Aging in Place in America Research Report

Aging in Place in America

Research Report February 2020

Overview Report contents

The Aging in Place in America survey aims to establish the extent to which people think they will be able to age in their own homes or communities, why they want to age in place, and what factors could prevent them from being able to do so. 3 Introduction The survey captures the views of the U.S. public and key demographic groups of interest, as well as a focus on people with chronic kidney disease (CKD), other chronic health 6 Executive summary conditions, and caregivers. As a leader in chronic disease care, Fresenius Medical Care North America (FMCNA) commissioned this research in order to understand more about the social determinants of 25 Further information on the health (SDOH) impacting people’s livelihoods and hopes for aging. research In order to understand how they can better help the CKD community, this report also 28 Appendix includes a deep dive on perceptions of CKD patients and CKD caregivers – how they hope to age in place, how SDOH affect their ability to age in place, and what specific barriers they need to overcome to make this happen. 29 Detailed findings The statistics in this survey are based on the self-reported answers of 2,750 U.S. adults aged 18 years or older. The interviews were conducted in an online survey, in English, from Aug. 9-20, 2019. The sample included 2,000 U.S. adults representative of 65 Focus on chronic kidney the online general public in terms of age, gender, and region. Additionally, a sample of 500 disease (CKD) patients CKD patients and 250 CKD family caregivers were included. 80 Focus on caregivers

Statistically significant differences, at the 95% confidence level, are denoted by arrows. 89 Sample profile

Bill Valle Chief Executive Officer of Fresenius Medical Care North America President of the Fresenius Medical Care Foundation

“We wanted to explore the perceptions of aging in place and uncover barriers, including social determinants of health and misperceptions around feasibility. Given an aging population and an increase in chronic disease, innovations that help more people remain in their homes for longer will be welcomed by patients and the health system alike. The role of family caregiving in helping those with chronic diseases, including chronic kidney disease, age in place while receiving quality care and support is also of critical importance going forward. Fresenius Medical Care North America is committed to identifying solutions for chronic disease patients and their caregivers and believes a dialogue about work underway and still to be done is a key step toward achieving the goal of more seniors aging in place. It is important for the healthcare community to commit to creating a future where older adults can age on their own terms and remain in control of their circumstances to the best of their ability. This is why we are moving beyond providing clinical care and toward support of overall societal shifts that allow individuals to thrive in the setting where they feel most comfortable.”

© 2020 Fresenius Medical Care A guide to the SDOH investigated in the Aging in Place in America survey. SDOH in this survey SDOH can be broken down into eight categories, each measured by four specific statements self-rated on a 4-point agreement scale.

Difficulty keeping up with home maintenance Do not communicate online with my doctor/pharmacy

Do not have enough space to live comfortably Struggle to use new technology

Do not live in a stable home Not accessing the internet on my mobile phone

Do not live in a safe and comfortable home Not managing bills online

Have trouble understanding doctors’ advice Not saving money for the future

Do not regularly monitor health Do not have disposable income for non-essentials Difficulty understanding medical information Social Do not pay bills on time (i.e. gas, phone, credit card) Do not have enough for everyday expenses Difficulty in knowing where to find health information Determinants Skip meals/reduce meal size for budget of Health Not physically fit and active Not eating nutritious meals most days Not walking in everyday life

Not able to cook fresh meals most days Do not get 15+ mins. of exercise every week

Do not have access to nutritious foods Struggle physically doing household tasks

Do not feel belonging in community Lack purpose and direction

Do not feel safe in community Not able to work and earn a living

Do not have strong social support network Not learning and developing skills

Lack access to public spaces or events in community Do not make independent decisions

Potential image slide Executive3 Storylines Summary

1 Aging in place in America: social barriers are significant.

2 SDOH create additional challenges for caregivers.

CKD patients are more likely to want to age in place, but express 3 concerns about quality of home care.

Aging in place in America: social barriers are significant.

U.S. general public

BUT ONLY of Americans surveyed say aging in place is a believe they will. 65%65% goal of theirs. 33%33%

Greatest 82% Greatest 61%

Boomers 78% Boomers 50%

Gen X 63% Gen X 29%

Millennials 56% Millennials 19%

Gen Z 46% Gen Z 14%

Q19: Which of the following words or phrases best describes your view of “aging in place”? | Q14/Q15: Do you think you will stay in the same community or move elsewhere as you grow older / And, where do you plan to live as you grow? | Base: U.S. General public – 18+ (n=2,000), Gen Z (n=177), Millennials (n=560), Gen X (n=519), Boomers © 2020 Fresenius Medical Care (n=637), Greatest Gen (n= 107) 9 U.S. general public Functional barriers Emotional barriers to aging in place to aging in place

Barriers to the 29%29% 19%19% of Americans say of Americans say perceived ability to “I would not have “I would feel alone.” age in place are enough money to both functional age in place.” and emotional. 24%24% 17%17% of Americans say of Americans say “My home is not “I would not be suitable for the elderly.” near friends and family.”

