MHP Assesment 2018

City of Portland Public Health Division
Minority Health Program
Minority Health Assessment Report

November 2018
TABLE OF CONTENTS
ACKNOWLEDGEMENTS……………………………………………………………......2
ORGANIZATIONAL BACKGROUND…………………………………………….….…3
EXECUTIVE SUMMARY……………………………………………………………….….5
METHODOLOGY AND APPROACH...………………………………………………..6
DISCUSSION of FINDINGS……………………………………………………………..11
APPENDICES…….………………………………………………………………………42
 City of Portland Minority Health Assessment Report 2018  1

Minority Health Assessment Report
November 2018
Acknowledgements
The City of Portland Public Health Division’s Minority Health Program (MHP) would like to
thank the individuals and organizations that contributed to the development and
implementation of this community health needs assessment. Particular individuals, Community
Health Outreach Workers (CHOWs), and groups helped to identify survey participants and
provided key background information on the health care needs of the racial and ethnic
language communities in Cumberland County.
We especially thank Dr. Kolawole Bankole, MD, MS, MBA; Director of the Public Health
Division, for this assessment funding allocation, technical review and approval of this report;
Alisa Monceaux, MPH, CHES and Zachariah T. Croll, who conducted the data collation
/processing and data analysis, and ensured standardization.
We would also like to specially thank Emilie Swenson, from University of Southern Maine’s
Data Innovation Project, for her analyses and summarization of the data.
Special thanks and appreciation are also offered to:

 The community leaders and representatives from each of the minority communities
 All City of Portland Public Health Division’s Minority Health Program Staff and
Contract Community Health Outreach Workers (CHOWs):
 Nélida R. Berke, MPH (MHP Coordinator)

 Brendan Johnson, BS (Caucasian-English Speaking CHOW)
 City of Portland Public Health Division’s Family Health Program (FHP)
 Anne Lang, MPH (Family Health Program Manager)
The network of CHOWs involved in this project and their communities of focus:
Sarah Madhi (Arabic) Karen Whitney Elliot (Russian)

Alisa Monceaux (Caucasian-English Speaking) Biljana Nedeljkovic (Serbian/Croatian/Bosnian)
Quilian Luo (Chinese) Saharo Sharif (Somali)
Christian Bisimwa (French) Asha Suldan (Somali)
Maurice Namwira (French) Lazarus Donato (South Sudanese)
Carina Foley (Portuguese) Victoria Chicon (Spanish)
Berthlley Despacho (Portuguese) Isabella Borrero (Spanish)
Lien Hoa Pham (Vietnamese)

Organizational Background
Minority Health Program: Who We Are

The Public Health Division (PHD), part of the City of Portland’s Health and Human Services
Department, has consistently demonstrated its commitment to ensuring the health of Portland’s
communities for nearly 120 years. All programming is guided by its mission to “improve the
health of all people in the community by working together to prevent disease, promote health,
and protect residents from environmental threats.” To that end, the Division has developed a
staff that is not only clinically competent, but also culturally competent regarding issues of
health equity and disparities.
The Minority Health Program of the Public Health Division, Health and Human Services
Department, City of Portland (MHP) addresses the health issues and needs of all minority
communities in Cumberland County, Maine. MHP links people to needed health and social
services and improves community health status through Community Health Outreach Workers
(CHOWs) and clinical partnerships.
The minority populations served include the following racial, ethnic, and language groups:
Acholi Croatian Lingala Somali

Arabic French Portuguese Spanish
Bosnian Khmer Russian Swahili
Burundi Kinyarwanda Serbian Vietnamese
Chinese

Our Vision
MHP’s vision of a healthy community is one where:
• Diversity within the community is respected and valued by community members and
institutions
• Everyone has access to quality health and social services
• Everyone has access to resources and conditions required for a healthy lifestyle
• Institutions and policy makers are responsive to community residents’ needs
• The assets and gifts of community residents are acknowledged and shared
• Work is conducted in partnership with community members, organizations, and service
providers to identify and address health priorities of minority communities
Our Mission
MHP’s mission is to:
• Decrease health disparities among immigrant, refugee, and low-income Caucasian and
African American populations
• Promote evidence-based public health practices and improve access to high quality and
affordable health care services

• Identify, evaluate, and respond to community health needs through innovative services
• Encourage community-clinical partnerships through leadership and advocacy
• Provide consultation, education, and training to promote quality of care and best
practices in our community, hospitals, and clinics
Our Objectives
MHP’s objectives are to:
• Improve minority health at the community, family, and individual levels
• Increase capacity of community groups to implement a locally defined community
health agenda
• Strengthen informal and formal social networks and awareness of minority communities
• Remain accessible and responsive to community interests by establishing a network of
Community Health Outreach Workers (CHOWs)
• Participate in health policy forums, health plans, task forces, and committees to improve
the health of minority groups
Our Values
We recognize that healthy individuals, families, and communities are vital to a healthy society.
We recognize the racial, ethnic, and language diversity and inherent worth of each individual
who collectively form the backbone of our community.
We value the importance of public health preventive measures and policies that enhance health
equity and reduce health disparities.
We respect the wisdom of community members, healthcare providers, faith-based leaders, and
policy makers, and their efforts toward improving access to care for our minority communities
in a safe and healthy environment.
Our Operating Principles

We are guided by these basic operational principles in all our services and activities:
 Acting with integrity – Integrity, trust, honesty, confidentiality, respect, and fiscal
responsibility.
 Satisfying our clients and patients – helping our clients identify their needs and working
diligently to meet or exceed their expectations.
 Community service – Ensuring that assets and resources of our community are utilized
to improve the health and wellness of the minority communities for optimum public
health indicators. Our goal is to reduce health disparities for every individual and family
in our community.
 Using sound business practices – We will use proven, sound business practices to
manage agency activities in a competitive environment.

Executive Summary
This report is the culmination of surveying over one thousand Cumberland County residents
from many different cultural backgrounds. The purpose of the survey was to get communities’
opinions about community health needs in Cumberland County. The City of Portland's
Minority Health Program (MHP) and partners will use the results of this assessment to evaluate
and address the most pressing needs through community action. The MHP conducts a
community health assessment every two to four years to determine the needs in the minority
communities in order to improve our services, enhance our communication with community
members, and to provide community health needs profiles for organizations addressing health
needs for these vulnerable communities.
A total of 1,076 assessments were conducted between January 26, 2018 and May 14, 2018. Since
the purpose of this assessment was to learn more about Cumberland County residents, only
those respondents who had a valid Cumberland County zip code were included in the analysis.
This resulted in a total of 1,013 participants (or 94% of the 1,076 assessments gathered). The
assessment was delivered to members of the racial, ethnic, and language minority communities
in Cumberland County. This report represents the results of the assessment from the following
regions1: East Africa (Somalia, South Sudan, Rwanda, and Burundi); Central Africa (Democratic
Republic of Congo and Angola); Middle East & West/Central Asia (Iraq); Russia; China;
Southeast Asia (Vietnam); South America (Colombia); Mexico, Central America and the
Caribbean (El Salvador, Honduras, Guatemala, and the Dominican Republic); the United States;
and the Balkan Region (Bosnia and Croatia). The groups were chosen based on their
demographic population size, within Cumberland County, and their unique vulnerability in
accessing public and clinical health services.
Overall, residents rated both themselves and their community as “Healthy.”
The top three most important factors for a “healthy community” (overall) were: low crime /
safe neighborhoods, good place to raise children, and access to health care (e.g., family doctor).
The top three most important “health problems” in your community (overall) were: diabetes,
dental problems, and high blood pressure
The top three most important “risky behaviors” in your community (overall) were: alcohol
abuse, drug abuse, and housing (unhealthy housing behaviors)
The top three most important “health problems or risky behaviors” for you (overall) were:
stress, dental problems, and aging.
1 Regionsmay have had more countries represented in the overall sample size. For confidentiality reasons, only countries with ten
or more respondents were included in this list.

Methodology and Approach
Minority Health Assessment Sampling Methodology

The 2018 Minority Health Assessment was administered through a survey (written in English),
orally translated, and administered to participants selected through non-random quota
sampling. With multiple entry points in each community to develop the widest range of
respondents within and among Cumberland County’s many ethnic communities, thirteen
different cultural and linguistic groups were focused on, but only eleven cultural and linguistic
groups were captured. The 2018 Minority Health Assessment was submitted to the University
of Southern Maine for Institutional Review Board (IRB) determination of project survey
sampling and methodology and was granted approval on November 21, 2017. Adjustments
between the 2014 and 2018 Minority Health Assessment questionnaire were made based on the
community and clinical partner feedback from the previous survey. Please see Survey in
Appendix C.
Community Health Outreach Workers (CHOWs) were trained in the methodology and
deployment of the survey to people throughout Cumberland County, with a focus on Greater
Portland (for more information on methodology, please contact Nélida R. Berke, MHP
Coordinator, at 207.874.8735).
Implementation of the Community Health Assessment Process

1. The recruitment of Community Health Outreach Workers (CHOWs) depended on the
targeted sampling groups and expected numbers of surveys in each subpopulation. A
total number of 17 Contract CHOWs were utilized across the focus coverage areas,
which included 11 respective communities. CHOWs are trusted, indigenous community
members who served as survey implementers in their respective communities.
2. Community-Based Participatory Research (CBPR) project data training on January 26,

2018 (8am-10:30 am). Contracted CHOWs were trained on how to implement the survey,
the survey logistics, and maintaining the integrity of the health information data. See
details of training method and protocols in Appendix B.
3. Survey Implementation: Surveys were given in a variety of different locations. Some

examples of those are: respondents’ homes, Adult Education, Amistad, markets, grocery
stores, barbershops, cafes, churches, mosques, clinics, coffee shops, community events,
community centers, Department of Health and Human Services locations, doctors’
offices, General Assistance, Immigrant Legal Advocacy Project, libraries, hospitals,
Preble Street Resource Center, Southern Maine Community College, and the YMCA.
Although the survey included all of Cumberland County, the vast majority of surveys
given were in Portland. Other Cumberland County areas surveyed included South
Portland, Scarborough, Westbrook, Gorham, Windham, Standish, Gray, and Yarmouth.

