Paige Shelton County Health Report

Running head: TRINITY HEALTH REPORT 1

Trinity County Health Report

Paige Shelton

California Polytechnic State University

TRINITY HEALTH REPORT

Abstract

Trinity County is located in northern California bordering Shasta, Humboldt, Siskiyou,

and Tehama counties. It is the perfect place for an outdoor vacation with redwoods, Trinity Lake,

and mountains nearby. The purpose of this report is to identify a health problem in Trinity

County by analyzing the different measures of health outcomes and factors and then proposing a

program to improve the status of this poor health outcome or factor. Analyzing these measures

can be done using the Robert Wood Johnson Foundation County Health Rankings project as a

tool to discover where different counties rank and the data on each measure for the county.

While this is a beautiful place to visit, it does not have the best health in California being ranked

number 54 out of 57 counties for health outcomes and number 42 out of 57 for health factors in

California (Robert Wood Johnson Foundation, 2015). Trinity County excelled in physical

environment and is doing okay in clinical care and quality of life, but needs work in social and

economic factors, health behaviors, and length of life. More specifically, the county really needs

to target the issues of adult smoking, poor mental health days, and children who are living in

poverty. All these areas are extremely low or the lowest for the California counties. The number

one health priority that should be focused on first for the county is adult smoking which is a

modifiable factor that can be changed through programs such as a cell phone-based cessation

intervention program. Through changes in policy and programs, the health of Trinity can

improve with time.

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Trinity County Health Report

Trinity County lies hidden in Northern California near Redding and the Cascade Range

and is approximately the size of the state of Vermont (About Trinity County, 2016). The views

are picturesque and the perfect place for an outdoor trip surrounded by tons of nature. Home to

the third largest reservoir in California is Trinity Lake with the American Bald Eagle

surrounding the shores (About Trinity County, 2016). Trinity County consists of a population of

13,786 with 87.9% being white and over half of the population being ages 18 to 65 years old

(United States Census Bureau, 2010- 2015). Almost one-fourth of the county lives in poverty

with a median household income in 2014 being $36,862 (United States Census Bureau, 2010-

2015). This report explores the health of Trinity County looking at different health factors,

behaviors, and outcomes. The purpose of this report is to identify a major health problem

existing in Trinity County after analyzing the county's health and providing a solution to help fix

the problem.

Premature Death

Overall, Trinity County is ranked 54 out of 57 counties in California for health outcomes

(Robert Wood Johnson Foundation, 2015). One of the health outcomes that is focused on the

County Health Rankings website is premature death which consists of data looking at the number

of deaths under the age of 75 and the years of potential life lost rate. Most of these premature

deaths could have been prevented. This data comes from a collaboration between the Robert

Wood Johnson Foundation and the University of Wisconsin Population Health Institute which

comprises its data from an assortment of more than 20 national data sources such as National

Center for Health Statistics (Mortality Files) used for premature death to then create its rankings

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with most of the data from 2010- 2012 (Robert Wood Johnson Foundation , 2015). For

premature death, Trinity County ranks 55 out of 57 with 9,952 premature deaths with California

on average only having 5,295 (Robert Wood Johnson Foundation, 2015). This county is much

worse off than all but two counties in the state which is sad that people are dying rather early

than living longer lives. Looking at how much higher the number of premature deaths than the

overall rate for California, it is twice as many deaths. Premature death is weighted 50% for the

health outcomes for a county which is big portion, but it makes since that an early death would

be a major indicator in county health (Robert Wood Johnson Foundation, 2015). Having a large

amount of weight, if premature death decreases in Trinity from an improvement of health factors

such as smoking, poor diet, and physical activity, the overall health of the county will skyrocket

up the rankings. This is quite an important outcome of Trinity County's health and is definitely a

weak area for them and is contributing to their almost last place ranking.

