1. Professional Research Consultants, Inc. 2014 PRC Community Health Needs Assessment Prepared for Lee Memorial Health System June 12, 2014 Lee County, Florida

2. 2 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Community Health Needs Assessment Customized Local PRC Community Health Survey Key Informant Focus Groups Key Informant Focus Groups Secondary Data Secondary Data Random-sample survey among 1,000 adults in Lee County By geography: o 250 in each of four Market Areas 149 survey items; 25-30 minute interview ±3.1% max error overall Four Key Informant Focus Groups, comprised of 53 community stakeholders: o Public health, Medical Society members & other health providers o Social services & other community leaders BENCHMARKING Prior Local Survey Data (2007& 2011) PRC National Health Survey Florida BRFSS data Healthy People 2020 targets National vital statistics data

3. 3 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Population & Survey Sample Characteristics (Lee County, 2014) Sources:●Census 2010, Summary File 3 (SF 3). U.S. Census Bureau. ●2014 PRC Community Health Survey, Professional Research Consultants, Inc. Total Sample Maximum Error = ±3.1% at the 95 percent confidence level

4. 4 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Assessment Findings General Observations

5. 5 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida 15.9% Fair/Poor 56.3% Excellent/ Very Good Self-Reported Health Status (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 6] Notes:●Asked of all respondents.

6. 6 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Experience “Fair” or “Poor” Overall Health Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 6] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. trend: statistically similar Lee County At-Risk Less favorable health status is found among: Market Area 2 residents = 25.1% Low-income residents (<200% FPL) = 29.0% Less age-related than typically found Lee County At-Risk Less favorable health status is found among: Market Area 2 residents = 25.1% Low-income residents (<200% FPL) = 29.0% Less age-related than typically found

7. 7 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Limited in Activities in Some Way Due to a Physical, Mental or Emotional Problem Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 123] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. Lee County Trend trend: statistically similarsimilar to FL/US Lee County At-Risk Greater activity limitations found among: Adults age 40+ ≈ 30% Low-income residents (<200% FPL) = 29.2% Non-Hispanic White respondents = 27.6% Most favorable in Market Area 3 (16.7%) Lee County At-Risk Greater activity limitations found among: Adults age 40+ ≈ 30% Low-income residents (<200% FPL) = 29.2% Non-Hispanic White respondents = 27.6% Most favorable in Market Area 3 (16.7%)

8. 8 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Selected Lee County Indicators Better Than the US: Age-adjusted death rates: cancer (including lung, prostate, breast and colorectal) ; heart disease; stroke; CLRD; diabetes; Alzheimer’s disease; kidney disease; pneumonia/influenza; homicide; HIV/AIDS Access barriers: physician office hours, transportation Routine medical care (adults and children) and regular vision care Blood pressure and cholesterol screening/management, diabetes screening Injury and safety: seat belt use, firearms in home (including homes with children), drinking and driving, violent crime Infant mortality STD incidence Obesity and medical advice on nutrition Cigarette smoking in homes

9. 9 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Selected Favorable Trends in Lee County Indicators: Age-adjusted death rates: cancer; heart disease; stroke; CLRD; unintentional injury (including motor vehicle crashes) ; Alzheimer’s disease; pneumonia/influenza; HIV/AIDS Insurance coverage for prescriptions Routine children’s medical care, ease of getting children’s healthcare HIV/AIDS incidence Teen births Infant mortality Seat belt usage, violent crime Children’s obesity Physical activity levels Cigarette smoking cessation, smoking in homes

10. 10 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Assessment Findings Healthy Lifestyles

11. 11 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Prevalence of Total Overweight (Percent of Adults With a Body Mass Index of 25.0 or Higher) Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 181] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. Notes:●Based on reported heights and weights, asked of all respondents. ●The definition of overweight is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 25.0, regardless of gender. The definition for obesity is a BMI greater than or equal to 30.0.

