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HEALTH, NUTRITION AND HEALTHCARE AVAILABILITY

Matthew M. Davis, MD, MAPP

FIELDED AUGUST - SEPTEMBER 2013 REPORT 2

Dianne C. Singer, MPH

Kathryn L. Moseley, MD, MPH Susan J. Woolford, MD, MPH

Jeny Tony Philip, MBA Anna Daly Kauffman, BA Megan K. Ramthun


MISSION OF THE NATIONAL VOICES PROJECT

Led by researchers at the University of Michigan, the National Voices Project is an effort to bring the perspectives of thousands of people in communities across the United States to the national dialogue about opportunities and barriers for children related to race/ethnicity. The National Voices Project conducts major national surveys twice each year among adults who work and volunteer on behalf of children. These surveys focus on racial/ethnic inequities at the community level that affect children’s health, education, and economic security. For more information, visit the project website: NationalVoicesProject.org. The National Voices Project team is grateful for the support and collaboration of the W.K. Kellogg Foundation (WKKF), through the America Healing initiative.

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CONTENTS EXECUTIVE SUMMARY

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METHODS

8

SELECTING THE NVP 2013 SAMPLE

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SECTION 1: RESPONDENT CHARACTERISTICS

11

SECTION 2: COMMUNITY CHARACTERISTICS

17

SECTION 3: HEALTH AND NUTRITION OPPORTUNITIES

21

SECTION 4: HEALTHCARE AVAILABILITY

37

COMMENTS FROM RESPONDENTS ABOUT PROGRAMS IN THEIR BEST-KNOWN COMMUNITIES

50

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EXECUTIVE SUMMARY

With support and collaboration from the W.K. Kellogg Foundation through the America Healing initiative, researchers at the University of Michigan are leading the National Voices Project (NVP) from 2011-2016. The central goals of the NVP are to examine the sources of racial/ethnic inequity and other disparities for children in the United States today and identify interventions that address disparities effectively. The NVP offers an unprecedented perspective on community-level opportunities for children throughout the country, in the domains of health and nutrition, education and learning, and economic security – through the eyes of adults whose occupations and volunteer work affect such opportunities. In other words, the NVP reflects the perceptions of individuals throughout the United States who are in a position to improve children’s opportunities in the future. We generally use the word ―children‖ throughout the report to describe children from age 0-18 years, unless otherwise noted. Findings from NVP surveys are shared with the W.K. Kellogg Foundation, and key results are posted on the NVP website (NationalVoicesProject.org). Findings from the NVP 2013 survey and subsequent NVP surveys will be shared similarly with the public.

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In NVP 2013, fielded in August-September 2013, the NVP team introduced 4 key innovations: (1) additional national sample of the general population to compare data among respondents who do versus not work and volunteer with children (to be featured in an NVP 2013 Supplemental Report) (2) new measurement of the diversity of racial/ethnic groups in communities best known to the respondents (3) new measurement of perceived housing segregation (also to be presented in an NVP 2013 Supplemental Report) (4) new measurement of life satisfaction of the respondents Report #2 for NVP 2013 focuses on opportunities for health and nutrition and availability of healthcare. For selected measures, Report #2 highlights differences from 2012 to 2013 for the ―Place Matters‖ sample versus a sample of Comparative Communities. Subsequent reports for NVP 2013 will center on findings related to children’s education and learning, and to economic opportunities.

Overall, the NVP 2013 sample included 2,712 adults from 50 states and the District of Columbia. They were eligible to participate based on their occupations and/or volunteer efforts that affect children, as follows: 1,480 respondents said that they have jobs that affect education, health, economic opportunities, or community and civic engagement for children; 1,232 respondents identified themselves as volunteering in these same domains. The NVP 2013 sample included 1,107 respondents from ―Place Matters‖ communities and 1,605 respondents from Comparative Communities throughout the rest of the United States. Six communities (Wayne-MI; King-WA; Alameda-CA; Suffolk-MA; Fresno-CA; Bernalillo-NM) constituted 85% of the ―Place Matters‖ subsample. About one-half of ―Place Matters‖ respondents said that their communities were more than 50% minority in racial/ethnic diversity, compared with one-quarter of respondents in Comparative Communities. 5

MULTIPLE INNOVATIONS IN NVP 2013 INCLUDED ADDITIONAL RESPONDENTS TO UNDERSTAND HOW THOSE WHO WORK OR VOLUNTEER ON BEHALF OF CHILDREN DIFFER FROM THOSE WHO DO NOT, AND NEW MEASURES OF HOUSING SEGREGATION AND LIFE SATISFACTION

ALL 50 STATES AND D.C. WERE REPRESENTED IN THE SAMPLE OF RESPONDENTS FOR

NVP 2013


HEALTH AND NUTRITION OPPORTUNITIES

RESPONDENTS IN ―PLACE MATTERS‖ COMMUNITIES WERE LESS LIKELY TO REPORT ―LOTS OF OPPORTUNITY‖ FOR YOUNG CHILDREN AND TEENS IN ALL FOUR DOMAINS OF HEALTH AND NUTRITION THAN RESPONDENTS IN

COMPARATIVE COMMUNITIES

NVP measures opportunities for young children and teens in four domains of health and nutrition: neighborhoods without violence, access to lots of fresh fruits and vegetables, places to get physical activity, and clean air, water and outdoor spaces. Respondents in ―Place Matters‖ communities were less likely to perceive ―lots of opportunity‖ for young children and teens in each of these domains of health and nutrition than respondents in the Comparative Communities. For all four domains of health and nutrition, differences in ―lots of opportunity‖ for children and teens were related to inequities in the community, housing segregation and respondents’ race/ethnicity. Respondents who generally perceived racial/ethnic inequities in their communities were less likely to perceive ―lots of opportunity‖ than those who reported little or no inequities. Respondents who rated housing in their community as very segregated were less likely to perceive ―lots of opportunity‖ than those who perceived no segregation. African American and Hispanic respondents were less likely to perceive ―lots of opportunity‖ than white and multi-race/other respondents.

AFRICAN AMERICAN AND HISPANIC RESPONDENTS WERE LESS LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY‖ FOR YOUNG CHILDREN AND TEENS FOR ALL FOUR DOMAINS OF HEALTH AND NUTRITION THAN WHITE AND MULTI-RACE/ OTHER RESPONDENTS

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AVAILABILITY OF HEALTHCARE SERVICES NVP measures availability of healthcare for children and teens in the following areas: primary care, specialty care, hospital care, dental care, mental health care; availability of reproductive care is measured for teens only. Respondents who perceived racial/ethnic inequities in their communities were less likely to perceive ―lots of availability‖ for young children and teens in all areas of healthcare. African American, Hispanic and multi-race/other respondents were less likely to perceive ―lots of availability‖ for primary care for young children than white respondents. Multirace/other respondents were more likely to perceive ―lots of availability‖ for reproductive care and mental health care for teens than African American, Hispanic or white respondents.

