Howard County General Hospital

Community Health Needs Assessment and Implementation Strategy

June 30, 2016

Howard County General Hospital

TABLE OF CONTENTS

CONTENTS PAGE I. Introduction ...... 1 II. Service Area and Population a. Overview ...... 2 b. The Community We Serve ...... 3 III. Approach and Methodology a. Primary Data ...... 7 b. Secondary Data ...... 8 c. Local Health Improvement Coalition ...... 9 d. Health Experts ...... 9 IV. Key Community Priorities a. Access to Affordable Care ...... 11 b. Behavioral Health ...... 11 c. Healthy Aging ...... 12 d. Healthy Weight, Exercise and Nutrition ...... 12 e. Other Identified Needs ...... 12 V. Implementation Strategy ...... 13

Appendices Appendix A: Community Resource Inventory ...... 20 Appendix B: Howard County Health Assessment Survey, 2014 ...... 23

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Howard County General Hospital

I. Introduction

With the enactment of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, tax-exempt hospitals require community health needs assessments (CHNA) and implementation strategies, which are approaches and plans to actively improve the health of communities served by health systems. These strategies provide hospitals and health systems with the information they need to deliver community benefits that can be targeted to address the specific needs of their communities. Coordination and management strategies, based upon the outcomes of a CHNA and implementing strategies, can improve the impact of hospital community benefits. To adhere to the requirements imposed by the IRS, tax-exempt hospitals and health systems must: • Conduct a CHNA every three years.

• Adopt an implementation strategy to meet the community health needs identified through the assessment.

• Report how it is addressing the needs identified in the CHNA and a description of needs that are not being addressed, with the reasons why. The Department of the Treasury and the IRS require a CHNA to include: 1. A description of the community served by the hospital facility and how the description was determined. 2. A description of the process and methods used to conduct the assessment. • A description of the sources and dates of the data and other information used in the assessment and the analytical methods applied to identify community health needs. • A description of information gaps that impact the hospital organization’s ability to assess the health needs of the community served by the hospital facility. • Identification of organizations that collaborated with the hospital/health system and an explanation of their qualifications. 3. A description of how the hospital took into account input from persons who represent the broad interests of the community served by the hospital. In addition, the report must identify any individual providing input that has special knowledge of or expertise in public health. The report must also identify any individual providing input who is a “leader” or “representative” of populations. 4. A prioritized description of all of the community health needs identified through the CHNA, as well as a description of the process and criteria used in prioritizing such health needs. 5. A description of the existing health care facilities and other resources within the community available to meet the community health needs identified through the CHNA.

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Howard County General Hospital

6. A description of the needs identified that the hospital intends to address, the reasons those needs were selected, and the means by which the hospital will undertake to address the selected needs. The 2016 CHNA process for Howard County General Hospital (HCGH) included the collection and analysis of primary and secondary data. Both public and private organizations, such as faith-based organizations, government agencies, educational systems and health and human services entities were engaged to assess the needs of the community. Primary data, gathered from more than 2,000 participants via an extensive phone survey in the Howard County Health Assessment Survey (HCHAS) and completed in 2014 was used for this report. Through interaction with a broad array of Howard County stakeholders, the survey results assessed health related behaviors and risk factors among the adult population in Howard County. Secondary data from local, state and federal sources provided essential information, insight and knowledge on a broad range of health and social issues and a resource inventory was compiled to assess the availability of services to residents in Howard County. Collecting and examining information about different community aspects and behaviors help explain and identify factors that influence the community’s health. The action plan developed for the county by the Local Health Improvement Coalition (LHIC) guided the creation of the Implementation Strategy for HCGH. More information on data gathering and analysis is included in section III. This report is a summary of primary and secondary data collected throughout the CHNA, the methodology used, the resulting identified key prioritized needs and an action plan (Implementation Strategy) addressing those needs.

II. Community Benefit Service Area The Hospital defines its Community Benefit Service Area (CBSA) using the twenty-five ZIP codes contained within the geographic boundaries of the Howard County jurisdiction as set forth by the Maryland Department of Planning and Zoning. U.S. Census-designated cities (CDP) within the boundaries of Howard County include Columbia, Ellicott City, Elkridge, Jessup, and Savage. The combination of HCGH’s status as the only acute care hospital in Howard County and the natural boundaries of the Patapsco and Patuxent rivers provide a level of “containment” of the local population for seeking health care and other services. In FY 2015, of HCGH’s total patient discharges approximately 68% (13,587 of 19,969) resided in the CBSA1, further supporting the definition of the Howard County jurisdiction as the Hospital’s CBSA. Map 1 below highlights the CBSA.

1 HSCRC and Johns Hopkins Medicine Business Planning and Market Analysis, 2015

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Howard County General Hospital

Map 1: Overall Community Benefit Service Area – 2015 Study Area Map

Howard County Zip Codes: 20701, 20723, 20759, 20763, 20777, 20794, 20833, 21029, 21036, 21042, 21043, 21044, 21045, 21046, 21075, 21076, 21104, 21163, 21723, 21737, 21738, 21771, 21784, 21794, 21797

Howard County is an affluent, educated and healthy community inhabited by 307,260 residents. Demographic projections estimate that the County will increase in population, as well as age overall, growing and graying. Between 2010 and 2035, the overall population is estimated to increase by 26.6%. During the same time period, those ages 50 and older will increase by 60.7%, which is more than double the aging rate for the total county population. An estimated 38% of county residents will be 50 or older by 2035. 2 This will be of particular importance as this population will be more likely to develop chronic diseases and potentially consume more health dollars. Howard County is also a diverse community, with higher rates of foreign born residents as compared to the state overall (18.2% versus 14%) and higher rates of languages other than English spoken in the home as compared to the rest of Maryland (22.5% versus 16%).

2 Maryland Department of Planning population projections, 2013.

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Tables 1-5 below offer snapshots of key county demographics, including population breakdowns by sex, age, race and ethnicity, educational attainment, and household income for Howard County, the Columbia census-designated place (which accounts for nearly a third of County residents), Maryland, and the nation.

Based on the population demographics below, it is notable that Howard County has higher educational attainment and higher household income than compared to Maryland as a whole. Also, the racial/ethnic makeup of Howard County differs from Maryland in that the percentage of the population that is Black/African American is lower than for Maryland, whereas the percentage of the population that is Asian & Pacific Islander is higher than for Maryland. The Columbia CDP, however, has higher African American and Hispanic residence and lower Asian & Pacific Islander residence, respectively, than the County as a whole.

Table 1. Population by Sex, Howard County 2015 Projected 2020 Total Male Population 152,265 (49.5%) 162,515 (49.5%)

Total Female Population 154,995 (50.4%) 165,807 (50.5%)

Source: Truven Health Analytics, 2015

Table 2. Population by Age Columbia Age Howard County CDP Maryland USA 0-14 58,081 (18.9%) 19.5% 18.9% 19.1% 15-17 13,708 (4.5%) 3.8% 4% 4% 18-24 27,536 (9%) 7.8% 9.6% 9.9% 25-34 37,848 (12.3%) 15.2% 13.6% 13.3% 35-54 92,308 (30%) 28% 28.4% 26.3% 55-64 40,611 (13.2%) 12.5% 12.5% 12.7% 65+ 37,168 (12.1%) 12.2% 13% 14.7% Source: Truven Health Analytics, 2015 and American Community Survey, 2015

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Table 3. Race/Ethnicity Howard County Columbia Maryland USA CDP White-Non-Hispanic 168,266 50.1% 53.6% 61.8% (54.8%) Black Non-Hispanic 57,401 (18.7%) 25.2% 29% 12.3%

Hispanic 20,628 (6.7%) 8.4% 8.8% 17.6% Asian & Pacific Is. Non- 49,454 (16.1%) 12.3% 5.8% 5.3% Hispanic All Others 11,511 (3.7%) 3.5% 2.8% 3.1% Source: Truven Health Analytics, 2015 and American Community Survey, 2015

Table 4. Education Attainment Age 25 or More Howard County Columbia Maryland USA CDP Less than High School 4,601 (2.2%) 2.8% 4.3% 5.9%

Some High School 6,019 (2.9%) 2.3% 6.7% 8%

High School Degree 30,712 (14.8%) 11.7% 25.7% 28.1%

Some College 43,839 (21.1%) 20.3% 25.9% 29.1% Bachelors Degree or 122,764 (59%) 62.8% 37.3% 28.9% Greater Source: Truven Health Analytics, 2015 and American Community Survey, 2015

Table 5. Household Income Howard County Columbia Maryland USA CDP <$15,000 4,672 (4.2%) 5.5% 8.5% 12.7% $15-25,000 3,544 (3.2%) 3.5% 6.9% 10.8% $25-50,000 11,701 (10.5%) 12.6% 18% 23.9% $50-75,000 14,080 (12.7%) 14.4% 17.2% 17.8% $75-100,000 14,435 (13.0%) 13.8% 13.4% 12% Over $100,000 62,705 (56.4%) 50.1% 36.1% 22.8% Source: Truven Health Analytics, 2015 and American Community Survey, 2015

Howard County is one of the healthiest counties in the state of Maryland as determined by the County Health Rankings website (www.countyhealthrankings.org) that is supported by the Robert Wood Johnson Foundation and hosted by the University of Wisconsin Population Health Institute. Of note, Howard County has a lower percentage than Maryland averages, and even top national counties, in measures such as the adult smoking rate (8% versus 15% Maryland and 14% national), adult obesity (23% versus 28% Maryland and 25% national), teen births (11 per 1,000 females

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Howard County General Hospital ages 15-19 versus 29 Maryland and 20 national), premature death (3,842 years of potential life lost before 75 per 100,000 versus 6,459 Maryland and 5,200 national), and uninsured population (7% versus 12% Maryland and 11% national). Conversely, the County exceeds the average rate in other counties nationwide in indicators such as low birthweight babies (8% versus 5.9%), excessive drinking (15% versus 10%), and alcohol-impaired driving deaths (38% vs. 14%). See Table 6 below for additional details.

Table 6. County Health Rankings 2015 – Howard County Howard Error Top U.S. County Margin Performers Maryland Health Outcomes Length of Life Premature death 3,842 3,576-4,108 5,200 6,459

Quality of Life Poor or fair health 9% 8-10% 10% 13% Poor physical health days 2.4 2.1-2.7 2.5 3 Poor mental health days 2.5 2.2-2.8 2.3 3.2 Low birthweight babies 8% 7.7-8.4% 5.9% 9%

Health Factors Health Behaviors Adult smoking 8% 7-10% 14% 15% Adult obesity 23% 21-26% 25% 28% Food environment index 9.3 n/a 8.4 8.2 Physical inactivity 18% 16-20% 20% 23% Access to exercise 98% n/a 92% 94% opportunities Excessive drinking 15% 14-18% 10% 15% Alcohol-impaired driving 38% n/a 14% 34% deaths Sexually transmitted infections 164 n/a 138 451 Teen births 11 10 to 12 20 29

Clinical Care Uninsured 7% 6-8% 11% 12% Primary care physicians 511:1 n/a 1,045:1 1,131:1 Dentists 1,248:1 n/a 1,377:1 1,392:1 Mental health providers 412:1 n/a 386:1 501:1 Preventable hospital stays 41 38-43 41 54 Diabetic monitoring 88% 84-91% 90% 84% Mammography screening 66.3% 62.9-69.6% 70.7% 64.6%

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Howard County General Hospital

Howard Error Top U.S. County Margin Performers Maryland Social & Economic Factors High school graduation 90% n/a 93% 83% Some college 84% 81.7-86.3% 71% 67.5% Unemployment 4.9% n/a 4.0% 6.6% Children in poverty 7% 5-8% 13% 14% Income inequality 3.6 3.5-3.7 3.7 4.5 Children in single-parent 22% 20-23% 20% 34% households Social associations 8.7 n/a 22 9 Violent crime 201 n/a 59 506 Injury deaths 33 30-36 50 54

Physical Environment Air pollution - particulate 12.7 n/a 9.5 12.5 matter Drinking water violations 0% n/a 0% 16% Severe housing problems 13% 12-14% 9% 17% Driving alone to work 81% 80-82% 71% 73% Long commute - driving alone 46% 44-47% 15% 47%

III. Approach and Methodology The CHNA process for Howard County General Hospital included the collection and analysis of primary and secondary data. Members of public and private organizations, such as faith-based organizations, government agencies, educational systems and health and human services entities provided their assessment of the needs of the community. The 2014 CHNA served as a baseline to provide a deeper understanding of the health and socioeconomic needs of the community.

Primary Data The 2014 Howard County Health Assessment Survey (HCHAS) was used for this CHNA. It is a biennial study first administered in 2012. Reaching more than 2,000 participants via a telephone survey it provided a wealth of direct information that would not have been attainable through individual hospital resources. The survey was jointly commissioned by the Horizon Foundation, the Howard County Health Department, Howard County General Hospital, and the Columbia Association. OpinionWorks, LLC provided the technical aspects of the survey, including recommendations on the precise wording of questions, population sampling, and telephone data collection. The fact sheets and website were developed by Simplicity Metrics. The organizations sponsoring the HCHAS jointly determined the questions that were asked. The survey approach, methodology, and questions were modeled after the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). This means that residents across the country have been asked many of the same questions and results from national studies may be effectively

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Howard County General Hospital

compared with Howard County results. Additional questions were added to the 2014 survey to gain more detailed information in certain areas.

The survey assessed health-related behaviors and risk factors among the adult population of Howard County, Maryland. Results of this study have enabled local government, health providers and stakeholders to measure progress and determine where to focus resources for improved health outcomes particularly focused on reduction of health disparities.

More than 2,000 residents participated in the phone survey between July 8 and August 18, 2014. In order to be compared geographically, the county was divided into five sampling areas, based on the seven regional planning areas, with the three westernmost planning areas combined into a single sampling area. Howard County households were dialed at random, and the first adult to answer the phone was asked to participate in the survey. Caregivers were not allowed to answer for others; answers for all study respondents reflected their own characteristics and experience. The survey was administered in English and in Spanish.

As is common with telephone surveys, some populations were underrepresented (including African Americans and residents ages 18 to 34), while other groups were overrepresented (including whites, women, and residents over age 65). To ensure the survey results reflected the characteristics of the county, a statistical procedure known as weighting was used. The demographic profile of the survey was adjusted to be similar to the actual population, based on the most recent U.S. Census data. In short, the answers from those groups underrepresented in the sample count more when totaling up responses and calculating averages to accurately represent all residents.

Secondary Data Information collected from secondary data provided essential information, insight and knowledge on a broad range of health and social issues. Data collected encompassed socioeconomic information, health statistics, demographics, children’s health, mental health issues, etc. The data sources included demographic information from Truven Health Analytics and the U.S. Census and reports and websites of local, state, and federal agencies, such as the U.S. Census American Community Survey, County Health Rankings, Maryland State Health Improvement Process (SHIP), and Howard Health Counts.

Resource Inventory Howard County has many resources that contribute to its being identified as one of the healthiest counties in Maryland, according to the 2015 County Health Rankings. The location of the county is a perfect suburban location between Baltimore, MD and Washington, D.C. The high income level (more than 50% of households earn more than $100,000/yr), high rate of advanced education of residents (close to 60% have a college education or advanced degree) and a high rate of insured residents (97%) add greatly to the overall health of the community.

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Howard County General Hospital

A resource inventory was created to identify services available within the HCGH community area to assess any gaps in care. The inventory identifies organizations and agencies in the community that are serving the various target populations within each of the priority needs. The resource inventory appears in Appendix A.

Local Health Improvement Coalition (LHIC) The Local Health Improvement Coalition (LHIC), a part of the State Health Improvement Plan (SHIP), was formed in 2012 and is responsible for guiding local health planning, specifically as it relates to addressing health disparities and inequities in the local community. After almost four years of combined efforts, focused interventions have occurred, groups are working more cohesively and expectations of improved outcomes are anticipated over time.

In order to ensure broad based input of the community served by the Hospital, the LHIC, led by the HCGH President, Steven Snelgrove and the Howard County Health Officer, Maura Rossman, M.D., served as the task force for identifying and prioritizing the highest needs of the community in Howard County. The task force included leaders of local health and human service organizations, county government leadership, local business leaders and hospital leaders who provided input through their participation in this process.

Health Experts The health experts for the August 2014 health survey were members of the Howard County Survey Planning Committee. LHIC membership also provided input during monthly meetings. Examples of the collaborative efforts between health experts appear in the Table 7 below.

Table 7. Howard County Survey Planning Committee Organization Key Collaborator and Title Collaboration Description LHIC Maura Rossman, M.D., Health More than 40 member Officer and LHIC co-chair organizations voted to determine Steve Snelgrove, HCGH the health priorities for calendar President and LHIC co-chair years 2015-2017 in November Jeananne Sciabarra, LHIC 2014. Director Howard County Maura Rossman, M.D. , Health Staff provided input on questions Health Department Officer of interest for the survey that Felicia Pailen, Dir., Policy and were reflective of community Planning health needs. Assistance was Jacqueline Douge, M.D., given in the outreach to the Director Child Health community about the survey as Kati Moore, Health Policy well as a point of contact for the Analyst data analysis. Columbia Association Shawni Paraska, Dir., Provided input on questions Community Health concerning healthy behaviors and Sustainability physical activity.

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Horizon Foundation Glenn Schneider, Chief Provided coordination of the Program Officer survey process, input into Au’Sha Washington, Research pertinent questions for the Associate survey and agency contact for Tiffany Callender, Sr. Program the consultant group performing Officer the survey.

