2018 Tazewell County Community Health Assessment Report by Carilion Clinic

Contents Disclaimer .............................................................................................................................................. 3 Acknowledgements ............................................................................................................................... 4 Project Management Team ................................................................................................................ 4 Project Support Team ........................................................................................................................ 4 Tazewell County Coordinated Community Response Team ............................................................. 4 Community Health Assessment Team (CHAT) .................................................................................. 5 CHAT Members ...................................................................................................................................... 5 Executive Summary ............................................................................................................................... 6 Description of the Community .............................................................................................................. 7 Defining the Community Served ........................................................................................................ 7 Community Demographics ................................................................................................................ 7 Service Area ....................................................................................................................................... 8 Existing Resources ................................................................................................................................. 9 Carilion Tazewell Community Hospital ............................................................................................. 9 Community Health Assessment Process ..............................................................................................10 Method ..............................................................................................................................................10 Collaboration .................................................................................................................................10 Community Health Improvement Process....................................................................................10 Step 1: Conduct Community Health Assessment .........................................................................10 Step 2: Strategic Planning ............................................................................................................. 11 Step 3: Implementation Strategy .................................................................................................. 11 Step 4: Program Implementation.................................................................................................. 11 Step 5: Evaluation ......................................................................................................................... 11 Data Collection .................................................................................................................................. 12 Community Health Survey (CHS): ................................................................................................. 12 Focus Groups: ................................................................................................................................ 12 Stakeholder Survey: ...................................................................................................................... 13 Prioritization ..................................................................................................................................... 13 Robert Wood Johnson Foundation Framework ............................................................................... 14 Target Population ............................................................................................................................. 14 Community Health Assessment Findings ............................................................................................. 15 1

Community Impact ............................................................................................................................... 17 Response Since the 2016 TCCHA ...................................................................................................... 17 Success Measures..............................................................................................................................18 2018 Community Health Assessment Data ..........................................................................................19 Primary Data and Community Engagement .....................................................................................19 Stakeholder Survey Results ..........................................................................................................19 Target Population Focus Group Results ...................................................................................... 25 Tazewell County Community Health Survey Results .................................................................. 33 Secondary Data ................................................................................................................................ 63 Demographics ............................................................................................................................... 64 Social and Economic Factors ........................................................................................................ 66 Health Behaviors........................................................................................................................... 75 Clinical Care .................................................................................................................................. 79 Physical Environment ................................................................................................................... 85 Health Outcomes / Health Status of the Population ...................................................................... 86 Appendices........................................................................................................................................... 93 Appendix 1: Community Health Improvement Process ................................................................. 93 Appendix 2: Gantt Chart .................................................................................................................. 94 Appendix 3: Community Health Need Prioritization...................................................................... 95 Appendix 4: Community Health Survey.......................................................................................... 96 Appendix 5: Stakeholder Survey....................................................................................................100 Appendix 6: Stakeholder Survey and Focus Group Locations ....................................................... 101 Appendix 7: Community Resource List ......................................................................................... 102 Appendix 8: Links and References to Other Community Health Assessments and Data...............104

Disclaimer This document has been produced to benefit the community. Carilion Clinic encourages use of this report for planning purposes and is interested in learning of its utilization. Comments and questions are welcome and can be submitted to Carilion Clinic Community Health & Outreach at communityoutreach@carilionclinic.org. Members of the Project Management Team reviewed all documents prior to publication and provided critical edits. Every effort has been made to ensure the accuracy of the information presented in this report; however, accuracy cannot be guaranteed. Members of the Tazewell County Community Health Assessment Team cannot accept responsibility for any consequences that result from the use of any information presented in this report.

Acknowledgements Success of the 2018 Tazewell County Community Health Assessment (TCCHA) was due to the strong leadership and participation of its Project Management Team, the Project Support Team, members of Tazewell County’s Coordinated Community Response Team (CCRT), and the Community Health Assessment Team. Thank you to all of the community members who participated in the Community Health Survey and focus groups.

Members of these teams included:

Project Management Team Project Director: Kathren Dowdy, Carilion Tazewell Community Hospital– Senior Director Project Director: Shirley Holland, Carilion Clinic– VP Planning and Community Development Project Manager: Aaron Boush, Carilion Clinic– Community Health & Outreach Manager Project Manager: Amy Michals, Carilion Clinic– Community Health & Outreach Analyst Project Manager: Stephanie Spencer, Carilion Tazewell Community Hospital – Health Educator Project Partner: Joey Carico, Southwest Virginia Legal Aid Society - Senior Staff Attorney

Project Support Team Carilion Clinic Community Health & Outreach Intern: Rohan Kaushal Carilion Clinic Community Health & Outreach Intern: Devki Patel Carilion Clinic Community Health & Outreach Intern: Emily Skywark Carilion Clinic Carilion Direct Volunteer Focus Group Facilitators and Scribes: Shenika Bowles, Kathren Dowdy, Ashley Hash, Amy Michals, Stephanie Spencer, Kenya Thompson

Tazewell County Coordinated Community Response Team The Tazewell County CCRT consists of a multidisciplinary team of professionals and citizens who gather regularly to examine the response of our community systems to victims and offenders of the crimes of domestic violence, sexual assault, dating violence and stalking. The multidisciplinary team is led by the local Juvenile and Domestic Relations Court Judge Martha Ketron, five (5) law enforcement agencies, the Commonwealth’s Attorney’s office, Clinch Valley Community Action (the local Domestic Violence Service Provider), the Department of Social Services, other family service providers, local health care providers, the Housing Authority, the Area Agency on Aging (AASC), court personnel, local collegiate higher education officials, magistrates and legal aid attorneys. The CCRT model is meant to be adapted to the needs of the community to include the identification of the health needs of the community.

Community Health Assessment Team (CHAT) Carilion Clinic’s CHAs are community-driven projects and success is highly dependent on the involvement of citizens, health and human service agencies, businesses, and community leaders. Community stakeholder collaborations known as “Community Health Assessment Teams” (CHAT) lead the CHA projects. The CHATs consists of health and human service agency leaders, persons with special knowledge of or expertise in public health, the local health department, and leaders, representatives, or members of the target pouplation. In Tazewell County, CCRT serves as the CHAT and additional key community leaders are invited to participate.

CHAT Members This list includes members that attended 50% (2) or more of the CHAT meetings.

Name

Organization

Briana Apgar

Cumberland Plateau Health District

Amelia Bandy

Cumberland Plateau Health District Southwest VA Community Health Systems

Community Health Education

Carilion Clinic Carilion Tazewell Community Hospital

Hospitals, Healthy Food

Attorney/Community Outreach

Alvin McCuiston

SWVA Legal Aid Society, Inc. Cumberland Plateau Regional Housing Authority Carilion Tazewell Community Hospital Southwest VA Community Health Systems

Pam Meade

Chamber of Commerce

Chamber Director Public Health / Community Health Assessment

Jamie Beavers Aaron Boush Kimberly Brown Joseph Carico Paula Culbertson Kathren Dowdy

Amy Michals

Carilion Clinic Carilion Tazewell Community Hospital and Carilion Giles Stephanie Spencer Community Hospital Sierra Steffen

Area of Expertise Public Health / Community Health Assessment

Outreach & Enrollment

Emergency Department Administration

Resident Services Coordinator CEO/CNO Medical Operations Director/PAC

Community Health

Carilion Clinic Appalachian Agency for Senior Brenda Thompson Citizens (AASC)

Health Data Analytics, Statistics

Kenya Thompson

Carilion Clinic

Hospitals, Scribe

Susan White

Clinch Valley Community Action

ROMA, Elder In-Home Support

Elder Rights/Ombudsina

Executive Summary Carilion Clinic and Tazewell County CCRT partnered to conduct the 2018 TCCHA. Together with partners, we are committed to the essential work of improving and maintaining the health of our communities. It is important to assess the health concerns of each community periodically to ensure that current needs are being addressed. A Community Health Assessment (CHA) every three years will uncover issues, indicate where improvement goals are needed, and track and promote progress in key areas, so that there is demonstrated, ongoing improvement. The work of conducting this CHA and the public availability of its findings is intended to enable the community to effectively plan the vital work of maintaining and improving health. The finding of the 2018 TCCHA revealed 10 priority health-related issues in the community, identified by the CHAT after review of the data collected. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Alcohol and drug use Access to mental / behavioral health services Transportation / transit system High uninsured / underinsured population Poverty / low average household income High prevalence of chronic disease Access to substance use services Poor diet Access to primary care Lack of health literacy / lack of knowledge of healthy behaviors

This report contains the findings of the 2018 TCCHA, including primary and secondary health and social determinant data on the service area and specific populations.

Description of the Community Defining the Community Served Tazewell County is nestled among the Appalachian Mountains in southwest Virginia and borders West Virginia to its north. Tazewell County has a land area of 518.85 square miles and about 86.9 persons per square mile1. Historically, what is now Tazewell County was a hunting ground for Native American tribes. The area’s abundance of wild game was a source of frequent skirmishes among these tribes. Tazewell County was chartered on December 19, 1799 and included five towns: Bluefield, Richlands, Tazewell, Cedar Bluff, and Pocahontas. The land for the county came from portions of the bordering Wythe and Russell counties2. Today, Tazewell County is home to an outstanding array of hiking, biking and ATV trails, scenic drives, including “Back of the Dragon,” outdoor parks, including Cavitt’s Creek Park, and venues for experiencing culture, art and history3.

Community Demographics The 2018 TCCHA revealed significant disparities both in health and in social determinants compared to the Commonwealth of Virginia. The 2012-2016 American Community Survey (ACS) found the total population of the counties of Tazewell County to be 43,3674. For Tazewell County, the ACS predicts very small positive future population change at 0.2% compared to the Commonwealth of Virginia at 9.2% by 2040. Median age is 43.7 in Tazewell County compared to 37.8 in Virginia5. The ACS finds that a larger percentage of the population is White in Tazewell County than in the Commonwealth of Virginia as a whole. In Tazewell County, 94.7% of the population is White and 3% of the population is Black6. All of Tazewell County is a designated Medically Underserved Area (MUA)7.

US Census, Quick Facts, 2010 Visit Tazewell County, Virginia. Retrieved from: http://visittazewellcounty.org/history/ 3 Visit Tazewell County, Virginia. Retrieved from: http://visittazewellcounty.org/ 4 U.S. Census Bureau, 2012-2016 5-year American Community Survey, Table S0101. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S0101&prodType=table 5 U.S. Census Bureau, 2012-2016 5-year American Community Survey, Table S0101 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S0101&prodType=table 6 U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table DP05 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_DP05&prodType=table 7 Department of Health and Human Services, Health Resources and Services Administration Data Warehouse (2018) https://datawarehouse.hrsa.gov/tools/analyzers/HpsaFindResults.aspx and https://datawarehouse.hrsa.gov/tools/analyzers/MuaSearchResults.aspx 1 2

Service Area The service areas for Carilion Clinicâ&#x20AC;&#x2122;s Community Health Assessments are determined by at least 70% of unique patient origin of the hospital in each respective market. There is a focus placed on areas that are considered MUAs and Health Professional Shortage Areas (HPSAs). Carilion Tazewell Community Hospital is located in Tazewell County, Virginia. In fiscal year 2017, CTCH served 5,592 unique patients. Patient origin data revealed that during this year, 82.89% of patients served by CTCH lived in Tazewell County.

Existing Resources Tazewell County is located in southwest Virginia and has a dedicated system of health and human service resources, as well and venues for exploring arts and culture and outdoor amenities. Health and human service organizations work to reduce the disparities in access to care and access to resources that still exist for many residents of the region. Please see Appendix 7 for a list of community resources serving Tazewell County.

Carilion Tazewell Community Hospital Carilion Tazewell Community Hospital (CTCH) is located in the beautiful mountains of southwest Virginia and primarily serves Tazewell County and the southern West Virginia counties of Mercer and McDowell. CTCH has private rooms and is equipped to treat patients needing medical care. They also support an extended care recovery program (Swing Bed) that gives eligible patients an opportunity to grow stronger before going home. CTCH hosts diagnostic services such as imaging, including screening mammography; and therapy services including physical therapy and respiratory therapy. CTCH offers 24/7 emergency services and can arrange access to higher levels of care if needed. Carilion Clinic Family Medicine and the Tazewell Veteranâ&#x20AC;&#x2122;s Outpatient Clinic offer primary care on site at entrance 2. CTCH officially became part of Carilion Clinic in 2008, but has been under Carilion's management since 1981. CTCH is dedicated to community, history, and family, as exemplified through memorials and tributes throughout the hospital. CTCH is part of Carilion Clinic, a not-for-profit health care organization based in Roanoke, Virginia. It is mission-driven, focusing everyday on improving the health of the communities we serve. Through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers, and other complementary services, quality care is provided close to home for nearly 1 million Virginians. With an enduring commitment to the health of our region, we also seek to advance care through medical education and research, helping our community stay healthy and inspire our region to grow stronger.

Community Health Assessment Process Method Carilion Clinic and Tazewell County CCRT partnered to conduct the 2018 TCCHA. A 16-member Community Health Assessment Team (CHAT) oversaw the planning activities. The service area included those living in Tazewell County. We strive to target the underserved/vulnerable populations disproportionately impacted by the social determinants of health, including poverty, race/ethnicity, education, and/or lack of insurance. Beginning in October 2017, primary data collection included a Community Health Survey, focus groups with key stakeholders and providers and focus groups with target populations. Secondary data collected include demographic and socioeconomic indicators as well as health indicators addressing access to care, health status, prevention, wellness, risky behaviors and the social environment. Collaboration In Tazewell County, CCRT has served as a convening partnership of health and human service organizations, the legal system and law enforcement, focused on domestic violence. CTCH has partnered with CCRT to conduct the 2018 Community Health Assessments and respond to identified community health priorities. CTCH participates regularly on CCRT and recruited CHAT members through CCRT for the 2018 TCCHA. CTCH and CCRT leadership partnered in the planning and execution of the 2018 TCCHA and will continue to partner and convene others to participate in strategies to address identified needs. Community Health Improvement Process Carilion Clinicâ&#x20AC;&#x2122;s Community Health Improvement Process was adapted from Associates in Process Improvementâ&#x20AC;&#x2122;s the Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle developed by Walter Shewhart8. It consists of five distinct steps: (1) conducting the CHA, (2) strategic planning, (3) creating the implementation strategy, (4) program implementation, and (5) evaluation. This cycle is repeated every three years to comply with IRS requirements. Each step in the process is explained below. Step 1: Conduct Community Health Assessment The first step in the Community Health Improvement Process is to conduct a Community Health Assessment. Led by a Community Health Assessment Team (CHAT), the assessment involves collection of primary and secondary data from numerous sources. Primary data include responses from a community health survey, open to all residents of the assessment area, as well as focus groups conducted with stakeholders and with target populations. The target populations are defined as underserved/vulnerable populations disproportionately impacted by the social determinants of health, including poverty, race/ethnicity, education, and/or lack of insurance.

