2015 PRC Community Health Needs Assessment Clinton County

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2015 PRC Community Health Needs Assessment Clinton County, Ohio Prepared for: Health. First for

2015 PRC Community Health Needs Assessment Clinton County, Ohio Prepared for: Health. First for Clinton County By Professional Research Consultants, Inc.

BENCHMARKIN G • Prior Local Survey Data (1996, 2001) • PRC National Health Survey

BENCHMARKIN G • Prior Local Survey Data (1996, 2001) • PRC National Health Survey • Ohio BRFSS data • Healthy People 2020 targets • National vital statistics data Random-sample survey among 400 adults in Clinton County • 137 survey items; 25 -30 minute interview • ± 4. 9% max error overall Customized Local PRC Community Health Survey PRC Community Health Needs Assessment Secondary Data Online Key Informant Survey among 88 community stakeholders: o Public health, physicians & other health providers o Social services & other community

PRC Community Health Needs Assessment Clinton County, Ohio Population & Survey Sample Characteristics (Clinton

PRC Community Health Needs Assessment Clinton County, Ohio Population & Survey Sample Characteristics (Clinton County, 2015) 3. 6% 3. 5% 0. 8% 20% 17. 7% 36. 9% 47. 7% 46. 6% 17. 7% 40% 34. 6% 35. 7% 51. 1% 51. 4% 48. 9% 60% 48. 6% 80% 36. 9% Weighted Survey Sample 95. 6% Actual Population 95. 7% 100% 0% Men Sources: ● ● Women 18 to 39 40 to 64 65+ White Census 2010, Summary File 3 (SF 3). US Census Bureau. 2015 PRC Community Health Survey, Professional Research Consultants, Inc. Hispanic Other <200% FPL

14 Identified Needs General Health Status Areas of Opportunity ► Access to Healthcare ►

14 Identified Needs General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Self-Reported Health Status (Clinton County, 2015)

PRC Community Health Needs Assessment Clinton County, Ohio Self-Reported Health Status (Clinton County, 2015) Fair 12. 7% Good 37. 8% “Fair/Poor” = 17. 1% Poor 4. 4% Excellent 12. 1% Very Good 33. 1% Sources: ● Notes: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 5] Asked of all respondents. “Excellent/ Very Good” = 45. 2%

PRC Community Health Needs Assessment Clinton County, Ohio Experience “Fair” or “Poor” Overall Health

PRC Community Health Needs Assessment Clinton County, Ohio Experience “Fair” or “Poor” Overall Health 50% Clinton County 40% Statistically similar to OH & US 30% 20% 17. 1% 18. 1% Clinton County OH Statistically similar to previous findings 15. 3% 14. 6 % US 1996 12. 4 % 17. 1 % 10% 0% 2001 2015 Sources: ● PRC Community Health Surveys, 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): 2013 Ohio data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents.

PRC Community Health Needs Assessment Clinton County, Ohio Experience “Fair” or “Poor” Overall Health

PRC Community Health Needs Assessment Clinton County, Ohio Experience “Fair” or “Poor” Overall Health (Clinton County, 2015) 50% 40% 27. 1% 30% 23. 0% 20% 16. 4% 17. 7% 20. 7% 17. 1% 9. 0% 8. 4% 10% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County Sources: ● 2015 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.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Healthcare Insurance Coverage (Among Adults Age

PRC Community Health Needs Assessment Clinton County, Ohio Healthcare Insurance Coverage (Among Adults Age 18 -64; Clinton County, 2015) No Insurance/ Self-Pay 11. 1% Other Gov't Medicaid & Coverage 1. 9% Medicare 1. 3% VA/Military 2. 4% Medicare 5. 5% Medicaid 17. 4% Insured, Self. Unknown Type Purchase 3. 0% 0. 6% Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 165] Notes: ● Reflects respondents age 18 to 64. Insured, Employer-Based 56. 8% Private insurance = 60. 4% Gov’t insurance = 28. 5% No insurance = 11. 1% • Men are much more likely to be uninsured (19. 2%). • No significant change since 1996.

