Community Health Assessment

In 2014 gonorrhea was the 4th highest reported disease in the WMHD and the 2nd highest sexuallytransmitted infection.23 Gonorrhea rates have remained fairly consistent nationally, but from 2007to 2011 throughout the state of Utah rates drastically declined. This changed in 2012, when aconcerning uptick in gonorrhea cases started and has since continued in Weber County and muchof Utah. The increase in positive gonorrhea rates indicates the need for increased sex educationthroughout Weber County and Utah. Again, Morgan County sets itself a role model in results.Chart 21: Annual Gonorrhea Incidence Rate per 100,000 Residents 1407560 12045 10030 8015 200 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 U.S.* Utah WMHD Morgan County DCHD SLCoHD UCHDSource: http://www.healthindicators.gov/Indicators/Gonorrhea-rate-per-100000_10062/Profile/ClassicData, http://ibis.health.utah.gov/indicator/view/GonCas.LHD.html, http://www.cdc.gov/std/stats13/tables/15.htm*Please note the axis on the right of the graph ranging to 140 is only to report the U.S. Gonorrhea rate per 100,000.Community ResourcesSeveral organizations educate the community on how to prevent the spread of STIs. Many ofthese organizations also provide treatment for sexually transmitted infections. They are:• The Weber-Morgan Health Department• Ogden Health Center (Planned Parenthood Association of Utah)• Midtown Clinic / Weber Human Services• Northern Utah Coalition HIV/AIDS Project• McKay-Dee Hospital• Ogden Regional Medical Center Community Health Assessment 51

Health Indicator 18 Vaccine Preventable Diseases Photo Credit: Laniece RobertsV accine preventable diseases are contagious diseases for which a vaccine has been thoroughly researched and developed to help create considerable immunity among the greater population.Vaccine preventable diseases primarily resurface due to incomplete vaccination series or novaccination at all by residents or immigrants.Chart 22: Pertussis Rate Per 100,000 Residents Pertussis is particularly unsettling because it is a highly infectious disease 75 that can cause illness regardless of60 age; it can be life-threatening, especially for infants.244530 Utah as a whole is significantly above the national average for pertussis cases.15 Since 2009 the WMHD has followed0 2010 2011 2012 2013 2014 state trends, but is now elevated above 2009 the state average and nearby LHDs.U.S. Utah WMHD Looking closely at the WMHD WICDCHD SLCoHD UCHDSource: http://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2014.pdf, population, 55% of WIC clients reporthttp://www.cdc.gov/pertussis/downloads/pertuss-survreport-2013.pdf, they have received a Tdap vaccine (adulthttp://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2012.pdf, pertussis vaccine) in the past 5 years.2015 UDOH Data Request72.2% of WIC clients report all of their children have received the DTap (child pertussis vaccine).38.2% of Spanish speaking WIC clients — more than one out of three — self-reported they didnot know it was important for all members of their family to receive the pertussis vaccine when anew child is born. In stark contrast, only 13.5% of English speaking WIC clients indicated theydid not know as well.25Chickenpox is also highly contagious and can create serious health complications resulting inhospitalization. Sometimes death occurs for infected infants, adolescents, adults, pregnantwomen and those with weakened immune systems.26 The CDC reports 3.5 million cases of52 Weber-Morgan Health Department

chickenpox, 9,000 hospitalizations, and Chart 23: Chickenpox Rate per 100,000 Residents100 deaths have been prevented bychickenpox vaccination in the U.S.27 The 40chickenpox vaccine became available in1995; chickenpox incidence rates 30declined 45% from 2000 to 2005 anddeclined an additional 77% from 2006 20to 2010 after a second dose of vaccinewas recommended. 10The WMHD is doing well in this 0 2010 2011 2012 2013 2014measurement and as of 2014 is slightly 2009 DCHD Utah WMHD SLCoHD UCHD Source: 2015 UDOH Data RequestChart 24: Hepatitis A Rate per 100,000 Residents below the average for both the state and nearby LHDs. 1 2010 2011 2012 2013 20140.9 Hepatitis A is a highly infectious disease0.8 WMHD that can cause liver failure and death,0.7 UCHD although this is rare.28 It is normally0.6 transmitted through person to person0.5 contact, contaminated food or water.0.4 Hepatitis A is concerning because a0.3 majority of children and less than 20%0.2 of adults do not exhibit symptoms.0.1 The WMHD performs exceptionally well 0 2009U.S.* UtahDCHD SLCoHDSource: 2015 UDOH Data Requestin this measurement when compared Chart 25: Hepatitis B (Chronic) Rate perto national, state, and nearby LHD 100,000 Residentsresults. Five out of the past six yearsthere have been no reported cases 16 2010 2011 2012 2013 2014of Hepatitis A in the WMHD. 14 UCHD 12 WMHD DCHD SLCoHDHepatitis B infects the liver and is 10transmitted through blood, semen orbody fluid from an infected person.29 8For adults, Hepatitis B is typically an 6acute disease, however for 90% of 4infants infected it will transition from 2acute to chronic Hepatitis B. Chronic 0Hepatitis B can lead to serious 2009 Utah Source: 2015 UDOH Data Request Community Health Assessment 53

Chart 26: Influenza-Associated Hospitalization health concerns, like liver cancer.Rate Per 100,000 Residents Hepatitis B should not be regarded lightly — an infected person can be 70 symptom free for up to 30 years.30 6050 For this measurement the WMHD is40 overall consistent with nearby LHDs30 and the state of Utah.2010 2011 2012 2013 2014 Seasonal influenza is a moderately UCHD contagious disease that causes mild 0 to severe respiratory illness.31 2009 2010 Seasonal influenza by itself is typically not life threating, howeverUtah WMHD DCHD SLCoHDSource: 2015 UDOH Data Requestit can lead to the development of pneumonia and other complications which can result in death.At risk populations for complications caused by seasonal influenza typically include, the old,young, and people with weakened immune systems.The WMHD is slightly elevated above the state average and most other LHDs for influenza-associated hospitalizations.54 Weber-Morgan Health Department

Health Indicator 19 Mental Health ConditionsM ental health is an essential element of Table 21: Adults With Major Depression (2005–07) overall health. Because mental healthdisorders contribute to a host of health related U.S. Utah WMHD DCHD SLCoHD UCHDproblems, such as disability, pain, or death they 4.2% 4.1% 4.7% 4.0% 4.2% 4.2%are an important measurement of community Equal to or better than both Utah and U.S.morbidity.32 Of mental health disorders, Worse than both U.S. and Utahdepression is a common health concern. TheWMHD has an opportunity to work with Source: http://health.utah.gov/opha/publications/brfss/Depression/Depression.pdfcommunity partners to improve the number of adults who self-report as having major depression.As noted in Chart 27, when compared to nearby areas the WMHD has a lower or comparablepercentage of adults diagnosed by the local mental health authority — Weber Human Services— with certain mental disorders.Chart 27: Percentage of the Adult Population Diagnosed With a Mental Disorder (2014)Attention Salt Lake County Behavior Health Services Deficit Davis Behavioral Health Services UCHD & Wasatch Mental Health Weber Human Services Mood Salt Lake County Behavior Health ServicesDisorder Davis Behavioral Health Services UCHD & Wasatch Mental Health Weber Human ServicesAnxiety Salt Lake County Behavior Health Services Davis Behavioral Health Services UCHD & Wasatch Mental Health Weber Human ServicesPersonality Salt Lake County Behavior Health Services Disorder Davis Behavioral Health Services UCHD & Wasatch Mental Health Weber Human ServicesSchizophrenia Salt Lake County Behavior Health Services & Other Davis Behavioral Health Services Psychosis UCHD & Wasatch Mental Health Weber Human ServicesDepression Salt Lake County Behavior Health Services Davis Behavioral Health Services UCHD & Wasatch Mental Health Weber Human Services 0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%Source: http://dsamh.utah.gov/pdf/Annual%20Reports/2014%20Annual%20Report%20Final%20Web%201_22_15.pdf Community Health Assessment 55