RESPONDENTS WHO PERCEIVED RACIAL/ ETHNIC INEQUITIES IN THEIR COMMUNITIES WERE LESS LIKELY TO PERCEIVE ―LOTS OF AVAILABILITY‖ FOR YOUNG CHILDREN AND TEENS IN ALL MEASURED AREAS OF HEALTHCARE

SUMMARY COMMENTS FOR NVP 2013—REPORT 2 In this report from NVP 2013, many themes from NVP 2012 are echoed. Consistently, lack of neighborhoods without violence is perceived as a major problem for young children and teens. Access to mental health care, another theme currently in the national mindset for children and youth, is widely perceived as lacking, as is reproductive care for adolescents. In NVP 2013, as in NVP 2012, widely perceived inequities at the community level are strongly connected to perceptions of diminished opportunities for young children and teens in the domains of health, nutrition and access to healthcare. In addition, NVP 2013 provides unprecedented levels of detail about perceptions within and across ―Place Matters‖ communities as compared with each other and with other communities across the nation—revealing perceptions of opportunities for children limited by racial/ethnic inequities that must be addressed in order to improve children’s health and nutrition. 7


METHODS The National Voices Project (NVP) is conducted in partnership with GfK, an international survey research organization that maintains the nationally representative, web-enabled KnowledgePanel® of adult members of households across the United States.

NVP 2013 INCLUDED >45% (N=1,129) OF THE SAMPLE FROM

―PLACE MATTERS‖ COMMUNITIES, WHICH ARE HOME TO ABOUT 9 MILLION OUT OF 315 MILLION PEOPLE IN THE

U.S.

TO OVERSAMPLE IN ―PLACE MATTERS‖ LOCATIONS, NVP 2013 RECRUITED FROM TWO SUPPLEMENTARY NATIONAL PANELS

GfK engages all of its panel members via the Internet (current panel size >55,000). Unlike other web-enabled panels, KnowledgePanel® is recruited through goldstandard, random-digit-dial (both landline and cell phones) and address-based sampling techniques. If contacted households do not have computer hardware or Internet access, GfK provides the necessary hardware and connections, free of charge. A major design objective for NVP 2013 is that it includes an oversample of respondents living in communities that are part of the ―Place Matters‖ program. ―Place Matters‖ is an initiative of the Joint Center for Political and Economic Studies that is designed to address health equity concerns through shared learning experiences that focus on social, economic and environmental conditions. The goal of oversampling in ―Place Matters‖ communities in NVP 2013 was to illuminate how perceptions of inequities may differ in communities highlighted in the ―Place Matters‖ initiative, compared with communities elsewhere in the United States. In terms of population, ―Place Matters‖ communities sampled in NVP 2013 include about 9 million individuals, compared with 306 million in the rest of the U.S. Specific ―Place Matters‖ communities were selected for oversampling in NVP through conversations with WKKF collaborators and ―Place Matters‖ team members. The NVP team then worked with GfK to supplement KnowledgePanel® households in ―Place Matters‖ locations. The supplementary sample was drawn from households that are not on GfK’s standing panels but

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are recruited on an ad hoc basis by GfK related to their characteristics – in this case, residing in a ―Place Matters‖ community and/or preferring to read/speak Spanish. For NVP 2013, GfK invited 12,474 KnowledgePanel® members 18 years or older to participate. For the supplementary sample, 49,799 households were invited to participate. Respondents in sampled households (n=6,761 from KnowledgePanel®; n=2,846 from supplementary households) completed a brief screening questionnaire. On the screening questionnaire, 1,480 respondents indicated that they have jobs that affect education, health/healthcare/nutrition, economic opportunities, or community and civic engagement for children. Another 1,232 respondents identified themselves as volunteering in ways that affect education, health/healthcare/nutrition, economic opportunities, or community and civic engagement for children. Respondents working or volunteering on behalf of children were thereby eligible to complete the full NVP 2013 questionnaire (see sample selection schematic, next page). This group included 2,712 adults from 50 states and D.C. The questionnaire for NVP 2013 was developed by the National Voices Project team at the University of Michigan, with input from WKKF collaborators. We examined how individuals who work or volunteer with children view opportunities for education, health/healthcare/nutrition, and economic well-being related to children. Many of the questions were identical to questions fielded for NVP 2012, to facilitate comparisons of responses across these different samples and over time. New questions in NVP 2013 centered on respondents’ perceptions of housing segregation, life satisfaction and on respondents’ awareness about efforts to address racial/ethnic inequities in those communities. NVP 2013 was also fielded in Spanish via a supplemental panel who preferred to answer in Spanish. Overall, 907 individuals participated by using the Spanish-language version, and 197 were eligible to complete the full NVP 2013 questionnaire. 9

THE FINAL ELIGIBLE SAMPLE FOR NVP 2013 INCLUDED 2,712 ADULTS FROM 50 STATES AND D.C.

7% OF RESPONDENTS ANSWERED IN

SPANISH


SELECTING THE NVP 2013 SAMPLE Contacted Supplementary Sample from “Place Matters” Communities = 49,799

Recruited Supplementary Sample from “Place Matters” Communities = 2,846

Completed Eligibility Screener N = 9,607

Contacted KnowledgePanel® Sample from “Place Matters” Communities = 1,379

Recruited KnowledgePanel® Sample from “Place Matters” Communities = 829

Contacted KnowledgePanel® in Comparative Communities = 11,155

Recruited KnowledgePanel® in Comparative Communities = 5,932

NVP 2013 Eligible Sample Based on Occupation N = 1,480 “Place Matters” Communities

Comparative Communities

Non-Hispanic white = 267 Non-Hispanic black = 62 Hispanic = 82 Non-Hispanic other = 157

Non-Hispanic white = 325 Non-Hispanic black = 247 Hispanic = 307 Non-Hispanic other = 33

DOES RESPONDENT OCCUPATION AFFECT CHILDREN?

OR DOES RESPONDENT

NVP 2013 Eligible Sample

VOLUNTEER WORK

N = 2,712

AFFECT CHILDREN?

