2016 PRC Community Health Needs Assessment Cass County

PRC Community Health Needs Assessment The PRC Community Health Needs Assessment consists of both

PRC Community Health Needs Assessment Cass County, Indiana Population Survey Total sample size gives

PRC Community Health Needs Assessment Cass County, Indiana Today’s Activities Presentation • Represents just

13 Areas of Opportunity General Health Status Areas of Opportunity ► Access to Healthcare

General Health Status Areas of Opportunity ► Access to Healthcare Services ► Cancer ►

PRC Community Health Needs Assessment Cass County, Indiana Would you say that in general

PRC Community Health Needs Assessment Cass County, Indiana Experience “Fair” or “Poor” Overall Health

PRC Community Health Needs Assessment Cass County, Indiana Healthcare Insurance Coverage (Among Adults Age

PRC Community Health Needs Assessment Cass County, Indiana Lack of Healthcare Insurance Coverage (Among

PRC Community Health Needs Assessment Cass County, Indiana Barriers to Access Have Prevented Medical

PRC Community Health Needs Assessment Cass County, Indiana Experienced Difficulties or Delays of Some

PRC Community Health Needs Assessment Cass County, Indiana Skipped or Reduced Prescription Doses in

PRC Community Health Needs Assessment Cass County, Indiana Have Visited a Physician for a

PRC Community Health Needs Assessment Cass County, Indiana Have Used a Hospital Emergency Room

PRC Community Health Needs Assessment Cass County, Indiana Child Has Visited a Dentist or

PRC Community Health Needs Assessment Cass County, Indiana Leading Causes of Death (Cass County,

PRC Community Health Needs Assessment Cass County, Indiana Cancer Incidence Rates by Site (Annual

Mammogram in Past 2 Yrs Pap Test in Past 3 Yrs (Among Women Age

PRC Community Health Needs Assessment Cass County, Indiana Kidney Disease: Age-Adjusted Mortality (2012 -2014

PRC Community Health Needs Assessment Cass County, Indiana Diabetes: Age-Adjusted Mortality Trends (Annual Average

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Diabetes (Cass County, 2016)

PRC Community Health Needs Assessment Cass County, Indiana Ranked #4 among key informant s

PRC Community Health Needs Assessment Cass County, Indiana Teen Birth Rate (Births to Women

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of High Blood Pressure (Cass

PRC Community Health Needs Assessment Cass County, Indiana Present One or More Cardiovascular Risks

PRC Community Health Needs Assessment Cass County, Indiana Select Injury Death Rates (By Cause

PRC Community Health Needs Assessment Cass County, Indiana Fell One or More Times in

PRC Community Health Needs Assessment Cass County, Indiana Have a Firearm Kept in or

PRC Community Health Needs Assessment Cass County, Indiana Have Experienced Symptoms of Chronic Depression

PRC Community Health Needs Assessment Cass County, Indiana Mental Health Treatment 100% Cass County

PRC Community Health Needs Assessment Cass County, Indiana Ranked #5 among key informant s

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Total Overweight Prevalence of

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Obesity (Percent of Adults

PRC Community Health Needs Assessment Cass County, Indiana Child Obesity Prevalence (Children Age 5

PRC Community Health Needs Assessment Cass County, Indiana Had Seven or More Sugar-Sweetened Beverages

PRC Community Health Needs Assessment Cass County, Indiana No Leisure-Time Physical Activity in the

PRC Community Health Needs Assessment Ranked Cass County, Indiana #2 among key informant s

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Potentially Disabling Conditions 100%

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Blindness/Deafness 100% Cass County

PRC Community Health Needs Assessment Cass County, Indiana CLRD: Age-Adjusted Mortality Trends (Annual Average

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Chronic Obstructive Pulmonary Disease

PRC Community Health Needs Assessment Cass County, Indiana Older Adults: Have Had a Flu

PRC Community Health Needs Assessment Cass County, Indiana Excessive Drinkers (Cass County, 2016) Healthy

PRC Community Health Needs Assessment Cass County, Indiana Have Ever Sought Professional Help for

PRC Community Health Needs Assessment Cass County, Indiana Ranked #1 among key informant s

