Community Health Assessment

When comparing Morgan County — the healthiest county in the state of Utah — to national, stateand local counties it is important to note that it has the:• Highest home ownership rate• Highest median house value• Lowest percentage of multi-unit dwellings• Least renters unable to afford a two-bedroom apartment• Least percentage of households with housing costs above 30% of household income• No homeless residentsWhen comparing Weber County — the 16th healthiest county in the state of Utah — to national,state, and local counties it is important to note that it has the:• Third highest home ownership rate• Lowest median house value• Third highest percentage of multi-unit dwellings• Second highest percentage of renters unable to afford a two-bedroom apartment• 3rd lowest percentage of households with housing costs above 30% of household income• 2nd most homeless residentsIn 2015 only 21.2% of WMHD WIC clients self-reported owning a home.20What are Residents Saying? “Another area that has to be addressed is the homeless youth in our area…these kids are not considered criminals, but they need help.”21Community Health Assessment 101

Health Indicator 41 Family & Social Support F amily and social support play a significant role in mental and physical wellbeing. Residents with greater social support, less isolation, and communal trust live healthier and longer lives than socially isolated residents.22 Socially isolated individuals are susceptible to developing unhealthy coping behaviors with foods, legal or illegal substances, and face increased levels of depression.23 Socially isolated individuals negatively impact the community’s morbidity and mortality rates. In short, the deeper and more extensive the connections and interactions that individuals have with others typically results in improved health outcomes for all. Table 36: Family & Social Support Indicators United State of Weber Morgan Davis Salt Lake Utah States Utah County County County County County Estimated Adult 20.7% 15.2% 15.9% 10.5% 13% 16.6% 13.7% Population Without Adequate Social/ Emotional Support (2006–12) Children in Single-Parent 34% 19% 24% 10% 16% 22% 11% Household (2009–13) (2013) Linguistically Isolated 4.8% 2.7% 3.4% 0.4% 1% 4% 2.1% Populations* (2009–13) *No person in the house 14 years or older can speak English proficiently. Sources: http://assessment.communitycommons.org/CHNA/report?page=2&id=214, http://www.countyhealthrankings.org/app/utah/2015/measure/ factors/82/data, http://assessment.communitycommons.org/CHNA/report?page=1&id=726 Weber County’s family and social support indicators potentially suggest weaker family and social ties than nearby counties or the State of Utah.102 Weber-Morgan Health Department

What are Residents Saying?Most Weber County residents indicated a multitude of activities with their family — indicative ofstrong family ties — however, some residents reported there is social isolation in Weber County.Weber County residents shared the following:24 “People are friendly; everybody talks to everybody.” “Depression stems from people here not being very social, people tend to stick with their family.” “…feel like an outsider…have felt that way my whole time spent here.” “Neighborhood mentality has gone by the wayside.” “My kids can’t play with certain kids in the neighborhood because we’re not Mormon.”A Morgan County resident shared the following:25 “There is such a good feeling of camaraderie…of people watching out for each other.”WMHD residents shared the followingabout family and social ties afterparticipating in the 2015 PhotoVoiceExhibit:26 “The photo of the turkeys gave me a feeling of joy, because I enjoy bird watching with my husband. We exercise our bodies & minds as we hike & look for new birds to add to our life lists.”Community Health Assessment 103

“I really like the picture of biking and hiking. My family and I enjoy Utah outdoor activities very much.” “Doing activities can leave a mark of enjoyment with friends & family, not only is it keeping you healthy, you’re making memories as well.” “My family really enjoys biking/rollerblading on the Ogden Trails. I like how the trials are kept tidy, away from traffic & are around scenic areas like trees & rivers. I also like how they connect parks, like the Botanical Gardens & the Dinosaur park.”104 Weber-Morgan Health Department

Health Indicator 42 Community Safety & CrimeV iolent crimes — face-to-face physical offenses between victims and perpetrators — are linked to elevated stress, hypertension, asthma, and poor mental health — it can also preventresidents from feeling safe enough to exercise outside of the home.27 The violent crime rate per100,000 is the measurement by which community safety is assessed. It is a broad indicator ofcommunity safety because it includes, homicide, forcible rape, robbery, and aggravated assault.28Not only can violent crimes increase mortality rates, they also contribute to higher morbidity andmental health challenges. Among key stakeholders in the Weber-Morgan Health District that wereinterviewed in 2015 crime was identified as a significant barrier to health.29Morgan County has low violent crime rates, however Weber County is slightly elevated above thestate of Utah’s average. The state of Utah, on average, is considered significantly safer than thenational average for violent crimes.Table 37: 2010–2012 Community Safety Indicator United State of Weber Morgan Davis Salt Lake Utah County County County States Utah County County 100 341.6 78.6Violent Crimes per 395.5 205.7 211.6 41.5100,000 ResidentsSource: http://assessment.communitycommons.org/CHNA/report?page=2&id=212In early 2015, most WMHD WIC clients claimed they felt safe exercising outside of their homes.76% — 3 out of 4 — of WMHD WIC clients that speak Spanish reported they felt safe exercisingoutside of their homes.30 For English speaking WMHD WIC clients the rate increased to 82.7% ormore than 4 out of 5.31WMHD WIC clients indicated low crime/safe neighborhoods as their 4th highest factor –out of 17possible sections– that they feel contribute to a healthy community.32 Community Health Assessment 105

