YORK COUNTY COMMUNITY

NEEDS ASSESSMENT REPORT

Prepared by: Kenneth Gleisner, York County
Community Nutritionist

January 2014
Table of Contents

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Overview.................................................................................................................... 3
Estimated Population of York County by Age...........................................................4
Income Data Comparison........................................................................................... 4
Adult Behavioral Health Risk Factors..........................................................................5
Health......................................................................................................................... 6
Child Health............................................................................................................. 6
Hospital Statistics.................................................................................................... 6
Health Comparison..................................................................................................... 7
Community Assessment Proposal............................................................................... 7
Target Population..................................................................................................... 7
Goal......................................................................................................................... 7
Objectives............................................................................................................... 8
Assessment Plan..................................................................................................... 8

Overview
York County is a county located in the U.S. in south central
Pennsylvania in a region known as the Susquehanna Valley (Highlighted in

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red below). The Susquehanna Valley is a region known for its fertile farmland,
small suburbs, and various industries.

The population of York County in 2011 was approximately 436,770

people which had increased by 0.4% from 2010 to 2011. The total population
of Pennsylvania in 2011 was 12,742,886 people which had increased by 0.3%
from 2010 to 2011. The population per square mile in York County is 483.1
people which is nearly twice the statistic for Pennsylvania (284.8 people per
square mile). This suggests that York County has more towns or cities with
higher population densities than compared to the state as a whole, which is
sparsely populated because of the abundance of rural areas.
14.4% of the population is 65 years of age or older. The population
aged 65 years or older in the whole state is 15.6%, which is marginally
higher probably because there are many towns in York County that are
growing and attracting a younger population. Statistics for other age
brackets and percentages are provided in the following table.

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Estimated Population of York County by Age

Age

Total

Under 5

26,151

Percentage of Total
Population
6.0%
1

5-14
15-24
25-34
35-44
45-54

56,632
54,529
51,126
58,845
68,549

13.0%
12.5%
11.8%
13.5%
15.7%
2

55-64
65-74
75+
All Ages

58,241
33,682
29,015
436,770

13.3%
7.7%
6.6%
100%

The population percentage with ages under 5 years old in York County
(6.0%) is also the lowest percentage for the population of PA (5.7%). This
may be because the crude birth rates of York County and Pennsylvania are
identical (11.2, 11.1, respectively).
2

The population percentage with ages of 45-54 in York County (15.7%) is also
the highest percentage for the population of PA (15.0%).

The median age of the population in York County is 39.8 years

compared the statewide median of 39.9 years. The median ages are very
similar possibly because of two statistics. For one, York County has almost
exactly the same crude birth rate per 1,000 people as compared to the rate
for all of Pennsylvania (11.2, 11.1, respectively). Secondly, the crude death
rate per 1,000 people is very similar to the rate statewide (8.6, 10.0,
respectively). This suggests that the population is balanced in its aging, with
39 years, plus or minus a few years, approximately the average middle of
someones expected life.

Income Data Comparison

Statistic
Per capita personal
income
% population with
income level below

York County
$37,380

Pennsylvania
$42,291

9.4

12.6
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poverty level
% labor force that is
7.8
7.9
unemployed
% population eligible 13.5
17.1
for medical
assistance
The per capita personal income amount for Pennsylvania is about
$5,000 higher. This could possibly be explained by the fact that Pennsylvania
has a higher % population 65 years and older. This is assuming that at the
age of 65 and older, residents are earning their highest potential income.
With Pa having the higher % population aged 65 and older, as compared to
York County alone, this may account for the higher per capita income.
The disparity between % population with income level below poverty
level between Pennsylvania and York County cannot be explained by the fact
that Pennsylvania as a whole has approximately the same percentage
unemployed as York County, solely. It could possibly be explained by the fact
that the Pennsylvania statistic includes larger metropolises like Pittsburgh
and Philadelphia which have regions where poverty is much higher. The
unemployment percentage for York County is consistent with the percentage
for the whole state.
In addition, the disparity between Pennsylvania and York County for the
statistic of percentage of eligible for medical assistance could be explained
because the Pa has a higher percentage of people who are 65 and over as
well as a higher median age. This suggests that the older population has a
higher eligibility for medical assistance.

