Fairfax Community Health Assessment 2017

#fairfax CHAvirginia Acknowledgments #fairfaxCHA This Community Health Assessment reflects the work and contributions of many community stakeholders and governmental partners across the Fairfax community. Sincere appreciation is extended to those who so graciously shared their expertise on the 12 assessment resources referenced in this document. Finally, a special note of gratitude is owed to the following individuals for their time, commitment, and insight in the development of this report.

Partnership for a Healthier Fairfax Steering Committee Fairfax County Health Gloria Addo-Ayensu, MD, MPH Gary Kreps Department Community Health Director Director Fairfax County Health Department Center for Health and Risk Communication Assessment Team George Mason University Sherryn Craig Marlene Blum Health Planner Chairman, Health Care Advisory Board Chair, Communications Committee Co-Chair, Partnership for a Healthier Fairfax Rachel Lynch Marie Custode Strategic Planner Lane Browning Program Outreach Administrator Strategic Projects Coordinator Inova Community Health Services Tina Dale Fairfax County Health and Human Services Co-Chair, Health Workforce Communications Specialist Co-Chair, Health Workforce Sara Pappa Elina Guralnik Jesse Ellis Regional Tobacco Control Coordinator Masters of Public Health Student Intern Prevention Manager Fairfax County Health Department George Mason University Tobacco-Free Living Fairfax County Department of Neighborhood Shawn Kiernan and Community Services Terri Siggins Epidemiology Manager Chair, Access to Health Services Program Coordinator Fairfax Food Council Susan Sanow Chris Garris Partnership Program Coordinator Programs Director Fairfax County Health Department Britepaths Robert Weiler Robin Wilson Chair, Fairfax Food Council Chair and Professor Senior Public Health Analyst Joe Gorney Global and Community Health Senior Planner George Mason University Fairfax County Department of Planning and Co-Chair, Partnership for a Healthier Fairfax Zoning Co-Chair, Healthy Environment and Active Living Samantha Hudson Senior Planner Fairfax County Park Authority Co-Chair, Healthy Environment and Active Living Table of Contents #fairfaxCHA

I. Approach...... 1 A. Assessment Process...... 2 B. Summary of Assessments...... 4 C. Community Engagement...... 7 D. Prioritization Process...... 8 II. Community Profile...... 9 A. Demographics...... 10 B. Health Indicators...... 13 III. Priority Issues...... 15 A. Healthy Eating ...... 16 B. Healthy Environment...... 18 C. Behavioral Health...... 20 IV. Next Steps...... 23

References...... 25

Appendix A: Acronyms...... 27 Appendix B: Assessment Methods...... 28 Appendix C: Assessment Participation...... 29 Appendix D: Assessment Themes...... 39

Approach

1 Approach Assessment Process #fairfaxCHA

Nearly a decade ago, the Fairfax County Health Department convened stakeholders from across the Fairfax community to conduct its first comprehensive Community Health Assessment (CHA) process. This diverse group of individuals, community organizations, schools, healthcare providers, businesses, faith communities, and government agencies formed the Partnership for a Healthier Fairfax (PFHF) in 2010. Since then, this coalition has employed a cyclical community strategic planning framework known as Mobilizing for Action through Planning and Partnerships (MAPP). MAPP outlines a process to assess the health of the community, identify priority issues, and develop a Community Health Improvement Plan (CHIP) every five years. The final phase of the MAPP process is ongoing as the plan is implemented and evaluated over time. The first iteration of the MAPP assessment process involved identifying external forces of change, recognizing the strengths and weaknesses of the local public health system, collecting community perspectives on assets and needs, and compiling quantitative data on health indicators. The data presented in the original MAPP assessments have been refreshed through several initiatives. First, implementation of the 2013-2018 CHIP1 resulted in gathering additional data to inform the work and acquiring an online data platform of health indicators called the Community Health Dashboard. Second, federal regulations were implemented requiring tax-exempt hospitals to conduct Community Health Needs Assessments every three years, providing new sources of recent, relevant data. Third, many of the partners involved in the coalition conducted their own research to better understand health-related issues in the community. After a review of available data, 12 assessment resources were identified that together provide a comprehensive profile of the Fairfax community. It was determined that these existing studies would provide the necessary information to fulfill the assessment phase of the MAPP process and to inform the development of the 2019-2023 CHIP.

Fairfax – An engaged and empowered community Visit the Community Health Dashboard working together to achieve at www.livehealthyfairfax.org to view the most current data available for more optimal health and well- than 100 health-related indicators. being for all those who live, work, and play here. 2 Approach Assessment Process, continued #fairfaxCHA Mobilizing for Action Through Planning & Partnerships (MAPP)

2010 Partnership Vision & Values 2011 & 2017 Development Creation Community Health Assessment

2013-2018 Implementation Strategic & & Evaluation Issues 2012 & 2017 2019-2023 Identification

Community Health Improvement Planning 2013 & 2018

Adapted from the National Association of County and City Health Officials MAPP Framework2 3 Approach Summary of Assessments #fairfaxCHA The five general assessments below were conducted to examine a broad range of health-related indicators across the Fairfax community. The data included in these sources provide insight into community strengths and needs related to a variety of health issues. See Appendix B for more information on assessment methods. Assessment Purpose Sponsor Date Major Data Sources

3 To achieve the goal outlined in Community Health Dashboard Launched in May the CHIP to facilitate access to Data from national, state, and local sources, Fairfax County 2015, with data up- A web-based data resource center with over 100 multiple sources of health-related including comparison values, disparities, Health Department dated continuously, indicators from various sectors available to the data in a centralized online and maps as available public platform

To assess the prevalence of Fairfax County Youth Survey4 risky behavior and protective Fairfax County Published in An annual, voluntary, anonymous survey of factors among youth to better Government and September 2017 A snapshot of the behaviors, experiences, and all Fairfax County Public Schools 6th, 8th, understand the community’s Fairfax County Public for school year other factors that influence the health and 10th, and 12th grade students wellbeing of youth in Fairfax County effectiveness in fostering healthy Schools 2016-2017 choices in young people

To identify key needs and The Path Toward Tomorrow: The 2016 Fairfax Data from national and state surveys, 5 challenges currently facing County Human Services Needs Assessment Fairfax County information from local programs and residents, especially among Published in Health and Human services, community feedback from A review of changes in the county and the resulting specific populations (e.g., by age, May 2016 Services residents and stakeholders, and a needs in the areas of housing, economic self- income, disability status, race, community survey sufficiency, health, and connections to resources and ethnicity)

To identify significant 6 community health needs to Approved by the Inova Community Health Needs Assessment Secondary data sources, other community inform the development of an Inova Board of Inova Health System assessments, key informant interviews, and An analysis of the health needs for each of five implementation strategy to Directors in June a community survey Inova hospital service areas in Northern * address those needs for each 2016 local Inova hospital

Approved by the Kaiser Community Health Needs Assessment7 To identify and measure Kaiser Foundation Kaiser Foundation Secondary data sources, other community community needs and assets to Health Plan of the Hospitals and Health An assessment of the health needs for the Kaiser assessments, key informant interviews, and tailor implementation strategies Mid-Atlantic States, Plans Board of Foundation Health Plan Mid-Atlantic States Region, a stakeholder survey including the service area* and community investments Incorporated Directors in May 2016 4 * The assessment covers a broader region; however, only information specific to the Fairfax community is reflected in this report. Approach Summary of Assessments, continued #fairfaxCHA The seven focused assessments below were conducted to study a specific program area or to learn more about a health-related issue. The data included in these sources provide insight into community strengths and needs related to the research topic. See Appendix B for more information on assessment methods.