Health Indicator 20 Oral Health ConditionsG ood oral health is essential to general health and quality of life for all stages of life.34 Untreated dental caries are an indicator of insufficient access to oral healthcare providers. The prevalence of dental caries experience is an indicator of poor oral health. The percentageof adults with 6 or more permanent teeth missing is an overall indicator of oral health and accessto oral health services. Chart 28: Percentage of 6–9 Year Olds with Untreated Dental Caries“If you don’t qualify for 25%the right kind ofMedicaid…you don’t 20%have any dental care.”33 15% 2005 2010–A Weber County 2000 Resident Utah WMHD SLCoHD UCHD Source: http://assessment.communitycommons.org/CHNA/report?page=6&id=619Chart 29: Percentage of 6–9 Year Olds with Weber County is ahead of nationalDental Experience averages, but behind to nearby counties and the state for adults with80% 2005 2010 six or more permanent teeth missing.60% UCHD40% WMHD SLCoHD The percentage of children with untreated dental caries is in need of 2000 improvement in the WMHD when Utah compared to the state. Likewise, the number of children with dental cariesSource: http://assessment.communitycommons.org/CHNA/report?page=6&id=61956 Weber-Morgan Health Department

experience is significantly elevated in the WMHD. HP2020 has set a goal of 49.0% for thismeasurement and it is unlikely the WMHD will hit this mark.35In 2015, 25.7% of WMHD WIC clients reported a lack of insurance prevented them from seeing adentist, even though there was a need to.36 22% of Weber County dentists reported acceptingMedicaid patients.37Graphic 10: Adults with 6 or More Permanent Teeth Missing (2006–10) U.S. Utah Weber Salt Lake Davis Utah15.65% 8.6% County County County County 9.49% 8.85% 6.19% 5.29%Source: http://assessment.communitycommons.org/CHNA/report?page=6&id=619Section 3 Endnotes Families/Facts_for_Families_Pages/Obesity_In_Children_And_ Teens_79.aspx1. http://ibis.health.utah.gov/phom/view/LBW.html 19. 2014 WMHD Ogden School District Weight and Height Report 20. Ibid Source 252. http://www.diabetes.org/diabetes-basics/gestational/what-is- 21. http://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf gestational-diabetes.html 22. http://webermorganhealth.org/pdf/2014%20BOH.pdf 23. http://webermorganhealth.org/pdf/2014%20BOH.pdf3. http://ibis.health.utah.gov/phom/view/PreBir.html 24. http://www.cdc.gov/pertussis/fast-facts.html 25. 2015 WMHD WIC Survey4. http://ibis.health.utah.gov/phom/view/UniPreg.html 26. http://www.cdc.gov/chickenpox/about/complications.html 27. http://www.cdc.gov/chickenpox/surveillance.html5. http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive- 28. http://www.cdc.gov/hepatitis/hav/afaq.htm#statistics health/teen-pregnancy/trends.html 29. http://www.cdc.gov/hepatitis/hbv/ 30. http://www.cdc.gov/hepatitis/hbv/bfaq.htm#statistics6. http://ibis.health.utah.gov/indicator/complete_profile/UniPreg.html 31. http://www.cdc.gov/flu/about/disease/symptoms.htm 32. http://www.healthypeople.gov/2020/topics-objectives/topic/7. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_ mental-health-and-mental-disorders Families/Facts_for_Families_Pages/When_Children_Have_ 33. WMHD 2014-2015 Focus Group Children_31.aspx 34. http://www.who.int/mediacentre/factsheets/fs318/en/ 35. http://www.healthypeople.gov/2020/topics-objectives/topic/8. http://epi.health.utah.gov/indicator/view/AdoBrth.Ut_USByAge.html oral-health/objectives 36. WMHD WIC Survey Results9. http://ibis.health.utah.gov/indicator/complete_profile/AdoBrth.html 37. 2015 Phone Interviews with Dentists in Weber County10. http://www.differencebetween.com/difference-between-prevalence- and-vs-incidence/11. http://ibis.health.utah.gov/indicator/complete_profile/Obe.html12. Ibid Source 2513. http://www.countyhealthrankings.org/app/utah/2015/rankings/ morgan/county/outcomes/overall/snapshot14. 2015 WMHD CHA Focus Group Report15. 2015 PhotoVoice Comment Board16. http://www.cdc.gov/obesity/childhood/defining.html17. http://www.cdc.gov/obesity/childhood/causes.html18. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_ Community Health Assessment 57

Section 4 Health Behaviors

Health Indicator 21 Alcohol AbuseP otentially serious alcohol abuse, such as binge and chronic drinking, Graphic 11: are significant risk factors for injury, violence, select acute and chronic Binge & Chronicdiseases, and even death. These forms of alcohol abuse may also indicateuntreated underlying mental and behavioral health needs.1 The CDC defines Drinkersbinge drinking as consuming four or more alcoholic drinks for women andfive or more drinks for men on one occasion during the past 30 days.2, 3 The BingeCDC defines chronic drinking as consuming an average of >1 alcoholic drink Drinkers:for women and >2 drinks for men per day in the past 30 days.4, 5 U.S. – 16.5% Utah – 12.3%When compared to national, state, and local results for binge drinking, theWMHD has room for improvement. Of all the LHDs in Utah, the WMHD has U.S. & Utahthe highest rate of adults who binge drink.6 For chronic drinking there is alsoa prospect for progress in the WMHD. Chronic Drinkers: U.S. – 6%Graphic 12: Adults who Binge Drink (2011–2012) When examining Utah – 4% the regions that Downtown comprise the Binge Ogden WMHD, all are Drinkers: 20.6% in need of either moderate or 16.8%Ben Lomond Riverdale Eastern significant Weber County improvement for WMHD12.6% 11.4% binge drinking, & Morgan except Riverdale ChronicRoy/Hooper County and the Drinkers: 10.7% combined13.7% South region of 4.1% Ogden eastern Weber County and Binge 13.6% Morgan County. Drinkers:Source: http://ibis.health.utah.gov/indicator/view/AlcConBinDri.LHD.html 9.1%Note: US Data 2013 and Utah Data 2012–2013 for chronic drinking. U.S. and Utah binge drinking data 2013. DCHDSources: http://ibis.health.utah.gov/indicator/view/AlcConBinDri.LHD.html, http://ibis.health.utah.gov/indicator/view/AlcConChrDri.LHD.html Chronic Drinkers: 2.7% Binge Drinkers: 14.8% SLCoHD Chronic Drinkers: 5.3% Binge Drinkers: 8.0% UCHD Chronic Drinkers: 1.7% Community Health Assessment 59

Health Indicator 22 Tobacco UseT obacco use is a behavior with significant health consequences — cigarette smoking is theprimary form of adult tobacco use. Smoking harms nearly every organ of the body and isthe leading cause of preventable death in the United States.7 From the 2015 Public HealthPriority Survey, residents selected smoking/e-cigarettes as the second most voted publichealth priority.8 Graphic 13: Adults Who Use Cigarettes (2014)As shown in Graphic 13, the WMHD WMHD DCHDis well below the national average 14.2% 8.7%for adults that smoke, however, it isin need of significant improvement SLCoHDwhen compared to the state average 10.7%and nearby LHDs. Smoking among adults is concentrated U.S. UCHD in Ogden City, Riverdale, and Ben 17.8% 5.4% Lomond; in these areas almost 1 out of 5 adults smoke cigarettes. (2013) State of Utah Of all the small regions examined 9.5% by the Utah Department of Health, Downtown Ogden — with a Sources: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index. smoking rate of 21.1% — has the htm#national http://www.tobaccofreeutah.org/pdfs/tpcpfy15report.pdf highest smoking rate in the state of Utah. Table 22 shows where Table 22: Adults Who Smoke in the WMHD (2013–14) smoking populations are located in the WMHD. Downtown Ogden 21.1%! It is uncertain if WMHD Riverdale 19.6% will achieve HP2020’s goal of 12% or fewer Ben Lomond 19.3% adults who use cigarettes. Roy/Hooper 13.9% Source: https://www.healthypeople.gov/2020/topics-objectives/ topic/tobacco-use/objectives South Ogden 10.6% Eastern Weber County & Morgan County 5.7% Source: http://ibis.health.utah.gov/query/result/brfss/LandlineCell_BRFSSAgeAdj8Sarea/ SmokeCurCig.html60 Weber-Morgan Health Department

Because tobacco is extremely addictive it makes quitting very difficult. A simple majority ofcurrent Utah smokers have tried unsuccessfully to quit in the past year. HP2020 has set agoal of 80% of adult cigarette users that attempt to quit smoking in the past 20 years. There isno WMHD specific data available for this measurement.Chart 30: 66%Current Utah 64%Smokers Who 62%Attempted to 60%Stop Smoking 58%in the Past 56%12 months 54% 2009 2010 2011 2012 2013 Current Male Smokers Current Female Smokers2015 WMHD Public Health Priority Survey Results: https://www.surveymonkey.com/analyze/nMA_2BT56SPkkHsOD6gDu8G7X6VORUmfdPQvCk0mE1_2Fo0_3DUnborn children and young children are particularly prone to long term harm from exposureto tobacco. In 2015, 10.4% of all WMHD WIC clients self-reported they are current cigaretteusers. Of these current cigarette users, 68% reported they attempted to quit smoking in thepast 12 months — this means 32% made no effort to quit smoking in the past year. Of theWMHD WIC clients that indicated they are current cigarette users, 34.5% self-reportedbeing e-cigarettes users as well.Graphic 14: Utah Women Who Smoke During their 3rd Trimester of Pregnancy WMHD DCHD 5.2% 2.5% SLCoHD 3.4% UCHD 1.3% State of Utah 3.2% Community Health Assessment 61

5.09% of WMHD WIC clients indicate they currently use e-cigarettes, but not cigarettes. Of the WMHD WIC clients that are currently e-cigarettes users, 47.8% have attempted to quit using e-cigarettes in the past 12 months — over 50% have made no effort to stop using e-cigarettes in the past year. Community Resources There are several national, state, and local organizations in Weber and Morgan Counties that offer resources and tools to help prevent or cease the use of tobacco products. National resources include: • Smokefree.gov • The American Heart Association • The American Cancer Society • The American Lung Association Local and state resources include: • The WMHD • Utah Department of Health (Way to Quit) • United Way of Northern Utah • Midtown Clinic • McKay-Dee Hospital • Ogden Regional Medical Center62 Weber-Morgan Health Department