PRC Community Health Needs Assessment Clinton County, Ohio Barriers to Access Have Prevented Medical

PRC Community Health Needs Assessment Clinton County, Ohio Barriers to Access Have Prevented Medical Care in the Past Year 50% Clinton County 1996 Clinton County 2001 Clinton County 2015 40% 30% 18. 3% 20% 17. 1% 15. 8% 12. 3% 10% 6. 8% 4. 7% 6. 6% 16. 1%15. 2% 12. 1% 9. 7% 9. 3% 9. 1% 3. 1% 1. 8% 0% Getting a Dr Appointment Sources: ● ● Notes: ● ● Finding a Doctor Cost (Doctor Visit) Inconvenient Office Hours Cost Lack of (Prescriptions) Transportation PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 7 -12] Significantly 2013 PRC National Health Survey, Professional Research Consultants, Inc. worse than US Asked of all respondents. 1996 data not available for cost of prescription, inconvenient office hours, or difficulty finding a doctor. (11. 0%).

PRC Community Health Needs Assessment Clinton County, Ohio Experienced Difficulties or Delays of Some

PRC Community Health Needs Assessment Clinton County, Ohio Experienced Difficulties or Delays of Some Kind in Receiving Needed Healthcare in the Past Year (Clinton County, 2015) 100% 80% 65. 7% 60% 49. 1% 54. 7% 42. 8% 40% 42. 6% 35. 9% 30. 6% 17. 7% 20% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 169] Notes: ● Asked of all respondents. ● Represents the percentage of respondents experiencing one or more barriers to accessing healthcare in the past 12 months. ● 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.

PRC Community Health Needs Assessment Clinton County, Ohio Have a Specific Source of Ongoing

PRC Community Health Needs Assessment Clinton County, Ohio Have a Specific Source of Ongoing Medical Care Healthy People 2020 Target = 95. 0% or Higher [All Ages] 90. 0% 79. 0% 78. 2% Similar to US (76. 3%) 1996 2001 Clinton County 2015 Also: • 66. 8% of adults (and 92. 8% of children) have had a routine checkup in the past year (similar to and better than US, respectively). • The Clinton County ratio of primary care physicians to population is similar to state and national ratios. • ER usage appears similar to US. • 20. 7% of respondents perceive local healthcare as “fair” or ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 166] “poor, ” significantly higher than in 2013 PRC National Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov 1996 (7. 6%). Sources: ● ● [Objective AHS-5. 1] Notes: ● Asked of all respondents.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Leading Causes of Death (Clinton County,

PRC Community Health Needs Assessment Clinton County, Ohio Leading Causes of Death (Clinton County, 2011 -2013) Heart Disease 23. 8% CLRD 7. 6% Stroke 5. 8% Unintentional Injuries 5. 6% Diabetes 3. 3% Alzheimer's 3. 2% #1 Cancer 24. 6% Other Conditions 26. 0% Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted September 2015. Notes: ● 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.

PRC Community Health Needs Assessment Clinton County, Ohio Age-Adjusted Cancer Death Rates by Site

PRC Community Health Needs Assessment Clinton County, Ohio Age-Adjusted Cancer Death Rates by Site (2004 -2013 Annual Average Deaths per 100, 000 Population) Clinton County OH US HP 2020 222. 1 181. 7 166. 2 161. 4 Lung Cancer 69. 4 56. 4 48. 6 45. 5 Prostate Cancer 29. 7 23. 2 22. 4 21. 8 Female Breast Cancer 23. 1 24. 8 22. 6 20. 7 ALL CANCERS #1 Leading Cause of Death Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted September 2015. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov Colorectal Cancer 20. 0 17. 9 16. 3 14. 5

PRC Community Health Needs Assessment Clinton County, Ohio Cancer Incidence Rates by Site (Annual

