Child & Adolescent Health: A Supplement to the 2015 Community Health Needs Assessment by UChicago Medicine Community Benefit Report

Child & Adolescent Health A Supplement to the 2015 Community Health Needs Assessment

Total Service Area Cook County, Illinois Prepared for: University of Chicago Medicine Comer Childrenâ&#x20AC;&#x2122;s Hospital

By: Professional Research Consultants, Inc. 11326 P Street Omaha, NE 68136-2316 www.PRCCustomResearch.com 2015-0541-02 ÂŠ December 2015

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Table of Contents Introduction

Project Overview

Project Goals

Methodology

Summary Tables: Comparisons With Benchmark Data

Community Description

Linguistic Isolation

Children in Low-Income Households

Perceptions of Health Issues Child Health

35 36

Perceived Top Health Issues

Perceived Availability of Resources

Adolescent Health

Perceived Top Health Issues

Perceived Availability of Resources

Health Status Overall Health Status

40 41

Evaluations of Child’s Overall Health

Activity Limitations

School Days Missed Due to Illness or Injury

Mental Health

Evaluation of Child’s Mental Health

Depression

Anxiety

Sleep Difficulties

Cognitive & Behavioral Disorders

Mental Health Services & Treatment

Chronic Disease & Special Health Needs Prevalence of Selected Medical Conditions

67 68

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Speech & Language Problems

Allergies

Neurological Conditions

Bone, Joint & Muscle Problems

Sickle-Cell Anemia

Asthma

Diabetes

Condition Requiring Prescriptions or Special Therapy

Special Health Needs

Prevalence of Special Health Needs

Managing Childrenâ&#x20AC;&#x2122;s Special Health Needs

Prenatal & Infant Health Prenatal Care

95 96

Lack of Prenatal Care

Birth Outcomes & Risks

Low-Weight Births Child Deaths Infant Mortality

97 99 99

Child & Adolescent Deaths

101

Leading Causes of Child Deaths

102

Family Planning Births to Teen Mothers

Postnatal Care Breastfeeding & Breast Milk

Modifiable Health Risks Nutrition

103 103

105 106

109 110

Fruits & Vegetables

111

Fast Food

114

Physical Activity

116

Recommended Physical Activity

116

Physical Activity Frequency & Duration

118

Screen Time

122

Weight Status

126

Childhood Overweight & Obesity

126

Perceptions of Overweight

129

Tobacco Exposure to Environmental Tobacco Smoke Injury & Safety

131 131 134

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prevalence of Injuries

134

Injury Control

138

Violence & Safety

142

Sexual Activity Chlamydia & Gonorrhea

Access to Health Services Health Insurance Coverage

156 156

158 159

Type of Health Insurance Coverage

159

Lack of Health Insurance Coverage

161

Difficulties Accessing Healthcare

164

Barriers to Healthcare Access

166

Access to Specialty Care

168

Outmigration for Childrenâ&#x20AC;&#x2122;s Healthcare

170

Primary Care Services

172

Usual Source of Care

172

Receipt of Routine Medical Care

175

Dental Care

177

Vision & Hearing

181

Emergent & Urgent Care

185

Emergency Room Utilization

185

Urgent Care Centers/Walk-In Clinics

188

Health Education & Outreach Health Education

190 191

Primary Source of Healthcare Information

191

Local Parenting Education

193

Access to Technology

195

Internet Access

195

Children with Cellphones

196

Introduction

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Project Overview Project Goals The goal of this child and adolescent supplement to the 2015 PRC Community Health Needs Assessment is to gather data to assist in determining the health status, behaviors and needs of children and adolescents in the service area of the University of Chicago Medicine (UCM) Comer Children’s Hospital in Cook County, Illinois. This project was conducted on behalf of UCM Comer Children’s Hospital by Professional Research Consultants, Inc. (PRC). PRC is a nationally-recognized healthcare consulting firm with extensive experience conducting Community Health Needs Assessments in hundreds of communities across the United States since 1994.

Methodology This report incorporates data from primary research (the PRC Child & Adolescent Health Survey) and secondary research (vital statistics and other existing health-related data). It also allows for trending and comparison to benchmark data at the state and national levels.

PRC Community Health Survey Survey Instrument The final survey instrument used for this study was developed by UCM Comer Children’s Hospital and PRC.

Community Defined for This Project The study area for the survey effort (referred to as the “Total Service Area” in this report) includes each of the residential ZIP Codes comprising the hospital’s service area (60609, 60615, 60617, 60619, 60620, 60621, 60628, 60636, 60637, 60643, 60649, and 60653); this community definition was determined based on the areas from which most UCM Comer Children’s Hospital patients originate. A geographic description is illustrated in the following map.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Sample Approach & Design A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Child & Adolescent Health Survey. Thus, to ensure the best representation of the population surveyed, a telephone interview methodology — one that incorporates both landline and cell phone interviews — was employed. The primary advantages of telephone interviewing are timeliness, efficiency and random-selection capabilities. In addition, these telephone interviews were supplemented with surveys among families in the total service area requested to participate in the study via a questionnaire completed online. The sample design used for this effort consisted of a stratified random sample of 462 parents of children under 18 in the UCM Comer Children’s Hospital Service Area. By geography, a total of 148 surveys were conducted in the northwest region of the service area, 174 in the northeast region, and 140 in the southern region. Once the interviews were completed, these were weighted in proportion to the actual child population distribution so as to appropriately represent the hospital’s service area as a whole. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). For statistical purposes, the maximum rate of error associated with a sample size of 462 respondents is ±4.6% at the 95 percent level of confidence.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Expected Error Ranges for a Sample of 462 Respondents at the 95 Percent Level of Confidence ±5.0

±4.5 ±4.0

±3.5 ±3.0

±2.5 ±2.0 ±1.5 ±1.0 ±0.5 ±0.0

0% Note: Examples:

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

The "response rate" (the percentage of a population giving a particular response) determines the error rate associated with that response. A "95 percent level of confidence" indicates that responses would fall within the expected error range on 95 out of 100 trials. If 10% of the sample of 462 respondents answered a certain question with a "yes," it can be asserted that between 7.3% and 12.7% (10% 2.7%) of the total population would offer this response. If 50% of respondents said "yes," one could be certain with a 95 percent level of confidence that between 45.4% and 54.6% (50% 4.6%) of the total population would respond "yes" if asked this question.

Respondent Selection Survey respondents were adults age 18 and older who have children residing in the household for whom they are a healthcare decision-maker. For households with more than one child under the age of 18, most questions were asked about a randomly selected child in the household, determined by which child has had the most recent birthday. This random selection process allows for the best representation of children by age and gender.

Sample Characteristics To accurately represent the population studied (children and adolescents in UCM Comer Children’s Hospital Service Area); PRC strives to minimize bias through application of a proven methodology. And, while this produces a highly representative sample of total service area children and adolescents, it is a common and preferred practice to “weight” the raw data to improve this representativeness even further. This is accomplished by adjusting the results of a random sample to match the geographic distribution and demographic characteristics of the population surveyed (poststratification), so as to eliminate any naturally occurring bias. Specifically, once the raw data are gathered, respondents are examined by key demographic characteristics (namely the child’s gender, age, race/ethnicity, and household poverty status) and a statistical application package applies weighting variables that produce a sample which more closely matches the population for these characteristics. Thus, while the integrity of each individual’s responses is maintained, one respondent’s responses may contribute to the whole the same weight as, for example, 1.1 respondents. Another respondent, whose child’s demographic characteristics may have been slightly oversampled, may contribute the same weight as 0.9 respondents.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

The following chart outlines the characteristics of the UCM Comer Children’s Hospital Service Area sample for key child/adolescent demographics, compared to actual population characteristics revealed in census data.

Population & Survey Sample Characteristics

48.0% 3.8%

15.1%

20%

3.9%

15.4%

31.4%

31.0%

38.0%

38.1%

40%

30.6%

30.9%

49.9%

49.8%

60%

50.1%

50.2%

80%

48.1%

Weighted Survey Sample

78.3%

Actual Population

74.8%

(Total Service Area, 2015) 100%

Boys Sources:

Girls

0 to 5

6 to 12

13 to 17

White

Hispanic

African American

<200% FPL

Census 2010, Summary File 3 (SF 3). U.S. Census Bureau. 2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc.

Further note that the poverty descriptions and segmentation used in this report are based on administrative poverty thresholds determined by the US Department of Health & Human Services. These guidelines define poverty status by household income level and number of persons in the household (e.g., the 2014 guidelines place the poverty threshold for a family of four at $23,850 annual household income or lower). In sample segmentation: “very low income” refers to community members living in a household with defined poverty status; “low income” refers to households with incomes just above the poverty level, earning up to twice the poverty threshold; and “mid/high income” refers to those households living on incomes which are twice or more the federal poverty level. The sample design and the quality control procedures used in the data collection ensure that the sample is representative. Thus, the findings may be generalized to the total child and adolescent population of the UCM Comer Children’s Hospital Service Area with a high degree of confidence.

Public Health, Vital Statistics & Other Data A variety of existing (secondary) data sources was consulted to complement the research quality of this child and adolescent health supplement. Data for UCM Comer Children’s Hospital Service Area were obtained from the following sources (specific citations are included with the graphs throughout this report):  Centers for Disease Control & Prevention, Office of Infectious Disease, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division for Adolescent and School Health

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Centers for Disease Control & Prevention, Office of Public Health Science Services, Center for Surveillance, Epidemiology and Laboratory Services, Division of Health Informatics and Surveillance (DHIS)  Centers for Disease Control & Prevention, Office of Public Health Science Services, National Center for Health Statistics  Community Commons  Cook County Department of Public Health  ESRI ArcGIS Map Gallery  Geolytics Demographic Estimates & Projections  OpenStreetMap (OSM)  US Census Bureau, American Community Survey  US Census Bureau, Decennial Census  US Department of Health & Human Services Note that some secondary data reflect county-level data.

Benchmark Data Trending A similar survey was administered in the total service area in 2012 by PRC on behalf of UCM Comer Children’s Hospital. Trending data, as revealed by comparison to prior survey results, are provided throughout this report whenever available. Historical data for secondary data indicators are also included for the purposes of trending.

National Data National survey data, which are provided in comparison charts, are taken from the 2014 PRC National Child & Adolescent Health Survey; the methodological approach for the national study is similar to that employed in this project, and these data may be generalized to the population of American children and youth with a high degree of confidence. National-level vital statistics are also provided for comparison of secondary data indicators.

Healthy People 2020 Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action. For three decades, Healthy People has established benchmarks and monitored progress over time in order to:  Encourage collaborations across sectors.  Guide individuals toward making informed health decisions.  Measure the impact of prevention activities. Healthy People 2020 is the product of an extensive stakeholder feedback process that is unparalleled in government and health. It integrates input from public health and prevention

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

experts, a wide range of federal, state and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public. More than 8,000 comments were considered in drafting a comprehensive set of Healthy People 2020 objectives.

Determining Significance Differences noted in this report represent those determined to be significant. For surveyderived indicators (which are subject to sampling error), statistical significance is determined based on confidence intervals (at the 95 percent confidence level) using question-specific samples and response rates. For secondary data indicators (which do not carry sampling error, but might be subject to reporting error), “significance,” for the purpose of this report, is determined by a 5% variation from the comparative measure.

Information Gaps While this data collection is quite comprehensive, it cannot measure all possible aspects of child/adolescent health in the community, nor can it adequately represent all possible populations of interest.

It must be recognized that these information gaps might in some

ways limit the ability to assess all of the community’s health needs. For example, certain population groups — such as the homeless, institutionalized children, or children of parents who only speak a language other than English or Spanish — are not represented in the survey data. Other population groups — for example, undocumented residents, and children of certain racial/ethnic or immigrant groups — might not be identifiable or might not be represented in numbers sufficient for independent analyses. In terms of content, this project was designed to provide a comprehensive and broad picture of the health of children and adolescents in the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Summary of Findings Significant Health Needs of the Community The following “areas of opportunity” represent the significant health needs of children and adolescents in the community, based on the information gathered through this child and adolescent health supplement and the guidelines set forth in Healthy People 2020. From these data, opportunities for children’s health improvement exist in the area with regard to the following health issues (see also the summary tables presented in the following section).

Areas of Opportunity Identified in This Supplement  Difficulty Accessing Children’s Healthcare

Access to Healthcare Services

Asthma & Other Respiratory Conditions

o o o o o o o

     

Inconvenient Office Hours Cost of Prescriptions Cost of Physician Visits Appointment Availability Finding a Physician Lack of Transportation Culture/Language Difference

Lack of Health Insurance Emergency Room Utilization Demand for Specialty Care Outmigration Reliance on the Internet for Healthcare Info Internet Access

 Prevalence of Asthma  Hospitalizations Due to Asthma  Loss of Productivity Due to Asthma o Parent Missed Work

 Environmental Tobacco Smoke Exposure in the Home

Diabetes

 Childhood Diabetes Prevalence

Injury & Violence

   

Safety Seat/Seat Belt Usage Helmet Usage Neighborhood Safety Children Feeling Unsafe At School or Going To/From School

Mental Health

     

Parental Awareness of Local Resources Diagnosed Depression. Autism Prevalence Learning Disabilities Developmental Delays ADD/ADHD Prevalence

Nutrition, Physical Activity & Weight

   

Difficulty Accessing Fresh Produce Breast Feeding Prevalence Electronic Devices in Child’s Bedroom Overweight & Obesity

─ continued on next page ─

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Areas of Opportunity (continued) Oral Health

 Children Receiving Dental Sealants

Potentially Disabling Conditions

     

Sexual Health

 Gonorrhea Incidence [All Ages]  Chlamydia Incidence [All Ages]

Vision, Hearing & Speech Conditions

 Vision Problems  Recent Eye Exams

Activity Limitations Respiratory Allergies Eczema/Skin Allergies Brain Injuries/Concussions Epilepsy/Seizure Disorders Sickle-Cell Anemia Prevalence

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Summary Tables: Comparisons With Benchmark Data The following tables provide an overview of child and adolescent health indicators in the Total Service Area, including comparisons among the individual regions, as well as trend data. These data are grouped to correspond with the Focus Areas presented in Healthy People 2020.

TREND SUMMARY (Current vs. Baseline Data)

Reading the Summary Tables  In the following charts, Total Service Area results are shown in the larger, blue column.  The green columns [to the left of the Total Service Area column] provide comparisons

Survey Data Indicators: Trends for survey-derived indicators represent significant changes since 2012. Note that survey data reflect the ZIP Codedefined total service area.

among the three regions, identifying differences for each as “better than” (B), “worse than”

Other (Secondary) Data Indicators: Trends for other indicators (e.g., public health data) represent point-to-point changes between the most current reporting period and the earliest presented in this report (typically representing the span of roughly a decade). Note that secondary data may reflect county-level data for the total service area.

People 2020 targets. Again, symbols indicate whether the Total Service Area compares

(h), or “similar to” (d) the combined opposing regions.  The columns to the right of the Total Service Area column provide trending, as well as comparisons between local data and any available state and national findings, and Healthy favorably (B), unfavorably (h), or comparably (d) to these external data. Note that blank table cells signify that data are not available or are not reliable for that area and/or for that indicator.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Social Determinants

Northwest

Northeast

South

Total Service Area 2.8

Linguistically Isolated Population (Percent)

Total Service Area vs. Benchmarks vs. IL

vs. US

5.1

68.8

Children Below 200% FPL (Percent)

40.8 Note: In the green section, each region is compared against all other regions combined. Throughout these tables, a blank or empty cell indicates that data are not available for this indicator or that sample sizes are too small to provide meaningful results.

Each Region vs. Others Overall Health % [Age 0-17] Child's Overall Health Is "Fair/Poor"

Northwest

Northeast

South

8.1

10.3

11.5

14.9

4.4

9.7

% [Age 0-17] Child's Activities/Abilities Limited Due to Health Condition

% [Age 5-17] Missed 10+ School Days Last Yr Due to Illness/Injury

Total Service Area

4.5

7.2

3.4

TREND

4.8

43.8

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

7.3

vs. US

vs. HP2020

TREND

2.3

9.3

6.9

9.9

4.6

Note: In the green section, each region is compared against all other regions combined. Throughout these tables, a blank or empty cell indicates that data are not available for this indicator or that sample sizes are too small to provide meaningful results.

vs. HP2020

6.1

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Access to Health Services % [Age 0-17] Child Is Uninsured

Northwest

Northeast

South

7.3

8.9

23.8

8.3

% [Insured Child] Child Went Without Insurance in Past Year

9.9

% [Insured Child] Received Insurance In Past Two Years Because of Affordable Care Act or GetCoveredIllinois % [Age 0-17] Difficulties Accessing Childâ&#x20AC;&#x2122;s Healthcare (Composite)

% [Age 0-17] Difficulty Finding Physician for Child in Past Year

% [Age 0-17] Difficulty Getting Appointment for Child in Past Year

% [Age 0-17] Cost Prevented Child's Dr Visit in Past Year

% [Age 0-17] Transportation Hindered Child's Dr Visit in Past Year

% [Age 0-17] Inconvenient Hrs Prevented Child's Dr Visit in Past Year

% [Age 0-17] Cost Prevented Getting Child's Prescription in Past Year

6.2

7.4

7.0

8.9

24.8

48.0

44.1

41.8

55.0

14.0

18.2

10.4

12.3

24.1

25.3

10.0

10.5

12.6

14.5

13.1

18.1

32.0

8.8

8.0

TREND

38.5

12.9

6.2

4.2

d 9.9

37.8

8.1

11.5

16.6

14.2

9.4

0.0

29.4

4.1

24.0

4.3

vs. HP2020

6.3

29.7

3.9

vs. US

5.7

22.7

9.7

vs. IL

7.1

19.6

6.7

Total Service Area vs. Benchmarks

6.5

25.4

21.1 % [Age 0-17] Culture Difference Prevented Child's Dr Visit in Past Year

Total Service Area

h 5.5

6.8

8.8

23.0

10.9

h 0.8

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Access to Health Services (continued) % Child Needed to See a Specialist in the Past Year

% [Child Needing Care] "Major/Moderate" Problem Getting Specialty Care

% [Age 0-17] Child Has a Usual Source of Medical Care

% [Age 0-17] Child Has Had Routine Checkup in Past Year

% [Age 0-17] Child Has Had 2+ ER Visits in Past Year

% [Age 0-17] Child Used Some Type of UCC in the Past Year

% [Parents] Feel Need to Leave the Area for Childrenâ&#x20AC;&#x2122;s Health Svcs

Total Service Area

Northwest

Northeast

South

37.9

42.5

37.8

33.9

34.9

38.6

25.1

93.3

95.8

95.1

93.5

96.5

91.4

16.9

17.5

13.0

33.0 49.3

55.6

45.1

% [Age 0-17] Child Has Respiratory Allergies

Northwest

Northeast

South

26.2

14.1

18.5

100.0

85.2

91.5

7.1

14.6

28.6

27.2

Allergies

38.7

46.1

Each Region vs. Others

d B

TREND

25.0

85.3

20.8

vs. HP2020

89.3

93.8

26.3

vs. US

32.3

89.5

35.1

vs. IL

24.2

41.6

39.5

Total Service Area vs. Benchmarks

Total Service Area 20.3

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

vs. US

17.8

vs. HP2020

TREND

12.9

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Allergies (continued) % [Age 0-17] Child Has Food/Digestive Allergies

% [Age 0-17] Child Has Eczema/Skin Allergies

Total Service Area

Northwest

Northeast

South

12.5

10.6

12.2

31.9

32.1

28.8

Northwest

Northeast

South

24.9

18.4

vs. HP2020

8.9

22.5

Total Service Area

26.7

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

19.9

vs. US

vs. HP2020

17.3

46.8

23.3

58.7

0.6

% [Age 5-17 With Asthma] Child Missed School Due to Asthma in Past Year

51.2

16.0

39.2 % [Age 0-17 With Asthma] Parent Missed Work Due to Child's Asthma in Past Year

56.1

57.7

29.4 Note: In the green section, each region is compared against all other regions combined. Throughout these tables, a blank or empty cell indicates that data are not available for this indicator or that sample sizes are too small to provide meaningful results.