Johns Hopkins Steve Arenberg, Dir. Provided advice on marketing Medicine Marketing Research, JHM research. Elizabeth Edsall Kromm, Sr. Howard County Dir., Population Health and Provided input on HCGH General Hospital Community Relations Community Health Needs. Cindi Miller, Dir. Community Health Education, HCGH

OpinionWorks, LLC Steve Rabe, President Provided expertise in survey question development, data collection and data summary.

Prioritization The LHIC served as the focus group and task force for the final determination of key priorities. Howard County General Hospital, a member of this group, contributed to the prioritization. All priorities were also to consider the following criteria: • The level of disparities related to the health outcome. • How improvement would affect large populations. • How improvement can improve several health outcomes. • The opportunity to control high cost and long-term impact while addressing the issue. • How results could be quantified.

For the 2015 HCGH CHNA, the LHIC Membership provided recommendations and support for the ongoing health priorities. They are local stakeholders with an active interest in health improvement and they are qualified to review current health status information and establish shared health improvement priorities. They represent diverse and important populations in Howard County.

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IV. Key Community Priorities The top priority needs were identified as: 1. Access to Affordable Care 2. Behavioral Health 3. Healthy Aging 4. Healthy Weight, (Exercise and Nutrition)

These areas were consistent with the four areas voted as health priorities by HCGH in their first CHNA in 2012. They are also the four identified LHIC priorities for 2015-2017. Chronic disease is considered to be incorporated into the four prioritized needs, as it is believed that by addressing these targeted areas there will be improvements in chronic diseases and conditions. All four priority areas are interconnected with the prevalence of chronic disease and a major factor impacting healthy aging. An example of how chronic disease is addressed within healthy aging is through interventions such as referrals to the Community Care Team (CCT) at the time of hospital discharge. The CCT will address greater compliance of the discharge plan, thus allowing for greater control of chronic disease.

The HCHAS results confirmed that Howard County is, on average, healthier than the rest of the country, but significant health challenges persist—especially among those with lower levels of income and education, as well as health outcomes related to everyday choices about smoking, drinking, diet, and exercise. Also, disparities still existed in access to care, with more than 10% of African Americans not having health insurance. Healthy weight improvement was very slight, and there were small changes in Emergency Department visits for behavioral health conditions. Please see Appendix B for the 2014 HCHAS report of findings, including a copy of the survey instrument.

Access to Care The survey revealed that 15,229 residents currently do not have health insurance coverage. This number has decreased by about 2,700 since 2012. However, problems of inequality compared by income, race and education still remain. While 95% of residents have some type of health care coverage, only 88% of respondents in households making less than $50,000 a year have coverage, and only 88% of those with a high school diploma or GED have coverage.

Respondents who identified their race as African American, Hispanic, or Native American/Other were more likely to experience health access difficulties. While 96% of White residents said they have health coverage, only 90% of African Americans, 90% of Hispanics, and 90% of those in the Native American/Other category report having coverage. Employment status also affected access to health care. For example, while 96% of those employed say they have some type of health insurance, only 90% of those who were self-employed and 78% of those unemployed were insured.

Behavioral Health Women were more likely than men to report taking medication or receiving treatment from a doctor or other health professional for a mental or emotional condition (9% vs. 5%). Between

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2012 and 2014, about the same percentage of residents reported being stressed about money for vital expenses, such as rent, mortgage, and food. However, respondents who identified their race as African American, Hispanic, or Native American/Other were more likely to experience this type of stress. 53% of White residents said they were never stressed about money for vital expenses, compared with 42% of African Americans, 28% of Hispanics, and 38% of those in the Native American/Other category.

Additionally, there was a noticeable increase in residents aged 18 to 34 who reported binge drinking or having more than five drinks for men and four drinks for women, at least once in a month. In 2012, 20% of residents in this age group reported binge drinking at least once in a month, and in 2014 that percentage increased to 27%.

Healthy Aging The population of older adults is growing, and this group is at high risk for developing chronic disease. Between 2012 and 2014 the same percentage of residents aged 50 – 64 reported having high blood pressure (35%), diabetes (10%) and COPD or another breathing condition (4%). This same age group reported a decrease in cholesterol (47% to 44%). Residents aged 65 and older had increases in high blood pressure (59% to 61%), cholesterol (50% to 56%) and diabetes (20% to 24%). Seniors 65+ reported a decrease in COPD or other breathing condition (9% to 6%). Continued efforts to decrease aspects of chronic disease by encouraging lifestyle changes of medication compliance, healthy eating and physical activity will support reduction in these above measurements.

Healthy Weight (Exercise and Nutrition) 56% percent of Howard County respondents reported BMI scores in the overweight or obese range, compared with 64% of Marylanders. Although fewer Howard County residents were overweight or obese compared to the State, many survey participants reported behaviors that contribute to unhealthy weight, including lack of exercise and low consumption of fruits and vegetables. When broken down by race, there were decreases in overweight/obesity rates among all races/ethnicities from 2012 to 2014, except a slight increase among White residents (55% to 59%) and a strong increase among Hispanic residents (39% to 53%). Additionally, residents earning less than $50,000 are getting more than 1 serving of fruit per day in 2014 (64%) compared to 2012 (46%).

Other Needs HCGH is a comprehensive, acute-care medical center with 266 licensed beds specializing in women`s and children’s services, surgery, cardiology, oncology, orthopedics, psychiatry, emergency services, outpatient therapy and services and community health education. To support the diverse health needs of the community, the hospital’s professional staff is comprised of more than 900 physicians and allied health professionals, representing nearly 100 specialties and subspecialties.

Although the four identified needs in this 2016 CHNA do not encompass all health needs of the community, HCGH has a full community health and wellness program addressing many needs

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including those not specifically discussed here. More information can be found in the FY2015 Community Benefit Report (CBR) which can found online at: http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/about/in_the_community/com munity_benefits.html. The hospital’s Wellness Center conducts over 500 classes, screenings and educational events addressing a full spectrum of community health needs. A few examples of programs and initiatives that are active at HCGH that address needs outside of the assessment key priorities are included in Table 8 below.

Table 8: Hospital Programs/Activities that Support Other Key Health Needs Health Need Program and Description Partners Infant Mortality/ Healthy Families Howard County - Family And Children’s Low Birth Weight Counseling and support for at-risk first time Services parents Early Prenatal Education classes - Local Children’s Free classes to focus on health for mom and Board infant. Breastfeeding Classes and support group - Howard County Promotes Breastfeeding as the best option Health Department for infants. Hypertension Regular Hypertension Screenings as well as 20 diverse faith ongoing health information and educational communities programming throughout Howard County Howard County Office on Aging – 50+ Centers

CPR Across Howard County - Annual event to American Heart teach Free Friends and Family CPR Association Howard County Fire Department Smoking Smoking Cessation Classes Howard County Health Department Diabetes Pre-Diabetes Classes Howard County Diabetes management classes Office on Aging Free Glucose Screenings

V. Implementation Strategy HCGH will continue to prioritize activities linked to our four community health needs priority areas and will monitor and evaluate progress made over the next three years. With a commitment to two additional cycles of the health assessment survey in 2016 and 2018, there will be close tracking of data to assess outcomes. HCGH’s commitment to improving the health of its community will be evident through deliberate collaborations targeting specific segments of our community experiencing gaps in any of the four priority health areas and providing in-kind

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and financial support to organizations and initiatives that share our commitment to addressing these priorities.

HCGH’s Board of Trustees and executive leadership will ensure the Hospital’s strategic and clinical goals are aligned with the four community health improvement initiatives. The implementation plan focuses on close alliances with organizations who have common goals and are key stakeholders. Collaboration yields the potential for enhanced outcomes and efficiency of resources. Most are also active member of the LHIC and are already committed to building a healthier Howard County community.

Implementation Strategy Action Items appear below.

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Community Health Need Priority Area – Access to Care Goal Strategies Metrics Partners Increase access to care for • Provide informational • Number of sessions held • Howard County Howard County residents. programs on Medicare and • Number of participants Department of Citizen educate residents on Services- Office on Aging importance of having a • Maryland Access Point medical home • Maryland Senior Health Insurance Program (SHIP) • Participate in school-based • Number of children served • Howard County Health telemedicine program for Department children in title I • Howard County Public elementary schools School System • Provide consultations for children who are uninsured or do not have regular access to a pediatrician • Provide health screenings • Increase number of • St. John’s Catholic Church and connection to attendees to Latino Health • FIRN community resources to Fair (organized and • Priority Partners (Medicaid improve access to care for administered by HCGH) MCO) Hispanic population • Howard County Health Department

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Community Health Need Priority Area – Behavioral Health Goal Strategies Metrics Partners Increase timely access to • Establish new partnerships • Number of patients • Howard County Mental behavioral health services for with community behavioral referred Health Authority residents of all ages. health providers to provide • Connection rate • Way Station, Inc. seamless connections to • Increase number of • Local Health Improvement treatment from the acute, patients with regular Coalition – Behavioral post-acute or primary care access to community- Health Work Group settings based behavioral health • Grassroots Crisis • Connect patients at risk for services Intervention Center suicide to outpatient follow • Reduce avoidable hospital • National Alliance for up program administered utilization Mental Illness (NAMI) by Grassroots Crisis Howard County Intervention Center • The Horizon Foundation • Implement urgent care • Howard County Health psychiatric stabilization Department services with community • HC Drug Free provider- Way Station, Inc. • On Our Own Howard Connect eligible residents County to first follow up • MD Chapter, American appointment within two Academy of Pediatrics business days. • Educate pediatricians and • Increase use of validated • Howard County Mental primary care practices on screening tool Health Authority behavioral health resources • Advanced Primary Care and promote use of Collaborative validated screening tool • MD and Howard County during visits Chapters, American Academy of Pediatrics • Local Health Improvement Coalition – Behavioral Health Work Group

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Community Health Need Priority Area – Healthy Aging Goal Strategies Metrics Partners Improve the health of older • Implement the Community • Number enrolled in • Community Care Team adults living in Howard County Care Team to provide community care team • Howard County Office on and provide comprehensive comprehensive care • Reduce hospital Aging care coordination for those coordination services for readmissions • Howard County Health with chronic conditions. chronically ill older adults • Reduce potentially Department with a focus on addressing avoidable utilization • Coalition of Geriatric social determinants of Services (COGS) health • NeighborRide • Community Action Council • Transition Howard County • Partner with post-acute, • Number older adults • Local Health Improvement primary care and specialty linked to medical home Coalition – Healthy Aging care providers to facilitate • Reduce hospital Work Group more effective and person- readmissions • Lorien Health Systems centered transitions of care • Reduce potentially • Gilchrist Services avoidable utilization • Advanced Primary Care Collaborative • Johns Hopkins Home Care • Howard County Office on Aging

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Community Health Need Priority Area – Healthy Weight Goal Strategies Metrics Partners Enable people of all ages and • Implement nutrition • Decrease in availability of • Johns Hopkins Health incomes to achieve and standards for beverages sugar sweetened beverages System maintain a healthy weight. sold in HCGH cafeteria in HCGH cafeteria • Local Health Improvement • Support LHIC advocacy Coalition – Healthy Weight work to update county • Decline in sales of sugar Work Group food and beverage sweetened beverages in • Howard County Health nutrition standards HCGH cafeteria Department • Support LHIC advocacy • The Horizon Foundation work to improve County • Decline in sugar sweetened • People Acting Together in Public School System’s beverage sales at county Howard County (PATH) Wellness Policy level • American Heart Association • Support programs • Increase number of Roving • Howard County including the Roving Radish Radish meal kits sold Government and expanded Farmers • Increase number of Roving • United Way of Central Market locations (WIC Radish subsidized kits sold Maryland office near Health Dept • Increase use of Electronic • The Horizon Foundation and Social Services) that Benefits Transfer (EBT) at • Howard County Farmers increase access to healthy farmers markets Market Association foods, especially for low- • Howard County Economic income families Development Authority • Howard County Health Department • Howard County Department of Social Services

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Community Health Need Priority Area – Healthy Weight (continued) Goal Strategies Metrics Partners Enable people of all ages and • Implement faith-based • Number of formal • Howard County Health incomes to achieve and health initiative focused on partnership with Dept. maintain a healthy weight. screenings and delivery of congregations/ faith-based • The Horizon Foundation evidence-based classes to organizations (signed • Howard County Dept. of reduce pre-hypertension covenants) Citizen Services and pre-diabetes and other • Number of screenings held • Parish Nurses chronic diseases closely • Number of classes held • St Johns Baptist Church linked to overweight and • Measured weight loss for • Abiding Savior Lutheran obesity class participants • New Hope Lutheran • Provide nutrition classes • Number of classes held • Atholton Seventh Day and counseling for county • Number of participants Adventist residents • Bike share ridership • Columbia Community • Implement multi-week Church walking program in North • Celebration Church Laurel area of the county • Locust United Methodist • Support LHIC advocacy Church work on Complete Streets • Muslim Family Center legislation at the county • Iglesia de Dios Pentecostal level • Unitarian Universalist • Support Howard County Columbia Congregation bike share program • Local Health Improvement Coalition – Healthy Weight Work Group • Maryland University of Integrative Health • We Promote Health • Get Active Howard County • Howard County Office of Transportation

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APPENDIX B HCGH Resource Inventory Link to Community Health Priority Areas LHIC Access Healthy Behavioral Healthy Organization Contact Information Services Provided Member to Care Weight Health Aging

9017 Red Branch Rd., Suite 204 A Better Way Counseling Services Columbia, MD 21045 Provides outpatient substance abuse program for adults & adolescents. Individual, group and family therapy, state certified program, drunk driving, X Phone: 410-730-4500 P.O. Box 958 Columbia, MD 21044 An active coalition of social, civic, professional, religious, cultural, and political groups committed to enhancing the overall quality of life for African-Americans throughout African American Community Roundtable X X X Phone: 858-859-1042 Howard County. [email protected] 8940 Old Annapolis Road ALFA is dedicated to providing comprehensive pharmacy services to the long-term care community, medication therapy management (MTM), clinical research and ALFA Specialty Pharmacy Columbia, MD 21045 X X compounding services to clients and the academic community. Phone: 410-992-6676 300 Thomas Drive American Center for Intellectual and Diverse Disorders (ACIDD) Maryland Laurel, MD 20707 Services to people with Mental Disorders and individuals with a dual diagnosis of Intellectual or Developmental Disability and Mental Illness X Phone: 301-377-0750 2002 Clipper Park Road, Ste 110, American Diabetes Association Baltimore, MD 21211 X Prevent and cure diabetes and to improve the lives of all people affected by diabetes. X Phone: 410-265-0075 217 E. Redwod Street, 23rd Fl American Heart Association Baltimore,MD 21202 X Building healthier lives where you live and work and making your community healthier by advocating for key health issues. X Phone: 410-246-6708 9891 Broken Land Parkway, Suite 101 Arthritis Foundation Columbia, MD 21046 Offers free health education events, resources on arthritis and related diseases, provides exercise classes nationwide. X Phone: 800-365-3811 10480 Little Patuxent Pkw #920 Columbia, MD 21044 Association of Community Services X A network of 100+ Howard County member organizations and individuals serving more than 100,000 Howard County families. X Phone: 410-715-9545 [email protected] 5525 Twin Knolls Road, Suite 332 BrightStar Care of Howard County Columbia, MD 21045 Home care services including companion care, skilled home care, Alzheimer's & dementia care, child care, personal care and transportation services. X X Phone: 410-910-9425 7625 Maple Lawn Blvd, Suite 1 Capital Women’s Care Howard County offers comprehensive gynecologic and obstetric care, including well-woman exams, routine and high-risk obstetrics, family planning, Capital Women's Care Howard County Fulton, MD 20759 X X treatment for heavy bleeding, menopause and urinary incontinence, minimally invasive surgery and postpartum care. Phone: 410-531-7557 5500 Knoll North Drive Suites 370 & 400 Chase Brexton Health Services, Inc. X Federally Qualified Health Center with a location in Howard County, MD. X X X X Columbia, MD 21045 Phone: 410-837-2050 5570 Sterrett Place, Suite 205 Columbia Addictions Center provides comprehensive counseling to those in need; offers a wide array of services including substance abuse treatment, comprehensive mental Columbia Addictions Center Columbia, MD 21044 X health services, anger management, couples counseling, family counseling, intervention and specialized help for teens at risk. Phone: 410-730-1333 6310 Hillside Court, Ste 100 Columbia Association Columbia, MD 21046 X Promoting health through physical activity and wellness. X X Phone: 410-715-3000 8930 Stanford Blvd Howard County Health Department provides Reproductive Health Services to Howard County women, men and teens. We see uninsured or underinsured clients. Payments for Columbia Health Center Columbia, MD 21045 X X services are based on a sliding fee scale. Phone: 410-313-7500 5500 Knoll North Drive Ste 180 Provides personalized, high-quality care for patients in Family Practice, Internal Medicine and Pediatrics.​ Columbia Medical Practice X X X X X Columbia, MD 21045 Phone: 410-964-6200 6751 Columbia Gateway Drive, Box 226 Community Action Council of Howard County Columbia, MD 21046 X Helps low income residents in the areas of housing, energy assistance, food and education. Also operates Head Start program. X X X X Phone: 410-313-6440 10630 Little Patuxent Parkway, Suite 209 and 209A Mental health and substance abuse care and counseling including depression, grief counseling, cognitive behavioral therapy, anger management, suicide prevention and Congruent Counseling Services, LLC & Integrative Counseling, LLC X Columbia, MD 21044 addictions counseling. Buprenorphine certified physicians and treatment providers. Phone: 410-740-8066 6600 Cradlerock Way East Columbia 50+ Center Columbia, MD 21045 Venue for various activities for seniors 50+. X X Phone: 410-313-7680 6540 Washington Blvd. Elkridge 50+ Center Elkridge, MD 21075 Venue for various activities for seniors 50+. X X Phone: 410-313-4930 9401 Frederick Road Ellicott City Senior Center and Senior Center Plus Ellicott City, MD 21042 Venue for various activities for seniors 50+ and structured activities for older adults who need extra care. X X Phone: 410-313-1400 9710 Patuxent Woods Dr. Ste 200 Evergreen Health Care Columbia, MD 21046 X Health insurance co-op. X X X X Phone: 301-575-8080 5999 Harpers Farm Rd, Columbia, MD 21044 FIRN Phone: 410-992-1923 X Empowers immigrants, refugees, asylees and other foreign-born individuals by helping them to access community resources and opportunities. X [email protected] 5470 Ruth Keeton Way Florence Bain Senior Center Columbia, MD 21044 Venue for various activities for seniors 50+. X X Phone: 410-313-7213 5537 Twin Knolls Rd, Suite 433 Gilchrist Hospice Care Columbia, MD 21045 Services include medical and nursing care, social work support, home health and volunteer assistance, as well as spiritual and grief counseling. X Phone: 410-730-5072 9150 Rumsey Road Suite A7 Girls on the Run of Central Maryland X Empowers girls to make healthy choices in their lives, to develop leadership skills, and to develop self-confidence and self-respect. X Columbia, MD 21045 Phone: 443-583-7740 LHIC Access Healthy Behavioral Healthy Organization Contact Information Services Provided Member to Care Weight Health Aging

