2016 PRC Community Health Needs Assessment

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1 2016 PRC Community Health Needs Assessment Staunton City, Waynesboro City, and Augusta County, Virginia Prepared for: Augusta Health By Professional Research Consultants, Inc.

2 The PRC Community Health Needs Assessment consists of both primary and secondary data. Customized Local Health Survey Population-based, stratified by city/county Conducted via landline and cell phones Targets health status, experience, behaviors BENCHMARKING PRC National Health Survey Virginia BRFSS data Healthy People 2020 targets National vital statistics data Secondary Data County-level and city-level data Census data, vital statistics, other health-related data Online Key Informant Survey Community stakeholder input physicians, public health, other health providers, social services, community leaders Based on their experiences, the populations they serve

3 Population Survey 400 surveys stratified across the service area: 100 in Staunton City 100 in Waynesboro City 200 in Augusta County Final sample weighted in proportion to total population Over 145 survey items; minute interview. Total sample size gives an overall maximum confidence interval of ±4.9%.

4 100% Population & Survey Sample Characteristics (Total Area, 2016) Actual Population PRC Survey Sample 88.6% 90.4% 80% 60% 40% 46.6% 44.9% 53.4% 55.1% 31.2% 32.4% 42.6% 42.2% 26.2% 25.4% 32.8% 32.3% 20% 11.4% 9.6% 0% Men Women 18 to to White Other <200% FPL Sources: Census 2010, Summary File 3 (SF 3). US Census Bureau PRC Community Health Survey, Professional Research Consultants, Inc.

5 Today s Activities Presentation Represents just a fraction of the data collected through this assessment. Primarily focuses on areas of need ("Areas of Opportunity"); however, there were many positive findings for the area as well. Will allow for Q&A at the end. Prioritization During the second half of our meeting, you will be asked to rank health issues along various criteria to inform the prioritization process.

6 13 Identified Areas of Opportunity General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

7 Self-Reported Health Status (Total Area, 2016) Fair 7.5% Poor 11.4% Excellent 20.1% Good 26.3% Very Good 34.7% Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 5] Notes: Asked of all respondents.

8 100% Experience Fair or Poor Overall Health 80% 60% 40% 34.4% Statistically similar to VA and US 20% 13.1% 16.5% 18.9% 16.9% 18.3% 0% Staunton City Waynesboro City Augusta County Total Area VA US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 5] Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents.

9 100% Experience Fair or Poor Overall Health (Total Area, 2016) 80% 60% 40% 20% 30.9% 9.1% 14.2% 15.5% 32.0% 27.1% 8.8% 18.9% 0% Men Women 18 to to Low Income Mid/High Income Total Area Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 5] Notes: Asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income includes households with incomes at 200% or more of the federal poverty level. In addition, 25.6% of adults report health-related activity limitations, significant higher than VA (18.6%) and US (20.0%).

10 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

11 Healthcare Insurance Coverage (Among Adults Age 18-64; Total Area, 2016) PRC Community Health Needs Assessment Other Gov't Coverage 1.9% No Insurance/ Self-Pay 11.2% Medicaid & Medicare 8.1% VA/Military 3.0% Medicare 2.9% Medicaid 3.4% Insured, Unknown Type 0.6% Insured, Self- Purchase 10.9% Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 190] Notes: Reflects respondents age 18 to 64. Insured, Employer- Based 58.0% Private Insurance = 69.5% Gov t-sponsored = 19.3% Uninsured = 11.2% (similar to US) Women and young adults more likely uninsured.

12 Barriers to Access Have Prevented Medical Care in the Past Year 50% 40% Total Area US 30% However, this was quite prevalent (24.2%) in Waynesboro. 20% 10% 0% 14.4% Getting a Dr Appointment 15.4% 14.4% 9.9% 9.6% Inconvenient Office Hours 5.0% Lack of Transportation 11.5% 8.1% 7.6% Cost (Doctor Visit) Cost (Prescriptions) 9.5% 8.7% 3.4% Finding a Doctor 0.1% 1.7% Language/ Culture Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 7-13] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents. In all, 36.9% encountered one or more of these barriers (similar to US), higher among low-income and young adults.