TREND

11.6

55.1

% [Age 0-17 With Asthma] Child Hospitalized for Asthma in Past Year

TREND

8.8

16.4

% [Age 0-17 With Asthma] ER/Urgent Care for Child's Asthma in Past Year

vs. US

33.6

Each Region vs. Others

% [Age 0-17] Child Currently Has Asthma

vs. IL

8.0

Asthma

Total Service Area vs. Benchmarks

49.0

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Bone, Joint & Muscle Disorders % [Age 0-17] Child Has Bone/Joint/Muscle Problems

Northwest

Northeast

South

7.6

3.9

Total Service Area

% [Age 0-17] Child Has Learning Disability

% [Age 0-17] Child Has Developmental Delays

South

5.0

10.6

12.0

16.9

10.1

11.2

9.5

9.0

6.2

14.5 % [Age 0-17] Child Has ADD/ADHD

% [Age 5-17] Child Has Behavioral/Conduct Problems

Total Service Area

Northeast

8.9

2.9

6.4

5.6

TREND

d 3.0

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

5.8

vs. US

vs. HP2020

3.7

8.0

8.2

7.3

6.8

9.1

5.7

8.7

4.2

TREND

h 1.4

8.5

vs. HP2020

6.0

Northwest

5.4

vs. US

2.8

Each Region vs. Others

% [Age 5-17] Child Has Autism

vs. IL

4.8

Cognitive & Behavioral Disorders

Total Service Area vs. Benchmarks

5.1

3.7

3.4

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Diabetes % [Age 0-17] Child Has Diabetes/High Blood Sugar

Northwest

Northeast

South

4.2

1.9

Total Service Area

% [Age 0-17] Parent Aware of Local Parenting Education Programs

% [Age 0-17] Parent Has Used a Local Parenting Education Program

Total Service Area

Northeast

South

16.7 31.0

15.3

17.4

35.2

37.6

53.4

vs. HP2020

1.2

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

vs. US

vs. HP2020

TREND

9.6

11.8

23.4

37.1

43.8

43.0

TREND

0.7

Northwest

16.7

vs. US

1.0

Each Region vs. Others

% Rely on the Internet for Healthcare Information

vs. IL

2.3

Health Education

Total Service Area vs. Benchmarks

38.4

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Injury & Safety % [Age 0-17] Child Has Sustained Injury Requiring Treatment in Past Year % [Age 0-17] Child "Always" Uses Seat Belt/Car Seat

% [Age 5-17] Child "Always" Wear a Bike Helmet % [Age 5-17] Child "Always" Wear a Skateboard/Scooter/Rollerblade Helmet % [Age 0-17] Neighborhood Is "Slightly" or "Not At All" Safe % [Age 5-17] Child Missed School in Past Year Because Felt Unsafe At School

Northwest

Northeast

South

14.6

9.4

10.4

92.4

91.1

34.3

48.2

31.3

28.5

35.5

22.8

56.8

53.4

54.5

8.0

5.9

8.6

% [Age 5-17] Gang Violence Made Child Feel Unsafe in Past Year

15.2

15.4

23.6

% [Age 5-17] Child Changed Normal Daily Routine in Past Year Due to Not Feeling Safe

9.2

12.6

6.0

12.0

d h h h

37.4

61.8

12.9

vs. US

46.5

30.5

5.6

vs. IL

95.7

29.4

5.9

Total Service Area vs. Benchmarks

10.6

96.5

9.7

% [Age 5-17] Child Missed School in Past Year Because Felt Unsafe At School or Going To/From

5.5

91.1

10.8 % [Age 5-17] Child Missed School in Past Year Because Felt Unsafe Going To/From School

Total Service Area

14.2

vs. HP2020

TREND

d 8.0

92.9

29.3

18.7

62.9

6.4

2.8

6.4

h 5.0

11.5

7.7

4.9

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Injury & Safety (continued) % [Age 5-17] Child talked to Parent About a Violent Incident that Affected Them % [Age 5-17] Bullied on School Property in the Past Year

% [Age 5-17] Child Electronically Bullied in Past Year

Northwest

Northeast

South

23.5

31.6

23.3

16.5

20.8

26.9

19.1

16.5

5.8

6.6

9.4

% [Age 5-17] Child Physically Injured from Bullying/Fighting in Past Year

Total Service Area

8.5

5.9

6.8

% [Age 5-17] Parent Aware of Community Mental Health Resources

% [Age 5-17] Needed Mental Health Svcs in the Past Yr

Total Service Area

South

6.6

46.4 12.6

5.4

41.5

48.3

49.6

14.2

12.2

TREND

4.8

Northeast

6.7

vs. HP2020

7.5

Northwest

7.8

vs. US

2.7

Each Region vs. Others

% [Age 5-17] Child's Mental Health Is "Fair/Poor"

vs. IL

16.1

Mental & Emotional Health

Total Service Area vs. Benchmarks

11.4

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

vs. US

vs. HP2020

TREND

5.5

9.7

65.0

46.4

10.8

8.4

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Mental & Emotional Health (continued)

Northwest

Northeast

South

% [Age 5-17] Child Unable to Get Needed Mental Health Svcs in Past Year % [Age 5-17] Child Has Ever Taken Rx for Mental Health

% [Age 5-17] Child Has Anxiety

% [Age 5-17] Child Has Difficulty Sleeping

% [Age 5-17] Child Had Symptoms of Depression in Past Year

6.0

23.1

8.4

vs. IL

20.4

12.2

8.0

9.1

11.4

10.7

12.1

7.5

5.2

8.8

5.5

19.3

d 4.4

23.0

19.1

7.9

4.3

9.0

7.9

13.2

11.8

4.9

1.9

TREND

19.3

4.7

vs. HP2020

6.9

29.0

6.5

vs. US

4.0

22.8

7.5

% [Age 5-17] Child Has Depression

Total Service Area vs. Benchmarks

16.3

6.6

% [Age 5-17] Child Worries A Lot

Total Service Area

6.0

2.6

4.4

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Mortality

Northwest

Northeast

South

Total Service Area 23.9

[Age 1-4] Mortality Rate per 100,000 (Cook County)

Total Service Area vs. Benchmarks vs. IL

23.1

12.1

[Age 5-9] Mortality Rate per 100,000 (Cook County)

11.2

15.5

[Age 10-14] Mortality Rate per 100,000 (Cook County)

13.7

61.2

[Age 15-19] Mortality Rate per 100,000 (Cook County) Note: In the green section, each region is compared against all other regions combined. Throughout these tables, a blank or empty cell indicates that data are not available for this indicator or that sample sizes are too small to provide meaningful results.

Each Region vs. Others Neurological Disorders % [Age 0-17] Child Has Migraines/Severe Headaches

Northwest

Northeast

South

6.6

5.5

2.3

5.4

% [Age 0-17] Child Has Brain Injury/Concussion

7.4

% [Age 0-17] Child Has Epilepsy/Seizure Disorder

Total Service Area

4.8

8.8

3.0

1.6

26.0

11.7

14.1

vs. HP2020

TREND

25.7

12.3

15.2

51.0

47.0

55.7

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

6.5

vs. US

vs. HP2020

4.0

3.9

0.4

TREND

d 6.7

5.3

vs. US

1.6

0.8

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Nutrition & Weight % [Age 2-17] Child Has 5+ Servings of Fruits/Vegetables per Day

% "Very/Somewhat" Difficult to Buy Fresh Produce

% [Age 2-17] Child Ate 3+ Fast Food Meals in Past Week

% [Age 5-17] Child Is Overweight or Obese

% [Age 5-17] Child Is Obese

Total Service Area

Northwest

Northeast

South

46.0

43.2

54.3

43.8

34.5

26.2

34.8

26.3

29.5

23.7

44.0 29.0

47.7

35.7

18.8

vs. HP2020

42.0

22.0

27.9

31.1

14.4

47.5

40.1

14.5

27.3

55.8

16.3 Note: In the green section, each region is compared against all other regions combined. Throughout these tables, a blank or empty cell indicates that data are not available for this indicator or that sample sizes are too small to provide meaningful results.

23.8

57.3 % [Parents] Have Been Told That Overwt Child [5-17] Is Overweight

TREND

29.2

% [Overweight Kids 5-17] Perceive Child "About the Right Weight"

vs. US

28.2

27.1

30.9

vs. IL

41.8

39.6

48.4

Total Service Area vs. Benchmarks

27.1

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Oral Health % [Age 2-17] Child Has Had a Dental Visit in Past Year

% [Age 6-17] Child Has Had Dental Sealants

Total Service Area

Northwest

Northeast

South

85.8 32.0

87.3

93.1

80.5

35.7

34.6

% [Age 2-17] Participates in Vigorous Physical Activity

% [Age 2-17] Participates in Moderate Physical Activity

% [Age 2-17] Participates in Muscle-Strengthening Activities

% [Age 5-17] Child Watches 3+ Hours of TV per Day

% [Age 5-17] Child Has a TV in Bedroom

Total Service Area

Northeast

South

44.4

33.3

48.3

51.6

69.7

79.1

65.8

46.9

55.7

49.5

50.6

54.7

46.9

34.6 59.9

60.2

54.8

62.2

84.6

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

vs. US

d d d

49.3

52.5

TREND

35.1

69.1

38.6

32.0

49.0

43.2

68.7

31.4

vs. HP2020

46.8

Northwest

39.3

vs. US

27.6

Each Region vs. Others

% [Age 2-17] Child Was Physically Active One Hour/Day in Past Week

vs. IL

84.9

Physical Activity

Total Service Area vs. Benchmarks

vs. HP2020

TREND

37.1

56.4

34.5

36.9

41.3

58.1

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Physical Activity (continued) % [Age 5-17] Child Has 3+ Hours of Computer Use per Day

% [Age 5-17] Has Computer/Device in the Bedroom

% [Age 5-17] Child Has 3+ Hours of Total Screen Time per Day

Total Service Area

Northwest

Northeast

South

19.6

22.7

15.1

19.3

50.4 58.4

48.4

58.8

47.7

60.6

52.3

Northeast

South

Total Service Area

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

6.7

49.7

67.6

68.0

61.3

vs. HP2020

TREND

17.3

22.1

6.3

vs. US

5.4

4.0

Infant Death Rate (Cook County)

TREND

54.3

8.9

% of Low Birthweight Births (Cook County)

vs. HP2020

39.4

5.6

% No Prenatal Care in First Trimester (Cook County)

% [Age 0-17] Child Was Ever Breastfed

vs. US

59.6

Each Region vs. Others Northwest

vs. IL

19.0

Prenatal & Infant Health

Total Service Area vs. Benchmarks

8.0

6.0

69.4

7.8

6.0

81.9

9.1

8.6

64.8

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Prenatal & Infant Health (continued)

Northwest

Northeast

South

% Exclusively Breastfed Until 6 Months

11.8

18.1

Total Service Area

Northeast

South

27.2

Total Service Area 230.8

[All Ages] Gonorrhea Incidence per 100,000 (Cook County)

727.3 7.9

% Births to Teenagers (Under Age 20) (Cook County)

TREND

25.5

similar

worse

Total Service Area vs. Benchmarks vs. IL

h h

vs. US

vs. HP2020

TREND

107.5

526.0

456.7

7.6

vs. HP2020

better

141.0 [All Ages] Chlamydia Incidence per 100,000 (Cook County)

vs. US

22.3

Each Region vs. Others Northwest

vs. IL

17.6

Sexual Activity

Total Service Area vs. Benchmarks

7.8

10.7

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Sickle-Cell Anemia % [Age 0-17] Child Has Sickle-Cell Anemia

Northwest

Northeast

South

6.1

2.7

Total Service Area

% [Age 0-17] Condition Requiring Meds

% [Age 0-17] Condition Requiring Special Therapy

Total Service Area

Northeast

South

66.9

70.2

65.0

36.8 11.5

42.1

34.7

33.4

10.7

vs. HP2020

h B

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

vs. US

vs. HP2020

TREND

68.3

60.3

10.1

TREND

1.1

Northwest

13.5

vs. US

0.9

Each Region vs. Others

% [Age 0-17] Child Has Special Health Needs

vs. IL

3.2

Special Health Needs

Total Service Area vs. Benchmarks

27.3

28.0

8.3

7.8

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Technology Access % Have Access to the Internet

% [Age 5-17] Child Has Own Cell Phone

Total Service Area

Northwest

Northeast

South

94.8 54.8

90.7

97.5

96.8

49.3

58.9

% [Age 0-17] Household Member Smokes Outside the Home

Total Service Area

Northeast

South

14.4 23.2

13.5

12.3

25.4

19.5

vs. HP2020

48.6

better

similar

worse

Total Service Area vs. Benchmarks vs. IL

vs. US

vs. HP2020

TREND

3.7

14.7

23.3

TREND

96.7

43.0

Northwest

17.4

vs. US

57.5

Each Region vs. Others

% [Age 0-17] Household Member Smokes Inside the Home

vs. IL

97.2

Tobacco

Total Service Area vs. Benchmarks

27.4

better

similar

worse

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Each Region vs. Others Vision, Hearing & Speech % [Age 0-17] Child Has Vision Problems

Northwest

Northeast

South

7.7

7.4

11.7

8.1

12.1

12.9

13.0 % [Age 0-17] Child Has Hearing Problems

10.2 % [Age 0-17] Child Has Speech/Language Problems

13.5 % [Age 0-17] Child Has Had 3+ Ear Infections (Ever)

% [Age 0-17] Child Has Had an Eye Exam in the Past 3 Years

% [Age 0-17] Child Has Had Hearing Tested in the Past 5 Years

Total Service Area

3.9

2.7

7.7

84.3 89.8

84.9

4.7

5.3

8.8

23.5

13.5

78.8

89.3

88.9

TREND

11.9

82.9

vs. HP2020

4.9

13.6

84.6

vs. US

2.5

10.2

84.3

vs. IL

5.1

14.0

94.2

Total Service Area vs. Benchmarks

84.9

87.7

better

similar

worse

Community Description

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Linguistic Isolation A total of 2.8% of the Total Service Area population age 5 and older live in a home in which no persons age 14 or older is proficient in English (speaking only English, or speaking English “very well”).  Lower than found statewide.  Lower than national findings.

Linguistically Isolated Population (2009-2013) 100%

80%

60%

40%

20%

2.8%

5.1%

4.8%

Total Service Area

Sources: Notes:

US Census Bureau American Community Survey 5-year estimates (2009-2013). Retrieved November 2015 from Community Commons at http://www.chna.org. This indicator reports the percentage of the population aged 5 and older who live in a home in which no person 14 years old and over speaks only English, or in which no person 14 years old and over speak a non-English language and speak English "very well."

In the survey, the vast majority of Total Service Area parents (95.7%) reported that English is the primary language spoken in their home, whereas 1.8% designated Spanish as the primary language, and 0.8% mentioned both English and Spanish. Other languages were only mentioned by 0.7% of respondents. [Note that the survey was conducted only in English and Spanish.]

Primary Language Spoken in the Home (Total Service Area, 2015) Spanish 1.8%

Don't Know/Not Sure 0.9% English and Spanish 0.8% Other 0.7% English 95.7%

Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 313] Asked of all respondents.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Children in Low-Income Households Additionally, 68.8% of Total Service Area children age 0-17 (representing an estimated 112,457 children) live below the 200% poverty threshold.  Well above the proportion found throughout Illinois.  Well above the US proportion.

Percent of Children in Low-Income Households (Children 0-17 Living Below 200% of the Poverty Level, 2009-2013) 100%

112,457 children 80%

68.8% 60%

40.8%

40%

43.8%

20%

Total Service Area Sources: Notes:

US Census Bureau American Community Survey 5-year estimates (2009-2013). Retrieved November 2015 from Community Commons at http://www.chna.org. This indicator reports the percentage of children aged 0-17 living in households with income below 200% of the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, healthy food, and other necessities that contribute to poor health status.

 Dark blue shading in the following graph shows the areas within the Total Service Area in which over 50% of children are living in low income households. Children (0-17) Living Below 200% of Poverty, Percent by Tract, ACS 2009-2013

Perceptions of Health Issues

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Health Perceived Top Health Issues The interrelated issues of obesity, nutrition and exercise received the largest share of The initial inquiry of the PRC Child & Adolescent Health Survey asked respondents the following: “In general, what do you feel is the number-one health issue affecting children under the age of 12 in your community today?” This question was open-ended, meaning that respondents were free to mention whatever came to mind, and their verbatim responses were recorded. These responses were then grouped thematically for reporting here.

responses (27.7%) as the perceived number-one health issue for children under the age of 12 among parents of children in that age group. Asthma followed with 22.7% of responses.  Respondents also frequently identified colds/flu (12.6%), allergies (3.7%), and lack of insurance (3.1%).

Perceived Number-One Health Issue Affecting Children Under 12 in the Community (Among Total Service Area Parents With a Child Age 0-11, 2015) Other (Each <3%) 22.7 %

Obesity (18.7%) Nutrition (8.4%) Exercise (0.6%)

Lack of Insurance 3.1 %

Obesity/Nutrition/Exercise 27.7 %

Allergies 3.7 % Don't Know/Nothing 7.7 %

Colds/Flu 12.6 %

Sources: Notes:

Asthma 22.7 %

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 7] Reflects respondents with a child under age 12 in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Perceived Availability of Resources Respondents were further asked to identify their perceptions of the availability of resources in the community to address that issue that they identified as the number-one concern. Those who mentioned obesity, nutrition or exercise as the top childrenâ&#x20AC;&#x2122;s health issue largely see community resources as insufficient (or non-existent) to address these problems. In contrast, the community resources that are available for asthma issues are mostly seen as sufficient or more than sufficient by the respondents who chose asthma as the number one health issue for children.

Perception of Existing Community Resources or Services for Number-One Health Issue Affecting Children Under 12 (By Perceived Primary Health Issue; Total Service Area, 2015) 100%

Sufficient/More Than Sufficient Insufficient 80%

Not Available 64.8%

60%

50.7%

40%

27.2%

22.1%

25.3%

20%

9.8% 0%

Obesity/Nutrition/Exercise Sources: Notes:

Asthma

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 8] Among respondents with children under age 12 who identified a top health concern.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Adolescent Health “In general, what do you feel is the number-one health issue affecting adolescents age 12-17 in your community today?”

Perceived Top Health Issues Combined, obesity, nutrition and exercise received the largest share of responses (23.0%) when parents of children age 12-17 were asked to name the number-one health issue for adolescents.  Other frequent responses included asthma (mentioned by 9.1%), illegal drugs (8.0%), crime/violence (4.9%), availability of healthcare (3.8%), ADD/ADHD (3.4%), and guns (3.0%).

Perceived Number-One Health Issue Affecting Adolescents (12-17) in the Community (Among Total Service Area Parents With an Adolescent Age 12-17, 2015) Other (Each <3%) 32.7%

Guns 3.0%

Obesity (14.6%) Nutrition (7.3%) Exercise (1.1%)

Obesity/Nutrition/Exercise 23.0%

ADD/ADHD 3.4% Availability of Healthcare 3.8%

Crime/Violence 4.9% Illegal Drugs 8.0%

Sources: Notes:

Don't Know/Nothing 12.0% Asthma 9.1%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 9] Reflects respondents with an adolescent age 12-17 in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Perceived Availability of Resources Respondents were further asked to identify their perceptions of the availability of resources in the community to address that issue that they identified as the number-one concern. A majority of those identifying obesity/nutrition/exercise as their top concerns for adolescents views community resources as insufficient (or nonexistent) to address these needs. Although based on relatively small samples, asthma resources are frequently perceived as sufficient or more than sufficient by those who see asthma as the main health issue, while half of respondents choosing illegal drugs as the top concern say that there are no services available to deal with the issue.

Perception of Existing Community Resources or Services for Number-One Health Issue Affecting Adolescents (By Perceived Primary Health Issue; Total Service Area, 2015) 100%

Sufficient/More Than Sufficient

Insufficient

Not Available

80%

62.5% 60%

50.8%

48.8% 40%

20%

34.4%

40.0% 29.5%

16.8% 8.0%

9.2%

Obesity/Nutrition/Exercise Sources: Notes:

Asthma*

Illegal Drugs*

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 10] Among respondents with children age 12-17 who identified a top health concern. *Note that these responses are based on a relatively small sample size (n<50).

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Health Status

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Overall Health Status Evaluations of Child’s Overall Health “Would you say that in general your child’s health is: excellent, very good, good, fair or poor?”

Most Total Service Area parents rate their child’s overall health as “excellent” (42.8%) or “very good” (26.9%).  Another 22.2% gave “good” ratings of their child’s overall health.

NOTE:

Child’s Health Status

Differences noted in the text represent significant differences determined through statistical testing.

(Total Service Area, 2015) Good 22.2%

The terms “child” and “children” are used throughout this report to refer to children and adolescents of all ages (0-17), unless otherwise specified. Although survey respondents are often referred to as “parents” throughout this report, they may in fact be a grandparent or other guardian for a child in the household.

Very Good 26.9%

Fair 7.1%

Poor 1.0%

Excellent 42.8% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 18] Asked of all respondents about a randomly selected child in the household.

However, 8.1% of Total Service Area adults believe that their child’s overall health is “fair” or “poor.”  Less favorable than the national proportion. NOTE: Where sample sizes permit, county data are provided.

 Statistically similar by region.  TREND: There is no statistical difference when comparing “fair/poor” overall health reports to previous survey results.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Experiences “Fair” or “Poor” Overall Health 100%

80%

60%

40%

20%

9.7%

7.2%

7.3%

8.1%

Northeast

South

Total Service Area

2.3%

6.9%

8.1%

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 18] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 When viewed by children’s basic demographic characteristics, Black children and those in lower income households are more likely to have reported “fair/poor” health (negative correlation with income).  Other differences among demographic groups are not statistically significant. Charts throughout this report (such as that here) detail survey findings among key demographic groups – namely by gender, age groupings, household income (based on poverty status), and child’s race/ethnicity.

Experience “Fair” or “Poor” Overall Health (Total Service Area, 2015) 100%

80%

60%

40%

17.4%

20%

7.5%

8.8%

7.6%

9.7%

6.8%

9.2%

4.5%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

9.2% 0.9% White

Black

5.0% Other

8.1% TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 18] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Activity Limitations A total of 11.5% of Total Service Area children are limited or prevented in some way in their ability to do things most children of the same age can do because of a medical, behavioral, or other health condition.  Less favorable than the US figure.  No statistical difference by region.  TREND: Statistically similar to 2012 findings.

Prevalence of Activity Limitations 100%

80%

60%

40%

14.9%

20%

10.3%

9.3%

11.5%

Northeast

South

Total Service Area

6.9%

9.9%

11.5%

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 75] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Children in lower income households report a significantly higher prevalence of activity limitations (negative correlation with income).

Prevalence of Activity Limitations (Total Service Area, 2015) 100%

80%

60%

40%

21.2% 20%

12.6%

10.5%

7.9%

Boy

Girl

Age 0 to 4

13.7%

12.3%

10.2%

8.7%

11.0%

10.8%

13.5%

11.5%

Low Income

Mid/High Income

White

Black

Other

TSA

Sources: Notes:

Age 5 to 12

Age Very Low 13 to 17 Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 75] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Activity limitations among Total Service Area children are most often attributed to conditions such as asthma (mentioned by 23.1% of parents of children with activity limitations), autism (15.5%), ADHD (10.8%), chronic coughing (5.3%), Down syndrome (4.7%), or learning disabilities (4.6%).

Type of Problem That Limits Activities (Among Children Reporting Activity Limitations; Total Service Area, 2015) 0%

20%

Asthma

80%

100%

15.5%

ADHD

Sources: Notes:

60%

23.1%

Autism

10.8%

Chronic Coughing

5.3%

Down Syndrome

4.7%

Learning Disabilities

4.6%

Don't Know/Not Sure

4.2%

Various Other (<4% Each)

40%

31.7%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 77] Asked of respondents for whom the randomly selected child in the household has some type of activity limitation.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

School Days Missed Due to Illness or Injury “During the past 12 months, about how many times did this child miss school because of illness or injury?”

While most Total Service Area school-age children (age 5-17) missed two or fewer school days in the past year due to illness or injury, 4.4% are reported to have missed 10 or more.

Number of School Days Missed in the Past Year Due to Illness or Injury (Total Service Area Children Age 5-17, 2015) One 14.6%

Two 14.1%

Three 11.0%

Four 4.3% Five 4.4%

None 43.1%

Six to eight 4.2% 10 or More 4.4% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 111] Asked of all respondents for whom the randomly selected child in the household is age 5 to 17.

 The prevalence of school-age children who missed 10 or more days of school in the past year due to illness or injury is similar to US reports.  Similar by region.

Child Missed 10+ School Days in the Past Year Due to Illness or Injury (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

4.5%

3.4%

4.6%

4.4%

6.1%

Northwest

Northeast

South

Total Service Area

Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 111] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household is age 5 to 17.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Boys and children living in low income households (100-199% of FPL) are more likely to have missed 10 or more school days in the past year due to injury or illness.

