Brown County & De Pere Health Department

Community Health Improvement Process

Action Plan

2012-2014

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Welcome and Invitation to Action

This plan is the result of the efforts of many community members, who are striving to move our

community toward a Healthy Brown County in 2020. While this assessment and action plan

represent the efforts of many partners, the accomplishments will depend on the response of

Brown County citizens individually and as a whole to embrace healthier lifestyles and support, in

some cases, a culture change, to improve personal and community health.

We would like to thank the Steering Committee, committee chairs/members, and community

assessment partner group for their efforts towards identifying the community priorities and

establishing the intervention plan enclosed. This effort began in 2010 with Steering Committee

planning, an assessment/priority selection process over a six month period, and more than a year

of action group meetings to develop the implementation strategies and benchmarks. We would

especially like to thank Bellin Health System and Hospital Sisters Health System -St. Vincent/St.

Mary’s hospitals- for their commitment and leadership on the Steering Committee and action

groups. We would also like to acknowledge the Wisconsin Division of Public Health and the

United Way of Brown County for their assistance on the Steering Committee and action groups.

Finally, we would like to invite anyone who wishes to participate on one of the three priority

action groups, identified in this report, to contact us (see below) for assistance. If this is not

possible, please monitor the progress of the action groups on www.co.brown.wi.us or www.de-

pere.org and follow the links to the health department and the Community Health Improvement

Planning Process (CHIP). A brochure outlining Brown County’s action plan is also available

through this link. We hope you will promote the CHIP strategies in the community as we strive

to achieve a Healthy Brown County for 2020.

Judy Friederichs, RN Chrystal Woller, RN

Health Officer/Director Health Officer/Director

Brown County Health Department De Pere Health Department

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Table of Contents

Invitation to the Community Page 2

Steering Committee Team Page 4

Executive Summary Page 5

Health Priority Pages 6-9 Adequate, Appropriate, and Safe Food & Nutrition

Health Priority Pages 10-14 Oral Health

Health Priority Pages 15-20 Alcohol & Other Drug Use

Resources Page 21-22

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Steering Committee

Brown County Health Department

Judy Friederichs

De Pere Health Department

Chrystal Woller

Bellin Health System

Laura Hieb

John Rocheleau

Jodi Wilmet

Hospital Sisters Hospital System- St. Vincent/St. Mary’s

Heidi Selberg

United Way

Howard Endow

Action Team

We would like to express a special thank you to everyone for their time, dedication, and support!

Please go to each of the three health priorities to view a complete list of current members and

their prospective agencies.

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Executive Summary

In the summer of 2010, the Community Health Improvement Plan (CHIP) Steering Committee

brought together a broad array of community partners (see listings on pages 4, 6, 10, and 15).

The partners’ purpose was to review community health data, and share their community

knowledge and expertise related to each issue’s strengths, weaknesses, resources, gaps, and

priority ranking in our community. The following health priorities were identified:

Adequate, Appropriate and Safe Food and Nutrition

Oral Health

Unhealthy Alcohol and Drug Use (primary focus on alcohol at this time)

Three action planning groups consisting of diverse community members met regularly to

develop a plan for each priority with goals, outcomes, and actions. These groups were facilitated

by Bellin Health System (food/nutrition and alcohol) and Hospital Sisters Health System –St

Vincent/St Mary’s (oral health). The groups continue to meet to implement the actions. The

Steering Committee continues to meet periodically to review and guide the progress of the action

groups.

This plan/assessment meets the Wisconsin state statute (public health departments) and Patient

Protection and Affordable Health Act (not-for-profit health networks) requirements.

