New River Valley Community Health Assessment 2024 by Carilion Clinic

CarilionClinic.org/community-health-assessments

Executive Summary

Carilion Clinic is committed to joining with our partners to pursue the essential work of improving and maintaining the health of the New River Valley in accordance with our mission. Periodically assessing the health concerns of each community is a key component of addressing needs Every three years, the New River Valley Community Health Assessment (NRVCHA) aims to uncover issues, indicate where improvement is needed and track and promote progress in key areas so that there is demonstrated, ongoing change. The CHA process and the public availability of its findings enable and empower our community to effectively improve and maintain health.

Carilion, the New River Health District (NRHD) and the Community Health Center of the New River Valley (CHCNRV) partnered with existing community networks/coalitions to conduct the 2024 NRVCHA, forming the Community Health Assessment Team (CHAT) After review and discussion of the data collected, the 2024 NRVCHA led the CHAT to identify seven priority health issues in the community.

Community Health Improvement Process

Carilion believes in continuous quality improvement. The triennial CHA serves as a formal way of identifying community needs and developing plans to address them. It shapes the ways we support our mission in the community and encourages collaboration and alignment with clinical teams Not only does this process identify current needs and disparities, but also helps to ensure we are regularly evaluating and shifting to meet emerging needs

Priority Health Needs

In collaboration with the CHAT, we identify key health needs to align resources and other efforts for the following three years. The CHAT reviews extensive data, asks questions and participates in a consensus-building prioritization process. The 2024 NRVCHA resulted in the following health priorities:

Drivers of Priority Health Needs

The CHA process focused on prioritizing health conditions and outcomes, rather than a broader focus on their root causes. We recognize that access to healthcare and other services and the social determinants of health (SDOH) are key facilitators of good health and well-being. As such, we are focused on those and other health factors as a strategic component of action planning. The key drivers of each priority health condition, as identified by the CHAT, are discussed in the corresponding sections of this report.

Board Adoption

This document was approved by the Carilion New River Valley Medical Center (CNRV) Board of Directors on July 23, 2024, and formally adopted as the 2024 New River Valley Community Health Assessment.

Disclaimers

This document has been produced to benefit the community. Carilion encourages the 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 at communityoutreach@carilionclinic.org.

Members of the leadership team reviewed all documents prior to publication. Every effort has been made to ensure the accuracy of the information presented in this report; however, accuracy cannot be guaranteed. Members of the New River Valley CHAT cannot accept responsibility for any consequences that result from the use of any information presented in this report.

Carilion began conducting CHAs prior to the IRS adoption of the 501(r)(3) standard which requires not-for-profit hospitals to conduct a Community Health Needs Assessment (CHNA) every three years. While meeting the CHNA requirement, Carilion maintains the longstanding formal name Community Health Assessment for our process and reports. A crosswalk of this document based on the 501(r)(3) standards can be found in Appendix A.

Our Partners

Community Health Assessment Leadership Team

The CHA Leadership Team collaborates to guide major functions of the CHA, including CHAT recruitment, data collection/analysis and shaping meeting structure. In addition to Carilion staff, membership includes leadership from the local health district, the local federally qualified health center, population health experts and representation from local community networks. Carilion organizes and facilitates leadership team meetings.

• Carilion Clinic:

o Shirley Holland, VP, Community Health and Development

o Molly Roberts, Manager, Community Benefit

o Ashley Hash, Community Health Improvement Program Manager

o Holly Ostby, Community Health Improvement Program Manager

o Nicholas (Nick) Bilbro, Community Benefit Analyst

• New River Health District:

o Noelle Bissell, MD, Health Director

• Community Health Center of the NRV:

o Michelle Brauns, CEO

• Virginia Tech Department of Population Health Sciences

o Sophie Wenzel, Assistant Professor of Practice

• Healthy Roots NRV:

o Jessica Wirgau, CEO, The Community Foundation of the NRV

• NRV Partnership for Access to Healthcare (PATH):

o Cayla Trueheart, Population Health Manager, New River Health District

• Giles County FOCUS (Focus on Communities Utilizing Services)

o Jeff Dinger, Giles County Administration

Community Health Assessment Team

The CHAT is a dynamic group of health and human service agency leaders, individuals/organizations serving/representing the interests of priority populations and local representatives from various community sectors. The following community partner organizations participated in the 2024 NRVCHA:

