EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 1

ACKNOWLEDGEMENTS

A thank you to the members of the Mobilizing for Action through Planning and Partnerships (MAPP) Operations Team and the Evanston Health Advisory Council for all of their work and input into the EPLAN: Creating a Healthier Evanston Community Health Assessment and Improvement Plan. The development of this plan could not have been done without them.

Thanks also to all of the MAPP Operations Team members, who were integral in planning and executing all of the assessments; Brina Auguste, Carl Caneva, Dr. Bruce Doblin, Christina Ferguson, Elizabeth Lassiter, Indira Perkins, Charlotte Picard, Kristin Preihs, Maitreyi Sistla, and Dr. Don Zeigler.

Sincerely,

Evonda Thomas-Smith, City of Evanston Health & Human Services Department, Director

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 2 EXECUTIVE SUMMARY

In order for the City of Evanston’s Health and Human Services Department to recertify as one of the four recognized local municipal health departments, the Illinois Department of Public Health requires a local assessment and strategic health plan for the next five years. Illinois refers to this process as IPLAN, the Illinois Project for Local Assessment of Needs. While local health departments conduct their own needs assessments, the state uses the findings from the local processes to conduct a state-wide needs assessment and develop a plan for the entire State of Illinois.

In Evanston, we refer to our local process as EPLAN, the Evanston Process for the Local Assessment of Needs. EPLAN is designed to prioritize top health needs so that public health resources can be directed most effectively toward health improvement. EPLAN is a community-driven process that is coordinated by the Health & Human Services Department. It directly involves community members, health professionals, academics, and others knowledgeable about and interested in the health of the community.

For this iteration of the EPLAN cycle, the Evanston Department of Health & Human Services (EDHHS) collaborated with the Evanston Health Advisory Council (EHAC) to conduct a needs assessment and produce a collaborative health improvement plan that spans from 2016-2021. The community health assessment process began in February 2015, and culminated in September 2015 with the selection of three health priorities. For this EPLAN, the Mobilizing Actions through Planning and Partnerships (MAPP) tool was used. Four assessments were conducted between February and September of 2015. Once results were reviewed, community leaders voted on three health priorities for the public health system to focus on from 2016-2021. The three health priorities selected were:

1. Mental Health 2. Violence 3. Obesity

This document details the results from the Community Health Assessment. EDHHS and EHAC recognize Community Health Assessment as an important health blueprint that serves as the precursor for the Community Health Improvement Plan.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 3 TABLE OF CONTENTS

ACKNOWLEDGEMENTS ...... 2 EXECUTIVE SUMMARY ...... 3 INTRODUCTION TO IPLAN AND MAPP ...... 5 OVERVIEW OF EVANSTON, ILLINOIS AND THE EVANSTON DEPARTMENT OF HEALTH AND HUMAN SERVICES ...... 7 COMMUNITY HEALTH ASSESSMENT PROCESS ...... 8 A. Purpose ...... 8 B. Methods ...... 8 C. Community Participation ...... 9 D. Timeline ...... 9 THE FOUR MAPP ASSESSMENTS ...... 10 A. Community Themes and Strengths Assessment ...... 10 B. Forces of Change Assessment ...... 18 C. Local Public Health System Assessment ...... 21 D. Community Health Status Assessment ...... 27 a. Community Health Survey Results ...... 27 b. Community Health Survey Correlation Results...... 38 c. Other Evanston Data ...... 40 d. County Health Rankings Summary ...... 47 HEALTH PRIORITY SELECTION...... 50 APPENDICES ...... 51 A. Appendix A: Focus Group Guide and Questions ...... 51 B. Appendix B: Forces of Change Assessment Organization Attendees ...... 54 C. Appendix C: Local Public Health System Assessment Organization Attendees ... 55 D. Appendix D: Health Priority Selection Organization Attendees ...... 56 E. Appendix E: Local Public Health System Assessment Results ...... 57 F. Appendix F: Community Health Status Assessment Questions ...... 64 G. Appendix G: Community Health Status Assessment Correlation Results ...... 82

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 4 INTRODUCTION TO IPLAN AND MAPP

The Illinois Project for the Local Assessment of Needs (IPLAN) was developed in 1992 by the Illinois Department of Public Health (IDPH) to establish a process for local health departments to conduct strategic planning within their communities. IPLAN is a series of planning activities led by a local health department, which result in a Community Health Assessment and Community Health Improvement Plan. The Illinois Administrative Code mandates that all local health departments conduct an IPLAN process every five years for recertification. IDPH guidelines mandate that health departments submit a Community Health Needs Assessment, Community Health Plan, and Organizational Capacity Assessment as part of their IPLAN application.

The Administrative Code allows local health departments to use an equivalent planning process, Mobilizing for Action through Planning and Partnerships (MAPP), for state certification. MAPP was developed by the Centers for Disease Control & Prevention (CDC) and the National Association of County and City Health Officials (NACCHO) as a community-driven strategic planning tool for improving community health. The tool helps communities apply strategic thinking to prioritize public health issues and identify resources to address them. The culminating products of MAPP include a Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP).

In January 2015, the Operations Team at the Evanston Department of Health & Human Services decided to use MAPP for their 2016-2021 IPLAN application. MAPP was chosen for numerous reasons: it provided a well-established structure for the creation of a Community Health Assessment and Improvement Plan, and could be easily tailored to fit with the Department’s resources. As a municipal health department within the largest County in Illinois (Cook), the MAPP process would also provide the City with Evanston-specific data.

The MAPP process is divided out into two main phases: the Community Health Assessment and the Community Health Improvement Plan. There are four assessments that are conducted for the Community Health Assessment: the Community Themes & Strengths Assessment, the Forces of Change Assessment, the Local Public Health System Assessment, and the Community Health Status Assessment. Once these assessments are complete, the community uses the data collected to identify health priorities for the next five years.

Once health priorities are selected, the Community Health Improvement Plan process begins. Subcommittees of community leaders and subject matter experts are created for each health priority, and an action plan is drafted to address each health priority from 2016-2021. Measurable goals for each priority are also created to drive progress.

The image on the next page is a depiction of the MAPP process. Each step of the MAPP process encourages community participation and collaboration, so as to create a comprehensive Community Health Assessment and Community Health Improvement Plan for Evanston.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 5

Source: http://www.healthynashville.org/index.php?module=InitiativeCenters&func=display&icid=8

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 6 OVERVIEW OF EVANSTON, ILLINOIS AND THE EVANSTON DEPARTMENT OF HEALTH AND HUMAN SERVICES

The City of Evanston, Illinois is a diverse community of just under eight square miles located on the west shore of Lake Michigan. With approximately 75,000 residents, Evanston is home to Northwestern University and Rotary International. Evanston is well known for being a progressive city that has long been committed to investing in the social, environmental and physical health of the community. In 2006, the Evanston City Council unanimously approved a Strategic Plan that included an overall vision of “Creating the Most Livable City in America.” Since then, the City of Evanston has used this plan as a roadmap for implementing programs and policies that make effective use of limited resources by focusing on key priorities.

From a demographic and socioeconomic perspective, Evanston is very diverse. According to 2009-2013 American Community Survey data, the population is 68% white, 9.6% Hispanic or Latino, 18% African American and 9.4% Asian. The median age is 34.6 years. Approximately 12% of the population is 65 or older. Evanston residents are relatively well-educated, with 94.3% of residents holding at least a high school diploma, 66.0% holding at least a bachelor’s degree, and 37.2% of the population holding a graduate or professional degree. Based on 2009-2013 American Community Survey data, just over 6 percent of households received supplemental income in the form of food stamps/SNAP benefits in 2009 and almost 13% of individuals, and 6% of families, have incomes below the poverty level.

The Evanston Department of Health and Human Services (EDHHS), established in 1874, defines its mission as protecting, preserving and promoting wellness for people who live, work and play in Evanston through creative and sustainable partnerships. EDHHS is one of only four municipal health departments in the Chicagoland area that are certified by the State of Illinois. The Department provides a broad range of services to Evanston residents, including licensing and inspections of food establishments and rental dwellings, communicable disease surveillance and investigation, public health emergency preparedness, vital records, General Assistance, and numerous public outreach and educational activities.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 7 COMMUNITY HEALTH ASSESSMENT PROCESS

Purpose

The community health assessment process was designed to collect qualitative and quantitative information from Evanston public health officials, residents, and community leaders. As most state and national data arrives at the county-level, the community health assessment process also provided a means of collecting Evanston-specific health information that could be used by the department and various other organizations. In addition, the assessment phase of EPLAN was designed to identify the major health issues impacting Evanston residents, and to serve as a starting point for the Community Health Improvement Plan. In asking residents, city leaders, and public health officials in the community about their perceptions of health in Evanston, the plan also encouraged collaboration between various agencies to assess and improve the health of the community.

Methods

The assessment process was initiated in February 2015. The MAPP Operations Team was identified, and consisted of Operations Team members at the Evanston Department of Health & Human Services, in addition to the chairs of the Evanston Health Advisory Council. The MAPP Operations Team met weekly, starting in February 2015. During these weekly meetings, the MAPP Operations Team would plan the four MAPP assessments and discuss results of the assessments.

In February 2015, a timeline was created for the Community Health Assessment and Community Health Improvement Plan. The entirety of the process was planned to take 18 months, as the department’s IPLAN application was due in September 2016. The Community Health Assessment would take 6 months, and would be completed by the end of September 2015. The Community Health Improvement Plan would take approximately one year, and would be completed by the end of July 2016.

For the Community Health Assessment, the four MAPP Assessments (Community Themes & Strengths, Forces of Change, Local Public Health System, and Community Health Status) occurred between April and September 2015. The Community Themes & Strengths Assessment was an online survey completed by community leaders in April and May 2015. The remaining three assessments were conducted in partnership with the Evanston Health Advisory Council (EHAC), in lieu of their meetings every two months. The assessments were conducted during EHAC meetings for multiple reasons. Serving as the City’s Health Advisory Council, EHAC members are well-established public health leaders who are essential to the process. By conducting the meetings during regularly- scheduled EHAC meeting times, the Department would ensure the presence and participation of most EHAC members. In addition, since future health priority subcommittees will report to the Evanston Health Advisory Council, it was integral that EHAC be intimately involved in the EPLAN process. Lastly, by scheduling the assessments during EHAC meetings, the Department would ensure that the EPLAN process was seen an inclusive community initiative.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 8 Community Participation

The MAPP Operations Team ensured that community organizations, leaders, and residents were deeply involved in the MAPP process. Appendices B, C, and D provide a list of all organizations that participated in the MAPP assessments and health priority selection. Over 200 community leaders, representing a variety of community organizations, were invited to each MAPP assessment. Focus groups and the Community Health Survey also allowed input from residents. The health prioritization included this larger group of community leaders as well, as the MAPP Operations Team wanted to ensure community involvement in the selection of health priorities.

Timeline

A timeline of the Community Health Assessment and Improvement Plan is shown below.

Timeline for EPLAN: Creating a Healthier Evanston Date Activity April-May 2015 Community Themes & Strengths Assessment (online) May 21st, 2015 Forces of Change Assessment (in-person meeting) June-September 2015 Community Health Status Assessment June 16, 2015 Local Public Health System Assessment (in-person meeting) Review results from four MAPP assessments & voting on health September 17, 2015 priorities from the community (in-person meeting) Selection of subcommittee co-chairs and rest of subcommittee October-November 2016 members First meeting of health priority subcommittees and completion of risk January 2016 factor analysis Identify organizations and specific programs that address health February 2016 topics Gap analysis of available programming and needed programs for February 2016 health priority subcommittees Review of evidence-based practices that fill gaps identified

March 2016 Identify Healthy People 2020 objectives that align with evidence- based practices Creation of action plan April 2016 Priority selection (over 5 years) and creation of timeline Communication plan to announce health priorities and how they will May 2016 be addressed July 2016 Health Summit/Press Announcement September 2016 IPLAN Application is due

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 9 THE FOUR MAPP ASSESSMENTS

As part of the MAPP process, four assessments must be conducted for the Community Health Assessment. Below are summaries and results from the four MAPP assessments conducted by the Evanston Department of Health & Human Services.

Community Themes and Strengths Assessment Purpose The Community Themes and Strengths Assessment aims to answer the following questions: “What is important to our community?”, “How is quality of life perceived in our community?”, and “What assets do we have that can be used to improve community health?”

Process The Community Themes and Strengths Assessment for EDHHS’s EPLAN process consisted of two components:  Part 1: An online survey sent to community leaders, which asked community leaders what their perceptions of the health issues in Evanston are, and what assets/barriers Evanston has to improve community health.  Part 2: Focus groups that were conducted by EDHHS staff members, which target groups of residents whose opinions were absent from previous EPLAN assessments. Results from these two components of the Community Themes & Strengths Assessment are shown below.

Part 1: Online Survey

Purpose The online survey for the Community Themes and Strengths Assessment aimed to identify perceptions of health issues from various Evanston leaders.

Process The MAPP Operations Team identified a list of approximately 200 community leaders who should participate in the Community Themes and Strengths Assessment. The team developed four questions that were sent in an online survey using Wufoo to the pre-identified community leaders in late April 2015. The survey doubled as an RSVP form for the Forces of Change Assessment occurring on May 21, 2015. The four questions included on the Community Themes and Strengths online survey were:

1. Based on your experience, what are the most important health issues that must be addressed to improve the health and quality of life in Evanston? (List as many as you would like.) 2. For each issue you identify, please answer the subsequent question: What ideal actions, policies, or funding priorities would address this health issue? 3. Based on your experience, what assets does Evanston have that can be used to improve community health?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 10 4. Based on your experience, what are the barriers to improving health in Evanston?

The survey was open from April 23, 2015-May 21, 2015. The MAPP Operations Team then reviewed the responses to the Community Themes and Strengths Assessment, and categorized the responses by larger themes. The MAPP team then tallied up the larger themes to determine the most popular themes for each question, and inputted these larger themes into a word cloud builder to illustrate them. A total of 77 Evanston leaders participated in the survey.

Results Listed on the following pages are the top responses that were identified for each question on the online survey, along with their corresponding word clouds. Word clouds are graphical representations of word frequency—phrases that are bigger illustrate the themes that were most popular in the online responses. The responses to question 2 were not aggregated into a word cloud, as they were quite varied.

1. Based on your experience, what are the most important health issues that must be addressed to improve the health and quality of life in Evanston?  Mental health  Access to care  Violence in communities  Affordable housing  Collaboration between agencies  Other notable responses: health and income disparities, physical activity, access to affordable healthy food

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 11

3. Based on your experience, what assets does Evanston have that can be used to improve community health?  Impassioned residents  Social service organizations, and non-profits  Educated citizens  Northwestern University  Two hospitals  Other notable responses: Erie, the school system, faith-based community, diversity, Cradle to Career

4. Based on your experience, what are the barriers to improving health in Evanston?  Lack of cross- collaboration between agencies  Funding  Segregation  Knowledge of services  No comprehensive health plan

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 12 Part 2: Focus Groups

Purpose The purpose of the Community Themes and Strengths Assessment focus groups was for the Department to hear the opinions of community members whose voices have historically been absent from community health conversations.

Purpose The MAPP Operations Team identified a list of seven groups of residents, whose voices have been absent from past community health conversations. These groups were:

 General Assistance clients  Senior citizens  Home daycare providers  District 65 (grades K-8 school district in Evanston) health clerks  Faith-based community  Hispanic community  Business community

The MAPP Operations Team contacted representatives from each of these groups to organize focus groups during the summer. Due to various organizations’ summer schedules, only three of the seven focus groups managed to be scheduled for the Community Health Assessment. These focus groups included General Assistance clients, senior citizens, and the Health/Wellness Business Association.

Methods

Various organizations were contacted to help gather participants for the focus groups. The organizations contacted for each of the resident groups identified by the MAPP Operations Team are listed below:

 General Assistance clients  City of Evanston General Assistance Office  Senior citizens  Levy Senior Center and Fleetwood-Jourdain Community Center Senior Group  Home daycare providers  S.E.W. Childcare Providers Association and Childcare Network of Evanston  District 65 (grades K-8 school district in Evanston) health clerks  District 65 Coordinator of Health Services  Faith-based community  Interfaith Action of Evanston and Evanston Interfaith Leaders & Clergy  Hispanic community  Latino Resources  Business community  City of Evanston Health/Wellness Business Association and Downtown Evanston Business District

The three focus groups were scheduled between June and August 2015. The first focus group, with General Assistance clients, occurred on June, 16, 2015, and 15 clients participated. The second focus group with health/wellness businesses in Evanston occurred at the Evanston Civic Center on

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 13 July 17, 2015, in partnership with the Health/Wellness Business Association of Evanston. Six members participated. The third focus group, with senior citizens, occurred at the Levy Senior Center on July 22nd, 2015 with a total of six participants.

Questions for the Focus Group can be found in Appendix A of this document. Two different sets of questions were asked: one for service providers (Health/Wellness Business Association), and one for resident groups (General Assistance clients and senior citizens).

Results

Summaries of the responses for each set of focus group questions (service providers and resident groups) can be found below.

Results for Service Provider Groups:

Question Health/Wellness Businesses 1. To you, what would a  Active living healthy community look  Programming for all ages like?  Pet friendly  Arts  Diversity in age and race  Environment: organic, environmentally aware, trees  Safe  Community: collaborative and supportive neighbors, individual responsibility to help the whole, unified 2. What do you think are the  Green spaces, lots of areas to go walking, bike lanes healthiest aspects of  Commitment to the environment: plastic bag ban, no pesticides, Evanston? community wildlife habitats 3. Thinking about people in  Pesticide use Evanston, what are your  Substance abuse among teenagers main health concerns?  Mental health issues among the aging population 4. Are there groups of people  Low-income individuals within your community  Access to affordable, fresh fruits and vegetables for the low-income whose healthcare needs population is difficult seem to be overlooked, or  Although there are programs for low income individuals, there is a not met? lack of participation in them (very little participation in free acupuncture and yoga classes) 5. What assets does  Marketing, communication Evanston have to promote  Lots of opportunities for community service in Evanston—Evanston health? Township High School students are mandated to participate  Community service in the religious communities as well 6. What are the barriers to  N/A—was skipped due to timing promoting health in Evanston? 7. If you were in charge, what  Ban pesticides specific things would you  Ban Burger King and McDonalds in Evanston do to improve the health  More community and gathering places status of community  More collaboration between the City and health/wellness members? businesses to make sure people show up to events like free yoga/acupuncture

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 14 8. Is there anything that we  A physician at the high school is promoting healthy eating and have not asked or that you physical activity. There seems to be more of an awareness at the would like to add? high school level then there was years ago

Results from Resident Groups

Question General Assistance Clients Senior Residents 1. To you, what would a  No drugs, gangs, violence, guns  Green space healthy community look  Greenery  Good hospitals like?  Responsive to people’s needs  Good street cleaning  Access to public transportation  Walkable sidewalks  Significant healthcare resources  Bike-able available  Water fountains  Community events  Healthy food services and restaurants  No hunger  Clean  Information and assistance in utilizing healthcare resources  Free dental  Affordable healthcare for all 2. What do you think are the  Lots of green spaces, access to  Levy Center most healthy things about the lakefront  Spraying for mosquitos Evanston?  General Assistance program  The City of Evanston going  Two hospitals systems out and getting feedback from residents, like this focus group 3. Thinking about people in  Drugs are number one issue  Mobility Evanston, what are your  Drugs that are the problems:  Accessibility—even the Civic main health concerns? cocaine, heroin, crack, and Center isn’t very accessible alcohol for the handicapped  Need a clean needle exchange  Housing in Evanston is program terrible for seniors. Services  Drugs cause many of the issues for the disabled are also in Evanston, they’re related to needed sex crimes, guns, verbal abuse  Visibility as a Health  Safety Department is low—need better PR efforts  Have some program to help seniors go grocery shopping, as that is a large issue for many of us  Have a program to help seniors with laundry, especially in the winter.  A hotline could be created to transport disabled and handicapped (a cab hotline service that is free); this exists in Marquette, Michigan

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 15 4. Where do you go for health  Erie Family Health Center  NorthShore University Health care services? [multiple individuals] System  “I don’t go to the doctor, I  Evanston needs more haven’t gone for 10 years, assisted living facilities! nothing has happened”  More affordable assisted  Northwestern Memorial Hospital living facilities are necessary in Chicago  Only 3 assisted living  A doctor’s office in Lincolnwood facilities in Evanston have a  “I don’t have health issues” sliding scale, that will base what you need to pay on income. Evanston needs more of that.  Northwestern University has a great hearing loss clinic  Levy has a lot of great resources  CJE [Evanston senior facility] posts a lot of great health information too  Mayo Clinic website 5. Tell us about your own  Evanston really does have a  N/A—skipped due to timing experiences getting the plethora of resources [multiple help you need in Evanston individuals agree]  Needs to be more help in receiving assistance  They are about to close the mental health assistance location on Main/Ridge, that is going to cause a lot of problems 6. What assets does  N/A—was skipped due to timing  N/A—skipped due to timing Evanston have to being healthy? 7. What are the barriers to  N/A—was skipped due to timing  N/A—skipped due to timing being healthy in Evanston? 8. Where do you and others  Online  N/A—skipped due to timing in your community get  Social workers at the YMCA— most of your health they give information on County information? Care  General Assistance office  Online, but all the information can be very overwhelming. Especially in terms of where your insurance is accepted—it’s very difficult to find that information  Finding what doctor’s accept certain insurance is VERY difficult, probably the biggest problem  Problem with online information: its outdated, and can be conflicting 9. Are there groups of people  Individuals with mental health  The homeless—the only within your community issues—don’t know where to go, homeless shelter in Evanston

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 16 whose healthcare needs and sometimes don’t have the lost funding a few months seemed to be overlooked, capability of bringing ago, so there is no place for or not met? themselves there them to go here  “I think sometimes you don’t  There should be a donation know how to ask about the location for things like health care, and if you don’t ask walkers, bath benches, etc. It and keep asking, you don’t get seems like the Evanston information. I think it’s there if Health & Human Services you know how to find it. But to Department would be a good get in the system can be place for this overwhelming, so you either put  Drug addicts and substance it off or don’t pursue it at all.” abuse users don’t seem to  It’s hard to get into the system get enough attention in to ask for help. Once you’re in Evanston the system, you can get great  More youth programs to keep assistance. But it’s that initial kids off the streets step  Evanston is very segregated racially, and it should help kids of color 10. If you were in charge, what  Giving people incentives for  Have the Erie Family Health specific things would you regular check-ups Center do a better job of do to improve the health  The City of Evanston allows promoting their programs to status of community people to use their LINK cards the public members? at the Farmer’s Market. We  Have a contract to build more should be able to do that at affordable assisted living places like Whole Foods, where facilities for seniors fresh food is extremely  There needs to be a central expensive location for health  Sunday transportation is very information, such as 311. difficult—many buses don’t Otherwise, there are too operate, the El is less frequent many places to go  There should be a tour system  Having volunteer programs in Evanston to show you where that connect younger the hospitals are, the clinics, individuals with senior the grocery stores, etc. Right citizens now, you have to learn public transit yourself, and that is hard  Signs on the El Stops to say “exit here for NorthShore Hospital”  Making the Central Street El station [the El station connected to NorthShore Hospital] handicap accessible— it’s horrible that it’s not 11. Is there anything that we  N/A—was skipped due to timing  No comments have not asked or that you would like to add?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 17 Forces of Change Assessment Purpose The Forces of Change Assessment aims to answer the following questions: “What is occurring or might occur that affects the health of our community or the local public health system?” and “What specific threats or opportunities are generated by these occurrences?”

Process The internal MAPP team at EDHHS identified a list of approximately 200 community leaders who should be participate in the Forces of Change Assessment. Attached to the invitation for the Forces of Change Assessment meeting was the Community Themes and Strengths Assessment, where participants were asked to identify their perceptions of health in Evanston. The MAPP Operations Team then reviewed the responses to the Community Themes and Strengths Assessment, and narrowed down the Forces of Change Assessment to focus on three themes: social, economic, and political. Before the assessment, facilitators were trained during a one-hour facilitator training session, and a facilitation guide was created. Each breakout session during the assessment would have three facilitators from EDHHS, each of whom would facilitate one of the themes.

The assessment occurred on May 21, 2015 in the Lorraine H. Morton Civic Center in Evanston from 8:30-10:30AM. During the assessment, participants were randomly placed in one of three rooms for a breakout session. There were three breakout sessions in total, each of which focused on one of the categories and lasted about 20 minutes. Participants were asked the question: “What trends, factors or events do you perceive may occur in the next five years that will affect the community’s health?” Participants were given three post-it notes, and were asked to identify three forces that are affecting, or will affect, public health in Evanston in the upcoming years within that category. Participants placed one idea on each post-it, and then placed the note on a larger white board, grouping similar ideas together. The three most popular ideas were further discussed by the group, as attendees identified the specific impact each force would have on public health in Evanston, and potential opportunities that could occur as a result of these forces. The process was then repeated for the remaining two categories. A total of 78 Evanston leaders participated in the meeting.