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Health Priority: Adequate, Appropriate, and Safe Food and Nutrition

Bellin Health System

John Rocheleau- Health Priority Leader

Lynne Nelson

Ron Wright

Regina Young, RD

Brown County Cooperative Extension

Karen Early, RD

Judy Knudsen

Brown County Health Department

Nicci Beeck, Community Health Educator

Judy Friederichs, RN, Health Officer

Meredith Hansen

Brown County United Way

Howard Endow

City of De Pere Health Department

Ellen Moore, RN

Chrystal Woller, RN, Health Officer

Downtown Green Bay

Molly Vandervest

Family & Childcare Resources of N.E.W.

Paula Breese, Executive Director

Festival Foods

Leah Anderson, RD

Stephanie Walker, RD, CD

Green Bay Area Chamber of Commerce

Jennifer Van Den Elzen

Green Bay Public Schools

Stan Kocos

Homeless Population Representative

Seth Moore

Konop Companies

Tom Konop, President

Food Power, LLC (representing Konop

Vending)

Carmen Gorniak, RD, Owner

Live54218

Melinda Morella M.S. Ed., Engagement

Specialist

Molina Healthcare

Dave Liethen

On Broadway, Inc.

Christoper Naumann

Oneida Tribe of Indians

Bill VerVoort

St. Vincent Hospital

Heidi Selberg

Syble Hopp School-School Representation

(Superintendent’s group)

Barb Natelle

University of Wisconsin- Green Bay

Sarah Himmelheber, Ph. D.

Leanne Zhu, Ph. D.

WIC Project Nutritionist and Vendor Contact

Jamie Campbell, RD

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Health Priority: Adequate, Appropriate, and Safe Food and Nutrition

Adequate, appropriate, and safe food and nutrition is defined as regular and sufficient

consumption of nutritious foods for all ages, to support normal growth and development of

children and promote physical, emotional, and social well-being for all people.

Adequate, appropriate, and safe food and nutrition is linked with a reduction in the risk

for a number of chronic disease, including:

o Obesity

o Type 2 diabetes

o Cancer

o Heart disease

o Stroke

Good nutrition is defined as meeting nutrient recommendations while maintaining proper

caloric intake. This also includes safe handling, preparation, serving, and storage of foods and

beverages. Ready and appropriate access to nutritious foods throughout the year for all

individuals and families in Wisconsin communities is a key factor in proper nutrition (U.S.

Dietary Guidelines, 2005).

Impact Healthy eating at the basic level provides a source of enjoyment and a sense of family and

community for all people across Wisconsin. It is a cornerstone to prevent chronic disease and

promote vibrant health. Healthy eating, simply put, is a staple for a good life. Finding a balance

in daily nutrition can be achieved from foods associated with very different cultures, customs, or

places of origin (United States Department of Agriculture [USDA], 2005; USDA My Pyramid

Plan).

24 % of Wisconsin and 27 % of Brown County adults are obese (2008 WCHR Full

Report).

77.2% of Wisconsin and 78.3% of Brown County adults eat LESS than 5 servings of

fruits and vegetables per day (2008 WCHR Full Report).

23% of high school students are overweight or obese in Wisconsin (Youth Risk Behavior

Survey, Wisconsin Department of Public Instruction, 2009; Youth Risk Behavior

Surveillance System, 2009, CDC).

60% of Wisconsin middle and high schools sell unhealthy foods, such as soda, candy,

chips, or cookies in school vending machines or snack bars (School Health Profiles:

School Level Impact Measures, 2008, Wisconsin Department of Public Instruction;

School Health Profiles, CDC).

30% of the 55,000 preschool-aged children participating in the WIC program

(Wisconsin Special Supplemental Nutrition Program for Women, Infants, and Children)

are overweight or obese (Pediatric Nutrition Data, Wisconsin Department of Health

Services, 2008; Pediatric Nutrition Surveillance System, CDC).

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Residents’ Food Security Conditions

One in ten Wisconsin households has low levels of food security, and one in twenty-five has low

enough levels that hunger is likely; both values have worsened over the past decade (Nord, et al.,

2009). Between 2005 and 2007, Wisconsin FoodShare participation increased by 37 percent.

