NUR448_SecondaryDataTemplate2.docx
Secondary Data Table Template
The data obtained on this table is to be used to assess community health needs and to identify health disparities within a community.
City/Town/Village Name: ________________________State: _______________Zip Code: _______ Population: __________
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Vital Statistics
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County Statistics
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State Statistics
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Age Distribution
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Race/Ethnicity
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Births
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Deaths
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Gender/Sex
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Add lines as needed
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Health Behaviors
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County Statistics
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State Statistics
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Example: Adult smoking
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12%
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14%
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Adult Smoking
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Physical inactivity
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Excessive drinking
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Alcohol-impaired driving deaths
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Sexually transmitted infections
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Teen births
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Clinical Care (5)
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County
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State
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Example: Uninsured
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10%
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12%
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Uninsured
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Example: Primary Care Physicians
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680:1
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1,200:1
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Primary care physicians
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Dentists
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Mental health providers
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Preventable hospital stays
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Diabetic monitoring
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Mammography screening
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Social & Economic Factors
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County
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State
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High school graduation
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Some college
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Unemployment
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Children in poverty
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Income inequality
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Children in single-parent households
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Social associations
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Violent crime
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Injury deaths
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Physical Environment
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County
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State
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Air pollution - particulate matter
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Drinking water violations
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Severe housing problems
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Driving alone to work
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Long commute - driving alone
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