niagara county community health needs …

NIAGARA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT DATA SUMMARY & ANALYSIS

Clement Nsiah, Ph.D., M.S.

Population Health Collaborative | pophealthwny.org | 716.322.1012| [email protected] | 371 Delaware Avenue, Buffalo NY 14202

Timeline

• Community Health Assessment (CHA) Steering Committee Established

• Review Previous CHA Questions• Finalize CHA Questions• Outline CHA Survey Distribution List

Phase IJuly 2018 – Sep. 2018 • CHA Survey Dissemination

• CHA Survey Data Collection• Demographic & Secondary Data Analysis• Focus Group Discussions• Stakeholder Discussions• Mid-CHA Survey Data Analysis• Intercept CHA Survey Dissemination• Final CHA Survey Data Analysis• Convene Steering Committee to Review CHA

Data• Identify Priorities for Plans

Phase IIOct. 2018 – Apr. 2019

• Write Report• Convene Steering Committee to Review

Report• Identify Priorities for Plans

Phase IIIMay. 2019 – July. 2019

Phase IVAug. 2019 – Nov. 2019

• Seek Hospital Board Approval —Report

• CHA & CHIP submitted by respective local health departments to New York State Department of Health

Demographics

Niagara County Serving Areas

Town Population Size (2017) Unemployment Rate (2017) Families Living in Poverty (2017)City of Lockport 20676 6.6% 9.7%

City of North Tonawanda 30752 6.8% 6.0%City of Niagara Falls 48976 9.4% 22.1%

Town of Cambria 5800 7.2% 3.7%Town of Hartland 4038 2.0% 7.0%Town of Lewiston 15991 3.4% 2.8%Town of Lockport 20222 5.9% 6.8%Town of Newfane 9432 5.5% 7.2%Town of Niagara 8148 6.2% 9.0%

Town of Pendleton 6583 5.0% 3.3%Town of Porter 6616 3.3% 2.1%

Town of Royalton 7564 3.4% 7.5%Town of Somerset 2706 8.4% 4.8%

Town of Wheatfield 18238 2.5% 3.2%Town of Wilson 5885 7.4% 4.8%

Village of Barker 754 7.0% 15.8%Village of Lewiston 2594 4.6% 4.0%

Village of Middleport 1807 4.6% 9.1%Village of Wilson

Village of Youngstown 1894 5.1% 2.2%

Niagara County Population Size, Unemployment Rate and Families Living in Poverty

Niagara County Demographics Summary

POPULATION

County Population has decreasedSince 2010 by

2.83%

Current: 210,340

GENDER 48.76% | 52.24%

ETHNICITY

WHITE 86.95%BLACK 7.1%HISPANIC 3.18%AM INDIAN 1.09%

Median age is 43.3 years

AGE

EDUCATION

GRADE 12/GED 34.66%SOME COLLEGE 20%ASSOCIATES 17.13%BACHELORS 12.87%MASTERS 7.81%MORE THAN MASTERS 1.80%

EMPLOYMENT

County unemployment rate is 5%

INCOME

Median household income $50,094Families living below poverty level is 9.8%

Source: Claritas, 2019

Community health needs assessment

2019 – 2024 NYSDOH Prevention Agenda

• VISION

• Vision of the Prevention Agenda for 2019 – 2024 is that NY is the Healthiest State in the Nation for People of All Ages

• UPDATE

• Since 2008, NY has moved from 28th to 10th healthies state on America’s Health Rankings demonstrating real progress toward achieving our visions

• STRATEGY

• Implement public health approaches that improve health and well-being; eliminate health inequities

• Emphasis on social determinants of health – social, cultural and environmental factors that influence health status and are root causes of poor health and adverse outcomes


• Prevent Chronic Diseases

• Focus Area 1: Healthy Eating and Food Security• Focus Area 2: Physical Activity• Focus Area 3: Tobacco• Focus Area 4: Chronic Disease Preventive Care/Management

