Lower 8 Community Health Assessment: Regional Overview

Introduction
During the summer of 2012, the Community Health Center of Southeast Kansas administered a survey for residents of the Lower 8 region of Southeast Kansas. The surveys main focus was the health needs and concerns in these counties. Public health employees asked area residents to complete this survey, which consisted of three multiple-choice questions and three write-in questions. The survey was available in both English and Spanish and in scannable paper and electronic formats. The counties that participated were Chautauqua, Cherokee, Crawford, Elk, Labette, Montgomery, Neosho, and Wilson. The following report is based on the responses of the 3,112 participants.

County of Residence
Wilson Chautauqua 4% 6% Neosho 10% Montgomery 21% Cherokee 8%

Crawford 28%

Labette 19%

Elk 4%

Note: A number of surveys from Elk County were received too late for inclusion in this report. However, the county-level report for Elk County does include the data from these surveys. The chart above shows the distribution of responses by county. The three counties with the most responses were Crawford (28%), Montgomery (21%), and Labette (19%), while Elk and Wilson had the fewest.

Age
62 & above 14% 18-25 13%

41-62 42%

26-40 31%

The chart above shows the age ranges of those that completed the survey. Almost half (42%) of respondents in all eight counties were in the age range of 41-62. The survey was not administered to anyone under the age of 18. 2

Presented first are results from the three multiple-choice questions. It is important to remember that respondents were asked to choose three answers for each of the multiple-choice questions, which is why the number of responses will add up to far more than the number of respondents.

Question 1
In the following list, what do you think are the three most important factors for a Healthy Community? (Those factors that would most improve the quality of life in your community.) The following chart represents the most popular choices of the respondents:
Good place to raise children Good schools Good jobs & healthy economy Low crime/safe neighborhood Access to health care (e.g., family doctors) Strong family life Healthy behaviors and lifestyles Religious or spiritual values Clean environment Affordale housing Parks & recreation Low level of child abuse Excellent race relations Arts & cultural events Low infant deaths Low adult death and disease rates Other 1441 1360 1305 1031 762 750 688 673 669 371 344 165 74 71 56 56 22

Considering the total number of participants (3,112), 46% agreed that being a Good place to raise children is an important factor for a healthy community, 44% selected Good schools, and 42% chose Good jobs & healthy economy.

Question 2
In the following list, what do you think are the three most important health problems in your community? (Those problems that have the greatest impact on overall community health.)

Cancers Diabetes Heart disease and stroke Teenage pregnancy Child abuse/neglect Aging problems Mental health problems High blood pressure Domestic violence Dental problems Respiratory/lung disease Motor vehicle crash injuries Sexually transmitted diseases Other Infectious disease Farming related injuries Rape/sexual assault HIV/AIDS Infant death Firearm-related injuries Homicide

1582 928 908 846 830 794 761 678 495 450 235 220 208 184 95 94 78 47 42 39 27

Based on the responses of the 3,112 participants, Cancers (51%), Diabetes (30%), and Heart disease and stroke (29%) are the most important health problems in their communities as reported by Lower 8 residents. Cancers was the single most prevalent choice by a wide margin.

Question 3
In the following list, what do you think are the three most important risky behaviors in your community? (Those behaviors that have the greatest impact on overall community health.)
Drug abuse Alcohol abuse Being overweight Poor eating habits Lack of exercise Tobacco use Not using birth control Dropping out of school Unsafe sex Not using seat belts/child safety seats Racism Not getting "shots' to prevent disease Other 41 231 186 129 470 443 411 666 802 724 1517 1747 2187

Among the 3,112 participants, Drug abuse was chosen most often (70%), followed by Alcohol Abuse at 56%, and Being overweight at 49%. There was a wide gap between these top three choices and the fourth-most-prevalent choice, which was Poor eating habits. It is also notable that the third, fourth and fifth-place choices (Being overweight, Poor eating habits and Lack of exercise, respectively) were closely related.

Open-ended questions
Questions 4-6 were open-ended in nature. In order to perform analysis, the handwritten responses to each question were transcribed into typed text. These typed responses, in addition to those from the online surveys, were then loaded into qualitative data analysis software. This software helped to identify commonly occurring themes and ideas. More than 2,000 write-in responses to each question were categorized into one or more distinct categories. Note that sometimes these responses contained multiple themes or ideas; for example, the response Lack of good pay jobs so adults can afford to raise their children without assistance was interpreted as referring to both the job market (categorized as Jobs/Economy) and to government assistance (categorized as Dependence on government). This response was tagged as containing both of those themes.