Health Outcomes – Poor Mental Health Days

The second area of health outcomes is quality of life which consists of four subgroups of

1) poor or fair health, 2) poor physical health days, 3) poor mental health days, and 4) low birth

weight; in this category Trinity County ranks much higher than length of life being 26 out of 57

(Robert Wood Johnson Foundation, 2015). While this is much better, the mental health days in

Trinity is the worst than any other county. This is based on a survey response answering this

question: "Thinking about your mental health, which includes stress, depression, and problems

with emotions, for how many days during the past 30 days was your mental health not good?"

(Robert Wood Johnson Foundation , 2015). This data comes from the Behavioral Risk Factor

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Surveillance System which is a national program that is a random telephone survey covering the

years from 2006 to 2012 (Robert Wood Johnson Foundation, 2015).

As mentioned before, Trinity has the highest number of mentally unhealthy days in all

the California counties having 9.2 days out of the last thirty being mentally bad compared with

the overall in California being 3.6 days (Robert Wood Johnson Foundation , 2015). Trinity

County is the worst in California for this measure with on average about one-third of the days in

a month being poor mentally. While the weight of this measure in the County Health Rankings is

only 10% for health outcomes, the statistics are very daunting (Robert Wood Johnson

Foundation , 2015) It is astonishing that a third of the average person's mental health days are

poor and this public health problem needs to be addressed for the county. It is important to note

that this data comes from 2006 to 2012 and could be a little out to date, but factors need to be

analyzed to collect data on what could be contributing to this poor quality of life. Even though

the weight of the outcome is quite small in the overall scheme of things, it is an important issue

that needs to be solved.

Health Factors – Health Behaviors

The health behavior that was looked at more in detail was adult smoking because this is

one of the four modifiable risk factors that can be decreased to reduce the risk of developing a

chronic disease. Overall for health factors, Trinity is 42 out of 57 which is much better than

health outcomes, but for the health behavior category, Trinity climbs back up to number 55 out

of 57 (Robert Wood Johnson Foundation, 2015). Adult smoking is considered to consist of "the

percentage of the adult population that currently smokes every day or most days and has smoked

at least 100 cigarettes in their lifetime" (Robert Wood Johnson Foundation ,2015). This data

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again comes from the Behavioral Risk Factor Surveillance system based on the years 2006 to

2012 (Robert Wood Johnson Foundation, 2015). Trinity County is one of the higher counties for

the percentage of people who smoke. 23% of people smoke there compared to only 13% for the

California overall making it a little less than twice the average looking at the statistics (Robert

Wood Johnson Foundation, 2015). Weighted at 10% in the scheme of health factors, adult

smoking is a decent chunk to consider. It contributes to a lot of the current major health issues in

our country. The weight should be considered more than 10% in the overall health rankings

because smoking is known to contribute to chronic disease which in turn can cause premature

death. With about a fourth of Trinity's adult population smoking there should be measures taken

to reduce the high prevalence of smoking.

Health Factors – Clinical Care

For clinical care factors, Primary Care Physician compares the number of people in the

population per one primary care physician. This data was retrieved from the Area Health

Resource File/ American Medical Association for 2012 which has data from 50 different sources

(Robert Wood Johnson Foundation, 2015). Trinity County is ranked about in the middle, number

33, for this category with 2,254 people to one physician with about 6 primary care physicians for

the entire county (Robert Wood Johnson Foundation, 2015). While the ranking seems solid to its

previous rankings in other areas, the number of primary care physicians is still low especially

when looking at some of the other counties ratios. The overall for California is 1,294 people to

one physician (Robert Wood Johnson Foundation, 2015). Though having access to care most

people associate with having insurance, what good does that do someone if they cannot get in to

see their primary care physician to seek diagnosis and treatment. This is not a huge indicator of

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the health of a county with only a 3% weight when looking at health factors (Robert Wood

Johnson Foundation, 2015). This is not an overall important measure when looking at the health

of Trinity County because it does not contribute very much and they seem to have an okay

amount of physicians for their small population.