4. The final community populations that the Community Health Assessment accessed
include: Somali, Spanish, Sudanese, Arabic, Serbian, French, Vietnamese, Chinese,
Russian, Portuguese and low-income English/Caucasian. We were unable to secure a
CHOW from the North Sudan or African American Communities. Unfortunately, in this
year’s assessment, outreach to the Hearing Impaired/ASL community proved to be cost
prohibitive, and was not conducted.
5. Our anticipated total survey projection was 1,640 and 1,076 were actually submitted
(65.6%). There were many reasons for this, including fewer CHOWs and communities
than expected, implementation barriers, and insufficient responses in the given time. In
some cases, populations were not as accessible as had been anticipated, and some
populations were wary of participating in a survey sponsored by the city government.
Community Health Assessment Recruitment Goals

Target population goals were established for each cultural and linguistic group based on the
Minority Health Needs Assessment 2014 response rates, Catholic Charities’ 2016 Refugees and
Asylum Resettlement in Maine data, and the U.S. Census data (population estimates, as of July
2016). Based on the data, a specified number of respondents were set for each sub-population.
The optimal number of respondents of each regional origination/ethnicity/language was

determined by the goal of reaching at least 4% of the estimated current population of each
target community. See Figure 1 and Table 1 below for more information about populations
surveyed.
Goals of survey population sample(s):

• Representation
• Comparability across subpopulations
• Generalizability of sample to larger community
Figure 1. Percent of ethnic or cultural group surveyed out of target.
101% 100%
91%
75% 75%
71%
63%
58%
49%
39% 36%

Table 1. Number of surveys collected by CHOWs for each ethnic or cultural group (n=1,076)
Cultural Group Number of surveys
Arabic 182
Somali 161
Spanish 149
French 142
Vietnamese 87
Caucasian/English speaking 84
Serbian 80
Sudanese/South Sudanese 71
Portuguese 65
Chinese 37
Russian 18
African American/English speaking 0
Hearing impaired (ASL) 0
Snowball or Chain Sampling

A non-random quota sampling – snowball or chain sampling - methodology was used.
Through respondents’ referrals, community and faith-based organizations and leaders, CHOWs
were able to reach a larger amount of respondents. This facilitated capturing a statistically
accurate representation of the target populations’ estimated respondents. Suggestions were
made in regards to possible points of entry to consider when searching for respondents such as
the following: friend or relative, neighbor, at community activities, nail salons, laundromats,
sports events, church, mosque, temple or other religious gathering places or event, farmers’
markets, English as a Second Language/English for Speakers of Other Languages classes, coffee
shop or local gathering spot, hospitals, and Portland Adult Education. CHOWs were expected
to ask their respondents for referrals; for example, a referral would be someone with similar or
dissimilar views of politics, religion, health, children, or education.
Each CHOW focused on the specific regional origination/ethnicity/language group they were
most familiar with, but at times, may also have interacted with those who identified with other
cultural groups that were comfortable administering the survey in English or another shared
language. If a person was interested in participating, but they preferred another language other
than what the CHOW was comfortable administering accurately, they were asked for their
contact information and contacted by a CHOW that spoke their language, if available.
Self-Administration and Oral Administration

The MHP is aware that there is varying fluency in spoken English and literacy in written
English, as well as varying fluency and literacy in an individual’s native language and other
languages they use to communicate. To address this, all surveys were completed either orally
in person, or a CHOW facilitated and assisted respondents who chose to self-administer.
CHOWs were trained on the facilitation of the survey in order to maintain the integrity of the

data in an unbiased manner. CHOWs were also encouraged to spend time reviewing the
English version of the assessment and develop a written template for use in their language.
These materials were culturally tailored prior to survey administration, which increased
efficiency and timeliness, and also ensured that surveys were conducted in the same manner
across language groups.
Participant Eligibility
For the purposes of this assessment, the community was defined as Cumberland County, with a
focus on Portland and included other areas, such as South Portland, Scarborough, Westbrook,
Gorham, Windham, Standish, Gray, and Yarmouth. Eligible participants included all
Cumberland County residents over the age of 18, with specific goals related to the largest
cultural, ethnic, and linguistic minority groups in the area.
Ethical Considerations
The well-being of participants was a primary concern throughout this process. The purpose of
conducting this assessment was to gather information in order to improve the health of the
community by consulting community members on their opinions. During the survey process,
participants were informed of the purpose of their participation and of the survey itself, which
was to carry out the mission2 of the City of Portland Public Health Division (PHD) through data
collection and the promotion of health and social services.
CHOW interviewers were also informed of their roles as representatives of the PHD’s MHP.
Additionally, as members of the communities they were assessing and serving, interviewers
were made aware that they may be seen as a bridge or link between their respondents and
services provided by the City of Portland. Based on experiences in prior assessments, it was
found that community members came to see the CHOW interviewer as a potential advocate or
resource for respondents in navigating the ‘system’ for desired services.
In order to support the CHOWs in effectively conducting the assessment and to provide
support to community members, a health and social services resource list was developed to be
given to participants as a closing to the interview. This was an opportunity for community
members to learn about services that may help them locally. For a list of resources made
available and guidelines for CHOWs, please see Appendix B.
Analysis Methodology
The MHP and PHD recognized and partnered with University of Southern Maine’s Data
Innovation Project (DIP) for data analysis for the report. It was critical to utilize an outside
partner to maintain data integrity, and to prevent any possible analysis biases or influences.
2 The Portland Health Division’s mission is “To enhance the health and well-being of Portland residents through collaboration with
the community.”

Impartiality and integrity of the data were recognized priorities. This report provides a
synthesis of the findings and their implications in the section below entitled Discussion.
Dissemination Plan
The 2018 Minority Health Assessment report will be disseminated through various channels,
including an official City of Portland press release. The MHP will share the report with all its
partners, and they will be involved in the various disseminations of the final assessment report.
Dissemination within communities involves the MHP’s Community Health Outreach Workers
(CHOWs) distributing to their communities via community meetings, community and faith-
based leaders/organizations, and through trusted community leaders and representatives.
Dissemination to agencies that have interest in or are already serving minority communities
will be sent a copy to inform their programs. Examples of channels include the Maine Shared
Community Health Needs Assessment Community Engagement Committee, Portland Public
Schools’ Multilingual & Multicultural Center, Maine Immigrants’ Rights Coalition, Office of
Maine Refugee Services - Catholic Charities Maine, Universities of Southern Maine and New
England, Multicultural Resource Centers, and health provider offices.

Discussion of Findings
A total of 1,076 assessments were gathered between January 26, 2018 and May 14, 2018. Since
the purpose of this assessment was to learn more about Cumberland County residents, only
those respondents who had a valid Cumberland County zip code were included in the analysis.
This resulted in a total of 1,013 participants (or 94% of the 1,076 assessments gathered).
Residence of participants
Most respondents listed the zip code of their residence (97%). Respondents were then grouped
by county with the exception of Portland residents, who were placed in their own group due to
large numbers (Table 2).
Table 2. Residence of participants (n=1,076)

Residence Number Percent
Portland 653 61%
Cumberland County (excluding Portland) 360 33%
No response 38 4%
York, Androscoggin, Oxford County 25 2%
2018 Community Health Assessment Participation Rates by Region of Cumberland County

• Portland: 653
• WEST: Bridgton, Gorham, Raymond, Sebago, Standish, Westbrook, Windham: 166
• SOUTH: South Portland, Scarborough, Cape Elizabeth: 154
• NORTH: Gray, Yarmouth, Cumberland, Freeport: 40
The following analysis was completed based on Cumberland County residents who reported a
valid zip code only (n=1,013). It is important to note that not all respondents answered every
question. If there was no response for a question, it was not tabulated in the overall percentage
listed below. The total number of respondents to each question is listed in each table (n).
Demographics
The most frequently cited races/ethnicities were Black/African American, White/Caucasian, and
Asian/Pacific Islander (Figure 2)3.
3 Other suppressed due to small sample size.

Figure 2. Number of participants by race or ethnicity.
Black/ African American 413
White / Caucasian 359
Asian / Pacific Islander 115
Two or more/Multiracial 43
Hispanic/Latino 23
Native American 15
Participants were asked separately to identify if they were of Hispanic/Latino (Figure 3) or

Middle/Near Eastern (Figure 4) origin. There were many missing responses for these questions,
however they do provide more information regarding ethnic identity.
Figure 4. Hispanic/Latino Origin Figure 3. Middle/Near Eastern Origin
(n=817, 81% response rate) (n= 593, 59% response rate)
Hispanic/Latino, Middle/Near
16% Eastern Origin,
29%
Non-Hispanic Latino, 84% Non-Middle/Near Eastern Origin, 71%
The top three countries of origin of respondents were: Iraq (n=167), Somalia (n=151), and USA
(n=102). Countries with 20 or more respondents who live in Cumberland County are listed in
the following table.
Table 3. Most frequently reported country of origin of participants (n=860)

Country Number Percent
Iraq 167 17%
Somalia 151 15%
USA 102 10%
Democratic Republic of Congo 86 9%
South Sudan 69 7%
Vietnam 65 6%
Angola 61 6%
Bosnia 57 6%
Burundi 28 3%
China 28 3%
Salvador 26 3%
Mexico 20 2%

Region of origin was also analyzed (Table 6). Regions are based on geographic location and the
United Nations’ Geoschemes, which are geographic regions, used by the United Nations’
Statistics Division and are based on continental regions which are further subdivided into sub-
regions and intermediary regions.4 There are a number of benefits of analysis with this
approach, including relative ease of grouping countries into regions; however, limitations do
exist, such as not all countries within a region share the same languages, cultures, or beliefs.
Regions defined
The Caribbean, Central America, and Mexico were grouped into one category to achieve a
larger sample size (Mexico is considered part of Central America in the UN Geoscheme).
Certain regions are not included in this analysis, as there were no respondents from those
regions, including Northern and Western Africa, or Northern, Western, or Eastern Europe.
West and Central Asia were combined with the Middle East (which in the UN Geoscheme is
considered as “Western Asia”) to achieve a larger sample size. The term Middle East was used,
as this is a term more commonly recognized when discussing countries such as Iraq. China is
part of Eastern Asia; however, due to those who participated in the assessment, China was the
only country of that region to respond and therefore is represented as the country itself rather
than the region. Southern Asia (Afghanistan, Bangladesh, Bhutan, India, Iran, Nepal, Pakistan,
and Sri Lanka) was not included, as there were no respondents from these countries.
The UN Geoscheme that includes the Balkan Region is titled Southern Europe. This term was
not used, as the country of origin of respondents was limited to the Balkan region. South
America aligns with the UN Geoscheme and includes all countries in the South American
continent. Due to small sample size, participants from Southern Africa and Australia and New
Zealand (Oceania), were combined into the Other category, along with participants who
responded Other as their country of origin.
Table 4. Region of origin of participants (n=1,005)