Organization

Agency on Aging

Carilion Community Benefit

Carilion Community Health and Outreach

Carilion Division of Equity and Inclusion

Carilion New River Valley Medical Center

Older adult population* NRV

Healthcare provider/community health center Regional

Healthcare provider/community health center NRV

Community Foundation of the NRV Philanthropy NRV

Community Health Center of the NRV

Disability Resource Center

Healthcare provider/community health center NRV

Minority population* NRV

Feeding America - Feeding Southwest Virginia Food access Regional

Giles Christian Mission

HCA - LewisGale

Literacy NRV

Faith community* Giles

Healthcare provider/community health center Pulaski

Medically underserved population* NRV

Organization

Montgomery County Public School System

Montgomery-Floyd Regional Library System

Montgomery County Administration

Montgomery County Dpt. of Social Services

NAACP Montgomery-Radford-Floyd

Ninevah

New River/Mt. Rogers Workforce Development

New River Community Action

NRV CARES

NRV Regional Commission

New River Valley Community Services

Onward NRV

Pulaski County Public Schools

Radford City Department of Social Services

Town of Blacksburg

Tri-Area Community Health

United Way SWVA

VDH - New River Health District

Virginia Foundation for Healthy Youth

Virginia Poverty Law Center

Virginia Tech

Women's Resource Center of the NRV

Wythe Hospice/Alzheimer’s Association

Local school district

Montgomery

Local community spaces Mont , Floyd

Local government Montgomery

Minority population* NRV

Faith community* Radford

Labor/workforce NRV

Low-income population* NRV

Medically underserved population* NRV

Economic development NRV

Medically underserved population* NRV

Labor/workforce NRV

Local school district Pulaski

Medically underserved population* Radford

Local government Blacksburg

Healthcare provider/community health center Floyd

Philanthropy Regional

Public health department NRV

Philanthropy NRV

Minority population* NRV

Academic expert Regional

Medically underserved population* NRV

Older adult population* Wythe

*member of or individual/organization serving/representing the interests of this population

To see a list of specific 2024 CHAT participants, and for more information about our stakeholder convening (CHAT invitation) methodology, please see Appendix B

Data Team

Additional data support was provided by the Virginia Department of Health (VDH) Division of Population Health Data.

• Khristina Morgan, Community Health Epidemiology Regional Coordinator

• LeeAnn Gardner, Community Health Epidemiologist, Central Shenandoah Health District

• Taiwo Ilechie, Community Health Epidemiologist, Roanoke City and Alleghany Health Districts

Our Process

The first step in the ongoing community health improvement process is to conduct a CHA. Every three years, Carilion follows the formal process described below to identify community needs and develop plans to address them. The 2024 NRVCHA officially began October 10, 2023, and concluded with the final CHAT meeting on June 11, 2024.

STEP 1: Define Community Served

Carilion New River Valley Medical Center (CNRV) serves the Southwest Virginia counties of Montgomery, Pulaski, Floyd, Wythe and Giles in addition to the City of Radford. CNRV is part of Carilion Clinic, a not-for-profit healthcare organization based in Roanoke, Virginia.

Centrally located in Virginia’s New River Valley, the 110-bed acute care facility serves as Carilion’s Western Region hub, providing a variety of inpatient and outpatient services, specialty care, medical education, a Level III Trauma Center and Birth Center.

The service areas for Carilion’s CHAs are determined by unique patient origin of the hospital in each respective market. Focus is placed on areas that are considered Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs).

In fiscal year 2023, CNRV served 53,264 unique patients. Patient origin data revealed that during this year, 85% of patients served by CNRV lived in the following localities:

• Montgomery County (33%)

• Pulaski County (16%)

• City of Radford (15%)

• Floyd County (8%)

• Wythe County (8%)

• Giles County (5%)

These localities comprise the NRVCHA service area, excluding Giles County. It is important to note that Giles County is also served by Carilion Giles Community Hospital (CGCH) located in Pearisburg, Virginia.

CGCH also conducted its own CHA of Giles County and Monroe County, West Virginia, concurrently. Giles County data are included in secondary data so complete data for the New River Valley will be available in this report. Please note that while Wythe County is included in the service area, it is not traditionally considered part of the New River Valley.

Additional Community Demographics

The New River Valley is composed of the independent City of Radford and the counties of Floyd, Giles, Montgomery and Pulaski. It is nestled among the Blue Ridge and Appalachian

Mountains in Southwest Virginia. The valley is home to two universities, Virginia Tech and Radford University, and New River Community College. Their presence enriches the local culture and workforce. A rich mix of urban and rural communities, the New River Valley boasts scenic views and thriving communities complete with restaurants, arts and culture offerings and an abundance of outdoor recreation and relaxation opportunities.

