McClain County needs assessment : 2011 bridging the way to health health McClain County.

              2011
Bridging the Way
to Health
McClain County
McClain County Health
Department
2011 State of the
County’s Health Report
McClain County
Needs Assessment
McClain County
Needs Assessment
http://mcclain.health.ok.gov
2
The 2011 State of the County’s Health Report, Bridging the Way to Health, McClain County is the
second Health Assessment since 2006. This report follows the Oklahoma Health Improvement Plan to
address several key health issues relevant to Oklahomans and McClain County residents.
· Obesity Reduction
· Child Health
· Tobacco Prevention
· Unintentional Injury and Violence/ Disaster Preparedness
The McClain County Health Department in partnership with the Blanchard Community Coalition, a
Turning Point partner, Community Youth Action Program (C.Y.A.P), Community Alliance of Resources
for Everyone (C.A.R.E) and other community partners work to improve the health and well-being of
McClain County residents. This report addresses the current health status of McClain County residents
and the initiatives to strengthen communities, unite vision, reduce health disparities, and unify a
community to promote a positive healthy environment to live, work, and play.
It is my sincere honor to serve you as administrative director and it is my hope that we can work
together to improve the health of our county. Thank you all for your dedication and contribution to
create a solution for a healthier McClain County.
Sincerely,
Shari Kinney, DrPH, RN
Administrative Director
919 N. 9th Street
Purcell, Oklahoma 73080
Telephone: (405) 527-6541
Fax: (405) 527-4775
P.O. Box 130
107 S. Main
Blanchard, Oklahoma 73010
Telephone: (405) 485-3319
Fax: (405) 485-9713
McClain County Health Department
Shari Kinney, DrPH, RN
Administrative Director
McCLAIN COUNTY BOARD OF HEALTH
Tony Christian Charles Foster George Kernek Doug Harryman D. Bryan Dye, MD
An Equal Opportunity Employer
Table of Contents
Cover………………………………………………..…….1
Letter from the Administrative Director…
Table of Contents………………………………
Summary and Implication……………………......…...
Demographics……………………………��……….….
McClain County Health Department Usage……......
Fighting Obesity with Good Nutrition………...….....
Fighting Obesity with Physical Activity……….……
Prenatal & Infant Health................……….............…..
Child & Adolescent Health..…………………….……
Tobacco Prevention………………………………..….
Disaster Preparedness/Injury & Violence……......
Conclusion…………………………………………..…..
Resources/ McClain County Board of Health…..…14
References……………………………………………....1
Director…..…….…..2
Contents……………………………….......….3
4
5
y 6
y 7
y 8
th................……….............…..9
10
n………………………………..….11
paredness/Violence……........12
13
eferences……………………………………………....15
3
4
Oklahoma ranks below average on key health status indicators and 46th nationally for
overall health. This is a result of the conditions many residents of McClain County live
with every day, including environmental factors, poverty, and limited access to medical
care as well as poor health behaviors including lack of exercise, tobacco use, and poor
nutrition.
In order to improve the health of McClain
County, we must understand resident’s quality
of life and what the community is doing to
improve health. The McClain County health
assessment focuses on three key health
behaviors: factors affecting obesity, children’s
health, and tobacco use. The Community
Health Assessment will also give attention to
other relevant issues such as Health Department use, disaster preparedness and
unintentional injury/violence. Noted below are relevant indicators of McClain County
health. It is our hope that by increasing awareness and knowledge of McClain County’s
health status, we can take action together to improve the health of it’s residents.
Summary &
Implications
Health Outcomes &
Factors
McClain
County
National
Benchmark
90th percentile
Oklahoma
Mortality
Premature Death
(Years of potential life lost before
age 75 per 100,000)
2005-2007
7,813 5,564 9,416
Uninsured Adults
(under age 65)
2007
26% 13% 23%
Primary Care Provider
(Ratio of population to Primary care
provider)
2008
1,547:1 632:1 1,152:1
Preventable Hospital Stays
(Hospital discharge rate for
ambulatory care-sensitive
conditions per 1,000 Medicare
enrollees)
2006-2007
104 52 89
Unemployment
(Percent of the civilian labor force,
age 16 and older, that is
unemployed but seeking work)
2009
5.8% 5.3% 6.4%
Household Income
2009
$52,822 $50,221
(National Avg.)