Child Missed 10+ School Days in the Past Year Due to Illness or Injury (Total Service Area Children Age 5-17, 2015)

100%

80%

60%

40%

20%

6.3%

2.2%

3.0%

0.8%

Age 5 to 12

Age 13 to 17

Very Low Income

Boy Sources: Notes:

Girl

7.7%

5.4%

Low Income

11.6% 4.9%

2.5%

2.7%

Mid/High Income

White

Black

4.4% Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 111] Asked of all respondents for whom the randomly selected child in the household is age 5 to 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Mental Health About Mental Health & Mental Disorders The existing model for understanding mental health and mental disorders emphasizes the interaction of social, environmental, and genetic factors throughout the lifespan. In behavioral health, researchers identify: risk factors, which predispose individuals to mental illness; and protective factors, which protect them from developing mental disorders. Researchers now know that the prevention of mental, emotional, and behavioral (MEB) disorders is inherently interdisciplinary and draws on a variety of different strategies. Over the past 20 years, research on the prevention of mental disorders has progressed. The major areas of progress include evidence that:  MEB disorders are common and begin early in life.  The greatest opportunity for prevention is among young people.  There are multiyear effects of multiple preventive interventions on reducing substance abuse, conduct disorder, antisocial behavior, aggression, and child maltreatment.  The incidence of depression among pregnant girls and adolescents can be reduced.  School-based violence prevention can reduce the base rate of aggressive problems in an average school by 25 to 33%.  There are potential indicated preventive interventions for schizophrenia.  Improving family functioning and positive parenting can have positive outcomes on mental health and can reduce poverty-related risk.  School-based preventive interventions aimed at improving social and emotional outcomes can also improve academic outcomes.  Interventions targeting families dealing with adversities, such as parental depression or divorce, can be effective in reducing risk for depression in children and increasing effective parenting.  Some preventive interventions have benefits that exceed costs, with the available evidence strongest for early childhood interventions.  Implementation is complex, it is important that interventions be relevant to the target audiences.  In addition to advancements in the prevention of mental disorders, there continues to be steady progress in treating mental disorders as new drugs and stronger evidence-based outcomes become available. –

Healthy People 2020 (www.healthypeople.gov)

Evaluation of Child’s Mental Health “Now thinking about your child’s mental health, which includes stress, depression and problems with emotions, would you say that, in general, your child’s mental health is: excellent, very good, good, fair or poor?”

Nearly three-fourths (74.8%) of Total Service Area parents of children age 5-17 rate their child’s mental health — which includes stress, depression, and problems with emotions — as “excellent” (45.4%) or “very good” (29.4%).  Another 18.7% gave “good” ratings of their child’s mental health status.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child’s Mental Health Status (Total Service Area Children Age 5-17, 2015) Very Good 29.4% Good 18.7%

Fair 5.7% Poor 0.9%

Excellent 45.4% Sources: Notes:

However, 6.6% of Total Service Area parents believe that their school-age child’s mental health is “fair” or “poor.”  Similar to national findings.  No statistically significant difference within the Total Service Area.  TREND: Statistically similar to 2012 survey findings.

Child Experiences “Fair” or “Poor” Mental Health (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

7.8%

6.7%

5.4%

6.6%

5.5%

Northwest

Northeast

South

Total Service Area

9.7%

6.6%

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 90] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 “Fair/poor” mental health status among children age 5-17 is much more prevalent among very low income households.  Black children are also more often reported to have “fair/poor” mental health.

Child Experiences “Fair” or “Poor” Mental Health (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

15.6%

20%

6.6%

6.5%

5.6%

7.8%

Boy

Girl

Age 5 to 12

Age 13 to 17

3.9%

3.7%

1.7%

Low Income

Mid/High Income

White

7.6%

4.4%

6.6%

Other

TSA

Sources: Notes:

Very Low Income

Black

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 90] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Depression Prevalence of Diagnosed Depression A total of 5.2% of Total Service Area parents report that they have been told by a doctor or other healthcare provider that their school-age child had depression.  Twice the proportion found across the US.  Highest in the northwest region; lowest in the south.  TREND: Statistically unchanged since 2012. Note that 14.2% of these respondents characterize their child’s depression as “severe.”

Child Has Been Diagnosed with Depression (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

Characterized as: Severe 14.2% Moderate 11.3% Mild 74.5%

40%

20%

8.8%

5.5%

1.9%

5.2%

2.6%

4.4%

5.2%

Total Service Area

2012

2015

Northwest

Northeast

South

Total Service Area Sources:

Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 99-100] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

 “Other” race children are statistically more likely to have diagnosed depression than their demographic counterparts.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Has Been Diagnosed with Depression (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

5.0%

5.4%

4.4%

6.1%

5.1%

3.2%

Boy

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

13.3%

7.4%

6.9%

Mid/High Income

White

5.2%

3.4%

Sources: Notes:

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 99] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Signs of Depression A total of 7.5% of Total Service Area parents indicate that their school-age child felt so sad or hopeless almost every day for two weeks or more in the past year that he/she stopped doing some usual activities.  Statistically comparable to the US percentage.  Comparable by region.  TREND: Statistically unchanged from 2012 findings.

Child Felt Sad or Hopeless for Two or More Weeks in the Past Year and Stopped Performing Usual Activities (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

7.5%

6.5%

7.9%

7.5%

4.9%

6.0%

7.5%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 97] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Such signs of depression are not statistically different by key demographic characteristics.

Child Felt Sad or Hopeless for Two or More Weeks in the Past Year and Stopped Performing Usual Activities (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

9.3%

5.6%

7.1%

7.9%

9.3%

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

14.3% 6.5%

7.6%

7.5%

6.1%

Low Income

Mid/High Income

White

Black

7.5%

Boy Sources: Notes:

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 97] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Further note that, of the 29 surveyed parents reporting signs of depression in their child, only 38.7% sought treatment for their child’s feelings of sadness or hopelessness; more than 60% did not.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Anxiety Prevalence of Anxiety Disorders A total of 8.0% of Total Service Area parents report that they have been told by a doctor or other health care provider that their school-age child had anxiety.  Nearly identical to US findings.  Most favorable in the south.  TREND: Statistically comparable to that reported in 2012. Note also that 2.1% of these respondents characterize their child’s anxiety as “severe.”

Child Has Been Diagnosed with Anxiety (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

Characterized as: Severe 2.1% Moderate 42.7% Mild 55.2%

40%

20%

9.1%

12.2% 4.7%

8.0%

7.9%

Total Service Area

4.3%

8.0%

Northwest

Northeast

South

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 105-106] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 There is no statistical difference in anxiety prevalence across the following demographic segments.

Child Has Been Diagnosed with Anxiety (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

8.7%

7.2%

7.4%

8.6%

Boy

Girl

Age 5 to 12

Age 13 to 17

12.5% 5.6%

8.8%

11.7%

15.5% 8.0%

6.2%

Sources: Notes:

Very Low Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 105] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Worry “Would you say that this child worries a lot?”

A total of 23.1% of Total Service Area parents indicate that their school-age child worries a lot.  Nearly identical to the national proportion for school-age children.  Statistically similar by region.  TREND: Statistically similar to 2012 findings.

Child Worries a Lot (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

22.8%

29.0%

20%

20.4%

23.1%

23.0%

South

Total Service Area

19.1%

23.1%

Northwest

Northeast

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 95] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Frequent worry is more often noted among teenagers than younger children.

Child Worries a Lot (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

26.1% 20%

30.1% 20.0%

17.3%

Girl

Age 5 to 12

28.2%

35.1%

32.4%

27.2%

23.1%

20.8%

19.5%

Boy Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 95] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Sleep Difficulties A total of 10.7% of Total Service Area parents indicate that their school-age child has difficulty falling asleep and/or sleeping through the night.  More favorable than nationwide findings.  Statistically similar among the three regions.  TREND: Statistically unchanged over time.

Child Has Difficulties Falling Asleep and/or Sleeping Through the Night (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

12.1%

11.4%

9.0%

10.7%

13.2%

11.8%

10.7%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 96] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

 Such sleep difficulties are higher among White children and “Other” race children.

Child Has Difficulties Falling Asleep and/or Sleeping Through the Night (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

11.8%

9.5%

11.4%

9.7%

11.0%

Boy

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

7.9%

13.2%

22.0%

17.4%

10.7%

8.0%

Sources: Notes:

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 96] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Cognitive & Behavioral Disorders Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) A total of 9.5% of Total Service Area children are reported to have ever suffered from or been diagnosed with ADHD (also sometimes referred to as attention deficit disorder, or ADD).  Similar to the US figure.  Similar by region.  TREND: Denotes a statistically significant increase in ADHD diagnoses since 2012.

Child Has ADD/ADHD (Total Service Area, 2015) 100%

80%

60%

40%

20%

9.0%

11.2%

9.1%

9.5%

8.7%

Northwest

Northeast

South

Total Service Area

5.1%

9.5%

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 71] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Total Service Area children are more likely to have suffered from/been diagnosed with ADD/ADHD the older they are (positive correlation with age).

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Has ADD/ADHD (Total Service Area, 2015) 100%

80%

60%

40%

17.6%

20%

10.9%

8.1%

8.3%

2.7%

14.5% 7.7%

9.2%

7.9%

8.9%

Low Income

Mid/High Income

White

Black

11.8%

9.5%

Other

TSA

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 71] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Learning Disabilities A total of 12.0% of Total Service Area children are reported to have some type of learning disability.  Higher than the US percentage.  Highest in the northwest.  TREND: The proportion of Total Service Area children with learning disabilities has significantly increased in the past three years.

Child Has a Learning Disability (Total Service Area, 2015) 100%

80%

60%

40%

20%

16.9%

10.6%

8.5%

Northeast

South

12.0%

8.0%

7.3%

2012

12.0%

Northwest

Total Service Area

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 65] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Teenagers are more likely than younger children to have been recognized as having some type of learning disability (positive correlation with age).

Child Has a Learning Disability (Total Service Area, 2015) 100%

80%

60%

40%

20%

14.8%

19.6% 9.2%

6.8%

Girl

Age 0 to 4

9.9%

13.5%

13.4%

10.8%

12.0%

12.8%

12.0%

Mid/High Income

White

Black

Other

TSA

10.5%

Boy Sources: Notes:

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 65] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Developmental Delays A total of 10.1% of Total Service Area children have been diagnosed with some type of developmental delay that affects his/her ability to learn.  Higher than the US prevalence.  Highest in the northwest.  TREND: Marks a statistically significant increase since 2012.

Child Has a Developmental Delay (Total Service Area, 2015) 100%

80%

60%

40%

20%

14.5% 6.4%

8.2%

10.1%

Northeast

South

Total Service Area

6.8%

5.7%

2012

10.1%

Northwest

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 67] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

In the Total Service Area, developmental delays are more prevalent among:  Boys.  Black or “Other” race children.

Child Has a Developmental Delay (Total Service Area, 2015) 100%

80%

60%

40%

20%

13.5% 6.5%

9.5%

9.1%

Age 0 to 4

Age 5 to 12

11.7%

15.0%

8.6%

7.4%

Low Income

Mid/High Income

3.9%

9.8%

11.7%

10.1%

Black

Other

TSA

Boy Sources: Notes:

Girl

Age Very Low 13 to 17 Income

White

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 67] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Behavioral/Conduct Disorders Among Total Service Area parents of children age 5-17, 6.2% indicate that a doctor or other health care provider has ever told them that their child has some type of behavioral or conduct disorder, such as oppositional defiant disorder or conduct disorder.  Statistically similar to US findings.  No statistical difference among the three regions.  TREND: Statistically similar to 2012 findings. Note that 6.6% of these parents characterize their child’s behavioral/conduct problems as “severe.”

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Has a Behavioral/Conduct Disorder (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

Characterized as: Severe 6.6% Moderate 24.0% Mild 69.4%

40%

20%

8.9%

5.6%

4.2%

6.2%

3.7%

3.4%

6.2%

Northeast

South

Total Service Area

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 101-102] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

 There is no statistical difference in the prevalence of behavioral/conduct disorders when viewed by child’s basic demographic characteristics.

Child Has a Behavioral/Conduct Disorder (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

8.2%

4.2%

4.8%

Girl

Age 5 to 12

7.9%

11.2%

8.1%

4.6%

6.2%

5.2%

Mid/High Income

White

Black

11.4%

6.2%

Boy Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 101] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prevalence of Autism Among Total Service Area parents of children age 5-17, 5.0% indicate that their child has been diagnosed with autism.  Notably less favorable than national reports.  Statistically comparable by region.  TREND: Statistically comparable to the prevalence reported in 2012. Note also that 22.9% of these parents characterize their child’s autism as “severe.”

Child Has Autism (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

Characterized as: Severe 22.9% Moderate 52.7% Mild 24.5%

40%

20%

5.4%

2.9%

5.8%

5.0%

Northwest

Northeast

South

Total Service Area

1.4%

3.7%

5.0%

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 103-104] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

 Among school-age children, boys are more likely to be autistic.

Child Has Autism (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

7.2%

2.8%

5.7%

4.2%

6.2%

5.8%

5.5%

4.4%

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

8.3%

5.0%

Boy Sources: Notes:

Girl

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 103] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Mental Health Services & Treatment Awareness of Mental Health Services A total of 46.4% of Total Service Area parents say that they are aware of local community resources for mental health.  Awareness in the Total Service Area is much lower than found nationally.  Statistically comparable among regions within the service area.  TREND: Identical to 2012 findings.

Aware of Mental Health Resources in the Community (Among Parents of Total Service Area Children Age 5-17, 2015) 100%

80%

65.0% 60%

48.3%

49.6%

Northeast

South

41.5%

46.4%

2012

2015

40%

20%

Northwest

Total Service Area

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 107] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

 Parents of boy are less likely than parents of girls to be aware of these services.

Aware of Mental Health Resources in the Community (Among Parents of Total Service Area Children Age 5-17, 2015) 100%

80%

60%

51.8%

41.0%

46.2%

46.7%

47.0%

Age 5 to 12

Age 13 to 17

Very Low Income

56.8%

51.9%

47.6%

44.8%

41.5%

46.4%

40%

20%

Boy Sources: Notes:

Girl

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 107] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Need for Mental Health Services A total of 12.6% of Total Service Area parents report that their child (age 5-17) has needed mental health services in the past year.  Statistically similar to the US proportion.  No statistical difference among regions.  TREND: Statistically unchanged since 2012.

Child Needed Mental Health Services in the Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

14.2%

12.2%

11.4%

12.6%

10.8%

8.4%

Northwest

Northeast

South

Total Service Area

2012

12.6%

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 91] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Children age 13 or older are more likely to have needed such services in the past year.

Child Needed Mental Health Services in the Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

16.3% were unable to receive treatment or counseling.

40%

20%

14.6%

16.4%

10.6%

9.4%

Girl

Age 5 to 12

18.4% 8.4%

19.7%

13.9%

12.6%

11.3%

Mid/High Income

White

Black

12.6%

Boy Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 91-92] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Among these parents with children needing services, 16.3% report that their child did not receive any type of mental health treatment or counseling — reasons primarily related to difficulty obtaining an appointment.

Prescriptions for Mental Health A total of 6.0% of Total Service Area parents report that their child (age 5-17) has ever taken prescribed medication for their mental health.  Comparable to US reports.  No statistical difference among regions.  TREND: Statistically similar to 2012 findings.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Has Ever Taken Prescription Medication for Mental Health (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

6.6%

8.4%

Northwest

Northeast

4.0%

6.0%

6.9%

4.4%

6.0%

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 94] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17.

 Children in households on either end of the income spectrum are more likely to have taken prescription medication for their mental health than children living right above the poverty level.

Child Has Ever Taken Prescription Medication for Mental Health (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

6.4%

5.5%

6.5%

Boy

Girl

Age 5 to 12

Age 13 to 17

13.2%

12.7% 1.3%

5.9%

3.4%

4.6%

Mid/High Income

White

Black

6.0%

Sources: Notes:

Very Low Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 94] Asked of respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Chronic Disease & Special Health Needs

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prevalence of Selected Medical Conditions Speech & Language Problems Prevalence of Chronic Ear Infections Respondents were asked to report on the prevalence of a number of different chronic conditions and illnesses afflicting children. “Would you please tell me if this child has ever suffered from or been diagnosed with any of the following medical conditions ….”

Among Total Service Area parents of children under the age of 18, 12.9% indicate that their child has had three or more ear infections in his/her life.  Much more favorable than US findings.  Statistically similar by region.  TREND: Remains statistically unchanged since 2012.

Child Has Had 3+ Ear Infections (Total Service Area, 2015) 100%

80%

60%

40%

23.5% 20%

14.0%

10.2%

13.6%

12.9%

South

Total Service Area

13.5%

12.9%

2012

2015

Northwest

Northeast

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 62] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 “Other” race children are more likely to have chronic ear infections.

Child Has Had 3+ Ear Infections (Total Service Area, 2015) 100%

80%

60%

40%

24.0% 20%

13.1%

12.8%

14.0%

12.3%

Boy

Girl

Age 0 to 4

Age 5 to 12

12.7%

11.5%

13.0%

14.6%

14.1%

Low Income

Mid/High Income

White

12.9%

10.1%

Sources: Notes:

Age Very Low 13 to 17 Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 62] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Speech/Language Issues A total of 11.7% of Total Service Area children have some type of speech or language problem.  Close to the national proportion.  Statistically comparable by region.  TREND: Statistically comparable to the 2012 figure.

Child Has Speech/Language Problems (Total Service Area, 2015) 100%

80%

60%

40%

20%

13.5%

8.1%

12.1%

11.7%

11.9%

8.8%

South

Total Service Area

2012

11.7%

Northwest

Northeast

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 69] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Boys and “Other” race children are more likely than their demographic counterparts to experience speech or language problems.

Child Has Speech/Language Problems (Total Service Area, 2015) 100%

80%

60%

40%

20%

16.0% 7.4%

11.3%

12.1%

Age 0 to 4

Age 5 to 12

11.5%

12.7%

17.8%

11.7%

9.8%

Low Income

Mid/High Income

7.0%

10.1%

11.7%

Boy Sources: Notes:

Girl

Age Very Low 13 to 17 Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 69] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Hearing Problems A total of 7.4% of Total Service Area children have been diagnosed with hearing problems.  Statistically similar to national findings.  Favorably low in the northeast.  TREND: Statistically unchanged since 2012.

Child Has Hearing Problems (Total Service Area, 2015) 100%

80%

60%

40%

20%

10.2% 2.7%

7.7%

7.4%

4.9%

5.3%

7.4%

South

Total Service Area

2012

2015

Northwest Sources: Notes:

Northeast

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 39] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

Total Service Area

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

In the Total Service Area, the following children are more likely to have been diagnosed with hearing problems:  Boys.  Children under age 13 (negative correlation with age).  “Other” race children.

Child Has Hearing Problems (Total Service Area, 2015) 100%

80%

60%

40%

20%

12.3%

10.7% 4.2%

9.3%

8.3%

16.7%

12.0% 5.1%

1.7%

9.3%

7.4%

4.4%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 39] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Vision Problems A total of 7.7% of Total Service Area children have vision problems that cannot be corrected with glasses or contact lenses.  Notably higher than the national prevalence.  Highest in the northwest; lowest in the northeast.  TREND: Statistically similar to 2012 findings

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Has Uncorrectable Vision Problems (Total Service Area, 2015) 100%

80%

60%

40%

20%

13.0%

3.9%

5.1%

7.7%

Northeast

South

Total Service Area

2.5%

4.7%

2012

7.7%

Northwest

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 37] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

Children more likely to have uncorrectable vision problems include:  Those living above the federal poverty level.  “Other” race children.

Child Has Uncorrectable Vision Problems (Total Service Area, 2015) 100%

80%

60%

40%

21.2% 20%

8.2%

7.2%

7.4%

7.0%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

11.2%

8.9%

10.4%

8.4%

0.8% Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

7.7%

3.9% Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 37] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Allergies Prevalence of Respiratory Allergies One in five Total Service Area children (20.3%) suffers from respiratory allergies.  Comparable to the US percentage.  Highest in the northwest; lowest in the northeast.  TREND: Denotes a statistically significant increase over time.

Child Has Respiratory Allergies (Total Service Area, 2015) 100%

80%

60%

40%

26.2% 20%

14.1%

18.5%

20.3%

South

Total Service Area

20.3%

17.8%

12.9%

Northwest

Northeast

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 55] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Children age 5 or older are more likely to have a respiratory allergy.

Child Has Respiratory Allergies (Total Service Area, 2015) 100%

80%

60%

40%

27.3% 20%

20.8%

19.8%

23.8%

20.2%

22.0%

28.1%

25.2% 18.7%

20.3%

17.8%

8.1% 0%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 55] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prevalence of Eczema/Skin Allergies A total of 31.9% of Total Service Area children have eczema or another skin allergy.  Considerably less favorable than national findings.  Statistically similar among the three regions.  TREND: Statistically similar to prior survey findings.

Child Has Eczema/Skin Allergies (Total Service Area, 2015) 100%

80%

60%

40%

32.1%

33.6%

28.8%

31.9%

26.7%

22.5%

31.9%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 57] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Children age 5 to 12 are more likely to experience eczema/skin allergies as are Black children.

Child Has Eczema/Skin Allergies (Total Service Area, 2015) 100%

80%

60%

40%

35.5% 28.3%

31.1%

36.5% 27.1%

31.9%

32.9%

35.2%

29.5%

26.5%

31.9%

15.9%

20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 57] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prevalence of Food/Digestive Allergies A total of 10.6% of Total Service Area children have some type of food or digestive allergy.  Similar to the national rate.  No statistical difference by region.  TREND: No statistically significant change in food/digestive allergies has occurred in the past three years.

Child Has Food/Digestive Allergies (Total Service Area, 2015) 100%

80%

60%

40%

20%

12.2%

12.5%

Northwest

Northeast

8.0%

10.6%

8.8%

8.9%

10.6%

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 56] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Food/digestive allergies are more prevalent among boys and children over age 4.

Child Has Food/Digestive Allergies (Total Service Area, 2015) 100%

80%

60%

40%

20%

15.4%

13.8% 5.7%

4.5%

Girl

Age 0 to 4

12.6%

8.7%

12.1%

11.8%

9.8%

Mid/High Income

White

Black

13.4%

10.6%

Boy Sources: Notes:

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 56] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Neurological Conditions Prevalence of Migraines/Severe Headaches A total of 6.6% of Total Service Area children suffer from migraines or severe headaches.  Nearly identical to the US percentage.  Statistically comparable by region.  TREND: Statistically unchanged since 2012.

