11: Pennsylvania adult residents without a personal health care provider by demographic, Behavioral

Risk Factor Surveillance System (BRFSS), 2015 ................................................................................................ 21

Figure 12: Pennsylvania adult residents without a personal health care provider by year, Behavioral Risk

Factor Surveillance System (BRFSS), 2011–2015 .............................................................................................. 22



Figure 13: Distribution of licensed physicians practicing direct patient care in Pennsylvania by demographic,

Bureau of Health Planning Workforce Reports, 2012 ....................................................................................... 23

Map 3: Pennsylvania’s currently designated primary care Health Professional Shortage Areas (HPSAs), 2016 24

Table 2: Primary care Health Professional Shortage Areas, Pennsylvania, Health Resources and Services

Administration (HRSA), 2016 ........................................................................................................................... 24

Figure 14: Distribution of licensed dentists practicing direct patient care in Pennsylvania by demographic,

Bureau of Health Planning Workforce Reports, 2013 ....................................................................................... 25

Figure 15: Distribution of licensed dental hygienists practicing direct patient care in Pennsylvania by

demographic, Bureau of Health Planning Workforce Reports, 2013 ................................................................ 26

Figure 16: Distribution of licensed dental hygienists practicing direct patient care in Pennsylvania by type of

location, Bureau of Health Planning Workforce Reports, 2013 ........................................................................ 27

Map 4: Pennsylvania’s currently designated dental Health Professional Shortage Areas (HPSAs), 2016 .......... 28

Table 3: Dental Health Professional Shortage Areas, Pennsylvania, Health Resources and Services


Map 5: Pennsylvania’s currently designated mental Health Professional Shortage Areas (HPSAs), 2016 ......... 29

Table 4: Mental health care Health Professional Shortage Areas, Pennsylvania, Health Resources and Services


Map 6: Pennsylvania’s currently designated Medically Underserved Areas/Populations (MUA/MUP), 2016 .. 30

Table 5: Number of MUA/Ps, Pennsylvania, Health Resources and Services Administration (HRSA), 2016 ...... 30

Figure 17: Pennsylvania youth (ages 1–20 years) having had a preventive dental service in the past year by

year, Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Participation Report, 2011–2015

........................................................................................................................................................................ 31

Workforce Status ................................................................................................................................................. 32

Figure 18: Pennsylvania adults having visited a dentist in the past 12 months by demographic, Behavioral Risk

Factor Surveillance System (BRFSS), 2014 ........................................................................................................ 32

Map 7: Active primary care physicians per 100,000 population, Center for Workforce Studies, 2014 .............. 33

Map 8: Residents and fellows per 100,000 population, Center for Workforce Studies, Dec. 31, 2014 .............. 34

Priority 3: Mental Health and Substance Use ....................................................................................................... 35

Tobacco Use ........................................................................................................................................................ 36

Figure 19: Pennsylvania adults identified as current cigarette smokers by demographic, Behavioral Risk Factor

Surveillance System (BRFSS), 2015 .................................................................................................................. 36

Figure 20: Pennsylvania adults identified as current cigarette smokers by sex and year, Behavioral Risk Factor

Surveillance System (BRFSS), 2011–2015 ......................................................................................................... 37

Map 9: Pennsylvania adults identified as current cigarette smokers by region, Behavioral Risk Factor

Surveillance System (BRFSS), 2013-2015 .......................................................................................................... 38

Figure 21: Pennsylvania adults who smoke cigarettes daily by demographic, Behavioral Risk Factor


Figure 22: Pennsylvania adults who smoke cigarettes daily by year and sex, Behavioral Risk Factor




Figure 23: Pennsylvania adults who smoke cigarettes some days by demographic, Behavioral Risk Factor


Figure 24: Pennsylvania adults who smoke cigarettes some days by sex and year, Behavioral Risk Factor


Figure 25: Pennsylvania’s adults identified as former cigarettes smokers by demographic, Behavioral Risk


Figure 26: Pennsylvania adults identified as former cigarette smokers by sex and year, Behavioral Risk Factor


Figure 27: Pennsylvania adults identified as never having smoked cigarettes by demographic, Behavioral Risk


Figure 28: Pennsylvania adults identified as never having smoked cigarettes by sex and year, Behavioral Risk

Factor Surveillance System (BRFSS), 2011–2015 .............................................................................................. 46

Substance Use ..................................................................................................................................................... 47

Figure 29: Pennsylvania resident deaths due to accidental poisoning and exposure to noxious substances,

Pennsylvania vital statistics, 2010–2014 .......................................................................................................... 47

Figure 30: Pennsylvania deaths due to accidental drug poisoning, Pennsylvania vital statistics, 2010–2014 ... 48

Figure 31: Pennsylvania deaths due to accidental drug poisoning and accidental poisoning and exposure to

alcohol (combined), Pennsylvania vital statistics, 2010–2014 .......................................................................... 49

Map 10: Pennsylvania deaths due to accidental drug poisoning, Pennsylvania Death Certificate Dataset, 2012-

2014 ................................................................................................................................................................ 50

Map 11: Pennsylvania deaths due to drug related overdose, Drug Enforcement Administration, 2015 ........... 51

Figure 32: Pennsylvania admissions aged 12 and older* by primary substance, Center for Behavioral Health

Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data

Set (TEDS), 2011 and 2014 ............................................................................................................................... 52

Figure 33: Pennsylvania admissions aged 12 and older* by primary substance, by demographic, Center for

Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration,

Treatment Episode Data Set (TEDS), 2014 ....................................................................................................... 54

Figure 34: Pennsylvanians needing but not receiving treatment for drug and alcohol use by age group,

National Survey on Drug Use and Health (NSDUH), 2013–2014. ...................................................................... 56

Figure 35: Pennsylvanians experiencing alcohol or illicit drug dependence or abuse within the past year by age

group, National Survey on Drug Use and Health (NSDUH), 2013–2014 ............................................................ 57

Suicide ................................................................................................................................................................. 59

Figure 36: Pennsylvania suicide deaths, Pennsylvania vital statistics, 2014 ..................................................... 59

Map 12: Pennsylvania suicide deaths, 2010-2014 ............................................................................................ 60

Appendix A: SHA – SHIP – HIP Crosswalk ............................................................................................................. 61

References ........................................................................................................................................................... 63



Introduction This Pennsylvania State Health Assessment (SHA) 2016 Update focuses on updating statistical information relevant to the State Health Improvement Plan (SHIP) and the Health Innovation in Pennsylvania (HIP) priorities. Appendix A shows the relationship between the 2013 SHA and the SHIP and HIP goals addressed in this update. The State Health Improvement Plan is a collaborative effort to identify priorities and strategies to improve health in the commonwealth’s residents. The health priority areas include:

Priority Issue 1: Obesity, Physical Inactivity, and Nutrition (OPIN); Priority Issue 2: Primary Care and Preventive Services (PCPS); and Priority Issue 3: Mental Health and Substance Use (MHSU).

The Health Innovation in Pennsylvania plan’s population health improvement plan seeks to change the way Pennsylvania pays for, delivers and coordinates care by transforming health and health care delivery. The population health improvement plan has two main goals: to advance population health across the commonwealth and to align population health outcomes with value-based payment methodologies. Building upon previous statewide health assessments, the population health improvement plan focuses on five key priorities that have the greatest impact on health outcomes:

1. Obesity/physical inactivity; 4. Substance use; and 2. Diabetes; 5. Tobacco use. 3. Oral health;

The following sections outline the SHIP and HIP priorities and the corresponding data updates relating to each priority.

