Central Kenai Peninsula 2012 Community Health Needs Assessment

Central Kenai Peninsula 2012 Community Health Needs Assessment

For Central Peninsula Hospital

Soldotna, Alaska

SUBMITTED: January 2013

UNE /CCPH • Central Peninsula Hospital Community Health Needs Assessment 2012 i

TABLE OF CONTENTS

Introduction ..................................................................................................................................... 2

Methods ............................................................................................................................................ 3 Overview of CPH CHNA Process .................................................................................................................. 3 Data Collection .............................................................................................................................................. 3 Data Analysis ................................................................................................................................................. 5 Prioritization and Recommendations ............................................................................................................. 6

Key Health Findings ...................................................................................................................... 7 Population Profile .......................................................................................................................................... 7 Health Based Social and Economic Characteristics ......................................................................................... 9 Functional Health Status and Chronic Disease Burden ................................................................................ 10 Access to Health Care................................................................................................................................... 11

Key findings for Specific Areas of Healthcare ...................................................................... 14 Cardiovascular Health .................................................................................................................................. 14 Respiratory Health ....................................................................................................................................... 16 Diabetes and Other Chronic Conditions ...................................................................................................... 18 Cancer Health and Screenings ...................................................................................................................... 20 Mental Health and Substance Abuse ............................................................................................................ 21 Youth Mental Health & Substance Abuse .................................................................................................... 22

Community Perceptions of Health Services and Needs ................................................... 24

Physician Workforce Analysis ................................................................................................. 28

Summary and Priority Health Issues ....................................................................................... 31

APPENDIX 1 – Central Peninsula Hospital Advisory Group Members ........................... 35

APPENDIX 2 - Health Status Profile (HSP) ........................................................................... 36

APPENDIX 3 – Health Status Trends Table .......................................................................... 40

APPENDIX 4 – Detailed Data Sources by Indicator ........................................................... 43

APPENDIX 5 - Definitions of Selected Indicators ............................................................... 47

APPENDIX 6 – Annotated CP Household Health Survey .................................................. 48

UNE / CCPH • Central Peninsula Hospital Community Health Needs Assessment 2012 2

INTRODUCTION

Central Peninsula Hospital (CPH) contracted with the University of New England’s Center for Community and Public Health (UNE/CCPH) to conduct a Community Health Needs Assessment (CHNA) in early 2012. Central Peninsula Hospital last conducted a Community Health Needs Assessment in late 2009. UNE/CCPH conducted this 2009 assessment as well as the prior assessment, conducted in 2004. New federal law that is part of the Patient Protection and Affordable Care Act (PPACA or ACA) requires a new assessment to be completed every three years as part of community benefit planning. This comprehensive study will enable Central Peninsula Hospital and other health officials to effectively develop new or expand resources, and plan future health services for the Central Peninsula area. Results of this study are extremely important to the strategic and master planning processes at Central Peninsula Hospital. The CHNA consisted of three major components:

a telephone and mail survey of randomly selected households in the Central Peninsula region on health status, utilization and preferences;

collection of existing de-identified secondary health data; and, discussion with members of an Advisory Workgroup formed to provide input to the assessment.

The survey was conducted for UNE/CCPH by Market Decisions, a Maine-based survey research firm. UNE/CCPH faculty and staff analyzed the data and wrote this report.

Objectives of Central Peninsula Hospital’s Community Health Needs Assessment There were three primary objectives of the CPH CHNA:

Complete a Community Health Needs Assessment by June 2013 to comply with IRS reporting requirements mandated in the PPACA.

o “take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health.”

o Make certain that it “be made widely available to the public.” Evaluate community perceptions of the need for various health services and of Central Peninsula

Hospital's services and facilities Inform strategic planning and provide recommendations for service delivery based on health status

findings and physician workforce analysis.


METHODS

Overview of CPH CHNA Process Earlier this year, Central Peninsula Hospital announced a competitive request for proposals to conduct a comprehensive community health needs assessment. The University of New England’s Center for Community and Public Health with a team including Market Decisions, a survey research firm, were selected. After an initial meeting with CPH Board, a project workplan was finalized to include regular meetings with an Advisory Workgroup to provide input including:

Identifying additional data sources for the study Content of the community household survey Interpretation and prioritization of survey findings Assessment dissemination and follow-up plans.

A list of CPH Workgroup members can be found in Appendix 1.

Data Collection PRIMARY DATA - HOUSEHOLD HEALTH SURVEY One of the major components of a health assessment in a region such as Central Peninsula, where secondary data is not available for the primary service area located within the Kenai Peninsula Borough (e.g. BRFSS results available for Gulf Coast region which includes entire Kenai Peninsula Borough, plus Kodiak), is a comprehensive, randomly sampled household health survey. In an effort to more effectively target the Central Peninsula population, the 2012 survey used Address Based Sampling, which utilizes the US Postal Service’s Computerized Delivery Sequence File (CDS), administered using dual modes – both telephone and mail. The random sample population survey is used as a tool to better understand the public health and health care needs, perceptions, issues, utilization and preferences among service area residents. The final survey questions have been selected from extensively used and validated state and/or national health surveys, and newly developed and pre-tested questions generated by the Central Peninsula Hospital Workgroup. Market Decisions (MD), a survey research firm, conducted the survey for this needs assessment. Address-Based Sampling (ABS) utilizes the US Postal Service’s Computerized Delivery Sequence File (CDS) which Marketing Systems Group (MSG) licenses. The CDS database contains over 135 million residential addresses and provides nearly 100% coverage of all households in the US. The CDS file contains a variety of address types, including city-style, rural routes, PO Boxes, seasonal, vacant, and drop points. Sample frames are defined by a level of geography (postal or census) from Census Block up to National. The current study used CPH’s primary service area, which included all addresses within the following zip code towns2:

CLAM GULCH - 99568 COHOE – no unique zip

2 The census designated places of Cohoe, Funny River, Ridgeway, Kalifornsky and Salamatof are regions in CPH’s primary service

contained within the zip codes list above (ie do not have unique zip codes of their own) and were included for secondary data

acquisition, such as census data and vital statistics.


COOPER LANDING – 99572 FUNNY RIVER – no unique zip KASILOF - 99610 KENAI – 99611,99635 NIKISKI – 99611, 99635 NINILCHIK - 99639 RIDGEWAY – no unique zip SOLDOTNA – 99669 STERLING – 99672 KALIFORNSKY – no unique zip SALAMATOF – no unique zip

Within these zip codes a random list of residential addresses was selected. Data collection relied on a combination of telephone and mail surveys. Once the sample was generated, it was sent out for reverse look-up to append telephone numbers. Those records with an identified telephone number were contacted by telephone. All others were sent a mail survey to complete. A total of 1,577 residents were mailed a copy of the survey. The mail survey methodology would include an initial mailing, a reminder post card, and a second mailing to those not initially responding. Among these, 372 were returned as undeliverable and 179 surveys were returned completed. A total of 421 residents completed the survey by telephone. Once a household was contacted, an adult (18+) respondent was selected within each household to complete the survey. A total of six hundred residents (N=600) completed a survey by telephone or by mail. The overall survey response rate was 30% with a response rate of 15% for the mail survey and a response rate of 53% to the telephone survey. Among those responding to the telephone survey the cooperation rate was 78% and the refusal rate was 3%. On average, the telephone survey took residents 18 minutes to complete. The remaining contacted households that did not complete the survey consisted of cases where a respondent started the survey but never completed it, those who could not speak English well enough to participate, and respondents who were infirm. The response rate for mail surveys was much lower than expected, but the response rate for telephone surveys was in line with prior years, as well as BRFSS and other national survey response rates. It was anticipated that half of the surveys would be completed by mail and half by phone, but the low response rate for mail surveys resulted in 70% of surveys being completed by phone. This was the first time the dual mode approach had been used in this region and it is not clear why more mail surveys were not returned. One possible reason is the preponderance of PO Boxes in the region. The survey was conducted within a window of about 4-6 weeks, so those people who do not get their mail daily or weekly may simply have not received the surveys before the return deadline. There are also many “snowbirds” in the Central Peninsula region who may keep a PO Box in the region but do not live there all year. Nevertheless, the mail survey was not successful in this region and future assessments should take this into consideration in determining methods for survey implementation. Despite this shortcoming with the mail surveys, the respondents in 2012 more closely reflected the actual age and gender distribution of the Central Peninsula than previous surveys, suggesting that the sample represented residents in the region well.


The percentages reported for the Central Kenai Peninsula household survey results are within plus or minus 4% of what would be found if all households and residents in the region participated. For example, if our survey showed that 50% of the sample was very concerned about the cost of health care, then the comparable figure for the population would be somewhere between 46% and 54%, with a confidence level of 95% that the proportion falls within this range. SECONDARY DATA SOURCES In addition to the household health survey data, health data for peer regions selected by the CPH Workgroup, as well as State and National secondary data, is identified to provide context for Central Peninsula’s findings. The Behavioral Risk Factor Surveillance System (BRFSS), US Census, Youth Surveys and Alaska Vital Statistics comprise the secondary data used for this assessment. The primary and secondary data is compiled into a health status profile, which is used by researchers and the Workgroup to identify priority health issues. Additionally, since UNE/CCPH had conducted previous health surveys in Central Peninsula in 2004 and 2009, a trending profile was developed to show health trends over time for the region.

Table 1: Secondary Data Sources

DATA TYPE SOURCE DATA YEAR(s)

Population US Census Bureau 2010 Demographics U.S. Census Bureau, 2010 Births and Mortality Alaska Bureau of Vital Statistics 2001-2010 Alaska Behavioral Risk Factor Surveillance System

Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention & Health Promotion; http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx

2010 & 2011

US Behavioral Risk Factor Surveillance System

www.brfss.gov 2010 & 2011

Central Kenai Peninsula Prevention Needs Assessment Survey

Community Action Coalition for prevention www.kpcac.net/pna

2011

Alaska Youth Risk Behavior Survey

Alaska Department of Health and Social Services, Division of Public Health, Section of Chronic Disease Prevention & Health Promotion; http://dhss.alaska.gov/dph/Chronic/Pages/yrbs/yrbsresults.aspx

2011

US Youth Risk Behavior Survey

MMWR Surveillance Summaries Vol 61 No. 4

2011

Data Analysis Where possible, raw datasets were acquired, but in some cases (e.g. birth and mortality data, Prevention Needs Assessment Survey) existing data reports and/or result tables were used. Household Health Survey and BRFSS datasets were analyzed using SPSS. Standard frequencies and crosstabs were used, but no statistical


testing was employed. The Household Health Survey was weighted and missing values were excluded by question. Post-stratification weighting by age and gender was applied to the survey data using 2010 Census data for Central Peninsula. Generally speaking, older women tend to be over-represented among survey respondents so weighting ensures that results for a population more accurately reflect the actual age and gender distribution of the population. As mentioned earlier, the unweighted sample for this survey was more similar to Central Peninsula’s actual age and gender profile than the 2009 sample, so smaller weights were applied to this year’s data.

Once data has been acquired and analyzed it is compiled into a standardized health status profile (see Appendix 2) comparing Central Peninsula to peer regions across several health domains (e.g. access to care, cardiovascular health, youth health). Fairbanks and Mat-Su Boroughs were chosen as peer regions due to their population size and relative proximity to Anchorage as a medical hub, respectively. State and US health findings are also used for comparison where possible. This allows for identification of demographics, disease prevalence, and/or medical care use findings that appear high or low compared to peer regions. None of the data presented in this report has been age-adjusted, a technique used to standardize age differences across populations being compared. The reason this assessment uses non-adjusted data, is that the purpose of this assessment is health planning. Therefore, the actual burden of disease, within a community’s age distribution, is important for understanding true health service needs. Although age-adjustment makes for valid comparisons in research, UNE-CCPH’s approach is designed to help hospitals and communities understand their own population’s health needs in order to make informed health planning decisions. Age stratification analyses by chronic condition were conducted and confirmed a pattern of increasing prevalence of disease with increasing age for every condition except for depression/anxiety. The initial health status profile was shared with members of the CPH CHNA Workgroup, including physician representatives, to get their impressions of the data and input to inform the health priorities. Where possible, this insight is included in the discussion of priority health findings and recommendations at the end of the report. In the case of Central Peninsula, there are also two prior surveys that provide context for understanding the current health findings. Results from the three survey years were compiled into a health status trends document (See Appendix 3), which allowed for comparisons of findings in 2012 to 2004 and 2009 and includes selected age- and gender-specific findings. Throughout this report data tables will be used to highlight sections of the health status profile relevant to each specific health domain and figures will be used to show trends over time for selected indicators within the same area of health.

Prioritization and Recommendations The key health findings and recommendations contained in this report are meant to provide the start for a broader conversation with hospital and community stakeholders. This report is intended to provide a summary of key community health needs, as identified through thorough data analysis, which needs to be prioritized with an eye toward local knowledge/contextual factors and resource availability. The next step in this process is for the hospital to engage internal and external stakeholders regarding which health needs are of highest priority for the hospital to address, and ultimately implement mechanisms to address prioritized health needs within a comprehensive implementation plan.


KEY HEALTH FINDINGS

Population Profile The Central Kenai Peninsula (hereafter referred to as Central Peninsula or CP) has a population of approximately 36,000 residents, per the 2010 Census, which represents an increase of about 4,000 residents since the 2000 Census. Much of this increase reflects an increase in the middle-aged and elderly population. The populations of most towns within the CP region saw a modest population growth since 2000. Most of the population growth was experienced in Kalifornsky, whose population grew by approximately 2,000 people since 2000, and which represents 50% of the total population growth in CP. Only one area, Cooper Landing saw a very modest decrease in population.

Figure 1: Population Growth 2000 to 2010 in Central Peninsula CDPs

The population growth seen in CP, which grew by about 13%, is consistent with the level of growth seen in the region for the past decade in both Fairbanks and Alaska, which grew 18% and 13%, respectively. Nationally, the U.S. population grew slightly less, by about 10%. The age structure of a population is a function of its past fertility, migration and mortality and is an important determinant of health and health service needs. Those over the age of 18 grew from 69% of the population in 2000, to 75% of the population. In particular, those over the age of 65 grew from 7.5% of the population, to 11% of the population. The proportion of those under the age of 18 fell from 31% to 25%. Figure 3 shows the 2010 age distributions for CP, as well as for Mat-Su, Fairbanks, Alaska, and the U.S. While CP’s population may be aging, it is still slightly younger relative to the rest of the U.S.; nationally, the proportion of those over the age of 65 is 13%, compared with 11% for CP. However, in comparison with other areas in Alaska, CP communities skew slightly older. The proportion of CP residents in the 45-64 age group (32%) is larger than other areas in Alaska and the U.S. In discussing the aging of the CP population in relation to other areas of Alaska, CPH Workgroup members suggested that one possible reason for this is the

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preferential property tax exemption for those over age 65 in Central Peninsula. This makes the region economically attractive for retirees on a fixed income who may be moving from the lower 48 and other areas of Alaska to retire in the Central Peninsula region.

Figure 2: Age Distribution

Central Peninsula birth rates have stayed relatively steady over the past 10 years. However, as shown in Figure 3, birth rates are lower than Alaska, Fairbanks or Mat-Su. This is not surprising given the older age distribution of the population in comparison to these regions.