Child Has Migraines/Severe Headaches (Total Service Area, 2015) 100%

80%

60%

40%

20%

5.4%

8.8%

6.5%

6.6%

6.7%

4.0%

6.6%

Northeast

South

Total Service Area

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 61] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Note the positive correlation between having migraines/severe headaches and child’s age.

Child Has Migraines/Severe Headaches (Total Service Area, 2015) 100%

80%

60%

40%

20%

8.0%

5.2%

2.6%

Girl

Age 0 to 4

6.8%

10.3%

7.1%

5.0%

7.4%

Low Income

Mid/High Income

4.3%

6.8%

7.0%

6.6%

White

Black

Other

TSA

Boy Sources: Notes:

Age 5 to 12

Age Very Low 13 to 17 Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 61] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prevalence of Brain Injury/Concussion A total of 5.5% of Total Service Area children have suffered a brain injury or concussion.  Similar to the US figure.  Statistically similar within the Total Service Area.  TREND: Marks a statistically significant increase in brain injuries over the past three years.

Child Has Had a Brain Injury/Concussion (Total Service Area, 2015) 100%

80%

60%

40%

20%

7.4%

3.0%

5.3%

5.5%

3.9%

1.6%

Northeast

South

Total Service Area

2012

5.5%

Northwest

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 60] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

This is predominantly noted among:  Boys.  Teenagers (positive correlation with age).

Child Has Had a Brain Injury/Concussion (Total Service Area, 2015) 100%

80%

60%

40%

20%

8.5%

12.0% 4.9%

2.6%

1.5%

3.5%

Girl

Age 0 to 4

Age 5 to 12

6.8%

5.3%

3.7%

4.6%

Low Income

Mid/High Income

White

Black

9.1%

5.5%

Boy Sources: Notes:

Age Very Low 13 to 17 Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 60] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Prevalence of Seizure Disorder/Epilepsy A total of 2.3% of Total Service Area children have epilepsy or a seizure disorder.  Higher than the US rate.  Highest in the northwest; lowest in the south.  TREND: Statistically, there has been no change in the prevalence of seizure disorders since 2012.

Child Has Seizure Disorder/Epilepsy (Total Service Area, 2015) 100%

80%

60%

40%

20%

4.8%

1.6%

0.4%

2.3%

0.8%

2.3%

Northeast

South

Total Service Area

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 58] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Boys are more likely to suffer from seizure disorders/epilepsy.

Child Has Seizure Disorder/Epilepsy (Total Service Area, 2015) 100%

80%

60%

40%

20%

3.6%

0.9%

1.8%

1.9%

Boy

Girl

Age 0 to 4

Age 5 to 12

Sources: Notes:

3.2%

1.8%

Age Very Low 13 to 17 Income

1.8%

3.0%

4.4%

Low Income

Mid/High Income

White

1.1% Black

5.7% Other

2.3% TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 58] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Bone, Joint & Muscle Problems Prevalence of Bone/Joint/Muscle Problems A total of 4.8% of Total Service Area children experience bone, joint or muscle problems.  Comparable to the nationwide proportion.  Statistically, no difference by region.  TREND: Statistically unchanged since 2012. Among these, the largest share (47.0%) identified this as a problem with their child’s bones, followed by joints (38.2%), muscles (6.5%), then bones and muscles (5.7%). The remaining 2.6% reported that their child suffers from cerebral palsy.

Child Has Bone, Joint, or Muscle Problems (Total Service Area, 2015) 100%

Problem is With: Bones Joints Muscles Bones & Muscles Cerebral Palsy

80%

60%

47.0% 38.2% 6.5% 5.7% 2.6%

40%

20%

7.6%

3.9%

2.8%

4.8%

6.0%

3.0%

4.8%

Northeast

South

Total Service Area

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 63-64] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Children living above the federal poverty level are more likely to suffer from bone, joint or muscle problems.

Child Has Bone, Joint, or Muscle Problems (Total Service Area, 2015) 100%

80%

60%

40%

20%

6.7%

2.9%

2.3%

Girl

Age 0 to 4

5.2%

6.7%

1.2%

7.0%

6.1%

7.0%

Low Income

Mid/High Income

White

9.9%

3.2%

4.8%

Boy

Sources: Notes:

Age 5 to 12

Age Very Low 13 to 17 Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 63] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Sickle-Cell Anemia A total of 3.2% of Total Service Area children age 0 to 17 currently have sickle-cell anemia.  Highest in the northwest; lowest in the south.  TREND: Denotes a statistically significant increase over time.

Child Has Sickle-Cell Anemia (Total Service Area, 2015) 100%

80%

60%

40%

20%

6.1%

2.7%

0.9%

3.2%

1.1%

3.2%

Northeast

South

Total Service Area

2012

2015

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 302] Asked of all respondents about a randomly selected child in the household.

 Sickle-cell anemia is most prevalent among “Other” race children.

Child Has Sickle-Cell Anemia (Total Service Area, 2015) 100%

80%

60%

40%

20%

3.2%

3.1%

5.8%

Boy

Girl

Age 0 to 4

2.9%

Sources: Notes:

Age 5 to 12

0.9%

2.2%

Age Very Low 13 to 17 Income

1.9% Low Income

5.0% Mid/High Income

8.9% 2.2%

1.7%

White

Black

Other

3.2% TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 302] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Asthma Prevalence of Asthma One-fifth (19.9%) of Total Service Area children age 0 to 17 currently have asthma.  Notably higher than the US rate.  Statistically similar by region.  TREND: Remains statistically unchanged from the 2012 findings.

Child Currently Has Asthma (Total Service Area, 2015) 100%

80%

60%

40%

24.9%

18.4%

20%

19.9%

16.4%

11.6%

17.3%

19.9%

2012

2015

Northwest

Northeast

South

Total Service Area

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 150] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 In the Total Service Area, Black children are more likely to have asthma.

Child Currently Has Asthma (Total Service Area, 2015) 100%

80%

60%

40%

22.1% 20%

17.7%

22.6%

22.7%

25.2% 14.3%

13.8%

17.8%

21.2% 12.7%

17.4%

19.9%

Other

TSA

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 150] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Asthma-Related Care Emergent/Urgent Care Among Total Service Area children with asthma, the majority (55.1%) has had emergency room or urgent care visits due to their asthma at least once in the past year.  Statistically comparable to national findings (not shown).  TREND: Statistically comparable to the 2012 rate.

Number of Asthma-Related ER/Urgent Care Visits in the Past Year (Total Service Area Children with Asthma, 2015) Child Had At Least One Asthma-Related ER/Urgent Care Visit in the Past Year

None 44.9%

Field note

One 14.4% 58.7%

55.1%

Two 18.8%

Five or More 8.6% Four 2.4%

Three 10.9% 2012

Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 51] Asked of respondents with a child who currently has asthma.

2015

Total Service Area

Hospitalization Among Total Service Area children with asthma, a total of 23.3% were hospitalized overnight in the past year because of asthma.  Much higher than national findings (not shown).  TREND: Statistically unchanged over time.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Number of Asthma-Related Hospital Stays in the Past Year (Total Service Area Children with Asthma, 2015) Child Had At Least One Asthma-Related Hospital Stay in the Past Year

None 76.7%

23.3%

One 15.1%

Five or More 4.8% Sources: Notes:

16.0%

Two to Four 3.4%

2012

2015

Total Service Area

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 52] Asked of respondents with a child who currently has asthma.

Loss of Productivity Missed School Days Among Total Service Area school-aged children with asthma, one-half (51.2%) missed school on one or more days in the past year because of asthma-related problems.  In fact, over 10% missed 5+ school days because of their asthma in the past year.  Statistically similar to national findings (not shown).  TREND: Since 2012, the prevalence of asthmatic children who missed school because of their asthma has remained statistically unchanged.

Number of School Days Missed Due to Asthma in the Past Year (Total Service Area Children Age 5-17 with Asthma, 2015) Child Missed School Due to Asthma in the Past Year

None 48.8% One 5.3%

57.7%

51.2%

Two 13.3% Six or More 5.7% Sources: Notes:

Five 5.3%

Four 2.6%

Three 19.0%

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 53] Asked of respondents with a child who currently has asthma.

2012

2015

Total Service Area

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Parents’ Missed Workdays Further, 56.1% of Total Service Area parents with asthmatic children missed at least one day of work in the past year because of their child’s asthma.  The prevalence includes 19.5% of parents who missed 5+ workdays in the past year due to their child’s asthma.  Nearly twice the proportion found nationally (not shown).  TREND: Since 2012, the change in the prevalence of parents who missed work because of a child’s asthma (although it appears sizeable) is not statistically significant.

Workdays Missed in the Past Year Due to Child’s Asthma (Total Service Area Parents of Children with Asthma, 2015) Parent Missed Work Due to Child’s Asthma in the Past Year

None 43.9% One 14.9%

56.1% 49.0%

Two 11.7%

Six or More 10.0% Sources: Notes:

Five 9.5%

Three 9.8% Four 0.2%

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 54] Asked of respondents with a child who currently has asthma.

2012

2015

Total Service Area

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Diabetes A total of 2.3% of Total Service Area children age 0 to 17 have been diagnosed with diabetes by a doctor or other health care provider.  Less favorable than the US prevalence.  No statistical difference among the three regions.  TREND: Statistically similar to 2012 findings.

Child Has Diabetes (Total Service Area, 2015) 100%

80%

60%

40%

20%

4.2%

1.9%

1.0%

2.3%

0.7%

1.2%

2.3%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 59] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 In the Total Service Area, children age 5 to 12 are more likely to have been diagnosed with diabetes.

Child Has Diabetes (Total Service Area, 2015) 100%

80%

60%

40%

20%

3.4%

1.2%

2.7%

3.6%

Boy

Girl

Age 0 to 4

Age 5 to 12

Sources: Notes:

0.5%

3.2%

Age Very Low 13 to 17 Income

0.8%

3.2%

2.8%

1.7%

Low Income

Mid/High Income

White

Black

4.7%

2.3%

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 59] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Condition Requiring Prescriptions or Special Therapy Prescriptions A total of 36.8% of Total Service Area children have a condition that requires prescription medication(s) (not counting vitamins).  Notably higher than the prevalence nationwide.  No statistically significant difference by region.  TREND: Shows a statistically significant increase in the Total Service Area since 2012.

Child Has a Condition That Requires Prescription(s) (Total Service Area, 2015) 100%

80%

60%

42.1% 34.7%

40%

33.4%

36.8%

36.8% 27.3%

28.0%

2012

20%

Northwest

Northeast

South

Total Service Area

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 32] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Black children are more likely than White children to have a condition that requires prescription medication.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Has a Condition That Requires Prescription(s) (Total Service Area, 2015) 100%

80%

60%

40%

38.8%

34.8%

40.8%

38.9%

39.6%

30.2%

34.6%

34.1%

36.9%

36.2%

36.8%

Black

Other

TSA

23.2% 20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 32] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Special Therapy Special therapy may include physical, occupational or speech therapy.

A total of 11.5% of Total Service Area children have a condition that requires special therapy.  Statistically similar to nationwide findings.  The three regions show statistically similar findings.  TREND: Statistically unchanged over the past three years.

Child Has a Condition That Requires Special Therapy (Total Service Area, 2015) 100%

80%

60%

40%

20%

13.5%

10.7%

10.1%

11.5%

Northwest

Northeast

South

Total Service Area

8.3%

7.8%

2012

11.5%

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 34] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Boys are more likely to have a condition that requires special therapy.

Child Has a Condition That Requires Special Therapy (Total Service Area, 2015) 100%

80%

60%

40%

20%

14.8%

14.2%

8.2%

12.1%

8.2%

11.0%

7.3%

13.5%

11.6%

9.9%

Mid/High Income

White

Black

14.0%

11.5%

Other

TSA

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 34] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

When these parents were asked to specify the condition requiring special therapy, speech difficulties was the most frequent response (34.8%), followed by behavioral problems (8.8%), autism (8.5%), and a variety of lesser-mentioned conditions. 12.6% of parents said they didn’t know the chronic condition their child needs special therapy for.

Type of Condition Requiring Therapy (Among Children Who Need Therapy; Total Service Area, 2015) 0%

20%

Speech Therapy

Sources: Notes:

60%

80%

100%

34.8%

Don't Know/Not Sure

12.6%

Behavioral Therapy

8.8%

Autism

8.5%

Developmental Delays

7.4%

Physical Therapy

7.2%

Asthma

5.5%

ADHD

5.1%

Various Other (<5% Each)

40%

10.1%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 36] Asked of all respondents whose child has a condition which requires special therapy.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Special Health Needs Prevalence of Special Health Needs Here, children with special health needs include those reported to have one or more of the chronic disease conditions tested in the survey or any another chronic condition not specifically tested.

In all, roughly two-thirds (66.9%) of Total Service Area children (age 0-17) are found to have special health needs.  Similar to the US figure.  Statistically similar by region.  TREND: Statistically similar to what was found in 2012.

Child Has a Special Health Need (Total Service Area, 2015) 100%

80%

70.2%

65.0%

66.9%

68.3%

Northeast

South

Total Service Area

60.3%

60%

66.9%

40%

20%

Northwest

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 181] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household. Includes respondents reporting a child’s diagnosis of any medical condition specifically measured in the survey, as well as any other not specifically addressed.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 “Other” race children are more likely to have special health needs.

Child Has a Special Health Need (Total Service Area, 2015) 100%

80%

70.9%

70.7% 63.1%

60%

69.0%

69.8%

59.7%

74.2% 65.9%

65.7%

66.9%

65.6%

57.4%

40%

20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 181] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. Includes respondents reporting a child’s diagnosis of any medical condition specifically measured in the survey, as well as any other not specifically addressed.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Managing Children’s Special Health Needs Parents’ Greatest Needs for Child “What is your greatest need for your child with special needs?”

Among parents of children with special health needs, the greatest share says that they “do not need any help.”  Common needs mentioned by parents included: more specialists (9.8%), accessible and affordable healthcare (9.7%), medication/pharmaceuticals (8.2%), and general healthcare needs (7.3%).  8.1% say that their child does not have any health concerns.

Respondents’ Greatest Need for Child with Special Needs (Total Service Area Parents of Children With Special Needs, 2015) More Specialists 9.8%

Accessible/Affordable Healthcare 9.7% Meds/Pharm. 8.2%

Child Doesn't Have Health Concerns 8.1%

Do Not Need Help 41.6%

Gen'l Healthcare 7.3%

Other (Each <3%) 15.3% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 73] Asked of all respondents whose child has a medical condition specifically measured in the survey, excludes those not respondent or unable to provide a response.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Parents’ Greatest Needs for Self “What is your greatest need for yourself in helping to take care of your child with special needs?”

With regard to the needs of parents themselves in taking care of their child with special health needs, the largest share of respondents said “nothing;” however, 16.2% mentioned financial help.  Other needs often mentioned included more time (8.7%), accessible/affordable healthcare (6.4%), increased doctor availability (6.0%), and patience (5.3%).

Respondents’ Greatest Need for Self in Caring for Child with Special Needs (Total Service Area Parents of Children w/Special Needs, 2015) Time 8.7% Financial Help/Money 16.2%

Accessible/Affordable Healthcare 6.4% Doctor Availability 6.0% Patience 5.3% Transportation 4.9%

Classes/Education for Self 4.5%

Nothing 23.5% Other (Each <4%) 24.6% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 74] Asked of all respondents whose child has a medical condition specifically measured in the survey; does not include those who were uncertain or unable to provide a response.

Prenatal & Infant Health

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Prenatal Care About Infant & Child Health Improving the well-being of mothers, infants, and children is an important public health goal for the Total Service Area. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the healthcare system. The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy) and inter-conception (between pregnancies) care. Moreover, healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential. Many factors can affect pregnancy and childbirth, including pre-conception health status, age, access to appropriate healthcare, and poverty. Infant and child health are similarly influenced by socio-demographic factors, such as family income, but are also linked to the physical and mental health of parents and caregivers. There are racial and ethnic disparities in mortality and morbidity for mothers and children, particularly for African Americans. These differences are likely the result of many factors, including social determinants (such as racial and ethnic disparities in infant mortality; family income; educational attainment among household members; and health insurance coverage) and physical determinants (i.e., the health, nutrition, and behaviors of the mother during pregnancy and early childhood). – Healthy People 2020 (www.healthypeople.gov)

Lack of Prenatal Care Between 2007 and 2010, 5.6% of all Cook County births did not receive prenatal care in the first trimester of pregnancy.  Close to the Illinois proportion.  Much more favorable than the national proportion.  Satisfies the Healthy People 2020 target (22.1% or lower).

Lack of Prenatal Care in the First Trimester (Percentage of Live Births, 2007-2010) Healthy People 2020 Target = 22.1% or Lower 100%

80%

60%

40%

17.3%

20%

5.6%

5.4%

Cook County

Sources: Note:

Centers for Disease Control and Prevention, National Vital Statistics System: 2007-10. Accessed using CDC WONDER. Retrieved November 2015 from Community Commons at http://www.chna.org. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-10.1] This indicator reports the percentage of women who do not obtain prenatal care during their first trimester of pregnancy. This indicator is relevant because engaging in prenatal care decreases the likelihood of maternal and infant health risks. This indicator can also highlight a lack of access to preventive care, a lack of health, knowledge insufficient provider outreach, and/or social barriers preventing utilization of services.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Birth Outcomes & Risks Low-Weight Births Low birthweight babies, those who weigh less than 2,500 grams (5 pounds, 8 ounces) at birth, are much more prone to illness and neonatal death than are babies of normal birthweight. Largely a result of receiving poor or inadequate prenatal care, many low-weight births and the consequent health problems are preventable.

A total of 8.9% of 2011-2013 Cook County births were low-weight.  Over twice the statewide findings.  Worse than the national proportion.  Fails to satisfy the Healthy People 2020 target (7.8% or lower).

Low-Weight Births (Percent of Live Births, 2011-2013) Healthy People 2020 Target = 7.8% or Lower 100%

80%

60%

40%

20%

8.9%

8.0%

4.0%

Cook County Sources: Note:

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-8.1] This indicator reports the percentage of total births that are low birthweight (Under 2500g). This indicator is relevant because low -birthweight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities.

 Low-weight births are more prevalent among Non-Hispanic Blacks in Cook County.

Low-Weight Births by Race/Ethnicity (Cook County; Percent of Live Births, 2011-2013) Healthy People 2020 Target = 7.8% or Lower 100%

80%

60%

40%

20%

14.1% 6.9%

9.0%

8.9%

Non-Hispanic Other

All Races/Ethnicities

Non-Hispanic White Sources: Note:

Non-Hispanic Black

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-8.1] This indicator reports the percentage of total births that are low birth weight (Under 2500g). This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

ï&#x201A;· TREND: The proportion of low-weight births in Cook County has changed little since 2007; similar to state and national trends.

Low-Weight Births by Race/Ethnicity (Cook County; Percent of Live Births, 2011-2013) Healthy People 2020 Target = 7.8% or Lower 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0%

Cook County Illinois US Sources:

Note:

2007-2009 9.1% 4.1% 8.2%

2008-2010 9.0% 4.1% 8.2%

2009-2011 9.0% 4.0% 8.1%

2010-2012 9.0% 4.0% 8.1%

2011-2013 8.9% 4.0% 8.0%

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. Centers for Disease Control and Prevention, National Center for Health Statistics. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-8.1] This indicator reports the percentage of total births that are low birth weight (Under 2500g). This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Deaths Infant Mortality Infant mortality rates reflect deaths of children less than one year old per 1,000 live births.

Between 2011 and 2013, there was an annual average of 6.7 infant deaths per 1,000 live births in Cook County.  Less favorable than the Illinois rate.  Less favorable than the national rate.  Fails to satisfy the Healthy People 2020 target of 6.0 per 1,000 live births.

Infant Mortality Rate (Annual Average Infant Deaths per 1,000 Live Births, 2011-2013) Healthy People 2020 Target = 6.0 or Lower 8

6.7 6

6.3

6.0

4 3 1 0

Cook County Sources: Notes:

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-1.3] Infant deaths include deaths of children under 1 year old. This indicator is relevant because high rates of infant mortality indicate the existence of broader issues pertaining to access to care and maternal and child health.

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 The infant mortality rate is nearly three times higher among births to Non-Hispanic Black mothers than mothers in other race categories.

Infant Mortality by Race/Ethnicity (Cook County; Annual Average Infant Deaths per 1,000 Live Births, 2011-2013) Healthy People 2020 Target = 6.0 or Lower 16

13.4

14 12 10 8

6.7

4.9

4.8

Non-Hispanic Asian

Hispanic

3.9

4 2 0

Non-Hispanic White

Sources: Notes:

Non-Hispanic Black

All Races/Ethnicities

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-1.3] Infant deaths include deaths of children under 1 year old. This indicator is relevant because high rates of infant mortality indicate the existence of broader issues pertaining to access to care and maternal and child health.

 TREND: The Cook County infant mortality rate has trended downward in recent years, echoing the state and national trends.

Infant Mortality Rate (Annual Average Infant Deaths per 1,000 Live Births) Healthy People 2020 Target = 6.0 or Lower 9 8 7 6 5 4 3 2 1 0

Cook County Illinois US Sources:

Notes:

2004-2006 8.6 7.7 7.1

2005-2007 8.5 7.5 7.1

2006-2008 8.3 7.4 7.0

2007-2009 8.2 7.2 6.8

2008-2010 8.0 7.2 6.5

2009-2011 7.5 6.8 6.3

2010-2012 7.2 6.6 6.1

2011-2013 6.7 6.3 6.0

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. Centers for Disease Control and Prevention, National Center for Health Statistics. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-1.3] Rates are three-year averages of deaths of children under 1 year old per 1,000 live births.

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Child & Adolescent Deaths Between 2011-2013, Cook County reported an annual average of 23.9 child deaths (age 1 to 4) per 100,000 population.  Similar to the Illinois rate.  Lower than the national rate.  Satisfies the Healthy People 2020 target of 25.7 per 100,000 population. With regard to children age 5 to 9, the Cook County crude death rate was 12.1 per 100,000 population (2011-2013 data).  Statistically higher than the Illinois rate.  Similar to the national rate.  Similar to the Healthy People 2020 goal of 12.3 deaths per 100,000 population. Among Cook County youth age 10 to 14, the 2011-2013 crude death rate was 15.5 per 100,000 population.  Statistically higher than the Illinois rate.  Statistically higher than the national rate.  Similar to the related Healthy People 2020 goal of 15.2 deaths per 100,000 population. Among Cook County teens (age 15 to 19), the 2011-2013 crude death rate was 61.2 per 100,000 population.  Notably less favorable than the Illinois rate.  Notably less favorable than the national rate.  Fails to satisfy the related Healthy People 2020 goal of 55.7 deaths per 100,000 population.