© 2020 Fresenius Medical Care Q22. Are any of the following reasons why you would not be able to live in the same home or community when growing older? | Q26. What concerns you the most about the idea of “aging in place”? | Base: General public (n=2000) 10

U.S. general public Any chronic condition 38% People with any chronic health condition 33% General public People with chronic health conditions are more likelyc to believe they will age in place than the general public. say they will live in the same home as they grow older

Lack of health literacy – an SDOH that significantly impacts a person’s ability to age in place – affects fewer of those living with chronic conditions (39%) compared to the general public (47%). Patients with chronic conditions are likely to have more frequent touchpoints with the healthcare system.

U.S. general public

38% 29% 28% 38% 25% 34% Racial and ethnic 23% minorities and African Americans/African lower-income Hispanic Americans High-income individualsThese same are groups also Asianhave Americans/Asian a disproportionatelyAverage higher-income number of Low-income Low-income less(SDOH) likely thatto think negatively impact their lives they can age in place. believe they will age in place

Racial and ethnic minorities and lower-income individuals also have a disproportionately higher number of SDOH that negatively impact their lives.

© 2020 Fresenius Medical Care Q14/Q15: Do you think you will stay in the same community or move elsewhere as you grow older / And, where do you plan to live as you grow? | Base: U.S. General public – 18+ (n=2,000), African Americans (n=230), Asian Americans (n=101), Hispanic Americans (n=357), Low-income individuals (n=624) Beyond physical fitness and financial health, lack of purpose, community, and tech skills are common SDOH challenges. U.S. general public Types of SDOH – among the general public % affected by types of SDOH

INTELLECTUAL FOOD HEALTH HOUSING TECH LITERACY FINANCIAL KINETICS COMMUNITY PURPOSE INSECURITY LITERACY SECURITY % affected by SDOH 66% 64% 60% 55% 55% 50% 47% 46% type 48% 34% 33% 25% 38% % affected Do not 44% 40% 43% Do not feel Skip meals/reduce Have trouble Difficulty keeping by each communicate Not saving money Not physically fit Lack purpose belonging in meal size for understanding up with home statement online with my for the future and active and direction community budget doctors’ advice maintenance doctor/pharmacy 25% 43% 31% 22% 20% 26% 21% 10% Do not have Not eating Do not have Struggle to use Not walking in Not able to work Do not feel safe in Do not regularly disposable income nutritious meals enough space to new technology everyday life and earn a living community monitor health for non-essentials most days live comfortably 19% 34% 29% 20% 13% 18% Do not pay bills on Do not get 15+ 8% Difficulty 8% Not accessing the Do not have Not able to cook time (e.g. gas, minutes of Not learning and understanding Do not live in a internet on my strong social fresh meals most phone, credit exercise every developing skills medical stable home mobile phone support network days card) week information 20% 26% 6% 15% 6% 5% 7% 11% Do not have Lack access to Difficulty in Struggle Do not make Do not have Do not live in a Not managing bills enough for public spaces or knowing where to physically doing independent access to safe and online everyday events in find health household tasks decisions nutritious food comfortable home expenses community information

Q6-Q13: To what extent do you agree or disagree with each of the following statements? | Base: U.S. General public – 18+ (n=2,000) 13

U.S. general public

Impact of SDOH on whether people will age in place

People 47% experiencing more SDOH 33% challenges are significantly less 24% likely to think they

will age in place. Likelihood of aging in in place aging of Likelihood

Affected by 2 or less Affected by 3-5 types of Affected by 6+ types of types of SDOH SDOH SDOH

© 2020 Fresenius Medical Care Q6-Q13: To what extent do you agree or disagree with each of the following statements? | Base: U.S. General public – 18+ (n=2,000) 14 Beyond physical fitness and financial health, lack of purpose, community, and tech skills are common SDOH challenges. U.S. general public Types of SDOH – among the general public % affected by types of SDOH

INTELLECTUAL FOOD HEALTH HOUSING TECH LITERACY FINANCIAL KINETICS COMMUNITY How many PURPOSE INSECURITY LITERACY SECURITY people are affected 66% 64% 60% 55% 55% 50% 47% 46% % affected by SDOH type

Impact on ability to age in place 9% -7% 3% -1% -10% -7% -7% -6% % more/less likely to be able to age in place, among those affected by SDOH type

Financial challenges are the Community health has the Food insecurity, health literacy, most common SDOH that strongest negative impact on and housing security affect fewer have an impact on a person’s one’s ability to age in place people, but those affected are ability to age in place (64%). (-10%), among those affected. significantly less likely to age in place.