13 Access to Primary Care (Number of Primary Care Physicians per 100,000 Population, 2012) Primary Care Physicians 19 Primary Care Physicians 29 Primary Care Physicians 63 Primary Care Physicians 6,091 Primary Care Physicians 233,862 Primary Care Physicians 0 Staunton City Waynesboro City Augusta County Total Area VA US Sources: US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File: Retrieved April 2016 from Community Commons at Notes: This indicator is relevant because a shortage of health professionals contributes to access and health status issues.

14 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

15 Leading Causes of Death (Total Area, 2014) Heart Disease 23.1% Other 35.9% Alzheimer's 3.4% Accidents 4.1% Stroke 4.7% CLRD 6.3% Cancer 22.5% Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). CLRD is chronic lower respiratory disease.

16 Cancer Age-Adjusted Mortality Rates (Deaths) Higher than US rates for: Cancers (all types combined) Lung cancer Female breast cancer Colorectal cancer Incidence Rates (New Cases Diagnosed) Higher than US rates for: Prostate cancer Lung cancer

17 250 Cancer: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Healthy People 2020 Target = or Lower Staunton City Waynesboro City Augusta County Total Area VA US Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April US Department of Health and Human Services. Healthy People December [Objective C-1] Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population. Mortality rates in the area are also higher for certain leading sites: lung cancer; female breast cancer; and colorectal cancer.

18 Prevalence of Skin Cancer Prevalence of Cancer (Other Than Skin Cancer) 50% 50% 40% 40% 30% 25.9% 30% 20% 10% 5.7% 6.8% 9.9% 5.5% 7.7% 20% 10% 12.7% 17.4% 4.4% 8.3% 6.3% 7.7% 0% Staunton Waynesboro Augusta Co. Total Area VA US 0% Staunton Waynesboro Augusta Co. Total Area VA US Incidence rates are high in the area for prostate and lung cancers; in addition, Waynesboro also has high rates for female breast and colorectal cancer diagnoses. Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 30] Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents.

19 Cancer Screenings 100% 100% 100% 80% 75.0% 80.0% 80.3% 80% 67.6% 85.2% 84.8% 80% 77.2% 69.1% 74.5% 60% 60% 60% 40% 40% 40% 20% 20% 20% 0% Total Area VA US 0% Total Area VA US 0% Total Area VA US Mammogram in the Past 2 Years (Women 50-74) Healthy People 2020 Target = 81.1% or Higher Pap Smear in the Past 3 Years (Women Age 21-65) Healthy People 2020 Target = 93.0% or Higher Colorectal Cancer Screening (Adults Age 50-75) Healthy People 2020 Target = 70.5% or Higher

20 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

21 Kidney Disease: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Staunton City N/A Waynesboro City Augusta County Total Area VA US Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.

22 50% Prevalence of Kidney Disease (Total Area, 2016) 40% 30% 22.5% 20% 10% 9.6% 4.9% 2.4% 1.6% 13.1% 3.2% 7.0% 3.6% 0% Men Women 18 to to Low Income Mid/High Income Total Area us Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 32] Notes: Asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income includes households with incomes at 200% or more of the federal poverty level.

23 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

24 Alzheimer's Disease: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Staunton City Waynesboro City Augusta County Total Area VA US Sources: Notes: 28.2% of residents report a family member diagnosed CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April Deaths are coded using the Tenth Revision of the International with dementia/alzheimer s. Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population. 11.2% of adults 45+ report themselves experiencing increasing confusion/memory loss over the past year.

25 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

26 50% Prevalence of Diabetes 40% 30% 20% 10% 12.1% 21.5% 12.4% Another 5.7% of adults report that they have been diagnosed with pre-diabetes or borderline diabetes. (vs. 5.7% nationwide) 13.9% 9.7% 14.5% 0% Staunton City Waynesboro City Augusta County Total Area VA US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 158] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data. Notes: Asked of all respondents.

27 50% Prevalence of Diabetes (Total Area, 2016) 40% 30% 30.6% 27.3% 20% 10% 18.5% 10.1% 18.1% 9.1% 13.9% 0% 0.6% Men Women 18 to to Low Income Mid/High Income Total Area Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 158] Notes: Asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income includes households The with City incomes of at 200% Staunton or more of the experiences federal poverty level. a Excludes gestational diabetes (occurring only during pregnancy). relatively high diabetes mortality rate.