$42,836
Individuals Below Poverty
2009
10.9% 14.3%
(National Avg.)
16.1%
US Census Bureau, County Health Rankings: Small Area Health Insurance Estimates,
Health Resources and Service Administration, Bureau of Labor Statistics, National Center
for Health Statistics, Medicare/Dartmouth Institute
Demographics
US Census Bureau
McClain County consists
of ten communities
Blanchard, Byars, Cole
Dibble, Goldsby,
Newcastle, Purc
Rosedale, Washington,
& Wayne
Population
· 34,506 (2010)
· 27,742 (2000)
Race/ Ethnicity (2005
· White ….. 27,378
· Black………… 37
· Hispanic … 1,349
· American Indian/
Native……. 1,562
· Asian…………
· Other ….…….834
Age (2005-2009)
· Under 18 …………
· 18-64 …………….
· 65-84 …………..
· 85+ ………………
in communities:
Purcell,
5
2005-2009)
(86.4%)
… (0.1%)
(6.2%)
Alaska
(4.9%)
……… 54 (0.2%)
(2.6%)
……… 25.6%
…………….… 61%
…………..… 12.2%
………………… 1.2%
McClain County Health
Department Usage
Child Health
Family Planning
Children First
Sooner Start
Sexually
Transmitted
Disease
Immunizations
Communicable
Disease
Dental Health
Education
Women, Infants &
Children (WIC)
Health Education
Environmental
Health
The McClain County Health Department
provides residents a variety of services
clinics and in the community to protect and promote
the health of the general population and
infants, children, youth, and adults. These services
work with the partnership of existin
organizations to support healthy residents.
For more information or questions,
McClain County Health Department
(405) 485­3319
(Blanchard) or (405)
County Health Department
Unduplicated Client Services by
Program, State Fiscal
6
(MCHD)
at the local
individual
existing non-profit
please contact the
at
527­6541
(Purcell).
lient Year 2009
7
Obesity rates are
abounding, affecting the
health of our nation,
state, and county.
Behavior and
environment are two of
the largest contributors
in this health epidemic.
If a person is overweight
or obese, this can
contribute to greater risk
in developing chronic
disease including stroke,
heart disease, high blood
pressure, type 2
diabetes, and some
kinds of cancer (CDC).
In addition to physical
morbidities, obesity
affects health care cost
significantly. On
average, an obese
individual may incur up
to $1,429 per person
extra in medical costs
compared to people of
normal weight (CDC).
Estimated health care
costs for McClain County
for one year due to
obesity comes to nearly
$2.8 million.
Good nutrition and
increased consumption
of fruits and vegetables
can help reduce overall
caloric intake and
enhance health.
Fighting
Obesity
With Good
Nutrition
Obesity Rates and
Relevant Indicators
McClain
County
McClain
County
National
Rate
Oklahoma
Obesity Rates
Age 20 and older of population
28.4%
(2006)
35.1%
(2009)
26.7%
(2009)
30%
(2008)
Access to Healthy Food
Zip codes in a county with a
healthy food outlet, produce
stands, farmers’ markets.
NA 33%
(2006)
92%
(2008)
48%
(2008)
Type 2 Diabetes
% Adults age 20 and older in a
county who have diagnosed
diabetes
7.6%
(2006)
10%
(2008)
6.86%
(2008)
%10
(2008)
Number of
Cardiovascular Deaths
(per 100,000 of population)
NA 308.4
(2007)
235.7
(2007)
351.6
(2006)
BRFSS, OSDH, CDC Wonder, County Health Ranking: National Center for Chronic Disease
Prevention and Health Promotion, Census Zip Code Business Patterns
Community Efforts for Nutrition Support
McClain County obesity rates have continued to rise from 2005-2009 by 6.7%.
Residents have notably less access to healthy foods compared to the state
and nation. Additionally, McClain County residents have a higher number
cardiovascular disease deaths and a higher rate of type 2 diabetes compared
to the national average.
· The Women, Infants and Children (WIC) program at the McClain County
Health Department provides specific supplemental foods vouchers for
eligible mothers, infants, and children at critical times of health and
growth. WIC provides culturally relevant nutrition education by licensed
nutritionist to address specific nutritional needs and help to reduce
childhood obesity.
