Racine City Community Health Survey Report 2015

Racine City Community Health Survey Report 2015 Commissioned by: Aurora Health Care Children s Hospital of Wisconsin Wheaton Franciscan Healthcare In Partnership with: Racine City Health Department Center for Urban Population Health Prepared by: JKV Research, LLC

Table of Contents Section Title Page Number Purpose... 1 Methodology... 1 Summary... 4 Key Findings... 11 Rating Their Own Health... 11 Health Care Coverage... 14 Health Care Needed... 21 Health Information and Services... 30 Routine Procedures... 39 Vaccinations... 48 Prevalence of Select Health Conditions... 51 Physical Well Being and Body Weight... 65 Nutrition... 75 Women s Health... 80 Colorectal Cancer Screening... 86 Tobacco Cigarette Use... 91 Exposure to Cigarette Smoke... 96 Other Tobacco Products... 100 Alcohol Use... 102 Household Problems... 106 Mental Health Status... 109 Personal Safety Issues... 115 Children in Household... 122 Community Health Issues... 131 Appendix A: Questionnaire Frequencies... 144 Appendix B: Survey Methodology... 161 Table Title Page Number Table 1. Weighted Demographic Variables of Community Health Survey Respondents for 2015... 3 Table 2. Fair or Poor Health by Demographic Variables for Each Survey Year... 13 Table 3. Personally No Health Care Coverage by Demographic Variables for Each Survey Year... 17 Table 4. Personally Not Covered by Health Insurance in Past 12 Months by Demographic Variables for Each Survey Year... 19 Table 5. Someone in Household Not Covered by Health Insurance in Past 12 Months by Demographic Variables for Each Survey Year... 20 Table 6. Delayed or Did Not Seek Medical Care Due to Cost in Past 12 Months by Demographic Variables for 2015... 23 Table 7. Prescription Medications Not Taken Due to Cost in Past 12 Months by Demographic Variables for Each Survey Year (Household Member)... 24 Table 8. Unmet Medical Care in Past 12 Months by Demographic Variables for Each Survey Year... 26 Table 9. Unmet Dental Care in Past 12 Months by Demographic Variables for Each Survey Year... 28 Table 10. Unmet Mental Health Care in Past 12 Months by Demographic Variables for Each Survey Year... 29 Table 11. Source for Health Information by Demographic Variables for Each Survey Year... 34 Table 12. Doctor s or Nurse Practitioner s Office as Primary Health Care Service by Demographic Variables for Each Survey Year... 36 Table 13. Advance Care Plan by Demographic Variables for Each Survey Year... 38 Table 14. Routine Checkup Two Years Ago or Less by Demographic Variables for Each Survey Year... 41 Table 15. Cholesterol Test Four Years Ago or Less by Demographic Variables for Each Survey Year... 43 Table 16. Dental Checkup Less than One Year Ago by Demographic Variables for Each Survey Year... 45 Racine City Community Health Survey Report 2015

Table Title Page Number Table 17. Eye Exam Less than One Year Ago by Demographic Variables for Each Survey Year... 47 Table 18. Flu Vaccination by Demographic Variables for Each Survey Year... 50 Table 19. High Blood Pressure in Past Three Years by Demographic Variables for Each Survey Year... 54 Table 20. High Blood Cholesterol in Past Three Years by Demographic Variables for Each Survey Year... 56 Table 21. Heart Disease/Condition in Past Three Years by Demographic Variables for Each Survey Year... 58 Table 22. Mental Health Condition in Past Three Years by Demographic Variables for Each Survey Year... 60 Table 23. Diabetes in Past Three Years by Demographic Variables for Each Survey Year... 62 Table 24. Current Asthma by Demographic Variables for Each Survey Year... 64 Table 25. Recommended Moderate Physical Activity by Demographic Variables for Each Survey Year... 67 Table 26. Recommended Vigorous Physical Activity by Demographic Variables for Each Survey Year... 69 Table 27. Recommended Moderate or Vigorous Physical Activity by Demographic Variables for Each Survey Year... 72 Table 28. Overweight by Demographic Variables for Each Survey Year... 74 Table 29. Two or More Servings of Fruit on Average Day by Demographic Variables for Each Survey Year... 77 Table 30. Three or More Servings of Vegetables on Average Day by Demographic Variables for Each Survey Year... 79 Table 31. Pap Smear Within Past Three Years by Demographic Variables for Each Survey Year (Respondents 18 to 65 Years Old and With a Cervix)... 83 Table 32. HPV Test Within Past 5 Years by Demographic Variables for 2015 (Respondents 18 to 65 Years Old and With a Cervix)... 84 Table 33. Cervical Cancer Screening in Recommended Time Frame by Demographic Variables for 2015 (Respondents 18 to 65 Years Old and With a Cervix)... 85 Table 34. Blood Stool Test Within Past Year by Demographic Variables for Each Survey Year (Respondents 50 and Older)... 87 Table 35. Sigmoidoscopy Within Past Five Years by Demographic Variables for Each Survey Year (Respondents 50 and Older)... 88 Table 36. Colonoscopy Within Past Ten Years by Demographic Variables for Each Survey Year (Respondents 50 and Older)... 89 Table 37. Colorectal Cancer Screening in Recommended Time Frame by Demographic Variables for Each Survey Year (Respondents 50 and Older)... 90 Table 38. Current Tobacco Cigarette Smokers by Demographic Variables for Each Survey Year... 93 Table 39. Smoking Not Allowed in Home by Demographic Variables for Each Survey Year... 97 Table 40. Nonsmokers Exposed to Second-Hand Smoke in the Past Seven Days by Demographic Variables for Each Survey Year... 99 Table 41. Use of Other Tobacco Products in Past Month by Demographic Variables for 2015... 101 Table 42. Binge Drinking in Past Month by Demographic Variables for Each Survey Year... 103 Table 43. Driver or Passenger in Vehicle When Driver Perhaps Had Too Much to Drink by Demographic Variables for Each Survey Year... 105 Table 44. Household Problem Associated with Alcohol in Past Year by Demographic Variables for Each Survey Year... 107 Table 45. Household Problem Associated with Marijuana in Past Year by Demographic Variables for Each Survey Year... 108 Table 46. Always/Nearly Always Felt Sad, Blue or Depressed in Past 30 Days by Demographic Variables for Each Survey Year... 111 Table 47. Considered Suicide in the Past Year by Demographic Variables for Each Survey Year... 113 Table 48. Seldom/Never Find Meaning and Purpose in Daily Life by Demographic Variables for Each Survey Year... 114 Table 49. Afraid for Personal Safety by Demographic Variables for Each Survey Year... 117 Table 50. Someone Pushed, Kicked, Slapped or Hit Respondent by Demographic Variables for Each Survey Year... 119 Racine City Community Health Survey Report 2015