PRC Community Health Needs Assessment Cass County, Indiana Member of Household Smokes at Home

PRC Community Health Needs Assessment Cass County, Indiana Other Tobacco Use 100% Cass County

PRC Community Health Needs Assessment Cass County, Indiana Ranked #3 among key informant s

Prioritizing Health Needs Click to edit Master text styles

Criteria PRC Community Health Needs Assessment Cass County, Indiana Scope & Severity • Rate

PRC Community Health Needs Assessment Next Steps

PRC Community Health Needs Assessment Cass County, Indiana Key Informants: Relative Position of Health

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2016 PRC Community Health Needs Assessment Cass County, Indiana Prepared for: Logansport Memorial Hospital By Professional Research Consultants, Inc.

PRC Community Health Needs Assessment The PRC Community Health Needs Assessment consists of both primary and secondary data. Customized Local Health Survey • 750 surveys across Cass County • Conducted via landline and cell phones • Targets health status, experience, behaviors BENCHMARKING Secondary Data • Previous Survey Data • County-level data • Census data, vital statistics, other health-related data • PRC National Health Survey • Indiana BRFSS data • Healthy People 2020 targets • National vital statistics data Online Key Informant Survey • Community stakeholder input (116 participants) — physicians, public health, other health providers, social services, community leaders • Based on their experiences, the populations they serve

PRC Community Health Needs Assessment Cass County, Indiana Population Survey Total sample size gives an excellent overall maximum confidence interval of ± 3. 6%. 80. 9% 100% Actual Population Weighted Survey Sample 81. 0% Population & Survey Sample Characteristics (Cass County, 2016) Over 125 survey items. 10. 6% 10. 8% 8. 4% 8. 3% 20% 18. 7% FP L 0% er th O ni c pa is W hi te + 65 64 40 to 39 18 to en om W M 3 en 0% 41. 1% 41. 8% 43. 6% 44. 1% 18. 5% 40% 37. 7% 37. 3% 52. 0% 51. 6% 48. 0% 60% 48. 4% 80% Many questions can be trended to previous (2013) survey.

PRC Community Health Needs Assessment Cass County, Indiana 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 • Following the data presentation, you will be asked to rank health issues along various criteria to inform the prioritization process. 4

13 Areas of Opportunity General Health Status Areas of Opportunity ► Access to Healthcare Services ► Cancer ► Chronic Kidney Disease ► Diabetes ► Family Planning ► Heart Disease & Stroke ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Use Q&A

General Health Status Areas of Opportunity ► Access to Healthcare Services ► Cancer ► Chronic Kidney Disease ► Diabetes ► Family Planning ► Heart Disease & Stroke ► Injury & Violence ► Mental Health ► Nutrition, Physical Activity & Weight ► Potentially Disabling Conditions ► Respiratory Diseases ► Substance Abuse ► Tobacco Use Q&A

PRC Community Health Needs Assessment Cass County, Indiana Would you say that in general your health is: Excellent, Very Good, Fair or Poor? Self-Reported Health Status (Cass County, 2016) Poor 4. 6% Fair 14. 2% Good 33. 4% Sources: ● Notes: ● Excellent 12. 8% Very Good 35. 0% 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 5] Asked of all respondents. Excellent/Very Good = 48. 8% Good = 33. 4% Fair/Poor = 18. 8% 7

PRC Community Health Needs Assessment Cass County, Indiana Experience “Fair” or “Poor” Overall Health 100% Cass County 80% 60% Cass County similar to IN & US. Significantly higher than 2013 findings 40% 20% 18. 8% 18. 9% 18. 3% 12. 5 % Cass County Indiana US 2013 18. 8 % 0% 2016 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): 2014 Indiana data. ● 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents. 8

PRC Community Health Needs Assessment Cass County, Indiana Experience “Fair” or “Poor” Overall Health (Cass County, 2016) 100% 80% 60% 40% 20% 16. 7% 24. 6% 20. 7% 26. 4% 26. 6% 13. 3% 8. 5% 18. 8% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Income Cass County 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. 9

