View the Report - Memorial Health System of East Texas

MemorialMedicalCenter–Livingston
CommunityHealthNeedsAssessment
andImplementationPlan
December2012
MemorialMedicalCenter–Livingston
CommunityHealthNeedsAssessmentand
ImplementationPlan
December2012
Conductedby:
TableofContents
Community Health Needs Assessment ……………………………………………………………………………………………….
2 Executive Summary ………………………………………………………………………………………………………………………….... 3 Process and Methodology ……………………………………………………………………………………………………………………
10 Hospital Biography ………………………………………………………………………………………………………………………………
14 Study Area …………………………………………………………………………………………………………………………………………..
17 Demographic Findings ………………………………………………………………………………………………………………………… 19 Health Data Findings ……….……………………………………………………………….………………………………………………….
32 Input from People Who Represent the Broad Interests of the Community .….……………………………………..
78 Prioritization …………………………………………………………………………………………................................................
93 Priorities that Will Not be Addressed …………………………………………………………………………………………………..
96 Resources in the Community………………………………………………………………………………………………………………..
98 Information Gaps………………………………………………………………………………………………………………………………… 158 About Community Hospital Consulting ………………………………………………………………………………………………..
160 Appendix ……………………………………………………………………………………………………………………………………………..
162 Reported Sources ………………………………………………………………………………………………………………………………..
192 Implementation Plan …………………………………………………………………………………………………………………………. Comments and Paper Copies …………………………………………………………………………………………………………….. ____________ 196 206 Section1
CommunityHealthNeedsAssessment
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
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ExecutiveSummary
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
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ExecutiveSummary
Memorial Medical Center – Livingston (Memorial – Livingston) engaged the resources of Community Hospital Consulting (CHC Consulting) to conduct a comprehensive, six‐step Community Health Needs Assessment (CHNA) of the community it serves. This CHNA utilizes relevant health data and stakeholder input to identify the main community health needs in Polk County, which is located in east Texas. The CHNA also includes data regarding two additional counties, Angelina and San Augustine Counties. The three additional hospitals within Memorial Health System of East Texas (MHSET) are located in Angelina and San Augustine Counties and those data elements are provided for comparison purposes. The CHNA Team, consisting of leadership from MHSET and a representative from the Angelina County Health District, met with consulting staff from CHC Consulting on November 6, 2012 to review the research findings and prioritize the community health needs. Eight community health needs were identified by assessing the prevalence of the issues identified in the health data findings, combined with the frequency and severity of mentions in the interview and survey findings. After a facilitated discussion the CHNA Team utilized a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the system’s capacity to address the need. Once this prioritization process was complete the CHNA Team discussed the results and decided to address the top seven of the eight ranked community health needs. The CHNA Team felt that lowest ranking priority, “increasing access to affordable dental care,” was not a core business function of the health system and that resources and efforts would be better spent addressing the top seven prioritized needs. The final list of prioritized needs is elaborated below: PRIORITY #1: There is a need for prevention, education and early detection for heart disease, cerebrovascular disease, diabetes and cancer. 
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Health data findings suggest that there is a high prevalence of both chronic and preventable diseases in Angelina, Polk and San Augustine Counties and Region 4/5N. For example, heart disease is the leading cause of death in each county and in Texas, with Angelina, Polk and San Augustine Counties heart disease mortality rates being much higher than Texas' rates in 2009. Rates of cardiovascular disease (a self‐reported measure) have been consistently higher in Region 4/5N than in Texas and the United States since 2005. Angelina County's cerebrovascular disease mortality rate is more than three times higher than Polk County and Texas' rates. Cancer is the second leading cause of death in Angelina, Polk and San Augustine Counties and Texas. In both 2008 and 2009 (the two most current years of available data), cancer mortality rates in Angelina, Polk and San Augustine Counties exceeded Texas’ rates. Prostate cancer incidence rates have also been identified as a concern for Angelina, Polk and San Augustine Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Counties, with 2005‐2009 rates substantially higher than the Texas’ rates. A higher percentage of men in Region 4/5N (47.2%) than in Texas (40.2%) and the United States (36.6%) report not receiving a Digital Rectal Exam (DRE) within the last five years. Colon and rectum cancer incidence rates were also higher in Angelina, Polk and San Augustine Counties than in Texas and female breast cancer and lung and bronchus cancer incidences rates were higher in Angelina and Polk Counties than in Texas. Diabetes is a prevalent condition in Region 4/5N, Texas and the United States. Excluding 2005, diabetes prevalence rates have been higher in Region 4/5N than in Texas and the United States since 2002. Many interviewees mentioned that education about resources in the community and the appropriate use of those resources was critical to improving the health status of the community. It was also consistently noted that the education efforts should focus on prevention, education and early intervention ‐ not simply disease management. One interviewee commented, "Patient education and compliance…due to socioeconomic status…this is the top barrier. We’re a rural area, and 'poor people have poor ways.' Cycles of bad habits repeat and people don’t learn to change their ways." PRIORITY #2: The community needs increased access to affordable
primary care. 
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The demographics of Angelina, Polk and San Augustine Counties, particularly the rural environment in Polk County and the low socio‐economic‐status of many residents in San Augustine County, undoubtedly contribute to the access barriers regarding the affordability of primary care. Unemployment rates in San Augustine County have nearly doubled since 2008, increasing from 6.3% in 2008 to 12.4% in 2011. Polk County has also seen a sharp increase in unemployment rates, increasing from 6.3% in 2008 to 9.7% in 2011. The most current uninsured rates demonstrate that more than 25% of residents in Angelina, Polk, and San Augustine Counties and Texas are uninsured. Nearly 30% (29.3%) of residents in Polk County are uninsured, compared to 27.5% in San Augustine County, 25.9% in Angelina County and 26.3% in Texas. Medical cost barriers also prevent residents from seeking treatment at the appropriate time. A higher percentage of residents in Region 4/5N (21.0%) than in Texas (18.8%) and the United States (14.6%) report that they have been unable to see a doctor because of cost. Survey results indicated that more than 50% of respondents felt that unemployed persons in the community were not having their needs adequately met. The need for access to affordable primary care was mentioned over and over again during the in depth interviews. Interviewees specifically noted that although there might be physicians working in the community, the access issue has more to do with the residents’ abilities to pay Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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for medical care. The state funded and county health clinics were mentioned as valuable resources, but those clinics aren’t able to help all of the community members needing reduced cost services. PRIORITY #3: The community needs additional healthcare providers. 
Primary care physicians, specialists, mental health providers, and physicians accepting Medicare and Medicaid HMO products 
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Angelina, Polk and San Augustine Counties are all designated as Health Professional Shortage Areas (HPSAs) with regard to mental health (current as of October 22, 2012). The Diboll prison and the low income populations in Angelina County, the Alabama‐Coushatta Tribe of Texas in Polk County, all of Polk County and all of San Augustine County are designated as primary care HPSAs (current as of October 22, 2012). Interviewees repeatedly discussed the need for additional healthcare providers, particularly in Polk and San Augustine Counties. Another key mention in the interviews was the acceptance of Medicare, Medicaid and governmental HMO products among physicians in the community. Even though residents may have these particular insurance plans, many primary care physicians are turning them away or not accepting new patients. PRIORITY #4: There is a need to address unhealthy lifestyles such as smoking and obesity. 
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There is a high prevalence of both smoking and obesity in Region 4/5N, Texas and the United States. There are much higher rates of physical inactivity and smoking in Region 4/5N than in Texas or the United States, but obesity appears to be a critical health problem nationwide. In 2011, Texas’ obesity rate exceeded 30% (30.4%), ranking the state 10th in the country with regard to obesity (1 being the most obese, 51 being the least obese). Projected medical costs surrounding the treatment of obesity related conditions in the United States are expected to total $66 billion per year by 2030. Physical activity is directly related to weight status and residents in Region 4/5N have reported higher rates of physical inactivity than residents in Texas and the United States since 2002. In 2010 the Region’s rate was 37%, compared to 26.7% in Texas and 24.4% in the United States. Furthermore, there are education and income disparities among residents who reported physical inactivity in Region 4/5N. Residents with no high school diploma and residents with incomes of less than $25,000 a year are more likely to report not engaging in any leisure time Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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physical activity and the percentage of residents with no high school diploma who don’t engage in leisure time physical activity increased 20 percentage points between 2008 and 2010. Education disparities exist among smoking prevalence rates in Region 4/5N as well. Residents with higher education levels (college+) were less likely than those with lower educational attainment levels to smoke, but the percentage of residents with college degrees who smoke has increased since 2008. Furthermore, while the overall prevalence of smoking decreased between 2002 and 2010, the prevalence of smoking among residents ages 18‐29 years old in Region 4/5N increased each consecutive year between 2008 and 2010 (the most current reporting years). More than 50% of survey respondents indicated that services for nutrition and weight management programs, as well as tobacco cessation programs are either inadequate or very inadequate in the community. While interviewees gave due credit to various programs that are addressing unhealthy behaviors, many also identified pressing lifestyle issues that need additional attention or promotion of available services. These topics included diabetes, obesity, smoking cessation, heart disease, parenting, fitness and substance abuse. PRIORITY #5: There is a lack of a mental health and behavioral health continuum of care. 
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Data suggests that an increasing percentage of residents in Region 4/5N report experiencing poor mental health days. Among them, females and residents making less than $25,000 a year were more likely than males and residents making more than $25,000 a year to report poor mental health days. Angelina, Polk and San Augustine counties are all designated as Health Professional Shortage Areas (HPSAs) with regard to mental health. More than 50% of survey respondents indicate that mental health screenings are either inadequate or very inadequate in the community. More than half of respondents also indicated that the needs of persons experiencing mental illness and persons with chemical dependency were not being adequately met. The interviews suggested a crucial need to address the gaps among the continuum of care for patients with mental or behavioral health issues. Substance abusers especially suffer. Interviewees noted that substance abusers aren’t able to clearly transition through the continuum of care because resources are not available to them. Interviewees also indicated that there are gaps for patients with “less severe” mental illnesses, such as depression and anxiety. Specific issues that were noted for each county included an extremely limited scope of mental health services in San Augustine County, as well as limited services for substance abusers. One interviewee also noted that there is only one licensed school psychologist serving Lufkin ISD. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Another person mentioned that the area has “the Angelina Drug and Alcohol Council – but they don’t have funding and they are overwhelmed – a real gap for substance abuse exists.” PRIORITY #6: There is a need to decrease health disparities by targeting specific populations. 
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The high prevalence of diabetes among Native Americans in Polk County Low income, un/underinsured and elderly A safe place for treatment for undocumented persons A culturally sensitive, language appropriate healthcare environment for minority populations Data suggests that there are various health disparities among specific populations in Region 4/5N. As previously mentioned, there are mental health disparities with regard to gender and income and physical inactivity disparities by education and income. There are also disparities among residents who cannot see a doctor because of medical cost. Women more than men, Black and Hispanic populations more than the White population, persons making less than $50,000 compared to those making more than $50,000 and those with no high school diploma compared to those with college degrees were more likely to report that they were unable to see a doctor because of medical cost. Interviewees noted over and over again that there was a specific need to reach targeted populations. Some mentioned the Native American population in Polk County, others mentioned the elderly. Nearly everyone spoke about the needs of under or uninsured residents in the community and many mentioned the needs of undocumented persons and other minority populations. Notable comments from interviewees include: o “…kids go without [healthcare] or travel to Houston. Our school clinics are overwhelmed.” o “The tribe members are highly at risk for Diabetes; prevalence is very high.” o “Our elderly are so indigent they get prescriptions and sell them to get food.” o “I am concerned about our Hispanic community – I do not know how they’re served. They are a silent population – we are just now making inroads to get information about them.” PRIORITY #7: There is a need to increase access to transportation for healthcare services for those without access (such as elderly and low income residents). 
Interviewees described transportation as a prominent need in the community. The rural and low income demographics of the community, specifically for Polk and San Augustine Counties, contribute to the transportation barrier. Many residents are unable to afford transportation, Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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vehicles or the cost of gasoline and cannot get the appropriate care at the appropriate time. One interviewee said, “The underlying main issue is transportation. Our county is spread out – the people who are indigent very seldom have access to reliable transportation.” The review and analysis of the above findings and health priorities culminates in the creation of specific Implementation Plans for each hospital. These plans, which take into account the hospital’s services, resources and capability of meeting the identified needs. The Implementation Plans will identify objectives and implementation tactics that correspond with each priority. *Please see the “Additional Services Available in the Community” section of this report if you’re interested in accessing resources that address the needs of Angelina, Polk and San Augustine Counties.
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ProcessandMethodology
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ProcessandMethodology
Background and Objectives This CHNA is designed in accordance with the CHNA requirements identified in the Federal Patient Protection and Affordable Care Act and further addressed in the Internal Revenue Service Notice 2011‐
52. The objectives of the CHNA are:  Meet Federal Government and regulatory requirements  Research and report on the demographics and health status of the study area  Gather input, data and opinions from persons who represent the broad interest of the community; specifically persons with special knowledge or expertise of public health, local and state health departments, and representatives of medically underserved, low‐income or minority populations and populations with chronic diseases  Analyze the quantitative and qualitative data gathered and communicate results via a final comprehensive report on the needs of the communities served by Memorial ‐ Livingston  Prioritize the needs of the communities served by each of the hospitals  Create a separate Implementation Plan for each hospital that addresses the prioritized needs Scope of CHNA Report: The CHNA components include:  Hospital biography  Study area definition, including a review of patient origin  Analysis the study area, including both a demographic and a health data analysis  Findings from twenty‐one comprehensive interviews conducted with people who represent a broad interest in the communities, including: o Local/regional governmental health agencies o Public health organizations o Not‐for‐Profit organizations o Health related entities  Findings from a survey distributed to organization leaders and community representatives (sent as a follow up to interviewees and forwarded on to others with similar backgrounds) who possess a broad knowledge base and vested interest in the health needs of the communities they serve (16 completed surveys)  The prioritized strategies and Implementation Plan formulated by hospital leadership to address the community needs identified by the research Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Methodology: MHSET contracted with an outside entity, CHC Consulting, to assist in the development of the CHNA for Memorial ‐ Livingston. MHSET provided essential data and resources necessary to initiate and complete the process, including the definition of the hospital’s unique study area, the identification of key community stakeholders to be surveyed and/or interviewed, services available in the community and hospital biographical information. CHC Consulting conducted the following research:  A demographic analysis of the study area  A study of the most recent health data available  Conducted one‐on‐one interviews with individuals who have special knowledge of the communities, and analyzed results  Created, distributed, and analyzed the community health needs survey  Facilitated the prioritization process during the CHNA Team Meeting on November 6, 2012 The methodology for each component of this study is summarized below. In certain cases methodology is elaborated in the body of the report.  Hospital Biography o Background information, including available services, about the hospital was provided by the respective hospitals or taken from their websites.  Study Area Definition o The study area is based on CY 2011 hospital inpatient discharge data and discussions with hospital staff.  Demographics of the Study Area o Population demographics, including population change by race, ethnicity, and age, a median age and median income analysis, and an economic and education analysis. o Demographic data sources include, but are not limited to, the United States Census Bureau and Truven Health’s Market Expert.  Health Data Collection Process o The health data includes, but is not limited to, statistics regarding natality, mortality, communicable disease, mental health, health behaviors, and access. A variety of sources, which are all listed in the references section of this report, were utilized in the health data collection process. Health data sources include, but are not limited to, the Texas Department of State Health Services, the County Health Rankings and the United States Census Bureau.  Interview Methodology o MHSET provided CHC Consulting with a list of people with special knowledge of Angelina, Polk and San Augustine Counties including public health representatives, not‐
for‐profit organization professionals, charities and other individuals who focus specifically on underrepresented groups. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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From that list, 21 in depth interviews were conducted using a structured interview guide. In order to further quantify the data, a follow up survey was sent to the list of 21 with the option to forward the survey on to others. o Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.) served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Survey Construction, Distribution, and Collection o An electronic survey was constructed using Survey Monkey™ software in order to gather opinions and input of those with special knowledge regarding the health needs and priorities of the study area. o The survey was restricted so that respondents could only complete the survey once per computer to protect the integrity of the data. o The survey was initially distributed to the 21 interviewees. Recipients were allowed to forward the survey to other stakeholders in the community. The survey remained open for approximately one month. o Responses were quantified and analyzed for reporting purposes, including any free‐form comments. Prioritization Strategy o Eight main health needs were determined by assessing the prevalence of the issues identified in the health data findings, combined with the frequency and severity of mentions in the interview and survey. o A structured matrix was used to prioritize the eight identified needs of the community during the CHNA Team Meeting on November 6, 2012. After a facilitated discussion, that health system chose to address the top seven of the eight ranked health needs. o See the prioritization section for a more detailed description of the prioritization methodology and final results. o
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HospitalBiography
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MemorialMedicalCenter–Livingston
Since Memorial Medical Center ‐ Livingston opened its new facility in July 2000 the hospital has provided emergent and acute care to thousands of area residents. The hospital specializes in critical access care with its 24/7 emergency room and diagnostic services, which includes MRI, Nuclear Medicine, CT, and X‐Ray scanning. Additionally, the hospital has a fully integrated women's center that offers obstetrics and gynecology care, plus digital mammography. The hospital also is equipped with a new Sleep Disorders Center, which is under the medical leadership of Dr. Robert Fayle, a board certified neurologist. Currently, the hospital is home to more than 50 physicians who specialize in primary care, internal medicine, pediatrics, cardiology, infectious diseases, rheumatology and nephrology. In 2007, the hospital opened two floors in its new bed tower. These floors are home to medical surgical rooms and a new intensive care unit. The 160,000‐square‐foot tower was designed by local physicians and nurses to be an active part of a patient's healing process. From the lighting to the carpeting, wood flooring, paint and new bedding, nurses and physicians designed a facility to maximize the healing process. In 2012, the hospital expanded its Imaging Center with the addition of a state‐of‐the‐art nuclear medicine system ‐ the first of its kind in the state ‐ which allows for early detection and staging of cancer, heart disease and other hard‐to‐diagnose disorders. A 128 ‐ slice CT scan was also added to the Imaging Department, which provides results in just four minutes. With the capacity to open 200 additional patient rooms, a highly skilled medical staff, and a talented and knowledgeable group of nurses and technicians, Memorial Medical Center ‐ Livingston is a premiere hospital located in one of the fastest growing retirement communities in Texas. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Mission,Vision&Values
Mission
Providing quality healthcare to the communities we serve. Vision
The finest people providing the finest service to every customer, every time. Values
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Team work: Every staff member of Memorial working together to achieve excellent customer service. 
Professionalism: Demonstrating to the customer through our methods, character and actions that we are professionals. 
Competence: Staff members having the skills and ability to perform the duties required of their profession, which is critical to a positive customer experience. 
Quality: Every staff member meeting or exceeding the standard of care for the customer. 
Respect: Every staff member recognizes the rights and uniqueness of each customer and acknowledges the contributions of others toward excellent customer service. 
Accountability: Every staff member is responsible for his or her actions, each realizing that providing excellent service for the customer is not an option, it’s an expectation. 
Integrity: Each staff member dedicated to exhibiting the stated values of Memorial. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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StudyArea
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TheStudyArea
Memorial – Livingston’s study area is identified as Polk County. Slightly more than 77% of the hospital’s inpatient discharges came from Polk County in CY 2011. Memorial ‐ Livingston Patient Origin Map and Distribution Memorial ‐ Livingston Patient Origin by County: Polk County makes up to 77.5% of inpatient discharges CY 2011 Discharges County Polk All Others Total State TX CY 2011 Discharges 1,887 547 2,434 % of Volume % of Total 77.5% 22.5% 100% Cumulative % of Total 77.5% 100.0% Source: Hospital Inpatient Discharge Data by DRG CY 2011; Normal Newborns MS‐DRG 795 excluded Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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DemographicsFindings
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DemographicFindings PopulationChange
Total Population As of 2012, Texas has almost 25.9 million residents.1 According to two articles released from the United States Census Bureau Newsroom, “Texas gained more people than any other state between April 1, 2010 and July 1, 2011 (529,000)” 2 and “Texas [also] had eight of the 15 most rapidly growing large cities between Census Day (April 1, 2010) and July 1, 2011.”3 Both Angelina County and Polk County are expected to grow 3.9% and 5.0% respectively by 2017. However, San Augustine County’s overall population is expected to remain relatively constant with neither a growth nor decline by 2017.4 Currently, the number of residents in Angelina County total about 88,000 compared to San Augustine County, which is much smaller, with slightly less than 8,200 residents. Polk County is a little more than half the size of Angelina County with slightly more than 46,000 residents, and has nearly six times as many people as San Augustine County.5 Overall Population Growth Geographic Location CY 2000 Angelina County 80,148
Polk County 41,071
San Augustine County 8,287
Texas 20,851,400
CY 2012 CY 2017 88,030
46,169
8,178
25,897,170
91,493
48,466
8,179
27,967,065
2012‐
2017 Change 3,463
2,297
1
2,069,895 2012‐
2017 % Change 3.9% 5.0% 0.0% 8.0% Source: Truven Health’s Market Expert 2012
Racial / Ethnic Composition and Growth 6 The majority of residents in Angelina, Polk, and San Augustine Counties racially identify as White (Non‐
Hispanic). In the state of Texas, there is not an identified racial or ethnic majority. As of 2012, the two Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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largest racial or ethnic populations in Texas are White Non‐Hispanic (44.1%) and Hispanic (38.6%). Due to the rapid growth of the Hispanic population, it is projected that Hispanics will represent the largest ethnicity in the state of Texas (about 11.5 million people) by 2017. San Augustine County is comprised of relatively few Hispanic residents (only 6.5% or 531 residents) compared to the state, but has a much higher percentage of Black (22.7%) residents than Angelina County, Polk County and Texas. Only about 15% of residents in Angelina County, 11.0% in Polk County and 11.5% in Texas identify as Black. Population by Race/Ethnicity 2012 Source: Truven Health’s Market Expert 2012 Polk County Angelina County Texas San Augustine County Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Various racial and ethnic groups in Texas are expected to experience a dramatic increase by 2017 including the Hispanic, Asian and Other populations. As previously mentioned, the Hispanic population is projected to increase 15.1% by 2017, exceeding the number of White (Non‐Hispanic) residents. The Asian population is expected to experience the greatest percentage increase (22.6% or 236,135 people), followed by the “Other” population, which is projected to increase by 15.3% (about 57,000 people). In both Angelina and Polk Counties the racial or ethnic group that is expected to have the largest population increase is the Hispanic population (about 16% and 18% growth respectively). Furthermore, the Hispanic population is the only group expected to have a consistent increase across Angelina, Polk, and San Augustine Counties and Texas. The White (Non‐Hispanic) population, which currently represents the majority of each county, is expected to decline in both Angelina County (‐0.7% or ‐382 people) and Texas (0.1% or ‐9,685 people). The only other racial or ethnic population that is expected to decline by 2017 is the Black population, decreasing about 2% (‐109 people) in Polk County and about 10% (‐190 people) in San Augustine County. *Please note that the actual number of residents in a given racial or ethnic group may be very low, which could result in misleading growth percentages. This is of particular concern for the Asian, American Indian and Other categories in San Augustine County. For a complete population distribution by race/ethnicity see the table on the next page. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Population by Race/Ethnicity
2000, 2012, 2017
Angelina County Race/Ethnicity White Non‐Hispanic Black Hispanic Asian American Indian Other Total 2000 2012 2017 55,629 11,660 11,499 539 171 650 80,148 54,788 13,063 18,181 794 271 933 88,030 54,406 13,679 21,132 906 314 1,056 91,493 2012 ‐ 2017 Change % ‐382 ‐0.7% 616 4.7% 2,951 16.2% 112 14.1% 43 15.9% 123 13.2% 3,463 3.9% Polk County Race/Ethnicity White Non‐Hispanic Black Hispanic Asian American Indian Other Total 2000 2012 2017 30,691 5,335 3,854 159 650 382 41,071 33,206 5,098 6,346 193 800 526 46,169 34,332 4,989 7,476 204 872 593 48,466 2012 ‐ 2017 Change % 1,126 3.4% ‐109 ‐2.1% 1,130 17.8% 11 5.7% 72 9.0% 67 12.7% 2,297 5.0% San Augustine County Race/Ethnicity White Non‐Hispanic Black Hispanic Asian American Indian Other Total 2000 2012 2017 5,551 2,361 302 19 10 44 8,287 5,651 1,859 531 22 13 102 8,178 5,721 1,669 624 23 16 126 8,179 2012 ‐ 2017 Change % 70 1.2% ‐190 ‐10.2% 93 17.5% 1 4.5% 3 23.1% 24 23.5% 1 0.0% Texas Race/Ethnicity White Non‐Hispanic Black Hispanic Asian American Indian Other Total 2000 2012 2017 10,933,008 2,364,229 6,669,565 565,218 68,873 250,507 20,851,400 11,425,721 2,983,485 9,985,964 1,046,150 82,623 373,227 25,897,170 11,416,036 3,258,054 11,492,117 1,282,285 88,284 430,289 27,967,065 2012 ‐ 2017 Change % ‐9,685 ‐0.1% 274,569 9.2% 1,506,153 15.1% 236,135 22.6% 5,661 6.9% 57,062 15.3% 2,069,895 8.0% Source: Truven Health’s Market Expert 2012 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Age Composition and Growth 7 Overall, the median age in Angelina, Polk and San Augustine Counties and the Texas has increased since 2000. Angelina County has the lowest median age (36.8), an age slightly younger than the state (37.0). Polk County’s median age (43.4) is almost 6.5 years older than the State’s and San Augustine County’s median age is more than 10 years higher than the State’s rate, with San Augustine having the highest median age (47.2). It is projected that Angelina County’s and Polk County’s median ages will slightly decrease by 2017, whereas San Augustine County’s and Texas’ median ages will slightly increase. Geographic Location Angelina County Polk County San Augustine County Texas Median Age 2000 35.5 39.7 44.1 35.7 2012 36.8 43.4 47.2 37.0 2017 36.4 42.5 47.5 37.3 Source: Truven Health’s Market Expert 2012 The Youth, Adolescent and Young Adult Population For the purposes of this demographic analysis the youth, adolescent, and young adult population are categorized by three age groups: the 0‐14, 15‐
17 and 18‐24 years of age populations. More than 35% of both Angelina County and Texas are youth, adolescents, and young adults ranging from ages 0 to 24 (35.7% and 38.0% respectively). Comparatively, about 28% of Polk County and 30.0% of San Augustine County are youth, adolescents, and young adults. Various segments of this population are expected to both grow and decline by 2017. Both Angelina and San Augustine Counties are expected to see a decline among their 15 to 17 years of age population (2.0% and 7.4% respectively), whereas Polk County and Texas will see a slight increase (1.7% and 2.5% respectively). The State’s youngest residents (age 14 years and younger) show a moderate projected increase of about 8%, third only to the 55 to 64 years and 65 years & older populations. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Finally, Polk County shows the most substantial projected increase compared to Angelina and San Augustine Counties in any age cohort among the youth, adolescent and young adult population. By 2017 the population of residents in Polk County between the ages of 18 and 24 is expected to increase by 16.4%. This increase marks not only the largest increase among youth, adolescents and young adults in the Angelina, Polk and San Augustine Counties, but also the most substantial increase among all Polk County age groups. The Adult Population For the purposes of this demographic analysis the adult population is categorized by three age cohorts: the 25 to 34, 35 to 54 and 55 to 64 years of age populations. Texas has a higher composition of young adults ages 25 to 34 and middle aged adults ages 35 to 54 (14.4% and 27.4% respectively) than Angelina, Polk and San Augustine Counties. Angelina County marks a close second with only about 1% less than Texas in both age groups. Conversely, Polk and San Augustine Counties have larger percentages of older adults (ages 55 to 64) than Angelina County and the State. However, the population of Texas residents ages 55 to 64 is expected to increase 20.2% by 2017. That population is also projected to increase in Angelina and Polk Counties (9.0% and 3.9% respectively), but slightly decline in San Augustine County (0.8%). The Aging Population In addition to the substantial representation of older adults (ages 55 to 64) in Polk and San Augustine Counties, there is also a large aging population (ages 65 and older) in both communities. This population represents one of the largest age cohorts in both counties, second only to residents ages 35 to 54. It is projected that by 2017 the aging population will increase to more than 21% of residents in Polk County and nearly 25% of residents in San Augustine County, making the aging population the largest age cohort in both counties. While the percentage of residents among the aging population isn’t nearly as high in Texas or Angelina County as it is in Polk and San Augustine Counties, they are both expected to increase by 2017. It is projected that the aging population in Angelina County and the State will grow by almost 11% and almost 30% respectively, marking the largest increase among any age cohort in the corresponding areas. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Population by Age (2000, 2012, 2017)
Angelina County Age Cohort 0‐14 15‐17 18‐24 25‐34 35‐54 55‐64 65+ Total 2012 % of Total 2017 % of Total 19,920 3,726 7,827 11,753 22,980 9,444 12,380 88,030 22.6%
4.2%
8.9%
13.4%
26.1%
10.7%
14.1%
100.0%
21,294
3,653
8,492
11,684
22,362
10,292
13,716
91,493
23.3%
4.0%
9.3%
12.8%
24.4%
11.2%
15.0%
100.0%
2012 ‐ 2017
Change %
1374 6.9%
‐73 ‐2.0%
665 8.5%
‐69 ‐0.6%
‐618 ‐2.7%
848 9.0%
1336 10.8%
3463 3.9%
Polk County Age Cohort 0‐14 15‐17 18‐24 25‐34 35‐54 55‐64 65+ Total 2012 % of Total 2017 % of Total 7,669 1,553 3,719 5,653 11,001 7,393 9,181 46,169 16.6%
3.4%
8.1%
12.2%
23.8%
16.0%
19.9%
100.0%
8,181
1,580
4,330
5,991
10,211
7,682
10,491
48,466
16.9%
3.3%
8.9%
12.4%
21.1%
15.9%
21.6%
100.0%
2012 ‐ 2017
Change %
512 6.7%
27 1.7%
611 16.4%
338 6.0%
‐790 ‐7.2%
289 3.9%
1310 14.3%
2297 5.0%
San Augustine County Age Cohort 0‐14 15‐17 18‐24 25‐34 35‐54 55‐64 65+ Total 2012 % of Total 2017 % of Total 1,496 337 619 725 2,006 1,109 1,886 8,178 18.3%
4.1%
7.6%
8.9%
24.5%
13.6%
23.1%
100.0%
1,516
312
665
851
1,722
1,100
2,013
8,179
18.5%
3.8%
8.1%
10.4%
21.1%
13.4%
24.6%
100.0%
2012 ‐ 2017
Change %
20 1.3%
‐25 ‐7.4%
46 7.4%
126 17.4%
‐284 ‐14.2%
‐9 ‐0.8%
127 6.7%
1 0.0%
Texas Age Cohort 0‐14 15‐17 18‐24 25‐34 35‐54 55‐64 65+ Total 2012 % of Total 2017 % of Total 6,092,907 1,154,988 2,591,794 3,735,239 7,090,846 2,575,296 2,656,100 25,897,170 23.5%
4.5%
10.0%
14.4%
27.4%
9.9%
10.3%
100.0%
6,600,021
1,183,846
2,782,639
3,792,240
7,302,778
3,095,444
3,210,097
27,967,065
23.6%
4.2%
9.9%
13.6%
26.1%
11.1%
11.5%
100.0%
2012 ‐ 2017
Change %
507,114 8.3%
28,858 2.5%
190,845 7.4%
57,001 1.5%
211,932 3.0%
520,148 20.2%
553,997 20.9%
2,069,895 8.0%
Source: Truven Health’s Market Expert 2012 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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EconomicandEducationComparison
Median Household Income 8 Overall, all three counties have a lower median household income than Texas, suggesting potential economic disparities. San Augustine County has the lowest median household income (slightly less than $32,000), followed by Polk County ($32,703). Finally, Angelina County has the highest median household income ($37,554), which is almost $6,400 more than San Augustine and about $7,300 less than Texas. These trends are projected to continue into the year 2017. Economic Status, Poverty, Educational Attainment 9 Following that San Augustine County has the lowest median household income it also has the highest percentage of families below poverty. More than one fourth of families in San Augustine County are living below the poverty line. The remaining counties, Angelina and Polk Counties, also have a higher percentage of residents living in poverty (14.8% and 16.4% respectively) than Texas (13.2%). Furthermore, only 8.6% of residents in Angelina County, 8.0% of residents in Polk County, and 7.4% of residents in San Augustine County earn more than $100,000 annually compared to more than 17% in Texas. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Finally, less than 15% of residents in Angelina, Polk and San Augustine Counties have received a Bachelor’s or advanced degree. This compares to more than 25% of Texas residents who have attained the equivalent. Economic Analysis 2012 Families Household Education Average Median Geographic Location Below Income Bachelor / Income Income Poverty $100K+ Advanced Angelina County $47,248
$37,554
14.8%
8.6% 14.7%
Polk County $41,970
$32,162
16.4%
8.0% 10.6%
San Augustine County $43,010
$31,145
25.6%
7.4% 12.8%
Texas $58,162
$44,889
13.2%
17.4% 25.5%
High School Dropout Rates 10 Source: Truven Health’s Market Expert 2012
Due to low volume, dropout rates could not be calculated for Polk or San Augustine Counties. However, rates for Angelina County and Texas are provided in the table below. In 2010, 7.3% of Texas students between ninth grade and graduation dropped out of high school, compared to 7.8% in Angelina County. Both Texas’ and Angelina County’s rates were down from the previous year. 2009 2010 County Number Percent Number Percent Angelina County 100 8.4% 89 7.8% Polk County NA* ‐ NA* ‐ San Augustine County NA* ‐ NA* ‐ Texas 28,856 9.4% 22,988 7.3% Source: datacenter.kidscount.org (utilizing data from the Texas Education Agency) Definitions: The number and percent of students who dropped out between ninth grade and graduation. Year indicates the graduating year of the cohort. *A code of NA indicates that the number is masked, either because it is a low number of events or because a different category that is a low number event could be imputed based on the number. English as a Second Language 11 An increasing percentage of students in Angelina County, Polk County and Texas are enrolled in Bilingual/ESL programs at school. In the 2010‐2011 school year 13% of students in Angelina County were enrolled in Bilingual/ESL programs compared to more than 16% in Texas, and only 5.4% in Polk County and 5.0% in San Augustine County. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Students in Bilingual/ESL Programs (Percent) County Angelina County Polk County San Augustine County Texas 2006‐2007 11.9% 5.5% 4.1% 14.8% 2007‐2008 12.4% 5.1% 4.1% 15.5% 2008‐2009 12.6% 5.6% 4.3% 16.0% 2009‐2010 13.0% 5.3% 5.0% 16.1% 2010‐2011 13.0% 5.4% 5.0% 16.2% Source: datacenter.kidscount.org (utilizing data from the Texas Education Agency) Definitions: Number and percent of students in all grades receiving bilingual or English as Second Language (ESL) instruction in the Texas public school system. *A code of NA indicates that the number is masked, either because it is a low number of events or because a different category that is a low number event could be imputed based on the number. Free and Reduced Price Lunch 12 More students in the Angelina, Polk and San Augustine Counties than in Texas have been receiving free or reduced price lunch since 2006. More than 62% of children in the public school system in Texas receive either free or reduced price lunch. However, San Augustine County’s rate is at least 22 percentage points higher than Angelina County’s and Polk County’s rates. Almost 95% of public school students in San Augustine County receive free or reduced price lunch. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Medicaid Covered Births 13 As of 2008, more than 53% of births in Angelina, Polk and San Augustine Counties and Texas are Medicaid covered births. San Augustine County has the smallest percentage (53.7%) of Medicaid covered births, compared to 60.8% in Angelina County and 70.9% in Polk County. Finally, about 55% (55.3%) of births in Texas are Medicaid covered births. Medicaid Covered Births (% of Total Births) Geographic Location Angelina County Polk County San Augustine County Texas 2007 58.0% 65.4% 67.3% 56.2% 2008 60.8% 70.9% 53.7% 55.3% Source: Texas Department of State Health Services; Health Facts Profiles 2007, 2008, 2009
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Unemployment 14 15 In 2011 Texas ranked 23rd in the country (1 being the best) in unemployment rates. Texas’ annual average unemployment rate was nearly 8% in 2011, one percentage point lower than the national average. Angelina County is the only county with a lower unemployment rate (7.7%) than the state (7.9%), while San Augustine County has the highest unemployment rate (12.4%). Nationally, statewide, and throughout Angelina, Polk and San Augustine Counties the unemployment rates have increased since 2008. The most substantial increase has occurred in San Augustine County, which increased from 6.3% in 2008 to 12.4% in 2011 and has yet to show a decline from the preceding year. While the United States’, Texas’, and Angelina County’s and Polk County’s unemployment rates either decreased or remained constant between 2010 and 2011, San Augustine County’s rate continued to increase. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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HealthDataFindings
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SpecificStudyAreaInformation
The following information outlines specific health data pertaining to Memorial – Livingston’s study area, which is defined as Polk County. Data regarding two additional counties, Angelina and San Augustine Counties, is also provided for comparison purposes. First, a snapshot of the community provides a broad overview of the County Health Rankings. Then, the following data reflects a deeper look at the most current natality and health statistics. This includes vital health statistics, mortality data, information regarding disease and chronic conditions, other causes of death, and communicable diseases. Data regarding mental health, health behaviors, and access to health coverage is also provided in this section. The majority of this data is presented at the county and state levels. However, if county level data was not available, data is presented at the region level. Texas counties are assigned to one of eleven public health regions. Angelina, Polk, and San Augustine Counties are all located in public health Region 5. More specifically, they are located in the northern part of Region 5, which is often incorporated into Region 4/5 North for administrative purposes. Please see the maps below for further clarification. 16 17 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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ASnapshotoftheCommunity
About the County Health Rankings 18 
The County Health Rankings measure the health of nearly all counties in the nation and rank them within states. The Rankings are compiled using county‐level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically‐informed weights.  The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. Building on the work of America's Health Rankings, the University of Wisconsin Population Health Institute has used this model to rank the health of Wisconsin’s counties every year since 2003. How the Counties Compare 19 The 2012 County Health Rankings rank six subcategories: mortality, morbidity, health behaviors, clinical care, social & economic factors, and physical environment. These groups fall into two larger categories, Health Outcomes (mortality and morbidity) and Health Factors (health behaviors, clinical care, social & economic factors, and physical environment). The Rankings rank 221 counties in Texas and Angelina, Polk and San Augustine Counties fall into either the 3rd or 4th (lower) quartiles in each category, excluding clinical care (Angelina and Polk counties are in the 2nd quartile, San Augustine is in the 3rd) and physical environment (Angelina and San Augustine Counties are in the 2nd quartile, Polk County is in the 3rd). Health Outcomes  Angelina County is ranked 177th out of 221 Texas counties (4th quartile).  Polk County is ranked 220th out of 221 Texas counties (4th quartile).  San Augustine County is ranked 214th out of 221 Texas counties (4th quartile). Mortality  Angelina County is ranked 149th out of 221 Texas counties (3rd quartile).  Polk County is ranked last, 221st out of 221 Texas counties (4th quartile).  San Augustine County is ranked 216th out of 221 Texas counties (4th quartile). Morbidity  Angelina County is ranked 194th out of 221 Texas counties (4th quartile).  Polk County is ranked 187th out of 221 Texas counties (4th quartile).  San Augustine County is ranked 159th out of 221 Texas counties (3rd quartile). Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Health Factors  Angelina County is ranked 149th out of 221 Texas counties (3rd quartile).  Polk County is ranked 209th out of 221 Texas counties (4th quartile).  San Augustine County is ranked 212th out of 221 Texas counties (4th quartile). Health Behaviors  Angelina County is ranked 208th out of 221 Texas counties (4th quartile).  Polk County is ranked 219th out of 221 Texas counties (4th quartile).  San Augustine County is ranked 152nd out of 221 Texas counties (3rd quartile). Clinical Care  Angelina County is ranked 63rd out of 221 Texas counties (2nd quartile).  Polk County is ranked 76th out of 221 Texas counties (2nd quartile).  San Augustine County is ranked 115th out of 221 Texas counties (3rd quartile). Social & Economic Factors  Angelina County is ranked 136th out of 221 Texas counties (3rd quartile).  Polk County is ranked 198th out of 221 Texas counties (4th quartile).  San Augustine County is ranked 215th out of 221 Texas counties (4th quartile). Physical Environment  Angelina County is ranked 69th out of 221 Texas counties (2nd quartile).  Polk County is ranked 166th out of 221 Texas counties (3rd quartile).  San Augustine County is ranked 56th out of 221 Texas counties (2nd quartile). *For a detailed description of data regarding each indicator and sourcing information please see the following three pages. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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2012 County Health Rankings Health Outcomes (Ranking) MORTALITY (Ranking) Premature death MORBIDITY (Ranking) Poor or fair health Poor physical health days Poor mental health days Low birthweight Health Factors (Ranking) HEALTH BEHAVIORS (Ranking) Adult smoking Adult obesity Physical inactivity Excessive drinking Motor vehicle crash death rate Sexually transmitted infections Teen birth rate CLINICAL CARE (Ranking) Uninsured Primary care physicians Preventable hospital stays Diabetic screening Mammography screening SOCIAL & ECONOMIC FACTORS (Ranking) High school graduation Some college Unemployment Children in poverty Inadequate social support Children in single‐parent households Violent crime rate PHYSICAL ENVIRONMENT (Ranking) Air pollution‐particulate matter days Air pollution‐ozone days Access to recreational facilities Limited access to healthy foods Fast food restaurants Angelina County 177 220 San Augustine County 214 7,186 19% 3.6 3.3 8.2% 149 9,215 194 25% 5.1 4.4 8.5% 221 14,814 187 25% 4.8 4.3 8.5% 216 12,341 159 ‐ ‐ ‐ 9.3% 149 209 212 19% 29% 25% 16% 17 435 63 26% 1,050:1 73 81% 62% 208 24% 32% 29% 10% 25 330 77 63 26% 1,183:1 92 79% 66% 219 27% 32% 31% 9% 43 199 76 76 30% 1,332:1 85 80% 72% 152 ‐ 30% 32% ‐ 39 245 78 115 25% 2,158:1 123 86% 62% 136 198 215 87% 51% 8.0% 27% 26% 36% 420 69 0 0 10 2% 63% 86% 35% 9.9% 31% 23% 49% 233 166 1 0 0 6% 48% 76% 24% 11.1% 35% ‐ 51% 357 56 0 0 0 11% 33% Texas 84% 56% 8.2% 26% 23% 32% 503 1 18 7 12% 53% Polk County Source: The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute (www.countyhealthrankings.org) Note: "‐" indicates that data was not available or not calculated. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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2012 County Health Rankings Sources and Years
FocusArea
Mortality(50%)
Morbidity(50%)
FocusArea
Tobaccouse(10%)
Dietandexercise
(10%)
Alcoholuse(5%)
Sexualactivity(5%)
FocusArea
Accesstocare(10%)
HealthOutcomes
Measure
Weight
Premature death (years of potential life lost before age 75 per 50%
100,000 pop)
Poor or fair health (percent of adults reporting fair or poor 10%
health)
Poor physical health days (average number in past 30 days)
10%
Source
Vital Statistics, National Center for Health Statistics (NCHS)
Behavioral Risk Factor Surveillance System (BRFSS)
Year(s)
2006‐2008
BRFSS
2004‐2010
2004‐2010
Poor mental health days (average number in past 30 days)
10%
BRFSS
2004‐2010
Low birthweight (percent of live births with weight < 2500 grams)
20%
Vital Statistics, NCHS
2002‐2008
HealthBehaviors(30%)
Measure
Weight
Source
Adult smoking (percent of adults that smoke)
10%
BRFSS
Adult obesity (percent of adults that report a BMI >= 30)
7.5%
National Center for Chronic Disease Prevention and Health Promotion, calculated from BRFSS
Year(s)
2004‐2010
2009
Physical inactivity (percent of adults that report no leisure time physical activity)
2.5%
National Center for Chronic Disease Prevention and Health Promotion, calculated from BRFSS
Excessive drinking (percent of adults who report heavy or bringe drinking)
Motor vehicle crash deaths per 100,000 population
Sexually transmitted infections (chlamydia rate per 100,000 population)
Teen birth rate (per 1,000 females ages 15‐19)
2.5%
BRFSS
2004‐2010
2.5%
2.5%
Vital Statistics, NCHS
CDC, National Center for Hepatitis, HIV, STD, and TB Prevention
Vital Statistics, NCHS
2002‐2008
2009
Source
Census/American Community Survey (ACS)—Small Area Health Insurance Estimates (SAHIE)
Year(s)
2009
2009
5%
Health Resources and Services Administration, Area Resource File (ARF)
Medicare claims/Dartmouth Atlas
5%
Medicare claims/Dartmouth Atlas
2009
5%
Medicare claims/Dartmouth Atlas
2009
2.5%
ClinicalCare(20%)
Measure
Weight
Uninsured (percent of population < age 65 without health 5%
insurance)
Ratio of population to primary care physicians
Qualityofcare(10%) Preventable hospital stays (rate per 1,000 Medicare enrollees)
Diabetic screening (percent of diabetics that receive HbA1c screening)
Mammography screening
5%
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2002‐2008
2009
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FocusArea
Education(10%)
Employment(10%)
Income(10%)
Familyandsocial
support(5%)
Communitysafety
(5%)
Measure
High school graduation SocialandEconomicEnvironment(40%)
Weight
Source
Year(s)
5%
State sources and the National Center for Education Varies by state, 2008‐
Statistics
2009 or 2009‐2010
Some college (Percent of adults aged 25‐44 years with some post‐secondary education)
Unemployment rate (percent of population age 16+ unemployed)
Children in poverty (percent of children under age 18 in poverty)
Inadequate social support (percent of adults without social/emotional support)
Percent of children that live in single‐parent household
Violent crime rate per 100,000 population
5%
ACS
10%
2.5%
Local Area Unemployment Statistics, Bureau of Labor Statistics
Census/CPS—Small Area Income and Poverty Estimates (SAIPE)
BRFSS
2004‐2010
2.5%
ACS
2006‐2010
Uniform Crime Reporting, Federal Bureau of Investigation –State data sources for Illinois
2007‐2009
10%
5%
PhysicalEnvironment(10%)
Source
FocusArea
Measure
Weight
2%
Environmentalquality Air pollution‐particulate matter days (average number of CDC‐Environmental Protection Agency (EPA) (4%)
unhealthy air quality days)
Collaboration Data not available for Alaska and Air pollution‐ozone days (average number of unhealthy air 2%
Hawaii
quality due to ozone)
Builtenvironment
Limited access to health foods (percent of population who 2%
United States Department of Agriculture, Food (6%)
lives in poverty and more than 1 or 10 miles from a grocery (all but AK & Environment Atlas Data not available for Alaska store)
HI)
and Hawaii
2%
Census Zip Code Business Patterns
Access to healthy foods (percent of zip codes with healthy (AK & HI)
food outlets) for Alaska and Hawaii
Access to recreational facilities
2%
Census County Business Patterns
Fast food restaurants (percent of all restaurants that are fast Census County Business Patterns 2%
food)
Source: The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute (www.countyhealthrankings.org)
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2006‐2010
2010
2010
Year(s)
2007
2006
2009
2009
2009
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www.countyhealthrankings.org
2012 National Benchmarks
Total # of counties/county equivalents in US – 3,143
Total # of unranked counties in 2012 - 107
Total # of ranked counties in 2012 – 3,034
Missing
Standard
10th
90th
National
Counties
Minimum Maximum Average
Median
Deviation Percentile
Percentile Benchmark
(out of 3034)
187
2,929
23,992
8,299
2,461
5,466
8,010
11,471
5,466
Mortality
Premature death
336
2
44
17
6
10
16
24
10
Morbidity
Poor or fair health (%)
125
0.6
11.2
3.8
1.1
2.6
3.7
5.2
2.6
Outcomes
Morbidity
Poor physical health days
126
0.7
9.6
3.5
1.0
2.3
3.4
4.8
2.3
Morbidity
Poor mental health days
124
3.0
18.0
8.2
2.0
6.0
7.9
10.9
6.0
Morbidity
Low birthweight (%)
561
4
48
21
6
14
21
29
14
Smoking
Adult smoking (%)
0
14
48
30
4
25
31
35
25
Diet and Exercise
Adult obesity (%)
0
10
44
28
5
21
28
34
21
Diet and Exercise
Physical inactivity (%)
Health
467
1
35
14
5
8
15
21
8
Alcohol Use
Excessive drinking (%)
Behaviors
613
0
137
25
12
12
23
40
12
Alcohol Use
Motor vehicle crash death rate
0
0
2,605
306
269
84
226
614
84
Sexual Activity
Sexually transmitted infections
96
4
135
47
21
22
46
75
22
Sexual Activity
Teen birth rate
123
126:1 16,949:1 1,718:1
1,575:1
631:1 1,274:1
3,145:1
631:1
Access to Care
Primary care physicians
0
3
43
18
6
11
18
26
11
Access to Care
Uninsured (%)
13
13
100
83
7
76
84
89
89
Clinical Care
Quality of Care
Diabetic screening* (%)
130
21
86
64
8
53
65
74
74
Quality of Care
Mammography screening* (%)
105
17
285
81
32
49
75
122
49
Quality of Care
Preventable hospital stays
16
14
100
82
10
70
83
94
Education
High school graduation* (%)
0
15
90
53
12
37
53
68
68
Education
Some college* (%)
0
1.7
29.7
9.3
3.1
5.4
9.1
13.1
5.4
Employment
Unemployment (%)
Social &
0
3
61
24
9
13
24
36
13
Economic
Income
Children in poverty (%)
Factors
Family & Social Support Children in single-parent household (%)
0
1
76
31
10
20
30
43
20
614
4
57
19
5
14
19
26
14
Family & Social Support Inadequate social support (%)
320
0
2,350
294
244
73
228
591
73
Community Safety
Violent crime rate
27
0
116
2
7
0
0
7
0
Air Quality
Air pollution-ozone days**
27
0
49
2
4
0
0
4
0
Air Quality
Air pollution-particulate matter**
Physical
0
0
78
8
8
0
7
16
16
Built Environment
Access to recreational facilities* (%)
Environment
12
0
100
44
15
25
47
60
25
Built Environment
Fast food restaurants (%)
28
0
71
10
11
0
7
25
0
Built Environment
Limited access to healthy foods** (%)
th
* Reverse-coded measures, the national benchmark is the 90th percentile. For all other measures, the national benchmark is the 10 percentile.
** No data were available for these measures for Alaska and Hawaii.
Category
Focus Area
Measure
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HealthDataFindings
Natality
Birth and Death Rates 20 