Results Listed below are the top 9 forces that were identified in each category, along with the impacts and opportunities that were discussed. A list of the organizations that participated in the Forces of Change assessment can be found in Appendix B.

Social Forces

Theme Impact Opportunity Cultural Competency  Language barriers impacts  More culturally-specific health education, as Evanston is interventions in all service a diverse community organizations  Language barriers impact access to advocates and service organizations  Social customs have impacted eating habits Mental Health  Less people are accessing  Common assessment tools

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 18 mental health programs amongst mental health providers  Closing of C4 (Community in Evanston Counseling Centers for Chicago)  Improved referral protocols in will affect access to mental Evanston for mental health (need health care greatly to collaborate, as Evanston has  Stigma many social service  Both over access and organizations) underutilization of care  Better integration of public health services and mental health services  Bringing the safety, emergency preparedness, and community into mental health discussions

Technology  Over engagement with  Intergenerational programs with technology creates sedentary high school students working lifestyle with the elderly population on  Cyberbullying technology  Data sharing privacy issues  Apps and community videos to engage youth  Cyberbullying education campaigns at an earlier age

Economic Forces

Theme Impact Opportunity Affordable Housing  School enrollments in Evanston  Sustain low-income housing (land have increased because families trust model) are doubling up  Changing Evanston’s zoning  Lack of low-income housing in ordinance for low-income Evanston housing  Gentrification: low-income  Forcing developers to set aside a families are priced out of certain number of units for low- Evanston income housing, and not letting  Impacts mental health and them “buy out” of this rule (as is homelessness done currently)

IL state funding cuts  Overall cutback on all services  Collaboration with organizations (health, social, and public for joint grant applications domain)  Increased public-private  Social service organizations are partnerships attracting less talent because of  Community organizing for future job and wage cuts. Movement state elections—there is not from public to private sector enough community organizing in  Less focus on preventative Evanston services  Finding grants from private  Decrease in quality of services organizations, not just  Uncertainty in government government funding makes it hard to plan  Can lead to more solidified, within our organizations focused programs  Coordinate all lobbying and funding requests to the state, and engage FBOs. Sending an

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 19 agenda of what needs to happen in Evanston, and sending that to the state as priorities Employment  Affects everything: access to  Advocacy for minimum wage care, housing, food, insurance increases in Evanston, and state-  Lack of quality jobs wide  Two-generation initiative programs  Job training programs at the high school

Access to care  Affects epidemiological outcomes  Navigators available at the  A lack of knowledge of resources library, PEER services, Erie, etc.  People may not understand how  Community health asset map Medicare model works  “211” number of seniors  More school-based health centers, such as ETHS  Universal fare cards  Data information sharing hub for Evanston providers  Increasing knowledge with resources such as HIRCULES desk at the library

Political Forces

Theme Impact Opportunity Civic engagement  Disengagement in politics by  Technology as a low-cost, high- residents impact way to reach a large  Lack of knowledge of resources group of people by residents  Partnerships and collaboration  Causes a waste of resources  Voting on the weekend in  Decisions are made without Evanston everyone’s opinions  Bill for automatic voter  There is an overload of registration through driver’s information license registration  Create a city action website to organize information

Increasing health awareness  Lead is still an issue with a large  Health as a major priority of City negative health impact on Council children  ETHS: Using high schoolers as  Air/water and environment are health educators being compromised

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 20 Local Public Health System Assessment

Purpose The Local Public Health System Assessment aims to answer the following questions: “What are the components, activities, competencies, and capacities of our local public health system?” and “How are the 10 Essential Public Health Services being provided to our community?”

Process The internal MAPP team at EDHHS identified a list of approximately 250 community leaders who should be part of the Local Public Health System Assessment. On the RSVP form for the Local Public Health System Assessment, attendees were asked to rate three Essential Public Health Services their positions best fit into. The internal MAPP team reviewed the Essential Public Health Services selected, and grouped attendees into one of three groups. The first group rated Essential Public Health Services 1-3, the second group rated Essential Public Health Services 4-6, and the third group rated Essential Public Health Services 7-9. All three groups also rated Essential Public Health Service 10.

Before the assessment, the internal MAPP team went through the Local Public Health System Assessment questions suggested by NACCHO. The team narrowed down and combined some of NACCHO’s suggested questions, so that each group would answer 12 questions total in a span of 75 minutes. In addition, facilitators were trained before the assessment in a one-hour facilitator training session. A facilitator guide was created as well. Each breakout session had three staff members: two co-facilitators, and a note-taker.

The assessment took place on Thursday, July 16, 2015, at the Lorraine H. Morton Civic Center in Evanston from 8:30-10:30AM. During the assessments, participants were broken up into one of the three pre-identified groups. Each participant was given a set of voting cards, ranging 1-5, and a final voting sheet. A facilitator from EDHHS posed one of the twelve questions to the group, and asked participants at what level Evanston’s public health system participates in that particular service. The ratings were defined as follows:

 1 = No activity; the local public health system has no activity in relation to this service  2 = Minimal activity; the local public health system has minimal activity in relation to this service  3 = Moderate activity; the local public health system has moderate activity in relation to this service  4 = Significant activity; the local public health system has significant activity in relation to this service  5 = Optimal activity; the local public health system has optimal activity in relation to this service

Once the question was posed, participants held up voting cards that indicated their initial rating for that question. After the initial rating, the facilitator asked participants for justification of their particular rating. The participants were allowed 5.5 minutes of discussion per question. Afterwards, the participants documented their final rating on an anonymous voting sheet. The process was repeated for all twelve questions. At the end of the assessment, the final voting sheets were

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 21 collected and tallied, and the internal MAPP team calculated average scores for each question. A total of 69 community leaders participated in the assessment.

Results Listed below are average scores for each question asked during the Local Public Health System Assessment, as well as the average score for each Essential Public Health Service. A list of the organizations that participated in the Local Public Health System Assessment can be found in Appendix C. A more detailed version of the Local Public Health System Assessment results, including notes from the breakout sessions, can be found in Appendix E.

The highest competencies ranked include Enforcing Laws (Standard 6), Diagnosing and Investigating Health Issues (Standard 2), and Assuring a Competent Workforce (Standard 8). The lowest competencies ranked include: Research/Innovation (Standard 10), Mobilizing Partnerships (Standard 4), and Educating/Empowering Citizens about Health Issues (Standard 3). Seven out of ten competencies were rated below a 3.

Major themes discussed during the Local Public Health System Assessment included  The need for more Evanston-specific data beyond the Community Health Assessment  The existence of an information disconnect between organizations  The need for rigorous evaluation of ALL social service programs  The need for more partnerships/collaborations with researchers and universities in the area  An overall lack of coordination between agencies

STANDARD 1: MONITOR HEALTH STATUS TO IDENTIFY AND SOLVE COMMUNITY HEALTH PROBLEMS Question Average Score (Out of 5) At what level does Evanston’s public health system…

1. Promote the use of a Community Health Assessment among 2.85 community members and partners?

2. Collect timely data consistent with current standards on specific 2.39 health concerns?

3. Use Evanston-specific data indicators from relevant data sources in 2.76 Community Health Assessments or other analyses?

STANDARD 2: DIAGNOSE AND INVESTIGATE HEALTH PROBLEMS AND HEALTH HAZARDS Average Score Question (Out of 5) At what level does Evanston’s public health system… 1. Maintain written instructions on how to investigate and handle communicable disease outbreaks and public health emergencies, 3.09 including details about case finding, contact tracing, and source identification and containment?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 22 2. Evaluate incidents for effectiveness and opportunities for improvement (such as After Action Reports, Improvement Plans, 3.22 etc.)? 3. Maintain constant (24/7) access to laboratories that can meet public health needs during investigations, emergencies, threats, or 3.20 other hazards?

STANDARD 3: INFORM, EDUCATE, AND EMPOWER PEOPLE ABOUT HEALTH ISSUES Average Score Question (Out of 5) At what level does Evanston’s public health system…

1. Coordinate health promotion and health education activities at the 2.71 individual, interpersonal, community, and societal levels?

2. Develop a health communications plan and use relationships with different media providers (e.g. print, radio, TV, the Internet) to share 2.11 information with residents and LPHS organizations?

3. Develop an emergency communications plan for each stage of an 2.94 emergency to allow for the effective dissemination of information?

STANDARD 4: MOBILIZE COMMUNITY PARTNERSHIPS TO IDENTIFY AND SOLVE HEALTH PROBLEMS Average Score Question (Out of 5) At what level does Evanston’s public health system… 1. Maintain a complete and current directory of community organizations, as well as create forums with these partners for 2.63 communication of public health issues? 2. Establish community partnerships and strategic alliances to provide a comprehensive approach to improving health in the community, as 2.38 well as assessing how well these partnerships are working to improve community health?

STANDARD 5: DEVELOP POLICIES AND PLANS THAT SUPPORT INDIVIDUAL AND COMMUNITY HEALTH EFFORTS Average Score Question (Out of 5) At what level does Evanston’s public health system… 1. Support the collaboration of the members of the system to ensure there are adequate resources to provide the 10 Essential Public 2.59 Health Services?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 23 2. Contribute to public health policies by reviewing existing policies at least every 3-5 years, and engaging in activities that inform the 3.29 policy development process? 3. Establish a Community Health Improvement Plan, with broad-based diverse participation, that uses information from the Community 2.69 Health Assessment, connects to organizational strategic plans? 4. Support a workgroup that develop and maintains emergency preparedness response plans, as well as actually develop an emergency preparedness response plan that defines when it would 3.07 be used, who would do what tasks, what standard operating procedures would be put in place, and what alert and evacuation protocols would be followed?

STANDARD 6: ENFORCE LAWS AND REGULATIONS THAT PROTECT HEALTH AND ENSURE SAFETY Average Score Question (Out of 5) At what level does Evanston’s public health system… 1. Stay up-to-date with current laws, regulations, and ordinances that promote public health, in addition to having access to legal counsel 3.75 for technical assistance when reviewing these laws, regulations, and ordinances? 2. Participate and provide technical assistance in changing existing laws, regulations, ordinances, and/or creating new laws, regulations, 3.57 and ordinances that promote public health? 3. Identify organizations that have the authority to enforce public health laws, regulations, and ordinances, and ensure that all 3.77 enforcement activities related to public health codes are done within the law?

STANDARD 7: LINK PEOPLE TO NEEDED HEALTH SERVICES AND ASSURE THE PROVISION OF HEALTHCARE WHEN OTHERWISE UNAVAILABLE Average Score Question (Out of 5) At what level does Evanston’s public health system…

1. Identify all personal health service needs and unmet needs 3.41 throughout the community?

2. Coordinate the delivery of personal health and social services so 2.35 that everyone in the community has access to the care they need?

STANDARD 8: ASSURE A COMPETENT PUBLIC HEALTH AND PERSONAL HEALTHCARE WORKFORCE Average Score Question (Out of 5)

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 24 At what level does Evanston’s public health system… 1. Complete a workforce assessment (a process to track the numbers, types, and skills/knowledge required of LPHS jobs) and use the 1.93 workforce assessment to identify and address gaps in the LPHS workforce? 2. Develop and maintain job standards and position descriptions based in the core knowledge, skills, and abilities needed to provide 3.75 the 10 Essential Public Health Services? 3. Provide opportunities and incentives for public health workers to attend trainings to develop core skills related to the 10 Essential 3.67 Services of Public Health?

4. Create a shared vision of community health and the LPHS, 3.12 welcoming all leaders and community members to work together?

STANDARD 9: EVALUATE EFFECTIVENESS, ACCESSIBILITY, AND QUALITY OF PERSONAL AND POPULATION-BASED HEALTH SERVICES Average Score Question (Out of 5) At what level does Evanston’s public health system… 1. Assess whether community members, including vulnerable populations, are satisfied with the approaches taken toward 2.35 promoting health and preventing disease, illness, and injury?

2. Evaluate population-based health services, and use evaluation 2.88 findings to improve plans, processes, or services?

3. Assess how well the organizations in the LPHS are communicating, 2.53 connecting, and coordinating services?

STANDARD 10: RESEARCH FOR NEW INSIGHTS AND INNOVATIVE SOLUTIONS TO HEALTH PROBLEMS Question Average Score (Out of 5) At what level does Evanston’s public health system…

1. Encourage community partnerships in research, including deciding 2.49 what will be studied, conducting research, and sharing results?

2. Partner with colleges, universities, or other research organizations to conduct public health research and develop continuing education 2.50 programs for public health workers?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 25 3. Collaborate with researchers who offer the knowledge and skills to 2.27 design and conduct health-related studies?

Average Score of each Essential Public Health Service Standard Average Score (Out of 5) Standard 1: Monitor Health Status 2.68 Standard 2: Diagnose/Investigate 3.17 Standard 3: Educate/Empower 2.57 Standard 4: Mobilize Partnerships 2.50 Standard 5: Develop Policies/Plans 2.89 Standard 6: Enforce Laws 3.70 Standard 7: Link to Health Services 2.88 Standard 8: Assure Workforce 3.10 Standard 9: Evaluate Services 2.59 Standard 10: Research/Innovations 2.43

Average Score for Essential Public Health Services from LPHSA 5

4.5

4 3.7 3.5 3.17 3.1 2.89 2.88 3 2.68 2.57 2.5 2.59 2.43 2.5 2 1.5

1 Average Score (Out of 5) of (Out Score Average 0.5 0

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 26 Community Health Status Assessment

Purpose The purpose of the Community Health Status Assessment is to answer the questions: “How healthy are our residents?”, and “What does the health status of our community look like?”

Part 1: Community Health Survey Results

Process The MAPP Operations Team used the 2013 Community Health Survey as a base for the 2015 Community Health Status Assessment. The Operations Team went through multiple drafts of the 2013 survey, and edited questions that they felt should be changed, added, or deleted. When possible, the MAPP Operations edited questions so that they were in line with questions from CDC’s Behavioral Risk Factor Surveillance System (BRFSS) survey, County Health Rankings, and other national surveys. The MAPP Operations Team also polled local organizations to see what Evanston- specific information was needed for their own needs. As Evanston has a lack of municipal health data, the Community Health Status Assessment served as a springboard to collect much-needed Evanston-specific information.

Once the Community Health Survey went through multiple internal revisions, it was sent to the Institutional Review Board (IRB) of NorthShore University HealthSystem. This IRB is comprised of fifteen physicians, researchers, and community leaders. The survey was discussed during the IRB’s June 2015 meeting. Once edits were sent back, the MAPP Operations Team continued to revise the survey. A final draft was published on June 19, 2015. The final survey, along with the sources of vetted questions, can be found in Appendix F.

Once the final draft of the survey was completed, it was uploaded online onto the HIPAA-complaint version of SurveyMonkey. Postcards and doorhangers were printed that provided a link to the online survey, as well as an explanation of the EPLAN process. Hard copies of the survey were also printed.

To distribute the survey electronically, the MAPP Operations Team emailed the link to a variety of Evanston mailing lists, including City of Evanston staff members, City Council members, Northwestern students, the Women out Walking Program, and Evanston Cradle to Career. In addition, a press release that described the survey and ended with a call to participate in the survey was drafted and released on June 22nd to all members on the City of Evanston mailing list. An advertisement to take the survey was also posted on the front page of the City of Evanston’s website during the entirety of when the survey was open. The City of Evanston utilized Facebook and Twitter to encourage community residents to participate.

In addition, postcards with the link to the Community Health Survey were distributed at various community centers, including City of Evanston facilities and the Evanston Public Libraries. In mid- July, halfway through the time period allotted for survey distribution, the MAPP Operations Team looked at which wards had relatively less participants. The wards were identified, and doorhangers were distributed in residential areas corresponding to the underrepresented wards. A promotion for

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 27 the survey was also printed on the bottom of the City’s water bill in August, which was mailed to thousands of Evanston residents. The MAPP Operations Team promoted the survey at any community meetings they were attending between June and August.

The surveys were also distributed at a variety of community centers and events. The MAPP Operations Team reserved tables at the Evanston Public Library and Levy Senior Center with iPads and hard copies of the survey, so that residents could take the survey at that location. Staff members were also present at a variety of community events with iPads, hard copies of the survey, and promotional postcards; these events included the Central Street Sidewalk Sale, the Lakeshore Arts Festival, Y.O.U. Summer Showcase, the Ethnic Arts Festival, the Farmer’s Market, and CommUNITY Picnic. Hard copies of the survey were also placed at a high school health center, so that parents of high school students participate.

Lastly, in order to promote the survey in populations that were historically more difficult to reach, the City’s General Assistance office agreed to have their clients take the survey during their monthly one- on-one meetings. In promoting the survey in these difficult-to-reach populations, the MAPP Operations Team attempted to reach all segments of the City.

The survey closed on August 26, 2015, and was open for a total of ten weeks. 610 responses were gathered.

Characteristics of Survey Responses The 2015 Community Health Survey was open for a total of 10 weeks, beginning on June 19th, 2015, and ending on August 26th, 2015. 610 completed survey responses were collected, a 28% increase from the last iteration of the Community Health Survey in 2013, which collected 478 responses. The survey respondents represent a convenience sample, as surveys were distributed via email mailing lists, and at various community events and community centers.

The demographic and socioeconomic characteristics of survey respondents can be seen in the graphs below, as compared to US Census Data. 69% of respondents were female, and 30% were male, with the remaining individuals selecting “Prefer not to respond”. The median age of respondents was 51, with a mean age of 50. 70% of respondents self-identified as “White”, 16% self-identified as African-American, 3% self-identified as “Two or More Races”, and 2.8% self- identified as Asian. 82% identified themselves as “Not Hispanic or Latino”, and 4.42% identified themselves as “Hispanic or Latino”. 48% of respondents recorded having a graduate or professional degree, 29.3% as a Bachelor’s Degree, 13% as “Some College”, 5.24% as a High School Diploma, and 2.45% as having “Less than a High School Diploma” as the highest education level obtained. 32% reported having an annual household income of Over $100,000, 24.4% as having an income between $50,000 and $99,000, 12% as having an income between $25,000 and $49,999, and 17% as having an income of less than $25,000.

The overall demographics of survey respondents are somewhat similar to Evanston’s reported demographics. 69% of respondents who took the survey were female, similar to responses gathered in the 2013 and 2010 community health surveys. Although our sample was a convenience sample, there were many similar characteristics to the sample population in terms of race and income level, as seen in the graphs below

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 28

Survey Responses by Age Group

71

111

113

Age Age Group Axis Title 149

109

56

Mean Age: 50.1

Median Age: 51

Race

0% 20% 40% 60% 80% % of respondents

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 29

%of Respodents

Health Insurance and Health Care According to the 2015 Community Health Survey, Evanston fares better in health care coverage and access rates compared to the state and nation. As seen in the graphs below, 88% of survey respondents have at least one person they think of as a person doctor of health care provider, compared to 80% in the state and 77% in the nation. In addition, according to ACS 2009-2013 results, 8.1% of Evanston’s population has no health insurance, as compared to 17% in Cook

County, 13% in Illinois, and 15% in the United States.

%of Respodents

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 30

%of Respondents

Responses to: “When did you last receive the following services? (Survey 2015) Complete physical Blood pressure check Dental Exam exam Within the past year 61% 84% 76% 1-2 years ago 26% 13% 13% 3-5 years ago 7% 2% 5% More than 5 years ago 6% 1% 5% Never 0% 0% 0%

The table above depicts when survey respondents last noted receiving certain services. 61% of respondents stated they had last received a physical exam in the last year. 13% had stated they had last received a physical exam more than 2 years ago. 84% of respondents stated they had last received a blood pressure check in the past year, while 76% of respondents stated they had last received a dental exam within the past year.

Chronic Health Conditions According to the 2015 Community Health Survey, Evanston fares better in chronic health conditions in relation to diabetes and hypertension. 6% of respondents stated they had ever been diagnosed with diabetes, as compared to 10% in both the state and nation. This is an improvement of the 11% from the 2013 survey. In addition, 25% of respondents stated they had ever been diagnosed with high blood pressure, as compared to 30% in the state and 31% in the nation. However, Evanston seems to fare worse in relation to asthma. 19% of respondents stated they had been diagnosed with asthma at some point in their lives, as opposed to 12% in the state and 14% in the nation. This is similar to higher asthma levels seen in the 2013 survey, where 15% of survey respondents stated they had ever been diagnosed with asthma.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 31

%of Respondents

Physical Activity and Nutrition Overall, Evanston residents seem to participate in physical activity more than at the county, state, and national levels. 92% of survey respondents stated they participated in some form of physical activity outside their regular job in the past month, in comparison to 75-78% found in Chicago, suburban Cook County, Illinois, and the United States. In addition, on average, survey respondents reported engaging in 47 minutes of physical activity per session.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 32 In relation to nutrition, 59% of respondents eat 3 or more servings of fruits/vegetables per day. This seems to be an increase from 2013, where 52% of respondents stated that they ate 3 or more servings of fruits and vegetables per day.

%of Respondents

In regards to sugar-sweetened beverages, 57% of respondents stated that they drank no sugar-sweetened beverages in the last 7 days. 34% said they drank sugar-sweetened beverages 1-5 times in the last 7 days. 9% of respondents stated they drank sugar- sweetened beverages more than 5 times in the last 7 days. These numbers are similar to those found in the 2013 survey. Sugar-sweetened beverages were defined as beverages such as soda, sugar-sweetened fruit drinks (such %of Respondents as Kool-Aid and lemonade), sweet tea, and sports or energy drinks (such as Gatorade or Red Bull). Diet soda, 100% fruit juice, or artificially sweetened drinks were not included.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 33 Most survey respondents seem to have access to fresh, healthy foods. 79% of respondents said it was “very easy” for them to get fresh produce, and 17% said it was “somewhat easy”. Only 4% of respondents stated it was “somewhat difficult” or “very difficult” to get fresh produce.

When looking at BMI rates in Evanston, it seems as though Evanston residents fare better than the county, state, and nation. 18% of respondents were calculated to have a BMI greater than or equal to 30, the cutoff for obesity. This is less than BRFSS estimates for Cook County, Illinois, and the United States, which are at 25%, 27%, and 31% respectively.

% of Adults that Report a BMI >=30 Evanston (Survey 2015) 18% Cook County 25% Illinois 27% United States 31%

Quality of Life and Mental Health

In response to mental health issues, 59% of respondents said they had no days in the past 30 days where their mental health was not good. 26% of respondents said their mental health was not good for 1-7 days in the past month, and 15% said their mental health was not good for 8-30 days in the past month. These responses are similar to those seen in the Illinois BRFSS survey responses in 2013.

10% said “Yes” in response to “During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it?” The top three reasons cited for not receiving mental health treatment were cost, health insurance not covering mental health treatment, and not knowing where to go for mental health services.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 34

%of Respondents

Immunizations

Evanston seems to fare well regarding childhood immunizations. 93% of parents stated that their child received all of the vaccinations required for school, similar to responses found in the 2013 survey. Only 5% said their children did not receive all of the vaccinations required for school, and 3%

didn’t know.

%of Respondents

Response

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 35 Axis Title

Substance Use

Evanston’s smoking rates are lower than state and national rates as well. According to the 2015 survey, 11% of respondents are current smokers. This is considerably lower than the state and national rates of 18% and 19%, respectively. EDHHS used CDC’s definition of current and former smokers. Current smokers were defined as those who reported smoking at least 100 cigarettes in their lifetime, and who, at the time of the survey, smoked either every day or some days. Respondents who reported smoking at least 100 cigarettes in their lifetime and who, at the time of the survey, did not smoke at all were defined as Former Smoker. Respondents who reported never

having smoked 100 cigarettes were defined as Never Smoker.

SmokingStatus

Evanston also fares better compared to the state and nation in regards to binge drinking. Only 10% of respondents were defined having partaken in binge drinking in the past 30 days. Binge drinking was defined by CDC standards—males having five or more drinks in one occasion, and females having four or more drinks in one occasion.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 36

%of Respondents

When looking at other substances, 60% of respondents reported that they had ever used marijuana. However, 79% of respondents stated that this was more than 12 months ago. 18% of respondents said they had ever used any other illicit substances, including cocaine, heroin, methamphetamine, etc. However, 94% of those who said they had ever used those illicit substances stated it was more than 12 months ago. 12% of respondents stated they had ever used prescription drugs that were specifically prescribed to them. Out of those 12%, 25% said they used prescription drugs that weren’t specifically prescribed to them within the past 12 months.