Table Title Page Number Table 51. At Least One of the Personal Safety Issues by Demographic Variables for Each Survey Year... 121 Table 52. Child s Personal Doctor/Nurse by Demographic Variables for Each Survey Year... 124 Table 53. Child s Nutrition and Exercise by Demographic Variables for Each Survey Year (Children 5 to 17 Years Old)... 128 Table 54. Child Experienced Bullying in Past 12 Months by Demographic Variables for Each Survey Year (Children 8 to 17 Years Old)... 130 Table 55. Alcohol or Drug Use as a Top Community Health Issue by Demographic Variables for Each Survey Year... 133 Table 56. Chronic Diseases as a Top Community Health Issue by Demographic Variables for Each Survey Year... 134 Table 57. Mental Health or Depression as a Top Community Health Issue by Demographic Variables for Each Survey Year... 136 Table 58. Teen Pregnancy as a Top Community Health Issue by Demographic Variables for Each Survey Year... 137 Table 59. Infectious Diseases as a Top Community Health Issue by Demographic Variables for Each Survey Year... 139 Table 60. Violence as a Top Community Health Issue by Demographic Variables for Each Survey Year... 140 Table 61. Infant Mortality as a Top Community Health Issue by Demographic Variables for Each Survey Year... 142 Figure Title Page Number Figure 1. Rate Own Health for 2015... 11 Figure 2. Fair or Poor Health... 14 Figure 3. Type of Health Care Coverage for 2015... 15 Figure 4. Health Care Coverage... 21 Figure 5. Unmet Health Care in Past 12 Months... 30 Figure 6. Health Information and Services... 39 Figure 7. Routine Procedures... 48 Figure 8. Vaccinations... 51 Figure 9. Health Conditions in Past Three Years for 2015... 52 Figure 10. Health Conditions in Past Three Years... 65 Figure 11. Physical Activity/Week for 2015.... 70 Figure 12. Physical Well Being and Body Weight... 75 Figure 13. Fruit and Vegetable Consumption on an Average Day... 80 Figure 14. Women's Health Tests... 85 Figure 15. Colorectal Cancer Screenings (Respondents 50 and Older)... 91 Figure 16. Current Tobacco Cigarette Smokers (Past 30 Days)... 94 Figure 17. Smoking Cessation in Past 12 Months (Current Smokers)... 95 Figure 18. Smoking Policy Inside Home for 2015... 96 Figure 19. Exposure to Cigarette Smoke... 100 Figure 20. Alcohol Use in Past Month... 106 Figure 21. Household Problems in Past Year... 109 Figure 22. Felt Sad, Blue or Depressed in Past 30 Days for 2015... 110 Figure 23. Mental Health Status... 115 Figure 24. Personal Safety Issues in Past Year... 122 Figure 25. Child s Unmet Needs in Past 12 Months... 125 Figure 26. Child Experienced Bullying in Past Year... 130 Figure 27. Community Health Issues for 2015... 131 Figure 28. Community Health Issues... 143 Racine City Community Health Survey Report 2015

Purpose The purpose of this project is to provide Racine City with information for an assessment of the health status of residents. Primary objectives are to: 1. Gather specific data on behavioral and lifestyle habits of the adult population. Select information will also be collected about the respondent s household. 2. Gather data on the prevalence of risk factors and disease conditions existing within the adult population. 3. Compare, where appropriate, health data of residents to previous health studies. 4. Compare, where appropriate and available, health data of residents to state and national measurements along with Healthy People 2020 goals. This report was commissioned by Aurora Health Care, Children s Hospital of Wisconsin and Wheaton Franciscan Healthcare in partnership with the Center for Urban Population Health and Racine City Health Department. The survey was conducted by JKV Research, LLC. For technical information about survey methodology, contact Janet Kempf Vande Hey, M.S. at (920) 439-1399 or janet.vandehey@jkvresearch.com. For further information about the survey, contact Dottie-Kay Bowersox, Racine City Health Department, at (262) 639-9201. Methodology Data Collection Respondents were scientifically selected so the survey would be representative of all adults 18 years old and older in the service area. The sampling strategy was two-fold. 1) A random-digit-dial landline sample of telephone numbers which included listed and unlisted numbers. The respondent within each household was randomly selected by computer and based on the number of adults in the household (n=300). 2) A cell phoneonly sample where the person answering the phone was selected as the respondent (n=100). At least 8 attempts were made to contact a respondent in both samples. Screener questions verifying location were included. Data collection was conducted by Management Decisions Incorporated. A total of 400 telephone interviews were completed between February 2 and March 3, 2015. Weighting of Data For the landline sample, weighting was based on the number of adults in the household and the number of residential phone numbers, excluding fax and computer lines, to take into account the probability of selection. For the cell-phone only sample, it was assumed the respondent, if an adult, was the primary cell phone user. Combined, post-stratification was conducted by sex and age to reflect the 2010 census proportion of these characteristics in the area. Margin of Error With a sample size of 400, we can be 95% sure that the sample percentage reported would not vary by more than ±5 percent from what would have been obtained by interviewing all persons 18 years old and older with telephones in the service area. This margin of error provides us with confidence in the data; 95 times out of 100, the true value will likely be somewhere between the lower and upper bound. The margin of error for smaller subgroups will be larger than ±5 percent, since fewer respondents are in that category (e.g., adults 65 years old or older who were asked if they ever received a pneumonia vaccination). In 2013, the Census Bureau estimated 57,396 adult residents in the service area. Thus, in this report, one percentage point equals approximately 570 adults. So, when 20% of respondents reported their health was fair or Racine City Community Health Survey Report 2015 1