Figure 3: Birth Rates for Central Peninsula and Peer Regions (per 1000 Females Age 15 or older)

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% Population Age 65 and Over

% Population Between Ages 45‐64

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% Population Under the Age of 18


In order to understand leading causes of death, two-year mortality rates were calculated for the Central Peninsula service area. Central Peninsula mortality rates for 2009-2010 mirror Alaska’s 2009 mortality findings in that mortality rates are highest for malignant neoplasms, followed by cardiovascular disease, and unintentional injuries. Chronic lower respiratory disease ranks 4th for Central Peninsula as well as Alaska and Cerebrovascular Disease ranks 5th. Although Central Peninsula does not differ from Alaska in these leading causes of death, the pattern is different nationally. In the US overall, cardiovascular disease is the leading cause of death, and malignant neoplasms (cancer) are 2nd. Unintentional injuries are 3rd in Central Peninsula and Alaska, but this is the 5th leading cause of death for the U.S. overall. Central Peninsula is primarily White, with 85% of residents reporting White as their only race. The only sizeable single race, non-White population is American Indian / Alaska Native, representing 6% of the CP population. Those who only reported Black / African-American (0.3%), Asian (1.1%), and Native Hawaiian/ Pacific Islander (0.2%) made up a very small percentage of the CP population. As with the 2000 Census, the 2010 Census tracks respondents who report more than one race. In CP, about 6% of residents reported two races, with the majority (67%) of this subpopulation reporting both American Indian/Alaska Native and White racial makeup. In comparison to Fairbanks and Alaska, CP is slightly less diverse overall. The share of White only respondents in Fairbanks and Alaska is lower (77% and 67%, respectively), while the proportion of other races, especially Black / African American (4.5% and 3.3%, respectively) and Asian (2.7% and 5.4%, respectively) is higher.

Health Based Social and Economic Characteristics Factors such as income, employment, educational attainment, and insurance status are interrelated characteristics and have been shown to impact the health status of populations. These factors are often termed the social determinants of health. Educational attainment is an important indicator of future success, as those with at least a high school diploma will likely have better employment opportunities. Limited education and employment opportunities can also impact residents in areas such as access to health care. Poverty and household income level can impact whether a person will have an adequate diet, healthy lifestyle and good medical care. Thus, it is important to understand the socioeconomic conditions of a community in order to completely understand the health and well being of its residents. In general, CP compares favorably with the State of Alaska and the U.S. with respect to many socioeconomic measures. CP saw a slight increase in the proportion of unemployed residents slightly since 2009, from 8.2% to 8.6%. Alaska and the U.S. both have higher rates of unemployment than Central Peninsula, but Fairbanks unemployment rate is slightly lower (6.4%). The median household income for CP households ($60,378) is lower than Mat-Su ($69,437), Fairbanks ($66,390), and Alaska ($64,576) overall, but higher than the U.S. ($50,046). However, when looking at the mean income, Central Peninsula is still lower than Alaska and peer regions, but is comparable to the US mean income. The mean, or average, income is more affected by very large or small values than the median, which is the middle value if all incomes were lined up in a row. Central Peninsula appears to have fewer outliers on the upper end (extremely high incomes) than other comparison regions because its mean and median do not differ as much in comparison. The proportion of CP households living below the Federal Poverty Line (9%) compares very favorably to the U.S (15%), and is similar to Alaska and MatSu (both 10%).


Finally, CP residents are generally well-educated relative to the U.S., with only 7% of residents not attaining a high-school diploma compared with 12% nationally. The proportion of non-high school graduates also approximates the rates of Fairbanks Borough (7%) and Alaska (8%) overall, but is slightly more than Mat-Su Borough (5%). Altogether, these socioeconomic indicators suggest that Central Peninsula residents are relatively prosperous and educated but a substantial proportion of CP households face financial barriers and challenges to achieving good health.

Table 2: Socioeconomic Characteristics

Socioeconomic Characteristics

Central Peninsula

Mat-Su Borough

Fairbanks Borough Alaska US

% of Labor Force Unemployed 8.6% 10% 6.4% 9.6% 10.8%% Population Not Attaining H.S. Diploma (>25 yrs) 7.3% 5.2% 7.0% 7.7% 12.3%Median Annual Household Income $ 60,378 $ 69,437 $ 66,390 $ 64,576 $ 50,046Mean Annual Household Income $ 68,541 $ 80,005 $ 80,095 $ 81,290 $ 68,259People and families living below federal poverty line 8.9% 9.7% 7.1% 9.9% 15.3%

Functional Health Status and Chronic Disease Burden Respondents to the household health survey considered themselves relatively healthy and did not report high levels of functional limitations, compared to peer communities, Alaska and the U.S. However, the rate of multiple (3+) chronic conditions is slightly elevated compared to Mat Su or Fairbanks, which may be linked to the older age of residents in Central Peninsula. This finding indicates a perception of living “well” despite chronic illnesses among many respondents.

Table 4: Functional Health Status

FUNCTIONAL HEALTH STATUS

Central Peninsula

Mat-Su Borough


% Health Fair to Poor 10% 16% 12% 16% 17% % 11+ Days Lost to Poor Mental or Physical Health 8.5% 9.1% 5.9% 7.9% 8.9%

% 3+ Chronic Conditions 15% 13% 9.4% 14% 21%

Wellness Categories (See Appendix 5 for definitions):

% Well 40% 39% 48% 43% NA % At Risk for Future Medical Problems 9.1% 8.4% 6.0% 8.6% NA

% Some Health Problems 35% 26% 25% 25% NA

% Not Well 16% 28% 21% 24% NA


All the indicators of functional health status appeared to improve from 2004 to 2012, despite the fact that Central Peninsula’s population is older in 2012 than it was in 2004. However, this does not change the fact that 15% of residents have 3 or more chronic conditions and about 35% were classified as having “some health problems” in our wellness index (those who reported their health as fair or poor, had lost 5 or more days to poor mental or physical health in past month, OR had been diagnosed with Hypertension, High Cholesterol, or Diabetes). Another 9% are at risk for future medical problems (those without chronic disease who currently smoke or are obese.). These populations with some health problems and at risk due to modifiable behavioral risk factors will be important groups to target to prevent future chronic disease and costly medical needs.

Figure 4: Functional Status Trends for Central Peninsula

Access to Health Care Access to health care in Central Peninsula appears similar or better than peer communities, Alaska and US. About 18% of residents report no receipt of check-up or routine medical visit in past 2 years and 16% report unmet medical need in past year due to cost. More than 1 out of 5 (22%) of non-elderly adults (18-64 years) are uninsured. This is similar to Alaska and US uninsured rates and lower than the peer regions of Alaska (Mat-Su and Fairbanks), but is nevertheless a high proportion of residents lacking access to care. Most of the indicators of access to health care have remained unchanged since 2004. An exception to this is the percentage reporting a usual source of health care, which dipped in 2009 but appears to have returned to 2004 levels. This is an important indicator of access to a primary health care provider, and ultimately the presence of a continuous, comprehensive medical home. Primary care, and medical homes in particular, are increasingly being included in policy and planning to improve the quality of care and decrease overall costs to the health system. Another indicator of access which appeared to improve since 2009, was the percentage reporting unmet medical care needs due to cost of care. It appears that most Central Peninsula residents are able to access a primary care provider, an indicator of adequate primary care physician workforce. This topic

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will be discussed in more detail in the Physician Workforce chapter, but among the 73% of residents that indicated a usual source of medical care, 95% named a clinic or doctor’s office, again pointing to an adequate array of primary care providers in the region to meet most residents’ needs. Nevertheless, more than 1 out of 4 (27%) residents report no usual source of primary care, which suggests a need to increase use of primary care among the un- and under-insured, using safety net providers willing to see this population. One possible option for this is to direct patients that repeatedly present in the emergency room for primary care needs toward the community health center in Soldotna, or other providers which offer a sliding fee scale and may be able to assist patients with enrolling for any available benefits (e.g. state-sponsored cancer screening, Medicaid, DenaliKidCare etc.).

Table 4: Access to Care

ACCESS TO CARE Central

PeninsulaMat-Su Borough


%Uninsured (18-64) 22% 26% 24% 22% 21% % Not Having a Checkup Within the Past 2 yrs 18% 27% 31% 26% NA % Needed Medical Care But Could not Afford it: Past Year 16% 21% 17% 17% 9.0%% Without Usual Source of Primary Care 27% 33% 35% 34% NA Of those with no usual source of care:% Go to ER if sick 22% NA NA NA NA Of those with a usual source of care: %Named a clinic or doctor's office as usual source of care 95% NA NA NA NA


Figure 5: Access to Health Care Trends for Central Peninsula

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KEY FINDINGS FOR SPECIFIC AREAS OF HEALTHCARE

Cardiovascular Health DISEASE PREVALENCE The 2012 household health survey revealed 7% of Central Peninsula adults have some heart disease (including Anginga/CAD, heart attack and stroke). More than 1 out of 3 (34%) adults have high blood pressure, and men were somewhat more likely to report a diagnosis of high blood pressure (37%) than women (30%). Rates of both high cholesterol and high blood pressure increased compared to 2004 and 2009. There are opportunities to intervene in prevention and control of these chronic diseases that often lead to more severe and lethal cardiovascular diseases if not controlled. Heart disease increased only slightly overall compared to 2004. However, it appears that prevalence of heart disease among women actually increased slightly and prevalence among men decreased slightly, resulting in 7% prevalence across both genders. Given these rates of heart disease, it will be important to ensure adequate clinical supports for prevention and healthy management of disease. Since the increase in hypertension could be due primarily to aging of the population, an analysis of hypertension prevalence by age was conducted to examine change within each age group between 2004 and 2012. This analysis only showed an increase in the percentage of 18-44 year olds with hypertension (from 14% in 2004 to 20% in 2009), while the older age groups (45-64 and 65+ year olds) remained the same. Prevalence of high blood pressure increases with age, so older adults are still more likely to have high blood pressure. However, this finding suggests that the overall increase in disease prevalence in Central Peninsula is not due to aging, but to an increase in diagnosis among adults less than 45 years. This has important implications for prevention and treatment.

Table 5: Cardiovascular Health

CARDIOVASCULAR HEALTH Central



% Diagnosed High Cholesterol 31% 35% 35% 34% 38%

% Diagnosed High Blood Pressure 34% 34% 27% 29% 31%

% Diagnosed Any Heart Disease 7.1% 5.5% 6.3% 5.9% NA

% Current Smokers 15% 26% 21% 23% 21%

% Overweight 37% 37% 34% 39% 38%

% Obesity 31% 30% 31% 27% 28%


Figure 6: Cardiovascular Disease Trends for Central Peninsula

RISK FACTORS One major risk factor contributing to elevated rates of cardiovascular and other chronic diseases is the prevalence of obese residents. Central Peninsula residents are slightly more likely to be obese compared to Alaska or US residents. Survey results indicate that the percentage of Central Peninsula residents who are obese increased from 2004 to 2012. This is important because obesity is a risk factor for most chronic diseases and, more importantly, it is a preventable/modifiable risk factor. Obesity was correlated with every chronic disease measured in the survey (i.e. obese respondents were more likely to report chronic disease diagnoses) except for cancer and auto-immune disease. This suggests a role for primary care providers in helping to address obesity in the medical home, particularly among those already experiencing chronic disease symptoms. Another modifiable risk factor, smoking status, appears to be improving in Central Peninsula. Rates of current smokers are lower than peer communities, Alaska, and US also appear to have declined since 2004. There are still a significant number of smokers among those with chronic diseases, including those with cardiovascular disease (e.g. 22% of those with high blood pressure currently smoke).

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Figure 7: Chronic Disease Risk Factor Trends for Central Peninsula

Respiratory Health DISEASE PREVALENCE About 10% of Central Peninsula residents report ever having asthma, less than peer communities, Alaska, and US, but consistent with prior years. About 5% report presence of a chronic lung disease such as Chronic Obstructive Pulmonary Disease (COPD), Chronic Bronchitis or Emphysema, similar to Alaska and US rates. Lung disease rates do not differ much between genders. RISK FACTORS As discussed above, Central Peninsula has relatively low rates of smoking compared to peer communities and compared to survey findings in prior years. Despite the decrease in smoking rates, the prevalence of lung disease did not change. Among those with COPD, there are elevated rates of current smoking compared to the overall population (35% of those with COPD are current smokers). This suggests that efforts to address cessation among this particular group, might have the greatest impact at decreasing disease burden, particularly given the low rates of smoking among the general population. A similar percentage of males and females report current smoking, however males were much more likely to report being former smokers (43%) compared to women (27%).

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Table 6: Respiratory Health

RESPIRATORY HEALTH Central



% Diagnosed Asthma (Ever) 10% 12% 13% 14% 14%

% Diagnosed Other Lung Disease (e.g. COPD, Chronic Bronchitis, Emphysema) 5.2% 6.3% 4.1% 5.2% 6.1%

% Current Smokers 15% 26% 21% 23% 21%

% Former Smokers 35% 31% 26% 28% 25%

Figure 8: Respiratory Disease Trends for Central Peninsula

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2004 2009 2012


Diabetes and Other Chronic Conditions About 1 in 10 adults (10%) in Central Peninsula have a diagnosis of diabetes. This is elevated compared to Alaska and the peer regions, although it is similar to the US rate overall. Diabetes prevalence went up only slightly since 2004, but continues to be a significant health issue for the region. Kidney disease is a relatively rare diagnosis with only 1.5% in Central Peninsula reporting this diagnosis, similar to peer regions and prior years. Chronic back pain and auto-immune disease are not asked about in the standard secondary health surveys used for comparison in this analysis, but were included in the household health survey due to interest/input from stakeholders/Workgroup members in current and prior survey years. However, a review of the literature provides some context for these conditions at the national level. The household health survey results for reported diagnosis, by a healthcare provider, of chronic back pain was 18%. National estimates for chronic back pain vary from extremely general (47% of US respondents to a Gallup poll report some type of chronic pain3) to extremely specific (10% of respondents in one state had chronic, impairing, lower back pain4), so it is hard to assess whether Central Peninsula’s rate of 18% chronic back pain is high or low. However, this represents almost more than 1 in 6 adult residents, so it plays a major part in the health needs of this community. There has been little study of the prevalence of auto-immune disorders until relatively recently. Furthermore, estimates of prevalence vary greatly depending on the number of auto-immune disorders studied and the country. Most estimates range from 5 to 8% for the United States, but a recent estimate from Denmark, including a wider range of disorders, found 8-9% prevalence of auto-immune disease5. Therefore, Central Peninsula’s prevalence of auto-immune disorders, at 6%, is in line with other results in this area. Women are much more likely to have a diagnosis of auto-immune disorders. In Central Peninsula, women were more than twice as likely to report an auto-immune disorder (8.9%) compared to men (2.7%). RISK FACTORS As discussed earlier, about 68% of the population is overweight or obese, a major risk factor for diabetes. This and the aging of the population indicate the need for diabetes prevention and pre-diabetes interventions to prevent increase in diabetes prevalence. Additionally, resources to meet the needs of current and future diabetics, including regular monitoring, medication adherence, and self-management services will be an important part of planning for future health needs.

3 2011 Gallup‐Healthways Well‐Being Index. Accessed via Huffington Post available at: http://www.huffingtonpost.com/2012/04/30/chronic‐pain‐united‐states‐adults‐age_n_1465222.html 4 Freburger et al. The Rising Prevalence of Chronic Low Back Pain Arch Intern Med. 2009;169(3):251‐258 5National Institutes of Health Autoimmune Diseases Coordinating Committee: Autoimmune Diseases Research Plan

Autoimmun. 2009 ; 33(3‐4): 197–207. doi:10.1016/j.jaut.2009.09.008.


Table 7: Diabetes Health & Other Chronic Conditions

Most studies of back pain indicate that being overweight or obese is also a risk factor for this condition. Being female and older age are other correlates of chronic back pain. Recent estimates of the cost of back pain in terms of health care use and productivity loss6 indicate that this condition is a significant driver of health care costs. Ensuring those with chronic back pain have adequate resources to keep disability and impairments to a minimum will be a critical part of health services planning for this population. Resources might include programs for weight loss, physical therapy, and therapeutic treatments, including but not limited to surgery and alternative treatments like acupuncture.