2400 Route 97 Glenwood 50+ Center Cooksville, MD 21723 Venue for various activities for seniors 50+. X X Phone: 410-313-5440 6700 Freetown Rd Grassroots Crisis Intervention Center Columbia, MD 21044 X A crisis intervention center providing 24-hour crisis intervention services, emergency and transitional shelter, and community education. X X Phone: 410-531-6006 Columbia, MD 21044 Guardian Primary Care Services X Primary care practice providing quality, affordable, patient centered, telemedicine care and home visit treatment utilizing a holistic approach. X X X X Phone: 443-367-8600 Wilde Lake Village Center 5305 Village Center Drive, Ste 206 HC DrugFree provides prevention, treatment, recovery, health and wellness resources to help Howard County residents develop knowledge and skills to understand and HC DrugFree Columbia, MD 21044 X X address behavioral health disorders. Phone : 443-325-0040 [email protected] 10280 Old Columbia Rd, Ste 220 Columbia, MD 21046 Health Promotion On Call X Nutrition services X Phone: 443-794-7187 [email protected] 8930 Stanford Blvd. Healthy Howard is a nonprofit based in Columbia, Md., that strives to serve as an innovative leader impacting quality of life in the community through the delivery of effective Healthy Howard Columbia, MD 21045 X health programs, services and resources. Programs focus on improving access to health care, promoting healthy lifestyles, building strong community partnerships for health X X X X Phone: 888-973-3155 and providing care coordination. 10480 Little Patuxent Pkwy, #900 Columbia, Horizon Foundation MD 21044 Phone: 410-715-0311 X Local health and wellness philanthropy. X X X X [email protected] 10901 Little Patuxent Pkwy HCC offers two-year degree and certificate programs built around careers that are in demand. Students of all ages and educational levels also can prepare for a new career, Howard Community College Columbia, MD 21044 X X sharpen job skills or explore personal interests through the many programs in our noncredit, Continuing Education and Workforce Development Phone: 443-518-1000 Phone: 410-635-0703 Howard County Dental Association X The HCDA is active in oral health literacy presentations by dental health professionals to reinforce school curricula. X X [email protected] The HCDHA is committed to ensuring access to quality oral health care and increasing awareness of the cost-effective benefits of prevention by educating the local community Howard County Dental Hygienists' Association [email protected] X X X on the importance of quality preventative dental care to improve total health. 6751 Columbia Gateway Drive, Howard County Department of Citizen Services/Office on Aging Columbia, MD 21046 X Improving the health of senior citizens through a variety of programs. X X X X Phone: 410-313-6400/410-313-6410 7121 Columbia Gateway Dr, Howard County Department of Social Services Columbia, Md 21046 X Provides Social Service programs to residents - children - adult. X X X X Phone: 410-872-8700 5755 Cedar Lane Howard County General Hospital: A Member of Johns Hopkins Medicine is a comprehensive, acute-care medical center with 266 licensed beds specializing in women`s and Howard County General Hospital Columbia, MD 21044 X X X X children`s services, surgery, cardiology, oncology, orthopedics, gerontology, psychiatry, emergency services, and community health education. Phone:410-740-7890 George Howard Building 3430 Court House Drive Since there are no incorporated cities or towns in Howard County, the county government provides all local government services including administration of the operating and Howard County Government X X X X X Ellicott City, MD 21043 capital budgets, zoning, enacting laws for the county, helping residents resolve problems.and handling criminal, civil and juvenile court matters. Phone: 410-313-2022 8930 Stanford Blvd, Cloumbia, MD 21045 Howard County Health Department Phone: 410-313-6300 X Public Health programs to benefit residents. X X X X [email protected] Administrative Branch Provides educational materials in all formats from a collection of one million items housed at six branches and a vast array of e-resources, provides research assistance and 9411 Frederick Road Howard County Library System X instruction and offers experiences with community partnerships, including A+ Partners in Education, Choose Civility, and Well & Wise, as well many signature events, such as X X Ellicott City, MD the HCLS Spelling Bee, BumbleBee, Battle of the Books, Rube Goldberg Challenge, Summer Reading Kickoff, notable author events, and Evening in the Stacks. Phone: 410-313-7750 8930 Stanford Blvd, Columbia, MD 21045 Howard County Mental Health Authority X Plan, manage, and monitor publicly funded mental health services for residents. X X Phone: 410-313-7350 [email protected] 10910 Clarksville Pike Howard County Public School System Ellicott Cityk, MD 21042 X Cultivate a vibrant learning for students to thrive. X X X Phone: 410-313-6600 7120 Oakland Mills Rd, Howard County Recreation and Parks Columbia, MD 21046 X Provide services in child care, outdoor recreation, physical activity and more for residents. X X Phone: 410-313-4700 6355 Woodside Court, Columbia, MD 21046 Humanim X Provide workforce development services, deaf services, developmental disability and mental health services. X X Phone: 410-381-7171 [email protected] 10176 Baltimore National Pike, Unit 115 JAEL Health Services, Inc. Ellicott City, MD 21042 Methadone maintenance treatment offered to persons who are addicted to illicit opiates and/or prescription narcotics for over a year. x Phone: 410-203-2120 6350 Stevens Forest Road Johns Hopkins Community Physicians Columbia, MD 21046 Family and Internal Medicine, Obstetrics and Gynecology, and Pediatrics. X X X X Phone: 443-259-3770 8160 Maple Lawn Blvd, Suite 150 Johns Hopkins Community Physicians Fulton, MD 20759 Family medicine services. X X X X Phone: 240-459-1800 Medical Arts Building 11085 Little Patexent Parkway, Suite 103 Johns Hopkins Community Physicians - General Surgery at Howard County Colorectal and general surgery services. X X Columbia, MD 21044 Phone: 410-730-1988 Medical Arts Building 11085 Little Patexent Parkway, Suite 201 Johns Hopkins Community Physicians - Pulmonology & Sleep Medicine Pulmonary medicine and sleep medicine services. X X Columbia, MD 21044 Phone: 410-715-1060 9400 Route 97 The Kindred Spirits Social Club provides a place for people diagnosed with an early stage memory disorder to interact with other people walking the same journey: held Kindred Spirits at Glenwood Cooksville, MD 21723 X X Monday, Wednesday, Friday 9a-1p. Phone: 410-313-5441 9411 Whickey Bottom Rd The Kindred Spirits Social Club provides a place for people diagnosed with an early stage memory disorder to interact with other people walking the same journey; held Tuesday Kindred Spirits at North Laurel Laurel, MD 20723 X X & Thursday 9:30a - 1:30p. Phone: 410-313-7691 LHIC Access Healthy Behavioral Healthy Organization Contact Information Services Provided Member to Care Weight Health Aging

10632 Little Patuxent Parkway, Suite 410 Kolmac Clinic Columbia, MD 21044 Addiction services including detoxification, rehabilitation and continuing care. x Phone: 443-276-0556 6150 Foreland Garth Longwood 50+ Center Columbia, MD Venue for various activities for seniors 50+. X X Phone: 410-313-7217 Howard Cnty Office on Aging 6751 Columbia Maryland Access Point of Howard County (MAP) is a trusted source of information and assistance for Howard County residents who need or want to plan for their immediate Maryland Access Point Gateway Dr, 2nd FL, Columbia, MD 21046 X X X X and future needs. MAP serves adults 50 years and older, adults 18 years and older with a disability, family members and other caregivers, and health or business professionals. Phone: 410-313-5980 David Robert McDuff, M.D. 3454 Ellicott Center Dr, Suite 106 Maryland Centers for Psychiatry Buprenorphone certified physicians and treatment providers. X Ellicott City, MD 21043 Phone: 410-461-3760 7750 Montpelier Road MUIH has educated practitioners in health and wellness through transformative and relationship-centered programs that draw from traditional wisdom and contemporary Maryland University of Integrative Health Laurel, MD 20723 X X X X X science. MUIH offers graduate degrees and certificates in a wide range of wellness fields, as well as programs for professional and personal developmen Phone: 410-888-9048 1211 Cathedral St. MD Chapter of the American Academy of Pediatrics Baltimore, MD 21201 X Provides communication among pediatricians, parents and other persons interested in the promotion of good health for children. X X X Phone: 410-878-9702 Southwest Office 5305 Village Center Drive, Suite 214 Meal service provided to homebound people due to age or disability and grocery assistance program for homebound, elderly and disabled clients who cannot shop for Meals on Wheels of Central Maryland X Columbia, MD 21044 themselves. Phone: 410-730-9476 Njideka Udochi, M.D. 8900 Columbia Parkway, Suite G Millenium Family Practive Buprenorphone certified physicians and treatment providers. X Columbia, MD 21045 Phone: 410-740-9001 9650 Santiago Rd, #1 Columbia, MD 21045 National Alliance on Mental Illness (NAMI) Howard County X Improves the lives of individuals and families living with mental illness through support, education, and advocacy. X X Phone: 410-772-9300 [email protected] 9411 Whickey Bottom Rd North Laurel 50+ Center Laurel, MD 20723 Venue for various activities for seniors 50+. X X Phone: 410-313-0380 6440 Dobbin Rd, On Our Own of Howard County, Inc. Columbia, MD 21045 X Mental health education and advocacy for people who receive mental health services and develops alternative, recovery-based mental health initiatives. X Phone: 410-772-7905 10260 Old Columbia Rd, B1, Columbia, MD Salvere Health and Fitness 21046 Phone: 410-707-0055 Health and fitness services. X [email protected] 8930 Stanford Blvd, Suite M100 Outpatient treatment for patients seeking effective treatment for addictions who do not require - or who have completed - detoxification, residential treatment or day Silverman Treatment Solutions Columbia, MD 21045 X treatment. Phone: 443-285-0807 Long Reach Village The purpose of the Loan Closet of Howard County is a clearinghouse of donated medical equipment for temporary use to all Howard County residents. Many residents in need 8775 Cloudleap Court, Suite 11 The Load Closet of Howard County of medical equipment may not be able to afford these items, or they may only need equipment for a short period of time. Others have medical equipment they no longer need. Columbia, MD 21045 The Loan Closet brings these two communities of people together. Phone: 410-313-0363 5466 Ruth Keeton Way The Village in Howard is a member-based community of Howard County residents 55 and older who want to continue to live independently in the homes and neighborhoods The Village in Howard Columbia, MD 21044 X they know. Membership benefits include, not only various social and cultural activities, but access to various services such as transportation, home repair from vetted X Phone: 443-367-9043 contractors, and assistance with simple house maintenance. These benefits enable members to actively age in place. 2814 Montclair Drive Transition Howard County is an all-volunteer organization that is focused on making the communities of Howard County more resilient and sustainable. Transition Howard Transition Howard County X X X Ellicott City, MD 21043 County has active committees focused on the following areas: ecosystem landscaping, economy, energy, food, health, knowledge, outreach and water. 4100 College Ave, Building #8 Tuerk House, Inc., Howard House Ellicott City, MD 21043 Men's halfway house for substance abuse recovery; prevides wraparound services including job counseling, x Phone: 410-313-1458 10480 Little Patuxent Pkwy, #900 United Way of Central Maryland Columbia, MD 21044 X Services to support families to achieve quality educaiton, financial stability and good health. X X X X Phone: 410-739-1319 3300 N Ridge Rd, Ste 240 University of Maryland Extension Ellicott City, MD 21043 X Non-formal education system to promote agriculture, health and wellness and more. X Phone: 410-313-2707 5585 Twin Knolls Road Walgreens Columbia, MD 21045 X Pharmacy, immunization and education services provided. X X Phone: 410-730-2789 9030 MD-108, Way Station Columbia, MD 21045 X A behavioral health non-profit that provides a broad range of services in a variety of settings to meet the needs of children, adolescents, adults, and families. X X Phone: 410-740-1901 5052 Dorsey Hall Dr., Suite 203 We Promote Health Ellicott City, MD 21042 X Through events and programs, strengthens the collaborative focus on wellness for every individual and organization in Howard County. X Phone: 410-988-3786 [email protected] Medical Pavilion at Howard County The HCGH Wellness Center provides outreach and education to the Howard County community. Located in the new Medical Pavilion at Howard County, the Wellness Center 10710 Charter Dr, Suite 100 Wellness Center at Howard County General Hospital offers a wide range of classes, screenings and fitness programs both in the Wellness Center and in community settings throughout the area ranging from CPR instruction to child X X X X Columbia, MD 21044 and adult safety classes to diet and nutrition counseling. Phone: 410-740-7601 4331 Montgomery Rd Y of Central Maryland Ellicott City, MD 21043 X Through programming, develops the full potential of every individual that builds healthy spirit, mind and body for all. X Phone: 410-465-4334 2014 Howard County Health Assessment Survey - Report of Findings 23

Project Overview The mission of this public study, known as the Howard County Health Assessment Survey (HCHAS), is to assess health-related behaviors and risk factors among the adult population of Howard County, Maryland. Results of this study enable health providers and advocates to measure progress and to know where to focus resources to help make the community healthier.

The Horizon Foundation sponsored this study, joined by the Howard County Health Department, Howard County General Hospital, and the Columbia Association. This is a biennial study, first conducted in 2012, and updated in 2014. The survey approach and methodology were modeled after the Federal Behavioral Risk Factor Surveillance System (BRFSS), which is conducted by Maryland and the other states under the auspices of the Centers for Disease Control and Prevention (CDC).

Survey Methodology The study sponsors met regularly during the planning phase to discuss survey content and methodology. Final decisions over survey content were made by the sponsors. Technical aspects of the survey project, including question wording recommendations, population sampling, and telephone data collection were administered by OpinionWorks, LLC, of Annapolis, Maryland.

Many questions on the HCHAS were replicated from the BRFSS so that results can be compared to other areas of Maryland and the nation, and to benefit from prior vetting of those questions. The survey also included customized questions to address the priorities of the project’s sponsors, and the local health environment in Howard County. In the end, these telephone interviews averaged 18.4 minutes. Field interviews were collected during the period July 8 – August 18, 2014.

Prior to field interviewing, the Howard County Health Department notified the public about the study, and as necessary fielded telephone inquiries from the public about the purposes of the study. OpinionWorks, the survey contractor, maintained a dedicated telephone line, named “Howard Health Survey,” the number and name of which appeared on residents’ caller ID readouts as interview calls were made; this phone number was monitored daily by the contractor and calls were returned by the study’s project manager to residents who had questions about the study.

During the interviewing process, a strict random respondent selection protocol was adhered to. Respondent selection within households was randomized, and all households in the County had an equal probability of being sampled. Caregivers were not allowed to answer for others; answers for all study respondents reflected their own characteristics and experience.

The population sample was stratified, based on Howard County’s seven Regional Planning Districts (RPDs). Five sampling areas were created, with the three westernmost RPDs combined into one for sampling purposes. This approach allowed each of these five geographic areas to be sampled and analyzed with a reasonable level 2014 Howard County Health Assessment Survey - Report of Findings 24 of statistical confidence. Once the interviews were collected, weights were applied at the Census Tract level to bring the sample into close conformity with the distribution of the adult population countywide, according to the most recent data available from the United States Census Bureau.

Accordingly, a total of 2,000 interviews were conducted, as follows: RPD-Based Sampling Area Interviews Conducted Maximum Sampling Error* West County 400 ± 4.9% Ellicott City 425 ± 4.7% Columbia 425 ± 4.7% Elkridge 392 ± 4.9% Laurel 358 ± 5.2% Howard County Total 2000 ± 2.1%

*Sampling error is calculated at the 95% confidence level. This means that, in 19 out of 20 cases we can be certain that the true results would fall within this range if every adult resident of these areas had been interviewed.

Interviews were considered completed if the respondent proceeded through the entire interview, though respondents may have refused to answer individual questions. Interviews were conducted in English and Spanish. Both landline and mobile telephone numbers were included in the sampling frame.