poor, this roughly equals 11,400 residents ±2,850 individuals. Therefore, from 8,550 to 14,250 residents likely have fair or poor health. Because the margin of error is ±5%, events or health risks that are small will include zero. In 2013, the Census Bureau estimated 28,878 occupied housing units in Racine City. In certain questions of the Community Health Survey, respondents were asked to report information about their household. Using the 2013 household estimate, each percentage point for household-level data represents approximately 290 households. Statistical Significance The use of statistics is to determine whether a true difference between two percentages is likely to exist. If a difference is statistically significant, it is unlikely that the difference between the two percentages is due to chance. Conversely, if a difference is not statistically significant, it is likely there is no real difference. For example, the difference between the percentage of adults reporting fair or poor health in 2003 (15%) and the percentage of adults reporting this in 2015 (20%) is not statistically significant and so it is likely not a real difference; it is within the margin of error of the survey. Data Interpretation Data that has been found statistically significant and not statistically significant are both important for stakeholders to better understand residents as they work on action plans. Additionally, demographic crosstabulations provide information on whether or not there are statistically significant differences within the demographic categories (gender, age, education, household income level and marital status). Demographic data cannot be broken down for race and ethnicity because there are too few cases in the sample. Finally, Healthy People 2020 goals as well as Wisconsin and national percentages are included to provide another perspective of the health issues. Throughout the report, some totals may be more or less than 100% due to rounding and response category distribution. Percentages occasionally may differ by one or two percentage points from previous reports or the Appendix as a result of rounding, recoding variables or response category distribution. Definitions Certain variables were recoded for better analysis and are listed below. Marital status: Married respondents were classified as those who reported married and those who reported a member of an unmarried couple. All others were classified as not married. Household income: It is difficult to compare household income data throughout the years as the real dollar value changes. Each year, the Census Bureau classifies household income into five equal brackets, rounded to the nearest dollar. It is not possible to exactly match the survey income categories to the Census Bureau brackets since the survey categories are in increments of $10,000 or more; however, it is the best way to track household income. This report looks at the Census Bureau s bottom 40%, middle 20% and top 40% household income brackets each survey year. In 2003 and 2005, the bottom 40% income bracket included survey categories less than $30,001, the middle 20% income bracket was $30,001 to $50,000 and the top 40% income bracket was at least $50,001. In 2009, 2012 and 2015, the bottom 40% income bracket included survey categories less than $40,001, the middle 20% income bracket was $40,001 to $60,000 and the top 40% income bracket was at least $60,001. The 2009 recommended amount of physical activity by the Centers for Disease Control is moderate activity for at least 30 minutes on five or more days of the week or vigorous activity for at least 20 minutes on three or more days of the week. Moderate physical activity includes walking briskly, bicycling, vacuuming, gardening or anything else that causes small increases in breathing or heart rate. Vigorous physical activity includes running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate. Insufficient physical activity includes participation in either activity, but not for the duration or the frequency recommended. Inactive respondents reported no moderate or vigorous physical activity in a typical week. Racine City Community Health Survey Report 2015 2

Overweight status was calculated using the Center for Disease Control s Body Mass Index (BMI). Body Mass Index is calculated by using kilograms/meter 2. A BMI of 25.0 to 29.9 is considered overweight and 30.0 or more as obese. Throughout the report, the category overweight includes both overweight and obese respondents. Current smoker is defined as someone who smoked a tobacco cigarette at least some days in the past 30 days. The definition for binge drinking varies. Currently, the Centers for Disease Control (CDC) defines binge drinking as four or more drinks per occasion for females and five or more drinks per occasion for males to account for weight and metabolism differences. Previously, the CDC defined binge drinking as five or more drinks at one time, regardless of gender. In 2003, 2012 and 2015, the Racine City Health Survey defined binge drinking as four or more drinks per occasion for females and five or more drinks per occasion for males to account for weight and metabolism differences. In 2005 and 2009, the definition was five or more drinks, regardless of gender. Demographic Profile The following table includes the weighted demographic breakdown of respondents in the service area. Table 1. Weighted Demographic Variables of Community Health Survey Respondents for 2015 Survey Results TOTAL 100% Gender Male 48% Female 52 Age 18 to 34 34% 35 to 44 17 45 to 54 19 55 to 64 14 65 and Older 16 Education High School Graduate or Less 44% Some Post High School 35 College Graduate 21 Household Income Bottom 40 Percent Bracket 54% Middle 20 Percent Bracket 13 Top 40 Percent Bracket 19 Not Sure/No Answer 14 Married 35% Percentages occasionally may differ by 1 or 2 percentage points from the Appendix as a result of rounding, recoding variables and response category distribution. Racine City Community Health Survey Report 2015 3