Region Number Percent
East Africa 268 27%
Middle East & West/Central Asia 176 18%
Central Africa 147 15%
USA 102 10%
Mexico, Central America & Caribbean 84 8%
Balkan Region 75 7%
Southeast Asia 69 7%
South America 30 3%
China 28 3%
4 United Nations. Methodology: Standard country or area codes for statistical use (M49). Retrieved from
https://unstats.un.org/unsd/methodology/m49/

Other 15 1%
Russia 11 1%
Of respondents, close to half (495 or 49%) responded that they can read or write in two
languages, and 7% (75) responded that they can read and write in three languages. The
following table describes the top languages participants reported (989 reported at one or more
languages read or written, or that they did not read or write).
Table 5. Languages read or written by participants (n=989)

Languages with 10 or more
Number Percent
respondents
English 526 53%
Arabic 214 22%
French 157 16%
Spanish 133 13%
Somali 96 10%
Portuguese 65 7%
Vietnamese 59 6%
Lingala 41 4%
Swahili 38 4%
Chinese 35 4%
None 31 3%
Serbian 31 3%
Bosnian 28 3%
Kirundi 21 2%
Croatian 20 2%
Russian 19 2%
Kinyarwanda 11 1%
Khmer 10 1%
Respondents also indicated their preferred language. Six percent (63) indicated that there are
two languages they prefer. The following table describes the top languages participants prefer
using (939 reported at one or more languages they prefer).
Table 6. Preferred language indicated by participants (n=939)

Preferred language Number Percent
English 266 28%
Arabic 182 19%
Somali 147 16%
Spanish 108 12%
French 104 11%
Portuguese 58 6%

Preferred language Number Percent
Vietnamese 54 6%
Chinese 21 2%
Serbian 21 2%
Bosnian 14 1%
Russian 14 1%
Of the total respondents, there was a fairly even split between those who identify as female
versus male. None responded as transgender.
Table 7. Gender identity of participants (n=1,009)
Gender Number Percent
Female 514 51%
Male 492 49%
Respondents were asked to report their year of birth rather than their age. Most respondents
are approximately 40 or younger (69%).
Table 8. Approximate participant age range (n=955)

Decade born Approximate age Number Percent
1989-99 20-29 272 27%
1979-88 30-39 210 21%
1969-78 40-49 177 17%
1949-58 50-59 116 11%
1959-68 60-69 116 11%
1939-48 70-79 53 5%
1929-38 80-89 11 1%
The majority of participants reported that they have a high school diploma or higher (77%).
Table 9. Education level (n=988)

Highest education level Number Percent
High school diploma or GED 356 36%
Some College 227 23%
College degree or higher 175 18%
Less than high school 148 15%
Only Primary School 50 5%
Professional field reported 17 2%
Other 15 2%
While not all participants reported their education level or what their degree of study was,
numerous respondents reported what was interpreted to be their professional field, although it

is unclear if it is a field of study, or an actual field that they worked in (e.g. social worker,
nursing, accounting, lawyer, agronomy, psychology, government administration, construction).
This was categorized as “Professional field reported.”
The majority of participants reported that they make less than $30,000 per year.
Table 10. Household income (n=967)

Income Number Percent
Less than $10,000 195 20%
$10,000 to $20,000 291 30%
$20,000 to $29,999 209 22%
$30,000 to $49,999 137 14%
Over $50,000 135 14%
Household characteristics
Participants responded to other detailed questions regarding their home life. Of respondents,
there was an almost even split among those who were married or not married.
Table 11. Marital status of participants (n=981)

Marital status Number Percent
Married 510 52%
Not married 471 48%
The majority of respondents reported that they are living with others (e.g. with roommates or
family).
Table 12. Household status of participants (n=843)
Household status Number Percent
Cohabitating 720 85%
Single or live alone 123 15%
Participants reported living with a range of others—from 1 to 11. Most people lived with
between two and five others. When examining the average household size, the overall average
was 3.56.
Table 13. Number of persons in household (n=857)
Number in
Number Percent
household
2 184 21%
3 163 19%
4 182 21%
5 133 16%

Health care, insurance and payment
Most respondents reported that they did not enroll in health insurance through the Affordable
Care Act (ACA) Marketplace (89%).
Table 14. Enrolled in health insurance through the Affordable Care Act Marketplace (n=873)
Enroll via ACA
Number Percent
Marketplace
Yes 100 11%
No 773 89%
Most respondents reported that they have some type of health insurance (private, Medicaid, or
Medicare) (67%).
Table 15. How participants report they pay for health care (n=986)
Method of payment Number Percent
Health insurance (e.g., private insurance, Anthem, MCHO) 347 35%
Uncompensated Care/Free Care 246 25%
MaineCare/Medicaid 196 20%
Medicare 119 12%
Pay cash (no insurance) or other 78 8%
Of those who reported that they have MaineCare or private insurance, 43 reported that they
also have Medicare.
When participants were asked where they usually get health care, most responded that they go
to a doctor’s office (60%). Free care or free clinic, emergency room, urgent care, none, and
Maine Medical Center were also responses. There was a lot of variability in responses to this
question; other responses with more than one response included: none (people did not have a
doctor, they did not have health care yet, or no insurance), Greater Portland Health, hospital,
school clinic, Chinese medicine, General Assistance, or MaineCare. This number exceeds the
number of survey participants as some respondents chose more than one response (even
though only one response was requested).
Table 16. Where participants report that they get health care (n=1,184)
Location Number Percent
Doctor's office 707 60%
Free Care or Free Clinic 191 16%
Emergency Room (ER) 141 12%
Urgent Care 72 6%
None 28 2%
MMC 10 1%

Most important factors for a “Healthy Community”
The top three most important factors for a “Healthy Community” were: low crime/safe
neighborhoods, good place to raise children, and access to health care (Table 17). There were a
total of 3,018 responses (participants could check up to three possible responses out of 17).
Table 17. Top 10 most important factors for a “Healthy Community” (N=1,011; n=3,018)
Factor Number Percent
1 Low crime / safe neighborhoods 366 12%
2 Good place to raise children 342 11%
3 Access to health care (e.g., family doctor) 333 11%
4 Good jobs and healthy economy 317 11%
5 Good schools 297 10%
6 Affordable housing 284 9%
7 Clean environment 187 6%
8 Healthy behaviors and lifestyles 157 5%
9 Safety 137 5%
10 Excellent race relations 126 4%
10 Strong family life 126 4%
10 Religious or spiritual values 115 4%
Other responses that got 2% or less included: parks and recreation, low adult death and disease
rates, arts and cultural events, low infant deaths, low level of child abuse, and other.
Most important “health problems” in your community

The top three most important “health problems” in your community were defined as: diabetes,
dental problems, and tied for third were high blood pressure, mental health problems, and
aging problems (e.g. arthritis, hearing/vision loss, etc.) (Table 18 ). There were a total of 2,790
responses (participants could check up to three possible responses out of a list of 23 choices).
Table 18. Top 10 most important “health problems” in your community (N=997; n=2,790)
1 Diabetes 397 13%
2 Dental problems 368 12%
3 High blood pressure 335 11%
4 Mental health problems 329 11%
5 Aging problems (e.g. arthritis, hearing/vision loss, etc.) 314 11%
6 Cancer 278 9%
7 Heart disease and stroke 167 6%
8 Domestic Violence 121 4%
9 Motor vehicle crash injuries 82 3%
10 Lung disease / asthma 76 3%

Other responses that got 2% or less included: child abuse/neglect, sexually transmitted
infections (STIs), hepatitis, firearm related injuries, HIV/AIDS, suicide, drug and alcohol abuse,
rape/sexual assault, homicide, diarrheal diseases, tuberculosis, infant death, and other.
Most important “risky behaviors” in your community

The top three most important “risky behaviors” in your community included: alcohol abuse,
drug abuse, and tied for third housing (unhealthy housing behaviors), lack of physical activity,
and job instability (Table 19). Unhealthy housing behaviors can include unaffordability of
housing, personal safety, smoking, exposure to lead, mold, pests, etc. There were a total of
2,995 responses (participants could check up to three possible responses out of 18 choices).
Table 19. Top 10 most important “risky behaviors” in your community N=1,008; (n=2,995)
1 Alcohol abuse 457 15%
2 Drug abuse 363 12%
3 Housing (unhealthy housing behaviors) 280 9%
4 Lack of physical activity 277 9%
5 Job Instability 275 9%
6 Stress 254 8%
7 Poor nutrition 240 8%
8 Being overweight/Obese 188 6%
9 Tobacco use/Vaping 161 5%
10 Racism 151 5%
Other responses that got 3% or less included: dropping out of school, transportation, not getting
vaccinations to prevent disease, unsafe sex, not using birth control, not using seat belts/child
safety seats, and other.
Most important “health problems or risky behaviors” for you

The most important “health problems or risky behaviors” for you were stress, dental problems,
aging, alcohol use, and diabetes (Table 20). There were a total of 2,929 responses (participants
could check up to three possible responses out of a list of 37 choices).
Table 20. Top most important health problems / risky behaviors for you (N=1,006; n=2,929)
1 Stress 304 10%
2 Dental problems 241 8%
3 Aging 233 8%
4 Alcohol use 220 8%
5 Diabetes 199 7%
6 Lack of exercise 186 6%
7 Heart disease and stroke 149 5%

8 Job Stability 137 5%
9 Housing issues 135 5%
10 Being overweight/obese 133 5%
Other responses that got 2% or less included: aging, poor eating habits/nutrition, dropping out
of school, transportation, mental health problems, hepatitis, not getting vaccinations, not using
birth control, domestic violence/abuse, child abuse/neglect, gun-related injuries, HIV/AIDS, not
enough diagnostic treatment/testing, gun violence/not enough safety for kids at school,
diarrheal diseases, not using seat belts/child safety seat/not wearing bike helmet, housing, ,
tuberculosis, job stability, tobacco use/vaping, teenage pregnancy, unsafe sex, sexually
transmitted infections (STIs), other (authority, depression, DUI, physical ailment).
Rating of health
Rating of community as a “Healthy Rating of own personal health

