Troubling trends for homelessness, physical activity, food security, and drug-related deaths

Part I of our double blog on recent trends in King County focused on some of the good news from King County Hospitals for a Healthier Community’s new Community Health Needs Assessment.  Now we’ll look at some of the more challenging findings.

Part II.  ACROSS KING COUNTY OVERALL, WHAT’S FAILING TO IMPROVE OR GETTING WORSE?  While many indicators showed little or no improvement in the 3 years since the previous report, those with special relevance for healthcare providers were highlighted in the Community Health Needs Assessment.

Homelessness:  In the context of escalating housing prices, student homelessness in King County more than doubled since 2008, reaching 8,411 (2.9% of enrolled students) in the 2015-16 school year. In 2016-17, this increased further, to 9,407 (3.2% of enrollees).

  • In most school districts, more than 40% of homeless students were in elementary school or pre-kindergarten.
  • In addition to student homelessness, the 2017 Count Us In Report identified 11,643 individuals experiencing homelessness, 50% of whom had one or more disabling conditions.

Too little physical activity: Fewer than 1 in 4 King County adults and youth get the recommended amount of exercise. Insufficient physical activity is associated with obesity, which in turn is linked to diabetes and other chronic diseases (including 4 in 10 cancers diagnosed in the United States).

  • This represents no change for adults, and modest but inadequate improvement for 8th, 10th, and 12th graders, given the importance of physical activity to health.
  • The overall obesity rate for King County adults has been flat since 2009 (at more than 1 in 5 adults). Nationally, adult obesity levels rose for decades, stabilized between 2003 and 2012, then rose again slightly for women.
  • At 22%, the 2015 adult obesity rate in King County was significantly lower than the Washington state rate of 26%, and the national rate of 29% (although the 2011-2015 rate in South Region matches the national rate, at 29%).
  • For King County youth, obesity has held steady around 9% since 2004 except in South Region, where it has increased. In comparison, high school students nationally experienced a steady increase in obesity from 1999 to 2013, which appeared to level off at a higher rate -14% in 2015.

Food insecurity:  By 2016, King County participation in the Basic Food program (formerly food stamps) had not returned to pre-recession levels and was increasing for older adults, especially in South Region.

  • A similar pattern was found for visits to King County food banks.
  • Although survey data about food hardship (running out of food without money to buy more) have not been collected since 2013, use of food assistance is often associated with food insecurity.

Feeling depressed: On the mental health front, 30% of youth reported that, every day for 2 or more consecutive weeks, they felt so sad or hopeless that they stopped doing some of their usual activities.

  • This indicator of depressive feelings has gotten worse in King County since 2004, driven by increases among youth in South Region.
  • Among adults, reports of frequent mental distress (poor mental health in at least 14 of the past 30 days) have increased among Hispanics since 2005, but remained stable among other race/ethnicity groups.
  • While the percentage of heterosexual adults reporting serious psychological distress has been flat since 2009, feeling “nervous, hopeless, restless, depressed, worthless, or that everything was an effort” within the past 30 days has increased significantly among lesbian, gay, and bisexual adults.

Drug-related deaths, especially those related to heroin and methamphetamine, increased dramatically between 2010 and 2016.  New data released last week revealed a 10% increase (from 348 to 379) in King County drug-related deaths in 2017.

What’s UP in King County?

In the midst of rapid economic growth, population growth, and increases in the cost of housing, how are the people who live in King County communities faring?  The new Community Health Needs Assessment released by King County Hospitals for a Healthier Community (HHC) offers a data-informed overview of how we’re doing.    

In a pair of blog posts, we look at what’s changing in our increasingly diverse county – in positive and negative directions.  First, the good news:

Part I.  ACROSS KING COUNTY OVERALL, WHAT’S GETTING BETTER?

Although disparities remain, 3 county-wide successes stand out. (To look at change over time in the hyperlinked visualizations below, please click on the “trends” tabs.)

Since implementation of the Affordable Care Act, health insurance coverage has improved dramatically – for all ages, racial/ethnic groups, and cities.

  • But… most communities of color remain disproportionately uninsured and residents of low-income neighborhoods were least likely to receive recommended preventive services such as vaccines, screenings, and dental care.

Cigarette smoking – still the leading preventable cause of death in the United States – has declined for adults and youth across regions, age groups, and racial/ethnic groups.  For youth, the decline in smoking was accompanied by a decline in overall tobacco use (combining cigarettes, chew, cigars, and hookah), exposure to secondary smoke at home, and use of alcohol, marijuana, painkillers, or illicit drugs.

  • But… smoking is inversely linked to income, with adults with in the lowest-income group 4 times more likely to smoke as those in the highest-income group.

Fewer students in 8th, 10th, and 12th grades are drinking non-diet sodas and other sugar-sweetened beverages daily, mirroring a national trend among high school students.

  • But… students in South Region are more likely than students in other regions to drink sugar-sweetened beverages.

All of these improvements occurred in the context of supportive policy changes – at the federal, state, county, city, and/or school levels.  Nevertheless, some improvements are swamped by the magnitude of ongoing disparities. For example, although health insurance for Hispanic adults improved by 11% between 2013 and 2016, 21% of Hispanic adults were still uninsured in 2016, compared to 4% of non-Hispanic white adults.