Question 4
What is your biggest concern about your community? The following table shows the number of times each theme or idea occurred within the write-in responses to question 4:
Theme Jobs/economy Drugs Alcohol Aging/dwindling population Poverty Crime Dependence on government Lack of activities/recreation Housing concerns Education Access to health/dental care Obesity/eating habits General health Child abuse/neglect Other Total N 587 377 108 106 101 98 91 83 76 73 71 61 59 54 343 2287 Percent 25.7% 16.5% 4.7% 4.6% 4.4% 4.3% 4.0% 3.6% 3.3% 3.2% 3.1% 2.7% 2.6% 2.4% 15.0% 100.0%

Note: Any theme occurring 50 or fewer times was grouped into the Other category. The top five themes that arose in response to this question were Jobs/economy, Drugs, Alcohol, Aging/dwindling population, and Poverty. Crime followed closely at number six. Jobs/economy and Drugs were the most prevalent themes by a wide margin. In fact, none of the other individual themes accounted for even 5% of the total. It is also worth considering the relationship between Jobs/economy and Poverty. These two themes are closely tied, and if combined, they would be found in more than 30% of all responses. Because Jobs/economy and Drugs were broad themes and included many responses, each was divided into sub-categories in order to more specifically describe the respondents concerns. The charts below illustrate the make-up of these responses:

Jobs/economy
Poor economy 26% Low-paying jobs 7%

Unemployment rate 6% Lack of jobs 52% Few jobs for young people 4% Lack of businesses 3% Jobs leaving area 2%

Drugs
General concern over drug use 81%

Meth use 5%

Youth drug use 5% Drug-related crimes 5%

Prescription drug abuse 1%

Sale/ manufacture of drugs 3%

The most common themes seen in both categories were broad Lack of jobs for Jobs/economy, and General concern over drug use for Drugs. Responses were placed in these sub-categories if they did not mention a more specific economy- or drug-related problem. Most often, respondents wrote short answers such as drugs or jobs.

Question 5
What one thing would you change about your community? (i.e., what is missing?) The following table shows the number of times each theme or idea occurred within the write-in responses to question 5:
Theme More jobs/better economy More activities/entertainment Reduction of drug use Exercise/recreation facilities Community involvement Increased access to health/dental care More housing options Education improvements Family/parenting improvement Lower taxes Other Total N 432 274 113 103 103 81 75 73 46 43 194 1537 Percent 28.1% 17.8% 7.4% 6.7% 6.7% 5.3% 4.9% 4.7% 3.0% 2.8% 12.6% 100.0%

Note: Any theme occurring 40 or fewer times was grouped into the Other category. The five most prevalent themes that emerged in response to question 5 were More jobs/better economy, More activities/entertainment, Reduction of drug use, Exercise/recreation facilities, and Community involvement. Because jobs and drug use were the two most prominent concerns raised by community members in answer to question 4, their presence in this list is unsurprising. However, this question also brought to light some new concerns. Perhaps most prominent among these was a desire for more activities and entertainment. Because this category was broad and encompassed many individual themes, it was broken down into sub-categories highlighting more specific concerns. Activities for youth was the central theme of 56% of the responses within the More activities/entertainment category. Many respondents mentioned that such activities were needed in order to keep youth from participating in risky behaviors. A breakdown of responses within the More activities/entertainment category is shown in the following chart:

More activities/entertainment
Activities for youth 56%

More activities in general 27%

Entertainment 8%

Activities for families 9%

Another theme unique to question 5 was a desire for exercise or recreation facilities. Once again, this category encompassed a range of ideas. Most of the people whose responses fell into this category stated a desire for a physical building at which people could exercise or hold social gatherings, while others wanted more parks or walking trails. The responses within the Exercise/recreation facilities category are shown in the following chart:

Exercise/recreation facilities

Park 19% Fitness/rec center 62%

Walking/biking trail 16%

Pool 3%

Question 6
What do you like most about living in your community? The following table shows the number of times each theme or idea occurred within the write-in responses to question 6:
Theme Friendliness Community size Community involvement Environment Safety Closeness to family Schools Rural life Low crime Recreation Health care Economical Short commutes Supportive community Religion Location Total N 848 652 416 300 236 210 169 97 77 54 49 48 29 25 23 18 3251 Percent 26.1% 20.1% 12.8% 9.2% 7.3% 6.5% 5.2% 3.0% 2.4% 1.7% 1.5% 1.5% 0.9% 0.8% 0.7% 0.6% 100.0%

It could be argued that the responses to questions 4 and 5 showed some of the drawbacks of living in a small, rural community. The responses to question 6, on the other hand, highlighted many of the benefits of small-town life. The five most common themes were Friendliness, Community size, Community involvement, Environment, and Safety. It is noteworthy that Community Involvement was the third-most-prevalent answer to this question, while it was also the fifth-mostmentioned theme in response to question 5.

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