Health Indicator 23 Adolescent Substance AbuseA dolescent substance abuse is a concerning public health matter. The WMHD reports high abuse rates of both marijuana and alcohol when compared to the state averageand nearby LHDs, however it is significantly below the national average.Chart 31: U.S. Alcohol8th, 10th and State Marijuana12th Graders WMHDusing Alcohol DCHDor Marijuana SLCoHDOne or More UCHDDays in theLast 30 Days 0% 10% 20% 30% 40%Source: http://ibis.health.utah.gov/indicator/view/SubAbuAdol.Alc_LHD.htmlRetailers in compliance with not selling Graphic 15: Alcohol Retailers in Compliancealcohol to minors is significantly lower in with Not Selling to Minors (2013)Weber County when compared to theaverage of the state and nearby counties. Weber County Morgan CountyIn 2013 one out of four inspected retailers 75% No Datain Weber County sold alcohol to a minorduring a compliance check. Salt Lake Davis County County 92%From the 2015 Public Health Priority 91.1%Survey, 33.9% of WMHD residents selected Utah Countyalcohol and drug abuse as one of the three State of Utah 93.8%topics they want the health department to 91.7%give prioritized attention. It is meaningfulthat this topic received the most votes from http://highwaysafety.utah.gov/drunkdriving/easy/ Community Health Assessment 63

a list of 20 possible public health priorities to vote on from both Spanish and Englishspeaking residents.Using tobacco products is another form of substance abuse among adolescents. Cigarettes and electronic nicotine delivery systems✓ The WMHD has achieved HP2020’s (ENDS) are the primary sources of goal of 16% or fewer of nicotine use in adolescents. Any form of adolescents that use cigarettes. smoking among teenagers is a tremendous public health concern. The 2012 Surgeon General’s ReportSource: https://www.healthypeople.gov/2020/topics-objectives/topic/ determined that 90% of all smokerstobacco-use/objectives” first used cigarettes as teens and that about75% of teen smokers will continue smoking into adulthood.Marketing efforts for ENDS — which circumvent current cigarette advertising restrictions —may be reversing the multi-decade long public health campaigns that denormalizedsmoking, by renormalizing smoking through “vaping” — a popular term used to describesmoking an ENDS. This renormalizing of smoking is especially detrimental to the adolescentsit targets. Lorrilard — a tobacco manufacturer — noted, “Kids may be particularly vulnerableto trying e-cigarettes [ENDS] due to an abundance of fun flavors such as cherry, vanilla,pina-colada and berry.” In 2014 Time Magazine reported 73% of 12 to 17 year olds during2013 were exposed to television and print ads of Lorrilard’s Blu ENDS brand. Time Magazinealso notes that advertising for e-cigarettes increased 256% during 2011 to 2013. From 2013–2014 U.S. ENDS use tripled from 4.5% to 13.4% among high school students; in middle school students it more than tripled from 1.1% to 3.9%. Recent research from the University of California, San Francisco indicates adolescents that use ENDS are more likely to smoke cigarettes and less likely to quit smoking.64 Weber-Morgan Health Department

As shown in Graphic Graphic 16: 8th, 10th, & 12th Graders Who Use ENDS or Cigarettes16, the WMHD is inneed of significant WMHD (2015)improvement in ENDS: 15%reducing the cigarettes: 4.3% DCHD ENDS: 8.4% cigarettes: 2.5%percentage of SLCoHDadolescents that use ENDS: 12.3%ENDS and cigarettes, cigarettes: 3.7%when compared tonational, state, and 2014 U.S. UCHDnearby LHDs. ENDS: 13.4% ENDS: 7.6% cigarettes: 9.2% cigarettes: 2.7%2013 Utah specific dataon experimentation State of Utahand current use of ENDS: 10.5%e-cigarettes shows a cigarettes: 3.4%pattern of increasedexperimentation and 3 out of 4 teenage smokers will become adult smokers.use of e-cigarettes Source: http://www.tobaccofreeutah.org/pdfs/tpcpfy15report.pdfamong the differentgrades. E-cigaretteexperimentation is defined as even trying it once and current use is defined as use in the past 30days. This trend highlights the need for earlier and sustained e-cigarette education. ! There is no HP2020 goal for adolescent e-cigarette use 35% 30%Chart 32: 25%Utah E-cigarette 20%Experimentation 15%and Current Use 10%Among 8th, 10th 5%and 12th Graders 0 2013 Utah 2015 2013 2015 Utah WMHD WMHD e-cigarette current use (past 30 days) e-cigarette experimentation (ever tried)Source: http://www.tobaccofreeutah.org/pdfs/tpcpfy15report.pdf Community Health Assessment 65

Health Indicator 24 Healthy EatingD iet is an impactful behavior with Graphic 17: Adults Who Eat Less Than 5 Servings immediate and long-term health of Fruit/Vegetables Each Day (2005–2009)benefits and consequences. A healthy dietemphasizes fruits, vegetables, whole grains, Weber Countylean meat or fish products, and nuts.9 79.1% Morgan CountyChoosemyplate.gov recommends vegetables 88.9%and fruits fill 50% of the plate of each Davis Countymeal for optimal nutrition.10 A related 77.3%measurement is the number of adults whoeat less than five combined servings of Salt Lakefruits and vegetables each day. The WMHD Countyand all of the nearby counties, except Utah 76.8%County, are doing worse than the stateaverage and/or national average for adults U.S. Utah Countywho eat less than five combined servings 75.7% 76.9%of fruits and vegetables each day. MorganCounty is in need of improvement with State of Utah 77.2% Source: http://assessment.communitycommons.org/CHNA/report?page=5&id=301Graphic 18: WMHD Eastern Weber CountyAdults Who 16.3% & Morgan CountyEat 3 or DCHD Downtown 18.5%More 18% OgdenVegetablesa Day SLCoHD Ben Lomond 17% 18.3% 16.1% UCHD Riverdale 2011–2013 17.8% Roy/Hooper 19.2% WMHD Small State of Utah 12.2% South Ogden Area Data 2013 State & LHD Data 17.5% 17.2%Source: http://ibis.health.utah.gov/indicator/view/5aDayVeg.SA.html, http://ibis.health.utah.gov/indicator/view/5aDayVeg.LHD.html66 Weber-Morgan Health Department

88.9% of its adult population reporting less than five combined serving of fruits and vegetables eachday. Morgan County has 13.2% more than national averages and 11.7% more than state averagesof its adult population that eats less than 5 combined servings of fruits and vegetables. WeberCounty is slightly above the state, national and averages of nearby LHDs for this measurement.A related measurement is the percentage of adults that eat three or more servings of vegetablesper day. When looking at this measurement it is apparent too few Utahans eat an appropriateamount of vegetables on a daily basis. Of the compared LHDs, the WMHD is in need of someimprovement. When looking at the areas that comprise the WMHD, Roy/Hooper is the area withthe most improvement needed.The number of fast food restaurants per Graphic 19: Number of Fast Food Restaurants100,000 population is an important per 100,000 Residentsmeasure of healthy food access and local Weber Countyinfluences that affect diet choices. MorganCounty is doing exceptionally well in this 67 Morgan Countymeasurement. Weber, Davis, and Utah 21.1 Davis County 64.9Counties all exceed the national and state Salt Lakeaverage for this measurement. County 86.4Food insecurity — the limited or uncertainaccess to adequate food — is a critical U.S. Utah Countymeasurement for healthy eating. For this 72.7 69.7measurement, Morgan County isoutperforming all nearby counties and the State of Utahnational and state. In five years Weber 76.4County has gone from being near theU.S. average to just slightly above the Source: http://assessment.communitycommons.org/CHNA/report?page=3&id=401state average — of the nearby counties only Davis and Morgan are outperforming Weber County.Chart 33: Total Population With Food Insecurity18% Weber County17% Morgan County16% Davis County15% Salt Lake County14% Utah County13% State of Utah12% United States11%10% 2009 2010 2011 2012 2013Source: http://www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/data-by-county-in-each-state.html Community Health Assessment 67

Food insecurity for children, a vulnerable subset of the population, is a vital measurementbecause a lack of sufficient healthy food will cause lasting health implications for many children.For this measurement Morgan County is outperforming the national, state, and average of nearbycounties. Weber County has improved in this measurement and is now below the state andnational average, however when compared to nearby counties it is in need of several percentagepoints worth of improvement.Chart 34: Children with Food Insecurity26% Weber County24% Morgan County22% Davis County20% Salt Lake County18% Utah County16% State of Utah14% United States12% 2009 2010 2011 2012 2013Source: http://www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/data-by-county-in-each-state.htmlAnother important component of healthy eating is found in not skipping meals. Information for thegeneral population is not available, however there is data for the at-risk-population of WIC clients.26.6% of WMHD WIC clients reported they or another family member sometimes skipped a mealor had their portion sizes cut because there was not enough money for food. 3.6% reported thiswas an often occurrence. For Spanish speaking WIC clients this number decreased slightly to24% for sometimes and 2.3% for often.40.9% of WIC clients reported they sometimes could not afford to feed their family healthymeals. 7.9% reported this was an often occurrence. This number increased to 56% reportingsometimes for Spanish speaking WIC clients and 8.5% reporting often.The foundation for excellent nutrition is established after birth through infants receiving breastmilk. Both mothers and children gain significant health benefits from breastfeeding. Because ofbreastfeeding, mothers receive a lower risk for pre-menopausal breast cancer and osteoporosisand infants have fewer ear, respiratory, and urinary tract infections. Examining how many womenhave ever breastfed is a good indicator of how prevalent and successful this foundation of healthyeating is being established. Since 2011 the percentage of women that have ever breastfed hasexponentially increased for WIC women in the state. Nationally and statewide all women haveremained fairly constant. In some instances, WIC clients are now on par with the state’s high rateof women who have ever breastfed. The WMHD is now on par with national results for all womenwho have ever breastfed.68 Weber-Morgan Health Department