PRC Community Health Needs Assessment Cass County, Indiana Healthcare Insurance Coverage (Among Adults Age 18 -64; Cass County, 2016) No Insurance/ Self-Pay 10. 7% Insured, Employer-Based 60. 4% Other Gov't Coverage 0. 7% Medicaid & VA/Military Medicare 4. 2% 1. 0% Medicare 5. 4% Medicaid 8. 8% Insured, Unknown Type Insured, Self. Purchase 7. 6% 1. 2% Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 190] Notes: ● Reflects respondents age 18 to 64. Private Insurance = 69. 2% Gov’t-Sponsored = 20. 1% Uninsured = 10. 7% (similar to US) 11

PRC Community Health Needs Assessment Cass County, Indiana Lack of Healthcare Insurance Coverage (Among Adults Age 18 -64) Healthy People 2020 Target = 0. 0% (Universal Coverage) 100% Cass County 80% 60% 40% 20% 18. 0% 10. 7% 10. 1% 13. 6 % 10. 7 % 0% Cass County Indiana US 2013 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 190] ● 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 Indiana data. ● 2015 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 AHS-1] Notes: ● Asked of all respondents under the age of 65. 12 Low income residents are more likely to be uninsured.

PRC Community Health Needs Assessment Cass County, Indiana Barriers to Access Have Prevented Medical Care in the Past Year 100% Cass County 2013 80% Cass County 2016 Significa ntly higher than US (8. 7%). Significa ntly higher than US (9. 5%). 60% n/a 0% Getting a Cost Dr Appointment (Doctor Visit) Sources: ● ● Notes: ● 13 Cost (Prescriptions) Inconvenient Office Hours Finding a Doctor PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 7 -13] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Asked of all respondents. Lack of Transportation 0. 7% 5. 1% 3. 4% 11. 8% 8. 0% 12. 0% 7. 5% 12. 6% 9. 7% 12. 9% 8. 4% 20% 13. 5% 10. 8% 40% Language/ Culture

PRC Community Health Needs Assessment Cass County, Indiana Experienced Difficulties or Delays of Some Kind in Receiving Needed Healthcare in the Past Year (Cass County, 2016) 100% 80% 60% 47. 0% 46. 0% 39. 0% 40% 39. 6% 34. 3% 29. 2% 28. 0% 37. 4% 35. 0% 20% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 194] 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. 14 Higher than previous findings (28. 3%).

PRC Community Health Needs Assessment Cass County, Indiana Skipped or Reduced Prescription Doses in Order to Stretch Prescriptions and Save Money 100% Cass County 80% 60% 40% 20% 13. 7% 10. 2% 9. 5% US 2013 13. 7 % 0% Cass County Sources: ● Notes: ● 15 ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 14] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Asked of all respondents. 2016

PRC Community Health Needs Assessment Cass County, Indiana Have Visited a Physician for a Checkup in the Past Year Child Has Visited a Physician for a Routine Checkup in the Past Year (Among Parents of Children 0 -17) 100% 80% 72. 2% 65. 1% 70. 5% 89. 3% 78. 5% 79. 0% 60% 40% 20% 0% 0% Cass County Sources: ● Notes: ● 16 Indiana US Cass County Children 0 - Children 1312 17 ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 138] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Asked of all respondents with children 0 to 17 in the household. US

PRC Community Health Needs Assessment Cass County, Indiana Have Used a Hospital Emergency Room More Than Once in the Past Year 100% Cass County 80% 60% 40% 20% Used the ER because: • Emergency Situation = 69. 3% • Weekend/After Hours = 24. 8% • Access Problems = 4. 4% 9. 4% 8. 5% 5. 8% Cass County US 2013 9. 4% 0% Sources: ● Notes: ● 17 ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 22 -23] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Asked of all respondents. 2016 The Primary Care Physician ratio is also significantly worse for Cass County compared to Indiana and the US.