• Promote a Healthy and Safe Environment

• Focus Area 1: Injuries, Violence and Occupational Health• Focus Area 2: Outdoor Air Quality• Focus Area 3: Built and Indoor Environments• Focus Area 4: Water Quality• Focus Area 5: Food and Consumer Products

2019 – 2024 NYSDOH prevention agenda

• Healthy Women, Infants and Children

• Focus Area 1: Maternal & Women’s Health• Focus Area 2: Perinatal & Infant Health• Focus Area 3: Child & Adolescent Health• Focus Area 4: Cross Cutting Healthy Women, Infants & Children

• Promote Well-Being and Prevent Mental and Substance Use Disorders

• Focus Area 1: Promote Well-Being• Focus Area 2: Mental and Substance Use Disorders Prevention


• Prevent Communicable Diseases

• Focus Area 1: Vaccine Preventable Diseases• Focus Area 2: Human Immunodeficiency Virus (HIV)• Focus Area 3: Sexually Transmitted Infections (STIs)• Focus Area 4: Hepatitis C Virus (HCV)• Focus Area 5: Antibiotic Resistance and Healthcare-Associated Infections

Methodology

Methodology

2018 Claritas2018 – 2019 Community Survey

2018 – 2019 Intercept Survey (Hard copies)

2008 – 2016 NYS Department of Health2011 – 2018 County Health Rankings

2011 – 2018 U.S. Census Bureau2011 – 2018 Centers for Disease Control

2011 – 2017 NYS Prevention NeedsNYS Department of Health Prevention Agenda

Demographics

Secondary Data

Community Survey1,492 Completed Surveys

Methodology

4 of stakeholder interviewed

Locations:Mount Saint Mary Hospital – 4 sessions

5 focus group discussion conducted

Locations:Eastern Niagara Hospital – 1 session

Niagara County Health Dept – 2 sessionsDeGraff Hospital – 1 session

Mt. St. Mary Hospital – 1 session Niagara Falls Memorial – 1 session

Stakeholder Interviews

Focus Group Discussion

Intercept Survey411 of hard copies completed

Community Survey Demographics – Overall

GENDER 25.66% | 73.74%

ETHNICITY


18 - 29 7.26%30 – 39 18.02%40 – 49 14.94%50 – 59 26.81%60 – 69 23.48%70+ 9.39%AGE

EDUCATION

GRADE 12/GED 19.73%SOME COLLEGE 19.64%ASSOCIATES 16.82%BACHELORS 26.39%MASTERS 10.93%MORE THAN MASTERS 4.36%

EMPLOYMENT

EMPLOYED 64.64%SELF-EMPLOYED 4.20%RETIRED 17.38%UNABLE TO WORK 6.08%OUT OF WORK (< 1 Y) 1.46%

INCOME

$75,000+ 39.28%$50,000 - $75,000 16.49%$35,000 - $50,000 15.77%$25,000 - $35,000 9.01%$10,000 - $15,000 11.11%

Source: 2018 – 2019 Niagara County Community Survey

Community Survey Demographics – Paper Copies

GENDER 42.81% | 55.94%

ETHNICITY


18 - 29 8.75%30 – 39 19.06%40 – 49 8.44%50 – 59 22.81%60 – 69 24.69%70+ 15.94%AGE

EDUCATION

GRADE 12/GED 35.42%SOME COLLEGE 21.00%ASSOCIATES 13.17%BACHELORS 17.55%MASTERS 4.08%MORE THAN MASTERS 1.57%

EMPLOYMENT

EMPLOYED 45.71%SELF-EMPLOYED 3.49%RETIRED 23.17%UNABLE TO WORK 13.23%OUT OF WORK (< 1 Y) 3.17%

INCOME

$75,000+ 19.71%$50,000 - $75,000 9.49%$35,000 - $50,000 13.87%$25,000 - $35,000 9.85%$10,000 - $15,000 30.29%


