PIMA COUNTY Community Health Needs Assessment 2018 Table of Contents Executive Summary & Core Findings ......................................................................................................... 4 Part 1: Introduction ......................................................................................................................................10 CHNA Background & Purpose .................................................................................................................10 Community Defined by CHNA ...........................................................................................................10 Written Comments Received & Evaluation of Impacts of Actions Since Prior CHNA ........................10 Who Was Involved? ................................................................................................................................ 12 CHNA Process & Methods ..................................................................................................................... 13 Secondary Data & Data Sources ...................................................................................................... 13 Primary Data Collection .................................................................................................................... 14 Key Informant Interviews ............................................................................................................ 15 Focus Groups .............................................................................................................................. 16 Community Forums .................................................................................................................... 17 Community Survey ..................................................................................................................... 18 Limitations with Data Sources .......................................................................................................... 20 Part 2: Demographics & Health ................................................................................................................. 21 Community Profile .................................................................................................................................. 21 Location & Geography ...................................................................................................................... 21 Population & Age Distribution ........................................................................................................... 22 Race & Ethnicity ............................................................................................................................... 23 Employment ..................................................................................................................................... 24 Key Social Determinants of Health (SDOH) ............................................................................................ 25 Education .......................................................................................................................................... 27 Health Insurance ............................................................................................................................... 29 Poverty .............................................................................................................................................. 31 Local SDOH Snapshot ...................................................................................................................... 32 Health Indicators ..................................................................................................................................... 33 Access to Health Services ................................................................................................................ 34 Air Quality ......................................................................................................................................... 36 Aging ................................................................................................................................................. 36 Cancer ............................................................................................................................................... 37 Clinical & Preventive Services ........................................................................................................... 39 Diabetes ............................................................................................................................................ 40 Disabilities ......................................................................................................................................... 41 Food Insecurity ................................................................................................................................. 41 Hospital Discharges ......................................................................................................................... 43 Housing Instability ............................................................................................................................ 44 Immunizations .................................................................................................................................. 45 Injury & Violence ............................................................................................................................... 47 Leading Causes of Death .................................................................................................................. 48 Maternal & Infant Health ................................................................................................................. 51 Mental Health ................................................................................................................................... 53 Nutrition ........................................................................................................................................... 55 Obesity ............................................................................................................................................. 56 Physical Activity ................................................................................................................................ 57 Sexually Transmitted Infections ........................................................................................................ 59 Substance Use and Misuse .............................................................................................................. 60 Suicide .............................................................................................................................................. 62 Tobacco Use ..................................................................................................................................... 64 Part 3: Community Input ............................................................................................................................ 64 Key Findings: Community Health Needs, Affected Populations & Proposed Solutions .......................... 67 Behavioral Health ............................................................................................................................. 67 Obesity & Related Chronic Diseases ............................................................................................... 69 Access to Services .......................................................................................................................... 71 Final Forum: Community Prioritized Solutions .........................................................................................74 Community Identified Assets & Resources ............................................................................................ 80 Appendices .................................................................................................................................................. 88 Health Care Facilities .............................................................................................................................. 88 Key Informant Interview Guide ............................................................................................................... 92 Focus Group Guide ................................................................................................................................. 95 Community Survey (English & Spanish) ................................................................................................. 98 Final Forum Rankings.............................................................................................................................102 Qualifications and Credentials of Consulting Team ................................................................................103 Welcome to the 2018 Pima County Community Health Needs Assessment! Executive Summary & Core Findings Welcome to the 2018 Pima County Community Health Needs Assessment, also known as the CHNA. Since the enactment in 2010 of the Patient Protection and Affordable Care Act (PPACA), which requires non-profit hospitals to assess and address the health needs of the communities they serve, Pima County’s nonprofit hospitals have taken a unified, collaborative approach to meeting these requirements by conducting a joint CHNA. Together with public health professionals,