PRC Community Health Needs Assessment Cass County, Indiana Child Has Visited a Dentist or Dental Clinic Within the Past Year (Among Parents of Children Age 2 -17) Healthy People 2020 Target = 49. 0% or Higher 100% 93. 3% 80% 90. 7% 70. 7 % 73. 8 % 64. 8% 60% 40% 20% Cass County Children 2 -12 Cass County Children 13 -17 Cass County US 2013 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 141] ● 2015 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 OH-7] Notes: ● Asked of all respondents with children age 2 through 17. Adults: 66. 6% (similar to US) 18

PRC Community Health Needs Assessment Cass County, Indiana Leading Causes of Death (Cass County, 2012 -2014) Heart Disease 24. 8% Other Conditions 28. 1% Alzheimer's Disease 3. 2% Unintentional Injuries 4. 1% Diabetes Mellitus 4. 6% Stroke 4. 7% Cancer 22. 2% CLRD 8. 3% #2 Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted May 2016. 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. Age-adjusted death rates are worse than IN & US for cancer overall, as well as leading sites (lung, breast, colorectal). 20

PRC Community Health Needs Assessment Cass County, Indiana Cancer Incidence Rates by Site (Annual Average Age-Adjusted Incidence per 100, 000 Population, 2008 -2012) Cass County 150 125 131. 7 114. 0 108. 9 119. 0 Indiana US 45. 1 41. 9 123. 0 106. 3 100 84. 0 75. 2 75 63. 7 42. 7 50 25 0 Prostate Cancer Female Breast Cancer Lung Cancer Colon/Rectal Cancer Sources: ● State Cancer Profiles. ● Retrieved April 2016 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. 21

Mammogram in Past 2 Yrs Pap Test in Past 3 Yrs (Among Women Age 50 -74) Healthy People 2020 Target = 81. 1% or Higher 100% 80% 60% (Among Women Age 21 -65) 100% 80. 3% 80% 72. 4% (Among Adults Age 50+) Healthy People 2020 Target = 93. 0% or Higher 100% 82. 9% Sigmoid/Colonoscopy Ever 72. 2% 78. 0% 84. 8% 80% 61. 6% Better than 2013 findin gs 60% 40% 20% 20% 0% 40% Cass County 74. 5% 68. 9% Indiana US Cass County Indiana US Better than 2013 findin gs Cass County Indiana US Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 151] ● 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 Indiana data. ● 2015 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 C-17] Notes: ● Reflects female respondents 50 -74.

PRC Community Health Needs Assessment Cass County, Indiana Kidney Disease: Age-Adjusted Mortality (2012 -2014 Annual Average Deaths per 100, 000 Population) 20 18 16 14. 3 13. 2 14 12 10 8 6 4 2 0 Cass County Indiana 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 May 2016. 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. Kidney disease mortality has significantly decreased in the past decade. 24

PRC Community Health Needs Assessment Cass County, Indiana Diabetes: Age-Adjusted Mortality Trends (Annual Average Deaths per 100, 000 Population) Healthy People 2020 Target = 20. 5 or Lower (Adjusted) 40 35 30 25 20 15 10 5 0 2005 -2007 Cass County 36. 3 Indiana 25. 5 US 23. 8 2006 -2008 36. 8 24. 8 22. 8 2007 -2009 30. 4 24. 2 21. 9 2008 -2010 24. 4 23. 9 21. 3 2009 -2011 22. 9 24. 1 21. 1 2010 -2012 30. 7 24. 7 21. 2 2011 -2013 36. 8 25. 9 21. 3 2012 -2014 36. 3 25. 5 21. 1 Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted May 2016. ● 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. 26

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Diabetes (Cass County, 2016) 100% 80% Another 6. 9% of adults report that they have been diagnosed with “pre-diabetes” or “borderline” diabetes. (vs. 5. 7% nationwide) 60% 40% 25. 5% 20% 14. 7% 17. 9% 14. 3% 17. 4% 13. 9% 14. 5% 5. 0% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US 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 with incomes at 200% or more of the federal poverty level. ● Excludes gestational diabetes (occurring only during pregnancy). 27

PRC Community Health Needs Assessment Cass County, Indiana Ranked #4 among key informant s Perceptions of Diabetes as a Problem in the Community (Key Informants, 2016) Major Problem Moderate Problem 45. 1% Sources: ● Notes: ● 32. 4% PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: • Lifestyle • Health Education • Affordable Care/Services 28 Minor Problem No Problem At All 9. 8% 12. 7%