Household Size for Homes Earning $75,000+


71%

94%

48%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Number of children (17 and under) Number of adults (18 to 64) Number of seniors (65+)

Community Survey Demographics: Age & Gender


NC MSMH NFMMC ENH DMH

Under 18 0.09% 0.00% 0.58% 0.00% 0.00%

18-29 7.26% 6.97% 8.14% 4.17% 4.21%

30-39 18.02% 18.79% 16.28% 18.06% 17.89%

40-49 14.94% 16.06% 9.88% 12.50% 11.58%

50-59 26.81% 22.73% 27.33% 28.47% 34.74%

60-69 23.48% 24.85% 25.58% 24.31% 25.26%

70+ 9.39% 10.61% 12.21% 12.50% 6.32%


Male 25.66% 30.61% 27.91% 25.52% 25.26%

Female 73.74% 69.09% 71.51% 73.79% 73.68%

NC – Niagara CountyMSMH – Mount St. Mary HospitalNFMMC – Niagara Falls Memorial Medical CenterENH – Eastern Niagara HospitalDMH – DeGraff Memorial Hospital

Community Survey Demographics: Race & Education



American Indian 2.39% 3.03% 4.65% 2.76% 0.00%

Hispanic/Latino 1.62% 1.82% 0.58% 2.76% 1.05%

Black/African American 5.20% 4.55% 13.95% 2.76% 5.26%

White/Caucasian 89.59% 90.91% 79.07% 91.03% 93.68%

Asian/Pacific Islander 0.34% 0.30% 0.58% 0.00% 0.00%

NC MSMH NFMMC ENH DMHGrade 12 or GED (high school graduate) 19.73% 21.58% 28.49% 22.07% 21.05%Some college or technical school 19.64% 23.10% 18.02% 25.52% 20.00%Associates degree 16.82% 17.33% 11.05% 19.31% 21.05%Bachelors degree 26.39% 24.62% 25.00% 20.00% 21.05%Masters degree 10.93% 7.90% 6.98% 6.21% 12.63%More than a Masters degree 4.36% 3.95% 3.49% 6.21% 4.21%


Community Survey Demographics: Empl & Income


NC MSMH NFMMC ENH DMHEmployed for wages 64.64% 61.59% 55.29% 61.38% 73.68%Self-employed 4.20% 2.74% 2.35% 4.83% 3.16%Out of work for 1 year or more 1.88% 2.13% 2.94% 3.45% 0.00%Out of work for less than 1 year 1.37% 1.22% 1.76% 3.45% 0.00%A homeworker 1.71% 2.44% 1.18% 0.69% 2.11%A student 1.28% 2.44% 1.76% 1.38% 2.11%Retired 17.38% 20.12% 16.47% 20.69% 12.63%Unable to work 6.08% 6.10% 14.12% 3.45% 6.32%

NC MSMH NFMMC ENH DMH$10,000 - $15,000 11.17% 12.54% 25.00% 10.71% 6.52%$15,000 - $20,000 3.42% 3.54% 5.13% 2.14% 2.17%$20,000 - $25,000 4.86% 3.86% 6.41% 5.71% 7.61%$25,000 - $35,000 9.01% 9.65% 7.69% 9.29% 13.04%$35,000 - $50,000 15.77% 15.76% 16.67% 20.71% 10.87%$50,000 - $75,000 16.49% 15.11% 14.10% 17.86% 13.04%$75,000+ 39.28% 39.55% 25.00% 33.57% 46.74%