Child & Adolescent Mortality Rates by Age Group (Annual Average Child Mortality per 100,000 Population; 2011-2013) Cook County

100

HP2020

61.2 60

51.0

55.7 47.0

23.9

23.1

26.0

25.7 12.1

11.2

11.7

12.3

15.5

13.7

14.1

15.2

Ages 1 to 4 Sources: Notes:

Ages 5 to 9

Ages 10 to 14

Ages 15 to 19

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-3.1] Rates are crude rates, representing the number of deaths of children in each age group per 100,000 population.

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Leading Causes of Child Deaths The predominant cause of death between 2004-2013 for Cook County children under one year of age was congenital conditions (congenital malformations, deformations, or chromosomal abnormalities). Accidents were the number-one leading cause of death for all other Cook County children under age 15 (especially motor vehicle crashes for those age 10 to 14). Homicide (over 90% with firearms) was the number-one leading cause of death for those age 15 to 19.  Other leading causes of death for infants included maternal factors or labor/delivery complications and sudden infant death syndrome.  Among children aged 1-4, congenital conditions and homicide followed accidents as the leading causes of death.  Cancer was the second-leading cause of death for Cook County children aged 5-9, followed by chronic lower respiratory disease (CLRD).  For children aged 10-14, cancer and homicide (nearly 75% with firearms) followed accidents as the leading cause of death.  Accidents (especially motor vehicle crashes) and suicide followed homicide as the leading causes of death for Cook County teens (15-19). See also Injury & Safety in the Modifiable Health Risks section of this report.

Leading Causes of Child Deaths by Age Group (Cook County, 2004-2013) Omaha Total Service Area

Under 1 Year

Ages 1 to 4

Ages 5 to 9

Number-One Leading Cause

Congenital Conditions*

Accidents

(especially Motor Vehicle Crashes)

Number-Two Leading Cause

Maternal factors or Labor/Delivery complications

Congenital Conditions*

Cancer

Number-Three Leading Cause

Sudden Infant Death Syndrome

Homicide

CLRD

Sources: Notes:

Ages 10 to 14

Accidents

Homicide (nearly 75% with Firearms)

Ages 15 to 19

Homicide (over 90% with Firearms)

Accidents (especially Motor Vehicle Crashes)

Suicide

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. *Congenital conditions include congenital malformations, deformations and chromosomal abnormalities. CLRD stands for chronic lower respiratory disease.

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Family Planning Births to Teen Mothers About Teen Births The negative outcomes associated with unintended pregnancies are compounded for adolescents. Teen mothers:  Are less likely to graduate from high school or attain a GED by the time they reach age 30.  Earn an average of approximately $3,500 less per year, when compared with those who delay childbearing.  Receive nearly twice as much Federal aid for nearly twice as long. Similarly, early fatherhood is associated with lower educational attainment and lower income. Children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems. Sons of teen mothers are more likely to be incarcerated, and daughters are more likely to become adolescent mothers. –

Healthy People 2020 (www.healthypeople.gov)

Between 2011 and 2013, 7.9% of all Cook County live births were to a mother under the age of 20.  Similar to the Illinois percentage.  Nearly identical to the national percentage.

Births to Teen Mothers (Under 20) (Births to Women Under 20 as a Percentage of Live Births, 2011-2013) 100%

80%

60%

40%

20%

7.9%

7.6%

7.8%

Cook County

Sources: Note:

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ď&#x201A;ˇ By race and ethnicity, Non-Hispanic Blacks exhibit the highest teen birth rate in Cook County, whereas Non-Hispanic Other race teens have a notably low birth rate.

Births to Teen Mothers (Cook County; Births to Women Under 20 as a Percentage of Live Births, 2011-2013) 100%

80%

60%

40%

18.6%

20%

7.9%

6.7%

0.9%

Non-Hispanic White Sources: Note:

Non-Hispanic Black

Non-Hispanic Other

All Races/Ethnicities

ď&#x201A;ˇ TREND: The teen birth rate in Cook County has significantly decreased over the past six years, following the state and national trends.

Teen Birth Trends (Births to Women Under Age 20 as a Percentage of Life Births) 12% 10% 8% 6% 4% 2% 0%

Cook County IL US Sources: Notes:

2007-2009 10.7% 9.9% 10.3%

2008-2010 10.2% 9.6% 9.9%

2009-2011 9.5% 8.9% 9.3%

2010-2012 8.8% 8.3% 8.5%

2011-2013 7.9% 7.6% 7.8%

CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted November 2015. This indicator reports the rate of total births to women under the age of 20 per 1,000 female population under 20. This indicator is relevant because in many cases, teen parents have unique social, economic, and health support services. Additionally, high rates of teen pregnancy may indicate the prevalence of unsafe sex practices.

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Postnatal Care

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Breastfeeding & Breast Milk Ever Breastfed “For the next question, I would like you to think back to when this child was an infant. As best you can recall, was this child ever breastfed or fed using breast milk?”

More than three-fifths of Total Service Area children age 0 to 17 (61.3%) were ever breastfed or fed using breast milk (regardless of duration).  Less favorable than US findings.  Fails to satisfy the Healthy People 2020 objective (81.9% or higher).  Lowest in the northwest; highest in the south (not shown).

Child Was Ever Fed Breast Milk (Total Service Area, 2015) Healthy People 2020 Target = 81.9% or Higher

Yes 61.3% US = 69.4%

No 38.7%

Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 134] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-21.1] Asked of those respondents with a randomly selected child who was fed breast milk as an infant.

Exclusive Breastfeeding for Six Months In total, 17.6% of all Total Service Area children (as infants) were fed breast milk exclusively for the first 6 months of life.  Notably lower than the US proportion.  Fails to satisfy the Healthy People 2020 objective (25.5% or higher).  Lowest in the northwest; highest in the south.

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Child Was Exclusively Breastfed for at Least 6 Months (Total Service Area, 2015) Healthy People 2020 Target = 25.5% or Higher 100%

80%

60%

40%

20%

11.8%

27.2%

22.3%

18.1%

17.6%

Northwest Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 159] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-21.5] Asked of respondents all respondents about a randomly selected child in the household.

 Exclusive breastfeeding for the first 6 months is more common among children living in higher income households (positive correlation with income).  No significant difference by child's age, representing trends over time.

Child Was Exclusively Breastfed for at Least 6 Months (Total Service Area, 2015) Healthy People 2020 Target = 25.5% or Higher 100%

80%

60%

40%

20%

18.1%

17.1%

14.8%

18.6%

19.4%

18.0%

21.9%

21.8%

Mid/High Income

White

16.7%

22.1%

17.6%

6.9% 0%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 159] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-21.5] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

More than one-half of all breastfed children (53.3%) were less than one month old when they were fed something other than breast milk. 30.5% were exclusively breast fed until they were one to five months old, whereas others (14.6%) were six to twelve months old. Still, 1.6% of children were not introduced to other foods until sometime after their first birthday.

Age of Child When Introduced to Foods Other Than Breast Milk (Among Total Service Area Children Who Were Ever Fed Breast Milk, 2015) Over 12 Months 1.6% 12 Months 4.4% Less Than 1 Month 53.3%

6-11 Months 10.2%

3-5 Months 9.0% 2 Months 7.4% 1 Month 14.1% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 135] Asked of those respondents with a randomly selected child who was fed breast milk as an infant; excludes those whose children are currently being breastfed.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Modifiable Health Risks

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Nutrition About Healthful Diet & Healthy Weight Strong science exists supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. Efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, healthcare organizations, and communities. The goal of promoting healthful diets and healthy weight encompasses increasing household food security and eliminating hunger. Americans with a healthful diet:  Consume a variety of nutrient-dense foods within and across the food groups, especially whole grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other protein sources.  Limit the intake of saturated and trans fats, cholesterol, added sugars, sodium (salt), and alcohol.  Limit caloric intake to meet caloric needs. Diet and body weight are related to health status. Good nutrition is important to the growth and development of children. A healthful diet also helps Americans reduce their risks for many health conditions, including: overweight and obesity; malnutrition; iron-deficiency anemia; heart disease; high blood pressure; dyslipidemia (poor lipid profiles); type 2 diabetes; osteoporosis; oral disease; constipation; diverticular disease; and some cancers. Diet reflects the variety of foods and beverages consumed since 2012 and in settings such as worksites, schools, restaurants, and the home. Interventions to support a healthier diet can help ensure that:  Individuals have the knowledge and skills to make healthier choices.  Healthier options are available and affordable. Social Determinants of Diet. Demographic characteristics of those with a more healthful diet vary with the nutrient or food studied. However, most Americans need to improve some aspect of their diet. Social factors thought to influence diet include:       

Knowledge and attitudes Skills Social support Societal and cultural norms Food and agricultural policies Food assistance programs Economic price systems

Physical Determinants of Diet. Access to and availability of healthier foods can help people follow healthful diets. For example, better access to retail venues that sell healthier options may have a positive impact on a person’s diet; these venues may be less available in low-income or rural neighborhoods. The places where people eat appear to influence their diet. For example, foods eaten away from home often have more calories and are of lower nutritional quality than foods prepared at home. Marketing also influences people’s—particularly children’s—food choices. – Healthy People 2020 (www.healthypeople.gov)

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Fruits & Vegetables Fruit & Vegetable Consumption A total of 46.0% of Total Service Area parents report that their child eats five or more To measure fruit and vegetable consumption, survey respondents were asked multiple questions, specifically about the foods their child eats on a typical day.

servings of fruits and/or vegetables per day.  Statistically comparable to national reports.  Highest in the northeast region.  TREND: Overall, child fruit/vegetable consumption in the Total Service Area has not changed significantly since 2012.

Child Has Five or More Servings of Fruits/Vegetables per Day (Total Service Area Children Age 2-17, 2015) 100%

80%

60%

54.3% 43.2%

43.8%

46.0%

South

Total Service Area

41.8%

42.0%

2012

46.0%

40%

20%

Northwest

Northeast

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 173] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Older children are more likely to not get the daily recommended servings of fruits and vegetables (note the strong negative correlation with age).

Child Has 5+ Fruits/Vegetables per Day (Total Service Area Children Age 2-17, 2015) 100%

80%

64.6% 60%

49.8%

46.0%

42.0%

45.1%

46.6%

45.6%

Low Income

Mid/High Income

49.3%

46.1%

44.2%

46.0%

Black

Other

TSA

35.2%

40%

20%

Boy Sources: Notes:

Girl

Age 2 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

White

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 173] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Difficulty Accessing Fresh Produce While most report little or no difficulty, 34.5% of Total Service Area parents report that it is “very” or “somewhat” difficult for them to access affordable, fresh fruits and “How difficult is it for you to buy fresh produce like fruits and vegetables at a price you can afford?”

vegetables.

Level of Difficulty Finding Fresh Produce at an Affordable Price (Total Service Area Parents, 2015) Not At All Difficult 41.8%

Very Difficult 8.8%

Somewhat Difficult 25.7% Not Too Difficult 23.7% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 131] Asked of all respondents.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Less favorable than the US proportion.  Lowest in the northeast.

Find It “Very” or “Somewhat” Difficult to Buy Affordable Fresh Produce (Total Service Area Parents, 2015) 100%

80%

60%

39.6%

40%

34.8%

34.5%

South

Total Service Area

28.2%

26.2% 20%

Northwest

Sources: Notes:

Northeast

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 131] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents.

Those more likely to report difficulty getting fresh fruits and vegetables include:  Parents of teenagers (age 13 to 17).  Lower-income residents (note the negative correlation with income).  Parents of Black children.

Find It “Very” or “Somewhat” Difficult to Buy Affordable Fresh Produce (Total Service Area Parents, 2015) 100%

80%

60%

48.3% 40%

32.7%

36.4%

39.2%

36.9%

37.2%

36.9%

28.9%

25.2%

20%

34.5% 26.8%

20.1%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 131] Asked of all respondents. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Fast Food Over two-thirds (68.7%) of Total Service Area children age 2-17 have had at least one “fast food” meal in the past week. “In the past 7 days, how many meals would you say this child has eaten from ‘fast food’ restaurants? Please include breakfasts, lunches, and dinners.”

Number of Fast Food Meals for Child in the Past Week (Total Service Area Children Age 2-17, 2015) Three 13.2% Two 22.0%

Four 5.8%

Five 3.1% Six/More 4.2%

One 20.4%

Sources: Notes:

None 31.3%

More than one in four parents (26.3%) report that their child has had three or more meals from “fast food” restaurants in the past week.  Statistically close to US findings.  Statistically, no difference within the Total Service Area  TREND: Similar to 2012 survey findings.

Child Had Three or More Fast Food Meals in the Past Week (Total Service Area Children Age 2-17, 2015) 100%

80%

60%

40%

27.1%

29.5%

Northwest

Northeast

23.7%

26.3%

South

Total Service Area

22.0%

27.9%

26.3%

2012

2015

20%

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 127] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household is between the ages of 2 and 17.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Fast food consumption is more prevalent among boys than girls.

Child Has Three or More Fast Food Meals in the Past Week (Total Service Area Children 2-17, 2015) 100%

80%

60%

40%

31.4%

31.4% 21.0%

23.3%

23.4%

Girl

Age 2 to 4

Age 5 to 12

21.9%

26.6%

29.5%

29.7%

Mid/High Income

White

25.6%

27.3%

26.3%

Black

Other

TSA

20%

Boy Sources: Notes:

Age Very Low 13 to 17 Income

Low Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 127] Asked of all respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Physical Activity About Physical Activity Children and adolescents should do 60 minutes (1 hour) or more of physical activity each day. – Centers for Disease Control & Prevention (CDC)

Recommended Physical Activity “The next questions are about physical activity. During the past 7 days, on how many days was the child physically active for a total of at least 60 minutes per day?”

A total of 44.4% of Total Service Area children age 2 to 17 had 60 or more minutes of physical activity on each of the seven days preceding the interview (1+ hours per day).  Note, however, that 18.4% had two or fewer days in the past week with adequate physical activity.

Number of Days in the Past Week on Which Child Was Physically Active for One Hour or Longer (Total Service Area Children Age 2-17, 2015) None 6.0%

Seven 44.4%

One 3.5%

Two 8.9%

Three 10.1%

Six 3.6% Five 13.8% Sources: Notes:

Four 9.8%

 Similar to the proportion reported nationally.  Particularly low in the northwest; high in the south.  TREND: Denotes a statistically significant increase since 2012.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Was Physically Active for One Hour or Longer on Every Day of the Past Week (Total Service Area Children Age 2-17, 2015) 100%

80%

60%

51.6%

48.3% 40%

44.4%

43.2%

37.1%

33.3%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 124] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17.

Those less likely to meet recommended levels of physical activity include:  Children over age 4.  Children living in households on either end of the income spectrum.  White children.

Child Was Physically Active for One Hour or Longer on Every Day of the Past Week (Total Service Area Children Age 2-17, 2015) 100%

80%

71.5% 57.8%

60%

42.2%

46.6% 38.8%

40%

46.4%

44.0% 36.4%

38.9%

33.9%

31.2%

Mid/High Income

White

44.4%

20%

Boy Sources: Notes:

Girl

Age 2 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 124] Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Physical Activity Frequency & Duration Note:  The term “moderate physical activity” includes 30 minutes of activity that does not make a child breathe hard, such as fast walking, slow bicycling, skating, or pushing a lawn mower.  The term “vigorous physical activity,” includes exercise for 20 minutes that makes a child breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities.  The term “muscle –strengthening activity” includes playing on playground equipment, climbing trees, playing tug-of-war, working with resistance bands, or lifting weights.

Throughout the seven days preceding the interview, 46.9% of Total Service Area children age 2 to 17 participated in moderate physical activity five or more times, for at least 30 minutes at a time.  Statistically similar to the US figure.  Highest in the northeast; lowest in the northwest.  TREND: Has increased considerably since 2012.

Child Participates in Moderate Physical Activity (Total Service Area Children Age 2-17, 2015) 100%

80%

55.7%

60%

49.5%

46.9%

49.3%

38.6%

40%

46.9% 34.5%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 178] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Includes exercising at least 5 times per week for 30+ minutes at a time, doing activities which do not make the child breathe hard, such as fast walking, slow bicycling, skating, or pushing a lawnmower.

Note the following:  Children age 2 to 4 are much more likely than older children to participate in moderate physical activity.  Participation in moderate physical activity is higher among Black children.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Participates in Moderate Physical Activity (Total Service Area Children Age 2-17, 2015) 100%

80%

67.7% 60%

51.5%

50.2%

42.6%

40.9%

40%

42.8%

50.8%

45.3%

42.0%

46.9% 36.1%

34.6%

20%

Boy Sources: Notes:

Girl

Age 2 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 178] Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Includes exercising at least 5 times per week for 30+ minutes at a time, doing activities which do not make the child breathe hard, such as fast walking, slow bicycling, skating, or pushing a lawnmower. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Within the seven days preceding the interview, a total of 69.7% of Total Service Area children age 2 to 17 participated in vigorous physical activity three or more times, for at least 20 minutes at a time.  Similar to US findings.  Notably high in the northeast.  TREND: Far above the 2012 findings.

Child Participates in Vigorous Physical Activity (Total Service Area Children Age 2-17, 2015) 100%

80%

79.1% 68.7%

65.8%

69.7%

69.1% 56.4%

60%

40%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 179] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Includes exercising at least 3 times per week for 20+ minutes each time, doing exercise which causes the child to breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Of the following demographic segments, children in very low income households show the lowest participation in vigorous physical activity.

Child Participates in Vigorous Physical Activity (Total Service Area Children Age 2-17, 2015) 100%

80%

78.8%

73.1%

78.5% 66.9%

66.2%

72.4%

69.7%

Other

TSA

60.6%

57.8%

60%

69.6%

69.2%

68.2%

40%

20%

Boy Sources: Notes:

Girl

Age 2 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 179] Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Includes exercising at least 3 times per week for 20+ minutes each time, doing exercise which causes the child to breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

During the seven days preceding the interview, one-half (50.6%) of Total Service Area children age 2 to 17 engaged in muscle-strengthening activity three or more times as part of their physical activity.  Does not vary significantly among the three regions.

Child Participates in Muscle Strengthening Activities Three or More Days per Week (Total Service Area Children Age 2-17, 2015) 100%

80%

60%

52.5%

54.7%

Northwest

Northeast

46.9%

50.6%

40%

20%

Sources: Notes:

South

Total Service Area

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Those less likely to participate in muscle-strengthening activity include:  Older children (negative correlation with age).  Children in very low income households.

Child Participates in Muscle Strengthening Activities Three or More Days per Week (Total Service Area Children Age 2-17, 2015) 100%

80%

63.6% 60%

54.1%

63.6%

46.9%

43.8%

40%

59.6% 53.1%

50.6%

48.3%

48.5%

White

Black

50.6%

40.0%

20%

Boy Sources: Notes:

Girl

Age 2 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 316] Asked of those respondents for whom the randomly selected child in the household is between the ages of 2 and 17. Muscle-strengthening activities include playing on playground equipment, climbing trees, playing tug-of-war, working with resistance bands, or lifting weights. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

121

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Screen Time Television Watching & Other Screen Time Among children aged 5 through 17: 34.6% are reported to watch three or more hours of television on an average week day; 19.6% are reported to spend three or more hours on “On an average week day, about how many hours or minutes does this child usually spend in front of a TV watching TV programs, videos, or playing video games?”

the computer doing non-school related activities.

Children’s Screen Time (Total Service Area Children Age 5-17, 2015) 3+ Hours 34.6%

“On an average week day, how many hours or minutes does this child usually spend with computers, cell phones, handheld video games, and other electronic devices?”

None 12.1%

None 21.1%

3+ Hours 19.6%

<1 Hour 9.2%

<1 Hour 15.5% 2 Hours 17.8%

2 Hours 23.1%

1 Hour 21.0%

Hours per Day of TV/Videos or Video Games Sources: Notes:

1 Hour 26.0% Hours per Day on a Computer (not schoolwork)

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 120, 122, 153-154] Asked of respondents for whom the randomly selected child in the household is age 5 to 17. For this issue, respondents with children who are not in school were asked about “weekdays,” while parents of children in school were asked about typical “school days.” “Three or more hours” includes reported screen time of 180 minutes or more per day.

Total Screen Time When combined, a total of 58.4% of Total Service Area school-age children spend three or more hours per day on screen time (whether television, computer, video games, etc.).  The proportions by region are statistically comparable.  TREND: Statistically unchanged since 2012.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Children With 3+ Hours per School Day of Total Screen Time (TV, Computer, Video Games, etc.) (Total Service Area Children Age 5-17, 2015) 100%

80%

60.6%

60%

59.6%

58.4%

South

Total Service Area

52.3%

54.3%

58.4%

40%

20%

Northwest

Northeast

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 155] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of respondents for whom the randomly selected child in the household is age 5 to 17. For this issue, respondents with children who are not in school were asked about “weekdays,” while parents of children in school were asked about typical “school days.” “Three or more hours” includes reported screen time of 180 minutes or more per day.

Those more likely to spend 3+ hours per day on screen time include:  Children living just above the federal poverty line.  “Other” race children.

Children With 3+ Hours per School Day of Total Screen Time (TV, Computer, Video Games, etc.) (Total Service Area Children Age 5-17, 2015) 100%

80%

75.2%

70.0% 61.8%

61.7% 60%

54.8%

55.5%

Girl

Age 5 to 12

59.3% 52.3%

52.4%

54.6%

White

Black

58.4%

40%

20%

Boy Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 155] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Electronic Media in Children’s Bedrooms 3 out of 5 Total Service Area school-age children (59.9%) have television in their bedrooms.  Much higher than the national proportion.  Statistically similar by region.  TREND: Has changed little the past three years (not shown). Furthermore, one-half (50.4%) of Total Service Area school-age children have access to computers or some type of electronic devices in their bedrooms.  Well above the US percentage.  Highest in the northeast.

Access to Electronic Media in Children’s Bedrooms (Total Service Area Children Age 5-17, 2015) 100%

Television

Computer/Electronic Device

80%

60%

60.2%

54.8%

58.8%

48.4%

62.2%

59.9% 50.4%

47.7%

41.3%

39.4%

40%

20%

Northwest Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 121, 123] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is age 5 to 17.