Science of Improvement: How to Improve. (2014). Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx 8

Step 2: Strategic Planning After the completion of the CHA, the CHAT enters the strategic planning phase of the process. First, the CHAT must decide what community health needs to focus on and provide explanation as to what issues will be the focus and why. To help with this determination, the CHAT participates in an activity charting the top priorities on an axis, based on the feasibility and potential impact of solutions that could be implemented locally to address these issues. After the priority areas (needs) have been identified, the team participates in a strategic planning session. Break-out session format is used for the planning session. CHAT members spend the strategic planning session developing a framework of goals and strategies to use as a starting point for potential future community work. They discuss existing community partnerships that could potentially lead this work, including the Tazewell County CCRT. In the future, groups will identify alignment opportunities between organizations and system changes that are likely to lead to improvement and select new or existing strategies for the community that are most likely to succeed in addressing the needs. Step 3: Implementation Strategy After the CHA is completed, Carilion Clinic develops a written Implementation Strategy that specifies what health needs were identified in the CHA, what needs the organizations plans to address and what needs the organizations does not plan to address and reasons for each. Included in the document are expected outcomes for each community issue being addressed and proposed evidence-based interventions with goals and objectives that will be tracked over time (both process and outcome measures). The document must be formally approved by the organizationâ&#x20AC;&#x2122;s Board of Directors and filed on the organizations 990 tax return. Carilion Clinic will integrate the implementation strategy with existing organizational and community plans. Step 4: Program Implementation Carilion Clinic Community Health & Outreach and the CHAT will establish and monitor new and ongoing community health programs implemented to respond to the community health needs identified in the CHA. New programs will be piloted on a small scale first and will be continually assessed and improved using the PDSA cycle9. The goal of the PDSA cycle is to make small, sustained improvements over time. Relevant data are collected and analyzed for each program. After successful implementation of the pilot, the program can be implemented on a larger scale throughout Carilion Clinic or with other organizations in the community. The PDSA cycle is ongoing for existing community health improvement programs. Step 5: Evaluation Community health programs and metrics associated with the expected outcome in the implementation strategy will be monitored by Carilion Clinic Community Health and Outreach.

Plan â&#x20AC;&#x201C;Do-Study-Act (PDSA) Cycle (2008). Retrieved from: https://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle 9

Progress will be reported to CTCH’s Board of Directors from time to time, which may include periodic updates in the Administrator’s Report throughout the year, for each community health need identified in the last CHA cycle. In addition, the Board will be informed of community grant awards given by the hospital to fund health safety net programs in the community. Decisions on funding of health safety net programs will be based on available resources and the impact on addressing a documented community health need identified in the CHA. For more information, see https://www.carilionclinic.org/communityhealth-outreach. Finally, Carilion Clinic will update progress made on each community health need identified in the most resent CHA cycle annually on the organization’s 990 tax form.

Data Collection The CHAT leads the assessment and oversees primary and secondary data collection. Beginning in October 2017, primary data collection included a Community Health Survey, focus groups with key stakeholders and providers, and focus groups with target populations. Secondary data were collected, including demographic and socioeconomic indicators, as well as health indicators addressing access to care, health status, prevention, wellness, risky behaviors and the social environment. Community Health Survey (CHS): The CHS consists of 38 questions for adults, age 18 and older, about access and barriers to healthcare, general health questions, and demographic information. The survey mirrors Healthy People 2020 goals, as well as many other national health surveys that do not collect health care data at the zip code level. This survey is not a scientific survey and the survey method uses oversampling techniques of the target population (please see Appendix 4 for Carilion Tazewell Community Hospital’s CHS). Efforts are made to keep as many questions consistent from the previous CHS for result trending purposes. An incentive for completing the CHS was provided to encourage participation. Focus Groups: Focus groups are conducted with many groups of individuals in an effort to best understand health in Tazewell County. The goal of the focus groups is to identify barriers to care and gaps in services for primary care, dental and mental health/substance use services for the population. An effort was made to meet with groups representing each lifecycle (parents and women of child-bearing age, adults, and the elderly) living in MUAs. We strive to target our assessment of health care and barriers for those underserved and vulnerable populations disproportionately impacted by the social determinants of health. Information provided by focus groups was analyzed to understand themes of group responses. For each group, there were no more than 15 participants. A facilitator and scribe conducted each focus group meeting and the audio of the meetings were recorded and later transcribed to be analyzed. In order to contribute, participants signed consent forms prior to each meeting agreeing on the format of the meeting, how information would be used and to ensure confidentiality. The groups were held in convenient, neutral locations and/or in sites where participants already congregate. Snacks and beverages were provided. 12

The script for the focus groups is simple and consists of six open-ended questions, as detailed below: 1. In one or two words, how would you describe good health? 2. Looking at this list, what things do you need to have good health like what weâ&#x20AC;&#x2122;ve described? Do you have these things? 3. What do you, or your family and friends, do when you need a check-up or are sick? 4. What do you, or your family and friends, do when you have a toothache or need your teeth cleaned? 5. What do you, or your family and friends, do when you need to talk to someone about your nerves/stress/depression or need help with alcohol or drug use? 6. Is there anything else you would like to tell us about your health or the health of others in Tazewell County? Stakeholder Survey: A six-question, open-ended survey is collected from key community stakeholders with insight into the health of the community, more specifically of those in target populations. Stakeholders are identified by the CHAT or by the Project Management Team.

Prioritization After all primary and secondary data collection is complete, the CHAT reviews all data and participates in a prioritization activity. This activity consists of each CHAT member picking the ten most pertinent community needs and ranking them on a scale of one to ten, with one being the most pertinent. The categories listed on the prioritization activity sheet align with the Robert Wood Johnson Foundation framework for what influences health (please see Appendix 3 to view the prioritization worksheet). The data are combined and priorities are selected based on the number of times a category is selected in the top 10, with average ranking serving as a tie-breaker. Once the priorities have been selected, the CHAT participates in an activity to rate the feasibility and potential impact of a solution to each health issue.

Robert Wood Johnson Foundation Framework According to the Robert Wood Johnson Foundation’s (RWJF) County Health Rankings10, where an individual lives, works and plays is a strong predictor of their health outcomes. Currently in the United States, a person’s zip code can help predict their life expectancy due to its direct link to the social determinants of health such as poverty, race/ethnicity, education and employment status in these areas11. These factors are so important to our overall health, that they were added to the 10year national Healthy People 2020 objectives with a goal to “create social and physical environments that promote good health for all”12. Carilion responds to community health needs in innovative ways: making sure our regions have access to state-of-the-art healthcare close to home; providing community grants and sponsorships to extend our mission and support other organizations that address health need; creating and implementing community-wide strategies to reduce barriers, coordinate resources and enhance community strengths; and by providing community-based health and wellness programming. Our community-based programs and community grants are categorized using the RWJF framework for what influences health: health behaviors; social and economic factors; clinical care access and quality; and physical environment13. We measure our success by tracking related indicators at the regional, local, and zip code level, as well as by monitoring change and improvement in the County Health Rankings of our municipalities.

Target Population The target population for Carilion Clinic’s CHA projects consists of the following groups: underserved/vulnerable populations disproportionately impacted by the social determinants of health including poverty, race/ethnicity, education, and/or lack of insurance. Populations are examined across the different life cycles including parents of children and adolescents, women of child-bearing age, adults, and the elderly as well as across various race and ethnic groups.

County Health Ranking & Roadmaps. Retrieved from: http://www.countyhealthrankings.org/ Robert Wood Johnson Foundation. Retrieved from: https://www.rwjf.org/en/library/interactives/whereyouliveaffectshowlongyoulive.html 12 Social Determinates of Health. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-ofhealth 13 County Health Ranking & Roadmaps. Retrieved from: http://www.countyhealthrankings.org/ 10 11

Community Health Assessment Findings The finding of the 2018 TCCHA revealed 10 priority health-related issues in the community, identified by the CHAT after review of the data collected. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Alcohol and drug use Access to mental / behavioral health services Transportation / transit system High uninsured / underinsured population Poverty / low average household income High prevalence of chronic disease (general) Access to substance use services Poor diet Access to primary care Lack of health literacy / lack of knowledge of healthy behaviors

The results of the assessment reflected a variety of social determinant of health factors, showing the understood impact that these factors have on overall health. The findings revealed distinct disparities in health for those living in poverty. As in years past, Tazewell County generally performs worse than the Commonwealth of Virginia as a whole. Academic attainment rates were lower as was median household income, more children were eligible for free and reduced lunch, and unemployment rates, while improving, were still lagging the statewide and national averages, impacting the social determinants of health. Many of the respondents to the Community Health Survey and focus group participants, whether insured or uninsured, noted that the cost of care keeps them from accessing preventive care and services. Survey responses revealed â&#x20AC;&#x153;Costâ&#x20AC;? to be the top reason that people feel prevents them from getting the healthcare they need. Stakeholders identified substance use as the biggest issue that impacts health, followed by lack of insurance. Lack of transportation was identified as the biggest barrier to health, followed by lack of insurance. Target population focus groups also discussed the barriers of transportation and lack of insurance. According to the American Community Survey (ACS), 42.2% of people in Tazewell County live below 200% of the Federal Poverty Level (FPL) compared to 26.5% for the Commonwealth of Virginia. This rate is even higher for children in Tazewell County. The rate of poverty can be seen through free and reduced lunch qualifications in school systems. As a whole in the 2017/2018 school year, 63% of students in Tazewell County qualified14. Graduation rates in Tazewell County have varied in the last couple of years, but fell shy of the state average of 91.3% in 2017 at 89.5%. Graham High School outperformed the state rate while Richlands High School and Tazewell High School underperformed. When evaluating the academic Virginia Department of Education National School Lunch Program Free and Reduced Price Eligibility Reports http://www.doe.virginia.gov/support/nutrition/statistics/ 14

attainment rates for the population 25 and over, Tazewell County has lower overall education levels than the Commonwealth of Virginia at 88.6% of residents with a high school degree or higher and 36.9% with a Bachelor’s degree or higher. In Tazewell, an average of 78.8% of people have a high school degree or higher, and only 14.6% have a Bachelor’s degree or higher15. When asked about the most important issues that affect health in our community, 54.4% of survey respondents answered “alcohol and illegal drug use,” followed by 43.0% answering “cancer,” and 36.6% answering “obesity/overweight.” Stakeholders reported that substance use and transportation were the most important issues. The Virginia Department of Health reports that in 2016, the emergency department (ED) opioid overdose rate in Tazewell County was 78.3 overdoses per 100,000 population. This compares to the state ED opioid overdose rate of 103.5 overdoses per 100,000 population16. The Commonwealth of Virginia, along with many other states, has declared opioid addiction to be a public health emergency and the health commissioner has issued a standing order making Naloxone available to any resident to treat an overdose17. Narcan (Naloxone) use rates have been lower than the state average in Tazewell County at 33.2 per 100,000 population according to Virginia Department of Health data. Fatal prescription overdose rates have been worse than the state rate of 5.5 per 100,000 at 11.9 per 100,000 population18. The CHAT prioritized “alcohol and drug use” as the top health need, recognizing the significance of this crisis in our region. When asked, what health care services were hard to get in our community, survey respondents answered that “specialty care” (40.9%) was the most challenging to access, followed by “cancer care” (38.1%), “alternative therapy” (29.3%), “substance abuse services for drugs and alcohol” (26.1%) and “adult dental care” (25.0%).

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S1501 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1501&prodType=table 16 Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/ 17 Virginia declared opioid emergency, makes antidote available to all. Retrieved from: https://www.washingtonpost.com/local/virginiapolitics/virginia-declares-opioid-emergency-makes-antidote-available-to-all/2016/11/21/f9b4f348-b00e-11e6-be1c8cec35b1ad25_story.html?noredirect=on&utm_term=.f0386afe4b79 18 Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/ 15

Community Impact Response Since the 2016 TCCHA Carilion Clinic responds to community health needs in innovative ways: making sure our regions have access to state-of-the-art healthcare close to home; providing community grants and sponsorships to extend our mission and support other organizations that address health need; creating and implementing community-wide strategies to reduce barriers, coordinate resources and enhance community strengths; and by providing community-based health and wellness programming. Our community-based programs and community grants are categorized by using the RWJF framework for what influences health: health behaviors; social and economic factors; clinical care access and quality; and physical environment. In response to the health needs that were identified in the 2016 TCCHA, Community Health and Outreach hired a part-time Health Educator to serve the Tazewell County area. Since fall of 2016, the hospital has provided 56 holistic health events that included a variety of health education, health screenings and immunizations that reached 1,544 people. Carilion also provided grant funding to the Four Seasons YMCA to build a walking trail open to community. Carilion and community partners have worked hard improve access to services in the area. To increase access to primary care, CTCH has expanded and relocated the Tazewell Family and Community Medicine practice site, added same day appointments, and partnered with the Veterans Administration to expand access to the veteran population. Practice staff has grown by 19 people and the practice reports seeing more patients. In addition, CTCH partnered with the local Federally Qualified Health Center (FQHC) to administered information packets to patients about Health Insurance Market Place enrollment. To address mental health and substance abuse, CTCH is piloting tele-psychology at the VA Clinic. In addition, CTCH leadership started participating in the Appalachian Substance Abuse Coalition and Tazewell County CCRT. CTCH Leadership serves on the Substance Abuse Taskforce in Rural Appalachia. Drug deactivation packets and drug tests have been given out and the hospital is working with Cumberland Mountain Community Services Board to implement peer-coaching project at the hospital.

Success Measures Tazewell County’s RWJF’s County Health Outcome Ranking has improved for the past three consecutive years, while its Health Factors Ranking has seen a decrease over the last three years. This means that today’s health (outcomes) appears to be improving, while factor that influence health (social determinates, access, environment, and healthy behaviors) is trending in the wrong direction19. In addition to County Health Rankings, Carilion Clinic monitors program outcomes for internal health programming, as well as for grant funded programs. A scorecard is being created to track specific secondary, primary, and program outcome indicators. The analysis below shows directional trends between the 2016 and 2018 CHS results. * Denotes significant change from 2016 measurement. Right direction:  ED visit in past 12 months  ED visits for injuries  Taking medicine doctor tells me to  Affording medicine needed for health conditions  Having a Pap smear  Having a mammogram  Having a colonoscopy  Neighborhood supporting physical activity  Having enough money for food for family  Being told by a doctor that you have high blood sugar or diabetes  Time since last doctor check-up *  Using dental care services  Having health insurance  Having dental insurance Wrong direction:  Neighborhood supporting healthy eating  Eating fruits and vegetables one or more times per day  Eating together with family  Being told by a doctor that you have: o Depression or anxiety o High cholesterol o Long-term, chronic illness

County Health Rankings http://www.countyhealthrankings.org/app/virginia/2018/downloads 19

2018 Community Health Assessment Data Primary Data and Community Engagement Stakeholder Survey Results Throughout the CHA process, community stakeholders, leaders, and providers were encouraged to complete the Stakeholder Survey (Appendix 5: Stakeholder Survey). This survey provided an additional perspective to the needs and barriers to health facing our community. Stakeholder focus groups were held in addition to Stakeholder Survey distribution, to ensure all responses were captured. The survey was available online and in print, and was distributed at meetings and focus groups. In total, 17 surveys were completed: 8 online surveys 9 print surveys 1 focus group Substance use was overwhelmingly identified by stakeholders as the most important issue that impacts health, followed by lack of insurance. Lack of transportation was identified as the biggest barrier to health, closely followed by lack of insurance. No single area was identified as a locality with the greatest unmet need. Most respondents reported that all areas have equal need, though some respondents singled out the smaller rural communities. The population groups identified with the greatest unmet need were those with low income, youth, and the elderly. Respondents identified physician recruitment, access to substance use treatment, and law enforcement support for substance use issues as possible changes the community could make to meet the needs and reduce the barriers to health. Stakeholders were asked the following questions. Main themes, subcategories, and percent of respondents that identified them are graphed.