In addition to the geographic weights by Census Tract, demographic weights were applied to the sample to ensure that it was as reflective as possible of the County’s population. Weights were applied to the following parameters: gender, age, race and ethnicity, and educational attainment.

A complete survey data file has been supplied by the contractor to the study sponsors, excluding identifying information for the individual respondents in order to protect their personal health information.

The Structure of This Report

This report provides a visual representation of each question on the survey, grouped by major topic area. Those major topics are:

1. Access to Care

2. Obesity and Healthy Living

3. Behavioral Health

4. Chronic Disease

5. Other Issues 2014 Howard County Health Assessment Survey - Report of Findings 25

Where a question was repeated from the 2012 survey, trends from the prior survey are illustrated. In cases where a questions was not asked in the 2012 survey, or where question wording was significantly changed, 2012 data do not appear in this report.

Survey results have also been broken out for a variety of geographic, demographic, and lifestyle indicators, so that propensities can be isolated within population subgroups. On the pages that follow, subgroup numbers have been placed in tables beneath each question in cases where there are statistically-significant differences within those subgroups. Therefore, not all subgroups are listed for each question.

The raw number of interviews collected in each subgroup is listed in parentheses below, followed by the weighted number reflecting that subgroup’s proportion of the overall countywide survey sample once the results were weighted to reflect the population distribution of Howard County (raw number → weighted number).

These subgroups are:

• Regional Planning District: West County, which combines the less populous Cooksville, West Friendship, and Clarksville Regional Planning Districts (400 raw number → 343 weighted number); Ellicott City (425 → 456); Columbia (425 → 717); Elkridge (392 → 339); and Laurel (358 → 324).

• Gender: Male (905 → 1036), Female (1095 → 1143).

• Age: 18 to 34 (282 → 600), 35 to 49 (918 → 748), 50 to 64 (477 → 490), and 65 or older (304 → 321).

• Race/Ethnicity: White (1474 → 1333); Black or African-American (287 → 437); Asian (174 → 302); Hispanic (42 → 128); and Others, such as Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native (79 → 127). Note that survey participants could choose more than one of these categories to describe themselves.

• Presence of Children under Age 18 in the Household: Yes (1057 → 1060), No (930 → 1108).

• Household Income: Less than $50,000 per year (215 → 388); $50,000 to $99,999 per year (395 → 458); $100,000 to $149,999 per year (461 → 454); $150,000 to $199,999 per year (306 → 290); $200,000 or more per year (327 → 257).

• Educational Attainment: High School Diploma/GED or less (191 → 437), Attended some college (288 → 421), 4-year college degree (584 → 661), Graduate-level work or degree (931 → 654).

• Employment Status: Employed for wages (1296 → 1291); Self-employed (152 → 151); Unemployed (49 → 96); Retired (268 → 298); or another status such as student, homemaker, or unable to work (229 → 327). 2014 Howard County Health Assessment Survey - Report of Findings 26

• Marital Status: Married (1487 → 1362), Divorced or separated (170 → 199), Widowed (88 → 121), Never married (222 → 449), or a member of an unmarried couple (26 → 39).

In many cases throughout this survey, the percentage of respondents who were not sure amounted to less than one-half percent. In those cases, where “not sure” equals or rounds to 0% of respondents, “not sure” does not appear as a response in the graphics below.

It should also be noted that throughout this report, it will occasionally appear that columns of numbers do not add correctly; those minor differences (for example a column of numbers that adds to 99% or 101%) are typically due to issues of rounding.

2014 Howard County Health Assessment Survey - Report of Findings 27

Table of Contents Question # Topic Page Access to Care 3.1 Health care coverage 7 3.2 Personal health care provider 9 3.3 Could not see a doctor because of cost 10 3.3A Typical health care provider 11 3.3B Wait for appointment 13 3.3C Emergency room visit in lieu of doctor appointment 14 M12.1 Mammograms 16 M12.2 Last mammogram 17 M12.3R Last breast exam 18 M12.5 Pap test 20 M12.5A Last Pap test 21 M14.1 Blood stool test 22 M14.3R Sigmoidoscopy/Colonoscopy 23 MD3-1 Time since last dental visit 24 MD4-1 Did not get dental care 26 MD4-2 Reason for not seeing dentist 27 Obesity and Healthy Living BMI Calculated Body Mass Index 29 8.12A Advised by doctor to lose weight 30 8.12B Trying to lose weight 31 9.2R Eating fruit 32 9.4R Eating vegetables 34 9.2R/9.4R Daily fruit and vegetable consumption 36 10.1A Physical activities or exercise 37 10.2A Frequency of physical activity 39 10.3A Location of physical activity 40 10.4A Physical activities to strengthen muscles 41 10.5A Frequency of activity to strengthen muscles 42 10.6A Location of activity to strengthen muscles 43 SD1 Regular soda 44 SD2 Sports drinks 45 SD3 Other types of sugar-sweetened drinks 46 SD4 Children drinking soda 48 SD5 Children drinking sports drinks 49 SD6 Children drinking other sugar-sweetened drinks 50 SD7 Has bought sugar-sweetened drinks 51 Behavioral Health M26.9 Mental health condition 52 M28.1 Money worries 53 M28.1A Did not get mental health treatment 55 2014 Howard County Health Assessment Survey - Report of Findings 28

M28.1B Reason for lack of mental health treatment 56 7.1 Smoked at least 100 cigarettes 57 7.2 Smoking frequency 58 7.5 Other tobacco products 59 7.5A E-cigarettes 60 M16.2 Secondhand smoke at home 61 M16.3 Secondhand smoke in vehicle 62 M16.5A Smell tobacco smoke from neighbors 63 15.1 Days consuming an alcoholic drink 65 15.3 Binge drinking 67 Chronic Disease 4.1 High blood pressure 69 4.1A High blood pressure medication 71 5.1 Blood cholesterol test 72 5.2 Last cholesterol test 73 5.3 Blood cholesterol is high 75 6.5 Asthma 76 6.8 COPD, Emphysema, or Chronic Bronchitis 77 6.13 Diabetes 78 M01.2 Pre-diabetes 80 M02.1 Age at diabetes diagnosis 81 M02.2 Taking medicine for diabetes 82 M02.5 Health care visits for diabetes 83 M02.6 Times A1C Tested 84 11.2 Health problem requiring special equipment 86 11.2A Special in-home care 87 Other Issues LD2 Lyme disease 88 Appendix Survey Instrument A-1

2014 Howard County Health Assessment Survey - Report of Findings 29

Access to Care

The Access to Care section includes questions about the incidence of health care coverage by residents, whether they feel they have a personal doctor or health care provider, whether cost or availability has been a barrier to seeing a primary care provider when they needed one, where they typically go for their care, and how knowledgeable they feel about the Affordable Care Act. This section also addresses the incidence of mammograms, breast exams, Pap tests, cancer screenings, and dental care.

Level of Health Care Coverage for Howard County Residents Ninety-five percent of Howard County adult residents had health care coverage in 2014. This is an increase from 93% coverage during the previous biennial survey in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 97% 97% 93% 92% 95% No 3% 3% 7% 6% 5% Not sure - - - 1% -

2014 Howard County Health Assessment Survey - Report of Findings 30

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 89% 95% 97% 98% No 10% 5% 3% 2% Not sure 1% - - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 96% 90% 97% 90% 90% No 4% 10% 3% 7% 10% Not sure - - - 3% -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 88% 91% 97% 99% No 12% 9% 3% 1% Not sure - - - 1%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 88% 96% 95% 98% 99% No 12% 3% 5% 2% 1% Not sure - 1% - - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 96% 90% 78% 98% 91% No 3% 10% 22% 2% 9% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 31

Nine out of ten Howard County residents (90%) have at least one person that they think of as their personal doctor or health care provider. This is an increase from 87% in 2012. In 2014, 80% said they have one person they think of this way, and 10% said there is more than one.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 76% 77% 86% 87% More than one 9% 13% 9% 9% No 14% 10% 5% 4% Not sure/Refused 1% *% *% -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 80% 81% 79% 70% 74% More than one 11% 8% 11% 12% 4% No 9% 11% 7% 18% 22% Not sure/Refused *% *% 2% - -

2014 Howard County Health Assessment Survey - Report of Findings 32

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 76% 81% 83% 77% 83% More than one 10% 8% 8% 18% 9% No 12% 10% 8% 5% 7% Not sure/Refused 2% - *% *% -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 84% 78% 79% 81% More than one 4% 14% 11% 10% No 12% 8% 8% 9% Not sure/Refused - - 2% -

Six percent of residents said there was a time in the past 12 months when they needed to see a doctor but could not do so because of cost. This is a decrease from the 8% measured in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 4% 2% 9% 6% 5% No 96% 98% 91% 94% 94% Not sure - - - - - 2014 Howard County Health Assessment Survey - Report of Findings 33

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 16% 5% 3% - 2% No 84% 94% 97% 99% 98% Not sure - - - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 9% 10% 3% 3% No 90% 90% 97% 97% Not sure - - - -

2014 Employment Self- Employed Unemployed Retired Other Status Breakouts Employed Yes 3% 11% 34% 1% 10% No 97% 89% 66% 99% 90% Not sure - - - - -

Three-quarters of residents (74%) in 2014 said they usually go to a doctor’s office when they are sick or need medical attention. This is a decrease of three percentage points since 2012. Meanwhile, urgent care has increased from 11% to 15% in that same time period.

2014 Howard County Health Assessment Survey - Report of Findings 34

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts A doctor's office 77% 79% 68% 77% 74%

An urgent care center 11% 13% 18% 16% 14%

A hospital emergency room 1% - 5% 2% 3% A community health 1% 1% 2% 2% 3% center Some other kind of place 1% - 2% ` 1%

No usual place 5% 5% 4% 1% 4%

Not sure 2% 1% 1% - -

2014 Age Breakouts 18-34 35-49 50-64 65+

A doctor's office 64% 71% 84% 85%

An urgent care center 22% 19% 6% 4% A community health 3% 1% 3% 1% center A hospital emergency room 3% 3% 2% 3%

Some other kind of place - 1% - 4%

No usual place 6% 4% 3% 2%

Not sure 1% - 2% 1%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 A doctor's office 62% 75% 78% 76% 80%

An urgent care center 15% 16% 14% 20% 13%

A hospital emergency room 7% 1% 1% 1% 2% A community health 5% 2% 1% 1% - center Some other kind of place 4% 1% 1% 1% -

No usual place 6% 3% 5% 1% 4%

Not sure 1% 2% 1% - 1%

2014 Howard County Health Assessment Survey - Report of Findings 35

The last time they needed a medical issue resolved quickly, 33% of residents were able to see their primary health care provider within the same day, and another 28% within two to three days. Twenty-eight percent had to wait longer than three days, and 11% waited longer than a week. This question was not asked in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Same day 35% 34% 33% 39% 26% Within 2-3 days 25% 27% 28% 31% 30% Within 1 week 17% 19% 17% 14% 18% Longer than 1 week 12% 11% 10% 7% 15% Does not apply to me 6% 5% 8% 6% 6% Not sure 4% 4% 4% 2% 4%

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Same day 32% 35% 33% 32% Within 2-3 days 26% 28% 30% 28% Within 1 week 19% 19% 16% 16% Longer than 1 week 11% 10% 10% 13% Does not apply to me 9% 6% 5% 8% Not sure 3% 1% 5% 4% 2014 Howard County Health Assessment Survey - Report of Findings 36

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Same day 34% 24% 37% 34% 30% Within 2-3 days 28% 27% 27% 30% 28% Within 1 week 17% 19% 7% 20% 15% Longer than 1 week 10% 17% 9% 9% 20% Does not apply to me 7% 10% 16% 2% 7% Not sure 3% 3% 4% 5% -

Seven percent of residents said there was a time in the past 12 when they needed to go to an emergency room because they could not get a timely appointment with a doctor. This measure of access has worsened slightly from 5% in 2012 to 7% in 2014.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 3% 5% 10% 5% 7% No 96% 94% 89% 94% 92% Not sure - - 1% - 1%

2014 Howard County Health Assessment Survey - Report of Findings 37

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 5% 11% 7% 9% 8% No 94% 89% 93% 89% 91% Not sure - - - 2% 1%

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 10% 10% 5% 4% No 89% 89% 95% 95% Not sure/ Refused 1% 1% - 1%

2014 Parent Breakouts Has Children No Children Yes 8% 5% No 91% 94% Not sure 1% -

2014 Howard County Health Assessment Survey - Report of Findings 38

Screenings Ninety-three percent of the women over 40 in Howard County have had a mammogram. This number is virtually unchanged from the 92% recorded in 2012.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 95% 96% 70% 69% 80% No 4% 4% 28% 31% 20% Not sure - - 3% - -

2014 Howard County Health Assessment Survey - Report of Findings 39

Eight-eight percent of the women who have had a mammogram had it within the prior two years. Seven percent had their last mammogram between two and five years ago; for 4%, it has been longer than five years.

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Within the past 2 years 89% 92% 73% 96% 84% 2 years but less than 5 years 7% 3% 15% 3% 16% ago 5 or more years ago 3% 3% 10% 1% -

Not sure/ Refused 1% 2% 1% - -

2014 Howard County Health Assessment Survey - Report of Findings 40

Seventy-two percent of women in Howard County had a clinical breast exam in the 12 months prior to the survey. This was a slight decline from the 76% who had had a breast exam during the 12 months prior to the 2012 survey. Another 14% in 2014 and 11% in 2012 had had a breast exam between 12 and 24 months prior.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Within the past year 64% 68% 76% 71% 73% 1 year but less than 2 years 21% 14% 11% 13% 17% ago 2 years but less than 3 years 2% 2% 4% 5% 6% ago 3 years but less than 5 years 2% 3% 1% 1% 1% ago 5 or more years ago 2% 4% 2% 3% - Have never had a clinical 7% 5% 3% 5% 2% breast exam Not sure/ Refused - 4% 4% 4% -

2014 Howard County Health Assessment Survey - Report of Findings 41

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Within the past year 73% 76% 55% 70% 57% 1 year but less than 2 years 15% 14% 12% 11% 19% ago 2 years but less than 3 years 3% 5% 2% 5% 7% ago 3 years but less than 5 years 2% 1% 3% - - ago 5 or more years ago 3% 2% 1% - - Have never had a clinical 2% 2% 25% 1% 3% breast exam Not sure/ Refused 2% - 2% 12% 14%

High School 4-Year Post- 2014 Education Breakouts Some College or less Degree graduate Within the past year 63% 69% 77% 77% 1 year but less than 2 years 13% 17% 15% 12% ago 2 years but less than 3 years 3% 6% 4% 2% ago 3 years but less than 5 years - 2% 2% 2% ago 5 or more years ago 5% 1% 1% 2% Have never had a clinical 12% 1% 1% 3% breast exam Not sure/ Refused 5% 4% 1% 1%

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Within the past year 77% 78% 48% 59% 72% 1 year but less than 2 years 15% 11% 20% 9% 19% ago 2 years but less than 3 years 4% 3% 6% 3% - ago 3 years but less than 5 years 1% 2% 2% 3% - ago 5 or more years ago 1% 2% 14% 1% - Have never had a clinical 1% 5% - 18% 9% breast exam Not sure/ Refused 1% 1% 10% 5% - 2014 Howard County Health Assessment Survey - Report of Findings 42

Eighty-nine percent of women in 2014 said they have had a Pap test. This is a decline from the 94% who said so in 2012.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 94% 85% 71% 81% 99% No 5% 15% 28% 19% 1% Not sure - - 1% - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 87% 93% 94% 79% 98% No 12% 7% 5% 19% 2% Not sure/ Refused - - 1% 2% -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 80% 84% 94% 97% No 20% 15% 6% 3% Not sure/ Refused - 1% - 1%

2014 Howard County Health Assessment Survey - Report of Findings 43

Of the women who have had a Pap test, 77% said their test was within the prior two years; 13% had the test between two and five year previously, and 9% said their Pap test was five or more years ago.

2014 Age Breakouts 18-34 35-49 50-64 65+

Within the past 2 years 90% 85% 76% 47% 2 years but less than 5 years 10% 12% 12% 18% ago 5 or more years ago - 3% 10% 31%

Not sure - - 1% 4%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Within the past 2 years 71% 78% 80% 88% 78% 2 years but less than 5 years 13% 14% 15% 9% 17% ago 5 or more years ago 16% 8% 5% 3% 3%

Not sure 1% - 1% - 2%

2014 Howard County Health Assessment Survey - Report of Findings 44

High School 4-Year Post- 2014 Education Breakouts Some College or less Degree graduate Within the past 2 years 70% 77% 81% 79% 2 years but less than 5 years 11% 12% 12% 16% ago 5 or more years ago 20% 9% 5% 4%

Not sure - 1% 2% 1%

2014 Employment Status Self- Employed Un-employed Retired Other Breakouts Employed Within the past 2 years 82% 87% 60% 49% 87% 2 years but less than 5 years 13% 8% 11% 19% 10% ago 5 or more years ago 4% 5% 29% 28% 3%

Not sure 1% - - 3% -

Forty percent of residents over the age of 50 have used a blood stool test at home. This percentage is virtually unchanged from 2012.

2014 Howard County Health Assessment Survey - Report of Findings 45

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 49% 41% 29% 45% 41% No 51% 55% 71% 55% 57% Not sure/ Refused - 4% - - 2%

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 46% 25% 24% 16% 26% No 52% 75% 74% 84% 74% Not sure 2% - 2% - -

Seventy-nine percent of residents over age 50 have had a sigmoidoscopy or colonoscopy; 62% have had this exam within the past five years.