Assessment Purpose Sponsor Date Major Data Sources

Community Assessment for Public Health 8 Emergency Response (CASPER) To measure community Face-to-face questionnaires at selected Fairfax County Published in preparedness for disasters or homes in specific neighborhoods using A survey of county residents on emergency Health Department September 2016 preparedness, communication during a disaster, emergencies statistically-valid random sampling and communicable disease awareness

Data on demographics and use of food Fairfax Food Council 2015 Community Food and nutritional assistance programs and Assessment9 To better understand the services, a food store assessment using challenges in the local food Published in the Healthy Food Availability Index created Fairfax Food Council A study of local food system needs and assets system and to inform efforts to October 2015 by the Johns Hopkins Center for a Livable for the Herndon/Reston, Bailey’s Crossroads, and foster greater food security Future, a community survey of residents, Mount Vernon areas of Fairfax County and stakeholder interviews with safety net providers

Culturally and Linguistically Appropriate To study healthcare providers’ 10 Services (CLAS) Survey consideration of workforce Partnership for a Phone interviews with healthcare provider composition, staff cultural Healthier Fairfax, Completed in An evaluation of healthcare professionals’ practices, healthcare clinics, and a competencies, and the availability Health Workforce March 2015 awareness and implementation of national healthcare system standards for delivering care to culturally and of language access services for Priority Issue Team linguistically diverse populations non-English speaking patients

To expand community PolicyLink and National and local data sources for 11 understanding of equity as a key the University of Equitable Growth Profile of Fairfax County demographics, employment, workforce, economic driver, and to establish Southern California’s Published in 2015 economic security, health access, and A profile of community strengths and areas of a baseline to track progress on a Program for Environ- connectedness and consultation with a vulnerability in building a strong, resilient economy series of indicators of equitable mental and Regional multi-sector community advisory group growth Equity

5 Approach Summary of Assessments, continued #fairfaxCHA

Assessment Purpose Sponsor Date Major Data Sources

A Study in Contrasts: Why Life Expectancy Varies 12 To study how health status varies in Northern Virginia Demographic information and life across local neighborhoods Northern Virginia Published in expectancy data at the census tract level A report examining the social determinants of and to uncover disparities by Health Foundation June 2016 for Northern Virginia counties and cities health to demonstrate how place matters for geography health

Interviews, focus groups, crowdsourcing, public forums, a statistically valid survey, Fairfax County Park Authority Needs Assessment To assess the alignment of Park 13 population projections, a cost analysis for – Parks Count! Authority facilities and programs Fairfax County Park Published in the preservation of natural and cultural with community needs, and to Authority April 2016 A comprehensive evaluation of the Fairfax County resources, an assessment of service level inform future resource allocation parks and recreation system standards for core facilities, and an asset investment analysis

The State of the Health Care Workforce in To learn about trends in the 14 regional healthcare workforce, Information from literature reviews, Northern Virginia Northern Virginia Published in specifically which professions employment data, labor market analyses, HealthFORCE March 2014 An analysis of the local demand and supply for 40 are likely to face the greatest interviews, focus groups, and surveys healthcare occupations shortage in supply

6 Approach Community Engagement #fairfaxCHA

Multiple sectors of the community were engaged in the collection of primary During the Community Assessment for Public data for nine of the assessments. Overall, these studies employed ten different Health Emergency Response, residents identified the top eight greatest assets or methods of gathering and analyzing community input (see Appendix B: strengths of the Fairfax community as: Assessment Methods). Survey administration was the most common approach to collect feedback, followed by stakeholder interviews and focus groups. In 1. Emergency preparedness and response addition to the general population, representatives from education, business, 2. Educational opportunities for everyone government, healthcare, nonprofits, and community advisory groups were invited 3. Community connectedness to participate (see Appendix C: Assessment Participation). Collectively, community 4. Communication of information input was gathered from nearly 50,000 youth and adults through surveys and 5. Services and support for everyone other methods of engagement. 6. Safe place to live An assessment showcase was held in the fall of 2016 to inform the Partnership 7. Jobs and a healthy economy for a Healthier Fairfax about each of the 12 data sources. The meeting included 8 roundtable discussions for each assessment resource. Use of this World Café 8. Well-managed government model enabled participants to explore assessment goals, methods, and findings Community perceptions of these areas of to inform their collective work. It also provided the opportunity to gather strength are in alignment with data from the 2018 County Health Rankings. The social coalition input about the strengths and needs impacting their community health and economic factors ranking, a composite improvement efforts. measure of education, employment, income inequality, crime, and social cohesion, ranks Falls Church City #1 in the Commonwealth of Virginia. Fairfax City and Fairfax County come in 4th and 5th in the state respectively, out of 133 jurisdictions.15

7 Approach Prioritization Process #fairfaxCHA

The Steering Committee of the Partnership for a Healthier Fairfax (PFHF) reviewed the assessment results, identified significant findings, and grouped them into assessment theme categories( see Appendix D: Assessment Themes). They identified the social determinants of health as an important cross-cutting theme to be integrated into the development of community health improvement strategies. They refined the list of health issues for prioritization by removing the areas that did not require a collaborative multi-sector approach and those that were already successfully being addressed outside of PFHF. They developed agreement on a prioritization process and criteria for the nine remaining issues. The prioritization exercise resulted in the selection of three health issues to be featured in the Community Health Assessment and to be addressed in the Community Health Improvement Plan. Indicators for these three areas, as well as community demographics and health statistics, are featured in the body of this report.

How much of a problem is this issue for our community overall? Impact • Very serious • Affects many people Healthy Eating How much of a problem is this issue for specific Health groups in our community? Equity • Evident disparities Healthy • Critical to advancing health equity Environment CRITERIA

To what degree are resources available to address this issue? Feasibility • Adequate resources • Leadership commitment Behavioral • Team of partners Health

8 Community Profile

9 Community Profile Demographics #fairfaxCHA

Over the last several decades, the Fairfax community has evolved from being a suburb of Washington, D.C. to a vibrant, densely-populated area with urban centers of its own. Fairfax County is the largest county in the National Capital Region, with an estimated 2017 population of 1,142,888. The Fairfax community includes the cities of Fairfax and Falls Church for a total of nearly 1.2 million residents. It is forecasted that the population will continue to grow over the next 30 years to approximately 1.4 million. In 2017, 31% of residents were immigrants, 87% of whom had been here at least 5 years. Overall, the population is diverse, highly educated, and wealthy, though disparities exist by race/ethnicity, age, and geography.16

Age Fairfax County has a relatively 65+ years 12% Gender young population, with 26% of residents under 20 years of age. However, the older adult 50-64 years 20% population is increasing female at a rate higher than the overall 35-49 years 22% population. The number of adults age 65 and older has 20-34 years 20% male16 increased from 8% in the year 16 2000 to nearly 12% in 2017. 0-19 years 26%