PRC Community Health Needs Assessment Cass County, Indiana Teen Birth Rate (Births to Women Age 15 -19 Per 1, 000 Female Population Age 15 -19, 2006 -2012) 80 60 49. 0 38. 9 40 36. 6 20 0 Cass County Indiana US Sources: ● Centers for Disease Control and Prevention, National Vital Statistics System. Accessed using CDC WONDER. ● Retrieved April 2016 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. 30

PRC Community Health Needs Assessment Cass County, Indiana Teen Birth Rate (Births to Women Age 15 -19 Per 1, 000 Female Population Age 15 -19; Cass County by Race/Ethnicity, 2006 -2012) White (Non-Hispanic) 120 Hispanic/Latina All Races/Ethnicities 97. 9 100 80 64. 6 60 62. 0 49. 0 41. 9 38. 9 33. 5 40 36. 6 24. 6 20 0 Cass County Indiana US Sources: ● Centers for Disease Control and Prevention, National Vital Statistics System. Accessed using CDC WONDER. ● Retrieved April 2016 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. 31

PRC Community Health Needs Assessment Cass County, Indiana Leading Causes of Death (Cass County, 2012 -2014) Other Conditions 28. 1% Alzheimer's Disease 3. 2% Unintentional Injuries 4. 1% Diabetes Mellitus 4. 6% Heart #1 Disease 24. 8% Cancer 22. 2% Stroke CLRD 8. 3% 4. 7% #4 CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Sources: ● Division of Public Health Surveillance and Informatics. Data extracted May 2016. 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. Stroke prevalence much higher than IN & US. 33

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of High Blood Pressure (Cass County, 2016) Healthy People 2020 Target = 26. 9% or Lower 100% 77. 1% 80% 60% 52. 8% 46. 7% 51. 4% 44. 1% 45. 5% 36. 5% 40% 21. 2% 20% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 147] ● 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. ● 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. 34 91. 7% of adults with multiple HBP readings are taking action to help control their levels (such as medication, diet, and/or exercise).

PRC Community Health Needs Assessment Cass County, Indiana Present One or More Cardiovascular Risks or Behaviors 100% 86. 6% 83. 0% 80% 90. 0 % 86. 6 % 60% 40% 20% Cass County US 2013 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 149] ● 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents. ● Cardiovascular risk is defined as exhibiting one or more of the following: 1) no leisure-time physical activity; 2) regular/occasional cigarette smoking; 3) hypertension; 4) high blood cholesterol; and/or 5) being overweight/obese. 35

PRC Community Health Needs Assessment Cass County, Indiana Select Injury Death Rates (By Cause of Death; Annual Average Deaths per 100, 000 Population) 16 Cass County Indiana US 14. 6 14 12 11. 4 10. 6 10 8. 1 7. 4 8 5. 5 6 4 2 0 Motor Vehicle Accidents (2010 -14) HP 2020 Goal = 12. 4 or Lower Falls (2005 -14) HP 2020 Goal = 7. 2 or Lower Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted May 2016. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective IVP-13. 1, IVP-23. 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. 37

PRC Community Health Needs Assessment Cass County, Indiana Fell One or More Times in the Past Year (Among Respondents Age 45 and Older) 100% 80% 60% 40% Of these adults, 38. 4% were injured as the result of a fall. 33. 6% 28. 2% 20% 0% Cass County Sources: ● ● Notes: ● 38 US 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 125 -126] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Asked of those respondents age 45 and older.

PRC Community Health Needs Assessment Cass County, Indiana Have a Firearm Kept in or Around the Home 100% 80% 60% Households With Children: 53. 0% (vs. 31. 0% nationwide) 52. 5% 40% 33. 8% 20% 44. 9 % 52. 5 % Cass County 0% Cass County US 2013 2016 Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 51, 159 -160] ● 2015 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. Firearm-related mortality is significantly lower than state and nation. 39

PRC Community Health Needs Assessment Cass County, Indiana Would you say that in general your mental health is: Excellent, Very Good, Fair or Poor? Experience “Fair” or “Poor” Mental Health (Cass County, 2016) 100% 80% 60% 40% 22. 4% 20% 7. 8% 13. 8% 14. 0% 10. 3% 11. 0% 6. 8% 15. 5% 4. 9% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 116] 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. 41

