Although it's the top county in the state when it comes to access to clinical care, Boone County has nothing to brag about on health outcomes and behaviors.
According to this year's county health rankings by the Robert Wood Johnson Foundation, Boone County has higher numbers than the state average on alcohol consumption-related behaviors and sexually transmitted diseases.
The health rankings use the chlamydia rate as a gauge. While the state average is 462.9 cases per 100,000 people, the county's rate is of 650.6 Like several other STDs, chlamydia can be prevented by using male or female condoms during sexual intercourse. The Columbia/Boone County Public Health and Human Services provides free condoms in locations around the city. The health department also provides low-cost testing.
One factor that could contribute to the high chlamydia rate is the high percentage of young people, between the ages of 15 and 24, living in the county, said Eric Stann, community relations specialist with the health department.
According to data from the 2015 U.S. Census Bureau, 23.4 percent of Boone County's population is in that age group.
In Adair County, home to several universities including Truman State, 31.8 percent of the population is between 15 and 24 years old, according to the Census Bureau . However, alcohol-impaired driving rates, excessive drinking and chlamydia numbers are lower than in Boone County. Adair County has a population of 25,378, compared to Boone County's 174,974.
According to the health rankings, 25 percent of driving deaths in Adair were attributed to alcohol, and 18 percent of adults reported engaging in excessive or binge drinking. The numbers are lower than Boone's, where 44 percent of driving deaths involved alcohol and 21 percent of adults binge-drink
"It helps that we are a small community and the places students drink are close to campus," said Joe Hamilton, chair of Truman's University Partners in Prevention, a higher education coalition that focuses on preventing underage and high-risk drinking in college students, according to its website.
"I think there's been awareness among our students for many years that it's not okay to drink and drive," he said. Truman University also heavily promotes CHEER, a state-wide program that offers free non-alcoholic drinks to designated drivers, according to its website.
"According to last year’s Missouri Assessment of College Health Behaviors (MACHB) 78 percent of Truman students had heard of the CHEERS program," Hamilton said. The state average was 22 percent.
The chlamydia rate in Adair is 273.7 per 100,000 people, lower than Boone County's. Lori Guffey, of the Adair County Health Department, said she wouldn't attribute the incidence of the disease to the younger population. "We see STIs in that age group, but I don’t think it’s that narrowed to it "
Without a Planned Parenthood center, the Health Department is the only affordable provider of sexual and reproductive health services in Adair, Guffey said. In 2016, there were 109 chlamydia and gonorrhea, 67 HIV and 65 syphilis tests done at the Health Department.
In 2016 the Boone County Department of Public Health and Services conducted 2,344 chlamydia, 2,345 gonorrhea and 2,173 HIV tests, according to Stann. "It is important to note with these numbers that we are not the only STD testing site in Boone County or Columbia," he said.
Indeed, Boone County residents have more options when it comes to low-cost testing and sexual health. In Columbia, Spectrum Healthcare and Planned Parenthood provide STD testing at low or no cost.
"It's easier to get tested here," said Cale Mitchell, executive director of Spectrum Healthcare That's one reason Boone County's numbers are higher, he said.
Spectrum works with MU, Stephens College, Westminster College, William Woods University and Columbia College, providing students with accessible testing services, Mitchell said. While Spectrum still tries to educate college students about safe sex practices, Mitchell said its best efforts are in getting people tested.
"Education and prevention are significant barriers in Boone County, said Kristin Metcalf-Wilson, Planned Parenthood Great Plains' assistant vice president of health services
Planned Parenthood, she said, is not allowed in schools, and accessing that population is very hard. While they can go to campuses, the problem is finding a place to reach the greatest number of people.
A racial disparity
According to data from a 2015 summary by the Columbia/Boone County Health Department, the chlamydia rate in Boone County is significantly higher within the black community. While the rate within the 15 to 19 years old age group in white males is 577.2 per 100,000 people, the rate for that same group within black males is 4,065 per 100,000.
Black women are most affected. The chlamydia rate within black females from 15 to 19 years old was 7,874.9 per 100,000, higher than their white counterparts, with a rate of 1,615.7 per the same number.
"There's generally a higher rate of female infection than male infection," said Metcalf-Wilson. Females are at a higher risk of getting infected after just one exposure to the bacteria during vaginal intercourse, she said .
STD inequities among minorities is a national trend. Chlamydia rates in the U.S., according to the CDC'S 2015 STDs Surveillance, present the same picture as in Boone County: The disease incidence is higher among blacks and Hispanics.
Metcalf-Wilson attributes this to the difficulties these groups encounter when it comes to testing or sex education. The CDC explains this by the correlation within minorities and income inequality, higher poverty rates and unemployment. While the poverty rate for whites in 2014 was 10.1 percent, the rate for blacks was 26.2 percent and 23.6 percent for Hispanics.
The Columbia/Boone County Health Department doesn't have any specific program or prevention campaign targeted toward those communities.
"We provide services to anyone regardless of their race, sexual orientation, gender and religion," Stann said.
Mitchell said specifically on campus, Spectrum works with the Black Culture Center. "We don't have a specific campaign [that targets minorities]," he said. "I think this is about where you are directing your message, not about a specifically crafted one."
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