High levels of increased participation were observed in central and western Wisconsin (Isaacs &

Smeedling, 2009).

The percentage of adults in Wisconsin that report 0-5 servings of fruits and vegetables consumed

in one day from 2001-2007 are reported below. The average consumption overall in Wisconsin

is 77.2 %, with a range of 64%-86.3%. The average consumption in Brown County was slightly

higher at 78.3%. Brown County ranks 42 out of 72 counties in Wisconsin for this statistic.

Of particular concern, overweight and obesity trends in the U.S. have been on the rise. In less

than 20 years, overweight and obesity has increased more than 25% across both genders, all

ages, races and educational attainments (Behavioral Risk Factor Surveillance System, CDC).

The counties are shaded, with lighter

counties having more people with

nutritious dietary habits. Hatched

counties are not reported (NR).

Source: 2008 WCHR Full Report

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Vision

Support programs that make healthy foods (fruits and vegetables) more accessible and affordable

for low income residents of Brown County through WIC, FoodShare and food pantry initiatives.

Goal 1

From 2012-2015, reduce the barriers and accelerate the use of WIC Farmer’s Market Nutrition

Program (FNMP) vouchers and Wisconsin Quest card from FoodShare Electronic Benefits

Transfer (EBT) system for low income residents of Brown County.

Outcomes

1. Increase the redemption rate of Farmer’s Market Nutrition Program vouchers by 5% in

Brown County.

2. Increase the utilization of Wisconsin Quest card from FoodShare EBT system at farmer’s

markets by 50%.

Key Actions

1. Continue to have Farmers at WIC East on check pick-up days in summer/fall as farmers

are available, to make it convenient to purchase fresh fruits and vegetables.

2. Identify/search for interested farmer for the West side WIC location for the check pick up

days for the upcoming farmers’ market season (3x per month).

3. Offer education sessions or demonstrations regarding produce preparation at either WIC

office when the farmer is on site (how often- will be determined). With this action, we

may partner with another agency such as a UWEX, UWGB Dietetic intern, or a chef.

4. Promote WIC and FoodShare voucher usage through local agencies (i.e. UWEX, WIC,

Healthcare providers, Hispanic Interagency, schools, etc.) and BadgerCare providers.

5. Develop a plan for sustainability for EBT FoodShare usage.

Assist Farmer’s Market Coordinators in finding funding and/or sponsors.

6. Investigate/Identify potential sponsor(s) for “Double your Bucks” program.

7. Identify best practices by using “Got-Access” tool kit.

Goal 2

From 2012-2015, improve the food choices offered by food pantries, increasing the percentage

of healthy* food options and reducing the amount of low-nutrient foods.

*as defined by dietary guidelines

Outcomes

1. Increase the percent of healthy foods that are donated in food pantry food drives by 5%.

2. At least two area pantries will adopt practices that prioritize healthy food selection in all

food sourcing.

Key Actions

1. Complete a base line inventory of what is currently being donated through food drives.

2. Educate public on donating healthy foods.

3. Build relationships with pantries to explore ways to maximize acquisition of nutritious

foods.

4. Educate pantries regarding what to keep and what to toss from their donations.

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Health Priority: Oral Health

Aging & Disability Resource Center

Tina Brunner

Janelle Walton

Aurora Bay Care

Yolo Diaz, MD

Sara Hebel for Dr. Diaz

Michael Schuh, DDS

Bay Oral Surgery

Michael Miskella, DDS

Bellin Health System

Jason Coisman, MD

Bonita Parrott

Ann Van Lanen

Jody Wilmet

Brown County Health Department

Judy Friederichs, RN, Health Officer

Meredith Hansen

Stacy Ross, RN

Brown County Oral Health Partnership

Carrie Stempski, RDH, BS, CDHC

Brown County United Way

Howard Endow

City of De Pere Health Department

Ellen Moore, RN

Chrystal Woller, RN, Health Officer

Hospital Sisters Health System

Heidi Selberg- Health Priority Leader

Jennifer Balthazor

Cinde Becker

Elaine Doxator

Kaitlin Swanson

Infinity Healthcare

Margaret Hujet

Northeast Wisconsin (NEW)