NVP 2013 Eligible Sample Based Only on Volunteering N = 1,232 “Place Matters” Communities

Comparative Communities

Non-Hispanic white = 324 Non-Hispanic black = 188 Hispanic = 197 Non-Hispanic other = 30

Non-Hispanic white = 278 Non-Hispanic black = 188 Hispanic = 197 Non-Hispanic other = 30

“Place Matters” Communities

Comparative Communities

Non-Hispanic white = 605

Non-Hispanic white = 1,244

Non-Hispanic black = 113

Non-Hispanic black = 490

Hispanic = 148

Hispanic = 588

Non-Hispanic other = 263

Non-Hispanic other = 122

Supplemental GfK® ―Place Matters‖ ―Place Matters‖ N = 843 10

N = 264

GfK® Comparative Communities N = 1,605


SECTION 1: RESPONDENT CHARACTERISTICS, NVP 2013

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TABLE 2013-2.1: SOCIODEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS, NVP 2012 VS. NVP 2013

NVP 2012 N= 2,311

NVP 2013 N= 2,712

Men Women

40% 60%

46% 54%

African American / Black Hispanic / Latino White Multi-race / Other Annual Household Income Less than $30,000 $30,000 - $60,000 $60,001 - $100,000 Greater than $100,000 Education Less than High School High School Some College Bachelor's Degree or Higher Age 18 - 29 30 - 44 45 - 59 60 + Paid Work Yes No Volunteer Work Yes No Community Respondents Know Best Live Work Volunteer Years in Best Known Community Less than 1 Year 1 - 2 Years 3 - 5 Years 6 - 10 Years Greater than 10 Years

12% 11% 72% 4%

11% 9% 74% 6%

18% 24% 29% 29%

18% 23% 29% 30%

8% 19% 31% 42%

7% 19% 32% 42%

20% 28% 33% 19%

22% 32% 28% 18%

70% 30%

75% 25%

65% 35%

67% 33%

55% 32% 14%

62% 27% 11%

3% 6% 11% 10% 69%

4% 5% 14% 15% 62%

Gender

Race / Ethnicity

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TABLE 2013-2.2: RESPONDENTS’ CONTACT WITH CHILDREN AT WORK AND THROUGH VOLUNTEER EFFORTS, NVP 2012 VS. NVP 2013

NVP 2012 N = 2,311

NVP 2013 N= 2,712

Education Health/Healthcare/Nutrition Economic or Job Opportunities Community or Civic Engagement Work or Volunteer with Children Work and Volunteer with Children Only Work with Children Only Volunteer with Children Occupation Education

57% 38% 21% 54%

58% 40% 28% 54%

24% 34% 42%

21% 37% 42%

Teaching (child care, preschool, elementary, and secondary)

23%

21%

Faith-based Organization or Clergy Member Other School or Education-related Activities Health/Healthcare/Nutrition Health or Mental Health Care Public Safety or Emergency Services Public Health Social Worker or Case Worker Economic or Job Opportunities Business Owner or Manager

1% 12%

2% 10%

20% 1% 1% 8%

18% 3% 4% 2%

12%

6%

Private Community Service Organization All Others

6%

2%

16%

22%

41% 25% 38%

Area of Contact with Children (could choose >1)

Participation with Volunteer Organizations (could choose >1) Education and/or schools Social or Community Service Religious Sports, Hobbies, Culture or Arts Food and Nutrition Hospital or Healthcare Youth Clubs, Scouting or 4-H Environmental Public Safety

22% 15% 8% 11% 6% 9%

40% 24% 38% 17% 14% 9% 7% 8% 6%

Shelter and Housing

5%

5%

Mental or Developmental Health

2%

6%

Advocacy

-

6%

Government Agency

-

3%

All Others

-

9%

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TABLE 2013-2.3: SOCIODEMOGRAPHIC CHARACTERISTICS AMONG RESPONDENTS IN “PLACE MATTERS” COMMUNITIES VS. COMPARATIVE COMMUNITIES, NVP 2013

"Place Matters" Communities N = 1,107

Comparative Communities N = 1,605

43% 57%

46% 54%

17% 15% 49% 19%

11% 9% 74% 6%

16% 23% 33% 28%

18% 23% 29% 30%

5% 13% 38% 44%

7% 19% 32% 42%

26% 25% 32% 17%

22% 32% 28% 18%

74% 26%

75% 25%

72% 28%

67% 33%

60% 22% 18%

62% 27% 11%

3% 8% 12% 12% 65%

4% 5% 14% 15% 62%

Gender Men Women Race / Ethnicity* African American / Black Hispanic / Latino White Multi-race / Other Annual Household Income Less than $30,000 $30,000 - $60,000 $60,001 - $100,000 Greater than $100,000 Education Less than High School High School Some College Bachelor's Degree or Higher Age 18 - 29 30 - 44 45 - 59 60 + Paid Work Yes No Volunteer Work Yes No Community Respondents Know Best Live Work Volunteer Years in Best Known Community Less than 1 Year 1 - 2 Years 3 - 5 Years 6 - 10 Years Greater than 10 Years

*P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

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TABLE 2013-2.4: RESPONDENTS’ CONTACT WITH CHILDREN AT WORK AMONG “PLACE MATTERS” COMMUNITIES VS. COMPARATIVE COMMUNITIES, NVP 2013

"Place Matters" Communities N = 1,107

Comparative Communities N = 1,605

57% 45% 30% 57%

58% 40% 28% 54%

22% 33% 45%

21% 37% 42%

20% 2% 7%

21% 3% 9%

21% 3% 5% 3%

18% 3% 4% 2%

10% 1% 19%

6% 2% 22%

41% 28% 25% 21% 12% 11% 9% 9% 11% 6% 5% 5% 3% 6%

40% 23% 38% 17% 14% 9% 7% 8% 5% 5% 6% 6% 2% 10%

Area of Contact with Children (could choose >1) Education Health or Healthcare Economic or Job Opportunities Community or Civic Engagement Work or Volunteer with Children Work and Volunteer with Children Only Work with Children Only Volunteer with Children Occupation Education Teaching (child care, preschool, elementary, and secondary) Faith-based Organization or Clergy Member Other School or Education-related Activities Healthcare Health or Mental Health Care Public Safety or Emergency Services Public Health Social Worker or Case Worker Economic or Job Opportunities Business Owner or Manager Private Community Service Organization All Others Participation with Volunteer Organizations (could choose >1) Education Social or Community Service Religious* Sports, Hobbies, Culture or Arts Food and Nutrition Hospital or Healthcare Youth Clubs, Scouting or 4-H Environmental Public Safety* Shelter and Housing Mental or Developmental Health Advocacy Government Agency All Others

*P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

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TABLE 2013-2.5: IDENTIFICATION OF SPECIFIC “PLACE MATTERS” COMMUNITIES WITH SUFFICIENT SAMPLE IN NVP 2013 TO PERMIT ANALYSES ACROSS COMMUNITIES

Proportion of “Place Matters" Communities N = 1,107 Community/County Location King, WA