2014 Howard County Health Assessment Survey - Report of Findings 46

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Within the past 5 years 63% 63% 47% 23% 64% 5 years but less than 10 years 16% 8% 8% 7% 2% ago 10 or more years ago 3% 5% 2% - 4%

Not sure/ Refused 3% 1% 7% - - Have never had a sigmoid- 16% 23% 36% 70% 30% oscopy or colonoscopy

High School 4-Year Post- 2014 Education Breakouts Some College or less Degree graduate Within the past 5 years 55% 64% 65% 64% 5 years but less than 10 years 12% 14% 12% 16% ago 10 or more years ago 1% 9% 3% 2%

Not sure/ Refused 1% 3% 4% 2% Have never had a sigmoid- 32% 10% 17% 16% oscopy or colonoscopy

Eighty percent of residents had visited a dentist or dental clinic within the prior 12 months. Another 9% had a dental visit between one and two years ago. These numbers were nearly identical in 2012.

2014 Howard County Health Assessment Survey - Report of Findings 47

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Within the past year 87% 83% 74% 80% 81% 1 year but less than 2 years 7% 5% 14% 8% 9% ago 2 years but less than 5 years 3% 6% 6% 6% 4% ago 5 or more years ago 3% 2% 4% 4% 4%

Never - 1% 1% - 1%

Not sure/ Refused 1% 4% 1% 3% 1%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Within the past year 61% 76% 87% 89% 94% 1 year but less than 2 years 18% 11% 5% 6% 5% ago 2 years but less than 5 years 7% 9% 5% 3% 1% ago 5 or more years ago 6% 4% 2% 1% 1%

Never 2% - - - -

Not sure/ Refused 4% 1% 1% 1% -

High School 4-Year Post- 2014 Education Breakouts Some College or less Degree graduate Within the past year 68% 74% 86% 86% 1 year but less than 2 years 11% 14% 6% 7% ago 2 years but less than 5 years 7% 7% 4% 4% ago 5 or more years ago 8% 3% 2% 2%

Never 2% 1% - -

Not sure/ Refused 3% 1% 2% -

2014 Howard County Health Assessment Survey - Report of Findings 48

Eleven percent of residents said they had a dental problem in the prior 12 months where they would have liked to have seen a dentist but did not do so. In 2012, the percentage was a slightly lower 9%.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 17% 10% 10% 3% No 83% 90% 89% 94% Not sure/ Refused - - - 3%

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 8% 18% 13% 27% 28% No 92% 81% 87% 73% 72% Not sure - 1% - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 16% 16% 8% 7% No 81% 84% 92% 93% Not sure/ Refused 2% - - -

2014 Howard County Health Assessment Survey - Report of Findings 49

Cost (41%) and lack of time (24%) were the two main reasons people did not see the dentist when they wanted to.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts It would cost too much 19% 32% 44% 31% 65%

Didn't have time 25% 47% 14% 47% 3% Didn't have anyone to care - - 2% 3% - for my children Couldn't get an appointment 2% - 1% - 1%

Would have to travel too far - - - 3% - Didn't have a way to get - - - - 1% there Some other reason 46% 21% 35% 17% 31%

Not sure/ Refused 7% - 4% - -

2014 Howard County Health Assessment Survey - Report of Findings 50

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 It would cost too much 49% 50% 18% 4% -

Didn't have time 19% 16% 25% 37% 58% Didn't have anyone to care - 6% - - - for my children Couldn't get an appointment - 2% 1% 2% -

Would have to travel too far - 2% - - - Didn't have a way to get - - - - - there Some other reason 25% 23% 56% 57% 42%

Not sure/ Refused 5% - - - -

2014 Howard County Health Assessment Survey - Report of Findings 51

Obesity & Healthy Living

The Obesity & Healthy Living Section includes a calculated average Body Mass Index (BMI) for Howard County based on survey responses, and questions about being overweight and trying to lose weight, consumption of fruits and vegetables, aerobic and strengthening physical activity, and consumption of sugary drinks.

Obesity Based on survey questions about residents’ height and weight, 33% of the Howard County population is overweight, and 23% is obese. The average BMI for the County is 26.65, or somewhat overweight. There is no significant change in these percentages since 2012.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Not Overweight/ Obese (BMI 41% 39% 64% 47% 46% < 25.00) Overweight (BMI 25.00 - 36% 27% 28% 27% 26% 29.99) Obese (BMI 30.00+) 23% 34% 8% 26% 27%

Mean 26.87 28.07 23.90 26.03 26.30

2014 Howard County Health Assessment Survey - Report of Findings 52

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Not Overweight/ Obese (BMI 41% 38% 42% 47% 47% < 25.00) Overweight (BMI 25.00 - 29% 31% 36% 36% 33% 29.99) Obese (BMI 30.00+) 30% 30% 22% 17% 20%

Mean 27.49 27.62 26.69 26.00 26.16

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Not Overweight/ Obese (BMI 40% 35% 44% 63% 32% < 25.00) Overweight (BMI 25.00 - 36% 29% 32% 24% 16% 29.99) Obese (BMI 30.00+) 24% 36% 23% 14% 52%

Mean 26.90 28.21 27.51 24.73 29.56

Slightly more than one-third (35%) of residents said they have been advised by a doctor to lose weight at some point in the past. This number is virtually unchanged from 2012 when it was 34%.

2014 Howard County Health Assessment Survey - Report of Findings 53

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 38% 35% 21% 35% 31% No 61% 65% 78% 64% 68% Not sure - - - 1% 1%

Forty-five percent of residents said they are trying to lose weight now. That number is three percentage points higher than in 2012.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 34% 51% 54% 37% No 66% 48% 46% 63% Not sure - - - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 45% 53% 34% 48% 37% No 55% 47% 66% 52% 63% Not sure - - - - 1%

2014 Howard County Health Assessment Survey - Report of Findings 54

2014 Gender Breakouts Male Female

Yes 37% 51% No 63% 49% Not sure - -

Fruit and Vegetable Consumption Most Howard County resident (53%) said they eat one or two servings of fruit a day. Fourteen percent eat three or more servings a day, while 31% eat less than a serving of fruit a day. Overall, these numbers are very similar to 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts 5 or more times per day 3% 2% 3% 1% 3% 3 but less than 5 times per 14% 14% 12% 11% 9% day 1 but less than 3 times 57% 57% 49% 50% 54% per day Less than once per day or 24% 26% 35% 33% 32% never Not sure 1% 1% - 5% 2%

2014 Howard County Health Assessment Survey - Report of Findings 55

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American 5 or more times per day 3% 3% 1% 1% - 3 but less than 5 times per 13% 12% 11% 2% 7% day 1 but less than 3 times 53% 45% 58% 78% 55% per day Less than once per day or 30% 38% 26% 19% 37% never Not sure 1% 1% 2% - 2%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 5 or more times per day - 2% 3% 2% 4% 3 but less than 5 times per 11% 12% 15% 11% 13% day 1 but less than 3 times 52% 51% 48% 55% 59% per day Less than once per day or 36% 35% 32% 30% 22% never Not sure/ Refused 1% 1% 2% 2% 2%

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree 5 or more times per day 2% 2% 2% 3% 3 but less than 5 times per 12% 11% 12% 14% day 1 but less than 3 times 42% 51% 55% 59% per day Less than once per day or 42% 35% 29% 23% never Not sure 1% 2% 2% 1%

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed 5 or more times per day 2% 2% 6% 2% 2% 3 but less than 5 times per 13% 15% 6% 11% 12% day 1 but less than 3 times 53% 52% 35% 50% 60% per day Less than once per day or 30% 29% 54% 35% 25% never Not sure 2% 1% - 2% 1%

2014 Howard County Health Assessment Survey - Report of Findings 56

Fifty-eight percent of residents eat one or two servings of vegetables a day. Twelve percent eat three or more servings a day, while 29% eat less than one serving of vegetables per day. Like fruit consumption, these numbers are very similar to 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts 5 or more times per day 4% 4% 2% 2% 2% 3 but less than 5 times per 8% 7% 10% 12% 7% day 1 but less than 3 times 65% 63% 56% 51% 57% per day Less than once per day or 23% 26% 30% 31% 32% never Not sure - 1% 1% 4% 2%

2014 Howard County Health Assessment Survey - Report of Findings 57

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American 5 or more times per day 2% 2% 5% 2% 4% 3 but less than 5 times per 10% 9% 4% 11% 1% day 1 but less than 3 times 62% 55% 55% 54% 44% per day Less than once per day or 25% 33% 32% 32% 48% never Not sure 1% 1% 3% 1% 3%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 5 or more times per day 1% 2% 1% 3% 3% 3 but less than 5 times per 7% 7% 10% 12% 7% day 1 but less than 3 times 52% 58% 61% 61% 70% per day Less than once per day or 39% 31% 26% 23% 19% never Not sure 1% 1% 2% 1% 1%

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree 5 or more times per day 3% 3% 2% 3% 3 but less than 5 times per 7% 9% 9% 10% day 1 but less than 3 times 54% 49% 60% 66% per day Less than once per day or 35% 36% 28% 20% never Not sure 1% 2% 1% 1%

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed 5 or more times per day 2% 3% 1% 3% 5% 3 but less than 5 times per 9% 7% 2% 7% 13% day 1 but less than 3 times 59% 63% 43% 62% 56% per day Less than once per day or 28% 25% 53% 27% 24% never Not sure 2% 1% 1% 1% 2% 2014 Howard County Health Assessment Survey - Report of Findings 58

An index of fruit and vegetable consumption can be calculated from these survey responses by combining the servings of fruit and the servings of vegetables that each survey respondent reported. Through this means, it can be identified that 99% of Howard County residents consume at least some fruits and vegetables. The vast majority of residents (81%) consume less than five servings daily, while 18% consume five or more servings of fruits and vegetables on a typical day. These numbers have not changed significantly since 2012.

2014 Gender Breakouts Male Female

None 1% - 0 to less than 5 servings/day 84% 78% 5 or more servings/day 14% 22% Median 2.00 2.71

2014 Age Breakouts 18-34 35-49 50-64 65+

None 1% - 1% - 0 to less than 5 servings/day 79% 81% 80% 87% 5 or more servings/day 20% 19% 18% 13% Median 2.29 2.57 2.14 2.00

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 None 1% 2% 1% 3% 3% 0 to less than 5 servings/day 86% 7% 10% 12% 7% 5 or more servings/day 13% 1% 2% 1% 1% Median 2.00 2.00 2.43 3.00 2.86 2014 Howard County Health Assessment Survey - Report of Findings 59

Physical Activity In the week prior to the survey, 81% of residents did physical activities for exercise, such as running, golf, swimming, yard work, or walking. This question was not asked in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 86% 79% 82% 75% 82% No 14% 21% 18% 25% 18% Not sure - - - - -

2014 Gender Breakouts Male Female

Yes 82% 79% No 18% 20% Not sure - -

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 77% 86% 84% 73% No 23% 14% 16% 27% Not sure - - - - 2014 Howard County Health Assessment Survey - Report of Findings 60

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 82% 76% 84% 83% 67% No 18% 24% 16% 17% 33% Not sure - - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 69% 81% 82% 83% 91% No 31% 19% 18% 17% 9% Not sure - - - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 73% 77% 81% 88% No 27% 23% 19% 12% Not sure - - - -

2014 Parent Breakouts Has Children No Children Yes 84% 78% No 16% 22% Not sure - -

2014 Howard County Health Assessment Survey - Report of Findings 61

Among those who said they had taken part in physical exercise during the prior week, the average (mean) number of times was 4.53.

2014 Howard County Health Assessment Survey - Report of Findings 62

Keeping in mind that the interviews were collected in the summer, most residents (73%) exercised outdoors, followed by at home (25%), or at a membership club (24%).

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Outside 69% 71% 78% 75% 70% In your home or friend's 30% 27% 22% 23% 24% home At your housing clubhouse 3% 2% 5% 2% 2%

At work 5% 3% 6% 7% 3%

At a membership club 24% 27% 23% 22% 24%

Somewhere else 5% 8% 6% 3% 3%

Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 63

In the week prior to the survey, 43% of residents did physical activities to strengthen their muscles. This question was not asked in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 49% 43% 40% 43% 46% No 51% 57% 59% 57% 54% Not sure - 1% - - -

2014 Gender Breakouts Male Female

Yes 47% 40% No 52% 60% Not sure - -

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 50% 44% 41% 35% No 49% 56% 59% 65% Not sure 1% - - -

2014 Howard County Health Assessment Survey - Report of Findings 64

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 30% 44% 46% 49% No 69% 56% 53% 50% Not sure - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 30% 45% 41% 55% 54% No 70% 55% 58% 45% 46% Not sure - 1% - - -

Among those who said they had taken part in physical activities or exercise to strengthen their muscles during the prior week, the average (mean) number of times was 3.32.

2014 Howard County Health Assessment Survey - Report of Findings 65

Residents were most likely to undertake strengthening exercises at home (54%) or at a membership club (41%).

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Outside 9% 18% 13% 14% 10% In your home or friend's 56% 54% 52% 59% 49% home At your housing clubhouse 3% 5% 4% 2% 3%

At work 4% - 4% 6% 4%

At a membership club 38% 42% 41% 37% 44%

Somewhere else 6% 7% 7% 1% 3%

Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 66

Sugary Drinks Forty-two percent of Howard County residents consume regular soda on at least an occasional basis. Eight percent said they consume soda daily, another 15% between two and six times a week, and 20% drink soda no more often than once a week.

Different answer categories in 2012 make trend data not comparable between 2012 and 2014 for this series of questions.

2014 Age Breakouts 18-34 35-49 50-64 65+

Daily (1+drinks/ day) 9% 8% 7% 7% 2-6 drinks/week 21% 15% 12% 7% 1/week or fewer 24% 22% 17% 12% None/ Never/ Rarely 46% 55% 64% 74% Not sure - - 1% -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Daily (1+drinks/ day) 9% 7% 5% 6% 5% 2-6 drinks/week 12% 22% 17% 21% 19% 1/week or fewer 16% 18% 32% 23% 36% None/ Never/ Rarely 63% 52% 44% 50% 40% Not sure - - 1% - -

2014 Howard County Health Assessment Survey - Report of Findings 67

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Daily (1+drinks/ day) 9% 5% 4% 5% 9% 2-6 drinks/week 16% 12% 27% 6% 13% 1/week or fewer 19% 23% 31% 12% 25% None/ Never/ Rarely 56% 59% 36% 77% 54% Not sure - - 2% - -

Twenty-three percent of residents consume sports drinks like Gatorade or Powerade at least occasionally. Four percent drink them daily, 6% between two and six times a week, and 13% no more often than once a week.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Daily (1+drinks/ day) 5% 3% 3% 5% 5% 2-6 drinks/week 11% 3% 6% 6% 7% 1/week or fewer 13% 13% 12% 13% 14% None/ Never/ Rarely 71% 81% 79% 75% 74% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 68

2014 Age Breakouts 18-34 35-49 50-64 65+

Daily (1+drinks/ day) 7% 4% 2% 1% 2-6 drinks/week 10% 7% 3% 2% 1/week or fewer 21% 13% 9% 5% None/ Never/ Rarely 62% 76% 86% 92% Not sure - - - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Daily (1+drinks/ day) 3% 8% 3% 12% 9% 2-6 drinks/week 6% 7% 8% 3% 6% 1/week or fewer 10% 19% 15% 19% 15% None/ Never/ Rarely 81% 66% 74% 66% 69% Not sure - - 1% - -

Forty-one percent of residents at least occasionally consume other kinds of sugary beverages such as fruit drinks like Snapple and cranberry juice cocktail, flavored teas and waters, and energy drinks like Red Bull and Monster. Fifteen percent drink them daily, another 15% between two and six times a week, and 12% drink them once a week or less often.

2014 Howard County Health Assessment Survey - Report of Findings 69

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Daily (1+drinks/ day) 14% 13% 13% 13% 23% 2-6 drinks/week 12% 16% 14% 16% 17% 1/week or fewer 12% 9% 13% 14% 10% None/ Never/ Rarely 60% 62% 59% 57% 49% Not sure/ Refused 2% - 1% - 1%

2014 Age Breakouts 18-34 35-49 50-64 65+

Daily (1+drinks/ day) 16% 14% 16% 13% 2-6 drinks/week 24% 15% 8% 9% 1/week or fewer 15% 14% 10% 6% None/ Never/ Rarely 44% 57% 66% 71% Not sure/ Refused 2% - - 1%

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Daily (1+drinks/ day) 11% 27% 11% 17% 17% 2-6 drinks/week 13% 23% 16% 20% 24% 1/week or fewer 11% 14% 14% 6% 10% None/ Never/ Rarely 64% 36% 58% 57% 44% Not sure/ Refused - - 1% - 1%

2014 Employment Self- Employed Unemployed Retired Other Status Breakouts Employed Daily (1+drinks/ day) 14% 13% 13% 14% 18% 2-6 drinks/week 16% 9% 36% 7% 13% 1/week or fewer 13% 11% 9% 5% 13% None/ Never/ Rarely 56% 65% 39% 72% 55% Not sure/ Refused 1% 2% 3% 1% 1%

2014 Howard County Health Assessment Survey - Report of Findings 70

According to parents, 38% of their children drink regular soda. Parents said that 3% of their children drink soda at least daily, 13% drink between two and six servings of soda per week, and 21% drink soda once a week or less often.