Summary This research provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Racine City residents. The following data are highlights of the comprehensive study. Overall Health Vaccinations (65 and Older) Racine City 2003 2005 2009 2012 2015 Racine City 2003 2005 2009 2012 2015 Excellent 21% 17% 16% 16% 16% Flu Vaccination (past year) 80% 42% 61% 56% 69% Very Good 26% 38% 30% 31% 38% Pneumonia (ever) 64% 65% 65% 71% 68% Fair or Poor 15% 19% 19% 22% 20% Other Research: (2013) WI U.S. Other Research: (2013) WI U.S. Flu Vaccination (past year) 55% 63% Fair or Poor 15% 17% Pneumonia (ever) 73% 70% Health Care Coverage Health Conditions in Past 3 Years Racine City 2003 2005 2009 2012 2015 Racine City 2003 2005 2009 2012 2015 Not Covered High Blood Pressure 23% 25% 27% 28% 32% Personally (currently) 8% 7% 17% 15% 7% High Blood Cholesterol 18% 19% 22% 20% 24% Personally (past 12 months) 23% 20% 15% Mental Health Condition 17% 18% 19% Household Member (past 12 months) 24% 26% 24% 24% 17% Heart Disease/Condition 7% 7% 9% 7% 9% Diabetes 8% 8% 8% 9% 9% Other Research: (2013) WI U.S. Asthma (current) 12% 12% 12% 14% 9% Personally Not Covered (currently) 12% 17% Sexually Transmitted Disease (past year) 3% Did Not Receive Care Needed Condition Controlled Through Meds, Racine City 2003 2005 2009 2012 2015 Therapy or Lifestyle Changes Delayed/Did Not Seek Care Due to High Blood Pressure 94% 94% Cost (past 12 months) 24% High Blood Cholesterol 90% 93% Prescript. Meds Not Taken Due to Mental Health Condition 89% 91% Cost (Household) (past 12 months) 16% 18% 14% Heart Disease/Condition 90% 97% Unmet Care (past 12 months) Diabetes 94% 91% Medical Care 11% 20% Asthma (current) 94% 97% Dental Care 19% 22% Mental Health Care 4% 3% Routine Procedures Racine City 2003 2005 2009 2012 2015 Health Information and Services Routine Checkup (2 yrs. ago or less) 84% 83% 81% 81% 85% Racine City 2003 2005 2009 2012 2015 Cholesterol Test (4 years ago or less) 69% 66% 70% 68% 78% Primary Source of Health Information Dental Checkup (past year) 67% 65% 51% 52% 53% Doctor 47% 34% Eye Exam (past year) 49% 43% 35% 41% 39% Internet 19% 29% Myself/Family Member in Health Field 5% 8% Other Research: WI U.S. Primary Health Services Routine Checkup ( 2 years; 2013) 82% 81% Doctor/nurse practitioner s office 81% 74% 69% 67% Cholesterol Test ( 5 years; 2013) 77% 76% Public health clinic/com. health center 3% 4% 8% 3% Dental Checkup (past year; 2012) 72% 67% Urgent care center 0% 1% 3% 15% Hospital emergency room <1% 1% 1% 5% Physical Health Hospital outpatient 2% 2% 3% 6% Racine City 2003 2005 2009 2012 2015 No usual place 1% 7% 3% 5% Physical Activity/Week Advance Care Plan 30% 35% 28% 29% 31% Moderate Activity (5 times/30 min) 28% 24% 37% 35% 31% Vigorous Activity (3 times/20 min) 26% 21% 25% Colorectal Cancer Screenings (50 and Older) Recommended Moderate or Vigorous 48% 45% 42% Racine City 2003 2005 2009 2012 2015 Overweight 63% 71% 63% 72% 75% Blood Stool Test (within past year) 35% 25% -- 12% 13% Fruit Intake (2+ servings/day) 64% 58% 53% 58% 55% Sigmoidoscopy (within past 5 years) 13% 12% 8% Vegetable Intake (3+ servings/day) 28% 22% 21% 19% 26% Colonoscopy (within past 10 years) 53% 57% 57% Screening in Recommended Time Frame 55% 59% 63% Other Research: (2013) WI U.S. Overweight 67% 64% Racine City Community Health Survey Report 2015 4

Women s Health Alcohol Use in Past Month Racine City 2003 2005 2009 2012 2015 Racine City 2003 2005 2009 2012 2015 Mammogram (50+; within past 2 years) 79% 83% 74% 73% 73% Binge Drinker 17% 20% 24% 25% 32% Bone Density Scan (65 and older) 74% 76% 69% 86% Driver/Passenger When Driver Cervical Cancer Screening Perhaps Had Too Much to Drink 5% 3% 4% 4% 3% Pap Smear (18 65; within past 3 yrs) 94% 91% 94% 81% 74% HPV Test (18 65; within past 5 yrs) 64% Other Research: (2013) WI U.S. Screening in Recommended Time Frame Binge Drinker 23% 17% (18-29: Pap every 3 yrs; 30 to 65: Pap and HPV every 5 yrs or Pap only every 3 yrs) 81% Household Problems Associated With Racine City 2005 2009 2012 2015 Other Research: WI U.S. Alcohol 8% 4% 5% 8% Mammogram (50+; within past 2 yrs; 2012) 80% 78% Marijuana 2% 4% Pap Smear (18+; within past 3 years; 2010) 85% 81% Misuse of Prescription or OTC Drugs 1% 1% Cocaine, Heroin or Other Street Drugs 1% 0% Tobacco Cigarette Use Gambling 1% 0% Racine City 2003 2005 2009 2012 2015 Current Smokers (past 30 days) 27% 34% 37% 31% 21% Mental Health Status Of Current Smokers Racine City 2003 2005 2009 2012 2015 Quit Smoking 1 Day or More in Past Felt Sad, Blue or Depressed Year Because Trying to Quit 37% 49% 58% 48% 52% Always/Nearly Always (past 30 days) 8% 7% 8% 10% 4% Saw a Health Care Professional Past Yr Find Meaning & Purpose in Daily Life And Advised to Quit Smoking 72% 81% 78% 70% Seldom/Never 8% 5% 5% 10% 6% Considered Suicide (past year) 6% 5% 6% 5% 5% Other Research: WI U.S. Current Smokers (2013) 19% 19% Children in Household Tried to Quit (2005) 49% 56% Racine City 2012 2015 Personal Health Doctor/Nurse who Exposure to Smoke Knows Child Well and Familiar with History 84% 83% Racine City 2009 2012 2015 Visited Personal Doctor/Nurse for Smoking Policy at Home Preventive Care (past 12 months) 91% 84% Not allowed anywhere 62% 64% 70% Did Not Receive Care Needed (past 12 months) Allowed in some places/at some times 19% 15% 16% Medical Care 4% 4% Allowed anywhere 5% 3% 2% Dental Care 10% 15% No rules inside home 14% 18% 13% Specialist 0% 7% Nonsmokers Exposed to Second-Hand Current Asthma 14% 16% Smoke In Past Seven Days 33% 31% 21% Safe in Community/Neighborhood (seldom/never) 6% 1% Children 5 to 17 Years Old Other Research: (WI: 2003; US: 2006-2007) WI U.S. Fruit Intake (2+ servings/day) 77% 74% Smoking Prohibited at Home 75% 79% Vegetable Intake (3+ servings/day) 24% 39% Physical Activity (60 min./5 or more days/week) 59% 52% Other Tobacco Products in Past Month Children 8 to 17 Years Old Racine City 2015 Unhappy, Sad or Depressed Electronic Cigarettes 8% Always/Nearly Always (past 6 months) 2% 1% Cigars, Cigarillos or Little Cigars 6% Experienced Some Form of Bullying (past 12 months) 17% 40% Smokeless Tobacco 4% Verbally Bullied 12% 25% Physically Bullied 7% 16% Community Health Issues Cyber Bullied 1% 1% Racine City 2012 2015 Chronic Diseases 41% 60% Personal Safety in Past Year Alcohol or Drug Use 60% 58% Racine City 2003 2005 2009 2012 2015 Violence 46% 36% Afraid for Their Safety 7% 8% 5% 6% 8% Mental Health or Depression 23% 33% Pushed, Kicked, Slapped, or Hit 5% 4% 6% 7% 4% Teen Pregnancy 38% 31% At Least One of the Safety Issues 10% 9% 10% 11% 10% Infectious Diseases 23% 22% Infant Mortality 15% 6% Lead Poisoning 1% 2% Racine City Community Health Survey Report 2015 5