PRC Community Health Needs Assessment Clinton County, Ohio Cancer Incidence Rates by Site (Annual Average Age-Adjusted Incidence per 100, 000 Population, 2007 -2011) Clinton County 200 150 120. 4 135. 8 OH US 142. 3 117. 5 120 122. 7 88. 3 100 72. 4 64. 9 50 53. 6 44. 5 43. 3 15. 3 7. 7 7. 8 0 Prostate Cancer Female Breast Cancer Lung Cancer Colon/Rectal Cancer Cervical Cancer Sources: ● State Cancer Profiles: 2007 -11. ● Retrieved September 2015 from Community Commons at http: //www. chna. org. Notes: ● This indicator reports the age adjusted incidence rate (cases per 100, 000 population per year) of cancers, adjusted to 2000 US standard population age groups (under age 1, 1 -4, 5 -9, . . . , 80 -84, 85 and older). This indicator is relevant because cancer is a leading cause of death and it is important to identify cancers separately to better target interventions. Survey data also reveal an increase in skin cancer prevalence from 2. 7% to 9. 0% between 1996 and 2015.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Alzheimer's Disease: Age-Adjusted Mortality (2011 -2013

PRC Community Health Needs Assessment Clinton County, Ohio Alzheimer's Disease: Age-Adjusted Mortality (2011 -2013 Annual Average Deaths per 100, 000 Population) 50 40 30. 8 27. 3 30 24. 0 20 10 0 Clinton County OH 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 September 2015. 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. 20. 3% of Clinton County residents age 45+ report more/worsening confusion or memory loss in the past year.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Diabetes: Age-Adjusted Mortality (2011 -2013 Annual

PRC Community Health Needs Assessment Clinton County, Ohio Diabetes: Age-Adjusted Mortality (2011 -2013 Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 20. 5 or Lower (Adjusted) 35 30. 6 30 26. 1 25 21. 3 20 15 10 5 0 Clinton County OH 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 September 2015. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective D-3] 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. ● The Healthy People 2020 target for Diabetes is adjusted to account for only diabetes mellitus coded deaths.

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Diabetes 50% Clinton County

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Diabetes 50% Clinton County 40% 30% 20% Another 7. 0% of adults report that they have been diagnosed with “pre-diabetes” or “borderline” diabetes (vs. 5. 1% nationwide) 15. 8 % 15. 8% 10. 4% 11. 7% OH US 10% 7. 1% 7. 7% 1996 2001 0% Clinton County 2015 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 136] ● 2013 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): 2013 Ohio data. Notes: ● Asked of all respondents. ● Local and national data exclude gestation diabetes (occurring only during pregnancy).

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Diabetes (Clinton County, 2015)

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Diabetes (Clinton County, 2015) 50% 40% 30% 19. 6% 17. 5% 20. 8% 18. 5% 14. 1% 12. 6% 9. 8% 10% 15. 8% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 136] 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. ● Excludes gestation diabetes (occurring only during pregnancy).

Diabetes Key Informants: Diabetes ranked as the #4 top health issue in the Online

Diabetes Key Informants: Diabetes ranked as the #4 top health issue in the Online Key Informant Survey. Key informants’ concern regarding diabetes reflected issues with: • Lack of Education/Awareness • Lack of Providers/Resources • Availability/Affordability of Medications • Lifestyle • Prevalence/Incidence Almost half of the respondents ranked this as a "major problem" for the community.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Leading Causes of Death (Clinton County,

PRC Community Health Needs Assessment Clinton County, Ohio Leading Causes of Death (Clinton County, 2011 -2013) Heart Disease 23. 8% #2 CLRD 7. 6% Stroke 5. 8% #4 Injuries 5. 6% Diabetes 3. 3% Alzheimer's 3. 2% Cancer 24. 6% Other Conditions 26. 0% Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted September 2015. Notes: ● 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.

PRC Community Health Needs Assessment Clinton County, Ohio Heart Disease: Age-Adjusted Mortality Stroke: Age-Adjusted

PRC Community Health Needs Assessment Clinton County, Ohio Heart Disease: Age-Adjusted Mortality Stroke: Age-Adjusted Mortality (2011 -2013 Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 156. 9 or Lower (Adjusted) (2011 -2013 Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 34. 8 or Lower 250 219. 7 188. 5 200 171. 3 200 150 100 54. 0 50 50 0 0 Clinton County OH US Prevalence of heart disease (9. 3%) is also higher than the US (6. 1%). Clinton County 40. 8 37. 0 OH US Prevalence of stroke has increased since 1996 (1. 8% to 4. 2%).