Community Clinic

Bonnie Kuhr

Northeast Wisconsin Technical College

(NWTC)

Scott Anderson

University of Wisconsin- Green Bay

(UWGB)

Christine Vandenhouten

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Health Priority: Oral Health

Oral health is defined as being free of mouth pain, tooth decay, tooth loss, oral and throat

cancer, oral sores, birth defects, gum (periodontal) disease, and other disease that affect the

mouth and surrounding structures. This requires access to a team approach to providing

comprehensive, good-quality health care services that are also only cost-effective.

Early preventions in oral health care include:

o Tooth brushing

o Flossing

o Balanced nutritional and infant feeding practices

o Fluoride varnish in both children and adults

o Dental sealants in both children and adults

o Care provided across the lifespan, especially in older adults who are at an

increased risk for malnutrition

Impact

Oral health includes being free of chronic oral-facial pain, oral and pharyngeal (throat) cancers,

oral soft-tissue lesions, birth defects (cleft lip and palate), and other diseases/disorders. Human

beings across the lifespan need to be able to carry out the basic human functions, which include:

chewing, swallowing, speaking, smiling, kissing, and singing. Oral health and overall health are

interrelated; good health can be directly affected by the conditions of a person’s oral health.

People that suffer from immune suppressant diseases, which can include HIV/AIDS, should take

extra precaution with oral health is this is a direct factor in developing infections. Research has

also shown to be linked with gum & tissue disease, diabetes, heart disease, stroke, and adverse

pregnancy outcomes.

The percentage of Wisconsin adults with toss loss due to decay or gum disease in

Wisconsin is 40%, with Brown County slightly lower at 32.1% (Wisconsin

Department of Health Services, Behavioral Risk Factor Surveillance System).

The percentage of Wisconsin adults that visited a dentist in the past year vary by

race, with Whites at 76%, African Americans at 66%, Hispanics at 61%, and

other multiracial groups at 69% (Wisconsin Department of Health Services,

Behavioral Risk Factor Surveillance System).

The number of adults 18 years and older that did not visit a dentist in the past year

in Brown County is 22%, slightly lower than the Wisconsin state percentage of

25%. Brown County ranks 23 of 72 in the state with this statistic (2008 WCHR

Full Report).

The percentage of Medicaid members that received a dental service in 2008/2009

was 25% in the state of Wisconsin, with Brown County at 20.1%. The ratio of

Medicaid dentists to Medicaid members is 1/72 (Wisconsin Division of Health

Services, Division of Health Care Access & Accountability).

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The percentage of Wisconsin’s Head Start Children, divided by region and race, that have

experience with Caries, untreated decay, and early childhood Caries is shown below.

Poor oral health has been linked to oral and throat cancers in research studies. The cancer and

mortality rates due to age-adjusted oral health for the United States and Wisconsin by race and

ethnicity is displayed in the table below.

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Vision

Assure appropriate access to effective and adequate oral health delivery systems, utilizing a

diverse and adequate workforce, for populations of differing races, ethnicities, sexual identities

and orientations, gender identities, and educational or economic status and those with

disabilities.

Goal 1

By 2015, we will reduce the number of oral health related emergency room visits by adults.

Outcome

By 2015, community leaders will have identified and implemented at least three programs that

have demonstrated effectiveness in preventing tooth decay in adults.

Key Actions

1. An oral health education program will be developed as a collaborative activity by the

three hospital system emergency departments. They will have considered the desirability

and feasibility of developing and including an oral health kit.