The New River Valley has many small-town communities, each with a different feel and array of resources. These small towns vary greatly in the demographic and economic makeup of the individuals who live there. Each locality is unique, with their own specific resources and challenges. The presence of the universities particularly impacts their home communities’ diversity, resources, workforce, housing market, health needs and societal structure.

The Weldon Cooper Center for Public Service predicts positive population change by 2040 for all communities except Giles County, Pulaski County and Radford City, which may have slight population loss.1

Table 1. Select Demographics of the NRVCHA Service Area

Source: US Census Bureau, ACS, 2018-2022

1 https://www.coopercenter.org/virginia-population-projections

Table 2. Income Data for the NRVCHA Service Area

Source: US Census Bureau, ACS, 2018-2022

Specific to CNRV inpatients and outpatients in fiscal year 2023, 20% received Medicaid while 3% were self-pay, a proxy for uninsured.2

Table 3. Insurance Status of NRVCHA Service Area

Source: US Census Bureau, ACS, 2018-2022

Montgomery County and Radford City, each home to Virginia Tech and Radford University, respectively, are more racially and ethnically diverse than the rest of the Metropolitan Statistical Area All localities are more racially homogenous and below the state average (10%) for the percentage of the population identifying as Hispanic or Latino, with the highest percentage (3.5%) in Montgomery County. 2 Strata internal data

Table 4. Racial Demographics, NRVCHA Service Area

Source: US Census Bureau, ACS, 2018-2022

The region is divided into urban and rural areas, which vary greatly in the economic means of the residents who live there. Primary care HPSAs cover the entire counties of Floyd and Giles, and the low-income population of Wythe County. Dental health HPSAs exist for the low-income population of each locality. Mental health HPSAs exist for the high-needs population in Wythe County, and the New River Valley’s low-income population.3 Additionally, Floyd, Giles, Montgomery and Wythe counties are all MUAs, along with Radford City.4

Target Population

The target population for Carilion’s CHA projects consists of underserved/vulnerable populations disproportionately impacted by SDOH, including poverty, race/ethnicity, age, education, access and/or lack of insurance. Data are reviewed where available by different life stages, including parents of children and adolescents, women of child-bearing age, adults and the elderly. Other considerations include race, ethnicity and income levels. All patients are included in this assessment regardless of insurance payments or financial assistance eligibility. Distinct efforts are taken to ensure the CHA reflects those residing in MUAs and HPSAs.

STEP 2: Convene Community Health Assessment Team

A 52-member CHAT participated in the assessment activities Hearing voices from across our service area is crucial to a CHA’s success. Broad-interest community reach is a main qualification when inviting individuals to join the CHAT, which was achieved through engaging the many collaborative networks working to improve various aspects of well-being in the New River Valley The CHA Leadership Team included representatives from two of these networks PATH and Healthy Roots NRV as well as the New River Health District (the regional health district) and the Community Health Center of the New River Valley (a regional Federally Qualified Health Center)

To honor existing network structures, invitations for CHAT meeting participation were sent through network email lists and shared openly at network meetings Additional invitations extended by the CHA Leadership team included representation from local governments, the

3 https://data.hrsa.gov/tools/shortage-area/hpsa-find

4 https://data.hrsa.gov/tools/shortage-area/mua-find

local school system, social service organizations, other community organizers and nonprofit leaders. For a list of the community networks/coalitions please see our Stakeholder Convening Methodology in Appendix B.

The CHAT met four times throughout the process, with each meeting serving a distinct purpose.

• Meeting 1: Introduction and Overview of the Process; Launch of Community Health and Well-Being Survey

• Meeting 2: Data Presentation and Data Walk

• Meeting 3: Prioritization of Needs and Discussion

• Meeting 4: Action Planning: Key Drivers and Impact/Feasibility Activity

Each meeting built on the one prior and fostered dialogue amongst CHAT members. Meetings were held in person with interactive opportunities to participate and engage with data and facilitated discussions with other CHAT members.

All members of the leadership team were engaged from the beginning of the planning process (spring of 2023) throughout the assessment period and CHAT meetings Their involvement helped shape all aspects of this assessment. The team identified community partners to serve on the CHAT, provided discussion points and suggestions on structure of CHAT meetings and offered feedback on the prioritized needs. Additionally, leadership team representatives were active on the CHAT and participated in all CHAT activities including the Stakeholder Listening Session and the prioritization activity.