1. What are the most important issues (needs) that impact health in your community? Main themes, subcategories, and percent of respondents that identified them: Access to services: Transportation Lack of specialty care Lack of mental health providers Lack of physicians Lack of dental care Lack of primary care Lack of access, general Lack of recreation facilities Lack of substance use programs Lack of care for aging population 0%

10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

Social factors: Lack of insurance Poverty Job opportunities Education Lack of economic development Population loss Food insecurity

Health behaviors: Substance use Healthy diet Lack of exercise

Health outcomes: Mental health problems Obesity Diabetes COPD % of respondents

Total respondents: 16 20

2. What are the barriers to health for the populations you serve? Main themes, subcategories, and percent of respondents that identified them: Access to services: Transportation Lack of primary care Wait times Access, general

Lack of specialists Easy access to fast food Lack of accessible walking areas Lack of substance use treatment 0%

10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

10%

20%

30%

40%

50%

60%

70%

Social factors: Lack / Cost of insurance Education Poverty Unemployment Lack of economic development Lack of knowledge of resources Stigma surrounding medical conditions

Lack of community support No contingency plan to escape circumstances

Health behaviors: Substance use

Overuse of ED % of respondents

Total respondents: 15

3. Is there one locality / neighborhood with the greatest unmet need? Main themes and percent of respondents that identified them:

All areas Smaller rural communities Tazewell County 0%

10%

20%

30% 40% % of respondents

50%

60%

Total respondents: 9

4. Is there one population group with the greatest unmet need? Main themes and percent of respondents that identified them: Low income Youth Elderly

Working poor Those with mental health issues Those with substance use issues Parents Uninsured Those with COPD Those with Black Lung 0%

10%

15%

20%

% of respondents

Total respondents: 9

25%

30%

35%

5. What are the resources for health for the populations you serve? Appalachian Agency for Senior Citizens Appalachian Substance Abuse Coalition for Prevention and Treatment Cardiopulmonary Physical Therapy Care Transition Program @ CTCH Carilion Tazewell Community Hospital Celebrate Recovery Churches Clinch Valley Community Action Clinch Valley Medical Center Community Health Coalitions Community Services Board Cumberland Mountain Community Service Board Department of Social Services Drug Court Programs Emergency Department Financial assistance programs Gathering Resources and Opportunities for Wellness Coalition (GROW) Health Department Hospital Methadone Clinic Remote Area Medical (RAM) Substance Abuse Taskforce in Rural Appalachia (SATIRA) Southside Virginia Community College Support Groups Taking Action for Special Kids (TASK) Tazewell Community Health Tazewell County Parks and Recreation Tazewell County Public Schools Virginia Cooperative Extension YMCA

6. If we could make one change as a community to meet the needs and reduce the barriers to health, what would that be? Main themes, subcategories, and percent of respondents that identified them: Physican recruitment Substance use treatment Law enforcement support for substance use issues Transportation Holistic solutions Local care / clinics Mental health focus Decrease substance abuse Affordable health insurance Make healthy the new norm

College/Career planning for students 0%

% of respondents

Total respondents: 14

12%

15%

Target Population Focus Group Results Target population focus groups were conducted to capture the needs and barriers to health for the uninsured, underinsured, low-income, minority, senior, and chronically ill populations. Focus group locations were chosen based on their service to target populations, and where existing groups already met. Four target population focus groups were held and were asked questions related to needs and barriers to health, and access to primary, oral, and mental health care. Focus group locations: Head Start: Head Start is a child development program that focuses on reaching low-income children and families. Children receive free mental and dental care, healthy meals, and educational activities to prepare them to enter kindergarten. The focus group was held with parents of children in the Head Start program. For more information, visit http://clinchvalleycaa.org/cvca-programs/head-start/ Labor of Love Mission: Labor of Love mission is a nonprofit organization located in Tazewell, Virginia, focused on providing relief free of charge for the poor, the distressed, and the underprivileged. They distribute food, commodities and clothing all year long, provide Christmas to children, help those without prescription insurance access prescribed medications, provide school age children with haircuts, and help provide furniture and other items to all in need For more information, visit http://www.laboroflovemission.org/ Tazewell Lions Club: Lions Clubs are known best for fighting blindness, but they also volunteer for environmental projects, feed the hungry, and aid seniors and the disabled. They also support local children and schools by providing scholarships, recreation, and mentoring programs. For more information, visit http://e-clubhouse.org/sites/tazewell/index.php Cumberland Mountain Community Services Board: Veterans Group: CMCSB is one of 40 Community Service Boards in the Commonwealth of Virginia. CMCSB provides a variety of child and family, intellectual disability, mental health and substance abuse services to residents of Tazewell, Buchanan and Russell Counties. For more information, visit https://www.cmcsb.com/

Focus Group Demographics Race / Ethnicity

Education Level 3%

Less than high school Some high school High school diploma Associates

14% White Black / African American

14%

94%

Masters / Phd

Yearly Household Income

Age Group 9%

15%

17-34

3% 3%

12% 42%

45-54 55-64

$10,001 - $20,000

38%

75-85

$40,001 -$50,000 $50,001 - $60,000

$60,001 - $70,000

21%

Employment Status 50%

Retired

40% 30%

Unemployed 20%

16%

Full-time

53%

$70,001 - $100,000

$100,001 and above

Insurance Type

3% 6%

$20,001 - $30,000 $30,001 - $40,000

14%

65-74

18%

$0 - $10,000

10%

35-44

22%

Bachelors

56%

Homemaker

10% 0%

Selfemployed

Focus Group Responses To begin the focus groups, attendees were asked to describe good health. A word cloud was created to show results; the larger the word is in the cloud, the more a term was used. 1. In one or two words, how would you describe good health?

Responses from the rest of the questions revealed that focus groups were aware of the many factors that influence good health- not just clinical care, but socioeconomic factors as well. These social needs can limit access to services and encourage home remedies or neglect in place of preventive and regular care. When care was needed, relying on home remedies was just as frequently identified as going to the doctor or dentist. Long wait times, out-of-town travel, and lack of specialty care were frequent themes as well. One focus group attendee described these barriers, saying “In this area, if you need to see a specialist, you need to go to Tennessee or West Virginia. A lot of people travel a long way or just don’t have the finances or transportation to go.” These needs of financial stability and transportation reflected a common theme from the stakeholder survey as well. Another focus group attendee described the lack of local care and services by saying, “Everything down here is kind of slighted. Virginia seems to stop at Roanoke.” Focus group attendees recognized the many barriers to accessing adequate healthcare, along with the socioeconomic factors that further complicate these barriers.

2. Looking at this list, what things do you need to have good health like what weâ&#x20AC;&#x2122;ve described? Main themes and percent of focus groups that identified them: Access to services Social needs Healthy environment

Healthy behaviors Other 0%

25%

50% % of focus groups

Subcategories of main themes: Access to services: Medications Access to doctors Good quality care Social needs: Family Education Insurance A good job Social support Healthy environment: Safe home Clean air and water Healthy behaviors: Exercise Motivation Rest / Sleep Healthy food Healthy lifestyle Positive outlook Time management Other: Faith Communication with doctor

75%

100%

3. What do you, or your family and friends, do when you need a check-up or are sick? Main themes and percent of focus groups that identified them: Go to the doctor Home remedies

Nothing Social support Other 0%

25%

50% % of focus groups

Subcategories of main themes: Go to the doctor: Go to ER Urgent Care Telemedicine Doctorâ&#x20AC;&#x2122;s office Go out of town for care Home remedies: Pray Stay home Rest / Sleep Drink fluids Hand hygiene OTC medication Internet research Nothing: Lack of trust Long wait times Hard to get appointments Social support: Talk with family and friends Other: Call 911 Misuse of EMS Self-medicate with alcohol 29

75%

100%

4. What do you, or your family and friends, do when you have a toothache or need your teeth cleaned? Main themes and percent of focus groups that identified them: Home remedies Go to dentist Pull tooth Nothing Other 0%

25%

50% % of focus groups

Subcategories of main themes: Home remedies: Orajel Clove oil Goodies powder Cinnamon paste Hot water bottle OTC pain medication Go to dentist: Go to ER RAM Clinics Dentist office Nothing: No insurance Long wait times Live with the pain Other: Change diet Lack of trust of local dentists

75%

100%

5. What do you, or your family and friends, do when you need to talk to someone about your nerves / stress / depression or need help with alcohol or drug abuse? Main themes and percent of focus groups that identified them: Visit health professional Social support Self-care Visit church / pastor Self-medicate 0%

25%

50% % of focus groups

Subcategories of main themes: Visit health professional: Counseling Help from personal doctor Social support: Recovery groups Talk to family and friends Self-care: Pray Yoga Sleep Exercise Take a bath Take vacation Listen to music Self-medicate: Drugs Alcohol Binge eat

75%

100%

6. Is there anything else you would like to tell us about your health or the health of others in Tazewell? Main themes and percent of focus groups that identified them: Wait times for appointments Must travel out of town for resources Lack of specialty services Coordination of care 0%

25%

50% % of focus groups

Other responses: Access to care Substance use Holistic medicine Parenting classes Bullying in schools Vaccine skepticism Lack of transportation Medication management Behavioral issues in children Lack of insurance - vision care Need walk in clinic / urgent care Physicians don't want to stay in this area Can't get medication because you are seen as a drug seeker Lack of trust in doctors: Doctors need to listen more to patients

75%

100%

Tazewell County Community Health Survey Results A Community Health Survey was conducted as part of the Tazewell County Community Health Assessment. This survey was used to evaluate the health of the community and identify potential geographic areas to target improvements. Input and oversight of survey development was provided by the Community Health Assessment Team (CHAT). A 38-question survey instrument was developed that asked questions about socioeconomic factors, access to medical, dental, and mental health care, healthy behaviors, physical environment, health outcomes, and demographics. The survey instrument included commonly used questions and metrics from the following established community surveys:  Community Themes and Strengths Assessments, National Association of County and City Health Officials (NACCHO), Mobilizing for Action through Planning and Partnerships (MAPP)  Community Healthy Living Index, YMCA  Behavioral Risk Factor Surveillance System, Centers for Disease Control (CDC)  National Health Interview Survey, Centers for Disease Control (CDC)  Youth Risk Behavior Surveillance System, Centers for Disease Control (CDC)  Martin County Community Health Assessment, Martin County, North Carolina  Previous Tazewell County Community Health Surveys Both an English and Spanish version of the survey was available (Appendix 4: Community Health Survey). The CHAT identified target populations, collection sites, and methods of survey distribution. The population of interest for the survey was Tazewell County residents 18 years of age and older. The following subpopulations were especially targeted for sampling: 

Underserved/vulnerable populations disproportionately impacted by the social determinants of health including: o Poverty o Race/ethnicity o Education o Lack of insurance

A non-probability sample method was used, where respondents were not randomly selected. Although the survey was available to all residents living in Tazewell County, oversampling of the targeted subpopulations occurred through specific outreach efforts. Oversampling of the targeted subpopulation ensured that needs and assets specific to this subpopulation of interest were captured. Surveys were distributed in October 2017 through February 2018. Over 10 organizations, agencies, and community members assisted in the distribution of the survey. A drawing for a $50 grocery gift card for those who completed the survey was offered as an incentive. 33

The survey instrument was available via the following methods:  Survey Monkey link (www.surveymonkey.com/r/2018CHA)  Phone line (888-964-6620)  Paper surveys (collected by volunteers and/or staff of partner agencies) Outreach strategies for survey distribution included:  Facebook  Face-to-face survey interviews at sites / agencies that serve the target populations using volunteers and/or staff  Flyers and posters distributed throughout the community with survey URL and phone line information  Survey URL posted on partner agency websites In total, 388 surveys were collected: 309 paper surveys 79 online surveys 0 phone surveys All responses were entered into Survey Monkey by survey respondents or by Carilion Direct who entered responses from paper or phone surveys. Surveys were analyzed and reported using Survey Monkey and Microsoft Excel.

Community Health Survey Demographics County of residence Locality Tazewell County Total responses:

# 388 388

% 100%

Which of the following describes your current type of health insurance? (Check all that apply)

Employer Provided Insurance Medicare Dental Insurance Medicaid Medicare Supplement No Health Insurance Individual / Private Insurance / Market Place / Obamacare No Dental Insurance Government (VA, Champus) Health Savings / Spending Account COBRA Answered Skipped

# 152 84 65 42 42 37 34 33 18 13 3 342 46

% 44.4% 24.6% 19.0% 12.3% 12.3% 10.8% 9.9% 9.7% 5.3% 3.8% 0.9%

If you have no health insurance, why donâ&#x20AC;&#x2122;t you have insurance? (Check all that apply)

Not applicable- I have health insurance Too expensive / cost Not available at my job Unemployed / no job I donâ&#x20AC;&#x2122;t understand Marketplace / Obamacare Options Student Other Answered Skipped

# 183 29 13 9 4 2 3 225 163

% 81.3% 12.9% 5.8% 4.0% 1.8% 0.9% 1.3%

What is your zip code? Zip Code 24630 24651 24609 24605 24641 24637 Other

# 104 88 41 40 21 17 54

% 28.5% 24.1% 11.2% 11.0% 5.8% 4.7% 14.8%

What is your age? Average: Answered Skipped

51.4 327 61

What is your gender? # 265 74 0 0 339 49

Female Male Transgender Other Answered Skipped

% 78.2% 21.8% 0.0% 0.0%

Gender

90% 80% 70%

60% 50% 40%

30% 20% 10% 0% Male

Female

Transgender

Other

Height, in inches: Median: Answered Skipped

Weight, in pounds: 65.0 328 60

Median: 180.0 Answered 318 Skipped 70

Weight status and BMI: Underweight Normal Overweight Obese Median BMI:

0.6% 21.8% 31.2% 46.4% 29.5

Weight Status 1%

22%

Underweight 46%

Normal Overweight Obese 31%

How many people live in your home (including yourself)? 0-17 average: 18-64 average: 65+ average: Answered Skipped

1.0 1.8 0.7 341 47

What is your highest education level completed?