Chart 35: Women and WIC Clients Who Have Ever Breastfed95% State WIC90% WMHD WIC85% DCHD WIC80% SLCoHD WIC75% UCHD WIC70% State of Utah65% (all women)60% United States55%50%45%40% 2011 2012 2013 2014Source: IBISWithout local data available for all women it is unknown whether the WMHD will achieveHP2020’s goal of 81% for women that have ever breastfed. Using WIC specific data 79% haveever breastfed, putting WMHD WIC clients only 2% away from achieving this HP2020 goal.A more meaningful measurement than ever breastfeeding is exclusive breast feeding.Unfortunately, over time this measurement declines with each progressive month after birth.Measuring the percentage of women that are exclusively breastfeeding at the 6-month mark is astrong indicator of how many infants are receiving the best nutrition available.When compared to national, state, and nearby LHDs the WMHD’s WIC population that is stillbreastfeeding exclusively at 6 months is in need of some improvement. There is no data for allwomen in the WMHD. It is unlikely the WMHD WIC population will reach HP2020’s goal of 25.5%that are still exclusively breastfeeding at 6 months.Chart 36: Women Who Still Exclusively Breastfeed at 6 Months35% State WIC30% WMHD WIC25% DCHD WIC20% SLCoHD WIC15% UCHD WIC10% State of Utah (all women) 5% United States 2011 2012 2013 2014Source: IBIS Community Health Assessment 69

Health Indicator 25 Physical Activity Photo Credit: Laniece RobertsR egular physical activity is Graphic 20: Adults Who Receive the Recommended essential to maintaining Amount of Aerobic Physical Activity (2013)optimal physical and mental health.This topic resonated strongly with WMHD DCHDWMHD residents. The WMHD exceeds 55.9% 56.8%national and state averages for thepercentage of adults that receive the SLCoHDrecommended amount of aerobic 54.2%physical activity. For therecommended amount of muscle- U.S. UCHDstrengthening activity the WMHD is 49.5% 57.2%ahead of the national average, butbehind when compared to the state State of Utahand nearby LHDs. 55.7% Source: http://ibis.health.utah.gov/indicator/view/PhysAct.LHD.htmlGraphic 21: Adults Who Receive the Watching excessive TV is a publicRecommended Amount of Muscle- health problem for all ages. It isStrengthening Physical Activity (2013) especially problematic for children, because it contributes to childhood WMHD DCHD obesity and establishes poor habits for 29.8% 32.9% life.11 Not only does TV take away from potential hours of physical SLCoHD activity, but it exposes children to 33.2% advertising which does not typically give objective information about U.S. UCHD healthy food choices and behaviors.1229.3% 33.2% In Utah this problem is approximately equally distributed between males and State of Utah females of the same racial/ethnic 31.6%Source: http://ibis.health.utah.gov/indicator/view/PhysActMusStr.LHD.html70 Weber-Morgan Health Department

Chart 37: Utah 9–12th Graders Who Watch 3 or More Hours of TV Daily55% Males White/50% Non-Hispanic45% Females White/40% Non-Hispanic35% Males Hispanic30% (all races)25% Females Hispanic20% (all races)15% Males Non-White/10% Non-Hispanic Females Non-White 5% /Non-Hispanic 0% United States 1999 2001 2003 2005 2007 2009 2011 2013Source: http://ibis.health.utah.gov/query/builder/yrbs/YRBS/TV3Hour.html,http://nccd.cdc.gov/NPAO_DTM/IndicatorSummary.aspx?category=85&indicator=61&year=2005&yearId=7background. The latest data available (2013)shows that TV watching among all 12th gradershas declined since 1999. Even though there hasbeen a decline, there is significant variancebetween the races and ethnic groups. In 2013,approximately more than 30% of Hispanicfemales (all races) watched 3 or more hours ofTV while less than 15% of White Hispanicsfemales did the same. In 2013, less than 20% ofHispanic males (all races) watched 3 or morehours of TV while less than 15% of WhiteHispanics females did the same. The positivenews is that excessive TV watching is trendingdownwards for all races/ethnic groups and allare approaching parity. However, trends forHispanic females have stabilized at a higheraverage than the rest and mirrors more closelyto national trends. Community Health Assessment 71

Chart 38: Utah 9–12th Graders Who are Physically Active for 60 Minutes 5 Days a Week70% Males White/Non-Hispanic60% Females White/Non-Hispanic50% Males Hispanic (all races)40% Females Hispanic (all races)30% Males Non-White/Non-Hispanic20% Females Non-White/Non-Hispanic10% 2009 2011 2013What are Residents Saying?Weber County residents shared the following about physical activity:13 “Photos with the kids being active, kids need that to keep from being bored & getting into trouble!!!” “The yoga photo made me wish for opportunities for respite, peace, community & reflection for everyone. We all have challenges & all need tools for coping.” “[We] need free or cheap venues [for exercising].” “I personally love rock climbing and recommend to all.” “Love the trails. Please keep them clean.” “[The] Ogden trail is a great influence for more people to enjoy nature & great exercise in a nonmonetary way!” “It’s good for kids to get outside and play =)” “I think kids need more places to play instead of the streets.”72 Weber-Morgan Health Department

“I really like the picture of biking and hiking. My family and I enjoy Utah outdoor activitiesvery much.”“Kids playing outside: we need to get more kids to do this instead of staying in.”“Doing activities can leave a mark of enjoyment with friends & family, not only is itkeeping you healthy you’re making memories as well.”“My family really enjoys biking/rollerblading on the Ogden Trails. I like how the trials arekept tidy, away from traffic & are around scenic areas like trees & rivers. I also like howthey connect parks, like the Botanical Gardens & the Dinosaur park.”Community Health Assessment 73

Health Indicator 26 SafetyS afety measures play a major role in preventing Graphic 22: Motor Vehicle Occupants injury, disability, death, and disease. Some of Who Wear Seatbelts (2014)these safety measures include: State National• Adults who always wear a seatbelt 83.4% 86.9%• Adults who practice safe practices in the sun Utah• Adults who do not use impairing substances and drive (17 of 29 County Counties) 84.7%In June 2014 the Utah Department of Public Safetyconducted an observational study to measure seatbelt Weber Salt Lake Countyuse in 17 counties; the study consisted of 19,588 County 85.9%drivers and 5,522 passengers.14 86%National data for this measurement was acquired from Davisa 2014 questionnaire that asked respondents if they Countydo not wear a seat belt or if they always or nearly 91.2%always wear a seat belt.15Weber County is doing well in this measurement and outperforms the state average, but not thenational average. Only Davis County exceeds both national and state rates for this measurement.Practicing safety in the sun, for the purpose of reducing skin cancer rates, consists of wearingsunblock, wearing a hat, avoiding the sun, or wearing a long-sleeve shirt.16 The WMHD is slightlybehind the state and other nearby LHDs for this measurement. Of the areas within the WMHD,Downtown Ogden and Roy/Hooper are in need of the most improvement.X It is unlikely the WMHD will WMHD’s skin cancer rate is 3.8 per achieve HP2020’s goal of 100,000, DCHD’s is 3.1, SLCoHD’s is 3.4, 80.1% or more of adults who and UCHD’s is 4.2.17 It is not surprising follow safe sun practices. that as safe sun practices go up, there is typically a decline in skin cancer rates.Source: http://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectives 86% of skin cancers are attributed to ultraviolet radiation from the sun.1874 Weber-Morgan Health Department

Graphic 23: Adults Who Utilize Safe Sun Practices (2012 (*2010 Data)) WMHD Eastern Weber County 62.7% & Morgan County 73%State DCHD65.8% 71.4% Downtown Ogden* 58.8% Ben Lomond* 64.1% SLCoHD 64.8%U.S.* Roy/Hooper* Ri7v8e.r3d%ale*South Ogden*70% 54.3% 69% UCHD 65.1%Sources: http://ibis.health.utah.gov/indicator/view/SunSafMea.SA.htmlhttp://ibis.health.utah.gov/indicator/view/SunSafMea.LHD.htmlhttp://progressreport.cancer.gov/prevention/sun_protectionThe number of DUI arrests, a measurement directly related to the number of adults that useimpairing substances while driving, is also an indicator of safety in the community. Over the pastfour years, all of the measured counties have steadily declined, except for Weber.19, 20, 21, 22Because Weber has remained fairly consistent it is now on par with Salt Lake County and isslightly elevated above the state and national averages for this measurement. In 2014 MorganCounty led in this measurement with only 177 DUI arrests per 100,000.Chart 39: DUI Arrests per 100,000 Population600 Weber County500 Morgan County400 Davis County300 Salt Lake County200 Utah County100 State of Utah United States 0 2011 2012 2013 2014 Community Health Assessment 75

