1. Ashland County Community Health Assessment Report SPRING, 2015 SPONSORS: ASHLAND COUNTY/CITY HEALTH DEPARTMENT & ASHLAND COUNTY FAMILY & CHILDREN FIRST COUNCIL

2. Ashland County’s Health Analysis Secondary Data Analysis (Ongoing Data Collection) ◦Economics ◦Health Status ◦Education ◦Risky Behaviors ◦Child Abuse/Neglect Health Needs Survey (April – May, 2015) ◦Macro Status ◦Micro Status Focus Groups (March and May, 2015)

3. Secondary Data - Economics  Unemployment is decreasing; however, wages are stagnant  Children living in poverty has decreased slightly since 2009 but not at the levels expected with the substantial decrease in unemployment  Single-parent families (female headed) significantly more likely to be in poverty compared to two parent families  Cash assistance welfare programs (i.e. TANF) have low number of recipients given the poverty levels  Food assistance programs had a significant increase in recipients through 2011, and since that time has stabilized.

11. Secondary Data - Health  Proportion of premature births has decreased during the last two years after having increased over the prior four years  Infants born at low birth rate has also seen a decrease since 2011  Infant mortality rates remains low after having reached its peak in 2008.  General decline in teen age births, however, still shows a lot of fluctuation  A significant decrease in the proportion of uninsured children since 2011. There was nearly a 7% reduction between 2012 and 2013.  Children living in households under the poverty level is the most likely group not to have insurance coverage, followed by children living in households that have incomes just below twice the poverty level.

18. Secondary Data - Education  Graduation rates have shown little fluctuation during the past eight years. This rate has always been above 90%.

19. Secondary Data - Education  Graduation rates have shown little fluctuation during the past eight years. This rate has always been above 90%.  Ohio Achievement Assessment results in Ashland have consistently been above state’s results.

21. Secondary Data – Risk Behaviors  The number of adolescents being adjudicated for felonies has decline or the past eleven years; however, it has increased during the last two years.  NO current data for substance use

22. Secondary Data – Child Abuse/Neglect  Increase in the number of incidents being investigated since 2010. A lot of fluctuation seen since 2006.  Number of children in custody has decreased since 2012. In 2013 and 2014 more children have left custody than entered into it.  Two-thirds of children in custody have been in custody for less than 2 years.  Significant differences in the reason for children leaving custody from year to year.  In 2009 placement with relatives/kinship care was the primary reason.  In 2013 reunification was the primary reason.

28. Community Health Needs Survey (General)  General agreement that Ashland is a good place to raise children. (Although there was stronger agreement to this from individuals without children.)  General agreement that Ashland is a good place to grow old.  Biggest concern is related to economic activity.  Low wages  Low income  The lower the income of the individual the greater the concern

29. Community Health Needs Survey (General)  Health care is available however  There is a long wait time for non-emergency care  There are concerns regarding quality  There are concerns regarding affordability  Ashland is a safe place to live  Ashland has a “community spirit” that brings people together in times of need.

30. Community Health Needs Survey (Community Issues)  Areas of most concern  Drug abuse  Low Income and Poverty  Violence within family units  Moderate concern with domestic violence and child abuse  Less concern with elder abuse  Low perception of problem level  Pollution  Lack of community support  Discrimination/Racism

31. Community Health Needs Survey (Risky Behaviors)  Behaviors with the most negative impact on the community  Drug abuse  Alcohol abuse  Poor eating habits  Lack of exercise  Obesity  Behaviors with the least negative impact on the community  Racism  Not using seat belts  Not getting vaccinated  Bullying (younger respondents viewed this behavior as having more of a negative impact than older respondents

32. Community Health Needs Survey (Services Needed)  Services that needs to be increased  Higher paying employment  Road maintenance  Availability of employment  Positive teen activities  Services that needs to be increased (difference between lower and higher income respondents)  Affordable housing  Services for people with disabilities  Health family activities  Higher paying employment

