Final 2014 CHS report with maps

The 2014 Portsmouth Community Health Assessment (CHS) using CASPER Methodology

Final Report April 2015

Portsmouth Health District Virginia Department of Health

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Acknowledgements We would like to acknowledge the following persons for their contributions during the CHS process: Portsmouth Health District: • David Chang, MD • Renee Davis-Wilkins • Triona Gateley • Sabrina Hansen • Janet McMillan • Jessica Mullen • Delores Paulding • Dwight Richards City of Portsmouth: • Andrew Winz Eastern Virginia Medical School: • Jennifer Cavin • Karis Childs • Maureen Filak • DaShaunda Hilliard

• • • • • • •

Donna Ruth Kathleen Walters Tanya Weaver Lin Whitley Jenique Wilson Michelle Winz Teri Young

Medical Reserve Corps: • Robin Boothe • Vicky Ferrell • Sheila Hunt • Susan Taylor Virginia Department of Health: • Ana Colon • Nelson Delacruz

Survey Respondents

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Executive Summary

Being able to assess the health status and needs of a population at the local level is an important role for public health, particularly when used to supplement readily available state and national data. Because of this, in the fall of 2014, the Portsmouth Health District (PHD) began the process of planning to conduct the 2014 Community Health Survey (CHS), using the Community Assessment for Public Health Emergency Response (CASPER) methodology, which is the second time CASPER methodology has been implemented in Portsmouth. The overarching goal of the CHS using CASPER methodology was to continue to build capacity at the local level in conducting this type of community assessment.

The objectives of the CHS were the following: 1) to gain a better understanding of health at the local/neighborhood level in Portsmouth; 2) to exercise and train public health professionals in using CASPER methodology in a local health district; 3) To gather baseline individual and household data for the Portsmouth Community Health Improvement Plan (CHIP) to measure progress in strategies identified by Healthy Portsmouth; 4) engage specific communities by conducting household interviews; and 5) to learn and effectively use ArcGIS™ and the Collector™ App to create spatial analysis maps of health indicators.

On October 28-31, 2014, PHD staff, partners, and volunteers conducted the CHS in the city of Portsmouth.

Interview teams were provided training before conducting the interviews over three evenings and one day in the field. A total of 185 household interviews were completed. The major findings of the survey were the following: • High blood pressure (42%), high blood cholesterol (33%), and Diabetes (19%) are the most frequently reported health conditions in Portsmouth • 11% of Portsmouth residents reported not being to get medical care due to cost, 8% reported not having health insurance of any kind • 31% of Portsmouth residents reported not visiting the dentist in the past 12 months.

• 47% of Portsmouth residents reported their general health as being poor or fair.

• 38% of Portsmouth residents are obese (BMI 30 and above). An additional 27% are overweight (BMI 2529.9) • 36% of Portsmouth residents report getting little to no physical activity • 13% of Portsmouth residents report eating no fruit • 33% of Portsmouth residents report drinking sugary drinks everyday • 22% of Portsmouth residents smoke cigarettes, 18% of residents report smelling cigarette smoke from a neighboring home.

• 31% of Portsmouth residents worry about having enough money for vital expenses like rent, mortgage or food.

• 34% Portsmouth residents say that have little to no knowledge of mental health and 63% say that have little to no knowledge of mental health resources in Portsmouth.

• 21% of new parents (last 5 years) reported not being educated on safe sleep practices.

• 60% of those needing substance abuse or other addiction services were either not able to get services they needed or never sought services.

Based on these findings identified so far, recommendations have been made as part of the follow-up to this CHS. PHD should use the survey results to guide ongoing work around resource planning.

• Promote active communities • Support multi-use agreements with schools • Promote healthy eating and increase access to healthy food and beverages • Promote a tobacco-free community

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• • • • • • •

Support smoking bans on city property Encourage apartment complexes to adopt smoke free housing Partner with other community agencies and groups to increase awareness of mental health resources Engage Community Health Workers to increase access to health care Promote resources for new parents that educate on safe sleep practices Support expanding sexual education in public schools Encourage work places to offer wellness programs that support healthy eating and physical activity

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Introduction and Background

Being able to assess the health status and needs of a population at the local level is an important role for public health, particularly when used to supplement readily available state and national data. Because of this, in the fall of 2014, the Portsmouth Health District (PHD) began the process of planning to conduct the 2014 Community Health Survey (CHS), using the Community Assessment for Public Health Emergency Response (CASPER) methodology, which is the second time CASPER methodology has been implemented in Portsmouth. The overarching goal of the CHS using CASPER methodology was to continue to build capacity at the local level in conducting this type of community assessment.

The objectives of the 2014 Portsmouth CHS were as follows: 1. To gain a better understanding of health at the local/neighborhood level in Portsmouth 2. To exercise and train public health professionals in using CASPER methodology in a local health district 3. To gather baseline individual and household data for the Portsmouth Community Health Improvement Plan (CHIP) to measure progress in strategies identified by Healthy Portsmouth 4. To engage specific communities by conducting household interviews 5. To learn and effectively use ArcGIS™ and the Collector™ App to create spatial analysis maps of health indicators To accomplish these objectives, a workgroup consisting of PHD personnel facilitated the CHS planning and implementation process. In accordance with Healthy Portsmouth and PHD priorities, a survey was developed to assess community households in the following areas: 1) physical activity, 2) nutrition, 3) tobacco use, 4) mental health, 5) teen pregnancy, 6) infant mortality, 7) access to care, 8) perceptions of health, and 9) demographics.

Methods and Materials

PHD conducted the CHS in Portsmouth on October 28–31, 2014. The team applied the CASPER methodology described in the CDC CASPER Toolkit Version 2.0 to define the households within the sampling frame of Portsmouth Health District. Based on the 2010 U.S. Census, the total number of housing units in this area was 40,806. PHD used the standard CASPER two-stage cluster sampling design so that 35 clusters were randomly selected and the aim was for seven interviews per cluster to be completed. PHD used CDC’s GIS cluster selection tool for automated sampling which requires ArcMap 10.2 to randomly select the clusters and develop cluster maps. Additional GIS layers for the maps were provided by the City of Portsmouth.

In September, PHD personnel and two Eastern Virginia Medical School (EVMS) MPH students developed a twopage survey to capture information about general health status which included physical activity, nutrition, tobacco use, mental health, teen pregnancy, infant mortality, access to care, and perceptions of health (see Attachment II for the full survey). Standardized survey questions were derived from sources such as BRFSS, the Howard County Health Assessment Survey, and the first CASPER conducted in Portsmouth in 2013. CASPER materials from CDC and other health departments were used to develop all PHD materials.

PHD staff, volunteers from the Portsmouth Medical Reserve Corps (MRC) and the Norfolk Health District, EVMS students, and staff from VDH’s Office of Epidemiology conducted the field interviews. A three-hour training was provided to the field teams to address the CASPER methodology, safety, logistics and electronic data capture using the Collector™ App installed on six smart phones and three tablets. Teams were instructed to systematically select seven housing units per cluster by selecting every nth housing unit, where n is the total number of housing units divided by seven. Teams were also instructed to attempt to revisit previously selected household up to three times; however, the replacement of households could occur before all three attempts were made.

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The CHS, using this CASPER methodology, was conducted over four days; on Days 1, eight field teams conducted interviews between 2p.m. and 7p.m.; on Day 2, nine field teams conducted interviews between 2p.m. and 7p.m.; on Day 3, seven teams conducted interviews between 2p.m. and 7p.m.; on Day 4, three teams conducted interviews between 10a.m. and 2p.m. The formulas for calculating response rates are presented in Table 1.

Completion rate =

Cooperation rate =

Number of completed Interviews Number of interviews goal (i.e., 245)(typically 210) Number of completed interviews All HUs where contact was made

(including completed interviews, incomplete interviews, and refusals)

Contact rate =

Number of completed interviews Number of HUs where contact was attempted

(including completed interviews, incomplete interviews, refusals, and non-respondents) Table 1: Calculation of CHS response rates (CASPER Methodology)

Un-weighted and weighted cluster analyses based on the total number of housing units within the sampling frame, the number of clusters randomly selected, and the number of interviews completed in each cluster were performed to estimate the frequency percentage, 95% confidence intervals (CI), and the projected number of households within the sampling frame for a particular variable. Data were analyzed using Epi-Info™ v7 (Atlanta, GA) and ArcGIS™. Included in the text of this preliminary report were un-weighted frequencies and percentages; weighted frequencies, percentages and 95% CI will be included in the final report.

Results

Over the four-day period, the interview teams completed 198 interviews out of the targeted 245 interviews for an overall completion rate of 81% (Table 1). Interviews were completed in 47% of households where contact was attempted (including completed interviews, incomplete interviews, refusals and non-respondents). Interviews were completed in 79% of households where contact was actually made (including completed interviews, incomplete interviews, language barriers and refusals). Un-weighted frequencies and percentages and projected (i.e., weighted) population estimates are presented in Tables 1-11.

1) Household Characteristics (Demographics)

Household characteristics are shown in Table 2. Among interviewed households, the majority (75%) were single family houses, 22% were multiple unit structures (such as apartments, condominiums, or townhomes), and the remaining 3% were mobile homes. 86% of the households reported having one (22%), two (33%), three (19%), or four (12%) persons living in the household. Nearly all households (98%) reported that English was the primary language spoken in the home; however, a criterion for interview was an English-speaking adult.

The highest levels of education in the household varied, from 36% of households reporting some college or technical school and 33% reporting a bachelor’s degree, to 24% reporting high school graduation or an equivalent and 7% reporting not completing high school. The most households—29%—reported household incomes between $25,000 and $50,000, followed by a close 27% of households reporting $50,000 to $75,000, 21% reported less than $25,000.

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Regarding respondent demographics, 59% of household respondents were female and 41% were male, 27% were under age 40, 33% were ages 40-60, and 39% were ages 60 and over. 50% of household respondents were White, 42% were African American, and the remaining 5% were other races—and according to the 2012 Census estimates, the population for Portsmouth is 42% White, 54% African American, and 4.5% other races; only 5% were Hispanic, which reflects Portsmouth’s overall Hispanic population of 3.3%. 39% of household respondents were employed for wages (11% reported working 46 hours or more per week), 30% were retired, and an additional 16% were unable to work or out of work; 22% had served on active duty in the U.S. Armed Forces. When asked about their primary source of transportation, 83% reported that their personal vehicle was their main transportation to get to leisure activities (going to get food, shopping, going to the park, etc), with 11% reported a friend’s car as their primary transportation.

2) Health Status

When asked if the respondent had been told by a doctor, nurse or other health professional that they had a chronic condition, 43% of households reported high blood pressure, 35% reported high blood cholesterol, 20% reported diabetes, 17% asthma, 13% cancer, 13% COPD/Emphysema/Chronic Bronchitis, 12% heart attack, and 6% stroke (Table 3).

