1. www.healthypeoplehealthyplacesjeffco.com
Community Health Improvement plan
Work Groups
October 22, 2013
Ana Marin
Epidemiologist
Jefferson County Public Health
1

2. 2
The objectives of this presentation are:
• To give an overview of the
demographic trends in Jefferson
County
• Present healthy eating, active living
data and their relationship with
obesity and chronic disease
• The data will be broken into three
groups, adults, youth, and children
• Finally, discuss how the SocialEcological Model can help address
the increase in obesity by improving
healthy food access and physical
activity

3. Overview:
 Sociodemographic factors that
 Healthy eating,
active living data
Youth
Children
(2-14)
influence health
(High School)
 The Socio-Ecological Model
Adult
(over 18 years old)

4. 4
Sociodemographic Factors
Population
Population
population:
534,543
th
Highest county population
45th fastest growth rate
(out of 63 counties)
Source: U.S. Census Bureau

5. 5
Sociodemographic Factors
Population
2010
2000
90 years & over
Males
Females
85 to 89 years
80 to 84 years
75 to 79 years
70 to 74 years
65 to 69 years
These population
pyramids show the
changes in
population over the
ten year period in
Jefferson County
from 2000 to 2010 by
age groups and
gender
60 to 64 years
55 to 59 years
Age group
50 to 54 years
45 to 49 years
40 to 44 years
35 to 39 years
30 to 34 years
25 to 29 years
20 to 24 years
15 to 19 years
10 to 14 years
5 to 9 years
Under 5 years
5
4
3
2
1
0
1
2
3
4
5
Percentage in age group from total population
Source: U.S. Census Bureau

6. 6
Sociodemographic Factors
Population
118, 754
Children under 18
68, 000
Adults 65 and older
Age is an important factor for health, therefore, it is important to consider age groups in Jefferson
county when we think about how to increase healthy food access and physical activity in our
community. Having a healthy population is important to the vitality and economic success of our
county.
Source: Colorado State Demography Office,2010

7. 7
Sociodemographic Factors
Population by race/ethnicity
Population Distributionor Latino
by Race andHispanic BlackJefferson County, 2000 and 2010
Ethnicity,
Hispanic
Non
Non Hispanic Asian
Other
Population Distribution by Race and Ethnicity, Jefferson County, 2000 and 2010
Non Hispanic White
2.2%
2.3%
0.9%
10.0%
2.3%
2.6%
0.9%
Other
Asian
Black
Other
Asian
Black
14.3%
These graphs show the race
and ethnic distribution in
Jefferson county comparing
data from 2000 to 2010
84.9%
2000
79.9%
2010
Source: U.S. Census Bureau 2000, 2010

8. 8
Sociodemographic Factors
Population by race/ethnicity
Population Distribution by Race and Ethnicity, Jefferson County, 2000 and 2010
Non Hispanic Asian
Other
Non Hispanic White
Hispanic or Latino
Non Hispanic
Population Distribution by Race and Ethnicity, Jefferson County, 2000 and 2010 Black
2.2%
2.3%
0.9%
10.0%
84.9%
2000
2.3%
2.6%
0.9%
Other
Asian
Black
14.3%
Other
The
Asian
Hispanic/Latino
Black
Population grew
30% in 10
years
79.9%
2010
Source: U.S. Census Bureau

9. 9
Sociodemographic Factors
Educational attainment
Less than 9th grade, 2.0%
9th to 12th grade, no
diploma, 4.7%
Graduate or professional
degree, 14.4%
High school graduate
(includes
equivalency), 22.2%
Bachelor's
degree, 26.40%
Some college, no
degree, 22.7%
Associate's degree,
7.50%
48.3%
of Jefferson County residents
over 25 have completed an
associate’s degree or higher
education
6.7%
of Jefferson County residents
over 25 did not received a
High School diploma, or
equivalent
*Adults 25 and older
Source: U.S. Census Bureau

10. 10
Sociodemographic Factors
Education and Income
The map on the left shows
the areas of the county
where a higher percent of
the population did not
graduate from high
school, the darker the blue
on the map the more
people who live in those
areas that did not
graduate from high school.
The map on the right
shows family poverty
level, the darker the
blue, the more families
living under poverty live in
those areas of the county.
These maps clearly show
that educational
attainment is directly
related to income.
Source: U.S. Census Bureau, 2010 American Community Survey

