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Fletcher Allen Health Care Community Health Needs Assessment 2013 FletcherAllen.org

COMMUNITY HEALTH IMPROVEMENT COMMUNITY HEALTH NEEDS ASSESSMENT TABLE OF CONTENTS Executive Summary ........................................................................................................................................................... 1 Community Health Needs Assessment Summary ........................................................................................................... 3 Implementation Plan .....................................................................

1 COMMUNITY HEALTH NEEDS ASSESSMENT Executive Summary Fletcher Allen Health Cares 2013 Community Health Needs Assessment CHNA was conducted over a two year period for the health service area of Chittenden and Grand Isle counties. A steering committee planned and guided the assessment. The committee included representatives from Fletcher Allen, Visiting Nurse Association of Chittenden and Grand Isle Counties, Vermont Department of Health and the Community Health Centers of Burlington. For a desc

2 DENTAL HEALTH ESPECIALLY CHILDREN Dental health needs were cited in key leader interviews focus groups, and the community survey as a high need in our community. This includes access to dental health providers, affordable dental health treatment and education. MENTAL HEALTH ESPECIALLY CHILDREN Through the CHNA, the community identified the need for mental health supports for children. Timely access to treatment for all ages and the early detection of mental health issues for children and teen

3 Fletcher Allens 2013 Community Health Needs Assessment Summary The federal Affordable Care Act requires that all hospitals complete a Community Health Needs Assessment CHNA by September 2013. The office of Community Health Improvement at Fletcher Allen Health Care, in collaboration with local partners and funded with a small grant from the Vermont Department of Health, completed the collection of data and community input from Chittenden and Grand Isle Counties and analyzed that information. T

4 Our Community For the last two years, Vermont has been ranked the healthiest state in the country by the United Health Foundation. Vermont ranks first in Americas Health Rankings by the American Health Foundation. Fletcher Allens Health Service Area HSA includes Chittenden and Grand Isle counties, as well as a few outlying towns in Lamoille and Franklin counties. For the purpose of this assessment, data collection efforts focused on Chittenden and Grand Isle counties. Chittenden County is hom

5 Methods of Data Collection The CHNA Steering Committee, which began meeting in August 2011, guided a traditional assessment approach reviewing quantitative community health indicators interviewing key leaders conducting focus groups and developing and disseminating a survey to the general public. Members, Appendix A KEY LEADER INTERVIEWS Karen McKnight, Quality Consultant, and Julie Cole, Project Coordinator at Fletcher Allen interviewed seventeen leaders in Chittenden and Grand Isle counties

6 Collation of Data from Focus Groups and Interviews Comments from participants in the focus groups and leader interviews were grouped into Theme Buckets and weighted by the number of times the theme was mentioned in focus groups and interviews. The categories Community Connections, Education, Substance AbuseMental Health, Access to Healthy Foods, Transportation, Language Barriers, Safety, Dental Health, Health Care, Case Management and Other. For the full list, sub categories and weighting see

7 While the age distribution is similar to the focus groups, the surveys reached a cohort with higher levels of education and higher incomes. In addition, more were employed 68 were employed full time, 18 parttime, 9 retired and 6 unemployed compared to 18, 16, 33, and 24 respectively in the focus groups. When compared to census figures, males, people under 20 years, and people who had not completed high school were underrepresented in the pool of survey respondents. The survey reached a differ

8 DATA FROM COMMUNITY SURVEY N1345 FletcherAllen.org

9 HEALTH CARE Ninety two percent of adults in Chittenden County have health insurance, 87 in Grand Isle County and almost all 99 of children under 18 have some health insurance. Interviewees and survey respondents felt that health care access is quite good, especially in Burlington where transportation is not an issue. But for those living off the bus route access is a problem. The offices at Tilley Drive were mentioned specifically as a transportation challenge in focus groups. Community indic

10 MENTAL HEALTH CARE The perennial concern with the availability of and timely access to mental health services continues to be noted in interviews and in survey responses. The need for early detection and prompt intervention for children with emotional and mental health needs was repeated with passion from several fronts in the face to face interviews. Leaders report that for those children at immediate risk, the DCF investigation lag is very long. Access to mental health service and to psych