SDOH create additional challenges for caregivers.

U.S. general public

Caregiver Generation

Gen Z 8% Millennial 41% Gen X 37% Boomers 13% Greatest 1% With the aging population in 34%34% Diabetes 25% the U.S., the role of Americans in Hypertension (high BP) 22% this survey of caregivers is Mental health condition 17% crucial. A physical disability 17% High cholesterol 15% are caring for a family Asthma 13% member with a chronic Alzheimer's / dementia 12% health condition. Heart disease / CVD 10% Cancer 10%

CKD caregivers

86%86% Focusing on CKD of CKD caregivers think the adult they care for has a CKD caregivers are specifically, most personal goal to age in place, more likely to say CKD caregivers vs. 65% of the U.S. general public say aging in place is a goal aging in place is a goal for their loved think their loved BUT ONLY one than the general one’s goal to age public is. in place is The pattern is the unrealistic. 58%58% same. of CKD caregivers think the adult they care for will age in place. vs. 33% of the U.S. general public thinks they will age in place

© 2020 Fresenius Medical Care Q19: Which of the following words or phrases best describes your view of “aging in place”? | Q14/Q15: Do you think you will stay in the same community or move elsewhere as you grow older / And, where do you plan to live as you grow? | Base: U.S. CKD family caregivers (n=250) 18

CKD caregivers

53%53% of CKD caregivers Caregivers worry say the adult they care for would not be that CKD patients able to age in place because they would need specialized healthcare and support. won’t be able to vs. 21% of the U.S. general public says aging in place is a goal get the specialized care they need in their own home. 48%48% of CKD caregivers say the adult they care for would not be able to age in place because they wouldn’t be able to cope with everyday needs. vs. 23% of the U.S. general public says aging in place is a goal

CKD patients are more likely to want to age in place, but express concerns about quality of home care.

CKD patients CKD patients are more likely to want to age in place than the general public. Yet, only half of these CKD patients actually believe they can.

Home is even CKD patients 82% 40% CKD patients General 65% 33% General more important to public public CKD patients, BUT compared to the ONLY general public.

say aging in place is say they will live in a goal of theirs, the same home as they grow old.

CKD patients

People experiencing 50% CKD patients six to eight of the eight SDOH challenges 37% General Unsurprisingly, measured. public CKD patients index extremely high on multiple SDOH.

CKD patients

Kinetics, financial 7575%%of CKD patients are affected by financials concerns, and versus 64% of the U.S. general public. intellectual purpose are the main SDOH facing 8585%%of CKD patients CKD patients, all are affected by kinetics of which impact versus 60% of the U.S. general public. their plans to age in place. 7373%%of CKD patients are affected by intellectual purpose

versus 55% of the U.S. general public.

Dialysis patients

Dialysis patients 5050%%of dialysis patients currently believe believe the quality of care would be better for the quality of care people having dialysis in a clinic or hospital. is better in a clinic or hospital setting than with home dialysis. 2525%%of dialysis patients believe the quality of care would be better for people having dialysis in their own home.

© 2020 Fresenius Medical Care Q30a: Based on what you know about dialysis treatment, which of the following statements do you agree with? | Base: U.S. CKD patients currently receiving dialysis (n=166) 24

Dialysis patients

There is strong If they believe the same type interest among of quality of care was found dialysis patients in home, in clinic, or in for home dialysis 54%54% hospital settings, if the quality of of dialysis 54% would care is the same patients choose home as in clinic and hospital settings. dialysis.