25%

Wayne, MI

19%

Alameda, CA Suffolk, MA Fresno, CA

18% 9% 8%

Bernalillo, NM Other ―Place Matters‖ locations

6% 15%

TABLE 2013-2.6: RESPONDENTS’ LIFE SATISFACTION AMONG “PLACE MATTERS” COMMUNITIES VS. COMPARATIVE COMMUNITIES, NVP 2013

"Place Matters" Communities N = 1,107

Comparative Communities N = 1,605

30% 56% 12% 2%

31% 56% 12% <1%

Overall Life Satisfaction Very Satisfied Satisfied Not Very Satisfied Not at all Satisfied

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SECTION 2: COMMUNITY CHARACTERISTICS

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WHICH OF THE FOLLOWING RACIAL/ETHNIC GROUPS LIVE IN THE COMMUNITY THAT YOU KNOW BEST? Figure 2013-2.1: Percent of Respondents Reporting "Some" or "A Lot" of the Following Racial / Ethnic Groups in their Communities 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

99%99%

% of Respondents, 2012

78%78%

% of Respondents, 2013

80% 83% 54%

58% 49% 44% 27%30%

Whites

African Americans / Blacks

Hispanics / Asian Arab Latinos Americans / Americans Pacific Islanders

Note: Response options included ―A lot‖, ―Some‖ and ―Very few or none‖

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American Indians / Alaska Natives

18% 19%

Hawaiian Natives


Compared with NVP 2012, respondents in NVP 2013 reported similar racial/ethnic makeups of their communities (Figure 2013-2.1). There appeared to be a trend toward greater perceived racial/ethnic diversity in communities, over time.

IN NVP 2013, ―PLACE MATTERS‖ COMMUNITIES WERE PERCEIVED TO HAVE

Within NVP 2013, respondents in ―Place Matters‖ communities perceived substantially greater proportions of all non-white race and ethnic groups in their communities, compared with respondents in Comparative Communities (Figure 2013-2.2). The largest absolute differences related to Asian Americans/Pacific Islanders and to Arab Americans.

SUBSTANTIALLY GREATER VARIETY OF ALL NON-WHITE RACE/ETHNIC GROUPS THAN

COMPARATIVE COMMUNITIES

Figure 2013-2.2: Percent of Respondents Reporting "Some" or "A Lot" of the Following Racial / Ethnic Groups in their Communities % Of "Place Matters" Respondents

100%

% Of Comparative Communities

98% 99%

91%

87%

90%

78%

80%

83%

79% 71%

70% 57%

60%

48%

50% 40%

44% 30%

30%

33% 19%

20% 10% 0% Whites

African Americans / Blacks*

Hispanics / Asian Arab Latinos* Americans / Americans* Pacific Islanders*

American Indians / Alaska Natives*

Hawaiian Natives*

Note: Response options included ―A lot‖, ―Some‖ and ―Very few or none‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities respondents across response options

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RACIAL/ETHNIC MIX IN BEST KNOWN COMMUNITIES New in NVP 2013, respondents were asked to identify the racial mix in the community they know best. About one-quarter of respondents in the Comparative Communities reported their best known community as majority minority or predominantly minority, while about one-half of respondents from ―Place Matters‖ communities reported their best known community as majority minority or predominantly minority.

Figure 2013-2.3: Percent of Racial Mix in Respondents' Communities % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70% 60%

50%

40%

28%

30% 20% 10% 0%

43%

42%

50%

19% 8%

7% Predominantly White (<10% non-white)

Majority White (10-50% non-white)

Majority Minority (51-90% non-white)

3%

Predominantly Minority (>90% non-white)

P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities respondents across response options

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SECTION 3: HEALTH AND NUTRITION OPPORTUNITIES

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HEALTH AND NUTRITION OPPORTUNITIES FOR YOUNG CHILDREN Figure 2013-2.4: Perception of "Lots of Opportunity" for Young Children to Have... % Of "Place Matters" Respondents, 2012

% Of "Place Matters" Respondents, 2013

% Of Comparative Communities, 2012

% Of Comparative Communities, 2013

100% 90% 80%

71% 71%

70% 55%

60%

58%

57% 57% 47%

50%

50%

54% 56%

61% 55% 55%

48%

40% 40%

40% 30% 20% 10% 0%

Neighborhoods without v iolence†*

Lots of fresh fruits and v egetables†*

Places to get physical activ ity†*

Clean air, water and outdoor spaces†*

Note: Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ †P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2012 *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2013

WHITE (63%) AND MULTI-RACE/OTHER (57%) RESPONDENTS WERE MORE LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY‖ FOR YOUNG CHILDREN TO LIVE IN NEIGHBORHOODS WITHOUT VIOLENCE

AFRICAN AMERICAN (34%) AND HISPANIC (38%) THAN

RESPONDENTS

Perceived inequities and opportunities For all four domains, respondents who perceived racial/ ethnic inequities in their communities were less likely to perceive ―lots of opportunity‖ for young children and teens regarding health and nutrition. Perceived housing segregation and opportunities Respondents who perceived housing in their communities as very segregated were less likely to perceive ―lots of opportunity‖ for young children and teens regarding all four domains of health and nutrition. Respondents’ race/ethnicity and opportunities African American and Hispanic respondents were less likely to perceive ―lots of opportunity‖ for young children and teens than white and multi-race/other respondents for each of the four domains of health and nutrition. 22


HEALTH AND NUTRITION OPPORTUNITIES FOR TEENS

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES IN THEIR COMMUNITIES

(53%)

WERE LESS LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY ‖ FOR TEENS TO HAVE PLACES TO GET PHYSICAL ACTIVITY THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(76%) IN

THEIR COMMUNITIES

Figure 2013-2.5: Perception of "Lots of Opportunity" For Teens to Have... % Of "Place Matters" Respondents, 2012

% Of "P lace Matters" Respondents, 2013

% Of Comparative Communities, 2012

% Of C omparative Communities, 2013

100% 90% 80% 70%

56% 58%

60% 50% 40%

62% 63% 50% 52%

67%

73% 71%

64%

53% 56%

56% 56%

37% 38%

30% 20% 10% 0% Neighborhoods without v iolence†*

Lots of fre sh fruits and v ege tables†*

Places to get physical activ ity†*

Clean air, water and outdoor spaces†*

Note: Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ †P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2012 *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2013

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HEALTH AND NUTRITION OPPORTUNITIES FOR YOUNG CHILDREN IN SELECT “PLACE MATTERS” COMMUNITIES

Note: Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ P<.05 for comparison among ―Place Matters‖ respondents across response options

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HEALTH AND NUTRITION OPPORTUNITIES FOR YOUNG CHILDREN IN SELECT “PLACE MATTERS” COMMUNITIES, 2012 VS 2013 TABLE 2013-2.7