0.0

0.0

0.0

0.1

0.2

0.5

0.8

0.9

1.5

1.8

2.0

2.2

2.4

2.4

3.5

4.3

4.6

6.7

7.4

8.8

12.8

16.7

20.4

0.0 5.0 10.0 15.0 20.0 25.0

14095

14107

14144

14109

14302

14126

14008

14105

14028

14067

14303

14172

14012

14132

14174

14131

14108

14301

14092

14305

14304

14120

14094

Niagara County Zip Code Response Rate by Percent

3.77

6.44

8.08

12.56

14.91

15.62

27.55

0 5 10 15 20 25 30

Kenmore Mercy Hospital

Buffalo General Medical Center

DeGraff Memorial Hospital

Eastern Niagara Hospital, Lockport

Niagara Falls Memorial Medical Center

Millard Fillmore Suburban

Mount Saint Mary's Hospital

Percent Utilization of Health Care Systems in Niagara County & Erie County

10.46

13.36

13.89

15.95

16.64

19.24

21.83

86.18

0 10 20 30 40 50 60 70 80 90 100

Television (TV) or Radio

Social Media (ex. Facebook, Twitter, etc.)

Newspaper or Magazine

Workplace

Health Insurance Company

Friends and Family

Other (please specify)

Doctor/Medical Provider/Primary Care Provider

Venue for Health Information by Percent

Where are people getting their health info?

Venue for Information NC MSMH NFMMC ENH DMH

% % % % %

Television (TV) or Radio 10.46 10.54 9.47 14.47 5.83

Social Media (ex. Facebook, Twitter, etc.) 13.36 13.39 12.63 18.24 16.5

Newspaper or Magazine 13.89 11.68 15.26 16.98 17.48

Workplace 15.95 14.81 9.47 13.21 27.18

Health Insurance Company 16.64 15.67 16.84 17.61 18.45

Friends and Family 19.24 21.08 16.32 20.13 21.36

Other (please specify) 21.83 23.36 20 15.72 26.21

Doctor/Medical Provider/Primary Care Provider 86.18 84.62 86.32 85.53 83.5


Venue of health information by Age

18 - 29 30-39 40-49 50-59 60-69 70+Doctor/Medical Provider/Primary Care Provider 78.16% 85.45% 88.64% 86.94% 83.81% 91.82%Library 2.30% 4.23% 1.14% 3.18% 4.32% 2.73%Newspaper or Magazine 11.49% 7.98% 9.66% 12.74% 21.94% 26.36%School Nurse/School Health Educator/Teacher 3.45% 3.29% 2.27% 0.96% 1.08% 0.91%Social Media (ex. Facebook, Twitter, etc.) 16.09% 15.49% 13.64% 11.78% 13.31% 10.91%Television (TV) or Radio 11.49% 9.86% 9.09% 7.96% 14.03% 13.64%Friends and Family 34.48% 18.78% 19.89% 17.83% 19.42% 17.27%Health Insurance Company 9.20% 10.80% 15.91% 15.61% 21.58% 31.82%Social Services 2.30% 1.88% 2.27% 2.55% 1.08% 0.91%Head Start 0.00% 0.94% 0.00% 0.00% 0.00% 0.91%WIC (Nutrition program for children and pregnant/nursing women) 5.75% 1.88% 0.57% 0.32% 0.36% 0.91%Workplace 16.09% 20.19% 23.30% 14.01% 14.75% 3.64%Community Health Worker/Peer Navigator 0.00% 1.41% 0.57% 0.00% 1.80% 1.82%Other (please specify) 21.84% 20.19% 18.18% 24.52% 25.54% 25.45%

Chronic diseases related health topics

2.142.522.893.573.744

9.6611.71

13.2816.2517.3817.4717.52

19.3119.58

21.0422.0322.78

26.9431.6331.73

31.832.33

39.1140.02

43.6146.24

67.4886.45

98.02

0 20 40 60 80 100 120

Don't go see my PCPDon't have PCP

Stores near me do not sell fresh fruits and vegetablesI am not sure how to cook/prepare fresh fruits and vegetables

My family does not like to eat healthyI don't like to eat healthy food

No physical activitySee PCP only when I'm sick

Have MedicaidEver told to have blood sugar problems, or diabetes by doctor/nurse

Nutrition/eating a healthy diet*Access to healthy food*

Currently smoke most days/all daysHave Medicare

Physical activity; fitness and exercise*Have fair/poor physical health

Overweight/obesity; weight management*Heart related issues (high blood pressure, heart disease, or stroke)*