Less than high school Some high school High school diploma Associates Bachelors Masters / PhD Answered Skipped

# 4 25 162 75 46 29 341 47

% 1.2% 7.3% 47.5% 22.0% 13.5% 8.5%

Education Level 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Less than high school

Some high school

High school diploma

Associates

Bachelors

Masters / PhD

What is your primary language?

English Spanish Other Answered Skipped

# 334 2 1 337 51

% 99.1% 0.6% 0.3%

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

Spanish

Other

What ethnicity do you identify with? (Check all that apply)

White Black / African American More than one race Asian Latino Native Hawaiian / Pacific Islander Decline to answer American Indian / Alaskan Native Other Answered Skipped 39

# 322 8 4 2 2 2 2 0 0 340 48

% 94.7% 2.4% 1.2% 0.6% 0.6% 0.6% 0.6% 0.0% 0.0%

What is your marital status? Married Single Divorced Widowed Domestic Partnership Answered Skipped

# 186 56 55 33 4 334 54

% 55.7% 16.8% 16.5% 9.9% 1.2%

Marital Status 60% 50% 40% 30% 20% 10% 0% Married

Single

Divorced

Widowed

Domestic Partnership

What is your yearly household income? $0 – $10,000 $10,001 – $20,000 $20,001 – $30,000 $30,001 – $40,000 $40,001 – $50,000 $50,001 – $60,000 $60,001 – $70,000 $70,001 – $100,000 $100,001 and above Answered Skipped

# 55 44 60 29 25 22 13 40 26 314 74

% 17.5% 14.0% 19.1% 9.2% 8.0% 7.0% 4.1% 12.7% 8.3%

Yearly Household Income 25% 20% 15% 10% 5%

0% $0 – $10,001 – $20,001 – $30,001 – $40,001 – $50,001 – $60,001 – $70,001 – $100,001 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $100,000 and above

What is your current employment status?

Full-time Retired Unemployed Part-time Homemaker Student Self-employed Answered Skipped

# 162 69 37 34 18 7 5 332 56

% 48.8% 20.8% 11.1% 10.2% 5.4% 2.1% 1.5%

Employment Status 60% 50% 40% 30% 20% 10% 0%

Community Health Survey Responses 1. Do you use medical care services? Yes No Answered Skipped

# 361 21 382 6

% 94.5% 5.5%

Do you use medical care services? 6%

Yes No

94%

Where do you go for medical care? (Check all that apply) Doctorâ&#x20AC;&#x2122;s Office Emergency Room Urgent Care / Walk in Clinic Carilion Clinic Family Medicine â&#x20AC;&#x201C; Tazewell Tazewell Community Health Bluefield Regional Medical Center Nurse Practitioner's Office Health Department Bland Clinic Free Clinic Salem VA Medical Center Other Answered Skipped

# 237 94 86 74 61 31 23 19 14 8 6 14 366 22

% 64.8% 25.7% 23.5% 20.2% 16.7% 8.5% 6.3% 5.2% 3.8% 2.2% 1.6% 3.8%

2. Do you use dental care services?

Yes No Answered Skipped

# 289 91 380 8

% 76.1% 24.0%

Do you use dental care services?

24%

Yes No

76%

Where do you go for dental care? (Check all that apply) Dentistâ&#x20AC;&#x2122;s office Free Clinic Salem VA Medical Center RAM (Remote Area Medical - once a year) Urgent Care / Walk in Clinic Emergency Room Other Answered Skipped

# 275 9 4 3 2 1 4 292 96

% 94.2% 3.1% 1.4% 1.0% 0.7% 0.3% 1.4%

3. Do you use mental health, alcohol abuse, or drug abuse services?

Yes No Answered Skipped

# 43 340 383 5

% 11.2% 88.8%

Do you use mental health, alcohol abuse, or drug abuse services? 11%

Yes No

89%

Where do you go for mental health, alcohol abuse, or drug abuse services? (Check all that apply) # % Doctor/Counselorâ&#x20AC;&#x2122;s Office 27 64.3% Cumberland Mountain CSB 9 21.4% Salem VA Medical Center 3 7.1% Emergency Room 1 2.4% Free Clinic 0 0.0% Urgent Care / Walk in Clinic 0 0.0% Other 6 14.3% Answered 42 Skipped 346

4. What do you think are the five most important issues that affect health in our community? (Please check five) # % Alcohol and illegal drug use 205 54.4% Cancers 162 43.0% Overweight / obesity 138 36.6% Prescription drug abuse 119 31.6% Diabetes 100 26.5% Heart disease and stroke 88 23.3% Access to healthy foods 84 22.3% Child abuse / neglect 69 18.3% Mental health problems 68 18.0% Poor eating habits 68 18.0% Tobacco use / smoking 61 16.2% Stress 60 15.9% Aging problems 58 15.4% Lack of exercise 54 14.3% High blood pressure 52 13.8% Cell phone use / texting and driving / distracted driving 49 13.0% Access to affordable housing 46 12.2% Bullying 39 10.3% Dental problems 35 9.3% Domestic violence 34 9.0% Lung disease 32 8.5% Environmental health (e.g. water quality, air quality, pesticides, etc.) 27 7.2% Not getting â&#x20AC;&#x153;shotsâ&#x20AC;? to prevent disease 16 4.2% Suicide 15 4.0% Accidents in the home (ex. falls, burns, cuts) 13 3.5% Teenage pregnancy 11 2.9% Not using seat belts / child safety seats / helmets 10 2.7% Neighborhood safety 7 1.9% Unsafe sex 7 1.9% Gang activity 5 1.3% Homicide 5 1.3% Sexual assault 5 1.3% HIV / AIDS 4 1.1% Infant death 1 0.3% Other 32 8.5% Answered 377 Skipped 11

5. Which health care services are hard to get in our community? (Check all that apply)

Specialty care (ex. heart doctor) Cancer care Alternative therapy (ex. herbal, acupuncture, massage) Substance abuse services â&#x20AC;&#x201C;drug and alcohol Adult dental care Family doctor Programs to stop using tobacco products Mental health / counseling Dermatology Eldercare Vision care Womenâ&#x20AC;&#x2122;s health services Domestic violence services Urgent care / walk in clinic Emergency room care Medication / medical supplies Child dental care Preventive care (ex. yearly check-ups) End of life / hospice / palliative care Physical therapy X-rays / mammograms Family planning / birth control None Ambulance services Inpatient hospital Lab work Chiropractic care Immunizations Other Answered Skipped

# 144 134 103 92 88 85 85 81 80 72 67 59 46 45 34 32 27 21 20 19 19 18 18 14 14 13 9 5 9 352 36

% 40.9% 38.1% 29.3% 26.1% 25.0% 24.2% 24.2% 23.0% 22.7% 20.5% 19.0% 16.8% 13.1% 12.8% 9.7% 9.1% 7.7% 6.0% 5.7% 5.4% 5.4% 5.1% 5.1% 4.0% 4.0% 3.7% 2.6% 1.4% 2.6%

6. What do you feel prevents you from getting the healthcare you need? (Check all that apply)

Cost Long waits for appointments High co-pay Lack of evening and weekend services I can get the healthcare I need No health Insurance Don’t know what types of services are available Location of offices Have no regular source of healthcare Afraid to have check-ups Don’t trust doctors / clinics Can’t find providers that accept my Medicaid insurance Can’t find providers that accept my Medicare insurance No transportation Childcare Don’t like accepting government assistance Language services Other Answered Skipped

# 153 103 100 89 80 53 42 36 31 20 20 19 18 18 12 8 5 9 336 52

% 45.5% 30.7% 29.8% 26.5% 23.8% 15.8% 12.5% 10.7% 9.2% 6.0% 6.0% 5.7% 5.4% 5.4% 3.6% 2.4% 1.5% 2.7%

7. Please check one of the following for each statement: Yes # I have had an eye exam within the past 12 months.

No #

Not applicable # %

210 59.7%

142 40.3%

41 11.8%

264 76.1%

I have had a dental exam within the past 12 months.

194 55.6%

152 43.6%

0.9%

I have been to the emergency room in the past 12 months.

103 29.8%

238 68.8%

1.5%

I have had a mental health / substance abuse visit within the past 12 months.

I have been to the emergency room for an injury in the past 12 months (e.g. motor vehicle crash, fall, poisoning, burn, cut, etc.). I have been a victim of domestic violence or abuse in the past 12 months. My doctor has told me that I have a long-term or chronic illness. I take the medicine my doctor tells me to take to control my chronic illness. I can afford medicine needed for my health conditions. I am over 21 years of age and have had a Pap smear in the past three years (if male or under 21, please check not applicable). I am over 40 years of age and have had a mammogram in the past 12 months (if male or under 40, please check not applicable). I am over 50 years of age and have had a colonoscopy in the past 10 years (if under 50, please check not applicable). Does your neighborhood support physical activity? (e.g. parks, sidewalks, bike lanes, etc.) Does your neighborhood support healthy eating? (e.g. community gardens, farmersâ&#x20AC;&#x2122; markets, etc.) In the area that you live, is it easy to get affordable fresh fruits and vegetables? Have there been times in the past 12 months when you did not have enough money to buy the food that you or your family needed? Have there been times in the past 12 months when you did not have enough money to pay your rent or mortgage? Do you feel safe in your neighborhood?

0.0%

42 12.1%

9.5%

308 88.8%

1.7%

3.2%

328 94.5%

2.3%

110 31.7%

230 66.3%

2.0%

144 42.2%

106 31.1%

91 26.7%

204 59.7%

84 24.6%

54 15.8%

156 45.1%

98 28.3%

92 26.6%

109 31.5%

110 31.8%

127 36.7%

120 34.7%

110 31.8%

116 33.5%

188 54.3%

151 43.6%

2.0%

194 56.7%

145 42.4%

0.9%

206 59.2%

141 40.5%

0.3%

89 25.3%

259 73.6%

1.1%

77 21.9%

254 72.2%

6.0%

311 88.6%

39 11.1%

0.3%

Answered 354 Skipped 34

8. Where do you get the food that you eat at home? (Check all that apply) Grocery store Take-out / fast food / restaurant Dollar store Home Garden Farmersâ&#x20AC;&#x2122; Market Food bank / food kitchen / food pantry Corner store / convenience store / gas station I regularly receive food from family, friends, neighbors, or my church Back-pack or summer food programs Community Garden I do not eat at home Meals on Wheels Other Answered Skipped

# 341 149 102 80 57 35 32 23 9 5 4 2 8 352 36

% 96.9% 42.3% 29.0% 22.7% 16.2% 9.9% 9.1% 6.5% 2.6% 1.4% 1.1% 0.6% 2.3%

9. During the past 7 days, how many times did you eat fruit or vegetables (fresh or frozen)? Do not count fruit or vegetable juice. (Please check one) I did not eat fruits or vegetables during the past 7 days 1 – 3 times during the past 7 days 4 – 6 times during the past 7 days 1 time per day 2 times per day 3 times per day 4 or more times per day Answered Skipped

# 26 140 100 24 40 18 6 354 34

% 7.3% 39.6% 28.3% 6.8% 11.3% 5.1% 1.7%

During the past 7 days, how many times did you eat fruit or vegetables (fresh or frozen)? 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% I did not eat 1 – 3 times 4 – 6 times 1 time per 2 times per 3 times per fruits or day day day during the during the vegetables past 7 days past 7 days during the past 7 days

4 or more times per day

10. Have you been told by a doctor that you haveâ&#x20AC;Ś (Check all that apply) High blood pressure Depression or anxiety Obesity / overweight High cholesterol I have no health problems High blood sugar or diabetes Heart disease Asthma Mental health problems COPD / chronic bronchitis / Emphysema Cancer Drug or alcohol problems Stroke / Cerebrovascular disease Cerebral palsy HIV / AIDS Other Answered Skipped

# 146 115 97 95 61 55 41 38 30 29 20 8 6 0 0 35 334 54

% 43.7% 34.4% 29.0% 28.4% 18.3% 16.5% 12.3% 11.4% 9.0% 8.7% 6.0% 2.4% 1.8% 0.0% 0.0% 10.5%

11. How long has it been since you last visited a doctor for a routine checkup? (Please check one) # % Within the past year (1 to 12 months ago) 285 80.5% Within the past 2 years (1 to 2 years ago) 31 8.8% Within the past 5 years (2 to 5 years ago) 16 4.5% 5 or more years ago 22 6.2% Answered 354 Skipped 34

How long has it been since you last visited a doctor for a routine checkup? 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Within the past year (1 to 12 months ago)

Within the past 2 years (1 to 2 years ago)

Within the past 5 years (2 to 5 years ago)

5 or more years ago

12. How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists. (Please check one) Within the past year (1 to 12 months ago) Within the past 2 years (1 to 2 years ago) Within the past 5 years (2 to 5 years ago) 5 or more years ago Answered Skipped

# 193 44 42 74 353 35

% 54.7% 12.5% 11.9% 21.0%

How long has it been since you last visited a dentist or a dental clinic for any reason? 60% 50% 40% 30% 20% 10% 0% Within the past year Within the past 2 (1 to 12 months ago) years (1 to 2 years ago)

Within the past 5 years (2 to 5 years ago)

5 or more years ago

13. How connected do you feel with the community and those around you?

Very connected Somewhat connected Not connected Answered Skipped

# 93 200 58 351 37

% 26.5% 57.0% 16.5%

How connected do you feel with the community and those around you? 60% 50% 40%

30% 20% 10% 0% Very connected

Somewhat connected

Not connected

14. In the past 7 days, on how many days were you physically active for a total of at least 30 minutes? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard for some of the time.) 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days Answered Skipped

# 47 43 45 62 32 49 11 58 347 41

% 13.5% 12.4% 13.0% 17.9% 9.2% 14.1% 3.2% 16.7%

In the past 7 days, on how many days were you physically active for a total of at least 30 minutes? 20% 18% 16%

14% 12% 10% 8% 6% 4% 2% 0% 0 days

1 days

2 days

3 days

4 days

5 days

6 days

7 days

15. During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together? # % Never 19 5.4% 1-2 times 60 17.1% 3-4 times 66 18.8% 5-6 times 39 11.1% 7 times 49 13.9% More than 7 times 66 18.8% Not applicable / I live alone 53 15.1% Answered 352 Skipped 36

During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together? 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Never

1-2 times

3-4 times

5-6 times

7 times

More than 7 Not times applicable / I live alone

16. Would you say that in general your health is: (Please check one)

Excellent Very good Good Fair Poor Answered Skipped

# 19 72 148 87 20 346 42

% 5.5% 20.8% 42.8% 25.1% 5.8%

Would you say that in general your health is: 45% 40% 35% 30% 25%

20% 15% 10% 5% 0% Excellent

Very good

Good

Fair

Poor

17. Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?* Median: Answered Skipped

3.0 293 95

18. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?* Median: Answered Skipped

2.0 282 106

*Median was used due to the skewed distribution of the responses. These median data are not directly comparable to the averages reported in the 2016 report.