11 DATA FROM COMMUNITY SURVEY N1345 FletcherAllen.org

12 SENIORS Seniors in focus groups spoke of a need for advocates within the hospital health care system to speak up for them and to help them understand diagnoses, treatment, and insurance. Seniors in Grand Isle cited the need for local senior housing and long term care. The Grand Isle focus group had high praise for C.I.D.E.R, the local senior resource organization, and noted that without the transportation that it provides, they would be very isolated. In the community survey, respondents cit

13 DATA FROM COMMUNITY SURVEY N1345 FletcherAllen.org

14 NUTRITION Access to affordable healthy foods and obesity prevention programs were cited by survey respondents as high needs. The opinions stated in the face to face interviews were similar. Adequate nutrition for adults was a lesser concern, even when survey responses are sorted by age. This is an example where the quantitative data looks good, but there is a distinct call for improvement. DATA FROM COMMUNITY SURVEY N1345 IMPROVING THE QUALITY OF LIFE The need for housing using descriptor

15 To the survey question of improving the quality of life, almost 90 of Black respondents very clearly cited the need to improve education opportunities for children, followed by the need for supports for children and families, then the need for affordable housing. Other groups were not as definitive. DATA FROM COMMUNITY SURVEY N1345 FletcherAllen.org

16 Community Environment Some significant concerns stood out in the leader interviews and focus groups which did not come out in the community survey. CULTURAL AND LANGUAGE BARRIER The problem of the language barrier for new Americans looms large, cited repeatedly in interviews by providers, educators and ethnic individuals as a multifaceted problem. They cannot understand their health care provider, to say nothing of the health care or insurance systems they are bright yet they struggle in sch

17 Assessment Summary As with any assessment this one generates as many questions as it answers. What is clear is that the Chittenden and Grand Isle County area is, in general, a very healthy and very livable area. Respondents noted the ongoing and over reaching concerns with good schools, affordable housing, a livable wage, a safe environment, accessible health care and economic opportunity. However there are pockets of specific needs and problems which deserve attention. If we can mend the po

18 Implementation Plan The Community Health Assessment Steering Committee determined from the results of the CHNA that several areas of need offered opportunities for focused funding efforts in the Fletcher Allen Health Service Area Chittenden and Grand Isle counties, to wit The language and cultural challenges of New Americans. Transportation for easier access to health care, child care, and healthy foods. Health Care o Access to dental care, o Access and availability of mental health care,

19 Quality Assurance as Patient Centered Medical Homes. Funds are paid directly to the clinics by the insurers on a Per Member Per Month basis and to 14 Health Service Area lead organizations 13 hospitals and one Federally Qualified Health Center to staff Community Health Teams which provide patients and clinics with nocost supports. In 2011, the Centers for Medicaid and Medicare Services awarded Vermont a MultiPayer Advanced Primary Care Practices MAPCP grant which allows for the use of Medica

20 optimal health and personal safety through access to care, safe and caring home, and good nutrition. o In FY12, Fletcher Allen supported several food and nutrition efforts. Examples included a grant to Vermont Works for Women in support of Fresh Food, which services highquality lunch and snacks to lowincome children at participating childcare centers seed money to start an organic garden at Smilie Elementary school and an exercise and nutrition program through the YMCA at Winooski Elementary

21 o o Fletcher Allens Pediatric Outreach Coordinator is working with the Tooth Tutor and School Nurses at the Winooski School District to implement a transportation system for dental visits. Fletcher Allen is partnering with United Way and others to develop a plan for increasing access to dental health care for lowincome families. Mental Health Focus on Children Why address it Through the CHNA the community identified the need for mental health supports for children. Timely access to treatme

22 Removing Barriers to Care Affordability, Transportation, Language Why address it As a federally designated refugee resettlement site, Vermont, and especially Chittenden County, is home to a large number of refugees, with approximately 35 languages spoken in the Burlington and Winooski schools. In focus groups and in key leader interviews, we heard of the challenges New Americans face, especially in terms of difficulties navigating the health care system and other social supports. In reviewin

23 Neighbor Rides will increase access to transportation options for seniors and adults with disabilities. The Interpreter Project will explore a systemic approach to quality translation needs of multiple organizations. Senior Issues Caregiving, Safety, WellBeing Why address it Our aging population presents unique challenges for our community. Although the percentage of residents 65 and over in Chittenden County is less than the overall States average, the rate at which Chittenden County is