12. 12 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Prevalence of Obesity (Percent of Adults With a Body Mass Index of 30.0 or Higher) Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 181] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective NWS-9] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. Notes:●Based on reported heights and weights, asked of all respondents. ●The definition of obesity is having a body mass index (BMI), a ratio of weight to height (kilograms divided by meters squared), greater than or equal to 30.0, regardless of gender. Lee County At-Risk Higher prevalence of obesity: Market Area 2 residents = 33.3% Low-income residents (<200% FPL) = 31.1% Adults age 40-64 = 30.5% Lee County At-Risk Higher prevalence of obesity: Market Area 2 residents = 33.3% Low-income residents (<200% FPL) = 31.1% Adults age 40-64 = 30.5%

13. 13 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Relationship of Overweight With Other Health Issues (By Weight Classification; Lee County, 2014) 69.9% of overweight/obese adults have not been advised about weight by a health professional in the past year. 61.2% of overweight/obese adults are not trying to lose weight by modifying both diet and exercise.

14. 14 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Child Obesity Prevalence (Percent of Children 5-17 Who Are Obese; Body Mass Index in the 95 th Percentile or Higher) Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 185] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective NWS-10.4] Notes:● Asked of all respondents with children age 5-17 at home. ● Obesity among children is determined by children’s Body Mass Index status equal to or above the 95 th percentile of US growth charts by gender and age. Lee County Trend 35.9% are overweight or obese Lee County At-Risk Childhood obesity is higher among younger children, age 5-12 = 29.1% Lee County At-Risk Childhood obesity is higher among younger children, age 5-12 = 29.1%

15. 15 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Consume Five or More Servings of Fruits/Vegetables Per Day Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 173] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. ● For this issue, respondents were asked to recall their food intake on the previous day. Lee County At-Risk Lower consumption among: Low-income residents (<200% FPL) = 24.3% African American (23.0%) or Hispanic (27.2%) residents Residents of Market Area 2 (28.6%) or Market Area 3 (28.8%) Men = 30.3% Lee County At-Risk Lower consumption among: Low-income residents (<200% FPL) = 24.3% African American (23.0%) or Hispanic (27.2%) residents Residents of Market Area 2 (28.6%) or Market Area 3 (28.8%) Men = 30.3%

16. 16 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Find It “Very” or “Somewhat” Difficult to Buy Affordable Fresh Produce Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 108] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. 49.8% report that this is “not at all difficult,” 29.1% “not too difficult.” Lee County At-Risk Greater difficulty among: Low-income residents (<200% FPL) = 39.7% Women = 26.4% Lee County At-Risk Greater difficulty among: Low-income residents (<200% FPL) = 39.7% Women = 26.4%

17. 17 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida No Leisure-Time Physical Activity in the Past Month Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 110] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective PA-1] Notes:● Asked of all respondents. Lee County At-Risk Higher among: Hispanic residents = 30.3% Women = 26.3% Low-income residents (<200% FPL) = 25.9% Most favorable in Market Area 4 (16.0%) Lee County At-Risk Higher among: Hispanic residents = 30.3% Women = 26.3% Low-income residents (<200% FPL) = 25.9% Most favorable in Market Area 4 (16.0%) Indicators of frequency, intensity and duration are similar to national findings, and similar among areas of the county.

18. 18 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Child Is Physically Active for One or More Hours per Day (Among Children Ages 2-17) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 142] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents with children age 2-17 at home. ● Includes children reported to have one or more hours of physical activity on each of the seven days preceding the survey. Children With Three or More Hours per School Day of Total Screen Time (Among Parents of Children 5-17) Highest in teens. Lowest in teens.

19. 19 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Lee County At-Risk Seat belt usage is lower among: Adults age 18-39= 86.6% Low-income residents (<200% FPL) = 86.8% Men = 87.5% Most favorable in Market Area 4 (93.3%) Lee County At-Risk Seat belt usage is lower among: Adults age 18-39= 86.6% Low-income residents (<200% FPL) = 86.8% Men = 87.5% Most favorable in Market Area 4 (93.3%) “Always” Wear a Seat Belt When Driving or Riding in a Vehicle Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 58] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective IPV-15] Notes:● Asked of all respondents.

20. 20 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Texted While Driving One or More Times in the Past Month (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 67] Notes:●Asked of all respondents. ●Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). ●Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. 13.2% said 3+ times

21. 21 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Lee County At-Risk Higher smoking rates among: Low-income residents (<200% FPL) = 22.1% Adults age 40-64 = 17.5% No significant difference by geography Lee County At-Risk Higher smoking rates among: Low-income residents (<200% FPL) = 22.1% Adults age 40-64 = 17.5% No significant difference by geography Current Smokers Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 186] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. ●Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective TU-1.1] Notes:●Asked of all respondents. ●Includes regular and occasional smokers (those who smoke cigarettes everyday or on some days). Smoking cessation attempts have increased significantly since 2007.