The CHAT included several individuals or organizations serving or representing the community’s medically underserved, low-income and minority populations. Examples include:

• Local health district (e.g., VDH - New River Health District)

• Federally qualified health centers (e.g., Community Health Center of the NRV)

• Social service agencies (e.g., New River Valley Community Action)

• Community services (e.g., New River Valley Community Services, Literacy NRV, Women’s Resource Center of the NRV, NRV CARES)

• Philanthropy (e.g., Community Foundation of the NRV)

• Economic development organizations (e.g., NRV Regional Commission, New River/Mt. Rogers Workforce Development Board)

These organizations and individuals helped gather community input by distributing the Community Health Survey. CHAT member input was solicited through the Stakeholder Survey and Listening Session. Combined, these efforts led to the identification and prioritization of community health needs.

STEP 3: Collect and Review Relevant Health Data

Various data were collected and shared with the CHAT regularly, including primary and secondary data on health outcomes, health status, socioeconomic factors and quality of life. Secondary data served as a key driver of the process, with primary data adding community context and perspectives to understand the needs of subpopulations within the community.

Community Health and Well-Being Survey

A Community Health and Well-Being Survey was conducted as part of the NRVCHA. 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 CHAT and the CHA leadership team

A 27-question survey instrument was utilized. It asked questions about access to care and other services, health status, community strengths, quality of life, subjective well-being and demographics (Appendix C: Community Health and Well-Being Survey). The survey instrument included commonly used questions and metrics from the following established community surveys:

• Cantril’s Ladder

• 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, CDC

• National Health Interview Survey, CDC

• Youth Risk Behavior Surveillance System, CDC

• Martin County Community Health Assessment, Martin County, North Carolina

• Previous New River Valley Community Health Surveys

The population of interest for the survey was NRVCHA Service Area residents 18 years of age and older. Surveys were distributed from October 2023 through December 2023. A drawing for a $50 grocery store gift card was offered as an incentive for those completing the survey.

The following subpopulations were especially targeted for sampling:

• Underserved/vulnerable populations disproportionately impacted by SDOH, including:

o Poverty

o Race/ethnicity

o Education

o Lack of insurance

o Insecure/unsafe housing

A non-probability sample method was used, where respondents were not randomly selected. Although the survey was available to all residents living in the service area, oversampling of the targeted subpopulations occurred through specific outreach efforts through community partners. Oversampling ensured that needs and assets specific to this subpopulation of interest were captured.

Oversampling was achieved through CHAT members’ relationships with the community populations they serve. Examples of oversampling methodology include:

• Collaborative effort with New River Community Action for survey collection and “read aloud” assistance at To Our House, a rotating-site shelter for unhoused NRV community members

• Survey collection/distribution in waiting rooms at Community Health Center of the NRV (FQHC) locations across the service area

The survey instrument was available in both English and Spanish via the following methods:

• Qualtrics link and QR code

• Phone line (888-964-6620)

• Paper surveys (collected by volunteers and/or staff of partner agencies)

Outreach strategies for survey distribution included:

• Social media

• Flyers and posters distributed throughout the community with survey QR code, URL and phone line information

• Survey URL posted on partner agency websites

• Recruitment of participants on site at CHAT member organizations

In total, 380 surveys were collected and validated. Full survey results and validation methodology can be found in Appendix D

All responses were entered into Qualtrics by survey respondents or by Carilion staff who entered responses from paper surveys. Surveys were analyzed and reported using Qualtrics and Microsoft Excel.

Stakeholder Listening Sessions and Survey

CHAT members were invited to provide an additional perspective on the needs and barriers to health facing our community. Carilion staff from across the organization facilitated small group discussions. To quantify focus group data, CHAT members were asked to complete the Stakeholder Survey. A summary of the data can be found in Appendix E.

Community stakeholders, leaders and providers were encouraged to complete the Stakeholder Survey after participating in a listening session. The survey was also shared with leaders who may not have attended a listening session. The online survey was shared at the CHAT meetings and via email. Surveys were analyzed and reported using Qualtrics and Microsoft Excel.