Community” Overall, the rating respondents gave of their
Overall, the community was given an own personal health was 3.13, or healthy.
average rating of 3.04 or healthy.
Table 22. Rating of personal health (n=998)
Table 21. Rating of community as a Healthy Scale of 1-4, 1 as Very Unhealthy and
Community (n=995) 4 as Very Healthy
Scale of 1-4, 1 as Very Unhealthy and Very healthy 31%
4 as Very Healthy Healthy 52%
Very healthy 21% Unhealthy 15%
Healthy 64% Very Unhealthy 2%
Unhealthy 13% Average 3.13
Very Unhealthy 2%
Average 3.04
Regional comparisons
The following section looks at regions and their demographic characteristics (average
household size, age, education, income, and insurance) along with the rating of community as a
“Healthy Community” and most important health problems in the community, most important
risky behaviors in the community, and most important health problems or risky behaviors for
you by region. Tables are organized alphabetically by region.
Demographics
Table 23. Average household size by region (n=849)
Region Average household size
Balkan Region 2.98
Central Africa 3.80
China 3.00

East Africa 4.25
Mexico, Central America & Caribbean 4.01
Middle East & West/Central Asia 3.43
Other 2.62
Russia 3.00
South America 2.86
Southeast Asia 2.84
USA 2.97
Overall 3.56
Table 24. Percentage of respondents aged 20-39 (approximate age) by region

Region Percent
Balkan Region 43%
Central Africa 56%
China 54%
East Africa 50%
Mexico, Central America & Caribbean 45%
Middle East & West/Central Asia 51%
Other, Russia, South America *
Southeast Asia 41%
USA 73%
*Indicates data suppressed due to small sample size.
Table 25. Percentage of respondents with a high school diploma or higher by region
Region Percent
Balkan Region 79%
Central Africa 87%
China 100%
East Africa 67%
Other 71%
Russia 91%
South America 72%
Southeast Asia 62%
USA 93%

Table 26. Percentage of respondents who have a household income of $29,999 or less by region
Region Percent
Balkan Region 30%
Central Africa 93%
China *
East Africa 85%
Other *
Russia *
South America *
Southeast Asia 57%
USA 37%
Table 27. Percentage of respondents with private insurance by region

Region Percent
Balkan Region 66%
Central Africa 15%
China 71%
East Africa 32%
Other *
Russia *
South America 77%
Southeast Asia 32%
USA 66%

For the following tables, N indicates the number of respondents to the question and n indicates
the number of responses. For each question, respondents could choose up to three responses.
Balkan Region
Balkan Region
Most important factors for a healthy Most important health problems in your
community (N=75; n=224) community (N=75; n=223)
Factor Percent Percent
Good jobs and healthy economy 26% Mental health problems 30%
Healthy behaviors and lifestyles 22% Heart disease and stroke 17%
Low crime / safe neighborhoods 14% Aging problems (e.g. arthritis, 13%
hearing/vision loss, etc.)
Good place to raise children 10% Cancer 10%
Strong family life 8% Sexually Transmitted Infections 8%
(STIs)
Most important risky behaviors in your Most important health problems or risky
community (N=75; n=225) behaviors for you (N=75; n=217)
Alcohol abuse 24% Mental health problems 14%
Drug abuse 15% Aging 14%
Being overweight/Obese 14% Being overweight/obese 11%
Poor nutrition 14% Heart disease and stroke 10%
Tobacco use/Vaping 12% Lack of exercise 9%
Central Africa
Most important factors for a healthy community Most important health problems in
(N=146; n=441) your community (N=138; n=360)
Good place to raise children 16% Dental problems 22%
Good schools 12% High blood pressure 12%
Access to health care (e.g., family 12% Mental health problems 11%
doctor)
Affordable housing 10% Aging problems (e.g., 10%
arthritis, hearing/vision
loss, etc.)
Low crime / safe neighborhoods 10% Diabetes 9%
Central Africa
Most important risky behaviors in your Most important health problems or
community (N=145; n=431) risky behaviors for you (N=145;

n=427)
Alcohol abuse 19% Alcohol use 18%
Drug abuse 15% Stress 11%
Job Instability 12% Aging 10%
Housing 11% Drug use 8%
Stress 8% Dental problems 8%
China
Factor Percent Factor Percent
Safety 23% Mental health problems 17%
Low crime / safe neighborhoods 15% High blood pressure 14%
Good jobs and healthy economy 12%

community (N=28; n=69) risky behaviors for you (N=28; n=56)
East Africa
Good place to raise children 13% Dental problems 17%
Low crime / safe neighborhoods 11% Diabetes 13%
Affordable housing 11% Aging problems (arthritis, 12%
Good schools 10% High blood pressure 11%
Good jobs and healthy economy 9% Mental health problems 10%

Alcohol abuse 13% Stress 13%
Housing 10% Alcohol use 8%
Lack of physical activity 10% Aging 7%
Racism 9% Housing 6%

Mexico, Central America & Caribbean
Access to health care (e.g., family 16% Diabetes 21%
doctor)
Good jobs and healthy economy 14% Cancer 18%
Good schools 13% Dental problems 10%
Good place to raise children 10% High blood pressure 8%
Low crime / safe neighborhoods 9% Heart disease and stroke 8%

Alcohol abuse 22% Diabetes 10%
Drug abuse 20% Alcohol use 9%
Being overweight/Obese 9% Cancer 8%
Racism 9% Being overweight/obese 7%
Middle East and West/Central Asia

doctor)
Low crime / safe neighborhoods 11% Dental problems 17%
Clean environment 11% Aging problems (e.g. arthritis, 17%
Affordable housing 10% High blood pressure 15%
Good schools 9% Mental health problems 9%
Housing 22% Dental problems 17%
Job Instability 21% Diabetes 16%
Poor nutrition 16% Lack of exercise 7%
Transportation 6% Cancer 7%

Russia and Other
Due to small sample size, Russia and Other were combined for this portion of the analysis.
Low crime / safe neighborhoods 21% Mental health problems 14%
Access to health care (e.g., family 14%
doctor)
Alcohol abuse 19%
South America
doctor)
Good jobs and healthy economy 12% Dental problems 12%
Affordable housing 12%
Good place to raise children 11%
Drug abuse 13% Lack of exercise 15%
Southeast Asia
Access to health care (e.g., family dr) 18% Diabetes 24%
Low crime / safe neighborhoods 14% High blood pressure 21%
Good place to raise children 12% Hepatitis 7%
Good schools 12% Aging problems (arthritis, 5%

Drug abuse 22% High blood pressure 11%
Stress 15% Lack of exercise 10%
Tobacco use/Vaping 11% Diabetes 10%
Lack of physical activity 10% Heart disease and stroke 7%
Housing 7%
USA
Good schools 12% Diabetes 11%
Access to health care (e.g., family 11% Heart disease and stroke 11%
doctor)
Affordable housing 9% High blood pressure 10%
Alcohol abuse 19% Alcohol use 8%
Being overweight/Obese 10% Poor eating habits/nutrition 8%
Stress 8% Being overweight/obese 6%
Demographic comparisons: Important factors for a “Healthy Community”

The following tables look at most important factors for a “Healthy Community” based on
various sub-populations.
For the following tables N indicates the number of respondents to the question and n indicates
Age
Age 20-39 (N=481; n=1,433) Age 40-59 (N=282; n=872)
Low crime / safe neighborhoods 13% Good place to raise children 13%
Access to health care (e.g., family doctor) 11% Low crime / safe neighborhoods 13%

Good jobs and healthy economy 11% Good jobs and healthy economy 11%
Good schools 11% Access to health care (e.g., family doctor) 10%
Good place to raise children 10% Good schools 9%
Age 60+ (N=180; n=539)

Access to health care (e.g., family doctor) 12%
Low crime / safe neighborhoods 11%
Gender
Female (N=514; n=1,538) Male (N=490; n=1,459)
Low crime / safe neighborhoods 12% Low crime / safe neighborhoods 12%
Access to health care (e.g., family doctor) 12% Good place to raise children 11%
Good place to raise children 12% Good jobs and healthy economy 11%
Good jobs and healthy economy 10% Access to health care (e.g., family doctor) 11%
Good schools 10% Affordable housing 10%
Marital status
Married (N=508; n=1,530) Not married (N=471; n=1,413)
Good place to raise children 14% Low crime / safe neighborhoods 13%
Low crime / safe neighborhoods 11% Good jobs and healthy economy 12%
Access to health care (e.g., family doctor) 11% Good schools 11%
Good jobs and healthy economy 9% Affordable housing 10%
Household status
Cohabitating (N=720; n=2,153) Living alone (N=123; n=367)
Good jobs and healthy economy 12% Low crime / safe neighborhoods 13%
Access to health care (e.g., family doctor) 12% Affordable housing 13%
Low crime / safe neighborhoods 12% Access to health care (e.g., family doctor) 10%
Good schools 10% Good jobs and healthy economy 10%
Good place to raise children 9% Good place to raise children 9%
Education level
Only primary school (N=50; n=148) Less than high school (N=148; n=444)
Good place to raise children 20% Access to health care (e.g., family doctor) 13%
Good schools 8% Low crime / safe neighborhoods 10%

Affordable housing 7% Good schools 10%
High school diploma or GED (N=354; n=1,056) Some college (N=227; n=675)
Affordable housing 11% Access to health care (e.g., family doctor) 10%
Good jobs and healthy economy 11% Good schools 10%
Good schools 10% Good jobs and healthy economy 8%
College degree or higher (N=175; n=525) Other (includes professional field) (N=32; n=96)
Low crime / safe neighborhoods 14% Good place to raise children 17%
Good jobs and healthy economy 12% Good jobs and healthy economy 14%
Access to health care (e.g., family doctor) 12% Access to health care (e.g., family doctor) 13%
Good place to raise children 12% Affordable housing 10%
Good schools 10% Low crime / safe neighborhoods 10%
Household income
Less than $10,000 (N=194; n=585) $10,000 to $20,000 (N=291; n=873)
Affordable housing 10% Affordable housing 11%
Good place to raise children 9% Good schools 10%
$20,000 to $29,999 (N=208n=627) $30,000 to $49,999 (N=137; n=411)

Access to health care (e.g., family doctor) 11% Access to health care (e.g., family doctor) 11%
Good jobs and healthy economy 11% Good place to raise children 11%
Affordable housing 9% Affordable housing 10%
Over $50,000 (N=135; n=405)