· The McClain County Health Department has a registered dietician who
works with infants and toddlers through the Sooner Start program. The
Sooner Start program works with infants and toddlers with disabilities
and special nutritional needs ranging from special diets to dietary
assistance due to oral sensitivities.
· The McClain County Health Department provides healthy eating
brochures and flyers for various health fairs, such as the Family Fun
Day, to encourage good nutrition.
· The McClain County Turning Point Coalition hosted a six-week
cookiclass to provide nutrition education and hands on cooking
experience to encourage healthy eating.
· Weekly farmers markets are hosted in season through the OSU
extension and Chickasaw Nation in McClain County. Markets are hosted
in Newcastle, Blanchard, and Purcell.
8
Obesity Rates and
Relevant
Indicators
McClain
County
National
Rate
Oklahoma
No Physical
Activity within
Past Month
(Adults over age 20)
27.3%
(2008)
NA 31%
(2008)
Did not reach the
recommended
Physical Activity
(Adults over age 20)
64.9% 49% 52.9%
2003-2008 BRFSS
Fighting
Obesity
With
Physical
Activity
McClain County residents have room for improvement with physical activity.
Only 35.1% of McClain County residents reached the recommended rates
of physical activity, which below the state’s average of 52.9%
Community Efforts for Physical Activity
According to the CDC,
physical activity can help
control weight, reduce
the risk of cardiovascular
disease, type 2 diabetes,
and some cancers. It
also strengthens bones
and muscles and
improves mental health
and mood. It improves
your ability to do daily
activities and prevent
falls if you are an older
adult. Finally, it
increases your chances
of living a longer,
healthier life.
The CDC recommends
adults get 150 minutes
of moderate aerobic
activity a week in
addition to 2 days of
muscle strengthening.
· The Blanchard Community Coalition together with the McClain
County Health Department hosts a yearly middle school camp, Go
Girl Go, where physical activity and good nutrition are promoted and
practiced in addition to nutrition education and leadership skills.
· The McClain County Health Department in collaboration with the 1st
United Methodist Church and Blanchard Community Coalition have
partnered to host WOW, Work Out Wednesday, utilizing the
Coordinated Approach To Child Health (CATCH) curriculum at the
1st United Methodist Church in Blanchard. This program is designed
to promote community, physical activity, and friendship among
children. The program aims to start children with a lifestyle of
physical activity and reduce childhood obesity.
· The CYAP (Community Youth Action Program) is in the planning
stages of increasing recreational facilities, including baseball and
softball fields, as well as a new skate park for youth and adults to
engage in sports. They currently facilitate a winter basketball
leagues for grades K-6 and an annual golf tournament.
· The city of Blanchard is working on building new sidewalks and has
implemented the Safe Routes to School program. This program
aims to increase walking among elementary school children through
a walking school bus.
9
Indicators of
Infant Health
McClain
County
National
Rate
Oklahoma
Infant Mortality
Rate
(per 1,000 births)
7.4%
2002-2006
6.8%
2003-2005
8.0%
2002-2006
Low Birth Weight
(% of Live Births)
(2003-2007)
8.5% 8.1% 8.1%
Immunizations
(By 25 months)
2007
72.68%
71.5% 71.7%
First Trimester
Prenatal Care
(% of live births)
(2002-2007)
81.3% 83.2% 75.6%
2003-2008 BRFSS, OSDH Vital Stats, National Immunization Survey
Prenatal &
Infant Health
Healthy babies begin
with healthy mothers and
appropriate first trimester
prenatal care. Babies
are healthiest when born
to mothers who did not
use substances
including tobacco,
alcohol, and drugs.
Mothers who exercise
and eat nutritiously
create the best
environment for a baby‘s
development. Babies
are protected from
various infectious
diseases and death by
getting immunized.
McClain County is better than the state average for infant mortality rates and
first trimester prenatal care but has room for improvement. The rates of low
birth weight births are slightly above the national and state level. Immunization
rates are slightly higher than the national and state level.
· Children’s First is a voluntary program for first time expecting
mothers to provide in-home education on child safety and healthy
development for women less than 28 weeks pregnant.
· The Women, Infants and Children (WIC) program at the McClain
County Health Department provides specific supplemental foods
vouchers for eligible mothers, infants, and children at critical times of
health and growth. The WIC program also provides culturally
relevant nutrition education by licensed nutritionists to address
specific nutritional needs and help to reduce childhood obesity.