19. During the past 30 days: (Check all that apply)* I have had 5 or more alcoholic drinks (if male) or 4 or more alcoholic drinks (if female) during one occasion. I have used tobacco products (cigarettes, smokeless tobacco, e-cigarettes, etc.) I have taken prescription drugs to get high I have used marijuana I have used other illegal drugs (e.g. cocaine, heroin, ecstasy, crack, LSD, etc.) None of these Answered Skipped

4.7%

23.2%

1 5

0.3% 1.5%

0.0%

247 340 48

72.7%

*These 2018 data are not comparable to 2016 data, as this question was reformatted for data quality and accuracy

During the past 30 days: 80% 70% 60% 50% 40% 30% 20% 10% 0% I have had 5 or I have used I have taken more alcoholic tobacco prescription drinks (if male) products drugs to get or 4 or more (cigarettes, high alcoholic smokeless drinks (if tobacco, efemale) during cigarettes, etc.) one occasion.

I have used marijuana

I have used None of these other illegal drugs (e.g. cocaine, heroin, ecstasy, crack, LSD, etc.)

20. Have you ever used heroin? Yes No Answered Skipped

# 6 345 351 37

% 1.7% 98.3%

Have you ever used heroin? 100% 90% 80%

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

0% Yes

21. How many vehicles are owned, leased, or available for regular use by you and those who currently live in your household? Please be sure to include motorcycles, mopeds and RVs Average: Answered Skipped

2.0 337 51

22. If you do not drive, what mode of transportation do you typically use? # % Not applicable- I drive 218 79.6% Friends / Family drive me 48 17.5% Public transit (i.e. bus, shuttle, similar) 16 5.8% Bike or walk 9 3.3% RADAR / CORTRAN 0 0.0% Taxi 0 0.0% Other 2 0.7% Answered 274 Skipped 114 If you do not drive, what mode of transportation do you typically use? 90%

80% 70% 60% 50% 40% 30% 20% 10% 0% Not Friends / Public Bike or walk RADAR / applicable- I Family drive transit (i.e. CORTRAN drive me bus, shuttle, similar)

Taxi

Other

Secondary Data Secondary data were collected to obtain a more comprehensive description of our community that goes beyond the scope of the primary data collected throughout the Community Health Assessment process. Relevant information from existing data sources validates the trends seen in primary data collection, but also provides more detailed descriptive information on the characteristics of our community. These population-level measures come from secondary sources such as:  The American Community Survey, U.S. Census Bureau  Behavioral Risk Factor Surveillance System, Center for Disease Control  County Health Rankings, Robert Wood Johnson Foundation  Virginia Department of Health  Virginia Department of Education The demographic data presented first define Tazewell County by population counts, age, income, race/ethnicity, etc. The subsequent sections are organized by Robert Wood Johnson Foundation’s County Health Rankings Model. Health factors are presented first and include social and economic factors, health behaviors, clinical care, and physical environment. Health outcomes close the secondary data section and include measures on disease status and quality of life. Data are presented by county or smallest available geographic area, and include census tracts from the MUAs when applicable. State and national level data are also included for comparison when available. Links and references to other community health assessments and data can be found in Appendix 8.

Demographics Total population Geography Virginia Tazewell County

Total Population 8,310,301 43,367

U.S. Census Bureau, 2012-2016 5-year American Community Survey, Table S0101 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S0101&prodType=table

Population change estimates, 2010-2040 Geography

2010

Virginia Tazewell County

2020

8,001,024 8,811,512 45,078 45,300

Pct. Change 10.1% 0.5%

2030 9,645,281 45,436

Pct. 2040 Change 9.5% 10,530,229 0.3% 45,535

Pct. Change 9.2% 0.2%

U.S. Census Bureau, Virginia Employment Commission Community Profiles (2018) https://data.virginialmi.com/gsipub/index.asp?docid=342

Median age Geography Virginia Tazewell County

Median Age 37.8 43.7

U.S. Census Bureau, 2012-2016 5-year American Community Survey, Table S0101 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S0101&prodType=table

Estimates of population by lifecycle Geography Virginia Tazewell County

Under 5 years

5 to 14 years

15 to 17 years

18 to 64 years

65 years and over

6.1% 5.0%

12.5% 10.8%

3.8% 3.6%

63.9% 61.3%

13.8% 19.2%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S0101 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S0101&prodType=table

Race and ethnicity

Geography

White

Black

Virginia Tazewell County

68.7% 94.7%

19.2% 3.0%

American Indian and Asian Alaskan Native 0.3% 0.1%

6.1% 0.4%

Native Hawaiian and Other Pacific Islander

Some other race

Two or more races

Hispanic or Latino

Not Hispanic or Latino

0.1% 0.0%

2.3% 0.1%

3.4% 1.5%

8.7% 0.9%

91.3% 99.1%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table DP05 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_DP05&prodType=table

Tazewell County public schools race/ethnicity 2016-2018 School Year

School Type

2016-2017 Elementary Schools Middle Schools High Schools District Grand Total 2017-2018 Elementary Schools Middle Schools High Schools District Grand Total

Hispanic

American Indian / Alaskan Native

Asian

Black, not of Hispanic origin

Native Hawaiian / Other

White

Two or more

0.7% 0.5% 1.5% 0.7%

0.1% 0.0% 0.2% 0.1%

0.4% 0.9% 1.1% 0.6%

3.1% 2.7% 3.9% 3.0%

0.0% 0.0% 0.0% 0.0%

93.0% 93.9% 90.1% 92.9%

2.7% 2.0% 3.7% 2.6%

0.9% 0.6% 0.6% 0.8%

0.0% 0.0% 0.1% 0.0%

0.4% 0.8% 1.1% 0.7%

3.2% 2.5% 2.3% 2.8%

0.0% 0.1% 0.0% 0.0%

92.4% 93.0% 93.9% 93.0%

3.1% 3.0% 2.0% 2.7%

Virginia Department of Education. Fall Membership Reports http://www.doe.virginia.gov/statistics_reports/enrollment/fall_membership/report_data.shtml

Population 5 years and over who speak a language other than English at home Geography Virginia Tazewell County

# 1,211,386 653

% 15.5% 1.6%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S1601 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1601&prodType=table

Marital status Geography Virginia Tazewell County

Now married (except separated) 50.0% 54.2%

Widowed 5.6% 9.9%

Divorced Separated 10.2% 11.8%

2.5% 3.3%

Never married 31.8% 20.7%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S1201 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1201&prodType=table

Social and Economic Factors Fall PALS-K scores that were below kindergarten readiness levels Geography Virginia Tazewell County

2015-2016

2016-2017

2017-2018

13.8% 16.2%

14.6% 19.0%

16.0% 23.0%

Virginia Department of Education vis Kids Count Data Center http://datacenter.kidscount.org/data/bar/3254-kindergarteners-whose-fall-pals-k-scores-werebelow-kindergarten-readiness-levels?loc=48&loct=5

Third grade Standards of Learning English Reading Assessment pass rate Geography Tazewell County

2014-2015

2015-2016

2016-2017

82.4%

80.8%

82.0%

Virginia Department of Education, Test Data http://www.doe.virginia.gov/statistics_reports/research_data/index.shtml

On time graduation rates, Tazewell County Geography Virginia Tazewell County

2016 91.4% 92.1%

2017 91.3% 89.5%

Virginia Department of Education, Virginia Cohort Reports http://www.doe.virginia.gov/statistics_reports/graduation_completion/cohort_reports/index.shtml

On time graduation rates, Tazewell County high schools Geography Virginia Graham High Richlands High Tazewell High

2016 91.4% 93.8% 89.4% 93.7%

2017 91.3% 94.7% 83.9% 91.2%

Virginia Department of Education, Virginia Cohort Reports http://www.doe.virginia.gov/statistics_reports/graduation_completion/cohort_reports/index.shtml

Dropout rates, Tazewell County Geography

2016

2017

Virginia Tazewell County

5.3% 4.3%

5.8% 7.2%

Virginia Department of Education, Virginia Cohort Reports http://www.doe.virginia.gov/statistics_reports/graduation_completion/cohort_reports/index.shtml

Dropout rates, Tazewell County high schools Geography Virginia Graham High Richlands High Tazewell High

2016 5.3% 3.4% 5.3% 3.8%

2017 5.8% 3.1% 10.1% 7.5%

Virginia Department of Education, Virginia Cohort Reports http://www.doe.virginia.gov/statistics_reports/graduation_completion/cohort_reports/index.shtml

High school students enrolled in an institution of higher education within 16 months of graduation Geography Virginia Tazewell County

2013 72% 74%

2014 72% 74%

2015 72% 72%

Virginia Department of Education, Postsecondary Enrollment Reports https://p1pe.doe.virginia.gov/postsec_public/postsec.do?dowhat=LOAD_REPORT_C11

Academic attainment for population 25 and over Geography

High school graduate or higher

Bachelorâ&#x20AC;&#x2122;s degree or higher

88.6% 78.8%

36.9% 14.6%

Virginia Tazewell County

Academic attainment for population 25 and over 100% 80% High school graduate or higher

60% 40%

Bachelorâ&#x20AC;&#x2122;s degree or higher

20% 0% Virginia

Tazewell County

Median household income Median Household Income

Geography Virginia Tazewell County

$66,149 $38,238

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S1903 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1903&prodType=table

Federal poverty guidelines for the 48 contiguous states and the District of Columbia Persons in family/household 1 2 3 4 5 6 7 8 9+

2016

2017

2018

$11,880 $16,020 $20,160 $24,300 $28,440 $32,580 $36,730 $40,890 Add $4,160 for each additional person

$12,060 $16,240 $20,420 $24,600 $28,780 $32,960 $37,140 $41,320 Add $4,180 for each additional person

$12,140 $16,460 $20,780 $25,100 $29,420 $33,740 $38,060 $42,380 Add $4,320 for each additional person

Federal Registrar, Annual Update of the HHS Poverty Guidelines https://www.federalregister.gov/documents/2018/01/18/2018-00814/annual-update-of-the-hhs-poverty-guidelines

Number of residents living in poverty Geography United States Virginia Tazewell County

Below 100% FPL # % 46,932,225 15.1% 921,664 11.4% 7,466 17.8%

100-199% FPL # % 57,457,973 18.5% 1,220,553 15.1% 10,203 24.4%

200% FPL and above # % 206,239,447 66.4% 5,918,675 73.4% 24,217 57.8%

Total 310,629,645 8,060,892 41,886

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table C17002 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_C17002&prodType=table

Residents living in poverty 80% 70% 60% 50% Below 100% FPL

40%

100-199% FPL

30%

200% FPL and above

20% 10% 0% United States

Virginia

Tazewell County

Ratio of income by poverty status, by age, Tazewell County

Geography United States Virginia Tazewell County

< 6 years of age Below 100% FPL 100-199% FPL # % # % 5,535,200 23.5% 5,399,378 22.9% 100,968 16.7% 119,744 19.8% 803 30.1% 817 30.6%

200% FPL and above # % 12,598,178 53.5% 384,499 63.5% 1,052 39.4%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table B17024 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_C17002&prodType=table

Geography United States Virginia Tazewell County

6-17 years of age Below 100% FPL 100-199% FPL # % # % 9,800,583 20.0% 10,629,109 21.7% 177,384 14.4% 222,105 18.0% 1,191 20.9% 1,487 26.1%

200% FPL and above # % 28,493,648 58.2% 833,512 67.6% 3,026 53.1%

18-64 years of age Geography United States Virginia Tazewell County

Below 100% FPL # % 27,401,015 14.2% 558,524 10.9% 4,436 17.5%

100-199% FPL # % 32,181,272 16.6% 682,490 13.4% 5,457 21.5%

200% FPL and above # % 133,716,676 69.2% 3,862,973 75.7% 15,466 61.0%

65+ years of age Geography United States Virginia Tazewell County

Below 100% FPL # % 4,195,427 9.3% 84,788 7.6% 1,036 12.7%

100-199% FPL # % 9,248,214 20.6% 196,214 17.5% 2,442 30.0%

200% FPL and above # % 31,430,945 70.0% 837,691 74.9% 4,673 57.3%

Poverty status in the past 12 Months, by race/ethnicity Geography

Population

Virginia Tazewell County

5,561,852 40,004

White Number in poverty 506,826 7,067

Percent in poverty 9.1% 17.7%

Black / African American Number in Percent in Population poverty poverty 1,522,283 303,397 19.9% 988 289 29.3%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S1701 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_C17002&prodType=table

Geography Virginia Tazewell County

American Indian / Alaskan Native Number in Percent in Population poverty poverty 20,911 2,852 13.6% 52 -0.0%

Population 494,027 153

Asian Number in poverty 39,385 12

Percent in poverty 8.0% 7.8%

Geography Virginia Tazewell County

Native Hawaiian and Other Pacific Islander Number in Percent in Population poverty poverty 5,074 383 7.5% 17 -0.0%

Some other race Population 186,105 31

Number in poverty 32,823 17

Percent in poverty 17.6% 54.8%

Geography Virginia Tazewell County

Two or more races Number in Percent in Population poverty poverty 270,640 35,998 13.3% 641 81 12.6%

Hispanic / Latino origin Number in Percent in Population poverty poverty 705,132 108,944 15.5% 293 79 27.0%

Number of TANF recipients for Tazewell County for calendar year 2015-2017 Geography Tazewell County

2015 721

2016 611

Virginia Department of Social Services Profile Report http://www.dss.virginia.gov/geninfo/reports/agency_wide/ldss_profile.cgi

2017 642

Number of SNAP recipients for Tazewell County for calendar year 2015-2017 Geography Tazewell County

2015

2016

2017

11,153

10,351

10,417

Virginia Department of Social Services Profile Report http://www.dss.virginia.gov/geninfo/reports/agency_wide/ldss_profile.cgi

Students eligible for free and reduced lunch program Geography Virginia Tazewell County

2016-2017 41.9% 56.5%

2017-2018 44.3% 62.9%

Virginia Department of Education National School Lunch Program Free and Reduced Price Eligibility Reports http://www.doe.virginia.gov/support/nutrition/statistics/

Tazewell County public schools free and reduced lunch eligibility, 2016-2017 SNAP membership Elementary Schools Abbs Valley-Boissevain Cedar Bluff Dudley Primary Graham Intermediate North Tazewell Raven Richlands Springville Tazewell Middle Schools Graham Richlands Tazewell High Schools Graham Richlands Tazewell