PRC Community Health Needs Assessment Cass County, Indiana Have Experienced Symptoms of Chronic Depression 100% Cass County 80% 60% 40% 28. 8% 29. 9% 22. 8 % Cass County US 2013 28. 8 % 20% 0% 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 117] ● 2015 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. 42

PRC Community Health Needs Assessment Cass County, Indiana Mental Health Treatment 100% Cass County US 80% 60% 40% 22. 0% 27. 4% 20% 13. 2% 13. 6% 0% Ever Sought Help for a Mental or Emotional Problem Sources: ● ● Notes: ● 43 Currently Taking Medication/ Receiving Mental Health Treatment 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 120 -121] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Reflects the total sample of respondents.

PRC Community Health Needs Assessment Cass County, Indiana Ranked #5 among key informant s Perceptions of Mental Health as a Problem in the Community (Key Informants, 2016) Major Problem 43. 5% Sources: ● Notes: ● 38. 0% PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: • Access to Care/Services • Disease Management • Access to Providers • Denial/Stigma 44 Moderate Problem 7. 4% 11. 1%

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Total Overweight Prevalence of Obesity (Percent of Adults With a Body Mass Index of 25. 0 or Higher) (Percent of Adults With a Body Mass Index of 30. 0 or Higher) 100% 80% Healthy People 2020 Target = 30. 5% or Lower 100% 72. 3% 80% 66. 4% 65. 2% 60% 40% 20% 0% 0% Cass County Indiana US 39. 0% Cass County 32. 7% 33. 4% Indiana US Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 176 -177] ● 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 Indiana 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. 46

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Obesity (Percent of Adults With a BMI of 30. 0 or Higher; Cass County, 2016) Healthy People 2020 Target = 30. 5% or Lower 100% 80% 60% 40% 36. 5% 34. 4% 48. 7% 45. 1% 43. 7% 37. 8% 39. 0% Mid/High Income Cass County 30. 7% 20% 0% Men Women 18 to 39 40 to 64 65+ Low Income Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 176] ● 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 47 squared), greater than or equal to 30. 0, regardless of gender. The prevalence of obesity has significantly increased since 2013 (31. 4%).

PRC Community Health Needs Assessment Cass County, Indiana 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% Cass County 80% 60% 40% 16. 4 % 20. 3% 20. 3 % 9. 5% 0% Cass County US 2013 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 180] ● 2015 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 NWS-10. 4] Notes: ● Asked of all respondents with children age 5 -17 at home. ● Obesity among children is determined by children’s Body Mass Index status equal to or above the 95 th percentile of US growth charts by gender and age. ● *Interpret with caution as sample size is small (<50). 48

PRC Community Health Needs Assessment Cass County, Indiana Had Seven or More Sugar-Sweetened Beverages in the Past Week (Cass County, 2016) 100% 80% 60% 46. 8% 44. 0% 39. 7% 40% 31. 6% 27. 6% 31. 2% 35. 5% 30. 2% 22. 5% 20% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 212] 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 defined poverty status up to incomes just above the FPL, earning up to twice the poverty threshold; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. 49

PRC Community Health Needs Assessment Cass County, Indiana No Leisure-Time Physical Activity in the Past Month (Cass County, 2016) Healthy People 2020 Target = 32. 6% or Lower 100% 80% 60% 40% 20. 2% 22. 4% Men Women 20% 28. 3% 17. 5% 31. 7% 21. 8% 27. 9% 18. 0% 21. 4% 0% 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 106] ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective PA-1] 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. 50 Significant improvement seen since 2013.