60%

50% 40% 30% 20%

%of Respondents 10%

0% everused substance %of Respondents that theystatedhad

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 37 Biggest Perceived Health Issues

The Community Health Survey asked residents to choose what they perceived as the three most important health issues that affect the health and quality of life of residents in Evanston. The results from this question are listed below:

1. Mental Health Issues—43.4% 2. Physical Inactivity—38.1% 3. Obesity—35.2% 4. Problems related to aging—22.6% 5. Injury/violence—21.4% 6. Alcohol/substance abuse—20.8% 7. Smoking/tobacco use—18.5% 8. Heart disease/stroke—11.5% 9. Diabetes—11.4% 10. High blood pressure—10.3% 11. Lack of access to fresh, healthy food—9.8% 12. Cancer—9.17% 13. Dental problems—5.4% 14. Teenage pregnancy—5.2% 15. Sexually transmitted infections—2.96%

Part 2: Community Health Survey Correlation Results

To further analyze results for health disparities, EDHHS partnered with Loyola University Chicago to perform in-depth statistical analysis on the results of the Community Health Survey. EDHHS asked Loyola University Chicago to analyze key questions with respect to five demographic variables to see whether correlations existed between certain survey items. The five demographic variables chosen were: age, gender, income, race, and ward number.

Below are summaries of which correlations were found to be statistically significant, with a p value of less than 0.001. The raw results of the correlations can be found in Appendix G of this document, along with further information on which statistical tests were used.

Age

 Having a personal physician  Completion of last physical  Last blood pressure check-up  Hypertension rate  Sugar-sweetened beverage consumption

Gender

 Last dental exam  Having blood pressure checked

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 38  Sugar-sweetened beverage consumption  Fruit and vegetable consumption

Income

 Having a personal physician  Last dental exam  Hypertension rate  Sugar-sweetened beverage consumption  Fruit and vegetable consumption  Condom use  Smoking status  Marijuana use

Race

 General perception of health in Evanston  Having a personal physician  Last dental exam  Diabetes rate  Hypertension rate  Physical activity participation  Sugar-sweetened beverage consumption

Ward

 No statistically significant results that could be marked as true correlations, due to all the levels

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 39 Part 3: Other Evanston Data

In addition to the Community Health Survey, EDHHS can query results from the Illinois Department of Public Health and the United States Census for more zip code specific information. All zip-code specific data that could be found from these sources are listed below.

Demographic and Socioeconomic Characteristics of Evanston, Illinois

Demographic Characteristics of Evanston Residents

Category Estimate % Total Population 74,486 100% Total Households: 30,047 100% Family Households 15,621 52.0% Non-family Households 14,426 48.0% Gender: Female: 38,996 52.4% Male: 35,490 47.6% Race: American Indian / Alaska Native: 175 0.2% African American, or Black: 13,474 18.1% Asian: 6,416 8.6% Native Hawaiian or Pacific Islander: 16 0.0% White: 48,872 65.6% Other: 2,687 3.6% Two or More Races: 2,846 3.8% Ethnicity: Hispanic or Latino: 6,739 9.0% Not Hispanic or Latino: 67,747 91.0% Age: Under 10: 8,391 11.3% 10-19: 10,037 13.5% 20 – 29: 14,299 19.2% 30 – 39: 10,037 13.5% 40 – 49: 9,480 12.7% 50 – 59: 9,380 12.6% 60 – 69: 6,547 8.8% 70 – 79: 3,207 4.3% > 80: 3,108 4.2%

Source: U.S. Census Bureau, 2010 Census for Evanston, IL

Income and Benefits (in 2013 Inflation-Adjusted Dollars)* Estimate Percent Total households 28,929

Less than $10,000 2,403 8.3%

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 40 $10,000 to $14,999 1,214 4.2% $15,000 to $24,999 2,277 7.9% $25,000 to $34,999 2,276 7.9% $35,000 to $49,999 3,648 12.6% $50,000 to $74,999 4,068 14.1% $75,000 to $99,999 2,930 10.1% $100,000 to $149,999 4,526 15.6% $150,000 to $199,999 2,046 7.1% $200,000 or more 3,541 12.2%

Median household income (dollars) 67,610 (X) Mean household income (dollars) 100,768 (X) Source: 2011-2013 American Community Survey 3-Year Estimates

Mean/Median Household Income Comparison

72,897 U.S.

52,176

77,143 Cook County Mean Household

53,172 Income Region Median Household 100,768 Evanston Income 67,610

0 50,000 100,000 150,000 Income (in 2013 inflation-adjusted dollars)

Percent of Residents Living Below the Poverty Level United States Cook County City of Evanston % Below Poverty Level % Below Poverty Level % Below Poverty Level All people 15.9 17.8 13.2 Families 11.7 13.8 5.8 Single mother 31.3 31.2 15.6 households Source: 2011-2013 American Community Survey 3-Year Estimates

Percent of Residents Receiving Food Stamps and Cash Public Assistance Income # Receiving % Receiving # Receiving % Receiving Food Stamps Food Stamps Cash Cash Assistance Assistance Evanston 1,995 6.9% 436 1.5% Cook County 299,287 15.5% 65,919 3.4% United States 15,467,053 13.4% 3,307,934 2.9% Source: 2011-2013 American Community Survey 3-Year Estimates

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 41 Employment Status of those 16 and older Estimate % of population 16 years and older Population 16 years and over 61,604 In a labor force 39,493 64.1% Civilian labor force 39,480 64.1% Employed 36,039 58.5% Unemployed 3,441 5.6% Armed Forces 13 <1% Not in labor force 22,111 35.9% Unemployment Rate 8.7% Source: 2011-2013 American Community Survey 3-Year Estimates

Educational Attainment in those 25 years and older Estimate Percent Population 25 years and over 47,495 63.1% Less than 9th grade 1,444 3.0% 9th to 12th grade, no diploma 1,335 2.8% High school graduate (includes equivalency) 4,963 10.4% Some college, no degree 6,307 13.3% Associate's degree 1,521 3.2% Bachelor's degree 13,890 29.2% Graduate or professional degree 18,035 38.0%

Percent high school graduate or higher (X) 94.1% Percent bachelor's degree or higher (X) 67.2% Source: 2011-2013 American Community Survey 3-Year Estimates

Educational Attainment Comparison by Region 100.0%

90.0% 80.0% 70.0% 60.0% % high school or higher 50.0% 40.0% % bachelors degree or 30.0% higher 20.0% % graduate/professional Percentagepopulationof 10.0% school 0.0% Evanston Cook U.S. County Region

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 42 Health Insurance Coverage Estimate Percent Civilian noninstitutionalized population 73,945 With health insurance coverage 68,181 92.2% With private health insurance 59,243 80.1% With public coverage 15,649 21.2% No health insurance coverage 5,764 7.8%

Percentage without health insurance for noninstitutionalized population 83 0.5% under 18 Percentage without health insurance for noninstitutionalized population ages 5,602 11.3% 18-64 Source: 2011-2013 American Community Survey 3-Year Estimates

Percentage of Residents with Health Insurance by Region

Healthy People 2020 100

USA 85.2

Cook County 83.4 Region

Evanston 92.2

*All data is for civilians who are 75 80 85 90 95 100 noninstitutionalized under 65 Percentage

Communicable Disease Data

Evanston HIV and AIDS Incidence and Prevalence Rates in 2013 HIV Cases Diagnosed in 2013 8 HIV Cumulative Cases Diagnosed Since 2006 95 AIDS Cases Diagnosed in 2013 7 AIDS Cumulative Cases Diagnosed Since 2006 52 Total Living HIV Cases in Evanston, as of 12/2013 91 Total Living HIV Causes in Evanston, as of 12/2013 129 Source: IDPH STD Monthly Surveillance Update for December 2013

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 43 Other Sexually Transmitted Diseases in Reported in 2013 Chlamydia Chlamydia Gonorrhea Gonorrhea Early Early Cases Cases per Cases Cases per Syphilis Syphilis 100,000 100,000 Cases Cases per 100,000 Evanston 230 308.8 43 57.7 1 1.3 Cook County 24,709 475.7 7,322 141.0 1,171 22.5 Illinois 53,848 419.7 13,332 103.9 1,260 9.8 United States 1,401,906 446.6 333,004 106.1 17,375 5.5 Note: Rates per 100,000 were calculated by using the population census for the region from 2010. *Source: IDPH STD Monthly Surveillance Update for December 2013 and CDC 2013 Reported STD Fact Sheet

STD Diagnosis Rates in 2013 by Region 500 446.6 450 475.7 400 419.7 350 308.8 300 Evanston 250 Cook County 200 Illinois 150 106.1 Rate per 100,000perRate United States 100 57.7 103.9 50 1.3 9.8 5.5 0 Chlamydia Gonorrhea Early Syphilis STD

Cancer Incidence Data

Cancer Incidences: 2008-2012 Male count Female Count Total Count Oral Cavity 25 15 40 Colorectal Cancer 62 84 146 Lung and Bronchus 73 87 160 Breast (invasive) 356 356 Breast in situ 101 101 Cervical Cancer 13 13 Prostate Cancer 247 247 Urinary System 73 44 117 Nervous System 11 8 19 Leukemia’s and Lymphomas 85 73 158 All other cancers 243 330 573 All cancers combined 819 1111 1930 Source: Illinois Department of Public Health Cancer in Illinois (http://app.idph.state.il.us/EpiStudies/public/genericdb/code/GenericList.asp)

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 44 Cancer Incidence Data by 5-Year Period in Zip Codes 60201 and 60202

2008-2012 1924

2003-2007 1833

1998-2002 1771

Year PeriodYear

- 5

1993-1997 1653

1500 1550 1600 1650 1700 1750 1800 1850 1900 1950 Cancer Incidence Counts by 5-Year Periods

Leading Causes of Death

Cause of Death 2010 2010 2011 2011 2012 2012 Number Percentage Number Percentage Number Percentage Total Number 476 464 511 Diseases of Heart 110 23.11% 105 22.63% 122 23.87% Malignant 101 21.22% 97 20.91% 115 22.50% Neoplasms Coronary Heart 64 13.45% 67 14.44% 69 13.50% Disease Influenza and 17 3.57% 11 2.37% 20 3.91% Pneumonia Chronic Lower 19 3.99% 31 6.68% 19 3.72% Resp. Disease Bronchus and 21 4.41% 22 4.74% 21 4.11% Lung Cancer Colorectal Cancer 11 2.31% 7 1.51% 13 2.54% Cerebrovascular 26 5.46% 37 7.97% 30 5.87% Disease Accidents 14 2.94% 12 2.59% 12 2.35% Suicide 6 1.26% 3 0.65% 7 1.37% Homicide 6 1.26% 2 0.43% 3 0.59% Other 92 19.33% 77 16.59% 93 18.20% Source: IDPH Vital Statistics

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 45 Leading Causes of Death in Evanston in 2012

Heart Disease

1% Malignant Neoplasm 1% 18% 24% 2% Coronary Heart Disease 6% Influenza and Pneumonia

23% Chronic Lower Respiratory 4% Disease 13% 4% Bronchus and Lung Disease 4% Cerebrovascular Disease

Accidents

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 46 Part 4: County Health Rankings Summary

As there is a lack of data regarding morbidity and behavioral risk factors for Evanston, the Evanston Department of Health and Human Services must use county level data to inform some initiatives. County Health Rankings provides a model of population health that emphasizes factors that can greatly affect a community’s health. Health indicators are weighted by a specific methodology and counties are ranked within a state. Although County Health Rankings can only provide information and rankings for Cook County, which includes the diverse city of Chicago and many of its surrounding suburbs, this information can still be used as a benchmark to judge Evanston’s health status. In addition, Evanston data is shown when Community Health Survey items could be compared to 2015 County Health Rankings data, or when Evanston-specific data could be pulled from data sources.

The counties are ranked in two large categories: health outcomes and health factors. The health outcomes rating is based on the length and quality of life in a county. The health factors rating is based on health behaviors, clinical care, social/economic factors, and the physical environment.

In terms of health outcomes, Cook County was ranked in the bottom 50% of Illinois, in 64th place out of 102 counties. In terms of health factors, Cook County was ranked in the bottom 40%, in 70th place out of 102 counties. 2015 Cook County Health Snapshot

Evanston United Cook Health Indicator Health indicator definition (if Illinois States County available) Median Years of potential life lost Premature death before age 75 per 100,000 6,794 6,349 7,681 population (age-adjusted) Percent of adults reporting fair Poor or fair health 17% 15% 17% or poor health (age-adjusted) *10% Average number of physically Poor physical unhealthy days reported in 3.5 3.4 3.7 health days past 30 days (age-adjusted) Average number of mentally Poor mental health unhealthy days reported in 3.5 3.3 3.5 days past 30 days (age-adjusted) Percent of live births with low Low birth weight 9.1% 8.4% 8% birth weight (< 2500 grams) Percent of adults who are Adult smoking *11% 18% 18% 21% current smokers Percent of adults that report a Adult obesity *18% 25% 27% 31% BMI >= 30 Index of factors that Food environment contribute to a healthy food 7.6 7.8 7.3 index environment (0-10) Percent of adults aged 20 and Physical inactivity over reporting no leisure-time 21% 23% 27% physical activity Percent of the population with Access to exercise adequate access to locations 99% 89% 65% opportunities for physical activity

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 47

Evanston United Cook (if Illinois States County applicable) Median Percentage of adults reporting Excessive drinking 21% 20% 16% binge or heavy drinking Alcohol-impaired Percent of driving deaths with 39% 37% 31% driving deaths alcohol involvement Sexually # of newly diagnosed transmitted chlamydia cases per 100,000 304** 725 526 291 infections population Number of teen births per Teen births 1,000 female population ages 42 35 41 15-19 % of adults under age 65 Uninsured adults 11.3%# 18% 15% 17% without health insurance Primary care Ratio of population to primary 1,088:1 1,266:1 2,015:1 physicians care physicians Dentists Ratio of population to dentists 1,250:1 1,453:1 2,670:1 Mental health Ratio of population to mental 505:1 604:1 1,128:1 providers health providers Number of hospital stays for Preventable ambulatory-care sensitive 44.6& 60 65 65.3 hospital stays conditions per 1,000 Medicare enrollees Percent of diabetic Medicare Diabetic screening enrollees ages 65-75 that 87.1%& 83% 85% 85% receive HbA1c screening Percent of female Medicare Mammography enrollees ages 67-69 that 70.9%& 62.4% 64.4% 61% screening receive mammography screening High school Percent of ninth grade cohort 78% 82% 85% graduation that graduates in 4 years Percent of adults aged 25-44 Some college years with some post- 67% 66.7% 56% secondary education Percent of population age 16 Unemployment years and older unemployed 8.5%# 9.6% 9.2% 7% but seeking work Percent of children under 18 Children in poverty 9.5%# 26% 21% 24% in poverty Ratio of household income at Income inequality the 80th percentile to income 5.3 4.8 4.4 at the 20th percentile Percent of children that live in Children in single- household headed by single 21%# 38% 32% 31% parent households parent Number of membership Social associations 7.1 9.9 12.6 associations per 10,000

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 48 population United Evanston, if Cook Illinois States applicable County Median Number of reported violent Violent crime crime offenses per 100,000 631 430 199 population Number of deaths due to Injury deaths 46 50 73.8 injury per 100,000 Average daily density of fine Air pollution- particulate matter in 13.1 12.5 11.9 particulate matter micrograms per cubic meter (PM2.5) Percent of population Drinking water potentially exposed to water 1% 2% 1.0% violations exceeding a violation limit during the past year Percent of households with Severe housing overcrowding, high housing 24% 19% 14% problems costs, or lack of kitchen or plumbing facilities Driving alone to Percent of workforce that 48.6%# 63% 74% 80% work drives alone to work Among workers who commute Long commute- in their car alone, the percent 49% 40% 29% driving alone that commute more than 30 minutes

*Evanston-specific information that was gathered via the 2015 Community Health Survey. 2015 Community Health Survey responses were not age-adjusted or statistically altered in any way, and may not be directly comparable to county, state, and national data provided by County Health Rankings

**Estimate based off of IDPH STD Data for Evanston, IL. Estimate was not age-adjusted or statistically altered in any way, and may not be directly comparable to county, state, and national data provided by County Health Rankings

#Based on American Communities Survey Data from 2009-2013 for Evanston, IL

&Based on data from the Dartmouth Atlas of Healthcare. However, Dartmouth Atlas of Healthcare estimates are by hospital region, not zip code. Thus, data from this source is not Evanston-specific, and refers to Evanston’s hospital referral region.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 49 HEALTH PRIORITY SELECTION

Once all of the Community Health Assessment data was collected, the MAPP Operations Team reviewed the data and identified themes that emerged from all four assessments. Upon review, the MAPP Operations Team identified eight strategic issues that could be selected as health priorities. These strategic issues were:

 Alcohol Use and Abuse  Mental Health  Obesity  Oral Health  Prescription Drug Abuse  Respiratory Health  Sexual Health  Violence

The eight strategic issues were presented at the third community-wide meeting for the EPLAN process, on September 17, 2015. Community stakeholders were invited by the MAPP Operations Team to review results from the assessments and vote on three health priorities. A total of 58 community leaders attended the meeting. When voting, attendees were asked to consider the following: what the data showed, the ability of the public health system in Evanston to improve health outcomes in each health priority area, and the creation of measurable, actionable goals for each health priority area. A list of attendees who participated in the health priority selection process can be found in Appendix D of this document.

Once the data was presented, community stakeholders were asked to rate what they believed the top three health priorities were using stickers labeled “1”, “2”, and “3”. The most important health priority for an attendee (stickers labeled with a “1”) was given 3 points, the second most important health priority (stickers labeled with a “2”) was given 2 points, and the third most important health priority (stickers labeled with a “3”) was given 1 point. Attendees were given 15 minutes to vote on their three health priorities.

After voting had occurred, the MAPP Operations Team tallied up the votes. The point totals were:

1. Mental Health—123 points 2. Violence—73 points 3. Obesity—67 points 4. Respiratory Health—18 points 5. Alcohol Use and Abuse—12 points 6. Sexual Health—11 points 7. Prescription Drug Abuse and Oral Health (tie)—10 points each

Based on the results of community stakeholder voting, the three health issues with the highest point totals were chosen as the strategic health priorities for 2016-2021. Thus, the final health priorities chosen were: Mental Health, Violence, and Obesity.

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 50 APPENDIX A: FOCUS GROUP GUIDE AND QUESTIONS

Below is a copy of the guide used for resident and service provider focus groups.

Introduction

 Thank you for taking the time to join us today.  INTRODUCE SELF AND NOTETAKER

I am working with the Evanston Department of Health and Human Services on an assessment of Evanston’s health needs titled EPLAN: Creating a Healthier Evanston. The process involves gathering residents, public health officials, and community leaders to discuss Evanston’s health needs and identify solutions to address them. Today, we would like to hear what you think about the physical, mental, and environmental health of your community. The information that you share, along with information gathered from a community survey and other discussions, will help us plan future programs that better meet the needs of residents in Evanston.

No names will be attached to any of the information we collect. We will share what we learn with community and agency members in a larger community health assessment, which may be presented in various meetings. In the fall of next year, we will write a report about our city’s health to submit to the state.

While we talk today, I want you to feel free to share your opinions and thoughts even if they are different from others and to react to each other’s thoughts. There are no right or wrong answers. I am here to help facilitate the discussion and listen to what you have to say. [Insert name] will be taking notes. Since this is a group discussion, you do not have to wait for me to call on you to speak. Anything we say here is confidential. I ask that when you all leave today that you remember to respect others’ privacy and not share any information outside of this discussion. We will take for 45 minutes- an hour.

You are here because you voluntarily agree to participate in this group discussion. However, if for any reason you feel uncomfortable and do not want to continue in this discussion, you are free to withdraw any time. This will not affect the services you received in the future from the City of Evanston in any way. Again, no names will be attached to the information we collect. Is this okay with everyone?

Does anyone have any questions?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 51 Focus Group Questions: Resident Groups

OPENING QUESTION

1. Let’s start with introductions. One at a time, please introduce yourself, and tell us how long you’ve been living in the Evanston community.

INTRODUCTORY QUESTIONS

2. Another way to think about health is looking at the health of a community, not just individuals. To you, what would a healthy community look like?

TRANSITION QUESTIONS

3. What do you think are the most healthy things about your physical community/Evanston?

KEY QUESTIONS

4. Thinking about the people in your community, what are your main health concerns? 5. Where do you go for health care services? a. Probe: The hospital, clinic, health department, other (cultural healers) 6. Tell us about your own experience getting the help you need in Evanston a. Probe: Positive experiences, challenges/barriers 7. What assets does Evanston have to being healthy? 8. What are the barriers to being healthy in Evanston? 9. Where do you and others in your community get most of your health information? a. Probe: TV, radio, internet? Experience or comfort level with technology? 10. Are there groups of people within your community whose healthcare needs seem to be overlooked, or not met? a. Probe: Who? Older adults, men, women. In what ways? Why do you think that may be? 11. Think back over all the topics we’ve discussed. If you were in charge, what specific things would you do to improve the health status of community members? a. Probe: What specific things do you wish that agencies were doing to help you and your community? Are there things you would do to improve people’s access to care, health information, quality of care, subsidies/cost, and types of services available?

CLOSING

12. We want to make sure that the health programs in this community will help you and your community. With that in mind, is there anything that we have not asked or that you would like to add?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 52 Focus Group Questions: Service Providers

OPENING QUESTION

1. Let’s start with introduction. One at a time, please introduce yourself, and tell us how long you’ve been working in the Evanston community.

INTRODUCTORY QUESTIONS

2. Another way to think about health is looking at the health of a community, not just individuals. To you, what would a healthy community look like? 3. Today, we are talking about people’s health here in Evanston. What is it like working in this community? a. Probe: What are some of the best things about working in Evanston? What are some of the challenges or potential opportunities working in Evanston?

TRANSITION QUESTIONS

4. What do you think are the healthiest aspects of Evanston?

KEY QUESTIONS

5. Thinking about the people in your community, what are your main health concerns? a. Probe: Physical, mental, environmental 6. Are there groups of people within your community whose healthcare needs seem to be overlooked, or not met? a. Probe: Who? Older adults, men, women? In what ways? Why do you think this may be? 7. What assets does Evanston have to promote health? 8. What are the barriers to promoting health in Evanston? 9. Think back over all the topics we’ve discussed. If you were in charge, what specific things would you do to improve the health status of community members? a. Probe: What specific things do you wish that agencies were doing to help you and your community? Are there things you would do to improve people’s access to care, health information, quality of care, subsidies/cost, and types of services available?

CLOSING

10. We want to make sure that the health programs in this community will help you and your community. With that in mind, is there anything that we have not asked or that you would like to add?

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 53 APPENDIX B: FORCES OF CHANGE ASSESSMENT ORGANIZATION ATTENDEES

Thursday, May 21, 2015 Lorraine H. Morton Civic Center

Albany Care Evanston Township High School

Child Care Center of Evanston Evanston Township High School Board

Child Care Network of Evanston Family Focus

City of Evanston Administration Heartland Health Centers

City of Evanston City Council Hip Circle Studio

City of Evanston Community Development Illinois Public Health Institute

City of Evanston Fire Infant Welfare Society of Evanston

City of Evanston Health and Human Services Legal Assistance Foundation

City of Evanston Parks and Recreation Loyola University

City of Evanston Police McGaw YMCA

CJE SeniorLife Moran Center

Community Members NorthShore University HealthSystem

Connections for the Homeless Northwestern Community Health Corps

District 65 Northwestern University

Erie Family Health Center PEER Services

ETHS/NorthShore Health Center Presence Behavioral Health

Evanston Age Friendly Task Force Rush University

Evanston Community Foundation Skokie Health Department

Evanston Cradle to Career Skokie Metropolitan Family Service

Evanston Health Advisory Council The Family Institute at Northwestern

Evanston Medical Reserve Corps UIC School of Public Health

Evanston Mental Health Board Youth Organizations Umbrella

Evanston Public Library YWCA Evanston/North Shore

Evanston Substance Abuse Prevention Coalition

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 54 APPENDIX C: LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT ORGANIZATION ATTENDEES

Thursday, July 16, 2015 Lorraine H. Morton Civic Center

Evanston Township High School AcuDesign Health Evanston Township High School Board Age Friendly Evanston! Task Force Housing Options for the Mentally Ill in Evanston, Albany Care Inc.

Blount Psychology Illinois Public Health Institute

City of Evanston Alderman Infant Welfare Society of Evanston

City of Evanston City Clerk Loyola University Chicago

City of Evanston City Manager’s Office Mather Lifeways

City of Evanston Economic Development McGaw YMCA

City of Evanston Fire Metropolitan Family Services

City of Evanston Health & Human Services North Shore Village NorthShore University HealthSystem City of Evanston Library Oak Park Liquor Control Review Board City of Evanston Parks & Recreation PEER Services Community Member Presence Behavioral Health Elder Care Sources, LLC Presence Health Erie Family Health Center Presence St. Francis Hospital ETHS/NorthShore Health Center Evanston Community Foundation Presence St. Joseph Hospital

Evanston Health Advisory Council UIC School of Public Health

Evanston Medical Reserve Corps United Way of Metropolitan Chicago

Evanston Mental Health Board Walsh Natural Health

Evanston Substance Abuse Prevention Coalition Whole Foods Market, Downtown Evanston

Y.O.U. Evanston

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 55

APPENDIX D: HEALTH PRIORITY SELECTION ORGANIZATION ATTENDEES

Thursday, September 17, 2015 Lorraine H. Morton Civic Center

Asian Human Services Family Health Center Housing Options for the Mentally Ill in Evanston, Childcare Center of Evanston Inc.