What are Residents Saying?33 Weber County residents shared the following: “[Crime} is still there.” “We’ve come a long way in making it a safe place, but it’s not…it hasn’t been that long, and the memories are still fresh.” “Ogden is not known as a safe city to walk around in” Morgan County residents shared the following: “I think it’s a safe place for my kids.” “We can let our kids walk to school.” “It’s safe for me as a single mom.”106 Weber-Morgan Health Department

Section 6 Endnotes1. http://www.rwjf.org/en/library/research/2012/12/why-does-education-matter-so-much-to-health-.html2. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/21/description3. http://www.cdc.gov/pcd/issues/2007/oct/07_0063.htm4. http://assessment.communitycommons.org/Footprint/5. 2015 WMHD Focus Group Report6. 2015 WMHD Focus Group Report7. http://www.rwjf.org/en/library/research/2012/12/how-does-employment--or-unemployment--affect-health-.html8. http://www.rwjf.org/en/culture-of-health/2013/01/stable_jobs_health.html9. http://www.rwjf.org/en/culture-of-health/2013/01/stable_jobs_health.html10. http://www.who.int/hia/evidence/doh/en/11. http://www.rwjf.org/en/library/research/2012/12/how-does-employment--or-unemployment--affect-health-.html12. http://www.srs.fs.usda.gov/trends/nsre-directory/Nsre/ORRRC/Ch8.pdf13. http://www.rwjf.org/en/culture-of-health/2013/01/stable_jobs_health.html14. 2015 WMHD Focus Group Report15. 2015 WMHD Focus Group Report16. https://www.healthcare.gov/glossary/federal-poverty-level-FPL/17. 2015 WMHD Interviews with Key Stakeholders18. 2015 WMHD Focus Group Report19. http://www.realtor.org/sites/default/files/social-benefits-of-stable-housing-2012-04.pdf20. 2015 WMHD WIC Survey21. 2015 WMHD Focus Group Report22. http://www.countyhealthrankings.org/our-approach/health-factors/family-and-social-support23. http://www.rwjf.org/en/culture-of-health/2013/01/stable_jobs_health.html24. 2015 WMHD Focus Group Report25. 2015 WMHD Focus Group Report26. 2015 WMHD PhotoVoice Comment Board27. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/43/description28. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/43/description29. 2015 WMHD Interviews with Key Stakeholders30. 2015 WMHD WIC Survey31. 2015 WMHD WIC Survey32. 2015 WMHD WIC Survey33. 2015 WMHD Focus Group ReportCommunity Health Assessment 107

Section 7 Physical Environment

T he environment — outdoor air, drinking water, and the general surroundings — all influence quality of life, length of life, and can create health disparities. This section is a compilationof air quality, water quality, and housing problems that create or exacerbate health conditions. Ofthe physical environments evaluated in the state of Utah, Weber and Morgan have an opportunityfor improvement. However, the same is equally true for the other metropolitan regions found inSalt Lake, Davis, and Utah Counties. Table 38 provides the ranking provided by the Robert WoodJohnson Foundation. Table 38: Physical Environment Score (Ranking out of 27) Weber County: 19 Morgan County: 22 Davis County: 16 Salt Lake County: 17 Utah County: 18 Source: Robert Wood Johnson FoundationCommunity Health Assessment 109

Health Indicator 43 Air Quality Photo Credit: Jeffrey Favero A ir quality directly impacts everyone’s health and quality of life. Poor air quality can cause more: Asthma in children Emphysema and bronchitis Cancer Strokes and heart attacks Hospital admissions Unnecessary non-life threatening emergency room use Premature death1, 2, 3110 Weber-Morgan Health Department

What Makes the Air Dirty?The state of Utah and the Environmental Protection Agency (EPA) measure six air pollutantsto determine how clean or dirty the air is; They are:• Particulate Matter (PM)• Ground level Ozone (03)• Carbon Monoxide (CO)• Nitrogen Dioxide (NO2) Graphic 30: PM and Ozone Sources• Sulfur Dioxides (SO2)• Lead (Pb)The state of Utah also measures volatile Miningorganic compounds (VOC) emissionsbecause they are a precursor for Particulatematter; Particulate matter (PM) is dividedinto two types: PM2.5 and PM10.PM2.5 air pollution is made up of ultrafine Construction Dust PM Wood Burningpieces of soot and dust — measuring 2.5 Unpaved Road Sources Stoves*microns or smaller. PM2.5 emissions are Dustconcerning to health because they aresmall enough to embed deeply inside thelungs.4, 5PM10 air pollution consists of coarse Power Plants* Ozone Gasoline & Dieselparticles — measuring 10 to 2.6 microns — Sources Emissions*which cause many of the same healthissues as PM2.5, but to a lesser extent. *These emissions also combine with VOCs to create ozone and PM.Ground level ozone pollution is created byVOC emissions interacting with nitrogen Sources: http://www.epa.gov/pmdesignations/faq.htm#0,emissions that come primarily from: http://www.epa.gov/groundlevelozone/• Gasoline and diesel vehicle emissions Of the pollutants measured, ground level ozone and PM constitute the two• Refineries greatest threats to health.• Chemical plants6, 7 Source: http://airnow.gov/index.cfm?action=aqibasics.aqiGround level ozone combines with othergases and particle pollution to create smog.8 Community Health Assessment 111