Adult Behavioral Health Risk Factors

The following table compares the adult behavioral health risk factors for
residents in York County to all Pennsylvania residents.

Risk Factors
Ever told they have
diabetes
Obese (BMI > 30)
Overweight (BMI > 25;
includes obese)

Percent (York County) Percent

(Pennsylvania )
9
9
32
64

27
61

The percent ever told they have diabetes for York County is consistent
with the statewide percentage. The percentage of residents who are obese in
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York County is 5 percentage points higher than the percentage for

Pennsylvania residents in total. The overweight percentage is then also
higher in York County compared to the state percentage. The effects of a
high prevalence of obesity and residents overweight can be shown by the
leading causes of death: diseases of the heart and cancer (both in the county
and statewide). Both of these chronic diseases can be developed with these
high risk factors of obesity of and being overweight.
The prevalence of obesity in the United States for 2009-2011 was
34.3% which is higher than both obesity prevalence of the county and the
state.

Health
Child Health
Birth Statistics York County
% low birth weight 7.5
% no prenatal 22.4
care in 1st
trimester

Pennsylvania
8.2
28.3

In comparison, the Pennsylvania % low birth weight is approximately 0.7

percentage points higher than the York County percentage alone. The only
significant difference in the York county percentage by race is that the black
percentage is nearly double at 14.7%. The Hispanic percentage is the same as the
value for all races and the white percentage is the lowest percentage at 6.8%.
The % no prenatal care in 1st trimester for Pennsylvania is approximately 6
percentage points higher than the percent for York County. The percents for the
black and Hispanic populations are both about 9 percentage points higher than the
percent for all races (31.7, 31.8, respectively). The percent for the white population
is smaller than the percent for all races at 20.4%.

Leading Causes of Death (for Population Under 5 Years of Age)

Cause of death
Perinatal Conditions
Birth Defects
Accidents
Assault (Homicide )

Number Affected
13
9
4
2

The major causes of death for children under the age of 5 years are the same for
the whole state of Pennsylvania, perinatal conditions being the top cause of child
death.
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Hospital Statistics
The following tables show general information about the health care services in York
County for 7/10-6/11.
Total hospitals
Hospital beds
Admissions
Per room cost

6
755
38,812
$591

Healthcare Workers
Profession

Estimated Number

Registered Nurses
Licensed Practical Nurses
Physicians

2,207
1,495
830

Health Comparison
Compared to the statewide population, York County has a significantly higher
obesity rate. This could be the case for a number of reasons. For one, the access to
healthy food options in urban areas could be limited in some areas in the county. As
stated in the overview, the population per square mile is higher in the county as
compared to the state. The higher population density could mean that a higher
number of people have limited access to healthy foods where supermarkets or
farmers markets are overshadowed by fast, convenient food stores or restaurants.
The per capita personal income is the best explanation for the higher obesity
and overweight rates in York County. The average income is approximately $5,000
less than the state average. Not having a sufficient income, along with everyday
household expenses can really decrease the lives of those in a household. Families
with low incomes will typically spend less on food by eating at fast food restaurants
or buying highly processed foods to be able to spend more in other budgeted areas.
The prevalence of Diabetes Mellitus is slightly larger for York County
compared to Pennsylvania. A good hypothesis for the slightly higher rate of
Diabetes Mellitus could be because the obesity rate is much higher in the county as
compared to the state; obesity being a risk factor for diabetes.
The major causes of death are ranked in the same order for both state and
county. However, York County has lower rates in the categories of diseases of the
heart, cancer, stroke, Chronic Lower Respiratory Disease, accidents,
Influenza/Pneumonia, and Septicemia. The lower rate of admissions into the hospital
for York County as compared to Pennsylvania may give insight to the lower numbers
of these causes of death.
The lower percentage low birth weight for York County could be explained by
the higher prevalence of residents who are overweight or obese.