Overall Health and Health Care Key Findings In 2015, 54% of respondents reported their health as excellent or very good; 20% reported fair or poor. Respondents who were 55 to 64 years old, with some post high school education or less, in the bottom 60 percent household income bracket, unmarried, inactive or smokers were more likely to report fair or poor conditions. From 2003 to 2015, there was no statistical change in the overall percent of respondents who reported their health as fair or poor. In 2015, 7% of respondents reported they were not currently covered by health care insurance; respondents who were male, 18 to 34 years old, with high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Fifteen percent of respondents reported they personally did not have health care coverage at least part of the time in the past 12 months; respondents who were 45 to 54 years old, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. Seventeen percent of respondents reported someone in their household was not covered at least part of the time in the past 12 months; respondents who were in the bottom 40 percent household income bracket or unmarried were more likely to report this. From 2003 to 2015, the overall percent statistically remained the same for respondents 18 and older as well as for respondents 18 to 64 years old who reported no current personal health care coverage. From 2009 to 2015, the overall percent statistically decreased for respondents who reported no personal health care coverage at least part of the time in the past 12 months. From 2003 to 2015, the overall percent statistically decreased for respondents who reported someone in the household was not covered by health insurance at least part of the time in the past 12 months. In 2015, 24% of respondents reported they delayed or did not seek medical care because of a high deductible, high co-pay or because they did not have coverage for the care in the past 12 months; respondents 45 to 54 years old, with a college education or in the middle 20 percent household income bracket were more likely to report this. Fourteen percent of respondents reported that someone in their household had not taken their prescribed medication due to prescription costs in the past 12 months; respondents in the middle 20 percent household income bracket were more likely to report this. Twenty percent of respondents reported there was a time in the past 12 months they did not receive the medical care needed; respondents 35 to 44 years old, with some post high school education or in the middle 20 percent household income bracket were more likely to report an unmet medical need. Twenty-two percent of respondents reported there was a time in the past 12 months they did not receive the dental care needed; respondents who were 18 to 44 years old or in the bottom 40 percent household income bracket were more likely to report they did not receive the dental care needed. Three percent of respondents reported there was a time in the past 12 months they did not receive the mental health care needed. From 2009 to 2015, the overall percent statistically remained the same for respondents who reported someone in their household had not taken their prescribed medication due to prescription costs in the past 12 months. From 2012 to 2015, the overall percent statistically increased for respondents who reported an unmet medical need in the past 12 months. From 2012 to 2015, the overall percent statistically remained the same for respondents who reported an unmet dental need or unmet mental health need in the past 12 months. In 2015, 34% of respondents reported they contact their doctor when they need health information or clarification while 29% reported they go to the Internet. Eight percent reported they personally or a family member was, in the health care field and was their source of information. Respondents who were female, 65 and older or in the top 40 percent household income bracket were more likely to report they contact their doctor. Respondents who were male, 18 to 34 years old, with a college education or in the middle 20 percent household income bracket were more likely to report they go to the Internet when they need health information or clarification. Respondents 18 to 44 years old, with a high school education or less, with a college education, in the middle 20 percent household income bracket or unmarried respondents were more likely to report they personally were or a family member was, in the health field and their source of information. Sixty-seven percent of respondents reported their primary place for health services was a doctor s or nurse practitioner s office; respondents who were female, 55 and older, with a college education or married were more likely to report this. Thirty-one percent of respondents had an advance care plan; respondents 65 and older, with some post high school education, in the middle 20 percent household income bracket or married respondents were more likely to report an advance care plan. From 2012 to 2015, there was a statistical decrease in Racine City Community Health Survey Report 2015 6

the overall percent of respondents reporting their source for health information was their doctor while there was a statistical increase in the overall percent of respondents reporting their source was the Internet. From 2012 to 2015, there was no statistical change in the overall percent of respondents reporting they personally, or a family member was in the health field and was their source for health information or clarification. From 2005 to 2015, there was a statistical decrease in the overall percent of respondents reporting their primary place for health services was from a doctor s or nurse practitioner s office. From 2003 to 2015, there was no statistical change in the overall percent of respondents having an advance care plan. In 2015, 85% of respondents reported a routine medical checkup two years ago or less while 78% reported a cholesterol test four years ago or less. Fifty-three percent of respondents reported a visit to the dentist in the past year while 39% reported an eye exam in the past year. Respondents 55 and older, with a college education or in the middle 20 percent household income bracket were more likely to report a cholesterol test four