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of High Blood Pressure Prevalence

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of High Blood Pressure Prevalence of High Blood Cholesterol Healthy People 2020 Target = 26. 9% or Lower Healthy People 2020 Target = 13. 5% or Lower Clinton County 38. 6% 24. 1% 1996 28. 5% 29. 3% 30. 1% 2001 2015 20. 7% 2001 2015 1996 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 43, 125] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2013 Ohio data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective HDS-5. 1] Notes: ● Asked of all respondents. Each is similar to national prevalence levels. 87. 8% of residents have one or more cardiovascular risk factors (higher than US).

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Teen Birth Rate (Births to Women

PRC Community Health Needs Assessment Clinton County, Ohio Teen Birth Rate (Births to Women Age 15 -19 Per 1, 000 Female Population Age 15 -19, 2006 -2012) 80 60 43. 2 40 36. 6 OH US 20 0 Clinton County Sources: ● Centers for Disease Control and Prevention, National Vital Statistics System: 2006 -2012. Accessed using CDC WONDER. ● Retrieved September 2015 from Community Commons at http: //www. chna. org. Notes: ● This indicator reports the rate of total births to women under the age of 15 - 19 per 1, 000 female population age 15 - 19. This indicator is relevant because in many cases, teen parents have unique social, economic, and health support services. Additionally, high rates of teen pregnancy may indicate the prevalence of unsafe sex practices.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Unintentional Injuries: Age-Adjusted Mortality (2011 -2013

PRC Community Health Needs Assessment Clinton County, Ohio Unintentional Injuries: Age-Adjusted Mortality (2011 -2013 Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 36. 4 or Lower 75 Leading Causes of Accidental Deaths: 59. 8 50 44. 4 39. 2 25 1. Poisoning/Noxiou s Substances 2. Motor Vehicle Accidents 3. Falls 0 Clinton County OH 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 September 2015. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective IVP-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.

PRC Community Health Needs Assessment Clinton County, Ohio Motor Vehicle Crashes: Age-Adjusted Mortality (2009

PRC Community Health Needs Assessment Clinton County, Ohio Motor Vehicle Crashes: Age-Adjusted Mortality (2009 -2013 Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 12. 4 or Lower 20 15 13. 0 10. 8 9. 4 10 5 0 Clinton County OH 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 September 2015. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective IVP-13. 1] 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. 85. 4% of resident report “always” wearing a seat belt; this indicator has improved significantly since 1996 (70. 1%).

PRC Community Health Needs Assessment Clinton County, Ohio Have a Firearm Kept in or

PRC Community Health Needs Assessment Clinton County, Ohio Have a Firearm Kept in or Around the Home 100% Clinton County 80% Households With Children: 41. 5% (vs. 37. 4% nationwide) 53. 0 % 60% 44. 7 % 34. 7% 40% 20% 0% Clinton County US 2001 2015 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 52, 137] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents. ● In this case, firearms include pistols, shotguns, rifles, and other types of guns; this does not include starter pistols, BB guns, or guns that cannot fire. Men and middle/high income residents more likely to have a firearm in the home.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Experience “Fair” or “Poor” Mental Health

PRC Community Health Needs Assessment Clinton County, Ohio Experience “Fair” or “Poor” Mental Health (Clinton County, 2015) 50% 40% 29. 4% 30% 24. 7% 19. 4% 18. 1% 16. 8% 14. 2% 13. 3% 11. 9% 7. 3% 10% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County US Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 100] 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. Excellent/Very Good = 46. 7% Good = 35. 2% Fair/Poor = 18. 1%

PRC Community Health Needs Assessment Clinton County, Ohio Have Experienced Symptoms of Chronic Depression

PRC Community Health Needs Assessment Clinton County, Ohio Have Experienced Symptoms of Chronic Depression 50% 40% 39. 7% 30. 4% 30% 21. 1 % 19. 3 % 10% Clinton County US 1996 2001 2015 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 101] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents. ● Chronic depression includes periods of two or more years during which the respondent felt depressed or sad on most days, even if (s)he felt okay sometimes. 26. 8% of residents report being diagnosed with depression, significantly higher than OH (20. 2%) and the US (20. 4%).