Section 4 Endnotes 1. http://assessment.communitycommons.org/CHNA/report?page=5&id=304 2. http://ibis.health.utah.gov/indicator/view/AlcConBinDri.LHD.html 3. http://www.cdc.gov/alcohol/pdfs/excessive_alcohol_use.pdf 4. http://ibis.health.utah.gov/indicator/view/AlcConChrDri.LHD.html 5. http://www.cdc.gov/alcohol/pdfs/excessive_alcohol_use.pdf 6. http://ibis.health.utah.gov/indicator/view/AlcConBinDri.LHD.html 7. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/ 8. 2015 WMHD Public Health Priority Survey Results: https://www.surveymonkey.com/ analyzenMA_2BT56SPkkHsOD6gDu8G7X6VORUmfdPQvCk0mE1_2Fo0_3D 9. http://www.cdc.gov/healthyweight/healthy_eating/ 10. http://www.choosemyplate.gov/about.html 11. http://www.med.umich.edu/yourchild/topics/tv.htm 12. http://www.med.umich.edu/yourchild/topics/tv.htm 13. 2015 Photovoice Comment Board 14. http://highwaysafety.utah.gov/wp-content/uploads/sites/22/2015/05/2014-Survey-Report-Basic.pdf 15. http://nccd.cdc.gov/brfssprevalence/rdPage.aspx?rdReport=DPH_BRFSS.ExploreByLocation&rdProcessAction=&SaveFileGenerated=1&rdCSRFKey=3 a3aa3b4-59d5-4bbf-86a3-a73921aade3d&islLocation=99&islClass=CLASS12&islTopic=Topic50&islYear=2013&hidLocation=99&hidClass=CLASS12&h idTopic=Topic50&hidTopicName=Seatbelt+Use&hidYear=2013&irbShowFootnotes=Show&iclIndicators_rdExpandedCollapsedHistory=&iclIndicators=_ RFSEAT3&hidPreviouslySelectedIndicators=&DashboardColumnCount=2&rdShowElementHistory=&rdScrollX=0&rdScrollY=190&rdRnd=61269 16. http://ibis.health.utah.gov/indicator/view/SunSafMea.SA.html 17. http://wonder.cdc.gov/controller/datarequest/D76 18. http://www.skincancer.org/skin-cancer-information/skin-cancer-facts#melanoma 19. http://www.usaav.utah.gov/Alcohol/2014%20DUI%20Annual%20Report.pdf 20. http://www.usaav.utah.gov/Alcohol/2013%20DUI%20Annual%20Report.pdf 21. http://www.usaav.utah.gov/Alcohol/2012%20DUI%20Annual%20Report.pdf 22. http://www.usaav.utah.gov/Alcohol/2011%20DUI%20Annual%20Report.pdf76 Weber-Morgan Health Department

Section 5 Clinical Care

W eber County ranks 8th and Morgan County ranks 3rd for clinical care out of the 27 Utah counties surveyed. Clinical care is comprised of two components: access to healthcare and quality of care. Access to healthcare measures the ability to receive preventative and/or corrective care from primary, specialist, emergency, mental, and oral healthcare providers. In all communities there are barriers that prevent residents from accessing healthcare. Some of the most common barriers include: language challenges, lack of insurance, inadequate insurance coverage, high cost, inability to get preventative services, lack of transportation, lack of knowledge of preventative services, and limited providers.1 Improving access to both preventative and corrective healthcare will improve morbidity, mortality, quality of life, and emergency department use in Weber and Morgan Counties. Quality of care is simply defined as: “…Getting the right care to the right patient at the right time — every time.”2 What are Residents Saying? Weber residents, speaking on quality and access to healthcare, said the following:3 “We have great hospitals, too, here.” “…at 4:30pm at (name of low-income clinic) you just cannot believe the impact of people that need…that can’t even get an appointment.” “To use any assistance program you have to be on the phone forever and press ten different buttons to get to who you need to be talking to.” “We’ve got a lot of community resources that are not well-communicated and under-utilized.” “You’re not old enough to qualify for Medicare, but not poor enough to qualify for Medicaid.” “There is a stigma [with seeking help for mental health].” “People turn towards prescriptions than counseling because they want a quick fix.” “It’s because judges have the mistaken idea that because we don’t have programs for those who are mentally ill, they’ll send them to prison, so they can get a program.”78 Weber-Morgan Health Department

“…have to think long and hard about taking a kid to the emergency room.” “If you don’t qualify for the right kind of Medicaid…you don’t have any dental care.” “Spanish-speaking residents…that’s a barrier, how they’re treated, access to care, all those resources…it’s huge.”Morgan County residents also shared some thoughts on quality and access to healthcare:4 “…fifteen minutes away from two major hospitals.” “I think I have great access at the Morgan Clinic…they’re always available.” “People think that because it’s a different county, it’s farther away, but we actually have access to great healthcare.” “Services for children with special needs…they’re just not as they should be….not enough people to go around.” “Is there mental health available in our community. For our kids in school, even?”Community Health Assessment 79

Health Indicator 27 InsuranceH aving insurance is often linked to being able to access preventative medical, oral, and eye care services, which are often more affordable than treatment. Benjamin Franklin, aFounding Father of America, once said, “An ounce of prevention is worth a pound of cure.”5A lack of insurance is a significant barrier to accessing healthcare. A 2014 study by the KaiserFamily Foundation indicated 30% of adults without insurance coverage reported they went withouthealthcare in the past year because of cost, whereas only 4% of adults with insurance reportedlikewise.6 As of 2012, 17% of Weber County and 11% of Morgan County residents are uninsured.Data for Table 23 is for 2013, unless otherwise noted.Table 23: Uninsured Residents United State of Weber Morgan Davis Salt Lake Utah States Utah County County County County CountyUninsured Residents 14.5% 16%* 17%* 11% 10%* 17%* 14%*65 or YoungerUninsured Children 8% 9% 9.4% 8.1% 6.4% 10.75% 8.4%*2012 DataSources: http://www.countyhealthrankings.org/app/utah/2015/measure/factors/85/map, http://kff.org/other/state-indicator/children-0-18/, Voices for Utah ChildrenHigh cost continues to be the primary reason why people do not have health insurance. 61% ofAmericans reported in 2013 they were without insurance due to high cost or from currently beingunemployed.7 States, like Utah, that have not expanded Medicaid coverage — as authorized underthe 2010 Affordable Care Act — have higher uninsured rates than states with expanded coverage.8In the 2015 WMHD Focus Group Report, Weber County residents reported of a “middle gap”population, consisting of those who do not make enough to afford healthcare services, but notlow income enough to qualify to receive those services.980 Weber-Morgan Health Department

Health Indicator 28 Cost of HealthcareC ost of healthcare is also a concern for residents in the WMHD. Using the average length and cost of the ten most common types of hospitalizations as a basis for determining theoverall affordability of health and time away from work, McKay-Dee, Ogden Regional, and allUtah Hospitals were compared.The ten most common causes of hospitalization were analyzed for all hospitals in the state andfor the two hospitals serving the Weber-Morgan Health District. A combined weighted averagewas calculated for the average length of stay and average discharge cost for all hospitals in thestate, as well as for the two hospitals in the WMHD. A weighted average is different from anaverage — where all data points contribute equally to the total average — because some pointscontribute more towards the average than others. In this particular case, the procedures with themost discharges contributed proportionally more toward the total average than procedures withfewer discharges.As shown in Table 24, the average hospitalized patient in the Weber-Morgan Health District willremain at the hospital 1% longer and pay 4.1% more than the average hospitalized patient willin the state of Utah; the cost of healthcare in the WMHD is essentially on par with the averagecost in the state of Utah.Table 24: Hospitalization in Utah – Cost and Length of Stay Average Length Length of Hospitalization Average Cost Difference of Hospitalization Compared to Discharge Cost* Compared to State Average State AverageMcKay-Dee Hospital 2.2 1% Longer Stay $10,656 4.1% Higher& Ogden RegionalMedical Center — All Utah Hospitals 2.18 — $10,233 (State Average)*Weighted Average UtilizedSources: http://utpricepoint.org/ Community Health Assessment 81

Health Indicator 29 Healthcare Provider RatiosA ccessing healthcare requires accessing providers of medical, oral, and mental health services. An insufficient number of health providers is one barrier to accessing healthcare.The optimal ratio of medical, oral, and mental health services is influenced by many factors,including the health of the community, population density, and the population’s proximity toproviders in nearby counties.Table 25 shows a mix of favorable and less favorable ratios of residents to medical, oral, andmental health service providers. Weber County has a less favorable ratio of residents to primarycare physicians and the best ratio for oral health providers when compared to national, state, andnearby county ratios. The mental health provider to resident ratio in Weber County indicatesmoderate improvement is needed when compared to the state or nearby county ratios.Table 25: Healthcare Provider Ratios Top 10% State of Weber Morgan Davis Salt Lake Utah County County County County CountyRatio of Residents Per: U.S. Counties Utah 2,231:1 1,637:1 2,037:1 1,374:1 2,271:1Primary Care Physicians 1,045:1 1,768:1 1,276:1 3,391:1(2012) 615:1 10,173:1Dentists (2013) 1,377:1 1,501:1 1,564:1 1,381:1 1,577:1 684:1 305:1 525:1Mental Health Providers 386:1 434:1(2014)Sources: http://www.countyhealthrankings.org/82 Weber-Morgan Health Department