Characteristic

Table 3. Health Status

Frequency (n=198)

Projected number of Households

Weighted %

Weighted 95% CI

12 88

4992 35368

12 88

6-19 81-94

42 58

17705 23024

43 56

36-51 49-64

33 67

14101 26413

35 65

26-43 56-73

12 88

5278 35139

13 87

6-20 80-94

5 95

2548 38179

6 94

2-10 89-98

14 85

6780 33715

17 83

9-25 75-91

8 91

5330 35398

13 87

78-95 4-22

19 81

8048 32262

20 80

13-27 73-87

% of households

Heart Attack Yes 23 No 172 High Blood Pressure Yes 83 No 114 High Blood Cholesterol Yes 65 No 132 Cancer Yes 23 No 174 Stroke Yes 9 No 188 Asthma Yes 27 No 169 COPD, Emphysema, or Chronic Bronchitis Yes 16 No 181 Diabetes Yes 37 No 157

Diabetes 8

Of the 20% of household respondents who reported being diagnosed with diabetes, 97% reported that their diabetes was under control. 18% of respondents reported being diagnosed with pre-diabetes, and of these 68% reported getting additional information from a health professional AND making lifestyle changes (Table 4).

Finally, only 7% of respondents reported that someone in the household had been told they had diabetes only during pregnancy.

Table 4. Diabetes

Characteristic

Frequency (n=198)

% of households

Projected number of Households

Weighted %

Diabetes Yes 37 19 8048 No 157 81 32262 Is your diabetes under control A1c<9 Yes 36 97 7830 No 1 1 218 Don't Know 0 --Pre-diabetes diagnosis Yes 33 17 7225 No 159 82 32722 Did a health professional give additional information with Pre-diabetes diagnosis Additional 2 7 729 Information Lifestyle Changes 5 19 1149 Both 20 74 3984 Anyone in household ever been told they had diabetes only during pregnancy Yes 10 5 2615 No 172 92 35482

Weighted 95% CI

20 80

13-27 73-87

97 1 --

----

18 82

12-24 76-88

12

-7 - 33

20 68

3-37 47-89

7 92

2-11 88-97

3) Access to Care

Over 80% of households reported having one person they thought of as their personal doctor, and of those that did not, 33% reported having more than one doctor and 67% reported having none; 89% of households reported having health insurance of any kind (Table 5). Only 9% of households reported ever needing medical care but not being able to get it and 11% of households reported not being able to see a doctor because of cost. While only 17% of households reported that they had not been to visit a doctor for a check-up in the past year, 30% of households reported not visiting a dentist in that same time.

Characteristic

Table 5. Access to Care

Frequency (n=198)

One person think of as your personal doctor Yes 157 No 39 If no, More than one personal doctor 11 No personal doctor 22 Ever needed medical care but not able to get it

% of households

Projected number of Households

Weighted Weighted % 95% CI

80 20

33309 7097

82 18

76-89 11-24

33 67

2198 4449

33 67

9-57 43-91

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Yes No Not able to see a doctor because of cost Yes No Health insurance of any kind Yes No Dentist Visit in the past 12 months Yes No Doctor for a check-up in past 12 months Yes No

21 175

11 89

3677 36856

9 91

3-14 86-96

21 174

11 89

4407 36086

11 89

6-16 84-94

182 15

92 8

36361 4278

89 11

84-95 5-16

136 61

69 31

28283 12356

70 30

62-77 23-38

167 30

85 15

33562 7078

83 17

75-90 10-25

4) General Health

Regarding perceptions of health, only 4% of household respondents would say that in general their health is excellent, 20% would say their health is very good, 34% good, 28% fair, and 14% would say their general health is poor (Table 6).

After reporting height and weight, 41% of respondents were classified as obese 1 and 26% percent were overweight. 2 Furthermore, while 46% of respondents reported getting an average of 7-8 hours of sleep per night, 38% reported 5-6 hours and 12% reported less than 4, but only 10% have been diagnosed with a sleep disorder.

Physical Activity For physical activity among household members in the last 2 weeks, only 24% of households reported getting at least 30 minutes of physical activity every day, while 40% reported getting fewer than 4 days of physical activity (Table 14). Among those who reported never or rarely doing physical activity, the most common barriers were no time (17%), health reasons (17%), and no desire (9%). Only 7% reported that the barrier was lack of sidewalks or parks in the areaâ&#x20AC;&#x201D;the majority (87%) of households reported having safe places to walk/exercise in their neighborhood (Table 6).

Characteristic General health Excellent Very Good Good Fair Poor BMI 1 2

Table 6. General Health and Physical Activity Frequency (n=198)

% of households

Projected number of Households

Weighted %

7 34 61 58 33

4 18 32 30 17

1750 7856 13494 11189 5520

4 20 34 28 14

Weighted 95% CI 1-8 13-26 27-41 21-36 8-20

Body Mass Index (BMI) of 30 and above BMI of 25.0-29.9

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30 and above (obese) 74 25.0-29.9 (overweight) 52 18.5-24.9 (normal) 56 Below 18.5 (Underweight) 8 How much sleep do you usually get in a night?

4 hours or less 20 5-6 hours 78 7-8 hours 90 9 or more hours 10 Diagnosed with a sleep disorder?

Yes 20 No 173

33-49

38

16283

41

27

10158

26

29

10376

26

4

2948

7

10 39 45 5

5032 15559 18590 1625

12 38 46 4

6-18 30-46 36-55 1-7

10 89

4018 36105

10 90

5-15 85-94

35471 5002

87 12

81-94 6-19

2131 6880 1219

5 17 3

2-9 9-25 0-6

2906 3808 233 5582 17629

7 9 1 14 44

5-14 0-2 8-20 34-53

8989 7448 9558 4845 9966

22 18 23 12 24

14-30 12-24 17-30 6-18 17-32

Physical activity Place to walk/exercise in your neighborhood?

Yes 173 88 No 23 12 What Prevents HH from getting regular physical activity Safety 9 5 No time 31 16 Cannot afford a gym 6 3 No sidewalks/parks in the area 12 6 Don't want to 18 9 Don't know how to 1 1 Health reasons 26 13 Does not apply 92 47 Did you get at least 30 minutes of physical activity None 35 17 1-4 (some days) 37 19 5-9 (every other day) 44 22 10-13 (most days) 26 5 Everyday 56 28

18-33 17-35 3-12

0-13

5) Nutrition

Once again focusing on the past 2 weeks, 35% of households reported stopping to purchase food at a convenience store at least once and 7% purchased food at a convenience every other day to every day. During the same time period, 57% of households reported eating at a fast food restaurant at least once and 9% reported eating fast food at least 5 times. However, most households (42%) reported cooking dinner at home every day, and additional 40% reported cooking dinner every other day or most days in the past 14 days (Table 7).

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Regarding eating habits in the past week, only 39% of households reported eating fruit 3 every day, and 47% reported eating vegetables 4 every day; 12% and 6% reported never eating fruits and vegetables in the past week, respectively (Table 7). For sugary drinks, the results were fairly evenly split between drinking at least one sugary drink every day (34%) and drinking no sugary drinks in the past week (37%). However, only 33% of households reported ever visiting the Farmers Market in Portsmouth, and 49% of households say they would be extremely likely to eat at a restaurant that offered more healthy options.

Characteristic

Frequency (n=198)

Table 7. Nutrition % of households

How often did you purchase food from a convenience store None 125 63 1-4 (some days) 57 22 5-9 (every other day) 7 4 10-13 (most days) 1 1 Everyday 8 4 Eat at a fast food restaurant None 79 39 1-4 (some days) 99 50 5-9 (every other day) 15 8 10-13 (most days) 2 1 Everyday 3 2 Cook dinner at home None 15 8 1-4 (some days) 19 10 5-9 (every other day) 36 18 10-13 (most days) 44 22 Everyday 84 42 Eat Fruit None 25 13 1-3 (some days) 52 26 4-6 (most days) 45 23 Everyday 76 38 Eat Vegetables None 11 6 1-3 (some days) 43 22 4-6 (most days) 48 24 Everyday 96 48 Drink at least one sugary drink None 75 38 1-3 (some days) 44 22 4-6 (most days) 14 7 Everyday 65 33 3 4

Projected number of Households

Weighted %

Weighted 95% CI

27013 11337 1141 106 1209

66 28 3 <1 3

58-75 20-35 0-1 0-1 1-5

17614 19474 3025 312 381

43 48 7 1 1

34-52 38-57 3-11 0-2 0-2

3463 3729 7944 8704 16967

9 9 19 21 42

4-13 5-13 12-27 15-27 33-50

5024 10276 9423 16083

12 25 23 39

7-18 18-32 17-29 29-47

2252 9872 9350 19332

6 24 23 47

2-9 17-32 17-29 38-57

15263 8183 3627 13722

37 20 9 34

28-47 14-26 2-16 25-42

Includes fresh, frozen, or canned fruit Eating colorful vegetables that were not fried (Does not include rice or other grains)

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Visit Farmers Market in Portsmouth Yes 69 35 No 126 64 Would you eat at a restaurant that offered more healthy options?

Not likely 8 4 Slightly likely 4 4 Moderately likely 17 9 Very likely 28 14 Extremely Likely 101 51

13328 26787

33 66

24-42 57-75

7259 1432 3674 6376 19921

18 4 9 16 49

1-6 1-6 1-9 9-22 39-59

6) Tobacco Use

24% of household respondents reported smoking cigarettes every day or some days, and only 3% reported smoking electronic cigarettes. However, 12% of households reported someone smoking inside the home, 20% reported someone smoking in the car, and 17% reported smelling cigarette, cigar, or pipe tobacco in their home in the past 14 days (Table 8).

Characteristic

Frequency (n=198)

Table 8. Tobacco Use % of households

Projected Weighted % Weighted number of 95% CI Households How often do you smell cigarette, cigar, or pipe tobacco smoke in your home from a neighboring home?

None 162 82 34052 84 77-90 1-4 (some days) 11 6 1909 5 1-9 5-9 (every other day) 2 1 312 1 0-2 10-13 (most days) 0 0 0 0 0-2 Everyday 23 12 4533 11 5-17 Do you smoke cigarettes?

Every day 36 18 7783 19 11-27 Some days 8 4 1977 5 1-9 Not at all 152 78 30685 76 68-84 Do you smoke Electronic cigarettes?

Every day 1 1 389 1 -1 - 3 Some days 5 3 866 2 0-4 Not at all 184 97 37609 97 94-100 Do you/someone else smoke in your home?

Yes, I do 17 9 3144 8 4-12 Yes, someone else 1-8 does 10 5 1742 4 No one smokes 169 86 35676 88 83-93 Do you/someone else smoke in the car?