Community Listening Sessions

Community members were invited to participate in Community Listening Sessions to collect qualitative data to further understand health-related needs. The Community Health Center of the NRV successfully hosted two sessions at their Christiansburg location in partnership with Carilion staff. Additional community sessions were organized across the New River Valley, one in each locality, that were subsequently cancelled due to no/low registration. A summary of the data can be found in Appendix E

Secondary Data

Secondary data came from two primary sources: SparkMap and the VDH Division of Population Health Data. SparkMap is a product from the University of Missouri that quickly and accurately aggregates data across geographies for 80+ indicators from publicly available sources such as the American Community Survey, County Health Rankings and the CDC. Secondary data analysis was provided through SparkMap’s tables, maps and visual diagrams depicting indicators that are better or worse than the state average, trends over time and comparisons across different population segments such as race and life cycle.

A team of VDH epidemiology staff provided and analyzed data from specific VDH departments a critical component of the data walk. Data provided included mortality due to specific chronic diseases, incidence rates of sexually transmitted infections, sociodemographic data, cancer rates and others. VDH also provided data broken down by gender and race/ethnicity for many health topics. All data shared with the CHAT for review can be found in the final section of this document, Appendix H.

Table 5. Data Sharing Summary

Community Demographic Data Secondary - CHAT 1 Presentation

Health Factors Data Secondary - CHAT 1 Presentation - CHAT 2 Overview in Presentation - Data Packet Email prior to CHAT 3

Health Outcomes Data Secondary - CHAT 1 Overview in Presentation - CHAT 2 Data Walk - Data Packet Email prior to CHAT 3

Community Health & Well-being Survey

Community Listening Sessions (CLS)

Stakeholder CLS

STEP 4: Prioritize Community Health Needs

- Data Packet Email prior to CHAT 3

Using their community knowledge, data collectively reviewed and additional data requested and shared, CHAT members were asked to complete an electronic survey to prioritize community health needs. The community health needs included for prioritization were specific health conditions or health outcomes reflecting those conditions which contribute to morbidity and mortality in the service area. The prioritization survey matched the structure utilized during the data walk at CHAT Meeting 2. This resulted in the identification of 13 health needs in the community.

During CHAT Meeting 3, CHAT members completed a dot voting activity to further refine the priority list, and a discussion ensued to determine the final prioritized need based on scope of issue, burden on community and feasibility to address at the community level based on CHAT member perspectives and perceptions.

The 2021 NRVCHA and the subsequent Implementation Strategy were posted publicly though multiple electronic channels and shared widely by community partners. An email address was provided for submission of written comments, but none were received for consideration in the identification and prioritization of health needs in the 2024 NRVCHA

STEP 5: Strategic Planning to Address Priority Health Needs

The final CHAT meeting served as a springboard into both hospital and community action planning. The prioritized needs were again reviewed with the CHAT and a two-part activity ensued. CHAT members identified key drivers of the prioritized health outcomes/conditions using the Robert Wood Johnson County Health Rankings framework as reference. Following the identification of drivers, an impact and feasibility analysis was completed in small groups to help identify leading strategies for community change.

Our Impact: Evaluation of Actions Taken in Response to 2021 NRVCHA

The prioritized needs established in the 2021 NRVCHA fell into three overarching categories: mental health, socioeconomic factors and health behaviors. Key strategies included health education, grant funding to address SDOH and support for the efforts of community partners in addressing the needs, both directly and indirectly. Below is a snapshot of outcomes from these efforts through June 30, 2024.

Our Priority: Health Equity

Carilion is part of a growing movement of health system stewards committed to unlocking our community’s potential to thrive. We, along with key partners, strive to identify and address health and socioeconomic factors that impact our communities’ health and well-being. We know that where you live is an important contributing factor of health status and outcomes. We are committed to advancing a culture of health where policies, systems, education, research and resources align for optimal health status.

Our mission calls for us to meaningfully address health inequities and disparities. Equity is a key lens for the CHA process, guiding our actions as we seek to understand community health needs. As we move forward into developing community heath improvement strategies, we will remain focused on identifying and serving those who need it most, seeking to broaden the potential for everyone across our communities to thrive.

The Area Deprivation Index (ADI), a tool developed by the University of Wisconsin-Madison, sheds light on what are considered disadvantaged areas of the community based on census block groups (neighborhoods).5 This granular data helps emphasize the importance of conditions that shape our daily lives. The image below shows the extreme variation seen across the service area in ADI scores and illustrates challenges experienced both within pockets of the central business/shopping locations and some of the most rural locations. Data used in creating the index includes factors for income, education, employment and housing quality some of the key social determinant factors that influence health outcomes.