Good schools 9%
Healthy behaviors and lifestyles 9%

Payment of health care
Health insurance (private) (N=347; n=1,036) Uncompensated Care/Free Care (N=244; n=636)
Good schools 10% Good schools 11%
MaineCare/Medicaid (N=196; n=587) Medicare (N=119; n=357)

Low crime / safe neighborhoods 12% Affordable housing 11%
Affordable housing 10% Good schools 10%
Good schools 8%
Pay cash (no insurance) or Other (N=78; n=228)

Access to health care (e.g., family doctor) 13%
Demographic comparisons: Most important “health problems” in your community

The following tables look at most important “health problems” in your community based on
various sub-populations.
For the following tables, N indicates the number of respondents to the question, and n indicates
Age
Age 20-39 (N=475; n=1,304) Age 40-59 (N=289; n=814)
Diabetes 14% Diabetes 14%
Dental problems 14% Dental problems 14%
Mental health problems 13% Aging problems (e.g., arthritis, 13%
High blood pressure 12% High blood pressure 12%
Aging problems (e.g., arthritis, 8% Cancer 11%

Age 60+ (N=179; n=539)
Aging problems (e.g., arthritis, 18%
Diabetes 14%
Cancer 13%
High blood pressure 13%
Dental problems 10%
Gender
Female (N=506; n=1,487) Male (N=484; n=1,408)
Mental health problems 11% Mental health problems 11%
Aging problems (e.g., arthritis, 11% Aging problems (e.g., arthritis, 11%
hearing/vision loss, etc.) hearing/vision loss, etc.)
Marital status
Dental problems 15% Diabetes 13%
Diabetes 14% Mental health problems 13%
Aging problems (e.g., arthritis, 12% High blood pressure 11%
High blood pressure 12% Dental problems 10%
Mental health problems 10% Cancer 9%
Household status
Diabetes 15% High blood pressure 13%
High blood pressure 11% Cancer 11%
Aging problems (e.g., arthritis, 10% Aging problems (e.g., arthritis, 9%
hearing/vision loss, etc.) hearing/vision loss, etc.)
Education level
Diabetes 17% Cancer 13%

Cancer 13% Aging problems (e.g., arthritis, 11%
High blood pressure 13% Dental problems 10%
High school diploma or GED (N=350; n=984) Some college (N=224; n=611)
Dental problems 15% Mental health problems 14%
Diabetes 14% Dental problems 13%
High blood pressure 12% Diabetes 12%
Aging problems (e.g., arthritis, 10% High blood pressure
hearing/vision loss, etc.) 11%
Mental health problems 10% Aging problems (e.g., arthritis,
hearing/vision loss, etc.) 11%
College degree or higher (N=175; n=485) Other (includes professional field) (N=32; n=90)
Mental health problems 15% Diabetes 19%
Diabetes 14% Aging problems (e.g., arthritis, 14%
High blood pressure 13% Mental health problems 12%
Dental problems 10%
Household income
Less than $10,000 (N=194; n=553) $10,000 to $20,000 (N=287; n=841)
High blood pressure Aging problems (e.g., arthritis,
11% hearing/vision loss, etc.) 15%
Mental health problems 9% High blood pressure 11%
Aging problems (e.g., arthritis, Mental health problems
hearing/vision loss, etc.) 8% 10%
$20,000 to $29,999 (N=206; n=610) $30,000 to $49,999 (N=137; n=406)

Diabetes 17% Mental health problems 14%
High blood pressure 14% Cancer 13%
Cancer 10% High blood pressure 11%
Aging problems (e.g., arthritis,
Mental health problems 10% 9%
hearing/vision loss ,etc.)

Over $50,000 (N=135; n=395)
Mental health problems 18%
Cancer 12%
Heart disease and stroke 10%

Health insurance (private) (N=346; n=1,006) Uncompensated Care/Free Care (N=236; n=687)
Mental health problems 14% Dental problems 19%
Aging problems (e.g., arthritis, 9% Mental health problems 10%

Pay cash (no insurance) or Other (N=77;

n=224)
Diabetes 13%
Dental problems 11%
Cancer 11%
Demographic comparisons: Most important “risky behaviors” in your community

The following tables look at most important health “risky behaviors” in your community
based on various sub-populations.

For the following tables N indicates the number of respondents to the question, and n indicates
Age
Age 20-39 (N=479; n=1,424) Age 40-59 (N=291; n=863)
Alcohol abuse 15% Alcohol abuse 14%
Drug abuse 13% Drug abuse 12%
Housing(unhealthy 11% Job Instability 10%
housing behaviors)
Job Instability 10% Stress 10%
Stress 9% Lack of physical activity 10%
Age 60+ (N=180; n=539)

Alcohol abuse 15%
Lack of physical activity 12%
Drug abuse 11%
Stress 10%
Poor nutrition 9%
Gender
Female (N=513; n=1,528) Male (N=488; n=1,446)
Job Instability 10% Lack of physical activity 10%
Poor nutrition Housing(unhealthy 9%
10% housing behaviors)
Housing(unhealthy Job Instability 8%
housing behaviors) 9%
Marital status
Housing(unhealthy 10% Job Instability 9%
housing behaviors)
Lack of physical activity 10% Housing(unhealthy 8%
housing behaviors)
Job Instability 10% Lack of physical activity 8%

Household status
Housing (unhealthy housing 10% Lack of physical activity 9%
behaviors)
Job Instability 9% Stress 9%
Poor nutrition 9% Job Instability 9%
Education level
Lack of physical activity 16% Alcohol abuse 19%
Housing(unhealthy housing 13% Drug abuse 15%
behaviors)
Racism 11% Poor nutrition 9%
Transportation 10% Stress 8%
Alcohol abuse 8% Tobacco use/Vaping 7%
High school diploma or GED (N=353; n=1,053) Some college (N=226; n=669)
Job Instability 11% Job Instability 11%
Housing(unhealthy housing 10% Lack of physical activity 10%
behaviors)
Stress 8% Housing (unhealthy housing 9%
behaviors)
Other (includes professional field) (N=32;

College degree or higher (N=174; n=515)
n=96)
Housing (unhealthy housing 10%
behaviors)
Job Instability 10%
Household income
Less than $10,000 (N=194; n=576) $10,000 to $20,000 (N=290; n=867)
Alcohol abuse 17% Housing (unhealthy 13%
housing behaviors)
Drug abuse 16% Lack of physical activity 12%

Housing (unhealthy 9% Job Instability 11%
housing behaviors)
Stress 8% Alcohol abuse 11%
Job Instability 7% Poor nutrition 10%
$20,000 to $29,999 (N=208; n=614) $30,000 to $49,999 (N=136; n=406)

Job Instability 12% Drug abuse 13%
Housing(unhealthy 12% Stress 11%
housing behaviors)
Drug abuse 10% Lack of physical activity 7%
Lack of physical activity 9% Job Instability 7%
Over $50,000 (N=134; n=396)

Alcohol abuse 18%
Drug abuse 18%
Being overweight/Obese 10%
Stress 8%

Health insurance (private) Uncompensated Care/Free Care
(N=345; n=1,018) (N=244; n=728)
Alcohol abuse 17% Job Instability 14%
Drug abuse 13% Alcohol abuse 14%
Lack of physical activity 9% Housing(unhealthy 13%
housing behaviors)
Stress 8% Drug abuse 12%
Being overweight/Obese 8% Lack of physical activity 9%
MaineCare/Medicaid (N=196;
Medicare (N=118; n=352)
n=585)
Lack of physical activity 12% Housing (unhealthy 11%
housing behaviors)
Housing (unhealthy 11% Drug abuse 10%
housing behaviors)
Poor nutrition 10% Poor nutrition 8%

Pay cash (no insurance) or Other
(N=78; n=231)
Alcohol abuse 18%
Drug abuse 14%
Job Instability 9%
Stress 8%
Demographic comparisons: Most important “health problems or risky behaviors” for you
The following tables look at most important “health problems or risky behaviors” for you
based on various sub-populations.
For the following tables N indicates the number of respondents to the question, and n indicates
Age
Age 20-39 (N=478; n=1,379) Age 40-59 (N=292; n=851)
Stress 12% Stress 10%
Alcohol use 9% Aging 8%
Lack of exercise 7% Alcohol use 8%
Job Stability 6% Diabetes 7%
Age 60+ (N=178; n=530)

Aging 20%
Diabetes 10%
Stress 8%
Gender
Female (N=513; n=1,493) Male (N=486; n=1,415)
Dental problems 9% Alcohol use 9%
Aging 8% Aging 8%
Lack of exercise 7% Dental problems 8%
Marital status

Aging 10% Stress 11%
Stress 10% Alcohol use 7%
Dental problems 9% Lack of exercise 7%
Diabetes 7% Dental problems 7%
Alcohol use 7% Diabetes 6%
Household status
Diabetes 8% Aging 8%
Aging 7% Lack of exercise 7%
Lack of exercise 7% Dental problems 6%
Housing 6%
Education level
Only primary school (N=48; Less than high school (N=148;
n=141) n=440)
Dental problems 15% Stress 10%
Aging 12% Aging 10%
Heart disease and stroke 7% Dental problems 7%
Alcohol use 7%
High school diploma or GED

Some college (N=224; n=611)
(N=354; n=1,037)
Alcohol use 8% Dental problems 9%
Aging 7% Diabetes 7%
Diabetes 7% Aging 6%
College degree or higher (N=175; Other (includes professional

n=504) field) (N=32; n=91)
Aging 10% Lack of exercise 11%
Dental problems 8%
Lack of exercise 8%
Diabetes 7%

Household income
Less than $10,000 (N=192; n=557) $10,000 to $20,000 (N=290; n=855)
Alcohol use 9% Dental problems 11%
Dental problems 7% Aging 10%
Aging 7% Diabetes 9%
Drug use 6% Alcohol use 7%
$20,000 to $29,999 (N=207; n=613) $30,000 to $49,999 (N=137; n=398)

Dental problems 11% Stress 11%
Diabetes 9% Lack of exercise 9%
Stress 8% Alcohol use 9%
Housing 6% Heart disease and stroke 6%
Over $50,000 (N=134; n=377)

Stress 15%
Lack of exercise 10%
Aging 9%
Poor eating habits/nutrition 9%
Being overweight/obese 7%

Health insurance (private) (N=346; n=983) Uncompensated Care/Free Care (N=242; n=713)
Lack of exercise 8% Alcohol use 10%
Aging 8% Stress 9%
Poor eating habits/nutrition 6% Diabetes 7%