In 2010, there were more than 385,000 births and more than 166,000 deaths in the state of Texas. Texas’ birth rate has slightly declined from 16.9 (per 1,000) in 2005 to 15.3 (per 1,000) in 2010. Texas’ death rate has remained relatively constant since 2005, decreasing from 6.8 (per 1,000) to 6.6 (per 1,000) in 2010. Texas Birth and Death Rates (Per 1,000 Population) Year 2005 2006 2007 2008 2009 2010 Number of Births 385,537 399,309 407,453 405,242 401,599 385,746 Birth Rate 16.9
17
17
16.7
16.2
15.3
Number of Deaths 155,924
156,525
160,166
164,135
162,792
166,059
Death Rate 6.8 6.7 6.7 6.7 6.6 6.6 Source: Texas Department of State Health Services, Center for Health Statistics; Rates per 1,000 population Infant Deaths 21 
Texas’ infant death rates have seen little change since 2005. Of the three infant death categories, the “Under 1 Year” death rate has seen the most change, decreasing from 6.5 (per 1,000 live births) in 2005 to 6.1 (per 1,000 live births) in 2010. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Texas Infant Death Rates (Per 1,000 Live Births) Year 2005 2006 2007 2008 2009 2010 Under 1 Month Number of Deaths 1,581 1,580 1,553 1,544 1,514 1,507 Under 1 Month Death Rate 4.1
4 3.8
3.8
3.8
3.9
1‐11 Months Number of Deaths 934
896
988
934
880
855
1 ‐ 11 Months Death Rate 2.4
2.2
2.4
2.3
2.2
2.2
Under 1 Year Number of Deaths 2,515
2,476
2,541
2,478
2,394
2,362
Under 1 Year Death Rate 6.5 6.2 6.2 6.1 6 6.1 Source: Texas Department of State Health Services, Center for Health Statistics; Rates per 1,000 Live Births Fertility Rates 22 


In 2009, Texas’ fertility rate dropped to 75.1 (per 1,000 women ages 15‐44), down from 78.3 (per 1,000 women ages 15‐44) since 2007. Angelina and Polk Counties have higher fertility rates than the State, whereas San Augustine County’s rate has been substantially lower than Texas’ rate since 2007. Despite having the lowest fertility rate, San Augustine County’s fertility rate increased from 63.5 (per 1,000 women ages 15‐44) in 2007 to 71.2 (per 1,000 women ages 15‐44) in 2009. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Preterm and Low Birth Weight Births 23 


More than 7% of births in each county are low birth weight. The percentages of low birth weight births in Angelina, Polk and San Augustine Counties were higher than Region 5 and Texas in 2008 and 2009, but all decreased in 2010 to rates lower than the Region 5’s and Texas’ rates. There are disparities among racial and ethnic groups regarding the percentage of low birth weight births. There are a much higher percentages of low birth weight births among Black residents compared to White or Hispanic residents in Angelina and Polk Counties, Region 5 and Texas. *Please note that the total number of low birth weight births, or the number of births in a given racial or ethnic group may be very low, which could result in misleading percentages. This is of particular concern for San Augustine County. Low Birth Weight Births (<2,500 Grams) by Place and Race/Ethnicity Geographic Location Angelina County Polk County San Augustine County Region 5 Texas Year 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 Total Low Birth Weight Births 124
127
103
52
61
39
10
11
7
1,020
999
941
34,228
34,157
32,490
% of Births 9.8
9.7
8.7
9.8
11.1
7.9
10
10.9
7.2
9.7
9.5
9.4
8.4
8.5
8.4
% of White** Births 9.8
7.8
8
8.5
9.3
7.2
12.1
5.8
11.5
8.5
8.4
8.2
7.8
8
7.7
Source: Texas Department of State Health Services, Center for Health Statistics Note: Denominator for percent excludes missing data. * Percent is not computed if denominator is less than or equal to 20. ‐ Percent is not computed if numerator is equal to 0. ** Includes Other and Unknown Race/Ethnicity. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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% of Black Births % of Hispanic Births 13.1 20 13 21.6 21.3 21.3 10.7 13.9 2.9 14.9 13.9 14 14 14.2 13.9 8
8.2
7.7
9
11.7
3.9
‐
*
‐
7.4
7.8
7.4
7.7
7.6
7.7
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Pregnancy Rates 24 


As of 2010, Texas has a pregnancy rate of 86.5 (per 1,000 female population), down for the second consecutive year since 2008. San Augustine County has the lowest pregnancy rate (76.9 per 1,000 female population), compared to 81 (per 1,000 female population) in Polk County and 79.1 (per 1,000 female population) in Angelina County. Angelina County’s, Region 5’s, and Texas’ pregnancy rates have decreased since 2008, while Polk County’s and San Augustine County’s rates have increased. Pregnancy Rate (Per 1,000 Women in the Specified Population) by Place Geographic Location Angelina County Polk County San Augustine County Region 5 Texas Year 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 Pregnancy Rate** 86.1
89
79.1
78.2
84.3
81
73.5
76.9
76.9
83.3
83.6
80.3
91.7
89.1
86.5
Female Population Age 15‐44+ 16,350
16,354
17,078
7,288
7,212
6,663
1,442
1,418
1,327
143,571
143,704
142,507
5,274,919
5,347,364
5,326,162
Source: Texas Department of State Health Services, Center for Health Statistics ** Pregnancy rates per 1,000 women in the specified age group + Population estimates for July 1, 2008 produced by the Texas State Data Center, February 2010. + Population estimates for July 1, 2009 produced by the Texas State Data Center, November 2010. + 2010 population data for Texas produced by the Texas State Data Center from the Census 2010 Summary Files, accessed February 2012. * Rate is not computed if denominator is less than or equal to 20. ‐ Rate is not computed if numerator is equal to 0. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Births to Unmarried Mothers 25 



In 2010, more than 48% of births in Angelina, Polk, and San Augustine Counties occur to unmarried mothers. Conversely, less than 43% of births in Texas are to unmarried mothers. The percentage of births to unmarried mothers has increased since 2006 in each county in the Angelina, Polk, and San Augustine Counties, Region 5 and the state. San Augustine County has the highest percentage of births to unmarried mothers (62.9%), followed by 48.1% in Angelina County and 54.3% in Polk County. The percentage of unmarried mothers with less than 12 years of education in Angelina, Polk and San Augustine Counties, Region 5 and Texas has decreased since 2006, with San Augustine at the lowest rate (26.7%). Educational Status of Unmarried Mothers by Place Geographic Location Angelina County Polk County San Augustine County Region 5 Texas Year Total Number of Births to Unmarried Mother % of All Mothers (1) 2006 2008 2010 2006 2008 2010 2006 2008 2010 2006 2008 2010 2006 2008 2010 601
612
572
230
250
268
70
55
61
4,736
5,045
4,976
157,929
169,878
164,205
44.1
48.3
48.1
43.4
47.3
54.3
58.3
55
62.9
45.5
48.1
49.6
39.6
41.9
42.6
% of % of Unmarried Unmarried Mothers Mothers with Less with 12 Years than 12 or More of Years of Education (2) Education (2) 38.1 61.9
34.2 65.8
32.1 67.9
40
60
37.8 62.2
34.7 65.3
38.6 61.4
29.1 70.9
26.7 73.3
35.4 64.6
34.2 65.8
32.3 67.7
43.3 56.7
39.5 60.5
37.3 62.7
Source: Texas Department of State Health Services, Center for Health Statistics
Note: Denominators for (1) and (2) exclude missing data; this chart excludes "Unknown" 1. Denominator is live births to Texas residents. 2. Denominator is live births to unmarried Texas residents only. ‐ Percent is not computed if numerator is equal to 0. * Percent is not computed if denominator is less than or equal to 20.
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Teen Births 26 


Slightly more than 4% of births in Texas are to women ages 17 or younger. Slightly more than 4.5% of births in Region 5 are to women ages 17 or younger. Polk County has had the highest percentage of teen births since 2008, at 5.5% in 2010 compared to 3.9% in Angelina County. *Please note that the total number of teen births, or the number of births in a given racial or ethnic group may be very low, which could result in misleading percentages. This is of particular concern for San Augustine County. Teen Births (Age 17 or Younger) by Place and Race/Ethnicity Geographic Location Angelina County Polk County San Augustine County Region 5 Texas Year 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 2008 2009 2010 Total Number of Births to Women 17 Years of Age or Younger 69
76
47
29
41
27
5
7
2
532
538
464
19,775
18,732
16,720
% of Total Births % White** % Black % Hispanic 5.4
5.8
3.9
5.5
7.4
5.5
5
6.9
2.1
5.1
5.1
4.6
4.9
4.7
4.3
4.5
4.7
2.9
4.1
7
5.2
3.4
9.6
‐
3.9
4.2
3.4
2.1
2
1.8
6.3 4.6 6.2 11.8 8.2 4.3 7.1 ‐ 2.9 6.4 6 6.3 5.7 5.6 5 6.7
8.4
4.7
7.2
8.7
6.9
*
*
*
6.9
6.9
6.1
6.8
6.5
6.2
Source: Texas Department of State Health Services, Center for Health Statistics * Percent is not computed if denominator is less than or equal to 20. ‐ Percent is not computed if numerator is equal to 0. ** Includes Other and Unknown Race/Ethnicity. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Prenatal Health Care 27 

The percentage of women receiving care in the first trimester of pregnancy has decreased in Angelina, Polk and San Augustine Counties and in Texas since 2007. Only half of women in San Augustine County receive care in the first trimester, compared to 53.2% in Angelina County, 61.9% in Polk County and 58.6% in Texas. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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OverviewofMortalityRates
The County Health Rankings indicate that Angelina, Polk and San Augustine Counties are ranked in the fourth quartile of Texas counties with regard to “Health Outcomes.” Mortality rankings, which are based on a premature death rate, rank Polk County (221 out of 221 counties) as the worst in Texas, with San Augustine County not far ahead (216 out of 221 counties). The following health statistics present a detailed look at the health of residents in Angelina, Polk and San Augustine Counties. According to the Texas Department of State Health Services, Heart Disease and Cancer are the two leading causes of death in the Angelina County, Polk County, San Augustine County and Texas. Because rates were not calculated if 20 or fewer deaths occurred in a specific area, additional mortality rates for San Augustine County were not available. In Angelina and Polk Counties, an additional four leading causes of death rates were calculated. In alphabetical order, the four additional leading causes of death in 2009 were accidents, Alzheimer’s, cerebrovascular disease (stroke), and chronic lower respiratory disease. The top six leading causes of death in Angelina and Polk Counties are also ranked as the top six in Texas, although neither Angelina, Polk, or the State reports those causes in the same rank order. Diabetes ranks as the seventh leading cause of death in the Texas, followed by nephritis, nephrotic syndrome and nephrosis, influenza and pneumonia, and septicemia to formulate the top 10 causes of death in Texas in 2009. See the table below for the leading causes of death in the Angelina, Polk and San Augustine Counties and Texas and the chart on the next page for a full listing of the number of deaths and corresponding age‐adjusted death rates. Leading Causes of Death 2009 Angelina County 1.
2.
3.
Heart Disease All Cancer Cerebrovascular Disease (Stroke) 4. Chronic Lower Respiratory Disease 5. Accidents 6. Alzheimer’s 7. ‐‐‐ 8. ‐‐‐ 9. ‐‐‐ 10. ‐‐‐ Polk County 1.
2.
3.
4.
Heart Disease
All Cancer Accidents Cerebrovascular Disease (Stroke) 5. Chronic Lower Respiratory Disease 6. Alzheimer’s 7. ‐‐‐ 8. ‐‐‐ 9. ‐‐‐ 10. ‐‐‐ San Augustine County 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Heart Disease
All Cancer ‐‐‐ ‐‐‐ ‐‐‐ ‐‐‐ ‐‐‐ ‐‐‐ ‐‐‐ ‐‐‐ Texas 1.
2.
3.
Heart Disease
All Cancer Cerebrovascular Disease (Stroke) 4. Chronic Lower Respiratory Disease 5. Accidents 6. Alzheimer’s 7. Diabetes 8. Nephritis, Nephrotic Syndrome and Nephrosis 9. Influenza and Pneumonia 10. Septicemia Source: Texas Department of State Health Services; Health Facts Profiles 2007, 2008, 2009 Note: Death rates were age adjusted to the 2000 standard per 100,000 population. No age‐adjusted rates were calculated if based on 20 or fewer deaths ("‐‐‐").
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Mortality Causes by County and Cause of Death (2007 ‐ 2009; Sorted descending Age‐Adjusted Death Rate 2009)
2007
Geographic Location
Disease
Heart Disease
All Cancer
Cerebrovascular Disease (Stroke)
Chronic Lower Respiratory Disease
Accidents
Alzheimer's
Suicide
Influenza and Pneumonia
Infant Deaths
Chronic Liver Disease & Cirrhosis
Nephritis, Nephrotic Syndrome and Nephrosis
Septicemia
Assault (Homicide)
Fetal Deaths
Diabetes
Angelina County
Deaths From All Causes
Heart Disease
Polk County
All Cancer
Accidents
Cerebrovascular Disease (Stroke)
Chronic Lower Respiratory Disease
Alzheimer's
Septicemia
Influenza and Pneumonia
Infant Deaths
Assault (Homicide)
Nephritis, Nephrotic Syndrome and Nephrosis
Fetal Deaths
Suicide
Chronic Liver Disease & Cirrhosis
Diabetes
Deaths From All Causes
Polk County
San Augustine County Heart Disease
All Cancer
Accidents
Influenza and Pneumonia
Septicemia
Alzheimer's
Fetal Deaths
Assault (Homicide)
Infant Deaths
Cerebrovascular Disease (Stroke)
Nephritis, Nephrotic Syndrome and Nephrosis
Chronic Liver Disease & Cirrhosis
Suicide
Angelina County
Number of Deaths
203
139
102
33
46
16
10
19
12
8
18
12
10
11
17
764
149
136
39
31
34
13
19
16
4
3
18
2
9
13
8
611
37
25
2
6
3
0
1
0
0
11
6
1
0
2008
2009
Age‐Adjusted Death Age‐Adjusted Death Age‐Adjusted Death Rate (Per 100,000 Number of Deaths Rate (Per 100,000 Number of Deaths Rate (Per 100,000 Population)
Population)
Population)
235.5
160
119.4
39.4
56.3
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
893.7
244.4
202.4
84.6
50.8
53.7
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
1035.2
243.1
178.2
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
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158
171
153
54
36
25
12
22
7
10
12
18
5
5
25
847
151
135
23
32
39
13
10
15
7
3
14
2
10
7
13
597
40
33
15
4
2
2
1
1
0
8
2
2
3
182.4
196.1
178.3
62.3
43.1
28.8
‐
26.6
‐
‐
‐
‐
‐
‐
28.8
981.9
252
209.7
50.8
49.8
60.3
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
1012.4
279.8
243.2
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
205
163
141
64
35
27
13
13
6
9
17
9
5
6
12
846
156
121
38
41
40
20
14
12
9
2
11
1
9
10
14
618
37
29
5
2
2
2
0
0
1
10
5
1
1
230.4
185
159.6
72.7
41.8
31.7
‐
‐
‐
‐
‐
‐
‐
‐
‐
965.2
255.3
188.1
80.2
67.5
62.3
32.9
‐
‐
‐
‐
‐
‐
‐
‐
‐
1060.5
247.5
189.2
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
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Chronic Lower Respiratory Disease
Diabetes
San Augustine County Deaths From All Causes
Heart Disease
Texas
All Cancer
Cerebrovascular Disease (Stroke)
Chronic Lower Respiratory Disease
Accidents
Alzheimer's
Diabetes
Nephritis, Nephrotic Syndrome and Nephrosis
Influenza and Pneumonia
Septicemia
Chronic Liver Disease & Cirrhosis
Suicide
Infant Deaths
Assault (Homicide)
Fetal Deaths
Texas
Deaths From All Causes
10
5
125
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
839.3
202.7
173.7
49.8
42.5
42.2
26.6
25.5
17
17.1
14.5
11.5
10.5
6.2
6.1
5.4
805.1
12
2
150
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
1168.5
194.3
172.4
49.4
45.8
41.4
28.7
25.4
17.9
18.3
14.8
11.7
11
6.1
5.9
5.6
808.8
9
7
136
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
958.1
186.7
167.6
45.8
43.4
40
26.9
23.1
18.2
16.7
15
11.6
11.4
6
5.9
5.2
781.2
Source: Texas Department of State Health Services; Health Facts Profiles 2007, 2008, 2009
Note: Infant death rates are per 1,000 live births. Fetal death rates are per 1,000 live births plus fetal deaths. All other death rates were age adjusted to the 2000 standard per 100,000 population. No age‐adjusted rates were calculated if based on 20 or fewer deaths. Infant and fetal death rates were not calculated if 20 or fewer births or births plus fetal deaths occurred. Note: Fetal deaths are those occurring after 20 weeks gestation and prior to birth. Note: "‐" Indicates that the value was either not provided or not calculated.
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MortalityandChronicConditions
The disease, chronic conditions and mortality causes in this section are presented in alphabetical order. The data is derived from the following two data sources: 

Texas Department of State Health Services: County Health Facts Profiles, up to the year 2009, detail the causes of death by county. The Health Facts Profiles were pulled for the three most recent available years (2007, 2008, and 2009) for Angelina, Polk, and San Augustine Counties and also included data for the state of Texas. Note that all death rates were age adjusted to the 2000 standard per 100,000 population. The Texas Behavioral Risk Factor Surveillance System (BRFSS): The Texas BRFSS provides a query system that allows users to select a variety of health behaviors, or conditions by year (2002 – 2010). This data, collected by a federally funded monthly telephone survey of randomly selected adults, is available at the region and state level. For the purposes of this community health needs assessment Region 4/5N was compared to the state and country. In some cases regional data is presented by gender, race/ethnicity, age, education level, and income. Accidental Deaths 28 San Augustine’s accident mortality rate was not calculated because fewer than 20 deaths occurred in that disease category. 