2012

2013

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

45% 24% 38% 57% 21% 41%

51% 30% 38% 55% 29% 43%

Wayne, MI Bernalillo, NM Alameda, CA King, WA

43% 33% 46% 57%

44% 52% 58% 59%

Suffolk, MA Fresno, CA

34% 42%

40% 59%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

38% 51% 44% 67% 33% 52%

52% 59% 53% 72% 41% 40%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

47% 65% 47% 78% 36% 35%

55% 76% 60% 73% 48% 40%

Neighborhoods Without Violence

Fresh Fruits and Vegetables

Places to Get Physical Activity

Clean Air, Water and Outdoor Spaces

In the six specific ―Place Matters‖ communities with sufficient sample size to permit robust measures, respondents reported differences in the four domains of health and nutrition for young children, shown on the previous page. Respondents in Suffolk County perceived the lowest rates of ―lots of opportunity‖ for young children to have neighborhoods without violence and lots of fresh fruits and vegetables. Respondents in Fresno County perceived the lowest rates of ―lots of opportunity‖ for places to get physical activity and to have clean air, water and outdoor spaces. Perceptions of opportunities measured in 2012 and in 2013 are listed in Table 2013-2.7 above. Respondents in all six ―Place Matters‖ communities reported higher rates of ―lots of opportunity‖ for young children to have lots of fresh fruits and vegetables, places to get physical activity and clean air, water and outdoor spaces in 2013 than in 2012. 25


HEALTH AND NUTRITION OPPORTUNITIES FOR TEENS IN SELECT “PLACE MATTERS” COMMUNITIES

Note: Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ P<.05 for comparison among ―Place Matters‖ respondents across response options

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HEALTH AND NUTRITION OPPORTUNITIES FOR TEENS IN SELECT “PLACE MATTERS” COMMUNITIES, 2012 VS 2013 TABLE 2013-2.8

2012

2013

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

44% 28% 35% 50% 17% 36%

48% 42% 40% 52% 32% 21%

Wayne, MI Bernalillo, NM Alameda, CA

40% 49% 50%

51% 56% 63%

King, WA

65%

61%

Suffolk, MA Fresno, CA

33% 49%

29% 54%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

46% 59% 42% 70% 50% 56%

56% 64% 63% 69% 38% 43%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

47% 66% 51% 76% 43% 38%

58% 75% 62% 72% 36% 36%

Neighborhoods Without Violence

Fresh Fruits and Vegetables

Places to Get Physical Activity

Clean Air, Water and Outdoor Spaces

Differences among the ―Place Matters‖ communities regarding the four domains of health and nutrition for teens are shown on the previous page. Respondents in Suffolk and Fresno Counties perceived the lowest rates of ―lots of opportunity‖ for teens to have neighborhoods without violence, places to get physical activity, and clean air, water and outdoor spaces. Table 2013-2.8 above shows perceptions of opportunities measured in 2012 compared with perceptions in 2013. The greatest change in perceptions was noted by respondents in Suffolk County: ―lots of opportunity‖ for neighborhoods without violence increased from 17% in 2012 to 32% in 2013.

27


OPPORTUNITY FOR YOUNG CHILDREN TO LIVE IN A NEIGHBORHOOD WITHOUT VIOLENCE

WHITE (47%) AND MULTI-RACE/OTHER (42%) RESPONDENTS WERE MORE LIKELY TO PERCEIVE

―LOTS OF OPPORTUNITY‖ FOR NEIGHBORHOODS WITHOUT VIOLENCE FOR YOUNG

AFRICAN

AMERICAN CHILDREN THAN HISPANIC (35%) AND AFRICAN AMERICAN (27%) RESPONDENTS

Figure 2013-2.8: Perception of "Lots of Opportunity" for Young Children to Live in a Neighborhood Without Violence % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70% 60%

73% 59%

50%

54% 47%

44%

44%

48% 37%

40%

28%

30%

29%

50% 43% 34% 25%

20% 10% 0% Whites*

African Americans / Blacks*

Hispanics / Latinos*

Asian Americans / Pacific Islanders*

Arab Americans

American Indians / Alaska Natives*

Hawaiian Natives

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

28


OPPORTUNITY FOR TEENS TO LIVE IN A NEIGHBORHOOD WITHOUT VIOLENCE Figure 2013-2.9: Perception of "Lots of Opportunity" for Teens to Live in a Neighborhood Without Violence % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70% 60%

71% 56%

54% 44%

50% 40%

30%

30%

48%

42%

49% 39%

30%

44%

49% 39%

26%

20% 10% 0% Whites*

African Americans / Blacks*

Hispanics / Latinos*

Asian Americans / Pacific Islanders*

Arab Americans

American Indians / Alaska Natives*

Hawaiian Natives

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

Of the four domains of health for children and teens, the biggest disparities were seen with ―lots of opportunity‖ to live in a neighborhood without violence. There was a greater disparity between ―Place Matters‖ communities and Comparative Communities as well as between race/ ethnic groups. Overall, respondents with annual household income levels of $60,000 or greater were more likely to perceive ―lots of opportunities‖ to live in neighborhoods without violence for children and teens than respondents with income levels of less than $60,000. Respondents who were ―very satisfied‖ or ―satisfied‖ with life were more likely to perceive ―lots of opportunity‖ for children and teens to have neighborhoods without violence than respondents who were ―not very satisfied‖ or ―not at all satisfied‖ with life. 29

RESPONDENTS WHO PERCEIVED THEIR COMMUNITIES AS VERY SEGREGATED

(15%)

WERE LESS LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY‖ FOR NEIGHBORHOODS WITHOUT VIOLENCE FOR

ARAB / ARAB AMERICAN TEENS THAN RESPONDENTS WHO PERCEIVED NO SEGREGATION

(83%) IN

THEIR COMMUNITIES


OPPORTUNITY FOR YOUNG CHILDREN TO HAVE LOTS OF FRESH FRUITS AND VEGETABLES Figure 2013-2.10: Perception of "Lots of Opportunity" for Young Children to Have Lots of Fresh Fruits and Vegetables % Of "Place Matters" Respondents 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

71% 62%

Whites*

55% 45%

African Americans / Blacks*

58% 49%

Hispanics / Latinos*

% Of Comparative Communities

62% 52%

Asian Americans / Pacific Islanders*

55% 50%

Arab Americans

47%48%

American Indians / Alaska Natives

55% 42%

Hawaiian Natives

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

RESPONDENTS WHO PERCEIVED THEIR COMMUNITIES AS VERY SEGREGATED WERE LESS

(38%) TO PERCEIVE ―LOTS OF OPPORTUNITY‖ FOR FRESH LIKELY

FRUITS AND VEGETABLES FOR YOUNG

HISPANIC

CHILDREN THAN RESPONDENTS WHO PERCEIVED NO SEGREGATION

(84%) IN

THEIR COMMUNITIES

30


OPPORTUNITY FOR TEENS TO HAVE LOTS OF FRESH FRUITS AND VEGETABLES Of the four domains of health for children and teens, the smallest difference in disparities was seen between Comparative Communities and ―Place Matters‖ communities in the measurement of ―lots of opportunity‖ to have fresh fruits and vegetables. Overall, respondents were more likely to report ―lots of opportunity‖ for white children and teens to have fresh fruits and vegetables than children and teens of other race/ethnic groups. Respondents with annual household income levels of $60,000 or greater were more likely to perceive ―lots of opportunity‖ for children and teens to have fresh fruits and vegetables than respondents with income levels of less than $60,000.