While we’re making progress, we still have a ways to go.

How are guns stored in King County homes?

Across all of King County, more than 1 in 5 adults reported keeping a gun in or around their homes, including in a car or other motor vehicle.  But where they lived made a big difference: Keeping a gun at home was least likely in Seattle neighborhoods (14%) and most likely in rural areas in east and south King County, with the highest rate (43%) in Covington / Maple Valley and Newcastle / Four Creeks.

To help gun owners protect their children and neighbors against accidental shooting, access by children, firearm suicides, and firearm theft, Public Health – Seattle & King County is partnering with firearms retailers, elected and tribal leaders, local hospitals, and law enforcement on the LOK-IT-UP safe storage initiative.

The same survey that asked about keeping guns around the home also asked how those guns were stored. In 2015 —

  • 43% of respondents with guns at home (about 150,000 people) said they stored at least one gun unlocked
  • 31% (about 105,000 people) stored at least one gun loaded
  • 15% (about 51,000 people) stored at least one gun unlocked and loaded

So we have room for improvement. While opinions are divided about gun legislation, we are united in wanting our children, families, schools, and communities to be safe.  

For more information about LOK-IT-UP, see the 10/31/2017 Public Health Insider blog; for background information about gun-violence prevention, see King County’s Gun Violence Prevention Initiative. Communities Count has just introduced two new indicators, with interpretive narrative, under the Public Safety topic: Homes with guns  and Carrying weapons at school.  These indicators, plus data on Not feeling safe at school, are also available at Public Health’s Community Health Indicators site. The LOK-IT-UP site provides information on how to get discounts on storage devices and lock boxes through December of 2018.

Live from King County, it’s interactive data!

For the first time, extensive interactive data on health and well-being in King County communities is available on Public Health’s Community Health Indicators website.  This rollout of new data coincides with the release of the 2018/2019 Community Health Needs Assessment for King County Hospitals for a Healthier Community.

Check out some of the new visualizations by clicking on the hyperlinked indicators in the bulleted text below. Once a visualization opens, you can click on the tabs above the title banner (see image above) to explore additional features.

  • Where in King County do more than 40% of households have guns? The cities/neighborhoods tab of the “firearms stored in home” maps the data to 48 sub-county geographies.
  • What proportion of King County residents have “unmet health care needs due to cost”? The summary tab displays a map that shows the range of values at the bottom, describes the data source, and reports the most recent 1-year and 5-year King County averages.
  • What’s the best predictor of a woman getting “early and adequate prenatal care” during pregnancy? In this demographics tab, bar charts compare results by mother’s age, education, race/ethnicity, and location.
  • Since legalization in 2012, how has marijuana use changed among King County adults and teens? Trend tabs show changes over time in King County, for King County regions, by race/ethnicity, and by sexual orientation (for adults).
  • How can you map “tuberculosis incidence” for people who don’t have an address? The Notes and sources tab answers this question and provides additional information and resources about the indicator.

Helpful hints: For legends (including options to select categories/groups and show/hide confidence intervals) see right margin of charts.  Hover over a colored bar, line, or map area to bring up a floating box with detailed information about the data.  Click on a bar, line, or map area to highlight that area; click anywhere else inside the chart to return to your previous view. For illustrated instructions, see this blog from Best Starts for Kids.

If you have questions or comments, please contact data.request@kingcounty.gov.

 

 

 

 

Updates showcase new “detailed comparisons” feature

Communities Count has posted 10 new data updates – with interpretation – of indicators about EDUCATION and FAMILY AND COMMUNITY SUPPORT.  Most of these indicators are also posted on Best Starts for Kids Indicators.  Communities Count interprets data with an equity lens and, when possible, in a policy-informed local context.

Although many of these indicators are familiar to Communities Count audiences, using Tableau for data visualization enables us to present more detailed analyses. To introduce you to this feature – and perhaps entice you to explore it more on your own—we preview a few of these detailed comparisons by race and place:

PLACE MATTERS when looking at differences by race-ethnicity. 

  • Kindergarten readiness: Overall, white, multiple-race, and Asian kindergarteners were most likely to be ready in all 6 skill areas.  This pattern was clear in Seattle School District, where 40% of Black children and 70% of white children were “kindergarten-ready.” In other districts, however, Black and white children showed no differences in kindergarten readiness.
    • Tukwila: 52% of both Black and white children were kindergarten-ready.
    • Auburn: 23% for both Black and white children were kindergarten-ready.
  • 3rd grade reading: Overall, only 7% of Native Hawaiian/Pacific Islander students met 3rd grade reading standards, but in Auburn School District 41% met standards, almost a 6-fold difference.
  • 4th grade math: Overall, only 20% of American Indian/Alaska Native 4th graders met state math standards.  In Auburn School District, however, 55% met state standards
  • Adolescents with adult support:
    • Across all 4 King County regions, white adolescents reported rates of adult support higher than the county average.
    • For all other race/ethnicity groups, living in South Region was associated with adult support levels below the King County average.
    • And for American Indian/Alaska Native, Asian, and Black adolescents, living in Seattle was also associated with below-average adult support; for adolescents in these 3 groups living in East and North regions, however, rates of adults support did not differ from the county average.