28 Ranked #4 among key informants Perceptions of Diabetes as a Problem in the Community (Key Informants, 2016) Major Problem Moderate Problem Minor Problem No Problem At All 47.5% 33.7% 11.0% 7.7% Sources: Notes: PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: Health Education Disease Management Nutrition Obesity Affordable Care/Access Key Informant Input

29 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

30 Leading Causes of Death (Total Area, 2014) Heart Disease 23.1% Other 35.9% Alzheimer's 3.4% Accidents 4.1% Stroke 4.7% CLRD 6.3% Cancer 22.5% Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). CLRD is chronic lower respiratory disease.

31 250 Heart Disease: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Healthy People 2020 Target = or Lower (Adjusted) Staunton City Waynesboro City Augusta County Total Area VA US Sources: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April The population survey also found a relatively high US Department of Health and Human Services. Healthy People December [Objective HDS-2] Notes: Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Stroke Rates mortality are per is 100,000 population, age-adjusted to the 2000 US Standard Population. a high percentage with high blood pressure. also high The in Healthy Staunton. People 2020 Heart Disease target is adjusted to account for all diseases of the heart. percentage of adults diagnosed with heart disease, and

32 50% Prevalence of Heart Disease 40% 30% 20% 17.4% 10% 8.3% 3.2% 6.7% 6.9% 0% Staunton City Waynesboro City Augusta County Total Area US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 146] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents. Includes diagnoses of heart attack, angina or coronary heart disease. 42.7% of adults have been told they have high blood pressure, significantly higher than found statewide (32.5%) or nationally (36.5%).

33 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

34 Unintentional Injuries: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Healthy People 2020 Target = 36.4 or Lower Staunton City Waynesboro City Augusta County Total Area VA US Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April US Department of Health and Human Services. Healthy People Motor December vehicle crashes, poisoning, [Objective IVP-11] falls and Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population. suffocation are leading causes of accidental death.

35 Select Injury Death Rates (By Cause of Death; Annual Average Deaths per 100,000 Population) Total Area VA US Motor Vehicle Accidents Drug-Induced Deaths* Falls (65+) Firearms-Related Deaths* Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April US Department of Health and Human Services. Healthy People December [Objective IVP-13.1, IVP-23.2, SA-12] 59.4% of local households have a firearm, Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard much Population. higher than found nationally (33.8%). *Includes both intentional and unintentional deaths.

36 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

37 100% Experience Fair or Poor Mental Health 80% 60% 40% 25.5% 20% 10.2% 3.6% 8.7% 15.5% 0% Staunton City Waynesboro City Augusta County Total Area US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 116] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents. Overall: 69.8% Excellent/Very Good Fair/poor responses particular high (20.6%) among lower-income residents

38 20 18 Suicide: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Healthy People 2020 Target = 10.2 or Lower Total Area VA US Sources: Notes: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April US Department of Health and Human Services. 14.9% Healthy People of adults December have been diagnosed[objective with MHMD-1] depression. Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population. 21.8% have experienced symptoms of chronic depression.

39 Mental Health Treatment 100% 80% Total Area US 60% 40% 20% 24.9% 27.4% 14.9% 13.6% 0% Ever Sought Help for a Mental or Emotional Problem Currently Taking Medication/ Receiving Mental Health Treatment Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items ] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: Reflects the total sample of respondents. 2.5% of area adults say they were unable to get needed mental health services in the past year (similar to US).

40 Ranked #2 among key informants Perceptions of Mental Health as a Problem in the Community (Key Informants, 2016) Major Problem Moderate Problem Minor Problem No Problem At All 52.8% 39.5% 6.2% Sources: Notes: PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: Access to Care/Affordability Prevalence Denial/Stigma Co-Occurrence With Substance Abuse Key Informant Input

41 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

42 100% Prevalence of Total Overweight (Percent of Adults With a Body Mass Index of 25.0 or Higher) 100% Prevalence of Obesity (Percent of Adults With a Body Mass Index of 30.0 or Higher) Healthy People 2020 Target = 30.5% or Lower 80% 60% 60.2% 71.9% 59.6% 61.9% 69.8% 65.2% 80% 60% 46.9% 40% 20% 40% 20% 23.0% 31.2% 32.4% 33.5% 33.4% 0% Staunton Waynesboro Augusta County Total Area VA US 0% Staunton Waynesboro Augusta County Total Area VA US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items ] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data. Notes: Based on reported heights and weights, asked of all respondents. The definition of overweight is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 25.0, regardless of gender. The definition for obesity is a BMI greater than or equal to 30.0.