Yes, I do 27 14 6228 15 8-23 Yes, someone else 0-9 does 12 6 1832 5 No one smokes 155 80 32141 80 72-88

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7) Mental Health

Using the standardized County Health Rankings indicator, in the last 2 weeks, 13% of respondents reported that their mental health was â&#x20AC;&#x153;not goodâ&#x20AC;? every day or most days, while an additional 16% had at least one poor mental health day. During that same timeframe, 13% felt nervous or anxious every day or most days and 17% felt anxious at least one day (Table 9). Also in the past 14 days, 7% reported that mental health kept them from doing their usual activities and 8% reported feeling depressed. However, 32% of households reported being worried or stressed about having enough money to pay vital expenses.

On the other hand, only 15% of households reported anyone in the household taking medicine or receiving treatment for any type of mental health condition; 6% reported anyone needing substance abuse or addiction treatment services, and of those 38% were able to get the services they needed, while 44% never sought services (Table 9). Finally, 34% of households reported they had little to no knowledge about mental health, and 58% reported little to know knowledge about mental health resources in Portsmouth.

Characteristic

Table 9. Mental Health

Frequency (n=198)

% of households

Projected number of Households

Weighted %

Weighted 95% CI

How often was your mental health not good?

None 139 70 29215 72 64-79 1-4 (some days) 20 10 4071 10 5-15 5-9 (every other day) 12 6 2255 6 2-9 10-13 (most days) 3 2 430 1 0-2 Everyday 24 12 4836 12 7-17 How often did you feel nervous or anxious?

None 137 69 28593 70 62-78 1-4 (some days) 24 12 4974 12 6-18 5-9 (every other day) 13 7 2196 5 2-9 10-13 (most days) 2 1 244 1 0-2 Everyday 22 11 4799 12 6-18 How often do you feel so depressed that nothing can cheer you up?

None 179 90 37486 92 88-96 1-13 (some days) 14 7 2237 5 2-9 Everyday 14 3 1083 3 0-5 How often does poor mental health keep you from doing your usual activities?

None 181 91 37904 93 89-97 1-13 (some days) 13 7 1269 5 2-9 Everyday 4 2 733 2 0-4 In the past year were you worried or stressed about having money to pay for vital expenses like rent, mortgage, or food?

Yes 61 31 12887 32 25-39 No 133 68 27219 68 60-75 Anyone in household taking medicine or receiving treatment for mental health condition Yes 32 16 5857 15 9-20 No 159 82 33652 84 77-90 Anyone in household needed substance abuse or other addiction services Yes 12 6 2440 6 2-10

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No 178 92 37431 How knowledgeable are you about mental health?

No knowledge 46 23 10084 Somewhat Knowledgeable 21 11 3493 Knowledgeable 57 29 12345 Very knowledgeable 36 18 6147 Professional Training 38 19 8736 How knowledgeable are you about mental health resources in Portsmouth?

No knowledge 91 46 17523 Somewhat Knowledgeable 34 17 6312 Knowledgeable 26 13 5658 Very knowledgeable 20 10 4400 Professional Training 27 14 6854

93

90-97

25 9 30 15 21

18-21 4-13 23-38 10-20 13-30

43 15 14 11 17

35-51 10-21 6-21 6-16 9-25

8) Maternal and Child Health

Among the households that reported someone in the house being pregnant within the past 5 years (16%), 96% sought pre-natal care, and 88% sought care in the first trimester; 47% used WIC services during the pregnancy and 80% were educated about safe sleep practices (Table 10). If there was an infant in the household in the past 5 years, only 12% of households reported that the infant was exclusively breast-fed and 48% reported that the infant was exclusively formula-fed.

Among the households that reported currently having children under 18 years of age in the household (with 24% of households reporting having 1 or 2 children), 26% reported that the children watched an average of 1 to 4 hours of TV on a typical day, and 2% reported more than 5 hours per day. Furthermore, 14% reported that the children use a computer or tablet for 1 to 4 hours per day, and 6% more than 5 hours (Table 10).

37% of households reported having teens between ages 12 and 19 living at home, and of those 32% reported being not comfortable or somewhat comfortable with talking to their teen about sex and pregnancy prevention, but 52% of households reported talking to their teen about sex and pregnancy prevention at least once a month (Table 10).

Characteristic

Table 10. Maternal and Child Health Frequency (n=198)

% of households

Projected number of Households Anyone in HH currently pregnant or been pregnant in the past 5 years?

Yes 33 18 6292 No 150 80 31409 If yes, did they see Pre-natal Care?

Yes 34 97 6689 No 1 3 291 When did they first receive Pre-natal Care?

First Trimester 30 88 5898 Second Trimester 2 6 458 Third Trimester 2 6 333 Did they use WIC services?

Yes 18 50 3370

Weighted %

Weighted 95% CI

16 81

11-22 75-87

96 4

87-105 -4 - 13

88 7 5

76-100 -3 - 17 -2 - 12

47

29-65

15

No 17 47 3611 Were they educated about safe sleep practices?

Yes 26 79 5480 No 7 21 1356 How many children less than 18 years old live in household Zero 141 71 28230 One 22 11 4248 Two 22 11 5521 Three 6 3 1128 Four 4 2 717 Five 3 2 962 Was your infant Breast-fed 4 11 777 Formula-fed 18 51 3162 Both 13 37 2687 How many hours of TV does your child watch in a day?

Zero 146 74 29281 1-2 hours 28 14 7392 3-4 hours 19 10 3419 5 or more hours 5 3 714 How many hours does your child use a computer/tablet in a day?

Zero 163 82 32599 1-2 hours 21 11 4569 3-4 hours 7 4 1237 5 or more hours 7 4 2400 Do you have a teen between the ages of 12 and 19 living at home?

Yes 24 36 5324 No 41 62 9059 How comfortable are you talking to your teen about sex and pregnancy prevention?

Not Comfortable (1) 3 11 588 Somewhat Comfortable (2-4) 6 22 1456 Very Comfortable (5) 18 67 4244 How often do you talk about sex with your teen?

Once a Week 4 18 631 Once a Month 9 41 2638 Once every 6 Months 2 9 486 Once a Year 7 32 1318

51

32-69

80 20

65-96 4-35

69 10 14 3 2 2

60-78 5-16 6-21 0-5 0-4 0-6

12 48 41

11-13 47-49 39-42

72 18 8 2

63-80 11-25 4-13 0-3

80 11 3 6

72-87 6-16 1-6 0-12

37 62

20-53 46-78

9

-1 - 20

23 67

4-42 45-90

12 52 10 26

-4 - 29 23-81 -5 - 24 3-49

9) Support/Oppose

For the final section on giving support or opposition (Table 11), 93% of respondents said they would support the public use of Portsmouth school property for physical activity, 67% would support a ban on smoking in

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apartments and multi-family buildings in Portsmouth, 71% would support a ban on smoking on city property, 5 and 83% would support expanding sexual education in schools beyond abstinence only education. 6 Characteristic

Table 11. Support/Oppose

Frequency % of Projected number of Weighted % Weighted 95% (n=198) households Households CI Would you support or Oppose The public use of Portsmouth school property for physical activity?

Support 186 94 37924 93 89-98 Oppose 7 4 1820 4 1-8 A ban on smoking in apartments and multi-family buildings in Portsmouth?

Support 130 66 27195 67 57-76 Oppose 43 22 8988 22 14-30 A ban on smoking on city property, such as parks, or around libraries and city buildings, in Portsmouth?

Support 142 72 28924 71 63-79 Oppose 40 20 9004 22 14-30 Expanding sexual education in schools beyond abstinence only education-to include health sexual behaviors and methods of contraception Support 160 82 33146 83 76-90 Oppose 21 11 4265 11 5-17

5 6

Such as parks, or around libraries and city buildings To include healthy sexual behaviors and methods of contraception

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Discussion

The results of this CHS using CASPER methodology provided a rapid assessment of 1) Demographics, 2) Health Status, 3) Access to Care, 4) General Health, 5) Nutrition, 6) Tobacco Use, 7) Mental Health, 8) Maternal and Child Health, and 9) Support/Opposition. These results can help to inform public health practitioners and community partners about how best to appropriately and effectively meet the health needs of the Portsmouth community. In addition, the CASPER methodology built the disaster epidemiology capacity of both PHD and MRC staff personnel. Preliminary discussion points are highlighted below.

CHS and Healthy Portsmouth

PHD is a partner with Healthy Portsmouth coalition, which is “a coalition of community leaders committed to promote change through partnership-building and policy-making for a healthier Portsmouth” with a vision of being “the healthiest place in Hampton Roads to live, learn, play, work, and worship.” After conducting its third CHA process from October 2013 to April 2014, Healthy Portsmouth selected four focus areas of: 1) physical activity, 2) healthy eating, 3) tobacco use, and 4) mental health literacy. The results of the CHS using the CASPER methodology will be helpful in establishing a baseline to inform resource allocation and measure progress in identified strategies in Healthy Portsmouth’s CHIP.

Feedback on Survey

During the implementation of the CHS, two evaluations were completed by field teams—one was a paper evaluation using a series of Likert scales of 1 to 5 (1 being not at all and 5 being very) to evaluate usefulness of the survey, as well as training, food, safety, communications, and supplies; this survey was completed by surveyors when they returned from the field each day. The second evaluation was an online survey, which was sent out to all surveyors after Day 4 to evaluate the survey in more detail, through open-ended questions, regarding what went well and what did not go well with the survey.

On the paper survey, 68% of respondents rated the usefulness of the assessment to the community as a 4 and 0% rated the survey as 1 or 2. For each individual aspect of the survey, 90% of respondents rated the training as a 5, 50% rated food as 4, 59% rated safety as 5, 41% rated communications as 5, and 55% rated supplies as 5.

100% of respondents said they would participate on a team in the future. On the online survey, 48% of qualitative comments focused on what worked well and had no issues with anything in the process.

Although the majority of comments on both evaluations were positive and had no suggestions for improvement, which may be at least partially attributed to the fact that this was the second instance of PHD using the CASPER methodology to deliver a survey, there were several areas for survey improvement that were identified in both of the evaluation surveys.

In the online survey, 29% of comments were suggestions for future surveys, without mentioning what did or did not work well this time and 23% of comments related to what did not work well. The qualitative comments could be divided into five categories: 1) No issues, 2) Questionnaire, 3) Technology, 4) Logistics, and 5) Results.

From these categories, most of the comments in each category related to the length of the survey, difficulties with technology, the time of day and year the survey was done, and mental health. For length of the survey, most respondents remarked that the survey should be shorter, because teams had difficulty with the length of time it took to deliver the survey. For difficulties with technology, many teams had various technical problems with using the Collector app on the smart phones and tablets while delivering the surveys, which may be solved by further training to help volunteers gain familiarity with the technology. For time of day and year the survey was done, most surveyors believed that the survey would have better success during the spring or summer months and later in the day—around the same time the first CASPER was delivered last year. Finally, if

18

volunteers commented on survey results, most of the comments related to mental health and the heaviness of mental health in the survey as well as surprising results.