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Daily (1+drinks/ day) 4% 3% 4% 2% 2-6 drinks/week 18% 13% 15% 9% 1/week or fewer 24% 21% 18% 23% None/ Never/ Rarely 44% 58% 59% 64% Not sure/ Refused 10% 2% 2% -

2014 Howard County Health Assessment Survey - Report of Findings 71

Thirty-six percent of children drink sports drinks like Gatorade or Powerade. Five percent drink them daily, 13% between two and six times per week, and 17% once a week or less.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Daily (1+drinks/ day) 7% 7% 5% 4% 4% 2-6 drinks/week 23% 15% 10% 13% 9% 1/week or fewer 19% 20% 17% 10% 21% None/ Never/ Rarely 46% 55% 64% 69% 61% Not sure/ Refused 5% 3% 5% 3% 5%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Daily (1+drinks/ day) 9% 6% 3% 10% 3% 2-6 drinks/week 10% 11% 15% 12% 15% 1/week or fewer 9% 11% 19% 19% 29% None/ Never/ Rarely 61% 69% 60% 55% 51% Not sure/ Refused 11% 3% 2% 4% 2%

2014 Howard County Health Assessment Survey - Report of Findings 72

According to parents, nearly two-thirds (62%) of their youngest children between the ages of two and 18 drink fruit drinks like cranberry juice cocktail, Capri Sun, Sunny D, Hi-C, Kool-Aid, or Hawaiian Punch. More than one in four of these children (27%) drink those kinds of fruit drinks every day. Another 23% drink them two to six times per week, and 13% drink them once a week or less.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Daily (1+drinks/ day) 21% 42% 25% 22% 29% 2-6 drinks/week 21% 26% 32% 15% 13% 1/week or fewer 14% 10% 11% 19% 21% None/ Never/ Rarely 41% 19% 26% 36% 26% Not sure/ Refused 2% 3% 6% 8% 11%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Daily (1+drinks/ day) 32% 38% 24% 20% 22% 2-6 drinks/week 27% 27% 23% 18% 20% 1/week or fewer 11% 7% 18% 18% 9% None/ Never/ Rarely 22% 25% 34% 39% 46% Not sure/ Refused 9% 3% 2% 4% 3%

2014 Howard County Health Assessment Survey - Report of Findings 73

In the month prior to the survey, 49% of survey respondents had bought a sugar sweetened beverage for their family to drink at home, including regular soda, sports drinks like Gatorade or Powerade, fruit drinks like Capri Sun or Hawaiian Punch, energy drinks, or sweetened teas and waters.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 48% 63% 45% 28% No 51% 37% 55% 71% Not sure 1% - - -

2014 Employment Self- Employed Unemployed Retired Other Status Breakouts Employed Yes 54% 49% 67% 30% 45% No 46% 51% 33% 70% 53% Not sure - - - - 3%

2014 Howard County Health Assessment Survey - Report of Findings 74

Behavioral Health

The Behavioral Health section includes questions about residents’ mental health condition, financial worry, access to mental health treatment, tobacco use, and alcohol use.

Mental Health Seven percent of residents in 2014 said they were presently taking medicine or receiving treatment from a health professional for a mental health condition or emotional problem. This is a slight decrease from the 9% who said so in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 5% 4% 11% 6% 7% No 95% 96% 88% 94% 92% Not sure - - 1% - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 8% 8% - 8% 3% No 92% 91% 100% 92% 97% Not sure - 1% - - -

2014 Howard County Health Assessment Survey - Report of Findings 75

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 5% 6% 16% 6% 15% No 95% 94% 80% 93% 85% Not sure - - 4% - -

One-quarter (26%) of Howard County residents said they worried at least sometimes in the prior 12 months about having enough money to pay vital expenses like your rent, mortgage, or food. Four percent said they “always” worried about that, 5% said they “usually did,” and 17% said they worried “sometimes.” The percentage who said they “never” worried declined slightly from 54% in 2012 to 51% in 2014.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Always 3% 2% 6% 5% 5% Usually 2% 3% 6% 7% 7% Sometimes 14% 16% 20% 18% 16% Rarely 21% 23% 20% 22% 21% Never 59% 56% 46% 47% 51% Not applicable - - 1% 1% - Not sure - 1% - - - 2014 Howard County Health Assessment Survey - Report of Findings 76

2014 Race/ Ethnicity African- White Asian Hispanic Others Breakouts American Always 3% 8% 1% 4% 9% Usually 4% 7% 6% 11% 16% Sometimes 15% 23% 16% 28% 22% Rarely 23% 19% 19% 23% 14% Never 53% 42% 57% 28% 38% Not applicable - - 1% 6% - Not sure - - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Always 11% 5% 2% 1% 1% Usually 11% 5% 3% 4% - Sometimes 34% 20% 15% 5% 7% Rarely 17% 25% 27% 20% 16% Never 25% 44% 52% 67% 76% Not applicable - - - 3% - Not sure 1% - - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Always 8% 6% 3% 2% Usually 9% 7% 4% 2% Sometimes 22% 23% 15% 13% Rarely 19% 24% 24% 18% Never 39% 38% 54% 65% Not applicable - 2% - - Not sure 1% - - -

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Always 3% 10% 2% 6% 18% Usually 4% 11% 6% 6% 2% Sometimes 15% 24% 24% 18% 44% Rarely 22% 20% 18% 20% 15% Never 56% 35% 42% 48% 21% Not applicable - - 2% 2% - Not sure/ Refused - - 5% - -

2014 Howard County Health Assessment Survey - Report of Findings 77

Three percent of residents said there was a time during the prior 12 months when they needed mental health treatment or counseling but did not get it.

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 3% 5% 2% 2% No 97% 94% 98% 97% Not sure - - - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 2% 2% 9% - 7% No 98% 98% 91% 99% 93% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 78

Residents who did not receive the mental health treatment they felt they needed cited cost concerns (22%), lack of time (14%), trepidation (12%), a conviction that they could overcome the problem themselves (11%), a provider that was too busy to see them (8%), their own laziness or procrastination (7%), transportation limitations (7%), or a lack of certainty how or where to seek those services (3%).

2014 Howard County Health Assessment Survey - Report of Findings 79

Tobacco Twenty-nine percent of residents said they have smoked at least 100 cigarettes in their life, a common measure of smoking behavior. This percentage is slightly larger than the 27% measured in 2012.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 33% 27% 12% 34% 30% No 67% 73% 88% 66% 68% Not sure - - - - 2%

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 36% 39% 25% 22% 22% No 63% 61% 75% 78% 78% Not sure 1% - - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 41% 37% 27% 17% No 58% 63% 73% 83% Not sure 1% - - -

2014 Howard County Health Assessment Survey - Report of Findings 80

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 29% 46% 41% 16% 50% No 71% 54% 59% 83% 46% Not sure - - - 1% 4%

Fifteen percent of people who have smoked at least 100 cigarettes in their life said they now smoke every day; an additional 11% said they smoke “some days.” This aggregate 26% is slightly lower than the 29% measured in 2012, when 20% of lifetime smokers said they currently smoked every day. Projected over the full adult population of Howard County, the smoking rate in 2014 is 7.5%, compared to 7.9% in 2012.

2014 Age Breakouts 18-34 35-49 50-64 65+ Every day 17% 14% 27% 4% Some days 23% 15% 6% 4% Not at all 60% 71% 68% 92% Not sure - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Every day 21% 22% 8% 11% 5% Some days 21% 9% 14% 2% 7% Not at all 58% 69% 79% 87% 88% Not sure - - - - - 2014 Howard County Health Assessment Survey - Report of Findings 81

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Every day 23% 19% 11% 5% Some days 10% 17% 9% 7% Not at all 67% 64% 80% 87% Not sure - 1% - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Every day 16% 17% 27% 9% 19% Some days 9% 15% 22% 4% 23% Not at all 75% 66% 51% 87% 58% Not sure - 2% - - -

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Every day 11% 28% 15% 18% 29% Some days 6% 19% 3% 23% 47% Not at all 83% 53% 82% 59% 24% Not sure - - - - -

There is negligible use of chewing tobacco, snuff, or snus in Howard County. In 2014, those who said they used these tobacco products every day and some days each rounded to zero; together, those two categories amounted to about 1% of the survey sample.

2014 Howard County Health Assessment Survey - Report of Findings 82

Two percent of residents said they use e-cigarettes some days. The number who said they use them every day was very small – less than one-half percent.

2014 Age Breakouts 18-34 35-49 50-64 65+ Every day 1% - - - Some days 5% 1% 1% 1% Not at all 95% 98% 99% 99% Not sure - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Every day - 1% 1% 1% - Some days 5% 2% 1% 2% 1% Not at all 95% 97% 99% 98% 99% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 83

Ninety-seven percent of residents said that no one else had smoked inside their home while they are at home during the previous seven days. Two percent said someone else smoked inside the home every day, and 1% said someone did that one or two days that week. Those numbers are virtually unchanged from 2012.

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 None 93% 97% 98% 99% 99% Rarely (1-2 days) 2% 1% 1% - - Frequently (3-6 days) - - - - - Every day (7 days) 4% 2% 1% 1% - Not sure - - - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree None 93% 96% 98% 99% Rarely (1-2 days) 3% 1% 1% 1% Frequently (3-6 days) - - - - Every day (7 days) 3% 3% 1% - Not sure 2% - - -

2014 Howard County Health Assessment Survey - Report of Findings 84

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed None 98% 96% 87% 95% 95% Rarely (1-2 days) 1% - 5% 1% 3% Frequently (3-6 days) - - - - - Every day (7 days) 1% 4% 2% 4% 2% Not sure - - 6% - -

Ninety-six percent of residents said that they did not ride in a vehicle during the previous week in which someone else was smoking. One percent said they rode with someone every day who smoked in the vehicle, and 2% said they rode with someone else smoked one or two days during the prior week. These numbers show a slight improvement from the 2012 survey.

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 None 90% 97% 98% 99% 97% Rarely (1-2 days) 9% 1% 1% 1% 1% Frequently (3-6 days) 1% 1% - - - Every day (7 days) 1% 1% - - 1% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 85

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree None 93% 94% 97% 99% Rarely (1-2 days) 3% 6% 2% 1% Frequently (3-6 days) 1% - 1% - Every day (7 days) 2% - - - Not sure - - - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed None 98% 96% 83% 99% 94% Rarely (1-2 days) 1% 2% 13% - 6% Frequently (3-6 days) 1% 1% - - - Every day (7 days) - 1% 5% 1% - Not sure - - - - -

Among residents of multi-family buildings, 14% said they can smell cigarette, cigar, or pipe tobacco smoke in their home from a neighbor. This is an improvement from the 23% who said so in 2012. In 2014, 3% said they could smell a neighbor’s smoke every day, another 3% said every couple of days, 5% said once a week, and 3% said once a month.

2014 Howard County Health Assessment Survey - Report of Findings 86

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Every day - 2% 4% 1% 2% Every couple of days - 3% 4% - 2% Once a week 2% 2% 7% 2% 4% Once a month 4% 3% 3% 4% 2% Never 94% 91% 81% 93% 89% Not sure - - - - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Every day 4% 1% 3% 4% Every couple of days 3% 2% 4% 3% Once a week 5% 2% 5% 7% Once a month 3% 3% 3% 3% Never 86% 93% 85% 83% Not sure - - - -

2014 Employment Self- Employed Unemployed Retired Other Status Breakouts Employed Every day 3% 2% 1% 1% 4% Every couple of days 2% 14% 10% - 1% Once a week 4% 16% 13% 2% 5% Once a month 3% 20% 1% - 2% Never 88% 49% 75% 96% 89% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 87

Alcohol Consumption Forty percent of residents in the 2014 survey said they consumed no alcoholic drinks in the previous 30 days, an increase of two percentage points compared to 2012. Another 22% in 2014 said they consumed less than one alcoholic drink per week. Three percent said they drank and alcoholic beverage at least daily.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American None 31% 50% 68% 29% 40%

1-3 days/month 23% 22% 13% 35% 19% 1 day/week or 4-6 15% 11% 5% 10% 17% days/month 2 days/week or 7-10 11% 6% 2% 6% 3% days/month 3 days/week or 11-14 5% 3% 2% 5% 11% days/month 4 days/week or 15-19 5% 3% 2% 1% 1% days/month 5 days/week or 20-23 5% 2% 3% 11% 6% days/month 6 days/week or 24-27 2% 1% 1% 2% - days/month 7 days/week or 28-31 4% 1% 1% - 1% days/month Not sure - 2% 2% 1% 2% 2014 Howard County Health Assessment Survey - Report of Findings 88

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 None 55% 38% 35% 34% 28%

1-3 days/month 18% 24% 24% 22% 23% 1 day/week or 4-6 12% 13% 13% 11% 18% days/month 2 days/week or 7-10 5% 7% 9% 12% 10% days/month 3 days/week or 11-14 3% 4% 5% 6% 4% days/month 4 days/week or 15-19 2% 4% 5% 5% 5% days/month 5 days/week or 20-23 2% 3% 3% 3% 6% days/month 6 days/week or 24-27 2% 1% 2% 1% 2% days/month 7 days/week or 28-31 1% 4% 3% 5% 4% days/month Not sure - 2% 1% 1% 1%

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree None 58% 41% 33% 35%

1-3 days/month 18% 24% 23% 22% 1 day/week or 4-6 8% 11% 15% 14% days/month 2 days/week or 7-10 6% 7% 11% 9% days/month 3 days/week or 11-14 3% 6% 4% 5% days/month 4 days/week or 15-19 1% 3% 4% 4% days/month 5 days/week or 20-23 3% 3% 3% 4% days/month 6 days/week or 24-27 1% 2% 1% 1% days/month 7 days/week or 28-31 1% 3% 4% 4% days/month Not sure - 1% 1% 1%

2014 Howard County Health Assessment Survey - Report of Findings 89

One-quarter (26%) of Howard County residents had engaged in at least one episode of binge drinking in the past 30 days, defined as at least five drink on a single occasion for men, and four drinks for women. Three percent of residents had engaged in binge drinking at least five times during the prior month. These numbers are very similar to the 2012 survey, when 24% had engaged in binge drinking at least once during the prior month.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts None 77% 74% 72% 67% 65% 1-2 12% 21% 18% 21% 22% 3-4 7% 1% 6% 3% 9% 5 or more 4% 2% 2% 9% 3% Not sure/ Refused 1% 1% 2% - 1%

2014 Age Breakouts 18-34 35-49 50-64 65+

None 49% 76% 77% 91% 1-2 34% 17% 13% 3% 3-4 8% 5% 4% 1% 5 or more 7% 1% 4% 1% Not sure 1% 1% 1% 3%

2014 Howard County Health Assessment Survey - Report of Findings 90

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 None 68% 65% 70% 76% 84% 1-2 18% 24% 23% 15% 11% 3-4 8% 7% 4% 5% 2% 5 or more 2% 4% 2% 3% 2% Not sure 4% 1% 1% - 1%

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree None 57% 66% 69% 83% 1-2 26% 23% 19% 13% 3-4 11% 6% 5% 2% 5 or more 5% 5% 4% 1% Not sure 1% - 3% -

2014 Howard County Health Assessment Survey - Report of Findings 91

Chronic Disease

The Chronic Disease section includes questions on high blood pressure, cholesterol, asthma, COPD, diabetes, health problems requiring special equipment, and in-home care.

One-quarter (24%) of Howard County residents have been told by a health professional that they have high blood pressure. Another 1% are women who were only told that during pregnancy, and 2% were told they were borderline high or pre-hypertensive. These numbers are unchanged since 2012.

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 26% 26% 12% 7% 17% Yes, but female told only 1% 1% 1% - 1% during pregnancy No 71% 70% 86% 89% 77% Told borderline high or 1% 3% 1% 4% 5% pre-hypertensive Not sure/ Refused - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 92

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 24% 33% 55% 10% 43% Yes, but female told only 1% - 1% - - during pregnancy No 73% 65% 42% 88% 48% Told borderline high or 2% 3% 1% 1% 9% pre-hypertensive Not sure/ Refused - - 2% - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 18% 21% 36% 60% 11% Yes, but female told only 1% - - - 1% during pregnancy No 79% 78% 58% 37% 87% Told borderline high or 2% - 6% 2% 1% pre-hypertensive Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 93

Of those who have been told they have high blood pressure, 81% are currently taking medication to help control it.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 38% 72% 79% 96% No 62% 28% 21% 4% Not sure - - - -

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 80% 85% 93% 64% 86% No 20% 15% 7% 36% 14% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 94

Eighty-five percent can remember having their blood cholesterol checked. Thirteen percent feel certain that their cholesterol has not been checked, while 2% are not sure. In 2012, a somewhat higher 89% recalled a blood cholesterol check at some point in the past.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 87% 85% 89% 78% 84% No 12% 11% 9% 22% 15% Not sure 2% 5% 2% 1% 1%

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 88% 81% 75% 80% 84% No 10% 17% 20% 20% 16% Not sure 2% 3% 5% - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 83% 90% 90% 82% 90% No 16% 7% 10% 16% 8% Not sure 1% 3% - 2% 2%

2014 Howard County Health Assessment Survey - Report of Findings 95

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 79% 78% 86% 93% No 17% 20% 12% 6% Not sure 5% 2% 1% 1%

For those who could remember a cholesterol test, 78% said it was within the past year, 13% said the test was between one and two years ago, 6% said it was between two and five years ago, and 2% said it was five or more years in the past. The number who remembered having a cholesterol test within the past year increased by three percentage points between 2012 and 2014.