124

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Black or “Other” race children are much more likely than white children to have a television in his/her bedroom.

Child Has a Television in His/Her Bedroom (Total Service Area Children Age 5-17, 2015) 100%

80%

60.8%

60%

58.9%

64.0%

64.6%

56.5%

62.3%

61.8%

59.2%

56.6%

59.9%

34.9%

40%

20%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 121] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

 Teenagers and Black children are more likely than their demographic counterparts to have access to some type of computer or other electronic device in his/her bedroom.  Note the strong positive correlation with household income.

Child Has a Computer or Device in His/Her Bedroom (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

51.9%

60.9%

56.4% 48.8%

53.8%

50.4%

45.5%

45.4%

40%

29.7%

35.5%

35.2%

20%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 123] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Weight Status Childhood Overweight & Obesity About Weight Status in Children & Teens In children and teens, body mass index (BMI) is used to assess weight status – underweight, healthy weight, overweight, or obese. After BMI is calculated for children and teens, the BMI number is plotted on the CDC BMI-for-age growth charts (for either girls or boys) to obtain a percentile ranking. Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children in the United States. The percentile indicates the relative position of the child's BMI number among children of the same sex and age. BMI-for-age weight status categories and the corresponding percentiles are shown below:    

Underweight <5th percentile Healthy Weight ≥5th and <85th percentile Overweight ≥85th and <95th percentile Obese ≥95th percentile

– Centers for Disease Control and Prevention

Based on the heights/weights reported by surveyed parents, 44.0% of Total Service Area children age 5 to 17 are overweight or obese (≥85th percentile).  Considerably less favorable than the obesity prevalence reported nationwide.  Particularly more favorable in the northeast.  TREND: Statistically similar to prior survey findings.

Child Is Overweight or Obese (Total Service Area Children Age 5-17 With a BMI in the 85th Percentile or Higher) 100%

80%

60%

48.4% 40%

47.7%

44.0%

40.1% 31.1%

30.9%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 157] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Overweight among children 5-17 is determined by child’s Body Mass Index status at or above the 85 th percentile of US growth charts by gender and age.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

School-age children in the Total Service Area who are more likely to be overweight or obese include:  Those age 5 to 12.  Those in households with very low incomes.  Black or “Other” race children.

Child Is Overweight or Obese (Total Service Area Children Age 5-17 With a BMI in the 85th Percentile or Higher) 100%

80%

60.4%

60%

45.4%

51.5% 42.7%

40.7%

36.0%

40%

45.4%

41.2%

42.2%

44.0%

Other

TSA

25.5% 20%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 157] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Overweight among children is determined by children’s Body Mass Index status equal to or above the 85th percentile of US growth charts by gender and age. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Further, 29.0% of Total Service Area children age 5 to 17 are obese (≥95th percentile). Note that this proportion is included in the “overweight or obese” percentage reported above.  Notably less favorable than the US findings.  Twice the Healthy People 2020 target (14.5% or lower).  Highest in the northwest; lowest in the northeast.  TREND: Statistically unchanged over time.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Obesity Prevalence (Total Service Area Children Age 5-17 with a BMI in the 95th Percentile or Higher) Healthy People 2020 Target = 14.5% or Lower 100%

80%

60%

35.7%

40%

29.2%

29.0%

20%

29.0%

23.8%

18.8%

14.4%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 157] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective NWS-10.4] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Obesity among children is determined by children’s Body Mass Index status equal to or above the 95 th percentile of US growth charts by gender and age.

 Obesity is higher among Total Service Area children age 5 to12 and those living in very low income households.

Child Obesity Prevalence (Total Service Area Children Age 5-17 with a BMI in the 95th Percentile or Higher) Healthy People 2020 Target = 14.5% or Lower 100%

80%

60%

43.5% 40%

36.8%

32.2% 25.8%

26.1%

20.7%

20%

28.3%

26.1%

33.7%

29.0%

19.1%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 157] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective NWS-10.4] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Overweight among children is determined by children’s Body Mass Index status equal to or above the 85 th percentile of US growth charts by gender and age. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Perceptions of Overweight Actual vs. Perceived Body Weight Interestingly, among parents of children age 5-17 who are overweight or obese (based on BMI), 47.5% sees their child as being at “about the right weight.”  Only 31.7% of parents with an overweight (not obese) child perceive their child as “somewhat overweight” or “very overweight.”  Only 12.2% of parents with an obese child consider that child to be “very overweight.”

Child’s Actual vs. Perceived Weight Status (Total Service Area Children Age 5-17 Who Are Overweight/Obese Based on BMI, 2015) 100%

80%

Among Children Overweight But Not Obese (Based on BMI 85th-94th Percentile) Among Obese Children (Based on BMI 95th Percentile) 62.1%

60%

43.0%

40.1%

40%

29.8%

20%

6.3%

12.2%

4.7%

1.9%

Parent Perceives Child as "Very/Somewhat Underweight" Sources: Notes:

Parent Perceives Child as "About the Right Weight"

Parent Perceives Child as "Somewhat Overweight"

Parent Perceives Child as "Very Overweight"

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 132] Asked of those respondents for whom the randomly selected child at home is age 5 to 17. Overweight in children is defined as a Body Mass Index (BMI) value at or above the 85 th percentile of US growth charts by gender and age; obesity in children is defined as a BMI value at or above the 95 th percentile.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Notification of Overweight Status A clear majority of parents with overweight or obese children (83.5%) has not been told in the past year by a school or health professional that their child is overweight. ď&#x201A;ˇ Notably higher than US findings (not shown). ď&#x201A;ˇ TREND: The prevalence of these notifications has barely changed within the past three years.

Parent Has Been Told in the Past Year by a School or Health Professional That Their Child Is Overweight (Total Service Area Children Age 5-17 Who Are Overweight/Obese Based on BMI, 2015) 100%

80%

60%

40%

20%

32.7%

27.1%

27.3%

2012

2015

16.5%

Among Parents of Overweight/Not Obese Children (Based on BMI) Sources: Notes:

Among Parents of Obese Children (Based on BMI)

Parents of Overweight or Obese Children

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 133] Asked of those respondents for whom the randomly selected child at home is age 5 to 17. Overweight in children is defined as a Body Mass Index (BMI) value at or above the 85 th percentile of US growth charts by gender and age; obesity in children is defined as a BMI value at or above the 95 th percentile.

130

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Tobacco Exposure to Environmental Tobacco Smoke About Tobacco Exposure There is no risk-free level of exposure to secondhand smoke. Secondhand smoke causes heart disease and lung cancer in adults and a number of health problems in infants and children, including: severe asthma attacks; respiratory infections; ear infections; and sudden infant death syndrome (SIDS). – Healthy People 2020 (www.healthypeople.gov)

A total of 14.4% of Total Service Area parents report that someone in the household smokes inside the home.  Well above the US proportion.  Statistically comparable by region.  TREND: Statistically comparable to 2012 findings.

Someone Smokes Tobacco Inside the House (Total Service Area, 2015) 100%

80%

60%

40%

20%

17.4%

13.5%

12.3%

14.4%

14.7%

14.4%

2012

2015

3.7% 0%

Northwest

Northeast

South

Total Service Area

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 119] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

These Total Service Area children are more likely to be exposed to tobacco smoke in the home:  Children in lower income households (note the negative correlation with income).  Black children.

Someone Smokes Tobacco Inside the House (Total Service Area, 2015) 100%

80%

60%

40%

20%

13.0%

15.8%

11.3%

21.8%

17.0%

14.3%

17.1%

16.3% 9.1%

7.9%

Mid/High Income

White

10.2%

14.4%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 119] Asked of all respondents. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

A total of 23.2% of Total Service Area parents report that someone in the household smokes outside the home.  Statistically similar by region.  TREND: Statistically similar to what was reported in 2012.

Someone Smokes Tobacco Outside the House (Total Service Area, 2015) 100%

80%

60%

40%

25.4% 20%

19.5%

23.3%

23.2%

South

Total Service Area

27.4%

23.2%

Northwest

Northeast

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 315] Asked of all respondents.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Smoking outside the home is notably higher among low income households.

Someone Smokes Tobacco Outside the House (Total Service Area, 2015) 100%

80%

60%

40%

32.5% 22.9%

23.5%

Boy

Girl

23.9%

23.8%

21.7%

25.5%

25.0%

20%

16.8%

16.7%

Mid/High Income

White

17.6%

23.2%

Sources: Notes:

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 315] Asked of all respondents. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Injury & Safety About Injury & Violence Injuries and violence are widespread in society. Both unintentional injuries and those caused by acts of violence are among the top 15 killers for Americans of all ages. Many people accept them as “accidents,” “acts of fate,” or as “part of life.” However, most events resulting in injury, disability, or death are predictable and preventable. Injuries are the leading cause of death for Americans ages 1 to 44, and a leading cause of disability for all ages, regardless of sex, race/ethnicity, or socioeconomic status. More than 180,000 people die from injuries each year, and approximately 1 in 10 sustains a nonfatal injury serious enough to be treated in a hospital emergency department. Beyond their immediate health consequences, injuries and violence have a significant impact on the well-being of Americans by contributing to:     

Premature death Disability Poor mental health High medical costs Lost productivity

The effects of injuries and violence extend beyond the injured person or victim of violence to family members, friends, coworkers, employers, and communities. Numerous factors can affect the risk of unintentional injury and violence, including individual behaviors, physical environment, access to health services (ranging from pre-hospital and acute care to rehabilitation), and social environment (from parental monitoring and supervision of youth to peer group associations, neighborhoods, and communities). Interventions addressing these social and physical factors have the potential to prevent unintentional injuries and violence. Efforts to prevent unintentional injury may focus on:     

Modifications of the environment Improvements in product safety Legislation and enforcement Education and behavior change Technology and engineering

Efforts to prevent violence may focus on:  Changing social norms about the acceptability of violence  Improving problem-solving skills (for example, parenting, conflict resolution, coping)  Changing policies to address the social and economic conditions that often give rise to violence – Healthy People 2020 (www.healthypeople.gov)

Prevalence of Injuries Injuries Requiring Treatment “In the past two years, has this child been injured seriously enough to need treatment from a doctor or a nurse?”

While most Total Service Area children were not injured seriously in the past year, 9.4% sustained injuries serious enough to require medical treatment.  Statistically comparable to US findings.  Highest in the northeast; lowest in the south.  TREND: Statistically unchanged over time.

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Child Was Injured Seriously Enough to Need Medical Treatment in the Past Year (Total Service Area, 2015) 100%

80%

Number of Times: 1 71.0% 2 9.5% 3+ 19.4%

60%

40%

20%

14.6%

10.4%

9.4%

10.6%

8.0%

9.4%

Total Service Area

2012

2015

5.5%

Northwest

Northeast

South

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 78-79] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

A total of 71.0% of respondents reported that their child was seriously injured just once in the past year. However, 9.5% reported two incidents and 19.4% said their child needed medical treatment for an injury three or more times in the past twelve months.  Total Service Area children more likely to have sustained a serious injury in the past year are those in mid/high income households.

Child Was Injured Seriously Enough to Need Medical Treatment in the Past Year (Total Service Area, 2015) 100%

80%

60%

40%

20%

11.2%

7.5%

7.0%

8.7%

Girl

Age 0 to 4

Age 5 to 12

12.5%

8.0%

14.0%

10.8%

8.6%

White

Black

4.4%

12.6%

9.4%

Boy Sources: Notes:

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 78] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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When asked what the child was doing when the injury occurred, parents of these children mentioned activities like organized sports (24.9%), falling or tripping (16.3%), unknown activity (13.7%), and accidents (13.3%). Other activities included playing (11.7%), running (6.3%), and car accidents (5.9%).

Childâ&#x20AC;&#x2122;s Activity When Most Seriously Injured in Past Two Years (Total Service Area Children Seriously Injured in the Past Year, 2015) Accident 13.3%

Don't Know/Not Sure 13.7%

Playing 11.7% Falling/Tripping 16.3% Running 6.3%

Car Accident 5.9%

Other (Each <4%) 7.9%

Organized Sports 24.9% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 80] Asked of all respondents for whom the randomly selected child in the household was seriously injured in the past year.

When asked about the type of injury sustained, these parents frequently mentioned broken bones (20.0%), sprained ankle/foot (12.1%), unknown injury (9.1%), sprained arm/wrist (6.9%), and injuries requiring stitches (6.8%). Injuries mentioned with less frequency included eye injuries, dislocated joints, torn ACL, and scratches.

Type of Injury Sustained (Total Service Area Children Seriously Injured in the Past Year, 2015) Sprained Ankle/Foot 12.1%

Don't Know/Not Sure 9.1%

Sprained Arm/Wrist 6.9% Stitches 6.8% Eye Injury 5.1%

Broken Bone 20.0%

Dislocated Joint 5.1% Torn ACL 4.8% Scratch 4.2% Other (Each <4%) 25.7% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 81] Asked of all respondents for whom the randomly selected child in the household was seriously injured in the past year.

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When asked where they sought help for the childâ&#x20AC;&#x2122;s injury, 59.8% of parents mentioned a hospital emergency room, followed by a family physician (19.6%), or an urgent care center (4.8%). Other sources of help were a parent/guardian (3.6%) or a specialist (3.2%). 9.1% of parents did not know or remember the source of care.

Source for Help After the Injury (Total Service Area Children Seriously Injured in the Past Year, 2015) Family Doctor 19.6%

Don't Know/Not Sure 9.1% Urgent Care 4.8% Hospital/ER 59.8%

Sources: Notes:

Parents/Guardian 3.6% Specialist 3.2%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 82] Asked of all respondents for whom the randomly selected child in the household was seriously injured in the past year.

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Injury Control Car Seats & Seat Belts A full 92.4% of Total Service Area parents report that their child (age 0 to 17) “always” wears a seat belt (or appropriate car seat for younger children) when riding in a motor vehicle.  Lower than the US percentage.  Favorably high in the northeast region.  TREND: Statistically unchanged since 2012.

Child “Always” Wears a Seat Belt or Appropriate Restraint When Riding in a Vehicle (Total Service Area, 2015) 100%

91.1%

80%

96.5%

91.1%

92.4%

South

Total Service Area

95.7%

92.9%

92.4%

2012

2015

60%

40%

20%

Northwest

Northeast

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 83] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 Car seat and seat belt usage is lower among children under age 5 (positive correlation with age).

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child “Always” Wears a Seat Belt or Appropriate Restraint When Riding in a Vehicle (Total Service Area, 2015) 100%

92.0%

92.8%

Boy

Girl

94.5%

95.2%

94.8%

86.5%

80%

96.8%

90.6%

93.3%

Low Income

Mid/High Income

93.7%

89.3%

92.4%

60%

40%

20%

Sources: Notes:

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 83] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Helmet Use Bicycles Roughly one-third (34.3%) of Total Service Area children age 5 to 17 are reported to “always” wear a helmet when riding a bicycle.  Notably less favorable than the US proportion.  Far more favorable in the northeast.  TREND: Statistically similar to 2012 findings.

Child “Always” Wore a Helmet When Riding a Bicycle in the Past Year (Total Service Area Children Age 5-17 Who Rode a Bike in the Past Year, 2015) 100%

80%

60%

48.2% 40%

46.5% 31.3%

29.4%

34.3%

29.3%

34.3%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 88] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household is age 5-17 and who rode a bike in the past year.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Among children (age 5-17), Black children are less likely to “always” wear a bike helmet.

Child “Always” Wore a Helmet When Riding a Bicycle in the Past Year (Total Service Area Children Age 5-17 Who Rode a Bike in the Past Year, 2015) 100%

80%

56.3%

60%

40%

38.6%

37.2% 29.5%

29.5%

33.9%

34.3%

Black

TSA

20%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

White

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 88] Asked of all respondents for whom the randomly selected child in the household is age 5-17 and who rode a bike in the past year. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents).

Skateboards, Scooters, Skates & Rollerblades A total of 28.5% of Total Service Area children age 5 to 17 are reported to “always” wear a helmet when riding a skateboard, scooter, skates, or rollerblades (denominator reflects only those who engage in these activities).  Lower than national findings.  Lowest in the south.  TREND: Marks a statistically significant increase in helmet usage since 2012.

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Child “Always” Wore a Helmet on Skateboards, Scooters, Skates or Rollerblades in the Past Year (Total Service Area Children Age 5-17 Who Engaged in These Activities in the Past Year, 2015) 100%

80%

60%

40%

30.5%

37.4%

35.5% 22.8%

28.5%

28.5% 18.7%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources:

Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 89] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household is age 5-17 and who rode a skateboard, scooter, skates or rollerblades in the past year; excludes the 50.5 of children who did not engage in these activities.

 Helmet usage is much lower among Black children than White children.

Child “Always” Wore a Helmet on Skateboards, Scooters, Skates or Rollerblades in the Past Year (Total Service Area Children Age 5-17 Who Engaged in These Activities in the Past Year, 2015) 100%

80%

57.3%

60%

40%

29.7%

27.1%

26.9%

Boy

Girl

Age 5 to 12

31.2%

28.1%

28.5%

Black

TSA

20%

Sources: Notes:

Age 13 to 17

White

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 89] Asked of all respondents for whom the randomly selected child in the household is age 5-17 and who rode a skateboard, scooter, skates or rollerblades in the past year; excludes the 50.5% of children who did not engage in these activities. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents).

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Violence & Safety Neighborhood Safety Only 43.2% of Total Service Area families live in “extremely safe” or “quite safe” neighborhoods leaving the majority (56.8%) of parents living in neighborhoods they consider only “slightly safe” or “not at all safe.”

Perceived Safety of Neighborhood (Total Service Area, 2015)

Slightly Safe 38.8%

Not At All Safe 18.0%

Extremely Safe 11.8%

Quite Safe 31.4% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 87] Asked of all respondents.

 The prevalence of “slightly/not at all safe” responses is extensively less favorable than national reports.  There is no statistically significant difference in perceptions of neighborhood safety among the three regions.  TREND: Perceptions of poor neighborhood safety have remained statistically unchanged since 2012.

Neighborhood Perceived to be “Slightly/Not At All” Safe (Total Service Area, 2015) 100%

80%

61.8% 60%

53.4%

54.5%

62.9%

56.8%

40%

20%

14.2%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 87] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents.

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 Note the strong negative correlation with household income level.  Also, parents of Black children are much more likely to live in neighborhoods they consider “slightly/not at all” safe,” followed by parents of “Other” race children.

Neighborhood Perceived to be “Slightly/Not At All” Safe (Total Service Area, 2015) 100%

80%

60%

72.4% 58.5%

55.2%

57.6%

63.8% 55.9%

61.9%

57.3%

56.8% 46.1%

43.1% 40%

24.9% 20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 87] Asked of all respondents. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Respondents who perceived their neighborhood as “quite”, “slightly”, or “not at all” safe, were then asked what they thought could be done to make the area safer for their child. Parents most often recommended an increase in police presence (33.1%), although some (11.4%) were not sure how to make the community safer. Other ideas included gun control (mentioned by 7.1%), community involvement (5.8%), decrease in crime (4.0%), more activities for children (3.7%), and moving to a different area (3.6%).

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How To Make Neighborhood Safer for Children (Among Parents Not Reporting Neighborhood as Extremely Safe; Total Service Area, 2015) 0%

20%

40%

More Police Presence

Community Involvement

100%

11.4% 7.1% 5.8%

Decrease Crime

4.0%

More Activities for Children

3.7%

Move

3.6%

Various Other (<3.5% Each)

Sources: Notes:

80%

33.1%

Don't Know/Not Sure Gun Control

60%

31.2%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 303] Asked of all respondents who perceive their neighborhood to be “quite”, “slightly”, or “not at all” safe.

Feeling Safe at School or Going to/From School “During the past year, how many days did this child not go to school because he/she felt unsafe at school or on the way to or from school?”

A total of 8.0% of Total Service Area children age 5-17 missed school at least once in the past year because he/she felt unsafe at school.  Statistically comparable findings among the three regions. Further, 5.9% of school-aged children missed school at least once in the past year because he/she felt unsafe on the way to/from school.  Highest in the northwest; lowest in the south.

Child Missed School Because Felt Unsafe (Total Service Area Children 5-17, 2015) 100%

At School

Going To/From School

80%

60%

40%

20%

10.8%

9.7%

5.9%

5.6%

6.4%

2.8%

8.0%

5.9%

Northwest Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 304, 306] Asked of those respondents for whom the randomly selected child in the household is age 5 to 17.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Children living in mid/high income households are more likely to miss school due to feeling unsafe at school.

Child Missed School in the Past Year Due to Feeling Unsafe at School (Total Service Area Children Age 5-17, 2015) 100%

Most parents reported that their child felt unsafe because of bullying (mentioned by 28.8%), followed by school shootings in the area (20.3%), and fights (14.9%). 16.7% of parents did not know why their child felt unsafe at school.

80%

60%

40%

20%

9.6%

6.1%

Girl

Age 5 to 12

9.9%

8.3%

11.5%

15.4%

3.5%

7.4%

8.8%

8.0%

Black

Other

TSA

Boy Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 304-305] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Most parents reported that their child felt unsafe at school because of bullying (mentioned by 28.8%), followed by school shootings in the area (20.3%), and fights (14.9%). However, 16.7% of parents did not know why their child felt unsafe at school.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Boys are more likely than girls to miss school because they feel unsafe while going to/from school.

Child Missed School in the Past Year Due to Feeling Unsafe Going To/From School (Total Service Area Children Age 5-17, 2015) 100%

Most parents reported that their child felt unsafe because of bullying (mentioned by 29.0%), followed by lingering bad crowds(15.4%), guns (9.5%), and gangs (9.4%). 17.2% of parents did not know why their child felt unsafe on the way to/from school.

80%

60%

40%

20%

8.6%

3.0%

6.3%

5.6%

6.5%

4.0%

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

8.0%

9.9%

Mid/High Income

White

11.3% 4.4%

5.9%

Boy Sources: Notes:

Girl

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 306-307] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Most parents reported that their child felt unsafe going to/from school because of bullying (mentioned by 29.0%), followed by lingering bad crowds (15.4%), guns (9.5%), and gangs (9.4%). However, 17.2% of parents did not know why their child felt unsafe on the way to/from school.

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Overall, 8.6% of Total Service Area children age 5 to 17 missed school in the past year because he/she felt unsafe at school or going to/from school.  Less favorable than national findings.  No statistical difference by region.  TREND: Statistically similar to 2012 findings.