24 o Work in partnership with the Burlington Housing Authority to employ a SASH nurse at Burlingtons housing sites to offer both individual and group education through 11 visits, group wellness classes, health education, medication management, assistance and support with chronic disease management and selfcare. Residents are lowincome seniors and disabled adults. o o Comprehensive transition planning for seniors, including arranging home care, transfers to rehab, skilled nursing care, and ot

25 and in managing distribution of free Nicotine Replacement Therapy to clients. During 20112012 Fletcher Allen supported the transition of the program to the Vermont Blueprint for Health, which supports the recognition National Committee on Quality Assurance of patientcentered medical homes and the creation of Community Health Teams which provide additional support to the PCMHs. From 20012011 the statewide program served 18,000 smokers with a quit rate of over 60. Since 2001 Fletcher Allen has

26 ActionImplementation plan Ongoing programs o o Fletcher Allen, in conjunction with the University of Vermont, operates the largest methadone treatment clinic in the state. Fletcher Allen supports HowardCenters ACT1 Bridge program through sponsorship of rent for the facility. ACT1 Bridge provides a safe detoxification center as well as offers shortterm substance abuse treatment. New initiatives and future plans o In 2012 Fletcher Allen was selected by the State of Vermont to host a pilot pr

27 Burlington Housing Trust, the ECOS Project and others are working on this issue. This focus was seen as outside Fletcher Allens purview or ability to impact in any material way. Livable Wage Economic Opportunities. A livable wage and economic opportunity was also noted as a need by key leaders, focus groups, and the community at large. As with affordable housing, a communitywide livable wage is outside Fletcher Allens purview. However, Fletcher Allen does participate in the Working Bridges

28 APPENDIX A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE 20122013 BEVERLY BOGET Director of Planning and Government Relations, Visiting Nurse Association of Chittenden and Grand Isle Counties ALISON CALDERARA Director of Community Relations and Development, Community Health Center of Burlington JULIE COLE Project Coordinator, Community Health Improvement, Fletcher Allen Health Care HEATHER DANIS District Director, Burlington District, Vermont Department of Health EDWIN DEMOTT Pub

29 APPENDIX B KEY LEADERS INTERVIEWED BURLINGTON POLICE DEPARTMENT Chief of Police C.I.D.E.R. Executive Director COMMUNITY HEALTH CENTER OF BURLINGTON Medical Director HOWARD CENTER Executive Director Director of Mental Health and Substance Abuse Services HUNGER FREE VERMONT Executive Director MILTON FAMILY CENTER Executive Director SPECTRUM YOUTH AND FAMILY SERVICES Executive Director Associate Executive Director UNITED WAY OF CHITTENDEN COUNTY Executive Director UNIVERSITY OF VERMONT Profess

30 APPENDIX C KEY LEADER INTERVIEWS EXECUTIVE SUMMARY Process During the late fallearly winter of 2011, seventeen leaders in Chittenden and Grand Isle counties were interviewed by Fletcher Allen as part of our community health assessment. Interviews were conducted by Karen McKnight, Quality Consultant, and Julie Cole, Project Coordinator. The interviews generally lasted sixty to ninety minutes. Interviewees were asked a series of questions about healthy communities, unmet needs, important heal

31 Barriers cited by leaders were transportation, excessive documentation requirements, difficulty navigation resources and systems, and cultural understanding. Leaders cited inadequacy of transportation, excessive documentation requirements, difficulty navigating resources and systems, and cultural understanding as barriers. Interviewees were asked their thoughts on efforts that could be done to improve the quality of life for residents. Supports for children and families was mentioned overwhe

32 APPENDIX D FOCUS GROUP SUMMARIES Prepared by Toby Knox Associates, LLC Shelburne, VT 8029853192 Research Objective The main objective of the focus groups was to hear from community members regarding their thoughts on the health of their community. The focus groups are part of a larger assessment being conducted by Fletcher Allen Health Care and other community agencies. Methodology Sampling Five focus groups were conducted during the period of November 2 December 16, 2011. The groups w

33 Children under 21 living at home 14 Residence 29 Burlington 6 South Burlington 10 Winooski 6 South Hero 2 Grand Isle One individual did not fill out a demographic form and on several forms some items were left blank so not all of the categories add up to 53. Executive Summary In spite of their various concerns, problems, challenges or disliked aspects, participants, by and large, feel positive about their community. The communitys small size and a sense of community are important and valued