The U.S. Department of Health & Human Services and the Health Resources and Services releaseda report in March 2015 evaluating health professional shortages across the United States. Thisreport evaluates whether an area is medically underserved and determines the number of healthprofessionals that are needed for adequate levels of service. This report only evaluates primarycare, dental, and mental health professionals; specialists are not included. As indicated byGraphic 24, Weber and Morgan Counties both have a mild shortage of health professional. Addingtwo more primary care, dental, and mental health providers would bring Weber County to anadequate level of service providers.10 Adding one primary care and one mental health providerwould bring Morgan County to an adequate level of service providers.Graphic 24: Number of Additional Primary Care, Dental,and Mental Health Providers Needed (03/2015)Weber County State of Utah Primary: 2 Primary: 57 Dental: 2 Dental: 52 Mental: 2 Mental: 38 Davis County Morgan County Primary: 0 Primary: 1 Dental: 1 Dental: 0 Mental: 1 Mental: 1 Salt Lake County Utah County Primary: 10 Primary: 2 Dental: 11 Dental: 2 Mental: 8 Mental: 2Sources: http://datawarehouse.hrsa.gov/topics/shortageAreas.aspx Community Health Assessment 83

Health Indicator 30 Mental Health & Substance Abuse Services Weber Human Services BuildingW eber Human Services (WHS) is the local authority for substance abuse and mental health service for residents in Weber and Morgan Counties.11 Other major substance abuse and mental health providers in Weber and Morgan Counties include LDS Family Services, McKay-DeeHospital, and Ogden Regional Medical Center.The 2014 data for WHS, in Table 26, suggests the substance abuse and mental health needs ofmany residents may be going untreated; estimated persons needing treatment may havereceived treatment through other private mental health and substance abuse providers. Currenttreatment capacity is the total number of clients treated by WHS in 2014.Table 26: Mental Health & Substance Abuse Treatment Needs & Capacity Evaluation Adults (18 years +) Minors (Under 18)Weber Human Estimated # Current Estimated # CurrentServices 2014 Needing Treatment Needing Treatment Treatment Capacity Treatment CapacityMental Health & 19,794 5,515 8,329 1,915Substance AbuseSource: http://dsamh.utah.gov/pdf/Annual%20Reports/2014%20Annual%20Report%20Final%20Web%201_27_15.pdfThe community perceives substance abuse is not being adequately treated. This is evidenced bythe top priority it puts on the matter. Residents also feel mental health is insufficiently addressedin the community.In 2015, both English and Spanish speaking Weber and Morgan residents identified drug abuse, amajor component of substance abuse, as the first priority issue for the WMHD to address. Mentalhealth, tied as the third highest priority with teen pregnancy and emergency preparedness.122015 interviews with key community stakeholders identified unaddressed mental health as thenumber one barrier to health.13Among WIC clients, drug abuse was identified as the top problem impacting the overall health ofthe community. Alcohol abuse was identified as the second top problem. Mental health wasselected by WIC clients as the fifth top problem influencing the overall health of the community.1484 Weber-Morgan Health Department

Health Indicator 31 Diabetes ManagementE arly detection of diabetes or pre-diabetes is crucial to reducing rates of morbidity, mortality, and emergency department utilization. Correct diabetes detection and management involvesregular blood-sugar testing. The A1c test is the primary test for evaluating whether a person isnormal, pre-diabetic, or diabetic.15, 16 Depending on whether a patient has type 1 or type 2diabetes determines whether the A1c test is administered two or four times a year.17Although, more of the adult population is diabetic in the WMHD than compared to the state of Utahand nearby counties, the WMHD also has the best A1c testing rate among its diabetic adults.Table 24: Evaluating Adult Diabetes Prevalence and Diabetes Management United States Utah WMHD DCHD SLCoHD UCHDAdults with Diabetes 9.3% 7.6% 8.8% 7.6% 7.7% 7.1%2011–2013 (Age-Adjusted) (2014)Diabetic Adults Who 66% 67% 72% 69.1% 61.6% 60.1%Received Two A1c Tests in thePast 12 Months 2009–2012Diabetic Medicare Enrollees – 84% Weber 83% 85% 86% 86%65–75 Years Who Receive Morgan 88%Regular A1c Testing 2012Sources: http://ibis.health.utah.gov/indicator/view/DiabMgt.html, http://ibis.health.utah.gov/indicator/view/DiabPrev.html, http://www.countyhealthrankings.org/app/utah/2015/measure/factors/7/mapThere is room for improvement in the WMHD in ✓ The WMHD has exceededterms of addressing diabetes management. As HP2020’s goal of 71.1% ofmore diabetic residents receive regular A1c diabetic adults receiving attesting and engage in appropriate tactics to least two annual A1c tests.manage their blood-sugar levels, thecomplications of diabetes can be delayed, Source: http://www.healthypeople.gov/2020/topics-objectives/topic/mitigated, or prevented. diabetes/objectives Community Health Assessment 85

Health Indicator 32 Breast Cancer Screening/ MammogramsA mong women, breast cancer is Graphic 25: Women 40 Years or Older Who Received the most common type of a Mammogram in the Past 2 Years (2011–2013)cancer.18 Nationally, about 1 in 8women will develop breast cancer WMHD State of Utahsometime in their lifetime.19 73.3% 66.9%Early detection of breast cancer is key DCHD UCHDto preventing death. Women who 70.9% 66.1%receive regular breast cancerscreenings, also known as SLCoHDmammograms, reduce their risk of 65.9%dying by 40%.20In the WMHD, 73.3% of women 40 yearsor older have received a mammogram,which is a higher rate than the stateof Utah and nearby LHDs.21 Source: http://ibis.health.utah.gov/indicator/view/BreCAMam.htmlIn 2012, among Weber County Medicarepatients, aged 67–69, the percent who received a mammogram in the past two years was 62.1%.The average from 2008 to 2012 in Weber County was 64.8%; this means the latest data availableindicates mammograms for Medicare patients aged 67–69 have been declining. For Morgan County,the number was 62.5% in 2012 and the 5 year average was 65.4%.22 Top counties in the U.S.have a rate of 70.7% for Medicare enrollees that receive a breast cancer screening in the pasttwo years.23While it is encouraging that from 2011–2013 in the WMHD nearly 3 out of 4 women 40 years orolder received a mammogram every two years, there is room for improvement when more than 1out of 4 did not. There is a need for additional education efforts with older Medicare patients whenin 2012 nearly 4 out of 10, between the ages of 67–69, did not receive a mammogram in thepast two years. Since 2008, the percent of Medicare patients in Weber and Morgan Counties thatreceive a mammogram in a two-year period is declining; this negative trend must be reversed.86 Weber-Morgan Health Department

Health Indicator 33 Prostate & Colorectal Cancer ScreeningProstate CancerData from 2007–2011 indicates prostate cancer was the second leading cause of cancer related deathsin men in the United States, but in Utah and Weber County it was the first leading cause of cancerrelated deaths.24, 25 In the past, there has been much disagreement between medical professionalsover the effectiveness of prostate screening. A 2015 study released in the New England Journal ofMedicine confirms that prostate screening improves the survival rate for all age groups by 21%.26The prostate produces an antigen that when measured in the blood in high doses usually signifiesprostate cancer.27 Regular testing for this antigen in males 40 years or older is an important methodfor early detection and treatment of prostate cancer. The WMHD is doing well in this measurementand had more 40 year old or older males completing prostate screening tests in 2010 or 2012 thanthe screenings reported for the state of Utah and many of the nearby local health departments.28Table 28: Prostate Cancer Screenings for 40 Year Old or Older Males in 2010 or 2012United States Utah WMHD DCHD SLCoHD UCHD 54.3% 56.2% 61.1% 60% 55.4% 57.3%Source: http://ibis.health.utah.gov/indicator/view/ProsCAScr.LHD.htmlColorectal Cancer ✓ The WMHD has exceeded HP2020’s goal of at leastData from 2007–2011 indicates colorectal 70.5% of adults that receivecancer was the third leading cause of cancer a colorectal cancer screeningrelated deaths in men and women in theUnited States, Utah, and Weber County. No Source: http://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectivescolorectal death rate is available for MorganCounty due to confidentiality concerns. Colon cancer screenings that detect cancer before it hasspread beyond the intestinal wall result in a 90% survival rate.29The WMHD is doing well in this measurement and had more 50 year old or older adults completingcolorectal cancer screenings in 2012–2013 than most of the nearby local health departments.30Table 29: Colorectal Cancer Screenings for 50 Year Old or Older Adults (2012–2013) Utah WMHD DCHD SLCoHD UCHD72.8% 76.8% 77.3% 74.3% 70%Source: http://ibis.health.utah.gov/indicator/view/ColCAScr.LHD.html Community Health Assessment 87

Health Indicator 34 Immunization & VaccinationO ver the past 20 years, the CDC estimates vaccines have immunized enough U.S. residents to prevent more than 21 million hospitalizations and 732,000 deaths among children.31Certain crippling disabilities that result from diseases, such as polio, have been preventedbecause of vaccines.Even with the documented advantages of vaccines against many different diseases, there arebarriers to vaccination. These barriers include: cost, lack of insurance, misconceptions aboutvaccine safety, and insufficient recommendation and follow up by healthcare professionals.Influenza VaccineInfluenza, also known as the flu, is one Chart 40: Adults Who Received an Influenzaof the most common vaccine Vaccine in the Past 12 Monthspreventable viruses in America.Influenza infects the nose, throat, and 50%lungs and typically lasts one to two 45%weeks.32 It can cause serious 40%complications in children under the age 35%of two, adults over 65, pregnant 30%women, and populations with certainchronic diseases. Typically, the flu is 2009 2010 2011 2012 2013 2014fairly mild, but it can mutate to intensestrains that can increase the severity Utah WMHD DCHD SLCoHD UCHDand contagiousness of the flu toepidemic or pandemic levels. Source: http://ibis.health.utah.gov/query/result/brfss/LandlineCell_BRFSSAgeAdj8/InflVac.htmlAs indicated in Chart 40, a minority of Utahns receive an annual influenza vaccination. Trend patternssuggest fewer Weber and Morgan Counties adults will receive the influenza vaccination in 2015.88 Weber-Morgan Health Department