Figure 9: Trends in Diabetes and Other Chronic Conditions

6 Darrell J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13

(8): 715 Accessed via Science Daily at http://www.sciencedaily.com/releases/2012/09/120911091100.htm

DIABETES HEALTH & OTHER CHRONIC CONDITIONS

Central Peninsula

Mat-Su Borough


% Diagnosed Diabetes 10% 8.8% 5.6% 7.9% 10%

% Diagnosed Kidney Disease 1.5% 1.9% 1.5% 2.3% 2.4%

% Diagnosed Chronic Back Pain 18.0% NA NA NA NA % Diagnosed Auto-Immune Disease (e.g. RA, Lupus, MS) 5.9% NA NA NA NA

% Overweight 37% 37% 34% 39% 38%

% Obesity 31% 30% 31% 27% 28%

7.6%

2.3%

NA

19%

12%

2.8%

6.5%

22%

10%

1.5%

8.2%

18%

0%

10%

20%

30%

40%

50%

% Diagnosed Diabetes % Diagnosed Kidney Disease

% Diagnosed Cancer % Diagnosed Chronic Back Pain

Perc

enta

ge o

f Cen

tral

Pen

insu

la R

esid

ents

2004 2009 2012


Cancer Health and Screenings There is little data about prevalence of cancer in Alaska due to the lack of a state cancer registry. However, the 2012 household health survey, and previous assessment surveys, asked residents whether they had ever been diagnosed with any type of cancer. 8.2% of residents reported a diagnosis of cancer at some point in their life. In 2009, 6.5% of respondents reported a cancer diagnosis. This difference does not likely represent a meaningful change, particularly since Central Peninsula rates are similar to Fairbanks and Alaska rates. However, it will be important to monitor this indicator moving forward. A statewide registry would provide invaluable information to determine the types of cancer and stage at diagnosis for a more accurate assessment of cancer health and prevention needs.

Table 8: Cancer Health

PREVENTIVE SCREENING Rates of receipt of preventive cancer screenings for females appears to be low compared to peer regions, state and U.S. The US Preventive Services Task Force recently changed their recommendations for mammogram and pap smear screening, so the indicators used in the assessment have been modified to reflect the latest recommended timings for these tests. These changes may have led to confusion among women about when and how often to go in for preventive screenings. Nonetheless, this finding suggests that efforts to increase awareness of the need for mammography after age 40 and pap screenings for all women over 18 would be warranted as well as efforts to encourage medical homes for both men and women to ensure continuous, comprehensive primary care including appropriate preventive care.

CANCER HEALTH Central



% Current Smokers 15% 26% 21% 23% 21% % Former smokers 35% 31% 26% 28% 25% % Overweight 37% 37% 34% 39% 38% % Obesity 31% 30% 31% 27% 28% % Diagnosed Any Cancer 8.2% 11% 8.7% 8.5% NA % Reported Mammogram past 2 years (40+) 65% NA 64% 72% 75% % Reported Pap Smear past 3 years (18+) 71% NA 81% 81% 81% % Reported Ever Having Sigmoid/ Colonoscopy (Age 50+) 66% NA 68% 62% 65%


Mental Health and Substance Abuse This section contains information about diagnosed mental health and substance abuse disorders, as well as information on alcohol consumption and access to mental health care. This is not considered a comprehensive analysis of mental health and substance abuse needs for Central Peninsula, but provides an overview for this area based on available health data. Only 6% of Central Peninsula residents reported needing, but not receiving, mental health treatment in the past year. However, about 1 in 6 (17%) reported a past diagnosis of Depression or Anxiety from a health care provider of some type. Women in Central Peninsula were more than twice as likely to report depression as men. About 1 in 4 (25%) female respondents in Central Peninsula reported having a diagnosis of depression or anxiety compared to 1 in 10 (10%) men reporting this diagnosis. Chronic pain is a risk factor for mental health problems like depression. Among those reporting chronic back pain, 40% report a depression diagnosis, compared to 12% among those without back pain. Obesity and smoking were also correlated with past diagnosis of depression or anxiety. 40% of those who reported a diagnosis of depression were obese compared to 27% of those without a diagnosis of depression. Similarly, 1 out of 4 (25%) of those with a diagnosis of depression were current smokers compared to 13% among those without depression. These correlations do not indicate causality but suggest that those with mental health diagnoses might be targeted for smoking cessation and weight reduction services as part of comprehensive health provision. Similarly, those with chronic pain might need mental health support services as part of their treatment plans.

Table 9: Mental Health & Substance Abuse

Alcohol consumption in Central Peninsula appears favorable compared to peer regions, State and US with only 5% of residents reporting heavy alcohol consumption in the past month (defined as an average of more than 1 drink every day for women and more than 2 drinks every day for men). 16% of residents report binge drinking in the past month (defined as more than 4 in a row for women and more than 5 in a row for men). Although this figure is lower than comparison regions, it is still a concerning number given the negative health and safety consequences of consuming large amounts of alcohol. Only 3% of residents reported a substance abuse diagnosis. This figure is an underestimate of the use of substances within a community, as many users of illegal substances never seek treatment or become diagnosed with substance abuse. Substance

MENTAL HEALTH & SUBSTANCE ABUSE

Central Peninsula

Mat-Su Borough


% Needed, but did not get, mental health treatment in past yr 6.3% NA NA NA NA

% Diagnosed Depression or Anxiety 17% 18% 13% 17% 18%

% Binge Drinking -Past Month 16% 21% 20% 21% 18%

% Heavy Alcohol Consumption - Past Month 5.1% 7.1% 6.1% 7.4% 6.6%

% Diagnosed with Substance Abuse Problem 3.2% NA NA NA NA


Abuse and Mental Health conditions are often co-occurring disorders. Among those reporting depression or anxiety in the Central Peninsula household health survey, 8% reported a substance abuse diagnosis, compared to 2% among those who had never been diagnosed with depression or anxiety. In order to better understand the rate of substance use, future surveys would need to inquire about illegal drug use, as well as use of non-prescribed prescription drugs, to get a better assessment of the level of substance abuse in the Central Peninsula. The high school youth use data provided in the next section provides a more detailed picture of the rate of substance use among the high school population.

Youth Mental Health & Substance Abuse There are two main sources of information used to assess youth health in this assessment. One is the Prevention Needs Assessment Survey (PNA) developed by Bach-Harrison and commissioned by the Central Kenai Peninsula Community Action Coalition for Prevention (CACP), a local non-profit advocacy group, and the other is a national survey, administered in every state, called the Youth Risk Behavior Survey7. Both of these youth surveys focus on risks and assets, but they contain only a small number of overlapping questions that could be compared. Table 10 below presents the key comparisons in areas of mental health and substance abuse. Although depressive symptoms appear to be elevated for Central Peninsula high school students compared to Alaska, and similar to the US rate, depressive symptoms are measured very differently between the two surveys so direct comparisons are difficult to interpret. However, Bach-Harrison reports a norm8 of 38-42% of 10th and 12th graders exhibiting depressive symptoms using their scale. Therefore, Central Peninsula’s rate of 29% depressive symptoms for 10th and 12th graders appears normal to low. Nevertheless, more than 1 out of 4 high school students reporting current depressive symptoms suggests a need to ensure adequate, accessible mental health supports for the youth population. More than 1 out of 3 (35%) high school students surveyed reported past month alcohol use and 1 out of 4 (25%) reported past month marijuana use. Central Peninsula youth appear similar in use rates for most substances to Alaska overall, and somewhat lower than national rates. However, these figures still indicate 1/4 to 1/3 of students using alcohol and/or other substances regularly. This has repercussions for these youth’s future mental and physical health as adults. The current smoking rate of 15% among high school youth is exactly the same as the Central Peninsula adult smoking rate found in the household health survey. This is interesting given that youth living in households with smokers are much more likely to report current smoking. These findings collectively suggest that interventions to address mental health and substance abuse issues be directed at high school students in an effort to prevent future burden on the health and mental health care system.

7 Additional information, including how to access full results from these surveys, can be found in the Data Sources table of the

Methods sections

8 The Bach Harrison Norm was developed by Bach Harrison L.L.C. to provide states and communities with the ability to compare

their results on risk, protection, and antisocial measures with more national measures. Survey participants from eight statewide

surveys and five large regional surveys across the nation were combined into a database of approximately 460,000 students.

The results were weighted to make the contribution of each state and region proportional to its share of the national popula‐

tion. In order to keep the Bach Harrison Norm relevant, it is updated approximately every two years as new data become avail‐

able.


Table 10: Youth Health

9 Depressive Symptoms in youth based on answering yes to one of four question scale developed by Bach‐Harrison (Sometimes I think that life is not worth it, At times I think I am no good at all, All in all, I am inclined to think that I ama failure, and In the past year, have you felt depressed or sad MOST days, even if you felt okay sometimes?), YRBS uses one question “so sad or hopeless stopped doing usual things for 2 weeks or more”

YOUTH HEALTH (10th & 12th Graders)

Central Peninsula Alaska US

% Depressive Symptoms9 29% 25% 29% % Current Smoker (Past Month) 15% 16% 20% % Current Chewing Tobacco User (Past Month) 8.8% 9.2% 8.1% % Alcohol Use (Past Month) 35% 32% 42% % Binge Drink (5+ in a row) (Past Month) 20% 18% 25% % Marijuana Use (Past Month) 25% 23% 25% % Sniffed Glue or Other Inhalant (Past Month) 1% NA NA % Used Prescription Drug w/out Rx (Past Month) 4% 7% NA


COMMUNITY PERCEPTIONS OF HEALTH SERVICES AND NEEDS

An important component of the Household Health Survey conducted in Central Peninsula is a series of questions about residents’ perceptions of priority health needs and the adequacy and quality of existing services in the region. This section provides an overview of these perceptions and ratings findings. More detailed responses to each question in the survey can be found in Appendix 6: Annotated Survey. One set of community perception questions asked about specific types of services and whether respondents thought there was an adequate amount of these services or a “need for more.” Results are shown in Figure 10 below.

Figure 10: Community Perceptions of Services Central Peninsula “Needs More of”

The top three services that residents reported a need for were Cancer Care (71%), Alzheimers’ Services (62%) and Cardiology Services (59%). All three of these services received more than half of respondents indicating a need for more. Dialysis services, assisted living, and wellness services all received just under half of respondents indicating need (47, 46, and 46% respectively). Only Emergency or Trauma Care received less than one third of respondents indicating a need (24%). Respondents were also asked whether there are any “medical services that you would travel outside of this area to receive because you feel there are no qualified physicians or specialists?” Almost 3 out of 5 respondents, (61%) answered yes to this question. As a follow-up, those who answered yes were asked to name the service or services they would travel to receive. The top answers can be found in Table 11 below. It is important to note that two of the three top answers, Oncology and Cardiology, were also among the most frequent

24%32%

35%35%37%37%38%

40%43%44%

46%46%47%

59%62%

71%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Q17K: Emergency or Trauma Care

Q17D: Primary Care Providers

Q17A: Tobacco Cessation Services

Q17J: Diabetes care

Q17I: Outpatient urgent care

Q17M5: Pediatric Services.

Q17M3: End of life care Services.

Q17B: Counseling, mental health, or psychiatric services

Q17M1: Pulmonary Services.

Q17C: Alcohol and drug abuse treatment services

Q17M: Wellness services for kids and adults

Q17F: Assisted living services

Q17M2: Dialysis Services.

Q17L: Cardiology Services

Q17M4: Alzheimer's Services.

Q17E: Cancer care

Percentage Report a Need for More of Service


responses to services needed (Cancer Care and Cardiology). Clearly there is unmet need for these services and/or qualified providers in the region.

Table 11: Most Common Services Residents Would Travel Outside of Area For

Number Percent

Oncology 67 21%

Cardiology 63 19%

Specialists, Surgeons 31 10%

Neurology 18 6%

Back, Neck, Spine 16 5%

Orthopedic 15 5% In order to understand Central Peninsula’s overall market share for inpatient and outpatient services, survey respondents were asked about services received at a hospital in the past two years, and where and why they chose to go for these services. Only about 15% of respondents had been hospitalized overnight in the past two years. Of these, about 2/3 (66%) were hospitalized at CPH, followed by Providence Hospital (13%) and out of state hospital (9%). The most common reason for choosing a hospital was location near home (44%), followed by doctor’s choice (20%) and admitted to emergency room (12%). Almost 40% of survey respondents had received an outpatient service at a hospital in the past year. The vast majority (84%) received this hospital outpatient service at CPH, followed by Providence (5%) and Other (4%). Again, location near home was the most common reason for choosing a hospital (56%), followed by doctor’s choice (29%), and previous good experience at hospital (10%). These results suggest that CPH maintains the majority of market share in both inpatient and outpatient services, although there is room to increase market share. Central Peninsula residents were also asked to rate the quality of the hospital’s current services and providers using a scale ranging from poor to excellent. The results are shown in Figure 11 on next page.


Figure 11: Percentage of Respondents Rated Selected CPH Services as Good (4) or Excellent (5)

All of the services asked about received at least half of respondents rating the service good or excellent, except for Quality of Cancer Care where only 42% rated the service good or excellent. This was also the most frequent area of need cited by residents, suggesting there is demand for more local access to oncology care. Quality of nursing care received the highest ratings with 75% rating nursing quality as good or excellent, followed by quality of maternity/prenatal care with 72% ratings this service line as good or excellent. Quality of surgical care (68%) and physicians (67%) received the next two highest ratings. Finally, respondents were asked to consider the overall quality of services as CPH with an eye toward whether it was getting better, staying the same, or getting worse. Overall 95% reported that CPH quality was staying the same or improving. About 2/3 (67%) reported the quality of services was getting better at CPH. This suggests overall favorable attitudes toward CPH quality. In addition to rating current services and providers at CPH, those with specific chronic diseases or service needs were asked about where they currently receive those services (current provider) and where they would go if they had their choice of providers (provider of choice). For all services where current provider was asked about (digestive system disease was not asked about in the survey so no current provider question was asked for this service), Central Peninsula Hospital was the first or second most common provider cited. Furthermore, for every service asked about, CPH was the most commonly cited provider of choice indicating potential for increasing market share among these service lines. For the two services where CPH was not the most common current provider (heart disease and back/spine treatment), doctor’s choice and location near home were the most frequently cited reasons for choosing their current provider. Therefore, it will be important to ensure local primary care physicians, particularly those not on the hospital’s medical staff, are aware of the existing and future service lines and resources available at CPH. Interestingly, more than two-thirds of women indicated CPH as their current provider of women’s health services. Although CPH provides mammograms and maternity/prenatal services, there are no comprehensive

75%

72%

68%

67%

66%

63%

58%

53%

42%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Q5B: Quality of nursing care

Q5G: Quality of maternity/prenatal care

Q5H: Quality of surgical care

Q5A: Quality of physicians

Q5E: Quality of the emergency room

Q5K: Quality of orthopedic services, or treatment of your body's bones, joints, ligaments, tendons, and …

Q5L: Quality of services for the elderly

Q5C: Having Specialty physicians and treatments

Q5F: Quality of cancer care

Percentage Rated Quality as Good or Excellent


women’s health services provided on an outpatient basis at CPH. It may be that women who give birth at the hospital or receive mammograms consider this their source of health care. This finding is puzzling and suggests a need to raise awareness about comprehensive primary care for women, including regular health screenings and preventive care.