Mental Health Key Informants: Mental Health ranked as the #2 top health issue in

Mental Health Key Informants: Mental Health ranked as the #2 top health issue in the Online Key Informant Survey. Key informants’ concern regarding mental health reflected issues with: • Lack of Providers/Resources • Access to Care • Affordability • Wait lists • Prevalence/Incidence • Stigma Over half of key informants ranked this as a "major problem" for the community.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Total Overweight (Percent of

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Total Overweight (Percent of Adults With a Body Mass Index of 25. 0 or Higher) 100% Clinton County 80% 71. 8% 65. 1% 63. 1% 58. 8 % OH US 1996 60% 40% 64. 3 % 71. 8 % Included in this is 34. 8% of Clinton County adults who are obese. 20% 0% Clinton County 2001 2015 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 151] ● 2013 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): 2013 Ohio 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. Only 32. 2% of overweight or obese residents are trying to lose weight.

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Obesity (Percent of Adults

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Obesity (Percent of Adults With a BMI of 30. 0 or Higher; Clinton County, 2015) Healthy People 2020 Target = 30. 5% or Lower 100% 80% 60% 40% 33. 0% 36. 7% 43. 6% 41. 3% 36. 0% 34. 7% 34. 8% 25. 2% 29. 0% 20% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County US Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 151] ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [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” includes households with incomes at 200% or more of the federal poverty level. ● 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. In Clinton County, only 34. 0% of obese residents have received advice from a health professional about their weight, significantly below US findings (48. 3%).

PRC Community Health Needs Assessment Clinton County, Ohio Consume Five or More Servings of

PRC Community Health Needs Assessment Clinton County, Ohio Consume Five or More Servings of Fruits/Vegetables Per Day (Clinton County, 2015) 100% 80% 60% 39. 5% 40% 20% 31. 9% 19. 7% 25. 5% 31. 0% 22. 7% 21. 9% 15. 3% 13. 2% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County US Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 146] Notes: ● Asked of all respondents. ● Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their Note that 41. 0% of low-income residents household size. “Low Income” includes households find it "very/somewhat difficult" to access 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. fresh fruits/vegetables. ● For this issue, respondents were asked to recall their food intake on the previous day.

Meets Physical Activity Recommendations (Clinton County, 2015) Also: 100% • 20. 4% of adults

Meets Physical Activity Recommendations (Clinton County, 2015) Also: 100% • 20. 4% of adults engage in no leisure-time physical activity (similar to US). 80% 63. 3% 60% 52. 2% 44. 7% 44. 0% 45. 0% 38. 3% 40% 50. 3% 33. 5% 27. 1% 20% S U In Low co m M e In id/H co ig m h C e lin to n C ou nt y 65 + 64 45 to 44 18 to en om W M en 0% • Participation in vigorous physical activity appears to be below US averages. • A relatively low percentage (37. 3%) of adults have received advice about exercise from a health professional in the past year. Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 147] 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 this case the term “meets physical activity recommendations” refers to participation in moderate physical activity (exercise that produces only light sweating or a slight to moderate increase in breathing or heart rate ) at least 5 times a week for 30 minutes at a time, and/or vigorous physical activity (activities that

Nutrition, Physical Activity & Weight Key Informants: Nutrition, Physical Activity, & Weight ranked as

Nutrition, Physical Activity & Weight Key Informants: Nutrition, Physical Activity, & Weight ranked as the #3 top health issue in the Online Key Informant Survey. Key informants’ concern regarding nutrition, physical activity, & weight reflected issues with: • Lack of Infrastructure for Healthy and Active Living • Poor Diet/Nutrition, Low Physical Activity • Obesity • Lack of Nutrition Education Over half of respondents ranked this as a "major problem" for the community.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Have Visited a Dentist or Dental Clinic Within the

PRC Community Health Needs Assessment Have Visited a Dentist or Dental Clinic Within the Past Year Clinton County, Ohio (Clinton County, 2015) Healthy People 2020 Target = 49. 0% or Higher Significantly below OH (67. 6%) and US (65. 9%). 100% 80% 67. 7% 67. 6% 61. 7% 60. 6% 60% 63. 9% 58. 2% 52. 3% 48. 5% 46. 0% 44. 0% 40% 20% 0% Men Women 18 to 44 45 to 64 65+ Low Income Mid/High Dental No Dental Income Insurance Clinton County Sources: ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 21] ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective OH-7] 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.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Potentially Disabling Conditions Clinton