2014 Age Breakouts 18-34 35-49 50-64 65+

Within the past year 75% 71% 84% 90% 1 year but less than 2 years 14% 19% 9% 4% ago 2 years but less than 5 years 7% 7% 5% 3% ago 5 or more years ago 1% 3% 1% 1%

Not sure 2% 1% 1% 2%

2014 Howard County Health Assessment Survey - Report of Findings 96

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Within the past year 76% 87% 70% 85% 83% 1 year but less than 2 years 14% 8% 16% 9% 12% ago 2 years but less than 5 years 7% 3% 6% 7% 3% ago 5 or more years ago 2% 2% 1% - 1%

Not sure 1% - 6% - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Within the past year 87% 76% 77% 75% 1 year but less than 2 years 7% 18% 14% 13% ago 2 years but less than 5 years 2% 5% 5% 9% ago 5 or more years ago 2% 1% 2% 2%

Not sure 2% - 2% 1%

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Within the past year 75% 71% 95% 91% 75% 1 year but less than 2 years 15% 21% 2% 3% 14% ago 2 years but less than 5 years 6% 3% 3% 3% 8% ago 5 or more years ago 2% 1% - 1% 2%

Not sure 1% 4% - 2% 1%

2014 Howard County Health Assessment Survey - Report of Findings 97

One-third (33%) who could remember having a cholesterol test said they were told their blood cholesterol was high. There is no significant difference from the 32% measured in 2012.

2014 Gender Breakouts Male Female

Yes 41% 27% No 58% 72% Not sure 1% 1%

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 35% 31% 17% 31% 43% No 63% 69% 83% 69% 57% Not sure 1% - 1% - -

High School 4-Year 2014 Education Breakouts Some College Postgraduate or less Degree Yes 36% 34% 35% 30% No 62% 66% 65% 69% Not sure 2% - - 1%

2014 Howard County Health Assessment Survey - Report of Findings 98

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 34% 45% 46% 19% 22% No 66% 55% 47% 81% 78% Not sure/ Refused - - 7% - -

Eleven percent of Howard County residents have asthma. In 2012, through a slightly different question, 9% said they have asthma.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 16% 9% 12% 6% No 83% 91% 88% 93% Not sure 1% - - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 9% 14% 12% 33% 30% No 90% 86% 87% 67% 70% Not sure - - 1% - -

2014 Howard County Health Assessment Survey - Report of Findings 99

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 18% 11% 9% 13% 8% No 82% 88% 91% 87% 92% Not sure - - - - -

Three percent of residents said they have been told they have chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis. This is nearly identical to the 4% who said they had one of these diseases in 2012.

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 6% 2% 1% 1% 1% No 93% 97% 98% 99% 99% Not sure 1% - 1% - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 2% 2% 11% 7% 2% No 98% 98% 89% 93% 98% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 100

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 2% 7% 9% 2% 3% No 98% 93% 91% 98% 97% Not sure - - - - -

Diabetes Eight percent of residents have been told they have diabetes. An additional 4% volunteered that they were told they had pre-diabetes or borderline diabetes.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 1% 5% 10% 24%

No 94% 92% 84% 72% No, pre-diabetes or 4% 3% 5% 2% borderline diabetes Not sure / Refused - - - 1%

2014 Howard County Health Assessment Survey - Report of Findings 101

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 13% 9% 8% 6% 2%

No 85% 85% 86% 92% 94% No, pre-diabetes or 1% 5% 6% 2% 4% borderline diabetes Not sure/ Refused 1% - - - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 5% 5% 9% 25% 4%

No 90% 92% 89% 73% 93% No, pre-diabetes or 4% 4% 2% 2% 3% borderline diabetes Not sure/ Refused - - - - -

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 8% 11% 15% 3% 23%

No 87% 86% 81% 93% 77% No, pre-diabetes or 4% 2% 3% 4% - borderline diabetes Not sure/ Refused - - 2% - -

2014 Howard County Health Assessment Survey - Report of Findings 102

Of those who have not been told they have diabetes, 8% have been told they have pre-diabetes or borderline diabetes. This is a slight increase from the 6% measured in 2012. Another 1% in both 2014 and 2012 said that was only while they were pregnant.

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 6% 12% 10% 8% 5% Yes, during pregnancy 2% 2% 1% 1% 1% No 88% 86% 89% 91% 94% Not sure/ Refused 4% 1% 1% - -

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 7% 6% 20% 8% 5% Yes, during pregnancy 2% 4% 1% - - No 91% 88% 76% 90% 95% Not sure/ Refused - 1% 3% 2% -

2014 Howard County Health Assessment Survey - Report of Findings 103

Based on their recollection, on average residents were 45 years old when they were first told they had diabetes. In 2012, a slightly higher average age of 50 was recorded.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Less than 40 14% 23% 19% 19% 24% 40-49 7% 20% 48% 40% 19% 50-59 30% 15% 16% 20% 41% 60+ 42% 24% 10% 21% 10% Not sure 7% 18% 6% - 7%

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Less than 40 20% 15% 18% 45% 27% 40-49 18% 59% 54% 31% 10% 50-59 27% 16% 13% 24% 27% 60+ 29% 3% 16% - 6% Not sure 6% 7% - - 30%

2014 Howard County Health Assessment Survey - Report of Findings 104

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Less than 40 11% 27% 23% 26% 8% 40-49 38% 20% 27% 33% 22% 50-59 24% 21% 30% 5% 70% 60+ 15% 28% 17% 17% - Not sure 12% 3% 2% 19% -

Ninety percent of residents who have been told they have diabetes said they are now taking insulin or other medicine to help with the disease.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 100% 89% 86% 93% No - 11% 14% 7% Not sure - - - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 91% 94% 64% 69% 100% No 9% 6% 36% 31% - Not sure - - - - - 2014 Howard County Health Assessment Survey - Report of Findings 105

In the 2014 survey, residents with diabetes said they had seen a health professional for their diabetes an average of 2.37 times in the prior 12 months. In 2012, the average was a very similar 3.35 visits.

2014 Gender Breakouts Male Female

None 5% 6% 1 17% 5% 2 24% 20% 3 20% 13% 4 21% 46% 5+ 11% 9% Not sure 2% 1%

2014 Age Breakouts 18-34 35-49 50-64 65+

None - - 8% 7% 1 - 11% 23% 6% 2 - 27% 11% 30% 3 - 19% 15% 19% 4 63% 32% 31% 30% 5+ 37% 11% 13% 6% Not sure - - - 3%

2014 Howard County Health Assessment Survey - Report of Findings 106

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed None 1% - 45% 6% 3% 1 12% - 9% 5% 58% 2 20% 10% - 31% 7% 3 11% 36% 10% 26% - 4 41% 54% 23% 28% 6% 5+ 12% - 13% 4% 26% Not sure 2% - - 1% -

Residents with diabetes received the A1C test an average of 2.85 times over the prior 12 months, according to the 2014 survey. Seven percent of respondents said they had not heard of the test. In 2012, the average was slightly higher at 3.13 times in the prior 12 months.

2014 Howard County Health Assessment Survey - Report of Findings 107

2014 Age Breakouts 18-34 35-49 50-64 65+

None - - 21% 1% 1 - 22% 5% 18% 2 - 25% 11% 34% 3 17% 23% 9% 13% 4 83% 28% 34% 23% 5+ - 2% 16% 5% Not sure - - 4% 6% Never heard of A1C test - - - -

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American None 2% 13% - - 30% 1 13% 3% 13% 69% 45% 2 22% 39% 16% - 7% 3 16% 8% 18% 31% 8% 4 37% 19% 40% - 10% 5+ 5% 18% - - - Not sure 4% - 13% - - Never heard of A1C test - - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 None 19% 1% 3% - - 1 14% 21% 13% 20% - 2 29% 9% 21% 49% 42% 3 2% 26% 12% 14% - 4 26% 39% 41% 9% 58% 5+ 8% 3% 3% 8% - Not sure 2% - 6% - - Never heard of A1C test - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 108

Special Equipment/ Special Care Five percent of residents said they have a health problem that requires them to use special equipment such as a cane, a wheelchair, a special bed, or a special telephone. In 2012, 4% of residents said they required special equipment.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 1% 3% 4% 16% No 99% 97% 96% 84% Not sure - - - -

$50,000- $100,000- $150,000- 2014 Income Breakouts <$50,000 $200,000+ $99,999 $149,999 $199,999 Yes 11% 5% 2% 2% 2% No 89% 95% 98% 98% 98% Not sure - - - - -

2014 Employment Status Self- Employed Unemployed Retired Other Breakouts Employed Yes 1% 3% 10% 18% 6% No 99% 97% 90% 82% 94% Not sure - - - - -

2014 Howard County Health Assessment Survey - Report of Findings 109

2014 Marital Status Divorced/ Never Unmarried Married Widowed Breakouts Separated Married Couple Yes 3% 4% 27% 4% 5% No 97% 96% 73% 96% 95% Not sure - - - - -

Three percent have someone living with them who requires special in-home case. In 2012, the number was 4%.

2014 Howard County Health Assessment Survey - Report of Findings 110

Other Issues

The Other Issues section includes a question on Lyme Disease.

Fifty-seven percent of residents said they are taking protective measures against ticks when they go outside such as wearing protective clothing, finding and removing ticks, or avoiding wooded and bushy areas. This number is down significantly from the 66% measured in 2012.

2014 Planning District West County Ellicott City Columbia Elkridge Laurel Breakouts Yes 64% 55% 57% 53% 54% No 36% 44% 42% 47% 46% Not sure/ Refused - - 1% - -

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 56% 63% 53% 50% No 44% 37% 46% 49% Not sure/ Refused - 1% - 1%

2014 Howard County Health Assessment Survey - Report of Findings 111

2014 Race/ Ethnicity African- White Asian Hispanic Other Breakouts American Yes 62% 49% 42% 52% 50% No 37% 51% 58% 47% 50% Not sure - - - 1% -

2014 Howard County Health Assessment Survey - Report of Findings 112

Appendix: Survey Instrument

2014 Howard County Health Assessment Survey - Report of Findings 113

Hello, I am calling for the Howard County Health Department. My name is ______. We are gathering information about the health of County residents. This project is being conducted by the health department following Centers for Disease Control and Prevention guidelines. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices.

To ensure we are speaking to a representative group of residents may I please speak to the youngest male age 18 or older who is at home right now?

IF NO: May I please speak to the youngest female in the household age 18 or older who is at home?

I will not ask for your last name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Any information you give me will be confidential. If you have any questions about the survey, please call 410- 280-3100.

S1. Just to confirm, do you live in Howard County?

1 Yes 2 No (Thank and terminate.) 9 Not sure/Refused to say (Thank and terminate.)

S2. In what zip code do you live? (Record 5-digit zip.)

20701 21042 21723 20723 21043 21737 20759 21044 21738 20763 21045 21765 20777 21046 21771 20794 21075 21784 20833 21076 21794 21029 21104 21797 21036 21150 21041 21163

8.22 I am required to ask this question. So that we have a balanced sample, what is your gender? (Note: Answer drives skip patterns for Q.4.1, 6.1, M01.2.) (151) 1 Male 2 Female 3 Transgender

C03 Health Care Access (general)

3.1 Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Indian Health Services? (80) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 114

3.2 Do you have one person you think of as your personal doctor or health care provider? If “No,” ask: “Is there more than one, or is there no person who you think of as your personal doctor or health care provider?” (81) 1 Yes, only one 2 More than one 3 No 7 Don‘t know / Not sure 9 Refused

3.3 Was there a time in the past 12 months when you needed to see a doctor but could not because of cost? (82) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

3.3A When you are sick or need medical attention, to which one of the following places do you usually go? Would you say:

Please read: 1 A doctor's office 2 A community health center like Chase Brexton 4 A hospital emergency room 5 An urgent care center like Patient First or Minute Clinic 6 Some other kind of place Or 8 No usual place Do not read: 7 Don’t know / Not sure 9 Refused

3.3B Thinking about your most recent visit to your primary health care provider for a medical issue you wanted resolved quickly, how long did you have to wait between when the appointment was made and when the appointment actually occurred?

Do not read: 1 Same day 2 Within 2-3 days 3 Within 1 week 4 Within 1 month 5 Longer than 1 month 6 Does not apply to me 7 Don’t know / Not sure 9 Refused

3.3C Was there a time in the past 12 months when you needed to go to the emergency room because you could not get a timely appointment with a doctor?

1 Yes 2 No 7 Don’t know / Not sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 115

C04 Hypertension

4.1 Have you EVER been told by a doctor, nurse, or other health professional that you have high blood pressure? (84) Read only if necessary: By “other health professional” we mean a nurse practitioner, a physician‘s assistant, or some other licensed health professional. If “Yes” and respondent is female, ask: “Was this only when you were pregnant?”

1 Yes 2 Yes, but female told only during pregnancy [Go to next section] 3 No [Go to next section] 4 Told borderline high or pre-hypertensive [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section]

4.1A Are you currently taking medication to help with your high blood pressure?

1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

C05 High Cholesterol

5.1 Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked? (86) 1 Yes 2 No [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section]

5.2 About how long has it been since you last had your blood cholesterol checked? (87) Read only if necessary: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 5 years (2 years but less than 5 years ago) 4 5 or more years ago Do not read: 7 Don‘t know / Not sure 9 Refused

5.3 Have you ever been told by a doctor, nurse or other health professional that your blood cholesterol is high? (88) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 116

C06 Chronic Health Conditions:

Now I would like to ask you some questions about general health conditions.

Has a doctor, nurse, or other health professional ever told you that you had any of the following? For each, tell me “Yes,” “No,” or you‘re “not sure.”

6.5 Do you currently have asthma? (93) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

C06 COPD

6.8 (Ever told) you have (COPD) chronic obstructive pulmonary disease, emphysema (em-fiz-ZEE-muh) or chronic bronchitis (bron-KITE-us)? (96) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

C06 Diabetes

6.13 (Ever told) you have diabetes? (101) (If “Yes” and respondent is female, ask): “Was this only when you were pregnant?”

If respondent says pre-diabetes or borderline diabetes, use response code 4.

1 Yes 2 Yes, but female told only during pregnancy 3 No 4 No, pre-diabetes or borderline diabetes 7 Don‘t know / Not sure 9 Refused

M01 Pre-Diabetes

NOTE: Only asked of those not responding “Yes” (code = 1) to Core Q6.13 (Diabetes awareness question).

CATI NOTE: If Core Q6.13 = 4 (No, pre-diabetes or borderline diabetes); answer Q2 “Yes” (code = 1).

M01.2. Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes? (246) If “Yes” and respondent is female, ask: “Was this only when you were pregnant?”

1 Yes 2 Yes, during pregnancy 3 No 7 Don‘t know / Not sure 9 Refused 2014 Howard County Health Assessment Survey - Report of Findings 117

M02 Diabetes

To be asked following Core Q6.13; if response is "Yes" (code = 1)

M02.1. How old were you when you were told you have diabetes? (247-248) _ _ Code age in years [97 = 97 and older] 98 Don‘t know / Not sure 99 Refused

M02.2. Are you now taking insulin or other medicine to help with your diabetes? (249) 1 Yes 2 No 9 Refused

M02.5. About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes? (256-257) _ _ Number of times [76 = 76 or more] 88 None 77 Don‘t know / Not sure 99 Refused

M02.6. A test for "A one C" measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for "A one C"? (258-259) _ _ Number of times [76 = 76 or more] 88 None 98 Never heard of ―A one C‖ test 77 Don‘t know / Not sure 99 Refused

C07 Tobacco Use

7.1 Have you smoked at least 100 cigarettes in your entire life? (102) NOTE: 5 packs = 100 cigarettes 1 Yes 2 No [Go to Q7.5] 7 Don‘t know / Not sure [Go to Q7.5] 9 Refused [Go to Q7.5]

7.2 Do you now smoke cigarettes every day, some days, or not at all? (103) 1 Every day 2 Some days 3 Not at all 7 Don‘t know / Not sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 118

7.5 Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all? (Snus rhymes with “goose‟) NOTE: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum. (107) 1 Every day 2 Some days 3 Not at all Do not read: 7 Don‘t know / Not sure 9 Refused

7.5A E-cigarettes are battery powered devices that provide inhaled doses of nicotine. Do you currently use e-cigarettes every day, some days, or not at all?

1 Every day 2 Some days 3 Not at all Do not read: 7 Don‘t know / Not sure 9 Refused

C08 Demographics

8.1 What is your age? (108-109) _ _ Code age in years (18-97) 07 Don‘t know / Not sure 09 Refused

8.2 Are you Hispanic or Latino? (110) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

8.3 Which one or more of the following would you say is your race? (111-116) (Code all that apply) Please read: 1 White 2 Black or African American 3 Asian 4 Native Hawaiian or Other Pacific Islander 5 American Indian or Alaska Native Or 6 Other [specify]______Do not read: 7 Don‘t know / Not sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 119

8.6 Are you…? (119) Please read: 1 Married 2 Divorced 3 Widowed 4 Separated 5 Never married Or 6 A member of an unmarried couple Do not read: 9 Refused

8.7A Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?

1 Yes 2 No 9 Refused

8.7 How many children less than 18 years of age live in your household? (120-121) _ _ Number of children 88 None [Go to Q.8.8.] 99 Refused [Go to Q.8.8.]

8.7A1 (If children in home): Have you ever been told by a health care professional that your child should lose weight? 1 Yes 2 No

8.7A2 (If yes): What age were they at the time? Under 6, 6 to 10, 11 to 14, or 15 to 18?