How is Air Quality Reported? The various pollutants in the air are measured and depending on the density present a score is given using the Air Quality Index (AQI); index scores are between 0 and 500, but anything at 100 or below is considered acceptable.9 A score 101 and higher is concerning to health. Table 39: Air Quality Index Index Value Meaning of Index Value AQI Category 0–50 Good Little to no risk for everyone. Moderate 51–100 Acceptable, but concerning for the Unhealthy for Sensitive Groups 101–150 unusually sensitive. Unhealthy 151–200 General public likely to not be impacted. Sensitive groups, including the old and Very Unhealthy 201–300 young, are likely to be affected. Hazardous 301–500 Everyone may begin to experience health issues. Sensitive groups experience more serious effects. The entire population is more likely to be affected. Everyone may begin to experience serious health effects. Source: http://airnow.gov/index.cfm?action=aqibasics.aqi How are We Doing? The American Lung Association has given Weber County a D score for Ozone, a F for PM pollution in 24 hour period, and a Pass for our annual PM results.10 The EPA has classified the lower valley part of Weber County as a nonattainment area (a region not meeting EPA standards on 24 hour pollution levels) for the following: • PM2.5 since 2009 • PM10 since 199511, 12 Weber County is 0.2 µg/m3 away from exceeding the annual EPA standard of 12 µg/m3 for PM pollution. Since 2006, the annual number of 100+ AQI days have shown a turbulent, but modest downward trend (Gray Line in Chart 44); this a favorable trend in air quality. Although that trend is in the right direction, 100+ AQI days are heading toward both a higher average (Blue Line) and maximum AQI (Red Line) each year; these are unfavorable trends in air quality.112 Weber-Morgan Health Department

Chart 44: Favorable and Unfavorable Trends in Air Quality180 40170 35160 30150 25140 20130 15120 10110 5100 0 2005 2006 2007 2008 2009 2010AQI Scores (Upward Trending) AQI Days Over 100 (Downward Trending) 2011 2012 2013 2014 Average AQI Over 100 Max AQI Days over 100 AQISource: http://www.epa.gov/airdata/We should expect fewer days per year with 100+ AQIs, however because 100+ AQI daysare trending higher — both in average and maximum AQI — this will likely cause more intensehealth effects on increasing numbers of the population in the future.The reduction in 100+ AQI Days is a step in the right direction, but it is slightly uncertainwhether Weber County will complete HP2020’s goal of 10% fewer 100+ AQI days. If allfactors remain constant and the downward trend of 100+ AQI days continues, Weber Countywill complete this HP2020 goal by 2020. See Table 40 for further information on this goal.Table 40: HP2020 Target Goal 10% Target Current ProgressReduction of 100+ AQI* Met? Towards TargetWeber County (2005–08 AQI Baseline)* ✗ 61%*Davis County ✔ 386%*Salt Lake County ✔ 221%*Utah County ✗ 36%United States ✔ 383.3%Source: http://airnow.gov/index.cfm?action=aqibasics.aqi, http://www.healthypeople.gov/sites/default/files/HP2020_LHI_Environ_Qual_0.pdf*Baseline: (2006–2008 population x 100+ AQI days for each respective year)/3, compared to Latest Data: (2012-2014 population x 100+ AQI daysfor each respective year of the latest data)/3 ! It is uncertain if the WMHD will achieve HP2020’s goal of 10% fewer days with an AQI of 100 or more. Source: https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health/objectives Community Health Assessment 113

Table 41 details the groups in Weber and Morgan Counties that are at increased risk for complications caused or compounded by poor air quality: Table 41: Populations at Risk for Air Quality Related Health Complications County Children Adults Chronic Cardiovascular Diabetes with with Obstructive Disease Pulmonary Asthma* Asthma Disease Weber 4,288 15,323 6,998 11,195 12,669 Morgan 217 609 296 485 547 Source: http://www.stateoftheair.org/2015/states/utah/ *17.2% of childhood asthma is due to exposure to PM2.5 air pollution.14 Table 42: Children with Asthma by Area Air pollution is a contributing factor as to why Local Health District Children with asthma rates are slightly elevated in the WMHD. Weber-Morgan Asthma 8.5% Davis 6.6% Salt Lake 6.8% Utah 6.2% State 6.7% National 9.3% Source: http://ibis.health.utah.gov/indicator/view_numbers/ AsthChiPrev.LHD.html When is Pollution the Greatest? Graphic 31: 100+ AQI Days by Season Most of our pollution occurs during the winter time and this is when we exceed the EPA standard for 24 Hour emissions 55% of PM2.5. In Utah during the winter time, vehicles are responsible for more than 50% of all PM22.5 pollution. Winter The two seasons with the most significant demand for December–February outdoor recreational activities also experience the worst air quality; this may discourage outdoor recreational activities. S3p%ring Likewise, poor air quality will likely impend tourism efforts catering to outdoor enthusiasts. March–April Factors Contributing to 42% Poor Air Quality Summer Numerous factors contribute to the air quality in Weber and June–August Morgan Counties. Some of these are unavoidable, but many are caused by choice. 0% Fall September–November114 Weber-Morgan Health Department