Table 12: Specialty Services – Current Provider and Provider of Choice

# 1 Current Provider

Market Share %

#2 Current Provider

Market Share %

#1 Provider of choice

Potential Market Share

Diabetic Wound Care CPH 35%Private Doctor's Office 14% CPH 46%

Heart Disease Treatment Providence 36% CPH 23% CPH 36%

Active Spine Care/ Back Pain Treatment

Alternative Thera‐pist (Acupuncture, Chiropractor etc.) 17% CPH 16% CPH 38%

Women's Health Services CPH 68%Private Doctor's Office 8% CPH 55%

Stomach/Digestive System Treatment NA NA CPH 45%


PHYSICIAN WORKFORCE ANALYSIS

A physician workforce analysis is intended to augment the community health needs assessment by providing information about physicians currently in practice and making projections for future physician needs. However, it is beyond the scope of this analysis to conduct projections specific to Central Peninsula, because data does not exist at this geographic level to estimate demand (e.g. utilization of health care by setting, age and gender) or future supply (e.g. graduates entering medical school, physician retirement patterns). However, projections for Alaska and US will be used to provide some understanding of future needs. There were two primary sources of information for the analysis of physicians (including MDs and Dos) currently in practice in Central Peninsula: the Alaska Division of Corporations, Business and Professional Licensing, which maintains a database of physicians licensed in Alaska by zip code, and the Central Peninsula Hospital Medical Staff listing. The latter provided additional information about specialty type and age profile of providers licensed and credentialed as medical staff. Since the Licensing database does not provide any information beyond the type and status of medical licenses, the Medical Staff listing will serve as a proxy for the physicians of Central Peninsula to look at specialty and age breakdowns10. Although this does not provide for a precise estimate, it does allow for estimation of current age and specialty of physician workforce to inform future needs.

Table 13: Active Physicians per 100,000 Population

Number Rate per 100,000

Central Peninsula11 73 200

Alaska12 1,721 243

United States 799,509 259

United States (Median of States) NA 215 Table 13 above shows that Central Peninsula has a physician to population ratio (200) that is lower than State (243) or US (259) ratios. Table 14 indicates that the percentage of female physicians is also lower than State or US. This is significant because physician shortages are predicted for both Alaska13 and the US14 by 2025,

10 No personal information beyond what is available on the hospital walls (ie name and specialty) was shared with research

staff. Age data was provided in table form with no link to list of providers. 11 CP number is based on search of active medical licenses (MD’s and DO’s) for all towns/zip codes in CPH service area as of

December 2012. This number does not include physicians with licenses in towns outside the service area that practice at CPH

(N=3). http://commerce.alaska.gov/occ/home.htm 12 Alaska and US Data are taken from the Association of American Medical Colleges 2011 State Physician Workforce Data Book –

Active Physicians by Degree Type (MD’s and DO’s) https://www.aamc.org/download/263512/data/statedata2011.pdf 13 Securing an Adequate Number of Physicians for Alaska’s Needs: Report of the Alaska Physician Supply Task

Force, August 2006 14 The Complexities of Physician Supply and Demand: Projections Through 2025, November 2008


based on the assumption that current levels are adequate. This suggests that Central Peninsula may experience a greater shortage if current trends continue in terms of population demographics, utilization and physician supply. Demographics are particularly significant because Central Peninsula is experiencing population growth and aging of the population, as is the US as a whole, both contributors to demand for health services.

Table 14: Female Physicians

Number of

Females Percentage of

Females

Central Peninsula 17 23%

Alaska 584 34%

United States 242,427 30% There were a total of 48 MD’s and DO’s in CPH’s medical staff list. Table 15 shows the age breakdowns for these physicians compared to Alaska and US data. Central Peninsula appears very similar to both Alaska and the US in terms of age breakdown. The physician supply analysis for Alaska predicts one-third of physicians in the State may be retiring in the next 10-15 years. It is reasonable to assume Central Peninsula will experience the same pattern given the similarity in age distribution. Although this comparison is limited by the fact that this is age data for CPH medical staff and not all the physicians in the region, there is no reason to assume the medical staff differs greatly from all licensed physicians in the area.

Table 15: CPH Physicians by Selected Age Groups

Percentage

Under Age 40 Percentage

Age 40 to 59 Percentage Age 60

or older

Central Peninsula 16% 58% 26%

Alaska 14% 61% 25%

United States 18% 56% 26% In addition to examining the demographics of current physicians, it is important to look at the breakdown by primary care and specialty providers. For this analysis primary care providers include: pediatricians, OB/Gyns, Internal Medicine and Family Practice providers. In comparing Central Peninsula Hospital’s medical staff to Alaska and US physician breakdowns, it appears that the region is similar to Alaska, and has a higher percentage of its physicians providing primary care services than the US as a whole. A recent


Workforce Analysis Study15 of the 5 States participating in the University of Washington WWAMI partnership (Washington, Wyoming, Alaska, Montana and Idaho) found that all of the WWAMI states had slightly higher physician to population ratios for family medicine than the rest of the country. It was posited that this might be due to the rural nature of the state and the emphasis of the WWAMI program on primary care. Nevertheless, University of Washington and other medical schools are experiencing decreases in the percentage of physicians choosing primary care so ensuring adequate workforce to meet the primary care needs in the future will likely become more difficult.

Table 16: CPH Physicians by Specialty Type

Percentage Primary Care

(Peds, OB/Gyn, IM or FP)

Central Peninsula 42%

Alaska 42%

United States 35% Given the aging of the population and the difficulties recruiting physicians to rural areas, particularly in a state with no medical school, planning to ensure an adequate physician workforce as current physicians age and retire will be a critical part of health planning for Central Peninsula. Although this analysis does not provide exact projections for future demand, it is likely that at least one-third of the current physician workforce will retire in the next 15 years, suggesting that about 24 physicians would need to be recruited in that time just to maintain the current supply. This does not take into account the changing demographics during this period that will likely increase demand. It also does not provide information on what specialty breakdown should be for recruitment. Alaska’s Physician Supply Task Force Report found that the greatest shortages statewide were in internal medicine, medical subspecialties and psychiatry. However, recruitment of local specialists needs to be informed by disease burden and local health needs, as well as resource availability. Selected models for providing access to specialty care in rural areas are explored in the summary section of this report. Overall, the picture presented in this analysis suggests that CPH will have to be part of a broader regional and state coordinated effort to ensure recruitment and retention of physicians in Alaska, particularly for rural areas such as Central Peninsula. Both primary care physicians and various specialists will be needed to respond to a growing and aging population, and CPH can play a crucial role in this effort to ensure new physicians are recruited to the region as existing physicians age and retire and/or reduce working hours.

15 Berg and Norris. A Workforce Analysis Informing Medical School Expansion, Admissions, Support for Primary

Care, Curriculum, and Research. Annals of Family Medicine, 4(1): 540‐544 (September/October 2006)


SUMMARY AND PRIORITY HEALTH ISSUES

This is a summary of the report of health needs for the Central Kenai Peninsula region of Alaska based on primary and secondary health data. Key health status findings from each segment of the report are highlighted in the summary along with recommendations for potential strategies to address the identified needs. The next steps for Central Peninsula Hospital will be to share findings with the broader community, prioritize among the identified health needs and embark on a planning process to address these needs. The key findings and recommendations contained in this report are intended to help inform this process, but not to supplant local knowledge and/or understanding of resource availability. Population Demographics and Socioeconomic Status

• There was an increase of 4000 residents in Central Peninsula between the 2000 and 2010 Census. • The Central Peninsula population has aged since last Census and there is now a greater of percentage

of residents age 45 and older than comparison regions in Alaska • Central Peninsula residents household incomes are slightly below the average for Alaska, but unem-

ployment and households living below federal poverty level are similar to rest of state (both about 9%)

Access to Health Care

• Access to health care in Central Peninsula appears similar or better than peer communities, Alaska and US, but there is a sizeable proportion of the community with limited access to care.

• About 18% of adult residents (about 1 in 6) report no receipt of check-up or routine medical visit in past 2 years and 16% report unmet medical need in past year due to cost.

• More than 1 out of 5 (22%) of non-elderly adults (18-64 years) are uninsured.

Functional Health Status • Only 10% of adults reported their health as fair or poor, which is low compared to peer communi-

ties, Alaska (16%) and the U.S (17%). • The rate of multiple (3+) chronic conditions is slightly elevated (15%) compared to Mat Su (13%) or

Fairbanks (9%), which may be due to the older age of residents in Central Peninsula. • This finding indicates a perception of living “well” despite the having been diagnosed with chronic

illnesses among many respondents. • All the indicators of functional health status appeared to improve from 2004 to 2012, despite the fact

that Central Peninsula’s population is older in 2012 than it was in 2004. • The percentage of Central Peninsula adults classified as “Well” (40%) using UNE/CCPH’s wellness

index16, was similar to Alaska (43%) and peer regions. The percentage “Not Well” (16%) was lower than all comparison regions.

16 The wellness index combines chronic disease status, functional health and risk behaviors to classify adults into four categories from “Well” to “Not Well”


• However, 35% were classified as having “some health problems” (either had some functional limita-tions or one chronic disease but not both) and another 9% are “at risk for future medical problems” (those without chronic disease but currently smoke or are obese).

Chronic Disease

• Prevalence rates of diagnosed high cholesterol and high blood pressure increased 5 and 6%, respec-tively, since 2004 and the increase was greatest among 18-44 year olds.

• Heart disease stayed same overall (7%), but increased in women and decreased in men. • Asthma (10%) and COPD (5%) prevalence did not change over time and appear similar to peer re-

gions. • 1 in 10 adult residents have diabetes. This is the same as US but a little bit higher than Alaska or

peer regions. • 1 in 6 residents has been diagnosed with chronic back pain. It is difficult to compare accurately to

other estimates but this represents a considerable proportion of residents nevertheless. • About 6% of residents report an auto-immune disease, such as Rheumatoid Arthritis, Lupus or Mul-

tiple Sclerosis. This is an emerging health issue which has not received much study until recently, but this percentage appears in line with National estimates.

• 8.2% of residents report cancer at some time in life, up slightly from last survey in 2009 (6.5%). This is consistent with trends in the US. However, cancer is the leading cause of mortality in Central Pen-insula and Alaska, unlike the U.S. overall where cancer is the second leading cause after cardiovascu-lar disease.

• Receipt of preventive cancer screenings among females (such as mammograms and pap smears) is low compared to Alaska and US. Changes in recommended schedule make comparison to prior years dif-ficult, but this rate was not low compared to other geographies in past assessments.

Chronic Disease Risk Factors

• 37% of Central Peninsula adult residents are overweight and 31% are obese, similar to State and US. The percentage of adults that are obese in Central Peninsula increased steadily since 2004.

• Obesity was correlated with every chronic disease measured in the survey except for cancer and auto-immune disease.

• Current smokers appear to have declined (15%) and former smokers increased (35%), the latter pri-marily among men. This might indicate success of local cessation efforts.

• Those with chronic disease, particularly COPD, are more likely to be current smokers (35% of those with COPD currently smoke).

Mental Health and Substance Abuse

• About 1 in 6 (17%) adult residents report a diagnosis of depression or anxiety at some time in life. Women were more than twice as likely to report a mental health diagnosis as men (25% and 10%, respectively).

• Chronic back pain, obesity and smoking were all correlated with mental health diagnosis. • 16% of adult residents report binge drinking in the past month and 5% report heavy alcohol con-

sumption – neither is elevated compared to peer regions, Alaska or US.


Youth Health • 29% of 10th and 12th graders completing a locally administered prevention needs assessment survey in

Central Peninsula report depressive symptoms. This is between 1 in 3 and 1 in 4 high school stu-dents experiencing some emotional distress.

• About 15% of high school students completing the survey reported being current smokers and 9% reported using chewing tobacco.

• More than 1 in 3 (35%) reported using alcohol in the past month and 1 in 4 (25%) reported mariju-ana use in past month.

• These are alarming statistics despite not differing much from Alaska or US findings. Community Perceptions

• The top three services that residents reported a need for were Cancer Care (71%), Alzheimer’s’ Ser-vices (62%) and Cardiology (59%).

• Oncology and Cardiology were also most frequent services respondents travel outside of area to re-ceive (about 20%) due to lack of qualified providers.

• About 15% of respondents were hospitalized overnight in the past two years and 2/3 (66%) of these people went to Central Peninsula Hospital.

• Almost 40% of respondents had received outpatient services at a hospital in the past year and 84% of them used Central Peninsula Hospital for this service.

• Respondents were asked about where they currently go for some specific specialty services and where they would prefer to go if had a choice. Central Peninsula Hospital was the provider of choice for all services asked about (i.e. CPH was most frequent response to “Where would you prefer to go if had a choice…”)

• The highest quality ratings for Central Peninsula Hospital were for nursing care, maternity/prenatal care, and surgical care. Lowest ratings were for cancer care, specialty care, and services for the elderly.

Physician Workforce • Central Peninsula currently has a lower physician to population ratio than Alaska or the U.S. • Alaska is anticipating a physician shortage in future years due to the growth in and aging of the popu-

lation, aging out and retirement of current physicians in Alaska, and the lack of a medical school in the state.

• Broad national forces, including the decline of US Graduate Medical Students selecting primary care as a specialty, suggest that rural areas will have to compete harder to recruit and retain physicians in the future.

These findings provide both opportunities and challenges for Central Peninsula Hospital in working to improve the quality and coordination of the local health care system to impact community health. Chronic Disease prevalence and associated behavioral risk factors need to be addressed to improve population health. Concepts such as patient centered medical homes, with inter-professional care teams, is one strategy increasing in popularity and federal program support. These programs are primarily for primary care providers, but hospitals can be a part of the resource teams by helping to staff inter-professional teams and working with primary care providers to ensure efficient care transitions and prevent hospital readmissions.


Mental Health and Substance Abuse findings for adults suggest that depression and alcohol abuse are somewhat prevalent. However, the findings for youth suggest that interventions to address mental health and substance abuse issues might be directed at middle and high school students in an effort to prevent future burden on the health and mental health care system. Given the plummeting number of new practitioners entering primary care, coupled with practitioner aging and burnout, ensuring adequate primary care provision resources will be critical part of planning for Central Peninsula hospital. Although the hospital does not have sole responsibility or control of local primary care resources, the hospital can collaborate with other community entities to increase recruitment and retention and to advocate for care models, such as inter-professional care teams described above, that will extend the ability of existing primary care providers and, ultimately, improve the quality of care. In terms of specialty care, there appear to be some population health needs that are congruent with community perception of needed services. In particular, the areas of oncology, cardiology, and geriatric services were identified as areas that residents perceived a need and/or currently travel for services and correspond with health findings in terms of prevalence of disease and aging of the population.

APPENDIX 1 – CENTRAL PENINSULA HOSPITAL ADVISORY GROUP MEMBERS

Central Peninsula Hospital CEO: Rick Davis Central Peninsula Hospital Board Members: Judy Salo Lore Weimer Irv Carlisle Alyson Stogsdill Rick Ross Physicians: Dr. Angus Warren Dr. Gonzalo Fraser Central Peninsula Hospital Service Area Board Members: Margaret Gilman Marion Nelson

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APPENDIX 2 - HEALTH STATUS PROFILE (HSP)

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CPH CHNA ‐ Health Status Profile

Central Peninsula

Mat-Su Borough


Total Population 36,363 88,995 97,581 710,231 308,745,538 % Population Under the Age of 18 25% 29% 26% 26% 24%% Population Between Ages 18-44 32% 35% 43% 38% 37%% Population Between Ages 45-64 32% 28% 25% 28% 26%% Population Age 65 and Over 11% 7.9% 6.5% 7.7% 13%% Population White (One-Race, Non-Hispanic) 85% 85% 77% 67% 72%% of Labor Force Unemployed 8.6% 10% 6.4% 9.6% 11%% Population Not Attaining H.S. Diploma (>25 yr)

7.3% 5.2% 7.0% 7.7% 12%

Mean Annual Household Income 68,541$ 80,005$ 80,095$ 81,290$ $68,259Median Annual Household Income 60,378$ 69,437$ 66,390$ 64,576$ $50,046People and families living below federal poverty line 8.9% 9.7% 7.1% 9.9% 15%

% Health Fair to Poor 10% 16% 12% 16% 17%

% 11+ Days Lost to Poor Mental or Physical Health

8.5% 9.1% 5.9% 7.9% 8.9%

% 3+ Chronic Conditions 15% 13% 9.4% 14% 21%Wellness Categories:

% Well 40% 39% 48% 43% NA

% At Risk for Future Medical Problems 9.1% 8.4% 6.0% 8.6% NA

% Some Health Problems 35% 26% 25% 25% NA

% Not Well 16% 28% 21% 24% NA

ACCESS TO CARE

% Uninsured (18-64) 22% 26% 24% 22% 21%

% Without Usual Source of Primary Care 27% 33% 35% 34% NA

% Of those with usu. source of care that named a clinic or doctor's office

95% NA NA NA NA

% Of those with no usu. source of care that go to ER if sick

22% NA NA NA NA

% Not Having a Checkup Within the Past 2 yrs

18% 27% 31% 26% NA

% Needed Medical Care But Could not Afford it: Past Year

16% 21% 17% 17% 9.0%

DEMOGRAPHICS

HEALTH STATUS



Central Peninsula

Mat-Su Borough


CARDIOVASCULAR HEALTH

% Current Smokers 15% 26% 21% 23% 21%% Overweight 37% 37% 34% 39% 38%% Obesity 31% 30% 31% 27% 28%

% Diagnosed High Cholesterol 31% 35% 35% 34% 38%

% Diagnosed High Blood Pressure 34% 34% 27% 29% 31%

% Diagnosed Any Heart Disease 7.1% 5.5% 6.3% 5.9% NARESPIRATORY HEALTH

% Current Smokers 15% 26% 21% 23% 21%

% Former Smokers 35% 31% 26% 28% 25%

% Diagnosed Asthma (Ever) 10% 12% 13% 14% 14%

% Diagnosed Other Lung Disease (COPD, Chronic Bronchitic, Emphys.)