(Code all that apply; code only once for each age group even if multiple children in a single age group.) 1 Under 6 2 6 to 10 3 11 to 14 4 15 to 18 7 Don’t know / Not sure 9 Refused

8.8 What is the highest grade or year of school you completed? (122) Read only if necessary: 1 Never attended school or only attended kindergarten 2 Grades 1 through 8 (Elementary) 3 Grades 9 through 11 (Some high school) 4 Grade 12 or GED (High school graduate) 5 College 1 year to 3 years (Some college or technical school) 6 College 4 years (College graduate) 7 Graduate-level work or degree (More than 4 years college) Do not read: 9 Refused / Don’t know

2014 Howard County Health Assessment Survey - Report of Findings 120

8.9 Are you currently…? (123) Please read: 1 Employed for wages 2 Self-employed 3 Out of work for more than 1 year 4 Out of work for less than 1 year 5 A Homemaker 6 A Student 7 Retired Or 8 Unable to work Do not read: 9 Refused

8.10 Is your annual household income from all sources— (124-125) 1 Less than $50,000 per year (Do not read: $4,166 or less per month/ $961 or less per week) 2 $50,000 to $99,999 per year (Do not read: $8,333 – 4,167 per month/ $1,923 – 962 per week) 3 $100,000 to $149,999 per year (Do not read: $12,500 – 8,334 per month/ $2,884 – 1,924 per week) 4 $150,000 to $199,999 per year (Do not read: $12,501 – 16,666 per month/$2,885 – 3,846 per week) 5 $200,000 or more per year (Do not read: $16,667 or more per month/ $3,847 or more per week) Do not read: 7 Don‘t know / Not sure 9 Refused If respondent refuses at ANY income level, code 99 (Refused)

8.11 About how much do you weigh without shoes? (126-129) Round fractions up.

_ _ _ _ Weight (pounds) 7777 Don‘t know / Not sure 9999 Refused

8.12 About how tall are you without shoes? (130-133) Round fractions down.

_ _ / _ _ Height (ft / inches) 77/ 77 Don‘t know / Not sure 99/ 99 Refused

8.12A Have you ever been advised by your doctor to lose weight?

1 Yes 2 No 7 Don’t know / Not sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 121

8.12B Are you trying to lose weight now?

1 Yes 2 No 7 Don’t know / Not sure 9 Refused

8.21A Which of these best describes your home?

Please read: 1 Single-family detached 2 Townhouse (Ask M16.5A) 3 Apartment, condo, or other multi-family building (Ask M16.5A) Do not read: 7 Don‘t know / Not sure 9 Refused

8.22A (Ask only in Columbia and Ellicott City planning areas): Do you live on property subject to the Columbia Association assessment?

1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

8.22B (All): Do you currently have a membership with the Columbia Association? (If yes): Which one?

Please read: 1 Pools only 2 Club only 3 Golf only 4 Tennis only 5 More than one, or a “package plan” Do not read: 6 No membership 7 Don‘t know / Not sure 9 Refused

C09 Fruits and Vegetables

These next questions are about the fruits and vegetables you ate or drank during the past 7 days. Please think about all forms of fruits and vegetables including cooked or raw, fresh, frozen or canned. Please think about all meals, snacks, and food consumed at home and away from home.

I will be asking how often you ate or drank each one: for example, once a day, twice a week, and so forth.

INTERVIEWER NOTE: If respondent responds less than once per week, put “0” times per week. If respondent gives a number without a time frame, ask: “Was that per day or per week?”

2014 Howard County Health Assessment Survey - Report of Findings 122

9.2R During the past week, not counting juice, how many times did you eat fruit? Count fresh, frozen, or canned fruit. (156-158) 1 _ _ Per day 2 _ _ Per week 555 Never 777 Don‘t know / Not sure 999 Refused

Read only if necessary: “Your best guess is fine.”

Read only if necessary: “Fruit includes apples, bananas, applesauce, oranges, grapefruit, fruit salad, watermelon, cantaloupe or musk melon, papaya, pomegranates, mangos, grapes, and berries such as blueberries and strawberries, and others.”

INTERVIEWER NOTE: Do not count fruit jam, jelly, or fruit preserves. Do not include dried fruit in ready-to-eat cereals. Do include dried raisins, cran-raisins if respondent tells you - but due to their small serving size they are not included in the prompt.

Do include cut up fresh, frozen, or canned fruit added to yogurt, cereal, jello, and other meal items. Include culturally and geographically appropriate fruits that are not mentioned.

9.4R During the past week, how many times did you eat vegetables that were not fried? Do not include rice or other grains. (162-164) 1 _ _ Per day 2 _ _ Per week 555 Never 777 Don‘t know / Not sure 999 Refused

Read only if necessary: “Your best guess is fine.”

INTERVIEWER NOTE: Each time a vegetable is eaten it counts as one time.

Include all raw leafy green salads including spinach, mesclun, romaine lettuce, bok choy, dark green leafy lettuce, dandelions, komatsuna, watercress, and arugula. Do not include iceberg (head) lettuce if specifically told type of lettuce. Include all cooked greens including kale, collard greens, choys, turnip greens, mustard greens.

Include all forms of carrots including long or baby-cut. Include carrot-slaw (e.g. shredded carrots with or without other vegetables or fruit). Include all forms of sweet potatoes including baked, mashed, casserole, pie, or sweet potatoes fries. Include all hard-winter squash varieties including acorn, autumn cup, banana, butternut, buttercup, delicate, hubbard, kabocha, and spaghetti squash. Include all forms including soup. Include pumpkin, including pumpkin soup and pie. Do not include pumpkin bars, cake, bread or other grain-based desert-type food containing pumpkin (i.e. similar to banana bars, zucchini bars).

Include corn, peas, tomatoes, okra, beets, cauliflower, bean sprouts, avocado, cucumber, onions, peppers (red, green, yellow, orange); all cabbage including American-style cole-slaw; mushrooms, snow peas, snap peas, broad beans, string, wax-, or pole-beans. Include any form of the vegetable (raw, cooked, canned, or frozen). Do include tomato juice. Include culturally and geographically appropriate vegetables that are not mentioned.

Do not include products consumed usually as condiments including ketchup, salsa, chutney, relish. Do not include rice or other grains.

2014 Howard County Health Assessment Survey - Report of Findings 123

C10 Physical Activity

The next few questions are about exercise, recreation, or physical activities.

10.1A During the past week, other than your regular job, did you do any physical activities or exercise such as running, golf, swimming, yard work, or walking for exercise?

1 Yes 2 No [Go to Q10.4A] 7 Don‘t know / Not sure [Go to Q10.4A] 9 Refused [Go to Q10.4A]

10.2A (If yes): During the past week, how many times did you take part in this activity? (162-164) 1 _ _ Per week 555 Never [Go to Q10.4A] 777 Don‘t know / Not sure 999 Refused [Go to Q10.4A]

10.3A Where did you do these activities? (Code all that apply.)

Please read: 1 Outside 2 In your home or friend’s home 3 At your housing clubhouse 4 At work 5 At a membership club 6 Or somewhere else (Specify.) Do not read: 7 Don‘t know / Not sure 9 Refused

10.4A During the past week, did you do physical activities or exercises to STRENGTHEN your muscles? Count activities using your own body weight like yoga, sit-ups or push-ups, or weight machines, free weights, or elastic bands.

1 Yes 2 No [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section]

10.5A (If yes): During the past week, how many times did you take part in this activity?

Please read: 1 _ _ Per week 555 Never [Go to Q11.2] 777 Don‘t know / Not sure 999 Refused [Go to Q11.2]

2014 Howard County Health Assessment Survey - Report of Findings 124

10.6A Where did you do these activities? (Code all that apply.)

Please read: 1 Outside 2 In your home or friend’s home 3 At your housing clubhouse 4 At work 5 At a membership club 6 Or somewhere else (Specify.) Do not read: 7 Don‘t know / Not sure 9 Refused

C11 Chronic Health Conditions/ Disability

11.2 Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone? (192) NOTE: Include occasional use or use in certain circumstances.

1 Yes 2 No 7 Don‘t know / Not Sure 9 Refused

11.2A Do you or someone living with you require special in-home care?

1 Yes 2 No [Go to next section] 9 Refused [Go to next section]

If 11.2A yes: 11.2B Who provides the in-home care? [single response]

1 Healthcare professional(s) 2 Friend or family members 9 Refused

C15 Alcohol Consumption

15.1 During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor? (209-211) 1 _ _ Days per week 2 _ _ Days in past 30 days 777 Don‘t know / Not sure [Go to next section] 888 No drinks in past 30 days [Go to next section] 999 Refused [Go to next section]

2014 Howard County Health Assessment Survey - Report of Findings 125

15.3 Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [CATI X = 5 for men, X = 4 for women] or more drinks on an occasion? (214-215) _ _ Number of times 77 Don‘t know / Not sure 88 None 99 Refused

Sugary Drinks

SD1 How often do you drink regular soda such as Coke Classic, Pepsi, Sprite, or Mountain Dew? Do not include diet soda or seltzer. READ IF NEEDED: How many sodas do you drink per day, per week, or per month?

1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused

SD2 How often do you drink sports drinks like Gatorade or Powerade? Do not include diet or low-calorie types. READ IF NEEDED: How many sports drinks do you drink per day, per week, or per month?

1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused

SD3 Now think about other types of sugar sweetened drinks that are not soda or sports drinks. Some examples include fruit drinks like Snapple and cranberry juice cocktail, flavored teas and waters, and energy drinks like Red Bull and Monster. Combining all these types together, how often do you have these drinks? READ IF NEEDED: How many fruit drinks, sweetened teas and water, and energy drinks do you drink per day, per week, or per month?

1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused

2014 Howard County Health Assessment Survey - Report of Findings 126

SD4 [Ask if number of children entered in Q8.7 > 0] Thinking about your youngest child between the ages of 2 and 18, (pause in case respondent volunteers no children) how often does he or she drink regular, not diet, soda like Coke Classic, Pepsi, Sprite, or Mountain Dew? READ IF NEEDED: How many sodas does your youngest child between the ages of 2 and 18 drink per day, per week, or per month?

1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused

SD5 [Ask if number of children entered in Q8.7] Still thinking about your youngest child between the ages of 2 and 18, how often does he or she drink sports drinks like as Gatorade or Powerade? Do not include diet or low-calorie types. READ IF NEEDED: How many sports drinks does your youngest child between the ages of 2 and 18 drink per day, per week, or per month?

1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused

SD6 [Ask if number of children entered in Q8.7] Still thinking about your youngest child between the ages of 2 and 18, how often does he or she drink fruit drinks like cranberry juice cocktail, Capri Sun, Sunny D, Hi-C, Kool-Aid, or Hawaiian Punch? One drink would equal one pouch, box, or a small 6-ounce glass. Count a regular-sized glass as two drinks. READ IF NEEDED: How many fruit drinks does your youngest child between the ages of 2 and 18 drink per day, per week, or per month?

1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused

SD7 In the last 30 days, have you bought any of the following types of sugar sweetened beverages for your family to drink at home? Regular soda, sports drinks like Gatorade or Powerade, fruit drinks like Capri Sun or Hawaiian Punch, energy drinks, or sweetened teas and waters?

1 Yes 2 No 7 Don‘t know / Not Sure 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 127

M12 Breast/ Cervical Cancer Screening

CATI NOTE: If respondent is male, go to the next module.

The next questions are about breast and cervical cancer screening.

(Women age 40 or older): M12.1. A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? (339) 1 Yes 2 No [Go to M12.3R] 7 Don‘t know / Not sure [Go to M12.3R] 9 Refused [Go to M12.3R]

M12.2. How long has it been since you had your last mammogram? (340) Read only if necessary: (Answer categories changed from 2012.) 1 Within the past 2 years (Less than 2 years ago) 2 Between 2 and 5 years (2 years but less than 5 years ago) 3 5 or more years ago Do not read: 7 Don‘t know / Not sure 9 Refused

(All women): M12.3R. A clinical breast exam is when a doctor, nurse, or other health professional feels the breasts for lumps. How long has it been since your last breast exam? (342) Read only if necessary: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 5 or more years ago Do not read: 7 Don‘t know / Not sure 8 Have never had a clinical breast exam 9 Refused

M12.5. A Pap test is a test for cancer of the cervix. Have you ever had a Pap test? (343) 1 Yes 2 No [Go to verify skip] 7 Don‘t know / Not sure [Go to verify skip] 9 Refused [Go to verify skip]

M12.5A When was your last Pap test?

Read only if necessary: 1 Within the past 2 years (Less than 2 years ago) 2 Between 2 and 5 years (2 years but less than 5 years ago) 3 5 or more years ago Do not read: 7 Don‘t know / Not sure 9 Refused 2014 Howard County Health Assessment Survey - Report of Findings 128

M14 Colorectal Cancer Screening

CATI NOTE: If respondent is < 50 years of age, go to next module.

M14.1. A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit? (354) 1 Yes 2 No 7 Don't know / Not sure 9 Refused

M14.3R. Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. How long has it been since you had your last sigmoidoscopy or colonoscopy? (358) Read only if necessary: (Answer categories changed from 2012.) 1 Within the past 5 years (Less than 5 years ago) 2 Between 5 and 10 years (5 years but less than 10 years ago) 3 10 or more years ago Do not read: 7 Don‘t know / Not sure 8 Have never had a sigmoidoscopy or colonoscopy 9 Refused

M16 Secondhand Smoke

The next questions are about exposure to secondhand smoke.

M16.2. Not counting decks, porches, or garages, during the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did someone other than you smoke tobacco inside your home while you were at home? (369-370) _ _ Number of days [01-07] 8 8 None 7 7 Don‘t know / Not sure 9 9 Refused

M16.3. During the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did you ride in a vehicle where someone other than you was smoking tobacco? (371-372) _ _ Number of days [01-07] 8 8 None 7 7 Don‘t know / Not sure 9 9 Refused

2014 Howard County Health Assessment Survey - Report of Findings 129

(Ask if 8.21A=2 or 3; i.e., lives in townhouse, apartment, condo, or multi-family building; all others go to next section): M16.5A How often do you smell cigarette, cigar, or pipe tobacco smoke in your home that comes from a neighboring condo, apartment, or hallway?

Please read: 1 Every day 2 Every couple of days 3 Once a week 4 Once a month 5 Never Do not read: 7 Not sure / Don’t know

M26 Anxiety and Depression

M26.9. 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? (451) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused

M28 Social Context

Now, I am going to ask you about several factors that can affect a person‘s health.

M28.1. How often in the past 12 months would you say you were worried or stressed about having enough money to pay vital expenses like your rent, mortgage, or food? Would you say you were worried or stressed--- (464) Please read: 1 Always 2 Usually 3 Sometimes 4 Rarely 5 Never Do not read: 8 Not applicable 7 Don‘t know / Not sure 9 Refused

M28.1A During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it?

1 Yes 2 No [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section]

2014 Howard County Health Assessment Survey - Report of Findings 130

M28.1B What was the main reason you did not get the mental health treatment and counseling you needed?

Do not read: 1 Couldn’t afford it or had no insurance covering mental health care 2 Didn’t know where to get the services 3 Getting health care might cause others to think negatively about me 4 Could handle the problem myself or wouldn’t respond to treatment 5 Lack of transportation 6 Didn’t have time/Didn’t fit my schedule 8 Some other reason (Specify.) 7 Don’t know / Not sure 9 Refused 10 Scared 11 Doctor too busy 12 Laziness/Procrastination

MD Oral Health

LASTDEN3 MD3-1 How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists.

1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 5 years (2 years but less than 5 years ago) 4 5 or more years ago Do Not Read: 7 Don’t know / Not sure 8 Never 9 Refused

CATI note: If LASTDEN3= 8 (Never), go to next section.

ORALCOS1 MD4-1 During the last 12 months, have you had a dental problem which you would have liked to see a dentist about but you didn’t see the dentist?

1 Yes 2 No [Go to next section] 7 Don’t know / Not sure [Go to next section] 9 Refused [Go to next section]

2014 Howard County Health Assessment Survey - Report of Findings 131

ORALCOS2 MD4-2 Why didn’t you see the dentist? [SINGLE RESPONSE]

Please read: 1 Didn’t have time 2 It would cost too much 3 Couldn’t get an appointment 4 Would have to travel too far 5 Didn’t have a way to get there 6 Didn’t have anyone to care for my children 8 Some other reason (Specify.) Do not read: 7 Don’t know / Not sure 10 Anxiety/Don’t like dentist 11 No dental insurance 12 Didn’t think necessary/Didn’t feel like it 13 Forgot to make appointment 14 Need to find a new dentist 9 Refused [Go to next section]

LYME DISEASE

LD2 Are you taking any protective measures against ticks when you go outside such as wearing protective clothing, finding and removing ticks, or avoiding wooded and bushy areas?

1 Yes 2 No 7 Don’t know / Not sure

ACA

ACA1 As you may know, President Obama signed a health reform bill, called the Affordable Care Act, into law in 2010. How much do you know about what is in this law? Would you say you know…?

Please read: 1 A lot 2 Some 3 A little 4 Not much Do not read: 7 Don’t know / Not sure 9 Refused

Closing Statement

Please read: That was my last question. Everyone’s answers will be combined to give us information about the health practices of people in this county. Thank you very much for your time and cooperation.

Language Indicator [INTERVIEWER: DO NOT READ THIS TO RESPONDENT.] Lang1. In what language was this interview completed?

1 English 2 Spanish