· The McClain County Health Department staff hosts and/or
participates in three to five car seat events annually. They serve an
estimated 400 car seat checks and/or instillations each year. The
staff is certified through the Safe Kids Worldwide Organization for
car seat certification.
Community Efforts for Prenatal and Infant Health
10
Child &
Adolescent
Health
Children are the future
of our county, state and
nation. Children are
more vulnerable to
health concerns due to
their stage of growth
and development.
Graduating from high
school, having health
insurance, and
abstaining or delaying
sexual activity are
important indicators of
good health practice for
children and
adolescents. In
addition, working
together to help
children and
adolescents overcome
the barriers of poverty
can significantly
improve health.
Indicators of Child
Health
McClain
County
National
Benchmark
Rate
Oklahoma
Child Poverty
(Under age 18)
2008
14.4%
11% 22%
High School
Graduation rate
(2006-2007)
90% 92% 78%
Uninsured children
under 19
2007
17.5% 9% 12.2%
Teen Birth Rates
(Out of 1,000)
2001-2007
42
22 59
Kids Count, County Health Ranking: National Center for Education Statistics
· The MCHD works with the McClain Public Schools to provide health
education including education on communicable diseases.
· The MCHD provides individual consultation for family planning services and
STD testing for adolescent health education and screening.
· Blanchard Community Coalition in partnership with the MCHD and
Covenant Freewill Baptist Church have worked together to create the
“Zone.” This is a teen center providing organized after school activities in a
safe and drug free environment for adolescents in McClain County.
· The McClain County Health Department in collaboration with the First
United Methodist Church and Blanchard Community Coalition have
partnered to host WOW (Work Out Wednesday) utilizing the Coordinated
Approach To Child Health (CATCH) curriculum at the First United Methodist
Church in Blanchard. The program aims to start children with a lifestyle of
physical activity and reduce childhood obesity.
McClain County has lower rates of child poverty compared to the state
percentage, yet is worse than the national benchmark. Residents of
McClain County have graduation rates comparable to the nation’s
benchmark. McClain County has a higher rate of uninsured children than
the state national benchmarks. Teen birth rates are lower than the state
level yet nearly double the national benchmark. While McClain County’s
children fair better than the state on some indicators, residents have many
areas to improve.
Community Efforts for Child & Adolescent Health
11
Tobacco
Prevention
Tobacco
Usage Rates
McClain
County
McClain
County
National
Benchmark
Oklahoma
Tobacco Use 15.3%
2003-2006
16.8%
2006-2009
15%
2003-2009
25.1%
2006
BRFSS
Tobacco use is the
single most preventable
cause of premature
death. It harms nearly
every organ in the body.
According to the CDC,
“more deaths are caused
each year by tobacco
use than by all deaths
from human
immunodeficiency virus
(HIV), illegal drug use,
alcohol use, motor
vehicle injuries, suicides,
and murders combined.”
According to the
Oklahoma State
Department of Health,
Tobacco use cost
Oklahomans over $2
billion in medical
expenses and lost
productivity every year,
or an average of about
$600 per person.
Medical costs
accumulated by tobacco
users in McClain County
add up to $14.2 million a
year. (2010 State of the
County’s Health Report)
McClain County smoking rates are lower than the overall state
rates but remain above the national benchmark. Rates have
risen slightly from 2003 to 2009 according to BRFSS.
· The McClain County Health Department (MCHD), Blanchard
Community Coalition (BCC), Community Alliance of Resources
(C.A.R.E) and other community partners together have passed a 24/7
tobacco free ordinance in Blanchard Public Schools.
· The MCHD, BCC, C.A.R.E and the Norman Alcohol Information
Center (NAIC) helped to pass a 24/7 tobacco free ordinance for
tobacco free parks in Blanchard.
�� The MCHD, BCC, and NAIC partnered to create, Project Alert, an
evidence based alcohol, tobacco, and drug prevention program for
Blanchard Middle school students, grades 6 through 8.
· McClain County recently received a T-SET grant (Oklahoma Tobacco
Settlement Endowment Trust) and is in the process of creating an
action plan to address tobacco related health concerns for McClain
County.
· The tobacco-quit line, 1-800-QUIT-NOW, is offered to McClain County
residents to empower them to quit the use of tobacco products. They
offer phone based coaching and access to nicotine patches and gum.