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES

(49%) IN THEIR COMMUNITIES WERE LESS LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY ‖ FOR FRESH FRUITS AND VEGETABLES FOR

ASIAN

TEENS THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(74%) IN

THEIR COMMUNITIES

Figure 2013-2.11: Perception of "Lots of Opportunity" for Teens to Have Lots of Fresh Fruits and Vegetables % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70%

70% 62%

60%

53% 49%

50%

59% 50%

55%

61% 54%54%

50% 47%

48%

52%

40% 30% 20% 10% 0% Whites

Afri can Ame ricans / Blacks

Hispanics / Latinos*

Asian Americans / Pacific Islanders*

Arab Americans

American Indians / Alaska Natives

Hawa iian Natives

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

31


OPPORTUNITY FOR YOUNG CHILDREN TO HAVE PLACES TO GET PHYSICAL ACTIVITY Figure 2013-2.12: Perception of "Lots of Opportuni ty" for Young Children to Have Places to Get Physical Activity % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70%

73% 65%

60%

47%

46%

50%

59%

58%

60% 54%

56% 51%

55% 48%

55% 49%

Arab Americans

American Indians / Alaska Natives

Hawaiian Natives

40% 30% 20% 10% 0% Whites

African Americans / Blacks*

Hispanics / Latinos*

Asian Americans / Pacific Islanders

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

RESPONDENTS WHO PERCEIVED THEIR COMMUNITIES AS VERY SEGREGATED

(44%) WERE LESS LIKELY TO PERCEIVE

―LOTS OF OPPORTUNITY‖ FOR PHYSICAL ACTIVITY FOR YOUNG NATIVE

HAWAIIAN CHILDREN THAN RESPONDENTS

Respondents were less likely to perceive ―lots of opportunity‖ to have places to get physical activity for all race/ethnic groups of children and teens than for white children or teens. ―Place Matters‖ respondents were less likely to report ―lots of opportunity‖ for African American and Hispanic children and teens to have places to get physical activity than respondents from Comparative Communities. Overall, respondents with annual household income levels of $60,000 or greater were more likely to perceive ―lots of opportunity‖ for places to get physical activity for children and teens than respondents with income levels of less than $60,000.

WHO PERCEIVED NO SEGREGATION

(90%)

IN THEIR COMMUNITIES

Respondents who were ―very satisfied‖ or ―satisfied‖ with life were more likely to perceive ―lots of opportunity‖ for places to get physical activity for children and teens than respondents who were ―not very satisfied‖ or ―not at all satisfied‖ with life. 32


OPPORTUNITY FOR TEENS TO HAVE PLACES TO GET PHYSICAL ACTIVITY

WHITE (64%) RESPONDENTS WERE MORE LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY ‖ FOR PLACES TO GET PHYSICAL ACTIVITY

AFRICAN AMERICAN TEENS THAN AFRICAN AMERICAN (41%) HISPANIC (47%) AND MULTI-RACE/OTHER (50%) FOR

RESPONDENTS

Figure 2013-2.13: Perception of "Lots of Opportunity" for Teens to Have Places to Get Physical Activity % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70%

73% 66%

60%

50%

50%

64%

62%

60% 52%

55%

59% 53%

49%

55%

61% 54%

40% 30% 20% 10% 0% Whites

African Americans / Blacks*

Hispanics / Latinos*

Asian Americans / Pacific Islanders*

Arab Americans

American Indians / Alaska Natives

Hawaiian Natives

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

33


OPPORTUNITY FOR YOUNG CHILDREN TO HAVE CLEAN AIR, WATER AND OUTDOOR SPACES

WHITE (66%) AND HISPANIC (53%) RESPONDENTS WERE MORE LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY‖ FOR CLEAN AIR, WATER, AND OUTDOOR SPACES FOR

AMERICAN INDIAN/ ALASKA NATIVE CHILDREN THAN AFRICAN AMERICAN (36%) AND MULTI-RACE/ OTHER (45%) RESPONDENTS

YOUNG

Figure 2013-2.14: Perception of "Lots of Opportunity" for Young Children to Have Clean Air, Water and Outdoor Spaces % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70%

77% 64%

60%

64% 52%

66%

65% 52%

56%

61% 55%

50%

59% 50%

62% 52%

40% 30% 20% 10% 0% Whites*

African Americans / Blacks*

Hispanics / Latinos*

Asian Americans / Pacific Islanders

Arab Americans

American Indians / Alaska Natives

Hawaiian Natives

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

34


OPPORTUNITY FOR TEENS TO HAVE CLEAN AIR, WATER AND OUTDOOR SPACES Figure 2013-2.15: Perception of "Lots of Opportunity" for Teens to Have Clean Air, Water and Outdoor Spaces % Of "Place Matters" Respondents

% Of Comparative Communities

100% 90% 80% 70%

76% 65%

60%

64% 54%

67% 55%

67% 60%

62% 59%

62% 52%

61% 55%

50% 40% 30% 20% 10% 0% Whites*

African Americans / Blacks*

Hispanics / Latinos*

Asian Americans / Pacific Islanders

Arab Americans

American Indians / Alaska Natives

Hawaiian Natives*

Note: Only respondents reporting ―some‖ or ―a lot‖ of people in these race / ethnic groups in their communities were asked this question. Response options included ―Lots of opportunity‖, ―Some opportunity‖ and ―Little or no opportunity‖ *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options

Overall, the smallest disparities were seen in the perception of ―lots of opportunities‖ for children and teens to have clean air, water and outdoor spaces. Respondents with annual household income levels of $60,000 or greater were more likely to perceive ―lots of opportunity‖ for children and teens to have clean air, water and outdoor spaces than respondents with income levels of less than $60,000. Respondents who were ―very satisfied‖ or ―satisfied‖ with life were more likely to perceive ―lots of opportunity‖ for children and teens to have clean air, water and outdoor spaces than respondents who were ―not very satisfied‖ or ―not at all satisfied‖ with life. 35

WHITE (71%) AND MULTI-RACE/OTHER (64%) RESPONDENTS WERE MORE LIKELY TO PERCEIVE ―LOTS OF OPPORTUNITY ‖ FOR CLEAN AIR, WATER, AND OUTDOOR SPACES FOR