Acknowledgements The Pennsylvania State Health Assessment 2016 Update is the result of collaboration among community partners and state agencies. We would like to thank those individuals, agencies and organizations listed here that have contributed their time and expertise to the development of this update. Janet Bargh, Division Director, Division of Plan Development, Pa. Dept. of Health Stephanie Bradley, Director, EPIS Center, Penn State University Matthew Hurford, Vice President, Medical Affairs, Community Care Behavioral Health Organization Caprice Knapp, Associate Professor, Dept. of Health Policy and Administration, Penn State University Zhen-qiang Ma, Epidemiologist, Bureau of Epidemiology, Pa. Dept. of Health Jason McCrea, Public Health Program Manager, Division of Bureau Operations, Pa. Dept. of Health Mark Milliron, Public Health Program Administrator, Division of Plan Development, Pa. Dept. of Health Edward Naugle, Division Director, Division of Health Professions Development, Pa. Dept. of Health Tony Norwood, Public Health Program Administrator, Bureau of Family Health, Pa. Dept. of Health Ashley Parsons, Health Innovation Analyst, Health Innovation Center, Pa. Dept. of Health Stephanie Rovito, Director of Population Health and SIM Project Director, Pa. Dept. of Health Rob Shipp, VP for Population Health Strategies, The Hospital and Healthsystem Association of Pa. Kristi Whitby, Public Affairs Coordinator, Pocono Health System Raymond Wright, Statistical Analyst, Division of Health Informatics, Pa. Dept. of Health Brian Wright, Statistical Support Division Chief, Division of Health Informatics, Pa. Dept. of Health

http://www.health.pa.gov/Your-Department-of-Health/Offices%20and%20Bureaus/Health%20Planning/Documents/SHIP/2015-2020_PA_SHIP.pdf

http://www.health.pa.gov/Your-Department-of-Health/innovation/Documents/Health%20Innovation%20in%20PA%20Plan%2020160630%20for%20CMMI.pdf



Priority Issue 1: Obesity, Physical Inactivity and Nutrition (OPIN) The first section of the Pennsylvania State Health Assessment 2016 Update includes data relevant to Priority Issue 1 of the SHIP: Obesity, Physical Inactivity and Nutrition. The SHIP problem statement for priority issue 1 is:

“Obesity, overweight, poor nutrition, and physical inactivity are associated with profound, adverse health conditions. These include high blood pressure, high cholesterol, type 2 diabetes, heart disease, some cancers, and other limiting physical and mental health issues. In Pennsylvania, two out of three adults (6.2 million residents) and one out of three school-age children (0.5 million) have excess weight. Evidence links obesity, physical inactivity, and poor nutrition to shortened lifespan. Today’s youth are in danger of dying at younger ages than their parents.”

Priority Issue 1 has three goals:

Goal 1. Decrease the percentage of adults and children who meet the criteria for overweight and obesity; Goal 2. Improve the health of Pennsylvania residents already impacted by obesity, poor nutrition, and physical inactivity; and Goal 3. Increase opportunities for and engagement in physical activity.

The HIP’s population health priorities of obesity, physical inactivity and diabetes are addressed in priority issue 1. The DOH programs will focus on the following areas:

1. Increasing health-related physical activity through population-based approaches; 2. Improving aspects of dietary quality most related to the population burden of chronic disease

and unhealthy child development; 3. Decreasing prevalence of obesity through preventing excess weight gain and maintenance of

healthy weight loss; and 4. Reduce the burden of diabetes and improve the quality of life of individuals living with diabetes

by preventing and controlling its complications.



Obesity and Overweight SHIP OPIN 1.1 Decrease the percentage of Pennsylvania adults who are obese from 30 percent in 2013 to 27 percent by December 2020

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Obesity among adults is defined as having a body mass index (BMI) greater than or equal to 30.

Rates of obesity among Pennsylvania men and women were both 30 percent. Among Pennsylvania adults in 2015, lower rates of obesity were found in:

0 5 10 15 20 25 30 35 40 45 50 55 60

All Adults

Male

Female

18-29

30-44

45-64

GE 65

Less Than High School

High School

Some College

College Degree

Less Than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

GE $75,000

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 1: Obesity in Pennsylvania adults by demographic, Behavioral Risk Factor

Surveillance System (BRFSS), 2015

Race/

ethnicity

Income

Education

Age

Sex

Percentage of adults with obesity

All adults, 30% %Pa. SHIP goal, 27%

$75,000 and above

65 and above

All adults

https://www.phaim.health.pa.gov/EDD/



Individuals with household incomes of $75,000 and above (24 percent);

Individuals with a college degree (21 percent); and

Individuals under 29 years old (18 percent).

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2011 - 2015) Obesity among adults is defined as having a body mass index (BMI) greater than or equal to 30.

The rate of obesity among Pennsylvania adults in 2011 was 29 percent and in 2015 it was 30 percent.

29 2930 30 30

0

3

6

9

12

15

18

21

24

27

30

33

36

2011 2012 2013 2014 2015

Figure 2: Obesity in Pennsylvania adults by year, Behavioral Risk Factor

Surveillance System, (BRFSS), 2011–2015

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Map 1: Overweight and obese adults in Pennsylvania by region, Behavioral Risk

Factor Surveillance System (BRFSS), 2015

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2013 - 2015)

Note: Red fonts indicate significantly higher than the state rate, and blue indicates significantly lower than the state rate of 65 percent. Overweight and obesity among adults is defined as having a body mass index (BMI) greater than or

equal to 25.

The statewide rate of overweight and obesity among Pennsylvania adults between 2013 and 2015 was 65 percent.

During that period, the lowest rate of overweight and obesity (58 percent) was found in Bucks County.

During that period, the highest rate of overweight and obesity (72 percent) was found in the combined area that includes Indiana, Cambria, Somerset and Armstrong counties.




SHIP OPIN 1.2 Decrease the percentage of Pennsylvania youth that are overweight or obese from 39 percent in 2012-13 school year to 36 percent by December 2020.

Source: Youth Risk Behavior Surveillance System (Division of Adolescent and School Health, 2009, 2015) According to the Centers for Disease Control and Prevention, BMI for children and teens:

Is expressed as a percentile which can be obtained from either a graph or a percentile calculator. These percentiles express a child’s BMI relative to children in the U.S. who participated in national surveys that were conducted from 1963-65 to 1988-94. Because weight and height change during growth and development, as does their relation to body fatness, a child’s BMI must be interpreted relative to other children of the same sex and age.

Overweight is described as being in the 85th to under the 95th percentile, and obesity is in the 95th percentile and above. In 2009, 27.5 percent of Pennsylvania youth in grades 9 through 12 were either overweight or obese, while in 2015, that rate climbed to 29.8 percent. Note: New data from the Pennsylvania Department of Health, Mandated School Health Program (Exams/Screens) is not yet available. This chart uses data from YRBS, which is not the same data source that was used in the objective.

27.5%

29.8%

0.0%

2.5%

5.0%

7.5%

10.0%

12.5%

15.0%

17.5%

20.0%

22.5%

25.0%

27.5%

30.0%

32.5%

35.0%

2009 2015

Figure 3: Overweight and obesity in Pennsylvania youth by two-year

comparison, Youth Risk Behavior Survey (YRBS), 2009 and 2015

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http://www.cdc.gov/healthyyouth/data/yrbs



SHIP OPIN 2.1 Decrease the percentage of Pennsylvania adults who have obesity who report they have fair or poor general health from 26 percent in 2013 to 23 percent by December 2020

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2011 - 2015) Obesity among adults is defined as having a body mass index (BMI) greater than or equal to 30. Adults in Pennsylvania with obesity reported a much higher rate of fair or poor health, at 26 percent in 2015, compared with adults in the general population at 16 percent.