5.2% 6.3% 4.1% 5.2% 6.1%

DIABETES HEALTH & OTHER CONDITIONS

% Overweight 37% 37% 34% 39% 38%

% Obesity 31% 30% 31% 27% 28%% Diagnosed Diabetes 10% 8.8% 5.6% 7.9% 10%% Diagnosed Kidney Disease 1.5% 1.9% 1.5% 2.3% 2.4%% Diagnosed Chronic Back Pain 18% NA NA NA NA% Diagnosed Auto-Immune Disease (e.g. RA, Lupus) 5.9% NA NA NA NA

CANCER HEALTH

% Current Smokers 15% 26% 21% 23% 21%% Former smokers 35% 31% 26% 28% 25%% Overweight 37% 37% 34% 39% 38%% Obesity 31% 30% 31% 27% 28%

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% Diagnosed Any Cancer 8.2% 11% 8.7% 8.5% NA

% Reported Mammogram past 2 years (Females 40+) 65% NA 64% 72% 75%% Reported Pap Smear past 3 years (Females 18+) 71% NA 81% 81% 81%% Reported Ever Having Sigmoid/Colonoscopy (Age 50+) 66% NA 68% 62% 65%M

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Central Peninsula

Mat-Su Borough


MENTAL HEALTH

% Needed, but did not get, mental health treatment in past yr 6.3% NA NA NA NA% Diagnosed Depression or Anxiety 17% 18% 13% 17% 18%% Chronic Back Pain 18% NA NA NA NA

% Heavy Alcohol Consumption - Past Month 5.1% 7.1% 6.1% 7.4% 6.6%% Binge Drinking -Past Month 16% 21% 20% 21% 18%% Diagnosed with Substance Abuse Problem 3.2% NA NA NA NA

YOUTH HEALTH**

% Depressive Symptoms* 29% NA NA 25% 29%% Current Smoker (Past Month) 15% NA NA 16% 20%% Current Chewing Tobacco User (Past Month) 8.8% NA NA 9.2% 8.1%% Alcohol Use (Past Month) 35% NA NA 32% 42%

% Binge Drink (5+ in a row) (Past Month) 20% NA NA 18% 25%% Marijuana Use (Past Month) 25% NA NA 23% 25%% Sniffed Glue or Other Inhalant (Past Month) 1.2% NA NA NA NA% Used Prescription Drug w/out Rx (Past Month) 3.5% NA NA 7.0% NA% Ever Been Diagnosed with Asthma (0-17) parental report*** 14% NA NA 22% 23%

% Overweight/Obesity Problem (0-17) parental report 4.3% NA NA NA NA*Depressive Symptoms in youth based on four question scale developed by Bach-Harrison, YRBS uses so sad or hopeless stopped doing usual things for 2 weeks or more

NA=Data is Not Available for Specific Indicator at this geographic level

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SUBSTANCE ABUSE

**All Youth Data is for 10th and 12th Graders only unless otherwise indicated


APPENDIX 3 – HEALTH STATUS TRENDS TABLE

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CPH CHNA - Health Status Trends

Indicator

GENERAL HEALTH STATUS: 2004 2009 2012 Difference 2004 to 2012

Total Population 30931 34925 36363 3994Total 18+ Population 21335 24199 27272 2864% of Labor Force Unemployed 9.5 8.2 8.6% -1.3% Population Between Ages 18-44 37 37 32 -0.3% Population Between Ages 45-64 25 26 32 0.9% Population Age 65 and Over 7.5 7.2 11 -0.3

% Health Fair to Poor 16 12 10 -5.8% 11+ Days Lost to Poor Physical Health or Mental Health 10 8.9 8.5 -1.9% 3+ Chronic Conditions 18 19 15 -2.9

Well 38 40 40 1.7At Risk for Future Medical Problems 9.7 8.3 9.1 -0.6Some Health Problems 39 38 35 -4.2Not Well 13 15 16 3.1

% Without Regular Source of Care 25 36 27 1.7 Males 34 46 36 2.3 Females 17 26 17 0.4% Not Having a Checkup Within the Past 2 Years 17 17 18 1.1 Males 23 22 23 -0.4 Females 9.8 11 12 2.2% Did Not Go to Doctor Because Could Not Afford 26 16 16.0% Uninsured (18-64) 23 20 22 -1.0

% Current Smokers 26 19 15 -11.3 Males 28 20 16 -11.9 Females 25 19 14 -10.5% Diagnosed High Cholesterol 26 29 31 5.2 Males 26 34 33 7.4 Females 26 23 29 2.7% Diagnosed High Blood Pressure 28 33 34 5.6 Males 28 37 37 8.8 Females 29 30 30 1.4% Diagnosed Any Heart Disease 5.0 8.3 7.1 2.1 Males 4.9 10 7.3 2.4 Females 5.1 6.2 6.8 1.7% Overweight 38 38 37 -0.5 Males 48 44 44 -3.7 Females 26 31 29 2.9% Obese 26 28 31 5.3 Males 26 34 33 7.0 Females 26 22 28 2.5

Central Peninsula - Trends 2004 to 2012

FUNCTIONAL HEALTH STATUS

Wellness Categories:

ACCESS TO PRIMARY CARE:

CARDIOVASCULAR:

UNE / CCPH • Central Peninsula Hospital Community Health Needs Assessment 2012

41

CPH CHNA - Health Status Trends

Indicator Central Peninsula - Trends 2004 to 2012

% Current Smokers 26 19 15 -11.3 Males 28 20 16 -11.9 Females 25 19 14 -10.5% Former Smokers 27 31 35 7.6 Males 32 28 43 11.5 Female 23 34 27 3.9% Diagnosed Asthma (Ever) 11 12 10 -0.8 Male 8.1 7.8 9.3 1.2 Female 14 16 12 -1.6% Diagnosed Other Lung Disease 6.0 5.1 5.2 -0.8 Male 6.1 3.3 4.3 -1.8 Female 5.8 6.9 6.1 0.3

% Diagnosed Diabetes 7.6 12 10 2.4 Ages 18-44 4.7 8.2 3.3 -1.4 Ages 45-64 9.6 16 13 3.3 Ages 65+ 15 19 22 6.7% Diagnosed Kidney Disease 2.3 2.8 1.5 -0.8 Ages 18-44 1.9 1.9 0.8 -1.1 Ages 45-64 2.3 3.7 1.2 -1.1 Ages 65+ 5.1 4.8 3.7 -1.4% Diagnosed Chronic Back Pain 19 22 18 -0.6 Ages 18-44 14 16 7.5 -6.3 Ages 45-64 25 28 25 -0.3 Ages 65+ 22 31 29 6.6% Diagnosed Cancer NA 6.5 8.2 1.7% Diagnosed Auto-Immune Disease (eg RA, Lupus, MS) 5.9 NA

% Diagnosed Depression 17 19 17 0.1% Reported Needed MH Treatment But Did not Get It NA 6.6 6.3 -0.3

% Substance Abuse Disorder 3.2 1.5 3.2 0.0 Males 3.6 1.6 4.3 0.7 Females 2.7 1.4 1.8 -0.9

RESPIRATORY:

Source: All population data are from the U.S. Census Bureau, Central Peninsula health data is from the 2004, 2009 and 2012 random sample household health survey

NA = Not Available because question was not asked in every survey year

DIABETES AND OTHER CHRONIC CONDITIONS:

MENTAL HEALTH

SUBSTANCE ABUSE


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APPENDIX 4 – DETAILED DATA SOURCES BY INDICATOR

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CPH CHNA ‐ Detailed Data Sources

SOURCE Central Peninsula

SOURCE Alaska & Boroughs

SOURCE US

DEMOGRAPHICS

Total Population 2010 2010 US Census 2010 2010 US Census 2010 US Census

% Population Under the Age of 18 2010 US Census 2010 US Census 2010 US Census

% Population Between Ages 18-44 2010 US Census 2010 US Census 2010 US Census

% Population Between Ages 45-64 2010 US Census 2010 US Census 2010 US Census

% Population Age 65 and Over 2010 US Census 2010 US Census 2010 US Census

% Population White (One-Race, Non-Hispanic)

2010 US Census 2010 US Census 2010 US Census

% of Labor Force Unemployed 2010 US Census 2010 US Census Bureau of Labor Statistics

% Population Not Attaining H.S. Diploma (>25 yr)

2012 Household Survey 2010 US Census 2010 US Census

Mean Annual Household Income 2010 US Census 2010 US Census 2010 US Census

Median Annual Household Income 2010 US Census 2010 US Census 2010 US Census

People and families living below federal poverty line

2012 Household Survey 2010 US Census 2010 US Census

% Health Fair to Poor 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% 11+ Days Lost to Poor Mental or Physical Health

2012 Household Survey BRFSS 2011 BRFSS 2011

% 3+ Chronic Conditions 1 2012 Household Survey BRFSS 2011 BRFSS 2011

Wellness Categories:

%Well 2012 Household Survey BRFSS 2011 NA

% At Risk for Future Medical Problems 2012 Household Survey BRFSS 2011 NA

%Some Health Problems 2012 Household Survey BRFSS 2011 NA

%Not Well 2012 Household Survey BRFSS 2011 NA

% Without Usual Source of Primary Care 2012 Household Survey BRFSS 2011 BRFSS 2011

%Uninsured (18-64) 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Named a clinic or doctor's office as usual source of care

2012 Household Survey NA NA

% Of those with no usual source of care that go to ER if sick


% Not Having a Checkup Within the Past 2 yrs

2012 Household Survey BRFSS 2011 BRFSS 2011

% Needed Medical Care But Could not Afford it: Past Year

2012 Household Survey BRFSS 2011 NHIS 2011

HEALTH STATUS

ACCESS TO CARE





SOURCE US

% Current Smokers 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Overweight 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Obesity 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% High Cholesterol (ever told) 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% High Blood Pressure (ever told) 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Heart Disease 2012 Household Survey BRFSS 2011BRFSS 2011 - web only reports

separate diseases


% Former Smokers 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Asthma (Ever) 2012 Household Survey BRFSS 2011 BRFSS 2010 (Median of States)

% Other Lung Disease (COPD, Chronic Bronchitic, Emphys.)

2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)



% Diagnosed Diabetes 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Diagnosed Kidney Disease 2012 Household Survey BRFSS 2011 NA

% Diagnosed Chronic Back Pain 2012 Household Survey NA NA

% Diagnosed Auto-Immune Disease (e.g. RA, Lupus)



% Former smokers 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)



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% Diagnosed Any Cancer 2012 Household Survey BRFSSBRFSS 2011 - web only reports

separate types

% Reported Mammogram past 2 years (40+)


% Reported Pap Smear past 3 years (18+) 2012 Household Survey BRFSS 2010 BRFSS 2010 (Median of States)

% Reported Ever Having Sigmoid/Colonoscopy (Age 50+)

2012 Household Survey BRFSS 2010BRFSS 2010 (only reports ever

received sig/col)

RESPIRATORY HEALTH

DIABETES HEALTH & OTHER CONDITIONS

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CARDIOVASCULAR HEALTH

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SOURCE US

% Needed, but did not get, mental health t t t i t


% Diagnosed Depression 2012 Household Survey BRFSS 2011 BRFSS 2011

% Chronic Back Pain 2012 Household Survey NA NA

% Heavy Alcohol Consumption - Past Month


% Binge Drinking -Past Month 2012 Household Survey BRFSS 2011 BRFSS 2011 (Median of States)

% Ever diagnosed with Substance Abuse Problem


% Depressive Symptoms*2011 PNA Survey

Results2011 Alaska YRBS 2011 US YRBS

% Current Smoker (Past Month)2011 PNA Survey


% Current Chewing Tobacco User (Past Month)

2011 PNA Survey Results

2011 Alaska YRBS 2011 US YRBS

% Alcohol Use (Past Month) 2011 PNA Survey


% Binge Drink (5+ in a row) (Past Month)2011 PNA Survey


% Marijuana Use (Past Month)2011 PNA Survey


% Sniffed Glue or Other Inhalant (Past Month)



% Used Prescription Drug w/out Rx (Past Month)



% Ever Been Diagnosed with Asthma (0-17) parental report***

2012 Household Survey 2011 Alaska YRBS 2011 US YRBS

% Overweight/Obesity Problem (0-17) parental report


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SUBSTANCE ABUSE

YOUTH HEALTH**

Calculations based on the Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY 2009 MSIS, 2012 and 2009 population estimates for other states from the United States Census Bureau, available at http://www.census.gov/popest/data/historical/2000s/vintage_2009/state.html

1. Chronic conditions include hi_bp hi_chol diabetes heart kidney othlng dprssion asthma (chronic back pain and SA not in BRFSS so not included for this indicator

*Depressive Symptoms in youth based on four question scale developed by Bach-Harrison, YRBS uses so sad or hopeless stopped doing usual things for 2 weeks or more

**All Youth Data is for 10th and 12th Graders only unless otherwise indicated

***CPH survey aks for parental report and is among households with children of any age, YRBS is self report among high school students 9-12

NA=Not AvailableMost US BRFSS data is Median of States and DC, exceptions are for datapoints specifically calculated by researchers for this report

MENTAL HEALTH


APPENDIX 5 - DEFINITIONS OF SELECTED INDICATORS

Definition of Indicators

Obesity = Body mass index of 30 or higher (based on reported height and weight). Overweight = Body mass index >= 25 and <30. Current Smoker = Respondents who have smoked at least 100 cigarettes in lifetime, and reported

smoking currently. Former Smoker = Respondents who have smoked 100 cigarettes in lifetime but currently do not

smoke. Prevalence Rate = the proportion of individuals in a population who have a particular disease or

condition at a specific point in time. 3+ Chronic Diseases = the diseases included in this measure are diabetes, hypertension, high choles-

terol, heart disease, kidney disease, asthma, other lung disease, and depression.

Wellness Profile: Well = Survey respondents that had never been diagnosed with any of the three long-standing condi-tions (hypertension, high cholesterol, or diabetes), that reported their health as excellent, very good, or good, had good functional health, and, if over 35 years old, did not smoke and were not obese based on their body mass index. At Risk for Future Medical Problems = Survey respondents never diagnosed with any of the three long-standing conditions (hypertension, high cholesterol, or diabetes), but were 35 years of age or older and smoked cigarettes regularly or were obese based on their body mass index. Some Health Problems = Survey respondents who reported their health as fair or poor, had reduced functional health, or had been diagnosed with high blood pressure, high cholesterol or diabetes. Not Well = Survey respondents that have been diagnosed with all three longstanding conditions (hypertension, high cholesterol, or diabetes), or had been diagnosed with at least one chronic disease and reported their health as either fair or poor or experienced significant functional health problems.