11. 11
Sociodemographic Factors
Education and Income
Percent of the population living below 125% of
poverty by race/ethnicity , Jefferson
County, 2012
25%
20%
15%
10%
5%
0%
Hispanic (of any race)
Non-Hispanic White
Source: U.S. Census Bureau, 2012 American Community Survey

12. 12
Sociodemographic Factors
Food deserts
Food deserts
low-income areas where a significant number of residents
live “far” from a super market.
What is "far“?
More than .5 mile for urban areas or 10 miles for rural areas
from the nearest supermarket
Source: United States Department of Agriculture, Accessed, October 2013

13. 13
Sociodemographic Factors
Food deserts
DENVER
JEFFCO
The orange squares on the map
represent food deserts by Census Tract.
Keep in mind that some people and
places, especially those with lowincome, may face greater barriers in
accessing healthy and affordable food
retailers, which may negatively affect
diet and food security.
Source: United States Department of Agriculture, Accessed, October 2013

14. 14
Sociodemographic Factors
Income
Median household Income
$63,826
Household income includes the income of the
householder and all other individuals 15 years old
and over in the household, whether they are
related to the householder or not.
Source: U.S. Census Bureau

15. 15
Sociodemographic Factors
Income
How much does it cost to live in Jeffco?
Family of 4:
2 adults
1 preschooler
1 school-age child

16. 16
Sociodemographic Factors
Income
How much does it cost to live in Jeffco?
$62,952*
The $62,952 annual income is for a family
of four with two adults, one
preschooler, and one school-age child.
This annual income was calculated using
the Self-Sufficiency Standard which
defines the income realistically needed to
support a family, without public or private
assistance.
Source: *Colorado Center on Law and Policy, The Self-Sufficiency Standard for Colorado, 2011

17. 17
Sociodemographic Factors
Income
How much does it cost to live in Jeffco?
$62,952*
$7.78 Minimum Wage
Both parents working 40hrs/wk
• No days off
• No holidays
Let’s think about a family in which both
parents work full time, make minimum
wage, and take no days off or holidays.
What would be their combined annual
gross income?
Source: *Colorado Center on Law and Policy, The Self-Sufficiency Standard for Colorado, 2011

18. 18
Sociodemographic Factors
Income
How much does it cost to live in Jeffco?
$62,952*
$7.78 Minimum Wage
Both parents working 40hrs/wk
• No days off
• No holidays
$32,365
Let’s think about a family in which both
parents work full time, make minimum
wage, and take no days off or holidays.
What would be their combined annual
gross income?
The combined annual gross income would
be about half of the Self Sufficiency
Standard
Source: *Colorado Center on Law and Policy, The Self-Sufficiency Standard for Colorado, 2011

19. 19
Sociodemographic Factors
Income
How much does it cost to live in Jeffco?
*
$62,952
$7.78 Minimum Wage
Both parents working 40hrs/wk
• No days off
• No holidays
$32,365
This is roughly HALF of what is needed
It was calculated that in Jefferson County for this
family to meet the Self Sufficiency Standard, the
minimum wage should be $14.90
$14.90 Self-sufficient Wage
Source: *Colorado Center on Law and Policy, The Self-Sufficiency Standard for Colorado, 2011

20. 20
Sociodemographic Factors
Social determinants of health
From the data on the previous slides we learned that the
more education an individuals have, the higher the income
they will make, and in turn the better their health

21. 21
Sociodemographic Factors
Income and health
There is a strong relationship between
income and health outcomes

22. 22
Sociodemographic Factors
Income and health
Obesity and hypertension rates among adults by income,
Jefferson County, 2009-2010
35
32.3
27.0
30
24.7
Percent
25
20
19.1
18.6
20
15
10
5
0
<$25,000
$25,000-49,999
≥$50,000
Obesity
Hypertension
This graph shows the percent of obesity and hypertension by income.
Notice that the lowest income bracket has the highest obesity rate and
the largest percent of adults who have ever been told by a
doctor, nurse, or other health professional that they have high blood
pressure. In turn the highest income bracket has the lowest percent.
Source: Colorado Behavioral Risk Survey, 2009-2010

23. Overview:
23
 Sociodemographic factors that
 Healthy eating,
Children
(2-14)
influence health
active living data
Youth
(High School)
Adult
(over 18 years old)

24. Children (2-14)
In 2010, in Jefferson
County there were 85,339
children between the
ages of 2-14 years old.
24
85,339 children
8.2% of population
Source: Colorado State Demography Office,2010