Recommendations

1. Conduct future surveys during warm weather during days of longer sunlight 2. Use tablet and paper for complete survey collection 3. Provide at least 1 hour of training in using tablets before the survey

19

Attachment I – Tables

Table 1. Questionnaire response rates for the Portsmouth Health District CHS, October 2014

Questionnaire response Completion* Contact† Cooperation‡

Percent 81 47

Rate 198/245 198/423

79

198/252

* Percent of questionnaires completed in relation to the goal of 245 † Percent of questionnaires completed in relation to all households where contact was attempted ‡ Percent of questionnaires completed in relation to all households where contact was made

Characteristic Housing Structure Single family Multiple unit Mobile home Sex Female Male Age 19-29 30-39 40-49 50-59 60-69 70-79 79-89 Number living in household One Two Three

Table 2. Household characteristics Frequency (n=198)

% of households

Projected number of Households

Weighted %

Weighted 95% CI

122 53 7

67 29 4

28709 8428 1197

75 22 3

63-87 10-34 1-6

122 75

62 38

24050 16679

59 41

51-67 33-49

32 31 29 27 47 14 18

16 16 15 14 24 7 9

4710 6300 7900 5793 9091 2232 4779

12 15 19 14 22 5 12

5-18 10-21 10-29 9-20 15-29 2-9 4-19

47 66 40

24 33 20

9000 13427 7551

22 33 19

15-29 26-40 13-24 20

Four Five Six Seven or more Education Grades 1-8 (Elementary) Grades 9-11 (some high school) Grade 12 or GED (High school graduate) College 1-3 years (Some college or technical school) College 4+years (College graduate) Language Households where English is the primary language spoken Race White Black or African American American Indian or Alaskan Native Asian Pacific Islander Hispanic Yes No Income < $25,000 $25,000-$50,000 $50,000-$75,000 More than $75,000 Employment Employed for wages Self-employed Out of work for 1 year or more Out of work for less than 1 year Homemaker Student

23 10 7 5

12 5 4 3

4978 2825 1507 1517

12 7 4 4

7-17 0-13 0-7 0-9

2 12

1 6

458 2352

1 6

0-3 1-10

46

23

9540

24

16-32

71

36

14643

36

28-44

65

33

13540

33

23-44

193

97

40005

98

96-100

101 82 3 2 3

51 42 2 1 2

20,282 17,234 313 137 1,138

50 42 1 <1 3

37-63 30-55 0-2 0-1 0-6

10 187

5 95

2169 38470

5 95

2-9 91-98

47 55 43 31

24 28 22 16

8342 11762 10802 6072

21 29 27 15

12-30 20-38 18-36 7-23

78 12 5 6 11 6

40 6 3 3 6 3

15907 2881 1264 1091 2353 865

39 7 3 3 6 2

31-47 3-12 0-6 0-5 2-10 0-4 21

Retired Unable to work Number of Hours Worked Zero <20 20-29 30-39 40-45 46+ Ever Served on active duty in the US Armed Forces Yes No Primary Transportation Walk Bus Car A friend's car

Characteristic Heart Attack Yes No High Blood Pressure Yes No High Blood Cholesterol Yes No Cancer Yes No Stroke

58 20

30 10

12206 3964

30 10

21-39 3-16

101 8 10 12 49 18

51 4 5 6 25 9

20949 1515 2346 2627 8697 4673

51 4 6 6 21 11

41-61 1-7 2-9 2-11 14-29 6-17

49 148

25 75

8877 31763

22 78

15-29 71-85

10 7 156 23

5 4 80 12

1232 1254 32703 4345

3 3 83 11

0-6 0-7 74-92 5-17

Table 3. Health Status Frequency (n=198)

% of households

Projected number of Households

Weighted %

Weighted 95% CI

23 172

12 88

4992 35368

12 88

6-19 81-94

83 114

42 58

17705 23024

43 56

36-51 49-64

65 132

33 67

14101 26413

35 65

26-43 56-73

23 174

12 88

5278 35139

13 87

6-20 80-94

22

Yes 9 No 188 Asthma Yes 27 No 169 COPD, Emphysema, or Chronic Bronchitis Yes 16 No 181 Diabetes Yes 37 No 157

5 95

2548 38179

6 94

2-10 89-98

14 85

6780 33715

17 83

9-25 75-91

8 91

5330 35398

13 87

78-95 4-22

19 81

8048 32262

20 80

13-27 73-87

Table 4. Diabetes Characteristic

Frequency (n=198)

% of households

Projected number of Households

Diabetes Yes 37 19 No 157 81 Is your diabetes under control A1c<9 Yes 36 18 No 1 1 Don't Know 0 -Pre-diabetes diagnosis Yes 33 17 No 159 82 Did a health professional give additional information with Pre-diabetes diagnosis Additional 2 7 Information Lifestyle Changes 5 19 Both 20 74 Anyone in household ever been told they had diabetes only during pregnancy Yes 10 5 No 172 92

Weighted %

Weighted 95% CI

8048 32262

20 80

13-27 73-87

7830 218 --

19 1 --

13-27 ---

7225 32722

18 82

12-24 76-88

729

12

-7 - 33

1149 3984

20 68

3-37 47-89

2615 35482

7 92

2-11 88-97 23

Table 5. Access to Care

Characteristic One person think of as your personal doctor Yes No If no, More than one personal doctor No personal doctor Ever needed medical care but not able to get it Yes No Not able to see a doctor because of cost Yes No Health insurance of any kind Yes No Dentist Visit in the past 12 months Yes No Doctor for a check-up in past 12 months Yes No

Characteristic General health Excellent Very Good Good Fair Poor

Frequency (n=198)

% of households

Projected number of Households

Weighted %

Weighted 95% CI

157 39

80 20

33309 7097

82 18

76-89 11-24

11 22

33 67

2198 4449

33 67

9-57 43-91

21 175

11 89

3677 36856

9 91

3-4 86-96

21 174

11 89

4407 36086

11 89

6-16 84-94

182 15

92 8

36361 4278

89 11

84-95 5-16

136 61

69 31

28283 12356

70 30

62-77 23-38

167 30

85 15

33562 7078

83 17

75-90 10-25

Table 6. General Health and Physical Activity

Frequency (n=198)

% of households

Projected number of Households

Weighted %

7 34 61 58 33

4 18 32 30 17

1750 7856 13494 11189 5520

4 20 34 28 14

Weighted 95% CI 1-8 13-26 27-41 21-36 8-20 24

BMI

30 and above (obese) 74 25.0-29.9 (overweight) 52 18.5-24.9 (normal) 56 Below 18.5 (Underweight) 8 How much sleep do you usually get in a night?

4 hours or less 20 5-6 hours 78 7-8 hours 90 9 or more hours 10 Diagnosed with a sleep disorder?

Yes 20 No 173 Physical activity Place to walk/exercise in your neighborhood?

Yes 173 No 23 What Prevents HH from getting regular physical activity Safety 9 No time 31 Cannot afford a gym 6 No sidewalks/parks I n the area 12 Don't want to 18 Don't know how to 1 Health reasons 26 Does not apply 92 Did you get at least 30 minutes of physical activity None 35 1-4 (some days) 37 5-9 (every other day) 44 10-13 (most days) 26 Everyday 56

38 27 29

16283 10158 10376

41 26 26

33-49 18-33 17-35

4

2948

7

10 39 45 5

5032 15559 18590 1625

12 38 46 4

6-18 30-46 36-55 1-7

10 89

4018 36105

10 90

5-15 85-94

88 12

35471 5002

87 12

81-94 6-19

5 16 3

2131 6880 1219

5 17 3

2-9 9-25 0-6

6 9 1 13 47

2906 3808 233 5582 17629

7 9 1 14 44

5-14 0-2 8-20 34-53

17 19 22 5 28

8989 7448 9558 4845 9966

22 18 23 12 24

14-30 12-24 17-30 6-18 17-32

3-12

0-13

25

Characteristic

Frequency (n=198)

Table 7. Nutrition

% of households

How often did you purchase food from a convenience store None 125 1-4 (some days) 57 5-9 (every other day) 7 10-13 (most days) 1 Everyday 8 Eat at a fast food restaurant None 79 1-4 (some days) 99 5-9 (every other day) 15 10-13 (most days) 2 Everyday 3 Cook dinner at home None 15 1-4 (some days) 19 5-9 (every other day) 36 10-13 (most days) 44 Everyday 84 Eat Fruit None 25 1-3 (some days) 52 4-6 (most days) 45 Everyday 76 Eat Vegetables None 11 1-3 (some days) 43 4-6 (most days) 48 Everyday 96 Drink at least one sugary drink None 75

Projected number of Households

Weighted %

Weighted 95% CI

63 22 4 1 4

27013 11337 1141 106 1209

66 28 3 <1 3

58-75 20-35 0-1 0-1 1-5

39 50 8 1 2

17614 19474 3025 312 381

43 48 7 1 1

34-52 38-57 3-11 0-2 0-2

8 10 18 22 42

3463 3729 7944 8704 16967

9 9 19 21 42

4-13 5-13 12-27 15-27 33-50

13 26 23 38

5024 10276 9423 16083

12 25 23 39

7-18 18-32 17-29 29-47

6 22 24 48

2252 9872 9350 19332

6 24 23 47

2-9 17-32 17-29 38-57

38

15263

37

28-47 26

1-3 (some days) 44 22 4-6 (most days) 14 7 Everyday 65 33 Visit Farmers Market in Portsmouth Yes 69 35 No 126 64 Would you eat at a restaurant that offered more healthy options?

Not likely 8 4 Slightly likely 4 4 Moderately likely 17 9 Very likely 28 14 Extremely Likely 101 51

Characteristic

8183 3627 13722

20 9 34

14-26 2-16 25-42

13328 26787

33 66

24-42 57-75

7259 1432 3674 6376 19921

18 4 9 16 49

1-6 1-6 1-9 9-22 39-59

Table 8. Tobacco Use

Frequency % of households Projected number of Weighted % (n=198) Households How often do you smell cigarette, cigar, or pipe tobacco smoke in your home from a neighboring home?

None 162 82 34052 84 1-4 (some days) 11 6 1909 5 5-9 (every other day) 2 1 312 1 10-13 (most days) 0 0 0 0 Everyday 23 12 4533 11 Do you smoke cigarettes?

Every day 36 18 7783 19 Some days 8 4 1977 5 Not at all 152 78 30685 76 Do you smoke Electronic cigarettes?

Every day 1 1 389 1 Some days 5 3 866 2 Not at all 184 97 37609 97 Do you/someone else smoke in your home?

Yes, I do 17 9 3144 8 Yes, someone else does 10 5 1742 4 No one smokes 169 86 35676 88

Weighted 95% CI 77-90 1-9 0-2 0-2 5-17 11-27 1-9 68-84 -1 - 3 0-4 94-100 4-12 1-8 83-93 27

Do you/someone else smoke in the car?