HISPANIC TEENS THAN AFRICAN AMERICAN (48%) AND HISPANIC (58%) RESPONDENTS


CHANGES IN PERCEPTIONS OF NUTRITION AND HEALTH OPPORTUNITIES FROM 2012 TO 2013 As in NVP 2012, in NVP 2013 we see the connection of generally perceived inequities at the community level to perceptions of diminished opportunities for young children and teens in the domains of nutrition and health. We continue to see the connection of lower levels of opportunities for children and teens related to housing segregation. Respondents who perceived their communities as very segregated were less likely to perceive ―lots of opportunity‖ for children and teens in all four domains of health and nutrition than those who perceive no segregation. Overall in ―Place Matters‖ communities, there were positive changes in perceptions of ―lots of opportunities‖ for young children and teens to have fresh fruits and vegetables and places to get physical activity from NVP 2012 to NVP 2013. There were no changes in perceptions in ―lots of opportunity‖ for young children and teens to live in neighborhoods without violence or to have clean air and outdoor spaces. Within ―Place Matters‖ communities, respondents in Wayne, Bernalillo, Alameda and Suffolk Counties perceived higher rates of ―lots of opportunity‖ for young children and teens in all four domains of health and nutrition in 2013 than in 2012.

IN ―PLACE MATTERS‖ COMMUNITIES, RESPONDENTS IN NVP 2013 REPORTED HIGHER RATES OF ―LOTS OF OPPORTUNITY‖ FOR YOUNG CHILDREN AND TEENS TO HAVE PLACES TO GET PHYSICAL ACTIVITY COMPARED WITH

NVP 2012

36


SECTION 4: HEALTHCARE AVAILABILITY

37


HEALTHCARE AVAILABILITY FOR YOUNG CHILDREN Figure 2013-2.16: Perception of "Lots of Availability" of Healthcare Services for Young Children 100% 90%

% Of "Place Matters" Respondents, 2012

% Of "Place Matters" Respondents, 2013

% Of Comparative Communities, 2012

% Of Comparative Communities, 2013

80% 70% 60%

55% 55% 47% 47%

50% 40%

40%

33% 32%

49% 50%

54% 56%

36%

30% 20% 10% 0% Specialty care†

Primary care†*

Hospital care*

Note: Response options included ―Lots of availability‖, ―Some availability‖ and ―Little or no availability‖ †P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2012 *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2013

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES

(43%) IN THEIR

COMMUNITIES WERE LESS LIKELY TO RATE ―LOTS OF AVAILABILITY‖ OF PRIMARY CARE FOR YOUNG CHILDREN THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(68%) IN THEIR

COMMUNITIES

38


Figure 2013-2.17: Perception of "Lots of Availability" of Healthcare Services for Young Children 100% 90%

% Of "Place Matters" Respondents, 2012

% Of "Place Matters" Respondents, 2013

% Of Comparative Communities, 2012

% Of Comparative Communities, 2013

80% 70% 60% 50%

42%

40% 30%

31% 22%

46%

51%

50%

31%

25%

20% 10% 0% Mental health care†

Dental care†

Note: Response options included ―Lots of availability‖, ―Some availability‖ and ―Little or no availability‖ †P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2012 *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2013

Perceived inequities For all measures, respondents who generally perceived racial/ethnic inequities in their communities were less likely to perceive ―lots of availability‖ for young children regarding healthcare. Perceived housing segregation Respondents who perceived housing in their communities as very segregated were less likely to perceive ―lots of availability‖ for young children regarding all five areas of healthcare services. Respondents’ race/ethnicity African American, Hispanic and multi-race/other respondents were less likely than white respondents to perceive ―lots of availability‖ for primary care for young children. Within the other four areas of healthcare services for young children, there were no differences by respondents’ race/ethnicity. 39

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES

(25%) IN

THEIR COMMUNITIES WERE LESS LIKELY TO RATE ―LOTS OF AVAILABILITY‖ OF MENTAL HEALTH CARE FOR YOUNG CHILDREN THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(39%) IN THEIR COMMUNITIES


HEALTHCARE AVAILABILITY FOR TEENS Figure 2013-2.18: Perception of "Lots of Availability" of Healthcare Services for Teens 100% 90%

% Of "Place Matters" Respondents, 2012

% Of "Place Matters" Responden ts, 2013

% Of Comparative Communities, 2012

% Of Comparative Communities , 2013

80% 70% 56% 57%

60% 50% 40%

40% 39%

47% 45%

55% 56% 48% 49%

33% 33%

30% 20% 10% 0% Specialty ca re

Primary care†*

Hospital care†*

Note: Response options included ―Lots of availability‖, ―Some availability‖ and ―Little or no availability‖ †P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2012 *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2013

Perceived inequities Respondents who perceived racial/ethnic inequities in their communities were less likely to perceive ―lots of availability‖ for teens regarding all six areas of healthcare services than respondents who perceived few or no inequities in their communities. Perceived housing segregation Respondents who perceived housing in their communities as very segregated were less likely to perceive ―lots of availability‖ for teens to have specialty care, primary care, mental health care and dental care than respondents who reported no segregation in their community. Respondents’ race/ethnicity African American and Hispanic respondents were less likely to perceive ―lots of availability‖ for primary care than white and multi-race/other respondents. Multi-race/other respondents were more likely to perceive ―lots of availability‖ for reproductive care and mental health care for teens than African American, Hispanic or white respondents. 40


Figure 2013-2.19: Perception of "Lots of Availability" of Healthcare Services for Teens 100% 90%

% Of "Place Matters" Respondents, 2012

% Of "Place Matters" Respondents, 2013

% Of Comparative Communities, 2012

% Of Comparative Communities, 2013

80% 70% 60%

52% 50%

50%

44% 43%

40% 30%

23%

26%

30%

34% 27%

29%

34% 34%

20% 10% 0% Mental health care*

Reproductiv e care†

Dental care

Note: Response options included ―Lots of availability‖, ―Some availability‖ and ―Little or no availability‖ †P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2012 *P<.05 for comparison of ―Place Matters‖ respondents versus Comparative Communities across response options in 2013

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES

(38%) IN THEIR COMMUNITIES WERE LESS LIKELY TO RATE ―LOTS OF AVAILABILITY ‖ OF DENTAL CARE FOR TEENS THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(62%) IN THEIR

COMMUNITIES

41


HEALTHCARE AVAILABILITY FOR YOUNG CHILDREN IN SELECT “PLACE MATTERS” COMMUNITIES In the six specific ―Place Matters‖ communities, respondents reported differences regarding ―lots of availability‖ in all five areas of healthcare services for young children, shown on the next page. Respondents in Suffolk and Fresno Counties reported the lowest rates of ―lots of availability‖ for mental health care for young children. Respondents in King County perceived the highest rates of ―lots of availability‖ for all five areas of healthcare services for young children. Overall, ―lots of availability‖ was rated the lowest for mental health care, followed by specialty care, dental care and primary care for young children. Hospital care received the highest rates of ―lots of availability‖ for young children.