Health Factors – Social and Economic Factors

Children in poverty is a great health factor to look at, yet can be very saddening how

many kids live in poverty. This measure is defined by how many of children under the age of 18

are living in poverty which is based on a family income compared to a threshold to determine if

the family is below the poverty line (Robert Wood Johnson Foundation, 2015). The data has

been collected from the year 2013 from the Small Area Income and Poverty Estimates under the

U.S. Census Bureau and other agencies (Robert Wood Johnson Foundation, 2015). Trinity

County ranks 40 out of 57 for social and economic factors and has a child poverty rate of 35%

with 780 children living in poverty compared to 24% overall in California (Robert Wood

Johnson Foundation, 2015). While Trinity County is not the worst county for childhood poverty,

it is not necessarily better off than most counties in California. It has a higher rate that California

overall and is towards the top range with 42% being the highest in a county; it is also concerning

as well because Trinity County is getting worse for this measure, see Figure 1 to look at this

trend (Robert Wood Johnson Foundation,2015).

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Figure 1. How the percentage of children in poverty is continuing to increase in Trinity

County at a much faster rate than California and the United States (Robert Wood Johnson

Foundation, 2015).

Children in poverty is weighted at 7.5% for health factors and is crucial to change this

current factor because it can strongly affect a child's quality of life (Robert Wood Johnson

Foundation, 2015). Living in poverty as a child is not ideal for having optimal health and can

bring on diseases and illness in a child much more frequently. This isn't a currently contributing

strongly to the health of the county, but in the future when those kids become adults, this could

negatively impact the health of the county especially when looking at premature death rates

which are already high.

Health Factors – Physical Environmental Factors

For the overall category of physical environmental factors, Trinity ranks number 2 out of

all the counties (Robert Wood Johnson Foundation, 2015). One of these factors is long commute

and driving alone which is the percentage of commuters who drive alone for more than 30

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minutes to work collecting its data from the American Community Service for the years 2009 to

2013 (Robert Wood Johnson Foundation, 2015). Roughly about 19% of the population of Trinity

County partakes in this compared to the 37% in California overall (Robert Wood Johnson

Foundation, 2015). This county is much better off than most counties in California, but you have

to take into account that Trinity is not a large county distance wise compared to some others in

California looking at the descriptive data. This measure is overall not that important to the health

of this county and only 1% of it is taken into account when looking at the health factors of a

county to rank them (Robert Wood Johnson Foundation, 2015). It seems very logical that this

shouldn't be a major component when looking at the health of the California counties.

Tools and Resources

The main tool and resource used was the County Health Ranking website that looks at

health outcomes and health factors and different measures of these two categories to rank all of

the California counties. Using this resource, one can look at descriptive data for all of these

measures and compare it to the overall descriptive data for California and to other counties. This

was a useful tool in the purpose of the report to identify a main health problem in Trinity County

by analyzing this data. Another resource that was useful was the United States Census Bureau to

get more of an idea of Trinity County, California since I am not from there and have never been

there before. Trinity County is excelling in the health factor of physical environment and is

average in clinical care, but needs a ton of help in other areas.

This county needs improvements in adult smoking, poor mental health days, children in

poverty, and premature death since they are close to the lowest ranking county in all these

measures. Both adult smoking and poor mental health days are top health priorities that need to

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improved upon, but adult smoking is a key problem that can be reduced with some new

programs and policies. Also tackling the number of people who smoke could in turn possibly

lower the number of poor mental health days. The main health related topic that needs to be

addressed currently for this county is the number of adults who smoke which is still quite high

than the overall California rate. Tobacco use is one of the main behavior risk factors contributing

to chronic disease and this number needs to decline in Trinity County to prevent people from

developing a chronic disease and dying prematurely.

Conclusion

These findings show that the state-level activists, policy-makers, healthcare providers,

and regulatory officials need to implement improved or more health policies to increase the poor

health of Trinity County. There are so many different areas of health outcomes and factors that

should be a major concern for the county. Being ranked 54 out of 57 for overall health outcomes

in California counties is not something to be ignored and to not make any changes. Even for this

report, it was hard to chose one health problem to focus on because there are lots of health

problems from the amount of children in poverty to adult smoking to poor mental health days

that require drastic changes to be made.