Pneumococcal VaccinePneumococcal (noo-muh-kok-uh-l) Chart 41: Adults Reporting They Have Received adisease typically infects the lungs Pneumococcal Vaccine(pneumonia), brain, or spinal cord(meningitis), or blood, (bacteremia and 80%sepsis).33 The severity of pneumococcal 75%diseases range from mild to deadly;approximately 20% of children who get 70%meningitis will die.34 The pneumococcal 65%vaccine may not prevent pneumonia 60%in elderly persons, but it can preventserious complications of pneumonia.35 2009 2010 2011 2012 2013 2014Typically, the pneumococcal vaccine isonly administered once or twice in a Utah WMHD DCHD SLCoHD UCHDperson’s life. Influenza and pneumonia Source: http://ibis.health.utah.gov/query/result/brfss/LandlineCell_BRFSSAgeAdj8/ PneumVac.htmltogether are the 8th leading cause of death in the WMHD and in the United States.36, 37, 38Influenza and pneumonia together are the 9th leading cause of death in the state of Utah.In 2014, with approximately 66–76% of adults (varies according to the LHD) reporting theyreceived the Pneumococcal Vaccine, there is room for some improvement in the WMHD and inthe rest of the state of Utah.Children ImmunizationsImmunizations for children examine vaccine series for Diphtheria, Tetanus, Pertussis, Polio,Measles, Mumps, and Rubella, Haemophilus influenza type b, Hepatitis B, and Varicella.39Table 30 indicates the three public school districts in the WMHD have excellent vaccinationcompliance. There is need for additional focus on vaccination outreach efforts for kindergartenaged children in the Ogden School District.Table 30: 2013/2014 Vaccine Rates by Public School District Ogden School District Weber School District Morgan School District Adequately Vaccine Adequately Vaccine Adequately Vaccine Immunized Exemptions Immunized Exemptions Immunized ExemptionsKindergarten 91.4% 1.6% 93.93% 2.5% 96.5% 2.0%7th Grade 94.2% 2.7% 95.7% 2.2% 93.6% 6.4%Source: http://www.immunize-utah.org/pdf/2014ImmCovRpt/Weber-MorganImmCov.pdfAlthough vaccination compliance rates are high, there is need for improved compliance in allschools to ensure sufficient herd immunity. Among schools in Utah vaccine exemption rates areconcentrated in charter schools; these schools are at elevated risk for outbreaks. Private andpublic schools currently have comparable vaccine exemptions in 2014, however historicallyprivate schools have had fewer parents claim a vaccine exemption for their children. Community Health Assessment 89

2013/2014Chart 42: Exemption Percentage by School Type 2012/2013 2011/201212% 2010/201110% 2009/2010 2008/20098% 2007/20086% 2006/20074% 2005/20062%2004/2005 0% Charter Public Private Source: UALBOH Presentation – Personal Exemptions to Mandatory Vaccine Requirements: Policy Options for Local Boards of Health. September 11, 2015. There are three types of vaccine exemptions for school children attending public schools in Utah: medical, religious, and personal. Although, these are the official exemptions there are many underlying reasons why parents opted for vaccination exemptions for their children. A 2012 survey conducted by the Utah Department of Health, with a sample size of 388 adults, indicated the primary reason parents filed for exemption was so they could enroll their children in school.40 Many of these parents likely intended to vaccinate their children, prior to school starting. It is probable they simply forget to do so. 3.6% of vaccine exemptions are due to insurance, access, or money issues. 5% of vaccine exemptions are due to poor record keeping. Together, these reasons constitute 40.3% of the exemptions. Vaccine exemptions could be reduced by up to 40.3% through additional efforts by the WMHD and our community partners. A majority of Chart 43: 2012 Vaccine Exemptions by Reason Lost Record Enroll Child Opted not to Repeat No Access No Insurance Too Much Money Vaccines too Soon Cause Chronic Disease Philosophical Beliefs Cultural Beliefs Reaction Source: UALBOH Presentation – Personal Exemptions to Mandatory Vaccine Requirements: Policy Options for Local Boards of Health. September 11, 2015.90 Weber-Morgan Health Department

kindergarten exemptions in the WMHD from 2004–2014 are for non-medical reasons, suggestingthere may be room for opportunity for increased vaccination compliance.41It is important to note that the WMHD has the lowest 10-year average for vaccine exemptions ofall the Utah LHDs with a rate of 2.18%.42 Even though the WMHD is doing well overall forvaccination compliance, there is a need for increased efforts in charter schools.Amongst WMHD WIC clients there is a need for increased education regarding the pertussisvaccine.43 In 2015 17.4% of WMHD WIC clients reported they were unaware that it wasimportant for all members of your family to receive a pertussis vaccine when a new child is born.Amongst Spanish speaking WMHD WIC clients, the rate increased to 38.2%.Community Health Assessment 91

Health Indicator 35 Preventable Hospital StaysP reventable hospital stays are highest in unhealthiest counties. 2012 preventable hospital stay information is available on a 1,000 patient basis for ambulatory care-sensitive Medicare enrollees.The Robert Wood Johnson Foundation defines ambulatory care-sensitive Medicare enrollees as having:44• Convulsions • Angina• Chronic obstructive pulmonary disease • Cellulitis• Bacterial pneumonia • Diabetes• Asthma • Gastroenteritis• Congestive heart failure • Kidney/urinary infection• Hypertension • DehydrationHospitalization for these treatable conditions, suggests the care provided by outpatient services weresubpar.45 This measurement also may signify a disposition to use hospitalization as the primary sourceof healthcare.46 Weber and Morgan Counties are in the top 10% nationally for this measurement byhaving a low rate of preventable hospital stays for ambulatory care-sensitive Medicare enrollees.Table 31: Preventable Hospital Stays per 1,000 Ambulatory Care-Sensitive Medicare Enrollees Top 10% State of Weber Morgan Davis Salt Lake UtahPerforming Utah County County County County County Counties41 or less 34 28 27 28 30 33Sources: http://www.countyhealthrankings.org/app/utah/2015/measure/factors/5/description92 Weber-Morgan Health Department

Section 5 Endnotes1. http://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services2. http://www.hhs.gov/asl/testify/2009/03/t20090318b.html3. 2015 WMHD Focus Group Report4. 2015 WMHD Focus Group Report5. http://www.ushistory.org/franklin/quotable/quote67.htm6. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/85/description7. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/8. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/9. 2015 WMHD Focus Group Report10. Source: http://datawarehouse.hrsa.gov/topics/shortageAreas.aspx11. https://www.weberhs.org/home/12. 2015 WMHD Public Health Priority Survey Results13. 2015 WMHD Interviews with Key Stakeholders14. 2015 WMHD WIC Survey Results15. http://www.diabetes.org/diabetes-basics/diagnosis/16. http://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/a1c-test-diabetes/Pages/index.aspx#117. http://www.mayoclinic.org/tests-procedures/a1c-test/basics/why-its-done/prc-2001258518. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics19. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics20. http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2015-06-04-breast-cancer-screening-cuts-deaths-by-40-expert-panel-says/21. http://ibis.health.utah.gov/indicator/view/BreCAMam.LHD.html22. http://assessment.communitycommons.org/CHNA/report?page=4&id=51123. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/50/map24. Sources: http://assessment.communitycommons.org/CHNA/report?page=6&id=610, http://assessment.communitycommons.org/CHNA/ report?page=6&id=611, http://assessment.communitycommons.org/CHNA/report?page=6&id=612, http://assessment.communitycommons.org/ CHNA/report?page=6&id=613, http://assessment.communitycommons.org/CHNA/report?page=6&id=61425. http://www.cancer.gov/types/colorectal26. http://lugpa.org/new-study-confirms-psa-screening-saves-lives/27. http://www.webmd.com/prostate-cancer/guide/psa28. http://ibis.health.utah.gov/indicator/view/ProsCAScr.LHD.html29. http://ibis.health.utah.gov/indicator/view/ColCAScr.LHD.html30. http://ibis.health.utah.gov/indicator/view/ColCAScr.LHD.html31. http://www.cdc.gov/media/releases/2014/p0424-immunization-program.html32. http://www.flu.gov/about_the_flu/seasonal/33. http://www.cdc.gov/vaccines/vpd-vac/pneumo/fs-parents.html34. http://www.cdc.gov/vaccines/vpd-vac/pneumo/fs-parents.html35. http://www.webmd.com/lung/tc/pneumonia-prevention36. http://ibis.health.utah.gov/query/result/brfss/LandlineCell_BRFSSAgeAdj8/PneumVac.html37. http://wonder.cdc.gov/controller/datarequest/D7638. Because influenza is a common cause of pneumonia, deaths attributed to either disease are combined together.39. http://www.immunize-utah.org/statistics/40. UALBOH Presentation — Personal Exemptions to Mandatory Vaccine Requirements: Policy Options for Local Boards of Health. September 11, 2015.41. http://www.immunize-utah.org/pdf/2014ImmCovRpt/Weber-MorganImmCov.pdf42. UALBOH Presentation — Personal Exemptions to Mandatory Vaccine Requirements: Policy Options for Local Boards of Health. September 11, 2015.43. 2015 WMHD WIC CHA Survey44. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/5/description45. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/5/description46. http://www.countyhealthrankings.org/app/utah/2015/measure/factors/5/descriptionCommunity Health Assessment 93