© 2020 Fresenius Medical Care Q34: If you could receive the same type of quality of care in each of the three locations below, which of the following dialysis options would you choose in an ideal world? | Base: U.S. CKD patients currently receiving dialysis (n=166) Further information on the research

About the Aging in Place Survey

About the survey About Edelman Intelligence This report outlines the findings from a survey conducted by Edelman Intelligence is a global, full-service market insights and Edelman Intelligence, an independent market research firm, on analytics firm that provides corporate, non-profit and government behalf of Fresenius Medical Care North America. A sample clients with strategic intelligence to make their communications and of 2,750 U.S. adults aged 18 years or older were interviewed engagements with stakeholders the smartest they can be. The firm online, in English, during Aug. 9-20, 2019. For more information, specializes in measurement, tracking and analysis in reputation, please visit www.fmcna.com/aging-in-place. branding, and communications. Edelman Intelligence is part of Edelman, the world’s largest public relations company. Edelman Audiences surveyed Intelligence has more than 200 employees and 12 offices around • 2,000 U.S. adults nationally representative of the online general the world. public in terms of age, gender, region and income • 500 U.S. “CKD patients” who are adults with kidney disease at For further information, please visit any stage (166 CKD patients in the sample are currently on www.edelmanintelligence.com dialysis) • 250 U.S. “CKD caregivers” of a friend or family member diagnosed with CKD (104 of the U.S. “CKD caregivers” look after a patient currently on dialysis)

Margin of error • General population +/- 2.2% at the 95% Confidence Level • CKD patients +/- 4.4% at the 95% Confidence Level • CKD caregivers +/- 6.2% at the 95% Confidence Level

About Fresenius Medical Care

About Fresenius Medical Care North America Media Contact: Fresenius Medical Care North America (FMCNA) is the premier Fresenius Medical Care North America healthcare company focused on providing the highest quality care to Brad Puffer people with renal and other chronic conditions. Through its industry- Corporate Communications leading network of dialysis facilities, outpatient cardiac and vascular [email protected] labs, and urgent care centers, Fresenius Medical Care North (781) 699-3331 America provides coordinated healthcare services at pivotal care points for hundreds of thousands of chronically ill customers throughout the continent. As the world’s largest fully integrated renal company, it offers specialty pharmacy and laboratory services, and manufactures and distributes the most comprehensive line of dialysis equipment, disposable products, and renal pharmaceuticals.

For more information, visit the FMCNA website at https://fmcna.com.

For more information on the detailed survey findings and how FMCNA is beginning to address barriers to aging in place, please visit www.fmcna.com/aging-in-place.

Only one in three think they will Current plans on where to age in place actually grow older in their

Stay in the same home current home. Stay in the same area, but move into a different home Move to a different area Don't know ONLY think they will live in the same home as they grow 12% 33% older. 33% 33%

AN ADDITIONAL 38% think they will live in the 17% same community/area, but 17%17% move to a different home.

Q14. Do you think you will stay in the same community or move elsewhere as you grow older? Q15. And, where do you plan to live as you grow older? | Q15. And, where do you plan to live as you grow older? Q19. Which of the following words or phrases best describes your view of “aging in place”? Base: U.S. General public – 18+ (n=2,000), CKD patients (n=500) Base: U.S. General public – 18+ (n=2,000) 31

Additional profiles: ‘Aging in place is a goal’ across different demographics Household Income (HHI) Ethnicity by Age 58% High Household Income 68% White 65% 79% Average Household Income 66% Millennials 47%* Gen X Low Household Income 62% 65% African American 63%* Boomers 65% 79%** of the general Ethnicity White 69% 57% population Hispanic American 59% 76%* say aging in African American 57% place is a goal. Hispanic American 60% 47%* Asian American 71%** General population vs. CKD Asian American 59% 62%** patients % Agree Generation Household Income by Age Gen Z 46% 82% Millennials 56% 64% 65% 69% High Household Income 66% Millennials Gen X 63% 76% Gen X Boomers 78% Greatest 82% Boomers 56% Gender Average Household Income 62% Gen Pop Any Chronic CKD 79% Health Patients Female 68% Condition 46% Male 62% Low Household Income 62% 77%

Q19: Which of the following words or phrases best describes your view of “aging in place”? | Base: U.S. General public – 18+ (n=2,000), CKD patients (n=500), Gen Z n=177, Millennials n=560, Gen X n=519, Boomers n=637, Greatest Gen n= 107 * Warning small sample size ** Warning very small sample size 32

Additional profiles: ‘Will age in place’ across different demographics Household Income Ethnicity by Age

High Household Income 34% 21% 33% White 32% Average Household Income 38% 51%

of the general Low Household Income 29% 19%* Millennials African American 15%* public 50%** Gen X Ethnicity think they will age Boomers White 38% 14% Hispanic American 31% in place. 47%* African American 23%