Accidental deaths are the third leading cause of death in Polk County and the fifth leading cause of death in Angelina County and Texas. Polk County has an accident mortality rate (80.2 per 100,000) that is twice as large as Texas’ rate (40.0 per 100,000). Angelina County’s accident mortality rate has declined substantially since 2007, decreasing from 56.3 (per 100,000) in 2007 to 41.8 (per 100,000) in 2009. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Asthma 29 The BRFSS defines “current asthma” as respondents 18 years and older who report that they have ever been diagnosed with asthma (and still have asthma).  Almost 9% of residents in Region 4/5N reported a current asthma diagnosis, 1.5 percentage points higher than the State’s rate (year 2010).  Region 4/5N’s percentage of “asthma sufferers” has increased consecutively since 2008 and is slightly higher than both the State and the Nation.  Both Texas’ and the United States’ rates increased by .1 percentage points between 2008 and 2010, while Region 4/5N increased almost 1.8 percentage points. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who report that they have ever been diagnosed with asthma (and still have asthma). The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Cancer Cancer Mortality 30  Cancer is the second leading cause of death in Angelina, Polk and San Augustine Counties and in Texas.  Cancer is also the leading cause of death among people age 85 and older and the leading cause of death from disease among children (ages 1 to 14 years). 31  As of 2009, Angelina, Polk and San Augustine Counties have a cancer mortality rate of at least 185 per 100,000.  Each county also has a higher cancer mortality rate than the State (167.6 per 100,000).  Texas’ cancer mortality rate decreased between 2007 and 2009, while Angelina County’s and San Augustine County’s Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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rates have increased. Leading Cancer Deaths in Texas 32  In Texas, lung cancer is responsible for the highest number of both male and female cancer deaths.  Colorectal cancer is responsible for the second highest number of male cancer deaths and breast cancer is responsible for the second highest number of female cancer deaths.  Prostate cancer is responsible for the third highest number of male cancer deaths and colorectal cancer is responsible for the third highest number of female cancer deaths. Average Annual Number of Cancer Deaths, 10 Leading Sites, Texas, 2005‐2009 Source: Texas Cancer Registry *Chart taken directly from the 2012 Texas Selected Cancer Facts Cancer by Race, Ethnicity and Sex in Texas 33  Male and female Black residents in Texas are more likely to die of cancer than any other race/ethnicity group.  Asian/Pacific Islanders have the lowest cancer incidence rates, but do not have the lowest cancer mortality rates. In fact, their mortality rates are very similar to Non‐Hispanic Whites, although they have substantially lower incidence rates. Cancer Rates by Race, Ethnicity and Sex, Texas, 2005‐2009 Source: Texas Cancer Registry *Chart taken directly from the 2012 Texas Selected Cancer Facts Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Cancer Incidence  In Texas, the three most commonly reported cancers for men are Prostate, Lung and Colorectal cancers. For women in Texas, the three most commonly reported cancers are Breast, Lung and Colorectal cancers. 34 Average Annual Number of New Cancer Cases, 10 Leading Sites, Texas, 2005‐2009 Source: Texas Cancer Registry *Chart taken directly from the 2012 Texas Selected Cancer Facts 