34 Increase the number of youth activities Assure residents personal safety and reduce the crime level Include dental and eye glasses Medicaid insurance coverage Reduce the anxiety and insecurity that many feel with respect to being on the edge and thus not having the resources to pay for medical costs or maintain a healthy lifestyle Address the substance abuse and treatment problem Increase the street lighting Reduce the waiting time in the ER Address the bus scheduling and routing

35 C.I.D.E.R. is wonderful and this community is wonderful. There is a strong sense of community and close knit connections among residents. The islanders are close knit and probably have to be under certain circumstances. The volunteer fire department, rescue squad and sheriffs are held in high esteem. Available locally are a doctor and physical therapist. A seniors living center is being planned. The schools and the local land trust are mentioned as positives as well as lack of pollution. So

36 South Hero Risky Behavior, Emergency Access and Preventive Care The only thing considered to be risky behavior concerns local highway safety and congestion during parts of the year. Its a bigger deal in the summer, spring and fall. Its better in the winter. Participants do not believe there is a problem accessing emergency services thanks to C.I.D.E.R.s services and the rescue squad. No desired preventive services are lacking. We get flu shots regularly. They have a foot clinic here at the

37 The crime rate and whats been going on. I dont feel safe going out at night by myself. The poor condition of the roads and sidewalks causes difficulties. What would make things better for me and people with walkers and wheelchairs would be for them to fix these roads. It would be wonderful if the sidewalks were cleared better in the winter. There is unhappiness with the waiting time in the emergency room. The transportation options for people on limited incomes are few, especially for places

38 South Square Healthcare Concerns or Needs It is suggested that there be improved publicity of the various programs for which residents are eligible. Several individuals indicate having had a negative experience with doctors who are not respectful of the elderly. Even though most residents are happy living at South Square, they express an anxiety as to where they would live if South Square were not available for some reason. Id be on the street. In a nursing home. Whats going to happen to me

39 Age 4 under 20 3 2029 Education 1 some high school 2 high school graduates, 3 some college, 1 unknown Income 5 less than 10,000 2 10,00024,999 Employment 2 parttime 5 unemployed Health insurance coverage 3 public 1 public private 1 yes have insurance 2 other Residence 6 live in Burlington and 1 in South Burlington Children under 21 living at home 1 HH 2 children 2 HH 1 child One person did not fill out the demographic form. SpectrumYouth Population Good about the Community The p

40 I think it would help if you had less cops on Church Street protecting the Market Place and more cops monitoring the Old North End. I think that cops pay a lot of attention to the petty stuff. Like they abuse their power. They want to protect Burlingtons image on Church Street and keep homeless people and youth off of Church Street from tainting the image of Church Street but there is not money in protecting the North End because theres no business and theres no rich people there. I honestly

41 Health insurance coverage 9 public 3 yes have insurance 3 no insurance Children under 21 living at home 6 HH 1 child 4 HH 2 children 2 HH 3 children Bhutanese Good about the community The Bhutanese refugees are tied to their culture and religion and, while there are challenges and difficulties in living in the Burlington area, they appreciate the general environment. We like our culture and our religious practice. The environment here, we love that. We like the rules and regulations

42 Medicaid insurance. That does not cover properly. Dental and eye glasses. Many are reluctant to access emergency services due to the cost not covered by health insurance. They call friends for help instead of calling the ambulance. They call the ambulance because of emergency problem and they send a really big bill. Many of our community people didnt go to the hospital because they dont have insurance. From the hospital, they call many times to take care but because of insurance she didnt go

43 Income 4 less than 10,000 4 10,00024,999 1 25,00049,999 1 50,00099,999 Employment 2 full time 3 parttime 4 disabled 1 unemployed Health insurance coverage 8 public 2 private Residence 3 live in Burlington 4 in Winooski 3 in S. Burlington Children under 21 living at home 2 HH I child 1 HH 3 children Community Health Center Participants Visions of a Healthy CommunityMake Community Better Not all aspects of the vision are currently attainable. Having a safe community and having the se

44 The whole bullying and harassment pieces with all kids who are different, whether they be in special education, whether its cultural competency or whatever that is, kids are being put at risk. A number of additional issues are raised that need attention Racism Crime rate Inadequate street lighting The need for more activities for youth. Housing Transitional housing for those discharged from correction facilities Alcoholism There is a strong undercurrent of racism in Vermont. There is