17 17 17 17

16

24 24

2625

26

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6

8

10

12

14

16

18

20

22

24

26

28

30

32

2011 2012 2013 2014 2015

Figure 4: Pennsylvania adults with and without obesity reporting fair or poor

general health by year, Behavioral Risk Factor Surveillance System

(BRFSS), 2011–2015

Perc

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ort

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fair

or

po

or

gen

era

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ealt

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All adults

Obese adults (BMI ≥ 30)

Year




Physical Inactivity SHIP OPIN 3.1 Decrease the percentage of Pennsylvania adults who engage in no leisure time physical activity from 26 percent in 2013 to 23 percent by December 2020

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Among Pennsylvania adults in 2015, the rate of reporting no leisure time physical activity in the past month was 28 percent.

28

26

30

21

25

29

35

37

35

27

15

41

33

30

30

19

27

30

32

0 10 20 30 40 50

All Adults

Male

Female

18-29

30-44

45-64

GE 65

Less Than High School

High School

Some College

College Degree

Less Than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

GE $75,000

White, non-Hispanic

Black, non-Hispanic

Hispanic

High school

Figure 5: Pennsylvania adults reporting no leisure time physical activity in

the past month by demographic, Behavioral Risk Factor Surveillance

System (BRFSS), 2015

Race/

ethnicity

Income

Education

Age

Sex

Percentage of adults reporting no leisure

time physical activity in the past month

All adults, 28% Pa. SHIP goal, 23%

$75,000 and above

College degree

Some college

Less than high school

65 and above

All adults




Higher rates of not participating in leisure time physical activity in the past month were found in:

Individuals with household incomes below $15,000 (41 percent) and between $15,000 and $24,999 (33 percent);

Individuals with a high school education (35 percent) or less than high school (37 percent); and

Individuals 65 years old or older (35 percent).


The rate of no leisure time physical activity in the past month among Pennsylvania adults in 2011 was 26 percent, and in 2015 it was 28 percent.

26

23

26

23

28

0

5

10

15

20

25

30

35

2011 2012 2013 2014 2015

Figure 6: Pennsylvania adults reporting no leisure time physical activity in

the past month by year, Behavioral Risk Factor Surveillance System

(BRFSS), 2011–2015

All adults

Perc

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no

leis

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tim

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hysic

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th

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ast

mo

nth

Year




Map 2: Participated in no leisure time physical activity in the past month among

Pennsylvania adults by region, Behavioral Risk Factor Surveillance System (BRFSS),

2013-2015

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2013 - 2015) Note: Red fonts indicate significantly higher than the state rate; blue indicates significantly lower than the state rate of 25 percent.

The statewide rate of no leisure time physical activity in the past month among Pennsylvania adults between 2013 and 2015 was 25 percent.

During that period, the lowest rate of no leisure time physical activity in the past month was found in Montgomery County (19 percent).

During that period, the highest rate of no leisure time physical activity in the past month (32 percent) was found in the combined area that includes Pike, Monroe and Susquehanna counties.




SHIP OPIN 3.2 Increase percentage of Pennsylvania adolescents who are physically active daily from 28 percent in 2009 to 31 percent by December 2020

Source: Youth Risk Behavior Surveillance System (Division of Adolescent and School Health, 2009, 2015)

In 2009, 27.7 percent of Pennsylvania youth in grades 9 through 12 were physically active for at least 60 minutes each of the past seven days, while in 2015, that rate fell to 24.8 percent.

27.724.8

32.0

27.828.025.725.3

21.924.9 24.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

22.0

24.0

26.0

28.0

30.0

32.0

34.0

36.0

38.0

40.0

2009 2015

Figure 7: Pennsylvania adolescents who were physically active by year and

school grade, Youth Risk Behavior Survey (YRBS), 2009 and 2015

Total Grade

9 Grade

10 Grade

11

Grade

12

Grade

12

Grade

11

Grade

10

Grade

9 Total Perc

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Year




SHIP OPIN 3.2 Increase percentage of Pennsylvania adolescents who are physically active daily from 28 percent in 2009 to 31 percent by December 2020

Source: Youth Risk Behavior Surveillance System (Division of Adolescent and School Health, 2009, 2015)

In 2015, male adolescents in Pennsylvania were almost two times more likely (32.4 percent) than females (17.3 percent) to be physically active for at least 60 minutes every day.

Students of multiple races and/or ethnicities were more likely to have been physically active every day for at least 60 minutes (37.5 percent) than were whites (25.1 percent).

24.8

27.7

32.4

17.3

22.6

37.5

27.0

25.1

27.8

25.7

21.9

24.0

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0

2015 Total

2009 Total

Male

Female

Hispanic

Multiple

Black

White

9

10

11

12

High school

grade

Race/ethnicity

Sex

Totals

Figure 8: Pennsylvania adolescents who were physically active by demographic,

Youth Risk Behavior Survey (YRBS), 2015

All adolescents, 24.8% Pa. SHIP goal, 31%

Percentage of adolescents who were physically active

for at least 60 minutes each day for seven days




Nutrition SHIP OPIN 4.1 Increase the percentage of Pennsylvania adults who consume at least five servings of fruits and/or vegetables every day from 15 percent in 2013 to 17 percent by December 2020

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015)

15

13

17

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19

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12

11

11

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19

13

14

18

15

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14

21

17

0 5 10 15 20 25 30

All adults

Male

Female

18–29

30–44

45–64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000–$24,999

$25,000–$49,999

$50,000–$74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 9: Pennsylvania adults who consume at least five servings of fruits and/or

vegetables every day by demographic, Behavioral Risk Factor Surveillance System

(BRFSS), 2015

All adults, 15% Pa. SHIP goal, 17%

Percentage of adults consuming five or more

servings of fruits and/or vegetables per day

Race/

ethnicity

Income

Education

Age

Sex




Among Pennsylvania adults, 15 percent said that they consumed at least five servings of fruits and/or vegetables every day. Higher rates of consuming at least five servings of fruits and/or vegetables were found among:

Black non-Hispanics (21 percent);

Individuals with a college degree (19 percent);

Individuals 30-44 years old (19 percent); and

Females (17 percent).

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2011, 2013, 2015)

The rate of consuming at least five servings of fruits and/or vegetables among Pennsylvania adults in 2011 was 15 percent, and in 2015, it was also 15 percent.

15 15 15

0

2

4

6

8

10

12

14

16

18

20

2011 2013 2015

Figure 10: Pennsylvania adults who consume at least five servings of fruits

and/or vegetables every day by year, Behavioral Risk Factor Surveillance

System (BRFSS), 2011–2015

All adults

Perc

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/or

veg

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s

Year




Priority Issue 2: Primary Care and Preventive Services (PCPS) The second section of the Pennsylvania State Health Assessment 2016 Update includes data relevant to Priority Issue 2 of the SHIP: Primary Care and Preventive Services. The SHIP problem statement for priority issue 2 is:

“Limited access to quality health care is a growing issue in many communities in Pennsylvania. Limits relate to the number of primary care practitioners, cultural competency, knowledge, location, and affordability, coordination of comprehensive care, reimbursement and technology, among other things. Such limitations prevent many people from obtaining quality preventive and disease management services.”

Priority Issue 2 has three goals:

Goal 1. Improve access to primary care services for Pennsylvanians; Goal 2. Increase the number of Pennsylvania residents receiving preventive health care services; and Goal 3. Improve health literacy (i.e., the capacity to obtain, process, and understand basic health information and services needed for informed health decision-making) of Pennsylvania residents.

The HIP’s population health priority of workforce development is addressed in priority issue 2. HIP goals include ensuring there is an adequately sized and competently trained workforce so that Pennsylvanians are not disadvantaged on the basis of where they live.