Aging 11% Aging 10%
Diabetes 10% Stress 10%
Heart disease and stroke 7% High blood pressure 5%
Cancer 5%

Pay cash (no insurance) or Other (N=78;
n=231)
Alcohol use 13%
Stress 8%
Dental problems 7%
Housing 6%
Lack of exercise 6%
Demographic comparisons: Community and Personal Health Rating by demographic

category
Region
Table 28. Health Rating by Region of Origin
Average Community Average Personal Health
Region
Health Rating Rating
Balkan Region 2.92 2.76
Central Africa 3.03 3.26
China 3.00 3.18
East Africa 2.88 2.91
Mexico, Central America & Caribbean 2.81 2.83
Middle East & West/Central Asia 3.53 3.40
Other 2.93 3.07
Russia 2.82 2.91
South America 2.77 2.97
Southeast Asia 3.06 3.10
USA 2.96 3.21
Age
Table 29. Health Rating by Approximate Age
Age Average Community Health Rating Average Personal Health Rating
20-39 3.10 3.30
40-59 3.03 3.13
60+ 2.88 2.62
Gender
Table 30. Health Rating by Gender
Gender Average Community Health Rating Average Personal Health Rating
Female 3.02 3.10
Male 3.06 3.16

Marital status
Table 31. Health Rating by Marital Status
Marital Status Average Community Health Rating Average Personal Heath Rating
Married 3.05 3.04
Not Married 3.24 3.04
Household status
Table 32. Health Rating by Household Status
Household Status Average Community Health Rating Average Personal Health Rating
Cohabitating (e.g.
3.09 3.18
roommates or family)
Single/live alone 2.91 3.02
Household income
Table 33. Health Rating by Annual Household Income
Annual Household
Average Community Health Rating Average Personal Health Rating
Income
Less than $10,000 2.93 2.98
$10,000 to $20,000 3.13 3.15
$20,000 to $29,999 3.14 3.21
$30,000 to $49,999 2.96 3.12
Over $50,000 3.00 3.24

Table 34. Health Rating by Payment of Health Care
Average Community
Payment type Average Personal Heath Rating
Health Rating
Health insurance (private) 3.04 3.23
MaineCare/Medicaid 3.08 2.93
Medicare 2.81 2.92
Pay cash (no insurance) or Other 2.92 3.04
Uncompensated Care/Free care 3.18 3.30

Appendices
A. Proposal document
2018 Minority Health Assessment Proposal
Statement of Purpose:
The City of Portland's Minority Health Program and its partners intend to administer a
community health assessment to 1,640 members from Cumberland County, from 13 racial and
ethnic language minorities, low-income Caucasian-English speakers, and persons with hearing
impairment. We will use the information to improve our services, communication with
community members, and organizations addressing health needs.
The purpose of this survey is to get communities’ opinions about community health needs in
the Cumberland County. The City of Portland's Minority Health Program and partners will use
the results of this assessment to evaluate and address the most pressing needs through
community action. The City of Portland’s Minority Health Program conducts a community
health assessment every 2-4 years to determine the needs in the minority communities in order
to improve our services, enhance our communication with community members, and to
provide a community health needs profile for organizations addressing health needs for these
vulnerable communities.
Project Management: Nélida R. Berke

Project Key Collaborators/Partners:
• Portland Adult Education
• Community-and faith-based organizations
Project Start Date: October 15th, 2017

Project End Date: November 30th, 2018
Project Activities:
Specific activities of the community health assessment involve a four-stage plan: 10/15/17-
6/30/18
a. Partners and community engagement, and review of 2014 survey- Oct. 15, 2017 -Dec. 31,
2018:
This stage involves collaborating with new partners to achieve the assessment purpose. We also
use this to rally partnership coordination with other agencies that conduct similar needs
assessment plan/ projects. The Minority Health Program will collaborate with community-and
faith- based organizations, Portland Adult Education, the Office of Maine Refugee Services to
conduct the assessment, and other potential new partners. There will be a series of planning
meetings with partners and community-and faith- based organizations to ensure adequate
implementation and increase number of respondents. The surveys were pilot-tested, in 2013,
with community members for time estimate for survey implementation and cultural/linguistic

appropriateness - timeframe for the implementation is 10 minutes. The health needs survey
will be submitted for Institutional Review Board (IRB) determination of project survey sampling
and methodology. See IRB determination appendix.
b. Implementation of the community health assessment – November 20th, 2017 - May 1st,
2018:
This stage involves:

1. The recruitment of Community Health Outreach Workers (CHOWs) per the targeted
sampling groups and expected numbers of survey. We anticipate having a
maximum number of 20 Contract CHOWs across the focus coverage areas and one
full time English-speaking CHOW who will implement the survey among his
current clients from Mercy Hospital and Portland Family Medicine. The CHOWs are
trusted, indigenous community members who serve as survey implementers in their
respective communities.
2. Community-based participatory research (CBPR) project data training on January
26th (8am-10:30 am). Contract CHOWs will be trained on how to implement the
survey, goals, implementation plan and methodology, and, distribution of survey
and supporting materials (details of sampling methodology in appendix).
3. Target areas: Cumberland County is the target area and surveys will be
implemented at multiple outreach points, such as the faith-based congregations,
schools, non-profit organizations, ethnic stores, community centers, universities,
organizations that offer English language classes, neighborhood areas, homeless
square, residential parks, etc.
4. Target Populations: Our survey will focus on the following communities; Somali,
Sudanese, Spanish, Arabic, Serbian, French, Chinese, Vietnamese, Russian, African
Americans, Caucasian-English speaking, Portuguese, and, the hearing-impaired
/ASL communities.
5. Survey implementation: An individual plan for recruiting participants will be
developed with each CHOW that includes; criteria for screening, target number of
respondents, location, and approach. We anticipated a minimum of 1,640 surveys
from Cumberland County respondents, however, our target number will likely
increase due to the additional surveys that our full time English-speaking CHOW
will implement.
6. Methods of survey implementation include one-on-one personal and group
implementations by the CHOWs. Surveys will be installed in nine tablets and
CHOWs will be filling out their surveys directly into the tablets (details of Tablet’s
Data Collection Initiative and Personal Information Protection Protocol in appendix).
c. Data collection, collation, and analysis – May 1st -31st, 2018:

The city’s Minority Health Program will collect, collate, and input the data in a
structured database for analysis. The analysis of the Cumberland County surveys will be
done by an external consultant.
d. Assessment reporting and dissemination – June 1st – November 30th, 2018.

This period involves a draft report of Cumberland County surveys by the external
consultant. The city’s MHP will share the report with various communities for feedback
and review. The reports will be disseminated through various channels. All project
partners will be involved in the various disseminations of the assessment report.
Disseminations within communities involve: community meetings, faith-based leaders,
and trusted community leaders and representatives. Disseminations with agencies that
have interest in or are already serving the minority communities will be sent a copy for
their information to inform their programs and services delivery. Examples of channels
include: the Office of Maine Refugee Services, Portland Adult Education, Universities of
Southern Maine and New England, Multicultural Resource Centers, neighborhood
parks/ centers, Maine Mobile Health Program Inc., medical homes and health provider
offices, and through community-and faith-based organizations.
Use of Survey Information

We will use the survey information to:
• Improve our services, communication with community members, and organizations
addressing health needs
• Determine health issues that community members identified as the most important
• Identify resources according to individual community needs
• Assess whether our current programs are meeting the needs of our community members
• Modify existing programs or develop new programs to address emerging health needs
• Find out where we need to communicate better with other city and private
organizations to ensure communities’ health needs are met
• Inform communities of existing resources to address their health concerns, thus,
improve our cross-communication with community members and organizations who
are addressing community health needs
B. Methodology & CHOWs training

Minority Health Program, Public Health Division, Health and Human Services Department
Community Health Assessment sampling methodology
We have tried to make this a fun project for CHOWs that produces reliable and comparative
data for us to use to improve our public health programs. Your assistance in administering each
survey in the most standard way possible to the many different individuals you will talk with is
invaluable in ensuring that we can compare the responses within and across ethnic and

language groups. We have developed a few guidelines that will help you understand why we
need you to administer the survey the same way every time – as much as possible. We hope this
document will also help you answer some of the questions you will receive from participants.
Goals of survey population sample(s):

 Representativeness
 Comparability across subpopulations
 Generalizability of sample to larger community
Methodology
We will orally administer the 2018 Community Health Assessment to respondents selected
through non-random quota sampling (described below) with multiple entry points in each
community to develop the widest range of respondents within and among Cumberland
County’s many ethnic communities. We are targeting as many as 13 different cultural and
linguistic groups in 2018. Based on experience, we will also receive completed assessments from
members of additional ethnic and language groups.
Ethical considerations
The well-being of our participants is our primary concern. We are conducting this assessment in
order to improve the health of the community by consulting community members on their
opinions. Your participation in this assessment serves dual purposes: data collection and
promotion of the City of Portland Public Health Division’s services and mission: “to enhance
the health and well-being of Portland residents through collaboration with the community.”
As an interviewer for this assessment, you fill many roles. You are a representative of the City
of Portland Public Health Division and the Minority Health Program. As members of the
communities you are assessing, you are, or will be seen as, a bridge or link between your
neighbors and services provided by the City of Portland. As a result, you are ‘marketing’ our
services to the community as you collect information on community health interests. Achieving
this ideal of balancing participant well-being and gathering useful information takes many
skills.
Please use the following guidelines as a starting point:

• Please respect the concerns of potential respondents as you recruit participants, and take
care to prevent any perception that you are coercing individuals into participating.
• Please ensure each respondent orally agrees to participate after you read them the
introduction to the survey.
• Please answer any questions. If you are not sure of the answer, please admit that you
don’t know the exact answer, and assure them you will find out – or refer them to the
phone number on the survey for additional information.