Other, Not Race/Ethnicity Hispanic Languages The Fairfax community 4% There are 182 languages or dialects spoken continues to grow in its racial Hispanic/Latino at home among elementary school-aged 16% and ethnic diversity. children in Fairfax County Since 2000, Fairfax County has Public Schools. The top 5 are seen a 70% increase in persons Spanish, Arabic, Vietnamese, who identify as Hispanic and 52% White, Not Korean, and Mandarin. a 67% increase in persons Hispanic Overall, 38% of residents age Asian/Pacific 19% who identify as Asian/Pacific Islander 5 or older speak a language Islander.16 other than English at home, and 7% of households 9% are linguistically isolated, meaning Black, Not that no members of the household speak 10 Hispanic English “very well.”16 Community Profile Demographics, continued #fairfaxCHA

Income Percent of Households by Income SocioNeeds Index Fairfax County is one of the Social and economic factors are strong wealthiest counties in the country. 22% determinants of health outcomes. The 2017 In 2016, the median household — $200,000+ SocioNeeds Index, created by Conduent income of $114,329 was double Healthy Communities Institute, summarizes 14% the national average of — $150,000 multiple socioeconomic indicators, such as $57,617. Among households in poverty and education, into a composite Fairfax County in 2017, 58% earned 22% score. The index value is a measure of over $100,000 annually, while 17% — $100,000 socioeconomic need that is correlated with earned under $50,000 per year.16 poor health outcomes. Geographic sectors 25% are scored to easily identify the areas of greatest need in the Fairfax community. — $50,000 17%

Poverty In Fairfax County, the total number of residents living in poverty in 2016 was 63,384 2.9% persons, or 5.4% of the population. Unemployment Poverty rates are higher among individuals identifying as non-white, non-Hispanic, and for the following groups of people: • Adults with disabilities: 13.3% Unemployment • Foreign-born residents: 8.7% The percent of people who are • Seniors: 6.7% unemployed has been 16 on the • Children: 6.3% decline over the last several years. Unemployment in the civilian labor force in October 2017 was 2.9% in The 2016 Federal Poverty Fairfax County, compared to 3.9% in Zip codes are ranked in the map above based the U.S. However, individuals who on their index value from 1, indicating low Level was $24,300 identify as non-white continue to need in white, to 5, indicating high need for a family of 4. have higher unemployment rates in dark blue. The four zip codes with the than white residents.3 highest needs in the Fairfax community are 22041, 22306, 22309, and 22312.3 11 Community Profile Demographics, continued #fairfaxCHA

Education Overall, educational attainment is very high in Fairfax County compared to Some college/ the nation. About 60% of Fairfax residents 25 Associate degree years of age or over have at least a bachelor’s 19% degree, compared with 30% nationally. However, there are differences in education by geography and race. The percent of people age 25 or older with a college degree or higher varies greatly by census tract, ranging from 16% in the Bailey’s Crossroads Bachelor’s degree Advanced degree High school < High area to 88% in McLean. Another difference is 31% 29% diploma or GED school that the percentage of blacks with at least a 13% diploma bachelor’s degree (44%) is lower than for the 8% county overall. 3

Housing Health Insurance There were 405,837 households in Fairfax County in 2017. Access to affordable healthcare is an Although half live in single-family detached homes, the number of important factor in promoting health multifamily units has been increasing with the growing population. and wellbeing. In 2016, about 9% of The median value of owned housing was $505,722, while the the population was uninsured, average rent for a one-bedroom unit was $1,561 in 2016.16 both locally and nationally. Of the 100,412 uninsured individuals in the This gap in affordable housing results in a large number Fairfax community, 55% were not U.S. of residents being housing-cost burdened, or spending more citizens and 76% spoke a language than 30% of their income on housing. Approximately a third of other than English at home.16 all households in Fairfax are cost-burdened, with low-income households disproportionately impacted. Among households earning less than $35,000 per year, as many as 89% of owners and 94% of renters experience a housing cost burden. Renters age 15 to 24 years old and 65 and older are most likely to spend greater than 17 12 30% of their income on rental expenses. Community Profile Health Indicators #fairfaxCHA

Obesity Chronic Disease Cancer Being overweight or obese affects quality The top five causes of morbidity and Overall cancer incidence in the Fairfax of life and puts individuals at risk for mortality in the Fairfax community are:18 community (390.1 per 100,000) compares developing many diseases, especially heart favorably to state rates (417.2 per 100,000). disease, stroke, diabetes, and cancer. Being Heart/Cardiovascular Disease While the incidence of most cancers has overweight or obese also carries significant declined, the rate of breast cancer economic costs due to increased healthcare has been increasing since 2010. Female spending and lost earnings. Nationally, 65% of Stroke breast cancer is the only type of cancer for the adult population is overweight or obese.3 which Fairfax rates (150.7 per 100,000) are Chronic Obstructive higher than Virginia (128.3 per 100,000).18 Pulmonary Disease Prostate cancer incidence rate is 48% Diabetes higher in Blacks than the overall value of 94.6 cases per 100,000 males.3 >54% Hypertension More than half of adults 20 years and older in 3 Fairfax are overweight or obese. Asthma and arthritis are also among the top reasons for hospitalization in Fairfax Life Expectancy 18 1 in 4 low-income County, but not for death. Life expectancy in Fairfax Blacks are hospitalized at a rate higher than County for both males preschoolers have and females is higher than high BMI the overall population for the following health conditions:18 the state and the nation at 82.3 and 85.1 years, respectively. Nationally, th 4X Fairfax County ranks 11 3x for male life expectancy 2x and 15th for female life expectancy as of 2014. Nationwide, childhood obesity has tripled Heart Failure Diabetes Hypertension Since 1980, life expectancy in Fairfax County in the past 30 years. Low-income preschool has increased 11 years for males and nearly 8 obesity rates in Fairfax County are among years for females.19 Though high overall, life the worst in the state and the nation. One expectancy varies by as much as 11 quarter of children age 2-4 who participate Communicable Disease years across the county, from 78 years in federally-funded health and nutrition The Fairfax community has higher rates of (5.7 per 100,000) and in parts of Centreville, Annandale, and the programs place above the 95th tuberculosis Lyme disease (18.0 per 100,000) compared to Route 1 corridor to 89 years in neighborhoods percentile for body mass index 18 near Reston Town Center and Tysons 3 Virginia overall. (BMI)-for-age. Corner.20 13 14 Priority Issues

15 Healthy Eating, continued

Priority Issues Healthy Eating #fairfaxCHA Access to fresh, healthy, and affordable food is essential for the optimal growth and development of children. The availability of healthy food choices is also a critical component to combating obesity and preventing chronic diseases and dental cavities. Families that are not able to easily access grocery stores due to distance or lack of transportation are less likely to purchase healthy food options and more likely to consume foods which are readily available at convenience stores and fast food outlets.