Yes, I do Yes, someone else does No one smokes

27 12 155

14 6 80

6228 1832 32141

15 5 80

8-23 0-9 72-88

Table 9. Mental Health Characteristic

Frequency (n=198)

% of households

Projected number of Households

Weighted %

Weighted 95% CI

139 20 12 3 24

70 10 6 2 12

29215 4071 2255 430 4836

72 10 6 1 12

64-79 5-15 2-9 0-2 7-17

69 12 7 1 11

28593 4974 2196 244 4799

70 12 5 1 12

62-78 6-18 2-9 0-2 6-18

37486 2237 1083

92 5 3

88-96 2-9 0-5

How often was your mental health not good?

None 1-4 (some days) 5-9 (every other day) 10-13 (most days) Everyday How often did you feel nervous or anxious?

None 137 1-4 (some days) 24 5-9 (every other day) 13 10-13 (most days) 2 Everyday 22 How often do you feel so depressed that nothing can cheer you up?

None 179 90 1-13 (some days) 14 7 Everyday 14 3 How often does poor mental health keep you from doing your usual activities?

None 181 91 37904 93 1-13 (some days) 13 7 1269 5 Everyday 4 2 733 2 In the past year were you worried or stressed about having money to pay for vital expenses like rent, mortgage, or food?

Yes No

61 133

31 68

12887 27219

32 68

89-97 2-9 0-4 25-39 60-75 28

Anyone in household taking medicine or receiving treatment for mental health condition Yes 32 16 No 159 82 Anyone in household needed substance abuse or other addiction services

5857 33652

15 84

9-20 77-90

Yes No How knowledgeable are you about mental health?

6 92

2440 37431

6 93

2-10 90-97

No knowledge 46 23 Somewhat Knowledgeable 21 11 Knowledgeable 57 29 Very knowledgeable 36 18 Professional Training 38 19 How knowledgeable are you about mental health resources in Portsmouth?

10084 3493 12345 6147 8736

25 9 30 15 21

18-21 4-13 23-38 10-20 13-30

17523 6312 5658 4400 6854

43 15 14 11 17

35-51 10-21 6-21 6-16 9-25

Projected number of Households

Weighted %

Weighted 95% CI

6292 31409

16 81

11-22 75-87

6689 291

96 4

87-105 -4 - 13

5898 458 333

88 7 5

76-100 -3 - 17 -2 - 12

No knowledge Somewhat Knowledgeable Knowledgeable Very knowledgeable Professional Training

Characteristic

12 178

91 34 26 20 27

46 17 13 10 14

Table 10. Maternal and Child Health

Frequency % of (n=198) households Anyone in HH currently pregnant or been pregnant in the past 5 years?

Yes 33 18 No 150 80 If yes, did they see Pre-natal Care?

Yes 34 97 No 1 3 When did they first receive Pre-natal Care?

First Trimester 30 88 Second Trimester 2 6 Third Trimester 2 6

29

Did they use WIC services?

Yes 18 50 No 17 47 Were they educated about safe sleep practices?

Yes 26 79 No 7 21 How many children less than 18 years old live in household Zero 141 71 One 22 11 Two 22 11 Three 6 3 Four 4 2 Five 3 2 Was your infant Breast-fed 4 11 Formula-fed 18 51 Both 13 37 How many hours of TV does your child watch in a day?

Zero 146 74 1-2 hours 28 14 3-4 hours 19 10 5 or more hours 5 3 How many hours does your child use a computer/tablet in a day?

Zero 163 82 1-2 hours 21 11 3-4 hours 7 4 5 or more hours 7 4 Do you have a teen between the ages of 12 and 19 living at home?

Yes 24 36 No 41 62 How comfortable are you talking to your teen about sex and pregnancy prevention?

Not Comfortable (1) 3 11 Somewhat Comfortable (2-4) 6 22 Very Comfortable (5) 18 67 How often do you talk about sex with your teen?

3370 3611

47 51

29-65 32-69

5480 1356

80 20

65-96 4-35

28230 4248 5521 1128 717 962

69 10 14 3 2 2

60-78 5-16 6-21 0-5 0-4 0-6

777 3162 2687

12 48 41

11-13 47-49 39-42

29281 7392 3419 714

72 18 8 2

63-80 11-25 4-13 0-3

32599 4569 1237 2400

80 11 3 6

72-87 6-16 1-6 0-12

5324 9059

37 62

20-53 46-78

588

9

-1 - 20

1456 4244

23 67

4-42 45-90 30

Once a Week Once a Month Once every 6 Months Once a Year

Characteristic

4 9 2 7

18 41 9 32

631 2638 486 1318

12 52 10 26

-4 - 29 23-81 -5 - 24 3-49

Table 11. Support/Oppose

Frequency % of households Projected number of Weighted % Weighted 95% CI (n=198) Households Would you support or Oppose The public use of Portsmouth school property for physical activity?

Support 186 94 37924 93 89-98 Oppose 7 4 1820 4 1-8 A ban on smoking in apartments and multi-family buildings in Portsmouth?

Support 130 66 27195 67 57-76 Oppose 43 22 8988 22 14-30 A ban on smoking on city property, such as parks, or around libraries and city buildings, in Portsmouth?

Support 142 72 28924 71 63-79 Oppose 40 20 9004 22 14-30 Expanding sexual education in schools beyond abstinence only education-to include health sexual behaviors and methods of contraception Support 160 82 33146 83 76-90 Oppose 21 11 4265 11 5-17

31

Attachment II – Survey

Q1. Interview Date (MM/DD/YY ): Q3. Cluster Number: Q5.Team Number: Q2. County Name: Q4. Survey Number: Q6: Interview Initials: Q7. Type of structure □ Single family □ Multiple unit □ Mobile home □ Other ___________ Q8. Indicate sex of respondent. (Ask only if Q10. Is English the primary language spoken in Q9. What is your age? ______ necessary.) □ Male □ Female the household? □ Yes □ No Q11. How many people Q12. What is your main mode of transportation to get to leisure activities (such as going to get food, live in your household? shopping, go to the park)? □Walk □Bike □Bus □Your Own Car □ A Friend's Car ______ Health Status: Now I am going to ask some questions about your health, health insurance, and access to care 13a.Heart Attack, Angina, or Coronary Artery Disease □ Yes □ No □ DK 13b.High Blood Pressure □ Yes □ No □ DK 13c.High Blood Cholesterol □ Yes □ No □ DK Q13. Have you EVER been told by a doctor, 13d.Cancer □ Yes □ No □ DK nurse or other health professional that you 13e.Stroke □ Yes □ No □ DK have had any of the following?

13f.Asthma □ Yes □ No □ DK 13g.COPD, Emphysema, or Chronic Bronchitis □ Yes □ No □ DK 13h.Diabetes □ Yes □ No □ DK IF YES Q14. Is your diabetes under control (A1c <9)? □ Yes □ No □ DK □ N/A Q15. Has anyone in your household ever been told they have diabetes only during pregnancy? □ Yes □ No □ DK Q16. Have you ever been told by a doctor, nurse, or other health IF YES Q16b. Did you get any additional information from a professional that you have pre-diabetes or borderline diabetes? health professional, make any lifestyle changes, or both? □ Yes □ No □ DK □ Additional Information □ Lifestyle Changes □ Both Q17.Do you have one person you think of as your personal IF NOQ17b. Is there more than one, or is there no person who doctor or health care provider? you think of as your personal doctor or health care provider? □ Yes □ No □More than one □No person Q18.Has anyone in your household ever needed medical care Q19. Was there a time in the past 12 months when you needed but was not been able to get it? □ Yes □ No □ DK to see a doctor but could not because of cost? □ Yes □ No Q21a. A dentist or dental Q20. Do you have health □ Yes □ No Q21. In the past year, have you hygienist? insurance of any kind? □Yes visited … □No Q21b. A doctor for a check-up? □ Yes □ No Q22. Would you say that in general your health is—? □ Excellent □ Very good □ Good □ Fair □ Poor Q23. How tall are you?

Q23b. How much do you weigh?

Q24. Is there a place to walk/exercise in your neighborhood? ______ ______ □ Yes □ No □ DK Q25. What prevents your household members from getting regular activity? □ Safety □ No time □ Cannot afford a gym □ Do not have transportation to a gym □ No sidewalks/parks in the area □ Don’t want to □ Don’t know how to □ Health reasons □ N/A Q26a. Did you get at least 30 minutes of physical activity (such as walking, running, basketball, fast bicycling, swimming, fast dancing)? _____ Q26b. Did you stop at a convenience store to purchase food? _____ Q26c. Did you eat at a fast food restaurant (e.g., McDonald’s, Taco Bell, KFC)? _____ Q26d. Did someone in your household cook dinner? _____ Q26. Of the past 14 days, Q26e. Did you smell cigarette, cigar, or pipe tobacco smoke in your home that came from a neighboring condo, how many apartment, or hallway? _____ days …

Q26f. Was your mental health not good (includes stress, depression, and problems with emotions)? _____ Q26g. Did you feel nervous or anxious? _____ Q26h. Did poor mental health keep you from doing your usual activities, such as self-care, work, or recreation? _____ Q26i. Did you feel so depressed that nothing could cheer you up? _____ Q27a. Eat fruit, not including juice (Count fresh, frozen, or canned fruit)? _____ Q27. Of the past 7 days, Q27b. Eat colorful vegetables that were not fried (Do not include rice or other grains)? _____ how many days did you …

Q27c. Drink at least one sugary drink (Sodas, flavored waters/teas, sports drinks, energy drinks)? _____ Q28. Has anyone in your household ever been to the farmers market in Portsmouth? □ Yes □ No □ DK □ Every day □ Some days □ Not at all Q29. Do you now smoke ... every day, some Q29a. Cigarettes days, or not at all?

Q29b. Electronic cigarettes □ Every day □ Some days □ Not at all

32

Q30a. Inside your home? □ Yes, I do □ Yes, Someone else does □ No one smokes Q30. Do you or anyone else smoke...?

Q30b. When you ride in a car? □ Yes, I do □ Yes, Someone else does □ No one smokes Q31. In the past year would you say you were worried or stressed about having enough money to pay vital expenses like your rent, mortgage, or food? □ Yes □ No Q32. Is anyone in your household now taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem? □ Yes □ No □ DK IF YESQ33b. Were they able to get the services they needed?

Q33. Has anyone in your household ever needed substance □ Yes □ No □ Never sought services □ Didn't know where to get abuse or other addiction treatment services? □ Yes □ No □ DK services □ DK Q34. How much sleep do you usually get at Q35. Have you ever been told by a doctor or other health professional that you have night on weekdays or workdays? ______ a sleep disorder? □ Yes □ No □ DK IF YESQ36a. Did they seek IF YESQ36ab. How far along in their pregnancy did they Q36. Is anyone in your pre-natal care? receive prenatal care? □ First Trimester □ Second Trimester □ house currently pregnant or □ Yes □ No □ DK Third Trimester □ No care been pregnant in the past 5 IF YESQ36b. Did they use WIC services during the pregnancy? □ Yes □ No □ DK years?