years ago or less. Respondents who were 35 to 44 years old, with a college education, in the top 40 percent household income bracket or married were more likely to report a dental checkup in the past year. Respondents 65 and older, with some post high school education or in the top 60 percent household income bracket were more likely to report an eye exam in the past year. From 2003 to 2015, there was a statistical increase in the overall percent of respondents reporting a cholesterol test four years ago or less. From 2003 to 2015, there was a statistical decrease in the overall percent of respondents reporting a dental checkup one year ago or less or an eye exam in the past year. From 2003 to 2015, there was no statistical change in the overall percent of respondents reporting a routine checkup two years ago or less. In 2015, 47% of respondents had a flu vaccination in the past year. Respondents who were 65 and older, in the middle 20 percent household income bracket or married were more likely to report a flu vaccination. Sixty-eight percent of respondents 65 and older had a pneumonia vaccination in their lifetime. From 2003 to 2015, there was a statistical increase in the overall percent of respondents 18 and older who reported a flu vaccination in the past 12 months. From 2003 to 2015, there was no statistical change in the overall percent of respondents 65 and older who reported a flu vaccination in the past year. From 2003 to 2015, there was no statistical change in the overall percent of respondents 65 and older who had a pneumonia vaccination. Health Risk Factors Key Findings In 2015, out of six health conditions listed, the two most often mentioned in the past three years were high blood pressure or high blood cholesterol (32% and 24%, respectively). Respondents who were 65 and older, in the middle 20 percent household income bracket, overweight or inactive were more likely to report high blood pressure. Respondents who were female, 65 and older or inactive were more likely to report high blood cholesterol. Nine percent of respondents reported they were treated for, or told they had heart disease or a heart condition; respondents 65 and older were more likely to report this. Nineteen percent reported a mental health condition in the past three years; respondents in the middle 20 percent household income bracket were more likely to report this. Nine percent reported diabetes; respondents 55 to 64 years old were more likely to report diabetes. Nine percent reported current asthma; respondents who were female, or 45 to 64 years old were more likely to report this. Three percent of respondents reported they had a sexually transmitted disease in the past year. From 2003 to 2015, there was a statistical increase in the overall percent of respondents who reported high blood pressure. From 2003 to 2015, there was no statistical change in the overall percent of respondents who reported high blood cholesterol, heart disease/condition, diabetes or current asthma. From 2009 to 2015, there was no statistical change in the overall percent of respondents who reported a mental health condition. From 2012 to 2015, there was no statistical change in the overall percent of respondents who reported their health conditions were controlled through medication, therapy or lifestyle changes. In 2015, 4% of respondents reported they always or nearly always felt sad, blue or depressed in the past 30 days; respondents 55 to 64 years old were more likely to report this. Five percent of respondents felt so overwhelmed they considered suicide in the past year; respondents who were in the bottom 40 percent household income bracket or unmarried were more likely to report this. Six percent of respondents reported they seldom or never find meaning and purpose in daily life; respondents in the bottom 40 percent household income bracket were more likely to report Racine City Community Health Survey Report 2015 7

this. From 2003 to 2015, there was a statistical decrease in the overall percent of respondents who reported they always or nearly always felt sad, blue or depressed. From 2003 to 2015, there was no statistical change in the overall percent of respondents who reported they considered suicide in the past year or they seldom/never find meaning and purpose in daily life. Behavioral Risk Factors Key Findings In 2015, 31% of respondents did moderate physical activity five times a week for 30 minutes while 25% did vigorous activity three times a week for 20 minutes. Combined, 42% met the recommended amount of physical activity; respondents who were male, 18 to 34 years old, with a high school education or less, who were unmarried or not overweight were more likely to report this. Seventy-five percent of respondents were classified as overweight. Respondents in the middle 20 percent household income bracket or who did not meet the recommended amount of physical activity were more likely to be classified as overweight. From 2003 to 2015, there was no statistical change in the overall percent of respondents who reported moderate physical activity five times a week for at least 30 minutes. From 2009 to 2015, there was no statistical change in the overall percent of respondents who reported vigorous physical activity three times a week for at least 20 minutes. From 2009 to 2015, there was no statistical change in the overall percent of respondents who met the recommended amount of physical activity. From 2003 to 2015, there was a statistical increase in the overall percent of respondents being overweight. In 2015, 55% of respondents reported two or more servings of fruit while 26% reported three or more servings of vegetables on an average day. Respondents who were female, with at least some post high school education or in the top 40 percent household income bracket were more likely to report at least two servings of fruit. Respondents who were female, 18 to 34 years old or with at least some post high school education were more likely to report at least three servings of vegetables on an average day. From 2003 to 2015, there was a statistical decrease in the overall percent of respondents who reported at least two servings of fruit on an average day. From 2003 to 2015, there was no statistical change in the overall percent of respondents who reported at least three servings of vegetables on an