Food Consumption, Youth • Three-quarters of Fairfax County youth do not eat the recommended number of daily servings of fruits and vegetables. For black students, only one in five reported that they eat fruits and vegetables at least five times per day.4 • Overall, more than one-third of students reported consuming sugary drinks, such as soda, lemonade, or sport drinks, at least once per day. Consumption of sweetened beverages varied by race/ethnicity, ranging from a quarter of Asian students to nearly half of Hispanic students. Males were more likely than females to consume sugary beverages daily.4

Food Consumption, Adults • Only 23% of adults in the Fairfax community meet dietary recommendations for eating at least five fruits and vegetables daily. Across Virginia, rates of fruit and vegetable ONLY 1 IN 4 PEOPLE consumption are worst among individuals who have not completed high school, those in the lowest income brackets, and non-Hispanic blacks.21 EAT • On average, Fairfax adults consume 1.6 fruits per day and 2.2 vegetables daily.21

FRUITS & VEGGIES A DAY

16 Priority Issues Healthy Eating, continued #fairfaxCHA Access to Healthy Food • The consumption of high-fat and high-calorie fast food increases the risk of obesity. The density of fast food restaurants is often higher in low-income neighborhoods, contributing to health disparities in these communities. All jurisdictions in the Fairfax community score in the lowest/worst quartile in the nation for high per capita fast food restaurant density.3 Lunch Time Percent of Elementary Students Eligible for Free and Reduced Food insecurity is the lack of reliable accessHou stoeho ald sufficientFree priced mea ls quantity- 130% R eofduc edaffordable, priced meals - 185% • Size Annual Monthly Weekly Annual Monthly Weekly Priced Lunches 2014-15 nutritious food. Fairfax’s food insecurity2 rate$20 has,449 been$1,705 on $39the4 decline$29,101 $2since,426 2011.$560 3 25,727 2,144 495 36,612 3,051 705 Despite this historic low, Fairfax County has the4 highest31,005 number2,584 59of7 food44,12 3insecure3,677 849 individuals in Virginia – 67,190 of its 1.1 million5 residents36,283 (6%).3,024 Of food698 51insecure,634 4,30 3 993 children, about half live in households thatFrom exceed 2002-2014 income the Fairfaxeligibility County requirements elementary for federal nutrition assistance.9 student membership increased by 17%. During the same time period the number of • The cost to purchase healthy and nutritiousstudents foods eligible remains for free a major and reduced barrier to healthy eating among those struggling withlunches poverty increased and byfood 72%. insecurity. Greater than 75% 50.1% to 75% At 0.3 stores for every 1,000 people, Fairfax County falls2002-0 3in 2008the-0 9lowest2014-15 35.1% to 50% Total Student 20.1% to 35% quartile of counties in Virginia and the U.S. for the ratio84,85 8of SNAP-87,864 99,393 Membership certified stores per 1,000 population. Fairfax City and Falls Church Less than 20% # of Students 3 City compare well at 1.2 and 1.4 stores per 1,000Eligible fopopulation.r 17,065 20,958 29,420 F/R Lunches % of Students Eligible for 20.1% 23.9% 29.6% F/R Lunches For the 2014-15 school year, Free and Reduced-Price Lunchelementary school student populations • From 2002 to 2014, the Fairfax County elementaryranged from student 283 to population 1,353 students, with a median population of 704 students. increased by 17%, while the number of students eligible for free and reduced-price lunches increased by 72%.22Change in Number of Elementary Students • Between 2008 and 2015, an additional 8,500Eligible elementary for Free and students 22 became eligible for free and reduced-price lunches.Reduced Price Lunches 2008-09 • Overall, nearly one third of Fairfax Countyto elementary 2014-15 school students receive free or reduced-price lunch. However, this percentage varies by geographic location within the county, with some sections of Bailey’s Crossroads, Reston/Herndon, and Mount Vernon reaching 75% or more.9 Elementary Students % Eligibility Free and Reduced Lunch 2002-2015 30%

%) (

17 s t n e d u

t 25% S

e l b i g i

l Increase in student eligibility E for the 08-14 school years. -151 to -250 20% -51 to -150 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 0 to -50 School Year

1 to 50 An additional 8,500 Source: Virginia Department of Education, National School Lunch Program (NSLP) Free 51 to 150 elementary students have and Reduced Price Eligibility Report, By Schools 2002-2015. Boundaries for the 2014-15 become eligible for school year were used. Percent change could be in uenced by boundary and enrollment 151 to 420 changes. Elementary schools divided into upper and lower were combined in this analysis (Bailey’s & Bailey’s Upper, Kings Park & Kings Glen). Free and Reduced Lunches Prepared by Erik Hovland, Economic, Demographic, and Statistical Research, Fairfax No Data since 2008-09. County Department of Neighborhood and Community Services, April 2015. To obtain this information in an alternative format please call 703-324-4600, TTY 711. Priority Issues Healthy Environment #fairfaxCHA Health and wellness are shaped by the environment where community members live, work, and play. Creating an environment that fosters healthy living for everyone begins with integrating health considerations into policies, plans, and procedures. This approach, called Health in All Policies (HiAP), aims to ensure that policy decisions promote community health rather than contribute to negative health outcomes. Improving the conditions that shape health and wellbeing requires an investment in the infrastructure of neighborhoods, parks, recreation facilities, and transportation systems to make the living environment healthier and safer.

What is good for our health is also good for “ the economy and will make Fairfax County a stronger community for all of its residents.20 ”

One Fairfax One Fairfax, adopted by the Fairfax County Board of Supervisors and School Board in 2017, is a social and racial equity policy that commits the County and schools to consider equity when making decisions, or developing or delivering programs or services. One Fairfax provides a framework for county and school leaders to look intentionally, comprehensively, and systematically at barriers that may be creating gaps in opportunity. The policy identifies 17 areas of focus to promote equity including community and economic development, housing, education, environment, and transportation. The Park Authority Board has also adopted the One Fairfax resolution. The adoption of One Fairfax provides a foundation for changes in policies, systems, and environments that improve community health through addressing the built environment and the social determinants of health.23

18 Priority Issues Healthy Environment, continued #fairfaxCHA Transportation • In Fairfax, residents have long commute times, with an average travel time to work of 32 minutes.16 In fact, commuters in the Washington Metropolitan Area experience an average delay of 82 hours per year, which is the worst in the nation among very large urban areas such as Los Angeles, Atlanta, and Houston.24

• While the percentage of workers age 16 and over in Fairfax who walk to work was 2% in 2012- 2016, there was a wide range among census tracts from 0% in communities across the county to 20% near George Mason University.3

• Residents below 150% of the federal poverty level are more likely to access public transit or carpool rather than drive to work compared with residents above the poverty level. For Fairfax County low-income residents using public transportation, the additional time and money spent on commuting and transferring across systems results in less take-home pay and less time spent with family.5

Physical Activity Fairfax County is becoming increasingly more urbanized, providing opportunities to employ urban design strategies that encourage walking, bicycling, and other physical activity. During the Park Authority Needs Assessment, community members identified high-priority needs for walking and biking trails, parks, and play areas to create options for active living.13

• In Fairfax County, 99.5% of individuals reside within a reasonable distance from a park or recreation facility,3 and 87% reported using parks in the last year.13

• Fairfax adults are slightly more physically active than adults in the state and nation. In 2014, 81% of adults participated in any physical activities or exercises in the past month other than their regular job.3 • According to the Fairfax County Youth Survey, 42% of youth were physically active at least one hour five or more days in the past week.4

19 Priority Issues Behavioral Health #fairfaxCHA Behavioral health conditions among adults and youth include mental, behavioral, or emotional disorders; serious mental illness; and dependence on alcohol or drugs. Substance use can exacerbate mental health problems and make coping with and treating mental illness more difficult. Preventing and treating behavioral health disorders reduces the extremely high personal costs associated with these conditions and lowers health care costs and loss of productivity.