Free lunch eligible Reduced lunch eligible # % # %

Total F/R lunch eligible # %

176 422 250 286 269 151 569 118 519

159 184 106 131 243 136 329 65 265

90.3% 43.6% 42.4% 45.8% 90.3% 90.1% 57.8% 55.1% 51.1%

0 29 14 19 0 0 28 16 51

0.0% 6.9% 5.6% 6.6% 0.0% 0.0% 4.9% 13.6% 9.8%

159 213 120 150 243 136 357 81 316

90.3% 50.5% 48.0% 52.5% 90.3% 90.1% 62.7% 68.6% 60.9%

397 567 416

134 276 210

33.8% 48.7% 50.5%

32 29 26

8.1% 5.1% 6.3%

166 305 236

41.8% 53.8% 56.7%

531 681 544

184 308 232

34.7% 45.2% 42.7%

34 48 40

6.4% 7.1% 7.4%

218 356 272

41.1% 52.3% 50.0%

Virginia Department of Education National School Lunch Program Free and Reduced Price Eligibility Reports http://www.doe.virginia.gov/support/nutrition/statistics/

Tazewell County public schools free and reduced lunch eligibility, 2017-2018 SNAP membership Elementary Schools Abbs Valley-Boissevain Cedar Bluff Dudley Primary Graham Intermediate North Tazewell Raven Richlands Springville Tazewell Middle Schools Graham Richlands Tazewell High Schools Graham Richlands Tazewell

Free lunch eligible Reduced lunch eligible # % # %

Total F/R lunch eligible # %

168 426 256 282 256 146 533 111 472

157 198 130 137 222 127 462 67 268

93.5% 46.5% 50.8% 48.6% 86.7% 87.0% 86.7% 60.4% 56.8%

0 22 11 19 0 0 0 9 31

0.0% 5.2% 4.3% 6.7% 0.0% 0.0% 0.0% 8.1% 6.6%

157 220 141 156 222 127 462 76 299

93.5% 51.6% 55.1% 55.3% 86.7% 87.0% 86.7% 68.5% 63.4%

416 559 408

174 299 222

41.8% 53.5% 54.4%

32 29 24

7.7% 5.2% 5.9%

206 328 246

49.5% 58.7% 60.3%

515 679 521

210 376 291

40.8% 55.4% 55.9%

39 26 33

7.6% 3.8% 6.3%

249 402 324

48.4% 59.2% 62.2%

Virginia Department of Education National School Lunch Program Free and Reduced Price Eligibility Reports http://www.doe.virginia.gov/support/nutrition/statistics/

Children living in single parent households, by race/ethnicity Geography Virginia Tazewell County

Total children living in single parent households 27.2% 27.0%

White

Black / African American

Hispanic or Latino

19.5% 25.9%

55.5% 55.0%

28.4% 25.3%

U.S. Census Bureau, 2010 Census Summary File 1, Table P31, P31A, P31B, P31H https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_SF1_P31&prodType=table

Families living in poverty Geography Virginia Tazewell County

Families living in poverty 8.1% 12.1%

Families living in poverty with related children under 18 years 12.8% 19.4%

Female head of household with related children under 18 years living in poverty 34.2% 40.5%

Grandparents living with grandchildren who are responsible for their grandchildren with no parent of the grandchild present Geography

Pct.

Virginia Tazewell County

12.9% 33.2%

U.S. Census Bureau, 2012-2016 5-year estimates, American Community Survey, Table S1002 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1002&prodType=table

Cost-burdened renters and homeowners, 2015 Geography Bluefield, WV-VA Micro Area

Renters

Homeowners

45.6%

18.1%

Harvard Joint Center for Housing Studies http://harvard-cga.maps.arcgis.com/apps/MapSeries/index.html?appid=6177d472b7934ad9b38736432ace1acb

Consumer opportunity profile Geography Tazewell County

Residents living in census tracts with low to very low Consumer Opportunity Scores 70%

Residents living in census tracts with high to very high Consumer Opportunity Scores 6%

Virginia Department of Health, Virginia Health Opportunity Index (2018) https://www.vdh.virginia.gov/omhhe/hoi/consumer-opportunity-profile

Economic opportunity profile Geography Tazewell County

Residents living in census tracts with low to very low Economic Opportunity Scores 100%

Residents living in census tracts with high to very high Economic Opportunity Scores 0%

Virginia Department of Health, Virginia Health Opportunity Index (2018) https://www.vdh.virginia.gov/omhhe/hoi/consumer-opportunity-profile

Unemployment rate Geography

2014

2015

2016

United States Virginia Tazewell County

6.2% 5.2% 8.2%

5.3% 4.5% 7.4%

4.9% 4.0% 7.5%

U.S. Census Bureau, Virginia Employment Commission Community Profiles (2018) https://data.virginialmi.com/gsipub/index.asp?docid=342

Rate of child abuse and neglect, 2012-2013

Geography Tazewell County

Completed child abuse and neglect cases per 1,000 children 2012 2013 1.89 0.78

Virginia Department of Social Services, Child protective Reports and Studies https://www.dss.virginia.gov/geninfo/reports/children/cps/all_other.cgi

Child abuse and neglect cases, count, 2017 Geography Virginia Tazewell County

9,578 101

2017 case counts may be from incomplete cases. Virginia Department of Social Services, Child protective Reports and Studies https://www.dss.virginia.gov/geninfo/reports/children/cps/all_other.cgi

Health Behaviors No leisure time physical activity Geography Virginia Tazewell County

2012

2013

2014

22% 31%

21% 30%

22% 32%

2016 County Health Rankings, 2012 CDC Diabetes Interactive Atlas 2017 County Health Rankings, 2013 CDC Diabetes Interactive Atlas 2018 County Health Rankings, 2014 CDC Diabetes Interactive Atlas http://www.countyhealthrankings.org/app/virginia/2017/downloads

Access to recreational facilities 2012 Facilities / # 1,000 2 0.05

Geography Tazewell County

2014 # 2

Facilities / 1,000 0.05

USDA Food Environment Atlas: Data Access and Documentation Downloads https://www.ers.usda.gov/data-products/food-environment-atlas/data-access-and-documentation-downloads/

Fast food restaurants rate Geography

Fast food restaurants per 1,000 2012 0.70

Tazewell County

2014 0.74

USDA Food Environment Atlas: Data Access and Documentation Downloads https://www.ers.usda.gov/data-products/food-environment-atlas/dataaccess-and-documentation-downloads/

Low income and low access to store Geography Tazewell County

2010 6.9%

2015 8.4%

USDA Food Environment Atlas: Data Access and Documentation Downloads https://www.ers.usda.gov/data-products/food-environment-atlas/dataaccess-and-documentation-downloads/

Low income and low access to store, by census tract, 2015

Census Tract Tazewell County 20200 20500 21000

Population

Low access to a supermarket or large grocery store

5,354 3,152 4,234

4,985 2,268 2,131

93.1% 71.9% 50.3%

Total population that is low-income and has low access to a supermarket or large grocery store # % 2,058 1,489 885

USDA Food Access Research Atlas https://www.ers.usda.gov/data-products/food-access-research-atlas/download-the-data/

Flu vaccination, 2014 Geography Virginia Tazewell County

43.5% 44.6%

Virginia Department of Health Behavioral Risk Factor Surveillance System, Small Area Estimation http://www.vdh.virginia.gov/data/health-behavior/

Adolescents (Ages 13-17) who receive three doses of HPV vaccine Geography Virginia

Girls 2014 35.9%

Boys 2015 38.5%

Virginia Department of Health, Virginia Plan for Well-Being https://virginiawellbeing.com/measures/

2014 22.5%

2015 25.7%

38.4% 47.2% 20.9%

Cancer screenings, 2014 Women with no Pap test in the past 3 years 20.5% 29.6% --

Geography Virginia Southwestern Region Cumberland Plateau District

Women 40 and older with no mammogram in past 2 years 25.0% 30.0% 30.6%

Adults 50 and older with no sigmoidoscopy or colonoscopy 28.0% 32.8% 27.3%

Virginia Department of Health, Behavioral Risk Factor Surveillance System http://www.vdh.virginia.gov/brfss/data/

Sexually transmitted infection rate Sexually transmitted infections per 100,000 Geography Virginia Tazewell County

2014 Early Syphilis 6.8 0.0

2015

Gonorrhea

Chlamydia

97.6 2.3

423.3 142.7

Early Syphilis 10.3 0.0

Gonorrhea Chlamydia 103.5 4.6

436.4 138.1

Virginia Department of Health, Sexually Transmitted Infections http://www.vdh.virginia.gov/data/sexually-transmitted-infections/

Late to no prenatal care rate, 2014 Geography Virginia Tazewell County

Late to no prenatal care per 1,000 live births 28.0 4.4

Virginia Department of Health, Statistical Reports and Tables http://www.vdh.virginia.gov/HealthStats/stats.htm

Birth rate, by race Live births per 1,000 Geography Virginia Tazewell County

Total 12.3 10.4

2014 White Black 10.8 12.4 10.5 4.9

Virginia Department of Health, Statistical Reports and Tables http://www.vdh.virginia.gov/HealthStats/stats.htm

Other 26.4 23.2

Total 12.3 10.3

2015 White Black Other 10.7 12.3 26.6 10.7 3.0 2.3

Teen pregnancy rate, by race, 2015 Geography Virginia Tazewell County

Teen pregnancies per 1,000 females ages 10-19 Total White Black Other 12.0 8.9 17.5 21.4 24.4 24.2 37.0 --

Virginia Department of Health, Statistical Reports and Tables http://www.vdh.virginia.gov/HealthStats/stats.htm

Adult smoking Geography Virginia Tazewell County

2014

2015

2016

20% 19%

17% 18%

15% 18%

2016 County Health Rankings, 2014 Behavioral Risk Factor Surveillance System 2017 County Health Rankings, 2015 Behavioral Risk Factor Surveillance System 2018 County Health Rankings, 2016 Behavioral Risk Factor Surveillance System http://www.countyhealthrankings.org/app/virginia/2018/downloads

ED heroin overdose rate Geography

Overdoses per 100,000 2015 9.5 0.0

Virginia Tazewell County

2016 16.7 0.0

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

ED opioid overdose rate Geography

Overdoses per 100,000 2015 87.4 49.0

Virginia Tazewell County

2016 103.5 78.3

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

Fatal prescription opioid overdose rate Geography Virginia Tazewell County

Fatal overdoses per 100,000 2014 6.0 34.5

2015 4.7 16.3

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

2016 5.5 11.9

Fatal fentanyl and/or heroin overdose rate Fatal overdoses per 100,000

Geography Virginia Tazewell County

2014 4.2 0.0

2015 5.6 2.3

2016 9.6 2.4

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

EMS Narcan use rate Geography Virginia Tazewell County

EMS Narcan use per 100,000 2014 2015 2016 26.0 33.9 48.5 27.6 25.6 33.2

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

Clinical Care Health insurance status Geography Virginia Tazewell County

Medicaid # % 865,073 10.9% 8,625 20.0%

Medicare # % 1,180,282 14.8% 10,862 25.1%

Private # % 5,944,729 74.6% 25,458 58.8%

U.S. Census Bureau, 2010-2014 5-year estimates, American Community Survey, Table S2701 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_5YR_S2701&prodType=table

Geography Virginia Tazewell County

Direct-Purchase # % 1,042,552 13.1% 4,946 11.4%

Employer Based # % 4,799,029 60.2% 20,928 48.4%

Uninsured # % 968,444 12.1% 6,482 15.0%

Less than 200% FPL health insurance status by age, Virginia, 2016

With health insurance Employer-based health insurance Direct-purchase health insurance Medicare Medicaid No health insurance Total number <200% FPL

< 18 years old # % 542,282 91.8%

18-64 years old # % 855,485 71.9%

65+ years old # % 270,731 98.5%

All ages # % 1,668,498 81.1%

139,623

23.6%

396,090

33.3%

53,006

19.3%

588,719

28.6%

34,132

5.8%

186,992

15.7%

89,270

32.5%

310,394

15.1%

9,488 365,483 48,744 591,026

1.6% 61.8% 8.2%

92,184 249,778 334,968 1,190,453

7.7% 21.0% 28.1%

264,239 54,746 4,164 274,895

96.1% 19.9% 1.5%

365,911 670,007 387,876 2,056,374

17.8% 32.6% 18.9%

U.S. Census Bureau, 2016 1-year estimates, American Community Survey, Table B27016 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_1YR_B27016&prodType=table

Less than 200% FPL health insurance status by age, Tazewell County, 2011-2013

With health insurance Employer-based health insurance Direct-purchase health insurance Medicare Medicaid No health insurance Total number <200% FPL

< 18 years old # % 4,005 88.2%

18-64 years old # % 7,060 64.2%

65+ years old # % 3,695 98.7%

All ages # % 14,760 76.5%

841

18.5%

2,476

22.5%

947

25.3%

4,264

22.1%

144

3.2%

763

6.9%

856

22.9%

1,763

9.1%

-3,320 537 4,542

0.0% 73.1% 11.8%

1,971 2,896 3,937 10,997

17.9% 26.3% 35.8%

3,689 906 49 3,744

98.5% 24.2% 1.3%

5,660 7,122 4,523 19,283

29.4% 36.9% 23.5%

U.S. Census Bureau, 2011-2013 3-year estimates, American Community Survey, Table B27016 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_3YR_B27016&prodType=table

Projected newly eligible for Medicaid through closing coverage gap, 2018 Geography Tazewell County

2,200

The Commonwealth Institute http://www.thecommonwealthinstitute.org/ 2018/01/11/closing-the-coverage-gap-by-locality/

Tazewell County Health Professional Shortage Areas Geography Tazewell County

MUA

Primary Care HPSA

Dental HPSA

Mental Health HPSA

Tazewell Service Area

Bluefield Internal Medicine, Clinch Valley Physicians, Inc., Merit Medical Rural Health Clinic Richlands, Low Income-Tazewell County, Tazewell

Low IncomeTazewell County, Tazewell

Pocahontas State Correctional Center, Cumberland Mountain Service Area, Tazewell

Department of Health and Human Services, Health Resources and Services Administration Data Warehouse (2018) https://datawarehouse.hrsa.gov/tools/analyzers/HpsaFindResults.aspx https://datawarehouse.hrsa.gov/tools/analyzers/MuaSearchResults.aspx

People who could not see a doctor due to cost, 2014 Geography Tazewell County

23.6%

Virginia Department of Health, Behavioral Risk Factor Surveillance System http://www.vdh.virginia.gov/data/health-behavior/

Adults with a regular healthcare provider, 2014 Geography Virginia Tazewell County

69.3% 77.7%

Virginia Department of Health Behavioral Risk Factor Surveillance System, Small Area Estimation http://www.vdh.virginia.gov/data/health-behavior/

Primary care provider population ratio, 2013 Geography Virginia Tazewell County

# PCPs

PCP Rate

PCP Ratio

6,216 34

75 77

1,329:1 1,297:1

Rates are per 100,000 population 2016 County Health Rankings, 2013 Area Health Resource File, American Medical Association http://www.countyhealthrankings.org/app/virginia/2017/downloads