The age‐adjusted (per 100,000) cancer incidence rates by county, calculated from combined data from 2005‐2009, are provided in the “Cancer Incidence Rates” graph below. Please note that the total numbers of cases (which may be small in comparison to the other two counties) are also listed in a detailed table below.35 Angelina, Polk and San Augustine Counties have a substantially higher prostate cancer incidence rate than the state. Angelina, Polk and San Augustine Counties have a higher colon and rectum cancer incidence rate than Texas. Finally, Angelina and Polk Counties also have higher female breast cancer and lung and bronchus cancer incidence rates than Texas. Source: Texas Cancer Registry, Cancer Inquiry System Note: Veterans Health Administration and military hospital reporting is incomplete for 2008‐2009 Texas Cancer Registry (TCR) cancer cases. Therefore, case counts and incidence rates in 2008‐2009 are underestimated and should be interpreted with caution. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Cancer Incidence Rates by Cancer Type (Age‐adjusted per 100,000) (2005‐2009) Location Angelina County Polk County San Augustine County Texas Cancer Type Colon and Rectum
Female Breast
Lung and Bronchus
Prostate Colon and Rectum
Female Breast
Lung and Bronchus
Prostate Colon and Rectum
Female Breast
Lung and Bronchus
Prostate Colon and Rectum
Female Breast
Lung and Bronchus
Prostate Population at Risk (2005‐2009) Number of Cases (2005‐2009) 412,324
209,652
412,324
202,672
230,990
112,096
230,990
118,894
43,412
22,698
43,412
20,714
119,092,087
59,696,145
119,092,087
59,395,942
223
277
369
446
174
193
343
369
37
28
39
62
46,298
66,920
65,226
66,792
Age‐adjusted Rate (per 100,000) 49.9
118.9
83.3
220.3
52.1
115.7
97.8
221.7
58
94.4
58.9
187.2
44.2
115.5
63.8
141.8
Heart Disease, Cerebrovascular Disease and Cardiovascular Disease. Heart Disease 36  Heart disease is the leading cause of death in Angelina, Polk and San Augustine Counties and Texas (year 2009).  With the exclusion of Angelina County in 2008, each of the three counties have had higher heart disease mortality rates than Texas since 2007.  As of 2009, the heart disease mortality rates in Angelina, Polk and San Augustine Counties all exceed 230 deaths (per 100,000), while Texas’ rate is less than 190 (186.7 per 100,000). Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Cerebrovascular Disease (Stroke) 37  Cerebrovascular disease is the third leading cause of death in Texas.  While rates were not calculated for San Augustine County because fewer than 20 deaths occurred, Angelina County has a much higher cerebrovascular disease mortality rate than Texas. In 2009, Angelina County’s cerebrovascular disease mortality rate (159.6 per 100,000) was more than three times as high as Texas (45.8 per 100,000). Cardiovascular Disease 38 The BRFSS defines “Cardiovascular Disease” as respondents 18 years and older who report that they have been diagnosed as having had a heart attack, myocardial infraction, angina, coronary heart disease, or stroke.  Region 4/5N has had a consistently higher percentage of residents with cardiovascular disease than the state and the country since 2005. In 2010, almost 12% (11.9%) of residents in Region 4/5N indicated that they suffered from cardiovascular disease compared to 8.3% in Texas and 8.4% in the United States.  Although the percentage of residents who had experienced cardiovascular disease decreased each consecutive year from 2005 to 2009 in Region 4/5N, the percentage substantially increased to 11.9% (its highest rate since 2005) in 2010.  The BRFSS also indicated that people with an income of $50,000 a year or greater are less likely than those with an income less than $50,000 a year to suffer from cardiovascular disease. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who report that they have been diagnosed as having had a heart attack, myocardial infraction, angina, coronary heart disease, or stroke. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Chronic Lower Respiratory Disease 39 San Augustine’s chronic lower respiratory disease mortality rate was not calculated because fewer than 20 deaths occurred in that disease category.  Chronic Lower Respiratory Disease is the 4th leading cause of death in Angelina County and Texas and the 5th leading cause of death in Polk County.  Angelina and Polk Counties have higher chronic lower respiratory disease mortality rates than Texas.  In 2009, the chronic lower respiratory disease mortality rate in Angelina County was 72.7 (per 100,000), compared to 62.3 (per 100,000) in Polk County, and 43.4 (per 100,000) in Texas. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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The mortality rate for this disease category has also increased in Angelina and Polk Counties since 2007. Between 2007 and 2009 the chronic lower respiratory disease mortality rate changed dramatically in Angelina County, increasing from 39.4 (per 100,000) to 72.7 (per 100,000). Diabetes The BRFSS defines “Diabetes” as respondents 18 years and older who report that they have been diagnosed with diabetes. This data does not include gestational diabetes. 40  Texas ranks 15th in the country, with 1 being the highest prevalence and 51 being the lowest, in terms of diabetes among adult residents. 41  Overall, the prevalence of diabetes in Region 4/5N, Texas, and the country has increased since 2002.  In 2010, more than 9% of Texans and Americans reported being diagnosed with diabetes, compared to nearly 12% of residents in Region 4/5N.  Excluding 2005, Region 4/5N has had a higher percentage of residents with diagnosed diabetes than Texas or the United States since Source: Texas Department of Health Services, Center for Health 2002. Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who report that they have been diagnosed with diabetes. Does not include gestational diabetes. Obesity In 2011, Texas’ obesity rate exceeded 30% (30.4%), ranking the state 10th in the country with regard to obesity (1 being the most obese, 51 being the least obese). According to the annual F as in Fat: How Obesity Threatens America’s Future 2012 report: “If obesity rates continue on their current trajectories, by 2030, 13 states could have adult obesity rates above 60%, 39 states could have rates above 50%, and all 50 states could have rates above 44%.” 42 This increase in obesity rates will drastically affect the health of Americans by increasing the prevalence of type 2 diabetes, coronary heart disease and stroke, cancer, hypertension and arthritis. “Obesity could contribute to more than 6 million cases of type 2 diabetes, 5 million cases of coronary heart disease and stroke, and more than 400,000 cases of cancer in the next two decades.” 43 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Medical costs related to obesity will also climb sharply with the projected increase. “By 2030, medical costs associated with treating preventable obesity‐related diseases are estimated to increase by $48 billion to $66 billion per year in the United States, and the loss in economic productivity could be between $390 billion and $580 billion annually by 2030. Although the medical cost of adult obesity in the United States is difficult to calculate, current estimates range from $147 billion to nearly $210 billion per year.” 44 Texas Youth 45  As of 2010, 15.3% of low income children ages 2‐5 are considered obese.  Texas has the 7th highest percentage (20.4%) of obese 10 ‐17 year olds in the country.  More than 15% (15.6%) of high school students in Texas are obese.  Finally, 16% of high school students in Texas are overweight. The BRFSS defines “Overweight and Obesity” as respondents 18 years and older who have a BMI that is considered overweight or obese, calculated by self‐reported height and weight. BMI is (weight in lbs divided by (height in inches squared)) times 703. Recommended BMI is 18.5 to 24.9 Overweight is 25.0 to 29.9 Obese is => 30.0. 46  In 2010, more than 64% of residents in Region 4/5N, Texas, and the United States were considered overweight or obese.  Overall, the overweight & obesity prevalence in Region 4/5N, Texas, and the United States has increased since 2002.  The overweight and obesity prevalence in Region 4/5N increased more than 10 percentage points between 2002 and 2010, increasing from 60.2% in 2002 to 71.1% in 2010. During the same time period Texas’ and the United States’ rates increased 3.8 and 5.5 percentage points respectively.  Both Texas and Region 4/5N have had consistently higher overweight and obesity rates than the United States since 2002.  Overweight and Obesity prevalence rates in Region 4/5N appear fairly similar regardless of education level and income. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Black residents have had slightly higher overweight and obesity rates than White and Hispanic residents since 2008. However, in 2010 the Hispanic prevalence rate increased to 83.6%, a rate higher than the both the Black and White populations (78.5% and 68.1% respectively). Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who have a BMI calculated by self‐reported height and weight. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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CommunicableDiseases
The following data regarding reported cases of communicable diseases reflects 2007, 2008, and 2009 statistics from the County Health Profiles provided by the Texas Department of State Health Services. Please note that rates are calculated for disease types, but small numbers of cases may lead to misleading rates. Use caution when drawing conclusions from a small number of reported cases. Communicable Disease 47 
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The most commonly reported communicable disease is chlamydia with 272 cases in Angelina County, 78 cases in Polk County, and 18 cases in San Augustine County (year 2009). In Texas, more than 400 residents (419) per 100,000 are diagnosed with chlamydia a year (year 2009). The second most commonly reported communicable disease is gonorrhea, with 108 cases in Angelina County, 26 cases in Polk County, and 15 cases in San Augustine County reported in 2009. In Texas, 116.1 residents per 100,000 are diagnosed with gonorrhea a year (year 2009). Seven cases of AIDS were reported in Angelina County in 2009, followed by 3 in Polk County, and 0 in San Augustine County. Texas’ AIDS disease rate was down for the second consecutive year at 9.2 per 100,000 in 2009. Other communicable diseases reported include tuberculosis, primary and secondary syphilis, pertussis (whooping cough), and varicella (chickenpox). *Please see the following page for a detailed listing a of communicable disease statistics. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Communicable Disease Statistics by Place 2007, 2008, 2009
2007
2008
Tuberculosis
Primary and Secondary Syphilis
Gonorrhea
Chlamydia
AIDS
Pertussis (Whooping Cough)
Varicella (Chickenpox)
2
1
109
242
6
11
94
Disease Rates (Per 100,000 Population)
2.5
1.2
131.7
292.5
7.4
13.3
113.6
Tuberculosis
Primary and Secondary Syphilis
Gonorrhea
Polk County Chlamydia
AIDS
Pertussis (Whooping Cough)
Varicella (Chickenpox)
1
0
31
90
4
2
14
Tuberculosis
Primary and Secondary Syphilis
Gonorrhea
San Augustine Chlamydia
County
AIDS
Pertussis (Whooping Cough)
Varicella (Chickenpox)
Geographic Location
Angelina County
Texas
Disease
Tuberculosis
Primary and Secondary Syphilis
Gonorrhea
Chlamydia
AIDS
Pertussis (Whooping Cough)
Varicella (Chickenpox)
2009
2
0
104
226
3
155
52
Disease Rates (Per 100,000 Population)
2.4
0
125.2
272
3.7
186.6
62.6
2.3
‐
67
194.4
9.2
4.3
30.2
0
0
25
65
3
3
104
1
0
14
20
0
2
2
10.9
‐
152.6
218
‐
21.8
21.8
‐
‐
‐
‐
‐
‐
‐
6.3
4.9
132.9
354.7
12
4.4
42.1
Number of Cases
1
5
108
272
7
32
29
Disease Rates (Per 100,000 Population)
1.2
6
129
324.9
8.4
38.2
34.6
‐
‐
54.1
140.6
6.9
6.5
225
0
0
26
78
3
1
7
‐
‐
56.2
168.7
6.5
2.2
15.1
0
0
11
18
0
2
14
‐
‐
121.8
199.4
‐
22.2
155.1
0
0
15
18
0
0
0
‐
‐
166
199.2
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
6.2
5.8
129.8
405.8
11.9
8.4
32.2
‐
‐
‐
‐
‐
‐
‐
5.9
6.6
116.1
419
9.2
13.5
17.9
Number of Cases
Number of Cases
Source: Texas Department of State Health Services; Health Facts Profiles 2007, 2008, 2009
Note: Disease rates are per 100,000 population. Use caution interpreting rates based on small numbers of cases.
Note: "‐" Indicates that the value was either not provided or not calculated.
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MentalHealth
HPSAs Health Professional Shortage Areas (HPSAs), designated by the Health Resources and Services Administration (HRSA), have shortages in health providers. The area may have a shortage in primary medical, dental or mental health physicians. The area can also be defined as an entire county or as a subset of the population, such as a particular demographic group or an institutional center. Angelina, Polk and San Augustine counties are all designated as Health Professional Shortage Areas (HPSAs) with regard to mental health (as of October 5, 2012)48 The ratio of mental health providers (per 100,000) is lower than the state in each county: 49  Angelina County: 13.3 mental health providers per 100,000  Polk County: 4.3 mental health providers per 100,000  San Augustine County: 0.0 mental health providers per 100,000  Texas: 27.7 mental health providers per 100,000 Poor Mental Health 50 The BRFSS defines “Greater than or Equal to 5 Poor Mental Health Days” as respondents 18 years and older who report that had five or more days of poor mental health days which includes stress, depression, and problems with emotions in the past 30 days.  As of 2010, more than 20% of adults in Texas and Region 4/5N report having 5 or more poor mental health days in the past 30 days.  The percentage of residents in Region 4/5N with “poor mental health” has consistently increased since 2008, increasing from 17.8% in 2008 to 21.2% in 2010.  Females and residents making less than $25,000 a year were far more likely than males and residents making $25,000 a year or more to report poor mental health. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who report that had five or more days of poor mental health which includes stress, depression, and problems with emotions in the past 30 days. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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HealthBehaviors
The health behaviors in this section are presented in alphabetical order. The majority of this data is derived from the following data source (see the Reported Sources section for full sourcing information): 
The Texas Behavioral Risk Factor Surveillance System (BRFSS): The Texas BRFSS provides a query system that allows users to select a variety of health behaviors, or conditions by year (2002 – 2010). This data, collected by a federally funded monthly telephone survey of randomly selected adults, is available at the region and state level. For the purposes of this community health needs assessment, Region 4/5N was compared to the state and country. In some cases regional data is presented by gender, race/ethnicity, age, education level, and income. Alcohol Use 51 The BRFSS defines “Alcohol Use: Binge Drinking” as respondents 18 years and older who reported having (men 5 or more drinks/women 4 or more drinks) on an occasion in past 30 days.  According to the 2010 BRFSS, more than 12% of residents in Region 4/5N, Texas, and the United States report binge drinking in the past 30 days.  Region 4/5N’s binge drinking rate has been consistently lower than Texas and the United States’ rates since 2003.  Region 4/5N’s rate decreased substantially (about 5.5 percentage points) between 2002 and 2003, but has decreased by less than 1 percentage point since then.  The data suggests that men are far more likely than women to engage in binge drinking in Region 4/5N. Nearly 18.5% of men reported binge drinking, compared to slightly more than 6.5% of women. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Residents with an income of $50,000 or more have also reported a higher rate of binge drinking than other lower income groups since 2008. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who reported having (men 5 or more drinks/women 4 or more drinks) on an occasion in past 30 days. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Immunizations 52 The BRFSS gathers information on flu vaccinations. The two flu shot indicators are “No Flu Shot in the Past Year Ages 18 Years and Over” and “No Flu Shot in the Past Year Ages 65 Years and Over.” Both groups represent respondents who report that they did not have a flu vaccine (shot or spray) within the past 12 months.  According to the BRFSS, between 57% and 60% of residents ages 18 years and older in Region 4/5N, Texas, and the United States have not had a flu shot in the past year.  A substantially higher percentage of younger residents (ages 18 – 29, 30‐
44, and 45‐64) than residents ages 65 years and older reported not receiving a flu shot in the past year in Region 4/5N. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Between 2008 and 2010, the percentage of residents ages 65 years and older not getting a flu vaccination has increased in Region 4/5N, Texas, and nationwide. Region 4/5N has seen the greatest increase, 7.3 percentage points. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older and respondents ages 65 years and older who report that they did not have a flu vaccine (shot or spray) within the past 12 months. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Nutrition 53 The BRFSS defines “Intake of Fruit & Vegetables is Less Than 5 Times a Day” as respondents 18 years and older who report that they have eaten fruits, fruit juices, or vegetable servings less than 5 times per day. This indicator is only available every other year. Therefore the most current three years of data are 2005, 2007, and 2009. 
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According to the BRFSS, more than 75% of residents in Region 4/5N, Texas, and the United States don’t consume the recommended daily intake of fruits and vegetables. The percentage of residents who consume fruits and vegetables less than 5 times a day is similar in Region 4/5N, Texas and the United States. However, in 2009 in Region 4/5N the rate increased to 82.1% (about 6 percentage points higher than the state and country). Physical Activity As of 2011, more than 27% (27.2%) of Texas residents are inactive, ranking the state 11th in the country with regard to physical inactivity among adults (1 being the most inactive and 51 being the least inactive). 54 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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The BRFSS defines “No Leisure Time Physical Activity” as respondents 18 years and older who report no leisure‐time physical activity during the past month. "Leisure‐time physical activity" is defined as physical activity or exercise other than his or her regular job. 55  More than one quarter of residents in Texas and Region 4/5N do not engage in any “leisure time physical activity.”  According to the BRFSS, a larger percentage of residents in Region 4/5N than the State and nationwide have reported not engaging in leisure time physical activity since 2002.  Residents with no high school diploma and residents with incomes of less than $25,000 a year are more likely than residents making more than $25,000 a year to report not engaging in any leisure time physical activity in Region 4/5N. Furthermore, the percentage of residents with no high school diploma who don’t engage in leisure time physical activity increased 20 percentage points between 2008 and 2010.  Older residents (ages 65 years and over) are also more likely than younger residents to report not engaging in leisure time physical activity in Region 4/5N. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who report no leisure‐time physical activity during the past month. "Leisure‐time physical activity" is defined as physical activity or exercise other than his or her regular job. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Screenings for Diseases 56 Mammogram and Pap Smear The BRFSS defines “No Mammogram Within 2 Years (Ages 40+)” as female respondents ages 40 years and older who report that they did not have a mammogram within the past two years. “No Pap Smear Within 3 Years (Ages 18+)” is defined as female respondents with uterine cervixes, 18 years and older, who report that they did not have a pap smear within the last 3 years.  More than 36% of women ages 40 years and older in Region 4/5N report not receiving a mammogram within the past 2 years, compared to 30% in Texas and 24.6% nationwide. In Region 4/5N, the percentage increased more than 5 percentage points between 2006 and 2010.  More than 18% of women age 18 years and older in Region 4/5N, Texas, and the United States report not receiving a pap smear within the past 3 years. Nationwide, that rate has slightly increased since 2006, but neither Texas, Region 4/5N, nor the United States fluctuated more than 2 percentage points between 2006 and 2010. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents female respondents ages 40 years and older who report that they did not have a mammogram within the past two years and female respondents with uterine cervixes, 18 years and older, who report that they did not have a pap smear within the last 3 years. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Digital Rectal Exam (DRE) and Prostate‐Specific Antigen (PSA) The BRFSS defines “No Digital Rectal Exam (DRE) Within The Past 5 Years” as male respondents 40 years and older who have not had a Digital Rectal Exam (DRE) within the past 5 years. “No Prostate‐Specific Antigen (PSA) Within The Past 2 Years” is defined as male respondents 40 years and older who have not had a Prostate‐Specific Antigen (PSA) Test within the past 2 years  According to the BRFSS, almost half of men in Region 4/5N have not received the DRE within the past 5 years or the PSA within the past 2 years, 47.2% and 49.5% respectively. In 2010, both rates were higher than the state and national rates.  The percent of men not receiving the DRE in Region 4/5N, Texas and the United States has increased since 2006, while the percent of men not receiving the PSA has decreased. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents male respondents 40 years and older who have not had a Digital Rectal Exam (DRE) within the past 5 years and male respondents 40 years and older who have not had a Prostate‐Specific Antigen (PSA) Test within the past 2 years. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Smoking/Tobacco 57 The BRFSS defines “Current Smoker” as respondents 18 years and older who have smoked 100 cigarettes in their lifetime and now smoke every day or some days. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Overall, the percentage of smokers in Region 4/5N, Texas and the United States has declined since 2002. Region 4/5N and Texas’ smoking rates have decreased 7.1 percentage points, while the United States’ rate has dropped 5.5 percentage points. In Region 4/5N the percentage of 18‐29 year olds and the percentage of college graduates that smoke has increased consistently since 2008. However, the percentages of all other age groups (30‐44, 45‐64, and 65+) and all other education levels (No high school diploma, high school graduate, and some college) declined between 2008 and 2010. Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who have smoked 100 cigarettes in their lifetime and now smoke every day or some days. The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Texas Youth 58 The Center for Disease Control and Prevention provides a comparison on the High School Youth Risk Behavior Survey. In 2011, Texas youth were more likely than the United States’ youth to have engaged in 40 different “risky behaviors.” These behaviors range from drug and alcohol use to dietary patterns to lack of physical activity. The results of those 40 risky behaviors are listed on the following three pages. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Unintentional Injury and Violence In 2011, Texas youth were more likely than United States youth to report that they:  Rarely or never wore a bicycle helmet during the past 12 months (91.9% compared to 87.5%)  Rode with a driver who had been drinking alcohol one or more times during the past 30 days (32.2% compared to 24.1%)  Drove when drinking alcohol one or more times during the past 30 days (10.2% compared to 8.2%)  Attempted suicide one or more times during the past 12 months (10.8% compared to 7.8%)  Suicide attempt resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse during the past 12 months (3.5% compared to 2.4%)  Hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend during the past 12 months (11.8% compared to 9.4%) Tobacco Use In 2011, Texas youth were more likely than United States youth to report that they:  Ever tried cigarette smoking (even one or two puffs) (50.2% compared to 44.7%)  Smoke cigars, cigarillos, or little cigars on at least 1 day during the past 30 days (16.0% compared to 13.1%) Alcohol and Other Drug Use In 2011, Texas youth were more likely than United States youth to report that they:  Drank alcohol for the first time before age 13 years (other than a few sips) (22.8% compared to 20.5%)  Ever used any form of cocaine one or more times (for example, powder, crack, or freebase) during their life (9.4% compared to 6.8%)  Used any form of cocaine one or more times (for example, powder, crack, or freebase) during the past 30 days (4.1% compared to 3.0%)  Ever used methamphetamines one or more times (also called “speed,” “crank,” or “ice”) during their life (5.0% compared to 3.8%)  Ever used ecstasy one or more times (also called “MDMA”) during their life (11.9% compared to 8.2%)  Ever took steroid pills or shots without a doctor’s prescription one or more times during their life (4.8% compared to 3.6%)  Ever used a needle to inject any illegal drug into their body one or more times (3.1% compared to 2.3%) Sexual Behaviors In 2011, Texas youth were more likely than United States youth to report that they:  Did not use a condom during last sexual intercourse (among students who were currently sexually active) (24.2% compared to 22.1%) Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Did not use birth control pills before last sexual intercourse (to prevent pregnancy, among students who were currently sexually active) (88.7% compared to 82.0%) Did not use Depo‐Provera (or any injectable birth control), Nuva Ring (or any birth control ring), implanon (or any implant), or any IUD use before last sexual intercourse (to prevent pregnancy, among students who were currently sexually active) (84.3% compared to 76.7%) Did not use both a condom during last sexual intercourse and birth control pills or Depo‐Provera (or any injectable birth control), Nuva Ring (or any birth control ring), implanon (or any implant), or any IUD before last sexual intercourse (to prevent pregnancy, among students who were currently sexually active) (93.6% compared to 90.5%) Did not use any method to prevent pregnancy during last sexual intercourse (among students who were currently sexually active (20.0% compared to 12.9%) Dietary Behaviors In 2011, Texas youth were more likely than United States youth to report that they:  Did not drink 100% fruit juices during the past 7 days (22.7% compared to 19.2%)  Did not eat fruit during the past 7 days (14.9% compared to 11.7%)  Did not eat green salad during the past 7 days (45.7% compared to 38.0%)  Did not eat potatoes (excluding French fries, fried potatoes, or potato chips) during the past 7 days (36.6% compared to 31.2%)  Did not eat carrots (59.7% compared to 52.0%)  Did not eat other vegetables (excluding green salad, potatoes, or carrots) during the past 7 days (23.8% compared to 17.0%)  Did not eat fruit or drink 100% fruit juices during the past 7 days (6.2% compared to 4.8%)  Ate fruit or drank 100% fruit juices less than one time per day during the past 7 days (42.1% compared to 36.0%)  Ate fruit or drank 100% fruit juices less than two times per day during the past 7 days (70.1% compared to 66.0%)  Did not eat vegetables (green salad, potatoes [excluding French fries, fried potatoes, or potato chips], carrots, or other vegetables during the past 7 days (9.0% compared to 5.7%)  Ate vegetables less than one time per day (green salad, potatoes [excluding French fries, fried potatoes, or potato chips], carrots, or other vegetables during the past 7 days (47.5% compared to 37.7%)  Ate vegetables less than two times per day (green salad, potatoes [excluding French fries, fried potatoes, or potato chips], carrots, or other vegetables during the past 7 days (78.6% compared to 71.7%)  Ate vegetables less than three times per day (green salad, potatoes [excluding French fries, fried potatoes, or potato chips], carrots, or other vegetables during the past 7 days (89.3% compared to 84.7%)  Obese (students who were greater than or equal to the 95th percentile for body mass index, based on sex and age‐specific reference data from the 2000 CDC growth charts (15.6% compared to 13.0%) Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Took diet pills, powders or liquids to lose weight or to keep from gaining weight (without doctor’s advice) during the past 30 days (7.2% compared to 5.1%) Vomited or took laxatives to lose weight or to keep from gaining weight during the past 30 days (6.3% compared to 4.3%) Physical Activity In 2011, Texas youth were more likely than United States youth to report that they:  Physically active at least 60 minutes per day on less than 5 days (doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time) during the past 7 days (55.5% compared to 50.5%)  Watched television 3 or more hours per day (on an average school day) (37.2% compared to 32.4%)  Did not participate in at least 60 minutes of physical activity on any day (doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time) during the past 7 days (16.4% compared to 13.8%). *Please see the Appendix for detailed tables regarding the BRFSS data. *Please see the Appendix for a comparison of Texas and the United States Youth Risk Behavior Survey indicators. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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AccesstoHealthCare
Health Professional Shortage Areas In addition to being designated as Health Professional Shortage Areas with regard to Mental Health, certain subsets or all of Angelina, Polk and San Augustine Counties are designated HPSAs in primary care or dental care as well (data as of October 22, 2012).59 
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Dental Care HPSAs: Angelina County o Angelina County ‐ Single County Polk County o No HPSAs San Augustine County o No HPSAs 
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Primary Care HPSAs: Angelina County o Diboll Prison ‐ Correctional Facility o Low Income – Population Group Polk County o Alabama‐Coushatta Tribe of Texas ‐ Native American Tribal Population o Polk County ‐ Single County San Augustine County o San Augustine ‐ Single County Medical Cost Barriers 60 The BRFSS defines “Could Not See a Doctor Because of Cost” as respondents 18 years and older who report that they could not see a doctor in the past 12 months because of cost.  According to the BRFSS, more than 14.5% of residents in Region 4/5N, Texas and the United States are unable to see a doctor because of medical cost barriers.  Region 4/5N and Texas have higher percentages of residents than the United States who cannot see a doctor because of cost.  Texas’ rate decreased by 1.7 percentage points between 2008 and 2010, while Region 4/5N and the United States’ rates slightly increased, 0.8 and 0.5 percentage points respectively.  In Region 4/5N: o A larger percentage of females than males (24.9% to 17.3% in 2010) and residents making less than $50,000 than residents making more than $50,000 are unable to see a doctor due to medical cost barriers. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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o
o
A higher percentage of Black and Hispanic residents face medical cost barriers compared to their White counterparts (28.2% of Black residents and 36.7% of Hispanic residents, compared to 16.5% of White residents in 2010). Substantially less college graduates (6.2%) face medical cost barriers, compared to residents with no high school diploma (32.1%), high school graduates (23.6%) and those who have attended some college (23.8%) Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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2008 Medical Cost Public Health Administrative Region 4/5N Texas Nationwide Public Health Region 4/5 North Sample Size* 10,685 413,565 1,043 Male Female 385 658 White Black Hispanic 829 107 75 18‐29 Years 30‐44 Years 45‐64 Years 65+ Years 74 189 380 386 No High School Diploma H. S. Graduate Some College College + 132 313 300 294 Less Than $25,000 $25,000 ‐ $49,999 $50,000 or more 312 239 328 2009 % at Sample Risk Size* 20.5 11,583 14.1 431,684 20.2 1,180 Gender 17 400 23.4 780 Race/Ethnicity 18.3 958 24 126 27.6 68 Age Group 25.6 70 26.4 197 20.5 493 5.5 414 Education 25.5 129 21.9 404 24.8 316 8 329 Income 32.5 329 25.3 287 7.6 383 2010 % at Risk 19.7 14.9 16.8 Sample Size* 18,004 449,950 1,750 % at Risk 18.8 14.6 21 11 22.4 614 1,136 17.3 24.9 13.1 29.5 22.2 1,393 182 116 16.5 28.2 36.7 14.3 21.4 21.3 5 94 241 679 720 28.3 27.2 22.7 5.2 32.6 17.5 14.3 7.6 201 550 511 481 32.1 23.6 23.8 6.2 28.9 14 5.9 521 407 519 30.4 21.5 8.2 Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) Note: This data represents respondents 18 years and older who report that they could not see a doctor in the past 12 months because of cost.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers. Uninsured 61 
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According to the most recently released (August of 2012) census data, more than one fourth of residents in Angelina, Polk and San Augustine Counties and Texas are uninsured. Polk County has the largest percentage of uninsured residents (29.3%), while San Augustine County has seen the largest increase in uninsured residents (a 5.9 percentage point difference) between 2007 and 2010. Angelina County has the smallest percentage of uninsured residents (25.9%) and also had the smallest increase (1.4 percentage points) between 2007 and 2010. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Uninsured and Insured Residents Under 65 Years of Age Location Angelina County Polk County San Augustine County Texas Year 2007 2008 2009 2010 2007 2008 2009 2010 2007 2008 2009 2010 2007 2008 2009 2010 Demographic Group: Number 70,013
69,234
69,938
72,621
34,468
34,164
36,171
32,787
6,564
6,456
6,315
6,715
21,504,681
21,348,989
21,730,992
22,098,206
Uninsured: Number Uninsured: % Insured: Number Insured: % 17,142
17,448
17,862
18,818
8,973
9,260
10,830
9,609
1,415
1,616
1,594
1,849
5,765,132
5,494,593
5,710,171
5,820,793
24.5
25.2
25.5
25.9
26
27.1
29.9
29.3
21.6
25
25.2
27.5
26.8
25.7
26.3
26.3
52,871 51,787 52,075 53,803 25,496 24,905 25,340 23,178 5,148 4,841 4,722 4,866 15,739,550 15,854,396 16,020,821 16,277,413 75.5
74.8
74.5
74.1
74
72.9
70.1
70.7
78.4
75
74.8
72.5
73.2
74.3
73.7
73.7
Source: United States Census Bureau, Small Area Health Insurance Estimates Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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InputFromPeopleWhoRepresent
theBroadInterestsofthe
Community
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InputFromPeopleWhoRepresenttheBroadInterestsoftheCommunity
InterviewFindings
As part of the data collection process, representatives from CHC Consulting conducted interviews with twenty‐one (21) stakeholders from September 5, 2012 – October 16, 2012. Interviews were conducted with people who represent the broad interests of the community including:  People with special knowledge of or expertise in public health  Federal, tribal, regional, state or local health departments or agencies with information relevant to the health needs of community served  Leaders, representatives or members of medically underserved, low‐income and minority populations, and populations with chronic disease needs in the community served The counties represented included Angelina, San Augustine and Polk. The goal of the interviews was to gather opinions and perceptions on current health care issues faced in the counties served and/or populations represented. These institutions shared statistical information along with anecdotal information about health needs in the community. Background information was gathered for each interview subject, including:  Organization Description and Functions  Respondent Position and Tenure with Organization  Subject’s Background, Related Years’ Experience and Community Connections The organizations represented in the interviews include: 
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Alabama‐Coushatta Tribe Alcohol and Drug Abuse Council‐ (Lufkin/Livingston 12‐county area) American Cancer Society – East Texas Region Angelina County Health District Boys and Girls Club – San Augustine County Family Crisis Center of East Texas Lufkin Independent School District Memorial Medical Center ‐ Livingston 
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Memorial Medical Center – Lufkin Memorial Medical Center – Lufkin Board of Trustees Polk County Advisory Committee San Augustine County San Augustine County Health District San Augustine County Judicial System The Burke Center Twin Lakes Rehabilitation and Care Center United Way – Angelina County *A full listing of respondent names and descriptions can be found in the Appendix. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Areas Served by Organization The counties served by the interviewees are broken out in the chart below. Five of those interviewed work for an organization that serves more than one county in the area, and three are employed by state or national organizations which also serve multiple counties. Community Need Summary The interview subjects were asked to identify what they felt to be the three “biggest health needs” in the county(ies) they serve. Many of these responses were “organization‐specific” – i.e. related to the populations served by subjects’ organizations. However, several other interview questions probed specifically on the greatest challenges felt to be inhibiting access to, or adequacy of, healthcare services for the community. Interviewees discussed the following general categories as the most significant health needs:  Access to affordable primary care  Access to affordable dental services  Need for additional providers  Lack of mental and behavioral health continuum of care  Unhealthy lifestyles  Patient education and preventive care  Access to transportation A more detailed breakdown of each category follows: Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Access to Affordable Primary Care Interviewees discussed that physicians may be present in the community but accessibility has more to do with ability to pay than the availability of primary care providers. Financial resources to “afford” primary or preventive care for the low income/indigent are limited. State‐funded and county health clinics for low income and under/uninsured patients are a valuable and effective resource for primary care, however additional funding is needed for these clinics to provide care for greater numbers of community members needing reduced cost services. Many primary care physicians (PCPs) with full practices don’t accept new patients, and others are turning away those with Medicare, Medicaid and governmental HMO products. This particularly impacts the elderly, retirees and low income that are limited in coverage options, and can find few providers accepting their insurance. Often the low income and under/uninsured patients view healthcare as a luxury, and use the emergency department (ED) for primary care because it is “affordable” and they can’t be turned away. The programs that the low income/underinsured can take advantage of are only available out of the county, and those at‐risk populations have to leave to access them. Medicaid has gone HMO and those patients trying to access primary care aren’t able to find physicians accepting their HMO products within a drivable distance. Access to Affordable Dental Care The consensus of the interview subjects was that the community seems to have an adequate volume of dental providers. However, there is need for locally available reduced fee or free clinics for the low income/uninsured. The uninsured do not typically seek preventive care, even at the free clinics that are available out of town in the larger cities. Dental care for these populations is typically not sought until dental issues escalate into serious, expensive problems. Low‐income families with health insurance frequently do not spend any discretionary income to obtain dental insurance or preventive dental care or maintenance. Dental providers were mentioned who are offering reduced fee services (Hollywood Dental, Nacogdoches FQHC); however, community awareness of these services is low, and wait times for an appointment can be three to four months. Lack of available transportation is another barrier to obtaining dental services. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Nacogdoches has an FQHC that has a dental program, but their waiting list is 3‐4 months long. And transportation becomes an issue. For kids, there is a little bit more because Medicaid pays, CHIP pays – we have a Title 5 program that pays for dental. A lot of dentists will donate time for kids, but not for adults. [The elderly] can’t get dentures through the Older Adult Protective Services because our local dentist can’t meet their fixed cost ($1000) We do have dentists and oral surgeons around…it’s not an access issue – it’s a coverage issue (insurance). Need for Additional Providers Interview subjects mentioned that in San Augustine and Polk Counties, there are an inadequate number of primary care physicians, and that the existing practitioners are overwhelmed. This is particularly true for the PCP’s accepting Medicare and Medicaid patients. Specialist care is available, but some specialists are not geographically located within driving distance, which becomes a barrier to those with limited or no transportation. Interviewees did acknowledge a difficulty with recruiting physicians to the community, particularly for Polk and San Augustine counties. There is a significant need for private practice psychiatrists accepting insurance to serve the communities (both inpatient and outpatient). The Burke Center (MHMR, state funded) is a respected resource but has very limiting criteria for admission (“priority population”) and typically has a waiting list. The Audubon Behavioral Healthcare (eldercare) has inpatient and outpatient programs, but only accepts insured seniors 55 and older. Also cited was the youth population, which has specific need for additional therapists to serve their psychiatric and behavioral issues. We do not have enough PCPs in east Texas. Those we do have are overwhelmed; many do not accept new patients or many types of insurance. Our school clinics are overwhelmed. Access to care for children is an issue. We only have one pediatric group and they limit their practice – they don’t take certain diagnoses and Medicaid products. So [children] go without or travel to Houston. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Lack of Mental and Behavioral Health Continuum of Care There was consensus among those interviewed that significant gaps exist in the continuum of care for patients with mental or behavioral health issues, particularly following discharge from an inpatient setting. Patients needing ongoing psychiatric medication management are underserved, due to the unavailability of psychiatrists serving the area. Substance abusers are particularly impacted as they need to transition through the continuum but the resources are not available for them. There is a complete gap for serving the needs of patients with “less severe” mental illness (Anxiety, Depression, Bi‐Polar, etc.) as they do not meet the criteria for admission to the Burke Center, and have difficulty finding psychiatric and therapist outpatient care in the area. The mentally ill and those with behavioral health issues have only episodic, crisis‐level care. We don’t have a full time psychiatrist. The jail is overcrowded with people with mental health issues and it is a vicious cycle. They go to ER, jail, health district, back to the ER, etc. Substance abusers have no residential treatment, no detox, limited triage. They fill up the ER’s. There exists no working system to get them stabilized and into proper care settings or follow‐
up treatment.
Unhealthy Lifestyles Interviewees identified top lifestyle issues needing additional attention or promotion of available services such as: I’m not sure there are an adequate number of  Diabetes programs. I think that’s a culture shift that needs  Obesity to be addressed on many fronts – not just  Smoking cessation through the healthcare system.  Heart Disease 
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Parenting Fitness Substance abuse The number of programs positively impacting unhealthy lifestyles has increased over the last two to three years, as well as the promotion of those programs. Specifically mentioned were:  the non‐smoking ordinance  early detection cancer screenings  The Coalition organization serving Angelina County and surrounding areas. Its mission is to “to eliminate the use of harmful substances by influencing public policy, laws, attitudes and behaviors to foster healthy life‐long choices in East Texas.”  “Transforming Texas” ‐ The Angelina County Health District obtained a Community Transformation Grant for this five‐year project, a federally funded initiative supporting Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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communities, workplaces, schools and healthcare providers as they work together to reduce chronic disease, lower the cost of care, and promote healthy living and prevention. Patient Education and Preventive Care The need to increase patient education and awareness of the appropriate usage of providers for primary care and non‐urgent needs was mentioned throughout the stakeholder interviews. Interviewees discussed the severe misuse of hospital emergency departments for primary care, and agreed that the community would benefit from increased awareness about what resources are available and how to access them. Education is needed to help patients with current issues, but equally important, to prevent future complications and unnecessary healthcare costs. The focus of the education should be on prevention, education and early intervention – not just disease management. Mental and dental health education is also necessary. Central to the success of any initiative is the need for increased patient compliance and responsibility. Educating the population and having resources out in the community to tell people they can access care – that they don’t even know that they need – is a real issue. Money for real prevention has been lacking, but it’s improving. Some of the Affordable Care Act money is coming. But it takes months for change to come. Our population (Native Americans) is especially at risk for unhealthy lifestyles – Diabetes especially. Outside of the 8‐week Diabetes education program, there is nothing else; no programs available outside of daytime working hours. Illegal immigrants – they have no insurance; they use the ED for primary care AND emergency care. Others have difficulty also – basically anyone who is not educated on what to do and where to go for services that are available. Fear of cost is the big issue driving low income patients to the ED. Patient education and compliance…due to socioeconomic status…this is the top barrier. We’re a rural area, and “poor people have poor ways”. Cycles of bad habits repeat and people don’t learn to change their ways. Diabetics and other especially non‐compliant patients…are sucking up the resources and still not getting control of their disease. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Access to Transportation In addition to affording the care, patients often have issues just getting transportation to healthcare providers. There is a specific need for access to affordable resources and transportation for low income and elderly. The underlying main issue is transportation. Our county is spread out – the people who are indigent very seldom have access to reliable transportation. County‐Specific Issues Some of the issues which were raised in the interviews pertained specifically, or more so, to one county. These observations are noted below, by county. Specific Issues for Angelina County 
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Angelina County has better resources and more providers than San Augustine or Polk Counties, but accessibility to affordable primary care continues to be a central issue While primary care providers exist in Angelina county, residents may travel out of town to larger cities for specialist care ‐ Interviewees perceive that specialists are either absent or do not accept many forms of insurance There is only one licensed school psychologist serving Lufkin ISD and no psychiatric care in the area In Angelina County we have 2 Medicaid products and 90% of the physicians only accept one of those products We have the Angelina Drug and Alcohol Council – but they don’t have funding and they are overwhelmed – a real gap for substance abuse exists. Specific Issues for Polk County 
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Largely rural area with higher ratios of low income, under/uninsured and minority populations Polk County has a large American Indian Tribal population ‐ High prevalence of Diabetes, obesity and Heart Disease among the tribe ‐ No locally available dialysis centers There are very few providers located in Polk County; residents tend to wait until they are in crisis to seek healthcare Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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No accessibility to mental health services in Polk County Dental patients have to drive long distances to find access to affordable dental care (dentists offering sliding scale, free clinics or dental schools) ‐ Transportation for those who do not have vehicles or cannot afford gasoline is a problem The ratio of PCPs/population nationwide is 1 per In Polk Co there are no safety net PCP providers. 650. In Texas it is 1 per 1000. In Polk County we are 1 per 1300, or about half the nationwide average. A lot of the problems are non‐medical issues, such as teenage pregnancies, obesity, number of high school graduates, etc. The medical issues revolve around the central problem of being critically underserved by primary care doctors. Considering the rapidly growing elderly population and number of retirement communities in Polk County, this is a tremendous problem. Specific Issues for San Augustine County 
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The under/uninsured drain the resources of the healthcare system Residents of San Augustine county do not have adequate knowledge of the health clinic located in Angelina County serving uninsured, immigrant and Medicaid populations from the entire region ‐ Greater awareness, education and usage of this clinic is needed to avoid misuse of the San Augustine ED High readmission rates for the County, which is linked to non‐compliance issues and shortage of PCPs in the area Mental health services are extremely limited, as well as services for substance abusers County is also underserved by PCPs We need more PCPs! The biggest thing is they are not taking Medicaid; some won’t take Medicare. Those who will are so overloaded, and also serve nursing homes and round at hospital – how do they do it?
We need on the ground help for people suffering from addiction – ready to go. There are no beds for detox; we need someone here 24/7 to help us. Burke Center does what they can but crises don’t happen during office hours. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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We have a very large non‐compliant population. Even those with insurance tend to be non‐
compliant so that their disease process is exacerbated and readmissions are high.
The illegal immigrant population are uninsured and don’t qualify for programs available to other low income residents of San Augustine County. People who live in rural areas, outlying cities farther out… San Augustine has a lot of little towns and the patients don’t come in town for care until they have major healthcare issues like a stroke or are in crisis. It is mostly due to finances – they can’t afford primary care or transportation. Too often it is too late to help them. Populations Most At Risk for Inadequate Care Interview participants were asked to identify those patient populations which they felt were most at risk for receiving inadequate healthcare, given the current circumstances and resources available to them. The following groups were mentioned specifically:  Low‐income and under/uninsured  Minority populations; especially undocumented Hispanics and non‐English speaking (fear of deportation is a factor)  Mentally ill – both adult and youth populations  Substance abusers  Elderly – especially those with Medicare HMOs widely rejected by physicians  Those without transportation  Medicare and Medicaid patients, due to non‐acceptance by PCPs and specialists  Native Americans – specialist care outside of the clinic services available on the reservation for chronic, prevalent conditions (Diabetes, Obesity, Heart Disease)  Children – lack of adequate volume of PCPs Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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The elderly – they fall through the cracks; they don’t have family to assist in the area, and also they may make too much money to qualify for a program, but their expenses have increased, so what looks good on paper is not reality. The tribe members are highly at risk for Diabetes; prevalence is very high. …kids go without or travel to Houston. Our school clinics are overwhelmed. I am concerned about our Hispanic community – I do not know how they’re served. They are a silent population – we are just now making inroads to get information about them. Our elderly are so indigent they get prescriptions and sell them to get food. Positive Aspects of the Healthcare System Interviewees were asked to pinpoint several of the characteristics which they felt were the most “positive” aspects of the current healthcare system serving the counties – the attributes which were noteworthy and genuine “pluses” for the community. The following assets were cited as positives, and are listed in order by those mentioned most often: Negative Aspects of the Healthcare System Conversely, interviewees were asked to pinpoint several of the characteristics of the current healthcare system which they felt stood out as being most in need of improvement. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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SurveyFindings
An electronic survey was distributed to all 21 telephone interviewees seeking information about crucial health issues affecting the residents of Angelina, Polk and San Augustine Counties. The survey remained open between September 5, 2012 and October 6, 2012. Sixteen of the 21 interviewees responded to the survey, yielding a response rate of 76.2%. Respondents were allowed to take the survey only once but were encouraged to forward the survey to additional community leaders. (We were not able to track the number of times the survey was forwarded so it is difficult to calculate an overall response rate.) It should be noted that not all survey questions were answered by all of those submitting surveys. The percentages reflected in the following summary were calculated using the actual number of respondents to the specific survey question. The following is a summary of the survey findings:
Organization Type 
Respondents were asked to select the type of organization they work for. The majority of respondents selected not for profit (44%), while 19% selected governmental agency and 12% selected healthcare facility. What type of company/organization do you work for?
25%
44%
Not for Profit Organization
Governmental Agency
Healthcare Facility
12%
Other
19%
n=16 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Organization Listing 
Of the 16 survey responses, 13 provided the name or a description of the organization they work. This includes: o
o
o
o
o
o
o
o
o
o
o
o
American Cancer Society Angelina Cities & County Health District Angelina Radiation Oncology Associates Burke Center Lufkin Independent School District Memorial Health System of East Texas Memorial Multi‐Specialty Associates Polk Oil Corporation San Augustine San Augustine City‐County Hospital District Twin Lakes Rehab and Care Center Women’s Shelter of East Texas, Inc. Areas Served by Organizations 
In terms of areas served, 62.5% (10 out of 16) of respondents serve Angelina County, TX residents, 50.0% (8 out of 16) serve Polk County, TX residents, 56.3% of respondents (9 out of 16) serve San Augustine County, TX residents and 31.3% (5 out of 16) serve other counties. Note that respondents were allowed to select all that apply. Percentages are greater than 100% due to multiple responses 100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Your organization assists residents in which of the following counties? 62.5%
56.3%
50.0%
31.3%
Angelina County
Polk County
San Augustine County
n=16 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Population Need Health Adequacy 
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Survey respondents were asked “How would you categorize the following groups with respect to how well each population’s health needs are currently being met?” Respondents were asked to select from 6 options: very adequate, adequate, neutral, inadequate, very inadequate and unsure. Results were analyzed in three groups: o Very adequate and adequate o Very inadequate and inadequate o Neutral and unsure More than 50 % of respondents selected very inadequate or inadequate services for: o Persons experiencing mental illness o Persons with chemical dependency o Unemployed n=16 Health Service Adequacy 
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Survey respondents were asked to rate a set of services to determine if they are adequately provided in their community, or if the services need to be improved to advance the health and safety of residents in their community. Respondents were asked to select from 6 options: very adequate, adequate, neutral, inadequate, very inadequate and unsure. Results were analyzed in three groups: o Very adequate and adequate Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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o Very inadequate and inadequate o Neutral and unsure More than 50 % of respondents selected very inadequate or inadequate services for: o Mental health screenings o Nutrition and weight management programs o Tobacco cessation programs Angelina and Polk County findings on this topic are consistent with overall findings, but San Augustine County respondents also identified vision/hearing screenings as an area where the services currently being provided are inadequate n=16 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Prioritization
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PrioritizationoftheCommunity’sNeeds
After reviewing the health data, interview findings and survey findings the CHNA Team participated in a facilitated discussion with CHC Consulting on November 6, 2012 to identify the top health needs facing the community. Findings indicated that there were eight main needs in the communities served by Memorial – Livingston. A matrix (see the appendix) was used to prioritize those health needs based on three characteristics: size and prevalence of issue, effectiveness of interventions, and MHSET’s capacity to influence change in that initiative. Each of the three characteristics (size and prevalence, effectiveness, and hospital capacity) was evaluated on a scale from 1 to 5; 1 being the most important and 5 being the least important. The numeric value for each characteristic (size and prevalence, effectiveness of interventions, hospital capacity) was calculated by averaging the responses in each category. The point values for the overall priorities were calculated by averaging the three characteristics associated with each priority. Therefore, the lower the number, the more important the priority was deemed. The needs were prioritized by the CHNA Team in the following order: 1. There is a need for prevention, education and early detection for heart disease, cerebrovascular disease, diabetes and cancer 2. The community needs increased access to affordable primary care 3. The community needs additional healthcare providers  Primary care physicians, specialists, mental health providers, and physicians accepting Medicare and Medicaid HMO products 4. There is a need to address unhealthy lifestyles such as smoking and obesity 5. There is a lack of a mental health and behavioral health continuum of care 6. There is a need to decrease health disparities by targeting specific populations, including:  The high prevalence of diabetes among Native Americans in Polk County  Low income, un/underinsured and elderly  A safe place for treatment for undocumented persons  A culturally sensitive, language appropriate healthcare environment for minority populations 7. There is a need to increase access to transportation for healthcare services for those without access (such as elderly and low income residents) 8. The community needs increased access to affordable dental care Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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The final ranked needs, along with their final scores, are shown in the chart below (note that the lower the score, the more important the need): After much discussion, the CHNA Team agreed to address the following top seven priorities (shortened for report purposes). 1. Prevention, education and early disease detection 2. Access to affordable primary care 3. Additional healthcare providers 4. Change in unhealthy lifestyles 5. The lack of mental health and behavioral health continuum of care 6. Decrease health disparities by targeting specific populations 7. Access to transportation to health services The CHNA Team decided not to specifically address the need for “increased access to affordable dental care.” Dental care was ranked last on the list, largely due to the health system’s lack of capacity to address that need. Dental services are not a core business function of the health system and the CHNA Team felt that resources and efforts would be better spent addressing the first seven prioritized needs. Please see the Memorial – Livingston’s hospital specific Implementation Plan, which identifies objectives and tactics that fit under the priorities they have chosen to address. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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PrioritiesthatWillNotbe
Addressed
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PrioritiesThatWillNotBeAddressed The need for “increased access to affordable dental care” was ranked eighth out of the eight identified health needs in the communities served by Memorial ‐ Livingston. While this is a concern in the community, the CHNA Team decided to focus their efforts on the other seven priorities because dental care is not a core business of the health system and is outside the scope of hospital influence. As a result, community benefit activities would be more beneficial in the other seven prioritized areas. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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ResourcesintheCommunity
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AdditionalResourcesintheCommunity
In addition to the services provided by Memorial ‐ Livingston, other charity care services and health resources available in the community are included in this section. In addition to MHSET, the organizations or publications that have provided this comprehensive list are as follows: 
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The Interagency Coalition Serving East Texas – August 2011 The Polk County Social Services Phone Directory The Angelina County and Cities Health District The Texas Cancer Information Website (texascancer.info) Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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ABUSE
Abuse Hotline .................................................. 1-800-252-5400
DETCOG STAR ................................................... 1-800-256-7696
Family Crisis Center of E. TX 24 Hr. Hotline ....... 1-800-828-7233
Harold’s House - Angelina Alliance for Children ... 936-634-1999
Sheepfold Texas Shelter ...................................... 936-465-4311
TX. Dept. of Family & Protective Services............. 936-633-3722
ADOPTION AND FOSTER CARE SERVICES
Bair Foundation ................................................... 936-632-2247
Buckner Children & Family Services ..................... 936-637-3300
Methodist Children’s Home ................................. 936-632-9537
Pregnancy Help Center of Lufkin .......................... 936-632-9292
ALCOHOL/DRUG ABUSE
Alcohol & Drug Abuse Council ............................. 936-634-5753
Alcoholics Anonymous ......................................... 936-634-6316
Celebrate Recovery .............................................. 936-634-8341
DETCOG STAR ................................................... 1-800-256-7696
Most Excellent Way (Adult) ................................. 936-632-8450
Partnership for a Drug-Free Texas .................... 1-877-966-3784
CHILD/ADOLESCENT SERVICES
COUNSELING/MENTORING SERVICES
Alcohol & Drug Abuse Council ... 1-800-445-8562/936-634-5753
Angelina College ................................................... 936-639-1301
Angelina Mental Health Care - Burke Center ........ 936-639-2384
Buckner Children & Family Services ...................... 936-637-3300
Consumer Credit Counseling Services................ 1-800-873-2227
DETCOG STAR .................................................... 1-800-256-7696
Family Counseling Associates ............................... 936-630-3799
Family Crisis Center of E. TX 24 Hr. Hotline........ 1-800-828-7233
For Kids Sake ........................................................ 936-639-3916
Lufkin Veteran’s Administration Clinic .................. 936-631-4358
Mosaic Center ...................................................... 936-639-5068
NAACP .................................................................. 936-559-5336
Planned Parenthood ............................................. 936-634-8446
Pregnancy Help Center of Lufkin .......................... 936-632-9292
SFA Counseling Center.......................................... 936-468-1041
Samaritan Counseling Center ............................... 936-639-6512
CRISIS INTERVENTION/EMERGENCY SERVICES
Alcohol & Drug Abuse Council (ADAC) .................. 936-634-5753
Alcoholics/Narcotics Anonymous ......................... 936-634-6316
Christian Information & Service Center (CISC) ..... 936-634-2857
DETCOG STAR .................................................... 1-800-256-7696
Diboll Christian Outreach ..................................... 936-829-2737
East Texas Lifeline ............................... 936-639-7675/635-9375
Emergency Mental Health Services ................... 1-800-392-8343
Family Crisis Center of E. TX 24 Hr. Hotline........ 1-800-828-7233
Pregnancy Help Center of Lufkin .......................... 936-632-9292
Red Cross.............................................................. 936-634-6013
Salvation Army ..................................................... 936-634-5132
United Way .......................................................... 936-632-3203
EDUCATION/TRAINING continued
Deep E.T. Workforce Development Board ...... 936-639-8898
DETCOG STAR .............................................. 1-800-256-7696
Harold’s House-Angelina Alliance for Children 936-634-1999
Head Start
Center Based ............................................... 936-639-4009
Home Based ................................................ 936-639-2060
Little Panthers ............................................. 936-225-3283
Health Horizons of East Texas ...................... 1-800-745-8240
Even Start Family Literacy
Diboll ........................................................... 936-829-3744
Lufkin .......................................................... 936-633-7327
Gateway Prevention ....................................... 936-699-3925
Goodwill Industries
LaWanda Clark Adaptive Technology Ctr ..... 936-632-8838
H.O.P.E. Center of North Lufkin ...................... 936-633-6863
Kurth Memorial Library-Lufkin ........................ 936-630-0561
Lufkin Adult Learning Center........................... 936-639-3059
Lufkin Workforce Solutions ............................. 936-639-1351
Lufkin Workshop & Opportunity Center ......... 936-639-1291
March of Dimes .............................................. 936-633-2630
Methodist Children’s Home-Parenting ............ 936-632-9537
Mosaic Center ................................................. 936-639-5068
National Alliance of Mental Illness (NAMI) ..... 936-632-6177
Pinewood Park Learning Center ...................... 936-699-1303
Pineywoods Area Health Education Ctr(AHEC) 936-632-7823
Planned Parenthood ....................................... 936-634-8446
Pregnancy Help Center of Lufkin ..................... 936-632-9292
Stubblefield Learning Center........................... 936-634-1100
Texas AgriLife Extension Services .................... 936-632-8239
Texas Department of Assistive and
Rehabilitative Services (DARS) .................. 1-800-628-5115
TLL Temple Library-Diboll................................ 936-829-5497
Alcohol & Drug Abuse Council (ADAC) ................. 936-634-5753
Angelina County & Cities Health District:
HIV & STD Counseling & Education................... 936-632-1139
Primary Care, CHIPS Provider ........................... 936-632-1139
Maternal & Infant Health ................................. 936-632-1139
Immunizations .................................................. 936-632-1139
Women, Infants & Children (WIC) .................... 936-637-7242
Boys & Girls Club of East Texas – Diboll ............... 936-829-5711
Boys & Girls Club of East Texas – Lufkin ............... 936-632-3301
Buckner Children & Family Services ..................... 936-637-3300
DISABILITY SERVICES
Cake Angels Foundation....................................... 936-637-3051
East Texas Lifeline ............................... 936-639-7675/635-9375
Children’s Protective Services (CPS) ..................... 936-632-7708
ELDERLY SERVICES
Goodwill Industries .............................................. 936-632-8838
Community Resource Coalition Group ................. 936-634-9308
Adult Protective Services ................................ 936-632-7708
Relay Texas ........................................................ 1-800-676-3777
Connections Prevention Program - Burke Center. 936-699-3925
Alzheimer’s Association .................................. 936-632-9930
Relay Texas (TTY/TDD ACCess) for Voice ........... 1-800-735-2988
Cornerstone Early Childhood Intervention (ECI) .. 936-634-4703
Angelina County Senior Citizens Center .......... 936-634-4179
for Hearing Impaired .......... 1-800-735-2989
Court Appointed Special Advocates (CASA) ......... 936-634-6725
Social Security Administration ........................... 1-877-407-3442
Area Agency on Aging of Deep East Texas.... 1-800-435-3377
East Texas Support Services
Lewis Toran Retirement Community ............... 936-634-8899
Texas Department of Assistive and
Child Care Management ............................... 1-800-256-1030
Salvation Army Adult Day Center .................... 936-634-1234
Rehabilitate Services (DARS) .......................... 1-800-628-5115
Quality Improvement Project ....................... 1-800-256-1030
Social Security Administration ..................... 1-877-407-3442
Division for Blind Services ................................. 936-630-3960
Family Counseling Associates ............................... 936-630-3799
Timber Pointe Apartment Homes ................... 936-634-1347
Division for Rehabilitation Service .................... 936-630-3940
Gateway Challenge Course .................................. 936-875-8100
Dept. of Aging & Disability Services .................. 936-632-7708
Gateway Prevention Services ............................... 936-699-3925
EMPLOYMENT SERVICES
The District (Transit) .......................................... 1-800-272-0039
Goodwill Industries/ Goodguides®Mentoring ...... 936-632-8838
Goodwill Industries ......................................... 936-632-8838
Harold’s House - Angelina Alliance for Children ... 936-634-1999
EDUCATION/TRAINING
Lufkin Workforce Solutions ............................. 936-639-1351
Head Start
Lufkin Workshop & Opportunity Center ......... 936-639-1291
Alcohol & Drug Abuse Council (ADAC) .................. 936-634-5753
Center Based ................................................... 936-639-4009
New Directions Industries (NDI) ...................... 936-633-7998
Alzheimer’s Association ........................................ 936-632-9930
Home Based .................................................... 936-639-2060
Texas Department of Human Services ............ 936-632-7708
Angelina College ................................................... 936-639-1301
Little Panthers ................................................. 936-225-3283
Boys & Girls Club of Deep East Texas – Diboll ....... 936-829-5711
Texas Department of Assistive and
Job Corps ............................................................. 936-639-1351
Boys & Girls Club of Deep East Texas – Lufkin ...... 936-634-4490
Rehabilitative Services (DARS) .................. 1-800-628-5115
Kurth Memorial Library-Lufkin ............................. 936-630-0561
Texas Veterans Commission ........................... 936-639-1351
Buckner Family & Children Services...................... 936-637-3300
Love, INC .............................................................. 936-637-6637
Burke Center ........................................................ 936-639-1141
Lufkin Parks and Recreation ................................. 936-633-0250
FINANCIAL ASSISTANCE
Communities in Schools of Deep East Texas
Lufkin Workforce Solution ................................... 936-639-1351
(Food, Clothing, Utilities, Transportations, $$$)
Lufkin High School ............................................. 936-630-4108
Texas AgriLife Extension Services ......................... 936-632-8239
Angelina County Senior Citizens Center .......... 936-634-4179
Lufkin Middle School ......................................... 936-633-6125
Texas Health Steps ............................................ 1-877-847-8377
AreaPlan
Agency on Aging of Deep East Texas.... 1-800-435-3377
Program-Burke
Center ...and
936-699-3925
Memorial Medical Center - Livingston Connections
CommunityPrevention
Health Needs
Assessment
Implementation
TLL Temple Library-Diboll..................................... 936-829-5497
Christian Information & Service Center(CISC) . 936-634-2857
Community Hospital Consulting
FINANCIAL ASSISTANCE continued
(Food, Clothing, Utilities, Transportations, $$$)
Community Action .................................................. 936-639-4787
Consumer Credit Counseling Services.................. 1-800-873-2227
Diboll Christian Outreach ....................................... 936-829-2737
East Texas Food Bank ............................................. 936-707-2139
Godtel Ministries .................................................... 936-637-2520
Goodwill Industries VITA Site ................................. 936-632-8838
Love, INC. ............................................................... 936-637-6637
Medicaid, TANF, SNAP ............................................ 936-632-7708
Red Cross ................................................................ 936-634-6013
Salvation Army ....................................................... 936-634-5132
Women, Infants and Children (WIC) ....................... 936-637-7242
HOUSING ASSISTANCE
Community Action .................................................. 936-639-4787
Creekside Estates ................................................... 936-639-4045
DETCOG Regional Housing Authority ...................... 936-634-2247
Main Office Location – Jasper ............................ 409-384-5704
Diboll Housing Authority ........................................ 936-829-5440
Family Crisis Center of E. TX 24 Hr. Hotline.......... 1-800-828-7233
Godtel Ministries .................................................... 936-637-2520
Habitat for Humanity .............................................. 936-632-8445
High Point Plaza ...................................................... 936-632-9585
Huntington Housing Authority................................ 936-876-5412
Inez Tims Apartments ............................................. 936-632-5706
Joe Elliott House ..................................................... 936-631-3400
Lotus Lane Apartments........................................... 936-634-2529
Love, INC ................................................................ 936-637-6637
Ministry in Action ................................................... 936-634-8899
Pinewood Park Apartments .................................... 936-632-6322
Pineywoods HOME Team ....................................... 936-637-7607
Red Cross ................................................................ 936-634-6013
Salvation Army ....................................................... 936-634-5132
Seasons of Hope ..................................................... 936-875-1900
Sheepfold Texas Shelter ........................................ 936-465-4311
Stephen’s Court ...................................................... 936-634-2289
Timber Pointe Apartment Homes ........................... 936-634-1347
USDA Rural Housing Development ...................... 1-800-414-1226
IMMIGRATION/CITIZENSHIP
Lufkin Adult Learning Center .................................. 936-639-3059
U.S. Congressional District Office ........................... 936-632-3180
INTELLECTUAL AND DEVELOPMENTAL SERVICES
Autism Coalition ..................................................... 936-632-7944
Burke Center .......................................................... 936-639-1141
New Directions Industries (NDI) .......................... 936-633-7998
IDD Support Services ........................................... 936-639-1479
Innovative Homes of Deep East Texas .................... 936-639-5273
Lufkin Living Center ................................................ 936-634-3353
Lufkin Workshop and Opportunity ......................... 936-639-1291
Oak Creek Center ................................................... 936-633-7480
St. Giles Living ........................................................ 936-639-1600
Texas Department of Assistive and
Rehabilitative Services (DARS) ......................... 1-800-628-5115
Check www.angelinacoalition.org
December 2012 for updates
Page 100
LEGAL/CIVIL RIGHTS SERVICES
Attorney General-Child Support........................ 1-800-252-8014
Lone Star Legal Aid ............................................ 1-800-354-1889
NAACP ................................................................. 936-632-8029
State Representative District Office ..................... 936-634-2686
Texas Workers Compensation.............................. 936-639-6425
U. S. Congressional District Office ........................ 936-632-3180
REHABILITATION SERVICES
Texas Department of Assistive and
Rehabilitative Services (DARS) ....................... 1-800-628-5115
Division for Blind Services ................................. 936-630-3960
Division for Rehabilitation Services ................... 936-630-3940
Wilson McKewen Rehabilitation Center ............... 936-634-2266
SUPERVISION & CORRECTIONS
MEDICAL/DENTAL/HEALTH SERVICES
American Cancer Society ..................................... 936-634-2883
Angelina County and Cities Health District:
Environmental Consumer Health ..................... 936-632-9109
HIV & STD Counseling and Education ............... 936-632-1139
Primary Care, CHIPS Provider ........................... 936-632-1139
Maternal and Infant Health .............................. 936-632-1139
Immunizations .................................................. 936-632-1139
Women, Infants and Children (WIC) ................. 936-637-7242
Angelina County Indigent Health Care ................. 936-634-5431
Caring for Children .................................. 1-800-258-KIDS (5437)
Communities in Schools of Deep East Texas
Lufkin High School ............................................ 936-630-4108
Lufkin Middle School ........................................ 936-633-6125
East Texas Community Health-Dental .................. 936-560-1122
East Texas Lifeline ................................ 936-639-7675/635-9375
East Texas Support Services Medical
Transportation/Medicaid .............................. 1-877-633-8747
Head Start
Center Based .................................................... 936-639-4009
Home Based ..................................................... 936-639-2060
Little Panthers .................................................. 936-225-3283
Health Horizons of East Texas .............................. 936-569-8240
Hospice in the Pines ............................................. 936-632-1514
Joe Elliott House .................................................. 936-631-3400
Love, INC. ............................................................. 936-637-6637
Lufkin Veteran’s Administration Clinic ................. 936-671-4300
Planned Parenthood ............................................ 936-634-8446
Pregnancy Help Center of Lufkin .......................... 936-632-9292
Texas Department of Human Services ................. 936-632-7708
Texas Health Steps ............................................ 1-877-847-8377
Texcare Partnership (CHIPS) ............................. 1-800-647-6558
MENTAL HEALTH SERVICES
Angelina Mental Healthcare ................................ 936-639-2384
Burke Center ........................................................ 936-639-1141
Emergency Mental Health Services Line ........... 1-800-392-8343
Family Counseling Associates ............................... 936-630-3799
Lufkin Veteran’s Administration Clinic ................. 936-671-4358
Lufkin Workshop and Opportunity Center ........... 936-639-1291
National Association for the Mentally Ill .............. 936-632-6177
Texas Department of Assistive and
Rehabilitative Services (DARS) ...................... 1-800-628-5115
Angelina County
Adult Probation Department ............................ 936-634-3976
Juvenile Probation Department ........................ 936-634-8365
TRANSPORTATION SERVICES
Angelina County Senior Citizen Center ................. 936-634-4179
Christian Information and Service Center (CISC)... 936-634-2857
East Texas Support Services
Medical Transportation/Medicaid ................. 1-877-633-8747
Love, INC .............................................................. 936-637-6637
The District ........................................................ 1-800-272-0039
The District (Handicap) ...................................... 1-800-272-0039
VETERAN’S SERVICES
Angelina County Veteran Service Officer .............. 936-639-3833
Lufkin Veteran’s Administration Clinic .................. 936-671-4300
Lufkin Veteran’s Administration Mental Health ... 936-671-4358
Lufkin Workforce Solutions .................................. 936-639-1351
Nacogdoches Workforce Solution ..................... 1-877-560-1441
Texas Veterans Commission ................................. 936-639-1351
Please dial 2·1·1 for assistance in finding additional
resources in Southeast Texas.
Call is toll-free, multilingual and TDD accessible.
Interagency Coalition
Interagency Coalition
The Interagency Coalition is a voluntary
organization of non-profit social service agencies
in the East Texas area working together to link
community needs with community resources. Our
meetings are held at the Lufkin/Angelina County
Chamber of Commerce Community Room on the
rd
3 Tuesday of each month at 1:30 p.m. For more
information, call (936)634-9308 or The Coalition
website: www.angelinacoalition.org
Serving East Texas
 Emergency Services
August 2011
 Education Training
 Employment
 Housing
This brochure made possible by the efforts of:
The Coalition which is a community coalition
 Medical
working to reduce youth drug abuse by nurturing a
community environment that exposes our youth to
positive influences. www.angelinacoalition.org
 Family Services
PREGNANCY SERVICES
&
Angelina County and Cities Health District
The Mosaic Center which is a non-profit dedicated
Maternal and Child Health ............................... 936-632-1139
 Transportation
to strengthening women and their families by
Women, Infants and Children (WIC) ................. 936-637-7242
bridging the gap from dependency to selfBuckner Children & Family Services .................... .936-637-3300
 Alcohol/Drug Abuse
sufficiency
a Christian
environment.
Planned ParenthoodMemorial
............................................
936-634-8446
Medical Center - Livingston Community
HealthinNeeds
Assessment
and Implementation Plan
Pregnancy Help Center
of Lufkin ..........................
936-632-9292
www.mosaiccenter.org
Community
Hospital Consulting
December 2012
Page 101
EMBRACING HOSPICE...................................... 936-327-9991
HOSPICE IN THE PINES .................................1-800-324-8557
ODYSSEY HEALTH CARE ..............................1-800-364-8173
LIGHTHOUSE HOSPICE .................................1-888-290-7727
HOUSING
AMERICAN RED CROSS (Disaster Relief) ....... 936-327-6867
GODTEL (Shelter/Mission) ................................. 936-327-8863
HABITAT for HUMANITY .....................................936-328-8529
HUD/Rural Polk County .......................................409-384-5704
LIVINGSTON EQUAL HOUSING OPPORTUNITY
Livingston Plaza ................................. 936-327-1102
Ridgecrest ...........................................936-327-7456
LIVINGSTON HOUSING AUTHORITY ............... 936-327-5100
LIVINGSTON SENIOR APARTMENTS ............... 936-327-6175
SALVATION ARMY (Disaster Relief) .................. 936-327-6813
WEATHERIZATION (Community Action) ............ 936-327-3011
IMMIGRATION
CITIZENSHIP/Immigration-Beaumont ................. 409-832-7994
ST. JOSEPH’S CATHOLIC CHURCH ................. 936-967-8385
INCOME ASSISTANCE
FOOD STAMPS- See SNAP
HHSC HOTLINE ...............................................1-800-252-9330
HHSC REPORT CHANGES CENTER .............1-888-980-9997
MEDICAID ELIGIBILITY
Corrigan ................................................. 936-398-4188
Livingston ............................................... 936-327-6700
SOCIAL SECURITY1-800-772-1213 or 936-632-2999
SUPPLEMENTAL NUTRITIONAL ASSISTANCE
PROGRAM (SNAP)
Corrigan.............................................. 936-398-4188
Livingston ........................................... 936-327-6700
TANF (Temp Assist to Needy Families)
Corrigan ............................................. 936-398-4188
Livingston ........................................... 936-327-6700
LAW ENFORCEMENT
CORRIGAN CITY POLICE ..................................936-398-2551
CRIME STOPPERS 936-327-7867 or ............. 1-800-336-1484
DEPT OF PUBLIC SAFETY ................................936-327-6858
IAH DETENTION CENTER .................................936-967-8000
LIVINGSTON CITY POLICE ...............................936-327-3117
ONALASKA CITY POLICE ..................................936-646-5676
POLK COUNTY SHERIFF ..................................936-327-6810
PROBATION:
Juvenile .............................................. 936-327-6850
Adult ................................................... 936-327-6872
TDCJ- Polunsky Unit .......................................... 936-967-8082
LEGAL SERVICES
ATTORNEY GENERAL ................................... 1-800-252-8014
Child Support-Woodville .................. 1-800-687-8249
TX REP – John Otto
Austin ................................................. 512-463-0507
Dayton ................................................ 936-258-8135
Consumer Protection ......................... 512-463-2185
EAST TEXAS LEGAL AID SERVICES ............ 1-800-695-5136
Huntsville Of¿ce ................................. 936-295-5136
REHABILITATION SERVICES
BURKE CENTER - (In Home & Family Support)
936-639-5419
BURKE CENTER - TCOOMMI ............................ 936-676-1229
BURKE CENTER - MR Services ......................... 936-967-0762
BURKE CENTER - Mental Health Srvc ............... 936-327-3786
CCAD - (Community Care Aged/ Disabled) ....... 936-327-6731
CROW THERAPIES ............................................ 936-328-8148
DADS - Division for Blind Service ....................1-800-687-7033
DADS - (In Home & Family Support) ................... 936-327-6752
DEPT OF ASSISTIVE REHAB SERVICES ........ 936-327-1490
LIVINGSTON PHYSICAL THERAPY .................. 936-327-4084
LUCI’S LEGACY (SECOND CHANCE RANCH)
............................................................................. 936-933-6228
MDCP - Med Depend Children Pgm ................ 1-877/438/5658
TWELFTH TRADITIONS ..................................... 936-662-9428
WILSON-MCKEWEN REHAB CENTER – Lufkin......................
............................................................................. 936-634-2266
SENIOR CITIZENS
AGED & DISABLED – HHSC ..............................936-327-6731
DADS - Community Care Aged & Disabled .........936-327-6731
HHSC - MEDICAID for Aged & Disabled .............936-327-6731
AREA AGENCY ON AGING 1-800-435-3377 or .......................
.............................................................................409-384-5704
ESCAPEES CARE CENTER (Day Care) ............936-327-4256
POLK COUNTY AGING SERVICES ...................936-327-6844
SENIOR CITIZENS CENTERS
AC Indian Reservation ......................... 936-563-4391
Corrigan ............................................... 936-398-4090
Livingston ............................................ 936-327-6844
Onalaska ............................................. 936-646-5914
SOCIAL SECURITY .........................................1-800-772-1213
Lufkin District Of¿ce ..................................1-877-407-3442
US REP – KEVIN BRADY ........................... 936-441-5700
SUPPORT GROUPS
AA & AL-ANON- Goodrich ................................... 936-327-7889
ABRAHAM LOW SELF HELP SYSTEMS ........... 936-967-0177
ALABASTER TEEN MOM SUPPORT GROUP.........................
............................................................................. 936-967-5360
ALCOHOLICS ANONYMOUS (Mon-Sat noon & 8pm) ............
............................................................................. 936-327-2204
ALZHEIMER’S SUPPORT GROUP .................... 936-327-2218
AMERICAN CANCER SOCIETY DIALOGUE GROUP .............
............................................................................. 936-327-4084
BETTER BREATHER’S CLUB ............................ 936-327-8825
CARE GIVERS (Escapees .................................. 936-327-4256
CELEBRAL PALSY AWARENESS GROUP ........ 936-397-3673
COMPASSIONATE FRIENDS 936-563-4180 or ....................
............................................................................ 936-646-4035
DIABETES SUPPORT GROUP .......................... 936-329-8253
DIVORCE CARE ................................................. 936-327-5614
SUPPORT GROUPS (continued)
FAITH-Support for Area Military Men & Women ........................
............................................................................. 936-327-4084
FIBROMYALGIA, CFS & CHRONIC PAIN ..........936-327-3829
GAMBLING PROGRAMS................................ 1-800-522-4700
GRIEF RECOVERY SUPPORT ..........................936-327-7100
HEMOCHROMATOSIS/NASH SUPPORT GROUP ..................
.............................................................................936-646-5198
LIFE RECOVERY SUPPORT GROUP (Women only) ..............
.............................................................................936-646-5575
NARCOTICS ANONYMOUS ...............................936-327-2204
NOON AL-A-NON ................................................936-967-4524
PARKINSONS SUPPORT GROUP .....................936-329-4009
SPANISH ALCOHOL ANONYMOUS ...................936-967-8385
STROKE SUPPORT GROUP .............................936-327-3696
TEEN SUPPORT GROUP (Girls only) ................936-646-5575
TEXAS LIVER COALITION ............................. 1-800-725-4837
VISION IMPAIRED SUPPORT GROUP ..............936-329-0438
WOMEN’S POWER LUNCH ...............................936-329-8290
TELEPHONE SERVICE FOR THE DEAF
USA RELAY ......................................................1-800-735-2988
Polk County
Social Services
PHONE
DIRECTORY
Help is just a phone call away.
TEXAS DEPT OF INSURANCE.......................1-800-252-3439
TRANSPORTATION
BRAZOS TRANSIT SYSTEM ...........................1-800-272-0039
Or. ................................................................... 979-778-4480
Demand & Response Service only. Reservations may be made
up to 7 days ahead. May be made by 4pm day prior to travel.
In County-$3.00 each way
KERRVILLE BUS LINES ..................................... 936-327-4224
MEDICAL TRANSPORTATION (Medicaid) ...............................
..........................................................................1-877-633-8747
Reservations required 2 to 5 days in advance
UTILITIES
COMMUNITY ACTION 1-888-327-3011 or ....... 936-327-3011
VETERANS AFFAIRS
AMERICAN LEGION POST #312 .......................936-327-7601
BENEFITS INFORMATION ............................ 1- 800-827-1000
OUTPATIENT CLINIC – Lufkin ............................936-637-1342
SERVICE OFFICER – Livingston ........................936-327-6838
VA COUNSELING – Lufkin ..................................936-633-2729
VA HOSPITAL – Houston 1-800-553-2278 or............................
.............................................................................713-791-1414
VETERANS OF FOREIGN WARS ......................936-327-9119
This brochure printed courtesy of
MEMORIAL MEDICAL CENTER
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
LIVINGSTON
December 2012
Page 102
POLK COUNTY SOCIAL SERVICES
2012
ABUSE
ADULT/CHILD PROTECTIVE SERVICES
Adult/Child Abuse Hotline .................................1-800-252-5400
Family Violence Hotline (Spouse/Partner)........1-800-799-7233
WOMEN’S SHELTERS:
Beaumont ................................... 409-832-7575
Huntsville (Collect) ..................... 936-291-3369
Livingston (Collect) ..................... 936-327-2513
Nacogdoches ..........................1-800-828-7233
ADVOCACY, INC
1-800-252-9108
CHILDRENZ HAVENS POLK CO CHILD ADVOCACY CNTR
1-855-222-4283
BOYS & GIRLS CLUB 936-327-1111
CHAMBER OF COMMERCE .............................. 936-327-4929
CHILD CARE (Subsidized) .............................1-800-256-1030
XCHANGE PLACE (Supervised Parental Visitation)
936-639-1327
CLOTHING
GODTEL (Shelter/Mission) .................................. 936-327-8863
GOODRICH CLOTHES CLOSET ....................... 936-365-3655
KIDS FREE CLOTHING EXCHANGE (Fri & Sat)
OASIS (St. Luke’s Episcopal Church) Tues & Fri only ...............
............................................................................. 936-327-1208
SENIOR CITIZENS COUNTRY STORE:
Livingston ................................... 936-327-3388
Onalaska .................................... 936-646-3003
COUNSELING
# ALCOHOL & DRUG ABUSE COUNCIL..........1-800-445-8562
Livingston – Weekly - Call for appointment
*+ DR. DOYLE BRASHER, Psychiatrist – Lufkin .....................
............................................................................ 936-634-5344
*+ BURKE CENTER OUTPATIENT SERVICES
Mental Health /Substance Abuse Services-Intake.
......................................................................... 1-866-242-4556
Local Of¿ces – Adult Services .. 936-327-3786
Family Counseling Associates & Children’s .....
Services .................................... 936-327-5551
* CLARK PSYCHOLOGICAL CONSULTATION PC .................
............................................................................ 936-327-9400
*+ LIFE ENRICHMENT Edward Pendleton, LPC, LCDC ...........
............................................................................ 936-328-5880
# CONSUMER CREDIT COUNSELING SERVICES ................
......................................................................... 1-800-873-2227
* DARRELL DEGRAW, LPC ............................. 936-524-8777
# DET-STAR -24 Hour Line ............................ 1-800-210-9252
*+ DR. SID EPPERSON, PhD, Psychologist – Lufkin ................
............................................................................ 936-637-0074
Cass Emerson- Integrity Drug Screening ........... 936-328-6222
# HEALTH HORIZONS (HIV/AIDS) ............... 1-800-745-8240
Methodist Children’s Home ............................. 1-800-853-1270
*+ PATRICIA HONEA-BOLES, LCSW ................ 936-639-3233
*+ STEPHANIE MILLER, LPC............................ 936-329-0457
*+ DR. P.K. ROY, Psychiatrist. – Kingwood ........ 281-358-4747
Abraham Low Self Help Systems ....................... 936-967-0177
COUNSELING (continued)
# SAAFE HOUSE:
Livingston (Collect) ....... 936-327-2513
Huntsville (Collect) .................... 936-291-3369
*+ SAMARITAN COUNSELING - Lufkin/Nacogdoches
............................................................................ 936-639-6512
FRANI SCATES, LPC.................................... 936-327-0443
* JERRIE SMITH, LPC ..................................... 936-967-0487
# VA Counseling Services. ............................... 936-633-2729
* ATHI P. VENKATESH, MD –KINGWOOD PSYCHIATRY
............................................................................ 281-358-5701
*+ CLAYTON L. WILLIAMSON, LPC .................. 936-328-8660
+Sliding scale
*Medicaid
#Free
DISASTER RELIEF
AMERICAN RED CROSS .................................. 936-327-6867
DSHS–COMMUNITY PREPAREDNESS ........... 903-533-5283
*To Report Suspected Outbreaks or Unusual
Expressions of Illness ................................. 1-800-705-8868
FEMA..................................................1-800-621-FEMA (3362)
POLK COUNTY EMERGENCY MANAGEMENT
............................................................................ 936-327-6826
SALVATION ARMY ............................................. 936-327-6813
EDUCATION
ALZHEIMERS ASSOC ........................................936-632-9930
24/7 ............................................................ 1-800-272-3900
ANGELINA COLLEGE ........................................936-639-1301
CORNERSTONE ECI (0 to 3 years) ............... 1-877-205-3630
DEPT OF ASSISTIVE REHAB SERVICES .........936-327-1490
ESL – Central Baptist Church ..............................936-327-5614
EXPERIENCE WORKS .......................................936-327-0205
FREE PARENTING CLASSES.............936-328-8240 EXT 228
FREE VOCATIONAL TMG & COUNSELING ......936-327-3212
GED TESTING – Angelina College .....................936-633-5495
HEADSTART - A/C Indian Reservation ...............936-563-1300
LISD COMMUNITY SERVICES (Adult Ed/GED) ......................
.............................................................................936-328-2303
POLK COUNTY SPECIAL SERVICES CO-OP .........................
.............................................................................936-328-2320
RIVER OF LIFE-Life Skills Training .....................936-327-4899
TEXAS AGRILIFE .....................................................................
.............................................................................936-327-6828
TWOGETHER MARRIAGE CLASSES ...............936-933-4391
WORKFORCE SOLUTIONS ...............................936-327-5421
EMPLOYMENT
ARMY RECRUITER:
Huntsville ....................................................... 936-291-0001
Lufkin ............................................................. 936-634-7744
DEPT OF ASSISTIVE REHAB SERVICES ........ 936-327-1490
NEW DIRECTIONS INDUSTRIES-Burke Center
............................................................................ 936-967-0762
TEXAS WORKER’S COMPENSATION ............. 936-639-6425
TEXAS UNEMPLOYMENT HOTLINE ............. 1-800-939-6631
WORKFORCE SOLUTIONS .............................. 936-327-5421
ENVIRONMENTAL
ENVIRONMENTAL/CONSUMER HEALTH (DSHS) .................
936-328-8240 EXT 222
POLK CO ENVIRONMENTAL SERVICES .......... 936-327-6826
Trinity River Authority .......................................... 936-365-2292
TX COMMISSION ON ENVIRONMENTAL QUALITY ...............
............................................................................. 409-898-3838
FOOD
ANGEL FOOD MINISTRIES ............................... 936-328-4665
CHURCH ON THE ROCK (1st & 3rd Fri 3:30-5:30 pm)
............................................................................. 936-327-5530
CORRIGAN CHRISTIAN RESOURCE CENTER (2nd Sat)
............................................................................. 936-398-2611
FAITH CHRISTIAN CHURCH (2nd Thurs 9am-Noon
Last Thurs 10am-1pm) ................................... 936-967-0717
GODTEL (Shelter/Mission) Meals on Site ........... 936-327-8863
MANNAFEST. Mon & Fri 9 am – 12 pm ............. 936-327-9555
MEALS ON WHEELS .......................................... 936-327-6844
POLK CO. MISSION CENTER (Tue & Thurs 1 -3pm) ..............
............................................................................. 936-327-7634
SENIOR CITIZENS NUTRITION CENTERS:
AC Indian Reservation ........................ 936-563-4391
Corrigan .............................................. 936-398-4090
Livingston............................................ 936-327-6844
Onalaska............................................. 936-646-5914
SNAP/FOOD STAMPS/LONE STAR CARD ....... 936-327-6700
SOUPS FOR SENIORS (Mon-Fri 8am-5pm) ...... 936-327-3696
ST. JOSEPH’S SOUP KITCHEN (Last Tues each month)
4:30-6:30 pm ................................... 936-967-8385
TRANSFORMATION CENTER (Thur. 10am-3pm) ...................
............................................................................. 936-646-5418
WIC (Women, Infants, Children)
Corrigan 1-800-917-8906. . . . . or ................. 936-398-2140
Livingston 1-800-917-8906.. . . . . or ............. .936-327-5433
GOVERNOR’S INFORMATION & REFERRAL HOTLINE
........................................................................ 1-800-252-9600
TEXAS INFORMATION & REFERRAL .............................. 211
HHSC OFFICE OF OMBUDSMAN ................ 1-877-787-8999
HEALTH CARE
A/C INDIAN HEALTH SERVICES ......................936-563-2058
AMERGROUP MANAGED CARE .................. 1-832-248-1634
ANGELINA HEALTH DEPT – Lufkin .................. 936-632-1139
CHIP (TEXCARE-Children’s Health Ins Program) ...................
........................................................................ 1-800-647-6558
COMMUNITY CLINIC – Conroe .........................281-298-3718
Medical Screening Mon-Fri 9:30am-12pm
Dental Screening 1st &3rd Mon 8-9am
DEPT OF ASSISTIVE & REHAB SERVICES
Livingston ..................................936-327-1490
(Comm for Blind) Lufkin.............936-634-8700
DEPT OF STATE HEALTH SERVICES-Livingston ..................
............................................................................936-328-8240
Immunizations ................................... EXT 221
Social Work Services /CSHCNEXT 230 or 232
Tuberculosis Elimination ................... EXT 235
Environmental/Consumer Health ...... EXT 222
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
HEALTH CARE (continued)
DIALYSIS -Livingston Davita Dialysis Center ..........................
............................................................................ 936-327-1108
EAST TX COMMUNITY HEALTH CLINIC (Nacogdoches)
.............................................................................936-560-1122
GENETIC COUNSELING – Baylor College of Medicine ............
............................................................................. 713-798-4363
+HEALTH CENTER OF SOUTHEAST TX-Shepherd ................
..............................................................................936-628-1100
HEALTH HORIZONS (HIV/AIDS) . . .1-800-745-8240 or
............................................................................. 936-569-8240
HEALTHY POLK COUNTY (Assistance with Stop Smoking,
COPD, CHF, Bacterial Pneumonia) ..................... 936-646-7290
IMMUNIZATIONS:
Calvary Medical Clinic .............................. 936-327-1055
Dept. of State Health Services .... 936-328-8240 EXT 221
Health Center of Southeast TX-Shepherd ..936-628-1100
Livingston Pediatric Clinic ........................ 936-328-8812
Polk County Children’s Clinic ................... 936-327-8661
Lone Star Family Health Clinic-Conroe .... 936-539-4004
MEDICAID – HHSC:
Corrigan..................................... 936-398-4188
Livingston ................................... 936-327-6700
MEDICARE/SOCIAL SECURITY 1-800-633-4227 or
............................................................................. 936-632-2999
MEMORIAL MEDICAL CENTER
Livingston ................................... 936-329-8700
MEMORIAL SHARE VAN (Mammogram – Pap Smear)
.......................................................................... 1-800-409-7890
MENTAL HEALTH SERVICES
Burke Center .......................................... 936-327-3786
Emergency Mental Health Services . 1-800-392-8343
Intake Services ................................ 1-866-242-4556
Abraham Low Self Help Systems .......... 936-967-0177
POLK COUNTY INDIGENT PROGRAM
Livingston ................................... 936-327-6830
PREGNANCY RESOURCE CENTER................. 936-646-5575
PRESCRIPTION ASSISTANCE PROGRAM
www.Needymeds.org
RX Assist (www.RXAssist.org) or ....... 1-409-929-2099
RX Outreach (www.rxoutreach.org) or 1-800-769-3880
SAN JOSE CLINIC (Houston) ..............................713-228-9411
STD (Sexually Transmitted Diseases, HIV/AIDS)
Lufkin/ACCHD ............................ 936-637-7204
UNIVERSITY OF TEXAS MEDICAL BRANCH:
Maternal/Child Hlth, Family Planning, STD, HIV/AIDS
Cancer Stop-50+ Yrs.
Conroe 1-800-917-8906 or ......................... 936-525-2800
New Caney (No Child Health) .............. 1-800-917-8906 or
............................................................................. 281-577-8966
URGENT DOC ................................................. 1-888-634-3627
WIC (Women, Infants, Children)
Corrigan 1-800-917-8906 or .............. 936-398-2140
Livingston 1-800-917-8906 or ........... 936-327-5433
HOSPICE
A PINEYWOODS HOSPICE 936-327-4771 or ..........................
.......................................................................... 1-888-452-8345
December 2012
Page 103
Angelina County
+++++
Access to Cancer Care
For Low-Income and Uninsured Patients
We hope this information is helpful if you are looking for cancer treatment or cancer screening, like a
mammogram, Pap test, or prostate exam, and do not have insurance or enough money to pay for medical care.
I want to be checked for cancer. Where do I go?
Page
1
I have cancer. Where do I go?
Page
4
I had cancer and need a check-up. Where do I go?
Page
5
How do I know if I can get help for cancer care?
Page
6
What if I still cannot get help for cancer care?
Page
7
Where can I learn more about cancer care?
Page
8
I want to be checked for cancer. Where do I go?
If you want to be checked for cancer and:
•
You live in Angelina County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Angelina County Indigent Health Care Program
If you live in Angelina County you may be able to get help through the Angelina County Indigent
Health Care Program. You will need to fill out a form and show certain documents, such as a water bill,
your mortgage or rent papers, or your driver’s license to prove that you live in Angelina County.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near Angelina County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
For Women
+ Women who want to get checked for cervical cancer or breast cancer may be able to get help through a
special program called Breast and Cervical Cancer Services (BCCS).
•
•
•
To have a PAP test for cervical cancer, you must be 18 to 64 years old.
To have a mammogram (breast cancer test), you must be 50 to 64 years old.
You will need to show how much money you make, so you may be asked to show a paycheck stub.
Call one of the clinics below to see about making an appointment:
Memorial Health System of East Texas
P.O. Box 1447
Lufkin, TX 75902
(936) 639- 7130
Memorial Medical Center – Lufkin
1201 W Frank Ave
Lufkin, TX 75904
(936) 634-8111
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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Community Hospital Consulting
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Page 105
Planned Parenthood - Lufkin Health Center
205 Shands Dr
Lufkin, TX 75904
(936) 634- 8446
UTMB Regional Maternal & Child Health Program
301 University Blvd
Galveston, TX 77555
(409) 747- 4952
+ Women of all ages who want to get checked for cervical cancer or breast cancer may be able to get help
through the Angelina County and Cities Health Department.
Call the clinic below for more information or to make an appointment:
Angelina County and Cities Health Department
503 Hill St
Lufkin, TX 75904
(936) 632- 1139
Appointments
When you go for your appointment, be sure to bring any medical records you have. This information will help
the doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 3 of 9
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Page 106
I have cancer. Where do I go?
If you have been told that you need treatment for cancer and:
•
You live in Angelina County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Angelina County Indigent Health Care Program
If you live in Angelina County you may be able to get help through the Angelina County Indigent
Health Care Program. You will need to fill out a form and show certain documents, such as a water bill,
your mortgage or rent papers, or your driver’s license to prove that you live in Angelina County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near Angelina County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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Community Hospital Consulting
Page 4 of 9
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Page 107
Appointments
When you go for your doctor’s appointment, be sure to bring any medical records you have. This will help the
doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
I had cancer and need a check-up. Where do I go?
If you have had cancer in the past and need to see a doctor for a check-up and:
•
You live in Angelina County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Angelina County Indigent Health Care Program
If you live in Angelina County you may be able to get help through the Angelina County Indigent
Health Care Program. You will need to fill out a form and show certain documents, such as a water bill,
your mortgage or rent papers, or your driver’s license to prove that you live in Angelina County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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Community Hospital Consulting
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Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near Angelina County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
Appointments
When you go for your appointment, be sure to bring any medical records you have. This information will help
the doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
How do I know if I can get help for cancer care?
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Angelina County Indigent Health Care Program
If you live in Angelina County you may be able to get help through the Angelina County Indigent
Health Care Program. You will need to fill out a form and show certain documents, such as a water bill,
your mortgage or rent papers, or your driver’s license to prove that you live in Angelina County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 6 of 9
December 2012
Page 109
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near Angelina County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
What if I still cannot get help for cancer care?
If you cannot get help from the county program or a Federally Qualified Health Center, you may want to call
one of the hospitals below.
+The National Cancer Institute (NCI) has named three cancer centers in Texas as leaders in cancer research.
Two of those centers are in Houston. These centers focus on finding new treatments for cancer through clinical
trial testing. To find out more, visit the Web sites or call the numbers below:
Cancer Therapy & Research Center at the UT Health Science Center at San Antonio
1-800-340-2872
http://www.uthscsa.edu/patient.shtml
The Dan L. Duncan Cancer Center at Baylor College of Medicine
(713) 798-1354
http://www.bcm.edu/cancercenter/
Harold C. Simmons Cancer Center at UT Southwestern Medical Center
(214) 645-HOPE (4673)
(800) 460-HOPE (4673)
http://www.simmonscancercenter.org/index.html
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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Page 110
The University of Texas MD Anderson Cancer Center
1-877-MDA-6789 (1-877-632-6789)
http://www.mdanderson.org/contact_us/
+
The following hospitals in your area may also treat low-income or uninsured patients. You would need
to contact each hospital to find out if you can make an appointment to be seen:
Memorial Health System of East Texas
(936) 634- 8111
http://www.memorialhealth.org
Woodland Heights Medical Center
(936) 634- 8311
http://www.woodlandheights.net
Where can I learn more about cancer care?
There are many groups that help cancer patients. These groups may offer financial assistance, support services
or free information about cancer. You can get a list of these groups from the National Cancer Institute by
clicking on or typing in the following link:
https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=8.1
+
+
+
+
You may also call the National Cancer Institute’s Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237).
The American Cancer Society (ACS) also has support groups and information about cancer. You may
call 1-800-227-2345 or go to the Web site: http://www.cancer.org/docroot/home/index.asp.
The Lance Armstrong Foundation (LAF) has information about financial assistance and support groups.
Call 1-866-235-7205 or visit the Web site: http://www.livestrong.org
Susan G. Komen for the Cure is a breast cancer helpline. Call 1-800–462–9273 (1-800–I’M AWARE®)
or visit the Web site: http://www.komen.org
+
Visit the Texas Cancer Information (texascancer.info) Web site at http://www.texascancer.info/ for
lists of doctors, hospitals, breast and colon cancer screening services, home health agencies, and
hospices. You can find support, counseling, education and other help such as transportation, housing
and medical equipment by clicking on Local/Community Resources.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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Page 111
+++++
This document can be found in PDF format on the Texas Cancer Information Web site at
http://www.texascancer.info/access/access_angelina.pdf.
If you have any information regarding changes to any procedures or locations, e-mail Texas Cancer Information at
[email protected]. Texas Cancer Information is funded by the Cancer Prevention & Research Institute of Texas and The
University of Texas M. D. Anderson Cancer Center. Inclusion in this document is not intended as an endorsement of any
individual, provider, service or Web site.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
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Page 112
Polk County
+++++
Access to Cancer Care
For Low-Income and Uninsured Patients
We hope this information is helpful if you are looking for cancer treatment or cancer screening, like a
mammogram, Pap test, or prostate exam, and do not have insurance or enough money to pay for medical care.
I want to be checked for cancer. Where do I go?
Page
1
I have cancer. Where do I go?
Page
4
I had cancer and need a check-up. Where do I go?
Page
5
How do I know if I can get help for cancer care?
Page
6
What if I still cannot get help for cancer care?
Page
7
Where can I learn more about cancer care?
Page
8
I want to be checked for cancer. Where do I go?
If you want to be checked for cancer and:
•
You live in Polk County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Polk County Indigent Health Care Program
If you live in Polk County you may be able to get help through the Polk County Indigent Health Care
Program. You will need to fill out a form and show certain documents, such as a water bill, your
mortgage or rent papers, or your driver’s license to prove that you live in Polk County.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 1 of 9
December 2012
Page 113
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
+Federally Qualified Health Centers
If you cannot get help from the Indigent Health Care Program, you may be able to see a doctor at a
Primary Care clinic that will let you pay on a “sliding scale.” This means that the amount of money you
pay is based on how many family members live in your house and how much money you make. For
example, if you have a big family and make just a little money, you would pay less for medical care. If
you have a smaller family or make a little more money, you would pay a little more.
For more information and to find the nearest clinic, call the number below:
Health Center of Southeast Texas - Shepherd
1651 South Byrd Avenue
Shepherd, Texas 77371
(936) 628-1100
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit one of the following VA facilities in or near Polk County:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
Page 2 of 9
December 2012
Page 114
For Women
+ Women who want to get checked for cervical cancer or breast cancer may be able to get help through a
special program called Breast and Cervical Cancer Services (BCCS).
•
•
•
To have a PAP test for cervical cancer, you must be 18 to 64 years old.
To have a mammogram (breast cancer test), you must be 50 to 64 years old.
You will need to show how much money you make, so you may be asked to show a paycheck stub.
Call one of the clinics below to see about making an appointment:
Memorial Medical Center- Livingston
1717 U.S. 59 Bypass
Livingston, TX 77351
(936) 639- 7066
Health Center of Southeast Texas
401 East Crockett St.
Cleveland, TX 77327
(281) 592- 2224
Memorial Health System of East Texas
P.O. Box 1447
Lufkin, TX 75902
(936) 639- 7130
Appointments
When you go for your appointment, be sure to bring any medical records you have. This information will help
the doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 3 of 9
December 2012
Page 115
I have cancer. Where do I go?
If you have been told that you need treatment for cancer and:
•
You live in Polk County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Polk County Indigent Health Care Program
If you live in Polk County you may be able to get help through the Polk County Indigent Health Care
Program. You will need to fill out a form and show certain documents, such as a water bill, your
mortgage or rent papers, or your driver’s license and that you live in Polk County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will also have to show how much money you make, so
you may also need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit one of the following VA facilities in or near Polk County:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
Page 4 of 9
December 2012
Page 116
I had cancer and need a check-up. Where do I go?
If you have had cancer in the past and need to see a doctor for a check-up and:
•
You live in Polk County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Polk County Indigent Health Care Program
If you live in Polk County you may be able to get help through the Polk County Indigent Health Care
Program. You will need to fill out a form and show certain documents, such as a water bill, your
mortgage or rent papers, or your driver’s license and that you live in Polk County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 5 of 9
December 2012
Page 117
You may also call or visit one of the following VA facilities in or near Polk County:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
Appointments
When you go for your appointment, be sure to bring any medical records you have. This information will help
the doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
How do I know if I can get help for cancer care?
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ Polk County Indigent Health Care Program
If you live in Polk County you may be able to get help through the Polk County Indigent Health Care
Program. You will need to fill out a form and show certain documents, such as a water bill, your
mortgage or rent papers, or your driver’s license and that you live in Polk County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 6 of 9
December 2012
Page 118
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit one of the following VA facilities in or near Polk County:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
What if I still cannot get help for cancer care?
If you cannot get help from the county program or a Federally Qualified Health Center, you may want to call
one of the hospitals below.
+The National Cancer Institute (NCI) has named four cancer centers in Texas as leaders in cancer research.
Two centers are in Houston, one is in Dallas and one is in San Antonio. These centers focus on finding new
treatments for cancer through clinical trial testing. To find out more, visit the Web sites or call the numbers
below:
Cancer Therapy & Research Center at the UT Health Science Center at San Antonio
1-800-340-2872
http://www.uthscsa.edu/patient.shtml
The Dan L. Duncan Cancer Center at Baylor College of Medicine
(713) 798-1354
http://www.bcm.edu/cancercenter/
Harold C. Simmons Cancer Center at UT Southwestern Medical Center
(214) 645-HOPE (4673)
(800) 460-HOPE (4673)
http://www.simmonscancercenter.org/index.html
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 7 of 9
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Page 119
The University of Texas MD Anderson Cancer Center
1-877-MDA-6789 (1-877-632-6789)
http://www.mdanderson.org/contact_us/
+
The following hospitals in your area may also treat low-income or uninsured patients. You would need
to contact each hospital to find out if you can make an appointment to be seen:
Memorial Medical Center – Livingston
(936) 275- 3446
http://www.mhset.net/cancer.htm
Sadler Clinic
(936) 756- 6631
http://www.sadler.com
Where can I learn more about cancer care?
There are many groups that help cancer patients. These groups may offer financial assistance, support services
or free information about cancer. You can get a list of these groups from the National Cancer Institute by
clicking on or typing in the following link:
https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=8.1
+
+
+
You may also call the National Cancer Institute’s Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237).
The American Cancer Society (ACS) also has support groups and information about cancer. You may
call 1-800-227-2345 or go to the Web site: http://www.cancer.org/docroot/home/index.asp.
The Lance Armstrong Foundation (LAF) has information about financial assistance and support groups.
Call 1-866-235-7205 or visit the Web site: http://www.livestrong.org
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 8 of 9
December 2012
Page 120
+
Susan G. Komen for the Cure is a breast cancer helpline. Call 1-800–462–9273 (1-800–I’M AWARE®)
or visit the Web site: http://www.komen.org
+
Visit the Texas Cancer Information (texascancer.info) Web site at http://www.texascancer.info/ for
lists of doctors, hospitals, breast and colon cancer screening services, home health agencies, and
hospices. You can find support, counseling, education and other help such as transportation, housing
and medical equipment by clicking on Local/Community Resources.
+++++
This document can be found in PDF format on the Texas Cancer Information Web site at
http://www.texascancer.info/access/access_polk.pdf.
Una versión en español de este documento también se puede encontrar en el formato de PDF en la página de Internet
de Texas Cancer Information:
http://www.texascancer.info/access/acceso_espanol_polk.pdf.
If you have any information regarding changes to any procedures or locations, e-mail Texas Cancer Information at
[email protected]. Texas Cancer Information is funded by the Cancer Prevention & Research Institute of Texas and The
University of Texas M. D. Anderson Cancer Center. Inclusion in this document is not intended as an endorsement of any
individual, provider, service or Web site.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 9 of 9
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Page 121
San Augustine County
+++++
Access to Cancer Care
For Low-Income and Uninsured Patients
We hope this information is helpful if you are looking for cancer treatment or cancer screening, like a
mammogram, Pap test, or prostate exam, and do not have insurance or enough money to pay for medical care.
I want to be checked for cancer. Where do I go?
Page
1
I have cancer. Where do I go?
Page
4
I had cancer and need a check-up. Where do I go?
Page
5
How do I know if I can get help for cancer care?
Page 6
What if I still cannot get help for cancer care?
Page 7
Where can I learn more about cancer care?
Page 8
I want to be checked for cancer. Where do I go?
If you want to be checked for cancer and:
•
You live in San Augustine County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ San Augustine County Indigent Health Care Program
If you live in San Augustine County you may be able to get help through the San Augustine County
Indigent Health Care Program. You will need to fill out a form and show certain documents, such as a
water bill, your mortgage or rent papers, or your driver’s license to prove that you live in San Augustine
County.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 1 of 9
December 2012
Page 122
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
+Federally Qualified Health Centers
If you cannot get help from the Indigent Health Care Program, you may be able to see a doctor at a
primary care clinic that will let you pay on a “sliding scale.” This means that the amount of money you
pay is based on how many family members live in your house and how much money you make. For
example, if you have a big family and make just a little money, you would pay less for medical care. If
you have a smaller family or make a little more money, you would pay a little more.
For more information and to find the nearest clinic, call the number below:
Sabine Community Clinic
505 N. Temple Dr.
Pineland, TX 75968
(936) 560-5413
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 2 of 9
December 2012
Page 123
You may also call or visit the following VA facility in or near San Augustine County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
For Women
+ Women who want to get checked for cervical cancer or breast cancer may be able to get help through a
special program called Breast and Cervical Cancer Services (BCCS).
•
•
•
To have a PAP test for cervical cancer, you must be 18 to 64 years old.
To have a mammogram (breast cancer test), you must be 50 to 64 years old.
You will need to show how much money you make, so you may be asked to show a paycheck stub.
Call one of the clinics below to see about making an appointment:
Memorial Medical Center - San Augustine
511 E. Hospital St
San Augustine, TX 75972
(936) 275-3446
East Texas Community Health Services, Inc.
1401 South University
Nacogdoches, TX 75961
(936) 560- 5413
Jasper Newton County Public Health District
139 West Lamar St.
Jasper, TX 75951
(409) 384- 6829
Memorial Health System of East Texas
1201 W. Frank St.
Lufkin, TX 75904
(936) 634- 8111
Appointments
When you go for your appointment, be sure to bring any medical records you have. This information will help
the doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 3 of 9
December 2012
Page 124
I have cancer. Where do I go?
If you have been told that you need treatment for cancer and:
•
You live in San Augustine County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ San Augustine County Indigent Health Care Program
If you live in San Augustine County you may be able to get help through the San Augustine County
Indigent Health Care Program. You will need to fill out a form and show certain documents, such as a
water bill, your mortgage or rent papers, or your driver’s license to prove that you live in San Augustine
County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near San Augustine County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 4 of 9
December 2012
Page 125
Appointments
When you go for your doctor’s appointment, be sure to bring any medical records you have. This will help the
doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
I had cancer and need a check-up. Where do I go?
If you have had cancer in the past and need to see a doctor for a check-up and:
•
You live in San Augustine County
•
You make a low income
•
You do not have health insurance
•
You cannot get Medicare or Medicaid
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ San Augustine County Indigent Health Care Program
If you live in San Augustine County you may be able to get help through the San Augustine County
Indigent Health Care Program. You will need to fill out a form and show certain documents, such as a
water bill, your mortgage or rent papers, or your driver’s license to prove that you live in San Augustine
County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 5 of 9
December 2012
Page 126
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near San Augustine County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Appointments
When you go for your appointment, be sure to bring any medical records you have. This information will help
the doctor understand your needs better. For example, bring:
• Results of past medical or lab tests
• Records of any treatments you have had
• A list of any medicines you are taking right now
How do I know if I can get help for cancer care?
You may be able to get help through one of the programs listed below. Each one may have different rules about
how you qualify for services, so call the number listed for more information.
+ San Augustine County Indigent Health Care Program
If you live in San Augustine County you may be able to get help through the San Augustine County
Indigent Health Care Program. You will need to fill out a form and show certain documents, such as a
water bill, your mortgage or rent papers, or your driver’s license to prove that you live in San Augustine
County.
You do not have to be a U.S. citizen to get help. But if you have any documents (like visas) from
Immigration and Naturalization Services (INS), you must show these. You will also need to tell how
many family members live in your house. You will have to show how much money you make, so you
also may need to show a paycheck stub.
For more information, call the number or go by the office listed below:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 6 of 9
December 2012
Page 127
For U. S. Military Veterans
+ If you are a veteran, you may be able to be seen at a Veterans Affairs (VA) clinic.
To find out more
about veteran’s benefits, go to http://www.va.gov/healtheligibility/. For more information, contact the
Department of Veterans Affairs at the number below:
Veterans Affairs
Health care questions call 1-877-222-8387
You may also call or visit the following VA facility in or near San Augustine County:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
What if I still cannot get help for cancer care?
If you cannot get help from the county program or a Federally Qualified Health Center, you may want to call
one of the hospitals below.
+The National Cancer Institute (NCI) has named four cancer centers in Texas as leaders in cancer research.
Two centers are in Houston, one is in Dallas and one is in San Antonio. These centers focus on finding new
treatments for cancer through clinical trial testing. To find out more, visit the Web sites or call the numbers
below:
Cancer Therapy & Research Center at the UT Health Science Center at San Antonio
1-800-340-2872
http://www.uthscsa.edu/patient.shtml
The Dan L. Duncan Cancer Center at Baylor College of Medicine
(713) 798-1354
http://www.bcm.edu/cancercenter/
Harold C. Simmons Cancer Center at UT Southwestern Medical Center
(214) 645-HOPE (4673)
(800) 460-HOPE (4673)
http://www.simmonscancercenter.org/index.html
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
Page 7 of 9
December 2012
Page 128
The University of Texas MD Anderson Cancer Center
1-877-MDA-6789 (1-877-632-6789)
http://www.mdanderson.org/contact_us/
+
The following hospitals in your area may also treat low-income or uninsured patients. You would need
to contact each hospital to find out if you can make an appointment to be seen:
Memorial Medical Center San Augustine
(936) 275-3446
http://www.memorialmedicalcenter-san Augustine.org
Memorial Medical Center Lufkin
(936) 634- 8111
http://www.mhset.net/lufkin.htm
Where can I learn more about cancer care?
There are many groups that help cancer patients. These groups may offer financial assistance, support services
or free information about cancer. You can get a list of these groups from the National Cancer Institute by
clicking on or typing in the following link:
https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=8.1
+
+
+
+
You may also call the National Cancer Institute’s Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237).
The American Cancer Society (ACS) also has support groups and information about cancer. You may
call 1-800-227-2345 or go to the Web site: http://www.cancer.org/docroot/home/index.asp.
The Lance Armstrong Foundation (LAF) has information about financial assistance and support groups.
Call 1-866-235-7205 or visit the Web site: http://www.livestrong.org
Susan G. Komen for the Cure is a breast cancer helpline. Call 1-800–462–9273 (1-800–I’M AWARE®)
or visit the Web site: http://www.komen.org
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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+
Visit the Texas Cancer Information (texascancer.info) Web site at http://www.texascancer.info/ for
lists of doctors, hospitals, breast and colon cancer screening services, home health agencies, and
hospices. You can find support, counseling, education and other help such as transportation, housing
and medical equipment by clicking on Local/Community Resources.
+++++
This document can be found in PDF format on the Texas Cancer Information Web site at
http://www.texascancer.info/access/access_sanaugustine.pdf.
If you have any information regarding changes to any procedures or locations, please e-mail Texas Cancer Information at
[email protected]. Texas Cancer Information is funded by the Cancer Prevention & Research Institute of Texas and The
University of Texas M. D. Anderson Cancer Center. Inclusion in this document is not intended as an endorsement of any
individual, provider, service or Web site.
Prepared by Texas Cancer Information, www.texascancer.info. Last updated May 2011.
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Condado de Angelina