Child Missed School in the Past Year Due to Feeling Unsafe at School or Going To/From School (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

12.9% 6.0%

6.4%

8.6%

Northeast

South

Total Service Area

11.5%

8.6%

2012

2015

5.0%

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 319] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household is age 5-17.

 The proportion of children missing school due to safety reasons is statistically higher among children in mid/high income households and Whites.

Child Missed School in the Past Year Due to Feeling Unsafe at School or Going To/From School (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

11.2%

6.1%

7.1%

Girl

Age 5 to 12

10.5%

9.5%

12.6%

17.7% 7.6%

3.8%

11.1%

8.6%

Other

TSA

Boy Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 319] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Gang Violence Gang violence did not make the vast majority (84.7%) of school-aged children living in the Total Service Area feel unsafe in the past year.  Yet 3.1% of children felt unsafe for more than ten days in the past year due to an incident of gang violence.

Days Child Felt Unsafe in Past Year Due to an Incident of Gang Violence (Total Service Area Children Age 5-17, 2015)

One 2.7% Two 2.3%

None 84.7%

Three to Five 5.9% Six to Ten 1.4% More Than Ten 3.1%

Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 309] Asked of all respondents for whom the randomly selected child in the household is age 5-17.

In all, 15.4% of children age 5 to 17 felt unsafe at least once in the past year because of gang violence.  Highest in the northwest; lowest in the south.

Gang Violence Made Child Feel Unsafe in Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

23.6% 15.4%

15.2%

20%

7.7% 0%

Northwest

Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 309-310] Asked of all respondents for whom the randomly selected child in the household is age 5-17.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Reasons given for their child’s feelings of insecurity following an incident of gang violence included general activity around the city (53.5%), the incident occurring in school or close to home (14.1%), fights (12.4%), and that the child was directly involved in the incident (10.3%). Other mentions each represent less than 4%.  Children of “Other” races are much more likely to feel unsafe following an incident of gang violence.

Gang Violence Made Child Feel Unsafe in Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

29.7% 18.9%

16.5%

14.1%

12.1%

Boy

Girl

Age 5 to 12

21.2%

23.2% 12.4%

15.3%

12.9%

White

Black

15.4%

Sources: Notes:

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 309] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Change in Daily Routine According to the National Institute of Mental Health, changes in normal daily routine may be a sign of post-traumatic stress disorder (PTSD). .

Feelings of unsafety caused a total of 9.2% of Total Service Area school-aged children to change their normal daily routine in the past year.  Lowest in the southern region.

Child Changed Normal Daily Routine Due to Not Feeling Safe (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

12.6%

12.0%

9.2%

4.9% 0%

Northwest

Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 311] Asked of all respondents for whom the randomly selected child in the household is age 5-17.

 A change in daily routine due to feelings of unsafety is more likely to be observed in boys and children of “Other” races.

Child Changed Normal Daily Routine Due to Not Feeling Safe (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

12.8% 5.6%

7.6%

Girl

Age 5 to 12

11.2%

13.3%

Age 13 to 17

Very Low Income

19.5% 10.5%

7.6%

7.4%

7.3%

Mid/High Income

White

Black

9.2%

Boy Sources: Notes:

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 311] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Communication with Parent Seeking out support from other people such as friends or family is a resilience factor that may reduce the risk of PTSD (NIMH).

Nearly one-fourth (23.5%) of Total Service Area parents reported that their child talked to them about a specific episode of violence in school or in their neighborhood that he/she experienced or witnessed and was affected by. ď&#x201A;ˇ Lowest in the southern region.

Child talked to Parent About a Violent Incident that Affected Them (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

31.6% 23.5%

23.3% 16.5%

20%

Northwest Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 312] Asked of all respondents for whom the randomly selected child in the household is age 5-17.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Note the following:  There is a negative correlation between children talking to their parent about a violent incident and the household income.  Black children are more likely to talk to their parents about a violent incident that affected them.

Child talked to Parent About a Violent Incident that Affected Them (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

36.0%

40%

23.8%

23.1%

22.7%

29.6%

24.3%

25.0% 17.6%

20%

14.1%

20.2%

23.5%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 312] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Bullying Among parents of school-age children (age 5-17), 20.8% report that their child has been Cyberbullying includes electronic bullying such as through email, chat rooms, instant messaging, websites, or texting.

bullied in the past year on school property; another 5.8% report that their child has been cyber-bullied (these percentages are not mutually-exclusive).  Both forms of bullying occur in the Total Service Area at statistically similar rates as seen nationwide.  Bullying on school property is more prevalent in the northwest region.

NOTE: It is important to recognize that these measures are reported by parents and are limited to incidents of which parents are aware; it is reasonable to presume that the true incidence for these measures is potentially quite a bit higher.

 Cyber-bullying is lowest in the southern region.

Child Was Bullied in the Past Year (Total Service Area Children 5-17, 2015) 100%

Bullied at School

Cyberbullied

80%

60%

40%

26.9% 20%

19.1% 9.4%

20.8%

16.5% 5.9%

2.7%

16.1% 7.5%

5.8%

Northwest Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 85, 86] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is age 5 to 17. Cyberbullying includes electronic bullying such as through email, chat rooms, instant messaging, websites, or texting.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Children age 5 to 12 are more likely to be bullied on school property than are teens.

Child Was Bullied on School Property in the Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

19.8%

21.9%

Boy

Girl

26.3%

25.2%

24.8%

16.2%

19.7%

17.2%

Mid/High Income

White

21.5%

21.3%

20.8%

Black

Other

TSA

Sources: Notes:

Age 5 to 12

Age 13 to 17

Very Low Income

Low Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 85] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

 Parents’ reports of cyberbullying are highest among White children.

Child Was Cyberbullied in the Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

15.9%

20%

4.8%

6.8%

4.3%

Boy

Girl

Age 5 to 12

7.4% Age 13 to 17

5.0%

6.6%

5.9%

Very Low Income

Low Income

Mid/High Income

4.8%

8.4%

5.8%

Other

TSA

Sources: Notes:

White

Black

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 86] Asked of those respondents for whom the randomly selected child in the household is between the ages of 5 and 17. Cyberbullying includes electronic bullying such as through email, chat rooms, instant messaging, websites, or texting. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

154

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Physical Injuries A total of 6.6% of Total Service Area school-aged children have been physically injured from bullying or fighting in the past year.  Statistically similar findings within the Total Service Area.

Child Was Physically Injured from Bullying/Fighting in Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

8.5%

6.8%

4.8%

6.6%

Northwest

Northeast

South

Total Service Area

Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 308] Asked of all respondents for whom the randomly selected child in the household is age 5-17.

 Boys are more likely than girls to have been injured from bullying or fighting in the past year.

Child Was Physically Injured from Bullying/Fighting in Past Year (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

40%

20%

9.7%

3.5%

12.5%

7.7%

5.2%

Age 5 to 12

Age 13 to 17

6.8%

4.6%

4.5%

6.3%

Low Income

Mid/High Income

White

Black

9.3%

6.6%

Other

TSA

Boy Sources: Notes:

Girl

Very Low Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 308] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

155

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Sexual Activity Chlamydia & Gonorrhea In 2012, there were 727.3 diagnosed chlamydia infections per 100,000 population in Cook County.  Much less favorable than statewide findings.  Much less favorable than national findings. In 2012, there were 230.8 diagnosed gonorrhea infections per 100,000 population in Cook County.  Less favorable than the Illinois rate.  Less favorable than the US rate.

Chlamydia & Gonorrhea Incidence (Incidence Rate per 100,000 Population, 2012) 800

Cook County

727.3

700 600

526.1 456.7

500 400 300

230.8

200

141.0

100

107.5

Chlamydia Sources: Notes:

Gonorrhea

Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: 2012. Retrieved November 2015 from Community Commons at http://www.chna.org. This indicator is relevant because it is a measure of poor health status and indicates the prevalence of unsafe sex practices. Gonorrhea rates for the Total Service Area are not available due to a small sample size.

156

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Of the 8,398 total chlamydia cases reported in Cook County in 2011, 36.2% were among adolescents and preteens age 10 to 19.

Chlamydia by Age Group (Cook County, 2011) 25 to 29 Yrs 15.5% 20 to 24 Yrs 35.8%

30 to 34 Yrs 6.6% 35 to 44 Yrs 4.6% >44 Yrs 1.3% 0 to 9 Yrs 0.1%

10 to 14 Yrs 0.9% 15 to 19 Yrs 35.3% Sources: Notes:

Cook County Department of Public Health, 2011 STI Surveillance Report. Percentages are based on 8,398 total cases.

Of the 2,067 total gonorrhea cases reported in Cook County in 2011, 34.1% were among adolescents and preteens age 10 to 19.

Gonorrhea by Age Group (Cook County, 2011) 25 to 29 Yrs 16.1% 20 to 24 Yrs 34.2%

30 to 34 Yrs 6.6%

35 to 44 Yrs 6.3% >44 Yrs 2.7% 0 to 9 Yrs 0.0% 10 to 14 Yrs 1.0% 15 to 19 Yrs 33.1% Sources: Notes:

Cook County Department of Public Health, 2011 STI Surveillance Report. Percentages are based on 2,067 total cases

157

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Access to Health Services

158

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Health Insurance Coverage Type of Health Insurance Coverage Survey respondents were asked a series of questions to determine their childâ&#x20AC;&#x2122;s healthcare insurance coverage, if any, from either private or governmentsponsored sources.

A total of 38.6% of parents report having healthcare coverage for their child through private insurance. Another 54.1% report coverage through a government-sponsored program (e.g., Medicaid, Medicare, state-sponsored CHIP, military benefits).

Healthcare Insurance Coverage for Child (Total Service Area, 2015) Private Coverage 38.6%

No Insurance/ Self-Pay 7.3% Other Gov. Sponsored 3.0% VA/Military 2.1%

Medicare 9.7%

State-Sponsored Program 8.0% Sources: Notes:

Medicaid 31.3%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 160] Asked of all respondents.

Affordable Care Act/GetCoveredIllinois During the past two years, 23.8% of currently insured children received coverage as a result of the Affordable Care Act (Obamacare) or the state insurance exchange called GetCoveredIllinois. ď&#x201A;ˇ Statistically comparable by region.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Child Received Insurance in Past Two Years Because of Affordable Care Act or GetCoveredIllinois (Total Service Area Insured Children, 2015) 100%

80%

60%

40%

25.4%

19.6%

20%

24.8%

23.8%

South

Total Service Area

Northwest

Sources: Notes:

Northeast

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 314] Asked of those respondents for whom the randomly selected child in the household has health insurance.

The following children are more likely to have received insurance coverage in the past two years as a result of the Affordable Care Act and GetCoveredIllinois:  Those in households below 200% of the federal poverty level.  Blacks.

Child Received Insurance in Past Two Years Because of Affordable Care Act or GetCoveredIllinois (Total Service Area Insured Children, 2015) 100%

80%

60%

40%

22.3%

25.4%

33.0%

29.4% 20.9%

20%

32.3% 25.6%

22.3% 15.0%

15.0%

Mid/High Income

White

19.8%

23.8%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 314] Asked of those respondents for whom the randomly selected child in the household has health insurance. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

160

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Lack of Health Insurance Coverage On the other hand, 7.3% of Total Service Area parents report having no insurance coverage for their child’s healthcare expenses, through either private or public sources.  Statistically comparable to the US figure.  The Healthy People 2020 target is universal coverage (100% insured).  Statistically comparable by region.  TREND: Children’s uninsured prevalence has shown a statistically significant increase since 2012.

Lack Healthcare Insurance Coverage for Child (Total Service Area, 2015) Healthy People 2020 Target = 0% (Universal Coverage) 100%

80%

60%

40%

20%

8.3%

6.2%

7.0%

7.3%

6.5%

4.2%

Northwest

Northeast

South

Total Service Area

2012

7.3%

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 160] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective AHS-1] Asked of all respondents.

161

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 In the Total Service Area, girls are more likely than boys to lack healthcare coverage.

Lack Healthcare Insurance Coverage for Child (Total Service Area, 2015) Healthy People 2020 Target = 0% (Universal Coverage) 100%

80%

60%

40%

20%

10.7% 3.8%

9.2%

6.9%

Age 0 to 4

Age 5 to 12

6.0%

7.4%

7.7%

7.3%

6.9%

8.5%

7.3%

Low Income

Mid/High Income

White

Black

Other

TSA

4.0%

Boy Sources: Notes:

Girl

Age Very Low 13 to 17 Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 160] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective AHS-1] Asked of all respondents. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Recent Lack of Coverage Among parents with insurance for their child, 8.9% report that their child was without healthcare coverage at some point in the past year.  Similar to the US proportion.  Statistically similar among the three regions.  TREND: Statistically unchanged over time.

Insured Child Went Without Coverage at Some Point in the Past Year (Total Service Area Children with Insurance, 2015) 100%

80%

60%

40%

20%

9.9%

7.4%

8.9%

7.1%

Northwest

Northeast

South

Total Service Area

9.9%

8.9%

2012

2015

Total Service Area Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 118] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household has healthcare insurance coverage.

162

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Among insured children, those age 5 to 12 are more likely to have gone without healthcare insurance coverage at some point in the past year.

Insured Child Went Without Coverage at Some Point in the Past Year (Total Service Area Children with Insurance, 2015) 100%

80%

60%

40%

20%

10.7%

7.0%

9.9%

11.4%

Age 0 to 4

Age 5 to 12

5.0%

9.7%

12.0%

7.8%

5.9%

8.1%

Mid/High Income

White

Black

13.0%

8.9%

Boy Sources: Notes:

Girl

Age Very Low 13 to 17 Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 118] Asked of all respondents for whom the randomly selected child in the household has healthcare insurance coverage. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

163

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Difficulties Accessing Healthcare About Access to Healthcare Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. It impacts: overall physical, social, and mental health status; prevention of disease and disability; detection and treatment of health conditions; quality of life; preventable death; and life expectancy. Access to health services means the timely use of personal health services to achieve the best health outcomes. It requires three distinct steps: 1) Gaining entry into the health care system; 2) Accessing a health care location where needed services are provided; and 3) Finding a health care provider with whom the patient can communicate and trust. – Healthy People 2020 (www.healthypeople.gov)

A total of 48.0% of Total Service Area parents report some type of difficulty or delay in This indicator reflects the percentage of parents experiencing problems accessing healthcare for their child in the past year, regardless of whether they needed or sought care.

obtaining healthcare services for their child in the past year.  Much less favorable than the national percentage.  Least favorable in the southern region.  TREND: Denotes a statistically significant increase in the past three years.

Experienced Difficulties or Delays of Some Kind in Receiving Child’s Needed Healthcare in the Past Year (Total Service Area, 2015) 100%

80%

55.0%

60%

44.1%

48.0%

41.8%

37.8%

40%

29.4%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 175] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household. Represents the percentage of respondents experiencing one or more barriers to accessing their child’s healthcare in the past 12 months.

164

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Note that parents of boys or those with low household incomes more often report difficulties accessing healthcare services for their child.

Experienced Difficulties or Delays of Some Kind in Receiving Child’s Needed Healthcare in the Past Year (Total Service Area, 2015) 100%

80%

60%

54.7%

48.9% 41.3%

52.0%

52.9%

57.2%

44.1%

53.1% 42.0%

40%

46.7%

48.0%

38.5%

20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 175] Asked of all respondents about a randomly selected child in the household. Represents the percentage of respondents experiencing one or more barriers to accessing their child’s healthcare in the past 12 months. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

165

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Barriers to Healthcare Access Total Service Area children (32.0% of parents say that inconvenient office hours prevented them from obtaining a visit to a physician for their child in the past year). Difficulty getting a doctor’s appointment impacted 24.1%.  Note that parents living in the northwest region reported the highest prevalence of difficulties due to lack of transportation, cost of prescriptions, and language or cultural differences.  The northeast region exhibited the best (lowest) percentages in the Total Service Area for inconvenient office hours and cost of prescriptions.  Parents in the southern region make up the highest proportion that is hindered by inconvenient office hours, but the lowest proportion thwarted by lack of transportation.

Barriers to Access Have Prevented Child’s Medical Care in the Past Year (By County, 2015) 100%

Northwest

Northeast

South

Total Service Area

80%

6.2%

4.3%

9.7%

3.9%

10.5%

8.8%

12.6%

10.0%

12.9%

9.4%

21.1%

6.7%

13.1%

8.0%

18.1%

14.5%

14.0%

12.3%

18.2%

20%

10.4%

25.3%

24.1%

22.7%

38.5%

40%

32.0%

60%

29.7%

Again, these percentages reflect all children, regardless of whether medical care was needed or sought.

Of the tested access barriers, Inconvenient office hours impacted the greatest share of

24.0%

To better understand healthcare access barriers, survey participants were asked whether any of seven types of barriers to access prevented their child from seeing a physician or obtaining a needed prescription in the past year.

Inconvenient Office Hours Sources: Notes:

Getting a Dr Appointment

Finding a Doctor

Lack of Transportation

Cost (Prescriptions)

Cost (Doctor Visit)

Culture/ Language

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 19-25] Asked of all respondents about a randomly selected child in the household.

227

166

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 For all of the tested barriers, the proportion of Total Service Area children impacted was statistically higher than nationwide findings.  TREND: For most of the tested barriers, the proportion of Total Service Area children impacted was statistically worse (higher) than 2012 findings; however, the prevalence of cost barriers (prescription and doctor) remained statistically unchanged.

Barriers to Access Have Prevented Child’s Medical Care in the Past Year (Total Service Area, 2015) 100%

Total Service Area 2012

Total Service Area 2015

80%

0.8%

6.2%

6.3%

10.5%

6.8%

5.5%

12.9%

10.9%

13.1%

4.1%

8.8%

5.7%

14.0%

8.1%

11.5%

24.1%

16.6%

14.2%

20%

32.0%

40%

23.0%

60%

Inconvenient Office Hours Sources: Notes:

Getting a Dr Appointment

Finding a Doctor

Lack of Transportation

Cost (Prescriptions)

Cost (Doctor Visit)

*Cultural/ Language

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 19-25] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household. *Culture/language difference was not included in the 2012 survey.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Access to Specialty Care A total of 37.9% of Total Service Area children are reported to have needed to see a specialist at some point in the past year.  Well above the US proportion.  Statistically similar among the three regions.  TREND: Denotes a statistically significant increase within the past three years.

Child Needed a Specialist in the Past Year (Total Service Area, 2015) 100%

80%

60%

42.5%

37.8%

40%

37.9%

33.9%

24.2%

25.0%

2012

20%

Northwest

Northeast

South

Total Service Area

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 30] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

 In the Total Service Area, Black children are more likely to have needed to see a specialist in the past year.

Child Needed a Specialist in the Past Year (Total Service Area, 2015) 100%

80%

60%

41.4% 40%

34.2%

34.8%

39.7%

38.7%

33.5%

36.7%

39.5%

38.2%

32.2%

27.7%

37.9%

20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 30] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Parents of children needing specialty medical care in the past year were further asked to evaluate the difficulty of getting the needed care; more than one-half (52.7%) expressed some level of difficulty, characterizing it as a “major,” “moderate” or “minor problem.”  In particular, 18.9% of these parents had “moderate problems” getting their child’s specialty care, and 16.0% had “major problems.”  “Major/moderate problem” responses in the Total Service Area are statistically similar to US findings.  Among the three regions, the prevalence of “major/moderate problem” responses is favorably low in the south.  TREND: Since 2012, “major/moderate problem” ratings have not changed significantly in the Total service Area (now shown).

Evaluation of Difficulty Getting Specialty Care for Child in the Past Year (Total Service Area Parents of Children Needing to See a Specialist in the Past Year) Major Problem

Moderate Problem

Minor Problem

Not a Problem at All

100%

80%

43.2%

46.9%

52.4%

47.4%

50.1%

60%

15.2% 40%

21.5%

14.5%

17.8% 22.6%

20.7%

20%

18.9% 14.8%

20.1%

17.9%

Northwest

Northeast

10.3%

South

16.0%

Total Service Area 2015

17.6%

23.2% 9.1%

Source: ● 2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 31] ● 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Notes: Asked of respondents for whom the randomly selected child in the household has needed to see a specialist in the past year.

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Outmigration for Children’s Healthcare Nearly one-half (49.3%) of Total Service Area parents report that they feel the need to leave their local areas in order to get certain children’s healthcare services.  Much higher than the national proportion.  Particularly high in the northwest region.

Feel the Need to Leave the Area for Children’s Healthcare Services (Total Service Area, 2015) 100%

80%

55.6%

60%

49.3%

46.1%

45.1% 40%

27.2% 20%

Northwest

Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 11] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc.] Asked of all respondents.

 Statistically no difference in outmigration across basic child demographic characteristics.

Feel the Need to Leave the Area for Children’s Healthcare Services (Total Service Area, 2015) 100%

17.9% of respondents did not know which services they feel the need to leave their local areas for, whereas others identified all services (16.1%), pediatrics/general medical care (19.0%), hospitalization (11.6%), mental health services (5.5%), and dental care (3.5%).

80%

60%

49.2%

49.4%

Boy

Girl

53.5% 44.7%

48.7%

50.1%

51.5% 45.0%

47.1%

Mid/High Income

White

50.5%

46.1%

49.3%

40%

20%

Sources: Notes:

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 11-12] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Asked to specify the services for which they feel they need to leave their areas to receive care, the greatest share of respondents (19.0%) said pediatrics/general medical care, 17.9% were not sure or didnâ&#x20AC;&#x2122;t know and 16.1% indicated all services. Other responses were for hospitalization (11.6%); mental health services (5.5%) and dental care (3.5%). A wide variety of other responses was given; none individually mentioned by more than 2.5%. Their reasons for feeling the need to leave their areas primarily related to perceptions that better care is available elsewhere (43.6%), or that services are not available locally (31.1%), followed by other access-related reasons (7.0%), and doctorâ&#x20AC;&#x2122;s recommendation (4.1%). 6.3% were unsure.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Primary Care Services About Primary Care Improving health care services depends in part on ensuring that people have a usual and ongoing source of care. People with a usual source of care have better health outcomes and fewer disparities and costs. Having a primary care provider (PCP) as the usual source of care is especially important. PCPs can develop meaningful and sustained relationships with patients and provide integrated services while practicing in the context of family and community. Having a usual PCP is associated with:  Greater patient trust in the provider  Good patient-provider communication  Increased likelihood that patients will receive appropriate care Improving health care services includes increasing access to and use of evidence-based preventive services. Clinical preventive services are services that: prevent illness by detecting early warning signs or symptoms before they develop into a disease (primary prevention); or detect a disease at an earlier, and often more treatable, stage (secondary prevention). – Healthy People 2020 (www.healthypeople.gov)

Usual Source of Care A total of 93.3% of Total Service Area children were determined to have a usual source Having a usual source of care for a child includes having a doctor’s office, clinic, urgent care center, walk-in clinic, health center facility, hospital outpatient clinic, or some other kind of place to go if the child is sick or needs advice about his or her health. This resource is crucial to the concept of “patientcentered medical homes” (PCMH).

of medical care, such as a specific doctor’s office or clinic they regularly use.  More favorable than the US percentage.  Fails to satisfy the Healthy People 2020 objective (100%).  Least favorable in the northwest.  TREND: The proportion of Total Service Area children having a usual source of care has significantly increased since 2012.