45 You can see a chiropractor but any other holistic or alternative medicine arent covered by Medicare. I want to see my insurance cover a doula or midwife. I dont see why existing providers cant provide a membership to a simple gym. Most participants, but not all, feel they have the knowledge or the ability to learn of the available resources that affect their health. FletcherAllen.org

45 APPENDIX E THEMES FROM KEY LEADER INTERVIEWS AND FOCUS GROUPS Fletcher Allen Community Health Assessment 2012 Themes that were mentioned more than once Focus Groups EDUCATION Day care Quality Youth Programming SUBSTANCE ABUSE MENTAL HEALTH Rx drug abuse and overprescribing Lack of treatment centerswait lists Access to MH services for children Early detection of MH problems for children ACCESS TO HEALTHY FOODS Costavailability nutrition education hunger HEALTH CARE Transportation to health c

46 APPENDIX F COMMUNITY SURVEY FletcherAllen.org

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55 APPENDIX G FLETCHER ALLEN COMMUNITY HEALTH ASSESSMENT COMMUNITY INDICATORS June 2012 Demographics Socioeconomic StatusEducation Level Indicator Population Age Distribution 18 1864 65 Gender Female Male Race White, NonHispanic Racial Ethnic Minority Under Federal Poverty Level Adults age 25 without high school education Adults age 25 with Bachelors Degree or Higher Median Household Income Unemployment2 of adults with health insurance3 Source www.census.gov unless otherwise footnoted

55 APPENDIX G FLETCHER ALLEN COMMUNITY HEALTH ASSESSMENT COMMUNITY INDICATORS June 2012 Demographics Socioeconomic StatusEducation Level Indicator Population Age Distribution 18 1864 65 Gender Female Male Race White, NonHispanic Racial Ethnic Minority Under Federal Poverty Level Adults age 25 without high school education Adults age 25 with Bachelors Degree or Higher Median Household Income Unemployment2 of adults with health insurance3 Source www.census.gov unless otherwise footnoted

56 Access to Health Care Indicator US Vermont Chittenden County Grand Isle County 13 89 na 25 15 42 77 25591 of Uninsured Adults5 of Adults with a usual primary care provider6 of Uninsured youth under 185 of Adults with Medicaid or other public program5 of Adults with Medicare5 of Children with MedicaidDr. Dynasaur7 of Adults who use the dental health care system8 Mental Health providers9 12 83 7 19 15 24 69 8 88 2.8 17 17 42 73 9451 8 89 1 17 11 29 81 5311

56 Access to Health Care Indicator US Vermont Chittenden County Grand Isle County 13 89 na 25 15 42 77 25591 of Uninsured Adults5 of Adults with a usual primary care provider6 of Uninsured youth under 185 of Adults with Medicaid or other public program5 of Adults with Medicare5 of Children with MedicaidDr. Dynasaur7 of Adults who use the dental health care system8 Mental Health providers9 12 83 7 19 15 24 69 8 88 2.8 17 17 42 73 9451 8 89 1 17 11 29 81 5311

57 Health Status of overall population and priority populations 5 Leading Causes of Death Indicator US Vermont Chittenden County 2008 Malignant Neoplasms cancer Cardiovascular disease Chronic Lower Respiratory Diseases COPD, Emphysema Accidents Diabetes Mellitus 123,706 135,952 305 278 43 27 51 18 404,030 616,067 127,924 1,275 1,208 343 264 307 62 Chittenden County 2005 262 283 70 Source VT Department of Health, Vital Statistics, 2008 VT Resident Deaths National Data Center for Disease Contro

57 Health Status of overall population and priority populations 5 Leading Causes of Death Indicator US Vermont Chittenden County 2008 Malignant Neoplasms cancer Cardiovascular disease Chronic Lower Respiratory Diseases COPD, Emphysema Accidents Diabetes Mellitus 123,706 135,952 305 278 43 27 51 18 404,030 616,067 127,924 1,275 1,208 343 264 307 62 Chittenden County 2005 262 283 70 Source VT Department of Health, Vital Statistics, 2008 VT Resident Deaths National Data Center for Disease Contro

58 Risk Factor behaviors and conditions related to top 5 causes of death Indicator Adults of adults age 20 who are obese BMI 30 of adults age 18 who engage in 30 min. of mod. physical activity 5 timesweek of adults who eat 3 daily servings of vegetables of adults who eat 2 daily servings of fruits of adults 18 who smoked cigarettes in past 30 days of adult binge drinking Source Behavioral Risk Factor Surveillance System, www.cdc.govbrfss US 25 34 Vermont 24 59 HSA 21 58 29 31 15 24

