By Your Side - A Special Report

For more than 110 years, Lancaster General has been guided by its mission to advance the health and quality of life of the individuals and communities we serve by providing superior healthcare that demonstrates community benefit.

As a non-profit health system, Lancaster General constantly reinvests its resources to ensure our community’s growing healthcare needs are met with talented professionals, advanced technologies and state-of-the-art facilities. As our community’s healthcare leader, Lancaster General takes a principal role in proactively addressing priority issues that adversely affect the health of Lancaster County. And, as a responsible steward of our community’s resources, we carefully evaluate and track program outcomes, measure effectiveness, reduce duplication of services and set direction to align our programs with state and national health goals.

Using federal reports like Healthy People 2010, which recognizes and establishes national health goals, as well as state and local reports and an advisory committee that includes

community members, we identify the priority healthcare needs to address in Lancaster County.

While we strive to address all healthcare issues in our community, from prenatal education to end-of-life care, certain issues are of particular concern in our community:

• Overweight and obesity
• Tobacco use
• Domestic violence

This report shows how Lancaster General, health organizations and community groups throughout Lancaster County work in partnership to direct our resources toward action around these priority issues:

Overweight and Obesity

According to the federal Centers for Disease Control (CDC), obesity in the United States has risen at an epidemic rate during the past 20 years. Results from the 1999-2002 National Health and Nutrition Examination Survey show that an estimated 65 percent of American adults are either overweight or obese.

Locally, 60 percent of Lancaster County adults are overweight, according to information from the 2003 Measure Up Lancaster report published by Lancaster General and several local service, civic, governmental and educational organizations.

“Overweight” is defined by the National Institutes of Health as having a Body Mass Index (BMI) of 25 or greater. Obesity is indicated by a BMI of 30 or greater. While BMI is a useful screening tool, it’s not a definitive measure of overweight and obesity.

Statistics on overweight children are also alarming. According to the CDC, the percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (more than 9 million young people) are considered overweight. In Pennsylvania, a recent study of height and weight of eighth graders across the state showed that 18 percent were overweight; another 17 percent were at risk for becoming overweight.

For the first time, during the 2005-2006 school year, the state is requiring schools to report children’s Body Mass Index (BMI) along with hearing and vision scores. To help parents better understand what BMI is and to learn how to ensure their children eat healthy and are physically active, we created

A Parent’s Guide to Healthy Eating & Activity for Children.

More than 40,000 copies of the free guide were distributed to schools, physician offices and community agencies in 2004. A Spanish version is also available. To download an electronic version of the guide, visit www.LancasterGeneral.org. To obtain guides for your school, call 544-3527.

In conjunction with the guides, staff from the Lancaster General Wellness Center gave 10 free presentations on BMI in eight school districts to provide additional information and answer questions. To schedule a presentation for your school, call 544-3143.

For children and teens who are having difficulty maintaining their weight, we offer Shapedown, a comprehensive, family-inclusive program for weight management.

Working with Highmark Blue Shield, Warwick School District and the School District of Lancaster, Lancaster General was able to provide scholarships for 42 children to participate in the Shapedown program in 2004.

For adults who can benefit from a structured program to maintain their weight and increase their physical activity, we offer community programs through our Wellness Center.

LEARN, a 15-week weight management class for adults, stands for Lifestyle, Exercise, Attitude, Relationships and Nutrition. It’s the most thoroughly tested lifestyle change program available for weight management. Classes are held throughout the year. Over 50 & Fit is a walking and exercise club for people over age 50. The group meets weekly at Lancaster General Health Campus. For more information or to register for classes offered at the Wellness Center, call 544-3138.

The key to any weight management program is diet and exercise. According to the 2003 Measure Up Lancaster report, only 46 percent of Lancaster Countians exercise regularly.

To encourage Lancaster Countians to become more physically active, we partnered with the Lancaster County Planning Commission to produce a comprehensive guide of free and low-cost places to be physically active. The booklet, titled Lancaster On The Move, highlights area parks and recreation centers.

Details about the activities available, difficulty of walking trails, accessibility, hours and other useful information are included for each location. Additionally, motivational tips and resources are included to help readers log their activity and stay active. The guides are free and are available at parks and recreation sites across Lancaster County or by visiting www.LancasterGeneral.org.

Physical limitations often prevent people from being physically active. Heart Healthy Yoga, Mindful Yoga and Mother-Baby Yoga provide the benefits of a yoga class with modifications for medical conditions. Qigong, Tai Chi, Feldenkrais and Focus on Healing, offered at Lancaster General Wellness Center, help improve flexibility and mobility for those dealing with chronic illness. Pregnancy Plunge, offered in conjunction with the Lancaster Family YMCA, provides exercise and instruction for expectant mothers.

Through Lancaster General Cardiac Rehabilitation and Physical Rehabilitation, patients who have undergone treatment for disease can ease back into an exercise routine with the help of trained staff.

Additionally, we partner with other organizations to provide opportunities for physical activity while supporting important community causes. Last year we sponsored the American Heart Association Heart Walk, American Cancer Society’s Relay for Life, Diabetes Walk for a Cure, Lancaster Movers & Shapers and the YWCA Race Against Racism.

