Final

CHIPOLA AREA HEALTHY
START
NEEDS ASSESSMENT
Calhoun, Holmes, Jackson, Liberty and Washington

Counties
Executive Director: Janet B. Spink
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Physical Address: 4636 Lafayette, Suite M, Marianna, FL 32446
Statement from the ED
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Special Thanks to the Healthy Start Advocacy Team for Serving as
the Community Needs Assessment Team.
We would also like to recognize to our local hospital, physicians,

ophthalmologists, civic organizations and many others for their
contributions to this process.
“Silent gratitude isn't much use to anyone.”
G.B. Stern
Carolyn Monroe West of Healthy Families Northwest Florida

Whitney Cherry of 4-H Ag Extension, University Florida, Calhoun and Liberty Counties
Judy L. Corbus of 4-H Ag Extension, University Florida, Washington County
Patsy Gainer from the Washington County Health Department
Glenna Padgett from the Holmes County Health Department
Jenny Hill of the Calhoun County School Board
Peggy Howland from the Calhoun and Liberty County Health Departments
Karen Edwards from the Jackson County Health Department
Kim Lee, Consumer
Ruth Kelley of Tri-County Head Start
Holly Segers-Holt from the Holmes County Health Department
William Long from the Jackson County Health Department
Connie Swearingen of Jackson Hospital
Christina Conrad of Jackson Hospital
Cheryl Fitzgerald of the Children’s Home Society
Suzan Gage of the Early Learning Coalition of Northwest Florida
Kim Gillis from Head Start/Early Head Start
Kelly Faircloth of the Department of Children and Families
Jolie Gillis of the Life Management Center
Edna Riley of the Early Head Start
Lisa Lamar of Chipola Healthy Start
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Charlsie Poole of the Healthy Families North Florida
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The Chipola Healthy Start Team
Board of Directors Chipola Healthy Start Staff
Chephus Granberry Chair Janet Spink, Executive Director
Jenny Hill Co-Chair Carmen Smith, Community Liaison
Suzan Gage, Lisa Lamar, Contract Administrator

Secretary/Treasurer
Amy Kitchen, Administrative Assistant
Cheryl Fitzgerald
Jenny Hill
Cyndi Jackson
Gloria Keenan
Joyce Wales
Judy Corbus
Whitney Cherry
Advisory Board Lead Care Coordinators
Dr. Eugene Charbonneau, Peggy Howland for Calhoun and Liberty

Representing County
Calhoun and Liberty County Health Departments
Health Departments
Glenna Padgett for Holmes County
Holly Holt, Representing Health Department
Holmes County Health
Departments Karen Edwards for Jackson County and
Washington
William Long, Representing County Health Departments
Jackson and Washington County
Health Departments
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Preface (statement from the Exe Director)
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Acknowledgments Page 3
I. Introduction
Who are we?
Board Membership and Staff Page 4
Advisory Board and Lead Care Coordinators
Our Mission Page 6
Services Description Page
Needs Assessment and Service Delivery Plan Process Page
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II. Literature Review: Birth Outcomes, Prevention, Social Policy,
Access to Care, and Health Disparities
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III. Methodology Page
Service Area Snapshot
IV. Findings Page

County Profiles Page
Child and Maternal Health Profile Page
Health, Well-Being and Access to Health Care Page
Behaviors Before and During Pregnancy Page
Key Informant Interview
V. Major Health Issues: Challenges Page
VI. Conclusions and Recommendations
VII. References
Appendix
Chipola Healthy Start Mission

Health Start’s mission is to reduce the number of infant deaths, the number of premature or
low-birth-weight births and to improve the health and development of children under the age
of three.
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Healthy Start strives to accomplish our mission primarily by (1) identifying at-risk moms and
newborns through a screening process, (2) providing education, counseling and care/case
management for those at risk, and (3) working in the community to increase awareness of
those at risk so they can use the services we offer.
Who Do We Serve?
Chipola Healthy Start Coalition serves pregnant women and children in a five-county region
of the Florida Panhandle: Calhoun, Holmes, Jackson, Liberty and Washington. The
geographic area covers the southern border of the states of Alabama and Georgia, to the
coastal regions of Florida which bring diverse socio-economic population. The Coalition is
made up of public and private health care providers, social service organizations,
representatives of the local school system, county governmental staff, maternal and infant
advocacy groups and consumers of health services.
Each of the five counties can be best described as rural with low population density and are
within the smallest 25% of the counties in the State. The total land mass for the service is
3419 square miles, with Jackson having 916 total square miles and the largest population.
Every county in our service area is designated as rural, defined by the U.S. Census Bureau
with less than 100 people per square mile.
Jackson County is also the only county within the service delivery area with a delivering
facility and practicing licensed OB/GYN’s physicians. There are 41,421 females and
Jackson County is worth noting because it places the County in a small group of Florida
counties that have a non-white percentage greater than 25%. Chipola Healthy Start has
approximately 1150 births each year. Of the births in Chipola Healthy Start’s service area,
approximately 60% are covered by Medicaid. The region has a disproportionate number of
persons with incomes at poverty level, lacking a high school education, teenage mothers,
the chronically ill, and over 25% are uninsured. Residents of the Florida Panhandle make
their living in farming, logging, manufacturing, construction, service industries, and as the
staff of state and federal institutions (serving incarcerated adults and juveniles, and the
profoundly retarded.) High smoking and teen pregnancy rates prove to be challenging for
our service delivery area as most teens (70.5%) feel it is a good time to be pregnant and do
not see harm in smoking as long as they “cut back” during their pregnancy . We also
struggle to provide care for the undocumented and underinsured who do not qualify for any
other type of public assistance using Healthy Start funding as the payer of last resort.
Services Description:
Chipola Healthy Start funds Healthy Start services to pregnant women, infants, and children
up to the age of three. It is our goal to promote healthy pregnancies and healthy babies by
providing funds to Calhoun, Holmes, and Jackson County Health Departments for services
to clients in their respective service areas. Additional services are provided through
contracts with other local providers for mental health assessments, nutrition education,
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prenatal care as payer of last resort and others. Some of the services provided by Chipola
Healthy Start include, but are not limited to: home or office visits with a care coordinator,
breastfeeding education and support, childbirth classes, parenting support and education,
nutritional guidance, smoking cessation services, and assistance with navigating the
healthcare system.
In addition, Chipola Healthy Start also conducts research as a part of the State of Florida’s
Fetal and Infant Mortality Review. This intervention examines the circumstances
surrounding infant deaths and premature babies. This information is used to teach other
pregnant women or women wanting to become pregnant of risks associated with pregnancy
and infant sleep.
Major Accomplishments
A consistent increase in the number of women’s who submit to prenatal screening.
1629 clients were served over the past contract year.
What Are We Up Against?

Jackson County is the only county in our service area which has a hospital where
expectant mothers can give birth. 57.3% of births to mothers from our service area
occur outside our service area. More than 60% of all births in our service area are
paid by Medicaid. There is a higher rate of low birth rate babies and infant mortality
among African Americans. There is a severe transportation deficit, most counties
have little or no public transportation and there is a longer than average commute for
many who reside in areas where there are no healthcare facilities. There is little or
access to high risk prenatal care. There are many impoverished families with
children in our area. A number of mother’s begin prenatal care later in the
pregnancy due to healthcare access issues. There is an increase in smoking rates
among youth due to generational acceptance. In addition, there are a noteable
number of teen mothers with repeat pregnancies. In addition to a plethora of
maternal and child issues, there is the significant challenge of resource deficits and
support for prevention programs, interventions, and services to address the identified
issues. Many citizens acknowledge through the key informant surveys they have
little knowledge of the types of services provides by Chipola Healthy Start. In
general many of the providers lack the cultural knowledge involving language and
health behaviors. Due to our promixity to two other states, Georgia and Alabama,
there is a little or no coordination between service providers across counties and
state-lines.
Can we make it sound better or are you comfortable with it? There are 41,421
females and Jackson County is worth noting because it places the County in a small
group of Florida counties that have a non-white percentage greater than 25%.
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How Will This Needs Assessment Be Used
It will be shared with our Board of Directors and other community organizations. The
primary goal of this needs assessment is to educate the community on the status of
maternal and child health; prioritize Coalition and community resources; advocate for
access to care and funding, and serve a basis for our five (5) year Service Delivery Plan.
Description of Process Used To Update the Service Delivery Plan

In an effort to better serve at-risk mothers and children and in keeping with a contracted
mandate, Chipola Healthy Start conducted a needs and gaps assessment to be used as a
guide for writing our updated service delivery plan. This process began at the end of 2009
and was completed November, 2010. Our first task was to review relevant literature on
birth outcomes, racial and ethnic health disparities, social determinants of health, access to
care, immigrant health, and healthcare.
II. Literature Review

Birth Outcomes, Prevention, and Social Policy, Access to Care, and Health Disparities Birth
Outcomes: In trying to make a positive impact on adverse maternal and birth outcomes,
community health providers should critically assess many factors, such as the social and
economic determinants of health and the health indicators that influence birth outcomes.
Particular attention should be paid to racial/ethnic disparities that exist in birth
outcomes, infant and maternal mortality, low birth weight infants, and pre-term births, must
be carefully reviewed and analyzed not only in the context of prenatal and perinatal care but
also in conjunction with social determinants of health. There are numerous studies that
have focused on reducing racial/ethnic disparities in perinatal care and birth outcomes in
various populations. Reviewing current studies are important to us because our service
area is becoming increasingly more diverse.
The body of evidence is growing on how the social determinants of health are important to
explaining and eliminating health inequities. Public health professionals are using the
determinants of health, social, economic, and environmental factors, health practices and
coping skills, as well as biology and genetics to reduce health disparities in ethnic and racial
groups. These same determinants can be used to analyze their impact on the racial/ethnic
disparities in perinatal care and birth outcomes.
Definitions of adverse birth outcomes critical to maternal and infant health issues:
Infant mortality is a phrase referring to infants who die prior to experiencing their first
birthday. The infant mortality rate (IMR) is the number of infant deaths during a calendar
year per 1,000 live births during the same year. The IMR is an important indicator of the
health and well being of a community. This indicator reflects multiple social determinants of
health.
Preterm birth is defined as those infants born at less than 37 weeks gestation. Preterm
births are the primary factor in infant mortality. Preterm birth can be the result of many
factors that include: genetics, birth defects, prior preterm birth, health conditions that the
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mother has before, during and after pregnancy. Racial and ethnic disparities continue to
exist between Black and White women that do not disappear when controlling for income
level. Therefore the rate of preterm birth must be carefully assessed.
Low birth weight (LBW) is a major factor in sixty five percent of infant deaths. That is,
infants born weighing less than 2,500 grams or 5 1/2 pounds contribute significantly to the
infant mortality rate. When we examine both the infant mortality rate and the low birth
weight rate in rural poor counties the rates are unacceptably higher than the overall state of
Florida rate.
Impacts of Birth Outcomes

Low birth weight rates children are developmentally delayed, lack coordination, develop
speech skills at a slower rate than average birth weight children. Newer research indicates
that babies born less than 5 pounds may experience delays in motor and social development
that could have impacts over a lifetime and perhaps become dependent on our strained
healthcare system.
A 2005 “American Journal of Nursing" study revealed that the average cost of medical and
follow-up care for a low birth weight baby during the first year of life is at least $90,000 per
child. For a very low birth weight baby, one weighing less than 3 pounds, the low end cost is
about $185,000 per year per child as compared to the cost for a normal weight baby (greater
than 5 pounds at birth), which averages around $6,500.
The long term costs and consequences include the costs of ongoing medical care, early
intervention services, special education, academic remediation and other support services
are consumed at a disproportionate rate by these children. These costs also strain our
already overburden school district budgets.
With all that being said, increasing the birth weight of infants and decreasing the number of
preterm births could be achieved by improving the health of the mothers prior to conception.
There are a plethora of causes of infant mortality, preterm birth, and low birth weight rates.
The research tells us why some babies are born too small, too soon, or both. Genetics and
environmental factors may also limit normal development. Multiple births (twins, triplets, or
higher) often are low birth weight, even if delivered at term. The mother's, preconception
health influences gestational age and birth weight. Her actions before and during the
pregnancy can affect birth outcomes (inadequate nutrition, smoking, drinking alcohol and/or
using drugs). Poverty in families and communities, teenage pregnancy, and other life
stressors have also been linked to poor birth outcomes.
Prevention and Social Policy Interventions

Minimizing the risk of preterm and low birth weight births is a difficult task at best. Most
intervention programs to reduce preterm and low birth weight include: early and regular
prenatal care, nutrition counseling, weight management, stress management, chronic
disease self-management, peer education, and support, and appropriate mental health,
economic and environmental interventions. The trend for interventions is focusing on
women in the preconception and interconceptional periods.
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During the later part of 2005, the Centers for Disease Control and Prevention (CDC)
convened a panel and selected a review group of professionals to develop
recommendations to improve preconception health and health care. These 19
recommendations were issued March 2006 and are included in the appendix.
Access to Care, Health of Immigrants and Health Disparities