22. 22 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Lee County At-Risk Higher exposure among: Low-income households (<200% FPL) = 16.5% African American households = 17.6% Market Area 2 households = 13.5% Lee County At-Risk Higher exposure among: Low-income households (<200% FPL) = 16.5% African American households = 17.6% Market Area 2 households = 13.5% Member of Household Smokes at Home Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 72, 188] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. ● “Smokes at home” refers to someone smoking cigarettes, cigars, or a pipe in the home an average of four or more times per week in the past month. same trend is seen in households with kids

23. 23 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Assessment Findings Primary Care Alternatives

24. 24 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Lee County At-Risk Higher uninsured: Low-income residents (<200% FPL) = 35.0% Hispanic residents = 35.1% African American residents = 34.7% Market Area 2 residents = 29.0% Adults age 18-39 = 28.9% Best coverage found in Market Area 4 Lee County At-Risk Higher uninsured: Low-income residents (<200% FPL) = 35.0% Hispanic residents = 35.1% African American residents = 34.7% Market Area 2 residents = 29.0% Adults age 18-39 = 28.9% Best coverage found in Market Area 4 Lack of Healthcare Insurance Coverage (Among Adults Age 18-64) Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 194] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective AHS-1] Notes:● Asked of all respondents under the age of 65. not statistically significant Another 8.3% of insured adults went without coverage at some point in the past year.

25. 25 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Experienced Difficulties or Delays of Some Kind in Receiving Needed Healthcare in the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 198] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. ● Represents the percentage of respondents experiencing one or more barriers to accessing healthcare in the past 12 months. Lee County At-Risk Greater difficulty: African American residents = 60.6% Low-income residents (<200% FPL) = 56.0% Market Areas 1 (47.3%) and 2 (46.3%) Adults age 18-39 (54.0%) or 40-64 (43.8%) Lee County At-Risk Greater difficulty: African American residents = 60.6% Low-income residents (<200% FPL) = 56.0% Market Areas 1 (47.3%) and 2 (46.3%) Adults age 18-39 (54.0%) or 40-64 (43.8%)

26. 26 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Barriers to Access Have Prevented Medical Care in the Past Year Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Items 8-12, 16] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:●Asked of all respondents. This indicator increased significantly between 2007 and 2011 and has since held steady.

27. 27 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Lack or Type of Insurance Coverage Prevented Medical Care at Some Point in the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 18-19] Notes:● Asked of all respondents. Reasons given: No health insurance coverage (38.5%) Problems with coverage limits (20.8%) Cost of services (16.8%) Insurance not accepted (9.6%) Problem with type of insurance (3.5%)

28. 28 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Lack or Type of Insurance Coverage Prevented Medical Care at Some Point in the Past Year (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 18] Notes:●Asked of all respondents. ●Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). ●Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. Lee County At-Risk Other segments with high impact: African American residents = 34.2% Low-income residents (<200% FPL) = 33.7% Adults age 18-39 = 29.8% Lee County At-Risk Other segments with high impact: African American residents = 34.2% Low-income residents (<200% FPL) = 33.7% Adults age 18-39 = 29.8%

29. 29 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have a Specific Source of Ongoing Medical Care Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 195] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective AHS-5.1] Notes:● Asked of all respondents. Lee County At-Risk Lower among: African American residents = 62.8% Hispanic residents = 66.7% Low-income residents (<200% FPL) = 67.7% Adults age 18-39 = 64.7% Market Area 2 residents = 70.3% Men = 71.2% Lee County At-Risk Lower among: African American residents = 62.8% Hispanic residents = 66.7% Low-income residents (<200% FPL) = 67.7% Adults age 18-39 = 64.7% Market Area 2 residents = 70.3% Men = 71.2%

30. 30 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Visited a Physician for a Checkup in the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 23] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. Lee County At-Risk Lower among: African American residents = 57.8% Adults age 18-39 = 65.2% Market Area 3 residents = 70.8% Men = 73.6% Lee County At-Risk Lower among: African American residents = 57.8% Adults age 18-39 = 65.2% Market Area 3 residents = 70.8% Men = 73.6% Routine checkups for children are higher than for adults and have improved consistently since 2007.