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APPENDIX 6 – ANNOTATED CP HOUSEHOLD HEALTH SURVEY

48


UNIVERSITY OF NEW ENGLAND CENTER FOR COMMUNITY AND PUBLIC HEALTH

716 STEVENS AVE. PORTLAND, ME 04103

Central Peninsula Hospital Community Health Needs Assessment

Annotated Survey Instrument (1/15/2013) Prepared by Kira Rodriguez, MHS CCPH - UNE Brian Robertson, Ph.D. Market Decisions

49

CPH CHNA – Annotated Household Health Survey

TableofContentsI. Survey Lead-in Statement, Introduction, Respondent Selection .................................... 1

II. Health Care Provider ..................................................................................................... 7

III. Hospital Care ............................................................................................................. 12

IV. General Health Status ................................................................................................ 15

V. Chronic Conditions ..................................................................................................... 17

VI. Youth ......................................................................................................................... 30

VII. Doctor’s Visits and Medical Tests ........................................................................... 31

VIII. Risk Factors............................................................................................................. 36

IX. Community Perceptions of Needed Services ............................................................ 40

X. Central Peninsula Hospital Quality Ratings ................................................................ 49

XI. Health Insurance Coverage and Access to Care ........................................................ 54

XII. Domestic Violence ................................................................................................... 57

XIII. Demographics ......................................................................................................... 58

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I.SurveyLead‐inStatement,Introduction,RespondentSelection Q:LEAD This is ____________ calling on behalf of the Center for Community and Public Health, an organization that has been contracted by the Central Peninsula Hospital to conduct a survey of health needs in the area. The survey will only take about 15 minutes. This is not a sales call and all the information you provide will be confidential. First, have I reached you at your home telephone? 11 YES 13 NO 15 NOT NOW, CALL BACK [Wait - Schedule Time] 17 OTHER 19 CONTACT ONLY 21 BUSINESS 23 LANGUAGE 25 INFIRM 27 GROUP QUARTERS, INSTITUTION (DORMS) 29 WRONG NUMBER 31 HANG UP 33 RESPONDENT NOT AVAILABLE DURING DATA COLLECTION PERIOD 88 HOUSEHOLD REFUSAL 99 NEED MORE INFORMATION - OR TO PROVIDE MORE INFORMATION

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INFORMATION SCREEN FOR INTERVIEWERS Q:INFOQ INFORMATION: GENERAL RELUCTANCE We are doing a study of health needs in your area to assist in the planning of health care services in the future. We are very interested in hearing what you think about health care. Your participation is important because you will be helping to represent your entire community. STUDY LENGTH The study will take about 15 minutes, depending on your answers. HOW WAS I SELECTED Your phone number has been chosen at random to be included in this study. Because we can't interview everyone in your community, we are randomly choosing a smaller group of people to speak on behalf of all residents. Will you help us? For specific information about this study, please ask for Dr. Brian Robertson of Market Decisions at our Toll Free Number 1-800-293-1538 ext. 102.

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Respondent Selection Q:RES Is this a... 1 Private residence in Alaska where SOMEONE lives at least 6 months of the year 2 Vacation residence or vacation rental? 3 An institutional residence? 4 A group home? 8 DK 9 REFUSED Q:SELC To start with, I need to know how many of the people living at this phone number are age 18 or above. 0 1 2-30 31 DK 32 REF

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Q:SEL1 Of these adults, may I please speak to the person who had the most recent birthday? 1 SPEAKING 2 SOMEONE ELSE 8 DK 9 REF VERIFICATION OF TOWN Q:INTO1 Just to verify that you live within the area we are surveying, could you please tell me what town you live in... 20 CLAM GULCH 21 COHOE 22 COOPER LANDING 23 FUNNY RIVER 24 KALIFORNSKY 25 KASILOF 26 KENAI 27 NIKISKI 28 NINILCHIK 29 RIDGEWAY 30 SALAMATOF 31 SOLDOTNA 32 STERLING 95 OTHER (TERMINATE)

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STATEMENT OF IMPLIED CONSENT Q:INTO Thank you. This survey is voluntary. If we ask a question that you do not want to answer, please let me know, and we will move on to the next one. I want to assure you that this survey is confidential. Your name will never be released, and the results of this study will be reported in combined form only. Also, my supervisor may listen to all or part of the interview to evaluate my performance if that is all right with you. 1 PROCEED WITH SURVEY 5 NOT A GOOD TIME, CALL BACK 9 REFUSED PERSUADER STATEMENT FOR INITIAL REFUSALS Q:PER GENERAL RELUCTANCE Your participation in this study is very important. We are doing a study of health needs in your area to assist in the planning of health care services in the future. We are very interested in hearing what you think about health care. Your participation is important because you will be helping to represent your entire community. Will you help us by doing this study? STUDY LENGTH The study will take about 15 minutes, depending on your answers TO VERIFIY THIS SURVEY: CALL: Dr. Brian Robertson of Market Decisions at our Toll Free Number 1-800-293-1538 ext. 102. 1 AGREES TO COOPERATE 3 NOT A GOOD TIME, CALL BACK 4 SOFT REFUSAL - HOUSEHOLD - DID NOT IDENTIFY RESPONDENT 5 SOFT REFUSAL - RESPONDENT - IDENTIFIED RESPONDENT 6 HARD REFUSAL - HOUSEHOLD - DID NOT IDENTIFY RESPONDENT 7 HARD REFUSAL - RESPONDENT - IDENTIFIED RESPONDENT

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MESSAGE LEFT ON ANSWERING MACHINE DISPOSITIONS Q:ANMACH INTS: LEAVE MESSAGE ON IDENTFIED RESIDENTIAL ANSWERING MACHINES ON THE 1st, 3rd, and 7th ATTEMPTS! This is ____________ calling on behalf of the Center for Health Policy Planning and Research, a firm contracted by the Central Peninsula Hospital to conduct a survey of health needs in your area to assist in the planning of health care services in the future. Another interviewer will be contacting your household in the next few days to participate in this important study. If you have any questions about the survey or need to verify it as legitimate, please feel free to call: Dr. Brian Robertson at 1-800-293-1538, extension 102. Thank you and goodbye. INTS CODING FOR ANSWERING MACHINES 1 IDENTIFIED RESIDENTIAL ANSWERING MACHINE 2 UNKNOWN IF RESIDENTIAL ANSWERING MACHINE

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II.HealthCareProvider Q:Q2A Do you have one person you think of as your personal doctor or health care provider? If not, is there more than one, or is there no person who you think of as your personal doctor or health care provider?

Count % Yes, only one 368 61%

More than one 70 12% No 161 27% Total 599 100%

Q:Q2B If you or someone in your family were ill and required medical care, where would you go?

Count % DOCTOR OR OTHER PROVIDER OFFICE 41 27%

A CLINIC OR HEALTH CENTER 53 35% HOSPITAL OUTPATIENT CLINIC 5 3% HOSPITAL EMERGENCY ROOM 33 22% WALK-IN, URGENT CARE CENTER 10 7% Hospital in general 3 2% VA Clinic 1 1% Would treat myself 3 2% Naturopath 1 1% Total 151 100%

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Q:Q2C What kind of place do you usually go? Is this place..

Count % DOCTOR OR OTHER PROVIDER OFFICE 303 69%

A CLINIC OR HEALTH CENTER 111 25% HOSPITAL OUTPATIENT CLINIC 8 2% WALK-IN, URGENT CARE CENTER 5 1% Hospital in general 2 % VA Clinic 4 1% Naturopath 1 % OTHER 2 1% Total 436 100%

Q:Q2D In addition to your usual doctor or place of care, are there any other doctors or health care providers that you use for a special health or medical care need?

Count % YES 257 59%

NO 177 41% Total 434 100%

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Q:Q2E1 Thinking about the most recent time you visited a doctor or health care provider for a special health or medical need, what type of doctor of health care provider was it?

Count % ALLERGIST 3 1%

CHIROPRACTOR 25 10% DERMATOLOGIST 10 4% ENDOCRINOLOGIST 4 2% GASTROENTEROLOGIST 4 2% HEART SPECIALIST, CARDIOLOGIST 13 5% INTERNAL MEDICINE 39 16% NEPHROLOGY 2 1% NEUROLOGY 10 4% OB, GYN 19 7% ONCOLOGIST 11 5% OPHTHALMOLOGIST 7 3% ORTHOPEDIST 22 9% PAIN MANAGEMENT 4 2% PHYSICAL THERAPY REHAB 4 2% PSYCHIATRIST 5 2% PODIATRIST 3 1% PULMONOLOGIST 1 % SURGEON 17 7% UROLOGIST 8 3% ACUPUNCTURIST 4 2% NATUROPATH 4 1% MIDWIFE 3 1% Dentist, Oral Surgeon 2 1% ENT specialist 2 1% General practitioner 11 5% audiologist 1 % OTHER 9 4% Total 249 100%

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Q:Q2E2 And, in what town is this doctor or health care provider located?

Count % ANCHORAGE 60 23%

HOMER 3 1% KENAI 35 14% SEATTLE - WA 2 1% SOLDOTNA 147 57% Ninilchik 1 % Sterling 1 % OTHER 7 3% Total 256 100%

60


Q:Q2E3 Why did you choose to seek care at this location?

Count % LOCATION NEAR HOME 78 31%

LOCATION NEAR WORK 11 4% HIGHEST QUALITY OF CARE 35 14% PREVIOUS EXPERIENCE 34 14% FRIEND FAMILY RECOMMENDED 32 13% REQUIRED BY INSURANCE 10 4% DOCTOR'S PERSONALITY 13 5% FRIENDLY STAFF 4 1% EMPLOYER RECOMMENDED 2 1% DOCTOR'S CREDENTIALS 32 13% REFERRED BY DOCTOR 41 16% CONVENIENT OFFICE HOURS 2 1% SELF, FAMILY EMPLOYED THERE 1 % STATE-OF-THE-ART TECHNOLOGY 6 2% GENDER OF PROVIDER 3 1% Nothing available locally 6 2% Cost 3 1% Only one available, Not many options 12 5% Doctor could see me, Had available appointments 1 % Reputation 4 2% Insurance reasons, On approved list of providers 6 2% Have always gone to this doctor 4 1% OTHER 5 2% Total 252 100%

61


III.HospitalCare Q:Q3A In the last two years, that is since October 2010, have you been a patient in a hospital for an overnight stay?

Count % YES 89 15%

NO 508 85% Total 597 100%

Q:Q3B At which hospital did you stay overnight?

Count % ALASKA NATIVE MEDICAL CENTER 3 4%

ALASKA REGIONAL HOSPITAL 7 8% CENTRAL PENINSULA HOSPITAL 56 63% PROVIDENCE HOSPITAL 11 13% SOUTH PENINSULA GENERAL HOSPITAL 1 2% Out of State 8 9% Soldotna 2 3% Total 89 100%

62


Q:Q3C Why did you choose to use that hospital?

Count % DOCTOR'S CHOICE 18 20%

LOCATION NEAR HOME 39 44% LOCATION NEAR WORK 1 1% HIGH QUALITY OF CARE 7 8% PREVIOUS GOOD EXPERIENCE AT HOSPITAL 6 6% RECOMMENDED BY FAMILY, FRIEND 1 1% AVAILABILITY OF SPECIALISTS 6 7% REQUIRED BY INSURANCE COVERAGE 6 7% ADMITTED TO EMERGENCY ROOM 10 12% GOOD REPUTATION 6 7% SELF, FAMILY EMPLOYED THERE 1 1% GOOD SERVICES, TREATMENTS 4 4% STATE-OF-THE-ART TECHNOLOGY 1 1% PROMPT TEST RESULTS AND FOLLOWUP 1 1% Nothing available locally 2 3% Only option available, Not many choices 3 3% No choice, It's where I was sent 5 6% Cost 1 2% OTHER 2 2% Total 89 100%

Q:Q4A In the last year, that is since October 2010, have you been a patient in a hospital for an outpatient service that did not require an overnight stay (such as day surgery, lab tests, or x-rays for example)?

Count % YES 237 40%

NO 362 60% Total 599 100%

63


Q:Q4B Which hospital did you go to for outpatient services?


ALASKA REGIONAL HOSPITAL 3 1% CENTRAL PENINSULA HOSPITAL 191 82% PROVIDENCE HOSPITAL 11 5% SOUTH PENINSULA GENERAL HOSPITAL 6 2% MAT-SU VALLEY HOSPITAL 2 1% Out of State 2 1% Kenai Peninsula General Hospital 5 2% OTHER 8 4% Total 234 100%

Q:Q4C Why did you choose to use that hospital?


LOCATION NEAR HOME 131 56% LOCATION NEAR WORK 4 2% HIGH QUALITY OF CARE 16 7% PREVIOUS GOOD EXPERIENCE AT HOSPITAL 24 10% AVAILABILITY OF SPECIALISTS 10 4% REQUIRED BY INSURANCE COVERAGE 10 4% ADMITTED TO EMERGENCY ROOM 9 4% GOOD REPUTATION 8 3% EMPLOYER RECOMMENDATION 2 1% SELF, FAMILY EMPLOYED THERE 5 2% MEDICAL INFO IS KEPT CONFIDENTIAL 1 % GOOD SERVICES, TREATMENTS 6 2% STATE-OF-THE-ART TECHNOLOGY 1 % PROMPT TEST RESULTS AND FOLLOWUP 1 % Only option available, Not many choices 17 7% Cost 7 3% OTHER 4 2% Total 236 100%

64


IV.GeneralHealthStatus Q:Q7 In general, would you say your health is...

Count % Excellent 136 23%

Very good 214 36% Good 189 32% Fair 42 7% Poor 16 3% Total 597 100%

Q:Q8 During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Count % 0 456 77%

1 21 3% 2 19 3% 3-5 21 3% 6-10 23 4% 11+ 51 9% DK 2 0% Total 593 100%

65


Q:Q9 During the past 30 days, for about how many days did pain make it hard for you to do your usual activities, such as self-care, work, or recreation?

Count % 0 411 69%

1 27 5% 2 22 4% 3-5 27 5% 6-10 24 4% 11+ 80 13% DK 1 0% Total 593 100%

66


V.ChronicConditions Q:Q10A Has a doctor ever told you that you have high blood pressure or hypertension?

Count % YES 198 34%

NO 393 66% Total 590 100%

Q:Q10B Has a doctor ever told you that you have high cholesterol?

Count % YES 181 31%

NO 406 69% Total 587 100%

Q:Q10C Has a doctor ever told you that you have diabetes or high blood sugar?

Count % YES 58 10%

NO 522 90% Total 580 100%

Q:Q10D Has a doctor ever told you that you have heart disease; such as hardening of the arteries, angina, congestive heart failure, or a heart attack?

Count % YES 41 7%

NO 538 93% Total 579 100%

67


Q:Q10E Has a doctor ever told you that you have kidney disease?

Count % YES 9 1%

NO 569 99% Total 578 100%

Q:Q10F Has a doctor ever told you that you have a substance abuse problem with alcohol or drugs?

Count % YES 18 3%

NO 559 97% Total 577 100%

Q:Q10G Has a doctor ever told you that you have depression or anxiety?

Count % YES 100 17%

NO 482 83% Total 582 100%

Q:Q10H Has a doctor ever told you that you have chronic back pain?

Count % YES 102 18%

NO 479 82% Total 582 100%

68


Q:Q10I Has a doctor ever told you that you have cancer?

Count % YES 47 8%

NO 532 92% Total 579 100%

Q:Q10J Has a doctor ever told you that you have asthma?