Mental Health Youth Adults • Overall, 36% of youth reported experiencing high levels of stress • Nearly 15% of adults in the Fairfax community experience five in the past month, growing with grade level from about one-fifth of or more poor mental health days per month.3 students in 8th grade to nearly half of 12th graders.4 • Occasional down days are normal, but having 14 or more poor mental health days per month is indicative of more chronic psychological distress and likely severe mental health issues. Approximately 8.5% of Fairfax adults report experiencing frequent mental distress.15

• About one in three female students (34%) and one in five male students (18%) reported feeling so sad or hopeless for two or more weeks in a row in the past year that they stopped doing some usual activities. Minority youth were at greater risk for poor mental health, with Hispanics reporting the highest rates of despair.4 • About 5% of students reported they had attempted suicide in the past year. Females (7%) were nearly twice as likely as males (3.7%) to report attempting suicide. A greater percentage of minority students reported attempting suicide than white students.4 • Female students were 3 times more likely to report having • Barriers to social and emotional wellbeing include difficulty experienced sexual harassment, and twice as likely to report accessing mental health providers. While the having been forced into sexual activity than their male Fairfax County ratio of population to mental health providers counterparts. Overall, 13% of youth reported having been sexually (680:1) is better than the state overall (730:1), the ratio is harassed in the past year, and 9% of dating students reported being 4 nearly double that of the highest performing counties in the forced to engage in sexual activity by a partner. 15 20 U.S. (360:1). Priority Issues Behavioral Health, continued #fairfaxCHA Substance Use

Tobacco • Tobacco is the primary cause of avoidable illness and death in the U.S. The national target for Healthy People 2020 is to decrease the number of adults who smoke to 12% or less of the population. Fairfax City (10.7%) and Fairfax County (11.5%) meet this goal; however, Falls Church City has 12.9% of adults who smoke.3 • Lifetime (11%) and past month (3%) prevalence rates for cigarette use among youth were the lowest reported in the past five years. More students reported smokinge-cigarettes in the past month (4%) than other tobacco products.4

Alcohol • Overall drinking – defined as the percentage of adults who have at least one drink per month – is highest in affluent, well-educated communities. The City of Falls Church ranks the highest nationwide with more than three-quarters (79%) of adults 21 years and older who drink.25 • Nearly one in five adults in the Fairfax community reportheavy drinking or binge drinking within the past 30 days.3 • Alcohol is the most commonly-used substance by teens in Fairfax County, with over half of 12th-graders reporting having consumed it at least once in their lifetime. Overall, the rates for alcohol use (lifetime, past month, and binge drinking) were lower than national comparison data and were the lowest reported in the past five years.4

21 Priority Issues Behavioral Health, continued #fairfaxCHA Substance Use Opioids

• Heroin and fentanyl deaths have been rising since 2013 both Fairfax Health District Overdose Deaths Rates by Select Drugs, 2013-2016 locally and nationally. In 2016, the rate of fatal overdose deaths in 10 the Fairfax community was highest among 25-34 year olds 9 for both fentanyl/heroin overdose at 12.3 per 100,000, as well as for 8 7 prescription opioid overdose at 7.4 per 100,000 people. These rates are 6

more than twice the rate of these types of overdoses for all age groups 5 18 combined. 4 • Emergency department visits for opioid overdose in the Fairfax 3 2 community in 2016 were 215.9 per 100,000 persons age 15-24 years old. Rate (per 100,000 population) 1 This is over 2.5 times the rate for all ages combined.18 0 Among youth, almost 7% reported misusing prescription medication 2013 2014 2015 2016 • Year in the past month, with 5% indicating use of painkillers without a doctor’s order and 4% reporting the non-medical use of other All Drug Overdoses Heroin Overdoses prescription drugs.4 Fentanyl Overdoses Prescription Opioid Overdoses All Opioid Overdoses • Fairfax County students had twice the rate for past-month prevalence of heroin use compared to U.S. youth (0.4% versus 0.2%).4

Other Drugs • Marijuana was the second most frequently used substance by students (11%), with rates for past month use higher among males (13%) than females (9%). Prevalence of use increased with grade level to nearly one in five high school seniors.4 • Fairfax County youth were slightly more likely than their peers nationally to have used LSD, cocaine, methamphetamines, or steroids in the past month.4

22 Next Steps

23 Next Steps #fairfaxCHA This Community Health Assessment (CHA) reaffirmed that the Fairfax community, overall, ranks among the healthiest jurisdictions in Virginia and in the United States. It illustrates the many factors contributing to the region’s high quality of life – racial and ethnic diversity, well-educated residents, high per capita income, and the abundance of community resources and services. What is also evident is that these indicators often mask the people in the community who carry a disproportionate burden of poverty, poor health, and premature death. These disparities in socioeconomic conditions, access to care, and health outcomes must be explored further to advance health equity. While the information in this report will serve as the foundation for the next Community Health Improvement Plan (CHIP), additional data analyses for specific populations and geographies are needed to target strategies to those with the greatest needs. The completion of this community profile marks the transition from the assessment phase to the planning phase of the Mobilizing for Action through Planning and Partnerships (MAPP) process. These data, in conjunction with an evaluation of progress on the 2013-2018 CHIP, will be shared with the Partnership for a Healthier Fairfax and other community stakeholders. This information will guide the selection of strategies for the priority issues of Healthy Eating, Healthy Environment, and Behavioral Health. The CHIP for 2019-2023 will outline new and revised goals, objectives, and key actions designed to transform the Fairfax community into a place where all may lead healthier, more productive lives. Achieving improved health outcomes takes time and a sustained commitment from community stakeholders and governmental partners. Only through its collective efforts can the Partnership for a Healthier Fairfax achieve its vision of optimal health and well-being for all who live, work, and play in the Fairfax community.