Access to Primary Care SHIP PCPS 1.1 Reduce the number of federally designated Geographic and Population Health Professional Shortage Areas (HPSA) by 3 percent by December 2020:

Primary Care: from 45 to 43 Dental: from 61 to 59 Mental Health: from 26 to 25

Table 1: Federally designated geographic and population Health Professional Shortage

Areas (HPSA), Pennsylvania, 2015 and 2016

2015 2016 2020 Goal

Primary care 45 44 43

Dental 61 60 59

Mental health 26 26 25

Source: Health Resources and Services Administration (Bureau of Health Planning, 2015, 2016)

https://bhw.hrsa.gov/shortage-designation



Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015)

Among Pennsylvania adults in 2015, 13 percent were without a personal health care provider.

Higher rates of not having a personal health care provider were found among: o Black non-Hispanics (17 percent) and Hispanics (30 percent); o Individuals whose household incomes were below $15,000 (17 percent) and between

$15,000 and $24,999 (17 percent); o Individuals 30-44 years of age (21 percent) and 18-29 (25 percent); and o Males (19 percent).

13

19

7

25

21

7

4

18

12

13

13

17

17

14

11

12

11

17

30

All adults

Male

Female

18–29

30–44

45–64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000–$24,999

$25,000–$49,999

$50,000–$74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 11: Pennsylvania adult residents without a personal health care provider

by demographic, Behavioral Risk Factor Surveillance System (BRFSS), 2015

Race/

ethnicity

Income

Education

Age

Sex

All adults, 13% Percentage of adults without a personal health care provider





The percentage of Pennsylvania adults without a personal health care provider in 2011 was 13 percent, and in 2015, the rate was also 13 percent.

13.0 13.014.0

15.0

13.0

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.016.017.018.019.020.0

2011 2012 2013 2014 2015

Year

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Figure 12: Pennsylvania adult residents without a personal health care provider by

year, Behavioral Risk Factor Surveillance System (BRFSS), 2011–2015

All adults




Source: Health Care Workforce Reports (Bureau of Health Planning, 2012)

Direct patient care was defined to include the following specialties: pediatrics, obstetrics and gynecology, internal medicine, gynecology only, general practice, and family medicine.

The greatest percentage of physicians practicing direct patient care in Pennsylvania in 2012 was either in family medicine (37.4 percent) or internal medicine (32.7 percent).

The age distribution of the direct patient care includes 11.2 percent of physicians who were 65 and over.

While only 3.3 percent of physicians practicing direct patient care in Pennsylvania in 2012 were black, 16.8 percent were Asian.

Females accounted for 31.7 percent of physicians practicing direct patient care in Pennsylvania in 2012.

31.7

68.3

3.0

97.0

3.0

16.8

3.3

76.8

11.2

39.2

38.5

11.1

37.4

2.3

2.2

32.7

10.0

15.4

0.0 20.0 40.0 60.0 80.0 100.0

Female

Male

Hispanic or Latino origin

Not Hispanic or Latino origin

Other

Asian

Black/African-American

White/Caucasion

65 and above

50–64

35–49

20–34

Family medicine

General practice

Gynecology only

Internal medicine general

Obstetrics and gynecology

Pediatrics general

Race

Age

Ethnicity

Practice type

Percentage distribution

Sex

Figure 13: Distribution of licensed physicians practicing direct patient care in

Pennsylvania by demographic, Bureau of Health Planning Workforce Reports,

2012

http://www.health.pa.gov/Your-Department-of-Health/Offices%20and%20Bureaus/Health%20Planning/Pages/Health-Care-Workforce-Reports.aspx



Map 3: Pennsylvania’s currently designated primary care Health Professional Shortage

Areas (HPSAs), 2016

Source: Health Resources and Services Administration (Bureau of Health Planning, 2016)

A significant portion of rural Pennsylvania has a shortage of primary care providers.

This shortage is especially prevalent among the low-income population in these rural areas.

Table 2: Primary care Health Professional Shortage Areas, Pennsylvania, Health Resources and

Services Administration (HRSA), 2016

2012 2016

Pennsylvania United States Pennsylvania United States

Designated Health Professional Shortage Areas (HPSAs) 155 5,805 159 6,550

Population of HPSAs 746,398 55,340,531 636,095 63,979,497

Percent of population in HPSAs 5.88% 17.58% 5.00% 19.91%

Additional providers needed to achieve a population to provider ratio of 3,500:1

167 15,431 88 8,893







The greatest percentage of dentists practicing direct patient care in Pennsylvania in 2013 were in general dentistry (77.0 percent).

The age distribution of the dentists practicing direct patient care includes 17.1 percent who were 65 and over.

Only 2.2 percent of dentists practicing direct patient care in Pennsylvania in 2013 were black, 2.0 percent were Hispanic, and 9.2 percent were Asian.

Females accounted for 23.3 percent of dentists practicing direct patient care in Pennsylvania in 2013.

23.3

76.7

2.0

98.0

3.3

9.2

2.2

85.3

17.1

44.3

27.3

11.4

77.0

6.3

4.7

3.5

2.9

2.8

2.1

0.7

0 10 20 30 40 50 60 70 80 90 100

Female

Male

Hispanic or Latino origin

Not Hispanic or Latino origin

Other

Asian


White/Caucasion

65 and Above

50–64

35–49

20–34

General dentistry

Orthodontics

Oral surgery

Pediatric dentistry

Endodontics

Periodontics

Prosthodontics

Geriatric dentistry

Race

Age

Ethnicity

Practice type

Sex


Figure 14: Distribution of licensed dentists practicing direct patient care in Pennsylvania

by demographic, Bureau of Health Planning Workforce Reports, 2013





The age distribution of the dental hygienists practicing direct patient care in Pennsylvania in 2013 shows 39 percent in the 35-49 age group and 33 percent in the 50-64 age group.

Ninety-six percent of these dental hygienists were white.

Females accounted for 99 percent of dental hygienists practicing direct patient care in Pennsylvania in 2013.

Figure 15: Distribution of licensed dental hygienists practicing direct patient care in

Pennsylvania by demographic, Bureau of Health Planning Workforce Reports, 2013

99

1

1

99

2

1

1

96

3

33

39

26

0 10 20 30 40 50 60 70 80 90 100

Female

Male

Hispanic or Latino Origin

Not Hispanic

or Latino origin

Other

Asian


White/Caucasion

65 and above

50–64

35–49

18–34


Race

Age

Ethnicity

Sex





The vast majority of dental hygienists practicing direct patient care in Pennsylvania had a primary job setting of either private practice partnership (36 percent) or a solo private practice (55 percent).

There are 13 percent of dental hygienists who volunteer their time in various settings, including at private office practices (20 percent of volunteers) and dental school clinics (19 percent of volunteers).

23

20

19

3

13

1

55

36

6

1

1

0 10 20 30 40 50 60

Other

Private office practice

Dental school clinic

Dental van

Federally Qualified HealthCenter (FQHC) or health center

Other

Private practice solo(excluding retail site)

Private practice partnership(excluding retail site)

Clinic or center

Mobile dental unit or community settingusing portable dental equipment

School health (K-12/college/university)

Retail/industry/business site

Figure 16: Distribution of licensed dental hygienists practicing direct patient care in

Pennsylvania by type of location, Bureau of Health Planning Workforce Reports, 2013

<1

Volunteer

location

Primary

job setting


In 2013, 13 percent of dental hygienists indicated

that they provided unpaid volunteer services at

locations other than their primary job.




Map 4: Pennsylvania’s currently designated dental Health Professional Shortage Areas

(HPSAs), 2016


Large sections of the commonwealth, especially in rural areas, are experiencing a shortage of dentists.

This situation is exacerbated by the lack of access to dental care by low-income population in these areas.