33. Community Health Needs Survey (Information Needed)  Parents of younger children  Recreational activities  Social and emotional support  Dealing with difficult behaviors of children  Parents with older children (their children need information on …)  Dealing with peer pressure  Bullying  Nutrition  Drug abuse  Reckless driving/spending

36. Community Health Needs Survey (Conditions “Diagnosed” by Health Professional)  Overweight/Obesity (over four out of ten)- Lower income levels more likely than higher income  High blood pressure (over three out of ten) – Older more likely than younger  Depression/Anxiety (nearly one out of three) – Females more likely than males; younger more likely than older  When controlling for both Age and Gender, group most likely (over 40%) was Females younger than 55 years old.  High Cholesterol (nearly one out of three) – Older more likely than younger

37. Community Health Needs Survey (Personal Observations and Daily Functioning)  Nearly one out of five stated that their daily functioning had been compromised due to feeling sad or worried in the past 30 days.  Younger respondents, and lower income individuals were more likely to have had this experience  Over one out of six stated that in the last 30 days their functioning had been compromised due to being anxious, confused, or overwhelmed.  Females, younger respondents, and lower income individuals were more likely to have had this experience  Over one out of four experienced physical pain and/or health problems that compromised their ability to carry out typical daily tasks.  Lower income individuals were more likely to have had this experience (twice as likely)

41. Community Health Needs Survey (Physical Activity/Exercise/Smoking)  Most of the respondents (70%) stated that they did engage in some form of physical activity at least once during a normal week.  Locations of physical activity were primarily at ones own home or in parks and walking trails.  Those indicating NOT engaging in some form of physical activity stated that the reason was due to  Lack of time  Too tired  Not liking to exercise  Not having anyone to exercise with  Those indicating NOT engaging in some form of physical activity were over twice as likely to have reported being sad or worried that impacted their daily functioning  Smoking  Just under 11% of respondents stated they use tobacco in any form.  Lower income individuals were significantly more likely to use tobacco than higher income individuals

42. Community Health Needs Survey (Access Health Care)  Nearly one of five indicated have a problem obtaining needed health care for themselves or a family member. (Most prevalent for those with incomes below $25,000; households with children, and those between the ages of 18 and 54.)  Reason(s) for barrier  Insurance coverage  Too long of wait  Not being able to get an appointment  Lack of transportation  Not knowing where to go

43. Focus Groups Six focus groups ◦Three conducted by MHRB of Ashland County ◦Three conducted by the Ashland Health Department ◦Participants ◦Veterans ◦Ministers ◦Senior citizens ◦School/business ◦ACCESS board members ◦Strength in Numbers support group

44. Focus Groups General Themes  Cohesiveness and togetherness describes the community (especially compared to other communities)  Lots of caring individuals who volunteer time, effort and money  Good place to raise kids  Generally a safe place to live  A good place to retire  Solid faith-based foundation supported my many good churches from various denominations  University presence adds to appeal and to the economy of the community  Much pride in the KROC center, and the sense of “community” this center provides

45. Focus Groups Concerns  Wages and employment conditions  Low wages  Individuals must often compromise best interest of their family for their job  e.g. – time off to attend to a sick child, work hours requiring child care late at night, working multiple jobs that results in spending little time with family  Number of available doctors  Those retiring are not being replaced  Long wait times to see a doctor  Lack of qualified health care specialists  Many choosing to seek out most expensive type of health care (ER) due to not being able to see doctor  Dental care lacking as either not available and or too expensive due to problems with insurance

46. Focus Groups Concerns  Lack of coordination between social service agencies  Increase need for food assistance has resulted in longer wait times at food banks  Drug abuse (seen as being related to other community problems)  Affordable housing  Insufficient shelter beds  Transportation not available for many, and not at the right time  Education system financially stressed  Too many children in custody resulting in budgetary problems at the county level  Decreasing proportion of intact family (defined as having two parents)  Overreliance by many on public assistance