· The Social Host Ordinance passed in Blanchard strengthened the
enforcement of county Minor in Possession laws. This ordinance
places a fine on adults hosting drinking parties for teenagers.
Community Efforts for Tobacco Prevention
12
· McClain County Health Department (MCHD), local businesses, and
emergency responders have collaborated to form a Local
Emergency Planning Committee (LEPC). This committee works to
protect the community from environmental and commercial hazards
through planning, preparation and
communication between residents,
businesses and government. This spring
the LEPC provided all-hazard weather
radios to senior residents outside siren
warning areas. The radios provide
access to severe weather alerts in case
of an electricity outage.
· The Integrated Risk Information System
(IRIS) provides alerts by calling, texting,
and emailing in case of emergencies or
severe weather. Following the May 24th
tornadoes, IRIS sent out messages to
inform tornado victims of access to
tetanus shots.
Disaster
Preparedness
Injury &
Violence
Unintentional injury and
violence is an
increasing problem in
Oklahoma as well as
McClain County.
According to the OSDH
vital statistics for 2002-
2006, unintentional
injury was the 5th
leading cause of death
for Oklahomans.
Disaster preparedness
can save lives and
prevent injury. Having a
plan of action during
severe weather can
keep you and your
family safe in an
emergency.
Using proper safety
precautions when
operating motor
vehicles and heavy
machinery including
seat belts, helmets, and
other safety equipment
can prevent injury and
violence. Additionally,
reporting suspected
violence and heeding
warning signs of suicide
could prevent injury,
death, and violence for
people at risk.
Injury &
Violence
Community Efforts
Disaster Preparedness Community Efforts
· MCHD holds an
annual bike
helmet event to
distribute helmets
to children in
need.
· MCHD staff hosts
and/or
participates in
three to five car
seat events annually. They serve an estimated 400 car seat checks
and/or instillations each year. The staff is certified through the Safe
Kids Worldwide Organization for car seat certification.
· MCHD held a grant funded smoke alarm event in Goldsby where
In McClain County, the leading cause of death
for residents ages 5 to 44 is injury and violence.
The death rate for McClain County residents in
2007 was 63.3% for people 44 and younger
(BRFSS).
According to the National Safety Council, an
estimated $4,300,000 is spent on a single
death due to a car accident (2009). According
to BRFFS, there were 16 deaths in McClain
County in the year 2007 due to unintentional
injury.
smoke alarms were provided to residents in need.
13
Conclusion
McClain County has been working together to improve the health of its residents and preserve the health for future
generations to come. McClain County is a growing region with a number of community assets but much more can be
done to improve its health.
McClain County gets a thumbs up for the following assets and achievements:
• Graduation rates of 90%
• Population growth of 24.4% since the year 2000
• Oklahoma Tobacco Settlement Endowment Trust
• Blanchard Community Coalition, Turning Point Partner
• Community Youth Action Program (C.Y.A.P)
• Community Alliance of Resources for Everyone (C.A.R.E.)
• McClain County Health Department services
• Farmers markets
• Social Host Ordinance
• Local Emergency Planning Committee (LEPC)
McClain County can work to improve the following health indicators:
• 6.4% increase in obesity from 2006-2009
• Increasing rates of type 2 diabetes by 2.4% since 2006
• Low rates of physical activity and limited access to healthy foods
• Higher rates of uninsured children (5.3%) and adults (3%) compared to the state
• Higher rates of preventable hospital stays and limited access to medical providers
• The leading cause of death is injury and violence for people 44 and younger. 63.9% of McClain County is under 44.
The McClain County Health Department is focusing on obesity reduction, child health, tobacco prevention as well as
injury and violence reduction. Together with coalitions, leaders, community partners, schools, and healthcare
professionals, the communities of McClain County can unite to change the tide of health for a stronger healthier future.