Since California has already increased tobacco prices and tax, the best way for Trinity

County to decrease its adult smoking rate is to focus on tobacco cessation programs for the

county to encourage and help people to quit. One scientifically support program is a cell phone-

based tobacco cessation intervention that with the use of cell phones helps smokers quit through

cessation advice and motivational messages that may include interactive features or personalized

components (Robert Wood Johnson, 2015). There is strong evidence that this program will

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assist smokers to quit for their life and one intervention in the United Kingdom, txt2stop, shows

that it can be cost-effective (Robert Wood Johnson, 2015). In the 2013 United States dollars, for

every 1,000 people enrolled, this program costs about $27,000, but it is estimated to have saved

the UK's National Health Service rough $69,000 since the reduce number of smokers will

improve upon the number of people who develop a chronic disease later in life (Robert Wood

Johnson Foundation, 2015). This is a very small price to pay when looking at the amount of

money that the United State spends on health and medicine a year and will severely help the poor

health. There are many different cell phone cessation programs already in place throughout the

country. For more information to start one of these programs in Trinity County, policy makers,

activists, and health specialists should look to the National Cancer Institute's Tobacco Control

Research Branch and Smokefree.gov to look at cell phone-based cessation programs that have

already been designed and take one these programs and adapt it to Trinity County (Robert Wood

Johnson Foundation, 2015). This program is feasible to implement into Trinity County and could

end up making a huge difference in the population of adults who smoke.

While Trinity County has a good amount of health problems that need to be improved,

they are definitely are measures that can be fixed. It will take time and they will not be magically

fixed overnight. But in the long run, Trinity County will have much better health and the high

rate of premature death will decrease overtime. People in Trinity County will eventually live

happier, healthier, and longer lives. It is worth the challenge to take action and move the county

up in the health rankings, but most importantly improve the health of the people living there.

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References

About Trinity County (2016). Retrieved from http://www.trinitycounty.org/index.aspx?page=2

Robert Wood Johnson Foundation. (2015). Adult Smoking. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/factors/9/description

Robert Wood Johnson Foundation. (2015). Adult Smoking. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/factors/9/datasource

Robert Wood Johnson Foundation. (2015). Cell Phone-based Tobacco Cessation Interventions.

Retrieved from http://www.countyhealthrankings.org/policies/cell-phone-based-tobacco-

cessation-interventions

Robert Wood Johnson Foundation. (2015). Children in Poverty. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/factors/24/data


http://www.countyhealthrankings.org/app/california/2015/measure/factors/24/description



Robert Wood Johnson Foundation. (2015). Long Commute- Driving Alone. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/factors/137/descriptio

n

Robert Wood Johnson Foundation. (2015). Long Commute- Driving Alone. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/factors/137/datasourc

e

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Robert Wood Johnson Foundation. (2015). Poor Mental Health Days. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/outcomes/42/descripti

on

Robert Wood Johnson Foundation. (2015). Poor Mental Health Days. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/outcomes/42/datasour

ce

Robert Wood Johnson Foundation. (2015). Premature Death. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/outcomes/1/datasourc

e

Robert Wood Johnson Foundation. (2015). Primary Care Physicians Retrieved from

http://www.countyhealthrankings.org/app/california/2015/measure/factors/4/data

Robert Wood Johnson Foundation. (2015). Primary Care Physicians. Retrieved from


Robert Wood Johnson Foundation. (2015). Ranking Methods. Retrieved from

http://www.countyhealthrankings.org/ranking-methods

Robert Wood Johnson Foundation. (2015). Trinity County. Retrieved from

http://www.countyhealthrankings.org/app/california/2015/rankings/trinity/county/outcomes/

overall/snapshot

United States Census Bureau. (2010-2015). Quick Facts Trinity County, California. Retrieved

from http://www.census.gov/quickfacts/table/PST045215/06105,00

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Documents

Paige Shelton County Health Report