Have a Usual Source for Child’s Ongoing Medical Care Healthy People 2020 Target = 100% 100%

80%

89.5%

95.8%

95.1%

93.3%

93.5%

93.3% 85.2%

60%

40%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 27] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective AHS-5.2] Asked of all respondents about a randomly selected child in the household. Having a specific source of ongoing care for a child includes having a doctor’s office, clinic, urgent care center, health department clinic, or some other kind of place to go if the child is sick or needs advice about his or her health.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Within each demographic breakout, children are equally likely to have a usual source of care.

Have a Usual Source for Child’s Ongoing Medical Care (Total Service Area, 2015) Healthy People 2020 Target = 100% 100%

92.8%

93.8%

Boy

Girl

80%

89.3%

93.9%

96.3%

94.3%

92.9%

92.4%

92.1%

94.4%

Low Income

Mid/High Income

White

Black

88.7%

93.3%

60%

40%

20%

Sources: Notes:

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 27] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objectives AHS-5.2] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. Having a specific source of ongoing care for a child includes having a doctor’s office, clinic, urgent care center, health department clinic, or some other kind of place to go if the child is sick or needs advice about his or her health.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Type of Place Used for Medical Care When asked where they take their child if they are sick or need advice about their health, the greatest share of respondents (51.0%) identified a particular doctor’s office, followed by those using some type of clinic (27.8%). A total of 8.4% say they usually go to a hospital emergency room, while 2.0% rely on an urgent care center, and 1.5% use a health department for their child’s medical care.

Particular Place Utilized for Child’s Medical Care (Total Service Area, 2015) Clinic 27.8%

Dr's Office 51.0% Hospital ER 8.4% None 6.8% Other 2.4% Health Deparment 1.5% Urgent Care 2.0% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 27-28] Asked of all respondents about a randomly selected child in the household.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Receipt of Routine Medical Care A routine checkup can include a well-child checkup or general physical exam, but does not include exams for a sports physical or visits for a specific injury, illness, or condition.

A total of 93.5% of Total Service Area children have had a routine checkup in the past year.  More favorable than US findings.  Statistically, no difference among the three regions.  TREND: Statistically unchanged since 2012.

Child Visited a Physician for a Routine Checkup in the Past Year (Total Service Area, 2015) 100%

93.8%

96.5%

80%

91.4%

93.5%

South

Total Service Area

85.3%

91.5%

93.5%

2012

2015

60%

40%

20%

Northwest

Northeast

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 29] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Note that routine checkups are highest among children under age 5.  Nonetheless, Total Service Area adolescents satisfy the Healthy People 2020 target (75.6% or higher) for their age group.

Child Visited a Physician for a Routine Checkup in the Past Year (Total Service Area, 2015) 100%

94.2%

92.8%

98.0% 90.2%

80%

60%

93.1%

96.6%

93.1%

92.6%

91.8%

93.9%

93.1%

93.5%

Mid/High Income

White

Black

Other

TSA

Healthy People 2020 Objective AH-1: Increase the proportion of adolescents who have had a wellness checkup in the past 12 months to 75.6% or higher.

40%

20%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 29] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective AH-1] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Dental Care About Oral Health Oral health is essential to overall health. Good oral health improves a person’s ability to speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions. However, oral diseases, from cavities to oral cancer, cause pain and disability for many Americans. Good self-care, such as brushing with fluoride toothpaste, daily flossing, and professional treatment, is key to good oral health. Health behaviors that can lead to poor oral health include: tobacco use; excessive alcohol use; and poor dietary choices. The significant improvement in the oral health of Americans over the past 50 years is a public health success story. Most of the gains are a result of effective prevention and treatment efforts. One major success is community water fluoridation, which now benefits about 7 out of 10 Americans who get water through public water systems. However, some Americans do not have access to preventive programs. People who have the least access to preventive services and dental treatment have greater rates of oral diseases. A person’s ability to access oral healthcare is associated with factors such as education level, income, race, and ethnicity. Barriers that can limit a person’s use of preventive interventions and treatments include: limited access to and availability of dental services; lack of awareness of the need for care; cost; and fear of dental procedures. There are also social determinants that affect oral health. In general, people with lower levels of education and income, and people from specific racial/ethnic groups, have higher rates of disease. People with disabilities and other health conditions, like diabetes, are more likely to have poor oral health. Potential strategies to address these issues include:    

Implementing and evaluating activities that have an impact on health behavior. Promoting interventions to reduce tooth decay, such as dental sealants and fluoride use. Evaluating and improving methods of monitoring oral diseases and conditions. Increasing the capacity of State dental health programs to provide preventive oral health services.  Increasing the number of community health centers with an oral health component. – Healthy People 2020 (www.healthypeople.gov)

Receipt of Dental Care Most Total Service Area children age 2-17 (69.9%) have received dental care (for any reason) in the past 6 months.  Asked to specify the reason for their child’s most recent dental visit, 79.7% of parents mentioned a routine cleaning or checkup, while other visits were for orthodontic work (5.7%), a cavity fill (4.1%), or repair work (4.1%).

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Characteristics of Child’s Most Recent Dental Visit (Total Service Area Children Age 2-17, 2015)

Orthodontic 5.7% Cavity Fill 4.1% Repair Work 4.1% Don't Know 4.0% Other (each <2%) 2.4%

6-12 Months 15.9% Within 6 Months 69.9%

Between 1-2 Years 9.2%

Routine Cleaning 79.7%

>2 Years 0.6% Never 4.5%

Length of Time Since Child’s Most Recent Dental Visit Sources: Notes:

Reason for Child’s Last Dental Visit (Among Children 2-17 Who Have Visited a Dentist)

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 46-47] Asked of those respondents for whom the randomly selected child in the household is age 2 to 17.

In all, 85.8% of Total Service Area children age 2-17 have visited a dentist or dental clinic (for any reason) in the past year.  Comparable to the US prevalence.  Satisfies the Healthy People 2020 target.  Most favorable in the northeast; least favorable in the south.  TREND: No statistically significant change in recent dental care has occurred over time.

Child Visited a Dentist or Dental Clinic Within the Past Year (Total Service Area Children Age 2-17, 2015) Healthy People 2020 Target = 49.0% or Higher 100%

80%

87.3%

93.1% 80.5%

85.8%

84.9%

Total Service Area

84.6%

85.8%

2012

2015

60%

40%

20%

Northwest

Northeast

South

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 46] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective OH-7] Asked of those respondents for whom the randomly selected child in the household is age 2 to 17.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Children age 2 to 5 and teenagers (13-17) are less likely to have visited a dentist or dental clinic in the past year.

Child Visited a Dentist or Dental Clinic Within the Past Year (Total Service Area Children Age 2-17, 2015) Healthy People 2020 Target = 49.0% or Higher 100%

84.1%

91.2%

87.4%

84.2% 77.0%

80%

88.0%

88.7%

87.3%

80.8%

80.0%

85.8%

60%

40%

20%

Boy Sources: Notes:

Girl

Age 2 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 46] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MICH-2.1] Asked of those respondents for whom the randomly selected child in the household is age 2 to 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Dental Sealants A total of 32.0% of parents report that their child (age 6 to 17) has had sealants put on their molars.  Well below the US proportion.  Statistically comparable by region.  TREND: Statistically comparable to 2012 findings.

Child Has Received Dental Sealants on His or Her Molars (Total Service Area Children Age 6-17, 2015) 100%

80%

60%

46.8% 35.7%

40%

34.6%

35.1%

32.0%

27.6%

32.0%

20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 48] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of those respondents for whom the randomly selected child in the household is age 6 to 17.

 The prevalence of dental sealants is lower among children in very low income households and Black children.

Child Has Received Dental Sealants on His or Her Molars (Total Service Area Children Age 6-17, 2015) 100%

80%

60%

42.5% 40%

34.2%

29.7%

30.5%

35.4%

33.5%

35.6% 28.5%

32.0%

22.0% 20%

Boy Sources: Notes:

Girl

Age 6 to 12

Age 13 to 17

Very Low Income

Low Income

Mid/High Income

White

Black

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 48] Asked of those respondents for whom the randomly selected child in the household is age 6 to 17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Vision & Hearing Recent Eye Exams RELATED ISSUE: See also Vision Problems and Hearing Problems in the Prevalence of Selected Medical Conditions section of this report

Note the following frequency of eye exams among Total Service Area children; as shown, 14.8% of Total Service Area children have never had an eye exam.

Child’s Most Recent Eye Exam (Total Service Area, 2015) 1 to 2 Years Ago 18.2%

3 Yrs Ago 3.6% >3 Years Ago 0.9% Within Past Year 62.5%

Sources: Notes:

Never 14.8%

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 38] Asked of all respondents about a randomly selected child in the household.

On the other hand, 84.3% of Total Service Area parents indicate that their child has had an eye exam within the past three years.  Higher than the US prevalence.  Similar findings when viewed by region.  TREND: Marks a statistically significant decrease since 2012.

Child Had an Eye Exam in the Past Three Years (Total Service Area, 2015) 100%

84.6%

82.9%

84.9%

84.3%

Northwest

Northeast

South

Total Service Area

80%

89.3% 78.8%

84.3%

60%

40%

20%

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 38] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

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 Children age 0 to 4 and those living in households at either end of the income spectrum are less likely to have received an eye exam in the past 3 years (note the positive correlation with age).  However, the prevalence of Total Service Area children age 0 to 5 who have had an eye exam in the past year (48.3%) is statistically similar to the Healthy People 2020 target (44.1% or higher) for their age group.

Child Had an Eye Exam in the Past Three Years (Total Service Area, 2015) 100%

95.8% 80%

82.4%

97.4%

86.2%

94.6% 87.5%

83.6%

80.8%

85.9%

84.3% 77.7%

60%

56.9% 40%

20%

Healthy People 2020 Objective V-1: Increase the proportion of preschool children aged 0-5 who receive vision screening to 44.1% or higher. In the Total Service Area, 48.3% of children 0-5 received an eye exam in the past year.

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 38] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective V-1] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Hearing Tests Note that 6.4% of Total Service Area parents indicate that their child has never had a hearing test.

Child’s Most Recent Hearing Test (Total Service Area, 2015)

1 to 2 Years Ago 17.6%

Within Past Year 61.6%

2 to 3 Years 7.7% 3 to 5 Years 2.9% >5 Years 3.8%

Never 6.4% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 40] Asked of all respondents about a randomly selected child in the household.

On the other hand, 89.8% of Total Service Area children have had a hearing test within the past five years.  Higher than US findings.  Lowest in the northeast; highest in the northwest.  TREND: Statistically similar to prior survey findings.

Child Had a Hearing Test in the Past Five Years (Total Service Area, 2015) 100%

94.2% 80%

84.3%

88.9%

89.8%

South

Total Service Area

84.9%

87.7%

89.8%

2012

2015

60%

40%

20%

Northwest

Northeast

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 40] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

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CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Statistically, no difference in hearing test prevalence when viewed by key demographic characteristics.  Note that the prevalence of hearing tests among Total Service Area adolescents age 12 to 17 (85.4%) is statistically similar to the Healthy People 2020 target (87.2% or higher) set for those age 12 to 19.

Child Had a Hearing Test in the Past Five Years (Total Service Area, 2015) 100%

80%

89.5%

90.1%

92.0%

91.0%

85.9%

92.0%

91.0%

87.3%

88.9%

91.6%

Mid/High Income

White

Black

84.8%

89.8%

60% Healthy People 2020 Objective ENT-VSL-4.3: Increase the proportion of adolescents aged 12 to 19 years who have had a hearing examination in the past 5 years to 87.2% or higher.

40%

20%

In the Total Service Area, 85.4% of adolescents age 12-17 had a hearing exam in the past 5 years.

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 40] US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective ENT-VSL-4.3] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

184

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Emergent & Urgent Care Emergency Room Utilization A total of 16.9% of Total Service Area parents report taking their child to a hospital emergency room (ER) more than once in the past year.  More than twice the US figure.  Statistically comparable within the Total Service Area.  TREND: Statistically unchanged over the past three years.

Child Used a Hospital Emergency Room More Than Once in the Past Year (Total Service Area, 2015) 100%

80%

60%

24.2% of visits resulted in a hospital admission (among all children with any ER visits in the past year).

40%

20%

20.8%

17.5%

13.0%

16.9%

14.6%

16.9%

2012

2015

7.1%

Northwest

Northeast

South

Total Service Area

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 41-42] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

185

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 Children age 5 to 12 are more likely to have used a hospital emergency room for care more than once in the past year.

Child Used a Hospital Emergency Room More Than Once in the Past Year (Total Service Area, 2015) 100%

80%

60%

40%

20%

16.9%

18.5%

21.0%

17.7% 10.0%

12.4%

23.8%

18.5%

16.4%

14.9%

Mid/High Income

White

Black

16.9%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 41] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

Of those whose child used a hospital ER, nearly one-fourth (24.2%) say the visit resulted in a hospital admission.

186

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Among Total Service Area parents of children with any ER visit in the past year, 55.0% say the visit was for something that might have been treated in a doctor’s office.  Asked why they used a hospital ER for their child’s care, 43.8% indicated that they needed the care after hours or on the weekend and 30.2% said the visit was to treat an actual emergency situation.  Another 16.5% of Total Service Area parents took their child to a hospital ER in the past year because of access-related issues, 4.5% were recommended to use the ER by the child’s primary care physician, and 2.5% did so because of the quality of care.

Emergency Room Visits (Among Total Service Area Children With Any ER Visits in the Past Year, 2015) 0%

20%

40%

After Hours/ Weekend No 45.0%

Yes 55.0%

ER Visit Was for Something That Might Have Been Treated in a Doctor’s Office Sources: Notes:

80%

100%

43.8%

Emergency Access-Related Issues Recommended by Doctor

60%

30.2% 16.5%

4.5%

Quality of Care

2.5%

Don't Know

2.4%

Reason for Using the Hospital ER Instead of a Doctor’s Office or Clinic (Among Those Responding “Yes” at Left)

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Items 43-44] Asked of respondents for whom the randomly selected child in the household used a hospital ER in the past year.

187

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Urgent Care Centers/Walk-In Clinics Nearly one-third (33.0%) of Total Service Area children visited an urgent care center or other walk-in clinic at least once in the past year.  The prevalence includes 7.1% of Total Service Area children who visited an urgent care center 3+ times in the past year.

Number of Visits to an Urgent Care Center or Other Walk-in Clinic in the Past Year (Total Service Area, 2015) One 16.2%

Two 9.7% Three 3.7% Four/More 3.4%

None 67.0%

Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 45] Asked of all respondents about a randomly selected child in the household.

 The prevalence of children using an urgent care clinic in the past year is statistically similar to national findings.  Most prevalent in the northwest; least prevalent in the south.

Child Used an Urgent Care Center, QuickCare Clinic, or Other Walk-In Clinic in the Past Year (Total Service Area, 2015) 100%

80%

60%

40%

39.5%

35.1%

33.0% 26.3%

28.6%

20%

Northwest Sources: Notes:

Northeast

South

Total Service Area

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 45] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

188

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

 The proportion of children who have sought care at a walk-in clinic in the past year is statistically similar across the following demographic segments.

Child Used an Urgent Care Center, QuickCare Clinic, or Other Walk-In Clinic in the Past Year (Total Service Area, 2015) 100%

80%

60%

40%

37.3%

34.1%

32.1%

30.3%

Boy

Girl

Age 0 to 4

30.7%

30.0%

30.6%

35.7%

38.7%

31.9%

36.4%

33.0%

20%

Sources: Notes:

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 45] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

189

Health Education & Outreach

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Health Education Primary Source of Healthcare Information “Where do you get most of your healthcare information for this child?”

Family physicians are the primary source of children’s healthcare information for 57.2% of Total Service Area parents.  The Internet received the second-highest response, with 16.7%.

Primary Source of Healthcare Information for Child (Total Service Area, 2015) Internet 16.7%

Don't Know 4.7% Friends/Relatives 3.6% Hospital Publications 3.3% Health Department 3.0%

Family Doctor 57.2%

Other (Each <3%) 11.5% Sources: Notes:

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 138] Asked of all respondents about a randomly selected child in the household.

 The prevalence of Total Service Area parents who rely on the Internet as their primary source of healthcare information for their child is higher than US findings.  Similar by region.  TREND: Marks a statistically significant increase since 2012.

Internet Is the Primary Source of Healthcare Information (Total Service Area, 2015) 100%

80%

60%

40%

20%

16.7%

15.3%

17.4%

Northeast

South

16.7% 9.6%

11.8%

2012

16.7%

Northwest

Total Service Area

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 138] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents about a randomly selected child in the household.

191

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

The proportion of parents who rely on the Internet for healthcare information is higher among:  Those with higher incomes (positive correlation with income).  Parents of White or “Other” race children.

Internet Is the Primary Source of Healthcare Information (Total Service Area, 2015) 100%

80%

60%

38.2%

40%

20%

30.2% 17.7%

22.8% 15.7%

13.8%

16.1%

14.2%

22.0%

16.7% 9.7%

5.6% 0%

Boy Sources: Notes:

Girl

Age 0 to 4

Age 5 to 12

Age Very Low 13 to 17 Income

Low Income

Mid/High Income

White

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 138] Asked of all respondents about a randomly selected child in the household. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

192

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Local Parenting Education Among Total Service Area survey respondents, 31.0% are aware of parenting education programs offered in the community.  Awareness is lowest in the southern region.  TREND: Statistically unchanged since 2012.

Aware of Local Parenting Education Programs 100%

80%

60%

37.6%

35.2%

40%

37.1%

31.0%

23.4% 20%

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 317] Asked of all respondents.

 When viewed by basic demographic characteristics of the respondent, men are notably more likely than women to be aware of local parenting programs.  Respondents for whom the randomly selected child is White also report higher awareness.

Aware of Local Parenting Education Programs (By Adult Respondents’ Demographic Characteristics*; Total Service Area, 2015) 100%

80%

60%

42.3%

41.8% 40%

28.4%

31.6%

32.1%

30.6%

35.9%

33.1%

31.7% 25.1%

24.7%

31.0%

20%

Men Sources: Notes:

Women

18 to 34

35 to 44

45+

Very Low Income

Low Income

Mid/High Income

White*

Black*

Other*

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 317] Asked of all respondents. *Race reflects that of the child, not the respondent. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

193

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Among respondents who are aware of local parenting education programs, 43.8% have ever used one.  A higher participation rate is found in the northwest than in the northeast.  TREND: Statistically comparable to 2012 findings.

Have Used a Local Parenting Education Program (Among Parents Aware of Local Programs; Total Service Area, 2015) 100%

80%

60%

53.4% 43.8%

43.0% 40%

20%

38.4%

43.8%

n/a

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 318] Asked of all respondents who were aware of a parenting education program offered in their community. Data for the South is unreliable due to a small sample size (<50).

194

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Access to Technology Internet Access Most respondents (94.8%) have access to the Internet.  Lower than the proportion found nationwide.  Lowest in the northwest region.  TREND: Current Internet access is statistically similar to previous findings.

Have Access to the Internet (Total Service Area, 2015) 100%

80%

97.5%

96.8%

94.8%

97.2%

96.7%

94.8%

Northeast

South

Total Service Area

2012

2015

90.7%

60%

40%

20%

Northwest

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Item 144] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents.

 Note the positive correlation with household income level.  Households with Black children are less likely to have access to the Internet.

Have Access to the Internet (Total Service Area, 2015) 100%

95.2%

94.3%

92.0%

94.7%

Age 0 to 4

Age 5 to 12

97.5%

95.8%

97.8%

99.3%

Low Income

Mid/High Income

White

93.3%

98.7%

94.8%

87.0%

80%

60%

40%

20%

Boy Sources: Notes:

Girl

Age Very Low 13 to 17 Income

Black

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 144] Asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

195

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Children with Cellphones Among parents of school-age children, over one-half (54.8%) indicates that their child has his/her own cell phone. Of these children, a full 86.4% have a smart phone, on which he/she can download apps or games and visit social media sites.  Considerably higher than the national proportion.  The prevalence of children with cell phones does not vary significantly by region.  TREND: Statistically similar to the 2012 prevalence.

Child Has Own Cell Phone (Total Service Area Children Age 5-17, 2015) 100%

80%

60%

58.9%

57.5%

49.3%

54.8% 43.0%

48.6%

54.8%

40%

20%

87.6% have a smart phone

92.9% have a smart phone

82.0% have a smart phone

86.4% have a smart phone

68.5% have a smart phone

Northwest

Northeast

South

Total Service Area

2012

2015

Total Service Area Sources: Notes:

PRC Child & Adolescent Health Surveys, Professional Research Consultants, Inc. [Items 147-148] 2014 PRC National Child & Adolescent Health Survey, Professional Research Consultants, Inc. Asked of all respondents for whom the randomly selected child in the household is age 5-17.

196

CHILD & ADOLESCENT HEALTH: A SUPPLEMENT TO THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT

Note the following:  Prevalence among Total Service Area teens increases to 80.1%.  Children living in mid/high income households are more likely to have a cellphone (positive correlation with income).

Child Has Own Cell Phone (Total Service Area Children Age 5-17, 2015) 100%

80.1%

80%

61.8% 60%

54.3%

55.4%

40%

44.2%

45.5%

Very Low Income

Low Income

60.9% 54.1%

54.0%

White

Black

54.8%

33.7%

20%

Boy Sources: Notes:

Girl

Age 5 to 12

Age 13 to 17

Mid/High Income

Other

TSA

2015 PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. [Item 147] Asked of all respondents for whom the randomly selected child in the household is age 5-17. Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Very Low Income” includes households with incomes below 100% of the federal poverty level; “Low Income” includes households with incomes between 100% and 199% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level.

197