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Potentially Disabling Conditions Clinton County 1996 Clinton County 2015 50 40 28. 6% 30 21. 1% 27. 2% 20. 1% 18. 4% 20 15. 5% 13. 6% 10 11. 7% 10. 3% 6. 2% 5. 5% 8. 5% 0 Arthritis Sources: ● ● Notes: ● Back Pain Hearing Trouble PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 139] 2013 PRC National Health Survey, Professional Research Consultants, Inc. Reflects respondents age 50 and older. Vision Trouble Additionally, 26. 0% of adults are limited in activities due to a health problem; these are predominantly musculoskeletal issues.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio CLRD: Age-Adjusted Mortality (2011 -2013 Annual

PRC Community Health Needs Assessment Clinton County, Ohio CLRD: Age-Adjusted Mortality (2011 -2013 Annual Average Deaths per 100, 000 Population) 100 80 69. 4 60 50. 9 42. 0 40 20 0 Clinton County OH 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 September 2015. 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.

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Chronic Obstructive Pulmonary Disease

PRC Community Health Needs Assessment Clinton County, Ohio Prevalence of Chronic Obstructive Pulmonary Disease (COPD) 50% Clinton County 40% 30% 13. 4 % 20% 13. 4% 8. 3% 10% 8. 6% 7. 4% 3. 5% 0% Clinton County OH US 1996 2001 2015 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 25] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2013 Ohio data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents. ● Includes those having ever suffered from or been diagnosed with COPD or chronic obstructive pulmonary disease, including bronchitis or emphysema. ● In prior data, the term “chronic lung disease” was used, which also included bronchitis or emphysema.

PRC Community Health Needs Assessment Clinton County, Ohio Adults Ever Diagnosed With Asthma Clinton

PRC Community Health Needs Assessment Clinton County, Ohio Adults Ever Diagnosed With Asthma Clinton County Adults age 45 -64 and low income residents are more likely to report having asthma. Also: 12. 5% 5. 6% 1996 2001 • 6. 3% of children have ever been diagnosed with asthma (similar to prior findings, better than US). 2015 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 37, 134] ● 2013 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): 2013 Ohio data. Notes: ● Asked of all respondents. ● “Currently have asthma” includes those who have ever been diagnosed with asthma, and who report that they still have asthma.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Drug-Induced Deaths: Age-Adjusted Mortality (2009 -2013

PRC Community Health Needs Assessment Clinton County, Ohio Drug-Induced Deaths: Age-Adjusted Mortality (2009 -2013 Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 11. 3 or Lower 30 25. 9 25 20 17. 7 13. 6 15 10 5 0 Clinton County OH 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 September 2015. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective SA-12] 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. 4. 9% of Clinton County adults report having ever sought professional help for an alcohol/drug-related problem, a significant increase from 1996 (1. 7%). 8. 0% dealing with a drug-related problem in their immediate family in the past 3 years.

Substance Abuse Key Informants: Substance Abuse ranked as the # 1 top health issue

Substance Abuse Key Informants: Substance Abuse ranked as the # 1 top health issue in the Online Key Informant Survey. Key informants’ concern regarding substance abuse reflected issues with: • Lack of Centers/Facilities • Lack of Motivation to Change • Cost of Care/Services • Lack of Awareness of Services Specific substances of concern included: 1) heroin; 2) alcohol; and 3) prescription medications. Nearly three in four respondents ranked this as a "major problem" for the community.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Current Smokers (Clinton County, 2015) Healthy

PRC Community Health Needs Assessment Clinton County, Ohio Current Smokers (Clinton County, 2015) Healthy People 2020 Target = 12. 0% or Lower 100% 80% 60% 45. 0% 40% 22. 9% 20% 25. 8% 18. 6% 21. 9% 20. 6% 13. 9% 14. 9% 6. 8% 0% Men Sources: Notes: Women 18 to 44 45 to 64 65+ Low Income Mid/High Income Clinton County US ● 2015 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 156] ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective TU -1. 1] ● 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. ● Includes regular and occasion smokers (everyday and some days). 15. 7% of adults have ever used an e-cigarette, increasing to 35. 8% among low-income populations.