PRC Community Health Needs Assessment Ranked Cass County, Indiana #2 among key informant s Perceptions of Nutrition, Physical Activity, and Weight as a Problem in the Community (Key Informants, 2016) Major Problem 50. 5% Sources: ● Notes: ● 28. 8% PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: • Obesity • Access to Healthful Foods • Lifestyle 51 Moderate Problem 8. 1% 12. 6%

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Potentially Disabling Conditions 100% Cass County US 80% 60% 40% 37. 6% 32. 0% 19. 5% 20% 10. 5% 19. 4% 8. 7% 0% Arthritis/Rheumatism (50+) Osteoporosis (50+) Sciatica/Chronic Back Pain (18+) HP 2020 Objective = 5. 3% or Lower Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 28, 161 -162] ● 2015 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 AOCBC-10] Notes: ● The sciatica indicator reflects the total sample of respondents; the arthritis and osteoporosis columns reflect adults age 50+. 53

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Blindness/Deafness 100% Cass County US 80% 60% Indiana = 4. 5% 40% 20% 5. 2% 7. 3% 11. 6% 8. 6% 0% Blindness/Trouble Seeing Even With Glasses Deafness/Trouble Hearing Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 25 -26] ● 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 Indiana data. Notes: ● Reflects the total sample of respondents. 54

PRC Community Health Needs Assessment Cass County, Indiana CLRD: Age-Adjusted Mortality Trends (Annual Average Deaths per 100, 000 Population) 70 60 50 40 30 20 10 0 2005 -2007 Cass County 49. 1 Indiana 51. 7 US 42. 1 2006 -2008 55. 7 52. 8 42. 4 2007 -2009 52. 1 54. 3 42. 9 2008 -2010 54. 9 56. 3 43. 2 2009 -2011 48. 4 56. 2 42. 5 2010 -2012 57. 8 56. 2 42. 1 2011 -2013 55. 5 57. 3 42. 0 2012 -2014 66. 6 56. 0 41. 4 Sources: ● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted May 2016. 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. 56

PRC Community Health Needs Assessment Cass County, Indiana Prevalence of Chronic Obstructive Pulmonary Disease (COPD) 100% Cass County 80% 60% 40% 20% 11. 1% 8. 7% 9. 5% 7. 2% Cass County Indiana US 2013 11. 1 % 0% 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 24] ● 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 Indiana data. ● 2015 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. 57

PRC Community Health Needs Assessment Cass County, Indiana Older Adults: Have Had a Flu Vaccination in the Past Year (Among Adults Age 65+) Healthy People 2020 Target = 70. 0% or Higher 100% 80% 60% High-Risk Adults = 46. 1% (HP 2020 Goal = 70%) 57. 2% 75. 6 % 56. 3% 57. 2 % 58. 9% 40% 20% Cass County Indiana US 2013 2016 Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 163 -164] ● 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 Indiana data. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective IID -12. 12] Notes: ● Reflects respondents 65 and older. ● “High-Risk” includes adults age 18 to 64 who have been diagnosed with heart disease, diabetes or respiratory disease. ● Includes Flu. Mist as a form of vaccination. 58

PRC Community Health Needs Assessment Cass County, Indiana Excessive Drinkers (Cass County, 2016) Healthy People 2020 Target = 25. 4% or Lower 100% 80% 60% 40% 27. 8% 20% 25. 3% 23. 7% 20. 3% 11. 9% 21. 2% 19. 4% 22. 2% 6. 4% 0% Men Women 18 to 39 40 to 64 65+ Low Income Mid/High Cass County Income US Sources: ● 2016 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 189] ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objective SA-15] 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. 60 ● Excessive drinking reflects the number of persons aged 18 years and over who drank more than two drinks per day on average (for men) or more than one drink per day on average (for women) OR who drank 5 or more drinks during a Excessive drinking has increased significantly since 2013.

PRC Community Health Needs Assessment Cass County, Indiana Have Ever Sought Professional Help for an Alcohol/Drug-Related Problem 100% Cass County 80% 60% 40% 2. 0% 4. 1% 3. 4% 2. 0% Cass County US 2013 2016 0% Sources: ● Notes: ● 61 ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 68] 2015 PRC National Health Survey, Professional Research Consultants, Inc. Asked of all respondents. 28. 9% report their life has been negatively affected by substance abuse.