Map 1. Area Deprivation Index Map

5 https://www.neighborhoodatlas.medicine.wisc.edu/

Source: University of Wisconsin School of Medicine and Public Health.Area Deprivation Index (ADI). 2022.

As we work to improve health equity across our region, our guiding principles include improving access to care and addressing SDOH. This assessment focuses on those principles in the context of specific prioritized health outcomes. To expect a shift in health outcomes, we must focus on improving the underlying factors that lead to them—seen in the figure below—in a coordinated manner. We will be addressing specific SDOH needs as aligned with the CHA focus areas.

Figure 1. Social Determinants of Health

Source: Institute for Clinical Systems Improvement; Going Beyond Clinical Walls: Solving complex Problems, 2014. Analysis and adaptation from the University of Wisconsin Population Health Institute’s County Health Rankings model, 2010. Graphic designed by ProMedica and shared by the American Hospital Association.

Our Priority: Addressing Chronic Disease

Our prioritization process resulted in the elevation of two specific chronic diseases as a focus area: overweight/obesity and hypertension. The following data indicates potential areas for opportunities

Data shows need

• NRV residents have a higher-thanaverage occurrence of physically unhealthy days

• Self-reported height and weight data indicate high rates of adult obesity

• Hypertension (high blood pressure) data shows variation across localities

Key informants indicate need

• Community survey respondents indicated:

o Overweight/obesity as a top health condition affecting their/their family’s health and well-being

o Lack of exercise and poor eating habits were two of the top health factors affecting their/their family’s health and well-being

o Access to parks and recreation and educational opportunities were two top responses to our community’s greatest strengths

• CHAT participants noted the interwoven relationship between chronic disease, mental health and many other identified priorities

Why This Matters

According to the Institute for Health Metrics and Evaluation (IHME), high body-mass index (BMI), high blood pressure and dietary risks are within the top 10 risks driving death and disability. In other words, these are some of the key impacts on overall health, well-being and life expectancy.6 Additionally, chronic diseases are a leading driver of healthcare costs 7

Data below shows physically unhealthy days and obesity across all service area localities as reported by the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Notably, the number of physically unhealthy days reported for all NRVCHA localities exceeded the Virginia state average and only Montgomery and Floyd counties had lower reported obesity prevalence rates than the Virginia state average

High blood pressure is another indicator reported through BRFSS. The graph below shows key differences when viewing crude rates versus age-adjusted rates by county. Radford City, which indicated the lowest prevalence of high blood pressure when analyzing the crude rates, ended up with the highest percentage when considering the age of the locality’s occupants. Because blood pressure is known to increase with age for most people,8 utilizing an age-adjusted rate can help lead to discovering other underlying variables that may be leading to these differences.

6 United States | Institute for Health Metrics and Evaluation (healthdata.org)

7 https://www.cdc.gov/chronic-disease/about/index.html

8 Franklin, Stanley S., et al. "Hemodynamic patterns of age-related changes in blood pressure: the Framingham Heart Study." Circulation 96.1 (1997): 308-315.

Chart 1. Physically Unhealthy Days

Source: Behavioral Risk Factor Surveillance System. 2021. Accessed via

Chart 2. Adults With Obesity

Chart 3. Adults With High Blood Pressure

SparkMap.

Key Drivers

Community partners identified many key drivers of these chronic diseases, including access to healthy foods, access to care, education of prevention and disease management, culture/readiness to change and the impact of stress and trauma According to the CDC, many preventable chronic diseases are caused by the same behaviors, which include smoking, poor nutrition, lack of physical activity and excessive alcohol use. This was evident in the CHAT participants’ discussion of the interwoven relationship of many of these priority areas. By adopting strategies to influence these behaviors, we can ultimately impact multiple diseases (and perhaps priority areas) with coordinated strategies

Resources Available

A detailed list of community partners is available in Appendix G. Key resources to address chronic diseases in the New River Valley Area include:

• Carilion health education programming

• Diagnostic, management and treatment services through healthcare systems

• Prevention and self-management education services

• Healthy behavior support services

• Healthy food access network (Thrive NRV)

Our Priority: Addressing Mental Health and Substance Use

Our prioritization process resulted in the elevation of mental health challenges, substance use and overdoses as focus areas. The following data indicates potential areas for opportunities.

Data shows need

• Residents of the service area have a higher average occurrence of:

o Depressive disorder

o Cigarette smoking

• Overdose deaths vary by locality with high occurrence in some localities

• Higher occurrence of mentally unhealthy days than physically unhealthy days