Childcare Network of Evanston Illinois Public Health Institute

CJE SeniorLife James B. Moran Center for Youth Advocacy

City of Evanston City Clerk Loyola University Chicago

City of Evanston Fire Mather Lifeways

City of Evanston Health & Human Services McGaw YMCA

City of Evanston Mayor NorthShore University HealthSystem

City of Evanston Parks & Recreation Northwestern University

City of Evanston Police Department Oak Park Liquor Control Review Board

Community Members PEER Services

Connections for the Homeless Presence Behavioral Health

Elder Care Sources, LLC Presence St. Francis Hospital

ETHS/NorthShore Health Center Second Baptist Church of Evanston

Evanston Community Foundation St. Mark’s Church of Evanston

Evanston Health Advisory Council United Way of Metropolitan Chicago Evanston Mental Health Board Village of Skokie Health Department Evanston Substance Abuse Prevention Coalition Y.O.U. Evanston Evanston Township High School YWCA Evanston/North Shore Heartwood Center

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 56

APPENDIX E: LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT RESULTS

Below is a copy of the detailed assessment results, along with discussion notes, from the Local Public Health System Assessment.

STANDARD 1: MONITOR HEALTH STATUS TO IDENTIFY AND SOLVE COMMUNITY HEALTH PROBLEMS Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system…  Though there is a good formal assessment system, there are big gaps in data, and we are not reaching the whole community with the Community Health 4. Promote the use of a Survey/Community Health Assessment Community Health  There is a long way to go in terms of collecting Evanston- Assessment among specific data, and effectively using data is a challenge 2.85 community members and  Promoting the use of the assessment has been good so partners? far, we have identified many community partners and members  Evanston Substance Abuse Prevention Coalition does community health assessments on a smaller scale  Evanston-specific data is very difficult to find, getting a representative sample for data is also difficult. Who are we capturing with these surveys? 5. Collect timely data  Though the Cook County Department of Public Health consistent with current collects data, they don’t share it with the other municipal 2.39 standards on specific health departments in the area (Skokie, Stickney, health concerns? Evanston)  There is not much information on whether the Evanston HHS is collecting data, tracing outbreaks, etc.  There are many gaps, even with the Community Health 6. Use Evanston-specific Assessment, no one knows how to access information data indicators from that is there relevant data sources in To the extent that we get Evanston-specific data, we use 2.76 Community Health  it well Assessments or other analyses?  Other organizations use the CDC, Evanston HHS, PEER Services to get Evanston-specific data

STANDARD 2: DIAGNOSE AND INVESTIGATE HEALTH PROBLEMS AND HEALTH HAZARDS Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system… 4. Maintain written  There is some guidance on the Evanston HHS website instructions on how to pertaining to various issues, such as bed bugs investigate and handle  The Illinois Department of Public Health’s guidelines are communicable disease generally not accessible to the public—we need a way to 3.09 outbreaks and public get this information health emergencies, including details about case finding, contact

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 57

tracing, and source identification and containment?

 Residents and community partners don’t know about drills and planning that goes on within the hospitals and 5. Evaluate incidents for region as a whole effectiveness and  There is no overarching knowledge on what is done at the opportunities for community-level, just within people’s own organizations 3.22 improvement (such as After Action Reports,  The process at the hospitals is quite detailed, they Improvement Plans, etc.)? document what did or did not go well, and create improvement plans. Many grants depend on improvement plans 6. Maintain constant (24/7)  Evanston Medical Reserve Corps have gone through access to laboratories scenarios a little bit, and there is some awareness, but it that can meet public is not extensive health needs during  IDPH does not offer much support in protocols for 3.20 investigations, transporting specimens; NorthShore University emergencies, threats, or HealthSystem has a great lab, but may not know what to other hazards? do in unusual situations

STANDARD 3: INFORM, EDUCATE, AND EMPOWER PEOPLE ABOUT HEALTH ISSUES Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system… 4. Coordinate health  Coordination is the key word—how much coordination is promotion and health actually going on? Organizations are isolated. education activities at the  The City of Evanston and Evanston organizations utilize 2.71 individual, interpersonal, social media well, but there are many at-risk residents in community, and societal the community we do not reach using this mechanism levels? 5. Develop a health  There is no single location to get information on events. communications plan and Only some events are well-publicized use relationships with  Outreach plans are available at about half of the different media providers agencies represented, but many still have challenges 2.11 (e.g. print, radio, TV, the with a formal plan Internet) to share  Youth should be represented here; we need to get them information with residents messages to share, a culture of including them and LPHS organizations? 6. Develop an emergency  Many organizations did not know of an emergency communications plan for communications plan each stage of an  Though communications are probably happening, are 2.94 emergency to allow for the they being put out in a timely fashion in a way that gets effective dissemination of out to people? information?

STANDARD 4: MOBILIZE COMMUNITY PARTNERSHIPS TO IDENTIFY AND SOLVE HEALTH PROBLEMS Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system…

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 58

3. Maintain a complete and  Many knew that a directory existed, but didn’t know current directory of where it was, and whether it was updated community organizations,  City of Evanston website is a good source of community as well as create forums information, but it’s hard to use 2.63 with these partners for communication of public health issues? 4. Establish community  The City partners with everyone, but does the community partnerships and strategic partner with each other? Interaction at community alliances to provide a events can be improved. comprehensive approach  Networking can improve to improving health in the 2.38 community, as well as assessing how well these partnerships are working to improve community health?

STANDARD 5: DEVELOP POLICIES AND PLANS THAT SUPPORT INDIVIDUAL AND COMMUNITY HEALTH EFFORTS Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system…  Various collaboratives are created every year to 5. Support the collaboration encourage coordination, but it seems like nothing is ever of the members of the done with them. Nothing concrete comes out of these system to ensure there various collaboratives. 2.59 are adequate resources to provide the 10 Essential  Erie partners well with the YMCA to refer patients to Public Health Services? them. A lot of outreach occurs at each organization as well. 6. Contribute to public  The Health & Wellness Business Association doesn’t health policies by meet very often, it would be more effective if they could reviewing existing policies  Many don’t know of other public health agencies don’t at least every 3-5 years, policy review, and when 3.29 and engaging in activities that inform the policy development process? 7. Establish a Community  Many don’t know of other strategic plans, such as the Health Improvement Plan, Community Health Improvement Plan. with broad-based diverse  The YMCA has a strategic plan relating to health for participation, that uses younger children information from the  Erie/YMCA have effective health improvement plans 2.69 Community Health  Many organizations didn’t know about the CHIP; if Assessment, connects to organizations don’t know about it, it means it’s not organizational strategic effective plans? 8. Support a workgroup that  Many knew that specific emergency response plans develop and maintains existed, but didn’t know what the plans consisted of, and emergency preparedness who they related to response plans, as well as  After-school programs at the schools don’t have actually develop an evacuation plans, this needs to be fixed 3.07 emergency preparedness  Many believed that the Fire Department was the only response plan that organization involved in Emergency Preparedness defines when it would be planning used, who would do what

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 59

tasks, what standard operating procedures would be put in place, and what alert and evacuation protocols would be followed?

STANDARD 6: ENFORCE LAWS AND REGULATIONS THAT PROTECT HEALTH AND ENSURE SAFETY Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system… 4. Stay up-to-date with  On the Environmental Health side, food safety, lead current laws, regulations, safety, and memberships keep the inspectors up to date and ordinances that on laws and regulations promote public health, in  There is a lot of work done on the provider side of this, addition to having access as there is no way around it 3.75 to legal counsel for  Many members did not know technical assistance when reviewing these laws, regulations, and ordinances? 5. Participate and provide  Many did not feel comfortable rating this question technical assistance in  Many expressed that they were not aware of laws that changing existing laws, are passed regulations, ordinances,  The laws that organizations are aware of include 3.57 and/or creating new laws, Tobacco 21, the Northwestern tobacco campus initiative, regulations, and and creation of bike lanes ordinances that promote public health? 6. Identify organizations that  Many did not feel comfortable rating this question have the authority to  Organizations assumed that the Health & Human enforce public health Services Department is responsible for making sure their laws, regulations, and codes are done within the law ordinances, and ensure  Organizations have not heard of anything related to this 3.77 that all enforcement front, which they expressed is a good thing; “no news is activities related to public good news” health codes are done within the law?

STANDARD 7: LINK PEOPLE TO NEEDED HEALTH SERVICES AND ASSURE THE PROVISION OF HEALTHCARE WHEN OTHERWISE UNAVAILABLE Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system…  Evanston has put a lot of effort to identify the needs. 3. Identify all personal Doesn’t mean that they have been satisfied, but there is health service needs and at least an awareness 3.41 unmet needs throughout  Evanston is one of the most engaged communities the community?  Though Evanston identifies needs fairly well, there are still pockets of health issues that are unidentified

EPLAN: Creating A Healthier Evanston, Community Health Assessment Page 60

 Very little coordination for two of Evanston’s biggest needs: dental and mental health care 4. Coordinate the delivery of  Though Evanston is asset rich, there is much personal health and social improvement for coordination. Many coalitions have tried services so that everyone and failed at this. How will we make this different? 2.35 in the community has  Coordination exists between childcare services, and access to the care they between the churches, making sure soup kitchens exist need? every day of the week. Many jurisdictions don’t have these coalitions, but Evanston still has room for improvement

STANDARD 8: ASSURE A COMPETENT PUBLIC HEALTH AND PERSONAL HEALTHCARE WORKFORCE Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system… 5. Complete a workforce  There are workforce assessments within individual assessment (a process to organizations, but there is no comprehensive Evanston- track the numbers, types, wide workforce assessment and skills/knowledge  The Cook County workforce partnership does assess required of LPHS jobs) workforce needs throughout the region, which tell you the 1.93 and use the workforce need in areas such as health and social services. There is assessment to identify an assessment, but it may not be used and address gaps in the LPHS workforce? 6. Develop and maintain job  Individual agencies are working to maintain these standards and position standards descriptions based in the  Evanston has a very qualified workforce; we are lucky in core knowledge, skills, this aspect 3.75 and abilities needed to provide the 10 Essential Public Health Services? 7. Provide opportunities and  Many organizations had to cut training and workforce incentives for public development due to state budget cuts and the 2008 health workers to attend crisis trainings to develop core  Certain organizations (especially hospitals) have 3.67 skills related to the 10 requirements for continuing education credits, and it is a Essential Services of line item on their budgets Public Health?  There are definitely people missing from the table; the same Evanston leaders are at these meetings, and we 8. Create a shared vision of are missing core individuals community health and the  There is no one set paradigm for a vision of community LPHS, welcoming all health in Evanston 3.12 leaders and community members to work  Though there is not one comprehensive vision statement, together? many organizations are working towards the same goal: to reduce health disparities, and improve the health of all that live and work in Evanston

STANDARD 9: EVALUATE EFFECTIVENESS, ACCESSIBILITY, AND QUALITY OF PERSONAL AND POPULATION- BASED HEALTH SERVICES Average Score Question Discussion Points (Out of 5)

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At what level does Evanston’s

public health system… 4. Assess whether  Are we asking our most vulnerable populations? community members,  Age-Friendly Initiative put out a giant survey, and tried to including vulnerable reach the most vulnerable senior citizens, but they don’t populations, are satisfied know if they were successful with the approaches  With the General Assistance clients, they said the 2.35 taken toward promoting Community Health Survey was the first time they had health and preventing completed a survey in years disease, illness, and  The hospitals do randomized surveys with their patients injury?  Programs that are government funded or through grants usually have required evaluations; many programs at social service organizations, and in the City government, 5. Evaluate population- may not be evaluated, however based health services,  Evanston has numerous initiatives, but all of them may and use evaluation 2.88 not be impactful. How do we look at our collective findings to improve plans, impact? processes, or services?  Though there may not be a standardized evaluations, conversations such as these show that programs are constantly being evaluated 6. Assess how well the  N/A—skipped due to timing organizations in the LPHS are communicating, 2.53 connecting, and coordinating services?

STANDARD 10: RESEARCH FOR NEW INSIGHTS AND INNOVATIVE SOLUTIONS TO HEALTH PROBLEMS Average Score Question Discussion Points (Out of 5) At what level does Evanston’s

public health system…  The Healthy Communities project involved sharing  Encourage results with other organizations community  There is no Evanston-specific data, and no researchers partnerships in have stepped up to help us provide this research, including  Many organizations do research (we are the home of 2.49 deciding what will be Northwestern University!) but there is not much studied, conducting collaboration across the City of Evanston research, and sharing results?  The public health system is not using research, it’s mostly Northwestern and the hospitals  Partner with colleges,  Y.O.U. relies on others for research, but no one in universities, or other Evanston research  Many did not know of any partnerships that existed organizations to between universities, and public health organizations in conduct public health Evanston 2.50 research and develop continuing education programs for public health workers?  Collaborate with  Many of the organizations involved did not know of any researchers who offer collaborations with researchers in Evanston for health- 2.27 the knowledge and related studies skills to design and

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conduct health- related studies?

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APPENDIX F: COMMUNITY HEALTH STATUS ASSESSMENT QUESTIONS

Below is a copy of the questions used for the Community Health Survey, along with the sources of vetted questions.

______

Directions: The purpose of this survey is for the City of Evanston Department of Health & Human Services to collect Evanston-specific health data from its residents. The information you provide identifies health needs throughout Evanston. We would greatly appreciate your assistance in helping us determine community health goals as to create a plan of action to address disparities for the next 5 years.

Your responses are completely anonymous and is in no way connected to a particular person or address. In addition, the storage of the data collected from this electronic survey are Health Insurance Portability and Accountability Act (HIPAA) compliant and meet federal guidelines for storing health information. The survey should take around 10-15 minutes to complete. Your input is vital to helping the public health system in Evanston focus its resources where they are most needed. Thank you in advance for your time.

Section 1: Eligibility

1) Is your primary residence in Evanston?

 Yes  No—Thank you for your interest, but you are not eligible to participate in our survey.

2) Are you 18 years of age or older?

 Yes  No— Thank you for your interest, but you are not eligible to participate in our survey.

Section 2: Demographic Information

3) ZIP code in which your home is located:**______

4) Ward in which your home is located (there are 9 total wards; for a detailed ward map, click here)**:______

5) Gender:**  Female  Male  Transgender  Prefer not to respond

6) Age: ______*

7) What is your height in feet and inches? Feet: ______Inches:______**

8) What is your current weight in pounds? ______**

9) Racial group you identify most strongly with:**  American Indian or Alaska Native  Asian  Black or African-American

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 Native Hawaiian and Other Pacific Islander  White  Two or More Races  Prefer not to respond  Other (please specify): ______

10) Ethnic group you identify most strongly with:  Hispanic or Latino  Not Hispanic or Latino  Prefer not to respond

11) Marital Status:**  Never married  Married  Separated  Divorced  Widowed  Prefer not to respond

12) Highest education level obtained:*  Less than high school graduate  High School Diploma or GED  Some college (including certificate or Associate’s Degree programs)  Bachelor’s degree  Graduate or professional degree  Prefer not to respond

13) Annual Household Income:*  Less than $25,000  $25,000 to $49,999  $50,000 to $99,000  Over $100,000  Prefer not to respond

Section 3: Community and Personal Health

14) In general, would you say that your health is excellent, very good, good, fair, or poor? (County Health Rankings 2015)**

□ Excellent □ Very Good □ Good □ Fair □ Poor □ Prefer not to respond

15) In general, would you say that the health of Evanston is excellent, very good, good, fair, or poor?**

□ Excellent □ Very Good □ Good □ Fair □ Poor □ Prefer not to respond

16) What are the most important factors for a community to be healthy? Choose only 5 from the following:**

 Access to affordable health care  Low crime/safe neighborhoods  Health/wellness education  Strong social networks  Active citizen participation  Clean environment  Positive race relations  Public parks and recreation facilities  Community encourages active lifestyle  Access to affordable housing  Supportive of all age groups  Prefer not to respond  Good jobs/a healthy economy  Other (please specify):______ Strong educational system/institutions

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17) Based on your experience, what are the most important issues that impact the health and quality of life in Evanston? Choose only 3 from the following:**

 Problems related to aging (arthritis, hearing/vision  Heart disease/stroke loss, etc.)  Sexually transmitted diseases/infections  Obesity  Smoking/tobacco use  Injury/violence  High blood pressure  Cancer  Alcohol/substance abuse  Diabetes  Teenage pregnancy  Mental health issues  Physical inactivity  Dental problems  Prefer not to respond  Lack of access to fresh, healthy food  Other (please specify): ______

18) Do you have one person you think of as your personal doctor or health care provider? (BRFSS 2013 & Healthy Chicago 2014)**  Yes, only one  More than one  No  Don’t know/not sure  Prefer not to respond

19) Where do you normally go for your health care needs? *  Doctor’s office or private clinic  Community health center or other public clinic  Hospital emergency room  College or university campus health clinic  Clinic located within a Walgreens, CVS, etc.  Prefer not to respond  Other (please specify):______

20) Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, government plans such as Medicare, or Indian Health Service? (BRFSS 2013 & Healthy Chicago 2014)  Yes  No  Don’t know/not sure  Prefer not to respond

21) During the past 12 months, have you delayed getting needed medical care? **  Yes  No— Skip to #23  Don’t know/not sure –Skip to #23  Prefer not to respond—Skip to #23

22) If you have delayed in getting needed medical care, what was the most important reason? (BRFSS 2013)**  I couldn’t afford the medical care  I couldn’t get through on the telephone  I couldn’t get an appointment soon enough  Once I got there, I had to wait too long to see the doctor  The clinic/doctor’s office wasn’t open when I got there  I didn’t have transportation  Prefer not to respond  Other (please specify): ______

23) During the past 12 months, have you delayed in getting a needed prescription? **  Yes  No— Skip to #25

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 Don’t know/not sure—Skip to #25  Prefer not to respond—Skip to #25

24) If you have delayed in getting a needed prescription, what was the most important reason?**  I couldn’t afford the cost of filling the prescription  I was worried about side effects or drug interactions  I didn’t think the medicine was needed for my condition  There is no pharmacy close to where I work or live  Prefer not to respond  Other (please specify):______

25) Where do you go to find information about your health? Select all that apply.*  Friends and family  The internet/websites (WebMD, Mayo Clinic website, government website, etc.)  Media other than the internet (books, magazines, television, radio, etc.)  School  Church community  Physician  Prefer not to respond  Other (please specify):______

26) When did you last receive the following services? (Place an “x” in the box)**

Within More than Don’t Prefer not the past 1 –2 3—5 years 5 years know/not Not to year years ago ago ago Never sure Applicable respond a) A complete physical exam         b) Your blood pressure         checked c) A dental exam         d) A screening for colon cancer (if you         are over 50) e) A mammogram         (females) f) A pap test (females)         g) A blood test or rectal exam for prostate         cancer (males over 40)

27) Do you have dental insurance?**  Yes  No  Don’t know/not sure  Prefer not to respond

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Section 4: Chronic Health Conditions

28) Have you ever been told by a doctor, nurse, or other health professional that you have diabetes? (BRFSS 2013 and Healthy Chicago 2014)**  Yes  No- Skip to #32  Don’t know/not sure—Skip to #32  Prefer not to respond

29) How are you managing your diabetes? Select all that apply.*  Oral medication  Insulin  Diet  Physical activity  Alternative therapies (acupuncture, herbal supplements, hypnosis, etc.)  I am not managing my diabetes.  Not applicable. I no longer suffer from diabetes.  Prefer not to respond  Other (please specify): ______

30) About how many times in the past 12 months has a health professional checked your feet for any sores or irritations? (BRFSS 2013 and Healthy Chicago 2014)  None  Don’t know/not sure  Prefer not to respond  Number of times checked in the past 12 months: _____

31) When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light. (BRFSS 2013 and Healthy Chicago 2014)  Within the past month (anytime less than 1 month ago)  Within the past year (1 month but less than 12 months ago)  Within the past two years (1 year but less than 2 years ago)  2 or more years ago  Never  Don’t know/not sure  Prefer not to respond

32) Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? (BRFSS 2013 and Healthy Chicago 2014)**  Yes  No- Skip to #34  Don’t know/not sure—Skip to #34  Prefer not to respond—Skip to #34

33) How are you managing your high blood pressure? Select all that apply.**  Medication  Diet  Physical Activity  Alternative therapies (acupuncture, herbal supplements, hypnosis, etc.)  I am not managing my high blood pressure.  Not applicable. I no longer suffer from high blood pressure.  Prefer not to respond  Other (please specify): ______

34) Have you ever been told by a doctor, nurse, or other health professional that you have asthma? (BRFSS 2013 and Healthy Chicago 2014)**

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 Yes  No—Skip to #36  Don’t know/not sure—Skip to #36  Prefer not to respond—Skip to #36

35) How are you managing your asthma? Select all that apply.*  Medication  Diet  Controlled physical activity  Alternative therapies (acupuncture, herbal supplements, hypnosis, etc.)  I am not managing my asthma  Not applicable. I no longer suffer from asthma.  Prefer not to respond  Other (please specify): ______

Section 5: Environmental Health and Food Safety

36) In the past 12 months, have you experienced an illness that may have been caused by something you ate away from your home (restaurant, fair, deli, movie theater, convenience store, etc.)? **  Yes  No- Skip to #38  Don’t know/not sure—Skip to #38  Prefer not to respond—Skip to #38

37) Did you report the illness to the Evanston Health and Human Services Department? **  Yes  No  I didn’t know I should  Prefer not to respond

Section 6: Physical Activity and Nutrition

38) During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? (BRFSS 2013 and Healthy Chicago 2014)**  Yes  No—Skip to #41  Don’t know/not sure—Skip to #42  Prefer not to respond—Skip to #42

39) In the past month, how many times did you take part in physical activities outside of work?  Don’t know/not sure  Prefer not to respond  Times per month: ______

40) And, when you took part in physical activity, for how many minutes did you usually keep at it? (BRFSS 2013 and Healthy Chicago 2014)  Don’t know/not sure—Skip to #42  Prefer not to respond—Skip to #42  Minutes (on average): ______--Skip to #42

41) If you did not participate in any physical activity outside of work for the past month, which of the following are reasons why? Select all that apply.**  I don’t have enough time  I’m afraid of getting hurt  Bad weather

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 I can’t afford to join a gym or health club  There are no recreation facilities near where I work/live  I feel too tired to exercise  I have a physical/medical condition that makes it difficult for me to exercise  My television/computer distract me from exercising  Prefer not to respond  Other (please specify): ______

42) Outside of activities for work and school, how many hours do you spend looking at a screen (screen time) such as your computer, smartphone, tablet or television in an average day?**  I do not have any screen time in an average day  Less than 1 hour per day  1-2 hours per day  3-5 hours per day  5+ hours per day  Prefer not to respond

43) During the past 7 days, how often did you drink sugar-sweetened beverages? This includes regular soda, sugar- sweetened fruit drinks (such as Kool-Aid and lemonade), sweet tea, and sports or energy drinks (such as Gatorade and Red Bull). Do not include diet soda, 100% fruit juice, or artificially sweetened drinks.**  None  1-5 times  6-10 times  11-15 times  16-20 times  21 or more times  Prefer not to respond

44) How many servings of fruits and vegetables do you typically consume each day? (One serving is typically 1 cup of juice/fruit/vegetables or 2 cups of leafy greens) *  None  1 - 2 servings per day  3 - 4 servings per day  5 or more servings per day  Prefer not to respond

45) How easy or difficult is it for you to get fresh produce (fruits and vegetables)? (Healthy Chicago 2014)  Very difficult  Somewhat difficult  Somewhat easy  Very easy  Don’t know/not sure  Prefer not to respond

Section 7: Quality of Life

46) Was your apartment, home, or current residence built prior to 1978?  Yes  No  Don’t know/not sure  Prefer not to respond

47) Which of the following health or safety measures have you taken in your current home? Select all that apply. (National Center for Healthy Housing 2009 Consumer Survey)  Checked the smoke alarm twice a year  Installed energy-efficient lighting

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 Repaired water damage or plumbing leaks  Brought non-toxic or “green” cleaning supplies  Installed a carbon monoxide alarm  Installed water-saving fixtures  Tested for lead based paint  Tested for radon  None of these  Prefer not to respond