24 References #fairfaxCHA

1. Fairfax County. (2013). Live Healthy Fairfax Community Health Improvement Plan 2013-2018. Retrieved from https://www.fairfaxcounty.gov/live- healthy/sites/livehealthy/files/assets/documents/pdf/community-health-improvement-plan.pdf

2. National Association of County and City Health Officials. (2018). Mobilizing for Action through Planning and Partnerships (MAPP). Retrieved from https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp

3. Conduent. (2018). Fairfax Community Health Dashboard. Retrieved from www.livehealthyfairfax.org

4. Fairfax County. (2017). Fairfax County Youth Survey, School Year 2016-2017. Retrieved from www.fairfaxcounty.gov/youthsurvey

5. Fairfax County Health and Human Services. (2016). The Path Toward Tomorrow: The 2016 Fairfax County Human Services Needs Assessment. Re- trieved from http://www.fairfaxcounty.gov/living/healthhuman/needs-assessment/

6. Inova Health System. (2016). Inova Community Health Needs Assessment. Retrieved from http://www.inova.org/inova-in-the-community/index.jsp

7. Kaiser Permanente of the Mid-Atlantic States. (2016). Kaiser Permanente Community Health Needs Assessment. Retrieved from http://www.com- munitycommons.org/groups/community-health-needs-assessment-chna/

8. Fairfax County Health Department. (2016). Community Assessment for Public Health Emergency Response (CASPER). Retrieved from http://www. fairfaxcounty.gov/hd/ep/pdf/casper-final-report-2016.pdf

9. Fairfax Food Council. (2015). Fairfax Food Council 2015 Community Food Assessment. Retrieved from http://www.fairfaxcounty.gov/livehealthy/ pdfs/cfa_report-final.pdf

10. Partnership for a Healthier Fairfax. (2015). Culturally and Linguistically Appropriate Services Survey.

11. PolicyLink. (2015). Equitable Growth Profile of Fairfax County. Retrieved from http://www.policylink.org/sites/default/files/Fairfax-Pro- file-6June2015-final.pdf

12. Center on Society and Health Virginia Commonwealth University (2016). A Study in Contrasts: Why Life Expectancy Varies in Northern Virginia. Re- trieved from http://novahealthfdn.org/wp-content/uploads/csh-nova-report-v10.pdf

13. Fairfax County. (2016). Fairfax County Park Authority Needs Assessment – Parks Count! Retrieved from http://www.fairfaxcounty.gov/parks/parks- count/downloads/needs-assessment-plan-050616.pdf

14. Jobs for the Future. (2014). The State of the Health Care Workforce in Northern Virginia. Retrieved from http://www.myskillsource.org/pdf/The- State-of-the-Health-Care-Workforce-in-Northern-Virginia_0327.pdf

15. County Health Rankings and Roadmaps. (2018). Retrieved from http://www.countyhealthrankings.org/

16. Fairfax County. (2018). Demographics. Retrieved from https://www.fairfaxcounty.gov/demographics/ 25 References #fairfaxCHA 17. Housing Virginia. (2015). Cost Burden: Households Paying More than 30% for Housing. Retrieved from http://www.housingvirginia.org/sourcebook/ cost-burden-households-paying-more-than-30-for-housing/

18. Virginia Department of Health. (2018). Data Portal. Retrieved from http://www.vdh.virginia.gov/data/

19. Institute for Health Metrics and Evaluation. (2016). County Profile: Fairfax County, Virginia. Retrieved from http://www.healthdata.org/sites/de- fault/files/files/county_profiles/US/2015/County_Report_Fairfax_County_Virginia.pdf

20. Northern Virginia Health Foundation. (2017). The Uneven Opportunity Landscape in Northern Virginia: Fairfax County. Retrieved from https://nova- healthfdn.org/wp-content/uploads/Fairfax-Co-TwoPager.pdf

21. Virginia Department of Health. (2013). Behavioral Risk Factor Surveillance Survey. Retrieved from http://www.vdh.virginia.gov/brfss/data/

22. Fairfax County Department of Neighborhood and Community Services. (2015). Lunch Time. Retrieved from https://www.fairfaxcounty.gov/de- mographics/sites/demographics/files/assets/vizpdf/school%20lunch%202015.pdf

23. Fairfax County. (2018). One Fairfax Policy. Retrieved from https://www.fairfaxcounty.gov/topics/one-fairfax

24. Texas A&M Transportation Institute, et al. (2015). 2015 Urban Mobility Scorecard. Retrieved from https://static.tti.tamu.edu/tti.tamu.edu/docu- ments/mobility-scorecard-2015.pdf

25. Dwyer-Lindgren, L.; Flaxman, A.D.; Ng, M.; Hansen, G.M.; Murray, C.; Mokdad, A.H. (2015). Drinking patterns in US counties from 2002 to 2012. American Journal of Public Health, 105(6), 1120-112.

26 Appendix A Acronyms #fairfaxCHA The following abbreviations represent the full name of each assessment in the appendices.

General Assessments CHD – Community Health Dashboard FCYS – Fairfax County Youth Survey HSNA – The Path Toward Tomorrow: The 2016 Fairfax County Human Services Needs Assessment ICHNA – Inova Community Health Needs Assessment KPCHNA – Kaiser Permanente Community Health Needs Assessment

Focused Assessments CASPER – Community Assessment for Public Health Emergency Response CFA – Fairfax Food Council 2015 Community Food Assessment CLAS – Culturally and Linguistically Appropriate Services Survey EGP – Equitable Growth Profile of Fairfax County LE – A Study in Contrasts: Why Life Expectancy Varies in Northern Virginia PANA – Fairfax County Park Authority Needs Assessment WFNOVA – The State of the Health Care Workforce in Northern Virginia

27 Appendix B Assessment Methods #fairfaxCHA Diverse methods were used in the assessments to collect and analyze primary and secondary data. The different methods employed are outlined in the table below from most frequently used to least frequently used. Half of all the assessments used both primary and secondary data sources, one quarter collected only primary data, and one quarter analyzed only secondary data. Multiple sectors of the community were engaged to gather input from diverse perspectives in nine of the assessments. Survey administration was the most common approach to collecting community feedback, followed closely by stakeholder interviews.

General Assessments Focused Assessments WF Methods CHD FCYS HSNA ICHNA KP CASPER CFA CLAS EGP LE PANA Count CHNA NOVA

Secondary Data Analysis X X X X X X X X X 9

Survey X X X X X X X X X 9

Interviews X X X X X X X 7

Focus Groups X X X 3

Meetings-on-the-Go X X 2

Public Forums X X 2

Board of Supervisors’ X 1 Stakeholder Meetings

Business Roundtables X 1

Crowdsourcing X 1

Food Store Assessment X 1

Voting Opportunities X 1

28 Appendix C Assessment Participation #fairfaxCHA Diverse sectors of the community were broadly represented through primary data collection in nine assessments. The organizations represented in these assessment processes are organized by sector in the table below. The diverse perspectives included in the assessments were from the business sector; various boards, authorities, commissions, and other community advisory groups; educational institutions and academia; federal, state, regional, and local government agencies; healthcare service providers; and nonprofits, including faith-based organizations. The Fairfax County Human Services Needs Assessment and the Park Authority Needs Assessment had the broadest outreach across sectors. Nonprofits comprised more than a third of assessment participation, followed by community advisory groups and governmental agencies. Overall, community input was gathered from nearly 50,000 youth and adults through surveys and other methods of engagement.