Table 3: Dental Health Professional Shortage Areas, Pennsylvania, Health Resources and Services

Administration (HRSA), 2016

2012 2016 Pennsylvania United States Pennsylvania United States

Designated health professional shortage areas (HPSAs) 153 4,534 164 5,450

Population in HPSAs 1,959,788 44,579,445 1,997,447 51,250,011

Percent of total population residing in HPSAs 15.43% 14.16% 15.60% 15.94%

Additional providers needed to achieve a population to practitioner ratio of 5,000:1

388 8,692 310 8,042






Map 5: Pennsylvania’s currently designated mental Health Professional Shortage Areas

(HPSAs), 2016


An insufficient number of psychiatrists are available to treat Pennsylvania’s population, especially in rural areas.

This circumstance is not restricted to the low-income population.

Table 4: Mental health care Health Professional Shortage Areas, Pennsylvania, Health

Resources and Services Administration (HRSA), 2016

2016

Pennsylvania United States

Designated HPSAs 122 4,570

Population of HPSAs 1,832,032 104,054,968

Percent of population in HPSAs 14.31% 32.37%

Additional providers needed 44 2,914

Source: Health Resources and Services Administration (Bureau of Health Planning, Workforce Reports, 2016)





Map 6: Pennsylvania’s currently designated Medically Underserved Areas/Populations

(MUA/MUP), 2016


Medically Underserved Areas/Populations are areas or populations designated by the Health Resources and Services Administration as having a shortage of primary health care services based on the following criteria: o the population to provider ratio; o the percent of the population below the federal poverty level; o the percent of the population over age 65; and o the infant mortality rate.

This map indicates MUA/Ps are dispersed throughout the commonwealth and are not limited to rural areas.

Table 5: Number of MUA/Ps, Pennsylvania, Health Resources and Services Administration (HRSA),

2016

2012 2016 Pennsylvania United States Pennsylvania United States

Medically Underserved Areas/Populations Designation 155 4,135 156 4,235






SHIP PCPS 2.3 For youth ages 1 to 20 years old who are enrolled in Medicaid with at least 90 days of continuous eligibility, increase the percentage who have had a preventive dental service in the past year from 42.5 percent in FFY 2014 to 47 percent by December 2020

Source: Annual EPSDT Participation Report (Centers for Medicare & Medicaid Services, 2011, 2012, 2013, 2014, 2015)

Of Pennsylvania youth aged 1-20 who were enrolled in Medicaid with at least 90 days of continuous eligibility, 34.3 percent in 2011 and 42.5 percent in 2015 had a preventive dental service in the past year.

The percentages shown were obtained from the referenced reports by dividing item 12.b. (Total Eligibles Receiving Preventive Dental Services) by item 1.b. (Total Individuals eligible for EPSDT for 90 Continuous Days).

34.3% 35.3%38.3%

40.7%42.5%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

2011 2012 2013 2014 2015

Figure 17: Pennsylvania youth (ages 1–20 years) having had a

preventive dental service in the past year by year, Annual Early and

Periodic Screening, Diagnostic and Treatment (EPSDT)

Participation Report, 2011–2015

Year

Perc

en

tag

e o

f yo

uth

in

Med

icaid

wit

h 9

0 d

ays

co

nti

nu

ou

s e

lig

ibilit

y, an

d h

av

ing

had

a

pre

ven

tiv

e d

en

tal se

rvic

e i

n t

he p

ast

year

https://www.medicaid.gov/medicaid/benefits/epsdt



Workforce Status

Source: Bureau of Health Planning Workforce Reports (Pennsylvania BRFSS, 2015) Among Pennsylvania adults in 2015, the percentage having visited a dentist in the past 12 months was 67 percent. Higher rates were found in:

White non-Hispanics (69 percent);

67

64

70

64

69

68

65

52

60

69

81

46

52

63

74

81

69

54

55

0 10 20 30 40 50 60 70 80 90

All adults

Male

Female

18–29

30–44

45–64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000–$24,999

$25000–$49,999

$50,000–$74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 18: Pennsylvania adults having visited a dentist in the past 12 months by

demographic, Behavioral Risk Factor Surveillance System (BRFSS), 2014

All adults, 67%

Percentage of adults who visited

a dentist in the past 12 months

Race/

ethnicity

Income

Education

Age

Sex




Individuals with household incomes at $75,000 and above (81 percent) and between $50,000 and $74,999 (74 percent);

Individuals with a college degree (81 percent) or some college (69 percent); and


Map 7: Active primary care physicians per 100,000 population, Center for Workforce

Studies, 2014

Source: 2015 State Physician Workforce Data Book (Center for Workforce Studies, 2015)

http://members.aamc.org/eweb/upload/2015StateDataBook%20(revised).pdf



Map 8: Residents and fellows per 100,000 population, Center for Workforce Studies, Dec.

31, 2014

Source: 2015 State Physician Workforce Data Book (Center for Workforce Studies, 2015) This map shows residents and fellows per 100,000 population on duty in an Accreditation Council for Graduate Medical Education accredited primary care program




Priority 3: Mental Health and Substance Use The third section of the Pennsylvania State Health Assessment 2016 Update includes data relevant to Priority Issue 3 of the SHIP: Mental Health and Substance Use. The SHIP problem statement for priority issue 3 is:

“Unmet mental health and substance use needs frequently lead to preventable illness and death in individuals, families and communities.”

Priority Issue 3 has one goal:

Goal 1. Pennsylvania residents will have access to the best practices in screening, support, assessment, and treatment for mental health and substance use disorders in order to achieve and maintain optimal health outcomes.

The HIP’s population health priorities focusing on substance and tobacco use are addressed in priority 3. The DOH programs will focus on the following areas:

1. Preventing initiation of tobacco use among youth and young adults; 2. Promoting tobacco use cessation among adults and youth, and in particular among women

(ages 18-49) during their pregnancy; 3. Eliminating exposure to secondhand smoke; 4. Identifying and eliminating tobacco-related disparities; 5. Enhancing Pennsylvania’s role as a nationally recognized leader in tobacco control programs and

policies; 6. Reducing drug-associated deaths.



Tobacco Use

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Current cigarette smokers are defined as those smoking cigarettes either every day or some days in the past 30 days prior to the survey and having smoked at least 100 cigarettes in their lifetime. Among Pennsylvania adults in 2015, the rate of current smoking was 18 percent. Higher rates were found in:

Black non-Hispanics (26 percent) and Hispanics (25 percent);


Individuals with a high school degree (21 percent) or no high school degree (30 percent);

Individuals between 30 and 44 years old (24 percent); and

Males (20 percent).

18

20

17

18

24

20

9

30

21

20

7

35

24

20

18

12

17

26

25

0 5 10 15 20 25 30 35 40 45

All adults

Male

Female

18-29

30-44

45-64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 19: Pennsylvania adults identified as current cigarette smokers

by demographic, Behavioral Risk Factor Surveillance System

(BRFSS), 2015

All adults, 18%

Percentage of adults who are current smokers

Race/

Ethnicity

Income

Education

Age

Sex

Age

Sex




Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2011 - 2015) Current cigarette smokers are defined as those smoking cigarettes either every day or some days in the past 30 days prior to the survey and having smoked at least 100 cigarettes in their lifetime.

During the five years of 2011 through 2015, men consistently had higher rates of current smoking than women.

In 2015, 20 percent of men and 17 percent of women were current smokers.

23 2324

2120

2120

19 19

17

0123456789

101112131415161718192021222324252627282930

2011 2012 2013 2014 2015

Figure 20: Pennsylvania adults identified as current cigarette smokers by sex

and year, Behavioral Risk Factor Surveillance System (BRFSS), 2011–2015

Year

Perc

en

tag

e o

f ad

ult

s w

ho

are

cu

rren

t cig

are

tte s

mo

kers

Adult males

Adult females




Map 9: Pennsylvania adults identified as current cigarette smokers by region, Behavioral

Risk Factor Surveillance System (BRFSS), 2013-2015

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2013 - 2015) Note: Red fonts indicate significantly higher than the state rate; blue indicates significantly lower than the state rate of 20 percent. Current cigarette smokers are defined as those smoking cigarettes either every day or some days in the past 30 days prior to the survey and having smoked at least 100 cigarettes in their lifetime.