While our service area is not as diverse as other areas in the state, there are a small
percentage of individuals across our service areas who do not speak English as their first
language and/or who are foreign born. Often times, new residents and recent immigrants
lack information about the availability of services and find it challenging to navigate the
system or enter into the healthcare system. In addition, most safety net providers in rural
North Florida do not consistently provide care that is appropriately tailored to the needs of
the ethnically diverse populations. The foreign born are most likely to be uninsured, less
likely to have a primary provider, and more likely to use the hospital emergency room for
care. Significant differences exist within the foreign-born population for the infant mortality,
low birth weights, and teen birth rates. Language and culture can be noted as barriers to
access to health care in all the reports due to the linguistic and cultural diversity in the
foreign-born population.
At this present time the Florida Charts data does not show a less than favorable number of
linguistically isolated individuals, however with a small influx of immigrants, the number is
increasing in a manner which should be noted when planning interventions.
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Methodology
Following the literature review, data and statistics for the counties was reviewed and
compiled from the most recent local, state, and federal resources and reports available.
The health indicators were analyzed for trends with corresponding state data were available
and applicable. A community survey, community focus groups, healthcare providers survey
was conducted to determine perception and awareness of our target audience, as they
relate to the mission of Chipola Area Healthy Start Coalition.
The following tasks were completed:
Review and Compile County Profiles for Each County

Demographics >Race,Age,Gender
Socioeconomics
Medicaid
Language
Foreign Born Mothers
Review and Analysis of Selected Health data
Infant Mortality Rate
Low Birth Weight
Teen Pregnancy
Infant Births and Deaths
% Foreign Born
Chronic Disease
Diabetes
Hypertension
Obesity
Map Community Health Resources: Assets
Community Organizations
Hospitals
Health Centers
Mental Health Providers
Key Informant Interviews
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The key informant groups were an integral component of the Needs Assessment.
They provided an opportunity to find out directly from medical/health providers,
community service providers, women, and adolescent youth what each group
perceived as the needs and gaps in services for adolescents, women and their
families.
Two key informant surveys were developed, one for providers and another for
clients/consumers, were developed to facilitate the information gathering
process on four areas: services, client population, challenges and barriers, and
infant mortality and low birth rates factors. Questions were developed to get specific
information in order to start developing a plan to address the needs and gaps.
Description of Data Collection

The key informant groups were facilitated by Chipola Healthy Start Coalition staff. At
each focus group meeting notes were recorded to ensure that all comments would
be included in the major themes and findings section.
Limitations
Key informant groups were conducted to obtain the direct input of clients and
health and social services providers. The group sizes varied from very small to very
large. However, we were able to confirm key information on the many health
concerns of consumers regarding community assets, needs and gaps for maternal,
and child health. Their comments are reflective of the concerns and issues
identified through the community demographic and health profiles as well as the
literature review. Therefore the key informants' feedback is included and
analyzed in the key findings.
Emerging Populations and Issues
While there is not an overabundance of people who are foreign born or whom are
linguistically isolated there are a small percent who will need services. The chart
below shows there are individuals who meet this criterion in our service area.
The racial/ethnic, cultural, and linguistic diversity poses particular challenges for
health care providers who must provide culturally and linguistically competent and
sensitive services to all they serve. The challenges also include the health and
cultural practices that may be very different from the U.S.-born residents; health
literacy issues; the ability to navigate the health care system; and non-English
proficiency.
County Foreign Born Language Other Than

English Spoken at Home
Calhoun 2.2% 5.7%
Holmes 1.7% 4.5%
Jackson 1.5% 4.4%
Liberty 2.1% 5.5%
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Washington 2.5% 5.5%
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SNAPSHOT OF OUR SERVICE AREA
Chipola Healthy Start Coalition Service area is comprised of Calhoun, Holmes,

Jackson, Liberty and Washington Counties. The total population is estimated at
116507 based on the U.S. Census bureau 2009 population estimate. In all our counties
women and children account for more than half of the population. The poverty rate in
all counties exceeds the 2000 U.S. poverty rate of 12.4%. Four of our counties,
Calhoun, Holmes, Liberty, and Jackson are designated by the USDA as Low Education
Counties. These are counties were 25 percent or more of residents 25-64 had neither a
high school diploma nor GED in 2000. Our service area is characterized by large
opens spaces, forest tracts, and agricultural lands. Many of the homes are located on
unpaved roads and hinder the ability of women and children from accessing healthcare
and services.
There are myriad of health, social, transportation and socioeconomic disparities which
plague our service area.
Demographics Snapshot of the Chipola Healthy Start Service Area

Calhoun Holmes Jackson Liberty Washington
,
2009 est. population 13,821 19,857 50,930 7983 23,916
Population % change 6.2% 7.0% 8.9% 13.7% 14%
Persons under 5 6.1% 5.5% 5.7% 6.6% 5.9%
Person under 18 20.9% 21.8% 20.2% 22.2% 21.6%
% females 2009 est. 46% 46.4% 45.9% 40.2% 46.4%
%High school 69.1% 65.2% 69.1% 65.6% 71.2%
graduates or higher
Median Household $33,613 $27,923 $37,707 $38,608 $34,632
income
Unemployment 8.7% 8.1% 7.4% 5.8% 10.1%
% persons living below 20.9% 21.0% 19.0% 21.5% 23.2%
poverty
% persons ages 0-17 25.2% 28.9% 23.2% 24.4% 31.4%
living below poverty
*U.S. Census Bureau and Florida Legislature
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Recommended Interventions To Address Identified Problems:
Establish initiatives to address health disparity issues of the African American

population.
Increase the level of awareness and knowledge along with the level of report and
help-seeking behaviors within the community regarding domestic violence.
Establish more general Wellness and between pregnancy care initiatives.
Facilitate shared data reporting system for maternal and child health providers within
and outside our service area.
Implement more programs addressing teen pregnancy, smoking cessation,