43 100% Prevalence of Obesity (Percent of Adults With a BMI of 30.0 or Higher; Total Area, 2016) Healthy People 2020 Target = 30.5% or Lower 80% 60% 40% 36.2% 29.1% 42.7% 37.7% 50.0% 32.4% 20% 20.4% 9.2% 0% Men Women 18 to to Low Income Mid/High Income Total Area Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 176] US Department of Health and Human Services. Healthy People December [Objective NWS-9] Notes: Based on reported heights and weights, asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income the includes area, households while with physical incomes at 200% activity or more of the levels federal poverty are level. low. The definition of obesity is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 30.0, regardless of gender. Overall, fruit/vegetable consumption appears good in

44 Child Total Overweight Prevalence (Children Age 5-17 Who Are Overweight/Obese; BMI in the 85th Percentile or Higher) 100% Child Obesity Prevalence (Children Age 5-17 Who Are Obese; BMI in the 95 th Percentile or Higher) Healthy People 2020 Target = 14.5% or Lower 100% 80% 80% 60% 58.0% 60% 40% 40% 37.8% 24.2% 20% 20% 9.5% 0% Total Area US 0% Total Area United States Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 180] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents with children age 5-17 at home. Overweight among children is determined by children s Body Mass Index status at or above the 85 th percentile of US growth charts by gender and age. These levels are very high, in spite of relatively high children s physical activity levels reported by parents.

45 Ranked #1 among key informants Perceptions of Nutrition, Physical Activity, and Weight as a Problem in the Community (Key Informants, 2016) Major Problem Moderate Problem Minor Problem No Problem At All 53.9% 33.0% 9.4% Sources: Notes: PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: Obesity Prevalence Health Education Nutrition/Access to Healthful Food Lifestyles/Lack of Physical Activity Key Informant Input

46 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

47 Have Visited a Dentist or Dental Clinic Within the Past Year (Total Area, 2016) Healthy People 2020 Target = 49.0% or Higher 100% 80% 65.2% 73.7% 63.8% 79.9% 64.2% 86.6% 89.4% 69.9% 67.2% 60% 47.7% 51.4% 40% 20% 0% Men Women 18 to to Low Income Mid/High Income Dental Insurance No Dental Insurance Total Area US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 20] US Department of Health and Human Services. Healthy People December [Objective OH-7] Notes: Asked of all respondents. Income categories reflect respondent's household income as a ratio 88.0% to the federal of poverty children level (FPL) age for their 2-17 household have size. Low had Income dental includes households care with incomes up to 200% of the federal poverty level; Mid/High Income includes households with incomes at 200% or more of the federal poverty level. in the past year (similar to US).

48 100% Have Insurance Coverage That Pays All or Part of Dental Care Costs (Total Area, 2016) 80% 67.6% 67.0% 66.5% 60% 40% 44.9% 56.3% 49.7% 30.2% 36.7% 51.1% 20% 0% Men Women 18 to to Low Income Mid/High Income Total Area US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 21] Notes: Asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income includes households with incomes at 200% or more of the federal poverty level.

49 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

50 CLRD: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Pneumonia/Influenza: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Staunton Waynesboro Augusta County Total Area VA US 0 Staunton Waynesboro Augusta County Total Area VA US Sources: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April Notes: Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population. CLRD is chronic lower respiratory disease.

51 50% Prevalence of Asthma (Adults) 50% Prevalence of Chronic Obstructive Pulmonary Disease (COPD) 40% 40% 30% 24.0% 30% 22.7% 20% 10% 11.7% 4.2% 9.1% 8.6% 9.5% 20% 10% 14.2% 6.6% 10.9% 6.4% 9.5% 0% Staunton Waynesboro Augusta County Total Area VA US 0% Staunton Waynesboro Augusta County Total Area VA US Asthma is particularly prevalent Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 156] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Behavioral (19.2%) Risk Factor in Surveillance lower-income System Survey adults. Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data. Notes: Also, Asked of asthma all respondents. affects 9.3% of children, Includes those who have ever been diagnosed with asthma, and who report that they still have asthma. statistically similar to US findings.