Table 43: Poor Air Quality ContributorsContributions by Choice Unavoidable ContributorsDriving solo — 79% of Weber drivers and 82% of drivers Geographically assisted inversionin Morgan drive alone to work. 76% of drivers in Utahdrive solo. Top U.S. states enjoy a 71% rate.Excessive diesel emissions due to the lack of a diesel Weather assisted inversionemission testing program.Wood burning is responsible for 15% of all PM2.5 emissions Pollution sources outside ofin Weber. In Morgan it contributes to only 2.5% of all Weber and Morgan CountiesPM2.5 emissions.Industries not using the best emission reducing technologyavailable.Source: http://www.epa.gov/cgibin/broker?_service=data&_debug=0&_program=dataprog.state_1.sas&pol=PM25_PRI&stfips=49,http://www.countyhealthrankings.org/app/utah/2015/measure/factors/67/mapWhat are Residents Saying?Air quality is the number one health concern in Weber County; seven sources of primary datacollection confirm this. Data collected by Professor Laura Santurri from Weber State indicateswhile there is tremendous concern about poor air quality, residents also feel there is generalsense of apathy, low motivation, or unwillingness to sacrifice to fix the air issues.15Weber County residents shared the following:16, 17 “We are not as bad as Salt Lake City, but we are getting there.”“Air quality improvement now!!”“The pollution in our air is hurting our lungs. I have asthma and when the air quality isbad I feel like a fish out of water.”“Air quality is terrible. Customer and diesel trucks polluting air.”“We all need air, let’s stop vehicles from blowing dirty clouds as exhaust. I like to drivewith the windows down & this is awful tasting. Community Health Assessment 115

Community Resources There are many resources in the community to help reduce air pollution. They are: • Public transit • Community and home gardens; these reduce pollution by decreasing food importing • Trails and pathways • Nonprofits, such as Weber Pathways, which encourage the use of trails and pathways, and the Ogden Bicycle Collective that encourages bicycling and places bicycles with low-income families • Some dedicated bicycle lanes • Gasoline vehicle emissions enforcement by the WMHD • UTA rideshare program; this service helps connects residents with resources to carpool, vanpool, carshare, tele-work and bicycle Air Quality Take Away Messages • Air quality is generally good in Weber and Morgan Counties — each year there are only a handful of days in the summer and winter when air quality crosses the 100+ AQI mark. • Air quality is trending positively in Weber County, although it is not improving as rapidly as it is in Davis and Salt Lake Counties. • For days over 100 AQI, the AQI score is averaging higher and more intense year after year; in plain English — when the air is unhealthy it is getting slightly worse year after year. The good news is that trend patterns indicate fewer days that the air quality will be unhealthy. • There is no need to panic about air quality in Weber or Morgan Counties, because generally the air quality is excellent most of the year. • Weber County’s population is growing at a modest rate and we should remain concerned about its impact on our air quality.116 Weber-Morgan Health Department

Health Indicator 44 Water QualityL ife is dependent upon water. Heathy living is dependent on clean drinking water. The WMHD regularly assesses drinking and recreational water to protect the public’s health.The majority of residents in the WMHD receive their water from a community water system, howeverthere are some residents who rely upon private wells. The EPA has set national standards for thetreatment and monitoring of 90 contaminants in community water systems.18 Drinking waterviolations occur when community drinking systems do not meet all applicable health-baseddrinking water standards. Health-based violations include maximum contaminant level, maximumresidual disinfectant level, and treatment technique violations.19In 2013 and 2014 more residents in Weber and Morgan Counties were potentially exposed todrinking water that did not meet all applicable health-based water standards than the percentageof residents exposed in the state of Utah or nearby counties.Table 44: Population Potentially Exposed to Drinking Water Exceeding aViolation Limit During the Past Year (2013–2014)Top 10% State of Weber Morgan Davis Salt Lake UtahCounties Utah County County County County County in U.S. 13%0% 9% 18% 16% 12% 2%Source: http://www.countyhealthrankings.org/app/utah/2015/measure/factors/124/map Community Health Assessment 117

There are limitations in the data available for this health indicator. The Robert Wood Johnson Foundation reports the following limitations: • “The number of violations within each system is not taken into account, and estimates are not available for the number of people who consume infected water or get ill from consumption. • A single violation in a very large water system can change the value of the measure drastically. • Not all violations are equivalent; some violations occur but are addressed quickly, while some violations can linger for years. • This measure only includes data on community water systems, not including private wells.”20 The important take away from this health indicator is that there is room for improvement in the public water drinking systems in the Weber and Morgan Counties and surrounding counties.118 Weber-Morgan Health Department

Health Indicator 45 Physical Dwelling SafetyS ubstandard housing can be problematic to health. Substandard housing is defined as lacking one or more of the following:21• Complete plumbing facilities (This requires having hot and cold running water, a flush toilet, and a bathtub or shower)• Complete kitchen facilities (This requires having a sink with a faucet, a stove or range, and a refrigerator)Having access to complete kitchen and plumbing facilities are essential to maintaining good health.Individuals without these complete facilities may be regularly accessing these facilities at publicand private buildings. Residents that are not regularly accessing these facilities at sources outsideof their housing units, are exposing themselves and potentially others to significant health risks.Table 45 shows how many housing units in Weber and Morgan Counties are without access to acomplete plumbing or kitchen facility. When compared to nearby health departments, the WMHDis in need of improvement. The WMHD is on par with the state of Utah for this health indicator.When compared to national results the WMHD is slightly better.Table 45: Substandard Housing Units U.S. Utah WMHD DCHD SLCoHD UCHD 0.34%Housing Units Lacking 0.49% 0.37% 1.56% 0.26% 0.27% 0.4%Complete Plumbing FacilitiesHousing Units Lacking 3% 1.68% 1.02% 1.21% 1.54%Complete Kitchen FacilitiesSource: http://assessment.communitycommons.org/CHNA/report?page=3&id=470 Community Health Assessment 119