58 Risk Factor behaviors and conditions related to top 5 causes of death Indicator Adults of adults age 20 who are obese BMI 30 of adults age 18 who engage in 30 min. of mod. physical activity 5 timesweek of adults who eat 3 daily servings of vegetables of adults who eat 2 daily servings of fruits of adults 18 who smoked cigarettes in past 30 days of adult binge drinking Source Behavioral Risk Factor Surveillance System, www.cdc.govbrfss US 25 34 Vermont 24 59 HSA 21 58 29 31 15 24

59 Child and Maternal Health Indicator Low birth weight 5.5 lbs. 2009 Low birth weight 3.3 lbs. pregnant women who received first trimester prenatal care of pregnant women who receive early and adequate prenatal care women using tobacco during pregnancy of pregnant women who quit smoking during the first trimester 3 months of pregnancy of pregnancies among adolescent females aged 1517 1013 22 21 17.7 1012 19 29 13 37 US 7 1 89 80 Statewide 6.5 1 90 89 Burlington HSA 7 1 86 92 Source Ver

59 Child and Maternal Health Indicator Low birth weight 5.5 lbs. 2009 Low birth weight 3.3 lbs. pregnant women who received first trimester prenatal care of pregnant women who receive early and adequate prenatal care women using tobacco during pregnancy of pregnant women who quit smoking during the first trimester 3 months of pregnancy of pregnancies among adolescent females aged 1517 1013 22 21 17.7 1012 19 29 13 37 US 7 1 89 80 Statewide 6.5 1 90 89 Burlington HSA 7 1 86 92 Source Ver

60 Top 5 Chronic Diseases Indicator ranked by state Arthritis among adults Hypertension among adults Obese age 20 with a BMI 30 Asthma among adults15 Cancer among adults Asthma prevalence 18 years 4 US 16 29.3 25 6.5 3.8 9.4 Vermont 24 22 24 9 9 10 Burlington HSA 25 23 21 9 5 8.3 Vermont Department of Health, Adult Behavioral Risk Factor Surveillance System, www.healthvermont.gov, 20052009 unless otherwise footnoted Social Environment Indicator Violent crime rate per 100,00018 Child abu

60 Top 5 Chronic Diseases Indicator ranked by state Arthritis among adults Hypertension among adults Obese age 20 with a BMI 30 Asthma among adults15 Cancer among adults Asthma prevalence 18 years 4 US 16 29.3 25 6.5 3.8 9.4 Vermont 24 22 24 9 9 10 Burlington HSA 25 23 21 9 5 8.3 Vermont Department of Health, Adult Behavioral Risk Factor Surveillance System, www.healthvermont.gov, 20052009 unless otherwise footnoted Social Environment Indicator Violent crime rate per 100,00018 Child abu

61 Sources 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. US Census, www.census.gov VT Dept of Labor, Economic and Labor Information, www.vtlmi.info VT Blueprint for Health, Annual Report 2010 Behavior Risk Factor Surveillance System, www.cdc.govbrfss BISCHA Report to Legislature 2010 County Health Risk Factors, USPHS, 2012 VT Kids Count 2011 Health Disparities of Vermonter 2010 Robert Wood Johnson, www.countyhealthrankings.org Vermont Dept. of Health, Vital Statistics, 2008 Cen

61 Sources 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. US Census, www.census.gov VT Dept of Labor, Economic and Labor Information, www.vtlmi.info VT Blueprint for Health, Annual Report 2010 Behavior Risk Factor Surveillance System, www.cdc.govbrfss BISCHA Report to Legislature 2010 County Health Risk Factors, USPHS, 2012 VT Kids Count 2011 Health Disparities of Vermonter 2010 Robert Wood Johnson, www.countyhealthrankings.org Vermont Dept. of Health, Vital Statistics, 2008 Cen

62 APPENDIX H CANCER INCIDENCE The Commission on Cancer requires an annual community outreach report. Section 3 of that report requires that prevention and earlydetectionscreening programs reflect the cancer experience of our region and that these measures be included in community needs assessment. BREAST CANCER The incidence of breast cancer in Chittenden County is 138.3100,000. Vermont 130.7100,000 Source Vermont Department of Health, Vermont Cancer Registry 2009. LUNG CANCER The incidence o

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