2. Oral health initiatives that can be implemented with groups serving adults will be

developed.

a. Local health professional educators will be encouraged to review and update

health professional educational curricula and continuing education courses to

include content on oral health and the associated between oral health and general

health. Education to include instruction on how to administer a Basic Screening

Survey (BSS).

b. Health care providers will be encouraged to conduct oral screenings as part of

routine physical exams and make appropriate referrals.

c. Interdisciplinary training of medical, oral health, and allied health professional

personnel in counseling patients about how to reduce risk factors common to oral

and general health will be developed.

3. The feasibility and desirability of a Community Dental Health Coordinator (CDHC) for

adults in Brown County will be explored.

4. A mechanism to provide cleaning and prevention services for adults will be developed.

a. A Basic Screening Survey (BSS) will be administered on a predetermined

schedule at outreach sites throughout the community (e.g., senior centers, shelters,

NWTC, etc.)

b. A list and schedule of community events at which oral health community leaders

can provide oral health supplies/oral health screenings will be identified.

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Goal 2

By 2015, improve the oral health services available for Medicaid patients.

Outcome

By 2015, expand and increase the access to oral health care for Medicaid and self- pay patients.

Key Actions

1. In collaboration with the Brown Door Kewaunee Dental Society, protocols for

identifying and setting priorities for adult patients needing general dentistry services will

be developed and implemented. Consideration will be given to approaching this through

identification of at risk populations, such as diabetics.

a. An active and up-to-date database of programs that have demonstrated

improvement in access to care will have been created.

b. Ways to assist low income patients in arranging and keeping oral health

appointments will be identified and implemented.

c. Protocols to provide care for adult patients in need of general dentistry services

through NEW community Clinic’s dental program at NWTC will be developed

and implemented.

2. New ways to stabilize patients with extensive decay will be identified.

a. In collaboration with local Oral Surgeons, what kinds of patients should be seen at

the NEW Community Clinic dental site will be identified.

b. We will continue to pursue ways that make seeing patients in the oral surgery

office feasible.

c. In consultation with local Oral Surgeons, options for Brown County to serve as a

rotation site for Oral Surgery students will have been explored.

d. Collaboration with WDA’s Mission of Mercy program to determine desirability

and feasibility of offering a community adult dental day will have taken place.

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Health Priority: Alcohol and Other Drug Use

Aging & Disability Resource Center

Jim Sweeney

Aurora Health Center

Cathy DeValk-Holl

Terri Zahorik

Bay Area Community Council

Father Paul Demuth

Pat Finder-Stone

Randall Lawton

Bob Woessner

Bellin Health System

Laura Hieb, Health Priority Leader

Tom Arndt

Sharla Baenen

Becki Detaege

Pat Phillips

Ann VanLanen

Brown County Health Department

Judy Friederichs, RN, Health Officer

Erin Tisch, RN

Brown County Human Services

Mary Miceli-Wink

City of De Pere Health Department

Chrystal Woller, RN, Health Office

City of De Pere Police Department

Jedd Bradley

Community Member

Pat Ryan

Family Services

Michele LaFond

Green Bay Police Department

Bill Bongle

Green Bay Veteran’s Center

Scott Katzka

Hospital Sisters Health System

Heidi Selberg

Libertas Treatment Center

Barbara Coniff

Tyler Luedke

Northeast Wisconsin (NEW) Community

Clinic

Bonnie Kuhr

Oneida Nation Behavioral Health

Tina Baeten

Prevea Behavioral Health

Dan Braaten

St. Norbert College

Tom Doughman

Wisconsin State Patrol

Mike Panosh

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Health Priority: Alcohol and Other Drug Use

Alcohol and other drug use are defined as any use of a substance(s) that results in negative

consequences. These negative effects can be induced by alcohol, prescription drugs, or illegal

mood-altering substances.