preconception health, teen parenting, prenatal and childbirth education.
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Calhoun County Profile
The Chipola River runs through Calhoun County.
As of the census of 2000, there were 13,017 people, 4,468 households, and 3,132 families
residing in the county. The population density was 23 people per square mile. There were
5,250 housing units at an average density of 9 per square mile. The racial makeup of the
county was 79.87% White, 15.79% Black or African American, 1.26% Native American,
0.53% Asian, 0.05% Pacific Islander, 1.04% from other races, and 1.45% from two or more
races. 3.78% of the population was Hispanic or Latino of any race.
There were 4,468 households out of which 32.50% had children under the age of 18 living
with them, 52.30% were married couples living together, 13.50% had a female householder
with no husband present, and 29.90% were non-families. 26.50% of all households were
made up of individuals and 12.40% had someone living alone who was 65 years of age or
older. The average household size was 2.53 and the average family size was 3.02.
In the county the population was spread out with 23.20% under the age of 18, 9.00% from
18 to 24, 31.50% from 25 to 44, 22.30% from 45 to 64, and 14.00% who were 65 years of
age or older. The median age was 36 years. For every 100 females there were 117.20
males. For every 100 females age 18 and over, there were 120.80 males.
The median income for a household in the county was $26,575, and the median income for
a family was $32,848. Males had a median income of $26,681 versus $21,176 for females.
The per capita income for the county was $12,379. About 14.80% of families and 20.00% of
the population were below the poverty line, including 23.60% of those under age 18 and
20.40% of those ages 65 or over.
A majority of the residents are employed by the service industry, governmental agencies, in
agriculture and forestry.
The incorporated municipalities for Calhoun County are Altha and Blountstown, with
Blountstown being the county seat. This county is primarily rural in nature and has a low
population density.
A review of Florida Charts Pregnancy and Youth Child Profile data ranks Calhoun County in
the least favorable quartile in the following areas.
• Poverty level
• Repeat births to teen mothers
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• Number of fathers who acknowledge birth certificate
• Foreign born mothers
• Mothers who smoked during pregnancy
• Number of women age15-34 with STD’s
• Overweight and obese mothers
• High number of births with >18 months interpregnancy interval
• Number of uninsured women >17
• Number of children receive services for developmental disabilities
• Number of very low birth and low birth weigh babies
• Number of post neonatal and Sudden Unexplained Infant Deaths
• Low number of mothers who initiate breastfeeding
• High number of Medicaid births
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Maternal and Child Health Indicators County State
Calhoun County Rate Comparison
Residents below 100% of the poverty level 20.0% 12.5%
Domestic Violence Offenses 260.3 613.5
Little English Spoken in Family 1.3% 5.9%
Unemployment Rate 5.2% 6.2%
Total Female Population 15-44 2,481 3,543,681
Births to Mothers 15-19 54.8 42.5
Repeat births to mothers 15-19 22.7% 18.3%
Total births to unwed mothers 44.1% 45.8%
Births among unwed mothers ages 15-19 77.3% 88.0%
Births with father acknowledged on birth certificate 79.8% 86.0%
Births to mothers born in other countries 5.8% 32.4%
Births to mothers >18 without high school education 17.6% 17.0%
Women 15-34 with STD’s 3067.8 2337.8
Females >17 who are current smokers 26.5% 17.5%
Births to underweight mothers at the time pregnancy 10.6% 12.5%
occurred
Births to overweight mothers at the time pregnancy 25.1% 22.8%
occurred
Births to obese mothers at time pregnancy occurred 27.6% 18.6%
Births to mothers who report smoking during 18.0% 7.1%
pregnancy
Births with 1st trimester prenatal care
Females >17 who have any type of health care 76.7% 82.4%
insurance coverage
Birth with late or no prenatal care 5.0% 5.8%
Births covered by Medicaid 62.2% 43.5%
Births<1500 grams (very low birth weight) 1.9% 1.6%
Births<2500 grams (low birth weight) 7.7% 8.7%
Births <37 weeks gestation 13.6% 14.2%
Mothers who initiate breastfeeding 58.3% 77.6%
Fetal Deaths 3.8(u) 7.4
Neonatal deaths (<28days) 3.8(u) 4.6
Post-neonatal deaths (28-364) days 9.6 2.6
Infant deaths (0-364 days) 13.4 7.2
Kindergarten children fully immunized 94.4% 92.7%
WIC children >1 who are overweight 26.2% 30.9%
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Jackson County Profile
The historic Jackson County Courthouse.
Jackson County is the only county in our service area that shares its borders with two (2) states
Alabama and Georgia. As of the census of 2000, there were 46,755 people, 16,620 households,
and 11,600 families residing in the county. The population density was 51 people per square
mile . There were 19,490 housing units at an average density of 21 per square mile. The racial
makeup of the county was 70.18% White, 26.56% Black or African American, 0.67% Native
American, 0.36% Asian, 0.03% Pacific Islander, 0.81% from other races, and 1.40% from two or
more races. 2.91% of the population was Hispanic or Latino of any race.
There were 16,620 households out of which 30.90% had children under the age of 18 living with
them, 51.50% were married couples living together, 14.40% had a female householder with no
husband present, and 30.20% were non-families. 27.00% of all households were made up of
individuals and 12.80% had someone living alone who was 65 years of age or older. The
average household size was 2.44 and the average family size was 2.95.
In the county the population was spread out with 22.30% under the age of 18, 9.70% from 18 to
24, 29.60% from 25 to 44, 23.80% from 45 to 64, and 14.60% who were 65 years of age or
older. The median age was 38 years. For every 100 females there were 110.40 males. For
every 100 females age 18 and over, there were 111.20 males.
The median income for a household in the county was $29,744, and the median income for a
family was $36,404. Males had a median income of $27,138 versus $21,180 for females.
The per capita income for the county was $13,905. About 12.80% of families and 17.20% of the
population were below the poverty line, including 23.70% of those under age 18 and 21.00% of
those ages 65 or over. Jackson County is ranked the 42nd most populous county in the state of
Florida.
Jackson County is the most populated and the largest county served by Chipola Area Healthy
Start and is centrally located in the five county cluster.
The incorporated municipalities for Jackson County: Town of Alford, Town of Bascom, Town of
Campbellton, Town of Cottondale, City of Graceville, Town of Grand Ridge, Town of
Greenwood, City of Jacob City, Town of Malone, City of Marianna, and the Town of Sneads with
Marianna the being the home of Chipola Healthy Start and the county seat.
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The major employers in Jackson County are government entities, service industries, agricultural
industries, and manufacturers.
A review of Florida Charts Pregnancy and Youth Child Profile data ranks Jackson
County in the least favorable quartile in the following areas.
• Poverty level
• Number of women age15-34 with STD’s
• Number of children receiving mental health services
• Number of very low birth and low birth weight babies
• Number of babies born in subspeciality perinatal centers
• Low number of women who initiate breastfeeding
• Number of children in foster care
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Jackson County Rate Comparison
Little English Spoken in Family .5% 5.9%
Women 15-34 with STD’s 3535.1 2337.8
occurred
occurred
Births to mothers who report smoking during pregnancy 14.9% 7.1%
Births with 1st trimester prenatal care 77.4% 76.5%
Females >17 who have any type of health care insurance 81.1% 82.4%
coverage
Birth with late or no prenatal care 6.1% 5.8
Births covered by Medicaid 61.0% 43.5
Births with adequate prenatal care (Kotelchuck index) 66.6% 69.4%
Fetal Deaths 8.3 7.4
Neonatal deaths (<28days) 3.9 4.6
Deaths from SUID 55.5(u) 104.0
Total Population Less Than 5 2,922 1,137,700
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An old dirt road in Bonifay.
Holmes County Profile
As of the census of 2000, there were 18,564 people, 6,921 households, and 4,893 families
residing in the county. The population density was 38 people per square mile. There were
7,998 housing units at an average density of 17 per square mile . The racial makeup of the
county was 89.79% White, 6.51% Black or African American, 1.01% Native American,
0.39% Asian, 0.03% Pacific Islander, 0.79% from other races, and 1.48% from two or more
There were 6,921 households out of which 30.90% had children under the age of 18 living
with them, 55.60% were married couples living together, 10.80% had a female householder
with no husband present, and 29.30% were non-families. 26.10% of all households were
made up of individuals and 12.40% had someone living alone who was 65 years of age or
older. The average household size was 2.43 and the average family size was 2.92.
In the county the population was spread out with 23.10% under the age of 18, 8.80% from
18 to 24, 29.30% from 25 to 44, 24.00% from 45 to 64, and 14.80% who were 65 years of
age or older. The median age was 38 years. For every 100 females there were 112.90
males. For every 100 females age 18 and over, there were 113.60 males.
The median income for a household in the county was $27,923, and the median income for
a family was $34, 286. Males had a median income of $25,982 versus $19,991 for females.
The per capita income for the county was $14,135. About 15.40% of families and 19.10% of
the population were below the poverty line, including 25.70% of those under age 18 and
17.90% of those ages 65 or over.
The primary employers in Holmes County work in the government, construction, services,
or retail industry.
The incorporated municipalities are Bonifay, Esto, Norma, Ponce DeLeon, and Westville.
23 | P a g e
A review of Florida Charts Pregnancy and Youth Child Profile data ranks Holmes
• Poverty level
• Number of mothers 15-19
• Number of mothers who receive late or no prenatal care
• Number of mothers who do not receive adequate care according to Kotelchuck index
• Number of babies born in subspeciality perinatal centers
• Females >17 who smoke
24 | P a g e
Maternal and Child Health Indicators County Rate State
Holmes County Comparison
Little English Spoken in Family .5% 5.9%
Births to mothers >18 without high school 15.7% 17.0%
education
Women 15-34 with STD’s 3535.1 2337.8
Births to underweight mothers at the time 9.3% 12.5%
pregnancy occurred
Births to overweight mothers at the time 19.3% 22.8%
pregnancy occurred
Births to obese mothers at time pregnancy 23.7% 18.6%
occurred
pregnancy
insurance coverage
Birth with late or no prenatal care 6.1% 5.8
Births covered by Medicaid 61.0% 43.5
Births with adequate prenatal care (Kotelchuck 66.6% 69.4%
index)
Neonatal deaths (<28days) 3.9 4.6
Total Population Less Than 5 2,922 1,137,700
25 | P a g e
26 | P a g e
Liberty County Profile
Liberty County is the least populous and least-densely populated of all of Florida’s counties
with a population density of around 8 people per square mile. It’s most
populous incorporated area and county seat is Bristol.
The Apalachicola National Forest occupies half the county.
As of the census of 2000, there were 7,021 people, 2,222 households, and 1,553
families residing in the county. The population density was 8 people per square mile.
There were 3,156 housing units at an average density of 4 per square mile. The racial
makeup of the county was 76.41% White, 18.43% Black or African American, 1.81%
Native American, 0.14% Asian, 2.08% from other races, and 1.13% from two or more
There were 2,222 households out of which 34.20% had children under the age of 18
living with them, 51.80% were married couples living together, 13.20% had a female
householder with no husband present, and 30.10% were non-families. 25.90% of all
households were made up of individuals and 10.60% had someone living alone who
was 65 years of age or older. The average household size was 2.51 and the average
family size was 3.00.
In the county the population was spread out with 21.80% under the age of 18, 9.40%
from 18 to 24, 37.70% from 25 to 44, 21.00% from 45 to 64, and 10.20% who were 65
years of age or older. The median age was 35 years. For every 100 females there were
144.90 males. For every 100 females age 18 and over, there were 159.50 males.
The median income for a household in the county was $28,840, and the median income
for a family was $34,244. Males had a median income of $22,078 versus $22,661 for
females. The per capita income for the county was $17,225. About 16.80% of families
and 19.90% of the population were below the poverty line, including 24.30% of those
under age 18 and 24.30% of those ages 65 or over.
A review of Florida Charts Pregnancy and Youth Child Profile data ranks Liberty
• Poverty level
27 | P a g e
• Median income
• Obese mothers
• Number of women >17 with no health insurance
• Fetal Deaths
• Repeat births 15 -19
• Unwed mothers 15-19
• Women >17 who smoke
28 | P a g e
Liberty County Rate Comparison
Women 15-34 with STD’s 2812.2 2337.8
occurred
occurred
Births with inter-pregnancy interval <18 months 27.1% 21.3%
pregnancy
insurance coverage
C-Section Births 29.8% 36.9%
Births<1500 grams (very low birth weight) 1.2%(u) 1.6%
Very low birth weight infants born in subspecialty 75.0% 73.9%
perinatal centers
Post-neonatal deaths (28-364) days 3.1(u) 2.6
Infant deaths (0-364 days) 6.2(u) 7.2
Total Population Less Than 5 442 1,137,700
29 | P a g e
30 | P a g e
Washington County Profile
As of the census of 2000, there were 20,973 people, 7,931 households, and 5,646
families residing in the county. The population density was 36 people per square
mile. There were 9,503 housing units at an average density of 16 per square mile. The
racial makeup of the county was 81.72% White, 13.69% Black or African American,
1.54% Native American, 0.36% Asian, 0.06% Pacific Islander, 0.58% from other races,
and 2.05% from two or more races. 2.30% of the population was Hispanic or Latino of
any race.
There were 7,931 households out of which 30.30% had children under the age of 18
living with them, 56.20% were married couples living together, 11.40% had a female
householder with no husband present, and 28.80% were non-families. 25.10% of all
households were made up of individuals and 12.00% had someone living alone who
was 65 years of age or older. The average household size was 2.46 and the average
family size was 2.93.
In the county the population was spread out with 23.40% under the age of 18, 7.70%
from 18 to 24, 28.50% from 25 to 44, 24.70% from 45 to 64, and 15.70% who were 65
years of age or older. The median age was 39 years. For every 100 females there
were 105.80 males. For every 100 females age 18 and over, there were 105.90 males.
The median income for a household in the county was $27,922, and the median
income for a family was $33,057. Males had a median income of $26,597 versus
$20,198 for females. The per capita income for the county was $14,980. About 15.40%
of families and 19.20% of the population were below the poverty line, including
26.90% of those under age 18 and 19.40% of those ages 65 or over.
Much of Washington County is uninhabited, with most of the population residing in or

around Chipley, Caryville, Ebro, Sunny Hills Vernon, Wausau, and other developments
around the county's many lakes.
A Waterfall in Washington County
31 | P a g e
A review of Florida Charts Pregnancy and Youth Child Profile data ranks Washington
• Poverty level
• Median income
• Foreign born mothers
• Number of women >17 with no health insurance
• Repeat births to mothers age 15 -19
• Number of Births with 1st Trimester care
• Number of mothers who receive late or no prenatal care
• Number of mothers who do not receive adequate care according to Kotelchuck index
• Number of children receive services for developmental delays
32 | P a g e
Maternal and Child Health Indicators County Rate State
Washington County Comparison
Women 15-34 with STD’s 2812.2 2337.8
occurred
occurred
Births with inter-pregnancy interval <18 months 27.1% 21.3%
pregnancy
insurance coverage
C-Section Births 29.8% 36.9%
Births<1500 grams (very low birth weight) 1.2%(u) 1.6%
Very low birth weight infants born in subspecialty 75.0% 73.9%
perinatal centers
Post-neonatal deaths (28-364) days 3.1(u) 2.6
Infant deaths (0-364 days) 6.2(u) 7.2
Total Population Less Than 5 442 1,137,700
33 | P a g e
Child and Maternal Health Profile
Total Births
The Chipola Healthy Start Coalition service area has experienced slight growth in number
of births from 1999-2008. Overtime, the birth rate remains consistent in all counties.
Exhibit 1
Further investigation reveals an important characteristic of the maternal population. Like

the general population, they are mostly white. Birth mothers in 2008 were 81% white
and 19% non-white. The percentage split of the birthing populations has been fairly
consistent at this level for six years 2003 thru 2008. The breakdown by race by county
can be seen in the graphic on the following page.
Since 2004 Calhoun, Holmes and Liberty counties have experienced decreases in
nonwhite births of 15, 31 and 45% respectively. Jackson and Washington counties
have experienced increases of 24 and 7 percent respectively. Total Coalition nonwhite
births increased 10% from 2004 to 2008. The breakdown of births by race and county
are by “count” and not by percentage to give a clearer picture of numbers in each
different sizes of each population.
Births by County by Race for Comparison for 2004 and 2008
34 | P a g e
2004Calhoun 2008Calhoun
17 5 12
3
125 148
2004Holmes 2008Holmes
49 43
2004ChipolaHSC
23 211
202 203
1,030
2004Jackson 2008Jackson
137 160 2008ChipolaHSC

8
412 20 413
40 217
1,095
2004Liberty 2008Liberty
1 5 15 2008ChipolaHSC
78 92
217
White
2004Washington 2008Washington 40
37 Other
7 10
37
213 239
Black
Births to Unwed Mothers
The number of births to unwed mothers is rising at a steady rate since 2000. The
percentage of unmarried births to total births has risen from 36.9% in 2000 to 47.3%
in 2008 (Exhibit 2) for the Chipola HSC service area. The same magnitude of increase
35 | P a g e
was seen in each of the five counties with Jackson seeing the largest rise of 12.8
percentage points.
Exhibit 2
ChipolaHSC%of Birthsto Unmarried Mothers

80%
70%
60%
50%
40% 46.8% 45.1% 45.1% 47.3%
42.3% 40.6% 42.9%
36.9% 39.6%
30%
20%
10%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008
Births to Unwed Mothers
The number of births to unwed mothers has been rising at a steady rate since 2000.
The percentage of unmarried births to total births has risen from 36.9% in 2000 to
47.3% in 2008 (Exhibit 2) for the Chipola HSC service area. More unmarried women
are choosing to give birth out-of-wedlock and most teen mother’s are unmarried, this
trend can be seen all over the United States.
Exhibit 3
Chipola HSC % of Births to Unmarried Mothers by Race
Wide differences appear when the 90%
“unmarried” risk factor is broken down 80%
by race. Exhibit 3 shows the 70%
71.1%
76.7% 76.2% 77.3% 76.8%
79.3%
75.1%
78.5% 79.3%
percentage for unmarried black 60%
mothers versus unmarried white 50%

38.3% 38.0% 36.0%
40.9%
40%
mothers. 30%
28.5%
33.3% 32.1% 32.0% 32.9%
20%
10%
In 2008 the black unmarried birth 0%
percentage was 38.4 points higher than 2000 2001 2002 2003 2004 2005 2006 2007 2008
the percentage for whites. However, Black W hite

there is a consistent rise in the
consistent rise of the number of white
mothers who are unmarried, keeping
with the trends of the United States. It
36 | P a g e
is increasingly more acceptable to have babies out-of-wedlock. From 2000 to 2008 the
percentage rose from 28.5% to 40.9% while the black percentage only changed 8.2 %. The
rise in births to unmarried mothers has a real and direct impact on the rates at which low
birth weights will occur. Studies have indicated that being unmarried, holding other risk
factors constant, will increase the risk of a low weight birth. A North Carolina study found
that, when other risk factors were controlled, unmarried mothers were 30% more likely to
have a low-weight birth.
Exhibit 4
2008%of Births <2500gm with Selected Risk Factors
By Martital Status For CHSC
Late/NoPC*
2ndTrimesterPC
<Age20
Smoked
<12Grade
0.0% 5.0% 10.0% 15.0% 20.0%
Unmarried Married
The percent of low-weight births were compared by marital status. The largest difference
was seen in the group delaying prenatal care to the second trimester and the least
difference came for the group with an education less than 12th grade.
Behaviors Before and During Pregnancy