Section 7 Endnotes 1. http://www.who.int/mediacentre/factsheets/fs313/en/ 2. http://www.epa.gov/air/particlepollution/2012/fshealth.pdf 3. http://www.epa.gov/oaqps001/nitrogenoxides/health.html 4. http://www.epa.gov/pmdesignations/faq.htm#0 5. http://www.epa.gov/pm/2012/decfsoverview.pdf 6. http://www.epa.gov/groundlevelozone/faq.html#where 7. http://www.epa.gov/groundlevelozone/ 8. http://www.epa.gov/ozonedesignations/faq.htm#smog 9. http://airnow.gov/index.cfm?action=aqibasics.aqi 10. http://www.stateoftheair.org/2015/states/utah/weber.htm 11. http://www.epa.gov/airquality/greenbook/anayo_ut.html 12. http://www.epa.gov/airquality/particlepollution/2012/decfsstandards.pdf 13. http://www.healthypeople.gov/2020/About-Healthy-People 14. http://ibis.health.utah.gov/indicator/view/EnvBurChiDis.html 15. 2015 WMHD Focus Group Report 16. 2015 PhotoVoice Commnet Board 17. 2015 WHMD Focus Group Report 18. http://ibis.health.utah.gov/indicator/view/DriWatPubWatSysUse.html 19. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/124/description 20. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/124/description 21. http://assessment.communitycommons.org/CHNA/report?page=3&id=470120 Weber-Morgan Health Department

Section 8 Conclusion and Future Planned Action Photo Credit: Laniece Roberts

T he ultimate aim of the Weber-Morgan Health Department is to expand quality and longevity of life for all residents in the Weber-Morgan Health District. To that end, it was essential to better understand the health status and challenges faced by the residents of Weber and Morgan Counties. Although, there are hundreds of indicators available to analyze the community, the ones most pertinent to the community’s health were selected. These indicators represent health topics that the WMHD believes are able to be influenced and improved by the dedicated efforts of the health department in conjunction with community partners. The many indicators utilized in this community health assessment have provided a sufficiently comprehensive view of the community’s health. This comprehensive view is essential to providing the Weber-Morgan Health Department with the information it needs to make more educated decisions in prioritizing public health actions. While assembling the numerous primary and secondary data sources that form the content of this Community Health Assessment many expected, fascinating, unexpected, disquieting, and inspiring data points were discovered. The entire health department can say this Community Health Assessment has been a journey of much learning and discovery. Like a hiker gains enhanced perspective of everything below with each step, every stage of this Community Health Assessment has provided the Weber-Morgan Health Department with a better perspective of the community’s health status, needs, and challenges. This CHA represents new knowledge that is Graphic 32: The Public Health Cycle ready to be acted upon. Action guided by this of Improving Health knowledge is the future for the WMHD and our community partners. It is our intent to work together with our community partners in evaluating the content of the CHA. Together, we can develop a compressive community Evaluate Actions Assess Needs health improvement plan that: & Resources • Identifies health priorities for Public Weber and Morgan Counties Health Healthcare Business • Includes measurable goals, Government Community Educators objectives, and strategies to achieve desired health outcomes Members • Selects and aligns community Act on What’s Community Philanthropy Focus on What’s policies and programs to address Important Development & Investors Important the selected health priorities Nonprofits • Identifies and divides responsibilities Choose Effective amongst community partners and the Policies & WMHD Programs • Provides for regular meetings and follow up of Source: http://www.countyhealthrankings.org/roadmaps/action-center progress by the WMHD and community partners122 Weber-Morgan Health Department

Naturally, as priorities are selected with community partners, additional in-depth analysis of age,gender, race, ethnicity, and/or zip code or census tract may be required to ensure the bestalignment of community health resources.At the end of each year, the WMHD will release a report detailing the progress of the CHA. Thisannual report will allow the WMHD and community partners to determine if completed activitiesare producing desired health improvements. The WMHD anticipates updating this CommunityHealth Assessment every three to five years.There is much work ahead for the Weber-Morgan Health Department and our communitypartners. Together, we will help individuals and families thrive in a clean, healthy, and safecommunity. This Community Health Assessment has laid the foundation and now the time forcareful planning and action is at hand.Community Health Assessment 123

Section 9 AppendixThis Appendixcontains additionalinformation on thePhotoVoice Project,Focus GroupFindings, and KeyStakeholderInterview Data. Photo Credit: Laniece Roberts

T he PhotoVoice was a project primarily undertaken by Professors Santurri and Zahabi on behalf of the Weber-Morgan Health Department and Weber State University. Communitymembers were invited to come view the exhibit, interact with posters to vote on importantissues, and add their own messages to the project. The information provided by this project hasbeen included in many portions of this Community Health Assessment.This project was exhibited at the Weber-Morgan Health Department at the end of April of 2015for two weeks. Community members were invited to come view the exhibit, and interact withposters to vote on important issues, and add their own messages to the project. The followingimages were part of that exhibit. The text by the images were provided by the PhotoVoiceparticipants who captured the images.This was found on a “This photo is of Organicschool property. We have Non-GMO seeds that aresome very high tobacco ready to be planted asuse rates among our seed starts. They willteens. It is disturbing that eventually be transferredthis can is littering our to a larger garden that willschool grounds reinforcing sustain a small communitythe acceptable attitude of friends and family. Thetowards tobacco.” community would benefit from education on how they can maintain a healthier diet by growing their own food.” Community Health Assessment 125

“Ogden City provides so many outlets for our community to be involved at little or no cost. Community members from different backgrounds can come together and participate in a nontraditional form of physical activity. Everyone has a common goal...to better themselves. Ogden cares about the health of its community and doesn’t want anyone to be limited to what is available.” “Sometimes it’s nice to hang out “This man is able to enjoy what he with our spouse or friend and loves without going on a vacation. relieve stress. It’s nice there are so He is able to escape to his outlet for many great places in Weber County enjoyment in his very own people can go and walk, run, ride a community. Our community has a bike, etc. Just to take a small break lot to offer if we get ourselves from a busy life and get outside.” engaged and involved.”126 Weber-Morgan Health Department