IF YESQ36c. Were they educated about safe sleep practices □ Yes □ No □ N/A □ Yes □ No □ DK (ABCs)?

Q37. How many children less than 18 years of age live in your household? _____ (If 0 skip to Q42) Q38. In the past five years, if there was an infant under the age of one in your household, was that infant exclusively breast-fed, exclusively formula-fed, or fed through a combination of both? □ Breast-fed □ Formula-fed □ Both □ DK □ N/A Q39. How many hours of TV does your child/children watch in a Q40. How many hours does your child/children use a typical day? ______ computer/tablet in a typical day? ______ IF YESQ41b. On a scale of 1-5, with 1 being not at Q41. Do you have a teen IF 3-5Q41ab. How often do you talk to your between the ages of 12 and 19 currently living at home? □ Yes □ No □ N/A

all comfortable and 5 being very comfortable, how comfortable are you with talking to your teen about sex and pregnancy prevention? □ 1 □ 2 □ 3 □ 4 □

teen about sex and pregnancy prevention? At least… □ Once a week □ Once a month □ Once every 6 months □ Once a year

5 Q42. On a scale of 1 to 5, Q42a. How knowledgeable are you about mental health? □1 □2 □3 □4 □5 with 1 being no knowledge Q42b. How knowledgeable are you about mental health resources in and 5 being receiving □1 □2 □3 □4 □5 Portsmouth? professional training, Q43. On a scale of 1-5, with 1 being not at all likely and 5 being very likely, how likely would you eat at a restaurant that offered more healthy options? □ 1 □ 2 □ 3 □ 4 □ 5 Demographics: Now I am going to ask you a few demographic questions Q44. Which one or more of the following would you say is your race? □White □Black or African American □American Indian or Alaska Native □Asian □Pacific Islander □ Other □ DK Q45. Are you Hispanic, □ Married □ Divorced □ Widowed □ Separated □ Yes □ No Q46. Are you...?

Latino, or Spanish origin? □ Never Married □ A member of an unmarried couple Q47. What is the highest level of education completed by anyone in your household? □Never attended school or only attended kindergarten □Grades 1 through 8 (Elementary) □Grades 9 through 11 (Some high school) □Grade 12 or GED (High school graduate) □College 1 year to 3 years (Some college or technical school) □ College 4 years or more (College graduate) Q49. Are you currently? □ Employed for wages □ SelfQ48. What is your annual household income from all sources? employed □ Out of work for 1 year or more □ Out of work for □Less than $25,000 □$25,000-$50,000 □$50,000-$75,000 less than 1 year □ A Homemaker □ A Student □ Retired □ □More than $75,000 □ DK Unable to work Q50. About how many hours do you work per week at all of your jobs and businesses combined? ______ Q51. Have you ever served on active duty in the United States Armed Forces? □ Yes □ No (Read if necessary: either in the regular military or in a National Guard or military reserve unit. Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the Persian Gulf War).

Q52a. The public use of Portsmouth school property for physical activity? □ Support □ Oppose □ DK Q52b. A ban on smoking in apartments and multi-family buildings in Portsmouth? □ Support □ Oppose □ DK Q52. Would Q52c. A ban on smoking on city property, such as parks, or around libraries and city you support □ Support □ Oppose □ DK buildings, in Portsmouth? or oppose…

Q52d. Expanding sexual education in schools beyond abstinence only education--to □ Support □ Oppose □ DK include healthy sexual behaviors and methods of contraception?

33

Attachment III â&#x20AC;&#x201C; References

1. Centers for Disease Control and Prevention (CDC). Community Assessment for Public Health Emergency Response (CASPER) Toolkit: Second edition. Atlanta (GA): CDC; 2012. http://emergency.cdc.gov/disasters/surveillance/pdf/casper_toolkit_508%20compliant.p df

34

Maps of Selected Indicators from 2014 CHS by Community Area

General Health ......................................................................................................................................................................................... 36 Percentage of Portsmouth Residents who Report their General Health as Fair or Poor .................................................................... 36 Percentage of Portsmouth Residents who are Obese ......................................................................................................................... 37 Percentage of Portsmouth Residents who are Overweight or Obese ................................................................................................. 38 Percentage of Portsmouth Residents who do NOT get enough Physical Activity ............................................................................... 39 Percentage of Portsmouth Residents who do NOT have a Place to Walk/Exercise in their Neighborhood ....................................... 40 Health Status ............................................................................................................................................................................................ 41 Percentage of Portsmouth Residents who have Diabetes .................................................................................................................. 41 Percentage of Portsmouth Residents who are Pre-diabetic ............................................................................................................... 42 Percentage of Portsmouth Residents who have had a Heart Attack .................................................................................................. 43 Percentage of Portsmouth Residents who have High Blood Pressure ................................................................................................ 44 Percentage of Portsmouth Residents who have High Blood Cholesterol............................................................................................ 45 Percentage of Portsmouth Residents who had Cancer ....................................................................................................................... 46 Percentage of Portsmouth Residents who have Asthma .................................................................................................................... 47 Access to Care .......................................................................................................................................................................................... 48 Percentage of Portsmouth Residents who do NOT have a Personal Doctor ....................................................................................... 48 Percentage of Portsmouth Residents who needed Medical Care but were not able to get it ............................................................ 49 Percentage of Portsmouth Residents who do NOT have Health Insurance ........................................................................................ 50 Percentage of Portsmouth Residents who have NOT had a Dentist Visit in the past 12 months ....................................................... 51 Percentage of Portsmouth Residents who have NOT had a Check-Up in the past 12 months ........................................................... 52 Nutrition................................................................................................................................................................................................... 53 Percentage of Portsmouth Residents who purchase Food from a Convenience Store ....................................................................... 53 Percentage of Portsmouth Residents who Eat Little to No Fruit......................................................................................................... 54 Percentage of Portsmouth Residents who Eat Little to No Vegetables .............................................................................................. 55 Percentage of Portsmouth Residents who Drink Sugary Drinks Most Days ........................................................................................ 56 Percentage of Portsmouth Residents who have Visited the Portsmouth Farmers Market ................................................................ 57 Tobacco Use ............................................................................................................................................................................................. 58 Percentage of Portsmouth Residents who Smoke Cigarettes ............................................................................................................. 58 Percentage of Portsmouth Residents who Smoke in the Home ......................................................................................................... 59 Percentage of Portsmouth Residents who have Smelled Cigarette Smoke in their Home from a Neighborhoring home ................. 60 Percentage of Portsmouth Residents who Smoke in the Car .............................................................................................................. 61 Mental Health .......................................................................................................................................................................................... 62 Percentage of Portsmouth Residents whose Mental Health was Not Good ....................................................................................... 62 Percentage of Portsmouth Residents who Feel Nervous or Anxious .................................................................................................. 63 Percentage of Portsmouth Residents who Worry about having Money to Pay for Vital Expenses (Like Rent, mortgage, or food) ... 64 Percentage of Portsmouth Residents who have at least One Person in the household Taking Medicine or Receiving Treatment for any Mental Health Condition............................................................................................................................................................... 65 Percentage of Portsmouth Residents who have Little to No Knowledge About Mental Health ......................................................... 66 Percentage of Portsmouth Residents who have Little to No Knowledge About Mental Health Resources in Portsmouth................ 67

Percentage of Portsmouth Residents who Report their General Health as Fair or Poor

Percentage of Portsmouth Residents who Report their General Health as Fair or Poor

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 15-25% of Portsmouth Residents who reported their general health as fair or poor.

Percentage of Portsmouth Residents who are Obese

Percentage of Portsmouth Residents who are Obese

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 36-48% of Portsmouth Residents who reported a BMI of 30 and above.

Percentage of Portsmouth Residents who are Overweight or Obese

Percentage of Portsmouth Residents who are Overweight or Obese

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 64-75% of Portsmouth Residents who reported a BMI of 25.0 and above.

Percentage of Portsmouth Residents who do NOT get enough Physical Activity

Percentage of Portsmouth Residents who do NOT get enough Physical Activity

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 35-47% of Portsmouth Residents who reported getting less than 30 minutes of activity 4 or fewer days out of 14 days.

Percentage of Portsmouth Residents who do NOT have a Place to Walk/Exercise in their Neighborhood

Percentage of Portsmouth Residents who do NOT have a Place to Walk/Exercise in their Neighborhood

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 81-94% of Portsmouth Residents who reported having a place to walk or exercise in their neighborhood.

Percentage of Portsmouth Residents who have Diabetes

Percentage of Portsmouth Residents who have Diabetes

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 13-27% of Portsmouth Residents who reported having Diabetes

Percentage of Portsmouth Residents who are Pre-diabetic

Percentage of Portsmouth Residents who are Pre-diabetic

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 12-24% of Portsmouth Residents who reported being Pre-diabetic

Percentage of Portsmouth Residents who have had a Heart Attack

Percentage of Portsmouth Residents who have had a Heart Attack

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 6-19% of Portsmouth Residents who reported having a heart attack.

Percentage of Portsmouth Residents who have High Blood Pressure

Percentage of Portsmouth Residents who have High Blood Pressure

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 36-51% of Portsmouth Residents who reported having high blood pressure.

Percentage of Portsmouth Residents who have High Blood Cholesterol

Percentage of Portsmouth Residents who have High Blood Cholesterol

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 26-43% of Portsmouth Residents who reported having high blood cholesterol.

Percentage of Portsmouth Residents who had Cancer

Percentage of Portsmouth Residents who had Cancer

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 6-20% of Portsmouth Residents who reported having Cancer.

Percentage of Portsmouth Residents who have Asthma

Percentage of Portsmouth Residents who have Asthma

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 9-25% of Portsmouth Residents who reported having Asthma.

Percentage of Portsmouth Residents who do NOT have a Personal Doctor

Percentage of Portsmouth Residents who do NOT have a Personal Doctor

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

*The average is the 95% Confidence Interval 76-89% of Portsmouth Residents who reported having a personal doctor.

Percentage of Portsmouth Residents who needed Medical Care but were not able to get it

Percentage of Portsmouth Residents who needed Medical Care but were not able to get it Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

*The average is the 95% Confidence Interval 3-14% of Portsmouth Residents who reported needing medical care but not able to get it.

Percentage of Portsmouth Residents who do NOT have Health Insurance

Percentage of Portsmouth Residents who do NOT have Health Insurance

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

*The average is the 95% Confidence Interval 84-95% of Portsmouth Residents who reported having health insurance of any kind.

Percentage of Portsmouth Residents who have NOT had a Dentist Visit in the past 12 months

Percentage of Portsmouth Residents who have NOT had a Dentist Visit in the past 12 months Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

*The average is the 95% Confidence Interval 62-77% of Portsmouth Residents who reported having a dentist visit in the past 12 months.