PRC Community Health Needs Assessment Cass County, Indiana Ranked #1 among key informant s Perceptions of Substance Abuse as a Problem in the Community (Key Informants, 2016) 60. 6% Sources: ● Notes: ● 27. 5% PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: • Access to Care/Services • Denial/Stigma • Prevalence/Incidence Most problematic substance mentioned: Methamphetamines, heroin & alcohol 62 Moderate Problem 4. 6% Major Problem 7. 3%

PRC Community Health Needs Assessment Cass County, Indiana Member of Household Smokes at Home 100% Cass County 80% 60% 40% 20% Households with children exposed to smoke in the home: 10. 1% 16. 0% 17. 0 % 16. 0 % 2013 2016 10. 2% 0% Cass County US Sources: ● PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 58, 184] ● 2015 PRC National Health Survey, Professional Research Consultants, Inc. Notes: ● Asked of all respondents. ● “Smokes at home” refers to someone smoking cigarettes, cigars, or a pipe in the home an average of four or more times per week in the past month. 16. 4% of respondents report current smoking (similar to US and 2013 findings). 64

PRC Community Health Needs Assessment Cass County, Indiana Other Tobacco Use 100% Cass County US 80% 60% 40% Indiana = 4. 3% 20% 4. 4% 3. 6% 5. 4% 3. 0% 0% Cigars HP 2020 Goal = 0. 2% or Lower Sources: Notes: 65 Smokeless Tobacco HP 2020 Goal = 0. 3% or Lower ● 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 Indiana data. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http: //www. healthypeople. gov [Objectives TU-1. 2, TU-1. 3] ● Reflects the total sample of respondents. ● Smokeless tobacco includes chewing tobacco or snuff.

PRC Community Health Needs Assessment Cass County, Indiana Ranked #3 among key informant s Perceptions of Tobacco Use as a Problem in the Community (Key Informants, 2016) Major Problem 48. 6% Sources: ● Notes: ● 29. 0% PRC Online Key Informant Survey, Professional Research Consultants, Inc. Asked of all respondents. Top Reasons for "Major Problem" Responses: • Prevalence/Incidence • Community Attitude • Comorbidities 66 Moderate Problem 13. 1% 9. 3%

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Criteria PRC Community Health Needs Assessment Cass County, Indiana Scope & Severity • Rate how much of a problem each issue is for our community. (i. e. , How big is the problem? ) NOT very prevalent at all, with only minimal health consequences SCALE: Scope & Severity ❶ ↔ ❷ ↔ ❸ ↔ ❹ ↔ ❺ ↔ ❻ ↔ ❼ ↔❽ ↔ ❾ ↔ ❶� EXTREMELY prevalent, with very serious health consequences 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? ) SCALE: Ability to Impact NO ability to impact 70 ❶ ↔ ❷ ↔ ❸ ↔ ❹ ↔ ❺ ↔ ❻ ↔ ❼ ↔❽ ↔ ❾ ↔ ❶� GREAT ability to impact

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PRC Community Health Needs Assessment Cass County, Indiana Key Informants: Relative Position of Health Topics as Problems in the Community Top-Ranked Issues 0% Substance Abuse Nutrition, Physical Activity, an. . . Tobacco Use Diabetes Mental Health Cancer Heart Disease and Stroke Oral Health/Dental Care Family Planning Dementia/Alzheimer's Disease Respiratory Diseases Infant and Child Health Access to Health Care Services Sexually Transmitted Diseases Chronic Kidney Disease Injury and Violence Arthritis/Osteoporosis/Back. . . HIV/AIDS Hearing and Vision Problems Immunization and Infectious. . . 20% 60. 6% 50. 5% 48. 6% 45. 1% 43. 5% 31. 1% 38. 7% 25. 0% 46. 0% 24. 5% 27. 4% 24. 2% 28. 3% 21. 6% 43. 3% 18. 1% 34. 0% 16. 8% 35. 6% 15. 8% 42. 1% 9. 8% 34. 8% 8. 0% 39. 1% 7. 1% 33. 3% 7. 1% 44. 9% 5. 6% 16. 7% 5. 2% 25. 0% 4. 1% 29. 6% Major Problem 73 40% Moderate Problem 60% 80% 100% 27. 5% 28. 8% 29. 0% 32. 4% 38. 0% Minor Problem No Problem At All