Negative consequences include, but are not limited to:

o Operating a motor vehicle while intoxicated

o Drinking while pregnant

o Alcohol dependence

o Fetal alcohol spectrum disorder

o Alcohol-related or drug-related hospitalizations or deaths

o Heavy drinking

o Alcohol-related liver cirrhosis deaths

o Motor vehicle injury or death

o Liquor law violations

o Underage drinking

o Non-medical or illicit drug use

o Arrests for drug law violations, or other related crimes (e.g., property or

violent crimes)

Impact

Wisconsin is at the top of the nation when it comes to wasted lives, harm, and death associated

with its drinking culture, which is tolerant of excessive and dangerous illegal drinking. These

effects of the culture are related to societal problems that include: homelessness, child abuse,

crime, unemployment, injury, health problems, hospitalization, suicide, as well as fetal

abnormalities and early death. All of these alcohol-related problems result in $2.7 billion in

costs (Milwaukee Journal-Sentinel).

Wisconsin ranked first in 2008 in the rate of adult drinkers, second in the rate of

adult heavy drinkers (60 or more drinks per month), and first in the rate of binge

drinking (5 or more drinks on occasion) (Centers for Disease Control and

Prevention’s Behavioral Risk Factor Surveillance System).

Wisconsin ranked fourth in the rate of youth who rode with a driver who had been

drinking, fifth in the rate of youth who drove after drinking, first in the rate of

alcohol use of youth, and third in the rate of binge drinking among youth (2007

Youth Risk Behavior Survey, Centers for Disease Control).

Wisconsin ranks third in the nation in per-capita consumption of beer (Centers for

Disease Control and Prevention’s Behavioral Risk Factor Surveillance System).

Drug-related mortality among American Indians and African Americans is two to

three higher than among Whites, with 19.4/100,000 and 18.6/100,000 respectively

to 8.7/100,000 for Whites (National Institute on Drug Abuse, 2003).

Homeless people have a higher rate of alcohol and other drug abuse, with a

decrease in access to services compared to the general population (Fischer &

Breakey, 1991; Johnson & Cnaan, 1995).

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The percentage of adults in Wisconsin that drank alcohol excessively is shown below by gender.

Motor vehicle crashes due to alcohol is shown below by age group, as well as the number of

injuries and deaths from alcohol related crashes in Brown County in 2008.

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The percentage of high school students in Wisconsin who had at least one drink of alcohol.

The percentages of high school students who had five or more drinks in a row within a couple of

hours (binge drinking) and those students that rode in a vehicle driven by someone who had been

drinking alcohol are depicted below, respectively.

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Vision

To positively impact the culture surrounding unhealty alcohol use in Brown County and De Pere

through a community-wide partnership among individuals, families, and organizations.

Goal 1

By 2014, 70% of all primary care providers in Brown County and De Pere will incorporate an

alcohol, depression, and substance abuse screening tool for patients over 18 years of age.

Outcomes 1. Bellin Health, Prevea, and Aurora Health Care will utilize a consistent approach to

screening for alcohol abuse among their primary care population by 2014.

2. A community-wide resource network for health care providers to access after screening

will be packaged and available for providers to access by 2014.

3. Data will be used to stratify high-risk groups and target initiatives to greatest opportunity

by 2014.

Key Actions

1. Identify current alcohol abuse screening tools used within each health system. Work

towards getting all patient care facilities to use a similar tool within the primary care

model.

2. Coordinate all resources and create an easy access platform for providers.

3. Support legislative intervention that will positively impact the reduction of alcohol abuse

and binge drinking.

Goal 2

By 2015, the incidence of binge drinking in accordance with county health rankings will

decrease from 27% to 25%.

Outcomes

1. Support a platform that educates the community on the effects of binge drinking.

2. Support the infrastructure and advocate for funding to train those who sell alcohol on the

key aspects of safe serving.

3. Partner with local businesses and events to create an awareness of the impact of binge

drinking during local events and work to mitigate the risks.

Key Actions

1. Educate and advocate.

2. Participate in local forums in support of uniform statutes within and throughout the

surrounding communities.