“A crossing guard stopping traffic so the children could safely cross the road on their way to school. It’s important that communities strive to keep our children safe”“This photo can go both ways. It’s positive in the fact thatkids are socializing and being physically active. From asafety standpoint, it’s concerning that they’re playing inthe street rather than their yard or the nearby park, butmaybe those weren’t an available option for them. This ismy neighborhood. I’m glad to see kids being active andplaying outside; however, I am concerned that they couldbe hit by a car.”“Playground at Riverside Park inMorgan – a great place for kids toplay. This is great place for communitymembers to enjoy and exercise.” Community Health Assessment 127

“This photo shows oil in a local “The Upper Ogden creek. In spite of what we think Valley is above people should do, things like this Pineview Dam – a still happen. All surface water is major source of contaminated. Our enjoyment of the drinking water for outside is related to how well we Ogden – is pollution take care of it.” a problem?” “This is a place that one might show in a low- income area of Ogden. It would be easy to walk to from many nearby homes. Especially when one is on food stamps, it can be difficult to eat healthy. Generally healthy food is viewed as expensive and time consuming to prepare. Having a produce store like this that accepts EBT cards encourages better eating.”128 Weber-Morgan Health Department

“Weber Countyhas a good mixof urban andrural areas. It’sneat to drivetwenty minuteseast of Ogdenand see this.”“There are some challenges to living in this “While it is difficult sometimes to walkneighborhood, but there are also people and for exercise right in town, becauseorganizations working on solutions. Many of traffic and other issues, Ogdenpeople who live in this neighborhood live in provides several places to walk.apartments where they can’t grow their own This includes the River Walk, andproduce, and supermarkets with fresh the trail heads such as this. Thisproduce are few and far between. This photo represents the opportunitiesgarden allows residents, for a small annual available for hiking in the area,fee, to grow vegetables in these plots.” right near town.”“Public transportation is a wayfor people to get around. Thisphoto shows how versatile theFrontrunner is whether you needto take your bike or your luggageas you travel to the airport. It’sgreat that Weber County hasaccess to three Frontrunnerstations and many bus routes.” Community Health Assessment 129

“I feel people don’t really understand how much pollution is caused on a daily basis. If one truck can do this, imagine what 100 or 1000 or 1 million could do? Pollution effects everyone.” “My place of employment has opened up a health clinic on site. This has made it much easier, cheaper, and more convenient for me to access quality healthcare. This is a great example for the community – especially other large employers.” “This image represents “A construction site with the small contribution power lines in the foreground. that we all make to our This photo portrays the type air quality. Either positive of work many members of the or negative. community perform on a day-to-day basis. Members of We all contribute to the this community are more air pollution problem. The prone to laborious jobs that choices we make to drive, increase risk for health to idle, to burn wood, to problems. Whether these carpool, to walk, etc., are problems are environmental, small at the individual social, or situational.” level. However, they all contribute. Good or bad, each one of our choices matter.”130 Weber-Morgan Health Department

“In order for me to get to the supermarket to buy groceries, I have to drive by almost TWO DOZEN fast food places, which are all cheap, convenient, and delicious, but much less nutritious. I don’t always win the battle. The simple act of buying nutritious food comes with its challenges.”“This photo shows a Dr. Pepperbottle wedged into a storm watergrate. This shows that pollutionwill eventually make it to thewaterways.We need to be more conscientiousof what we do or how we affectour surroundings.”Community Health Assessment 131

Focus Group Findings Text Analysis from Focus Groups These were the 55 most often used words in the focus groups conducted as part of this project. The larger the word, the more often people mentioned it. This analysis offers a quick summary of what people in the focus groups were discussing. Focus Group Findings #1 Important health issues to you/your community? Lack of access to care • Need more access to healthcare places (doctors and dentists) • No dental care help or coverage from Medicare • Restrictions on Medications-dosage and how much you can receive during a time limit132 Weber-Morgan Health Department

• Poor healthcare coverage• One woman said, “you’re not old enough to qualify for Medicare but not poor enough to qualify for Medicaid.”• Much agreement and complaints about the Medicaid “Gap” in our state and how it is difficult to qualify for assistance and this “middle zone” (as one woman called it)• Many raised questions of wanting to know why we are not expanding healthcare coverage in our state• People need more access to mental healthcare, especially those who don’t have insurance or have high deductiblesAccess to services• Without minor children you can’t get help or qualify for assistance• Access to vaccinations; one woman mentioned that they will go to the schools to provide vaccinations (she did not specify who “they” are)• Concern about services provided in the community and assistance opportunities that are not marketed or promoted well so the community is not aware• Concern for senior citizen care and programs• Needs for homeless youth need to be addressed• Not enough funding for programs like Planned Parenthood and the Health DepartmentSpecific health issues• Diabetes• Pain management [specific issues with pain management is doctors not taking you seriously if on assistance; feelings of discrimination; pain treated differently because patient is using Medicaid or any other assistance]• Asthma in children• Children getting “sickness of the skin” in school• Grandparents raising their grandchildren and the toll it takes on their health• Obesity: children not as healthy as before or as healthy as they should beCommunity Health Assessment 133