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Allegra Marketing X 1 Alliance Law Group X 1 Consistent Voice Communications X 1 David Alstadt Consulting, LLC X 1 Flowers ‘n’ Ferns X 1 Greater Springfield Chamber of Commerce X 1 Halt, Buzas, & Powell, LTD X 1 Korean-American Chamber of Commerce X 1 Marriott X 1 New Earth X 1 Northern Virginia Association of Realtors X 1 Optfinity X 1 Pro-Line Embroidery X 1 Renewed Living X 1 Businesses & Employers Retail food establishments X 1 Strategy & Management Services, Inc. X 1 The Khalil Law Firm, PLLC X 1 Tysons Partnership X 1 Virginia Hispanic Chamber of Commerce X 1 WeePlay, LLC X 1

29 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Advisory Social Services Board X 1 Architectural Review Board X 1 Board of Zoning Appeals X 1 Child Care Advisory Council X 1 Citizen Corps Council X 1 Commission for Women X X 2 Commission on Organ & Tissue Donation & X 1 Transplantation Community Action Advisory Board X X 2 Community center advisory boards X X 2 Community Criminal Justice Board X 1 Community Revitalization & Reinvestment X 1 Advisory Group Consolidated Community Funding Advisory X 1 Committee Criminal Justice Advisory Board X 1 District advisory boards X 1 Economic Advisory Commission X 1

Community Advisory Groups Economic Development Authority X 1 Environmental Quality Advisory Council X 1 Fairfax Area Commission on Aging X X 2 Fairfax Area Disability Services Board X X 2 Fairfax Community Long Term Care X 1 Coordinating Council Fairfax County Athletic Council X 1 Fairfax County Convention & Visitors X 1 Corporation Board Fairfax County Health Department X 1 Multicultural Advisory Council Fairfax County Park Authority Board X 1

30 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Fairfax County Safety Net Health Center X 1 Commission Fairfax-Falls Church Community Policy & X 1 Management Team Fairfax-Falls Church Community Services X 1 Board Fairfax-Falls Church Partnership to Prevent X 1 & End Homelessness Fairfax Food Council X 1 Health Care Advisory Board X X X 3 History Commission X 1 Human Rights Commission X 1 Human Services Council X X 2 Juvenile & Domestic Relations District Court X X 2 Citizens Advisory Council Library Board X 1 Northern Virginia Regional Park Authority X 1 Partnership for a Healthier Fairfax X X X 3 Planning Commission X 1 Redevelopment & Housing Authority X X 2 Resident Advisory Council X 1 Community Advisory Groups Small Business Commission X 1 South County Task Force for Human X 1 Services Trails & Sidewalks Committee X 1 Transportation Advisory Commission X 1 Tree Commission X 1 Upper Occoquan Sewage Authority X 1 Volunteer Fire Commission X 1 Water Authority X 1 Wetlands Board X 1 Youth Basketball Council Advisory Board X 1 31 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Fairfax County Public Schools X X X X X X 6 Fairfax Education Association X 1 George Mason University X X X X X X 6 Indiana University X 1 Johns Hopkins Center for a Livable Future X 1 Loudoun County Public Schools X 1 Marymount University X 1

Education Northern Virginia Community College X X X 3 NoVa HealthFORCE X 1 Old Dominion University X 1 Parent Teacher Associations X X 2 Prince William County Schools X 1 Shenandoah University X 1 Virginia Commonwealth University X 1 Arlington County X X X 3 Centers for Disease Control & Prevention X 1 City of Alexandria X X X 3 City of Fairfax X X 2 City of Falls Church X X 2 District of Columbia X 1 Fairfax County Board of Supervisors X X X X 4 Fairfax County Department of Family X X 2 Services Government Fairfax County Department of Housing & X 1 Community Development Fairfax County Department of X X X X X X 6 Neighborhood & Community Services Fairfax County Department of Planning & X 1 Zoning

32 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Fairfax County Department of Public Works X 1 & Environmental Services Fairfax County Economic Development X 1 Authority Fairfax County Fire & Rescue Department X 1 Fairfax County Health Department X X X X X 5 Fairfax County Juvenile & Domestic X 1 Relations District Court Fairfax County Office for Children X 1 Fairfax County Office for Women & X 1 Domestic & Sexual Violence Services Fairfax County Office of Community X 1 Revitalization Fairfax County Office of Public & Private X 1 Partnerships Fairfax County Office of the County X X 2 Executive Fairfax County Park Authority X 1 Fairfax County Police Department X 1 Government Fairfax-Falls Church C0mmunity Services X X X 3 Board Loudoun County X X X 3 National Park Service X 1 Northern Virginia Regional Commission X 1 Northern Virgina Soil & Water Conservation X 1 District Office of the National Coordinator for X 1 Health Information Technology Prince William County X X 2 Reston Community Center X 1 Route 1 Emergency Providers X 1 Southgate Community Center X 1 Town of Herndon X 1 33 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Town of Vienna X 1 Virginia Department of Forestry X 1 Virginia Department of Health X 1 Virginia Housing Development Authority X 1 Virginia State Senate X 1

Government Volunteer Solutions X 1 Adams Compassionate Healthcare Network X 1 Arlington Free Clinic X 1 Arlington Pediatric Center X 1 Associate Counseling Center X 1 Autumnleaf Group, Inc. X 1 Birmingham Green Adult Care X 1 Dental practices in Fairfax County X 1 Developmental Support Associates X 1 Flip the Clinic, Inc. X 1 Community Hospital X 1 Generalist physician practices in Fairfax X X 2 County HealthWorks for Northern Virginia

Healthcare X X 2 Inova Health System X X X X 4 Insight Memory Care Center X 1 Kaiser Foundation Health Plan of the Mid- X X 2 Atlantic States Kaiser Permanente X X 2 Medical Reserve Corps Volunteers X 1 Medical Society of Northern Virginia X X 2 Molina Healthcare of Virginia X 1 Mt. Vernon at Home X 1 Neighborhood Health Services X X 2

34 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Northern Virginia Dental Clinic X 1 Northern Virginia Health Services Coalition X 1 Novant Health X 1 NOVA Scripts Center X X 2 Occoquan Counseling, LLC X 1 Pharmacies in Fairfax County X 1 Potomac Health Foundation X 1 Regional Primary Care Coalition X 1

Healthcare Reston Hospital X 1 Sentara Northern Virginia Medical Center X X 2 Specialist physician practices in Fairfax X 1 County The Medical Team X 1 Virginia Association of Free Clinics X 1 Virginia Hospital Center X X 2 A Way Forward X 1 Access to Wholistic Living X 1 Alliance for a Healthier Generation X 1 Alternative House X 1 American Association of Nurse Executives X 1 Animal welfare organizations X 1 Arlington Boulevard Community X 1 Development Organization Arlington Home Ownership Made Easier X 1 Artemis House X 1 Asian American Youth Leadership X 1 Nonprofit Organizations Empowerment & Development Autism Society of Northern Virginia X 1

35 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Brain Injury Services X 1 Building Economic Opportunity X 1 Campagna Center X 1 Catholic Charities X 1 Celebrate Fairfax, Inc. X 1 Centreville Labor Resource Center X 1 Community Residences, Inc. X 1 Concerned Fairfax, Northern Virginia X 1 Chapter, National Alliance on Mental Illness Cornerstones X X 2 Cycling groups X 1 Easter Seals X 1 ENDependence Center of Northern Virginia X 1 Enroll Virginia! X 1 Environmental organizations X 1 Equestrian groups X 1 Fairfax County Interfaith Clergy & X 1 Leadership Council Fairfax County Park Foundation X 1