14
Resources
McCLAIN COUNTY BOARD OF HEALTH
Tony Christian, Charles Foster, George Kernek, Doug Harryman, D. Bryan Dye, MD
All Health and Safety Topics
· Oklahoma State Department of Health
o www.ok.gov/health
· Center for Disease Prevention and Control
o http://www.cdc.gov
Obesity Reduction and Prevention
· American Heart Association
o http://www.heart.org
· Cooper Aerobics
o http://www.cooperaerobics.com
· American Dietetic Association
o http://www.eatright.org
Tobacco Prevention
· Smokefree.gov
o http://www.smokefree.gov
· American Lung Association
o http://www.breathehealthy.org
Child Health
· Safe Kids USA
o www.safekids.org
· Mayo Clinic
o http://www.mayoclinic.com
Injury and Violence Prevention
• National Safety Council
o http://www.nsc.org
15
Reference List
· Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed
Mortality File 1999-2006. CDC WONDER On-line Database, compiled from Compressed
Mortality File 1999-2006 Series 20 No. 2L, 2009. Accessed at
�� http://wonder.cdc.gov/cmf-icd10-archive2006.html on June 20,2011.
· Center for Disease Control and Prevention (May 11, 2009), Fit Physical Activity into Your Life,
Your Way, Accessed on June 7,2011 on http://www.cdc.gov/Features/PhysicalActivity.
· Center for Disease Control and Prevention (August 3, 2010), More States Reach 30 Percent
Obesity Rates, Accessed on June 7, 2011 on
http://www.cdc.gov/Features/VitalSigns/AdultObesity.
· Center for Disease Control and Prevention (March 21, 2011) Smoking and Tobacco Use,
Accessed on June 1, 2011 on
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking.
· County Health Rankings,(2011), 2011 McClain County, Accessed June 17, 2011 from
http://www.countyhealthrankings.org. (Primary Sources include: National Center for Health
Statistics, BRFSS, National Center for Chronic Disease and Health Promotion, National Center
for Health Statistics, Small Area Health Insurance Estimates, U.S. Census, Health Resources
& Service administration, Medicare/Dartmouth Institute, National Center for Education
Statistics, Census Zip Code Business Patterns).
· Department of Health and Human Services, Centers for Disease Control and Prevention,
National Center for Immunization and Respiratory Disease, Comprehensive CASA, Summary
Report, McClain County Health Department Blanchard, Accessed June 20,2011.
· Kids Count Data Center, Oklahoma Institute for Child Advocacy, (2007), Uninsured Under 19,
Accessed June 14, 2011 from http://datacenter.kidscount.org.
· Oklahoma State Department of Health (OSDH), Center for Health Statistics, Health Care
Information, Behavioral Risk Factor Surveillance (BRFFS), on Oklahoma Statistics on Health
Available for Everyone (OK2SHARE). Accessed at http://www.health.ok.gov/ok2share on
June 7, 2011.
· Oklahoma State Department of Health (OSDH), Center for Health Statistics, Health Care
Information, Death Statistics, on Oklahoma Statistics on Health Available for Everyone
(OK2SHARE). Accessed at http://www.health.ok.gov/ok2share on June 7,2011.
· Oklahoma State Department of Health (OSDH), Center for Health Statistics, Health Care
Information, Youth Risk and Behavior Survey (YRBS), on Oklahoma Statistics on Health
Available for Everyone (OK2SHARE). Accessed at http://www.health.ok.gov/ok2share on June
7, 2011.
· Oklahoma State Department of Health, 2010 State of the County’s Health Report, Accessed
May 31, 2011 on www.ok.gov/health/documents/McClain%20County%202010.pdf.
16
· National Immunization Survey, Estimated Vaccination Coverage with 4::3:1:3:3:1 Among
Children 19-35 Months of Age by Race/Ethnicity and by State and Local Area – US, National
Immunization Survey, Q3/2009-Q2/2010, Accessed June 20,2011.
· National Safety Council, Estimating the Cost of Unintentional Injuries, Accessed 6,22,2011 at
http://www.nsc.org/news_resources/injury_and_death_statistics/Pages/EstimatingtheCostsofU
nintentionalInjuries.aspx.
· State of the State’s Health Report, 2008, Indicator Report Card-all, Accessed June 22, 2011 at
http://www.ok.gov/health/pub/boh/state/index.html.
· United Health Foundation, America’s Health Rankings (2011), Accessed June 1, 2011 on
http://www.americashealthrankings.org.
· U.S. Census Bureau, _2005-2009 American Community Survey 5-Year Estimates, McClain
County_ Accessed June 1, 2011 from www.census.gov.
· U.S. Census Bureau, (03-Jun-2011) State and County Quick Fact, www.census.gov.