Count % YES 60 10%

NO 519 90% Total 579 100%

Q:Q10K Has a doctor ever told you that you have other lung diseases such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, or emphysema?

Count % YES 30 5%

NO 548 95% Total 578 100%

Q:Q10L Has a doctor ever told you that you have an auto-immune disease, such as rheumatoid arthritis, lupus, or multiple sclerosis?

Count % YES 34 6%

NO 544 94% Total 578 100%

69


Q:NQ10A Where do you currently go for diabetic wound care, by this I mean services to check and treat any wounds you have related to your diabetes?


ALASKA REGIONAL HOSPITAL 1 1% CENTRAL PENINSULA HOSPITAL 17 35% KENAI VA CLINIC 4 8% ANCHORAGE VA HOSPITAL 1 2% Peninsula Internal Medicine 2 4% Clinic - in general 2 4% Doctor's office, private physician in general 7 14% Do not have any wounds, Do not need this kind of care 5 11% Cottonwood Clinic 1 1% Dena'ina Clinic 1 2% None, Self-treat, Live with it 1 1% No specific place 1 1% PCHS, Primary Care Health Services 1 1% Family Medical Center 1 2% OTHER 2 5% None 2 3% Total 49 100%

70


Q:NQ10B Why did you choose this provider?


LOCATION NEAR HOME 11 29% LOCATION NEAR WORK 2 5% HIGH QUALITY OF CARE 4 9% PREVIOUS GOOD EXPERIENCE AT HOSPITAL 8 19% RECOMMENDED BY FAMILY, FRIEND 2 4% AVAILABILITY OF SPECIALISTS 2 5% REQUIRED BY INSURANCE COVERAGE 3 8% GOOD REPUTATION 5 13% SELF, FAMILY EMPLOYED THERE 1 1% GOOD SERVICES, TREATMENTS 2 6% Cost, Sliding scale 1 2% Only one in area, Not many options 1 2% OTHER 1 2% Total 39 100%

71


Q:NQ10C If you had your choice of providers to treat your diabetes where would you go?


ALASKA REGIONAL HOSPITAL 5 1% CENTRAL PENINSULA HOSPITAL 209 46% MAYO CLINIC - ROCHESTER MN 2 % PROVIDENCE HOSPITAL 26 6% SOUTH PENINSULA GENERAL HOSPITAL 5 1% UNIVERSITY OF WASHINGTON HOSPITAL 2 % MAT-SU REGIONAL MEDICAL CENTER 1 % KENAI VA CLINIC 9 2% ANCHORAGE VA HOSPITAL 8 2% Peninsula Internal Medicine 5 1% Clinic - in general 9 2% Doctor's office, private physician in general 81 18% Chiropractor, Acupuncturist, Naturopath in general 6 1% Alaska Heart Institute 1 % Anchorage - in general 2 1% Cottonwood Clinic 11 2% Dena'ina Clinic 5 1% Specialist - in general 6 1% Homer Clinic 1 % Internal Medicine, Internist - in general 8 2% Kenai Clinic 9 2% Kenai - in general 2 % Kenai MediCenter 4 1% None, Self-treat, Live with it 4 1% No specific place 1 % Soldotna - in general 1 % Out of state hospital, clinic 3 1% PCHS, Primary Care Health Services 2 1% Family Medical Center 2 % OTHER 19 4% Total 458 100%

72


Q:NQ10D Where do you currently go for services to treat your heart disease?


ALASKA REGIONAL HOSPITAL 1 2% CENTRAL PENINSULA HOSPITAL 8 23% PROVIDENCE HOSPITAL 13 36% SOUTH PENINSULA GENERAL HOSPITAL 1 1% KENAI VA CLINIC 2 5% Doctor's office, private physician in general 1 4% Alaska Heart Institute 2 6% Anchorage - in general 1 1% Cottonwood Clinic 1 2% Specialist - in general 2 4% Internal Medicine, Internist - in general 1 4% Soldotna - in general 1 1% Out of state hospital, clinic 1 1% OTHER 1 2% Total 36 100%

73


Q:NQ10E Why did you choose this provider?


LOCATION NEAR HOME 7 20% LOCATION NEAR WORK 3 7% HIGH QUALITY OF CARE 4 12% PREVIOUS GOOD EXPERIENCE AT HOSPITAL 2 5% RECOMMENDED BY FAMILY, FRIEND 3 7% AVAILABILITY OF SPECIALISTS 4 12% REQUIRED BY INSURANCE COVERAGE 3 9% ADMITTED TO EMERGENCY ROOM 3 8% GOOD REPUTATION 2 7% MEDICAL INFO IS KEPT CONFIDENTIAL 1 2% GOOD SERVICES, TREATMENTS 3 9% STATE-OF-THE-ART TECHNOLOGY 1 1% Cost, Sliding scale 2 4% Only one in area, Not many options 1 1% Total 38 100%

74


Q:NQ10F If you had your choice of providers to treat your heart condition where would you go?


ALASKA REGIONAL HOSPITAL 9 2% CENTRAL PENINSULA HOSPITAL 169 36% MAYO CLINIC - ROCHESTER MN 8 2% PROVIDENCE HOSPITAL 92 19% SOUTH PENINSULA GENERAL HOSPITAL 1 % SWEDISH HOSPITAL - SEATTLE, WA 1 % UNIVERSITY OF WASHINGTON HOSPITAL 7 1% KENAI VA CLINIC 11 2% ANCHORAGE VA HOSPITAL 21 5% Peninsula Internal Medicine 3 1% Clinic - in general 4 1% Doctor's office, private physician in general 44 9% Chiropractor, Acupuncturist, Naturopath in general 4 1% Alaska Heart Institute 12 3% Anchorage - in general 8 2% Cottonwood Clinic 9 2% Dena'ina Clinic 4 1% Specialist - in general 3 1% Homer Clinic 1 % Internal Medicine, Internist - in general 6 1% Kenai Clinic 4 1% Kenai - in general 3 1% Kenai MediCenter 2 % None, Self-treat, Live with it 2 % Soldotna - in general 4 1% Out of state hospital, clinic 10 2% Family Medical Center 1 % OTHER 22 5% Total 475 100%

75


Q:NQ10G Where do you currently go for active spine care or services to address you back and spine problems?


ALASKA REGIONAL HOSPITAL 1 1% CENTRAL PENINSULA HOSPITAL 15 16% MAYO CLINIC - ROCHESTER MN 1 1% PROVIDENCE HOSPITAL 3 3% SOUTH PENINSULA GENERAL HOSPITAL 1 1% SWEDISH HOSPITAL - SEATTLE, WA 1 1% KENAI VA CLINIC 5 5% ANCHORAGE VA HOSPITAL 3 3% Peninsula Internal Medicine 2 2% Clinic - in general 1 2% Doctor's office, private physician in general 11 12% Chiropractor, Acupuncturist, Naturopath in general 16 17% Spine Institute - Alaska, Kenai 5 6% Cottonwood Clinic 2 2% Specialist - in general 2 2% Internal Medicine, Internist - in general 1 1% Kenai Clinic 1 1% Kenai - in general 1 1% None, Self-treat, Live with it 9 9% No specific place 1 1% Soldotna - in general 1 1% Family Medical Center 2 2% OTHER 4 4% None 4 4% Total 95 100%

76


Q:NQ10H Why did you choose this provider?


LOCATION NEAR HOME 20 22% LOCATION NEAR WORK 2 2% HIGH QUALITY OF CARE 12 14% PREVIOUS GOOD EXPERIENCE AT HOSPITAL 11 13% RECOMMENDED BY FAMILY, FRIEND 8 10% AVAILABILITY OF SPECIALISTS 6 7% REQUIRED BY INSURANCE COVERAGE 3 3% ADMITTED TO EMERGENCY ROOM 1 1% GOOD REPUTATION 12 14% GOOD SERVICES, TREATMENTS 6 7% STATE-OF-THE-ART TECHNOLOGY 2 2% Cost, Sliding scale 6 7% OTHER 7 8% Do not go 3 4% Total 88 100%

77


Q:NQ10I If you had your choice of providers to treat your back and/or spine problems where would you go?


ALASKA REGIONAL HOSPITAL 9 2% CENTRAL PENINSULA HOSPITAL 174 38% MAYO CLINIC - ROCHESTER MN 11 2% PROVIDENCE HOSPITAL 45 10% SOUTH PENINSULA GENERAL HOSPITAL 1 % SWEDISH HOSPITAL - SEATTLE, WA 4 1% UNIVERSITY OF WASHINGTON HOSPITAL 6 1% KENAI VA CLINIC 11 2% ANCHORAGE VA HOSPITAL 10 2% Peninsula Internal Medicine 2 % Clinic - in general 6 1% Doctor's office, private physician in general 53 11% Chiropractor, Acupuncturist, Naturopath in general 40 9% Spine Institute - Alaska, Kenai 11 2% Anchorage - in general 4 1% Cottonwood Clinic 5 1% Dena'ina Clinic 4 1% Specialist - in general 5 1% Homer Clinic 1 % Internal Medicine, Internist - in general 2 1% Kenai Clinic 6 1% Kenai - in general 4 1% Kenai MediCenter 2 1% None, Self-treat, Live with it 2 % Soldotna - in general 6 1% Out of state hospital, clinic 14 3% Family Medical Center 1 % OTHER 16 3% Total 462 100%

78


Q:NQ10J If you or someone in your family needed health care for problems with your stomach or digestive system, where would you go?


ALASKA REGIONAL HOSPITAL 5 1% CENTRAL PENINSULA HOSPITAL 215 45% MAYO CLINIC - ROCHESTER MN 7 1% PROVIDENCE HOSPITAL 36 8% SOUTH PENINSULA GENERAL HOSPITAL 4 1% UNIVERSITY OF WASHINGTON HOSPITAL 3 1% MAT-SU REGIONAL MEDICAL CENTER 1 % KENAI VA CLINIC 11 2% ANCHORAGE VA HOSPITAL 6 1% Peninsula Internal Medicine 5 1% Clinic - in general 8 2% Doctor's office, private physician in general 72 15% Chiropractor, Acupuncturist, Naturopath in general 8 2% Anchorage - in general 4 1% Cottonwood Clinic 9 2% Dena'ina Clinic 4 1% Specialist - in general 5 1% Homer Clinic 1 % Internal Medicine, Internist - in general 11 2% Kenai Clinic 8 2% Kenai - in general 4 1% Kenai MediCenter 6 1% None, Self-treat, Live with it 4 1% Soldotna - in general 5 1% Out of state hospital, clinic 1 % Family Medical Center 2 % OTHER 13 3% Total 473 100%

79


VI.Youth Q:EINTO Are there any children under the age of 18 living in this household?

Count % YES 231 39%

NO 367 61% Total 599 100%

Q:E2a Have any children in your household under the age of 18 ever been diagnosed with Asthma?

Count % YES 33 14%

NO 196 86% Total 230 100%

E4a Have any children in your household under the age of 18 ever been diagnosed with a problem with overweight or obesity?

Count % YES 10 4%

NO 219 96% Total 229 100%

80


VII.Doctor’sVisitsandMedicalTests Q:Q12 About how long has it been since you last visited a doctor or health care provider for a routine checkup or physical examination?

Count % WITHIN THE PAST YEAR (ANYTIME <12 MONTHS AGO) 415 70%

WITHIN THE PAST 2 YEARS (1 YEAR BUT <2 YEARS AGO) 73 12% WITHIN THE PAST 5 YEARS (2 YEARS BUT <5 YEARS AGO) 58 10% 5 OR MORE YEARS AGO 48 8% Total 593 100%

Q:Q13A A mammogram is an x-ray of the breast to look for cancer. Have you ever had a mammogram?

Count % YES 207 72%

NO 83 28% Total 290 100%

Q:Q13B How long has it been since you had your last mammogram?

Count % WITHIN THE PAST YEAR 108 53%

WITHIN THE PAST 2 YEARS 51 25% WITHIN THE PAST 3 YEARS 20 10% WITHIN THE PAST 5 YEARS 6 3% 5 OR MORE YEARS AGO 20 10% Total 205 100%

81


Q:NQ10K Where do you currently go for women’s health services, such as mammograms?


ALASKA REGIONAL HOSPITAL 1 1% CENTRAL PENINSULA HOSPITAL 137 68% PROVIDENCE HOSPITAL 12 6% SOUTH PENINSULA GENERAL HOSPITAL 4 2% KENAI VA CLINIC 1 1% ANCHORAGE VA HOSPITAL 1 1% Peninsula Internal Medicine 1 % Clinic - in general 4 2% Doctor's office, private physician in general 15 8% Chiropractor, Acupuncturist, Naturopath in general 2 1% Alaska Mammogram Mobile 3 1% Anchorage - in general 1 % Cottonwood Clinic 1 1% Dena'ina Clinic 1 1% Specialist - in general 1 % Homer Clinic 1 % Internal Medicine, Internist - in general 1 % Kenai Clinic 1 1% Soldotna - in general 2 1% Out of state hospital, clinic 3 1% OTHER 5 3% None 1 % Total 201 100%

82


Q:NQ10L Why did you choose this provider?


LOCATION NEAR HOME 91 51% LOCATION NEAR WORK 5 3% HIGH QUALITY OF CARE 16 9% PREVIOUS GOOD EXPERIENCE AT HOSPITAL 15 8% RECOMMENDED BY FAMILY, FRIEND 4 2% AVAILABILITY OF SPECIALISTS 4 2% REQUIRED BY INSURANCE COVERAGE 9 5% GOOD REPUTATION 9 5% SELF, FAMILY EMPLOYED THERE 5 3% GOOD SERVICES, TREATMENTS 8 5% STATE-OF-THE-ART TECHNOLOGY 6 3% MIDWIFERY SERVICES 1 % PROMPT TEST RESULTS AND FOLLOWUP 2 1% Cost, Sliding scale 7 4% Only one in area, Not many options 5 3% OTHER 3 2% Total 179 100%

83


Q:NQ10M If you had your choice of providers for women’s health where would you go?


ALASKA REGIONAL HOSPITAL 1 % CENTRAL PENINSULA HOSPITAL 134 55% MAYO CLINIC - ROCHESTER MN 6 2% PROVIDENCE HOSPITAL 17 7% SOUTH PENINSULA GENERAL HOSPITAL 2 1% SWEDISH HOSPITAL - SEATTLE, WA 1 % UNIVERSITY OF WASHINGTON HOSPITAL 2 1% MAT-SU REGIONAL MEDICAL CENTER 1 % ANCHORAGE VA HOSPITAL 1 % Peninsula Internal Medicine 1 % Clinic - in general 5 2% Doctor's office, private physician in general 33 14% Anchorage - in general 5 2% Cottonwood Clinic 2 1% Dena'ina Clinic 1 % Specialist - in general 2 1% Homer Clinic 2 1% Internal Medicine, Internist - in general 1 % Kenai Clinic 3 1% Kenai MediCenter 2 1% Soldotna - in general 3 1% Out of state hospital, clinic 1 % PCHS, Primary Care Health Services 2 1% OTHER 15 6% Total 242 100%

Q:H11 A Pap smear is a test for cancer of the cervix. Have you ever had a Pap smear?

Count % YES 285 98%

NO 5 2% Total 290 100%

84


Q:H11a How long has it been since you had your last Pap smear?

Count % Within the past year (1 to 12 months ago) 122 43%

Within the past 2 years (1 to 2 years ago) 53 19% Within the past 3 years (2 to 3 years ago) 30 11% Within the past 5 years (3 to 5 years ago) 21 7% 5 or more years ago 57 20% Total 282 100%

Q:Q14A Sigmoidoscopies and colonoscopies are exams in which a tube is inserted in the rectum to view the bowel for signs of cancer or other health problems. Have you ever had either of these exams?

Count % YES 235 40%

NO 360 60% Total 596 100%

Q:Q14B How long has it been since you had your last sigmoidoscopy or colonoscopy?