Use emergency department within past yearCouldn't get care because of cost (with health insurance, too expensive)

Cancer*Don't eat fruits and vegetables because of cost

Ever told to have high cholestrolEver told to have high blood pressure, or hypertension by doctor/nurse

See PCP several times a yearSee PCP for yearly check-up

Access to affordable health care*Have health insurance through employer

Seek medical care from doctor's officeI have health insurance

Niagara County Residents Selected Health Concerns by Percent

* Residents selected and identified community health concerns

Condition NC MSMH NFMMC ENH DMH% % % % %

Access to affordable health care* 46.24 44.11 42.86 54 48.42Access to healthy food* 17.47 13.6 19.05 16 16.84Cancer* 31.73 34.74 27.38 34.67 27.37Couldn't get care because of cost (with health insurance, too expensive) 31.63 37.33 24.49 30.56 21.05Currently smoke most days/all days 17.52 16.26 28.07 16.56 15.22Don't eat fruits and vegetables because of cost 31.8 33.43 31.76 31.08 32.26Don't go see my PCP 2.14 1.71 1.06 1.28 2.91Don't have PCP 2.52 1.99 2.65 1.28 1.94Ever told to have blood sugar problems, or diabetes by doctor/nurse 16.25 14.37 20.93 18 17.89Ever told to have high blood pressure, or hypertension by doctor/nurse 39.11 39.52 39.53 44.67 43.16Ever told to have high cholesterol 32.33 34.13 29.07 30.67 42.11Have fair/poor physical health 21.04 21.32 25 19.46 21.06Have health insurance through employer 67.48 65.81 46.84 71.7 71.84Have Medicaid 13.28 13.68 25.79 13.21 8.74Have Medicare 19.31 20.51 27.37 20.13 15.53Heart related issues (high blood pressure, heart disease, or stroke)* 22.78 24.47 16.67 25.33 27.37I am not sure how to cook/prepare fresh fruits and vegetables 3.57 3.04 3.53 3.38 4.3I don't like to eat healthy food 4 3.04 5.88 4.05 2.15I have health insurance 98.02 97.15 97.89 96.88 99.03My family does not like to eat healthy 3.74 2.74 2.35 5.41 7.53No physical activity 9.66 9.01 8.19 14.09 5.32Nutrition/eating a healthy diet* 17.38 14.5 13.1 16 20Overweight/obesity; weight management* 22.03 20.54 19.05 18 24.21Physical activity; fitness and exercise* 19.58 18.13 13.1 16.67 22.11See PCP for yearly check-up 43.61 41.88 31.75 39.74 46.6See PCP only when I'm sick 11.71 13.68 14.29 12.18 12.62See PCP several times a year 40.02 40.74 50.26 45.51 35.92Seek medical care from doctor's office 86.45 87.75 85.19 88.05 83.5Stores near me do not sell fresh fruits and vegetables 2.89 3.04 3.53 2.7 2.15Use emergency department within past year 26.94 28.21 32.8 24.38 35.92


Identified Community Health Concerns/Conditions by Niagara County Residents and Hospital Respondents