average day. In 2015, 73% of female respondents 50 and older reported a mammogram within the past two years. Eighty-six percent of female respondents 65 and older had a bone density scan. Seventy-four percent of female respondents 18 to 65 years old reported a pap smear within the past three years. Sixty-four percent of respondents 18 to 65 years old reported an HPV test within the past five years. Eighty-one percent of respondents reported they received a cervical cancer test in the time frame recommended (18 to 29 years old: pap smear within past three years; 30 to 65 years old: pap smear and HPV test within past five years or pap smear only within past three years). Respondents who were 30 to 65 years old, with a college education or in the top 40 percent household income bracket were more likely to meet the cervical cancer recommendation. From 2003 to 2015, there was no statistical change in the overall percent of respondents 50 and older who reported having a mammogram within the past two years. From 2005 to 2015, there was no statistical change in the overall percent of respondents 65 and older who reported a bone density scan. From 2003 to 2015, there was a statistical decrease in the overall percent of respondents 18 to 65 years old who reported having a pap smear within the past three years. In 2015, 13% of respondents 50 and older reported a blood stool test within the past year. Eight percent of respondents 50 and older reported a sigmoidoscopy within the past five years while 57% reported a colonoscopy within the past ten years. This results in 63% of respondents meeting the current colorectal cancer screening recommendations; respondents in the bottom 60 percent household income bracket were more likely to report this. From 2003 to 2015, there was a statistical decrease in the overall percent of respondents who reported a blood stool test within the past year. From 2009 to 2015, there was no statistical change in the overall percent of respondents who reported a sigmoidoscopy within the past five years or a colonoscopy within the past ten years. From 2009 to 2015, there was no statistical change in the overall percent of respondents who reported at least one of these tests in the recommended time frame. In 2015, 21% of respondents were current tobacco cigarette smokers; respondents who were female, in the bottom 40 percent household income bracket, or unmarried were more likely to be a smoker. In the past 12 months, 52% of Racine City Community Health Survey Report 2015 8

current smokers quit smoking for one day or longer because they were trying to quit. Seventy percent of current smokers who saw a health professional in the past year reported the professional advised them to quit smoking. From 2003 to 2015, there was no statistical change in the overall percent of respondents who were current tobacco cigarette smokers. From 2003 to 2015, there was a statistical increase in the overall percent of current smokers who reported they quit smoking for one day or longer in the past 12 months because they were trying to quit. From 2005 to 2015, there was no statistical change in the overall percent of current smokers who reported their health professional advised them to quit smoking. In 2015, 70% of respondents reported smoking is not allowed anywhere inside the home. Respondents who were in the top 40 percent household income bracket, married or nonsmokers were more likely to report smoking is not allowed anywhere inside the home. Twenty-one percent of nonsmoking respondents reported they were exposed to second-hand smoke in the past seven days; respondents 35 to 44 years old, with a high school education or less, in the bottom 40 percent household income bracket or unmarried respondents were more likely to report this. From 2009 to 2015, there was a statistical increase in the overall percent of respondents who reported smoking is not allowed anywhere inside the home. From 2009 to 2015, there was a statistical decrease in the overall percent of respondents who reported they were exposed to second-hand smoke in the past seven days. In 2015, 8% of respondents used electronic cigarettes in the past month; respondents 18 to 34 years old, with a high school education or less, or in the bottom 60 percent household income bracket were more likely to use e-cigs. Six percent of respondents used cigars, cigarillos or little cigars in the past month; respondents 35 to 44 years old were more likely to report this. Four percent of respondents used smokeless tobacco in the past month. In 2015, 32% of respondents were binge drinkers in the past month. Respondents 18 to 44 years old were more likely to have binged at least once in the past month. Three percent reported they had been a driver or a passenger when the driver perhaps had too much to drink. From 2003 to 2015, there was a statistical increase in the overall percent of respondents who reported binge drinking in the past month. From 2003 to 2015, there was no statistical change in the overall percent of respondents who reported they were a driver or passenger in a vehicle when the driver perhaps had too much to drink in the past month. In 2015, 8% of respondents reported someone in their household experienced a problem, such as legal, social, personal or physical in connection with drinking alcohol in the past year; respondents in households with children were more likely to report an alcohol problem in the house. Four percent of respondents reported someone in their household experienced a problem with marijuana; respondents who were unmarried or in households with children were more likely to report this. One percent of respondents reported someone in their household experienced a problem with the misuse of prescription drugs/over-the-counter drugs. Zero percent of respondents each reported a household problem in connection with cocaine/heroin/other street drugs or with gambling. From 2005 to 2015, there was no statistical change in the overall percent of respondents reporting they, or someone in their household, experienced some kind of problem, such as legal, social, personal or physical in connection with drinking alcohol in the past year. From 2012 to 2015, there was a statistical decrease in the overall percent of respondents reporting a household problem with cocaine/heroin/other street drugs or gambling in the