The health of a woman prior to and during pregnancy is very important in determining birth
outcomes for the infant. These maternal behaviors also indicate the areas in which more
maternal health promotion and education, and/or access to services are needed: safe sleep
practices, fetal alcohol disorders, and smoking cessation. Smoking is a risk factor for
preterm birth and low birth weight infants, as well as alcohol use.
Delayed Prenatal Care

Early initiation of prenatal care (PNC) is an important component of safe motherhood
programs, which aim to improve maternal and infant health outcomes. Women who receive
delayed (i.e., entry into PNC after the first 12 weeks of pregnancy) or no PNC do not receive
timely preventive care or education and are at risk for having undetected complications of
pregnancy that can result in severe maternal morbidity. In fact, according to Health
37 | P a g e
Resources Services Administration: Maternal Child Health Bureau, babies born to mothers
who received no prenatal care are three times more likely to be born at low birth weight,
and five times more likely to die, than those whose mothers received prenatal care. Stress,
lack of family and friend support, Medicaid enrollment, age under 20 or over 34, low
acceptance of pregnancy, and lack of a high school diploma have all been identified as
predictors of late entry.
In Exhibit 5, we examine low birth weight for total births by trimester prenatal care began
for ten years from 1999-2008. The green bars indicate the range of percentage results with
the red square marking the overall ten (10) year average. While the average for third
trimester entry was actually better than 1st and 2nd trimester entry, the variation is
demonstrated to be riskier. The full picture demonstrates that the experience of Chipola
Healthy Start Coalition and reflects current literature on the subject.
Exhibit 5
The percentages of total births to mothers not initiating care until the second trimester for
the five counties of Chipola Healthy Start are presented in the following graph.
(Exhibit 6)
Exhibit 7
BirthstoMothersWith2ndTrimesterPrenatal Care
TenSingle-Year Percentagesfor All RacesAll Sexes
County 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RSq
Calhoun 7.1 7.7 10.6 12 8.3 14.8 17.4 13.2 17.6 14.6 67.5%
Holmes 8 10.6 4.2 9.4 5 19 15.7 15.1 23.1 15.7 53.1%
Jackson 8.3 7.6 5.3 5.8 6.9 16.1 16 15.8 16.7 16.9 70.7%
Liberty 4.9 7.8 14.6 10 7.4 16.7 8 8.4 9 8.3 0.3%
Washington 10.3 11.1 14.3 6 5.9 17.7 17.7 22.2 19.4 27.2 61.2%
StateTotal 12.6 12.8 12.5 11.7 11.4 14.7 16.2 17.5 18 17.3 73.4%
DataSource: FloridaDepartment of Health, Bureauof Vital Statistics
Each of the county rates over the ten year period, with slight variation, mirrors the State
rates in amplitude and maybe more importantly in trend. Not initiating care before the 12th
week of pregnancy is one of the steepest upward trends in this analysis. In last column of
Exhibit 7 the results of an R-Squared computation on each data series are included.
The trends for Florida, Jackson County, Calhoun County and Washington County are not
only noticeably steep and consistent but also demonstrate some of the most statistically
significant growth curves in this examination. (Exhibit 8)
38 | P a g e
Exhibit 8
BirthstoMothersWith3rdTrimesterorNoPrenatal Care
Ten Single-Year Percentagesfor All RacesFemales
County 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Calhoun 0 1.9 3.5 0 1.5 1.6 3 6 4.7 4.4
Holmes 2.5 1.9 1.4 1 2.3 13.7 10.7 8.6 12.5 11.1
Jackson 1.6 1.7 0.8 1.2 2.3 5.1 4.2 4.7 8.2 5.5
Liberty 1.2 1.3 3.7 1.3 1.1 0 2.3 4.2 7.9 3.6
Washington 3 1.4 2.4 2.7 1.8 10.9 9.1 15.9 15.3 9.7
State 3.4 3.5 3.4 2.9 2.8 4.3 5.3 5.7 6 5.8
Another measure of the adequacy of prenatal care is the Kotelchuck Index. As

described by Milton Kotelchuck, this index “attempts to characterize prenatal care
(PNC) utilization on two independent and distinctive dimensions – namely adequacy
of initiation of PNC and adequacy of received services (once PNC has begun). The
index uses information readily available on U.S. birth certificates (month of initial
PNC visit, number of visits, and gestational age).”
The results of the Kotelchuck measurements for Chipola Healthy Start reinforce the
trends found when examining the statistics on the timing of prenatal care initiation.
Exhibit 9 presents the percentage change in the number of mothers falling into each
one of the four categories in the Index between 2000 and 2008.
Exhibit 9
39 | P a g e
300%
263%
KotelchuckIndex
Percent ChangeFrom2000to 2008
250%
200% 184%
150%
Chipola Total
100% Black
White
50% 40%
18%
0%
-10% -8% -10% -14%
-20% -20% -17%
-26%
-50%
Inadequate PC Intermediate PC Adequate Adequate +
The percentage of women in “Inadequate” group grew at a substantial rate, while the
rate in the better three categories decreased. Breaking the result down by race
reveals that most of the growths in the “Inadequate Prenatal Care” results were
attributable to the white population. The one positive change was the increase in the
percent of black mothers getting “Adequate Prenatal Care”.
Smoking
Women who smoke during their pregnancy have an increased risk factor for many
pregnancy complications. Some of the complications include increased risk of:
miscarriage or stillbirth, placenta previa, placental abruption, preterm birth, apnea &
SIDS and genetic defects. Babies exposed to cigarette smoke in the womb, whether
directly or from second-hand smoke, are more likely to be born with a low birth
weight. In fact, smoking reduces the birth weight of babies in direct proportion to the
number of cigarettes smoked, with pack-a-day smokers 30% more likely to give birth
to a low birth weight child than a nonsmoker. Prenatal exposure to cigarettes can
also lead to long-term physical and intellectual problems in children, especially if the
smoking continues after birth. Some of the longer term implications include
respiratory diseases, ear infections, food allergies, cancer, asthma, attention
disorders and restricted growth.
The smoking rates among pregnant women in each of the Coalitions five counties, as
in many of Florida’s rural communities, run significantly higher than the State rates.
40 | P a g e
Four of our counties consistently run percentages in the range of 18 to 20% with the
fifth, Jackson, ranging between 12 and 18%. The graphic representation of these
numbers, framed in red, can be seen in Exhibit 10.
Exhibit 10
PercentofBirthsto MothersWhoSmokedDuringPregnancy
30
25
20 State
Calhoun
15 Holmes
Jackson
10 Liberty
Washington
5
0
9
9 0
0 1
0 2
0 3
0 4
0 5
0 6
0 7
0 8
0
9
1 0
2 0
2 0
2 0
2 0
2 0
2 0
2 0
2 0
2
Births to Mothers Who Smoked During Pregnancy

County 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
State Total 10.2 9.5 9.1 8.6 8.1 7.5 7.8 7.6 7.1 6.8
Calhoun 20.2 16.6 23.1 20.5 24.6 18.6 15.8 18.9 17.6 17.6
Holmes 20.6 18.8 27.2 26.7 21 20 25.5 20.7 22.3 21.4
J ackson 14 15.6 18.5 16.5 14.6 12.4 14.8 15.1 13.5 16
Liberty 25.6 20.5 21.4 19.8 24 16.7 19.4 20.7 18.1 22.4
W ashington 20 23.2 19.2 19.2 19.9 18.3 20.9 23.8 17.4 22.9
When smoking rates are divided by race, the Coalition’s results are similar to but not exactly
like the State’s experience (Exhibit 11). White and Black mothers-to-be in the service area
smoked at rates twice as high as their counterparts in the State from 1999 thru 2008. The
Florida smoking rate for white mothers has been steadily decreasing over the period while
the Chipola Healthy Start Coalition rate has remained steady over the course.
Exhibit 11
Chipola Healthy Start

Also, Percent Who Admitted Smoking During Pregnancy presented in
Exhibit By Year & Race 12, there is a
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 comparison of
White 20.3 20.7 23.7 22.5 21.5 17.7 20.8 20.7 18.4 21.0
mother’s tobacco
Florida 12.2 11.4 10.9 10.3 9.6 8.9 9.3 9.0 8.3 8.0
status to the birth
weight Black 6.5 7.7 11.0 6.4 7.4 7.1 7.8 8.0 7.3 8.3 of the infant for
Chipola Florida 4.7 4.2 4.1 4.0 3.9 3.5 3.9 3.7 3.7 3.5 HS cumulatively
41 | P a g e
for the period 2001-2008. One of the results of smoking during pregnancy can be
seen in the bar graph. Non smokers had babies weighing less than 2500 grams 8.2%
of the time while smokers had the same result 14% of the time. Smokers also had
fewer babies over 4000 grams.
Exhibit 12
C-Sections
Fortunately, Chipola Healthy Start coalition counties report c-section rates that run
below the State rates. However, there the data tells us there is a consistent rise in
rates for each county.
Exhibit 13 shows the trends as compared to the State. Significant benefits could be
realized by reducing the rates and rate growth for C-Sections in the service area.
Exhibit 13
Exhibit 14
Total CesareanSectionDeliveries
Ten Single-Year Percentages for All Races All Sexes
County 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RSQ
StateTotal 24.3 25.5 26.8 29 31.1 33.1 34.8 36 37.2 37.6 96.8%
Calhoun 24 23.6 25.2 24.2 26.8 27.6 30.4 26.7 32.4 23 6.9%
Holmes 23.1 32.4 20.5 25.8 21.4 18.1 30 31.5 30.8 32.9 61.5%
Jackson 24.6 29.2 18.7 26.9 24.1 25.1 30.9 34.2 32.6 35.9 85.1%
Liberty 19.5 20.5 10.7 22.2 15.6 26.7 25 32.4 25.9 31.6 69.5%
Washington 28.1 21.8 24.2 31.6 24.3 27.6 28.1 34.5 30.9 33 45.6%
Looking at C-sections by race did not reveal significantly different rates for white and
nonwhite. The trends were also similar in slope and values.
Alcohol
Drinking alcohol during pregnancy can cause a wide range of physical and mental birth
defects. Fetal alcohol spectrum disorders (FASDs) is the most common term used to
describe the effects of alcohol during pregnancy. Even though many realize that heavy
drinking is dangerous during pregnancy, unacceptable percentages don’t realize that
any level of alcohol consumption is not safe.
The percentages of women admitting the use of alcohol during
pregnancy in Coalition’s service area remained steady from 2004
thru 2008. The levels ran from a high of 21.8% to a low of 18.1%
(Exhibit 15). These numbers are taken from the results of the infant
42 | P a g e
screens and of mothers who self-admit drinking during pregnancy.
The actual numbers may be higher.
Exhibit 15
Percentage ofChipolaHSCBirthMothersAdmittingAlcohol Use

DuringPregnancyComparedtothe FloridaRate
30%
25%
20%
21.1%
19.2% 19.8%
18.9% 18.1%
15%
10%
5%
1.1% 1.1% 1.0% 0.9% 0.8%
0%
2004 2005 2006 2007 2008
ChipolaHSC Florida
The Chipola Service area rates of birth mother who admitted

drinking during pregnancy are much higher than the Florida rates.
Racial disparity is evident in the numbers when broken down by
white and nonwhite. While both white and nonwhite mothers run
higher intra-pregnancy alcohol usage percentages than the
aggregate. State rates show nonwhite mothers do much better
than white mothers in Chipola Healthy Start Service area. In
contrast, black mothers- to-be alcohol usage ran at high levels when
compared to the State levels.
One of the effects of alcohol on our mothers and babies may be

visible in Exhibit 16. As with smoking, the drinkers had babies less
than 2500 grams 13.6% of the time and non drinkers 9.7% of the
time. However, these results are tempered given the great
differences in the actual numbers versus the percentages. The
9.7% represents 897 births over the eight year period while the
13.6% is only 6 births. (Exhibit 17)
Exhibit 16
Exhibit 17
43 | P a g e
Resident Births
Chipola HSC
2001-2008
Birth Weight of Infant
<1500 1500 to 2500 to 4000+ Not All Birth
Mother's Alcohol Statusgms % 2499 gms % 3999 gms % gms % Known % Weight
Yes 0 0.0% 6 13.6% 36 81.8% 2 4.5% 0 0.0% 44
No 148 1.6% 749 8.1% 7,797 84.5% 535 5.8% 0 0.0% 9,229
Unknown 18 1.7% 52 4.9% 870 82.8% 109 10.4% 2 0.2% 1,051
All Mother's Alcohol Status 166 1.6% 807 7.8% 8,703 84.3% 646 6.3% 2 <0.1% 10,324
Data Source
: Florida Department of Health, Office of Vital Statistics, Florida Birth Certificate
Weight (BMI) – Before and During Pregnancy