• Please respect individual confidentiality. Many of your respondents may prefer to have
friends or family with them during the interview. In this case, the respondent is
choosing to share personal information with their friend or family member. Please note
on the assessment form any additional participants in the interview and their
relationship to the respondent (if possible). If you feel that any respondent is
uncomfortable with responding in the presence of a friend or family member, please
note that on the assessment form before turning it in.
• Please, ensure coverage of diverse immigration statuses in recruitment: United States
Citizens, Naturalized (Green Card holders), Refugees, Visa holders, Asylees, Asylee-
pending, Visitors-nonimmigrant, seasonal workers-permit status, Undocumented
persons, etc.
Please, indicate the respondent’s Immigration Status on survey’s top right-hand corner.
We found during the 2014 assessment that community members come to see the CHA
interviewer as a potential advocate or resource for respondents in navigating the ‘system’ for
desired services. While we want to improve the perception and usefulness of our services
through this assessment - and this is part of the role you perform as a CHOW - it is a potentially
overwhelming demand on your time to address individual respondent needs. As a result, we
have developed a list of resource for you to provide to respondents in return for their
participation. We highly recommend that you complete the oral interview before providing
respondents with this list of resources. In this way, we hope the resource list serves as both a
conclusion to this particular interaction and an inclusive act bringing respondents closer to
available resources.
Participant Recruitment
CHOWs will start with an individual training on data entry on tablets, with Brendan Johnson.
Then, CHOWs will have a training meeting with Nélida Berke to discuss our goals, design a
plan to enter the community, discuss methodology, and obtain the necessary surveys and
supporting materials. An individual plan for recruiting participants will be developed with
each CHOW that includes:
• Criteria for screening
• Target number of respondents
• Location
• Approach
Please clearly explain the project to each participant. Respondent willingness to participate in
an interview or focus group (and their responses) will depend on how well the participants
understand what the study is about, what will be expected of them if they participate, and how
their privacy will be respected. As you recruit participants, it is important to take special care to
avoid saying anything that could be interpreted as coercive. Please emphasize the voluntary
nature of participation. Use the list of projects developed or influenced by the previous

Minority Health Assessment to demonstrate how participation will improve our services to
community members. Remember: Not only are you an interviewer, your participation in this
project is a way for us to show our commitment to our community and their needs and
interests.
On another accompanying Excel Spreadsheet titled “Preferred Sample Profile”*, we have

provided a table with our goals for respondents for each ethnic/language group. Ideally we’d
like to reach many age groups with this assessment. We recognize that some populations will
have different age distributions, and different CHOWs will have access to different ages. Please
use this table as a guideline.
*Information is available on only those ethnicities released by the US Census at this time.
Non-random quota sampling.

We have established quotas, or goals, for each cultural and linguistic group we want to target.
Because we do not have a master list of all community members, we can’t do truly random
sampling. At the same time, we want to achieve the widest range of respondents, so we want
you to use snowball or chain sampling (see below) to find respondents. Using this method will
ensure that our data provides the most accurate representation of the health concerns and
interests of the whole population and each distinct group, and holds up under critical
scrutiny(should we encounter any).
Quotas
Using Minority Health Needs Assessment 2014 response rates, Catholic Charities’ 2016
Refugees and Asylee Resettlement in Maine data and Census data (population estimates, as of
July 2016), we determined the optimal number of respondents of each ethnicity that will allow
us to reach at least 4% of the estimated current population of each target ethnicity. For certain
ethnic and language groups, we have set higher goals. You can see the breakdown in the
attached chart, and you can use the chart to track your responses. You will receive an update of
this chart every week so you can see our overall progress and adjust your targets if necessary.
Snowball or Chain Sampling

With these quotas and age and gender breakdowns in mind, we ask you to make a list of 5 very
different people or activities in your community. Please consider different ages, genders,
languages, residential location, and political and religious views when developing this list of
initial respondents. Once you have completed an interview with each of these initial
respondents, please ask that person for a referral to another respondent within your target
community. Ask that person “Who do you think would be good for me to talk to about these
issues?” To include the full range of diversity within each culture and language group, please
alternate between asking for a referral to:
• Someone with similar views on (politics, religion, health, children, education), and

• Someone with very different views on (politics, religion, health, children, education)
Please do not accept more than three referrals from any respondent. This limitation will
help us broaden the range of opinions in our responses.
Here is a list of possible points of entry for you to consider when searching for respondents.
Please use this list to get started - and let us know your ideas for additional places to contact
respondents.
• Friend or relative • Farmer’s market

• Neighbor • ESL/ESOL classes
• Community activity • Coffee shop or local gathering spot
• Nail salons • Hospitals
• Laundromats • Portland Adult Education
• Sports events • Other places
• Church, mosque, temple or other
religious gathering place or event
While each CHOW/assessor will target the specific ethnic groups you are most familiar with,
you may at times encounter willing respondents in other targeted groups. If you are
comfortable conducting an interview in English or other shared language, please ‘nab’ that
additional respondent! If you are not comfortable conducting an oral interview with a willing
participant, please ask for that individual’s contact information, call Nélida Berke, and we will
forward that contact to another CHOW with the desired language and cultural knowledge.
Oral administration
In 2018, we would like all health assessments to be completed orally and in person by the
assessor. We’d also like you to use the same phrasing, in English and in your language, as much
as possible. While this sometimes takes longer than handing out surveys to individuals to
complete on their own, it allows you to be consistent about phrasing, responses to questions,
completeness of responses and allows you to be sure the demographic information on the
survey matches the respondent.
Translation
Individuals in our target populations will have varying fluency in spoken English and literacy
in written English. In addition, they may have varying fluency and literacy in their native
language and other languages they use to communicate. Unfortunately, we do not have the
budget to translate and validate this assessment into all the languages we anticipate
encountering. To address this potential obstacle for you (and data collection flaw for us!) we ask
that you take one paid hour to review the English version of the survey and annotate it in the
language(s) you anticipate using. Please take this opportunity to create standard phrasing that

you will use consistently throughout your interviews. Using standard phrasing in each
language helps us ensure that respondents always answer the same questions.
Respondent eligibility
Eligible participants include all greater Portland residents over the age of 18. We would like to
limit respondents to individuals living within the City of Portland Public Health Division’s
Service area – Cumberland County. Please confirm that respondents live in Cumberland
County before starting the assessment interview. Some individuals from various culture and
language groups are starting to move outside Cumberland County. As a result, community
gathering places and events (locations of worship, community holiday fairs, etc.) may take place
in York County or other locations outside Cumberland County. These events are useful in
gathering respondents for the assessment. Please take the time to ensure that each respondent’s
residence is within Cumberland County!
We rely on the discretion and cultural knowledge of our interviewers to respect cultural norms
when seeking out assessment respondents. If it is most appropriate to speak to the head of a
household before interviewing individual members of a family group, please do so.
Multiple family member responses

The results of this survey will be most useful if we receive participation from a broad range of
participants. You may encounter situations where you find all members of a large extended
family offer to complete an assessment response. This can appear to be a useful strategy to
increase the number of responses. On the other hand, given our small populations and even
smaller sampling groups, taking advantage of this opportunity may mean we do not hear from
the full range of voices and opinions in the community. This could result in PHD developing
new programs that only meet the needs of a small number of community members. If you
encounter this situation, please use the recommended gender and age breakdown provided to
request one response from a representative of each gender and age in the household. (ex.: if two
sisters live together and both want to respond, please first ask for only one response. If you find
they wish to collaborate on their response, please note on the assessment form that the
responses are a combination of two participants’ opinions)
Chaperones
If you find it helpful to bring a member of the opposite sex with you on interviews to promote
respondent willingness to participate, please try to team up with another CHOW trained in this
assessment. A female interviewer may bring a male family member or coworker as a chaperone
to facilitate the interview. A male interviewer may wish to team up with a female interviewer in
order to interview female members of a household. Please remember - if you need to bring a
non-CHOW chaperone of either sex with you on assessment interviews, please emphasize the

importance of preserving respondent confidentiality as well as asking questions exactly as
written. Finally, please identify the individual who assisted you on the completed survey.
Family Interpreters
If you encounter a situation where you share a language with younger members of the family
who offer to interpreter for older members of the family who use an unfamiliar language or one
you are not fluent speaking, please use your judgment and cultural insight to determine if this
situation will provide the respondent a clear understanding of the purpose of the assessment
and/or the questions and potential responses. Please ensure family interpreters are over 16 years
of age, and note their age and agreement to participate as an interpreter on the survey form. If
you are not comfortable that the respondent understands the assessment, please feel free to
discontinue the interview. If you complete the interview and still have concerns, please note
those concerns on the completed assessment before turning it in.
Evaluation of assessment
To improve the 2018 health assessment and the data we collect, we interviewed CHOWs who
participated in the 2014 survey for their opinions on the process. We also asked for insight and
suggestions on target populations and survey wording from CHOWs who will be
administering this survey. As a result of these conversations, we have made a few changes to
the survey and process, including the following:
• changed the wording of a couple of other questions.
• developed a brief evaluation form and comment form for evaluators to provide feedback
on this year’s assessment that we can use to identify challenges this year, and use to
improve the next survey.
Yes, we are doing an evaluation of our assessment! Your comments on the process of
interviewing respondents to this assessment will help in many ways. This will help us share
what you learn with other CHOWs, help you find ways to stay close to our preferred
methodology, or suggest new approaches to find respondents. Please keep copies of the
evaluation/comment form with you and complete a form whenever you have questions or
concerns or unusual situations. This information will help us give you the support you need to
succeed with this project. If you are having concerns or problems with any part of the survey,
tell us right away!
Use the form to write down your experiences, thoughts, and comments as you progress. Keep
them separate from the assessment that generated the comment – you can use one comment
sheet for many comments, and you can turn the comments in anonymously if you prefer. Please
turn your comments in along with the competed surveys each week. If you prefer to share your
observations verbally, please call Nelida before you drop off your completed evaluations so I
can chat with you.
We will also use your comments to improve the next survey. We will use your observations to
train future assessors – and data crunchers! - on survey administration. Your comments will
help them improve their performance and the data we collect. Ultimately, all this will help us
improve our services to our community.
Thank YOU! Without you we could not continuously improve our services to our communities!

Survey
Minority Health Program, Public Health Division,
Health and Human Services Department
Community Health Assessment
Please take a moment to complete the survey below. The purpose of this survey is to get your
opinions about community health needs in the Greater Portland Area. The City of Portland’s
Minority Health Program will use the results of this survey to evaluate and address the most
pressing needs through community action.
Your participation is voluntary, and all information you share with us on this survey is
considered confidential. All information collected in this survey is grouped into a summary and
cannot be used to identify individual respondents. Do you have any questions? Do you agree to
participate?
For this survey, your community is your age group within your racial/ethnic or language
group. Thank you and if you have any questions, please contact us (see contact information on
back).
Remember… your opinion is important!
What do we do with the information we collect?