Acceso a los Cuidados del Cáncer
para los Pacientes que tienen Bajos
Ingresos y sin Seguro
Esperamos que esta información sea útil si usted está buscando tratamientos o pruebas para el cáncer, como el
mamograma, la prueba Pap, la prueba de la próstata, y no tiene seguro o suficiente dinero para pagar los
cuidados médicos.
Quiero que me chequeen si tengo cáncer. ¿A dónde voy?
Pág 1
Tengo cáncer. ¿A dónde voy?
Pág 3
Tuve cáncer y necesito un chequeo. ¿A dónde voy?
Pág 5
¿Cómo sé si puedo obtener ayuda para el cuidado del cáncer?
Pág 6
¿Qué pasa si todavía no puedo obtener ayuda para el cuidado del cáncer?
Pág 7
¿Dónde puedo aprender más sobre el cuidado del cáncer?
Pág 8
Quiero que me chequeen si tengo cáncer. ¿A dónde voy?
Si usted quiere que le chequeen si tiene cáncer y:
•
•
•
•
usted vive en el Condado de Angelina
tiene bajos ingresos,
no tiene seguro médico,
no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
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 Programa de Indigent Health Care del Condado de Angelina
Si vive en el Condado de Angelina usted podría obtener ayuda a través del programa Indigent Health
Care del Condado de Angelina. Usted necesitará llenar una forma y mostrar ciertos documentos, tales
como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que
vive en el Condado de Angelina.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
Para los Veteranos del Servicos Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de Angelina o cerca
de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
Para las Mujeres
Para las mujeres que quieren un chequeo para el cáncer del cuello de la matriz o del seno pueden obtener
ayuda a través de un programa especial llamado Breast and Cervical Cancer Services (BCCS por sus
siglas en inglés).
•
Para hacerse una prueba Pap para el cáncer del cuello de la matriz, usted debe tener entre 18 y 64
años de edad.
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•
•
Para hacerse un mamograma (prueba para el cáncer de seno) usted debe tener entre 50 y 64 años de
edad.
Usted necesitará mostrar cuánto dinero gana, así que es posible que le pidan un recibo de pago de su
sueldo (talón de su cheque).
Llame a las clínicas que se indican abajo para hablar sobre hacer una cita:
Memorial Health System of East Texas
P.O. Box 1447
Lufkin, TX 75902
(936) 639- 7130
Planned Parenthood - Lufkin Health Center
205 Shands Dr
Lufkin, TX 75904
(936) 634- 8446
Memorial Medical Center – Lufkin
1201 W Frank Ave
Lufkin, TX 75904
(936) 634-8111
UTMB Regional Maternal & Child Health Program
301 University Blvd
Galveston, TX 77555
(409) 747- 4952
 Para las mujeres que quieren un chequeo para el cáncer del cuello de la matriz o del seno pueden obtener
ayuda a través del Angelina County and Cities Health Department.
Llame la clínica que se indica abajo para más información o para hacer una cita:
Angelina County and Cities Health Department
503 Hill St
Lufkin, TX 75904
(936) 632- 1139
 Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
• los resultados pasados de pruebas médicas o de laboratorio,
• documentos sobre cualquier tratamiento que usted haya tenido,
• una lista de todas las medicinas que está tomando en este momento.
Tengo cáncer. ¿A dónde voy?
Si le han dicho que usted necesita tratamiento para el cáncer y:
•
•
•
•
usted vive en el Condado de Angelina
tiene bajos ingresos,
no tiene seguro médico,
no puede obtener Medicare o Medicaid.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
 Programa de Indigent Health Care del Condado de Angelina
Si vive en el Condado de Angelina usted podría obtener ayuda a través del programa Indigent Health
Care del Condado de Angelina. Usted necesitará llenar una forma y mostrar ciertos documentos, tales
como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que
vive en el Condado de Angelina.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
Para los Veteranos del Servicos Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de Angelina o cerca
de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
 Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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•
•
•
los resultados pasados de pruebas médicas o de laboratorio,
documentos sobre cualquier tratamiento que usted haya tenido,
una lista de todas las medicinas que está tomando en este momento.
Tuve cáncer y necesito un chequeo. ¿A dónde voy?
Si usted ha tenido cáncer en el pasado y necesita ver un doctor para un chequeo y:
•
•
•
•
usted vive en el Condado de Angelina
tiene bajos ingresos,
no tiene seguro médico,
no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
 Programa de Indigent Health Care del Condado de Angelina
Si vive en el Condado de Angelina usted podría obtener ayuda a través del programa Indigent Health
Care del Condado de Angelina. Usted necesitará llenar una forma y mostrar ciertos documentos, tales
como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que
vive en el Condado de Angelina.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
Para los Veteranos del Servicos Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
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Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de Angelina o cerca
de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
 Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
•
•
•
los resultados pasados de pruebas médicas o de laboratorio,
documentos sobre cualquier tratamiento que usted haya tenido,
una lista de todas las medicinas que está tomando en este momento.
¿Cómo sé si puedo obtener ayuda para el cuidado del cáncer?
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
 Programa de Indigent Health Care del Condado de Angelina
Si vive en el Condado de Angelina usted podría obtener ayuda a través del programa Indigent Health
Care del Condado de Angelina. Usted necesitará llenar una forma y mostrar ciertos documentos, tales
como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que
vive en el Condado de Angelina.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Angelina County Indigent Health Care Program
PO Box 908
Lufkin, TX 75901
(936) 634- 5431
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Para los Veteranos del Servicos Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de Angelina o cerca
de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr.
Lufkin, TX 75904-1776
(936) 671-4300
¿Qué pasa si todavía no puedo obtener ayuda para el cuidado del cáncer?
Si usted no puede obtener ayuda del programa del condado o de un Centro de Salud Federalmente Calificado,
probablemente usted quiera llamar a uno de los hospitales que se indican abajo.