 

Here are links to the 10 new updates, with samples of 2 of 3 findings for each:

  • Child care affordability
    • 76% of preschool-aged children (6 months to 5 years old) in King County were in regularly scheduled non-parental childcare. Among the parents/guardians of those children, 69% said their childcare was affordable.
    • 41% of children in kindergarten through 5th grade were in regularly scheduled before- and/or after-school care; among their parents/guardians, 76% said their childcare was affordable.
  • Daily Reading, Singing & Telling Stories to Young Children
    • Overall, 73% of parents/guardians of children age 6 months to 5 years reported reading, singing, or telling stories to their children every day.
    • Daily reading, singing, or telling stories occurred in 45% of households where Spanish was the language most often spoken at home, significantly below the county average.
    • There were no differences by income, education, or King County region.
  • Emotional Support for Parenting
    • 75% of parents and caregivers reported that, during the past 12 months, they had someone to turn to for day-to-day emotional support with parenting or raising children.
    • At 94%, parents of American Indian/Alaska Native children were most likely to report having someone to turn to for day-to-day emotional support for parenting.
    • Parents and caregivers were most likely to have support with parenting if English was the language most commonly spoken at home.
  • Adolescents with Adult Support  [NEW INDICATOR]
    • 75% of King County 8th, 10th, and 12th graders reported having a supportive adult in their neighborhood or community who they “could talk to about something important.”
    • Since 2004, disparities by both race and place – have increased (see trends). Averaging data from 2014 and 2016,
      • 83% of white students could turn to a supportive adult in their neighborhood or community compared to 63% of Latino students.
      • South Region students (69%) were least likely to have an adult they could talk to, compared to 81% of students in East Region.
    • Mother’s education was a strong predictor of whether students had adult support, with more education predicting a greater chance of having support.
  • Youth in School or working  [NEW INDICATOR]
    • Of youth ages 16 to 24 in King County, 90% were connected to their communities either through employment or enrollment in school.
    • At 93%, Seattle had the highest rate of youth engagement.
    • Asian youth had the highest rate (93%) of being in school or employed.
  • Kindergarten Readiness
    • Fewer than half (47%) of King County students entering state-funded, full-day kindergarten had the skills expected for school readiness.
    • Even “next-door neighbors” varied considerably in the proportion of kindergarteners with the skills expected of 5-year-olds, from 21% in Auburn to 58% in neighboring Enumclaw.
    • Children who were white, 2 or more races, or Asian were most likely to display readiness in 6 specific skill areas.
  • 3rd Grade reading
    • 62% of King County 3rd graders met state reading standards.
    • Girls were more likely than boys to meet reading standards.
    • At 83%, 3rd graders in Mercer Island were most likely to meet reading standards, compared to only 36% of students in Highline District.
  • 4th Grade Math
    • 64% of King County 4th graders met state math standards.
    • 4thgraders who qualify for free or reduced-price school meals are considered low-income, and were less likely to meet math standards than those who were not considered low-income (40% vs. 75%).
    • Only 20% of 4th grade students in foster care met math standards.
  • Chronic Absenteeism  [NEW INDICATOR]
    • In the 2014-2015 school year, 14% of King County students were chronically absent.
    • Students who qualified for free or reduced-price school meals were twice as likely to be chronically absent as those who were not low-income (21% vs. 9%, respectively).
    • Highline and Federal Way School Districts reported the highest rate chronic absenteeism (20%); the lowest rate was in Issaquah School District (6%).
  • Child Abuse & Neglect
    • Investigations and assessments by Child Protective Services declined from a high of 9,756 King County households in 2007 to 8,238 in 2016.
    • Similarly, the rate of children in foster care declined from 5.72 per 1,000 in 2000 to 3.44 per 1,000 in 2017.
    • Despite these declines, the likelihood of being placed in out-of-home care in 2017 was disproportionately high for children who were American Indian / Alaska Native, Black / African American, or Native Hawaiian / Pacific Islander.

Communities Count is pleased to have new data sources for (i) Child Care; (ii) Reading, Singing & Telling Stories to Children; (iii) Emotional Support for Parenting; (iv) Kindergarten Readiness; and (v) Child Abuse & Neglect.  Previous data came from:

  • The Communities Count Survey (indicators I, ii, and iii); questions about these topics are now included in the Best Starts for Kids Survey, which received responses from a representative sample of almost 6,000 parents and guardians of children from 6 months old through 5th grade! Best Starts for Kids will repeat this survey within the coming year and then again 2 years later.
  • The Early Development Instrument (EDI) (indicator iv), which was replaced by the Washington Kindergarten Inventory of Developing Skills (WaKIDS).
  • The Washington State Department of Social and Health Services’ famlink database (indicator v), which Partners for Our Children, a collaboration between the Washington State Department of Social and Health Services, University of Washington School of Social Work, and private sector funding.