25. 25
Children (2-14)
Population characteristics
Percent of children under 18 living in families with income
below poverty level, Jefferson County, 2006-2011
16
14
Percent
12
10
8
6
4
2
0
2006
There has been a steady
increase of poverty levels in
Jefferson among families with
children under 18
2007
2008
2009
2010
2011
Data Source: U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE)

26. 26
Children (2-14)
Overweight and obesity by
race/ethnicity
Overweight and obesity among children 2-14 by parentreported race/ethnicity, Colorado, 2004-2008
The obesity rates for Black and
Hispanic children is two times
the rate of their White
counterparts
Source: The Weight of the State: 2009 Report on Overweight and Obesity in Colorado

27. 27
Children (2-14)
Fruit and vegetable, and fast food
consumption
Fruit and vegetable and fast food consumption among children by
age group, Colorado 2006-2008
As children get older, their
consumption of fruits and
vegetables decreases
meanwhile their consumption
of fast food increases
Source: The Weight of the State: 2009 Report on Overweight and Obesity in Colorado

28. Children (2-14)
28
Free and reduced lunch (all
grades)
of schools in Jeffco at least 3 out
of 5 students qualify for free or
reduced lunch.
In other words, in 32 schools out of 145, more than 60% of students
qualified for free or reduce lunch. (Oct 2013)
In 2012, 34% of students in
Jeffco qualified to receive
free or reduced lunch (this
is an average of all schools
in the district). (Oct 2013)
Source: Jeffco Public Schools

29. Children (2-14)
29
Food insecurity
Notice that this is the
number of SNAP cases
not the number of
individuals.
Open SNAP cases
in Jeffco (September 2013)
Keep in mind that
the WIC program is
for children under
the age of 5
Children in Jeffco
received vouchers
(2011)
Source: Hunger Free Colorado, 2013 Kids Count in Colorado Report

30. Children (2-14)
30
Food insecurity
35.4%
of parents reported
often or sometimes
relied on low-cost
food to feed their
children because
they were running
out of money to buy
food. (2012 data)
Source: Colorado Child Health Survey, Colorado Department of Public Health and Environment

31. Overview:
31
 Sociodemographic factors that
 Healthy eating,
Children
(2-14)
influence health
active living data
Youth
(High School)
Adult
(over 18 years old)

32. Youth (High School
32
Students)
In 2010, in Jefferson
County there were
35,727 young adults
between the ages of
14-18.
Notice that the data
presented for youth is
collected in High
School and may mean
that those who
participated might
have been younger
than 14 and/or older
than 18 at the time of
the health survey
35,724
ages 14-18
Source: Colorado State Demography Office,2010

33. 33
Youth (High School
Students)
High school graduation rates
High school graduation rates by
race/ethnicity, Jefferson County, 2010-2011
100
89.0
90
80
79.1
73.1
70
Rate
83.1
64.8
61.8
60
50
40
30
20
10
0
District
Non-Hispanic White Hispanic
Black
Asian
American Indian or
Alaska Native
Although high school graduation rates in Jefferson County are high, the graduation rates vary depending on
the race/ethnicity of the students. White students have the highest graduation rates while American
Indian/Alaska Native students have the lowest. This is important to health because educational attainment is
directly related to income and income is related to health.
Source: Colorado Department of Education

34. Youth (High School Students)
34
Percent
Overweight and Obesity by
race/ethnicity
Students Students in grades 9-129-12 overweight are overweight or obese by
in grades who are who or obese by race/ethnicity, Colorado, 2011
race/ethnicity, Colorado, 2011
18
16
14
12
10
8
6
4
2
0
17%
15%
8%
5%
Obese
Non-Hispanic White
Overweight
Hispanic
Hispanic/Latino high school students’
obesity rates are three times as high as
those for White high school students
Source: Colorado Youth Risk Behavior Surveillance Survey, 2011

35. Youth (High School Students)
35
Physical activity
53.1%
of adolescents in
high school met the
recommendation
of physical activity
Percent of adolescents in high school who
met the recommended physical activity by
race/ethnicity, Colorado 2011
56.1%
44.9%
(2011)
The recommendation for physical
activity is at least 60 minutes per day
on at least 5 of the past 7 days
Non-Hispanic White
Hispanic
Source: Colorado Youth Risk Behavior Surveillance Survey, 2011