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Community Assessment Proposal

I am proposing to do a further study on obesity in York County. It is difficult to tell
what factors are involved in the high obesity rate in the county and from the
existing data, it does not appear that poverty or any barrier to accessing health care
are contributing factors. Seeing that the rate of obesity is much higher in our county
compared to the state, I would like to look into the different aspects of the
community that contribute to these higher rates and figure out if it is occurring at
younger ages.

Target Population
I would like to target elementary school and middle school students to look into this
issue. The target group will be composed of male and female students who are in
grades 1-8 between the ages of 5 and 15 years old.

Goal
The goal of this study is to find out if the food services provided in York County
elementary and middle schools are contributing to the high obesity/overweight
rates in our county and if proper nutrition is being demonstrating in an effective
manner.

Objectives
1. Assess anthropometric data of school students from grades 1-8 and compare
the growth rates of students with clinical growth charts.
2. Evaluate the quality of lunches that are provided in cafeterias for randomly
selected elementary and middle schools in York County.
3. Randomly select elementary and middle school students from York County
and collect opinions of the students on what good nutrition means to them
and whether their school provides a satisfactory lunch.

Assessment Plan
In order to contact participants, I will send out letters to randomly selected
elementary and middle school principals that explain the assessment I plan on
conducting and the goal we plan on achieving. Following a response from each
school, I will then survey the organizers via email who plan and coordinate lunches
to collect nutrition data, collect anthropometric data of the target population from
school nurses, and request that either school counselors or nurses conduct
interviews with randomly selected students from the selected schools.
The anthropometric data we are collecting is height and weight, which we will
then compute BMI. We can then compare growth charts for students and find out
the ages where being overweight is a problem. This data will help us accomplish
objective one and give us a better understanding of the age group that is
problematic in terms of weight. This will also help us assess if the quality of nutrition
in elementary and middle schools has strong or weak influence on the overall health
of the students and its effect on weight.
The survey given to the school lunch organizers will help me to understand
the kind and variety of food choices provided. In the survey, I will ask about a
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typical menu provided each day for two weeks. We will also ask for specific nutrition
information for each meal like calories of food items, total and saturated fats, added
sugars, dietary cholesterol, and fiber. The list of foods will allow us to assess
whether the choices are a healthy representation of a food group. For example, a
poor representation would be if French fries were a choice of starch/vegetable for a
meal. By finding problematic food choices we can help work with organizers to alter
the meals to lower saturated fats, and increase the options for vegetables, fruits
and whole grains. I will use this data along with student opinions to see if good
nutrition is being presented at a young age.
Lastly, with all the school lunch data we will be able to find out the impact it
has on students perceptions and fondness of food options. By conducting surveys,
counselors and nurses being the interviewers, we can interview randomly selected
students in a comfortable environment with an interviewer they are comfortable
with. This will help the students to open up about whether or not they know what
good foods are and whether or not they like the school lunches. We will ask students
what they had to eat on a particular day and ask about their opinions on what it
was. On a scale of very bad to very good, students will tell us their opinions on
school lunches, their preference in certain foods and how certain foods make them
feel physically and mentally. It may be helpful to find out fruits and vegetables kids
like the most and help us to incorporate the preferred foods into the menu with the
help of cafeteria coordinators.
In finding out how influential school lunches are on students perceptions of
good nutrition and how children may be growing we can possibly address our
county problem. Obesity is primarily a preventative chronic disease and if we
promote better health at younger ages, we can someday lower the rate. It is
important that we not only collect objective data, but gather opinions to address
any misconceptions our target group has about good health and nutrition.
In conclusion, our findings can help county officials make decisions on
implementing change to educate the population at an earlier age on good nutrition
and healthy eating habits. It is in our best interest to get the obesity rate down to or
below the state rate so we can help prevent unnecessary death or chronic disease
for residents living in York County as a result of obesity. With your help, we can
improve lives.