2013 COMMUNITY HEALTH NEEDS ASSESSMENT Table of Contents (This page intentionally left blank) Table of Contents Table of Contents EXECUTIVE SUMMARY HISTORY AND ACCOMPLISHMENTS METHODOLOGY DEMOGRAPHICS ACCESS TO QUALITY HEALTH CARE CHRONIC DISEASE HEALTHY ENVIRONMENT HEALTHY MOTHERS, BABIES, CHILDREN INFECTIOUS DISEASE MENTAL HEALTH AND SUBSTANCE ABUSE PHYSICAL ACTIVITY AND NUTRITION TOBACCO USE INJURY CONCLUSIONS PRIORITIZATION AND IMPLEMENTATION Table of Contents (This page intentionally left blank) Table of Contents TABLE OF CONTENTS Executive Summary ............................................................................................................................... iii Methodology ......................................................................................................................................... 3 Demographics ..................................................................................................................................... 23 Access to Quality Health Care ............................................................................................................. 61 Focus group input ................................................................................................................... 82 Stakeholder input.................................................................................................................... 88 Access conclusions .................................................................................................................. 89 Chronic Disease ................................................................................................................................... 93 Focus groups and interviews ................................................................................................. 121 Focus group input ................................................................................................................. 124 Stakeholder input.................................................................................................................. 125 Chronic disease conclusions ................................................................................................. 126 Healthy Environment ........................................................................................................................ 129 Marcellus shale hydraulic fracturing .................................................................................... 141 Focus group input ................................................................................................................. 152 Stakeholder input.................................................................................................................. 154 Healthy environment conclusions ........................................................................................ 155 Healthy Mothers, Babies and Children ............................................................................................. 157 Childhood obesity ................................................................................................................. 169 Focus group input.................................................................................................................. 176 Stakeholder input .................................................................................................................. 178 Healthy mothers, babies and children conclusions .............................................................. 179 Infectious Disease ............................................................................................................................. 181 Focus group input.................................................................................................................. 189 Stakeholder input.................................................................................................................. 191 Infectious disease conclusions .............................................................................................. 192 Mental Health and Substance Abuse ................................................................................................ 195 Focus group input ................................................................................................................. 213 Stakeholder input.................................................................................................................. 214 Mental health and substance abuse conclusions ................................................................. 216 Physical Activity and Nutrition .......................................................................................................... 219 Focus group input ................................................................................................................. 226 Stakeholder input.................................................................................................................. 228 Physical activity and nutrition conclusions ........................................................................... 229 Table of Contents Tobacco Use ...................................................................................................................................... 231 Focus group input ................................................................................................................. 239 Stakeholder input.................................................................................................................. 240 Tobacco use conclusions ....................................................................................................... 241 Injury ................................................................................................................................................. 243 Focus group input ................................................................................................................. 250 Stakeholder input.................................................................................................................. 251 Injury conclusions ................................................................................................................. 252 Conclusions ....................................................................................................................................... 255 Access conclusions ................................................................................................................ 260 Chronic disease conclusions ................................................................................................. 262 Healthy environment conclusions ........................................................................................ 263 Healthy mothers, babies and children conclusions .............................................................. 264 Infectious disease conclusions .............................................................................................. 265 Mental health and substance abuse conclusions ................................................................. 265 Physical activity and nutrition conclusions ........................................................................... 267 Tobacco use conclusions ....................................................................................................... 267 Injury conclusions ................................................................................................................. 268 Prioritization and implementation ................................................................................................... 271 Appendix ......................................................................................................................................... 277 Appendix A: Interview guide ................................................................................................ 277 Appendix B: Focus group topic guide .................................................................................. 279 Table of Contents TABLE OF TABLES Table 1…Steering committee membership .......................................................................................... 7 Table 2…Steering committee dates and agenda topics........................................................................ 7 Table 3...CGH Focus Groups ................................................................................................................ 13 Table 4...Stakeholders interviewed .................................................................................................... 14 Table 5...Classification system employed for inpatient ACSC ............................................................ 15 Table 6...Emergency department ACSC .............................................................................................. 17 Table 7…Prioritization criteria ............................................................................................................ 19 Table 8...CGH primary service area population by zip code ............................................................... 26 Table.9WPAHS primary service area Alzheimer’s care facilities (1 of 2) ............................................ 34 Table 10.WPAHS primary service area Alzheimer’s care facilities (2 of 2) ......................................... 35 Table 11.WPAHS primary service area skilled nursing facilities (1 of 3) ...........................................