52 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

53 25 Cirrhosis/Liver Disease: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Healthy People 2020 Target = 8.2 or Lower Drug-Induced Deaths: Age-Adjusted Mortality ( Annual Average Deaths per 100,000 Population) Healthy People 2020 Target = 11.3 or Lower N/A Staunton Waynesboro Augusta County Total Area VA US 0 Total Area VA US Sources: CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted April US Department of Health and Human Services. Healthy People December [Objective SA-11] Notes: Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Rates are per 100,000 population, age-adjusted to the 2000 US Standard Population.

54 50% Have Ever Sought Professional Help for an Alcohol/Drug-Related Problem 40% 30% 20% 10% 3.1% 4.9% 10.4% 8.0% 4.1% 0% Staunton City Waynesboro City Augusta County Total Area US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 68] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: Asked of all respondents.

55 100% Life Has Been Negatively Affected by Substance Abuse (by Self or Someone Else) (Total Area, 2016) 80% 60% 40% 28.0% 42.7% 38.2% 42.5% 27.3% 33.3% 42.7% 36.2% 32.2% 20% 0% Men Women 18 to to Low Income Mid/High Income Total Area US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 69] Notes: Asked of all respondents. Geographically, Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income includes households with incomes at 200% or more of the federal poverty level. highest (42.9%) in Staunton.

56 Ranked #3 among key informants Perceptions of Substance Abuse as a Problem in the Community (Key Informants, 2016) Major Problem Moderate Problem Minor Problem No Problem At All 51.3% 38.7% 6.3% Sources: Notes: PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: Denial/Stigma Access to Care/Affordability Incidence/Prevalence Health Education Key Informant Input

57 General Health Status Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

58 50% Current Smokers Healthy People 2020 Target = 12.0% or Lower 40% 30% 20% 14.9% 23.4% 16.2% 17.2% 19.5% 14.0% 10% 0% Staunton City Waynesboro City Augusta County Total Area VA US Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 57, 181] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data. US Department of Health and Human Services. Healthy People December [Objective TU-1.1] Notes: Asked of all respondents. Includes regular and occasional smokers (those who smoke cigarettes every day or on some days).

59 50% Current Smokers (Total Area, 2016) Healthy People 2020 Target = 12.0% or Lower 40% 30% 27.8% 26.5% 20% 10% 21.1% 14.1% 11.9% 7.8% 9.3% 17.2% 0% Men Women 18 to to Low Income Mid/High Income Total Area Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 181] US Department of Health and Human Services. Healthy People December [Objective TU-1.1] Notes: Asked of all respondents. 17.2% of residents live in a home where Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. Low Income includes households with incomes up to 200% of the federal poverty level; Mid/High Income includes someone households with smokes incomes at 200% regularly or more of the federal (US=10.2%). poverty level. Includes regular and occasion smokers (every day and some days).

60 50% Other Tobacco Use Total Area US 40% 30% 20% 10% 9.6% 3.6% 3.2% 3.0% 0% Cigars HP2020 Goal = 0.2% or Lower Smokeless Tobacco HP2020 Goal = 0.3% or Lower Sources: 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 59-60] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2014 Virginia data. US Department of Health and Human Services. Healthy People December [Objectives TU-1.2, TU-1.3] Notes: Reflects the total sample of respondents. Smokeless tobacco includes chewing tobacco or snuff.

61 Areas of Opportunity Access to Healthcare Services Cancer Chronic Kidney Disease Dementia, Including Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use Q & A

62 Questions? Professional Research Consultants, Inc. Bruce Lockwood Director, Community Health

63 Prioritizing Health Needs

64 Criteria for Prioritizing Health Needs Scope & Severity Today, you will be asked to rate each area of opportunity along two specific sets of criteria (details to follow): Rate how much of a problem each issue is for our community. (i.e., How big is the problem?) Ability to Impact Rate how much we are able to have a positive impact, either alone or with community partners. (i.e., Can we make a difference?)