The statewide rate of current smoking among Pennsylvania adults between 2013 and 2015 was 20 percent.

During that period, the lowest rate of smoking was found in Chester (14 percent) and Montgomery (14 percent) counties.

Also during that period, the highest rate of smoking (25 percent) was found in the combined region that includes Fayette, Greene and Washington counties.




SHIP MHSU 1.2 Decrease adults who smoke every day from 16 percent in 2013 to 11.3 percent by December 2020.

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Among Pennsylvania adults in 2015, the rate smoking cigarettes daily was 13 percent. Higher rates were found in:

Black non-Hispanics (19 percent);


Individuals with a high school degree (17 percent) or no high school degree (21 percent); and

Individuals between 30 and 44 years old (16 percent) and between 45 and 64 years (16 percent).

13

14

13

13

16

16

6

21

17

14

4

25

18

16

13

9

13

19

16

0 5 10 15 20 25 30 35

All adults

Male

Female

18-29

30-44

45-64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Race/

ethnicity

Income

Education

Age

Figure 21: Pennsylvania adults who smoke cigarettes daily by

demographic, Behavioral Risk Factor Surveillance System

(BRFSS), 2015

Sex

All adults, 13% Pa. SHIP goal, 11.3%

Percentage of adults who smoke cigarettes daily





During the five years of 2011 through 2015, Pennsylvania men consistently had higher rates of daily smoking than women, except for 2014, when both had a 14 percent rate of smoking daily.

In 2015, 14 percent of men and 13 percent of women were daily smokers.

1817 17

14

16

14 14 14

13

0123456789

10111213141516171819202122232425

2011 2012 2013 2014 2015

Adult males

Adult females

Year

Perc

en

tag

e o

f ad

ult

s s

mo

kin

g c

iga

rett

es

ev

ery

da

y

Figure 22: Pennsylvania adults who smoke cigarettes daily by year and sex,

Behavioral Risk Factor Surveillance System (BRFSS), 2011–2015




SHIP MHSU 1.2 By December 2020: Decrease adults who smoke some days from 5.7 percent in 2012 to 4.4 percent

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Among Pennsylvania adults in 2015, the rate of smoking cigarettes on some days was 5 percent. Higher rates were found in:

Hispanics (9 percent) and black non-Hispanics (7 percent);

Individuals with household incomes below $15,000 (10 percent);

Individuals with no high school degree (9 percent);

Individuals between 30 and 44 years old (8 percent); and

Males (6 percent).

5

6

4

5

8

4

3

9

5

6

3

10

6

4

5

3

4

7

9

0 1 2 3 4 5 6 7 8 9 10111213141516171819

All adults

Male

Female

18-29

30-44

45-64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 23: Pennsylvania adults who smoke cigarettes some days by


All adults, 5% Pa. SHIP goal, 4.4%

Race/

ethnicity

Income

Education

Age

Sex

Percentage of adults who smoke tobacco some days





During the five years of 2011 through 2015, Pennsylvania men consistently had higher rates of some days smoking than women.

In 2015, 6 percent of men and 4 percent of women were some days smokers.

6 6 6

7

6

5 5

4

5

4

0

1

2

3

4

5

6

7

8

9

10

2011 2012 2013 2014 2015

Figure 24: Pennsylvania adults who smoke cigarettes some days by sex and


Perc

en

tag

e o

f ad

ult

s w

ho

sm

oke c

igare

ttes

so

me d

ays

Year

Adult males

Adult females




SHIP MHSU 1.2 By December 2020: Increase adults who are former smokers from 26 percent in 2013 to 31.8 percent

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Among Pennsylvania adults in 2015, the rate for former cigarette smoking was 26 percent. Higher rates were found in:

Whites (28 percent);

Individuals with household incomes between $25,000 and $74,999;

Individuals with no college degree;

Individuals over 65 years old (42 percent) and between 45 and 64 (28 percent); and

Males (28 percent).

26

28

24

10

22

28

42

28

27

28

22

25

30

30

29

24

28

20

19

0 5 10 15 20 25 30 35 40 45 50

All adults

Male

Female

18-29

30-44

45-64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 25: Pennsylvania’s adults identified as former cigarettes smokers by


Pa. SHIP

goal, 31.8% All adults, 26%

Race/

ethnicity

Income

Education

Age

Sex

Percentage of adults who are former cigarette smokers





During the five years of 2011 through 2015, Pennsylvania men consistently had higher rates of former cigarette smoking than women.

In 2015, 28 percent of men and 24 percent of women were former smokers.

29 29 2927

28

22 22 23 2224

0

5

10

15

20

25

30

35

2011 2012 2013 2014 2015

Adult males

Adult females

Figure 26: Pennsylvania adults identified as former cigarette smokers by sex and


Perc

en

tag

e o

f ad

ult

s Id

en

tifi

ed

as

form

er

sm

oke

rs

Year




SHIP MHSU 1.2 Increase adults who have never smoked from 53 percent in 2013 to 57.6 percent by December 2020

Source: Behavioral Risk Factor Surveillance System (Pennsylvania BRFSS, 2015) Among Pennsylvania adults in 2015, the rate for never smoking cigarettes was 56 percent. Higher rates were found in:

Individuals with household incomes above $75,000 (64 percent);

Individuals with a college degree (71 percent);

Individuals between 18 and 29 (72 percent); and


56

52

59

72

54

52

49

42

51

53

71

40

46

50

54

64

55

54

56

0 10 20 30 40 50 60 70 80

All adults

Male

Female

18-29

30-44

45-64

65 and above


High school

Some college

College degree

Less than $15,000

$15,000-24,999

$25,000-49,999

$50,000-74,999

$75,000 and above

White, non-Hispanic

Black, non-Hispanic

Hispanic

Figure 27: Pennsylvania adults identified as never having smoked cigarettes by


All adults, 56% Pa. SHIP

goal, 57.6%

Percentage of adults who never smoked cigarettes

Race/

ethnicity

Income

Education

Age

Sex





During the five years of 2011 through 2015, Pennsylvania females consistently had higher rates of never smoking cigarettes than men.

In 2015, 59 percent of women and 52 percent of men never smoked cigarettes.

47 48 4751 52

57 58 59 59 59

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

2011 2012 2013 2014 2015

Figure 28: Pennsylvania adults identified as never having smoked cigarettes by

sex and year, Behavioral Risk Factor Surveillance System (BRFSS), 2011–2015

Year

Perc

en

tag

e o

f ad

ult

s w

ho

nev

er

sm

oked

cig

are

ttes

Adult males

Adult females




Substance Use SHIP MHSU 1.3 For Pennsylvania adults and adolescents, decrease rate of deaths due to substance use from 17.1 per 100,000 in 2012 to 15.4 per 100,000 by December 2020

Source: Pennsylvania Vital Statistics (Pennsylvania Death Certificate Dataset, 2010 - 2014)

The age-adjusted death rate due to accidental poisoning and noxious substances increased over

50 percent from 13.3 per 100,000 population in 2010 to 20.3 in 2014.

13.3

16.317.1

17.8

20.3

0123456789

101112131415161718192021222324252627282930

2010 2011 2012 2013 2014

Figure 29: Pennsylvania resident deaths due to accidental poisoning and

exposure to noxious substances, Pennsylvania vital statistics, 2010–2014

Year

Ag

e a

dju

ste

d d

eath

rate

du

e t

o a

ccid

en

tal

po

iso

nin

g a

nd

no

xio

us s

ub

sta

nces p

er

100,0

00

po

pu

lati

on





The age-adjusted death rate due to accidental drug poisoning increased over 50 percent from 12.5 per 100,000 population in 2010 to 19.3 in 2014.