Percentage of Portsmouth Residents who have NOT had a Check-Up in the past 12 months

Percentage of Portsmouth Residents who have NOT had a Check-Up in the past 12 months Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 75-90% of Portsmouth Residents who reported having a check-up in the past 12 months.

Percentage of Portsmouth Residents who Purchase Food from a Convenience Store

Percentage of Portsmouth Residents who Purchase Food from a Convenience Store

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 58-70% of Portsmouth Residents who reported purchasing food from a convenience store.

Percentage of Portsmouth Residents who Eat Little to No Fruit

Percentage of Portsmouth Residents who Eat Little to No Fruit

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

*The average is the 95% Confidence Interval 54-66% of Portsmouth Residents who reported eating fruit 3 or fewer days out of 7 days.

Percentage of Portsmouth Residents Eat Little to No Vegetables

Percentage of Portsmouth Residents Eat Little to No Vegetables

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 67-78% of Portsmouth Residents who reported eating vegetables 3 or fewer days out of 7 days.

Percentage of Portsmouth Residents who Drink Sugary Drinks Most Days

Percentage of Portsmouth Residents who Drink Sugary Drinks Most Days

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 56-68% of Portsmouth Residents who reported drinking sugary drinks 4 or more days out of 7 days.

Percentage of Portsmouth Residents who have Visited the Portsmouth Farmers Market

Percentage of Portsmouth Residents who have Visited the Portsmouth Farmers Market

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 24-42% of Portsmouth Residents who reported having visited the Portsmouth Farmers Market.

Percentage of Portsmouth Residents who Smoke Cigarettes

Percentage of Portsmouth Residents who Smoke Cigarettes

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 14-24% of Portsmouth Residents who reported smoking cigarettes.

Percentage of Portsmouth Residents who Smoke in the Home

Percentage of Portsmouth Residents who Smoke in the Home

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 11-19% of Portsmouth Residents who reported someone smoking in their home.

Percentage of Portsmouth Residents who have Smelled Cigarette Smoke in their Home from a Neighboring Home

Percentage of Portsmouth Residents who have Smelled Cigarette Smoke in their Home from a Neighboring Home

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 13-22% of Portsmouth Residents who reported having smelled cigarette smoke in their home from a neighboring home.

Percentage of Portsmouth Residents who Smoke in the Car

Percentage of Portsmouth Residents who Smoke in the Car

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 16-26% of Portsmouth Residents who reported someone smoking in the car.

Percentage of Portsmouth Residents whose Mental Health was Not Good

Percentage of Portsmouth Residents whose Mental Health was Not Good

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 16-26% of Portsmouth Residents who reported their mental health as not good 5 or more days out of 14 days.

Percentage of Portsmouth Residents who Feel Nervous or Anxious

Percentage of Portsmouth Residents who Feel Nervous or Anxious

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 14-23% of Portsmouth Residents who reported feeling nervous or anxious 5 or more days out of 14 days.

Percentage of Portsmouth Residents who Worry about having Money to Pay for Vital Expenses (Like rent, mortgage, or food)

Percentage of Portsmouth Residents who Worry about having Money to Pay for Vital Expenses (Like rent, mortgage, or food)

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 25-39% of Portsmouth Residents who reported worrying about having money to pay for vital expenses like rent, mortgage, or food.

Percentage of Portsmouth Residents who have at least One Person Taking Medicine or Receiving Treatment for Any Mental Health Condition

Percentage of Portsmouth Residents who have at least One Person Taking Medicine or Receiving Treatment for Any Mental Health Condition Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 9-20% of Portsmouth Residents who reported someone in their household taking medicine or receiving treatment for any mental health condition.

Percentage of Portsmouth Residents who have Little to No Knowledge About Mental Health

Percentage of Portsmouth Residents who have Little to No Knowledge About Mental Health

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 67-78% of Portsmouth Residents who reported being knowledgeable about mental health.

Percentage of Portsmouth Residents who have Little to No Knowledge About Mental Health Resources in Portsmouth

Percentage of Portsmouth Residents who have Little to No Knowledge About Mental Health Resources in Portsmouth

Compared to Portsmouthâ&#x20AC;&#x2122;s Average*

1

1

2

2

3

3

5

4

5 4

7

7

6

6

9

8

9

8

10

10

11 18

11 18

17

17

13

13

12

20

19

14

12 20

19

14

16 15

16 15

21

21

Legend Percentage o f Popu lation

Prima ry Road s

<20%

Water Bodies

20% - 39%

Study Areas

Legend Frequency of Occura nce

Prima ry Road s

40% - 59%

Below Average

Water Bodies

60% - 79%

Average

Study Areas

>80%

Above Avera ge

2014 Community Health Survey Portsmouth, Virginia

* The average is the 95% Confidence Interval 37-49% of Portsmouth Residents who reported being knowledgeable about mental health resources in Portsmouth.

Supplemental CHS Report: Neighborhood Health Profile Reports Neighborhood Health Profile Reports The Neighborhood Health Profiles bring together data about major health outcomes, health behaviors, health care access, and social, economic, and physical factors that affect health for each of the 21 Community Areas in the city of Portsmouth, VA. These Community Areas are clusters of neighborhoods developed by the Cityâ&#x20AC;&#x2122;s Department of Neighborhood Advancement based on Census Block Groups (BGs). Using BGs allows Census Data to be used to measure the social, economic, and physical factors that affect health at the sub-city level. The data provided are from both primary and secondary data: the 2014 Portsmouth Community Health Survey and the 2010-2014 American Community Surveys (ACS), respectively. The combination of multiple years of data allows for more reliable estimates in a small population. Using the data collected, the health department utilized kriging, a spatial interpolation method. Using ESRI spatial analysis software and Emperical Baysian kriging, this technique estimates responses in unsampled areas; transforming data points onto a continuous surface and allowing for the creation of maps of the health indicators at the neighborhood level.

The purpose of this document is to create a snapshot of health, behaviors, access to health care, and social determinants of health for the 21 Community Areas. The social determinants of health are factors apart from medical care that strongly influence health and can be shaped by social policies. Each Community Area is compared as above, below or equal to the city of Portsmouthâ&#x20AC;&#x2122;s data. Data from the state of Virginia (VA) and the United States (US) are included as a reference comparison. The profiles will allow the Portsmouth Health Department, residents and city officials to determine priority health issues, but also to identify underlying behaviors and factors that are more immediately actionable.

Community Area #1: Includes River Shores, Windy Pines, Hidden Cove, Stone Mill Estates, Bishops Green, Long Point, and Peachtree

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

United States (%)

average below above average below

42 43 35 13 6

16.9 32.5 38.6 11.8 2.8

16.8 31.4 38.4 12.9 3

Asthma Diabetes Pre‐diabetes Health Behaviours

average above above

17 20 18

8.6 9.7 1.2

8.9 10 1.3

Get enough Physical Activity Eat enough Fruit Eat enough vegatables

below average below

36 39 47

51.9 62.6 78.6

50.8 60.8 77.1

Obesity

above

41

28.5

29.6

Smoke Cigarettes Health Care Check‐up in past 12 months

below

24

19.5

18.1

average

83

73.4

69.6

above above

70 89

69.3 87

65.3 87.6

average

11

13.1

13.1

average

74

85

86.3

above above

36 28

69 16

45.8 21.9

Health Status General health as Fair or Poor High Blood Pressure High Blood Cholesterol Cancer Stroke

Dentist visit in past 12 months Health Insurance Could not get medical care due to cost Social, Economic Factors, & Physicial Factors High school graduation Some college Children in Poverty

Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

17.8 12.5 19.2

Community Area #2: Includes Woods of Hampton, Southhampton, Windmill Shores, Brandon Square, Edgefield East, Edgefield Apts, Edgefield, Merrifields, Merrifields Estates, Twin Pines, Willow Breeze, Westwind Apts

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

United States (%)

Health Status General health as Fair or Poor High Blood Pressure High Blood Cholesterol Cancer Stroke Asthma Diabetes Pre‐diabetes Health Behaviours

average average average average below average above above

42 43 35 13 6 17 20 18

16.9 32.5 38.6 11.8 2.8 8.6 9.7 1.2

16.8 31.4 38.4 12.9 3 8.9 10 1.3

Get enough Physical Activity Eat enough Fruit

average above

36 39

51.9 62.6

50.8 60.8

Eat enough vegatables Obesity

average above

47 41

78.6 28.5

77.1 29.6

below

24

19.5

18.1

above

83

73.4

69.6

Dentist visit in past 12 months Health Insurance

above average

70 89

69.3 87

65.3 87.6

Could not get medical care due to cost Social, Economic Factors, & Physicial Factors High school graduation

average

11

13.1

13.1

below

74

85

86.3

Some college Children in Poverty

average above

36 28

69 16

45.8 21.9

Smoke Cigarettes Health Care Check‐up in past 12 months

Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

17.8 12.5 19.2

Community Area #3: Includes Bayberry Commons, Huntington Park, Stoneridge Apts, Ebony Heights, The Gateway at Sterling, Point, Vacado Apts, Villages at Western Branch, Arbor Reach, Laurel Park, Churchland Square, Chelsea Point Apts

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol above 35 38.6 Cancer average 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes above 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit average 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes below 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost average 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college average 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing above 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #4: Includes N. Siesta Gardens, Hosiers Oaks, Edgewood Park, Pride Homes, Siesta Gardens, Sweethaven, Briarwood, Belevedere, Greenfield Farms, Pinecroft, Westermoreland, Baylaine Apts, Cedar Creek Apts

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor average 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer above 13 11.8 Stroke below 6 2.8 Asthma below 17 8.6 Diabetes average 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity average 36 51.9 Eat enough Fruit above 39 62.6 Eat enough vegatables above 47 78.6 Obesity average 41 28.5 Smoke Cigarettes average 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance above 89 87 Could not get medical care due to cost below 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation above 74 85 Some college average 36 69 Children in Poverty average 28 16 Children in single‐parent households below 56 30 Vacant housing below 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #5: Includes Castle Heights, Cavalier Forest, Hunters Point, Jordansville, Centre Port, The Lanterns, First Watch at River Points, Egrets Cive, Villas at River Pointe, The Pointe, Pointe of View, Windledon Chase, Creekside, West Norfolk, River Peace, North Point,Hatton Point Estates, Hardee Point, Oneliaacress, Cypress Cove Villas, Wise Beach, Pinehurst, Carney Farm, Hatton Square, Westwood, Midfield Pointe

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor below 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer above 13 11.8 Stroke below 6 2.8 Asthma below 17 8.6 Diabetes below 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit above 39 62.6 Eat enough vegatables above 47 78.6 Obesity above 41 28.5 Smoke Cigarettes average 24 19.5 Health Care Check‐up in past 12 months above 83 73.4 Dentist visit in past 12 months above 70 69.3 Health Insurance below 89 87 Could not get medical care due to cost below 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation above 74 85 Some college average 36 69 Children in Poverty average 28 16 Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #6: Incudes Sterling Cove, Woodbine, Sweetbriar, Nottingham Homes, Sterling Point, Green Acres