PRC Community Health Needs Assessment Clinton County, Ohio Use of Smokeless Tobacco Healthy People

PRC Community Health Needs Assessment Clinton County, Ohio Use of Smokeless Tobacco Healthy People 2020 Target = 0. 3% or Lower 50% Clinton County 40% 30% 20% 10% 7. 2% 4. 0% OH US 8. 2% 7. 4% 7. 2% 1996 2001 2015 0% Clinton County Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 60] ● 2013 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): 2013 Ohio data. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective TU-1. 2] Notes: ● Asked of all respondents. ● Smokeless tobacco includes chewing tobacco or snuff.

Tobacco Use Key Informants: Tobacco Use ranked as the #5 top health issue in

Tobacco Use Key Informants: Tobacco Use ranked as the #5 top health issue in the Online Key Informant Survey. Key informants’ concern regarding substance abuse reflected issues with: • Prevalence/Incidence • Culture • Habits/Lack of Motivation to Quit • Comorbidities Roughly 40% of key informants ranked this as a "major problem" for the community.

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias,

General Health Status Areas of Opportunity ► Access to Healthcare ► Cancer ► Dementias, Including Alzheimer’s Disease ► Diabetes ► Heart Disease & Stroke ► Infant Health & Family Planning ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Oral Health ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Prioritization Results

PRC Community Health Needs Assessment Clinton County, Ohio Criteria for Prioritizing Health Needs Scope

PRC Community Health Needs Assessment Clinton County, Ohio Criteria for Prioritizing Health Needs Scope & Severity 20 community stakeholders attended a presentation on November 16, 2015 and engaged in a prioritization exercise. • 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? )

PRC Community Health Needs Assessment Clinton County, Ohio Scope & Severity Ranking Results 9.

PRC Community Health Needs Assessment Clinton County, Ohio Scope & Severity Ranking Results 9. 40 8. 45 8. 25 8. 05 7. 90 7. 45 6. 95 6. 70 6. 35 6. 15 6. 05 5. 74 Substance Abuse Mental Health Cancer Diabetes Tobacco Use Heart Disease & Stroke Nutrition, Physical Activity & Weight Access to Healthcare Services Respiratory Diseases Oral Health Dementias, Including Alzheimer's Disease Injury & Violence Infant Health & Family Planning Potentially Disabling Conditions

PRC Community Health Needs Assessment Clinton County, Ohio Ability to Impact Ranking Results 7.

PRC Community Health Needs Assessment Clinton County, Ohio Ability to Impact Ranking Results 7. 75 7. 40 7. 10 7. 00 6. 85 6. 80 6. 75 6. 35 5. 89 5. 85 5. 35 4. 80 4. 35 Substance Abuse Mental Health Infant Health & Family Planning Access to Healthcare Services Oral Health Tobacco Use Diabetes Nutrition, Physical Activity & Weight Heart Disease & Stroke Cancer Injury & Violence Respiratory Diseases Potentially Disabling Conditions Dementias, Including Alzheimer's Disease

PRC Community Health Needs Assessment Clinton County, Ohio Prioritization of Community Issues 10 Access

PRC Community Health Needs Assessment Clinton County, Ohio Prioritization of Community Issues 10 Access Cancer Dementias Diabetes Ability to Impact Cardiovascular Infant Health Injury/Violence Mental Health Nutr/PA/Weight Oral Health Disabling Cond Respiratory Disease Substance Abuse Tobacco Use 1 Scope & Severity 10

PRC Community Health Needs Assessment Clinton County, Ohio Identified Areas of Opportunity for Clinton

PRC Community Health Needs Assessment Clinton County, Ohio Identified Areas of Opportunity for Clinton County Access to Healthcare Services Heart Disease & Stroke Nutrition, Physical Activity & Weight Cancer Dementias, Alzheimer’s Disease Diabetes Infant Health & Family Planning Injury & Violence Mental Health Oral Health Potentially Disabling Conditions Respiratory Diseases Substance Abuse Tobacco Use

PRC Community Health Needs Assessment Clinton County, Ohio Thank You Professional Research Consultants, Inc.

PRC Community Health Needs Assessment Clinton County, Ohio Thank You Professional Research Consultants, Inc. www. PRCCustom. Research. com