31. 31 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Used a Hospital Emergency Room More Than Once in the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 32-33] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. Lee County At-Risk Higher among: Residents of Market Area 1 (16.5%) or Market Area 2 (14.2%) Low-income residents (<200% FPL) = 16.4% Adults age 18-39 = 14.2% Lee County At-Risk Higher among: Residents of Market Area 1 (16.5%) or Market Area 2 (14.2%) Low-income residents (<200% FPL) = 16.4% Adults age 18-39 = 14.2%

32. 32 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Visited a Dentist or Dental Clinic Within the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 30] ●2013 PRC National Health Survey, Professional Research Consultants, Inc. ● US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective OH-7] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. Notes:●Asked of all respondents. Dental insurance coverage is low (54.6% vs. 65.6% nationally), although it has improved since 2007.

33. 33 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Visited a Dentist or Dental Clinic Within the Past Year (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 30] ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective OH-7] Notes:●Asked of all respondents. ●Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). ●Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. Among kids, utilization is low (72.1% have had dental care in the past year, versus 81.5% nationally).

34. 34 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Assessment Findings Chronic Disease Management

35. 35 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Prevalence of Diabetes Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 207] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. Notes:● Asked of all respondents. ● Local and national data exclude gestation diabetes (occurring only during pregnancy).

36. 36 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Prevalence of Diabetes (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 207] Notes:●Asked of all respondents. ●Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). ●Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. ● Excludes gestation diabetes (occurring only during pregnancy). Of those who are not diabetic, 60.9% have had their blood sugar level tested in the past 3 years (better than US, 49.2%).

37. 37 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Adult Asthma Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 161] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. Notes:● Asked of all respondents. ● Includes those who have ever been diagnosed with asthma, and who report that they still have asthma. Childhood Asthma (Among Parents of Children Age 0-17) statistically similar to FL/US; no significant trendstatistically similar to US; no significant trend Lee County At-Risk Statistically higher among: Low-income residents (<200% FPL) = 11.2% Favorably low in Market Area 4 Lee County At-Risk Statistically higher among: Low-income residents (<200% FPL) = 11.2% Favorably low in Market Area 4 10.2% of county residents have COPD, just above statewide prevalence, similar to US.

38. 38 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Prevalence of Heart Disease Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 151] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. ● Includes diagnoses of heart attack, angina or coronary heart disease. Prevalence of Stroke Lee County At-Risk Statistically higher among: Residents age 65+ = 21.5% Market 4 residents = 14.8% Lee County At-Risk Statistically higher among: Residents age 65+ = 21.5% Market 4 residents = 14.8%

39. 39 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Prevalence of Skin Cancer Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 40] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. Lee County At-Risk Statistically higher in: Market 4 = 20.1% Lee County At-Risk Statistically higher in: Market 4 = 20.1% Prevalence of Cancer (Other Than Skin Cancer)

40. 40 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Assessment Findings Behavioral Health

41. 41 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Experience “Fair” or “Poor” Mental Health Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 118] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. 33.5% “Excellent” 32.2% “Very Good” Lee County At-Risk Higher among: Low-income residents (<200% FPL) = 25.5% Adults age 18-39 (17.4%) or age 40-64 (15.3%) Most favorable in Market Area 4 Lee County At-Risk Higher among: Low-income residents (<200% FPL) = 25.5% Adults age 18-39 (17.4%) or age 40-64 (15.3%) Most favorable in Market Area 4

42. 42 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Experienced Symptoms of Chronic Depression Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 119] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. ● Chronic depression includes periods of two or more years during which the respondent felt depressed or sad on most days, even if (s)he felt okay sometimes. 17.4% of Lee County adults have been diagnosed with a depressive disorder by a physician. Lee County At-Risk Chronic depression affects: 51.9% of low-income residents (<200% FPL) ≈35% of adults <65 Most favorable in Market Area 4 Lee County At-Risk Chronic depression affects: 51.9% of low-income residents (<200% FPL) ≈35% of adults <65 Most favorable in Market Area 4