The BMI (Body Mass Index) of women at the time of conception has critical implications for
pregnancy outcome and child development. This is true for low BMI (<18) as well as high
BMI (>25) and obesity (>30).
In women who are at a low body mass index (BMI), there is an increased risk for premature
birth and increased risk for intrauterine growth restrictions resulting in low birth weight.
Recent studies suggest that severely underweight women (less than 18 BMI) are 72% more
likely to miscarry and have increased risk of having a low birth weight baby. In women with
a high BMI, there is good evidence of a greater risk of complications during pregnancy.
Some of these risks include: gestational diabetes, pre-eclampsia, epidural

complications, delivery by emergency caesarian section, heavy bleeding after
delivery, increased risk of forming abnormal blood clots, bladder and kidney
infections, wound infection and increased risk of stillbirth.
The percentage of mothers with a BMI less than 18 for our area compares well
against the State’s rolling 3 year average (assumed for nine years for comparison
purposes) in Exhibit 18.
Exhibit 18
44 | P a g e
Percentageof Birthsto Motherswith BMI<18
14%
12%
10%
Calhoun
8% Holmes
Jackson
6%
Liberty
4% Washington
Florida
2%
0%
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
9
0
2
The State is averaging just above 12% while the five counties of Chipola HS run generally
between 2 and 6%. Holmes is the only exception as it has been falling between 4 and 10%.
Being overweight or obese is a very serious problem in the Nation, the State and the
Coalition’s service area. The percentage of births to women with BMI over 25 is over 40%
for the State and in the last few years the clients of Chipola HS have caught up (Exhibit 19).
Since 2003, the five counties have moved from 30% or less to all being over 40% in 2009.
If the statistics are correct about the probabilities of the babies of overweight mothers
becoming overweight adults, then the increases in this category will be exponential until the
cycle is broken.
Exhibit 19
45 | P a g e
PercentofBirthtoMotherswithBMI>25
60.0%
50.0%
40.0%
Calhoun
Holmes
30.0%
Jackson
Liberty
20.0% Washington
State
10.0%
0.0%
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
9
0
2
The differences in low and high BMI pregnancy outcomes for the constituents of Chipola
Heart Coalition can be seen in Exhibits 20 and 21. The graphs show baby’s birth weight
compared to four categories of mother’s weight. In the first, the percentages of births in
four baby weight ranges are shown for all four levels of mother’s weight. With careful
examination, you can visualize the shape of the bell curve with the four data points for
mothers at normal weight. If you do the same for underweight mothers you can see the bell
curve shift to the left (LBW), for the obese category the curve as expected shifts to the right.
Babies at this end, are more likely to be predisposed to being obese throughout life.
Graphing the Low Birth Weight and 4000+ gram categories separately clearly shows the
linear relationship between mother’s weight and baby’s weight for Chipola Healthy Start
families.
Birth Weight by Mother's BMI

8
%
.6
5
%
.7
4
8
.%
3
8
%
.7
3
8
Exhibit 20 90%
80%
70%
60%
50% Underweight (<18.5)
40% Normal Weight (18.5
-24.9)
1
%
.4
3
30% Overweight (25.0

-29.9)
%
.0
9
%
.4
8
%
.4
7
%
.2
7
20%
%
.0
6
3
%
.6
1
%
.8
%
.7
1
%
.6
1
%
.3
1
%
.9
0
Obese(30.0+)
10%
0%
<1500 grams 1500-2499 gms 2500-3999 gms 4000+gms
(VLBW)
46 | P a g e
Mother'sBMI versus LBW & 8lbs 13.9oz or Greater
16%
14%
12% Underweight (<18.5)
10%
8% Normal Weight (18.5
-24.9)
6%
Overweight (25.0
-29.9)
4%
2%
Obese (30.0+)
0%
1500-2499 gms 4000+gms
Exhibit 21
Exhibit 22
Between White and
70%
CHS%Births byMother'sBMI by Race Nonwhite mothers,
60%
Nonwhites have the largest
50%
percentage of the births
40%
White% with higher BMIs. However,
30%
Nonwhite% at rates of 40 and 50+%
20%
neither group is most
10%
favorable.
0%
Normal Weight Overweight Underweight
Equally significant are the
underweight percentages. They
are much lower but also carry the
more significant immediate risk to
mother and baby.
47 | P a g e
Breastfeeding Initiation
Data on breastfeeding shows that every county in our service area is well below the state
average of 77.6% for women who initiate breastfeeding after birth. This indicates that perhaps
women may need more breastfeeding education and support in the immediate postpartum
period to increase breastfeeding initiation.
Exhibit 23
Health, Well-Being and Access to Health Care
This section provides a quick look at few of the indicators of health and well-being, access
to a regular health care, health insurance, and health conditions that contribute to poor birth
outcomes. These indicators are important to analyze since that may indicate potential areas
for improving preconception, interconception, and perinatal health care for women who are
at-risk. They also contribute to our understanding of the health behaviors and conditions
that are risk factors and contribute to preterm births, low birth weight infants, and poor
maternal and infant outcomes. On average 60% of Chipola Service Area Births are
covered by Medicaid and approximately 25% of others have no insurance at all.
Exhibit 24
Exhibit 25
48 | P a g e
As shown in the chart the Chipola Service area counties exceed the state rate of 16.6
percent of adults who consider themselves to be in fair or poor health.
Exhibit 26
Percent of People Who Rate Their Overall Health As Fair or

Poor
Holmes Jackson Liberty Calhoun Washington State
24.6 20.6 24 30.6 21.6 16.6
Three health conditions that can impact adversely on pregnancy and infant health
are obesity, diabetes and high blood pressure. The percent of adults are obese
and overweight exceed state rates of 38% for overweight and 24.1%. Obesity can
lead to a variety of health problems including heart disease, high blood pressure,
high cholesterol, and diabetes. Lack of health insurance can lead to lack of access
to care which can impact negatively on good health. In fact, the uninsured are less
likely to have a regular doctor than the insured. Individuals who are foreign born are
more likely to be uninsured than those born in the United States.
There is disparity in the number of obese and diabetic people in our service verses
the state rate. These rates indicate how our service parallels what is happening
across the United States.
Exhibit 27
Therefore more attention needs to be focused on pregnant women who are obese
and at risk for developing diabetes or have diabetes. These women are at greater risk
of developing gestational diabetes, and delivering pre-term infants and low birth
weight infants.
Key Points
Chronic conditions, such as obesity, high blood pressure, and diabetes, must be
carefully monitored before, during and after pregnancy to insure the health of the
mother and infant. These are some of the conditions which impact on the Maternal
Health/Prematurity and Maternal Care. Careful monitoring must be done to prevent
pre-term, low birth weight infants or fetal deaths.
The analysis for the health statistics in our five (5) county service area shows that
there is a multiplicity of issues that need to be addressed to further decrease infant
mortality, pre-term and low birth weight infants, improve access to prenatal care,
and improve maternal and infant health.
Prevention education should focus on topics such as, nutrition, exercise, good
health practices, infant care, injury prevention, weight control, and diabetes.
49 | P a g e
In addition, access to care is a critical issue for the immigrant population, particularly
the foreign born who have recently immigrated and those whom immigration status
is not permanent. Access to public health insurance is limited therefore impacting on
the ability to have a primary care provider and a regular provider of care.
Health disparities in the infant mortality rate continue to exist

between Black and White infants. This is evident by the
comparisons provided in this needs assessment. Several studies
over the years have found that inter-pregnancy intervals can have
an impact on
R 2.5
perinatal
BabySpacingRiskRatio
i 2.0 outcomes. One of
s 1.5
k
the effects is an
1.0
increase in the
R 0.5
a 0.0
risk of having a
t low birth weight
i
o
baby. This
MonthsBetween DeliveryandConception
pregnancy
interval to risk
ratio is
demonstrated
graphically in
Exhibit 28
Exhibit 28. Risk of LBW is two times as high with the interval less
than six months. The risk ratio continues to drop from 6months to
18 months at which point the ratio holds at 1.0.
It continues at this level until the 24th month when it begins to rise again. At sixty
months, the risk ratio jumps to 1.5 and continues to increase as time passes.
Examining pregnancy interval for the Chipola Healthy Start Coalition service area
reveals consistency across several comparisons. Exhibit 29 shows very little
variation by year, by the geographic area or by race. When examined by County and
by age groups the same pattern was found except for the under 18 group whose
percentage, not surprisingly dropped. The spike seen in 2005 for Chipola nonwhite
appears large but is only a change
of 22 births from the previous year.
C h ip o la H e alth y S ta rt Teen B irth s
250
200
150
225 214 214 224 230
194 196 206 200
181
100
50
9
1
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
50 | P a g e
35%
Inter-PregnancyInterval <18 Months
30%
25%
20% Florida15-44
15% Chipola 15-44

CHSWhite
10%
CHSNonwhite
5%
0%
1
9
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
Exhibit 29
The visible correlation between the State percentage (larger population) and the
Coalitions percentage (smaller population) points toward a reasonable assumption
that baby spacing practices are driven by societal norms that have developed over
time.
One noticeable trend on an upward rise is the percentage of CHSC pregnancies that
occur less than six months from the last birth Exhibit 30. Pregnancies falling in this
zone have a risk ratio for low birth weight of 2.12, a ratio for preterm birth of 1.77, and
a 1.39 times greater risk for having a baby small for the gestational age.
Exhibit 30
51 | P a g e
ChipolaInter-Pregnancy<18MonthsbyMonthIntervals
8.3%
2008
8.1%
2007
8.4%
2006
7.6%
2005
7.0%
2004
6.5%
2003
6.2%
2002
6.6%
2001
7.0%
2000
5.7%
1999
0% 5% 10% 15% 20% 25%
<6months 6-11months 12-17months
Teen Pregnancy
Exhibit 31
84.04% 84.29%
20.00%
86. 00%
18.00%
16.00%
BirthWeight Percentages
0-19 vs. 20-44
14.00%
12.00%
10.00%
9.07%
8.00% 7.57%
6.74%
6.00%
3.75%
4.00%
2.60%
2.00% 1.41%
0.00%
<1500 grams (Very LBW) 1500-2499 grams 2500-3999 grams 4000+grams Teens 20 thru 44
Teen pregnancy has serious consequences for the teen mother and father, including
decreased chances of finishing school, a depressed financial future, and health risks for
both mother and child. These children who live with only their mother are also five times
more likely to be poorer than children with both parents at home. The children of teen
mothers are more likely to be born prematurely and at low birth weight.
52 | P a g e
The risk of teen mothers giving birth to low birth weight babies is demonstrated by Exhibit
31. The chart compares the groupings of birth weights for teens and the 20-44 age groups
for our clients. As can be seen, the weight groupings for teens shift to the left of the 20-44
groups. Teen mothers had babies in the Very Low Birth Weight category 2.6% of the time,
while the percentage for older women was only 1.41%. The same is true for the Low Birth
Weight category with teens at 9.07% and older mothers at 7.57%. The number of babies at
4000+ grams for teen mothers is where the larger disparity lies.
Exhibit 32
Teen births are further analyzed by race in Exhibit 32. This graph shows the
percentage teens make up of the births within each of the three groups and for the
Coalition as a whole. Black and Hispanic percentages have run higher than the
White and Total percentages for a majority of the ten year represented. They also
display more volatility. Again, this has a partial explanation in the behavior of
statistics in small populations. The White population controls the overall movement
of the Coalition’s trend line.
Exhibit 34
CHSTeen %of Total Births Within Their Category

35%
30%
25%
20% Hispanic
15% CHS
10% Black
5% White
0%
1
9
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
To get a better look at the picture of teen birth by race and ethnicity each groups ten year
numbers have been represented in Exhibit 35 as percentages of the total births in the
Chipola service area. The total line remains unchanged from the previous graph but the
relationship of the other trends changes. The White trend mimics the Chipola Healthy Start
trend almost identically. The Black and Hispanic trends also flatten out and become more
consistent. Both together make up right at 5% of total births while the white teen mothers
make up between 11 and 13%. All four lines are noticeably show only minor changes over
the period.
Exhibit 35
53 | P a g e
CHSTeen Births as a Percentage of Total Births
ByRace andEthnicity
20%
15%
Hispanic
10%
White
5% Black
Total %
0%
1
9
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
Examining the birth rates for the same period reveals a few important points (Exhibit
36). First, the rate per 1000 for 18-19 year olds is remarkably higher than the 0-17
group. For example, in 2006 the 10-17
Exhibit 36
200
TeenBirthRateper 1000
180
18-19
160
140
120 Calhoun
100 Holmes
Jackson
80
Liberty
60
Washington
40
Florida
20
10-17
0
9
1
0
2
1
0
2
0
2
3
0
2
4
0
2
5
0
2
6
0
2
7
0
2
8
0
2
rate per 1000 was 10.4 as compared to the 18-19 rates of 194.8 per 1000. Second, that
while the Coalition compares fairly well with all of Florida on the 10-17 rates, the
rates for 18-19 run well above the State rate for every county. Jackson compares
most favorably because the number of births lowers the volatility of the rates relative
to the other smaller birth counties.
54 | P a g e
The percentage breakdown of total teen births for the Coalition for ten years has
averaged 31% for the 10-17 age group and 69% the 18-19 age group.
Exhibit 37 compares the 2008 percentage of births to unmarried 10-