Tobacco Use

According to Lancaster General’s 2004 Health Data Report, 668 Lancaster Countians die each year from a tobacco-related illness.

Tobacco use is a major contributing factor in heart disease, lung disease, stroke and cancer. Second-hand smoke also is associated with Sudden Infant Death Syndrome (SIDS), asthma and chronic respiratory infections in children.

We are one of the founders of the Tobacco-Free Coalition of Lancaster County, a group dedicated to decreasing tobacco use and illness and death related to tobacco use, in our community. The coalition is the governing body of the Pennsylvania Tobacco Settlement Funds, which are overseen by the Lancaster County Drug & Alcohol Commission.

Twelve percent of the Tobacco Settlement Funds must be used directly for tobacco prevention and cessation programs. We have worked closely with this coalition to identify needs and provide programs aimed at making Lancaster a tobacco-free community.

According to a 2002 survey by the state Department of Health, 28.4 percent of high school students smoke. Recognizing that a lifetime of tobacco use often begins during adolescent years, our staff teaches LifeSkills in 21 elementary schools, 15 middle schools, one high school and two post-secondary technical schools in Lancaster County.

Touted by the CDC as a “best practice program” for preventing youth from starting to smoke, Lifeskills has been shown to slash smoking in elementary schools by 61 percent. Students who learn the LifeSkills curriculum in middle or junior high are 50 to 75 percent less likely to use tobacco, alcohol and marijuana. Additionally, it reduced the number of pack-a-day student smokers by 25 percent.

Adults who smoke can receive help in quitting through our Freedom from Smoking program, a seven-week class that provides support, education and a refund for participants who successfully quit.

Using our relationship with the physician community, we help to increase the number of clinicians who routinely counsel smokers to quit, increase quitting attempts and rates and reduce the number of people who are regularly exposed to tobacco smoke by providing training through Clean Air.

In an effort to prevent future hospital visits, we provide inpatient smoking cessation counseling for patients at Lancaster General Hospital and Women & Babies Hospital who want to stop smoking. Specially trained counselors connect with patients who say that they have smoked in the past 12 months. These counselors offer support, education, referral and follow-up for patients interested in quitting. In the first six months of the program, 2,431 patients who smoked were admitted to LGH or Women & Babies Hospital. Of these patients, 1,372 agreed to counseling through our inpatient smoking cessation program. At the six-month follow-up, 43.2 percent of those patients reported being non-smokers.

Domestic Violence

An overwhelming amount of domestic violence goes unreported, even though it can seriously affect quality of life.

Victims of domestic violence are at greater risk for poverty, homelessness, dropping out of school and a continued cycle of violence. We want victims of domestic violence to achieve an optimal level of health. In order for that to happen, we take an upstream, proactive approach and provide support and encouragement for victims to enable them to escape from this harmful destructive cycle.

As a member of the Lancaster Coalition Against Family Violence, we work with the medical community, social service agencies, the faith community, schools, shelters and others to provide training to recognize domestic violence and provide assistance.

This past year, we reviewed domestic violence screening protocols within our health system. Systemwide changes have been initiated to better identify domestic violence victims and properly—and sensitively—intervene to help. A four-course training class was provided for staff and managers this fall and a free community seminar featuring Robert F. Anda, MD, MS, discussed domestic violence and the Adverse Childhood Experiences study.

Posters and resource cards, printed by Lancaster General, hang in our facilities as well as hundreds of locations throughout the county where domestic violence victims can discreetly access them. Materials are available by calling the Wellness Center, 544-3138.

As a member of the Sexual Assault Forensic Examiner (SAFE) program, we provide specially trained nurses who are on-call 24-hours-a-day in our Emergency Department to aid in evidence collection and care of sexual assault survivors in a sensitive, supportive environment.

The Lancaster County district attorney’s office estimates that more than 400 cases of physical and sexual child abuse are reported in the county each year.

Last spring, Lancaster General partnered with the Lancaster County District Attorney’s Office, the Lancaster County Children & Youth Agency and the YWCA of Lancaster to develop the Lancaster County Children’s OASIS for child abuse victims. OASIS stands for Organizations Allied for Safety, Intervention and Support.

The center’s space and infrastructure, provided by Lancaster General, allows physicians and investigators to collaboratively collect evidence of the abuse.

Exposure to violence in early life can produce changes in brain chemistry and function that appear to be permanent. It’s a risk factor for many later problems, including teen violence, self-mutilation and general lack of impulse control. It affects the involved child’s ability to learn and to become a productive citizen, increases demands on social services and schools and can affect the quality of life for the entire community.

As part of Healthy Beginnings Plus and the Nurse-Family Partnership Program, specially trained nurses reinforce positive parenting skills during a child’s early years and support new mothers in caring for their child. A report in the August issue of the Journal of the American Medical Association concluded that the Nurse-Family Partnership is the only program with evidence of preventing child abuse and neglect.

An Ongoing Commitment

Lancaster General collaborates with many individuals, organizations and agencies to address these important health issues. Our thanks to our partners for their continued dedication and support.

In addition to the focus areas outlined above, we work to address all healthcare issues that affect our community by providing quality, award-winning care that Lancaster County residents deserve.

Our annual community health report, due out in early 2006, will detail our ongoing work in improving our community’s health.