36. Overview:
36
 Sociodemographic factors that
 Healthy eating,
Children
(2-14)
influence health
active living data
Youth
(High School)
Adult
(over 18 years old)

37. Adults (18 and older)
In 2010, in Jefferson County
there were 204,884 adults 18
and older. The population of
adults over 65 was 68,000.
37
204, 884
18 and older
Source: Colorado State Demography Office,2010

38. Adults (18 and older)
Income
38
Median household income by
race/ethnicity, Jefferson County, 2012
$80,000
Median $67,512
$70,000
Percent
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$0
Non-Hispanic White
Hispanic
Black
Since income is directly linked to health, this graph shows income by race/ethnicity in
Jefferson County. Notice that while Non-Hispanic Whites make more than the
median, Hispanic and Blacks fall below the median income level.
The median on this slide is different from the earlier slide where median income was
presented because the data on this slide is from 2012 (the median household income
in 2010 was $63,826).
Source: U.S. Census Bureau, 2012

39. ‹#›

40. 40
Adults (18 and older)
Overweight and Obesity
Percent of adults (18+) who are overweight or obese
(BMI Percent of adults (18+) who are overweight or obese (BMI ≥ 25), Jefferson County, 2001-2010
≥ 25), Jefferson County, 2001-2010
Obese
Overweight
60
2016 Target
50
12.9
14.6
40
Percent
14.9
12.0
35.1
37.6
38.1
2002
2003
2004
18.6
18.9
17.7
17.7
35.3
35.3
35.3
36.2
38.0
2005
2006
2007
2008
2009
14.8
20.4
30
20
40.1
34.4
10
0
2001
2010
Year
Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

41. Adults (18 and older)
41
Obesity
40
Percent of adults (18+) who are obese by
race/ethnicity, Colorado, 2011-2012
35
30
Percent
25
20
15
10
5
0
Non-Hispanic White
Hispanic
Black
We can see in this graph that the income an education data are good predictors of obesity rates among NonHispanic Whites, Hispanics, and Blacks. There is strong correlation between income, education, and health
outcomes. Non-Hispanic Whites have the highest educational attainment and the highest incomes, in turn they
have the best health outcome (lowest obesity rates). The opposite is true for Hispanics and Blacks
Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

42. Adults (18 and older)
42
Physical activity
Percent of adults reporting not engaging in any
leisure time physical activity during the past 30
days, Colorado, 2011-2012
30
25
20
15
10
5
0
Non-Hispanic White
Hispanic
Black
Similar to obesity rates graph on the previous slide, this graph shows that
income an education data are good predictors of health outcomes.
Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

43. Adults (18 and older)
43
Not physically active by
income Percent of adults engaging in no physical activity (2008) by annual
household income, Colorado.
The graph on the left shows
that as income
decreases, the percent of
adults engaging in physical
activity increases. Clearly
showing that there is a strong
relationship between income
and health outcomes.
Source: The Weight of the State: 2009 Report on Overweight and Obesity in Colorado

44. Overview:
 Sociodemographic factors that
 Healthy eating,
Children
(2-14)
influence health
active living data
Youth
(High School)
 The Social-Ecological Model
Adult
(over 18 years old)

45. Social-Ecological
Model
45
The Social -Ecological Model
stresses that society is composed of
interconnected elements that
invariably affect one another. The
model is based on the premise that
changes in individual behavior will
come about through a combination
of
societal, community, organizational
, interpersonal, and individual
efforts
Effective prevention initiatives to improve access to healthy foods and
physical activity to reduce obesity, should address multiple levels of the
environment and engage multiple sectors of society in order to affect social
change and achieve health impact.
Source: CDC, http://www.cdc.gov/obesity/downloads/CDC_Healthy_Communities.pdf

46. Social-Ecological
Model
46
Public Policies like the construction
of parks and bike lanes support
physical activity and active
lifestyles
Activities at the community
level help facilitate individual
behavior change, for
example, media and
advocacy groups can help
promote healthy
eating, active living in the
community
COMMUNITY
ORGANIZATIONAL
RELATIONSHIPS
Organizational changes like
having worksite wellness
programs or providing healthy
school lunches support
individuals to live healthier lives
Relationships with our
friends, family, and health care
providers represent sources of
interpersonal messages and
can help support to healthy
eating and an active lifestyle
Each individual may have different
degrees of access to education, income
and these factors may in turn affect the
individual’s believes and behaviors toward
eating healthier foods and being physically
active.