Issues/problems with local healthcare • Feelings of having to advocate for self and Doctors treating you like you “just want drugs” or not really in pain • Lack of access to pain medication • In regards to Midtown clinic some felt they have been treated well and expressed gratitude for the services; however, more than one participant referred to the difficulty getting to speak with a doctor over the phone or simple questions answered • Discussion of Midtown clinic and other clinics for low income and assistance programs, one said they are always “booked” and take too long for immediate health needs. Issues/problems with local services • Concern about bed bugs at the local homeless shelter • Services for health education and resources not well communicated or promoted and therefore under utilized Health habits • Discussion on concern with E-Cigarettes and the increase of them, many raised the question of not knowing what kind of a risk they are to them second hand • E-Cigarettes: kids curious about them, kids being targeted; one man said “my children are fascinated by them” • Underage drinking and prescription pill misuse and abuse • Substances and drugs easy to access; especially for youth in public schools • People not coming to get tested for things like STI/D’s, ie: HIV; and concerns with teen pregnancy • Not enough time to exercise or walk because have to work all the time, no time to get out and take care of self • Going outside more; kids with technology not going outside • Not having enough time as a parent to take kids outside or be outside with them to play outside • Sedentary children: overweight/obesity134 Weber-Morgan Health Department

Focus Group Findings #2Important health issues to you/your community?Having places to go exercise• Facilities with recreation (tennis courts/pools)• No swimming pools for lessons, one woman said that her child has to travel all the way to Ogden to the Marshal White Center for her child’s swim practice• Like how Ogden promotes hiking trails, bicycling, lots of healthy activitiesAir quality and natural environment• Some people felt they had good air quality except for the times when farmers are burning their fields creates health problems• Some people felt the air and water quality is good• Some people felt that there is bad air quality as a result of too many vehicles and not utilized other transportation means• Some people felt the air quality is not good, but not as bad as it is in Davis County• Not enough promotion for less car use to improve air quality; not enough promotion for bike riding specifically• Air quality is something we struggle with, programs are in place, could be more stringent, need to change people’s mindset, to get people to use public transportationIssues around food• Lack of knowledge for eating and preparing healthier foods• Nutritious food at food banks• Easy access to fast food- busy schedule fast pace of life: “don’t have an eating schedule anymore”; “we don’t pay attention to what we are eating”Perceptions of safety• One woman said “ Ogden is not known as a safe city to walk around in”• Ogden is up and coming now, can remember how bad 25th street used to be, now it’s a hubCommunity Health Assessment 135

Social issues • Poverty (behind higher rates) • Education • High suicide rates; parents lost to suicide; need more outreach for prevention • Depression: “depression stems from people here not very social, people tend to stick with their family” • Cultural differences: “my kids can’t play with certain kids in the neighborhood because we’re not Mormon” • Barriers when you’re not part of the dominant religion Transportation • Alternate transportation is out there, if people choose to use it; some people afraid to use it • Lack of bike lanes, and bad drivers on the streets for bikers; not a “bike friendly area” Focus Group Findings #3 What do you like about living in your community? Geography and environment • Mountains • Access to outdoors and state parks • Beautiful scenery • Geology of the area; the scenery, “love driving up the canyons” • Water quality is good (more than one participant agreed) Institutions • Weber State University • More than one person said they like the schools • Good education system • Ogden works hard at improving their community • Diversity of businesses (big and small companies)136 Weber-Morgan Health Department

• Like working in Ogden, primarily because we work together, willing to come together for the greater good instead of individual agendas, good feel of cooperationInfrastructure• Easy access parking; good parking; free parking• Transportation system has improved and is very good now• Proximity to I-15 and grocery storesServices/Access to Care• Prenatal care at midtown clinic is good• Hospitals and health clinics are close• RAMP program: for kids• Free lunches for kids at the parks during the summer• Farmers Market-one resident stated, “I wish it would last throughout the year”• Marshall White Center (local community recreation center)• Good hospitals and emergency rooms• Weber Human Services (“great service”, “helpful”)• Libraries• Early intervention programsSafety• Feels safe; some even feel they can leave their doors unlocked• Not dangerous as people say• Many said that they feel safer than in bigger cities• In comparison to bigger cities, crime rate isn’t the same; “I feel safer here”• There is a perception that Ogden is not safe; it’s an old, weird idea, but it persistsCommunity Health Assessment 137

Social aspects • Friendly, helpful, and safe neighborhoods • You get to know your neighbors • Neighbors are willing to help out and look out for you • There are a lot of volunteers in the area, including doctors who are willing to help out • Volunteer opportunities/ and many people in the community who volunteer • Clean neighborhoods/ no garbage or gang graffiti • The people, “good people” • A lot of diversity Lifestyle • Mellow, calmer than Salt Lake City or other bigger cities • “Slower pace of life than Davis County” • One man said that “it’s like I’m in Mayberry” • Smaller town, less “complicated” • Cost of living is affordable; more affordable than other areas • Access easy; transportation, parking, streets less confusing and busy than big cities • Access to things (bigger cities are not too far) • Everything is closer and you don’t have to get on the freeway to get to locations Activities • More places to take the children/ activities for children • Active outdoor life • Outdoor recreation, and trails; the city keeps working on their trails and takes care of them • Recreation has improved much since earlier times • Arts (the arts) • Local parks138 Weber-Morgan Health Department