Count % Within the past year (1 to 12 months ago) 59 25%

Within the past 2 years (1 to 2 years ago) 42 18% Within the past 3 years (2 to 3 years ago) 42 18% Within the past 5 years (3 to 5 years ago) 35 15% 5 or more years ago 55 24% Total 233 100%

85


VIII.RiskFactors Q:Q16A Have you smoked at least 100 cigarettes in your entire life?

Count % YES 290 51%

NO 282 49% Total 572 100%

Q:Q16B Do you now smoke cigarettes every day, some days or not at all?

Count % EVERYDAY 67 23%

SOMEDAYS 20 7% NOT AT ALL 203 70% Total 290 100%

Smoking Status Calculated from Q16A and Q16B

Count % Current Smoker 87 15%

Former Smoker 203 35%

Non-smoker 282 49%

Total 572 100%

86


Q:Q16C During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor?

Count % YES 316 55%

NO 256 45% Total 572 100%

Q:Q16D During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage? Q:Q16D1 ENTER NUMBER PER WEEK OR MONTH Number of Days during Past 30 Had an Alcoholic Beverage Calculated from Q16D and Q16D1

Count % 0 256 45%

1 36 6% 2 38 7% 3 - 5 91 16% 6 - 10 59 10% 11 - 20 69 12% 21-30 19 3% Total 568 100%

87


Q:Q16E One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on the average? Total Drinks during Past 30 Days Calculated from Q16D, Q16D1 and Q16E

0 256 46%

1 - 5 97 17% 6 - 10 62 11% 11 - 20 66 12% 21 - 30 25 4% 31 - 40 27 5% 41 - 50 9 2% 51+ 19 3% Total 562 100%

Heavy Drinkers Adult men having more than two drinks per day and adult women having more than one drink per day. Calculated from Q16D, Q16D1 and Q16E

Count % Heavy Drinker 29 5% Not Heavy Drinker 536 95% Total 565 100%

88


Q:Q16F Considering all types of alcoholic beverages, how many times during the past 30 days did you have four/five or more drinks on an occasion?

Count % 0 474 84%

1 35 6% 2 23 4% 3 8 1% 4 12 2% 5+ 14 2% Total 566 100%

89


IX.CommunityPerceptionsofNeededServices Q:Q17A Do you think there is a need for more tobacco cessation services or services to help quit smoking in your area, an adequate number, or too many?

Count % NEED FOR MORE 133 35%

ADEQUATE 235 62% TOO MANY 14 4% Total 381 100%

Q:Q17B Do you think there is a need for more counseling, mental health, or psychiatric services in your area, an adequate number, or too many?



Q:Q17C Do you think there is a need for more alcohol and drug abuse treatment services in your area, an adequate number, or too many?



90


Q:Q17D Do you think there is a need for more primary care providers in your area, an adequate number, or too many?



Q:Q17E Do you think there is a need for more cancer care in your area, an adequate amount, or too many?



Q:Q17F Do you think there is a need for more assisted living services in your area, an adequate number, or too many?



91


Q:Q17I Do you think there is a need for more outpatient urgent care in your area, an adequate amount or too many?



Q:Q17J Do you think there is a need for more diabetes care in your area, an adequate amount, or too many?



Q:Q17K Do you think there is a need for more emergency or trauma care in your area, an adequate number, or too many?


ADEQUATE 387 75% TOO MANY 2 % Total 515 100%

92


Q:Q17L Do you think there is a need for more cardiology services in your area, an adequate number, or too many?


ADEQUATE 166 41% Total 405 100%

Q:Q17M Do you think there is a need for more wellness services for kids and adults such as nutrition and exercise classes or the SAFE kids program in your area, an adequate number, or too many?



Q:Q17M1 Do you think there is a need for more pulmonary services in your area, an adequate number, or too many?



93


Q:Q17M2 Do you think there is a need for more dialysis services in your area, an adequate number, or too many?


ADEQUATE 166 53% TOO MANY 1 % Total 316 100%

Q:Q17M3 Do you think there is a need for more end of life care services in your area, an adequate number, or too many?



Q:Q17M4 Do you think there is a need for more Alzheimer's services in your area, an adequate number, or too many?


ADEQUATE 123 38% Total 325 100%

94


Q:Q17M5 Do you think there is a need for more pediatric services in your area, an adequate number, or too many?



Q:Q17N Are there any other healthcare services for which you think there is a need in your area?

Count % YES 180 33%

NO 364 67% Total 545 100%

What services are needed?

Count % Day clinics 3 2%

Senior medicine, geriatric specialists 2 1%

More local doctors & hospitals, More qualified doctors 5 3%

Low income clinics 2 1%

Holistic, alternative medicine, Naturopathic 7 4%

Trauma centers 3 2%

Skin doctors, dermatology 1 1%

Allergy specialists 1 %

Cardiology 9 5%

Ophthalmology 4 3%

Oncology 11 6%

Podiatry 2 1%

In home care 4 2%

Dentistry 12 7%

Pediatrics 2 1%

ENT 2 1%

Patient education 3 2%

95


Emergency rooms 1 %

Fitness club 1 1%

Grief counseling 3 2%

Homeless shelter 1 1%

Internal medicine 7 4%

Mental health care 2 1%

Family doctors 1 %

Addiction specialists 3 2%

Orthopedic 3 2%

Pain management 4 2%

Neurology 5 3%

Physical therapy 4 2%

Respiratory, Pulmonary care 1 1%

Transportation services for ill and elderly 1 %

Women's health 14 8%

Doctors who accept Medicare 5 3%

Nutrition, Wellness, Health, Exercise 9 5%

Specialists, Surgeons 15 8%

Back, Neck, Spine 1 1%

Burn care 1 %

Affordable care 5 3%

Veterans Care Services 3 1%

Other 12 7%

Total 173 100%

Q:Q17N2 Are there any medical services that you would travel outside of this area to receive because you feel there are no qualified physicians or specialists?

Count % YES 333 61%

NO 214 39% Total 547 100%

96


What type of services?

Count % More local doctors & hospitals, More qualified doctors 5 2%

Holistic, alternative medicine, Naturopathic 3 1% Trauma centers 2 1% Skin doctors, dermatology 2 % Allergy specialists 1 % Cardiology 63 19% Ophthalmology 7 2% Audiologists 1 % Oncology 67 21% Diabetes 1 % Podiatry 4 1% Dentistry 5 2% Pediatrics 11 4% Eating disorders 2 % Emergency rooms 2 1% Internal medicine 9 3% Orthopedic 15 5% Pain management 2 1% Neurology 18 6% Respiratory, Pulmonary care 1 % Women's health 9 3% Doctors who accept Medicare 1 % Specialists, Surgeons 31 10% Anything serious 10 3% Back, Neck, Spine 16 5% Burn care 5 2% Everything 11 3% Affordable care 2 1% Veterans Care Services 1 % Other 14 4% Total 322 100%

97


Q:DOCV13 Please tell me if you or other family members had any of the following problems during the past 12 months:

Count % You, another family member were told by a doctor's office they weren't accepting patients with your type of insurance

66 11%

You, another family member were told by a doctor's office or clinic that they weren't accepting new patients

106 18%

You, another family member had to change to a new doctor's office or clinic because of a change in your insurance plan

50 8%

You, another family member were unable to get an appointment at the doctor's office as soon as one was needed.

159 27%

You, another family member were unable to get an appointment at the doctor's office at a convenient time

132 22%

Do not have insurance 7 1% Do not accept Medicare, Medicaid 6 1% Hard to find doctors, specialists, Shortage of doctors 9 1% Doctor had poor bedside manner, rude 4 1% Cost, Can't afford care, prescriptions 2 % Poor quality of care from doctor 7 1% Other 13 2% None 325 55% Total 595 100%

98


X.CentralPeninsulaHospitalQualityRatings Q:Q5A Please rate Central Peninsula Hospital on the quality of physicians.

Count % VERY POOR 13 2%

2 21 4% 3 137 26% 4 185 36% EXCELLENT 165 32% Total 521 100%

Q:Q5B Please rate Central Peninsula Hospital on the quality of nursing care.


2 20 4% 3 94 19% 4 176 36% EXCELLENT 191 39% Total 491 100%

Q:Q5C Please rate Central Peninsula Hospital on having specialty physicians and treatments.


2 46 10% 3 138 31% 4 137 31% EXCELLENT 99 22% Total 442 100%

Q:Q5E Please rate Central Peninsula Hospital on the quality of the emergency room.

99



2 52 10% 3 111 21% 4 160 30% EXCELLENT 185 35% Total 525 100%

Q:Q5F Please rate Central Peninsula Hospital on the quality of cancer care.


2 43 15% 3 88 31% 4 79 27% EXCELLENT 41 14% Total 289 100%

Q:Q5G Please rate Central Peninsula Hospital on the quality of maternity/prenatal care.


2 19 5% 3 68 19% 4 129 36% EXCELLENT 126 35% Total 357 100%

100


Q:Q5H Please rate Central Peninsula Hospital on the quality of surgical care.


2 28 6% 3 94 22% 4 149 34% EXCELLENT 146 34% Total 433 100%

Q:Q5K Please rate Central Peninsula Hospital on the quality of orthopedic services, or treatment of your body’s bones, joints, ligaments, tendons, and muscles.


2 36 9% 3 90 23% 4 137 35% EXCELLENT 106 27% Total 386 100%

Q:Q5L Please rate Central Peninsula Hospital on the quality of services for the elderly.


2 41 12% 3 88 25% 4 124 36% EXCELLENT 78 22% Total 347 100%

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Q:Q5M Please rate Central Peninsula Hospital on the quality of addiction/substance abuse treatment.


2 25 10% 3 92 37% 4 68 27% EXCELLENT 39 16% Total 250 100%

Q:Q5N Please rate Central Peninsula Hospital on the quality of outpatient care services.


2 15 3% 3 95 21% 4 175 39% EXCELLENT 148 33% Total 451 100%

Q:Q5O Please rate Central Peninsula Hospital on the quality of newborn and infant care services?


2 20 5% 3 82 22% 4 124 34% EXCELLENT 131 35% Total 369 100%

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Q:Q6 Thinking again about Central Peninsula Hospital, would you say that the overall quality of service there is...

Count % Getting better 349 67%

Staying about the same 149 28% Getting worse 27 5% Total 524 100%

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XI.HealthInsuranceCoverageandAccesstoCare Q:Q20A Do you currently have health insurance that would cover at least part of the bill if you had to stay in the hospital overnight?

Count % YES 469 79%

NO 63 11% YES, BUT DK ABOUT HOSPITAL STAY 14 2% NO COVERAGE AT ALL 50 8% Total 595 100%

Q:Q20B What is that coverage? Is it...

Count % Medicaid or DenaliKidCare 40 9%

Medicare without supplemental insurance 46 10% Medicare with supplemental insurance such as AARP 56 12% Insurance that you get through an employer or former employer 311 66% Insurance that you buy on your own 34 7% Alaska Native Health Service or Indian Health Service coverage 14 3% Alaska Care 4 1% Private or Medicaid with Supplement Check Age 1 % Military, Tri Care 13 3% something else 2 % Total 471 100%

Q:Q21 During the past 12 months, was there any time when you needed healthcare or thought you should go to a doctor but did not go?

Count % YES 158 26%

NO 439 74% Total 597 100%

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Q:Q21a Was this because…

Count % Trouble finding a doctor or other health care provider 8 5%

Trouble getting an appointment with a doctor or health care provider

11 7%

Hard to get to the place where the care located -too far away, trouble arranging transportation

15 10%

The hours that care was available were not convenient 9 6% Cost 93 59% Poor quality of care, No confidence in the doctors 8 5% No insurance 4 2% Couldn't take time off of work 3 2% Self-healed instead, Waited the issue out 7 4% Did not want to, Don't like going 18 12% OTHER 9 6% Total 157 100%

Q:Q22 During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn't get it?

Count % YES 37 6%

NO 559 94% Total 596 100%

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Q:Q23 Was this because you couldn't afford mental health treatment or counseling, or was there some other reason you didn't get the care you needed?

Count % COULDN'T AFFORD IT 11 30%

DIDN'T KNOW WHERE TO GO 8 20% TOOK TOO MUCH TIME 4 10% EMBARRASED OR FEARFUL OTHERS WOULD FIND OUT

6 15%

DIDN'T THINK IT WOULD HELP 3 8% OTHER 2 7% Lack of Providers, No open appointments 4 10% Total 37 100%

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XII.DomesticViolence Q:Q24 In the past 12 months, did an intimate partner push, hit, slap, kick, choke or physically hurt you in any other way?

Count % YES 4 1%

NO 585 99% Total 589 100%

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XIII.Demographics Q:Q25 What was your age on your last birthday?

Count % 18 - 34 117 20%

35 - 44 168 28% 45-64 214 36% 65+ 91 15% Total 590 100%

Q:Q26 How tall are you with your shoes off? Q:Q27 What is your weight with your shoes off? BMI Categories Calculated from Q26 and Q27

Count % Underweight 8 1%

Normal 172 31% Overweight 207 37% Obese 173 31% Total 561 100%

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Q:Q11 INDICATE SEX OF RESPONDENT BY OBSERVATION (DO NOT READ)

Count % MALE 308 51%

FEMALE 291 49% Total 600 100%

Q:Q28 Are you currently:

Count % Employed for wages 310 52%

Self-employed 48 8% Out of work for more than 1 year 17 3% Out of work for less than 1 year 12 2% A Homemaker 50 8% A Student 12 2% Retired 117 20% Unable to work 30 5% OTHER 2 % Total 597 100%

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Q:HSLD How many people are currently living in your household, including yourself?

Count % ONE 94 16%

2 242 41% 3 99 17% 4 83 14% 5 34 6% 6 18 3% 7 8 1% 8 11 2% 9 2 % 10 2 % 11 1 % Total 593 100%

Q:KIDS Of these people, how many are age 17 or younger?

Count % 0 266 54%

1 84 17% 2 86 17% 3 30 6% 4 13 3% 5 9 2% 6 2 % 7 5 1% 8 1 % Total 496 100%

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Q:EDU What was the highest grade in school that you have completed?

Count % LESS THAN HIGH SCHOOL 40 7%

HIGH SCHOOL/GED 146 25% SOME COLLEGE/JUNIOR COLLEGE/ASSOCIATES DEGREE/TECHNICAL DEGREE

208 35%

4 YEAR COLLEGE (BACHELORS DEGREE) 126 21% GRADUATE DEGREE (MASTERS/MA, MS) 54 9% GRADUATE DEGREE (PHD/MD/JD) 19 3% Total 594 100%

Q:INC02 During the entire year of 2011, what was the total income for THIS FAMILY before taxes, including money from jobs, investments, social security, retirement income, child support, unemployment payments, public assistance, and so on? Q:INC03 Which of the following income ranges is closest to the family's 2011 total income from all sources?

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Annual Income Calculated from INC02 and INC03. Income Categories

Count % Less than $5,000 12 2%

$5,000 to $7,499 9 2% $7,500 to $9,999 1 % $10,000 to $12,499 17 3% $12,500 to $14,999 8 2% $15,000 to $19,999 23 5% $20,000 to $24,999 18 4% $25,000 to $29,999 15 3% $30,000 to $34,999 23 4% $35,000 to $39,999 17 3% $40,000 to $49,999 36 7% $50,000 to $59,999 45 9% $60,000 to $74,999 77 15% $75,000 or more 207 41% Total 507 100%

Percent of Federal Poverty Level Calculated from INC02, INC03 and HSLD FPL Categories

Count % Less than 100% 50 10%

100% to 199% 79 16% 200% to 299% 78 15% 300% to 399% 89 18% 400% or more 210 41% Total 506 100%

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716 Stevens Avenue Portland, Maine 04103-2670 T: 207-221-4560 F: 207-523-1914 www.une.edu/ccph

Central Kenai Peninsula 2012 Community Health Needs Assessment

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