RESPONDENTS WITH A BACHELOR’S DEGREE OR HIGHER (36%), SOME COLLEGE (40%), OR A HIGH SCHOOL DEGREE

(37%) WERE MORE LIKELY TO RATE ―LOTS OF AVAILABILITY‖ OF SPECIALTY CARE FOR YOUNG CHILDREN THAN THOSE WITH LESS THAN A HIGH SCHOOL DEGREE

(18%)

42


Note: Response options included ―Lots of availability‖, ―Some availability‖, ―Little or no availability‖ and ―I don’t know‖ P<.05 for comparison among ―Place Matters‖ respondents across response options

43


HEALTHCARE AVAILABILITY FOR YOUNG CHILDREN IN SELECT “PLACE MATTERS” COMMUNITIES, 2012 VS 2013

TABLE 2013-2.9

2012

2013

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

23% 19% 19% 29% 33% 9%

34% 29% 24% 32% 19% 18%

Wayne, MI Bernalillo, NM Alameda, CA

33% 33% 27%

33% 34% 34%

King, WA

42%

41%

Suffolk, MA Fresno, CA

43% 16%

27% 37%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

43% 39% 33% 53% 43% 30%

52% 49% 43% 57% 35% 39%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

42% 52% 39% 60% 52% 34%

50% 53% 42% 63% 43% 41%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

45% 52% 38% 61% 59% 41%

57% 58% 44% 60% 45% 53%

Mental Health Care

Specialty Care

Dental Care

Primary Care

Hospital Care

44


Changes in perception of opportunities for ―Place Matters‖ communities in 2012 compared with 2013, are shown in table 2013-2.9 on the previous page. For each ―Place Matters‖ community, except Suffolk County, respondents perceived an increase in ―lots of availability‖ for all five areas of healthcare services for young children from NVP 2012 to NVP 2013. Respondents in Fresno County perceived the greatest change in perception of ―lots of availability‖ of specialty care for young children: from 16% in NVP 2012 to 37% in NVP 2013. The greatest change in perceptions for dental care and mental health care were noted by respondents in Wayne County: ―lots of availability‖ of dental care for young children increased from 43% in 2012 to 52% in 2013 and ―lots of availability‖ of mental health care for young children increased from 23% in 2012 to 34% in 2013.

RESPONDENTS WITH A BACHELOR’S DEGREE OR HIGHER (56%), SOME COLLEGE (56%), OR A HIGH SCHOOL DEGREE

(57%) WERE MORE LIKELY TO RATE ―LOTS OF AVAILABILITY ‖ OF PRIMARY CARE FOR YOUNG CHILDREN THAN THOSE WITH LESS THAN A HIGH SCHOOL DEGREE

(32%)

45


HEALTHCARE AVAILABILITY FOR TEENS IN SELECT “PLACE MATTERS” COMMUNITIES

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES

(27%) IN THEIR

COMMUNITIES WERE LESS LIKELY TO RATE

―LOTS OF AVAILABILITY‖ OF REPRODUCTIVE CARE FOR TEENS THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(43%) IN THEIR

COMMUNITIES

In ―Place Matters‖ communities, respondents rated ―lots of availability‖ for six areas of healthcare services for teens, shown on the next page. Respondents in Suffolk and Fresno Counties reported the lowest rates of ―lots of availability‖ of reproductive care for teens and the highest rates of ―lots of availability‖ of hospital care for teens. Respondents in King County perceived the highest rates of ―lots of availability‖ of dental care and primary care for teens. Respondents in Alameda County perceived the lowest rates of ―lots of availability‖ of hospital care for teens and perceived the highest rates of ―lots of availability‖ of reproductive care for teens.

46


Note: Response options included ―Lots of availability‖, ―Some availability‖, ―Little or no availability‖ and ―I don’t know‖ P<.05 for comparison among ―Place Matters‖ respondents across response options

47


HEALTHCARE AVAILABILITY FOR TEENS IN SELECT “PLACE MATTERS” COMMUNITIES

TABLE 2013-2.10

2012

2013

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

25% 20% 19% 30% 28% 10%

31% 27% 24% 31% 25% 27%

Wayne, MI Bernalillo, NM Alameda, CA

27% 27% 22%

30% 30% 39%

King, WA

32%

33%

Suffolk, MA Fresno, CA

31% 22%

23% 24%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

34% 38% 25% 42% 38% 20%

34% 32% 39% 39% 30% 42%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

47% 54% 37% 54% 40% 25%

46% 42% 43% 53% 34% 37%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

51% 55% 38% 59% 43% 24%

48% 47% 42% 58% 50% 40%

Wayne, MI Bernalillo, NM Alameda, CA King, WA Suffolk, MA Fresno, CA

48% 57% 37% 59% 52% 41%

55% 52% 43% 54% 61% 58%

Mental Health Care

Reproductive Care

Specialty Care

Dental Care

Primary Care

Hospital Care

48


Changes in perception of availability of healthcare for ―Place Matters‖ communities from 2012 to 2013 are shown in table 2013-2.10 on the previous page. Wayne, Alameda, King and Fresno County respondents reported an increase in ―lots of availability‖ for all six areas of healthcare services from NVP 2012 to NVP 2013. Respondents in Fresno County perceived the greatest change in perceptions of ―lots of availability‖ for teens of all areas of healthcare, except reproductive care. Most notably, the perception of ―lots of availability‖ of specialty care for teens increased from 20% in NVP 2012 to 42% in NVP 2013. The greatest change in perceptions for reproductive care was noted by respondents in Alameda County: ―lots of availability‖ of reproductive care for teens increased from 22% in 2012 to 39% in 2013. Alameda County respondents also noted the greatest change in perceptions for specialty care: ―lots of availability‖ of specialty care for teens increased from 25% in 2012 to 39% in 2013.

RESPONDENTS WHO PERCEIVED MANY OR SOME RACIAL/ETHNIC INEQUITIES

(35%) IN

THEIR COMMUNITIES WERE LESS LIKELY TO RATE

―LOTS OF AVAILABILITY‖ OF SPECIALTY CARE FOR TEENS THAN RESPONDENTS WHO PERCEIVED FEW OR NO INEQUITIES

(45%) IN

THEIR COMMUNITIES

49


COMMENTS FROM NVP 2013 RESPONDENTS ABOUT PROGRAMS TO ADDRESS RACIAL/ETHNIC INEQUITIES IN THEIR COMMUNITIES

50

National Voices Project 2013 Report 2  
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