48) If you haven’t taken any of the health or safety measures in the previous question, which of the following best describes why? (NCHH 2009 Consumer Survey)  I didn’t have the money  I didn’t own the home  It was not a priority for me  I didn’t know what I should be doing or how to do it  I didn’t have enough time  I have taken at least one of the health or safety measures in the previous question  Don’t know/not sure  Prefer not to respond  Other (please specify): ______

49) To the best of your knowledge, which of the following health problems can result from the way your home is built or maintained? Select all that apply. (NCHH 2009 Consumer Survey  Asthma or allergies  Lead poisoning  Injuries such as broken bones, burns, or poisonings  Cancer  None of these  Prefer not to respond

50) Which of the following describes your current home? (NCHH 2009 Consumer Survey)  No carbon monoxide alarms  No smoke alarms or has non-working smoke alarms  Outside air enters the home through leaks in the windows, doors, holes, or cracks  Smoking is permitted  Water leaks have been present in the last nine months  Pesticides are used  Mold or mildew is present  Pests such as roaches or mice have been present in the last three months  The home is built before 1978 and the paint is peeling  None of these  All of these  Prefer not to respond

51) In the past 12 months, were there any instances when you felt physically unsafe in Evanston?**  Yes  No—Skip to #53  Don’t know/not sure—Skip to #53  Prefer not to respond—Skip to #53

52) Please indicate why you felt physically unsafe in Evanston in the past 12 months. Select all that apply:**  Public intoxication  Property maintenance issues or homes not being  Groups of young people blocking roads or kept up sidewalks  Presence of guns in the neighborhood  Gang activity  Graffiti/vandalism  Abandoned vehicles

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 Drug use/drug dealing  Prefer not to respond  Loud music  Other (please specify): ______ Domestic violence

53) Were you a victim of crime in Evanston during the past 12 months?**  Yes  No—Skip to #55  Don’t know/not sure—Skip #55  Prefer not to respond—Skip to #55

54) Did you report the crime to the Evanston Police?**  Yes  No  Prefer not to respond

55) Do you happen to have in your home any guns or revolvers? (General Social Survey 2014)  Yes  No  Don’t know/not sure  Prefer not to respond

56) In the past year, have you been in a motor vehicle accident/pedestrian/bike accident? **  Yes  No  Don’t know/not sure  Prefer not to respond

57) How often do you use seat belts when you drive or ride in a car? (BRFSS 2013)**  Always  Nearly always  Sometimes  Seldom  Never  Prefer not to respond

58) How often do you use a child restraint system (infant or child car seat, booster seat, etc.) when driving with a child in your car?**  Not applicable, I have never driven with a child in my car  Always  Nearly always  Sometimes  Seldom  Never  Prefer not to respond

Section 8: Mental Health

59) During the past 30 days, for about how many days have you felt sad, blue or depressed? (BRFSS 2013)**

 None  Don’t know/not sure  Prefer not to respond  Number of days: _____

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60) During the past 30 days, for about how many days have you felt worried, tense or anxious? (BRFSS 2013)**

 None  Don’t know/not sure  Prefer not to respond  Number of days: _____

61) On average, how many hours of sleep do you get in a 24-hour period? (BRFSS 2013)

 Don’t know/not sure  Prefer not to respond  Hours of sleep per day: _____

62) Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health NOT good? (BRFSS 2013)*

 None  Don’t know/not sure  Prefer not to respond  Number of days: _____

63) Are you now taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem? (BRFSS 2013)*  Yes  No  Don’t know/not sure  Prefer not to respond

64) During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it? (Healthy Chicago 2014, NSDUH 2010)  Yes  No—Skip to #66  Don’t know/not sure—Skip to #66  Prefer not to respond—Skip to #66

65) Which of these statements explains why you did not get the mental health treatment or counseling you needed? Select all that apply. (Healthy Chicago 2014, NSDUH 2010)  You couldn’t afford the cost  You were concerned that getting mental health treatment or counseling might cause your neighbors or community to have a negative opinion of you  You were concerned that getting mental health treatment or counseling might have a negative effect on your job  Your health insurance does not cover any mental health treatment or counseling  Your health insurance does not pay enough for mental health treatment or counseling  You did not know where to go to get services  You were concerned that the information you gave the counselor might not be kept confidential  You were concerned that you might be committed to a psychiatric hospital or might have to take medicine  Prefer not to respond  Other: ______

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Section 9: Sexual Health

66) Have you been sexually active within the past 3 months?**  Yes  No—Skip to #71  Don’t know/not sure—Skip to #71  Prefer not to respond—Skip to #71

67) During the past 3 months, with how many people have you had sexual intercourse?**  1 person  2 people  3 people  4 or more people  Don’t know/not sure  Prefer not to respond

68) Did you or your partner use a condom the last time you had sexual intercourse?**  Yes – Skip to #70  No  Don’t know/not sure—Skip to #70  Prefer not to respond—Skip to #70

69) What was the reason you did not use a condom? Select all that apply.**  Trying to get pregnant  Currently use another form of birth control  Religious reasons  Currently having sex with only one partner  Partner did not want to use a condom  Condom was not available  Prefer not to respond  Other (please specify):______

70) Did you or your partner use birth control, other than or in addition to a condom, the last time you had sexual intercourse?  Yes  No  Don’t know/not sure  Prefer not to respond

Section 10: Immunizations and Infectious Disease

71) There are two ways to get the flu vaccine, one is a shot in the arm and the other is a spray, mist, or drop in the nose called FluMist™. During the past 12 months, have you had either a flu shot or a flu vaccine that was sprayed in your nose? (BRFSS 2013)**  Yes  No  Don’t know/not sure  Prefer not to respond

72) A pneumonia shot or pneumococcal vaccine is usually given once or twice in a person’s lifetime and is different from the flu shot. Have you ever had a pneumonia shot? (BRFSS 2013)**  Yes  No  Don’t know/not sure

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 Prefer not to respond

73) Since 2005, have you had a tetanus shot? (BRFSS 2013)  Yes  No—Skip to #75  Don’t know/not sure—Skip to #75  Prefer not to respond—Skip to #75

74) Was this Tdap, the tetanus shot that also has pertussis or whooping cough vaccine? (BRFSS 2013)**  Yes, received Tdap  Yes, received tetanus shot, but not Tdap  Yes, received tetanus shot, but not sure what type  Prefer not to respond

75) If you are age 49 or under: A vaccine to prevent the human papilloma virus or HPV infection is available and is called the cervical cancer or genital warts vaccine, HPV shot, Gardasil, or Cervarix. Have you ever had an HPV vaccination? (BRFSS 2013)**  Not applicable—I am over the age of 49  Yes  No  Doctor refused when asked  Don’t know/not sure  Prefer not to respond

76) If you have children younger than 18: Have your children received all of their vaccinations required for school?**  Not applicable, I do not have children under 18—Skip to #78  Yes—Skip to #78  No  Don’t know/not sure—Skip to #78  Prefer not to respond—Skip to #78

77) Please indicate the primary reason as to why your children have not received all their vaccinations required for school:**  Could not find a healthcare provider for vaccinations  Concerns about vaccine safety/side effects  Unsure about effectiveness of vaccines and whether they prevent illness  Current vaccine schedule is too aggressive – too many shots given too early  Religious reasons  Many childhood diseases are no longer a threat (polio, measles, etc.)  My children are home-schooled and vaccines are not needed  Prefer not to respond  Other (please specify)______

Section 11: Substance Abuse

78) Have you smoked at least 100 cigarettes in your entire life? (BRFSS 2013 and Healthy Chicago 2014)** (Note: 5 packs = 100 cigarettes)  Yes  No—Skip to #82  Don’t know/not sure—Skip to #82  Prefer not to respond—Skip to #82

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79) Do you now smoke cigarettes every day, some days, or not at all? (BRFSS 2013 and Healthy Chicago 2014)  Every day  Some days  Not at all—Skip to #82  Don’t know/not sure—Skip to #82  Prefer not to respond—Skip to #82

80) During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? (BRFSS 2013 and Healthy Chicago 2014)**  Yes  No—Skip to #82  Don’t know/not sure—Skip to #82  Prefer not to respond—Skip to #82

81) If you have tried to quit smoking during the past year, what method(s) have you tried? Select all that apply.**  Prescription medication, such as Chantix®, Zyban®, Wellbutrin®, etc.  Called the state Quitline  Attended a local support group for tobacco cessation  Used nicotine gum or patches  Used e-cigarettes  Cold turkey (stopping all at once without reducing smoking first)  Took herbal supplements, hypnosis or other alternative medicines  Prefer not to respond  Other (please specify): ______

82) Have you ever used any tobacco products other than cigarettes, including chewing tobacco, snus, cigars, dip, hookah, or pipe?  Yes  No  Don’t know/not sure  Prefer not to respond

83) Does anyone smoke in your household?  Yes  No  Don’t know/not sure  Prefer not to respond

84) Please indicate which of the following best represents your behavior with regard to e-cigarettes or other nicotine replacement devices:  I have tried using e-cigarettes or other nicotine replacement devices, but never really picked up the habit.  I quit using e-cigarettes or other nicotine replacement devices, but I do miss smoking them.  I use e-cigarettes or other nicotine replacement devices once or twice a month.  I use e-cigarettes or other nicotine replacement devices on average once or twice a week.  I use e-cigarettes or other nicotine replacement devices daily.  I have never used e-cigarettes or other nicotine replacement devices.  Prefer not to respond

85) One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?  Yes  No—Skip to #88  Don’t know/not sure—Skip to #88

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 Prefer not to respond—Skip to #88

86) During the past 30 days, how many days did you have at least one drink of any alcoholic beverage?**  Don’t know/not sure  Prefer not to respond  Days in the last month: ______

87) During the past 30 days, what is the largest number of drinks you had on any one occasion? (BRFSS 2013)**

 Don’t know/not sure  Prefer not to respond  Number of drinks: ______

88) During the past 12 months, have you ever driven a vehicle while you were under the influence of alcohol? (SAMHSA National Survey on Drug Use and Health, 2013)  Yes  No  Don’t know/not sure  Prefer not to respond

89) Have you ever, even once, used marijuana or hashish? (SAMHSA National Survey on Drug Use and Health, 2013)  Yes  No—Skip to #91  Don’t know/not sure—Skip to #91  Prefer not to respond—Skip to #91

90) How long has it been since you last used marijuana or hashish? (SAMHSA National Survey on Drug Use and Health, 2013)  Within the past 30 days  More than 30 days ago but within the past 12 months  More than 12 months ago  Don’t know/not sure  Prefer not to respond

91) Have you ever, even once, used any illicit substances other than marijuana, including heroin, cocaine, crack, methamphetamine, etc.?  Yes  No—Skip to #93  Don’t know/not sure—Skip to #93  Prefer not to respond—Skip to #93

92) How long has it been since you last used any illicit substances other than marijuana?  Within the past 30 days  More than 30 days ago but within the past 12 months  More than 12 months ago  Don’t know/not sure  Prefer not to respond

93) Have you ever, even once, used any prescriptions drugs that were not specifically prescribed to you by a doctor or medical professional?  Yes  No—Skip to #95  Don’t know/not sure—Skip to #95  Prefer not to respond—Skip to #95

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94) How long has it been since you last used prescription drugs that were not specifically prescribed to you by a doctor or medical professional?  Within the past 30 days  More than 30 days ago but within the past 12 months  More than 12 months ago  Don’t know/not sure  Prefer not to respond

Section 12: Maternal/Child Health

95) How many children do you have?  1  2  3  4  5+  I do not have any children  Prefer not to respond

96) For females: To your knowledge, are you now pregnant? (BRFSS 2013)  Not applicable, I am male—Skip to #102  Yes  No  Don’t know/not sure  Prefer not to respond—Skip to #102

97) For females: Are you now pregnant, or have you had any children in the past 5 years?  Yes  No—Skip to #102  Don’t know/not sure—Skip to #102  Prefer not to respond—Skip to #102

98) At any time during the 12 months before you got pregnant with your child, did you do any of the following things? Select all that apply. (CDC Pregnancy Risk Assessment Monitoring System 2012)  I was dieting (changing my eating habits) to lose weight  I was exercising 3 or more days of the week  I was regularly taking prescription medicines other than birth control  I visited a health care worker and was checked for diabetes  I visited a health care worker and was checked for high blood pressure  I visited a health care worker and was checked for depression or anxiety  I talked to a health care worker about my family medical history  I had my teeth cleaned by a dentist or dental hygienist  None  Don’t know/not sure  Prefer not to respond

99) During your most recent pregnancy, did you take a class or classes to prepare for childbirth and learn what to expect during labor and delivery? (CDC Pregnancy Risk Assessment Monitoring System 2012)  Yes  No  Don’t know/not sure  Prefer not to respond

100) Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period of time? (CDC Pregnancy Risk Assessment Monitoring System 2012)  Not applicable, I am currently pregnant with my first child—Skip to #102

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 Yes  No—Skip #102  Don’t know/not sure—Skip to #102  Prefer not to respond—Skip to #102

101) How many months did you breastfeed or pump milk to feed your baby? (CDC Pregnancy Risk Assessment Monitoring System 2012)  Less than 1 month  Don’t know/not sure  Prefer not to respond  Number of months: ______

Section 13: Community Information

102) In the past year, have you visited a park or other public space?  Yes  No  Don’t know/not sure  Prefer not to respond

103) How strongly would you agree or disagree with the following statement: Evanston has quality public spaces and parks.  Strongly Agree  Agree  Neither agree nor disagree  Disagree  Strongly Disagree  Prefer not to respond

104) Related to neighborhood cohesion, how strongly would you agree or disagree with the following statements: Neither Strongly Agree nor Strongly Prefer not Agree Agree Disagree Disagree Disagree to respond My neighborhood is a close-knit neighborhood      

People in my neighborhood can be trusted      

People around my neighborhood are usually willing to trust their neighbors      

People in my neighborhood share the same values      

People in my neighborhood get along      

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105) Do you feel your neighbors could be counted on to intervene or do something under the following situations? Select the likelihood of intervention for each situation. Neither Very likely nor Very Prefer not Likely Likely unlikely Unlikely Unlikely to respond Children were skipping school and hanging out in the neighborhood      

Children were vandalizing property in the neighborhood (e.g. graffiti)      

Children were showing disrespect to an adult      

A fight broke out in front of their house      

A fire station or community center near their home was threatened by budget cuts      

106) How strongly would you agree or disagree with the following statement related to residents: I have opportunities to participate in my local government’s decision making.  Strongly agree  Agree  Neither agree nor disagree  Disagree  Strongly disagree  Prefer not to respond

End of Survey Message: Thank you for participating in the 2015 Evanston Community Health Survey. Results from this assessment will be used for our EPLAN: Creating a Healthier Evanston process, and will be used to create a five-year strategic health plan for Evanston. If you would like more information on the EPLAN process, please visit our webpage at www.cityofevanston.org/health/eplan-creating-a-healthier-Evanston/

Key: * = exact replica of 2013 Community Health Survey

**= similar to a question asked on the 2013 Community Health Survey (data can probably be compared)

Sources:

 BRFSS 2013: CDC BRFSS 2013 Questionnaire (http://www.cdc.gov/brfss/questionnaires/pdf- ques/2013-brfss_english.pdf)  County Health Rankings 2015: County Health Rankings Questions from 2015 (http://www.countyhealthrankings.org/app/illinois/2015/measure/outcomes/1/map)

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 SAMHSA National Survey on Drug Use and Health, 2013: 2013 National Survey on Drug Use and Health, by SAMHSA (http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/35509)  NSDUH 2010: 2010 National Survey on Drug Use and Health, by SAMHSA (http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/32722)  CDC Pregnancy Risk Assessment Monitoring System 2012: (http://www.cdc.gov/prams/questionnaire.htm)  General Social Survey 2014: General Social Survey: http://www3.norc.org/GSS+Website/Publications/GSS+Questionnaires/  NCHH 2009 Consumer Survey: National Center for Healthy Housing 2009 Consumer Research Survey: http://www.nchh.org/LinkClick.aspx?fileticket=uOQnnhazFrs%3d&tabid=368  Healthy Chicago 2014: See Maitreyi for copy

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APPENDIX G: COMMUNITY HEALTH STATUS ASSESSMENT CORRELATION RESULTS

Below is a copy of the data analysis performed by Loyola University Chicago for the Community Health Survey. The results below depict correlations between five demographic variables (age, gender, income, race, ward) and certain survey questions. The results were analyzed by Dr. Stephanie Kliethermes, Dr. Justin Harbison, and Dr. Ruth Kafensztok from Loyola University Chicago. The first section below, describes how to read table findings.

How to read table findings

Step 1: Describe your findings

Examine the distribution of responses by each age group (column number and percent)

Compare distributions of responses to each question for the different age groups

Describe what you find. E.g.: A greater percentage of working age respondents (31 to 60) were perceived the general health in Evanston community to be fair or poor (15-19%) than other age groups (4-14%)

18-30 31-40 41-50 51-60 61-70 70+ p-

(N=71) (N=111) (N=113) (N=149) (N=109) (N=56) value In general, Evanston Health is: Excellent 6 (8%) 0 (0%) 2 (2%) 2 (1%) 0 (0%) 0 (0%) Very Good 21 (30%) 30 (27%) 24 (21%) 33 (22%) 22 (20%) 19 (34%) Good 33 (46%) 59 (53%) 63 (56%) 76 (51%) 61 (56%) 22 (39%) 0.05 Fair 8 (11%) 18 (16%) 21 (19%) 22 (15%) 15 (14%) 4 (7%) Poor 2 (3%) 1 (1%) 1 (1%) 3 (2%) 0 (0%) 0 (0%) Prefer not to respond 1 (1%) 3 (3%) 2 (2%) 13 (9%) 11 (10%) 11 (20%)

Step 2: Examine whether differences by age group are found to be statistically significant

P-values should be interpreted with caution. The p-value represents the overall association between the survey item and demographic variable (e.g. Evanston health and age). It does not represent significance within various levels of the survey items and/or demographic variables. That is, it is not correct to say working age respondents were more likely to perceive the general health in Evanston as fair/poor compared to other age groups. Also, p-values have not been adjusted for multiple comparisons; therefore, borderline significance should be interpreted cautiously (p=0.05).

______

2015 Evanston Community Health Survey Results--Age

Loyola Team-Members: S. Kliethermes, R. Kafensztok, J. Harbison

The following tables compare responses to the Evanston Community Health Survey based on age. One individual was missing an age record and therefore excluded from analyses. Tabled frequencies are based on all survey responses; however statistical analyses exclude “prefer not to respond” and “Don’t know/not sure”

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and “Not Applicable” when appropriate. Pearson chi-square tests were used for all analyses unless there were insufficient cell counts in which case Fisher’s Exact Tests were used. Caution should be made when interpreting sexual health and certain substance use survey items in particular as there was a lot of missing data which could be indicative of survey response bias.

Table 1a: Community and Personal Health Responses by Age 31-40 41-50 51-60 61-70 18-30 (N=71) 70+ (N=56) p-value1 (N=111) (N=113) (N=149) (N=109) In general,

Evanston Health is: Excellent 6 (8%) 0 (0%) 2 (2%) 2 (1%) 0 (0%) 0 (0%) Very Good 21 (30%) 30 (27%) 24 (21%) 33 (22%) 22 (20%) 19 (34%) Good 33 (46%) 59 (53%) 63 (56%) 76 (51%) 61 (56%) 22 (39%) 0.05* Fair 8 (11%) 18 (16%) 21 (19%) 22 (15%) 15 (14%) 4 (7%) Poor 2 (3%) 1 (1%) 1 (1%) 3 (2%) 0 (0%) 0 (0%) Prefer not to 1 (1%) 3 (3%) 2 (2%) 13 (9%) 11 (10%) 11 (20%) respond 3 most important issues that impact health and QOL in Evanston Mental Mental Physical Physical Mental Health Obesity 1st Issue Health Health Inactivity Inactivity (45%) (46%) (46%) (48%) (47%) (46%) Physical Mental Mental Problems Physical Inactivity Obesity 2nd Issue Inactivity Health Health related to -- (37%) (31%) (43%) (38%) (44%) aging (45%) Physical Physical Smoking/Tobacco Obesity Obesity Obesity 3rd Issue Inactivity Inactivity Use (31%) (36%) (38%) (36%) (36%) (26%) Has a Personal

Doctor Yes, only one 26 (37%) 55 (50%) 55 (49%) 84 (56%) 61 (56%) 29 (52%) More than one 19 (27%) 35 (32%) 44 (39%) 44 (30%) 45 (41%) 26 (46%) <0.001* No 21 (30%) 21 (19%) 11 (10%) 17 (11%) 1 (1%) 0 (0%) Don’t Know/not 5 (7%) 0 (0%) 1 (1%) 2 (1%) 0 (0%) 1 (2%) sure Prefer not to 0 (0%) 0 (0%) 2 (2%) 2 (1%) 2 (2%) 0 (0%) respond Has Health

Coverage Yes 66 (93%) 106 (96%) 108 (96%) 141 (95%) 107 (98%) 56 (100%) 0.61* No 2 (3%) 5 (5%) 4 (4%) 3 (2%) 2 (2%) 0 (0%) Don’t Know/not 3 (4%) 0 (0%) 0 (0%) 3 (2%) 0 (0%) 0 (0%) sure Prefer not to 0 (0%) 0 (0%) 1 (1%) 2 (1%) 0 (0%) 0 (0%) respond Delayed medical care in last 12 months Yes 16 (23%) 31 (28%) 35 (31%) 37 (25%) 19 (17%) 2 (4%) <0.001* No 48 (68%) 79 (71%) 75 (66%) 109 (73%) 88 (81%) 54 (96%) Don’t Know/not 6 (8%) 1 (1%) 2 (2%) 2 (1%) 2 (2%) 0 (0%) sure Prefer not to 1 (1%) 0 (0%) 1 (1%) 1 (1%) 0 (0%) 0 (0%) respond Delayed receiving prescription in last 12 months Yes 6 (8%) 10 (9%) 18 (16%) 17 (11%) 7 (6%) 0 (0%) 0.01*

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31-40 41-50 51-60 61-70 18-30 (N=71) 70+ (N=56) p-value1 (N=111) (N=113) (N=149) (N=109) No 60 (85%) 100 (90%) 94 (83%) 131 (88%) 101 (93%) 56 (100%) Don’t Know/not 4 (6%) 1 (1%) 0 (0%) 1 (1%) 1 (1%) 0 (0%) sure Prefer not to 1 (1%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) respond Last received complete physical Past year 32 (45%) 56 (50%) 66 (58%) 87 (58%) 79 (72%) 44 (79%) 1-2 years ago 25 (35%) 31 (28%) 30 (27%) 38 (26%) 21 (19%) 11 (20%) 3-5 years ago 8 (11%) 9 (8%) 8 (7%) 12 (8%) 5 (5%) 0 (0%) 0.004* More than 5 years 3 (4%) 12 (11%) 7 (6%) 9 (6%) 2 (2%) 1 (2%) ago Never 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Don’t Know/Not 3 (4%) 2 (2%) 0 (0%) 0 (0%) 2 (2%) 0 (0%) Sure Prefer not to 0 (0%) 0 (0%) 2 (2%) 3 (2%) 0 (0%) 0 (0%) respond Last had blood pressure checked Past year 52 (73%) 78 (70%) 88 (79%) 126 (85%) 99 (93%) 56 (100%) 1-2 years ago 15 (21%) 24 (22%) 18 (16%) 17 (11%) 6 (6%) 0 (0%) 3-5 years ago 3 (4%) 4 (4%) 0 (0%) 2 (1%) 0 (0%) 0 (0%) <0.001* More than 5 years 0 (0%) 4 (4%) 2 (2%) 1 (1%) 1 (1%) 0 (0%) ago Don’t Know/Not 0 (0%) 1 (1%) 1 (1%) 1 (1%) 0 (0%) 0 (0%) Sure Prefer not to 1 (1%) 0 (0%) 2 (2%) 2 (1%) 1 (1%) 0 (0%) respond Last Dental Exam Past year 45 (63%) 86 (77%) 84 (75%) 108 (73%) 83 (76%) 50 (91%) 1-2 years ago 16 (23%) 13 (12%) 14 (13%) 18 (12%) 17 (16%) 2 (4%) 3-5 years ago 8 (11%) 3 (3%) 7 (6%) 6 (4%) 4 (4%) 2 (4%) 0.05* More than 5 years 2 (3%) 8 (7%) 4 (4%) 12 (8%) 4 (4%) 1 (2%) ago Never 0 (0%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) Don’t Know/Not 0 (0%) 1 (1%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Sure Prefer not to 0 (0%) 0 (0%) 2 (2%) 3 (2%) 1 (1%) 0 (0%) respond Last screen for colon cancer Past year 2 (3%) 4 (4%) 9 (9%) 27 (18%) 21 (19%) 10 (18%) 1-2 years ago 2 (3%) 0 (0%) 4 (4%) 29 (20%) 25 (23%) 15 (27%) 3-5 years ago 1 (1%) 0 (0%) 2 (2%) 31 (21%) 33 (31%) 24 (43%) <0.001* More than 5 years 0 (0%) 0 (0%) 0 (0%) 20 (14%) 19 (18%) 5 (9%) ago Never 9 (13%) 22 (21%) 19 (18%) 34 (23%) 8 (7%) 2 (4%) Don’t Know/Not 0 (0%) 1 (1%) 1 (1%) 0 (0%) 1 (1%) 0 (0%) Sure Not Applicable 53 (79%) 78 (74%) 65 (63%) 3 (2%) 0 (0%) 0 (0%) Prefer not to 0 (0%) 0 (0%) 3 (3%) 3 (2%) 1 (1%) 0 (0%) respond Last Mammogram Past year 4 (6%) 9 (8%) 53 (50%) 58 (42%) 45 (48%) 28 (56%) 1-2 years ago 0 (0%) 7 (7%) 14 (13%) 33 (24%) 20 (22%) 7 (14%) 3-5 years ago 2 (3%) 2 (2%) 5 (5%) 7 (5%) 7 (8%) 1 (2%) <0.001* More than 5 years 1 (1%) 4 (4%) 1 (1%) 4 (3%) 3 (3%) 3 (6%) ago Never 26 (38%) 36 (34%) 5 (5%) 3 (2%) 1 (1%) 0 (0%)