past year. From 2012 to 2015, there was no statistical change in the overall percent of respondents reporting a household problem with marijuana or the misuse of prescription drugs/over-the-counter drugs in the past year. In 2015, 8% of respondents reported someone made them afraid for their personal safety in the past year; respondents who were in the bottom 40 percent household income bracket or unmarried were more likely to report this. Four percent of respondents reported they had been pushed, kicked, slapped or hit in the past year; respondents who were female, in the bottom 40 percent household income bracket or unmarried were more likely to report this. A total of 10% reported at least one of these two situations; respondents who were female, in the bottom 40 percent household income bracket or unmarried were more likely to report this. From 2003 to 2015, there was no statistical change in the overall percent of respondents reporting they were afraid for their personal safety or they were pushed, kicked, slapped or hit. From 2003 to 2015, there was no statistical change in the overall percent of respondents reporting at least one of the two personal safety issues. Racine City Community Health Survey Report 2015 9

Children in Household Key Findings In 2015, a random child was selected for the respondent to talk about the child s health and behavior. Eighty-three percent of respondents reported they have one or more persons they think of as their child s personal doctor or nurse, with 84% reporting their child visited their personal doctor or nurse for preventive care during the past 12 months. Fifteen percent of respondents reported there was a time in the past 12 months their child did not receive the dental care needed. Seven percent reported their child was not able to visit a specialist they needed. Four percent reported their child did not receive the medical care needed. Sixteen percent of respondents reported their child currently had asthma. One percent of respondents reported their child was seldom or never safe in their community. Seventy-four percent of respondents reported their 5 to 17 year old child ate two or more servings of fruit on an average day while 39% reported three or more servings of vegetables. Fifty-two percent of respondents reported their 5 to 17 year old child was physically active five times a week for 60 minutes. One percent of respondents reported their 8 to 17 year old child always or nearly always felt unhappy, sad or depressed in the past six months. Forty percent reported their 8 to 17 year old child experienced some form of bullying in the past year; 25% reported verbal bullying, 16% physical bullying and 1% reported cyber bullying. From 2012 to 2015, there was no statistical change in the overall percent of respondents reporting their child has a personal doctor/nurse or their child visited their personal doctor/nurse for preventive care in the past year. From 2012 to 2015, there was a statistical increase in the overall percent of respondents reporting in the past 12 months their child needed to see a specialist but could not. From 2012 to 2015, there was no statistical change in the overall percent of respondents reporting their child had an unmet dental need or medical need in the past 12 months. From 2012 to 2015, there was no statistical change in the overall percent of respondents who reported their child had asthma. From 2012 to 2015, there was a statistical decrease in the overall percent of respondents who reported their child was seldom/never safe in their community. From 2012 to 2015, there was no statistical change in the overall percent of respondents who reported their 5 to 17 year old child ate two or more servings of fruit on an average day or their child was physically active five times a week for at least 60 minutes. From 2012 to 2015, there was a statistical increase in the overall percent of respondents who reported their child ate three or more servings of vegetables. From 2012 to 2015, there was no statistical change in the overall percent of respondents who reported their 8 to 17 year old child always or nearly always felt unhappy, sad or depressed in the past six months. From 2012 to 2015, there was a statistical increase in the overall percent of respondents who reported in the past year their 8 to 17 year old child was bullied overall or verbally bullied. From 2012 to 2015, there was no statistical change in the overall percent of respondents who reported their 8 to 17 year old child was physically bullied or cyber bullied. Community Health Issues Key Findings In 2015, respondents were asked to pick the top three health issues in the community out of eight listed. The most often cited were chronic diseases (60%), alcohol or drug use (58%) and violence (36%). Respondents in the top 60 percent household income bracket were more likely to report alcohol/drug use as a top health issue. Respondents who were 18 to 34 years old, 45 to 54 years old or married were more likely to report chronic diseases. Thirty-three percent of respondents reported mental health/depression; respondents with a college education were more likely to report this. Thirty-one percent of respondents reported teen pregnancy as a top issue; respondents 18 to 34 years old or with a high school education or less were more likely to report this. Twenty-two percent reported infectious diseases; respondents who were female, 35 to 44 years old or in the bottom 40 percent household income bracket were more likely to report infectious diseases. Six percent reported infant mortality; respondents who were male, 35 to 44 years old or in the middle 20 percent household income bracket were more likely to report this. Two percent reported lead poisoning. From 2012 to 2015, there was a statistical increase in the overall percent of respondents who reported chronic diseases or mental health/depression as one of the top health issues. From 2012 to 2015, there was a statistical decrease in the overall percent of respondents who reported teen pregnancy, violence or infant mortality as one of the top health issues. From 2012 to 2015, there was no statistical change in the overall percent of respondents who reported alcohol/drug use, infectious diseases or lead poisoning as one of the top health issues. Racine City Community Health Survey Report 2015 10