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor below 42 16.9 High Blood Pressure below 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes below 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity average 36 51.9 Eat enough Fruit average 39 62.6 Eat enough vegatables above 47 78.6 Obesity below 41 28.5 Smoke Cigarettes below 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost average 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation above 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* average 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #7: Includes Port Norfolk, Mt Hernon, Whispering Oaks, London Oaks Apts, My Hermon Village, Seaboard Square, Crescent Place, Norcom Park

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor average 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol below 35 38.6 Cancer average 13 11.8 Stroke below 6 2.8 Asthma below 17 8.6 Diabetes below 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity above 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables average 47 78.6 Obesity average 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months below 83 73.4 Dentist visit in past 12 months above 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost below 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college average 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing above 10.1 10.6 Severe housing problems* average 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #8: Includes Marrimac Point, Greenbrier, Lynn Shores, Lake Shores, Forrest Park, Skyler Cove, Waterview Colonial Manor, Waterview, Glenshellah

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor average 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol below 35 38.6 Cancer average 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes below 20 9.7 Pre‐diabetes average 18 1.2 Health Behaviours Get enough Physical Activity average 36 51.9 Eat enough Fruit above 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes average 24 19.5 Health Care Check‐up in past 12 months below 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #9: Includes Sugar Hill, Shea Terrace, West Park View, Park View, The Myrtles at Downtown

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke average 6 2.8 Asthma below 17 8.6 Diabetes above 20 9.7 Pre‐diabetes average 18 1.2 Health Behaviours Get enough Physical Activity above 36 51.9 Eat enough Fruit average 39 62.6 Eat enough vegatables above 47 78.6 Obesity below 41 28.5 Smoke Cigarettes average 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance above 89 87 Could not get medical care due to cost below 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing above 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #10: Includes Swimming Point, The Heights at Old Towne, Downtown, Worthington Square, One Crawford Pkwy, Olde Towne Square, Olde Towne Commons, Crawford Square, Admirals Landing, Crawford Bay, Old Towne, Columbia Commons, Columbia Place, Effingham Green

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor below 42 16.9 High Blood Pressure below 43 32.5 High Blood Cholesterol average 35 38.6 Cancer average 13 11.8 Stroke average 6 2.8 Asthma average 17 8.6 Diabetes below 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity above 36 51.9 Eat enough Fruit above 39 62.6 Eat enough vegatables above 47 78.6 Obesity below 41 28.5 Smoke Cigarettes average 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months above 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households below 56 30 Vacant housing above 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #11: Includes Uptown, Kings Square, Holley Square at Westbury, Westbury, Ebenezer Plaza

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma below 17 8.6 Diabetes average 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months below 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance below 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation above 74 85 Some college above 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #12: Includes Hope Village, Port Centre Complex, Southside Gardens, Southside, Portside Manor, Effingham Plaza

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure above 43 32.5 High Blood Cholesterol above 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes average 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months below 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing average 10.1 10.6 Severe housing problems* average 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #13: Includes Prentis Park, Prentis Place, Chestnut Apts, Harbor Square, Dale Homes, Lincoln Park, Brighton

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure above 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke above 6 2.8 Asthma below 17 8.6 Diabetes average 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing above 10.1 10.6 Severe housing problems* average 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #14: Incudes New Port, Douglass Park, Arcadia Heights, North Truxtun, Truxtun, Fairville, Maplewood Park, Highland Biltmore,

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure above 43 32.5 High Blood Cholesterol above 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes below 20 9.7 Pre‐diabetes below 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes below 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost below 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation below 74 85 Some college above 36 69 Children in Poverty above 28 16 Children in single‐parent households average 56 30 Vacant housing above 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #15: Includes Marsh Landing, Cradock, Afton Commons, Afton Village, Cradock Colonials, Cradock Gardens

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma above 17 8.6 Diabetes average 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity above 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity average 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households average 56 30 Vacant housing average 10.1 10.6 Severe housing problems* average 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #16: Includes Highland Park New Gosport Town and Country Apts, West Cradock, Deep Creek Village, Stanley Court, Victory Village Apts, Bayview Garden, Victory Garden Apts, Independence Square

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes average 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity below 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost average 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation above 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households below 56 30 Vacant housing above 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #17: Includes Westhaven, Westhaven Apts, Winchester Woods, Waters Edge, Amelia Cove, Grove Park, Oregon Acres, Kingman Heights, Hamilton Place, West Grove, Westhaven Park

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor above 42 16.9 High Blood Pressure average 43 32.5 High Blood Cholesterol average 35 38.6 Cancer above 13 11.8 Stroke below 6 2.8 Asthma above 17 8.6 Diabetes below 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit average 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes average 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance below 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college average 36 69 Children in Poverty average 28 16 Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #18: Includes Park Manor, Sadie Point, South Park Manor, Simonsdale, Century Homes, Elmhurst Square, Baywood, Kimberly Acres, Cedar Point, Belmont, Elizabeth Acres, Pine Acres, Cypress Point, Mimosa Cove

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor below 42 16.9 High Blood Pressure above 43 32.5 High Blood Cholesterol average 35 38.6 Cancer above 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes average 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity above 36 51.9 Eat enough Fruit average 39 62.6 Eat enough vegatables above 47 78.6 Obesity average 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months above 83 73.4 Dentist visit in past 12 months average 70 69.3 Health Insurance above 89 87 Could not get medical care due to cost below 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation below 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #19: Includes Mayflower Park, Hodges Ferry East, Hodges Manor, Heritage, Heritage West Apts, Heritage Manor Apts, West Park Homes, Manor View, Elms Way Condos, Green Lakes, Portsmouth Acres, Stewart Manor, Elizabeth Manor

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor below 42 16.9 High Blood Pressure above 43 32.5 High Blood Cholesterol average 35 38.6 Cancer below 13 11.8 Stroke below 6 2.8 Asthma average 17 8.6 Diabetes above 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit below 39 62.6 Eat enough vegatables below 47 78.6 Obesity above 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months below 83 73.4 Dentist visit in past 12 months above 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost above 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation average 74 85 Some college below 36 69 Children in Poverty average 28 16 Children in single‐parent households below 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #20: Hodges Manor East Apts, Park East Apts, Cherokee Park Apts, Portsmouth Estates, Rollingwood, Collinswood Apts, Chowan Trace, Collinswood, Kings Gate Crossing, Mallard Cove Apts, Manorview Apts

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

Health Status General health as Fair or Poor average 42 16.9 High Blood Pressure above 43 32.5 High Blood Cholesterol average 35 38.6 Cancer average 13 11.8 Stroke below 6 2.8 Asthma above 17 8.6 Diabetes above 20 9.7 Pre‐diabetes above 18 1.2 Health Behaviours Get enough Physical Activity below 36 51.9 Eat enough Fruit average 39 62.6 Eat enough vegatables average 47 78.6 Obesity average 41 28.5 Smoke Cigarettes above 24 19.5 Health Care Check‐up in past 12 months average 83 73.4 Dentist visit in past 12 months below 70 69.3 Health Insurance average 89 87 Could not get medical care due to cost average 11 13.1 Social, Economic Factors, & Physicial Factors High school graduation below 74 85 Some college below 36 69 Children in Poverty above 28 16 Children in single‐parent households above 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

United States (%) 16.8 31.4 38.4 12.9 3 8.9 10 1.3 50.8 60.8 77.1 29.6 18.1 69.6 65.3 87.6 13.1 86.3 45.8 21.9 17.8 12.5 19.2

Community Area #21: Includes Crystal Lake, Lake Forest, Charlestowne Townhouses, Evergreen At Bethel, Cavalier Manor, Victory Park, Lincoln Garden

Neighborhood/ Community Area

Portsmouth (%)

Virginia (%)

United States (%)

average above above average average average above above

42 43 35 13 6 17 20 18

16.9 32.5 38.6 11.8 2.8 8.6 9.7 1.2

16.8 31.4 38.4 12.9 3 8.9 10 1.3

Health Behaviours Get enough Physical Activity

below

36

51.9

50.8

Eat enough Fruit Eat enough vegatables

below below

39 47

62.6 78.6

60.8 77.1

above average

41 24

28.5 19.5

29.6 18.1

above

83

73.4

69.6

below average

70 89

69.3 87

65.3 87.6

below

11

13.1

13.1

average

74

85

86.3

below above

36 28

69 16

45.8 21.9

Health Status General health as Fair or Poor High Blood Pressure High Blood Cholesterol Cancer Stroke Asthma Diabetes Pre‐diabetes

Obesity Smoke Cigarettes Health Care Check‐up in past 12 months Dentist visit in past 12 months Health Insurance Could not get medical care due to cost Social, Economic Factors, & Physicial Factors High school graduation Some college Children in Poverty

Children in single‐parent households average 56 30 Vacant housing average 10.1 10.6 Severe housing problems* below 21 15 *households with at least 1 of 5 housing problems overcrowding, high housing costs, or lack of kitchen or plumbing facilities

17.8 12.5 19.2

Conclusions The residents of Portsmouth, VA disproportionally suffer higher mortality and morbidity rates compared to their neighboring cities in Hampton Roads. When presenting the Community Health Assessment to the Healthy Portsmouth Coalition, the phrase â&#x20AC;&#x153;Portsmouth has the highest rate of X disease or X poor socio-economic indicatorâ&#x20AC;? was repeated frequently. Portsmouth ranks in the bottom 13th percentile of the cities/counties in Virginia (County Health Rankings). Of the 23 indicators presented in the Neighborhood Profiles, Portsmouth ranks poorly compared to VA and the US in all but 6. One health indicator, high blood cholesterol, was about the same as state and national averages and all the access to health care indicators were above state and national averages. Vacant housing was also about the same as same as VA and slightly lower than the US. Not every resident, however, experiences the same burden of disease or poor health outcomes; significant disparities exist between race, gender, socioeconomic status, and neighborhoods within the city. By examining these indicators by neighborhood level, resources can be targeted to those community areas most at risk. Analysis of the data shows a correlation between poor socio-economic indicators and poor health outcome indicators. Examples of these patterns can be found in Community Area 13, which encompasses some of the poorer neighborhoods in the City. This study area shows significantly higher percentages of children in poverty, low education, and sub-standard housing environments. Health outcomes are poorer than the cityâ&#x20AC;&#x2122;s average and in access to medical care. Finally, these neighborhoods also show nearly half of the state and national averages of physical activity and healthy eating habits. The 2014 CHS and community profiles will allow the health department, city officials, and other stakeholders to concentrate socio-economic programs and funding opportunities to communities at need.