17 and 18-19 year olds for each county and the Coalition.
Interestingly, the two group percentages for the Coalition are only
1.4% apart with unmarried 18-19 year olds at 82.6% and the 10-17
at 84%. This leaves a
married rate for the groups
2008%of Teens MothersUnmarried by Age Group
at 17.4% and 16% 100.0%
100.0%
respectively. For 2008, that 90.0%

90.0%
85.0%
79.3%
86.8%
85.5%
90.0%
81.3% 84.0%82.6%
equates to a combined total

76.5%
80.0%
66.7%
70.0%
of 39 births to married teens. 60.0%
10 thu 17
If these births are removed 50.0%
40.0%
18 thru 19
from calculations of the teen 30.0%
pregnancy problem, then

2008 the Coalition’s teen
pregnancy percentage would
drop from 17% to 14.1%.
Exhibit 37
A couple of final interesting statistics on teen births for the Coalition relate to their
desire to be pregnant. A 2008-2009 survey of teenage girls in our service area
indicated, 78.1% of unmarried 15-17 pregnant girls wanted to be pregnant and 64.1%
expressed feelings that teenage years are a good time for a pregnancy (Exhibit
38).For of unmarried 18-19 pregnant girls, 84.1% wanted to be pregnant and 70.5%
expressed feelings teenage years are a good time to become pregnant.
Exhibit 38
55 | P a g e
Unmarried Pregnant Teenagers 2008-2009
Viewson the Pregnancy
100.0%
84.1%
78.1%
80.0% 70.5%
64.1%
60.0%
40.0%
20.0%
0.0%
15-17 18-19
%Wanting to be Pregnant It’s a Good Time to be Pregnant
The last topic on teen birth is the occurance of repeat births to teen mothers before
they reach twenty. The actual percentage of these mothers for the service area
averaged 20.99% over the past ten years while Florida averaged 19.76% for the same
period. In Exhibit 39 there is noticeable variation when looking at a couple of the
counties which again is explained by very low counts and populations. Jackson is
again the county that most closely follows the trend for the Coalition and the State.
The Coalitions trend line is very similar to the State’s experience and in fact has
stayed within plus or minus 5 percentage points for all but two of the ten years.
Exhibit 39
40
Percentage of Age 15
-19 MothersWho Hada Repeat BirthBefore Age 20
35
Calhoun
30 Holmes
Jackson
25
Liberty
Washington
20
ChipolaHSC
15 Florida
10
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
56 | P a g e
Poverty: In all five counties of the Chipola HSC service area, overall poverty is at or above
20% of the population. Florida's rate is 13.3%. More troubling is the statistic for families
and single mothers with children under 5 years old”. Service area families in this group
have levels of poverty running 22 to 28 percent as compared to a State rate of 17.4%.
Single females, with children under 5, have poverty levels that range from a high of 72.2%
in Holmes to an area low of 55.6% in Jackson. The rates for these two groups also run
higher than Florida’s 44.5%. Exhibit 40 gives a clear picture of the challenges.
Exhibit
40
2008Percentagein Poverty
80% 72.2%
70%
58.3% 57.7% 59.1%
60% 55.6%
48.5% 47.9%
50% 44.8% 44.6%
38.6%
40%
31.1%
26.4% 27.8% 27.0% 28.1%
30% 23.9% 21.6%
17.4%
20%
20.9% 21.0% 23.2%
19.0% 21.5%
10% 13.3%
0%
The CalhounCounty Holmes County JacksonCounty LibertyCounty WashingtonCounty Florida
problem Total Poverty %
of Families w/children<5 in Poverty
Females w/Childre<5 in Poverty
children
in
poverty
has been
around the service area for a long time. In fact, the USDA Economic Research
Service has labeled Holmes, Jackson and Washington as “persistant child poverty
counties”.
This label identifies counties in which the poverty rate for children under 18 years old
was 20% or more in 1970, 1980, 1990, and 2000. There are 734 counties labeled this
way out of 3086 total counties in the United States. That equates to 23.8% of the
counties in the country as opposed to 60% for the Coalition.
Community Health Resources

There are noticeable gaps in the types of facilities and services available in our
service area. There is only one hospital in our service area that can accommodate
labor, delivery and births. Pregnant women and their families must travel to other
counties or out-of-state. This provides particular challenge transportation wise
since there is no organized consistent public transportation and the commute to
most other counties with adequate facilities is nearly one (1) hour by car.
The availability of public transit for those who do not have their own transportation
or access to transportion is limited to J-Trans for Jackson County and Tri-County
Transport which two of our counties Holmes and Washington. Travel by automobile
57 | P a g e
is slowed significantly by the high prevelance of dirt roads in each of the counties.
Figure 41 outlines the percentage of miles of dirt roads to total miles of roads in each
county. The Florida and Leon County percentages are offered for comparison.
Percentageof Total RoadMileageUnpaved
100.0%
75.7%
80.0% 67.2% 72.0% 69.1%
52.3%
60.0%
40.0%
12.8% 7.7%
20.0%
0.0%
Healthcare: Health Workforce

Like many other areas rural areas, the Chipola Healthy Start Coalition service area is
challenged by the shortage of healthcare professionals. The U.S. Department of HHS
has designated both Washington and Liberty as whole county Primary Care HPSAs
(Health Professional Shortage Area). The other three counties each contain
geographic areas with the designation. Exhibit 42 is a map of the shortage areas.
Exhibit 42
Dental care is another recognized shortage for the area as well as most of Florida.
Specifically, there are few dental practices within our service area who will accept
Medicaid due to the low reimbursement rates. Lack of timely dental care can have
ramifications for pregnant women who suffer from or develop periodontal disease.
58 | P a g e
Exhibit 43
One of the most serious shortages seen in the five counties is in the area of Mental
Health (Exhibit 44). HHS has designated part of Holmes and all of the other four as
shortage areas. As with dental care, the lack of mental healthcare capacity can have
ramifications mothers, mothers to be and children.
Exhibit 44
59 | P a g e
Community Health Resources Provider Y N
Assets
Outreach services for pregnant Health Departments X
women Chipola Healthy Start X
Coalition
Outreach services for children Health Departments X
Chipola Healthy Start X
Coalition
Process for assuring access to Health Departments X
Medicaid (PEPW & ongoing) Chipola Healthy Start X
Coalition
Clinical prenatal care for all Marianna OB/GYN X
unfunded women
Clinical well-child care for all Health Departments X
unfunded infants
Funding to support the CHD Vital Health Departments X
Statistics Healthy Start screening Chipola Healthy Start X
infrastructure Coalition
Ongoing training for providers doing Health Departments X
screens and referrals Chipola Healthy Start X
Coalition
Initial contact after screening Health Departments X
Initial assessment of service needs Health Departments X
Ongoing care coordination Health Departments X
Interconceptional education and Health Departments X
counseling
Childbirth education Health Departments X
Parenting support and education Health Departments X
Nutritional counseling Health Departments - X
WIC
Provision of psychosocial Health Departments X
counseling
Smoking cessation counseling Health Departments X
Breastfeeding education and Health Departments X
support
Data entry into HMS Health Departments X
MomCare Program (SOBRA) Chipola Healthy Start X
Coalition
Psychosocial Counseling Liberty County FQHC X
Other – specify:
60 | P a g e
Key Informant Major Themes and Findings
Chipola Healthy Start staff conducted two types of key informants gathering
activities. The first was a survey of groups to discuss their knowledge and
perceptions of maternal, teen and child health services and the challenges and
barriers that participants encounter when seeking and provider health and/or social
services. The second was a series of community focus groups.
Key Informant Group Sites

Community Informant Survey: Surveys were distributed at a variety of community
events, i.e. health fairs, WIC offices, civic clubs, high school life skills classes,
physician’s offices, etc. By the end of the survey period, 345 surveys had been
completed across our five (5) county service area.
Description of Participants
Key informant participants were recruited through other community organizations,
schools, high schools, the Hispanic community, and county health departments. The
participants and health/social services providers were representative of our service
area.
This survey revealed a variety of issues which may be addressed by interventions

implemented or already implemented by Chipola Healthy Start Coalition based on the
responses to the community survey:
Domestic violence is an issue in our service area.
Nearly 20% of pregnant respondents indicated they had moved more than 3
times in a year.
Nearly 20% reported a high level of stress and 77% reported medium to high
stress.
35% of respondents reported they smoke.
Nearly 10% reported they use the emergency room to get most of their
healthcare.
More than 30% reported have or had been depressed.
36% report being advised by a doctor that they have a weight problem.
27.7% don’t know it is not OK for babies less than 10 months to sleep with
adults.
30.9% don’t know babies should sleep on their back.
25% were not aware that babies of smoking parents have a higher risk of SIDS.
Nearly 16% did not know even a small amount alcohol can cause problems in
pregnancy.
23.7% don’t know teenage pregnancy is a problem in our service area.
42.9% don’t know folic acid is important to pregnancy.
49.6% don’t know when a baby’s brain is developed in the uterus.
48% don’t know mother’s weight before conception can affect the pregnancy
and the baby’s health.
Nearly 14% thinks it is OK to for pregnancies to be close together.
61 | P a g e
48% report they don’t remember discussing Healthy Start during their last
pregnancy.
52% don’t remember anyone discussing a Healthy Start Screen after their last
delivery.
23% reported having a child with problems at birth.
23 % are going to or have a baby without a crib.
Major trends are analyzed from input from the health/community service providers
and adolescents.
Major Findings and Gaps
Table summarizes the major themes and findings from the key informants' groups
with maternal and child health and community-based providers and teenagers.
62 | P a g e
Community Survey NEEDS/GAPS
Findings
Domestic Violence is an Issue Education
Knowledge of Services Better Marketing/More outreach
Mental Health More places to refer
Smoking Cessation More prevention information
Transportation Lack of reliable/and or public
Communities with LimitedMore Services/Funding
Services Education
Lack of Knowledge about
Safe Infant Sleeping
Community Survey NEEDS/GAPS

Findings
Stress in Homes Education/Outreach
Teen Pregnancy Education/Outreach
Education Health Literacy
Poverty/Unemployment Resources/Economy
Smoking Cessation Education/Cessation
Transportation More Available/Funding
Domestic Violence Education/Interventions
Substance Abuse Education/Interventions
63 | P a g e
RESULTS OF COMMUNITY FOCUS GROUPS
During the first six months of 2010, 16 meetings were held. These groups
represented the diversity of our service area. The participants ranged from Chamber
of Commerce professionals, to high school students, to those in our Hispanic
community.
Each meeting began with a presentation of the data included in the outcomes and
risk factors section of this analysis, narrowed to the relevant county. After this, the
risk factors were discussed by the entire group. They were encouraged to discuss
the causes for each of the problem areas and offer ideas about solutions. As
expected, each group was different in terms of where they focused their attention.
Some discussed them all and some narrowed to one or two areas. In every meeting
someone indicated they had learned something new.
The results for each group were mapped out individually and then combined with
results of all the groups. These results are presented in the following sections. Each
section is also labeled with its most probable impact areas and its timing factors as
follows: Impacts - Low Birth Weight (LBW), Infant Mortality (IM), and Fetal Mortality
(FM) Timing Factors – Prenatal (PC), Inter-conceptional (IC) and Pre-conceptional
(PrC).
While not all the solutions suggested are practical to carry out, the concerns and the
desired outcomes associated with those solutions can be very valuable to the
process.
Smoking (LBW/PC, IC, PrC)
Smoking came up as a topic, with almost all of the groups. This assumption can be
re-enforced by the slide of Florida showing the counties in the fourth quartile for
women who smoked during pregnancy (dark blue). It was noted that they are mostly
rural.
Boredom was an interesting

observation, primarily because it
was made by the teenagers.
These feelings also played out in
the teenagers discussions on teen
pregnancy.
64 | P a g e
Education was a theme that ran through the discussion of solutions. Interest was
expressed in increasing the education about the dangers of smoking and second-
hand smoke to the entire community and improving the quality of that education.
Interestingly, the adult groups suggested after school activities even though the
teens, in completely separate groups, had given boredom as reason for smoking.
Almost universally, there was the realization that the society would have to change in
order for all women to stop smoking before they became pregnant. This was
combined with the realization that a pregnancy is not always enough to stop an
addiction as strong as nicotine.
Late or No Prenatal Care (LBW/IM/FM, PC)