12.5

15.4

16.316.9

19.3

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

2010 2011 2012 2013 2014

Figure 30: Pennsylvania deaths due to accidental drug poisoning, Pennsylvania

vital statistics, 2010–2014

Ag

e-a

dju

ste

d d

eath

rate

du

e t

o a

ccid

en

tal d

rug

po

iso

nin

g

Year





The crude rate of death associated with the combined number of deaths attributable to accidental drug poisoning and accidental alcohol poisoning increased by 51.2 percent, from 12.7 in 2010 to 19.2 per 100,000 population in 2014.

12.7

15.516.3

16.8

19.2

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.016.017.018.019.020.021.022.023.024.025.0

2010 2011 2012 2013 2014

Figure 31: Pennsylvania deaths due to accidental drug poisoning and accidental

poisoning and exposure to alcohol (combined), Pennsylvania vital statistics,

2010–2014

2014

Year

Cru

de d

eath

rate

per

100,0

00 p

op

ula

tio

n d

ue

to

accid

en

tal p

ois

on

ing

an

d e

xp

osu

re t

o a

lco

ho

l




Map 10: Pennsylvania deaths due to accidental drug poisoning, Pennsylvania Death

Certificate Dataset, 2012-2014

Percent 21+ 18 - 20.9 15 - 17.9 12 - 14.9 5 - 11.9 Not displayed

Source: Pennsylvania Vital Statistics (Pennsylvania Death Certificate Dataset, 2012 - 2014) Age-adjusted rates per 100,000.

In the combined years of 2012-2014, the highest age-adjusted death rates due to accidental

drug poisoning occurred in Wyoming (30.6), Cambria (28.2), Philadelphia (27.9) and

Westmoreland (27.8) counties.




Map 11: Pennsylvania deaths due to drug related overdose, Drug Enforcement

Administration, 2015

Number 422 and 720 101 – 200+ 61 – 100 21 – 60 1 – 20 0

Source: Analysis of Drug-Related Overdose Deaths in Pennsylvania, 2015 (DEA Philadelphia Field Division, 2016)

In 2015, the counties with the highest number of deaths due to drug related overdoses in 2015 were Philadelphia (720), Allegheny (422) and Westmoreland (126) counties.

https://www.dea.gov/divisions/phi/2016/phi071216_attach.pdf



Source: Treatment Episode Data Set (TEDS): 2004-2014 (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality)

Among Pennsylvanians age 12 years and above, there was a total of 51,858 admissions in 2011 and 42,204 in 2014. This represents an 18.6 percent point decrease over that period.

An examination of 2014 admissions by primary substance revealed that opiates comprised the highest proportion with 49 percent of all admissions. Heroin comprised 37.8 percent, and “other opiates” comprised 11.2 percent.

Alcohol only, 23.6

Alcohol only, 22.8

Alcohol with secondary,

6.3

Alcohol with secondary,

14.6

Heroin, 37.8

Heroin, 20.6

Otheropiates,

11.2

Otheropiates,

12.5

Smoked cocaine,

3.0

Smoked cocaine,

6.0

Cocaine other route,

1.8

Cocaine other

route, 3.3

Marijuana/hashish,

12.1

Marijuana/hashish, 16.2

Other subs.**,

4.2

Other subs.**,

3.9

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2014

2011

Figure 32: Pennsylvania admissions aged 12 and older* by primary substance, Center

for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health

Services Administration, Treatment Episode Data Set (TEDS), 2011 and 2014


* The total admissions aged 12 and older in 2011 were 51,858 and, in 2014, were 42,204

** Other substances include: methamphetamine/amphetamines, tranquilizers, sedatives, hallucinogens,

PCP, inhalants, and other/none specified.

Notes: (1) TEDS does not include all admissions to substance abuse treatment. It includes admissions to

facilities that are licensed or certified by the state substance abuse agency to provide substance abuse

treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are

those that receive state alcohol and/or drug agency funds (including Federal Block Grant funds) for the

provision of alcohol and/or drug treatment services. (2) Percentages may not sum to 100 due to rounding.

Alcohol, 29.9 Opiates, 49.0

Alcohol, 37.4 Opiates, 33.1

http://www.samhsa.gov/data/sites/default/files/2014_Treatment_Episode_Data_Set_State_Admissions_9_15_16.pdf



The proportion of admissions attributable to heroin as the primary substance increased 83.5 percent, from 20.6 percentage points in 2011 to 37.8 percentage points in 2014.

Between 2011 and 2014, the proportion of admissions attributable to alcohol only (no secondary) increased slightly by 3.5 percent, from 22.8 percentage points to 23.6 percentage points.

Between 2011 and 2014, the proportion of admissions attributable to marijuana/hashish as the primary substance decreased by 25.3 percent, from 16.2 percentage points in 2011 to 12.1 percentage points in 2014.



Source: Treatment Episode Data Set (TEDS): 2004-2014 (Substance Abuse and Mental Health Services

Administration, Center for Behavioral Health Statis-tics and Quality)

71.4

28.5

1.5

3.0

5.7

7.2

8.4

10.8

18.0

23.3

17.6

4.6

1.7

6.0

10.3

81.9

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90

Male

Female

60 and above

55–59

50–54

45–49

40–44

35–39

30–34

25–29

20–24

12–19

Other

Hispanic

Black, non-Hispanic

White, non-Hispanic

Figure 33: Pennsylvania admissions aged 12 and older* by primary substance, by

demographic, Center for Behavioral Health Statistics and Quality, Substance

Abuse and Mental Health Services Administration, Treatment Episode Data Set

(TEDS), 2014

* The total admissions aged 12 and older in 2014 were 42,204.

** Other substances include: methamphetamine/amphetamines, tranquilizers, sedatives,

hallucinogens, PCP, inhalants, and other/none specified.

Note: TEDS does not include all admissions to substance abuse treatment. It includes admissions

to facilities that are licensed or certified by the state substance abuse agency to provide substance

abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting

TEDS data are those that receive state alcohol and/or drug agency funds (including Federal Block

Grant funds) for the provision of alcohol and/or drug treatment services.

Race/

ethnicity

Age

Sex


http://www.samhsa.gov/data/sites/default/files/2014_Treatment_Episode_Data_Set_State_Admissions_9_15_16.pdf



Among Pennsylvania’s population aged 12 years and above, there were 42,204 admissions in 2014.

Of those total admissions: o 81.9 percent were among the state’s white, non-Hispanic population; o 10.3 percent were among the state’s black, non-Hispanic population; o 6.0 percent were among the state’s Hispanic population; and o 1.7 percent were among the state’s race/ethnicity “other” category.

Most admissions (23.3 percent) were among those aged 25 through 29 years.

Admissions among Pennsylvanians under 30 years of age comprised 45.5 percent of the total.

Most admissions (71.4 percent) were among males. Admissions among females comprised 28.5 percent.



Source: National Survey on Drug Use and Health, 2013 and 2014 (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statis-tics and Quality, 2014)

Within all age groups examined except one, ages 12 through 17 years, the proportion of Pennsylvanians needing but not receiving treatment for alcohol use exceeded the proportion needing but not receiving treatment for illicit drug use.

The highest proportion of those needing but not receiving treatment was realized within the age group of 18 through 25 years, wherein 13 percent needed but did not receive treatment for alcohol use and 6.4 percent needed but did not receive treatment for illicit drug use.

Among Pennsylvanians aged 12 years and above, 6.3 percent needed but did not receive treatment for alcohol use, and 2.3 percent needed but did not receive treatment for illicit drug use.