3. Assist with speaking engagements that highlight the work of this Task Force and the

collaborative efforts of the Bay Area Community Council.

4. Partner with local businesses to support “responsible drinking” at community events.

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Goal 3

Zero deaths from alcohol induced traffic fatalities by 2020.

Outcomes

1. The OWI Task Force will continue and there will be a reduction of alcohol induced

traffic fatalities.

2. The culture within the community will shift and individuals will take accountability for

not drinking and driving, and increased alternatives will be available.

Key Actions

1. Assist in securing funding for further OWI Task Force operations.

2. Speak to local agencies in support of stronger regulations surrounding drunk driving.

3. Create a video depicting the OWI Task Force in action. Utilize for local speaking

engagements.

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Resources

Bay Area Community Council, Alcohol Abuse in Brown County, 2010. Available at:

http://www.bayareacommunitycouncil.org/media/59241/alcohol%20abuse%20in%20brown%20

county%20v.3.pdf

Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 2005.

Retrieved March, 2010 from

http://apps.nccd.cdc.gov/s_broker/htmsql.exe/weat/freq_analysis.hsql?survey_year=2005

Centers for Disease Control and Prevention. Pediatric and Pregnancy Nutrition Surveillance

Systems. Available at: http://www.cdc.gov/pednss/what_is/index.htm

Centers for Disease Control and Prevention. School Health Profiles. Available at:

http://www.cdc.gov/healthyyouth/profiles/

Centers for Disease Control and Prevention. YRBSS: Youth Risk Behavior Surveillance

System. Available at: http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2008. Retrieved on

March 2010 from http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Fischer, P. J., & Breakey, W. R. (1991). The epidemiology of alcohol, drug, and mental

disorders among homeless persons. American Psychologist, 46, 1115-1128.

Isaacs, J.B., & Smeedling, T.M. (2009). The first Wisconsin Poverty Report. Available at:

http://www.irp.wisc.edu/research/wipoverty.htm

Milwaukee Journal-Sentinel (October 2008). Wasted in Wisconsin (five-part series), Retrieved

March 2010 from http://www.jsonline.com/news/30565984.html

National Institutes of Health, National Institute on Drug Abuse, 2003, Drug Use Among

Racial/Ethnic Minorities.

Nord, M., Andrews, M., and Carlson, S. Household Food Security in the United States,2008.

ERR-83, U.S. Dept. of Agriculture, Econ. Res. Serv. November 2009.

Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569.

American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 122:417-22.

SEER Stat Database Mortality File.

U.S. Department of Agriculture [USDA]. (2005). Dietary guidelines for Americans. Available

from: http://www.health.gov/dietaryguidelines/dga2005/document/default.htm

22

U.S. Department of Agriculture [USDA]. (n.d.). My pyramid plan. Available at:

http://www.mypyramid.gov/mypyramid/index.aspx

Wisconsin Cancer Reporting System 2003-2006.

Wisconsin High School Survey [ Alcohol Graphs ]

Wisconsin Department of Health, Division of Health Care Access & Accountability.

Wisconsin Department of Health Services. Data Retrieved on March 15, 2010 from Pediatric

Nutrition Surveillance System. Available at:

http://dhs.wi.gov/WIC/WICPRO/data/PedNSS/index.htm

Wisconsin Department of Human Services, Division of Public Health. Health Counts in

Wisconsin, Wisconsin Behavioral Risk Factor Survey, 2009.

Wisconsin Department of Human Services, Healthy Smiles for a Health Head Start.

Wisconsin Department of Public Instruction. School Health Profiles. Available at:

http://dpi.wi.gov/sspw/shepindex.html

Wisconsin Department of Public Instruction. Wisconsin Youth Risk Behavior Survey. Available

at: http://dpi.wi.gov/sspw/yrbsindx.html

Wisconsin Department of Transportation, Bureau of Transportation Safety.

2008 WCHR Full Report.

Updated: November 2013