Discussion of inadequate prenatal care generally focused on four topical areas:
Transportation
OB/GYNrefusal toaccept lateterm

patients
Advertise(media)the
Someprovider refusal of PEPW
Medicaidcoverageavailable
Access - Toofewproviders
CommunityEducation
Lackofunderstanding/education on
theimportance Grandmother Education
Can'ttakeoff work/Fearof losingjob
DrugTestingbeforePEPWis
Lackof support systems - ex.Noone granted
totakecareof theother kids
Educationtargetedat
TeenageWiring specificgroupsandthe
Insuranceproblems communityatlarge
Medicaidrejectionbasedonassest IncreaseHomeVisiting
i.e.land
"ParishNurse"
Cultural Myths/"Grandmother"
myths/Rural myths
Increase
Teeninsecurity, denial, lackof providers/physician
knowledge extenders
Hidingillegal drug Improvetransportation

behavior/production alternatives
Lackof initiative
Abettercoordinated
Poverty systemof care
"Secondtime" Momstooconfident
access inhibitors, lack of knowledge, support systems and teens. Under access
inhibitors, the behavior of and perceived lack of cooperation by insurance providers
including Medicaid was discussed. There was also discussion about some
physicians refusing to take-late term patients and some refusing to accept Medicaid
presumptive eligibility. The other thoughts under access inhibitors relate directly to
some of the challenges outlined in the first parts of this assessment. Poverty,
transportation difficulties and too few providers were discussed in a majority of the
groups. The lack of knowledge discussion focused on a general lack of
understanding, unreliable information sources and mothers with experience being
too confident. Inadequate support systems were discussed in relation to so many
single mothers. Problems with daycare transportation, and not having easy access
to knowledgeable individual were a few of the topics frequently discussed.
65 | P a g e
A few of the solutions offered up involved expanding the number of points in the
provider system and improving the coordination among those provider points.
Increased home visitation by Healthy Start was suggested as well as the recruitment
of more physician extenders capable of doing OB/GYN. Another interesting
suggestion to improve the system was to institute a “parish nurse” program. As
described, in logical groupings of people such as churches and/or neighborhoods, a
member of the group would be designated as the go to individual for questions
related to women’s health and pregnancy. This individual would not provide the
answers but would be formally educated on the system and where to go to get the
answers. The role would be voluntary and function as the “reliable grandmother” for
the women in their “parish”.
Education was again part of the solution. Broad base community education was
suggested along with education for smaller targeted populations such as
grandmothers. The use of media was discussed for messages about Medicaid
availability and the need for early prenatal care.
Coordination of all the parts of the system was stressed repeatedly. This included
the payment system, the provider system and the social network system. The
thoughts here seemed to be the desire for a system that is hassle free, affordable
and comprehensive enough so that failure to get the right care is only a matter of “I
don’t want to” and not “I can’t”.
66 | P a g e
Under and Overweight/BMI (LBW/IM, IC/PC/PrC)
Target interconceptual care

FitnessLevels
Have the schools take nutrition
Nutrition and fitness education seriously
for all
Seriouslack of
knowledge/education Use lunch periods as labs for
nutrition
Southern culture norms Education targeted at specific
groups and the community at
Baby Spacing large
"Myths" Community Gardens
DrugUse - Under weight Provider education to

communicate specific pregnancy
Content of"Quick&Easy" target weights
Food Develop a pregnancy exercise
program
No Exercise at all
Community wide nutrition
Bad Diets/No money for the education
good stuff
Targeted nutrition education
Fast food &buffets
Use of new media ie Facebook,
Twitter, texting tc.
Weight discussion among the groups was very interesting. It seemed to be a topic
that all could relate to. Discussion of causes centered on fitness and nutrition.
Southern diets, the content of store bought “quick foods”, fast food and buffets were
some of the topics related to nutrition. Lack of knowledge about nutrition was also
identified. The reality that they had grown up not learning the right way to eat and
that no one was adequately teaching the children was an interesting point of view
expressed. Knowing how and what to eat was an important part of the discussion
but not the only part. Availability of the right foods was discussed in terms of cost
and location. Even though these are rural communities, it is not a reasonable
assumption to make that everybody has a garden. Therefore, some of these
communities are dependent one or two small grocery stores and the nutritional
quality of the restaurants within a reasonable distance. Not quite the same as an
inner city “food desert” but similar in its challenges. As far as fitness goes, the total
lack of exercise by most was seen as a problem. In addition, the lack of cultural
encouragement was identified as a contributing factor.
Weight, like smoking, was seen as a community problem which affects pregnant
women as well. The most effective solutions were recognized as those which would
impact the children so that the cycle of BMI problems could be broken.
Suggested solutions for the problems with weight can be broken down into a few
time horizons. The ones suggested for immediate results were increasing
67 | P a g e
interconceptual care, targeted nutrition education, social media reminders and
having providers always communicate weight goals quantifiably. The ones that take
a little longer to blossom and yield fruit include teaching with a community garden,
community wide nutrition education and developing pre-, intra-, and post pregnancy
exercise programs. The long term results solutions involve the schools and
changing the kids while they’re young. One solution offered up was to have the
schools start taking nutrition and fitness education seriously by teaching both every
year to all grades. Another was to make lunch period into a lab class on nutrition.
Baby Spacing (LBW/IM/FM, IC)
Misconceptions
PopulationEducation
Rural Myths targetedat specificgroups
"I want another new CommunityEducation&

baby" "The last media
onesgrowingupto fast"
Provider education-Obs,
Ageat Marriage FP, ARNPs
Waitingtoolong Add"birthcontrol" tothe

OBdischargechecklist for
"MEN" thephysicians
Lackof understanding
The fact that conceiving another baby less the 18 months after the birth of a previous
baby could cause bad outcomes surprised many of the groups’ participants. Not
understanding the relationship was seen at the root of the problem for the area. Part
of this is the prevalence of rural myths, such as “you can’t get pregnant when your
breastfeeding”’ that back fill the information void that exists. The baby spacing
dilemma was also blamed on men’s insensitivity to the problem and to women
starting later thus reducing the time they have.
Realizing that children two years apart are actually 14 months apart birth to
conception and that the 2nd one is at greater risk highlighted the need for better
education. Education was recommended for the community at large as well as
specific groups. Educating providers or reminding them was also suggested for
providers so that they would diligently inform patients. A physician in one group
even recommended that “birth control” be added to the OB discharge checklist for
the physician so that they wouldn’t forget to have the postpartum discussion.
68 | P a g e
Pre-Term Birth (LBW/IM/FM)
Develop regional area protocols
Telemedicine links to specialists
Cooperation of all EMS providers & hospital &

Domestic Violence Drs. on the problem
Refinethe understanding or the content of

No area universal medical/emergency
EMTALA regulations for transfer of a laboring
protocol for treating pretermlabor
patient
Lack of access to prenatal care More agresssive education about recognizing
pretermlabor
Scheduled inductions & c-sections for
convience of provider or patient Develop a Hotline for suspected preterm
labor for those who don't have a Doctor
Lack of knowledge/understanding and Rural
myths Establish ateam fromthe regional center
who would fly in and take over the patient to
Norisk based pre-coordination of services avoid transfer
Develop area risk based protocols for EMS

Smoking- plus the other risk factors
InformEMS of the existance of high risk
"Not going to happen to me" pregnancies
Wanting smaller babies so delivery is Have physicians prepare patient specific

"easier" instruction sheets for the patient to give to
EMS
Move pretermlabor to the same

non-political category as heart attacks and
strokes
Education
Each group identified several area circumstances that were seen as contributing
causes for pre-term births. The first was the lack of knowledge and/or false beliefs.
The most common examples given to highlight this were “it’s not going to happen to
me” and thoughts like “having a baby earlier means it will be smaller and easier to
deliver “. Secondly, points were raised about all the other risk factors like smoking
and baby spacing and how they are no doubt affecting preterm births. Another point,
which was brought out in the environmental data, was the access to prenatal care.
Because so many women have to or choose to see obstetricians 50+ miles away, the
surprise of early labor may leave them without immediate transportation or they
may wait too long in order to avoid an expensive “ false alarm”. The absence of
enough dispersed providers in the geographically large service area, generated
discussion about the lack of coordination within the medical system to handle early
labor. It was noted that there are no area protocols for handling early labor and no
risk based pre-coordination of service.
69 | P a g e
In addition to improving community education, the solutions are centered on
improving the preemptive cooperation of the system relative to early labor. The idea
is to move preterm labor to the same level as heart attacks and strokes in terms of
building protocols that would be implemented throughout the area. It would need to
involve the cooperation of the whole regional system. The knowledge and tools of
Emergency Management Services would need to be improved, as outlined clearly in
the diagram. Other suggestions included a hotline for suspected labor and
telemedicine connections to Pensacola to help small Emergency Rooms (with no
OBs) cope with early labor.
Teen Pregnancy (LBW, PC/PrC)

Teen pregnancy was by far the most widely discussed topic both collectively and
individually by each group. For the adults, it seemed to be the most emotionally
charged topic and the one they really felt they had a chance to improve. For the
teens it was just about the only topic they wanted to talk about because it was about
them and the reality of their lives.
The diagram above lists the adults input on causes in the left column and the teens
in the right column. The yellow highlights in the middle are where there was direct
idea overlap, the green highlight is where the concepts were similar but not exact.
The ones that don’t overlap were not shared ideas.
The two problems that were brought up first and immediately in all five of the teen
groups were the lack of self esteem and the absence of a father figure. The adults
felt the same but they weren’t quite as emphatic about those causes. They were
more centered on the concept of broken families and parenting falling short. A
noticeable contrast between the two groups was the adults suggesting more
supervision and the teens thinking pregnancy is a way to independence. Date rape
was mentioned by the teens and was probably the intent of the drug/alcohol
comment by the adults. There was a shared a shared observation between the adults
and the teen girls on one other causal factor – the behavior of teenage boys.
70 | P a g e
Suggested actions to help solve the problem of teenage pregnancy are listed below
grouped by category.
Each group, teenagers included, recognized that teen pregnancy is a problem. In

suggesting education and programs they were clear that the efforts should be
targeted toward things that have proven to work in other places. The adults were
also committed to the concept that the teens themselves have to participate in
formulating whatever solutions are tried.
71 | P a g e
Major Health Issues: Challenges
The preceding analysis provides a comprehensive assessment of the multifaceted
needs of the Chipola Healthy Start Service Area with respect to critical indicators of
not only the health and well-being
Teen Education of individuals and communities but also in
P e er to P e er Ed ucation
A bstinence e ducation
particular access to health Edcare ucation fo r girls to "see w hat really infants
for women, happen s" and children. The community
health indicators,--infant mortality,
Targe t Educatiopreterm births, low birth weight infants, late or no
n to w ard the guys
prenatal care, thatParent

were reviewed,
Education P are nting classe illustrate
s for th e paren ts of that there
pretee ns and teen s are very serious racial and
ethnic health disparities persistent across
P are nting Education our
i.e. "Be Th five (5) county service area.
e W all"
Consequences Approach P u blish th e e co no m ic costs fo r the individual for STDs

The challenges are not only health-related
Let th em but
exp erie nce the real co nse que nces also include issues of language,
STD e ducation
culture, transportation, and Exposure
access to economic resources. Each at-risk county has
to W hat re al baby is like i.e . "practice" b aby
its own distinct demographic characteristics and health challenges that must be
addressed to impact on adverse
Self Esteem
birth outcomes and the preconception health of
Se lf Este em Classes
Exposure to a bigger w orld/ b igger dre am s
women. Even though the characteristics
M entor/ Ro le M odel e xpo and
sure health challenges may be different, they
transverse some county andBe state lines
ing m o re upfront
Cre ate d re am s
abo utand
se x are not limited to health issues but also
include social and economic determinants
M entoring program s as well as advocacy, education and
political issues. Many of the challenges have been delineated in the Key Informant
Pure Prevention A fter Scho ol A ctivites
Major Findings section, however, Birth controlthey bear reiterating due to their multidimensional
nature.
The challenges include but are not limited to:

Determining how to appropriately address the health disparities in birth
outcomes in a comprehensive and effective manner medical/health care
providers, community- based organizations, and community residents.
Decreasing the percent of African American women including teenagers who
receive late or not prenatal care by increasing access to health care and health
insurance through individual and community education.
Increasing awareness of the factors that contribute to infant mortality, preterm
births, and low birth weight infants in the racially and ethnically diverse
foreign-born and African American women of childbearing age.
Increasing access to health care and health insurance to foreign-born women
of childbearing ages and families who may or may not be documented to
improve birth outcomes.
Providing culturally competent and linguistically appropriate health services
to all women of childbearing age at health facilities located within their
respective county.
Increasing access to English as a Second Language (ESL) classes to foreign-
born women who want to improve their ability to communicate in English with
their health and social service providers.
Collaborating and coordinating with medical, health and social services
providers and non-health providers to assist with addressing non-health
oriented issues such as immigration, education, transportation, housing,
employment, and other issues.
Developing and implementing a comprehensive plan of action to address
educationally the chronic diseases,--hypertension, diabetes, obesity,--and
72 | P a g e
health behaviors in women of childbearing ages that impact on adverse birth
outcomes.
Addressing critical issues in teenage pregnancy and birth outcomes in a
coordinated, systematic, comprehensive manner with medical/health care
providers, community-based youth providers, adolescents, the Department of
Education, city and state health departments, and other appropriate providers.
Increasing communication among medical, health, education, social services
providers to address and resolve health systems issues, language and cultural
issues, and to determine how to best provide preconception health and health
care to an ethnically and racially diverse population.
These health challenges cannot be addressed in a vacuum but must include

participation of other providers and the community from across the spectrum of
resources available to the coalition and its network of agencies. It is important to
recognize from the outset that additional financial and human resources will be
needed to address the multitude of issues in each county.
Recommendations and Next Steps

This Community Needs Assessment provides an opportunity to develop a series of
recommendations based on the community demographic and health data analyzed
as well as the community health resources inventory identified, key informant
interviews conducted, and literature reviewed. The medical and health providers, the
community-based organizations, and adolescents provided valuable information
regarding the needs and gaps in services during key informant interviews. Even
though there are limitations based on the small number of persons interviewed, this
information corroborated most of the information in the Florida Department of Health
Florida Charts data regarding community health, health care access and immigrant
health. In addition, the mapping of community health resources in their respective
county provided an analysis of the maternal and child health assets available to
community residents in our service area and also indicated where needs or gaps
exist.
The following recommendations are gleaned from the data analyzed in this report:
General
Prioritize the needs and gaps identified in order to at-risk maternal and child
health interventions: health education services, parenting skills classes,
community education, patient/health system navigators/medical
translators/translation services, funding for supportive services, etc.
Prioritization process should include clients/consumers and providers.
Identify and coordinate with additional community-based agencies that focus

on women, infants, children, and adolescents that can provide community-
based interventions, such as health education workshops, referral services,
case management, outreach, health fair, etc.
73 | P a g e
Convene a community forum to discuss the community needs assessment
report and next steps.
Identify potential funding resources for community-based interventions and

to implement report recommendations.
Collaboration and Coordination

Increase communication and coordination among health care and social
service providers, community-based organizations, and immigrant services
agencies on women's health care, preconception health, and access to health
care.
Work with community and civic organizations to implement a coordinated

strategy to provide more community education on the reasons for high infant
mortality rates and adverse birth outcomes in the counties.
Develop a culturally diverse adolescent advisory committee to our coalition on

the ongoing adolescent perspective on reproductive health, adolescent health
and teen pregnancy.
Health Care Access and Education

Increase access to health care services by providing more community
outreach and education about health insurance options for pregnant and
parenting women; reviewing health facilities' hours for women's health and
prenatal care services; educating immigrant communities regarding the
availability of public health insurance.
Implement CDC's preconception health and health care recommendations

regarding consumer awareness, preventive visits, developing a reproductive
health life plan.
Focus health education workshops on topics that will impact on adverse

health outcomes, --infant mortality, preterm births, and low birth weight.
Topics should include: alcohol and drug use, chronic diseases that impact on
pregnancy, hypertension, diabetes, obesity; smoking, safe sleep practices and
SIDS, folic acid, etc.
Work with medical/health care providers to provide culturally competent and

linguistically appropriate health care services to foreign and U.S.-born
women of childbearing ages.
Chipola Healthy Start Strategy
Review health and birth outcome indicators on a yearly basis to inform
programmatic decisions on health education topics and specific at-risk
groups to target interventions.
74 | P a g e
Use community needs assessment results to develop a comprehensive staff
training plan in the areas of preconception health, family planning, child
spacing, prenatal and perinatal health, preterm births, low birth weight,
chronic diseases in pregnancy, safe sleep practices and SIDS, teen pregnancy
prevention, etc., to increase knowledge and skills to use for health education
workshops and community forums.
75 | P a g e
References
Kitsantas P. Ethnic differences in infant mortality by cause of death. Journal of
Perinatalogy (2008) 28, 573-579.
Petrova A, Mehta R, Anwar M, Hiatt M, and Hegyi T. Impact of race and ethnicity on the
outcome of preterm, infants below 32 weeks of gestation. Journal of Perinatalogy
(2003) 23:404-408.
Shi L, Stevens GD, Wulu JT, Politzer RM and Xu J. America's health centers: Reducing
racial and ethnic disparities in perinatal care and birth outcomes. Health Services
Research (2004) 39:6, 1881-1902.
Schofield T. Health inequity and its social determinants: A sociological commentary.

Health Sociology Review (2007) 16, 2: 105-114.
Thisted RA. Are there social determinants of health and disease? Perspectives in
Biology and Medicine (2003) 46,3: 565-573.
Mooney G and Fahtung N. Issues in the measurement of social determinants of

health. Health Information Management Journal (2008) 37, 3: 26-32.
Courtwright AM. Justice, stigma, and the new epidemiology of health disparities.
Bioethics (2009) 23, 2: 90-96.
Cuevas KD, Silver DR, Brooten D, Yongblut JM and Bobo CM. The cost of
prematurity: Hospital charges at birth and frequency of rehospitalizations and acute
care visits over the first year of life. American Journal of Nursing (2005), 105(7): 56-64.
Petrou S. Economic consequences of preterm birth and low birth weight. British
Journal of Obstetrics and Gynecology (2003) 110 (Suppl 20): 17-23.
Petrou 5, Sach T, and Davidson L. The long-term cost of preterm birth and low birth
weight: results of a systematic review. Child: Care, Health and Development
(2001) 27 (2): 97-115.
Petrou S. Editorial: Preterm birth—What are the relevant economic issues? Early
Human Development (2006) 82: 75-86.
Lewit EM, Schuurmann Baker L, Corman H, Shiono P. The direct cost of low birth
weight. The Future of Children (1995) 5 (1).
Callaghan WM, MacDorman MF, Rasmussn SA, Qin, C, and Lackritz EM. The
contribution of preterit' birth to infant mortality rates in the United States. Pediatrics
(2006) 118, 4: 1566-1574. Retrieved from Health Reference Center Academic, Gale,
CUNY Hunter College, October 3, 2009
76 | P a g e
Krieger N, Rehkopf DH, Chem JT, Waterman PD, Carcelli E, and Kennedy M. The fall
and rise of US inequities in premature mortality: 1960-2002. P1 o S Medicine
(2008) 5, 2: 227(15). Retrieved from Health Reference Center Academic, Gale, CUNY
Hunter College, October 3, 2009
Rodwin VC and Neuberg LG. Infant mortality and income in 4 world cities: New York,
London, Paris and Tokyo. American Journal of Public Health (2005) 95: 86-90
Centers for Disease Control and Prevention. Recommendations to improve

preconception health and health care – United States: a report of the CDC/ATSDR
Preconception Care Work Group and the Select. Panel on Preconception Care.
MAIVVR 2006; 55 (No. RR-6)
Centers for Disease Control and Prevention. Proceedings of the Preconception

Health and Health Care Clinical, Public Health, and Consumer Workgroup Meetings –
June 27-28, 2006, Atlanta Georgia.
Lu MC and Halfon N. Racial and ethnic disparities in birth outcomes: A life-

course perspective. Maternal and Child Health Journal (2003) 7 (1): 13-30.
Keith, LG (editor). Preconception Health and Health Care. Maternal and Child Health
Journal (2006) 10 Supplement
Jacobs Institute of Women's Health. Policy and Financing Issues for Preconception
and Interconception Health. Women's Health Issues (2008) 18, 65 Supplement.
US Census Bureau. 2000 Census Data. Retrieved 11/10/2010.
Florida Charts Pregnancy and Young Child Profile (2010). Retrieved

11/10/2010 from www.floridacharts.com .
77 | P a g e
Index 200_ - 200_
SERVICE DELIVERY PLAN OF Chipola Healthy Start
1. DESCRIPTION OF PROCESS USED TO UPDATE THE SERVICE DELIVERY PLAN

PG. 5
2. SUMMARY OF ALL FINDINGS FROM THE UPDATED NEEDS ASSESSMENT

PG.22-59
(Send Needs Assessment electronic copy to Contract Manager)
3. MAJOR HEALTH INDICATORS SELECTED FOR THE NEW PLANNING CYCLE

PG.61-63
4. TARGET POPULATION OR AREA FOR RECEIPT OF SPECIAL EMPHASIS

PG.11
5. FACTORS CONTRIBUTING TO THE HEALTH STATUS INDICATORS IN THE

PG.22-59
TARGET POPULATION INCLUDING:
CONSUMER AND PROVIDER INPUT PG.51
6. RESOURCE INVENTORY INCLUDING:

PG.49
SERVICE GAPS
PG.51
7. HEALTH STATUS PROBLEM LINKED TO ACTION PLAN

(Planning Phase Questions PG._____
8. INTERNAL QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN

PG._____
9. PROCESS FOR ALLOCATING FUNDS

PG._____
10. EXTERNAL QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN

PG._____
11. NEW ACTION PLAN (Category A, B, C format)

PG._____
12. QUARTERLY REPORT SECTION
78 | P a g e
(Documents “close out” the previous AAPU with completion of the reporting phase
questions, and all other quarterly deliverables). PG.____
79 | P a g e

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CHIPOLA AREA HEALTHY

Calhoun, Holmes, Jackson, Liberty and Washington

We would also like to recognize to our local hospital, physicians,

Carolyn Monroe West of Healthy Families Northwest Florida

Board of Directors Chipola Healthy Start Staff

Chephus Granberry Chair Janet Spink, Executive Director

Jenny Hill Co-Chair Carmen Smith, Community Liaison

Suzan Gage, Lisa Lamar, Contract Administrator

Advisory Board Lead Care Coordinators

Dr. Eugene Charbonneau, Peggy Howland for Calhoun and Liberty

IV. Findings Page

V. Major Health Issues: Challenges Page

VI. Conclusions and Recommendations

Chipola Healthy Start Mission

A consistent increase in the number of women’s who submit to prenatal screening.

1629 clients were served over the past contract year.

What Are We Up Against?

Description of Process Used To Update the Service Delivery Plan

II. Literature Review

Impacts of Birth Outcomes

Prevention and Social Policy Interventions

Access to Care, Health of Immigrants and Health Disparities

The following tasks were completed:

Review and Compile County Profiles for Each County

Description of Data Collection

Emerging Populations and Issues

County Foreign Born Language Other Than

Chipola Healthy Start Coalition Service area is comprised of Calhoun, Holmes,

Demographics Snapshot of the Chipola Healthy Start Service Area

Establish initiatives to address health disparity issues of the African American

Establish more general Wellness and between pregnancy care initiatives.

Implement more programs addressing teen pregnancy, smoking cessation,

The Chipola River runs through Calhoun County.

Holmes County Profile

Much of Washington County is uninhabited, with most of the population residing in or

A Waterfall in Washington County

Child and Maternal Health Profile

Further investigation reveals an important characteristic of the maternal population. Like

Births by County by Race for Comparison for 2004 and 2008

137 160 2008ChipolaHSC

Births to Unwed Mothers

ChipolaHSC%of Birthsto Unmarried Mothers

Births to Unwed Mothers

percentage for unmarried black 60%

mothers versus unmarried white 50%

the percentage for whites. However, Black W hite

0.0% 5.0% 10.0% 15.0% 20.0%

Behaviors Before and During Pregnancy

Delayed Prenatal Care

Another measure of the adequacy of prenatal care is the Kotelchuck Index. As

Inadequate PC Intermediate PC Adequate Adequate +

Births to Mothers Who Smoked During Pregnancy

Chipola Healthy Start

Percentage ofChipolaHSCBirthMothersAdmittingAlcohol Use

The Chipola Service area rates of birth mother who admitted

One of the effects of alcohol on our mothers and babies may be

Weight (BMI) – Before and During Pregnancy

Some of these risks include: gestational diabetes, pre-eclampsia, epidural

Birth Weight by Mother's BMI

30% Overweight (25.0

Health, Well-Being and Access to Health Care

Percent of People Who Rate Their Overall Health As Fair or