Hispanic American 25% 13%* Asian American 29%** General public vs. CKD patients 42%** % agree Asian American 28% Generation Household Income by Age 38% 40% Gen Z 14% 33% Millennials 19% Gen X 29% 23% Millennials High Household Income 30% Boomers 50% 46% Gen X Greatest 61% Boomers 19% General Any chronic CKD Gender Average Household Income 28% 58% public health patients Female 30% condition 15% Low Household Income 28% Male 36% 45%

Q14/Q15: Do you think you will stay in the same community or move elsewhere as you grow older / And, where do you plan to live as you grow older? | Base: U.S. General public – 18+ (n=2,000), CKD patients (n=500), Gen Z n=177, Millennials n=560, Gen X n=519, Boomers n=637, Greatest Gen n= 107 * Warning small sample size ** Warning very small sample size 33

People with chronic health conditions, such as CKD patients, are more inclined to say they will age in place.

General public General public 65% 33% Any chronic condition Any chronic condition 69% 38% CKD patient CKD patient 82% 40% Lung disease/COPD* Lung disease/COPD* 64% 41% Diabetes 73% 42% Diabetes Cancer* 77% 49% Cancer*

say aging in place is a goal of theirs say they will live in the same home as they grow older

Q15. And, where do you plan to live as you grow older? | Base: U.S. General public– 18+ (n=2,000), CKD patients (n=500), Any chronic condition (n=918), Lung disease (n=56*), Diabetes (n=199), Cancer (n=75*) 34

Why is aging in place appealing? The majority say comfort, familiarity, and independence.

Benefits of aging in place Desire for independence % reported increases with age 84% of the Greatest Generation and 74% of Boomers see independence as a benefit, compared to 48% of Millennials and 40% of Gen Z. The Greatest Generation and Boomers are also more 68% 68% likely to say it’s where they feel 61% comfortable (83% and 78% respectively) and familiar (82% and 76% respectively). 52%

44% 43%

35%

7% 1%

It's a place I'm It's where I feel I would remain I'd be able to It's where my I would have a I would remain a Other None of the familiar with comfortable independent continue to do friends and family better quality of part of the above the things I love are life community

Q24. In your opinion, what would be the main benefits of “aging in place” in your home and community? | Base: General public n=2000, Gen Z n=177, Millennials n=560, Gen X n=519, Boomers n=637, Greatest Gen n= 107 35

The barriers to aging in place are both functional and emotional.

FINANCIAL

Money is the top barrier Americans face to aging in place. • 29% say it will prevent them from aging in place % general • 45% of patients are concerned about having enough money to age in population place Rank Barriers to aging in place mentioning

1 I would not have enough money 29% HOUSING SECURITY 2 My home is not suitable for the elderly 24% Changing to a more suitable home or downsizing is a key 3 I would not be able to cope with everyday needs 23% reason to move. • 24% of Americans say their home is not suitable for the elderly 4 I would need specialized healthcare and support 21% • 21% say they would need to downsize 5 I would need to downsize from my current home 21%

6 I would feel alone 19% COMMUNITY Loneliness is another key barrier to aging in place. 7 I would not be near friends and family 17% • 19% of Americans say they would not be able to age in place because they “would feel alone” 8 My community is not suitable for the elderly 10% • A quarter (27%) of the public are concerned about feeling alone as they 9 Other 3% age in place

Q22. Are any of the following reasons why you would not be able top live in the same home or community when growing older? | Q26. What concerns you the most about the idea of “aging in place”? | Base: General public n=2000 36

Millennials are more affected by loneliness.

COMMUNITY

Fear of loneliness is significantly more likely to “I would feel alone” prevent younger generations from thinking they as a barrier to aging in place, by age will age in place. % selected “I would feel alone” as a barrier • 28% of Gen Z and 23% of Millennials say they would not be able 28% to age in place because they would feel alone (versus 14% of Boomers and 11% of the Greatest Gen) 23% 19% 14% Younger generations are also more likely to be negatively 11% affected by social factors relating to their community. • 37% of Gen Z and 43% of Millennials don’t feel part of the community (versus 30% of Boomers and 18% of the Greatest of lonelinessFear Generation) • 28% of Gen Z and 24% of Millennials don’t feel safe in their community (versus 15% of Boomers and 17% of the Greatest Z M X B G Generation) Z=Gen Z • 20% of Gen Z and 19% of Millennials don’t have public spaces Age M=Millennial nearby (versus 11% of Boomers and 9% of the Greatest X=Gen X Generation) B=Boomers G=Greatest Gen Q22. Are any of the following reasons why you would not be able to live in the same home or community when growing older? | Q26. What concerns you the most about the idea of “aging in place”? | Q8: To what extent do you agree or disagree with each of the following statements? Base: General public n=2000, Gen Z n=177, Millennials n=560, Gen X n=519, Boomers n=637, Greatest Gen n= 107 37

Where you live impacts your chances of aging in place.