El National Cancer Institute (NCI por sus siglas en inglés) ha nombrado a tres centros para el cáncer en
Texas como líderes en investigación para el cáncer. Dos de esos centros están en Houston. Estos centros
se enfocan en encontrar nuevos tratamientos para el cáncer a través estudios clínicos. Para mayor
información, por favor visite las páginas de Internet o llame a los números listados abajo:
Cancer Therapy & Research Center at the UT Health Science Center at San Antonio
1-800-340-2872
http://www.uthscsa.edu/patient.shtml
The Dan L. Duncan Cancer Center at Baylor College of Medicine
(713) 798-1354
http://www.bcm.edu/cancercenter/
Harold C. Simmons Cancer Center at UT Southwestern Medical Center
(214) 645-HOPE (4673)
(800) 460-HOPE (4673)
http://www.simmonscancercenter.org/index.html
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
The University of Texas MD Anderson Cancer Center
1-877-MDA-6789 (1-877-632-6789)
http://www.mdanderson.org/contact_us/

Los siguientes hospitales en su área pueden también tratar pacientes con bajos ingresos o sin seguro. Usted
necesitaría contactar a cada hospital para saber si puede hacer una cita para que lo vean:
Memorial Health System of East Texas
(936) 634- 8111
http://www.memorialhealth.org
Woodland Heights Medical Center
(936) 634- 8311
http://www.woodlandheights.net
¿Dónde puedo aprender más sobre el cuidado del cáncer?
Hay muchos grupos que ayudan a los pacientes con cáncer. Estos grupos pueden ofrecer asistencia financiera,
servicios de apoyo o información gratis sobre el cáncer. Usted puede obtener una lista de estos grupos del
National Cancer Institute al hacer clic en el vínculo o al escribir la siguiente dirección:
https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=8.1





Usted también puede llamar al National Cancer Institute’s Cancer Information Service al 1-800-4CANCER (1-800-422-6237).
American Cancer Society (ACS por sus siglas en inglés) también tiene grupos de apoyo e información
sobre el cáncer. Usted puede llamar al 1-800-227-2345 o ir a la página de Internet:
http://www.cancer.org/docroot/home/index.asp.
LIVESTRONG tiene información sobre asistencia financiera y grupos de apoyo. Por favor llame al 1-866235-7205 o visite la página de Internet: http://www.livestrong.org
Susan G. Komen for the Cure, tiene una línea de ayuda contra el cáncer del seno. Llame al 1-800-4629273 (1-800-I’M AWARE®) o visite la página de Internet: http://www.komen.org
Visite la página de Internet de Texas Cancer Information (texascancer.info) al
http://www.texascancer.info/ para una lista de doctores, hospitales, servicios de pruebas para el cáncer del
seno y del colon, agencias de hogares de salud, y hospicios. Usted puede encontrar apoyo, consejería,
educación y otros tipos de ayuda como transporte, vivienda, y equipos médicos al hacer clic en Local
Community Resources
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
Este documento lo puede encontrar en el formato de PDF en la página de Internet de Texas Cancer Information:
http://www.texascancer.info/access/acceso_espanol_angelina.pdf
An English version of this document can also be found in PDF form on the Texas Cancer Information Web site at
http://www.texascancer.info/access/access_angelina.pdf.
Si usted tiene alguna información relacionada con cambios a cualquier procedimiento o direcciones, por favor envíe un e-mail a
Texas Cancer Information al [email protected]. Texas Cancer Information está patrocinado por el The University of Texas
M D Anderson Cancer Center. Actualizaciones del acceso a el cuidado del cáncer son financiados en parte por una contribución
del Cancer Prevention & Research Institute of Texas. La inclusión de este documento no debe ser considerada como un respaldo
o apoyo a algún individuo, proveedor, servicio o sitio en la red.
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Condado de Polk
+++++
Acceso a los Cuidados del Cáncer para los
Pacientes que tienen Bajos Ingresos y sin
Seguro
Esperamos que esta información sea útil si usted está buscando tratamientos o pruebas para el cáncer, como el
mamograma, la prueba Pap, la prueba de la próstata, y no tiene seguro o suficiente dinero para pagar los
cuidados médicos.
Quiero que me chequeen si tengo cáncer. ¿A dónde voy?
Pág. 1
Tengo cáncer. ¿A dónde voy?
Pág. 4
Tuve cáncer y necesito un chequeo. ¿A dónde voy?
Pág. 5
¿Cómo sé si puedo obtener ayuda para el cuidado del cáncer?
Pág. 7
¿Qué pasa si todavía no puedo obtener ayuda para el cuidado del cáncer?
Pág. 8
¿Dónde puedo aprender más sobre el cuidado del cáncer?
Pág. 9
Quiero que me chequeen si tengo cáncer. ¿A dónde voy?
Si usted quiere que le chequeen si tiene cáncer y:
• usted vive en el condado de Polk,
• tiene bajos ingresos,
• no tiene seguro médico, y
• no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
Preparado por el Texas Cancer Information, www.texascancer.info. Última actualización: mayo del 2011. Página 1 of 9
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Page 140
+Programa de Indigent Health Care del Condado de Polk
Si vive en el Condado de Polk usted podría obtener ayuda a través del programa Indigent Health Care
del Condado de Polk. Usted necesitará llenar una forma y mostrar ciertos documentos, tales como el
recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que vive en el
Condado de Polk.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
Para los Veteranos del Servicio Militar de los Estados Unidos
+ Si usted es un veterano, es posible que a usted lo vean en una Clínica de VA (Veterans Affairs). Para
mayor información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/.
Para más información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar una de las siguientes Clínicas de VA que estén en el Condado de Polk o
cerca de este Condado:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
Preparado por el Texas Cancer Information, www.texascancer.info. Última actualización: mayo del 2011. Página 2 of 9
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+Centros de Salud Federalmente Calificados
Si no puede obtener ayuda del Programa Indigent Health Care, es posible que usted pueda ver a un doctor
en una Clínica de Cuidados Primarios que le dejará pagar usando una “tabla de precios.” Esto quiere
decir que la cantidad de dinero que usted paga se basa en cuántos miembros de su familia viven en su casa
y cuánto dinero usted gana. Por ejemplo, si usted tiene una familia grande y gana muy poco dinero, usted
pagaría menos por los cuidados de salud. Si usted tiene una familia más chica o gana un poco más de
dinero, usted pagaría un poco más.
Para más información y para encontrar la clínica más cercana, llame al número que se indican abajo:
Health Center of Southeast Texas - Shepherd
1651 South Byrd Avenue
Shepherd, Texas 77371
(936) 628-1100
Para las Mujeres
+
Para las mujeres que quieren un chequeo para el cáncer del cuello de la matriz o del seno pueden
obtener ayuda a través de un programa especial llamado Breast and Cervical Cancer Services (BCCS
por sus siglas en inglés).
•
•
•
Para hacerse una prueba Pap para el cáncer del cuello de la matriz, usted debe tener entre 18 y 64
años de edad.
Para hacerse un mamograma (prueba para el cáncer de seno) usted debe tener entre 50 y 64 años de
edad.
Usted necesitará mostrar cuánto dinero gana, así que es posible que le pidan un recibo de pago de su
sueldo (talón de su cheque).
Llame a las clínicas que se indica abajo para hablar sobre hacer una cita:
Memorial Medical Center- Livingston
1717 U.S. 59 Bypass
Livingston, TX 77351
(936) 639- 7066
Health Center of Southeast Texas
401 East Crockett St.
Cleveland, TX 77327
(281) 592- 2224
Memorial Health System of East Texas
P.O. Box 1447
Lufkin, TX 75902
(936) 639- 7130
Preparado por el Texas Cancer Information, www.texascancer.info. Última actualización: mayo del 2011. Página 3 of 9
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Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
• los resultados pasados de pruebas médicas o de laboratorio,
• documentos sobre cualquier tratamiento que usted haya tenido,
• una lista de todas las medicinas que está tomando en este momento.
Tengo cáncer. ¿A dónde voy?
Si le han dicho que usted necesita tratamiento para el cáncer y:
• usted vive en el Condado de Polk,
• tiene bajos ingresos,
• no tiene seguro médico, y
• no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para
más información.
+Programa de Indigent Health Care del Condado de Polk
Si vive en el Condado de Polk usted podría obtener ayuda a través del programa Indigent Health Care
del Condado de Polk. Usted necesitara llenar una formar y mostrar ciertos documentos, tales como el
recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que vive en el
Condado de Polk.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
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Para los Veteranos del Servicio Militar de los Estados Unidos
+ Si usted es un veterano, es posible que a usted lo vean en una Clínica de VA (Veterans Affairs). Para
mayor información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/.
Para más información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar una de las siguientes Clínicas de VA que estén en el Condado de Polk o
cerca de este Condado:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
Tuve cáncer y necesito un chequeo. ¿A dónde voy?
Si usted ha tenido cáncer en el pasado y necesita ver un doctor para un chequeo y:
• usted vive en el Condado de Polk,
• tiene bajos ingresos,
• no tiene seguro médico, y
• no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
+Programa de Indigent Health Care del Condado de Polk
Si vive en el Condado de Polk usted podría obtener ayuda a través del programa Indigent Health Care
del Condado de Polk. Usted necesitará llenar una forma y mostrar ciertos documentos, tales como el
recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que vive en el
Condado de Polk.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
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Para más información, llame al número o vaya a la oficina que se lista abajo:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
Para los Veteranos del Servicio Militar de los Estados Unidos
+ Si usted es un veterano, es posible que a usted lo vean en una Clínica de VA (Veterans Affairs). Para
mayor información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/.
Para más información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar una de las siguientes Clínicas de VA que estén en el Condado de Polk o
cerca de este Condado:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
• los resultados pasados de pruebas médicas o de laboratorio,
• documentos sobre cualquier tratamiento que usted haya tenido,
• una lista de todas las medicinas que está tomando en este momento.
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¿Cómo sé si puedo obtener ayuda para el cuidado del cáncer?
Usted puede obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
+Programa de Indigent Health Care del Condado de Polk
Si vive en el Condado de Polk usted podría obtener ayuda a través del programa Indigent Health Care
del Condado de Polk. Usted necesitará llenar una forma y mostrar ciertos documentos, tales como el
recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar para probar que vive en el
Condado de Polk.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
Polk County Social Services Dept.
602 E. Church St. Ste. 145
Livingston, TX 77351
(936) 327- 6830
Para los Veteranos del Servicio Militar de los Estados Unidos
+ Si usted es un veterano, es posible que a usted lo vean en una Clínica de VA (Veterans Affairs). Para
mayor información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/.
Para más información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar una de las siguientes Clínicas de VA que estén en el Condado de Polk o
cerca de este Condado:
Beaumont Clinic
3420 Veterans Cir
Beaumont, TX 77707
(409) 981- 8550
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Conroe CBOC
800 Riverwood Ct. Ste. 100
Conroe, TX 77304
(936) 522- 4000
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¿Qué pasa si todavía no puedo obtener ayuda para el cuidado del cáncer?
Si usted no puede obtener ayuda del programa del condado o de un Centro de Salud Federalmente Calificado,
probablemente usted quiera llamar a uno de los hospitales que se indican abajo.
+ El National Cancer Institute (NCI por sus siglas en inglés) ha nombrado a cuatro centros para el cáncer
en Texas como líderes en investigación para el cáncer. Dos centros están en Houston, uno está en Dallas y
uno está en San Antonio. Estos centros se enfocan en encontrar nuevos tratamientos para el cáncer a través
estudios clínicos. Para mayor información, por favor visite las páginas de Internet o llame a los números
listados abajo:
Cancer Therapy & Research Center at the UT Health Science Center at San Antonio
1-800-340-2872
http://www.uthscsa.edu/patient.shtml
The Dan L. Duncan Cancer Center at Baylor College of Medicine
(713) 798-1354
http://www.bcm.edu/cancercenter/
Harold C. Simmons Cancer Center at UT Southwestern Medical Center
(214) 645-HOPE (4673)
(800) 460-HOPE (4673)
http://www.simmonscancercenter.org/index.html
The University of Texas MD Anderson Cancer Center
1-877-MDA-6789 (1-877-632-6789)
http://www.mdanderson.org/contact_us/
+
Los siguientes hospitales en su área pueden también tratar pacientes con bajos ingresos o sin seguro.
Usted necesitaría contactar a cada hospital para saber si puede hacer una cita para que lo vean:
Memorial Medical Center – Livingston
(936) 275- 3446
http://www.mhset.net/cancer.htm
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Sadler Clinic
(936) 756- 6631
http://www.sadler.com
¿Dónde puedo aprender más sobre el cuidado del cáncer?
Hay muchos grupos que ayudan a los pacientes con cáncer. Estos grupos pueden ofrecer asistencia
financiera, servicios de apoyo o información gratis sobre el cáncer. Usted puede obtener una lista de estos
grupos del National Cancer Institute al hacer clic en el vínculo o al escribir la siguiente dirección:
https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=8.1
+ Usted también puede llamar al National Cancer Institute’s Cancer Information Service al 1-800-4CANCER (1-800-422-6237).
+ American Cancer Society (ACS por sus siglas en inglés) también tiene grupos de apoyo e información
sobre el cáncer. Usted puede llamar al 1-800-227-2345 o ir a la página de Internet:
http://www.cancer.org/docroot/home/index.asp.
+ Lance Armstrong Foundation (LAF por sus siglas en inglés) tiene información sobre asistencia
financiera y grupos de apoyo. Por favor llame al 1-866-235-7205 o visite la página de Internet:
http://www.livestrong.org
+ Susan G. Komen for the Cure, tiene una línea de ayuda contra el cáncer del seno. Llame al 1-800-4629273 (1-800-I’M AWARE®) o visite la página de Internet: http://www.komen.org
+ Visite la página de Internet de Texas Cancer Information (texascancer.info) al
http://www.texascancer.info/ para una lista de doctores, hospitales, servicios de pruebas para el cáncer
del seno y del colon, agencias de hogares de salud, y hospicios. Usted puede encontrar apoyo,
consejería, educación y otros tipos de ayuda como transporte, vivienda, y equipos médicos al hacer clic
en Local/Community Resources.
+++++
Este documento lo puede encontrar en el formato de PDF en la página de Internet de Texas Cancer Information:
http://www.texascancer.info/access/acceso_espanol_polk.pdf.
An English version of this document can also be found in PDF form on the Texas Cancer Information Web site at
http://www.texascancer.info/access/access_polk.pdf.
Si usted tiene alguna información relacionada con cambios a cualquier procedimiento o direcciones, por favor envíe un e-mail a
Texas Cancer Information al [email protected]. Texas Cancer Information está patrocinado por el Cancer Prevention &
Research Institute of Texas y The University of Texas M. D. Anderson Cancer Center. La inclusión de este documento no debe
ser considerada como un respaldo o apoyo a algún individuo, proveedor, servicio o sitio en la red.
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Condado de San Augustine

Acceso a los Cuidados del Cáncer
para los Pacientes que tienen Bajos
Ingresos y sin Seguro
Esperamos que esta información sea útil si usted está buscando tratamientos o pruebas para el cáncer, como el
mamograma, la prueba Pap, la prueba de la próstata, y no tiene seguro o suficiente dinero para pagar los
cuidados médicos.
Quiero que me chequeen si tengo cáncer. ¿A dónde voy?
Pág. 1
Tengo cáncer. ¿A dónde voy?
Pág. 3
Tuve cáncer y necesito un chequeo. ¿A dónde voy?
Pág. 5
¿Cómo sé si puedo obtener ayuda para el cuidado del cáncer?
Pág. 6
¿Qué pasa si todavía no puedo obtener ayuda para el cuidado del cáncer? Pág. 7
¿Dónde puedo aprender más sobre el cuidado del cáncer?
Pág. 8
Quiero que me chequeen si tengo cáncer. ¿A dónde voy?
Si usted quiere que le chequeen si tiene cáncer y:
•
•
•
•
usted vive en el Condado de San Augustine
tiene bajos ingresos,
no tiene seguro médico,
no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
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 Programa de Indigent Health Care del Condado de San Augustine
Si vive en el Condado de San Augustine usted podría obtener ayuda a través del programa Indigent
Health Care del Condado de San Augustine. Usted necesitará llenar una forma y mostrar ciertos
documentos, tales como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar
para probar que vive en el Condado de San Augustine.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
Centros de Salud Federalmente Calificados
Si no puede obtener ayuda del Programa Indigent Health Care, es posible que usted pueda ver a un doctor
en una Clínica de Cuidados Primarios que le dejará pagar usando una “tabla de precios.” Esto quiere
decir que la cantidad de dinero que usted paga se basa en cuántos miembros de su familia viven en su casa
y cuánto dinero usted gana. Por ejemplo, si usted tiene una familia grande y gana muy poco dinero, usted
pagaría menos por los cuidados de salud. Si usted tiene una familia más chica o gana un poco más de
dinero, usted pagaría un poco más.
Para más información y para encontrar la clínica más cercana, llame al número que se indica abajo:
Sabine Community Clinic
505 N. Temple Dr.
Pineland, TX 75968
(936) 560-5413
Para los Veteranos del Servicio Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de San Augustine o
cerca de este Condado:
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Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Para las Mujeres
 Para las mujeres que quieren un chequeo para el cáncer del cuello de la matriz o del seno pueden
obtener ayuda a través de un programa especial llamado Breast and Cervical Cancer Services (BCCS
por sus siglas en inglés).
•
•
•
Para hacerse una prueba Pap para el cáncer del cuello de la matriz, usted debe tener entre 18 y 64
años de edad.
Para hacerse un mamograma (prueba para el cáncer de seno) usted debe tener entre 50 y 64 años de
edad.
Usted necesitará mostrar cuánto dinero gana, así que es posible que le pidan un recibo de pago de su
sueldo (talón de su cheque).
Llame a las clínicas que se indican abajo para hablar sobre hacer una cita:
Memorial Medical Center - San Augustine
511 E. Hospital St
San Augustine, TX 75972
(936) 275-3446
East Texas Community Health Services, Inc.
1401 South University
Nacogdoches, TX 75961
(936) 560- 5413
Jasper Newton County Public Health District
139 West Lamar St.
Jasper, TX 75951
(409) 384- 6829
Memorial Health System of East Texas
1201 W. Frank St.
Lufkin, TX 75904
(936) 634- 8111
Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
•
•
•
los resultados pasados de pruebas médicas o de laboratorio,
documentos sobre cualquier tratamiento que usted haya tenido,
una lista de todas las medicinas que está tomando en este momento.
Tengo cáncer. ¿A dónde voy?
Si le han dicho que usted necesita tratamiento para el cáncer y:
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•
•
•
•
usted vive en el Condado de San Augustine
tiene bajos ingresos,
no tiene seguro médico,
no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
 Programa de Indigent Health Care del Condado de San Augustine
Si vive en el Condado de San Augustine usted podría obtener ayuda a través del programa Indigent
Health Care del Condado de San Augustine. Usted necesitará llenar una forma y mostrar ciertos
documentos, tales como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar
para probar que vive en el Condado de San Augustine.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
Para los Veteranos del Servicio Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de San Augustine o
cerca de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
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Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
•
•
•
los resultados pasados de pruebas médicas o de laboratorio,
documentos sobre cualquier tratamiento que usted haya tenido,
una lista de todas las medicinas que está tomando en este momento.
Tuve cáncer y necesito un chequeo. ¿A dónde voy?
Si usted ha tenido cáncer en el pasado y necesita ver un doctor para un chequeo y:
•
•
•
•
usted vive en el Condado de San Augustine
tiene bajos ingresos,
no tiene seguro médico,
no puede obtener Medicare o Medicaid.
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
 Programa de Indigent Health Care del Condado de San Augustine
Si vive en el Condado de San Augustine usted podría obtener ayuda a través del programa Indigent
Health Care del Condado de San Augustine. Usted necesitará llenar una forma y mostrar ciertos
documentos, tales como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar
para probar que vive en el Condado de San Augustine.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
Para más información, llame al número o vaya a la oficina que se lista abajo:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
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Para los Veteranos del Servicio Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de San Augustine o
cerca de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
Citas
Cuando vaya para su cita, asegúrese de traer todos los documentos médicos que tenga. Esta información
ayudará a su doctor a entender mejor sus necesidades. Por ejemplo, traiga:
•
•
•
los resultados pasados de pruebas médicas o de laboratorio,
documentos sobre cualquier tratamiento que usted haya tenido,
una lista de todas las medicinas que está tomando en este momento.
¿Cómo sé si puedo obtener ayuda para el cuidado del cáncer?
Usted podría obtener ayuda a través de uno de los programas que se listan abajo. Cada uno puede tener
diferentes reglas sobre cómo usted puede calificar por los servicios, así que llame al número listado para más
información.
 Programa de Indigent Health Care del Condado de San Augustine
Si vive en el Condado de San Augustine usted podría obtener ayuda a través del programa Indigent
Health Care del Condado de San Augustine. Usted necesitará llenar una forma y mostrar ciertos
documentos, tales como el recibo del agua, sus papeles de la hipoteca o la renta, o su licencia de manejar
para probar que vive en el Condado de San Augustine.
Usted no necesita ser ciudadano americano para obtener ayuda. Pero, si usted tiene alguno de los
documentos (como visas) del Servicio de Inmigración y Naturalización (INS por sus siglas en inglés),
usted debe mostrarlos. Usted también necesitará decir cuántos miembros de su familia viven en su casa.
Usted tendrá que demostrar cuánto dinero gana, así que puede ser necesario que usted muestre el recibo de
pago de su sueldo (talón de cheque).
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Para más información, llame al número o vaya a la oficina que se lista abajo:
San Augustine Hospital District
511 Hospital
San Augustine, TX 75972
(936) 275- 3446 ext. 2
Para los Veteranos del Servicio Militar de los Estados Unidos
 Si usted es un veterano, puede que a usted lo vean en una Clínica de VA (Veterans Affairs). Para mayor
información sobre los beneficios de los veteranos vaya a, http://www.va.gov/healtheligibility/. Para más
información, contacte el Department of Veterans Affairs al siguiente número:
Veterans Affairs
Para preguntas sobre cuidados de salud llame al: 1-877-222-8387
Usted también puede llamar o visitar la siguiente Clínica de VA que está en el Condado de San Augustine o
cerca de este Condado:
Charles Wilson VA Outpatient Clinic
2206 North John Redditt Dr
Lufkin, TX 75904
(936) 671- 4300
¿Qué pasa si todavía no puedo obtener ayuda para el cuidado del cáncer?
Si usted no puede obtener ayuda del programa del condado o de un Centro de Salud Federalmente Calificado,
probablemente usted quiera llamar a uno de los hospitales que se indican abajo.
 El National Cancer Institute (NCI por sus siglas en inglés) ha nombrado a tres centros para el cáncer en
Texas como líderes en investigación para el cáncer. Dos de esos centros están en Houston uno en Dallas y uno
en San Antonio. Estos centros se enfocan en encontrar nuevos tratamientos para el cáncer a través estudios
clínicos. Para mayor información, por favor visite las páginas de Internet o llame a los números listados abajo:
Cancer Therapy & Research Center at the UT Health Science Center at San Antonio
1-800-340-2872
http://www.uthscsa.edu/patient.shtml
The Dan L. Duncan Cancer Center at Baylor College of Medicine
(713) 798-1354
http://www.bcm.edu/cancercenter/
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Harold C. Simmons Cancer Center at UT Southwestern Medical Center
(214) 645-HOPE (4673)
(800) 460-HOPE (4673)
http://www.simmonscancercenter.org/index.html
The University of Texas MD Anderson Cancer Center
1-877-MDA-6789 (1-877-632-6789)
http://www.mdanderson.org/contact_us/

Los siguientes hospitales en su área pueden también tratar pacientes con bajos ingresos o sin seguro. Usted
necesitaría contactar a cada hospital para saber si puede hacer una cita para que lo vean:
Memorial Medical Center San Augustine
(936) 275-3446
http://www.memorialmedicalcenter-san Augustine.org
Memorial Medical Center Lufkin
(936) 634- 8111
http://www.mhset.net/lufkin.htm
¿Dónde puedo aprender más sobre el cuidado del cáncer?
Hay muchos grupos que ayudan a los pacientes con cáncer. Estos grupos pueden ofrecer asistencia financiera,
servicios de apoyo o información gratis sobre el cáncer. Usted puede obtener una lista de estos grupos del
National Cancer Institute al hacer clic en el vínculo o al escribir la siguiente dirección:
https://cissecure.nci.nih.gov/factsheet/FactsheetSearch.aspx?FSType=8.1




Usted también puede llamar al National Cancer Institute’s Cancer Information Service al 1-800-4CANCER (1-800-422-6237).
American Cancer Society (ACS por sus siglas en inglés) también tiene grupos de apoyo e información
sobre el cáncer. Usted puede llamar al 1-800-227-2345 o ir a la página de Internet:
http://www.cancer.org/docroot/home/index.asp.
LIVESTRONG tiene información sobre asistencia financiera y grupos de apoyo. Por favor llame al 1-866235-7205 o visite la página de Internet: http://www.livestrong.org
Susan G. Komen for the Cure, tiene una línea de ayuda contra el cáncer del seno. Llame al 1-800-4629273 (1-800-I’M AWARE®) o visite la página de Internet: http://www.komen.org
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
Visite la página de Internet de Texas Cancer Information (texascancer.info) al
http://www.texascancer.info/ para una lista de doctores, hospitales, servicios de pruebas para el cáncer del
seno y del colon, agencias de hogares de salud, y hospicios. Usted puede encontrar apoyo, consejería,
educación y otros tipos de ayuda como transporte, vivienda, y equipos médicos al hacer clic en
Local/Community Resources

