Health Behaviors

The CASPER door-to-door assessment collected information from community members regarding health behaviors. Health behaviors include those health-related behaviors that ultimately affect a person's risk of developing a chronic disease, or other health conditions that may reduce a person's quality of life or cause premature death.

The CASPER assessment data, combined with data from other sources, paints a picture of the status of diet and exercise, tobacco use, cancer, injuries, and mental health in Richland County.

The disease burden in Richland County is significantly impacted by health behaviors. In the CASPER assessment, community members identified that they considered several issues contributing to the disease burden that are related to health behaviors.

Diet & Exercise

Evidence shows a strong relationship between increased sedentary behavior and increased of heart disease, high blood pressure, and all-cause mortality. ~Centers for Disease Control and Prevention

Diet and exercise plays a significant role in the development of obesity. According to the Community Health Rankings, 31% of Richland County adults are obese. Richland County has consistently held an adult obesity rate greater than that of both Montana and the United States.

Contributing to obesity rates in Richland County is the amount of physical activity adults participate in. The CASPER door-to-door assessment revealed that of those surveyed, more than one quarter reported having no physical activity in the last seven days.  The Centers for Disease Control & Prevention recommends adults get at least 150 to 300 minutes of moderate-intensity aerobic activity each week.

In conjunction with exercise, good nutrition plays a key role in maintaining health. In the CASPER door-to-door assessment, those surveyed identified several barriers to healthy eating. Though many reported that cost was a prohibitive factor to healthy eating, almost half of those surveyed felt that food was affordable in Richland County. According to the County Health Rankings, Richland County had a food environment index of 7.9, compared to 7.1 in Montana.

Tobacco Use

Tobacco use continues to be a significant issue in Richland County. The percentage of adults who use tobacco remains greater than the Healthy People 2020 objective, at 17% of adults versus the target at 12%. The inpatient admission rate for chronic obstructive pulmonary disease (COPD), a disease generally regarded as a result of long-term tobacco use, was 388 in Richland County versus 278.1 per 100,000 in Montana.

Healthy People 2020 also calls for a target of 98.6% of pregnant women who abstain from smoking during pregnancy, which would be an increase of 14.6% in Richland County.

Data show that though 18% of middle school students had tried smoking in 2017, 19% of middle school students tried e-cigarettes. More recently, Richland County has seen an increase in the use of electronic cigarettes, or "vaping", particularly in school-aged children. According to Healthy People 2020, e-cigarettes surpassed cigarettes as the most commonly used tobacco product among U.S. middle and high school students in 2014. E-cigarette use has increased 900% among high school students from 2011 to 2015, according to a Surgeon General's report. These devices are currently unregulated and the long-term health effects not well-studied, though emerging studies show significant health effects.


Cancer is the second leading cause of death in Richland County, in Montana, and across the United States. Nearly three quarters of those surveyed in the CASPER door-to-door assessment felt that cancer was a problem in Richland County. According to the Montana Central Tumor Registry, both cancer incidence rates and cancer death rates have remained stable between 2011 and 2015. Women are more likely than men to be diagnosed with cancer in Richland County, though men experience greater mortality due to cancer. Richland County has had more cancer deaths than both Montana and the US for almost 15 years.

The most common cancers diagnosed in Richland County, as well as the US, prostate in men and breast in women, followed by lung and bronchus, and colon and rectum. Lung and bronchus cancers caused the most deaths in both men and women in 2015, according to the American Cancer Society.

Unintentional Injuries

Unintentional injury is the third leading cause of death in Richland County, and in the US. The unintentional injury death rate in Richland County is 103 compared to 92 per 100,000 in Montana. However, as shown, Richland County ranks near the median in this category compared to other Montana counties.

Though most of those surveyed in the CASPER door-to-door assessment reported that they felt falls resulting in injuries were either not a problem or they didn't know, the number of emergency visits related to falls in Richland County shows that this is a problem. About 35% of respondents felt that motor vehicle injuries were a problem. The number of emergency visits related to motor vehicle injuries is about 1.5 times that of Montana.

Though only approximately 35% of surveyed residents felt that motor vehicle injuries were a problem in Richland County, the rate of motor vehicle crash deaths is nearly double that of Montana.

Most respondents to the CASPER door-to-door assessment reported wearing a seatbelt.

Mental Health

Nationally, one in five adults experiences a mental health condition each year, and in Montana, one in ten adults have had recurring mental distress in the past month. According to the CASPER door-to-door assessment, approximately 60% of respondents reported a moderate to high level of day to day stress, though the 2019 County Health Rankings showed that 10% of adults experience frequent mental distress, and experience 3 poor mental health days per month.

For those seeking care locally, Sidney Health Center offers primary care providers who often diagnose and may treat a variety of mental health disorders. Of those patients who maintain a primary care providers at the Sidney Health Care Clinic, many had diagnoses of varying levels of anxiety and depression, according to ICD-10 codes. 

Suicide is the 10th leading cause of death in the US, according to 2016 CDC data; and Montana has the highest rate of suicide of any state. The suicide rate for Richland county is 23.36 per 100,000 (IBIS, 2011-2015)

Youth ages 18 and younger comprise a significant portion of patients treated at the Sidney Health Center emergency department for both suicidal thoughts or a suicide attempt between 2018 and 2019. The 2016 Prevention Needs Assessment revealed that 18.5% of students in grades 8-12 had planned a suicide in the past 12 months, and 12.1% had actually attempted a suicide. Of surveyed students, 42.9% reported that they felt depressed or sad most days in the last year.

Substance Use

Substance use, which includes the use of drugs and alcohol, continues to be an issue in Richland County. A crash, fatality or injury is alcohol or drug-related if at least one driver or motorcycle operator involved in the crash is determined to have a Blood Alcohol Content (BAC) of 0.01g/dL or higher, OR if police indicate on their investigation report that there is evidence of alcohol or drugs present.

The legal BAC limit is 0.08 g/dL for people 21 and older operating a non-commercial vehicle. The threshold for persons under 21 is 0.02g/dL. A BAC of > or equal to 0.16 g/dL is considered an aggravated DUI. The average BAC in Richland County in 2017 was 0.183 g/dL in a breathalyzer test, almost 15% higher than the state average. In 2017, 45% of DUI convictions were aggravated DUI convictions.

Of 545 motor vehicle crashes in Richland County in 2017, 49 were DUI-related crashes, resulting in 2 fatalities and 1 serious injury.

Richland County has a high number of repeat DUI offenders, called "recidivism", resulting in second, third, and sometimes fourth or more DUI convictions.

According to the County  Health Rankings in 2019, 24% of Richland County residents report binge or heavy drinking in the past 30 days.

CASPER assessment respondents largely reported that they felt both illegal drug use and alcohol abuse were a problem in Richland County. Richland County's rate of drug hospitalizations was 240.2 versus 372.5 per 100,000 in Montana from 2012-2014. For drug-related crimes, however, Richland County rates in near the top, even surpassing larger counties like Yellowstone County and Cascade County.