Condition NC $10k - $20k $20k - $35k $35k - $50k$50k- $75k $75k+% % % % % %

Access to affordable health care* 46.24 41.4 50 48.31 49.18 43.38Access to healthy food* 17.47 20.38 17.53 17.42 18.03 16.21Cancer* 31.73 22.29 31.82 33.71 34.97 32.19Couldn't get care because of cost (with health insurance, too expensive) 31.63 28.3 35.59 45.45 27.66 28.92Currently smoke most days/all days 17.52 30 21.57 20.9 12.78 10.28Don't eat fruits and vegetables because of cost 31.8 39.13 44.52 35.8 33.88 23.5Don't go see my PCP 2.14 1.85 1.28 1.69 2.17 2.73Don't have PCP 2.52 4.32 3.21 0.56 2.72 1.14Ever told to have blood sugar problems, or diabetes by doctor/nurse 16.25 25.93 15.38 15.17 15.76 12.3Ever told to have high blood pressure, or hypertension by doctor/nurse 39.11 43.21 39.1 50 38.04 31.89Ever told to have high cholestrol 32.33 33.95 35.26 33.71 36.96 27.79Have fair/poor physical health 21.04 41.62 28.85 16.38 21.19 22.21Have health insurance through employer 67.48 9.82 50 71.91 78.26 91.3Have Medicaid 13.28 55.83 20.51 6.74 4.35 0.46Have Medicare 19.31 38.04 23.72 22.47 14.13 7.55Heart related issues (high blood pressure, heart disease, or stroke)* 22.78 16.56 18.18 26.4 24.59 24.89I am not sure how to cook/prepare fresh fruits and vegetables 3.57 4.97 3.87 3.98 3.83 2.53I don't like to eat healthy food 4 6.21 3.87 2.84 2.19 4.38I have health insurance 98.02 97.55 96.15 99.44 97.83 99.32My family does not like to eat healthy 3.74 1.86 4.52 2.27 3.83 4.84No physical activity 9.66 11.25 11.54 13.56 10.33 7.97Nutrition/eating a healthy diet* 17.38 11.46 15.58 13.48 17.49 21.92Overweight/obesity; weight management* 22.03 13.38 18.83 27.53 19.13 25.57Physical activity; fitness and exercise* 19.58 6.37 14.94 19.66 19.13 25.11See PCP for yearly check-up 43.61 24.69 33.97 39.89 45.65 53.76See PCP only when I'm sick 11.71 14.81 15.38 11.8 14.67 10.02See PCP several times a year 40.02 54.32 46.15 46.07 34.78 32.35Seek medical care from doctor's office 86.45 76.07 78.85 91.01 86.34 91.1Stores near me do not sell fresh fruits and vegetables 2.89 4.97 3.23 2.27 1.64 3.23Use emergency department within past year 26.94 45.4 33.55 29.21 21.86 21.64

Identified Community Health Concerns/Conditions by Niagara County Residents According to Income

Healthy & safe environment related health topics

2.03

2.19

6.58

6.92

6.92

9.45

11.56

12.74

20.44

0 5 10 15 20 25

Homicide*

Firearm related injuries*

Asthma/COPD*

Domestic violence*

Injury prevention (falls, motor vehicle safety, etc.)*

Child abuse/neglect*

Food/water safety and quality*

Safety of neighborhood*

Ever been told you have Asthma/COPD by doctor or nurse




Homicide* 2.03 1.21 5.95 2 2.11Firearm related injuries* 2.19 2.72 3.57 2 3.16Asthma/COPD* 6.58 9.67 7.74 8.67 5.26Domestic violence* 6.92 6.95 8.93 10 3.16Injury prevention (falls, motor vehicle safety, etc.)* 6.92 6.95 3.57 11.33 6.32Child abuse/neglect* 9.45 9.37 10.71 11.33 4.21Food/water safety and quality* 11.56 11.18 9.52 12 15.79Safety of neighborhood* 12.74 12.99 17.86 10 9.47Ever been told you have Asthma/COPD by doctor or nurse 20.44 22.75 25 17.33 21.05



Condition NC $10k - $20k $20k - $35k $35k - $50k $50k- $75k $75k% % % % % %

Homicide* 2.03 2.55 3.25 2.25 1.09 0.91Firearm related injuries* 2.19 1.91 2.6 3.37 1.64 1.6Asthma/COPD* 6.58 14.01 8.44 7.3 4.37 3.42Domestic violence* 6.92 7.64 13.64 6.74 4.37 4.79Injury prevention (falls, motor vehicle safety, etc.)* 6.92 5.1 5.19 7.3 8.74 6.85Child abuse/neglect* 9.45 11.46 12.99 10.67 6.56 7.53Food/water safety and quality* 11.56 8.28 11.04 8.99 13.66 12.56Safety of neighborhood* 12.74 12.74 11.04 17.98 13.11 10.27