Primary care provider population ratio, 2014 Geography Virginia Tazewell County

# PCPs

PCP Rate

PCP Ratio

6,321 32

76 74

1,317:1 1,358:1

Rates are per 100,000 population 2017 County Health Rankings, 2014 Area Health Resource File, American Medical Association http://www.countyhealthrankings.org/app/virginia/2017/downloads

Primary care provider population ratio, 2015 Geography Virginia Tazewell County

# PCPs

PCP Rate

PCP Ratio

6,368 28

76 65

1,316:1 1,532:1

Rates are per 100,000 population 2018 County Health Rankings, 2015 Area Health Resource File, American Medical Association http://www.countyhealthrankings.org/app/virginia/2018/downloads

Mental health provider population ratio, 2015 Geography Virginia Tazewell County

# MHPs

MHP Rate

MHP Ratio

10,814 54

130 124

770:1 805:1

Rates are per 100,000 population 2016 County Health Rankings, 2015 CMS, National Provider Identification File http://www.countyhealthrankings.org/app/virginia/2017/downloads

Mental health provider population ratio, 2016 Geography Virginia Tazewell County

# MHPs

MHP Rate

MHP Ratio

11,479 54

137 126

730:1 794:1

Rates are per 100,000 population 2017 County Health Rankings, 2016 CMS, National Provider Identification File http://www.countyhealthrankings.org/app/virginia/2017/downloads

Mental health provider population ratio, 2017 Geography Virginia Tazewell County

# MHPs

MHP Rate

MHP Ratio

12,294 54

146 128

684:1 781:1

Rates are per 100,000 population 2018 County Health Rankings, 2017 CMS, National Provider Identification File http://www.countyhealthrankings.org/app/virginia/2018/downloads

Dentist population ratio, 2014 Geography

# Dentist

Dentist Rate

Dentist Ratio

5,303 17

64 39

1,570:1 2,556:1

Virginia Tazewell County

Rates are per 100,000 population 2016 County Health Rankings, 2014 Area Health Resource File, National Provider Identification File http://www.countyhealthrankings.org/app/virginia/2017/downloads

Dentist population ratio, 2015 Geography

# Dentists

Dentist Rate

Dentist Ratio

5,465 15

65 35

1,534:1 2,860:1

Virginia Tazewell County

Rates are per 100,000 population 2017 County Health Rankings, 2015 Area Health Resource File, National Provider Identification File http://www.countyhealthrankings.org/app/virginia/2017/downloads

Dentist population ratio, 2016 Geography

# Dentists

Dentist Rate

Dentist Ratio

5,631 17

67 40

1,494:1 2,479:1

Virginia Tazewell County

Rates are per 100,000 population 2018 County Health Rankings, 2016 Area Health Resource File, National Provider Identification File http://www.countyhealthrankings.org/app/virginia/2018/downloads

Adults with a dental visit in the last year, 2014 Geography Tazewell County

60.3%

Virginia Department of Health, Health Behavior http://www.vdh.virginia.gov/data/health-behavior/

Youth with no dental visit in the last year, 2013 Geography Virginia Tazewell County

21% 19%

Virginia Atlas of Community Health http://www.atlasva.com

Physical Environment Severe housing problems, 2010-2014

Geography Virginia Tazewell County

Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, or lack of kitchen or plumbing facilities 15% 12%

2018 County Health Rankings, Comprehensive Housing Affordability Strategy (CHAS) http://www.countyhealthrankings.org/app/virginia/2018/downloads

Occupied housing units with no vehicles available Geography Virginia Tazewell County

# 196,917 1,466

% 6.4% 8.3%

U.S. Census Bureau, 2012-2016 5-year American Community Survey, Table DP04 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_DP04&prodType=table

Driving alone to work Geography Virginia Tazewell County

Drive alone to work 77% 85%

Drive alone to work, commute > 30 minutes 39% 29%

2018 County Health Rankings, 2012-2016 5-year American Community Survey http://www.countyhealthrankings.org/app/virginia/2018/downloads

Health Outcomes / Health Status of the Population County Health Rankings: health outcomes (out of 133) Geography

2016

2017

2018

126

119

118

Tazewell County

County Health Rankings http://www.countyhealthrankings.org/app/virginia/2018/downloads

County Health Rankings: health factors (out of 133) Geography

2016

2017

2018

110

114

120

Tazewell County

County Health Rankings http://www.countyhealthrankings.org/app/virginia/2018/downloads

Adults reporting poor or fair health Geography Virginia Tazewell County

2014

2015

2016

17% 16%

15% 15%

16% 19%

Average poor physical health days in the past month Geography Virginia Tazewell County

2014

2015

2016

3.5 3.9

3.2 3.6

3.5 4.2

Average mentally unhealthy days in the past month Geography

2014

2015

2016

3.3 3.6

3.3 3.5

3.5 4.0

Virginia Tazewell County

Adults who report having one or more days of poor health that kept them from doing their usual activities during the past 30 days, 2013-2014 Geography Virginia Cumberland Plateau Health District

41.1% 55.9%

Virginia Department of Health Behavioral Risk Factor Surveillance System http://www.vdh.virginia.gov/brfss/data/

Youth with dental caries in their primary or permanent teeth, 2013 Geography Virginia Tazewell County

18% 15%

Virginia Atlas of Community Health http://www.atlasva.com

Youth with teeth in fair/poor condition, 2013 Geography Virginia Tazewell County

6% 5%

Virginia Atlas of Community Health http://www.atlasva.com

Confirmed elevated blood lead levels in children under 36 months Geography Virginia Tazewell County

Population 2014 <36 months 303,439 185 1,360 0

2015 164 0

Virginia Department of Health, Lead-Safe http://www.vdh.virginia.gov/leadsafe/data-statistics/

Low birthweight Geography

2014

2015

Virginia Tazewell County

7.9% 7.9%

7.9% 9.3%

Virginia Department of Health, Statistical Reports and Tables http://www.vdh.virginia.gov/HealthStats/stats.htm

HIV infection rate HIV infections per 100,000

Geography

2014 11.1 2.3

Virginia Tazewell County

2015 11.2 0.0

Virginia Department of Health, Sexually Transmitted Infections http://www.vdh.virginia.gov/data/sexually-transmitted-infections/

New HIV diagnosis rate Geography Virginia Tazewell County

New diagnoses per 100,000 2014 11.0 2.3

2015 11.6 2.3

2016 10.3 0.0

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

Reported tuberculosis rate Geography Virginia Tazewell County

Reported tuberculosis cases per 100,000 2014 2015 2016 2.4 2.5 2.4 0.0 2.3 0.0

Virginia Department of Health, Tables of Selected Reportable Diseases http://www.vdh.virginia.gov/surveillance-and-investigation/virginiareportable-disease-surveillance-data/tables-of-selected-reportablediseases-in-virginia-by-year-of-report

New reported hepatitis C case rate New cases per 100,000, ages 18-30

Geography Virginia Tazewell County

2014 76.3 829.7

2015 89.7 584.0

2016 131.3 602.7

Virginia Department of Health http://www.vdh.virginia.gov/data/opioid-overdose/

High blood pressure, 2015 Geography Virginia Cumberland Plateau Health District Virginia Department of Health http://www.vdh.virginia.gov/data/chronic-disease/

33.2% 48.4%

Obesity Geography

2012

2013

2014

27% 29%

27% 30%

28% 32%

Virginia Tazewell County

Heart disease prevalence, 2014 Geography Tazewell County

7.2%

Virginia Department of Health Behavioral Risk Factor Surveillance System http://www.vdh.virginia.gov/data/chronic-disease/

Diabetes prevalence, 2014 Geography Tazewell County

13.7%

Virginia Department of Health Behavioral Risk Factor Surveillance System http://www.vdh.virginia.gov/data/chronic-disease/

Chronic obstructive pulmonary disease (COPD) prevalence, 2014 Geography Tazewell County

13.0%

Virginia Department of Health Behavioral Risk Factor Surveillance System http://www.vdh.virginia.gov/data/chronic-disease/

Chronic disease discharges by age group Asthma, June 2016 â&#x20AC;&#x201C; June 2017 Geography Tazewell County

Discharge rate per 100,000 18-44 years old 24.0

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

45-64 years old 21.4

65+ years old --

Angina, June 2016 – June 2017 Discharge rate per 100,000

Geography Tazewell County

18-44 years old 57.4

45-64 years old 111.9

65+ years old 75.0

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

Chronic obstructive pulmonary disease, June 2016 – June 2017 Discharge rate per 100,000

Geography Tazewell County

18-44 years old 86.1

45-64 years old 687.4

65+ years old 1,575.4

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

Congestive heart failure, June 2016 – June 2017 Geography Tazewell County

Discharge rate per 100,000 18-44 years old 28.7

45-64 years old 343.7

65+ years old 1,286.0

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

Diabetes, June 2016 – June 2017 Geography Tazewell County

Discharge rate per 100,000 18-44 years old 157.8

45-64 years old 271.8

65+ years old 214.3

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

Hypertension, June 2016 – June 2017 Geography Tazewell County

Discharge rate per 100,000 18-44 years old 7.2

45-64 years old 48.0

65+ years old 53.6

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

Pneumonia, June 2016 – June 2017 Geography Tazewell County

Discharge rate per 100,000 18-44 years old 150.6

Rates based on primary diagnosis hospital discharges Sg2, Virginia Health Information, 2018

45-64 years old 287.7

65+ years old 1,018.1

Overall death rate Deaths per 100,000

Geography

2014 74.1 122.0

Virginia Tazewell County

2015 74.6 100.2

2016 69.0 80.7

Virginia Department of Health Office of Chief Medical Examinerâ&#x20AC;&#x2122;s Annual Report, Table 1.8 http://www.vdh.virginia.gov/medical-examiner/annual-reports/

Infant mortality rate, by race 2015 Geography Virginia Tazewell County

Infant deaths / 1,000 live births White Black Other 4.7 11.3 3.5 6.9 200.0 --

Total 5.9 9.0

Virginia Department of Health, Statistical Reports and Tables http://www.vdh.virginia.gov/HealthStats/stats.htm

Malignant neoplasm deaths per 100,000, 2013 Geography Virginia Tazewell County

161.3 198.3

Virginia Department of Health http://www.vdh.virginia.gov/HealthStats/stats.htm

Heart disease deaths per 100,000, 2013 Geography Virginia Tazewell County

155.9 239.6

Virginia Department of Health http://www.vdh.virginia.gov/HealthStats/stats.htm

Cerebrovascular disease deaths per 100,000, 2013 Geography Virginia Tazewell County

38.5 36.3

Virginia Department of Health http://www.vdh.virginia.gov/HealthStats/stats.htm

Chronic lower respiratory disease deaths per 100,000, 2013 Geography Virginia Tazewell County

37.2 66.7

Virginia Department of Health http://www.vdh.virginia.gov/HealthStats/stats.htm

Diabetes mellitus deaths per 100,000, 2013 Geography Virginia Tazewell County

18.3 30.5

Virginia Department of Health http://www.vdh.virginia.gov/HealthStats/stats.htm

Suicide death rate Geography Virginia Tazewell County

Suicide deaths per 100,000 2014 13.8 13.8

2015 13.1 28.0

2016 13.2 14.2

Virginia Department of Health Office of Chief Medical Examiner’s Annual Report, Table 1.8 http://www.vdh.virginia.gov/medical-examiner/annual-reports/

Accidental death rate Geography Virginia Tazewell County

Accidental deaths per 100,000 2014 31.6 52.9

2015 34.2 37.3

2016 35.2 33.2

Virginia Department of Health Office of Chief Medical Examiner’s Annual Report, Table 1.8 http://www.vdh.virginia.gov/medical-examiner/annual-reports/

Drug/Poison death rate Geography Virginia Tazewell County

Drug/Poison deaths per 100,000 2014 11.4 39.1

2015 11.6 28.0

2016 16.0 14.2

Virginia Department of Health, Office of Chief Medical Examiner’s Annual Report, Table 5.8 http://www.vdh.virginia.gov/medical-examiner/annual-reports/

Appendices Appendix 1: Community Health Improvement Process

Appendix 2: Gantt Chart

Tasks 2018 Tazewell County CHA Create Gantt Chart 2018 CHA Planning Meeting & Identify additional CHAT members Pre-CHAT #1 Work CHAT #1 Meeting Survey Distribution Focus Groups Collect Secondary Data for CHA CHAT #2 Meeting Analyze Survey Data CHAT Meeting #3- Data and Prioritization Final CHA Report CHAT Strategic Plan Create Implementation Strategy Communication Plan

Assigned To:

Duration (working % days) complete

Start Date

End Date

08-07 Mon

11-01 Thu

323

86%

Amy

08-10 Thu

08-11 Fri

100%

Amy / Stephanie / Kathren,

08-08 Tue

100%

Amy / Stephanie / Kathren

08-07 Mon 11-01 Wed

100%

CHAT

11-01 Wed 11-01 Wed

100%

All

10-01 Sun

02-28 Wed

107

100%

Amy / Stephanie

11-01 Wed 02-28 Wed

100%

Sierra

12-01 Fri

03-31 Sat

100%

CHAT

01-29 Mon

100%

Sierra

03-01 Thu

05-07 Mon

100%

CHAT

05-07 Mon

100%

Carilion Clinic

06-01 Fri

07-19 Thu

100%

CHAT

07-12 Thu

100%

Carilion Clinic / Amy / Aaron

07-01 Sun

09-17 Mon

20%

Carilion Clinic / Amy / Aaron

09-26 Wed

11-01 Thu

Appendix 3: Community Health Need Prioritization Community Health Assessment Prioritization From the entire list, please pick 10 of the most pertinent community needs and rank on a scale of 1 - 10, with 1 being the most pertinent. Rank Community Issue Health Behavior Factors Alcohol and drug use Culture: healthy behaviors not a priority Lack of exercise Lack of health literacy / lack of knowledge of healthy behaviors Lack of knowledge of community resources Poor diet Risky sexual activity Tobacco use Clinical Care Factors Access to primary care Access to dental care Access to mental / behavioral health services Access to specialty care (general) Access to specific specialty care: ______________________(write in) Access to substance use services Communication barriers with providers Coordination of care High cost of care High uninsured / underinsured population Quality of care Social and Economic Health Factors Child abuse / neglect Community safety / violence Domestic violence Educational attainment Lack of family / social support systems Poverty / low average household income Unemployment Physical Environment Factors Air quality Affordable / safe housing Injury prevention / safety of environment Outdoor recreation Transportation / transit system Water quality Health Outcomes High prevalence of chronic disease (general) High prevalence of specific chronic disease: _________________ (write in) Write-in section Other: Other: Other: Other: Other: Other:

Appendix 4: Community Health Survey

TAZEWELL COUNTY COMMUNITY HEALTH SURVEY ACCESS and BARRIERS TO HEALTHCARE

1. Do you use medical care services?  Yes  No      

 If yes, where do you go for medical care? (Check all that apply) Doctor’s Office  Health Department Bland Clinic  Nurse Practitioner’s Office Bluefield Regional Medical Center  Salem VA Medical Center Carilion Clinic Family Medicine - Tazewell  Tazewell Community Health Emergency Room  Urgent Care / Walk in Clinic Free Clinic  Other: _______________________

2. Do you use dental care services?  Yes  No  If yes, where do you go for dental care? (Check all that apply)  Dentist’s Office  Salem VA Medical Center  Other: _______________________  Emergency Room  RAM (Remote Area Medical – once a year)  Free Clinic  Urgent Care / Walk in Clinic

3. Do you use mental health, alcohol abuse, or drug abuse services?  Yes  No   

 If yes, where do you go for mental health, alcohol abuse, or drug abuse services? (Check all that apply) Doctor/Counselor’s Office  Free Clinic  Urgent Care / Walk in Clinic Cumberland Mountain CSB  Salem VA Medical Center  Other: _________________________ Emergency Room

4. What do you think are the five most important issues that affect health in our community? (Please check five)            

Access to healthy foods Access to affordable housing Accidents in the home (e.g. falls, burns, cuts) Aging problems Alcohol and illegal drug use Bullying Cancers Cell phone use / texting and driving / distracted driving Child abuse / neglect Dental problems Diabetes Domestic violence

          

Environmental health (e.g. water quality, air quality, pesticides, etc.) Gang activity Heart disease and stroke High blood pressure HIV / AIDS Homicide Infant death Lack of exercise Lung disease Mental health problems Neighborhood safety

           

Not getting “shots” to prevent disease Not using seat belts / child safety seats / helmets Overweight / obesity Poor eating habits Prescription drug abuse Sexual assault Stress Suicide Teenage pregnancy Tobacco use / smoking Unsafe sex Other:_____________________

Which health care services are hard to get in our community? (Check all that apply)

 

Adult dental care Alternative therapy (e.g. herbal, acupuncture, massage) Ambulance services Cancer care Child dental care Chiropractic care Dermatology Domestic violence services Eldercare Emergency room care

       

End of life / hospice / palliative care Family doctor Family planning / birth control Immunizations Inpatient hospital Lab work Medication / medical supplies Mental health / counseling Physical therapy Preventive care (e.g. yearly check-ups)

         

        

Programs to stop using tobacco products Specialty care (e.g. heart doctor) Substance abuse services –drug and alcohol Urgent care / walk in clinic Vision care Women’s health services X-rays / mammograms None Other:_____________________

6. What do you feel prevents you from getting the healthcare you need? (Check all that apply)      

Afraid to have check-ups Can’t find providers that accept my Medicaid insurance Can’t find providers that accept my Medicare insurance Childcare Cost Don’t know what types of services are available

Don’t like accepting government assistance Don’t trust doctors / clinics Have no regular source of healthcare High co-pay Lack of evening and weekend services Language services

     

Location of offices Long waits for appointments No health insurance No transportation I can get the healthcare I need Other:__________________

GENERAL HEALTH QUESTIONS

7. Please check one of the following for each statement I have had an eye exam within the past 12 months. I have had a mental health / substance abuse visit within the past 12 months. I have had a dental exam within the past 12 months. I have been to the emergency room in the past 12 months. I have been to the emergency room for an injury in the past 12 months (e.g. motor vehicle crash, fall, poisoning, burn, cut, etc.). I have been a victim of domestic violence or abuse in the past 12 months. My doctor has told me that I have a long-term or chronic illness. I take the medicine my doctor tells me to take to control my chronic illness. I can afford medicine needed for my health conditions. I am over 21 years of age and have had a pap smear in the past three years (if male or under 21, please check “Not applicable”). I am over 40 years of age and have had a mammogram in the past 12 months (if male or under 40, please check “Not applicable”). I am over 50 years of age and have had a colonoscopy in the past 10 years (if under 50, please check “Not applicable”). Does your neighborhood support physical activity? (e.g. parks, sidewalks, bike lanes, etc.) Does your neighborhood support healthy eating? (e.g. community gardens, farmers’ markets, etc.) In the area that you live, is it easy to get affordable fresh fruits and vegetables? Have there been times in the past 12 months when you did not have enough money to buy the food that you or your family needed? Have there been times in the past 12 months when you did not have enough money to pay your rent or mortgage? Do you feel safe in your neighborhood?

Yes

Not applicable

   



   

 



  



8. Where do you get the food that you eat at home? (Check all that apply)       

Back-pack or summer food programs Community garden Corner store / convenience store / gas station Dollar store Farmers’ market Food bank / food kitchen / food pantry Grocery store

     

Home garden I do not eat at home I regularly receive food from family, friends, neighbors, or my church Meals on Wheels Take-out / fast food / restaurant Other: ___________________

9. During the past 7 days, how many times did you eat fruit or vegetables (fresh or frozen)? Do not count fruit or vegetable juice. (Please check one)  

I did not eat fruits or vegetables during the past 7 days 1 – 3 times during the past 7 days

4 – 6 times during the past 7 days 1 time per day 2 times per day

  

 

3 times per day 4 or more times per day

10. Have you been told by a doctor that you have… (Check all that apply)     

Asthma Cancer Cerebral palsy COPD / chronic bronchitis / emphysema Depression or anxiety

     

Drug or alcohol problems Heart disease High blood pressure High blood sugar or diabetes High cholesterol HIV / AIDS

    

Mental health problems Obesity / overweight Stroke / cerebrovascular disease I have no health problems Other: ___________________

11. How long has it been since you last visited a doctor for a routine checkup? (Please check one)  

Within the past year (1 to 12 months ago) Within the past 2 years (1 to 2 years ago)

 

Within the past 5 years (2 to 5 years ago) 5 or more years ago

12. How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists. (Please check one)  

Within the past year (1 to 12 months ago) Within the past 2 years (1 to 2 years ago)

 

Within the past 5 years (2 to 5 years ago) 5 or more years ago

13. How connected do you feel with the community and those around you?  Very connected

 Somewhat connected

 Not connected

14. In the past 7 days, on how many days were you physically active for a total of at least 30 minutes? (Add up all

the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard for some of the time.)

 0 days

 1 day

 2 days

 3 days

 4 days

 5 days

 6 days

 7 days

15. During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together?  

Never 1-2 times

 

3-4 times 5-6 times

 

7 times More than 7 times



Not applicable / live alone

16. Would you say that in general your health is: (Please check one) 

Excellent



Very good



Good



Fair



Poor

17. Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? Days 18. Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? Days 19. During the past 30 days: (Check all that apply)   

I have had 5 or more alcoholic drinks (if male) or 4 or more alcoholic drinks (if female) during one occasion. I have used tobacco products (cigarettes, smokeless tobacco, e-cigarettes, etc.) I have taken prescription drugs to get high

  

I have used marijuana I have used other illegal drugs (e.g. cocaine, heroin, ecstasy, crack, LSD, etc.) None of these

20. Have you ever used heroin?  Yes  No 21. How many vehicles are owned, leased, or available for regular use by you and those who currently live in your household? Please be sure to include motorcycles, mopeds and RVs. Vehicles 22. If you do not drive, what mode of transportation do you use typically use?   

Not applicable- I drive Bike or walk Friends / family drive me

 

Public transit (i.e. bus, shuttle, similar) RADAR / CORTRAN

 

Taxi Other:____________________

DEMOGRAPHIC INFORMATION and HEALTH INSURANCE

23. Which of the following describes your current type of health insurance? (Check all that apply)    

COBRA Dental Insurance Employer Provided Insurance Government (VA, Champus)

  

Health Savings / Spending Account Individual / Private Insurance / Marketplace / Obamacare Medicaid

   

Medicare Medicare Supplement No Dental Insurance No Health Insurance

24. If you have no health insurance, why don’t you have insurance? (Check all that apply)    

Not applicable- I have health insurance I don’t understand Marketplace / Obamacare options Not available at my job Student

  

Too expensive / cost Unemployed / no job Other: ________________

25. What is your ZIP code? __________________________ 26. What is your street address (optional)? __________________________ 27. What is your age? __________________________ 28. What is your gender?  Male  Female  Transgender 29. What is your height? __________________________ 30. What is your weight? __________________________ 31. How many people live in your home (including yourself)? Number who are 0 – 17 years of age __________________________ Number who are 18 – 64 years of age __________________________ Number who are 65 years of age or older __________________________ 32. What is your highest education level completed? Less than high school

 Some high school

 High school diploma / GED

 Associates

 Bachelors

 Masters / PhD

33. What is your primary language?  English  Spanish  Other__________________________ 34. What ethnicity do you identify with? (Check all that apply)  Native Hawaiian / Pacific Islander  American Indian / Alaskan Native

 Asian  Latino

 Black / African American  More than one race

35. What is your marital status?  Married Single

Divorced

Widowed

 White  Decline to answer  Other:__________ Domestic Partnership

36. What is your yearly household income?  $0 – $10,000  $50,001 – $60,000

 $10,001 – $20,000  $60,001 – $70,000

 $20,001 – $30,000  $70,001 – $100,000

 $30,001 – $40,000  $100,001 and above

 $40,001 – $50,000

37. What is your current employment status?  Full-time

 Part-time

 Unemployed

 Self-employed

 Retired

 Homemaker  Student

38. Is there anything else we should know about your (or someone living in your home) health care needs in Tazewell County? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Thanks for helping make Tazewell County a healthier place to live, work, and play

Appendix 5: Stakeholder Survey Tazewell County Professional Informant Survey Barriers and Challenges Faced by Residents and Health and Human Services Agencies An online version of this survey is available at https://www.surveymonkey.com/r/2018CHStakeholder Responses will not be identified, either in written material or verbally, by name or organization. 1. Your name, organization, and title: NAME: ___________________________________________________________________ ORGANIZATION:__________________________________________________________ TITLE: ___________________________________________________________________ 2. What are the most important issues (needs) that impact health in Tazewell County? __________________________________________________________________________________________________________________ ________________________________________________________ 3. What are the barriers to health for the populations you serve? __________________________________________________________________________________________________________________ ________________________________________________________ 4. Is there one locality / neighborhood with the greatest unmet need? If so, why? __________________________________________________________________________________________________________________ ________________________________________________________ 5. Is there one population group with the greatest unmet need? If so, why? __________________________________________________________________________________________________________________ ________________________________________________________ 6. What are the resources for health for the populations you serve? __________________________________________________________________________________________________________________ ________________________________________________________ 7. If we could make one change as a community to meet the needs and reduce the barriers to health in Tazewell County, what would that be? __________________________________________________________________________________________________________________ ________________________________________________________ Thank you for your input!

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Appendix 6: Stakeholder Survey and Focus Group Locations Organization/Group Tazewell County CCRT & Community Health Assessment Team

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Appendix 7: Community Resource List Community Resources listed by Stakeholders are listed below along with publicly available contact information collected in spring 2018. A more comprehensive resource list can be found at https://tinyurl.com/yb7bh8ys. This list is a point-in-time snapshot of resources available and is not updated regularly. Please note that information may have changed since the collection date. Community members can also learn more about available resources by calling 2-1-1 or going online to https://www.211virginia.org/consumer/index.php. 2-1-1 is a free service available to help callers find appropriate resources in their locality. Appalachian Agency for Senior Citizens 216 College Ridge Road Cedar Bluff, VA 24609 (276) 964- 4915 www.aasc.org

Clinch Valley Community Action 200 Riverside Drive North Tazewell, VA 24630 (276) 988- 5583 http://clinchvalleycaa.org/

Appalachian Community Transitions (ACTion) 216 College Ridge Road Cedar Bluff, VA 24609 (276) 964- 4915 http://www.aasc.org/

Clinch Valley Comprehensive Treatment Center 111 Town Hollow Road Cedar Bluff, VA 24609 (276) 218- 1733 https://www.westernvirginiactc.com/locatio n/clinch-valley/

Appalachian Substance Abuse Coalition for Prevention 196 Cumberland Road Cedar Bluff, Virginia 24609 http://stopsubstanceabuse.com/2012/index. html (Multiple Locations, no phone number in file)

Clinch Valley Medical Center 6801 Governor G C Peery Highway Richlands, VA 24641 (276) 596- 6000 http://www.clinchvalleyhealth.com/ Cumberland Mountain Community Services 526 W. Main Street Tazewell, VA 24651 (276) 988- 7961 https://www.cmcsb.com/

Carilion Tazewell Community Hospital 388 Ben Bolt Avenue Tazewell, VA 24651 (276) 988- 8700 https://www.carilionclinic.org/locations/cari lion-tazewell-community-hospital

Financial Assistance Tazewell County Social Services 253 Chamber Drive Tazewell, VA 24651 (276) 988- 8500 http://dss.tazewellcounty.org/

Celebrate Recovery 118 Main Street Tazewell, VA 24651 (276) 988- 2519

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Gathering Resources and Opportunities for Wellness (GROW) Tazewell County Health Department 253 Chamber Drive Tazewell, VA 24651 (276) 988- 5585 http://growswva.wixsite.com/growswva

Tazewell County Drug Court Program In Tazewell Circuit Court P.O. Box 810 Cedar Bluff, VA 24609 (276) 964- 6702 http://www.vdca.net/drug-courts-in-va/

Remote Area Medical Wise County Fairgrounds 10101 Fairground Road Wise, VA 24293 https://www.ramusa.org/ram-of-virginia/

Tazewell County Health Department 253 Chamber Drive Tazewell, VA 24651 (276) 988- 5585 http://www.vdh.virginia.gov/

Southside Virginia Community College 109 Campus Drive Alberta, VA 23821 (434) 949- 1000 http://southside.edu/

Tazewell County Parks and Recreation 163 Walnut Street Bluefield, VA 24605 (800) 588- 9401 http://visittazewellcounty.org/

Substance Abuse Task Force in Rural Appalachia (SATIRA) 196 Cumberland Road Cedar Bluff, Virginia 24609 http://stopsubstanceabuse.com/2012/index. html (Multiple Locations, no phone number in file)

Tazewell County Social Services 253 Chamber Drive Tazewell, VA 24651 (276) 988- 8500 http://dss.tazewellcounty.org/ Tazewell County VPI Extension 552 E Riverside Drive North Tazewell, VA 24630 (276) 988- 0405 https://tazewell.ext.vt.edu/

Taking Action for Special Kids (TASK) Tazewell Sheriff Department Building 315 School Street Tazewell, VA 24630 (276) 979-0408 https://www.taskforkids.org/

YMCA 106 Gratton Road Tazewell, VA 24651 (276) 979- 0280 http://fsymca.org/

Tazewell Community Health 583 C East Riverside Drive North Tazewell, VA 24630 (276) 979- 9899 http://www.svchs.com/

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Appendix 8: Links and References to Other Community Health Assessments and Data ď&#x201A;ˇ

Virginia Youth Survey, Virginia Department of Health http://www.vdh.virginia.gov/virginia-youth-survey/data-tables/

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