Regions most likely to age in place Urban versus rural Rural populations are more likely to say aging in place is a goal • 70% of rural populations Rocky Mountain 40% • 63% of urban populations

Southwest 37% New England Rocky (32%) Great Lakes 35% Mountain Plains Urban populations are more likely to say that Far West (40%) (31%) Great Lakes Mideast Mideast 33% (28%) aging in place is not a goal (35%) (33%) Southeast 33% • 37% of urban populations

New England 32% Southwest • 30% of rural populations (37%) Southeast Plains 31% (33%)

Far West 28% Urban populations are less likely to think they will age in place • 38% of rural populations • 31% of urban populations 38

Tech literacy, kinetics, and financial issues are the most common SDOH challenges.

Types of SDOH currently negatively experienced – general public % affected by at least one

Tech Literacy 66% 48% Do not communicate online with my doctor/pharmacy

Financial 64% 43% Do not have enough disposable income for non-essentials Kinetics 60%

Intellectual Purpose 55% 43% Lack purpose and direction Community 55%

Food Security 50% 33% Skip meals/reduce meal size for budget

Health Literacy 47% 25% Have trouble understanding doctors’ advice Housing Security 46%

Q6-Q13: To what extent do you agree or disagree with each of the following statements? | SDOH 39

Most Americans are currently dealing with at least three types of SDOH.

Number of types of SDOH currently experienced % of U.S. general public

The majority of the U.S. People affected by 6-8 3 in 4 general population are 37% types of SDOH 3+ types of affected by multiple types of SDOH (77%, 3 SDOH People affected by 3-5 or more types). 40% types of SDOH Over a third are affected People affected by 0-2 1 in 3 by several types of 23% types of SDOH 6+ types of SDOH (37%). SDOH

Q6-Q13: To what extent do you agree or disagree with each of the following statements? | SDOH 40

High-income individuals are much less affected by SDOH challenges and low-income individuals are more affected. Statistically significant differences, Types of SDOH – by key demographics compared to the general population at 90% % affected by types of SDOH level: Sig. more affected / Sig. less affected

African Asian General Average Hispanic Male Female Gen Z Millennial Gen X Boomers Greatest Low HHI High HHI White American American public HHI American /African /Asian

0-2 SDOH 23% 26% 21% 12% 17% 22% 31% 32% 8% 22% 39% 26% 13% 31% 19% No. SDOH 3-5 SDOH 40% 38% 41% 33% 39% 41% 41% 45% 36% 43% 41% 40% 45% 39% 36% 6-8 SDOH 37% 36% 38% 54% 44% 38% 28% 23% 56% 35% 20% 34% 42% 31% 45%

Types TECH 66% 69% 63% 68% 58% 63% 70% 85% 75% 67% 56% 65% 64% 65% 68% of LITERACY SDOH FINANCIAL 64% 60% 67% 68% 70% 71% 55% 45% 85% 67% 41% 61% 77% 42% 69% KINETICS 60% 57% 64% 62% 60% 59% 62% 63% 71% 60% 51% 61% 60% 48% 64%

INTELLECTUA L PURPOSE 55% 52% 58% 73% 60% 52% 50% 51% 75% 52% 40% 53% 61% 54% 60%

COMMUNITY 55% 53% 57% 65% 64% 55% 47% 39% 68% 53% 43% 52% 63% 61% 57%

FOOD INSECURITY 50% 51% 50% 70% 62% 52% 38% 28% 67% 50% 36% 46% 64% 42% 56%

HEALTH LITERACY 47% 49% 46% 71% 58% 50% 33% 25% 54% 49% 39% 43% 56% 54% 52%

HOUSING SECURITY 46% 45% 47% 50% 53% 49% 37% 39% 56% 45% 38% 43% 48% 45% 54% Q6-Q13: To what extent do you agree or disagree with each of the following statements? | SDOH | Base: U.S. General public – 18+ (n=2,000). 41