43. 43 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Suicide: Age-Adjusted Mortality (2008-2010 Annual Average Deaths per 100,000 Population) Sources:● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted March 2014. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MHMD-1] Notes: ● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). ● Rates are per 100,000 population, age-adjusted to the 2000 U.S. Standard Population. ●Local, state and national data are simple three-year averages. higher in non- Hispanic Whites

44. 44 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Suicide: Age-Adjusted Mortality Trends (Annual Average Deaths per 100,000 Population) Sources:● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted March 2014. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective MHMD-1] Notes: ● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). ● Rates are per 100,000 population, age-adjusted to the 2000 U.S. Standard Population. ● Local, state and national data are simple three-year averages.

45. 45 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Member of Household Sought Mental Health Services in the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Items 26-27] Notes:●Asked of all respondents. Note that 76.5% of Lee County adults diagnosed with a depressive disorder have ever sought help for mental health (US=76.6%).

46. 46 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Cirrhosis/Liver Disease: Age-Adjusted Mortality (2008-2010 Annual Average Deaths per 100,000 Population) Sources:● CDC WONDER Online Query System. Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Public Health Surveillance and Informatics. Data extracted March 2014. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective SA-11] Notes: ● Deaths are coded using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). ● Rates are per 100,000 population, age-adjusted to the 2000 U.S. Standard Population. ●Local, state and national data are simple three-year averages. Drug-Induced Deaths: Age-Adjusted Mortality (2008-2010 Annual Average Deaths per 100,000 Population) Lee County Trend: Historically comparatively high, but not increasing as sharply as FL/US rates. Lee County Trend: Relatively stable over the past decade.

47. 47 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Binge Drinkers Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 192] ● Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2012 Florida data. ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. ●US Department of Health and Human Services. Healthy People 2020. December 2010. http://www.healthypeople.gov [Objective SA-14.3] Notes:● Asked of all respondents. ● Binge drinkers are defined as men having 5+ alcoholic drinks on any one occasion or women consuming 4+ drinks on any one occasion. Lee County At-Risk Binge drinking is higher among: Adults age 18-39 = 29.3% Hispanic residents = 25.7% Mid/High-income residents (200%+ FPL) = 23.8% Men = 23.6% Lee County At-Risk Binge drinking is higher among: Adults age 18-39 = 29.3% Hispanic residents = 25.7% Mid/High-income residents (200%+ FPL) = 23.8% Men = 23.6% A total of 2.7% of county adults acknowledge using an illicit drug in the past month (similar to US).

48. 48 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Ever Sought Professional Help for an Alcohol/Drug-Related Problem Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 80] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents.

49. 49 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida PRC Assessment Findings Public Awareness of Services

50. 50 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Participated in a Health Promotion Activity in the Past Year Sources:●PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 127] ● 2013 PRC National Health Survey, Professional Research Consultants, Inc. Notes:● Asked of all respondents. Lower among: Adults age 65+ = 9.1% Men = 10.7% Low-income residents (<200% FPL) = 10.8% Lower among: Adults age 65+ = 9.1% Men = 10.7% Low-income residents (<200% FPL) = 10.8%

51. 51 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Heard of Healthy Lee Community Initiatives (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 128] Notes:●Asked of all respondents. ●Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). ●Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. statistically similar by geography

52. 52 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Have Heard the “Choose, Commit, Change!” Message (Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 129] Notes:●Asked of all respondents. ●Hispanics can be of any race. Other race categories are non-Hispanic categorizations (e.g., “White” reflects non-Hispanic White respondents). ●Income categories reflect respondent's household income as a ratio to the federal poverty level (FPL) for their household size. “Low Income” includes households with incomes up to 200% of the federal poverty level; “Mid/High Income” includes households with incomes at 200% or more of the federal poverty level. statistically similar by geography

53. 53 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida Healthy Lee Has Impacted Lifestyle Choices (Among Adults Who Have Heard of Healthy Lee Community Initiatives or the Healthy Lee “Choose, Commit, Change!” Message; Lee County, 2014) Sources:●2014 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 194] Notes:●Asked of respondents who have heard of either Healthy Lee Community Initiatives or the Healthy Lee “Choose, Commit, Change!” message.

54. 54 Professional Research Consultants, Inc. PRC Community Health Needs Assessment Lee County, Florida