Este documento lo puede encontrar en el formato de PDF en la página de Internet de Texas Cancer Information:
http://www.texascancer.info/access/acceso_espanol_sanaugustine.pdf.
An English version of this document can also be found in PDF form on the Texas Cancer Information Web site at
http://www.texascancer.info/access/access_sanaugustine.pdf.
Si usted tiene alguna información relacionada con cambios a cualquier procedimiento o direcciones, por favor envíe un e-mail a
Texas Cancer Information al [email protected]. Texas Cancer Information está patrocinado por el The University of Texas
M D Anderson Cancer Center. Actualizaciones del acceso a el cuidado del cáncer son financiados en parte por una contribución
del Cancer Prevention & Research Institute of Texas. La inclusión de este documento no debe ser considerada como un respaldo
o apoyo a algún individuo, proveedor, servicio o sitio en la red.
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InformationGaps
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InformationGaps
While the following information gaps exist in the health data section of this report, please note that every effort was made to compensate for these gaps in the interviews conducted by Community Hospital Consulting.  This assessment seeks to address the community’s health needs by evaluating the most current data available. However, published data inevitably lags behind due to publication and analysis logistics. Data from the Texas Department of State Health Services has only published the “County Health Facts Profiles” through 2009 as of November of 2012.  The Texas Behavioral Risk Factor Surveillance System only allows users to query data at the Region level; therefore, county level data was not available on certain health behaviors.  Finally, data regarding youth health behaviors was not available through the Center for Disease Control specifically for Angelina, Polk and San Augustine Counties. A detailed comparison of Texas and national data regarding youth was used instead. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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AboutCommunityHospital
Consulting
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AboutCommunityHospitalConsulting
Community Hospital Corporation owns, manages and consults with hospitals through three distinct organizations – CHC Hospitals, CHC Consulting and CHC Continue Care, which share a common purpose of preserving and protecting community hospitals. Based in Plano, Texas, CHC provides the resources and experience community hospitals need to improve quality outcomes, patient satisfaction and financial performance. For more information about CHC, please visit the website at www.communityhospitalcorp.com. Memorial Health System of East Texas contracted with CHC Consulting to conduct its Community Health Needs Assessment and Implementation Plans, which included the following: 





Description of the hospital’s mission, vision and services; Analysis of service area demographics and community health status; Input from persons with special expertise in public health and leaders or members of medically underserved, low‐income or minority populations; Listing of prioritized health needs of the community; Listing of additional services available in the community to meet the identified needs; An implementation strategy that describes how the hospital plans to meet the health need, or identifies the health need as one the hospital does not intend to meet and explains why. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Appendix
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Community Health Needs Assessment Interview Participants NAME Tina Battise ORGANIZATION(S)
Alabama‐Coushatta Tribe
TITLE Deputy Administrator
Ms. Battise has been in her current position for 4 years. The Alabama‐Coushatta Tribe is located in Polk County, in the Livingston area between Livingston and Woodville (Livingston is 15 miles away). Administration has supervision over economic development, education, senior and youth programs, social services, and more. She has worked for the Tribe for 20 years overall, in various positions including IT (10 yrs), Casino, and Tribal Administration and is currently in charge of 20 of the current 40 programs the Tribal Administration is doing. She has lived in the area her entire life. John L. Brink, R.N. Memorial Medical Center – Lufkin; Angelina County Heart Alliance; Smoke‐
Free Lufkin Committee Nurse Manager‐Cardiac Cath Lab; Member, ACHA and SFLC Mr. Brink has been Nurse Manager of the Cath Lab at Memorial Lufkin for 12 years. He serves at public health fairs, and gives speeches on stroke and diabetes education. He is one of the founding members of the Angelina County Heart Alliance (similar to AHA except “all the money stays in Angelina County”). He serves on the Smoke‐
Free Lufkin Committee and previously served on the Public Health Coalition with the Angelina Health District. He has lived in the community 12 years. Robert W. Fayle, M.D. Memorial Medical Center ‐ Livingston
Neurologist Dr. Fayle has been on staff with the Memorial Health System of East Texas for 4 years. He previously served on the medical staff of The Texas Medical Center, Houston. Phyllis Grandgeorge Alcohol and Drug Abuse Council
Executive Director
Ms. Grandgeorge has served in her current position for 21 years. Previously, she worked in juvenile probation and also has experience with a long term care psychiatric hospital. The Council serves 12 counties – including Lufkin and Livingston. She has lived in the area all her life. Jerry Hathorne Polk County Advisory Committee
Chairman Mr. Hathorne has served as Chairman of the Polk County Advisory Committee since Jan 2011. Before then, he was a member of the committee, which was initiated in May 2010. His experience includes over 35 years in healthcare – starting in 1976 as an ENT, and since that time being a paramedic, and an offshore safety director/medic. He has lived in Polk Co for the last 13 years, and has lived in east Texas since high school. Carla Hight Angelina County United Way
Director Ms. Hight has served 15 years as Director of Angelina County United Way. Prior to that she was with the Angelina County Senior Citizen’s Center for 9 years. She has lived in the community nearly all her life – 40 years. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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NAME Jean Hines ORGANIZATION(S)
San Augustine County Hospital District
TITLE Employee; former Board Member Ms. Hines served as a Board Member on San Augustine County Hospital District from the 1980’s to 2002. She remains a part‐time employee of the district who handles their books, takes minutes and pays indigent healthcare bills. She previously worked for the Electric Co‐op as assistant manager, and retired in 2002. She has lived in community since 1960, except for brief period. Brittney Johnson San Augustine County
Project Manager Ms. Johnson has been in her current position a year. Prior to that she worked for the Art Institute for San Antonio. She grew up in San Augustine County, and graduated from the University of Texas. Judge Sammye Johnson San Augustine County
Judge Judge Johnson has served as county judge for San Augustine county since 2011. Before that she owned a business in San Augustine, and was a business analyst for Bell Labs prior to that in Dallas. She has lived in San Augustine since 2003. Heather Kartye Family Crisis Center of East Texas (also known as the Women’s Shelter of East Texas) Executive Director
Ms. Kartye has held her current position 1 ½ years. The Center serves victims of domestic violence and physical assault for a 9‐county region which includes all 3 counties in the study area. She has always worked in non‐profit management, since college. Previously she worked for the Lufkin Chamber of Commerce for 8 years. Ms. Kartye has lived in Lufkin 25 years, since childhood. Marilyn Kegler, R.N. Lufkin Independent School District
Director of Nurses
Ms. Kegler supervises all the Lufkin ISD school nurses, oversees the SHAC (School Health Advisory Council), and AED requirements (health requirements mandated by TEA). She has been 7 years in her current position, and 25 years total with the Lufkin ISD. Her background is health and physical education (college major). She moved into administration and has previously served as a school principal, assistant principal, and Coordinator of Grants. Ms. Kegler has lived in the community for 34 years (originally from Greenville). Marshall McMillan Boys and Girls Club of America– San Augustine; Memorial Medical Center‐San Augustine Board of Trustees President of the Board (BGCA); Board Member‐
Memorial San Augustine Mr. McMillan has been President of the Board for the area Boys and Girls Club for 15 years. He was superintendent of the school district at the time of the creation of the Club, and retired 6 years ago. He serves on the San Augustine County Hospital Board. He also serves on the Lions Club – they have worked to raise (internationally) over 400 million dollars toward the prevention of blindness and free eyeglasses to the needy. He has lived in the community for 18 years. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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NAME Ray Polk ORGANIZATION(S)
Memorial Medical Center of Lufkin
TITLE Diabetes Activist, Hospital Board Member Mr. Polk is a diabetes activist who has been on insulin for 40 years; both his parents died from Diabetes. He spearheaded the movement to open the Diabetic Center at Memorial Hospital – trying to reproduce a program he had experienced personally at another hospital that he felt saved his life. He is a former board member of the Memorial Medical Center – Lufkin. His background is in gas/oil and he has lived in the area for 70 years. Minerva Palomino Memorial Health System, Case Management Department Social Worker Ms. Palomino is a licensed social worker who has been in her current position 4 years since graduating with her degree (BSW). She has lived in the community since graduating high school (Diboll). She works with patients from all three counties in the study area, and is familiar with numerous area resources for patients and families. Sid Roberts, M.D. Memorial Medical Center of Lufkin
Radiation Oncologist
Dr. Roberts is a Radiation Oncologist in private practice and working as a hospital‐based physician at Memorial Medical Center of Lufkin. He has been on staff at the hospital almost 20 years, and lived in the area this same amount of time (20 years). Susan Rushing The Burke Center
CEO Ms. Rushing has been CEO of The Burke Center for 12 years, and an employee for a total of 32 years. She moved to the community for graduate school and never left. The Burke Center serves the mental health needs of a 12‐ county area. Sharon Shaw Angelina County and Cities Health District; Memorial Health System of East Texas Director Ms. Shaw has served 13 years with the Angelina County and Cities Health District, a standalone government entity which is different than many of those in the state. It is a health district, but not directly governed by the city or the county – it is run as an independent business. Ms. Shaw is also a 13‐year employee of Memorial Health System, where she is a department director. Prior to this she worked at Woodland Heights for 8 years in Administration and was a physician recruiter, the director of their volunteer and college program, and ran some of their offsite clinics. Prior to that she worked for UTNB and operated the perinatal clinic in Nacogdoches. She has lived in Lufkin for 27 years. Judge John Thompson Polk County
Judge Judge Thompson has served Polk County for 22 years. He was a hospital pharmacist previously, and consulted with local hospitals. He has been in medical/healthcare related positions most of his previous career. He is also Chairman of a Health Benefits Pool for employees across the state – with 42,000+ members. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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NAME Letha Tullos ORGANIZATION(S)
TITLE East Texas Region, American Cancer Society Regional Vice President
Ms. Tullos has served in her current role for 11 years. The East Texas Region of the ACS consists of 49 counties –
throughout east, southeast and northeast Texas. She is a hospital employee with 20 years experience, and has lived in the area all her life. Carrie Yocum Twin Lakes Rehabilitation and Care Center
Administrator Ms. Yocum has been with Twin Lakes more than 27 years. The facility is a Texas Department of Human Services, Medicare, and Medicaid licensed facility in San Augustine county that offers skilled nursing, rehabilitation, intermediate and long term care. She has lived in the area all her life. Deborah Walters Memorial Health System of East Texas System Director‐Case Management and Social Work Ms. Walters serves as System Director‐Case Management and Social Work for the Lufkin, Livingston and San Augustine Memorial hospitals. She has been in her current position since Jan 2010 – 2 ½ years. Prior to that she was Director of Case Management at another facility in Tyler for 12 years. She also previously served as administrator for a home health agency in Tyler for a year. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Memorial Health System of East Texas
Community Health Needs Assessment Prioritization Ballot


Please review the primary criteria we will use to identify the top community health priorities for
Memorial Health System of East Texas (MHSET)
Then cast 3 votes for each priority
1. Size and Prevalence of the Issue
a. How many people does this affect?
b. How does the prevalence of this issue in our communities compare with its prevalence in other counties or
the State?
c. How serious are the consequences? (urgency; severity; economic loss)
2. Effectiveness of Interventions
a. How likely is it that actions taken will make a difference?
b. How likely is it that actions will improve quality of life?
c. How likely is it that progress can be made in both the short term and the long term?
d. How likely is it that the community will experience reduction of long-term health cost?
3. MHSET Capacity
a. Are people at MHSET likely to support actions around this issue? (ready)
b. Will it be necessary to change behaviors and attitudes in relation to this issue? (willing)
c. Are the necessary resources and leadership available to us now? (able)
Using the criteria listed above, please indicate how important you believe this priority is for the communities we serve, with #1
indicating the highest importance and #5 indicating the lowest importance. To cast your votes, just fill in one circle in every row.
The community needs increased access to affordable primary care
Size and Prevalence of the issue




Effectiveness of Interventions





MHSET’s Capacity






More Important ------- Less Important
The community needs increased access to affordable dental care
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
The community needs additional healthcare providers
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
Lack of mental health and behavioral health continuum of care
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
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There is a need to increase access to transportation for healthcare services for those
without access
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
There is a need for prevention, education and early detection for Heart Disease,
Cerebrovascular Disease, Diabetes and Cancer
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
There is a need to address unhealthy lifestyles such as smoking and obesity
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
There is a need to decrease health disparities by targeting specific populations
Size and Prevalence of the issue