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31-40 41-50 51-60 61-70 18-30 (N=71) 70+ (N=56) p-value1 (N=111) (N=113) (N=149) (N=109) Don’t Know/Not 3 (4%) 1 (1%) 2 (2%) 0 (0%) 0 (0%) 0 (0%) Sure Not Applicable 32 (47%) 48 (45%) 26 (24%) 29 (21%) 16 (17%) 11 (22%) Prefer not to 0 (0%) 0 (0%) 1 (1%) 5 (4%) 1 (1%) 0 (0%) respond Last Pap-test Past year 22 (32%) 40 (38%) 39 (36%) 45 (32%) 31 (34%) 10 (20%) 1-2 years ago 8 (12%) 29 (27%) 31 (29%) 38 (27%) 22 (24%) 7 (14%) 3-5 years ago 5 (7%) 5 (5%) 5 (5%) 9 (6%) 13 (14%) 8 (16%) <0.001* More than 5 years 0 (0%) 1 (1%) 4 (4%) 9 (6%) 3 (3%) 8 (16%) ago Never 11 (16%) 3 (3%) 0 (0%) 1 (1%) 0 (0%) 1 (2%) Don’t Know/Not 0 (0%) 1 (1%) 1 (1%) 1 (1%) 1 (1%) 0 (0%) Sure Not Applicable 22 (32%) 27 (25%) 26 (24%) 32 (23%) 21 (23%) 15 (31%) Prefer not to 0 (0%) 0 (0%) 1 (1%) 5 (4%) 1 (1%) 0 (0%) respond Last Blood test/rectal exam (prostate) Past year 2 (3%) 1 (1%) 11 (11%) 21 (17%) 19 (23%) 11 (26%) 1-2 years ago 0 (0%) 0 (0%) 6 (6%) 7 (6%) 5 (6%) 3 (7%) 3-5 years ago 1 (2%) 1 (1%) 1 (1%) 4 (3%) 6 (7%) 2 (5%) <0.001* More than 5 years 0 (0%) 0 (0%) 2 (2%) 7 (6%) 1 (1%) 0 (0%) ago Never 9 (14%) 15 (15%) 16 (16%) 10 (8%) 4 (5%) 2 (5%) Don’t Know/Not 0 (0%) 1 (1%) 0 (0%) 1 (1%) 2 (2%) 1 (2%) Sure Not Applicable 53 (80%) 85 (83%) 61 (62%) 73 (57%) 42 (52%) 23 (53%) Prefer not to 1 (2%) 0 (0%) 2 (2%) 4 (3%) 2 (2%) 1 (2%) respond Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1b: Chronic Health Condition Responses by Age 18-30 31-40 41-50 51-60 61-70 70+ p- (N=71) (N=111) (N=113) (N=149) (N=109) (N=56) value1 Have you ever been told you have diabetes? Yes 0 (0%) 2 (2%) 8 (7%) 8 (5%) 12 (11%) 5 (9%) No 71 51 0.01 (100%) 109 (98%) 102 (90%) 139 (93%) 96 (88%) (91%) Don’t Know/not sure 0 (0%) 0 (0%) 2 (2%) 0 (0%) 1 (1%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 2 (1%) 0 (0%) 0 (0%) Have you ever been told you have high blood pressure? Yes 24 8 (11%) 14 (13%) 21 (19%) 40 (27%) 43 (39%) (43%) <0.001 No 32 63 (89%) 96 (86%) 90 (80%) 106 (71%) 66 (61%) (57%) Don’t Know/not sure 0 (0%) 1 (1%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 3 (2%) 0 (0%) 0 (0%) Have you ever been told you have asthma?

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18-30 31-40 41-50 51-60 61-70 70+ p- (N=71) (N=111) (N=113) (N=149) (N=109) (N=56) value1 Yes 15 (21%) 30 (27%) 24 (21%) 19 (13%) 18 (17%) 6 (11%) No 50 0.04 56 (79%) 81 (73%) 88 (78%) 128 (86%) 91 (83%) (89%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 1 (1%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1c: Physical Activity and Nutrition Responses by Age 18-30 31-40 41-50 51-60 61-70 70+ p-value1 (N=71) (N=111) (N=113) (N=149) (N=109) (N=56) In past 12 months did you participate in physical activity? Yes 65 100 104 133 101 53 (92%) (90%) (92%) (89%) (93%) (95%) 0.91 No 5 (7%) 11 (10%) 8 (7%) 13 (9%) 8 (7%) 3 (5%) Don’t Know/not sure 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 3 (2%) 0 (0%) 0 (0%) How many hours do you spend looking at a screen on avg day (outside of work/school) No screen time 0 (0%) 0 (0%) 0 (0%) 2 (1%) 0 (0%) 0 (0%) <1 hour per day 3 (4%) 7 (6%) 10 (9%) 20 (13%) 11 (10%) 5 (9%) 1-2 hrs 21 25 (30%) 47 (42%) 56 (50%) 49 (33%) 42 (39%) (45%) 0.09 3-5 hrs 32 18 (45%) 37 (33%) 29 (26%) 52 (35%) 43 (39%) (32%) 5+ hrs 15 (21%) 20 (18%) 17 (15%) 22 (15%) 12 (11%) 6 (11%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 4 (3%) 1 (1%) 2 (4%) Last 7 days, how often drink sugar-sweetened beverage? None 28 45 (39%) 46 (41%) 61 (54%) 88 (59%) 76 (70%) (80%) 1-5 times 34 (48%) 53 (48%) 37 (33%) 42 (28%) 28 (26%) 9 (16%) <0.001* 6-10 times 8 (11%) 6 (5%) 5 (4%) 6 (4%) 1 (1%) 1 (2%) 11-15 times 1 (1%) 0 (0%) 5 (4%) 3 (2%) 3 (3%) 0 (0%) 16-20 times 0 (0%) 2 (2%) 0 (0%) 2 (1%) 1 (1%) 0 (0%) 21 or more times 0 (0%) 3 (3%) 3 (3%) 5 (3%) 0 (0%) 1 (2%) Prefer not to respond 0 (0%) 0 (0%) 2 (2%) 2 (1%) 0 (0%) 0 (0%) How many servings of fruits/veggies on typical day? None 4 (6%) 3 (3%) 4 (4%) 4 (3%) 1 (1%) 0 (0%) 1-2 servings per day 29 20 (41%) 46 (41%) 46 (41%) 54 (36%) 37 (34%) (36%) 3-4 servings per day 21 28 0.38* (30%) 49 (44%) 43 (38%) 60 (40%) 49 (45%) (50%) 5+ servings per day 17 (24%) 13 (12%) 19 (17%) 29 (19%) 22 (20%) 8 (14%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 2 (1%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and

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“Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1d: Quality of Life and Sexual Health Responses by Age 18-30 31-40 41-50 51-60 61-70 70+ p-value1 (N=71) (N=111) (N=113) (N=149) (N=109) (N=56) In the past 12 months have you ever felt unsafe in Evanston? Yes 31 36 37 28 18 (25%) (28%) (32%) (25%) (26%) 4 (7%) 0.03 No 72 75 109 74 49 (69%) (65%) (66%) (73%) (68%) 48 (86%) Don’t Know/not sure 4 (6%) 7 (6%) 2 (2%) 2 (1%) 5 (5%) 3 (5%) Prefer not to respond 0 (0%) 1 (1%) 0 (0%) 1 (1%) 2 (2%) 1 (2%) Are you currently taking medicine or receiving treatment from a health professional for mental health? Yes 15 25 27 21 10 (14%) (14%) (22%) (18%) (19%) 1 (2%) 0.03 No 93 85 114 87 61 (86%) (84%) (75%) (77%) (80%) 54 (96%) Don’t Know/not sure 0 (0%) 1 (1%) 0 (0%) 1 (1%) 0 (0%) 1 (2%) Prefer not to respond 0 (0%) 2 (2%) 3 (3%) 7 (5%) 1 (1%) 0 (0%) Did you or your partner use a condom the last time you had sex? Yes 16 17 15 22 (54%) (18%) (22%) (19%) 1 (2%) 0 (0%) <0.001* No 67 59 58 37 19 (46%) (76%) (76%) (75%) (86%) 17 (85%) Prefer not to respond 0 (0%) 5 (6%) 2 (3%) 4 (5%) 5 (12%) 3 (15%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1e: Substance Use Responses by Age 18-30 31-40 41-50 51-60 61-70 70+ p-value1 (N=71) (N=111) (N=113) (N=149) (N=109) (N=56) Current Smoking Status Every Day 4 14 18 (57%) 2 (7%) (31%) (30%) 3 (6%) 1 (3%) Some Days 1 10 <0.001* (14%) 3 (10%) 7 (16%) (17%) 3 (6%) 0 (0%) Not at all 2 24 24 32 (29%) (83%) (53%) (53%) 48 (89%) 29 (97%) Have you ever used any tobacco products (other than cigarettes)? Yes 26 24 24 16 (37%) (22%) (21%) (11%) 13 (12%) 8 (14%) <0.001 No 44 86 88 131 (62%) (77%) (78%) (88%) 95 (87%) 47 (84%) Don’t Know/not sure 1 (1%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 1 (1%) 1 (1%) 1 (1%) 1 (1%) 1 (2%) Have you ever used marijuana or hashish? Yes 33 50 76 97 76 (70%) 17 (30%) <0.001

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18-30 31-40 41-50 51-60 61-70 70+ p-value1 (N=71) (N=111) (N=113) (N=149) (N=109) (N=56) (46%) (45%) (67%) (65%) No 38 54 33 42 (54%) (49%) (29%) (28%) 29 (27%) 38 (68%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) Prefer not to respond 0 (0%) 7 (6%) 4 (4%) 10 (7%) 4 (4%) 0 (0%) Have you ever used illicit substances other than marijuana? Yes 11 30 41 5 (7%) (10%) (27%) (28%) 16 (15%) 3 (5%) <0.001 No 65 94 83 101 (92%) (85%) (73%) (68%) 87 (80%) 52 (93%) Don’t Know/not sure 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) Prefer not to respond 1 (1%) 5 (5%) 0 (0%) 7 (5%) 6 (6%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

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2015 Evanston Community Health Survey Results--Gender

Loyola Team-Members: S. Kliethermes, R. Kafensztok, J. Harbison

The following tables compare responses to the Evanston Community Health Survey based on gender. One individual indicated gender his/her gender as transgender and 4 individuals preferred not to respond. These 5 individuals were excluded from all analyses. Tabled frequencies are based on all survey responses; however statistical analyses exclude “prefer not to respond” and “Don’t know/not sure” when appropriate. Pearson chi- square tests were used for all analyses unless there were insufficient cell counts in which case Fisher’s Exact Tests were used. Caution should be made when interpreting sexual health and certain substance use survey items as there was a lot of missing data which could be indicative of survey response bias. SAS v9.4 was used for all analyses.

Table 1a: Community and Personal Health Responses by Gender Community and Personal Health Survey Items Female Male p-value1 (N=422) (N=183) In general, Evanston Health is: Excellent 6 (1%) 4 (2%) Very Good 101 (24%) 48 (26%) Good 221 (52%) 92 (50%) 0.89* Fair 59 (14%) 27 (15%) Poor 4 (1%) 2 (1%) Prefer not to respond 31 (7%) 10 (5%) 3 most important issues that impact health and QOL in Evanston Physical Inactivity 161 (38%) 70 (38%) Mental Health Issues 204 (48%) 58 (32%) -- Obesity 158 (37%) 55 (30%) Has a Personal Doctor Yes, only one 197 (47%) 112 (61%) More than one 177 (42%) 33 (18%) <0.001 No 41 (10%) 30 (16%) Don’t Know/not sure 4 (1%) 5 (3%) Prefer not to respond 3 (1%) 3 (2%) Has Health Coverage Yes 406 (96%) 175 (96%) 0.99*

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Community and Personal Health Survey Items Female Male p-value1 (N=422) (N=183) No 11 (3%) 4 (2%) Don’t Know/not sure 3 (1%) 3 (2%) Prefer not to respond 2 (0.5%) 1 (1%) Delayed medical care in last 12 months Yes 98 (23%) 40 (22%) 0.79 No 315 (75%) 136 (74%) Don’t Know/not sure 8 (2%) 2 (1%) Prefer not to respond 1 (1%) 5 (3%) Delayed receiving prescription in last 12 months Yes 35 (8%) 22 (12%) 0.13 No 383 (91%) 156 (85%) Don’t Know/not sure 3 (1%) 4 (2%) Prefer not to respond 1 (1%) 1 (1%) Last received complete physical Past year 263 (62%) 98 (54%) 1-2 years ago 111 (26%) 45 (25%) 3-5 years ago 27 (6%) 15 (8%) 0.01 More than 5 years ago 16 (4%) 18 (10%) Never 0 (0%) 1 (1%) Don’t know/Not Sure 2 (1%) 4 (2%) Prefer not to respond 3 (1%) 2 (1%) Last had blood pressure checked Past year 353 (84%) 144 (79%) 1-2 years ago 53 (13%) 25 (14%) 0.01* 3-5 years ago 2 (1%) 7 (4%) More than 5 years ago 4 (1%) 4 (2%) Don’t Know/Not Sure 3 (1%) 0 (0%) Prefer not to respond 4 (1%) 2 (1%) Last Dental Exam Past year 334 (79%) 118 (65%) 1-2 years ago 51 (12%) 29 (16%) 3-5 years ago 16 (4%) 14 (8%) 0.001 More than 5 years ago 15 (4%) 16 (9%) Never 0 (0%) 1 (1%) Don’t Know/Not Sure 1 (1%) 1 (1%) Prefer not to respond 4 1%) 2 (1%) Last screen for colon cancer Past year 46 (11%) 26 (15%) 1-2 years ago 48 (12%) 26 (15%) 3-5 years ago 69 (17%) 21 (12%) 0.002 More than 5 years ago 38 (9%) 6 (3%) Never 53 (13%) 41 (23%) Don’t Know/Not Sure 1 (1%) 2 (1%) Not Applicable 144 (36%) 55 (31%) Prefer not to respond 5 (1%) 2 (1%) Last Mammogram Past year 191 (46%) 4 (3%) 1-2 years ago 80 (19%) 1 (1%) 3-5 years ago 24 (6%) 0 (0%) -- More than 5 years ago 15 (4%) 0 (0%) Never 64 (15%) 7 (5%) Don’t Know/Not Sure 5 (1%) 1 (1%) Not Applicable 36 (9%) 126 (89%) Prefer not to respond 4 (1%) 3 (2%) Last Pap-test Past year 182 (44%) 3 (2%) 1-2 years ago 134 (32%) 1 (1%) -- 3-5 years ago 44 (11%) 1 (1%)

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Community and Personal Health Survey Items Female Male p-value1 (N=422) (N=183) More than 5 years ago 24 (6%) 0 (0%) Never 9 (2%) 7 (5%) Don’t Know/Not Sure 3 (1%) 1 (1%) Not Applicable 16 (4%) 126 (89%) Prefer not to respond 5 (1%) 2 (1%) Last Blood test/rectal exam (prostate) Past year 9 (3%) 55 (31%) 1-2 years ago 3 (1%) 18 (10%) 3-5 years ago 2 (1%) 13 (7%) -- More than 5 years ago 0 (0%) 9 (5%) Never 30 (9%) 26 (15%) Don’t Know/Not Sure 2 (1%) 3 (2%) Not Applicable 287 (84%) 49 (28%) Prefer not to respond 7 (2%) 3 (2%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1b: Chronic Health Condition Responses by Gender Chronic Health Conditions Survey Items Female Male p-value1 (N=422) (N=183) Have you ever been told you have diabetes? Yes 23 (5%) 12 (7%) 0.57 No 396 (94%) 168 (92%) Don’t Know/not sure 1 (1%) 2 (1%) Prefer not to respond 2 (1%) 1 (1%) Have you ever been told you have high blood pressure? Yes 93 (22%) 56 (31%) 0.02 No 327 (77%) 123 (67%) Don’t Know/not sure 0 (0%) 2 (1%) Prefer not to respond 2 (1%) 2 (1%) Have you ever been told you have asthma? Yes 83 (20%) 29 (16%) 0.29 No 338 (80%) 152 (83%) Don’t Know/not sure 0 (0%) 1 (1%) Prefer not to respond 1 (1%) 1 (1%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1c: Physical Activity and Nutrition Responses by Gender Physical Activity and Nutrition Survey Items Female Male p-value1 (N=422) (N=183) In past 12 months did you participate in physical activity? Yes 387 (92%) 166 (91%) 0.79 No 32 (8%) 15 (8%) Don’t Know/not sure 1 (1%) 0 (0%) Prefer not to respond 2 (1%) 2 (1%) How many hours do you spend looking at a screen on avg day (outside of work/school) No screen time 0 (0%) 2 (1%) <1 hour per day 37 (9%) 18 (10%) 0.10 1-2 hrs 175 (41%) 64 (35%) 3-5 hrs 145 (34%) 65 (36%)

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5+ hrs 58 (14%) 33 (18%) Prefer not to respond 7 (2%) 1 (1%) Last 7 days, how often drink sugar-sweetened beverage? None 265 (63%) 79 (43%) 1-5 times 126 (30%) 74 (40%) 6-10 times 13 (3%) 14 (8%) <0.001* 11-15 times 5 (1%) 7 (4%) 16-20 times 4 (1%) 0 (0%) 21 or more times 5 (1%) 7 (4%) Prefer not to respond 2 (1%) 2 (1%) How many servings of fruits/veggies on typical day? None 7 (2%) 9 (5%) 1-2 servings per day 140 (33%) 91 (50%) <0.001* 3-4 servings per day 187 (44%) 62 (34%) 5+ servings per day 86 (20%) 20 (11%) Prefer not to respond 2 (1%) 1 (1%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1d: Quality of Life and Sexual Health Responses by Gender Quality of Life and Sexual Health Survey Items Female Male p-value1 (N=422) (N=183) In the past 12 months have you ever felt unsafe in Evanston? Yes 110 (26%) 42 (23%) 0.30 No 289 (68%) 137 (75%) Don’t Know/not sure 19 (5%) 3 (2%) Prefer not to respond 4 (1%) 1 (1%) Are you currently taking medicine or receiving treatment from a health professional for mental health? Yes 76 (18%) 23 (13%) 0.20 No 334 (79%) 156 (85%) Don’t Know/not sure 2 (1%) 1 (1%) Prefer not to respond 10 (2%) 3 (2%) Did you or your partner use a condom the last time you had sex? Yes 39 (17%) 32 (28%) 0.04 No 181 (78%) 75 (66%) Prefer not to respond 13 (6%) 6 (5%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1e: Substance Use Responses by Gender Substance Use Survey Items Female Male p-value1 (N=422) (N=183) Current Smoking Status Every Day 17 (12%) 24 (30%) Some Days 13 (9%) 11 (14%) 0.001 Not at all 113 (79%) 46 (57%) Have you ever used any tobacco products (other than cigarettes)? Yes 38 (9%) 72 (39%) <0.001* No 380 (90%) 108 (59%) Don’t Know/not sure 2 (1%) 0 (0%) Prefer not to respond 2 (1%) 3 (2%) Have you ever used marijuana or hashish?

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Yes 235 (56%) 114 (62%) 0.28 No 169 (40%) 61 (33%) Don’t Know/not sure 1 (1%) 0 (0%) Prefer not to respond 17 (4%) 8 (4%) Have you ever used illicit substances other than marijuana? Yes 63 (15%) 43 (24%) 0.02 No 346 (82%) 132 (72%) Don’t Know/not sure 2 (1%) 0 (0%) Prefer not to respond 11 (3%) 8 (4%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

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2015 Evanston Community Health Survey Results—Household Income

Loyola Team-Members: S. Kliethermes, R. Kafensztok, J. Harbison

*Note: For future surveys: $99,000 should be switched to $99,999

The following tables compare responses to the Evanston Community Health Survey based on household income. No individuals had missing data; however 87 individuals preferred not to respond to the household income question. Because a large enough number of individuals chose this response, these individuals have been included in analyses. Tabled frequencies are based on all survey responses; however statistical analyses exclude “prefer not to respond” and “Don’t know/not sure” and “Not Applicable” on survey items, when appropriate. Pearson chi-square tests were used for all analyses unless there were insufficient cell counts in which case Fisher’s Exact Tests were used. Caution should be made when interpreting sexual health and certain substance use survey items, in particular, as there was a lot of missing data which could be indicative of survey response bias. SAS v9.4 was used for all analyses.