Other benefits/thoughts• The history of the area• You get to experience all four seasons• National rankings have boosted image of Ogden Focus Group Findings #4: Themes Common themes from focus groups overall1 The Health Department needs to improve the promotion of the services offered, and do so bilingually as well. A very common comment was that the residents of the community found out about a service that would have benefited them after it had already passed.2 Concern and frustration with healthcare coverage for the middle class or as one participant described it “the middle gap,” where those who make too much to qualify for aid or assistance but don’t make enough to be able to afford to buy good healthcare coverage are left with no options.3 Waiting time for healthcare, and difficulty getting appointments for low income healthcare services; residents were pleased with the care that they received with these services but talked about the difficulty getting to that point.4 There was much confusion with services and the roles of WMHD and Midtown Clinic and Weber Human Services.5 The most common aspects of living in Weber County that residents liked most are the mountains, access to the outdoors, and the trails.6 Another common thing that residents liked was feeling that the area has a slower, calmer pace of life than larger cities.7 When talking about emergency preparedness most felt unprepared and said that part of it was to blame on taking their safety for granted and not feeling the need. Another barrier for this is lower income residents not being able to afford the supplies for something like a 72-hour kit.8 Many felt that the area is safe, including some residents of Ogden the more perceived “dangerous” part of the county.9 Volunteer opportunities and many who volunteer were also mentioned throughout groups as a positive of living in the community.10 Ogden City School District was discussed in nearly each group with an overall feeling of dissatisfaction. Community Health Assessment 139

Key Stakeholder Interview Results T he subsequent information is the PowerPoint presentation delivered by Abigail Weymouth, Jamie Davis, and Lizbeth Torres in May 2015. Their findings are as follows: Methodology Demographic Statistics and Survey • Administered via Survey Monkey NVivo Content Analysis • Words/ phrases were placed into 1 of 25 categories. o Example: Mental health was defined by the following: mental health, PTSD, trauma therapy, therapy, schizophrenia, anxiety disorders, anxiety, depression, stress, trauma, psychological. Table 1: Demographics of the WMHD Community Health Assessment Participants (2015) Characteristic Number % Sex Male 4 40% Age Female 6 60% Ethnicity 26–33 2 20% Education 34–41 2 20% Residing County 42–49 5 50% 50+ 1 10% Years of Residency in Counties White/Caucasian Non-Hispanic 2 20% White/Caucasian Hispanic 6 60% Undergraduate Degree 4 40% Graduate Degree 6 60% Weber County 2 20% Morgan County 2 20% Other 1 10% Two to Five Years 7 70% Six+ Years 2 20% Other140 Weber-Morgan Health Department

Table 2: WMHD Community Health Assessment Participant Views on Health,Environment, and Quality of Life in Weber and Morgan Counties (2015)Views Number %Views on Health1 Below Average 1 10% Average 2 20% Above Average 6 60% Excellent 0 0%Views on Environment2 Below Average 0 0% Average 2 20% Neutral 3 30% Above Average 5 50% Excellent 0 0%Quality of Life3 Below Average 2 20% Average 5 50% Neutral 0 0% Above Average 2 20% Excellent 1 10%1. Views on health are defined as physical, mental, spiritual in Weber and Morgan Counties.2. Views on environment are defined as physical and social in Weber and Morgan Counties.3. Views on quality of life and environment of population served in Weber and Morgan Counties.Table 3: WMHD Community Health AssessmentOnline Survey Concerns Voiced by Participants (2015)Concerns Frequency of Topics MentionedTopics1Lack of Affordable Insurance and Access to Care 11Mental Health Resources 5Physical Activity and Nutrition 4Lack of Programs 4Air Quality and Pollution 3Substance Use and Abuse 2Stigma 11. Community Health Assessment participants could voice three top health concerns which were then grouped into categories by the researchers. Community Health Assessment 141

Table 4: WMHD Community Health Assessment Opinions Voiced by Participants About the Health Department (2015) Knowledge of the Health Department Number % Knowledge of Hours of Operation Yes 4 40% No 6 60% Previously Accessed WMHD Website Yes 5 50% No 5 50% Knowledge of Services Offered by WMHD Yes 6 60% No 4 40% Previously Utilized WMHD Services Yes 6 60% No 4 40% WMHD Services Personally Environmental Health 5 50% Utilized Most Frequently1 Clinical Nursing & Immunizations 4 40% Birth and Death Certificates 3 30% Health Promotions 3 30% Auto Emissions 1 10% Women, Infants, and Children (WIC) 2 20% Overall Perception of WMHD 1 10% Health Department staff are inactive in the community 4 40% Health Department staff are somewhat active in the community 5 50% Health Department Staff are active in the community 0 0% Health Department Staff are overactive in the community 1. Participants could select more than one option.142 Weber-Morgan Health Department

Table 5: WMHD Community Health AssessmentHealth Department Services Referred to Clients by Participants (2015)Referral of Services Number %Previously Referred Clients 2 20%No, the health department does not have services for our clients 0 0%Rarely, the health department services are scarce for our clients 7 70%Sometimes, the health department has a few services for our clients 1 10%Yes, the health department has services for our clients 40%WMHD Services Referred to Clients Most Frequently1 4 50%Environmental Health 5 40%Clinical Nursing and Immunizations 4 50%Birth and Death Certificates 5 10%Health Promotion 1 40%Auto Emissions 4Women, Infants, and Children (WIC)1. Participants could select more than one option. Community Health Assessment 143

Content AnalysisDiscussion I n summary, this CHA determined key stakeholder perceptions of health barriers in Weber and Morgan Counties, Utah. According to the content analysis the five areas of highest concern were mental health, emergency preparedness, healthcare disparities, vulnerable populations, and environmental concerns.144 Weber-Morgan Health Department