Ever been told you have Asthma/COPD by doctor or nurse 20.44 30.86 23.08 21.35 22.28 15.49


Healthy WIC related health topics

1.6

2.7

4.3

5.32

0 1 2 3 4 5 6

Infant death*

Teenage pregnancy*

Family planning (pregnancy prevention)*

Maternal health (care for moms, during and after pregnancy)*




Infant death* 1.6 2.11 1.79 2.67 0Teenage pregnancy* 2.7 2.42 5.36 3.33 2.11Family planning (pregnancy prevention)* 4.3 3.02 6.55 5.33 5.26Maternal health (care for moms, during and after pregnancy)* 5.32 6.04 4.76 4.67 3.16



Condition NC$10k -$20k

$20k -$35k

$35k -$50k

$50k-$75k $75k

% % % % % %Infant death* 1.6 2.55 1.95 1.12 1.64 1.14Teenage pregnancy* 2.7 1.91 4.55 2.81 1.09 2.51Family planning (pregnancy prevention)* 4.3 5.73 5.84 3.93 3.28 3.88Maternal health (care for moms, during and after pregnancy)* 5.32 1.91 5.19 5.06 5.46 6.62


Well-being, mental health & subs use disorders related health topics

8.44

11.75

13.59

17.72

18.65

30.97

0 5 10 15 20 25 30 35

Suicide prevention*

Drink beer, wine or liquor most days

Stress management*

Alcohol and/or substance use or addiction*

Have fair/poor mental health

Mental health/depression/anxiety*




Suicide prevention* 8.44 7.55 5.95 8.67 10.53Drink beer, wine or liquor most days 11.75 11.71 9.88 19.46 15.79Stress management* 13.59 14.8 10.12 11.33 13.68Alcohol and/or substance use or addiction* 17.72 17.82 19.64 22 13.68Have fair/poor mental health 18.65 19.88 23.97 20.27 12.63Mental health/depression/anxiety* 30.97 26.28 32.14 33.33 37.89



Condition NC $10k - $20k$20k - $35k$35k - $50k$50k- $75k $75k% % % % % %

Suicide prevention* 8.44 7.01 9.74 8.43 5.46 9.59Drink beer, wine or liquor most days 11.75 8.59 8.97 10.73 16.85 13.9Stress management* 13.59 12.74 14.29 12.36 10.38 16.67

Alcohol and/or substance use or addiction* 17.72 24.2 17.53 17.98 14.75 17.12Have fair/poor mental health 18.65 42.5 21.94 17.51 16.3 11.42Mental health/depression/anxiety* 30.97 34.39 35.06 25.84 25.14 34.02


HIV, sexually transmitted disease, vaccine-preventable diseases

2.03

4.56

12.49

0 2 4 6 8 10 12 14

Sexually transmitted infections*

Infectious diseases (hepatitis, TB)*

Immunization and/or prevention of infectious disease (such as flu)*


Condition NC MSMH NFMMC ENH DMH

% % % % %Sexually transmitted infections* 2.03 1.81 2.38 4 2.11Infectious diseases (hepatitis, TB)* 4.56 5.44 5.36 6.67 4.21Immunization and/or prevention of infectious disease (such as flu)* 12.49 12.08 7.74 16.67 9.47



Condition NC $10k - $20k $20k - $35k $35k - $50k $50k- $75k $75k% % % % % %

Sexually transmitted infections* 2.03 3.18 3.9 1.69 1.09 1.37

Infectious diseases (hepatitis, TB)* 4.56 3.18 6.49 5.06 4.37 3.88Immunization and/or prevention of infectious disease (such as flu)* 12.49 4.46 8.44 15.73 12.02 14.84


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