Table 1a: Community and Personal Health Responses by Household Income Prefer Not to Less than $25,000- $50,000- Over p-value1 Respond $25,000 $49,999 $99,000 $100,000 (N=87) (N=104) (N=73) (N=148) (N=198) In general, Evanston Health is: Excellent 0 (0%) 5 (5%) 0 (0%) 3 (2%) 2 (1%) Very Good 19 (22%) 14 (13%) 22 (30%) 48 (32%) 46 (23%) Good 45 (52%) 52 (50%) 36 (49%) 71 (48%) 111 (56%) 0.004* Fair 15 (17%) 24 (23%) 7 (10%) 18 (12%) 24 (12%) Poor 1 (1%) 4 (4%) 1 (1%) 1 (1%) 0 (0%) Prefer not to respond 7 (8%) 5 (5%) 7 (10%) 7 (5%) 15 (8%) 3 most important issues that impact health and QOL in Evanston 1st Issue Physical Mental Mental Mental Mental Health Inactivity Health Issues Health Issues Health Issues Issues (47%) (48%) (30%) (44%) (48%) 2nd Issue Mental Health Obesity (30%) Physical Physical Physical Issues (41%) Inactivity Inactivity Inactivity -- (38%) (47%) (39%) 3rd Issue Obesity (36%) High blood Obesity (36%) Obesity (36%) Obesity (37%) pressure (24%) Has a Personal Doctor

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Prefer Not to Less than $25,000- $50,000- Over p-value1 Respond $25,000 $49,999 $99,000 $100,000 (N=87) (N=104) (N=73) (N=148) (N=198) Yes, only one 46 (53%) 62 (60%) 30 (41%) 71 (48%) 101 (51%) More than one 30 (34%) 8 (8%) 31 (42%) 63 (43%) 81 (41%) <0.001 No 8 (9%) 28 (27%) 8 (11%) 12 (8%) 16 (8%) Don’t Know/not sure 1 (1%) 3 (3%) 3 (4%) 2 (1%) 0 (0%) Prefer not to respond 2 (2%) 3 (3%) 1 (1%) 0 (0%) 0 (0%) Has Health Coverage Yes 82 (94%) 95 (91%) 69 (95%) 143 (97%) 196 (99%) 0.003* No 3 (3%) 6 (6%) 4 (5%) 3 (2%) 0 (0%) Don’t Know/not sure 1 (1%) 3 (3%) 0 (0%) 1 (1%) 1 (1%) Prefer not to respond 1 (1%) 0 (0%) 0 (0%) 1 (1%) 1 (1%) Delayed medical care in last 12 months Yes 19 (22%) 28 (27%) 17 (23%) 39 (26%) 37 (19%) 0.33 No 65 (75%) 71 (68%) 56 (77%) 104 (70%) 158 (80%) Don’t Know/not sure 2 (2%) 3 (3%) 0 (0%) 5 (3%) 3 (2%) Prefer not to respond 1 (1%) 2 (2%) 0 (0%) 0 (0%) 0 (0%) Delayed receiving prescription in last 12 months Yes 6 (7%) 19 (18%) 6 (8%) 10 (7%) 17 (9%) 0.02 No 80 (92%) 82 (79%) 67 (92%) 134 (91%) 180 (91%) Don’t Know/not sure 0 (0%) 2 (2%) 0 (0%) 4 (3%) 1 (1%) Prefer not to respond 1 (1%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Last received complete physical Past year 51 (59%) 58 (56%) 49 (67%) 79 (53%) 127 (64%) 1-2 years ago 23 (26%) 25 (24%) 16 (22%) 44 (30%) 49 (25%) 3-5 years ago 5 (6%) 8 (8%) 2 (3%) 13 (9%) 14 (7%) 0.68* More than 5 years ago 4 (5%) 7 (7%) 6 (8%) 10 (7%) 7 (4%) Never 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (1%) Don’t Know/Not Sure 2 (2%) 3 (3%) 0 (0%) 2 (1%) 0 (0%) Prefer not to respond 2 (2%) 3 (3%) 0 (0%) 0 (0%) 0 (0%) Last had blood pressure checked Past year 69 (79%) 83 (81%) 62 (85%) 121 (82%) 165 (84%) 1-2 years ago 12 (14%) 15 (15%) 9 (12%) 20 (14%) 24 (12%) 0.98* 3-5 years ago 1 (1%) 1 (1%) 0 (0%) 3 (2%) 4 (2%) More than 5 years ago 1 (1%) 2 (2%) 2 (3%) 1 (1%) 2 (1%) Don’t Know/Not Sure 1 (1%) 0 (0%) 0 (0%) 2 (1%) 0 (0%) Prefer not to respond 3 (3%) 2 (2%) 0 (0%) 0 (0%) 1 (1%) Last Dental Exam Past year 72 (83%) 52 (51%) 53 (73%) 109 (74%) 171 (87%) 1-2 years ago 8 (9%) 19 (19%) 11 (15%) 22 (15%) 20 (10%) 3-5 years ago 2 (2%) 10 (10%) 4 (5%) 10 (7%) 4 (2%) <0.001* More than 5 years ago 2 (2%) 16 (16%) 5 (7%) 6 (4%) 2 (1%) Never 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Don’t Know/Not Sure 0 (0%) 1 (1%) 0 (0%) 1 (1%) 0 (0%) Prefer not to respond 3 (3%) 3 (3%) 0 (0%) 0 (0%) 0 (0%) Last screen for colon cancer Past year 9 (11%) 20 (19%) 12 (17%) 14 (10%) 18 (10%) 1-2 years ago 10 (12%) 16 (16%) 8 (11%) 13 (9%) 28 (15%) 3-5 years ago 20 (24%) 9 (9%) 10 (14%) 22 (16%) 30 (16%) 0.04 More than 5 years ago 8 (10%) 2 (2%) 3 (4%) 12 (9%) 19 (10%) Never 15 (18%) 23 (22%) 13 (18%) 22 (16%) 21 (11%) Don’t Know/Not Sure 0 (0%) 2 (2%) 0 (0%) 1 (1%) 0 (0%) Not Applicable 19 (23%) 29 (28%) 25 (35%) 56 (40%) 71 (38%)

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Prefer Not to Less than $25,000- $50,000- Over p-value1 Respond $25,000 $49,999 $99,000 $100,000 (N=87) (N=104) (N=73) (N=148) (N=198) Prefer not to respond 3 (4%) 2 (2%) 0 (0%) 1 (1%) 1 (1%) Last Mammogram Past year 37 (48%) 14 (15%) 26 (38%) 47 (32%) 73 (41%) 1-2 years ago 8 (10%) 8 (8%) 8 (12%) 29 (20%) 28 (16%) 3-5 years ago 1 (1%) 2 (2%) 2 (3%) 8 (6%) 11 (6%) 0.08* More than 5 years ago 3 (4%) 4 (4%) 4 (6%) 4 (3%) 1 (1%) Never 11 (14%) 9 (9%) 11 (16%) 17 (12%) 23 (13%) Don’t Know/Not Sure 0 (0%) 3 (3%) 1 (1%) 2 (1%) 0 (0%) Not Applicable 14 (18%) 53 (55%) 17 (25%) 38 (26%) 41 (23%) Prefer not to respond 3 (4%) 3 (3%) 0 (0%) 0 (0%) 1 (1%) Last Pap-test Past year 28 (36%) 14 (15%) 32 (46%) 49 (35%) 65 (37%) 1-2 years ago 17 (22%) 10 (10%) 11 (16%) 37 (26%) 60 (34%) 3-5 years ago 4 (5%) 9 (9%) 4 (6%) 12 (8%) 16 (9%) 0.005* More than 5 years ago 5 (6%) 3 (3%) 6 (9%) 8 (6%) 3 (2%) Never 6 (8%) 3 (3%) 2 (3%) 3 (2%) 2 (1%) Don’t Know/Not Sure 1 (1%) 2 (2%) 0 (0%) 1 (1%) 0 (0%) Not Applicable 12 (16%) 52 (54%) 15 (21%) 32 (23%) 32 (18%) Prefer not to respond 4 (5%) 3 (3%) 0 (0%) 0 (0%) 0 (0%) Last Blood test/rectal exam (prostate) 4 (5%) 3 (3%) 0 (0%) 0 (0%) 0 (0%) Past year 8 (11%) 24 (25%) 7 (11%) 9 (7%) 17 (11%) 1-2 years ago 2 (3%) 5 (5%) 3 (5%) 5 (4%) 6 (4%) 3-5 years ago 3 (4%) 2 (2%) 1 (2%) 1 (1%) 8 (5%) 0.27* More than 5 years ago 1 (1%) 5 (5%) 0 (0%) 1 (1%) 3 (2%) Never 13 (18%) 15 (15%) 8 (12%) 12 (10%) 8 (5%) Don’t Know/Not Sure 1 (1%) 2 (2%) 1 (2%) 1 (1%) 0 (0%) Not Applicable 43 (59%) 40 (41%) 45 (68%) 94 (76%) 116 (72%) Prefer not to respond 2 (3%) 4 (4%) 1 (2%) 0 (0%) 3 (2%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1b: Chronic Health Condition Responses by Household Income Prefer Not to Less than $25,000- $50,000- Over p- Respond $25,000 $49,999 $99,000 $100,000 value1 (N=87) (N=104) (N=73) (N=148) (N=198) Have you ever been told you have diabetes? Yes 4 (5%) 13 (13%) 6 (8%) 5 (3%) 7 (4%) 0.01 No 80 (92%) 89 (86%) 67 (92%) 143 (97%) 190 (96%) Don’t Know/not sure 2 (2%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 1 (1%) 1 (1%) 0 (0%) 0 (0%) 1 (1%) Have you ever been told you have high blood pressure? Yes 21 (24%) 38 (37%) 25 (34%) 32 (22%) 34 (17%) 0.001 No 64 (74%) 64 (62%) 48 (66%) 116 (78%) 162 (82%) Don’t Know/not sure 0 (0%) 1 (1%) 0 (0%) 0 (0%) 1 (1%) Prefer not to respond 2 (2%) 1 (1%) 0 (0%) 0 (0%) 1 (1%) Have you ever been told you have asthma? Yes 12 (14%) 22 (21%) 15 (21%) 28 (19%) 36 (18%) 0.73 No 74 (85%) 80 (77%) 58 (79%) 120 (81%) 162 (82%) Don’t Know/not sure 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%)

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Prefer Not to Less than $25,000- $50,000- Over p- Respond $25,000 $49,999 $99,000 $100,000 value1 (N=87) (N=104) (N=73) (N=148) (N=198) Prefer not to respond 1 (1%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1c: Physical Activity and Nutrition Responses by Household Income Prefer Not to Less than $25,000- $50,000- Over p-value1 Respond $25,000 $49,999 $99,000 $100,000 (N=87) (N=104) (N=73) (N=148) (N=198) In past 12 months did you participate in physical activity? Yes 77 (89%) 89 (86%) 66 (90%) 139 (94%) 186 (94%) 0.27 No 8 (9%) 13 (13%) 6 (8%) 9 (6%) 12 (6%) Don’t Know/not sure 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) Prefer not to respond 2 (2%) 2 (2%) 0 (0%) 0 (0%) 0 (0%) How many hours do you spend looking at a screen on avg day (outside of work/school) No screen time 0 (0%) 2 (2%) 0 (0%) 0 (0%) 0 (0%) <1 hour per day 11 (13%) 6 (6%) 5 (7%) 14 (9%) 20 (10%) 1-2 hrs 30 (34%) 31 (30%) 35 (48%) 60 (41%) 84 (42%) 0.11 3-5 hrs 32 (37%) 40 (38%) 24 (33%) 52 (35%) 63 (32%) 5+ hrs 11 (13%) 22 (21%) 7 (10%) 22 (15%) 31 (16%) Prefer not to respond 3 (3%) 3 (3%) 2 (3%) 0 (0%) 0 (0%) Last 7 days, how often drink sugar-sweetened beverage? None 51 (59%) 32 (31%) 47 (64%) 84 (57%) 131 (66%) 1-5 times 28 (32%) 40 (38%) 21 (29%) 55 (37%) 59 (30%) 6-10 times 5 (6%) 12 (12%) 1 (1%) 5 (3%) 4 (2%) <0.001* 11-15 times 0 (0%) 7 (7%) 0 (0%) 3 (2%) 2 (1%) 16-20 times 1 (1%) 1 (1%) 1 (1%) 1 (1%) 1 (1%) 21 or more times 0 (0%) 8 (8%) 3 (4%) 0 (0%) 1 (1%) Prefer not to respond 1 (1%) 3 (3%) 0 (0%) 0 (0%) 0 (0%) How many servings of fruits/veggies on typical day? None 1 (1%) 6 (6%) 2 (3%) 2 (1%) 5 (3%) 1-2 servings per day 28 (32%) 61 (59%) 25 (34%) 59 (40%) 59 (30%) <0.001 3-4 servings per day 40 (46%) 24 (23%) 29 (40%) 65 (44%) 93 (47%) 5+ servings per day 16 (18%) 12 (12%) 17 (23%) 22 (15%) 41 (21%) Prefer not to respond 2 (2%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1d: Quality of Life and Sexual Health Responses by Household Income Prefer Not to Less than $25,000- $50,000- Over p- Respond $25,000 $49,999 $99,000 $100,000 value1 (N=87) (N=104) (N=73) (N=148) (N=198) In the past 12 months have you ever felt unsafe in Evanston? Yes 23 (26%) 25 (24%) 27 (37%) 31 (21%) 48 (24%) 0.16 No 55 (63%) 75 (72%) 45 (62%) 109 (74%) 144 (73%)

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Prefer Not to Less than $25,000- $50,000- Over p- Respond $25,000 $49,999 $99,000 $100,000 value1 (N=87) (N=104) (N=73) (N=148) (N=198) Don’t Know/not sure 8 (9%) 3 (3%) 0 (0%) 7 (5%) 5 (3%) Prefer not to respond 1 (1%) 1 (1%) 1 (1%) 1 (1%) 1 (1%) Are you currently taking medicine or receiving treatment from a health professional for mental health? Yes 10 (11%) 24 (23%) 18 (25%) 17 (11%) 30 (15%) 0.04 No 67 (77%) 79 (76%) 55 (75%) 129 (87%) 165 (83%) Don’t Know/not sure 2 (2%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) Prefer not to respond 8 (9%) 1 (1%) 0 (0%) 1 (1%) 3 (2%) Did you or your partner use a condom the last time you had sex? Yes 7 (17%) 23 (49%) 3 (9%) 20 (23%) 18 (13%) <0.001 No 31 (76%) 22 (47%) 27 (84%) 60 (70%) 117 (83%) Prefer not to respond 3 (7%) 2 (4%) 2 (6%) 6 (7%) 6 (4%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1e: Substance Use Responses by Household Income Prefer Not to Less than $25,000- $50,000- Over p- Respond $25,000 $49,999 $99,000 $100,000 value1 (N=87) (N=104) (N=73) (N=148) (N=198) Current Smoking Status Every Day 2 (7%) 25 (45%) 6 (24%) 9 (17%) 0 (0%) Some Days 0 (0%) 12 (22%) 0 (0%) 9 (17%) 3 (5%) <0.001 Not at all 27 (93%) 18 (33%) 19 (76%) 36 (67%) 59 (95%) Have you ever used any tobacco products (other than cigarettes)? Yes 14 (16%) 17 (16%) 16 (22%) 30 (20%) 34 (17%) 0.78 No 70 (80%) 87 (84%) 57 (78%) 115 (78%) 163 (82%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 1 (1%) 1 (1%) Prefer not to respond 3 (3%) 0 (0%) 0 (0%) 2 (1%) 0 (0%) Have you ever used marijuana or hashish? Yes 34 (39%) 55 (53%) 43 (59%) 81 (55%) 136 (69%) <0.001 No 42 (48%) 46 (44%) 29 (40%) 62 (42%) 56 (28%) Don’t Know/not sure 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) Prefer not to respond 11 (13%) 3 (3%) 0 (0%) 5 (3%) 6 (3%) Have you ever used illicit substances other than marijuana? Yes 10 (11%) 25 (24%) 8 (11%) 29 (20%) 34 (17%) 0.12 No 68 (78%) 76 (73%) 64 (88%) 115 (78%) 160 (81%) Don’t Know/not sure 0 (0%) 0 (0%) 1 (1%) 1 (1%) 0 (0%) Prefer not to respond 9 (10%) 3 (3%) 0 (0%) 3 (2%) 4 (2%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

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2015 Evanston Community Health Survey Results—Race

Loyola Team-Members: S. Kliethermes, R. Kafensztok, J. Harbison

The following tables compare responses to the Evanston Community Health Survey based on race. No individuals had missing data; however 28 individuals preferred not to respond to the race question. Because a large enough number of individuals chose this response, these individuals have been included in analyses. Tabled frequencies are based on all survey responses; however statistical analyses exclude “prefer not to respond” and “Don’t know/not sure” and “Not Applicable” on survey items, when appropriate. Pearson chi- square tests were used for all analyses unless there were insufficient cell counts in which case Fisher’s Exact Tests were used. Caution should be made when interpreting sexual health and certain substance use survey items, in particular, as there was a lot of missing data which could be indicative of survey response bias. SAS v9.4 was used for all analyses.

Table 1a: Community and Personal Health Responses by Race Prefer Not to Black or African White Other (N=54) p-value1 Respond (N=28) American (N=98) (N=430) In general, Evanston Health is: Excellent 1 (4%) 1 (1%) 7 (2%) 1 (2%) Very Good 3 (11%) 19 (19%) 111 (26%) 16 (30%) Good 11 (39%) 44 (45%) 235 (55%) 25 (46%) <0.001* Fair 5 (18%) 27 (28%) 45 (10%) 11 (20%) Poor 2 (7%) 4 (4%) 1 (0%) 0 (0%) Prefer not to respond 3 most important issues that impact health and QOL in Evanston 1st Issue Obesity (29%) Mental Health Issues Mental Physical Inactivity (36%) Health (39%) Issues (48%) 2nd Issue Injury/Violence High Blood Pressure Physical Obesity (33%)

(25%) (29%) Inactivity (44%) 3rd Issue Diabetes/ Physical Alcohol/substance Obesity Smoking/tobacco Inactivity (21%) abuse (29%) (39%) use (26%) Has a Personal Doctor Yes, only one 17 (61%) 56 (57%) 212 (49%) 25 (46%) More than one 4 (14%) 19 (19%) 178 (41%) 12 (22%) <0.001* No 4 (14%) 19 (19%) 35 (8%) 14 (26%) Don’t Know/not sure 1 (4%) 2 (2%) 4 (1%) 2 (4%) Prefer not to respond 2 (7%) 2 (2%) 1 (0%) 1 (2%) Has Health Coverage Yes 24 (86%) 92 (94%) 419 (97%) 50 (93%) 0.04* No 2 (7%) 5 (5%) 7 (2%) 2 (4%) Don’t Know/not sure 1 (4%) 1 (1%) 2 (0%) 2 (4%) Prefer not to respond 1 (4%) 0 (0%) 2 (0%) 0 (0%) Delayed medical care in last 12 months Yes 6 (21%) 16 (16%) 103 (24%) 15 (28%) 0.31 No 21 (75%) 80 (82%) 316 (73%) 37 (69%) Don’t Know/not sure 1 (4%) 1 (1%) 9 (2%) 2 (4%) Prefer not to respond 0 (0%) 1 (1%) 2 (0%) 0 (0%) Delayed receiving prescription in last 12 months Yes 2 (7%) 11 (11%) 35 (8%) 10 (19%) 0.08 No 26 (93%) 84 (86%) 390 (91%) 43 (80%)

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Prefer Not to Black or African White Other (N=54) p-value1 Respond (N=28) American (N=98) (N=430) Don’t Know/not sure 0 (0%) 2 (2%) 4 (1%) 1 (2%) Prefer not to respond 0 (0%) 1 (1%) 1 (0%) 0 (0%) Last received complete physical Past year 14 (50%) 65 (66%) 259 (60%) 26 (48%) 1-2 years ago 10 (36%) 21 (21%) 110 (26%) 16 (30%) 3-5 years ago 1 (4%) 4 (4%) 31 (7%) 6 (11%) 0.27* More than 5 years ago 1 (4%) 3 (3%) 26 (6%) 4 (7%) Never 0 (0%) 1 (1%) 0 (0%) 0 (0%) Don’t Know/Not Sure 1 (4%) 1 (1%) 3 (1%) 2 (4%) Prefer not to respond 1 (4%) 3 (3%) 1 (0%) 0 (0%) Last had blood pressure checked Past year 19 (68%) 76 (79%) 365 (85%) 40 (74%) 1-2 years ago 7 (25%) 17 (18%) 45 (11%) 11 (20%) 0.03* 3-5 years ago 0 (0%) 0 (0%) 7 (2%) 2 (4%) More than 5 years ago 1 (4%) 1 (1%) 5 (1%) 1 (2%) Don’t Know/Not Sure 0 (0%) 0 (0%) 3 (1%) 0 (0%) Prefer not to respond 1 (4%) 2 (2%) 3 (1%) 0 (0%) Last Dental Exam Past year 20 (71%) 55 (57%) 347 (81%) 35 (65%) 1-2 years ago 4 (14%) 20 (21%) 46 (11%) 10 (19%) 3-5 years ago 1 (4%) 8 (8%) 17 (4%) 4 (7%) <0.001* More than 5 years ago 2 (7%) 9 (9%) 15 (4%) 5 (9%) Never 0 (0%) 1 (1%) 0 (0%) 0 (0%) Don’t Know/Not Sure 0 (0%) 0 (0%) 2 (0%) 0 (0%) Prefer not to respond 1 (4%) 3 (3%) 2 (0%) 0 (0%) Last screen for colon cancer Past year 4 (16%) 16 (17%) 48 (12%) 5 (10%) 1-2 years ago 5 (20%) 14 (15%) 53 (13%) 3 (6%) 3-5 years ago 6 (24%) 7 (7%) 75 (18%) 3 (6%) <0.001* More than 5 years ago 0 (0%) 4 (4%) 36 (9%) 4 (8%) Never 3 (12%) 24 (25%) 51 (12%) 16 (31%) Don’t Know/Not Sure 0 (0%) 1 (1%) 2 (0%) 0 (0%) Not Applicable 6 (24%) 27 (28%) 146 (35%) 21 (40%) Prefer not to respond 1 (4%) 3 (3%) 3 (1%) 0 (0%) Last Mammogram Past year 5 (22%) 23 (26%) 158 (40%) 11 (21%) 1-2 years ago 5 (22%) 12 (13%) 59 (15%) 5 (9%) 3-5 years ago 0 (0%) 3 (3%) 19 (5%) 2 (4%) 0.52* More than 5 years ago 1 (4%) 2 (2%) 11 (3%) 2 (4%) Never 2 (9%) 11 (12%) 49 (12%) 9 (17%) Don’t Know/Not Sure 0 (0%) 2 (2%) 3 (1%) 1 (2%) Not Applicable 9 (39%) 35 (39%) 98 (25%) 21 (40%) Prefer not to respond 1 (4%) 2 (2%) 2 (1%) 2 (4%) Last Pap-test Past year 7 (29%) 32 (36%) 134 (34%) 15 (29%) 1-2 years ago 4 (17%) 12 (13%) 112 (28%) 7 (14%) 3-5 years ago 1 (4%) 5 (6%) 37 (9%) 2 (4%) 0.002* More than 5 years ago 1 (4%) 4 (4%) 19 (5%) 1 (2%) Never 1 (4%) 3 (3%) 5 (1%) 7 (14%) Don’t Know/Not Sure 0 (0%) 0 (0%) 4 (1%) 0 (0%) Not Applicable 8 (33%) 31 (35%) 86 (22%) 18 (35%) Prefer not to respond 2 (8%) 2 (2%) 2 (1%) 1 (2%) Last Blood test/rectal exam (prostate) Past year 4 (17%) 18 (21%) 40 (11%) 3 (6%) 0.12*

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Prefer Not to Black or African White Other (N=54) p-value1 Respond (N=28) American (N=98) (N=430) 1-2 years ago 0 (0%) 5 (6%) 16 (4%) 0 (0%) 3-5 years ago 1 (4%) 2 (2%) 11 (3%) 1 (2%) More than 5 years ago 1 (4%) 1 (1%) 5 (1%) 3 (6%) Never 4 (17%) 18 (21%) 26 (7%) 8 (16%) Don’t Know/Not Sure 0 (0%) 2 (2%) 2 (1%) 1 (2%) Not Applicable 13 (54%) 37 (43%) 256 (71%) 32 (64%) Prefer not to respond 1 (4%) 3 (3%) 4 (1%) 2 (4%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1b: Chronic Health Condition Responses by Race Prefer Not to Black or African White Other p-value1 Respond (N=28) American (N=98) (N=430) (N=54) Have you ever been told you have diabetes? Yes 4 (14%) 16 (16%) 11 (3%) 4 (7%) No <0.001* 22 (79%) 82 (84%) 415 (97%) 50 (93%) Don’t Know/not sure 0 (0%) 0 (0%) 3 (1%) 0 (0%) Prefer not to respond 2 (7%) 0 (0%) 1 (0%) 0 (0%) Have you ever been told you have high blood pressure? Yes 8 (29%) 41 (42%) 89 (21%) 12 (22%) <0.001 No 18 (64%) 57 (58%) 337 (78%) 42 (78%) Don’t Know/not sure 0 (0%) 0 (0%) 2 (0%) 0 (0%) Prefer not to respond 2 (7%) 0 (0%) 2 (0%) 0 (0%) Have you ever been told you have asthma? Yes 4 (14%) 22 (22%) 76 (18%) 11 (20%) 0.66 No 23 (82%) 76 (78%) 353 (82%) 42 (78%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 1 (2%) Prefer not to respond 1 (4%) 0 (0%) 1 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1c: Physical Activity and Nutrition Responses by Race Prefer Not to Black or African White Other p-value1 Respond (N=28) American (N=98) (N=430) (N=54) In past 12 months did you participate in physical activity? Yes 26 (93%) 76 (78%) 405 (94%) 50 (93%) <0.001* No 0 (0%) 20 (20%) 25 (6%) 3 (6%) Don’t Know/not sure 1 (4%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 1 (4%) 2 (2%) 0 (0%) 1 (2%) How many hours do you spend looking at a screen on avg day (outside of work/school) No screen time 0 (0%) 0 (0%) 2 (0%) 0 (0%) <1 hour per day 3 (11%) 7 (7%) 44 (10%) 2 (4%) 1-2 hrs 12 (43%) 28 (29%) 190 (44%) 10 (19%) <0.001* 3-5 hrs 6 (21%) 35 (36%) 148 (34%) 22 (41%) 5+ hrs 5 (18%) 25 (26%) 44 (10%) 19 (35%) Prefer not to respond 2 (7%) 3 (3%) 2 (0%) 1 (2%)