Section 6 Social & Economic Factors

Health Indicator 36 EducationE ducation leads to better jobs and higher income, but it also provides individuals with improved information about how to properly manage their mental and physical health. Nationally,college graduates will live an average of five years more than individuals that did not complete ahigh school education.1 Research shows parental education levels also impact the health ofchildren, because education is connected to the quality and quantity of resources available toprovide to offspring.2 In short, better education equals healthier lives for individuals and familiesand is one of the strongest predictors of health.3As shown in Table 32, Morgan County excels in educational attainment and Weber County has anopportunity for improvement.Table 32: United State of Weber MorganEducation States Utah County CountyNinth-Grade Cohort Who Graduates in — 80% 75% 91%Four Years (2011–2012)Adults 25 or Older with High School 86% 90.9% 88.8% 97.6%Education or Higher (2009–2013)Adults 25–44 with Some College (2009–2013) — 68.7% 59.3% 70.6%Adults 25 or Older with a Bachelor’s 28.8% 30.3% 22.7% 33.4%Degree or Higher (2009–2013)Sources: http://quickfacts.census.gov/qfd/states/49/49057.html, http://quickfacts.census.gov/qfd/states/49/49057.html, http://quickfacts.census.gov/qfd/states/00000.html, http://quickfacts.census.gov/qfd/states/49/49029.html, http://www.schools.utah.gov/data/Reports/Graduation-Dropout.aspx ✓ Only Morgan County has achieved the HP2020 goal of 87% or higher of 9th Graders that Graduate in 4 Years. Source: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/objectives Community Health Assessment 95

Graphic 28: Residents Without a High School Diploma In Weber County an undereducated population resides south of Ogden River. The map to left reveals a cluster where 30% of adults have not completed a high school education. Graphic 28 reveals a cluster where 30% of adults are without a high school degree. There are no concentrated areas in Morgan County where residents are without a high school degree; only 1–2% of all Morgan’s residents are without a high school degree.4 What are Residents Saying? Weber County residents shared the following: “You either help these kids and motivate them to go to college and do better or go build another jail, because that’s what’s coming up.”5 “I would like someone to explain why I pay 43% taxes and our kids are failing.” A Morgan County resident shared the following: “Our school system is very taxed. There’s just not a lot of resources. A lot of things that other schools have, our schools don’t.”696 Weber-Morgan Health Department

Health Indicator 37 EmploymentA stable well-paying job provides the consistency and resources needed to afford goods and services — such as nutritious foods, quality childcare, educational opportunities, and safeand healthy living conditions — that are necessary for optimal health. Conversely, job loss, low-paying employment, and unemployment often leads to adverse health effects.7 Unemployedworkers are 83% more likely to develop stress-related conditions — like heart disease orhypertension.8 They are also more likely to lose access to health insurance, develop unhealthycoping behaviors with legal or illegal substances, and face increased levels of depression.9 Inshort, stable jobs make for healthier individuals and families.As shown in Table 33, the official unemployment rate is low in all of Utah, but especially inMorgan County. The average monthly unemployment rate, derived from historical unemploymentdata from June 2014–July 2015, was 3.4% for Morgan County and 4.4% for Weber County. Thesetwo averages are comparable with the unemployment rates recorded in Table 33 for July 2015.The minor variance between the July 2015 data and the June 2014–July 2015 data reveals astable job market in Weber and Morgan Counties.Table 33: July 2015 Snapshot of Unemployment Rates United State of Weber Morgan Davis Salt Lake Utah States Utah County County County County CountyPercent of 6.6% 4% 4.6% 3.5% 3.8% 3.9% 3.8%UnemployedNumber of 10,485,762 57,684 5,478 4,494 6,002 22,558 9,610UnemployedSource: http://assessment.communitycommons.org/CHNA/report?page=2&id=207The inherent weakness in measuring employment is that it includes underemployed andtemporary workers. These types of workers typically do not have the well-paying income or longterm employment stability needed to acquire the goods and services necessary for optimalhealth. Moreover, the types of jobs held by these workers typically do not offer health insuranceor other health benefits. Community Health Assessment 97

Health Indicator 38 IncomeT here is a relationship between health and income. Higher income is linked to better health.10 Higher incomes have better access to healthcare, nutritious foods, and safe living conditions.11Higher incomes typically spend more time in exercise and outdoor recreational and general leisure,which are important for physical and mental wellbeing.12High income earners in the top half of incomes, retiring at age 65, live an average of six moreyears than retiring 65-year-old workers in 1977 did. Low income earners in the bottom half ofincomes, retiring at the age of 65, live only 1.3 more years than retiring workers in 1977 did.13As such, gains in life expectancy are exponentially concentrated where wealth is concentrated.Table 34 reveals that Morgan County is doing well against national and state averages in eachmeasurement of income. Weber County is slightly behind the state, but is better than thenational average for every measurement of income.Table 34: Income IndicatorsIncome U.S. State of Utah Weber MorganMedian Household Income (2009–2013) $53,046 $58,821 $54,974 $80,337Persons Below Poverty Level (2009–2013) 15.4% 12.7% 12.8% 4.0%Children Living in Households with Income 21.6% 14.7% 16.4% 5.16%Below 100% of the Federal Poverty LevelChildren Eligible for Free Lunch (2013–2014) 52.4% 37% 46.8% 21.6%Sources: http://quickfacts.census.gov/qfd/states/49000.html, http://quickfacts.census.gov/qfd/states/49/49057.html, http://quickfacts.census.gov/qfd/states/49/49029.html, http://assessment.communitycommons.org/CHNA/report?page=2&id=781, http://assessment.communitycommons.org/CHNA/report?page=2&id=209What are Residents Saying?Residents noted challenges surrounding having sufficient income to access healthcare.“You’re not old enough to qualify for Medicare, but not poor enough to qualify for Medicaid.”14“…have to think long and hard about taking a kid to the emergency room.”1598 Weber-Morgan Health Department

Health Indicator 39 Economic DisparitiesA reas with the most economic disparities are Graphic 29: Residents Below the also at high risk for health disparities. One Federal Poverty Levelsection of the WMHD was identified as containinga vulnerable population because 35% of theresidents live below the federal poverty level. Thefederal poverty level varies according to age andfamily size.16 For a family of two under the age of64, the 2015 federal poverty level is $15,930. Fora family of eight under the age of 64, the 2015federal poverty level is $40,890.It is not surprising that this economicaldisadvantaged area overlaps with much of thearea where 30% of the population has notcompleted a high school education.Challenges that low income populations face withaccessing healthcare are at the forefront of both Source: http://assessment.communitycommons.org/Footprint/residents and community leaders in the WMHD.During the 2015 Focus Groups, Weber County residents spoke of a “middle gap” where there areresidents with insufficient incomes to acquire healthcare, but too much income to qualify forMedicaid. Interviews with key community stakeholders in the WMHD indicated they view healthdisparities and economic disparities as linked.17What are Residents Saying?“There is still a lot of poverty in our area, and it’s hard to see people struggling so much.”18 Community Health Assessment 99

Health Indicator 40 Housing H ome ownership is linked to considerable community benefits.19 Homeownership increases the likelihood of: • Higher education • Civic participation • Lower crime • Improved health outcomes Because homeownership is linked to improved health outcomes, it is an important measurement of social and economic factors that influence health. Table 35: 2009–2013 Housing Statistics United State of Weber Morgan Davis Salt Lake Utah States Utah County County County County County Homeownership Rate 64.9% 70.1% 71.6% 89.2% 77.7% 67.3% 67.9% Median Value of Owner- Occupied Housing Units $176,700 $212,800 $170,000 $264,400 $222,600 $232,100 $222,100 Percent of Housing Units 26% 21.4% 20.6% 2.8% 15.7% 27.7% 22.2% in Multi-Unit Structures Persons per Household 2.63 3.12 2.90 3.39 3.25 3.01 3.61 Renters Unable to Afford — 47% 48% 32% 41% 50% 45% Fair Market Rent for a 2 Bedroom Apartment (2014) Housing with Housing 35.5% 32.2% 28.9% 24.3% 28% 34.7% 34.5% Costs Above 30% of Household Income Percent of the Population Which are Homeless (2012) 0.2% 0.11% 0.5% 0% 0.1% 1% 0.1% Sources: http://quickfacts.census.gov/qfd/states/00000.html, http://quickfacts.census.gov/qfd/states/49/49057.html, http://quickfacts.census.gov/qfd/ states/49/49029.html, http://quickfacts.census.gov/qfd/states/49/49011.html, http://www.caputah.org/poverty-in-utah/, https://jobs.utah.gov/housing/ documents/Utah2012ComprehensiveReportonHomelessness.pdf100 Weber-Morgan Health Department