65 Guidance & Advocacy Before we begin, are there any of these Areas of Opportunity that you would like to lobby for? AREAS OF OPPORTUNITY Access to Healthcare Services Cancer Chronic Kidney Disease Dementias, Alzheimer's Disease Diabetes Heart Disease & Stroke Injury & Violence Mental Health Nutrition, Physical Activity & Weight Oral Health Respiratory Diseases Substance Abuse Tobacco Use

66 Criteria for Prioritizing Health Needs: Criterion 1 Scope & Severity How many people are affected by this health issue? How do we compare to state or national levels, or Healthy People 2020 targets? To what degree does this lead to death or disability, impair quality of life, or impact other health issues? NOT very prevalent at all, with only minimal health consequences SCALE: Scope & Severity ❶ ❷ ❸ ❹ ❺ ❻ ❼ ❽ ❾ ❶⓿ EXTREMELY prevalent, with very serious health consequences

67 Scope & Severity Ranking 8.88 Nutrition, Physical Activity & Weight 8.14 Diabetes 7.75 Heart Disease & Stroke 7.68 Mental Health 7.55 Cancer 7.53 Substance Abuse 6.47 Dementias, Including Alzheimer's Disease 6.13 Access to Healthcare Services 6.09 Injury & Violence 5.98 Tobacco Use 5.88 Respiratory Diseases 5.14 Chronic Kidney Disease 4.21 Oral Health

68 Criteria for Prioritizing Health Needs: Criterion 2 Ability to Impact What is the likelihood of our organization having a positive impact on this health issue? This should reflect our ability to address this issue independently or in conjunction with potential community partners. SCALE: Ability to Impact NO ability to impact ❶ ❷ ❸ ❹ ❺ ❻ ❼ ❽ ❾ ❶⓿ GREAT ability to impact

69 Ability to Impact Ranking 8.59 Nutrition, Physical Activity & Weight 8.02 Diabetes 7.84 Mental Health 7.59 Access to Healthcare Services 7.30 Substance Abuse 7.30 Heart Disease & Stroke 6.34 Tobacco Use 6.12 Cancer 5.45 Injury & Violence 5.41 Respiratory Diseases 5.00 Oral Health 4.59 Chronic Kidney Disease 4.07 Dementias, Including Alzheimer's Disease

70 Quadrant Analysis Results

71 10 Ability to Impact 6 1 Prioritization of Community Issues Scope & Severity Access Cancer Kidney Disease Dementias Diabetes Cardiovascular Injury/Violence Mental Health Nutr/PA/Weight Oral Health Respiratory Disease Substance Abuse Tobacco Use

72 Next Steps PRC Community Health Needs Assessment

73 Thank You! Professional Research Consultants, Inc. Bruce Lockwood Director, Community Health

74 Keypoint Interactive SAVE presentation Write down scores in case! Keypoint > Reports > Create Report(s) Close presentation REMOVE Transceiver!

75 Key Informants: Relative Position of Health Topics as Problems in the Community Top-Ranked 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Issues Nutrition, Physical Activity, and Weight 53.9% 33.0% Mental Health 52.8% 39.5% Substance Abuse 51.3% 38.7% Diabetes 47.5% 33.7% Heart Disease and Stroke 29.6% 46.9% Tobacco Use 28.3% 47.2% Cancer 23.5% 46.4% Oral Health/Dental Care 22.8% 44.4% Dementia/Alzheimer's Disease 20.9% 57.6% Access to Health Care Services 14.3% 44.4% Respiratory Diseases 13.2% 42.5% Arthritis/Osteoporosis/Back Conditions 11.5% 44.8% Family Planning 9.4% 40.0% Chronic Kidney Disease 7.9% 41.2% Injury and Violence 5.7% 46.0% Hearing and Vision Problems 4.7% 37.6% Infant and Child Health 4.7% 39.4% Sexually Transmitted Diseases 4.3% 35.4% HIV/AIDS 12.8% Immunization and Infectious Diseases 26.9% Major Problem Moderate Problem Minor Problem No Problem At All

76 Additional Areas of Concern for Waynesboro City (in addition to the identified Areas of Opportunity) Access to Healthcare Services Cancer Heart Disease & Stroke Infant Health & Family Planning Nutrition, Physical Activity & Weight Potentially Disabling Conditions Respiratory Disease Tobacco Use Cost of Dr. Visits Stretching Prescriptions Female Breast Cancer Incidence Colorectal Cancer Incidence Cancer Prevalence (Skin & Other) Heart Disease Deaths Heart Disease Prevalence Blood Pressure Screening Overall Cardiovascular Risk Teen Births Infant Mortality Obesity Prevalence Low Food Access Hearing Loss Falls COPD Prevalence Asthma Prevalence Cigarette Smoking

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