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Prefer Not to Black or African White Other p-value1 Respond (N=28) American (N=98) (N=430) (N=54) Last 7 days, how often drink sugar- sweetened beverage? None 15 (54%) 27 (28%) 281 (65%) 22 (41%) 1-5 times 8 (29%) 47 (48%) 121 (28%) 27 (50%) 6-10 times 2 (7%) 7 (7%) 14 (3%) 4 (7%) <0.001* 11-15 times 0 (0%) 6 (6%) 6 (1%) 0 (0%) 16-20 times 1 (4%) 2 (2%) 2 (0%) 0 (0%) 21 or more times 0 (0%) 7 (7%) 4 (1%) 1 (2%) Prefer not to respond 1 (4%) 2 (2%) 1 (0%) 0 (0%) How many servings of fruits/veggies on typical day? None 0 (0%) 5 (5%) 7 (2%) 4 (7%) 1-2 servings per day 10 (36%) 64 (65%) 134 (31%) 24 (44%) <0.001* 3-4 servings per day 12 (43%) 20 (20%) 199 (46%) 20 (37%) 5+ servings per day 4 (14%) 8 (8%) 90 (21%) 6 (11%) Prefer not to respond 2 (7%) 1 (1%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1d: Quality of Life and Sexual Health Responses by Race Prefer Not to Black or African White Other p- Respond (N=28) American (N=98) (N=430) (N=54) value1 In the past 12 months have you ever felt unsafe in Evanston? Yes 9 (32%) 30 (31%) 102 (24%) 13 (24%) 0.40 No 17 (61%) 64 (65%) 309 (72%) 38 (70%) Don’t Know/not sure 0 (0%) 4 (4%) 17 (4%) 2 (4%) Prefer not to respond 2 (7%) 0 (0%) 2 (0%) 1 (2%) Are you currently taking medicine or receiving treatment from a health professional for mental health? Yes 1 (4%) 9 (9%) 79 (18%) 10 (19%) 0.04 No 25 (89%) 88 (90%) 340 (79%) 42 (78%) Don’t Know/not sure 0 (0%) 0 (0%) 2 (0%) 1 (2%) Prefer not to respond 2 (7%) 1 (1%) 9 (2%) 1 (2%) Did you or your partner use a condom the last time you had sex? Yes 1 (8%) 18 (35%) 44 (17%) 8 (32%) 0.01 No 8 (67%) 31 (61%) 201 (78%) 17 (68%) Prefer not to respond 3 (25%) 2 (4%) 14 (5%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1e: Substance Use Responses by Race Prefer Not to Black or African White Other p-value1 Respond (N=28) American (N=98) (N=430) (N=54) Current Smoking Status Every Day 0 (0%) 28 (57%) 10 (7%) 4 (18%) <0.001* Some Days 0 (0%) 8 (16%) 11 (7%) 5 (23%)

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Prefer Not to Black or African White Other p-value1 Respond (N=28) American (N=98) (N=430) (N=54) Not at all 7 (100%) 13 (27%) 126 (86%) 13 (59%) Have you ever used any tobacco products (other than cigarettes)? Yes 7 (25%) 16 (16%) 73 (17%) 15 (28%) 0.18 No 21 (75%) 82 (84%) 351 (82%) 38 (70%) Don’t Know/not sure 0 (0%) 0 (0%) 1 (0%) 1 (2%) Prefer not to respond 0 (0%) 0 (0%) 5 (1%) 0 (0%) Have you ever used marijuana or hashish? Yes 3 (11%) 52 (53%) 261 (61%) 33 (61%) <0.001 No 21 (75%) 42 (43%) 154 (36%) 18 (33%) Don’t Know/not sure 0 (0%) 0 (0%) 1 (0%) 0 (0%) Prefer not to respond 4 (14%) 4 (4%) 14 (3%) 3 (6%) Have you ever used illicit substances other than marijuana? Yes 1 (4%) 24 (24%) 68 (16%) 13 (24%) 0.04 No 21 (75%) 72 (73%) 351 (82%) 39 (72%) Don’t Know/not sure 0 (0%) 1 (1%) 1 (0%) 0 (0%) Prefer not to respond 6 (21%) 1 (1%) 10 (2%) 2 (4%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

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2015 Evanston Community Health Survey Results--Ward

Loyola Team-Members: S. Kliethermes, R. Kafensztok, J. Harbison

The following tables compare responses to the Evanston Community Health Survey based on ward. Tabled frequencies are based on all survey responses; however statistical analyses exclude “prefer not to respond” and “Don’t know/not sure” and “Not Applicable” when appropriate. Pearson chi-square tests were used for all analyses unless there were insufficient cell counts in which case Fisher’s Exact Tests were used. Caution should be made when interpreting sexual health and certain substance use survey items in particular as there was a lot of missing data which could be indicative of survey response bias. SAS v9.4 was used for all analyses.

Table 1a: Community and Personal Health Responses by Ward 1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78 ) In general, Evanston Health is: Excellent 2 (4%) 0 (0%) 1 (1%) 1 (1%) 1 (2%) 2 (2%) 1 (2%) 0 (0%) 2 (3%) Very Good 20 20 21 16 19 18 10 18 (37%) (30%) (24%) (23%) 7 (13%) (23%) (28%) (19%) (23%) Good 20 27 57 39 24 46 31 25 46 0.003* (37%) (40%) (65%) (57%) (44%) (57%) (48%) (46%) (59%) Fair 14 10 16 13 6 (11%) (21%) 5 (6%) (14%) (29%) 9 (11%) 8 (13%) (24%) 7 (9%) Poor 0 (0%) 2 (3%) 0 (0%) 0 (0%) 2 (4%) 0 (0%) 1 (2%) 1 (2%) 1 (1%) Prefer not to respond 6 (11%) 4 (6%) 4 (5%) 3 (4%) 5 (9%) 5 (6%) 5 (8%) 5 (9%) 4 (5%)

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1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78 ) 3 most important issues that impact health and QOL in Evanston

1st Issue Mental Mental Mental Mental Mental Physica Physica Mental Menta Health Health Health Health Health l l Health l (44%) (37%) (50%) (51%) (31%) Inactivit Inactivit (39%) Health y (46%) y (53%) (49%) 2nd Issue Obesity Obesity Physica Physica Obesity Mental Obesity Obesity Obesit (37%) (33%) l l (24%) Health (38%) (33%) y Inactivit Inactivit (44%) (42%) --- y (47%) y (38%) 3rd Issue Physica Physica Obesity Obesity Injury/ Obesity Mental Physica Physic l l (35%) (30%) violenc (41%) Health l al Inactivit Inactivit e (24%) (38%) Inactivit Inactiv y (35%) y (31%) y (33%) ity (33%) Has a Personal Doctor Yes, only one 25 36 41 39 25 47 31 26 40 (46%) (54%) (47%) (57%) (45%) (58%) (48%) (48%) (51%) More than 24 20 33 18 15 29 27 21 26 0.37 one (44%) (30%) (38%) (26%) (27%) (36%) (42%) (39%) (33%) No 10 13 11 10 4 (7%) (15%) (15%) 9 (13%) (20%) 4 (5%) 6 (9%) 5 (9%) (13%) Don’t Know/not sure 1 (2%) 1 (1%) 0 (0%) 1 (1%) 1 (2%) 1 (1%) 0 (0%) 2 (4%) 2 (3%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 2 (3%) 3 (5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Has Health

Coverage Yes 51 66 85 66 51 80 62 51 73 (94%) (99%) (97%) (96%) (93%) (99%) (97%) (94%) (94%) 0.32* No 1 (2%) 0 (0%) 3 (3%) 2 (3%) 1 (2%) 0 (0%) 2 (3%) 3 (6%) 4 (5%) Don’t Know/not sure 2 (4%) 1 (1%) 0 (0%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 1 (1%) 0 (0%) 0 (0%) 1 (1%) Delayed medical care in last 12 months Yes 17 17 12 20 19 16 24 6 (11%) 9 (13%) (19%) (25%) (22%) (25%) (30%) (30%) (31%) 0.10 No 46 54 70 48 41 60 44 37 54 (85%) (81%) (80%) (70%) (75%) (74%) (69%) (69%) (69%) Don’t Know/not sure 1 (2%) 4 (6%) 0 (0%) 4 (6%) 2 (4%) 1 (1%) 1 (2%) 0 (0%) 0 (0%)

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1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78 ) Prefer not to respond 1 (2%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) Delayed receiving prescription in last 12 months Yes 10 7 (13%) 6 (9%) 4 (5%) 4 (6%) 8 (15%) 8 (10%) 4 (6%) 7 (13%) (13%) 0.34 No 47 61 83 64 44 73 59 44 68 (87%) (91%) (94%) (93%) (80%) (90%) (92%) (81%) (87%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 1 (1%) 3 (5%) 0 (0%) 1 (2%) 2 (4%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) Last received complete physical Past year 32 39 51 37 31 49 40 40 45 (59%) (58%) (58%) (54%) (56%) (60%) (63%) (74%) (58%) 1-2 years ago 16 20 23 20 11 22 14 10 21 (30%) (30%) (26%) (29%) (20%) (27%) (22%) (19%) (27%) 3-5 years ago 0.96* 3 (6%) 3 (4%) 7 (8%) 6 (9%) 3 (5%) 7 (9%) 5 (8%) 2 (4%) 6 (8%) More than 5 years ago 2 (4%) 5 (7%) 4 (5%) 4 (6%) 5 (9%) 3 (4%) 4 (6%) 1 (2%) 6 (8%) Never 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Don’t Know/Not Sure 1 (2%) 0 (0%) 1 (1%) 1 (1%) 2 (4%) 0 (0%) 1 (2%) 1 (2%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 2 (2%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Last had blood pressure checked Past year 45 57 74 53 44 71 55 45 56 (83%) (85%) (85%) (78%) (80%) (88%) (86%) (85%) (73%) 1-2 years ago

11 16 0.86* 7 (13%) 9 (13%) 9 (10%) (16%) 8 (15%) 8 (10%) 5 (8%) 7 (13%) (21%) 3-5 years ago 2 (4%) 1 (1%) 1 (1%) 1 (1%) 1 (2%) 1 (1%) 1 (2%) 0 (0%) 1 (1%) More than 5 years ago 0 (0%) 0 (0%) 1 (1%) 1 (1%) 1 (2%) 1 (1%) 1 (2%) 0 (0%) 3 (4%) Don’t Know/Not Sure 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (3%) 0 (0%) 1 (1%) Prefer not to respond 0 (0%) 0 (0%) 2 (2%) 2 (3%) 1 (2%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) Last Dental Exam Past year 49 43 64 50 34 62 54 45 56 0.07* (91%) (65%) (74%) (72%) (62%) (77%) (84%) (83%) (73%)

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1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78 ) 1-2 years ago 15 14 13 12 8 2 (4%) (23%) (16%) (19%) (22%) 9 (11%) 3 (5%) 4 (7%) (10%) 3-5 years ago 1 (2%) 4 (6%) 4 (5%) 2 (3%) 3 (5%) 6 (7%) 3 (5%) 2 (4%) 5 (6%) More than 5 8 years ago 2 (4%) 2 (3%) 3 (3%) 3 (4%) 4 (7%) 4 (5%) 3 (5%) 2 (4%) (10%) Never 0 (0%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Don’t Know/Not Sure 0 (0%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 2 (2%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) Last screen for colon cancer Past year 10 10 13 10 4 (7%) 9 (14%) (12%) 8 (12%) (18%) (17%) (16%) 4 (8%) 5 (7%) 1-2 years ago 10 11 10 9 8 (15%) 3 (5%) (12%) (17%) 7 (13%) 8 (11%) (16%) 9 (17%) (12%) 3-5 years ago 12 21 14 10 0.30 9 (17%) 7 (11%) (14%) 5 (8%) 6 (11%) (28%) 7 (11%) (27%) (14%) More than 5 10 years ago 6 (11%) 5 (8%) (12%) 6 (9%) 2 (4%) 4 (5%) 4 (7%) 3 (6%) 4 (5%) Never 13 12 12 11 12 14 8 7 (13%) (20%) (14%) (18%) (20%) (16%) (23%) 5 (10%) (11%) Don’t Know/Not Sure 0 (0%) 1 (2%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) Not 20 28 30 22 16 17 15 16 36

Applicable (37%) (42%) (35%) (34%) (29%) (23%) (25%) (31%) (49%) Prefer not to respond 0 (0%) 0 (0%) 2 (2%) 1 (2%) 2 (4%) 0 (0%) 0 (0%) 1 (2%) 1 (1%) Last

Mammogram Past year 18 16 34 20 15 30 30 18 16 (35%) (24%) (41%) (33%) (30%) (41%) (49%) (35%) (24%) 1-2 years ago 16 13 13 6 (12%) 8 (12%) 7 (8%) 7 (11%) 5 (10%) (22%) 6 (10%) (25%) (19%) 3-5 years ago 1 (2%) 3 (5%) 3 (4%) 3 (5%) 1 (2%) 5 (7%) 2 (3%) 3 (6%) 3 (4%) 0.27* More than 5 years ago 2 (4%) 3 (5%) 1 (1%) 2 (3%) 1 (2%) 1 (1%) 1 (2%) 2 (4%) 3 (4%) Never 13 10 10 9 8 (16%) 7 (11%) (16%) (16%) 7 (14%) 2 (3%) (16%) 5 (10%) (13%) Don’t Know/Not Sure 0 (0%) 1 (2%) 1 (1%) 0 (0%) 0 (0%) 1 (1%) 1 (2%) 1 (2%) 1 (1%) Not 15 28 22 18 19 18 11 23 Applicable (29%) (42%) (27%) (30%) (38%) (25%) (18%) 9 (17%) (34%) Prefer not to respond 1 (2%) 0 (0%) 2 (2%) 1 (2%) 2 (4%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) Last Pap-test Past year 17 16 33 19 13 24 20 21 25 (33%) (24%) (40%) (30%) (28%) (34%) (33%) (40%) (36%) 0.61* 1-2 years ago 12 15 19 17 17 21 11 16 (24%) (23%) (23%) (27%) 7 (15%) (24%) (34%) (21%) (23%)

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1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78 ) 3-5 years ago 10 2 (4%) 5 (8%) 7 (8%) 5 (8%) 4 (9%) (14%) 3 (5%) 5 (10%) 4 (6%) More than 5 years ago 2 (4%) 3 (5%) 2 (2%) 2 (3%) 1 (2%) 3 (4%) 3 (5%) 4 (8%) 5 (7%) Never 3 (6%) 2 (3%) 0 (0%) 3 (5%) 2 (4%) 0 (0%) 5 (8%) 1 (2%) 0 (0%) Don’t Know/Not Sure 0 (0%) 1 (2%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 1 (1%) Not 15 24 20 15 17 17 18

Applicable (29%) (36%) (24%) (24%) (36%) (24%) 8 (13%) 9 (17%) (26%) Prefer not to

respond 0 (0%) 0 (0%) 2 (2%) 1 (2%) 3 (6%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) Last Blood test/rectal exam (prostate) Past year 12 11 5 (10%) (19%) 9 (12%) 9 (16%) 8 (17%) (18%) 3 (6%) 3 (7%) 5 (7%) 1-2 years ago 3 (6%) 3 (5%) 2 (3%) 3 (5%) 2 (4%) 2 (3%) 0 (0%) 3 (7%) 3 (4%) 3-5 years ago 1 (2%) 1 (2%) 2 (3%) 1 (2%) 0 (0%) 5 (8%) 2 (4%) 2 (5%) 1 (1%) 0.34* More than 5 years ago 1 (2%) 2 (3%) 0 (0%) 1 (2%) 0 (0%) 2 (3%) 2 (4%) 0 (0%) 2 (3%) Never 9 6 (12%) 6 (10%) 8 (10%) 8 (14%) 6 (13%) 3 (5%) 9 (17%) 1 (2%) (13%) Don’t Know/Not Sure 0 (0%) 0 (0%) 1 (1%) 0 (0%) 1 (2%) 0 (0%) 1 (2%) 2 (5%) 0 (0%) Not 35 39 52 32 28 38 35 32 47 Applicable (67%) (62%) (67%) (57%) (60%) (61%) (67%) (74%) (70%) Prefer not to respond 1 (2%) 0 (0%) 4 (5%) 2 (4%) 2 (4%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1b: Chronic Health Condition Responses by Age 1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) Have you ever been told you have diabetes? Yes 1 (2%) 6 (9%) 3 (3%) 4 (6%) 6 (11%) 1 (1%) 2 (3%) 6 (11%) 6 (8%) No 52 60 84 65 47 79 62 48 72 0.07* (96%) (90%) (95%) (94%) (85%) (98%) (97%) (89%) (92%) Don’t Know/not sure 1 (2%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 0 (0%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Have you ever been told you have high blood 12 27 13 13 21 21 13 18 12 pressure? (22%) (40%) (15%) (19%) (38%) (26%) (20%) (33%) (15%) Yes 12 27 13 13 21 21 13 18 12 (22%) (40%) (15%) (19%) (38%) (26%) (20%) (33%) (15%) <0.001 No 41 39 74 55 32 60 51 36 66 (76%) (58%) (84%) (80%) (58%) (74%) (80%) (67%) (85%)

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1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) Don’t Know/not sure 1 (2%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Have you ever been told you have asthma? 0 (0%) 0 (0%) 1 (1%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Yes 10 13 15 16 12 18 15 8 (15%) (15%) (15%) (22%) 6 (11%) (20%) (19%) (33%) (19%) 0.14 No 46 57 74 53 48 65 52 36 63 (85%) (85%) (84%) (77%) (87%) (80%) (81%) (67%) (81%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1c: Physical Activity and Nutrition Responses by Age 1 2 3 4 5 6 7 8 9 p- (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) value1 In past 12 months did you participate in physical activity? Yes 52 61 43 59 49 71 (96%) (91%) 84 (95%) 64 (93%) (78%) 74 (91%) (92%) (91%) (91%) 0.29 No 2 (4%) 5 (7%) 4 (5%) 4 (6%) 9 (16%) 7 (9%) 5 (8%) 5 (9%) 7 (9%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 1 (1%) 0 (0%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) How many hours do you spend looking at a screen on avg day (outside of work/school) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (1%) No screen time 1 (2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (1%) <1 hour per day 5 (9%) 6 (9%) 7 (8%) 6 (9%) 5 (9%) 10 (12%) 8 (13%) 5 (9%) 4 (5%) 1-2 hrs 18 29 15 24 21 32 (33%) (43%) 32 (36%) 35 (51%) (27%) 34 (42%) (38%) (39%) (41%) 0.42* 3-5 hrs 20 17 21 26 20 24 (37%) (25%) 34 (39%) 21 (30%) (38%) 28 (35%) (41%) (37%) (31%) 5+ hrs 10 15 11 17 (19%) (22%) 13 (15%) 5 (7%) (20%) 9 (11%) 5 (8%) 8 (15%) (22%) Prefer not to respond 0 (0%) 0 (0%) 2 (2%) 2 (3%) 3 (5%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) Last 7 days, how often drink sugar-sweetened beverage? None 28 37 20 42 24 41 (52%) (55%) 57 (65%) 47 (68%) (36%) 49 (60%) (66%) (44%) (53%) 1-5 times 23 21 20 19 21 31 (43%) (31%) 25 (28%) 15 (22%) (36%) 28 (35%) (30%) (39%) (40%) 6-10 times 3 (6%) 5 (7%) 4 (5%) 2 (3%) 3 (5%) 2 (2%) 1 (2%) 3 (6%) 4 (5%) 0.03* 11-15 times 0 (0%) 3 (4%) 0 (0%) 1 (1%) 3 (5%) 1 (1%) 1 (2%) 2 (4%) 1 (1%) 16-20 times 0 (0%) 0 (0%) 0 (0%) 1 (1%) 2 (4%) 0 (0%) 1 (2%) 1 (2%) 0 (0%) 21 or more times 0 (0%) 1 (1%) 1 (1%) 2 (3%) 4 (7%) 1 (1%) 0 (0%) 3 (6%) 0 (0%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) 0 (0%) 1 (1%) Prefer not to respond 0 (0%) 0 (0%) 1 (1%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) How many servings of fruits/veggies on typical 2 (4%) 1 (1%) 2 (2%) 1 (1%) 6 (11%) 2 (2%)

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1 2 3 4 5 6 7 8 9 p- (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) value1 day? None 2 (4%) 1 (1%) 2 (2%) 1 (1%) 6 (11%) 2 (2%) 1 (2%) 1 (2%) 0 (0%) 1-2 servings per day 16 33 27 22 15 21 34 (30%) (49%) 34 (39%) (39%) 30 (55%) (27%) (23%) (39%) (44%) <0.00 3-4 servings per day 28 19 29 41 40 22 31 1* (52%) (28%) 32 (36%) (42%) 9 (16%) (51%) (63%) (41%) (40%) 5+ servings per day 14 11 16 8 10 13 8 (15%) (21%) 20 (23%) (16%) 8 (15%) (20%) (13%) (19%) (17%) Prefer not to respond 0 (0%) 0 (0%) 0 (0%) 1 (1%) 2 (4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1d: Quality of Life and Sexual Health Responses by Age 1 2 3 4 5 6 7 8 9 p- (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) value1 In the past 12 1 2 3 4 5 6 7 8 9 p-value months have you (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) ever felt unsafe in Evanston? Yes 16 15 19 20 16 17 16 15 20 (30%) (22%) (22%) (29%) (29%) (21%) (25%) (28%) (26%) 0.86 No 35 50 65 48 38 62 45 32 53 (65%) (75%) (74%) (70%) (69%) (77%) (70%) (59%) (68%) Don’t Know/not 6

sure 2 (4%) 1 (1%) 4 (5%) 1 (1%) 0 (0%) 1 (1%) 3 (5%) (11%) 5 (6%) Prefer not to

respond 1 (2%) 1 (1%) 0 (0%) 0 (0%) 1 (2%) 1 (1%) 0 (0%) 1 (2%) 0 (0%) Are you currently taking medicine or receiving treatment from a health professional for mental health? Yes 7 11 15 15 8 11 12 11 9 (13%) (16%) (17%) (22%) (15%) (14%) (19%) (20%) (12%) 0.77 No 47 53 70 53 45 69 48 43 67 (87%) (79%) (80%) (77%) (82%) (85%) (75%) (80%) (86%) Don’t Know/not

sure 0 (0%) 1 (1%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 0 (0%) 0 (0%) Prefer not to

respond 0 (0%) 2 (3%) 2 (2%) 1 (1%) 2 (4%) 1 (1%) 3 (5%) 0 (0%) 2 (3%) Did you or your partner use a condom the last time you had sex? 0 (0%) 2 (3%) 2 (2%) 1 (1%) 2 (4%) 1 (1%) 3 (5%) 0 (0%) 2 (3%) Yes 7 11 13 9 9 6 4 3 9 (22%) (33%) (24%) (23%) (30%) (14%) (12%) (10%) (18%) 0.18 No 24 19 41 28 19 35 26 28 37 (75%) (58%) (75%) (70%) (63%) (80%) (79%) (90%) (76%) Prefer not to respond 1 (3%) 3 (9%) 1 (2%) 3 (8%) 2 (7%) 3 (7%) 3 (9%) 0 (0%) 3 (6%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and

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“Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

Table 1e: Substance Use Responses by Age 1 2 3 4 5 6 7 8 9 p-value1 (N=54) (N=67) (N=88) (N=69) (N=55) (N=81) (N=64) (N=54) (N=78) Current Smoking Status Every Day 3 6 3 15 4 7 2 (19%) (21%) 0 (0%) (13%) (58%) (12%) 2 (8%) (29%) (10%) Some Days 2 4 3 3 4 <0.001* (13%) (14%) 2 (8%) 2 (8%) 2 (8%) 2 (6%) (12%) (13%) (19%) Not at all 11 19 24 19 9 28 20 14 15 (69%) (66%) (92%) (79%) (35%) (82%) (80%) (58%) (71%) Have you ever used any tobacco products (other than cigarettes)? Yes 9 16 17 12 10 16 8 6 17 (17%) (24%) (19%) (17%) (18%) (20%) (13%) (11%) (22%) 0.66 No 44 49 71 56 45 63 56 47 61 (81%) (73%) (81%) (81%) (82%) (78%) (88%) (87%) (78%) Don’t Know/not sure 1 (2%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 1 (1%) 0 (0%) 1 (1%) 0 (0%) 2 (2%) 0 (0%) 1 (2%) 0 (0%) Have you ever used marijuana or hashish? Yes 32 40 48 42 32 46 40 27 42 (59%) (60%) (55%) (61%) (58%) (57%) (63%) (50%) (54%) 0.97 No 22 22 36 27 19 32 23 23 31 (41%) (33%) (41%) (39%) (35%) (40%) (36%) (43%) (40%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 0 (0%) 5 (7%) 4 (5%) 0 (0%) 4 (7%) 2 (2%) 1 (2%) 4 (7%) 5 (6%) Have you ever used illicit substances other than marijuana? Yes 10 15 18 15 11 11 8 9 9 (19%) (22%) (20%) (22%) (20%) (14%) (13%) (17%) (12%) 0.54 No 43 48 68 54 39 68 54 43 66 (80%) (72%) (77%) (78%) (71%) (84%) (84%) (80%) (85%) Don’t Know/not sure 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) Prefer not to respond 1 (2%) 4 (6%) 2 (2%) 0 (0%) 4 (7%) 1 (1%) 2 (3%) 2 (4%) 3 (4%) Note: 1: Pearson chi-square test used for all analyses, unless otherwise specified. *Fisher’s Exact Test used due to insufficient cell counts. P-values are based on comparisons after excluding “Don’t know/not sure” and “Prefer not to respond categories” for each survey item. Percentages reflect all responses and are listed column wise. Percentages associated with statistical tests can be provided via SAS 9.4 output.

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