We primarily use the information from this survey to improve our services for you. We also feel
that this survey improves our communication with you, your community members and other
organizations addressing community health needs.
We use the survey information to

• Determine what community members feel are important health issues
• Find out if different communities want different resources
• Assess whether our current programs are meeting the needs of our community members
• Modify existing programs or develop new programs to address emerging health needs
• Find out where we need to communicate better with other city and private
organizations to ensure your health needs are met
• Inform you of existing resources to address your health concerns
We used information gathered in the previous surveys to address identified community

health needs with public health solutions; for example:
• Established physical activity programs for the Somali and Latino communities.
• Continued to improve access to needed care by connecting community members with
healthcare services and primary care providers. We provide cultural brokering,
interpreting services and other healthcare medication and patient navigation.

• Provided annual health screening to identify, educate, counsel and follow-up
community members with high blood pressure, diabetes, cholesterol, and oral cancer
health issues.
• Enhanced our partnership and collaboration with communities and agencies to better
serve our minority communities.
• Instituted disease-specific interventions, like alcohol abuse prevention, a lead prevention
awareness campaign, asthma help–lines in Somali and Spanish languages, and
Affordable Care Act Helplines in four languages (French, Spanish, Arabic and Somali);
and, more.
1. In the following list, what do you think are the three most important factors for a “Healthy
Community?” (Those factors which most improve the quality of life in a community.) Check
only three:
Good place to raise children

Low crime / safe neighborhoods
Safe
Good schools
Access to health care (e.g., family doctor)
Parks and recreation
Clean environment
Affordable housing
Arts and cultural events
Excellent race relations

Good jobs and healthy economy
Strong family life
Healthy behaviors and lifestyles
Low adult death and disease rates
Low infant deaths
Religious or spiritual values
Other
2. How would rate your community as a “Healthy Community?”

Very unhealthy
Unhealthy
Healthy
Very healthy
3. How would rate your own personal health?

Very unhealthy
Unhealthy
Healthy
Very healthy
4. In the following list, what do you think are the three most important “health problems” in
your community? (Those problems which have the greatest impact on overall community
health.) Check only three:
Aging problems (e.g., arthritis, hearing/vision loss, injuries etc.)
Firearm-related injuries
Motor vehicle crash
Heart disease and stroke
Cancer
Child abuse / neglect
Dental problems
Diabetes
Diarrheal diseases
Domestic Violence
Hepatitis
High blood pressure
HIV / AIDS
Homicide
Infant Death
Lung disease / asthma
Mental health problems
Rape / sexual assault
Sexually Transmitted Infections (STIs)
Suicide
TB (tuberculosis)
Teenage pregnancy
Other
5. In the following list, what do you think are the three most important “risky behaviors” in
your community? (Those behaviors which have the greatest impact on overall community
health.) Check only three:
Alcohol abuse
Being overweight/obese
Dropping out of school
Drug abuse
Housing
Job Instability
Lack of physical activity
Not getting vaccinations/“shots” to prevent disease
Not using birth control
Not using seat belts / child safety seats
Poor nutrition
Racism
Stress
Transportation
Tobacco use/vaping
Unsafe sex
Not wearing a bike helmet
Other
6. In the following list, what do you consider to be the three most important “health problems
or risky behaviors” for you? Check only three:
Aging
Alcohol use
Heart disease and stroke
Hepatitis
Not using seat belts /child safety seats/Not wearing bike helmet
Being overweight/obese
Cancer
Child abuse / neglect
Dental problems
Diabetes
Diarrheal diseases
Domestic Violence/Abuse
Dropping out of school
Drug use
Gun-related injuries
Housing
Stress
Transportation
Job Stability
Poor eating habits/nutrition
Not using birth control
High blood pressure
HIV / AIDS
Homicide
Infant Death
Lack of exercise
Lung disease/asthma
Mental health problems
Motor vehicle injuries
Not getting “shots”/vaccinations
Rape / sexual assault
Sexually Transmitted Infections (STIs)
Suicidal thoughts
TB (tuberculosis)
Teenage pregnancy
Tobacco use/vaping
Unsafe sex
Other
7b. What services have you used to address these issues in the past year?
7c. What services would you like to have available to address these issues?
7d. Where do you usually get health care?

Doctor’s office
Free Clinic
Urgent Care
Emergency Room (ER)
Veterans’ Administration
Other
Nowhere
Please answer questions #8-19 so we can see how different types of people feel about local
health issues.
8. Country of Origin:
9. No. of years living in U.S.
10. Zip code where you live:
11. Year of birth:
12. Sex/Gender – male, female, transgender
13a.Hispanic Origin yes or no

Hispanic / Latino (specify)
13b. Middle/Near Eastern Origin yes or no
Middle/Near Eastern (specify)
14. Race/Ethnicity/Groups: Please specify all groups you identify with:

Native American
Black/ African American
Asian / Pacific Islander
White / Caucasian
Two or more/Multiracial
Other
15a. Marital Status:

Married
Not married
15b. Household Status:

Cohabitating (ex: roommates, family)
Single/live alone
15c. Number of persons in household
16. Education
Only Primary School
Less than high school
High school diploma or GED
Some College
College degree or higher
Major:_________________________
17a. In what language(s) can you read or write?
17b. Your preferred language:
18. Household income per year (total of all contributors)

Less than $10,000
$10,000 to $20,000
$20,000 to $29,999
$30,000 to $49,999
Over $50,000
19. Have you enrolled into health insurance through the Affordable Care Act MarketPlace?
Yes__ No__
20. How do you pay for your health care? (check all that apply)
Pay cash (no insurance)
Health insurance (e.g., private insurance, Anthem, MCHO)
Medicaid
Medicare
Uncompensated Care (Maine Med)
Free Care
Veterans’ Administration
Indian Health Services
Other
21. Who do you think would be good for me to talk to about these issues?
Date of Interview:
Site of Interview:
Name of person conducting interview:
Interviewer Comments
□ Oral English □ Oral translated□ Self-Administered

C. Feedback from CHOWs on process
CHOW Survey Feedback
The number one concern for every CHOW (17 total) was insufficient compensation. Travel,
translation and administering surveys were included in the compensation, but the length of
travel throughout Cumberland County, time consuming factors of full complete translations,
and the length of the survey concluded to be insufficient compensation. The CHOWs also
expressed that the 12 minutes of time allotted per survey was grossly underestimated.
Multiple electronic tablets were made available for the entirety of the survey collection. The
only requirement for tablet utilization, besides CHOWs training, was connection to Wi-Fi and
access to the survey through the internet. This was extremely problematic and underutilized.
Participants were hesitant on sharing their personal Wi-Fi passwords to utilize tablets. They
perceived their anonymity would be breached; additionally, there was hesitation of using the
tablets for fear of self-identifying.
The physical formatting on the printed copy of the survey was difficult for some CHOWs and
participants. CHOWs also expressed a need for proper identification in order to verify their
identity and purpose, and ensure trust with participants.
It should be noted that a large percentage of minorities from every community felt uneasy
answering two personal identifying questions: their zip code, and their year of birth. Both
questions made some participants feel that they were too self-identifying and chose not to
disclose the information, or felt uncomfortable in doing so. Some questions asked for health
information went against their personal, cultural, or religious beliefs, and as such, were
abstained from, in those surveys.
CHOW Participant Feedback

Many sub-populations expressed difficulty in finding participants in the age category of 60+
willing to complete the survey. This specific age demographic was either difficult to find or
unwilling to participate. Currently, the United States is undergoing policy changes that affect
immigrants, minorities, and asylum seekers. This directly affected the number of survey
participants negatively. Many community members shared that they had no previous
knowledge of this health assessment and some expressed the need for privacy filling out the
assessment, which proved to be difficult in public or community settings. The two demographic
categories that were most willing to participate were women and people ages 24- 60.

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City of Portland Public Health Division

Minority Health Program

Minority Health Assessment Report

METHODOLOGY AND APPROACH...………………………………………………..6

 City of Portland Minority Health Assessment Report 2018  1

Special thanks and appreciation are also offered to:

 Nélida R. Berke, MPH (MHP Coordinator)

Sarah Madhi (Arabic) Karen Whitney Elliot (Russian)

 City of Portland Minority Health Assessment Report 2018  2

Minority Health Program: Who We Are

Acholi Croatian Lingala Somali

 City of Portland Minority Health Assessment Report 2018  3

Our Operating Principles

 City of Portland Minority Health Assessment Report 2018  4

 City of Portland Minority Health Assessment Report 2018  5

Minority Health Assessment Sampling Methodology

Implementation of the Community Health Assessment Process

2. Community-Based Participatory Research (CBPR) project data training on January 26,

3. Survey Implementation: Surveys were given in a variety of different locations. Some

 City of Portland Minority Health Assessment Report 2018  6

Community Health Assessment Recruitment Goals

The optimal number of respondents of each regional origination/ethnicity/language was

Goals of survey population sample(s):

 City of Portland Minority Health Assessment Report 2018  7

Snowball or Chain Sampling

Self-Administration and Oral Administration

 City of Portland Minority Health Assessment Report 2018  8

 City of Portland Minority Health Assessment Report 2018  9

 City of Portland Minority Health Assessment Report 2018  10

Table 2. Residence of participants (n=1,076)

2018 Community Health Assessment Participation Rates by Region of Cumberland County

3 Other suppressed due to small sample size.

 City of Portland Minority Health Assessment Report 2018  11

Black/ African American 413

White / Caucasian 359

Asian / Pacific Islander 115

Participants were asked separately to identify if they were of Hispanic/Latino (Figure 3) or

Non-Hispanic Latino, 84% Non-Middle/Near Eastern Origin, 71%

Table 3. Most frequently reported country of origin of participants (n=860)

 City of Portland Minority Health Assessment Report 2018  12

Table 4. Region of origin of participants (n=1,005)

 City of Portland Minority Health Assessment Report 2018  13

Table 5. Languages read or written by participants (n=989)

Table 6. Preferred language indicated by participants (n=939)

 City of Portland Minority Health Assessment Report 2018  14

Table 8. Approximate participant age range (n=955)

Table 9. Education level (n=988)

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Table 10. Household income (n=967)

Table 11. Marital status of participants (n=981)

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Most important “health problems” in your community

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Most important “risky behaviors” in your community

Most important “health problems or risky behaviors” for you

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Rating of community as a “Healthy Rating of own personal health

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