Nonprofit Organizations Fairfax Court Appointed Special Advocates, X 1 Inc. Faith Communities in Action X 1 Family Preservation & Strengthening X 1 Services Family Services Network X 1 Food for Others X 1 Food Providers Network X 1 Foundation for Appropriate & Immediate X 1 Temporary Help Social Services Friends groups X 1

36 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Good Shepherd Housing & Family Services, X 1 Inc. Greater Prince William Community Health X 1 Center HomeAid Northern Virginia X 1 Homeowners’ associations X 1 Houses of worship X X X 3 Jewish Social Service Agency X 1 Jobs for the Future X 1 Just Neighbors X 1 League of Women Voters in the Fairfax Area X 1 Legal Aid Justice Center X 1 Legal Services of Northern Virginia X X 2 Literacy Council of Northern Virginia X 1 Loudoun Interfaith Relief X 1 Naomi Project X 1 National Alliance for Mental Health X 1 Neighborhood civic associations X X 2 Neighbor’s Keeper X 1

Nonprofit Organizations New Hope Housing X 1 Northern Virginia Affordable Housing X 1 Alliance Northern Virginia Area Health Education 1 Center Northern Virginia Family Service X X X 3 Northern Virginia Health Foundation X X X 3 Opportunities, Alternatives & Resources of X X 2 Fairfax Our Daily Bread (currently Britepaths) X 1 Pathway Homes X 1

37 Appendix C Assessment Participation, continued #fairfaxCHA

WF Sector Organization FCYS HSNA ICHNA KP CASPER CFA CLAS PANA Count CHNA NOVA Psychiatric Rehabilitation Services, Inc. X 1 Rotary Club of Springfield X 1 SafeSpot Children’s Advocacy Center of X 1 Fairfax County Seeds of Humanity Foundation X 1 ServiceSource, Inc. X 1 Shelter House, Inc. X 1 Shepherd Center of Fairfax-Burke X 1 SkillSource Group, Inc. X 1 Special Olympics in Northern Virginia X 1 Stop Child Abuse NOW (Scan) of Northern X 1 Virginia The Arc of Northern Virginia X 1 The Community Gardens Project X 1 The Koinonia Foundation X 1 The Lamb Center X 1 Nonprofit Organizations The Morris & Gwendolyn Cafritz Foundation X 1 The Women’s Center X 1 Trail groups X 1 United Community Ministries X 1 Virginia Healthcare Foundation X 1 Washington Regional Association of X 1 Grantmakers Wedgewood X 1 Wesley Housing X 1 Wolf Run Foundation X 1 Total Number of Organizations 4 118 26 44 3 14 10 74 22 315

38 Appendix D Assessment Themes #fairfaxCHA Each of the assessments was examined to identify major health-related issues. The table below outlines overarching themes from the assessment review and their corresponding topic areas. The identified health issues are listed in order from those that appeared in the greatest number of assessments to those that were documented in the smallest number of assessments. The matrix was a pivotal tool in the prioritization of the health issues presented in the Community Health Assessment.

General Assessments Focused Assessments WF Assessment Themes CHD FCYS HSNA ICHNA KP CASPER CFA CLAS EGP LE PANA Count CHNA NOVA Healthy & Safe Physical X X X X X X X X 8 Environment

Transportation X X X X X 5

Affordable & accessible pub- • X X X X X 5 lic transportation services Assessment Themes Built Environment X X X 3

• Physical environment X X 2

Preservation of open space & • X 1 environment Walking, hiking, & biking • X 1 trails

Housing X X X X 4

• Affordable housing X X X X 4

• Accessible housing for older adults & individuals with X 1 disabilities

Health in all Policies X X 2

39 Appendix D Assessment Themes, continued #fairfaxCHA

General Assessments Focused Assessments WF Assessment Themes CHD FCYS HSNA ICHNA KP CASPER CFA CLAS EGP LE PANA Count CHNA NOVA Social Determinants of X X X X X X X 7 Health

Socioeconomic Factors X X X X X X X 7

• Disparities by geography X X X X X 5

• Socioeconomic security X X X 3

• Racial economic gaps X X X 3

• Financial assistance X 1

• High cost of living X 1

Education X X X 3

Educational barriers for • X X 2 marginalized communities Affordable child care & early • X 1 education opportunities

Employment X X 2

Gaps in employment • X X 2 opportunities Disconnected youth (neither • X 1 in school nor working)

40 Appendix D Assessment Themes, continued #fairfaxCHA

General Assessments Focused Assessments WF Assessment Themes CHD FCYS HSNA ICHNA KP CASPER CFA CLAS EGP LE PANA Count CHNA NOVA

Health Eating X X X X X X 6

Access to Healthy Foods X X X X X 5

SNAP/WIC benefits • X X X 3 acceptance Low fruit/vegetable • X X X 3 consumption Access to community • X X 2 gardens

Nutrition Literacy X X X X X 5

Obesity/overweight & • X X X X X 5 obesity-related concerns

• Need for nutrition education X X 2

Food Insecurity X X X X 4

Mental Health X X X X X 5

Substance Use X X X X 4

• Drug use X X X X 4

• Alcohol use X X � 3

• E-cigarettes X 1

Access to Health Services X X X X 4

• Behavioral health services X X X X 4

Healthcare access, coverage, • X X X X 4 & preventative services

• Dental care X X 2 41 Appendix D Assessment Themes, continued #fairfaxCHA

General Assessments Focused Assessments WF Assessment Themes CHD FCYS HSNA ICHNA KP CASPER CFA CLAS EGP LE PANA Count CHNA NOVA

Active Living X X X X 4

• Physical activity X X X X 4

• Screen time X 1

Health Workforce X X X X 4

Culturally & Linguistically X X X X 4 Appropriate Services

• Cultural competency in care X X X 3

Linguistically appropriate • X X 2 services

Recruitment X 1

Shortages for allied health & • X 1 rehabilitation occupations Risk of shortages for some • X 1 healthcare occupations Need for student clinical • X 1 placements

Chronic Diseases X X X 3

• Diabetes X X 2

Hypertension/cardiovascular/ • X X 2 heart disease

• Cancer X 1

• Asthma X 1

• Other chronic diseases (osteoporosis, kidney X 1 disease) 42 Appendix D Assessment Themes, continued #fairfaxCHA

General Assessments Focused Assessments WF Assessment Themes CHD FCYS HSNA ICHNA KP CASPER CFA CLAS EGP LE PANA Count CHNA NOVA

Services for Older Adults X X X 3

Conditions & care of the • X X 2 elderly Services to support • X 1 independent living

Infectious Diseases X X X 3

• Infectious diseases X 1

• Safe sex X 1

• Mosquito control measures X 1

Violence X X 2

• Aggressive behaviors X 1

• Bullying/cyberbullying X 1

• Dating aggression X 1

• Domestic violence X 1

Sleep X 1

Vehicle Safety X 1

Access to Human Services X 1 Information

Emergency Preparedness X 1

43 #fairfaxfairfaxcounty.gov/livehealthyCHA A Fairfax County, Va., publication. April 2018. For more information facebook.com/fairfaxcountyhealth or to request this information in an alternate format, call the Fairfax twitter.com/fairfaxhealth County Health Department at 703-246-2411, TTY 711.