Among Pennsylvanians ages 12 through 17 years, 2.5 percent needed but did not receive treatment for alcohol use, and 2.8 percent needed but did not receive treatment for illicit drug use.

2.32.8

6.4

1.6

2.3

6.3

2.5

13.0

5.7

6.7

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

11.0

12.0

13.0

14.0

15.0

12 and above 12–17 18–25 26 and above 18 and above

Perc

en

tag

e n

eed

ing

bu

t n

ot

receiv

ing

tre

atm

en

t

Age groupIllicit drug use

Alcohol use

Figure 34: Pennsylvanians needing but not receiving treatment for drug and

alcohol use by age group, National Survey on Drug Use and Health (NSDUH),

2013–2014.

http://www.samhsa.gov/data/sites/default/files/1/1/NSDUHsaePennsylvania2014.pdf





Source: National Survey on Drug Use and Health, 2013 and 2014 (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statis-tics and Quality, 2014)

Based on 2013-2014 annual averages, 18.4 percent of Pennsylvanians ages 18 through 25 years experienced alcohol or illicit drug dependence or abuse within the past year.

8.6 percent of Pennsylvanians ages 18 and above experienced alcohol or illicit drug dependence or abuse within the past year.



8.3

4.7

18.4

7.1

8.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

17.0

18.0

19.0

20.0

12 and above 12– 17 18– 25 26 and above 18 and above

Age group

Figure 35: Pennsylvanians experiencing alcohol or illicit drug dependence or

abuse within the past year by age group, National Survey on Drug Use and

Health (NSDUH), 2013–2014

Perc

en

tag

e e

xp

eri

en

cin

g a

lco

ho

l o

r illic

it d

rug

dep

en

den

ce o

r ab

us

e w

ith

in t

he p

ast

year




4.7 percent of Pennsylvanians ages 12 through 17 years experienced alcohol or illicit drug dependence or abuse within the past year.

Based on this data, Pennsylvanians ages 18 through 25 years were almost four times (3.9) more likely than Pennsylvanians ages 12 through 17 years to have experienced alcohol or illicit drug dependence or abuse within the past year.



Suicide SHIP MHSU 1.4 Reduce the rate of suicides from 12.1 per 100,000 in 2012 to 10.9 per 100,000 in December 2020.


The age-adjusted suicide (intentional self-harm) death rate increased by 12.8 percent, from 11.7 in 2010 to 13.2 per 100,000 population in 2014.

11.7

12.912.1

13.3 13.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

17.0

18.0

19.0

20.0

2010 2011 2012 2013 2014

Figure 36: Pennsylvania suicide deaths, Pennsylvania vital statistics, 2014

Year

Ag

e-a

dju

ste

d d

eath

rate

du

e t

o s

uic

ide




Map 12: Pennsylvania suicide deaths, 2010-2014

Source: 2010-2014 Combined Injury Report (Division of Health Informatics, 2014) Age-adjusted rates by county with significant differences versus the state:

In the combined years of 2010-2014, the highest age-adjusted suicide death rates occurred in these nine Pennsylvania counties:

Berks Cambria Carbon Elk Luzerne Northumberland Schuylkill Susquehanna Wayne

http://www.statistics.health.pa.gov/HealthStatistics/BehavioralStatistics/InjuryStatistics/Pages/InjuryStatistics.aspx



Appendix A: SHA – SHIP – HIP Crosswalk Item 2013 SHA SHIP HIP

Fig. 1 Adults, obesity p. 3-9 - 3-11 OPIN 1.1 1.1, 7.1, 7.2

Fig. 2 Adults, obesity p. 3-9 - 3-11 OPIN 1.1 1.1, 7.1, 7.2

Map 1 Adults, overweight and obese p. 3-9 - 3-11 OPIN 1.1 1.1, 7.1, 7.2

Fig. 3 Children and teens, overweight and obese P. 3-11 OPIN 1.2 1.1, 7.1, 7.2

Fig. 4 Adults, obese reporting health status OPIN 2.1 1.1

Fig. 5 Adults, no leisure time physical activity p. 3-15 - 3-17 OPIN 3.1 7.1, 7.2

Fig. 6 Adults, no leisure time physical activity p. 3-15 - 3-17 OPIN 3.1 7.1, 7.2

Map 2 Adults, no leisure time physical activity p. 3-15 - 3-17 OPIN 3.1 7.1, 7.2

Fig. 7 Adolescents, physical activity OPIN 3.2 7.2

Fig. 8 Adolescents, physical activity OPIN 3.2 7.2

Fig. 9 Adults, five servings fruits/vegetables p. 3-19 - 3-21 OPIN 4.1

Fig. 10 Adults, five servings fruits/vegetables p. 3-19 - 3-21 OPIN 4.1

Table 1 HPSAs p. 9-29 PCPS 1.1 1.4, 10.1

Fig. 11 Adults, without personal care provider PCPS 1.1 1.1

Fig. 12 Adults, without personal care provider PCPS 1.1 1.1

Fig. 13 Practicing primary care physicians p. 9-7 PCPS 1.1 1.4, 10.1

Map 3 HPSAs, primary care PCPS 1.1 1.4, 10.1

Table 2 HPSAs, primary care PCPS 1.1 1.4, 10.1

Fig. 14 Practicing dentists p. 9-28 - 9-30 PCPS 1.1 1.1, 1.4, 10.1

Fig. 15 Practicing dental hygienists p. 9-28 - 9-30 PCPS 1.1 1.1, 1.4, 10.1

Fig. 16 Practicing dental hygienists p. 9-28 - 9-30 PCPS 1.1 1.1, 1.4, 10.1

Map 4 HPSAs, dental p. 9-28 - 9-30 PCPS 1.1 10.1

Table 3 HPSAs, dental p. 9-28 - 9-30 PCPS 1.1 10.1

Map 5 HPSAs, mental health PCPS 1.1 10.1

Table 4 HPSAs, mental health PCPS 1.1 10.1

Map 6 MUAs/MUPs PCPS 1.1

Table 5 MUAs/MUPs PCPS 1.1

Fig. 17 Youth, Medicaid receiving dental care p. 9-28, 9-30 PCPS 2.3

Fig. 18 Adults, dentist visit 10.1

Map 7 Primary care physician per 100,000 10.1

Map 8 Residents/fellows per 100,000 10.1

Fig. 19 Adults, current smokers p. 3-2 - 3-4 1.1, 7.1

Fig. 20 Adults, current smokers p. 3-2 - 3-4 1.1, 7.1

Map 9 Adults, current smokers p. 3-2 - 3-4 1.1, 7.1

Fig. 21 Adults, daily smokers p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 22 Adults, daily smokers p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 23 Adults, some days smokers p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 24 Adults, some days smokers p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1



Fig. 25 Adults, former smokers p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 26 Adults, former smokers p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 27 Adults, never smoked p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 28 Adults, never smoked p. 3-2 - 3-4 MHSU 1.2 1.1, 7.1

Fig. 29 Deaths, accidental poisoning and noxious substances p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 30 Deaths, accidental drug poisoning p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 31 Deaths, accidental drug poisoning and alcohol p. 3-25 - 3.27 MHSU 1.3 7.1

Map 10 Accidental drug poisoning rate p. 3-25 - 3.27 MHSU 1.3 7.1

Map 11 Deaths, drug overdose p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 32 D and A treatment admissions, by substance p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 33 D and A treatment admissions, by demographics p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 34 D and A treatment, needing but not receiving p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 35 D and A dependence or abuse p. 3-25 - 3.27 MHSU 1.3 7.1

Fig. 36 Deaths, suicides MHSU 1.4

Map 12 Deaths, suicides MHSU 1.4



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