Effectiveness of Interventions





MHSET’s Capacity





More Important ------- Less Important
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Texas BRFSS 2008, 2009, 2010
Risk Factor: Current Asthma
Area: Public Health Administrative Region 4/5N
2008
Current Asthma
Male
Female
386
656
White
Black
Hispanic
830
105
75
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
75
189
380
385
No High School Diploma
H. S. Graduate
Some College
College +
133
313
299
294
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
313
238
327
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,651
411,949
1,042
2009
% at Risk
7.3
8.5
7.1
Sample Size*
11,512
429,860
1,179
Gender
4.1
398
10.1
781
Race/Ethnicity
6.9
955
10
127
5
69
Age Group
6.4
71
4.5
198
7.9
486
10.3
419
Education
11.6
130
5.3
406
7.2
317
6.7
325
Income
8.9
332
10
285
4.3
380
2010
% at Risk
6.5
8.4
8.5
Sample Size*
17,948
448,084
1,745
% at Risk
7.4
8.6
8.9
8.7
8.2
614
1,131
5.2
12.9
9.3
8.1
2.7
1,390
181
115
8.6
13.3
6.9
7.6
7.1
7.1
13.2
93
239
679
718
10.3
8.6
9.7
7.1
5.8
7.3
11
8.4
201
549
511
477
11.3
7
10.8
8.1
8.3
9.2
5.9
520
403
519
7.5
14.2
3.9
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who report that they have ever been diagnosed with asthma (and still have asthma).
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
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Texas BRFSS 2008, 2009, 2010
Risk Factor: Cardiovascular Disease
Area: Public Health Administrative Region 4/5N
2008
Cardiovascular Disease
Male
Female
376
651
White
Black
Hispanic
818
104
74
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
73
187
377
378
No High School Diploma
H. S. Graduate
Some College
College +
127
310
296
291
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
304
236
327
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,599
410,585
1,027
2009
% at Risk
7.9
8.2
9.5
Sample Size*
11,476
428,330
1,167
Gender
8.8
395
10.1
772
Race/Ethnicity
9.6
945
11.2
126
7.6
69
Age Group
‐
70
1.5
195
8.7
483
33.2
413
Education
7.7
125
11.6
403
8
314
9.4
323
Income
11.5
325
10.5
282
4.8
381
2010
% at Risk
6.5
7.7
9.3
Sample Size*
17,858
446,304
1,741
% at Risk
8.3
8.4
11.9
9.8
8.9
614
1,127
14.4
9.2
10.9
11.8
0.3
1,390
179
114
13.4
4.9
7.2
3
0.1
11.3
26.1
95
240
673
717
4.5
1.6
12.8
28.7
9.9
10.6
7.1
9.9
201
547
507
479
19.3
10.7
12.2
9
9.7
13.3
4.8
517
404
521
16.2
15.3
4.1
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who report that they have been diagnosed as having had a Heart Attack, Myocardial Infarction, Angina, Coronary Heart Disease, or Stroke.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
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Texas BRFSS 2008, 2009, 2010
Risk Factor: Diabetes
Area: Public Health Administrative Region 4/5N
Diabetes
2008
Male
Female
387
657
White
Black
Hispanic
830
107
75
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
75
189
381
385
No High School Diploma
H. S. Graduate
Some College
College +
133
313
299
295
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
312
239
328
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,708
414,070
1,044
2009
% at Risk
9.7
8.8
10
Sample Size*
11,595
432,182
1,186
Gender
11.6
400
8.4
786
Race/Ethnicity
8.9
962
19.6
127
10.4
69
Age Group
2.4
71
6.4
198
11.9
492
20.3
419
Education
16.9
130
9.7
406
8.4
319
7.6
329
Income
13.2
333
12.6
287
5
384
2010
% at Risk
9.3
9.1
12.4
Sample Size*
18,051
450,606
1,756
% at Risk
9.7
9.3
11.9
12.7
12
617
1,139
13.5
10.2
11.7
18.6
7.9
1,400
182
115
11.9
15.9
5.8
1.4
9.8
15.9
22.6
94
242
682
722
5.2
3.3
14.2
23.8
14.9
9.3
14.4
13.5
205
552
511
481
13.5
12.5
10.6
11.6
14.8
18.8
6.4
523
408
521
17
8.7
8.5
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who report that they have been diagnosed with diabetes. Does not include gestational diabetes.
The '‐' indicates that the sample size was < 50.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
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Texas BRFSS 2008, 2009, 2010
Risk Factor: Overweight & Obesity (BMI 25 or greater)
Area: Public Health Administrative Region 4/5N
Obesity
2008
Male
Female
378
611
White
Black
Hispanic
795
102
62
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
69
178
363
371
No High School Diploma
H. S. Graduate
Some College
College +
123
299
282
283
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
301
226
318
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,011
395,832
989
2009
% at Risk
66.2
63
67.5
Sample Size*
10,971
423,117
1,134
Gender
73.8
399
61.1
735
Race/Ethnicity
66.2
924
80.7
122
66.9
62
Age Group
55.3
67
70.9
186
71.9
476
68.8
403
Education
67.1
119
67.6
389
68.2
304
67.1
320
Income
67.4
318
72.4
272
65.7
376
2010
% at Risk
66.8
63.8
73.4
Sample Size*
17,020
441,510
1,681
% at Risk
66.6
64.3
71.1
79.5
66.9
608
1,073
76.3
65.4
75
80.6
58
1,352
179
97
68.1
78.5
83.6
70.8
77.6
74.2
69
88
232
646
701
61.9
73.1
79.6
63.5
88.8
73.7
69.9
68.9
185
534
494
466
71.6
71.7
73.1
67.1
70.7
80.7
74.7
506
398
502
66.9
74.4
74.3
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who have a BMI calculated by self reported height and weight.
The '‐' indicates that the sample size was < 50.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 172
Texas BRFSS 2008, 2009, 2010
Risk Factor: Alcohol Use: Binge Drinking
Area: Public Health Administrative Region 4/5N
2008
Alcohol Use
Male
Female
375
653
White
Black
Hispanic
819
104
74
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
75
187
374
378
No High School Diploma
H. S. Graduate
Some College
College +
127
310
297
290
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
308
237
323
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,535
405,371
1,028
2009
% at Risk
14.7
15.1
13.1
Sample Size*
11,314
419,834
1,162
Gender
19.5
395
6.8
767
Race/Ethnicity
12
947
23.1
122
14.7
68
Age Group
20.6
68
15.5
196
11.5
481
3.5
412
Education
11.2
124
16
401
12.5
314
11
321
Income
8.5
323
12.8
284
20.3
382
2010
% at Risk
14.9
15.1
13
Sample Size*
17,723
440,266
1,730
% at Risk
14.6
14.7
12.6
20.6
5.3
608
1,122
18.4
6.6
11.7
7.1
24.2
1,379
180
115
11
16.5
18.9
17.7
20.8
9.4
2.1
94
239
669
712
19.6
16.6
10.9
5.2
15.4
13
15.1
8
201
544
507
473
8.5
18.2
7.7
11.9
11.7
9.1
14.2
517
402
513
10.6
11
18
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who reported having (men 5 or more drinks/women 4 or more drinks) on an occasion in past 30 days.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 173
Texas BRFSS 2008, 2009, 2010
Risk Factor: No Flu Shot in the past year, age 18 Years and over
Area: Public Health Administrative Region 4/5N
2008
No Flu Shot
Male
Female
382
652
White
Black
Hispanic
822
106
74
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
75
187
378
381
No High School Diploma
H. S. Graduate
Some College
College +
132
311
298
290
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
312
237
325
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,600
408,031
1,034
2009
% at Risk
63.9
63.3
60.6
Sample Size*
11,323
421,178
1,160
Gender
62.2
393
58.9
767
Race/Ethnicity
59.9
948
69.8
120
60.3
67
Age Group
74.7
67
74.2
197
59
477
27.8
414
Education
64.2
123
59.5
397
67.6
317
50.5
321
Income
66.4
320
59.5
283
60.9
381
2010
% at Risk
61.8
61.5
61.7
Sample Size*
17,681
439,755
1,711
% at Risk
58.9
57.4
59.4
67.6
55.9
600
1,111
64.3
54.3
61.7
54.2
67.5
1,364
177
114
55.8
66.7
71.7
68.1
77.6
60.7
33.4
92
237
662
706
80.1
68.4
57.6
35.1
61.7
67.9
62.4
48.1
201
535
500
468
63.3
62.7
61.3
48.5
67.6
56.2
63
520
394
509
60
64
57.5
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who report that they did not have a flu vaccine (shot or spray) within the past 12 months.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 174
Texas BRFSS 2008, 2009, 2010
Risk Factor: No Flu Shot in the past year, age 65 Years and over
Area: Public Health Administrative Region 4/5N
2008
No Flu Shot
Male
Female
132
249
White
Black
Hispanic
335
‐
‐
No High School Diploma
H. S. Graduate
Some College
College +
59
122
102
95
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
142
93
63
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
3,318
121,550
381
2009
% at Risk
28.9
30.5
27.9
Sample Size*
3,374
132,577
415
Gender
39.1
121
20.3
294
Race/Ethnicity
31.5
365
‐
‐
‐
‐
Education
28
‐
24.1
149
38.1
120
21.2
98
Income
35.3
129
17.8
119
37.9
66
2010
% at Risk
32.7
31.6
33.9
Sample Size*
6,014
148,146
706
% at Risk
32.7
33.5
35.2
36.5
32.2
240
466
36
34.6
33.3
‐
‐
625
‐
‐
31.1
‐
‐
‐
36
37.3
27.5
83
250
201
171
33.5
39
39.4
24.4
35
29
26
229
178
128
34.4
35.8
35.3
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 65 years and older who report that they did not have a flu vaccine (shot or spray) within the past 12 months.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 175
Texas BRFSS 2005, 2007, 2009
Risk Factor: Intake of Fruit & Vegetables is < 5 times a day
Area: Public Health Administrative Region 4/5N
Intake of Fruit & Vegetables
2005
Male
Female
192
353
White
Black
Hispanic
424
‐
54
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
62
121
203
157
No High School Diploma
H. S. Graduate
Some College
College +
96
189
136
120
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
183
139
127
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
6,348
349,151
545
2007
% at Risk
77.4
75.8
76.4
Sample Size*
16,792
420,696
1,331
Gender
78.1
462
75.1
869
Race/Ethnicity
76.7
990
‐
133
79.2
148
Age Group
68.2
122
82.7
220
76.6
503
76
476
Education
88.1
233
77.1
476
71
339
71.3
277
Income
81.3
442
74.8
326
75.5
331
2009
% at Risk
74.8
75.4
75.9
Sample Size*
11,170
415,324
1,147
% at Risk
76.2
76.3
82.1
76.5
75.3
385
762
85.8
78.8
75.5
77.5
75.3
944
112
66
81.2
78.4
89.7
77.3
77
74.1
76.4
66
195
471
410
83
86
81.4
76.7
84
73.3
83.3
63.6
123
392
313
317
90.9
83.4
80.2
76.4
78.2
72
74.1
320
281
376
84
82.2
80.8
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents a calculated field of respondents 18 years and older who report that they have eaten fruits, fruit juices, or vegetables servings less than 5 times per day.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 176
Texas BRFSS 2008, 2009, 2010
Risk Factor: No Leisure Time Physical Activity
Area: Public Health Administrative Region 4/5N
2008
Physical Activity
Male
Female
386
657
White
Black
Hispanic
829
107
75
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
75
189
381
384
No High School Diploma
H. S. Graduate
Some College
College +
133
312
300
294
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
311
239
328
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,706
414,003
1,043
2009
% at Risk
28.5
25.5
31
Sample Size*
11,588
432,051
1,186
Gender
28.5
400
33.6
786
Race/Ethnicity
30.6
962
25.3
127
37.7
69
Age Group
24.2
71
34
198
28.8
493
38.5
418
Education
39.3
130
36.3
406
31.3
318
17
329
Income
40.5
332
36.5
287
21.1
384
2010
% at Risk
27.3
24.6
29.5
Sample Size*
18,039
450,439
1,751
% at Risk
26.7
24.4
37
21.9
36.9
616
1,135
36.8
37.2
29.1
28.5
33.7
1,397
180
115
32.9
54.1
46.9
23.9
27.8
29.8
37
94
241
682
718
37.3
29.5
39.9
42
52.8
30.7
22.4
21.5
202
550
511
481
61.3
46.5
25.9
19.3
40
26.4
20.8
521
405
521
52.4
35.3
19
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who report no leisure‐time physical activity during the past month. "Leisure‐time physical activity" is defined as physical activity or exercise other than his or her regular job.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 177
Texas BRFSS 2006, 2008, 2010
Risk Factor: No Mammogram within 2 Years, Women >= 40 Years
Area: Public Health Administrative Region 4/5N
2006
No Mammogram
Sample Size*
3,082
160,465
480
Public Health Administrative Region 4/5
Texas
Nationwide
Public Health Region 4/5 North
2008
% at Risk
Sample Size*
29
5,221
23.4
199,690
30.5
500
Race/Ethnicity
2010
% at Risk
27.4
23.2
28.1
Sample Size*
9,024
224,254
932
% at Risk
30
24.6
36.3
White
Black
Hispanic
385
53
‐
32.4
15.8
‐
413
54
‐
Education
26.6
39.2
‐
763
108
‐
34.8
41.5
‐
No High School Diploma
H. S. Graduate
Some College
College +
83
148
126
121
39.9
26.5
25.9
31.3
63
158
158
118
28.1
32.8
29.7
18.4
99
321
293
217
46
40.3
31.8
29.4
169
105
135
41.4
27.2
17.1
309
213
235
48.4
38.7
23.2
Income
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
152
118
114
36
25
31.5
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents female respondents ages 40 years and older who report that they did not have a mammogram within the past two years.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 178
Texas BRFSS 2006, 2008, 2010
Risk Factor: No Pap Smear within 3 Years, Women >= 18 Years
Area: Public Health Administrative Region 4/5N
2006
No Pap Smear
Sample Size*
2,755
151,648
353
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
White
Black
Hispanic
254
50
‐
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
57
101
127
68
No High School Diploma
H. S. Graduate
Some College
College +
58
109
91
95
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
119
95
87
2008
% at Risk
Sample Size*
19.8
4,388
16.1
176,713
20.3
359
Race/Ethnicity
23
266
12.9
‐
‐
‐
Age Group
20.8
‐
21.4
104
19.2
109
18.9
98
Education
20.4
‐
19.1
113
25.1
105
16.3
99
Income
21.8
107
17.9
83
24
113
2010
% at Risk
18.5
17.1
17
Sample Size*
7,119
183,161
592
% at Risk
20.6
18.1
18.7
15
‐
‐
454
66
58
19.8
13.1
16.4
‐
8.6
20.9
23.3
54
132
223
183
8.9
15.1
21.2
35.8
‐
23.2
21.1
9.5
72
180
183
155
24.9
18.2
13.9
21.6
24
14.8
11.7
182
138
172
18.4
26.5
13.2
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents female respondents with uterine cervixes, 18 years and older, who report that they did not have a pap smear within the last 3 years.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 179
Texas BRFSS 2006, 2008, 2010
Risk Factor: No Prostate‐Specific Antigen (PSA) within the past 2 years, Males 40 years of age or older
Area: Public Health Administrative Region 4/5N
2006
No PSA
Sample Size*
1,661
93,781
233
Public Health Administrative Region 4/5
Texas
Nationwide
Public Health Region 4/5 North
2008
% at Risk
Sample Size*
51.6
2,768
46.9
114,197
56.8
303
Race/Ethnicity
2010
% at Risk
47.2
44.7
45.6
Sample Size*
4,859
128,799
478
% at Risk
48.3
45.9
49.5
White
Black
Hispanic
187
‐
‐
51.8
‐
‐
251
‐
‐
Education
48.1
‐
‐
405
‐
‐
41.5
‐
‐
No High School Diploma
H. S. Graduate
Some College
College +
‐
73
51
64
‐
63.5
35.7
33.2
‐
81
73
112
‐
53.9
40.3
31.8
55
118
122
182
74.3
59.8
37.2
34.3
77
76
115
55.1
52.4
38.6
122
113
183
62.7
52.6
38.5
Income
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
54
61
89
59.2
63.2
45.2
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents male respondents 40 years and older who have not had a Prostate‐Specific Antigen (PSA) Test within the past 2 years.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 180
Texas BRFSS 2006, 2008, 2010
Risk Factor: No Digital Rectum Exam (DRE) within the past 5 years, Males 40 years of age or older
Area: Public Health Administrative Region 4/5N
2006
No DRE
Sample Size*
1,695
97,214
232
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
2008
% at Risk
38.3
33.1
43.5
Sample Size*
2,839
118,455
306
2010
% at Risk
40
34.5
45.2
Sample Size*
5,019
133,356
492
% at Risk
40.2
36.6
47.2
44.7
‐
‐
419
‐
‐
43.4
‐
‐
‐
83
74
111
‐
47.2
57.5
24.8
53
123
129
186
70.6
49.7
41.2
38.3
81
74
118
54.8
52.2
37.5
120
117
190
48.3
52.9
40.4
Race/Ethnicity
White
Black
Hispanic
186
‐
‐
33.7
‐
‐
254
‐
‐
Education
No High School Diploma
H. S. Graduate
Some College
College +
‐
72
54
61
‐
52.9
21.8
29.7
Income
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
57
60
87
55.1
44.3
30.5
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents male respondents 40 years and older who have not had a Digital Rectal Exam (DRE) within the past 5 years.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
Community Hospital Consulting
December 2012
Page 181
Texas BRFSS 2008, 2009, 2010
Risk Factor: Current Smoker
Area: Public Health Administrative Region 4/5N
2008
Current Smoker
Male
Female
384
654
White
Black
Hispanic
828
105
73
18‐29 Years
30‐44 Years
45‐64 Years
65+ Years
75
188
379
382
No High School Diploma
H. S. Graduate
Some College
College +
130
313
299
293
Less Than $25,000
$25,000 ‐ $49,999
$50,000 or more
312
238
327
Public Health Administrative Region 4/5N
Texas
Nationwide
Public Health Region 4/5 North
Sample Size*
10,663
412,878
1,038
2009
% at Risk
18.5
18.4
23
Sample Size*
11,544
429,858
1,183
Gender
25.9
398
20.1
785
Race/Ethnicity
23.1
959
34.3
127
17.6
69
Age Group
19.3
71
28.2
198
29.5
490
8.9
418
Education
29.4
130
30.1
404
22.2
317
8.5
329
Income
23.1
332
34
286
16.3
382
2010
% at Risk
17.9
18
20.2
Sample Size*
17,967
448,163
1,744
% at Risk
15.8
17.1
21.4
21.2
19.3
613
1,131
21.2
21.7
23.6
12.2
10.6
1,389
182
114
22.5
22.1
9.9
24.5
17.3
24.4
13.5
95
241
677
715
26.4
23
26.6
7.9
23.7
27
16.5
9.5
203
552
506
476
28
24.7
20.1
13.4
23.4
26.1
15.2
522
405
517
28.5
23.5
11.9
Source: Texas Department of Health Services, Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Note: This data represents respondents 18 years and older who have smoked 100 cigarettes in their lifetime and now smoke every day or some days.
The '‐' indicates that the sample size was < 50 or that the data was not provided.
The sample size includes all survey respondents except those with missing, "don't know", or "refused" answers.
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Youth
Online: High
School YRBS
Texas 2011 and United States 2011 Results
High School Youth Risk Behavior Survey
Texas 2011
United
States 2011
p-value
91.9 (89.7–93.7)†
87.5 (85.0–89.7)
0.00
8.0 (6.7–9.6)
7.7 (6.5–9.1)
0.72
Rode with a driver who had been drinking alcohol one or more
times
(in a car or other vehicle during the 30 days before the survey)
32.2 (28.8–35.7)
24.1 (22.9–25.3)
0.00
Drove when drinking alcohol one or more times
(a car or other vehicle during the 30 days before the survey)
10.2 (8.8–11.7)
8.2 (7.6–8.8)
0.01
Carried a weapon on school property on at least 1 day
(for example, a gun, knife, or club during the 30 days before the
survey)
4.9 (4.0–5.9)
5.4 (4.7–6.1)
0.39
Did not go to school because they felt unsafe at school or on their
way to or from school on at least 1 day
(during the 30 days before the survey)
7.1 (5.7–8.7)
5.9 (5.1–6.9)
0.18
Question
Texas 2011
United
More Likely States 2011
Than United More Likely
States 2011 Than Texas
2011
No Difference
Unintentional Injuries and Violence
Rarely or never wore a bicycle helmet
(among students who had ridden a bicycle during the 12 months
before the survey)
Rarely or never wore a seat belt
(when riding in a car driven by someone else)
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Threatened or injured with a weapon on school property one or
more times
(for example, a gun, knife, or club during the 12 months before the
survey)
6.8 (6.0–7.7)
7.4 (6.8–8.1)
0.20
In a physical fight on school property one or more times
(during the 12 months before the survey)
12.5 (11.1–13.9)
12.0 (11.3–12.8)
0.59
Bullied on school property
(during the 12 months before the survey)
16.5 (15.0–18.1)
20.1 (18.7–21.5)
0.00
Felt sad or hopeless
(almost every day for 2 or more weeks in a row so that they
stopped doing some usual activities during the 12 months before
the survey)
29.2 (27.8–30.8)
28.5 (27.2–29.7)
0.41
Seriously considered attempting suicide
(during the 12 months before the survey)
15.8 (14.6–17.1)
15.8 (15.1–16.5)
0.99
Made a plan about how they would attempt suicide
(during the 12 months before the survey)
13.2 (12.2–14.2)
12.8 (12.0–13.6)
0.53
Attempted suicide one or more times
(during the 12 months before the survey)
10.8 (9.7–12.1)
7.8 (7.1–8.5)
0.00
3.5 (2.8–4.3)
2.4 (2.0–2.9)
0.02
17.6 (16.1–19.1)
16.6 (15.4–18.0)
0.35
6.0 (5.0–7.3)
5.1 (4.6–5.7)
0.15
34.1 (32.1–36.0)
32.8 (31.5–34.1)
0.28
3.9 (3.2–4.8)
3.9 (3.5–4.4)
0.98
11.8 (11.0–12.7)
9.4 (8.6–10.3)
0.00
8.8 (7.8–9.9)
8.0 (7.3–8.8)
0.22
Suicide attempt resulted in an injury, poisoning, or overdose that
had to be treated by a doctor or nurse
(during the 12 months before the survey)
Carried a weapon on at least 1 day
(for example, a gun, knife, or club during the 30 days before the
survey)
Carried a gun on at least 1 day
(during the 30 days before the survey)
In a physical fight one or more times
(during the 12 months before the survey)
Injured in a physical fight one or more times
(injuries had to be treated by a doctor or nurse, during the 12
months before the survey)
Hit, slapped, or physically hurt on purpose by their boyfriend or
girlfriend
(during the 12 months before the survey)
Ever physically forced to have sexual intercourse
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(when they did not want to)
Ever been electronically bullied
(including through e-mail, chat rooms, instant messaging, Web
sites, or texting during the 12 months before the survey)
13.0 (11.7–14.5)
16.2 (15.3–17.2)
0.00
Ever tried cigarette smoking
(even one or two puffs)
50.2 (47.1–53.4)
44.7 (42.3–47.2)
0.01
Smoked a whole cigarette for the first time before age 13 years
10.0 (8.9–11.1)
10.3 (9.3–11.5)
0.65
Smoked cigarettes on at least 1 day
(during the 30 days before the survey)
17.4 (15.5–19.4)
18.1 (16.7–19.5)
0.55
Smoked cigarettes on 20 or more days
(during the 30 days before the survey)
4.5 (3.8–5.3)
6.4 (5.8–7.1)
0.00
Smoked more than 10 cigarettes per day
(among students who currently smoked cigarettes, on the days
they smoked during the 30 days before the survey)
3.7 (2.1–6.3)
7.8 (6.3–9.7)
0.00
Smoked cigarettes on school property on at least 1 day
(during the 30 days before the survey)
3.4 (2.6–4.3)
4.9 (4.4–5.4)
0.00
Ever smoked at least one cigarette every day for 30 days
8.5 (7.3–10.0)
10.2 (9.2–11.2)
0.05
Did not try to quit smoking cigarettes
(among students who currently smoked cigarettes, during the 12
months before the survey)
50.7 (44.8–56.5)
50.1 (47.0–53.1)
0.85
Usually obtained their own cigarettes by buying them in a store
or gas station
(among the students who were aged <18 years and who currently
smoked cigarettes, during the 30 days before the survey)
12.6 (9.4–16.6)
14.0 (11.5–16.9)
0.52
Used chewing tobacco, snuff, or dip on at least 1 day
(during the 30 days before the survey)
6.2 (5.3–7.2)
7.7 (6.6–9.0)
0.04
Used chewing tobacco, snuff, or dip on school property on at least
1 day
(during the 30 days before the survey)
3.7 (3.1–4.4)
4.8 (4.0–5.9)
0.05
Smoked cigars, cigarillos, or little cigars on at least 1 day
(during the 30 days before the survey)
16.0 (14.8–17.3)
13.1 (12.2–14.1)
0.00
Smoked cigarettes; smoked cigars, cigarillos, or little cigars;
or used chewing tobacco, snuff, or dip on at least 1 day
22.9 (20.9–25.2)
23.4 (21.8–25.1)
0.72
Tobacco Use
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(during the 30 days before the survey)
Alcohol and Other Drug Use
Ever had at least one drink of alcohol on at least 1 day
(during their life)
72.7 (69.9–75.4)
70.8 (69.0–72.5)
0.22
Drank alcohol for the first time before age 13 years
(other than a few sips)
22.8 (21.0–24.7)
20.5 (19.2–21.8)
0.04
Had at least one drink of alcohol on at least 1 day
(during the 30 days before the survey)
39.7 (37.4–42.2)
38.7 (37.2–40.3)
0.46
Had five or more drinks of alcohol in a row within a couple of
hours on at least 1 day
(during the 30 days before the survey)
23.5 (21.1–26.0)
21.9 (21.0–22.8)
0.21
Usually obtained the alcohol they drank by someone giving it to
them
(among students who currently drank alcohol during the 30 days
before the survey)
38.3 (34.5–42.3)
40.0 (37.5–42.5)
0.46
Had at least one drink of alcohol on school property on at least 1
day
(during the 30 days before the survey)
3.9 (3.2–4.7)
5.1 (4.5–5.8)
0.01
40.5 (36.8–44.3)
39.9 (37.8–42.1)
0.79
9.0 (7.9–10.3)
8.1 (7.3–9.0)
0.22
20.8 (18.2–23.6)
23.1 (21.5–24.7)
0.14
Used marijuana on school property one or more times
(during the 30 days before the survey)
4.8 (3.9–5.9)
5.9 (5.1–6.7)
0.09
Ever used any form of cocaine one or more times
(for example, powder, crack, or freebase, during their life)
9.4 (8.1–11.0)
6.8 (6.2–7.5)
0.00
Used any form of cocaine one or more times
(for example, powder, crack, or freebase, during the 30 days
before the survey)
4.1 (3.5–4.9)
3.0 (2.6–3.5)
0.01
11.4 (10.1–12.9)
11.4 (10.7–12.1)
0.95
3.3 (2.6–4.1)
2.9 (2.5–3.3)
0.35
Ever used marijuana one or more times
(during their life)
Tried marijuana for the first time before age 13 years
Used marijuana one or more times
(during the 30 days before the survey)
Ever sniffed glue, breathed the contents of aerosol spray cans, or
inhaled any paints or sprays to get high one or more times
(during their life)
Ever used heroin one or more times
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(also called "smack", "junk", or "China white", during their life)
Ever used methamphetamines one or more times
(also called "speed", "crystal", "crank", or "ice", during their life)
5.0 (4.3–5.9)
3.8 (3.4–4.3)
0.01
11.9 (10.0–14.1)
8.2 (7.2–9.4)
0.00
4.8 (3.9–5.9)
3.6 (3.2–4.1)
0.03
Ever took prescription drugs one or more times without a
doctor's prescription
(such as Oxycontin, Percocet, Vicodin, codeine, Adderall, Ritalin,
or Xanax, during their life)
22.1 (19.7–24.7)
20.7 (19.2–22.2)
0.33
Ever used a needle to inject any illegal drug into their body one
or more times
(during their life)
3.1 (2.5–3.9)
2.3 (1.9–2.7)
0.03
29.4 (26.7–32.3)
25.6 (23.6–27.6)
0.03
51.6 (47.5–55.7)
47.4 (45.0–49.9)
0.07
7.0 (5.7–8.7)
6.2 (5.6–6.9)
0.31
Had sexual intercourse with four or more persons
(during their life)
16.7 (14.5–19.2)
15.3 (14.2–16.4)
0.25
Had sexual intercourse with at least one person
(during the 3 months before the survey)
36.2 (32.3–40.2)
33.7 (31.8–35.7)
0.26
Drank alcohol or used drugs before last sexual intercourse
(among students who were currently sexually active)
24.2 (21.7–27.0)
22.1 (20.6–23.6)
0.16
Did not use a condom during last sexual intercourse
(among students who were currently sexually active)
46.2 (43.4–49.0)
39.8 (37.1–42.5)
0.00
Did not use birth control pills before last sexual intercourse
(to prevent pregnancy, among students who were currently
sexually active)
88.7 (86.1–90.9)
82.0 (79.8–84.1)
0.00
Were never taught in school about AIDS or HIV infection
19.0 (15.4–23.1)
16.0 (14.4–17.7)
0.14
Ever used ecstasy one or more times
(also called "MDMA", during their life)
Ever took steroid pills or shots without a doctor's prescription
one or more times
(during their life)
Offered, sold, or given an illegal drug by someone on school
property
(during the 12 months before the survey)
Sexual Behaviors
Ever had sexual intercourse
Had sexual intercourse for the first time before age 13 years
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Did not use Depo-Provera (or any injectable birth control), Nuva
Ring (or any birth control ring), implanon (or any implant), or
any IUD use before last sexual intercourse
(to prevent pregnancy, among students who were currently
sexually active)
95.6 (94.4–96.6)
94.7 (93.6–95.6)
0.19
Did not use birth control pills or Depo-Provera (or any injectable
birth control), Nuva Ring (or any birth control ring), implanon
(or any implant), or any IUD before last sexual intercourse
(to prevent pregnancy, among students who were currently
sexually active)
84.3 (81.8–86.6)
76.7 (74.3–79.0)
0.00
Did not use both a condom during last sexual intercourse and
birth control pills or Depo-Provera (or any injectable birth
control), Nuva Ring (or any birth control ring), implanon (or any
implant), or any IUD before last sexual intercourse
(to prevent pregnancy, among students who were currently
sexually active)
93.6 (91.4–95.3)
90.5 (89.1–91.8)
0.01
Did not use any method to prevent pregnancy during last sexual
intercourse
(among students who were currently sexually active)
20.0 (17.6–22.7)
12.9 (11.6–14.2)
0.00
Did not drink 100% fruit juices
(during the 7 days before the survey)
22.7 (20.8–24.9)
19.2 (18.0–20.5)
0.00
Did not eat fruit
(during the 7 days before the survey)
14.9 (13.6–16.2)
11.7 (10.8–12.6)
0.00
Did not eat green salad
(during the 7 days before the survey)
45.7 (43.9–47.7)
38.0 (36.1–39.9)
0.00
Did not eat potatoes
(excluding French fries, fried potatoes, or potato chips, during the
7 days before the survey)
36.6 (34.0–39.3)
31.2 (30.0–32.6)
0.00
Did not eat carrots
(during the 7 days before the survey)
59.7 (57.1–62.2)
52.0 (49.9–54.1)
0.00
Did not eat other vegetables
(excluding green salad, potatoes, or carrots, during the 7 days
before the survey)
23.8 (20.8–27.1)
17.0 (15.8–18.2)
0.00
Drank a can, bottle, or glass of soda or pop
(not counting diet soda or diet pop, during the 7 days before the
80.7 (79.1–82.1)
79.1 (77.6–80.5)
0.12
Dietary Behaviors
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survey)
Drank a can, bottle, or glass of soda or pop one or more times
per day
(not counting diet soda or diet pop, during the 7 days before the
survey)
29.0 (26.4–31.7)
27.8 (25.6–30.1)
0.49
Drank a can, bottle, or glass of soda or pop two or more times per
day
(not counting diet soda or diet pop, during the 7 days before the
survey)
19.9 (17.7–22.3)
19.0 (16.9–21.3)
0.58
Drank a can, bottle, or glass of soda or pop three or more times
per day
(not counting diet soda or diet pop, during the 7 days before the
survey)
10.2 (8.5–12.2)
11.3 (9.9–12.9)
0.34
6.2 (5.3–7.3)
4.8 (4.3–5.4)
0.02
Ate fruit or drank 100% fruit juices less than one time per day
(during the 7 days before the survey)
42.1 (40.4–43.9)
36.0 (34.3–37.8)
0.00
Ate fruit or drank 100% fruit juices less than two times per day
(during the 7 days before the survey)
70.1 (68.1–72.0)
66.0 (64.4–67.7)
0.00
Ate fruit or drank 100% fruit juices less than three times per
day
(during the 7 days before the survey)
79.9 (78.0–81.8)
77.6 (76.2–79.0)
0.05
Did not eat vegetables
(green salad, potatoes [excluding French fries, fried potatoes, or
potato chips], carrots, or other vegetables, during the 7 days
before the survey)
9.0 (7.8–10.4)
5.7 (5.1–6.4)
0.00
Ate vegetables less than one time per day
(green salad, potatoes [excluding French fries, fried potatoes, or
potato chips], carrots, or other vegetables, during the 7 days
before the survey)
47.5 (45.2–49.8)
37.7 (36.0–39.5)
0.00
Ate vegetables less than two times per day
(green salad, potatoes [excluding French fries, fried potatoes, or
potato chips], carrots, or other vegetables, during the 7 days
before the survey)
78.6 (77.2–80.0)
71.7 (70.3–73.1)
0.00
Ate vegetables less than three times per day
89.3 (87.8–90.7)
84.7 (83.6–85.7)
(green salad, potatoes [excluding French fries, fried potatoes, or
potato chips],
carrots, or other vegetables, during the 7 days
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Did not eat fruit or drink 100% fruit juices
(during the 7 days before the survey)
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before the survey)
Overweight
(students who were >= 85th percentile but < 95th percentile for
body mass index, based on sex- and age-specific reference data
from the 2000 CDC growth charts)
16.0 (14.7–17.4)
15.2 (14.4–16.1)
0.34
Obese (students who were >= 95th percentile for body mass
index, based on sex- and age-specific reference data from the
2000 CDC growth charts)
15.6 (13.7–17.6)
13.0 (11.7–14.4)
0.03
Described themselves as slightly or very overweight
30.3 (28.2–32.5)
29.2 (27.7–30.6)
0.35
Did not eat for 24 or more hours to lose weight or to keep from
gaining weight
(during the 30 days before the survey)
12.8 (11.5–14.2)
12.2 (11.3–13.1)
0.43
Took diet pills, powders or liquids to lose weight or to keep from
gaining weight
(without a doctor's advice, during the 30 days before the survey)
7.2 (6.1–8.5)
5.1 (4.5–5.6)
0.00
Vomited or took laxatives to lose weight or to keep from gaining
weight
(during the 30 days before the survey)
6.3 (5.6–7.1)
4.3 (3.8–4.7)
0.00
Physically active at least 60 minutes per day on less than 5 days
(doing any kind of physical activity that increased their heart rate
and made them breathe hard some of the time during the 7 days
before the survey)
55.5 (52.0–59.0)
50.5 (48.5–52.6)
0.01
Did not attend physical education classes in an average week
(when they were in school)
49.2 (45.0–53.4)
48.2 (42.4–54.0)
0.77
Did not attend physical education classes 5 days in an average
week
(when they were in school)
64.0 (59.8–67.9)
68.5 (62.6–73.9)
0.19
Did not play on sports teams
(run by their school or community groups during the 12 months
before the survey)
42.4 (39.3–45.5)
41.6 (39.3–44.0)
0.70
Watched television 3 or more hours per day
(on an average school day)
37.2 (33.7–40.8)
32.4 (30.9–34.0)
0.01
Used computers 3 or more hours per day
(played video or computer games or used a computer for
32.2 (29.7–34.9)
31.1 (29.3–32.9)
0.46
Physical Activity
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something that was not school work on an average school day)
Physically active at least 60 minutes per day on less than 7 days
(doing any kind of physical activity that increased their heart rate
and made them breathe hard some of the time during the 7 days
before the survey)
72.9 (70.1–75.5)
71.3 (69.7–72.9)
0.32
Did not participate in at least 60 minutes of physical activity on
any day
(doing any kind of physical activity that increased their heart rate
and made them breathe hard some of the time during the 7 days
before the survey)
16.4 (14.3–18.8)
13.8 (12.8–14.8)
0.03
21.4 (19.3–23.6)
23.0 (21.7–24.3)
0.20
9.7 (8.0–11.6)
11.9 (10.9–12.9)
0.03
Asthma
Ever told by a doctor or nurse that they had asthma
Ever told by a doctor or nurse that they had asthma and still have
asthma
Footnotes
†
Percentage, confidence interval
Application URL:http://apps.nccd.cdc.gov/youthonline/App/Results.aspx?
TT=G&OUT=0&SID=HS&QID=QQ&LID=TX&YID=2011&LID2=XX&YID2=2011&COL=&ROW1=&ROW2=&HT=QQ&LCT=&FS=1&FR=1&FG=1&
FSL=&FRL=&FGL=&PV=&TST=True&C1=TX2011&C2=XX2011&QP=G&DP=1&VA=CI&CS=N&SYID=&EYID=&SC=DEFAULT&SO=ASC&PF=1
Centers for Disease Control and Prevention 1600
Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day - [email protected]
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ReportedSources
Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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ReportedSources
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“Texas Dominates List of Fastest‐Growing Large Cities Since 2010 Census, Census Bureau Reports.” United States Census Bureau, Newsroom. http://www.census.gov/newsroom/releases/archives/population/cb12‐117.html (Accessed August 21, 2012 / Published June 28, 2012) 4
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Texas Department of State Health Services, Center for Health Statistics, Heath Facts Profiles 2007 and 2008; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ 14
Bureau of Labor Statistics, Local Area Unemployment Statistics; http://www.bls.gov/lau/ (Accessed August 27, 2012 / Last modified April 20, 2012 [County Data]). 15
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Texas Department of State Health Services, Center for Health Statistics; http://www.dshs.state.tx.us/chs/vstat/vs10/data.shtm (Accessed August 29, 2012) 22
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 23
Texas Department of State Health Services, Center for Health Statistics, Vital Statistics Annual Reports; http://www.dshs.state.tx.us/chs/vstat/annrpts.shtm (Accessed August 29, 2012) 24
Texas Department of State Health Services, Center for Health Statistics, Vital Statistics Annual Reports; http://www.dshs.state.tx.us/chs/vstat/annrpts.shtm (Accessed August 29, 2012) 25
Texas Department of State Health Services, Center for Health Statistics, Vital Statistics Annual Reports; http://www.dshs.state.tx.us/chs/vstat/annrpts.shtm (Accessed August 29, 2012) 26
Texas Department of State Health Services, Center for Health Statistics, Vital Statistics Annual Reports; http://www.dshs.state.tx.us/chs/vstat/annrpts.shtm (Accessed August 29, 2012) 27
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 2
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Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 29
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 30
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 31
Texas Cancer Registry, Texas Fact Sheets; http://www.dshs.state.tx.us/tcr/statisticalData/Texas‐Fact‐Sheets‐
2012.aspx (Accessed October 12, 2012). 32
Texas Cancer Registry, Texas Fact Sheets; http://www.dshs.state.tx.us/tcr/statisticalData/Texas‐Fact‐Sheets‐
2012.aspx (Accessed October 12, 2012). 33
Texas Cancer Registry, Texas Fact Sheets; http://www.dshs.state.tx.us/tcr/statisticalData/Texas‐Fact‐Sheets‐
2012.aspx (Accessed October 12, 2012). 34
Texas Cancer Registry, Texas Fact Sheets; http://www.dshs.state.tx.us/tcr/statisticalData/Texas‐Fact‐Sheets‐
2012.aspx (Accessed October 12, 2012). 35
Texas Cancer Registry, Cancer Inquiry System; http://www.cancer‐rates.info/tx/index.php (Accessed October 12, 2012). 36
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 37
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 38
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 39
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 40
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 41
F as in Fat: How Obesity Threatens America’s Future 2012 (Accessed October 12, 2012 / Published September 2012) http://healthyamericans.org/reports/obesity2012/ 42
F as in Fat: How Obesity Threatens America’s Future 2012 (Accessed October 12, 2012 / Published September 2012) http://healthyamericans.org/reports/obesity2012/ 43
F as in Fat: How Obesity Threatens America’s Future 2012 (Accessed October 12, 2012 / Published September 2012) http://healthyamericans.org/reports/obesity2012/ 44
F as in Fat: How Obesity Threatens America’s Future 2012 (Accessed October 12, 2012 / Published September 2012) http://healthyamericans.org/reports/obesity2012/ 45
F as in Fat: How Obesity Threatens America’s Future 2012 (Accessed October 12, 2012 / Published September 2012) http://healthyamericans.org/reports/obesity2012/ 46
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 47
Texas Department of State Health Services, Center for Health Statistics, Health Facts Profiles 2007, 2008, 2009; http://www.dshs.state.tx.us/chs/cfs/Texas‐Health‐Facts‐Profiles/ (Accessed August 29, 2012) 48
Health Resources and Services Administration; http://hpsafind.hrsa.gov/HPSASearch.aspx (Accessed October 5, 2012) 49
Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver; http://www.utmb.edu/1115/CountyInformation.asp (Accessed October 5, 2012) 50
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 51
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 52
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 54
F as in Fat: How Obesity Threatens America’s Future 2012 (Accessed October 12, 2012 / Published September 2012) http://healthyamericans.org/reports/obesity2012/ 55
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 56
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 57
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 58
Center for Disease Control and Prevention, Adolescent and School Health, Youth Risk Behavior Survey Fact Sheets; http://www.cdc.gov/healthyyouth/yrbs/factsheets/index.htm#compare (Accessed October 12, 2012). 59
Health Resources and Services Administration; http://hpsafind.hrsa.gov/HPSASearch.aspx (Accessed October 22, 2012) 60
Texas Department of State Health Services, Behavioral Risk Factor Surveillance System; http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm (Accessed September 28, 2012) 61
United States Census Bureau, Small Area Health Insurance Estimates; http://www.census.gov/did/www/sahie/data/interactive/ (Accessed September 26, 2012) Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Section2
ImplementationPlan
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MemorialMedicalCenter‐LivingstonImplementationPlan
MeasurableObjectivesandImplementationActivities
A comprehensive Community Health Needs Assessment (CHNA) was conducted for Memorial Medical Center – Livingston from August to December of 2012. The hospital’s study area was defined as Polk County. The CHNA also included data regarding two additional counties, Angelina and San Augustine Counties. The three additional hospitals within Memorial Health System of East Texas are located in Angelina and San Augustine Counties and those data elements are provided for comparison purposes. The analysis included a careful review of the most current health data available and input from numerous community representatives with special knowledge of public health. Findings indicated that there were eight main needs in the communities served by Memorial Medical Center – Livingston. The CHNA Team prioritized those eight needs and decided to address the top seven. The CHNA Team decided not to specifically address the need for “increased access to affordable dental care,” largely due to its position (last) on the prioritized list and the health system’s capacity to address that need. Dental services are not a core business function of the health system and the leadership team felt that resources and efforts would be better spent addressing the first seven prioritized needs. The final list of prioritized needs, in descending order, is listed below: 1. There is a need for prevention, education and early detection for heart disease, cerebrovascular disease, diabetes and cancer 2. The community needs increased access to affordable primary care 3. The community needs additional healthcare providers  Primary care physicians, specialists, mental health providers, and physicians accepting Medicare and Medicaid HMO products 4. There is a need to address unhealthy lifestyles such as smoking and obesity 5. There is a lack of a mental health and behavioral health continuum of care 6. There is a need to decrease health disparities by targeting specific populations, including:  The high prevalence of diabetes among Native Americans in Polk County  Low income, un/underinsured and elderly  A safe place for treatment for undocumented persons  A culturally sensitive, language appropriate healthcare environment for minority populations 7. There is a need to increase access to transportation for healthcare services for those without access (such as elderly and low income residents) Memorial Medical Center – Livingston leadership has developed the following Implementation Plan to identify specific activities and services which directly address these seven priorities. The objectives were identified by studying the prioritized health needs, within the context of the hospital’s overall strategic plan, and the availability of finite resources. The Plan includes a rationale for each objective categorized under each health priority, followed by specific implementation activities. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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PRIORITY #1: There is a need for prevention, education and early detection for heart disease, cerebrovascular disease, diabetes and cancer. Objective #1: Memorial Medical Center – Livingston will focus financial and staff resources on educating the community about diabetes prevalence, prevention and disease management. Rationale: As of 2009, diabetes is the seventh leading cause of death in Texas and the state also ranks 15th in country, with 1 being the highest prevalence and 51 being the lowest, in terms of diabetes among adult residents. Excluding 2005, self‐reported diabetes prevalence rates have been higher in Region 4/5N than Texas and the United States since 2002. Education regarding diabetes and available resources will allow community members to better cope with or prevent diabetes. Implementation Activities: • Memorial Health System of East Texas will produce a monthly cooking show, Memorial Cooking Innovations, which is a 30 minute cooking show featuring a registered dietitian and a certified chef. The show features diabetic friendly foods that are delicious and easy to prepare and is broadcast on the local government access television channels daily and in 49 cities across the United States. Additionally, the broadcast is made available to view at any time online at http://www.memorialhealth.us/cooking. • Diabetes Classes are offered through the HC Polk Education Center at a minimal charge. Memorial Medical Center ‐ Livingston also provides space for diabetes classes to meet in the hospital’s cafeteria. • Memorial Medical Center – Livingston offers a support group that meets regularly to share experiences on living with diabetes successfully. • Memorial Medical Center – Livingston employs a certified dietician. Objective #2: Memorial Medical Center – Livingston will participate in a variety of cancer related events, such as campaigns and luncheons, to increase awareness and promote early cancer detection through appropriate screenings. Rationale: As of 2009, cancer is the second leading cause of death in Angelina County, Polk County, San Augustine County and Texas. There are much higher incidence rates of particular cancers, such as prostate cancer, in the study area than in Texas. Self‐reported rates of Digital Rectal Exams at the appropriate times also suggest a potential disparity among residents in Region 4/5N compared to Texas. Increased awareness and opportunities for appropriate screenings will help community members improve their prognoses by detecting cancer in its earliest stages. Implementation Activities: • Memorial Health System of East Texas will bring the Know Your Stats Prostate Awareness Campaign to Memorial Medical Center – Livingston for the first time in CY 2013. This will include hosting a men's breakfast to educate men on the importance of prostate screenings. Local Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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•
•
•
urologists will participate to offer information on prostate cancer, signs and symptoms, risk factors and treatment methods. Prostate Specific Antigens will also be offered at a discounted rate. Memorial Health System of East Texas recently brought the annual breast cancer awareness luncheon, Power of Pink to Memorial Medical Center ‐ Livingston. At this event, which will be implemented again in 2013, the hospital works with the American Cancer Society to supply vendors and sign women up to get mammograms. In 2012, the Power of Pink luncheon reached more than 200 women. Memorial Medical Center – Livingston will actively participate in Mammography Month. The hospital will run an educational media campaign on understanding the signs and symptoms of breast cancer and encourage women to get mammograms. A free gift is offered to those scheduling a mammogram at one of MHSET’s facilities. Memorial Health System of East Texas’ Cancer Committee will evaluate the possibility of offering lung cancer screenings at each of its facilities. Objective #3: Memorial Medical Center – Livingston will engage in collaborative initiatives to educate the community on a variety of health topics. Rationale: Many interviewees, which all had special knowledge of public health in Angelina, Polk and San Augustine Counties, indicated that education about resources in the community and the appropriate use of those resources are critical to improving the health of the community. It was also mentioned that education efforts should focus on prevention, education and early disease intervention. Providing an opportunity for community members to actively learn about important health topics will help increase appropriate healthcare utilization. Implementation Activities: • Memorial Health System of East Texas will participate in the monthly Speakers' Bureau at each of its facilities. At this event, MHSET physicians speak to civic clubs on a variety of health care topics. • Memorial Health System of East Texas will conduct the monthly Women’s Power Lunch, which features local physicians speaking on pertinent health topics, at Memorial Medical Center – Livingston. • This year Memorial Medical Center—Livingston partnered with Memorial Hermann Hospital in Houston to enhance the care of stroke patients in the Livingston ED. Through telemedicine Memorial Medical Center—Livingston and Memorial Herman are elevating the care for stroke patients presenting to the Livingston ED. Additionally, Memorial Medical Center—Livingston will be a part of the East Texas Heart and Vascular Initiative, where public education forums are held at industries, schools, assisted living centers, retirement centers, and civic clubs. Objective #4: Memorial Medical Center – Livingston will serve as a resource to other healthcare providers in the community, and as a clinical resource for allied health academic institutions. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Rationale: [See Rationale from Priority 1, Objective 3] By collaborating with and serving as a resource to other institutions in the community, Memorial Medical Center – Livingston can improve the community’s access to healthcare resources and services. Implementation Activities: • Memorial Medical Center – Livingston will serve as resource for other healthcare care providers, such as nursing homes, the Regional Advisory Council, the Emergency Preparedness Team, the Rural East Texas Health Network and EMS. • Memorial Medical Center—Livingston serves as a clinical resource for allied health academic institutions. This includes clinical rotations, “mini‐internships,” and serving as a training site for Sam Houston State University for dietetic interns to come obtain clinical and food service hours. • Memorial Health System of East Texas will enhance its online patient library that serves as medical resource for surgical procedures, illnesses, etc. PRIORITY #2: The community needs increased access to affordable primary care. Objective #1: Memorial Medical Center – Livingston will coordinate with various providers to offer affordable and discounted care to community members. Rationale: The demographics of the study area suggest that cost is a significant barrier in obtaining healthcare. More than 25% (25.9%) of residents in Angelina County, 27.5% in San Augustine County and nearly 30% (29.3%) in Polk County are uninsured. The unemployment rates in Polk and San Augustine Counties (9.7% and 12.4% respectively) are higher than both Texas’ and the United States’ averages (7.9% and 8.9% respectively). More than one fourth (25.6%) of people in San Augustine County are living below the poverty line, as are 16.4% of people in Polk County and 14.8% of people in Angelina County. Providing services at a discounted rate will help ensure that community members are getting the care they need regardless of ability to pay. Implementation Activities: •
•
Memorial Health System of East Texas will collaborate with Express Lab to offer very affordable lab testing at all of the system’s facilities. Many of the discounted screenings offered at Memorial Medical Center – Livingston are offered through Express Lab. Memorial Health System of East Texas, including Memorial Medical Center – Livingston, will offer Lifeline In‐service, a home alert system, at a discounted rate. Objective #2: Memorial Medical Center – Livingston will provide staff members that aim to connect patients with available resources and affordable healthcare options. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Rationale: [See Rationale from Priority #2, Objective #1] By providing staff that works to connect patients to available resources, Memorial Medical Center – Livingston can increase access for community members that are unable to pay. Implementation Activities: • Memorial Medical Center – Livingston employees a Medicaid staff member, who works to connect indigent and disabled patients to available payer sources. The hospital contributes to half of the staff member’s salary, while the state pays the remaining half. PRIORITY #3: The community needs additional healthcare providers.  Primary care physicians, specialists, mental health providers, and physicians accepting Medicare and Medicaid HMO products Objective #1: Memorial Medical Center – Livingston will recruit primary care and specialist care physicians. Rationale: Angelina, Polk and San Augustine Counties are all designated as Health Professional Shortage Areas (HPSAs) with regard to mental health. The Diboll prison and the low income populations in Angelina County, the Alabama‐Coushatta Tribe of Texas in Polk County, all of Polk County and all of San Augustine County are designated as primary care HPSAs (current as of October 22, 2012). In addition, interviewees repeatedly discussed the need for additional healthcare providers, particularly in Polk and San Augustine Counties. By recruiting physicians, Memorial Medical Center – Livingston will increase access to additional healthcare providers in the community. Implementation Activities: • Memorial Medical Center ‐ Livingston will actively recruit primary care and specialist physicians, based on a recently conducted Medical Staff Development Plan, via its MMA affiliation. PRIORITY #4: There is a need to address unhealthy lifestyles, such as smoking and obesity. Objective #1: Memorial Medical Center – Livingston will engage in a variety of initiatives to promote healthy lifestyles, such as good nutrition and smoking cessation. Rationale: There is a high prevalence of both smoking and obesity in Region 4/5N, Texas and the United States. Data suggests that there are much higher rates of physical inactivity and smoking in Region 4/5N than in Texas or the United States, but obesity appears to be a critical health problem nationwide. More than 50% of survey respondents indicated that services for nutrition and weight management programs, as well as tobacco cessation programs are either inadequate or very inadequate in the community. Many interviewees also identified pressing lifestyle issues that need additional attention or promotion of available services. These topics included diabetes, obesity, smoking cessation, heart disease, Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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parenting, fitness and substance abuse. By engaging in initiatives that promote healthy lifestyles, the hospital will contribute to improving healthy lifestyles in the community. Implementation Activities:  Memorial Health System of East Texas will participate in the city wide, smoke free initiative. In addition, all of Memorial Health System of East Texas’ campuses are all smoke free.  Memorial Medical Center – Livingston will advocate for improved health and well‐being among staff by offering discounted or free services to employees. Memorial Medical Center – Livingston operates an employee health clinic.  Memorial Health System of East Texas will provide nutritional articles on a monthly basis to various news sources, including the Lufkin Daily News, the Polk County Enterprise and East Texas Magazines.  Memorial Medical Center – Livingston will provide healthy options in the facility’s cafeteria.  Memorial Medical Center – Livingston will provide financial support and volunteers to organizations that strive to improve unhealthy lifestyles in the community. Some of these organizations include:  American Cancer Society  The Coalition  Mosaic Center‐Shelter  Hospice  Alzheimer's Association  Smoking cessation and lifestyle changes are also addressed in the public health fairs and senior and women’s expos (detailed under Priority #6). Objective #2: Memorial Medical Center – Livingston will offer and provide space for programs that work to address unhealthy lifestyles through education, group meetings, or classes. Rationale: [See Rationale from Priority 4, Objective 1] By offering an opportunity to get involved in a support group or class, Memorial Medical Center – Livingston can improve lifestyle choices in the community. Implementation Activities: • Memorial Medical Center – Livingston will organize and provide space for diabetes support groups. • Memorial Medical Center – Livingston provides space for weight watchers meetings in the hospital’s cafeteria. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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PRIORITY #5: There is a lack of a mental health and behavioral health continuum of care. Objective #1: Memorial Medical Center – Livingston will provide financial support, staff and volunteers to organizations that either offer services or strive to address mental health and substance abuse concerns in the community. Rationale: Data suggests that an increasing percentage of residents in Region 4/5N report experiencing poor mental health days. More than 50% of survey respondents indicate that mental health screenings are either inadequate or very inadequate in the community and more than half of respondents also indicated that the needs of persons experiencing mental illness and persons with chemical dependency were not being adequately met. The interviews suggested a crucial need to address the gaps among the continuum of care for patients with mental or behavioral health issues, with substance abusers specifically at risk. By providing financial support and volunteers to organizations that work to meet these identified needs, the hospital can help address mental health and substance abuse concerns in the community. Implementation Activities: • Memorial Medical Center – Livingston will provide financial support and volunteers to organizations that offer prevention and/or treatment for alcohol and drug abuse, underage drinking, etc. Some of these organizations include: • Alcohol Drug Abuse Council of Deep East Texas • Alzheimer's Association • Memorial Medical Center ‐ Livingston is one of only a few hospitals in East Texas that offers the SANE program. These nurses, who treat sexual assault victims, are specially trained and certified in this field through the office of the Texas Attorney General. Memorial Medical Center – Livingston will provide access to these nurses in the Emergency Department. Objective #2: As a part of the larger health system, Memorial Medical Center – Livingston will provide staff and leadership to organizations in the community that work to improve the continuum of care between mental health and behavioral health services. Rationale: [See Rationale from Priority 5, Objective 1] By working as a collaborative health system, the hospital can address mental health and substance abuse concerns in the community. Implementation Activities: • Memorial Health System of East Texas will provide leadership to various boards that seek to improve the mental health continuum of care in the community. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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PRIORITY #6: There is a need to decrease health disparities by targeting specific populations. 
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The high prevalence of diabetes among Native Americans in Polk County Low income, un/underinsured and elderly A safe place for treatment for undocumented persons A culturally sensitive, language appropriate healthcare environment for minority populations Objective #1: As a part of the larger health system, Memorial Medical Center – Livingston will focus on decreasing health disparities among specific populations by collaborating, organizing, and participating in a variety of initiatives that target specific groups. Rationale: Data suggests that there are various health disparities among specific populations in Region 4/5N. There are mental health disparities with regard to gender and income and physical inactivity disparities by education and income. There are also disparities among residents who cannot see a doctor because of medical cost. Women more than men, Black and Hispanic populations more than the White population, persons making less than $50,000 compared to those making more than $50,000 and those with no high school diploma compared to those with college degrees were more likely to report that they were unable to see a doctor because of medical cost. Interviewees noted over and over again that there was a specific need to reach targeted populations. Some mentioned the Native American population in Polk County, others mentioned the elderly. Nearly everyone spoke about the needs of under or uninsured residents in the community and many mentioned the needs of undocumented persons and other minority populations. The hospital can work to address these needs through collaboration with the larger system. Implementation Activities: • Memorial Health System of East Texas, including Memorial Medical Center – Livingston, will continue to be a presenting sponsor for the Senior Expo. • Memorial Medical Center – Livingston will engage in outreach in public schools, such as infection and behavior related activities. • In collaboration with the larger system, Memorial Medical Center – Livingston will sponsor or endorse community wide health fairs and health screenings, such as the Physician/New Product presentations and area school events. • Memorial Health System of East Texas provides Women’s Special Services that offers mammograms, GYN exams and pap smears and GYN educational services to the uninsured population in the community. Memorial Medical Center – Livingston participates in these service offerings. • Memorial Health System of East Texas provides bacterial pneumonia and flu vaccinations at all of its facilities. Objective #2: Memorial Medical Center – Livingston will conduct and participate in events that raise funds for specific populations, such as women and indigent cancer patients. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Rationale: [See Rationale from Priority 6, Objective 1] By providing participating in events that target specific populations, the hospital can address health disparities among these groups. Implementation Activities: • Memorial Medical Center – Livingston will offer events specifically targeted at women, such as the Women’s Power Lunches and the Power of Pink. • Part of the proceeds from Power of Pink goes to the Cancer Center for indigent care and transportation. PRIORITY #7: There is a need to increase access to transportation for healthcare services for those without access (such as elderly and low income residents). Objective #1: Memorial Medical Center – Livingston will work to provide access to transportation and transportation vouchers to patients at the hospital. Rationale: Transportation was cited by multiple interviewees as a barrier to accessing health services. By providing access to transportation for those without access, Memorial Medical Center – Livingston can increase access to healthcare for community members who would otherwise go without care. Implementation Activities: • Part of the proceeds that are raised through Power of Pink will go to provide gas vouchers for cancer treatment and prescription medication for qualified patients. Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Section3
CommentsandPaperCopies
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Please address written comments on the CHNA and Implementation Plan and requests for a copy of the CHNA to: Marketing Department Phone Number: (936) 639‐7613 1201 W. Frank Ave Lufkin, TX 75904 Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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Community Hospital Consulting 5801 Tennyson Parkway, Suite 550 Plano, Texas 75024 Phone: (972) 943‐6400 Fax: (972) 943‐6401 Website: www.communityhospitalcorp.com Memorial Medical Center - Livingston Community Health Needs Assessment and Implementation Plan
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