Mt. Nittany Hospital CHNA : simplebooklet.com

June 2022 Mount Nittany Health 2022 CHNA 1 Table of Contents OUR COMMITMENT TO COMMUNITY HEALTH ................................................................ 2 EXECUTIVE SUMMARY ....................................................................................................... 4 MOUNT NITTANY HEALTH SERVICE AREA .................................................................................... 4 CHNA LEADERSHIP ....................................................................................................................... 5 METHODOLOGY ........................................................................................................................... 5 COMMUNITY ENGAGEMENT ........................................................................................................ 6 SUMMARY OF FINDINGS .............................................................................................................. 7 COMMUNITY HEALTH PRIORITIES ................................................................................................ 9 BOARD APPROVAL ...................................................................................................................... 10 FULL REPORT OF CHNA RESEARCH FINDINGS ............................................................ 11 SECONDARY DATA PROFILE ........................................................................................................ 12 BACKGROUND................................................................................................................... 12 CENTRE COUNTY POPULATION STATISTICS ....................................................................... 13 SOCIAL DETERMINANTS OF HEALTH ................................................................................. 27 COVID-19 IMPACT ON COMMUNITIES ............................................................................. 33 STATISTICAL HEALTH DATA ANALYSIS ................................................................................ 37 KEY STAKEHOLDER SURVEY ....................................................................................................... 68 MOUNT NITTANY MEDICAL CENTER UTILIZATION DATA ........................................................... 80 PARTNER FORUM SUMMARY .................................................................................................... 90 PROVIDER ENGAGEMENT SURVEY ............................................................................................ 95 EVALUATION OF IMPACT FROM 2019 CHNA IMPLEMENTATION PLAN ...................... 105 BOARD APPROVAL AND NEXT STEPS ....................................................................... 112 APPENDIX A: SECONDARY DATA SOURCES ............................................................... 113 APPENDIX B: KEY STAKEHOLDER SURVEY PARTICIPANTS .......................................... 115 APPENDIX C: PARTNER FORUM PARTICIPANTS ........................................................ 118

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June 2022 Mount Nittany Health 2022 CHNA 2 Our Commitment to Community Health Originally established as a community hospital, Mount Nittany Health (MNH), based in State College, Pennsylvania, has been serving our community for 120 years. During this time, we have grown exponentially to add the healthcare services our community needs, where it needs them. We are also a top employer in the region, contributing to the economic growth, and good health, of the community. Mount Nittany Health employs 2,400 employees and 220 providers across 17 locations and 30+ medical specialties. Our commitment to community health is guided by our not-for-profit status and mission: Healthier People. Stronger Community. Mount Nittany Health is proud to offer modern, comprehensive, award-winning healthcare. Our clinical excellence has earned us a 5-star health system rating by the Centers for Medicare & Medicaid Services, the 2021 Newsweek “World’s Best Hospitals” ranking, and a “Best Hospitals for Maternity” ranking from U.S. News and World Report, among other recognitions. We believe our community should receive a continuum of care, close to home, and with specialties like cardiology, orthopedics, oncology, urology, and more, we are committed to future growth. This commitment is also seen in investments in infrastructure projects, including a new Women and Children's Services Unit opened in April 2022, a new laboratory opened in May 2022, a new diagnostic pavilion opening late 2024, and a new outpatient center opening in Toftrees West in 2024. As a trusted local healthcare leader, MNH is dedicated to understanding and addressing the most pressing health and wellness concerns for our community. Every three years, MNH conducts a Community Health Needs Assessment (CHNA) in partnership with community agencies and residents and creates a corresponding Implementation Plan to address the health priorities identified by the CHNA. The 2022 CHNA was guided by the input and leadership of a community Advisory Council, comprised of representatives from 36 Centre County organizations. Prior CHNAs conducted by MNH have informed the work of countywide programs and partnerships, including the Centre County Mental Health Task Force, Centre County Heroin Opioid Prevention Education (HOPE), Communities that Care Coalition, and Centred Outdoors, among others. The CHNA also helps to guide healthcare advancement and innovation at MNH to better serve our patients. Over the past decade, MNH has developed clinical programs to enhance care delivery, including emergency department case management, psychiatric care coordination, oncology patient navigation, diabetes programming, and palliative care services. Centred Outdoors, a community partnership providing free outings and activities open to the public

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June 2022 Mount Nittany Health 2022 CHNA 3 The 2022 CHNA builds upon previous assessments and will continue to guide our community benefit and community health improvement efforts. Consistent with previous assessments, the 2022 CHNA focused on the health needs of all residents of Centre County. Based on the CHNA research and community insight, the following health issues were identified as priorities for Centre County:  Behavioral Health  Chronic Disease As we strive every day to live our vision – “Our compassion, excellent clinical care, and extraordinary service make us the community's preferred choice," – we thank you for partnering with us to improve the health of our community. We invite our community partners to learn more about the CHNA and opportunities for collaboration to address identified health needs. Please visit our website or contact Nena Ellis, Director of Brand & Community Engagement at Nena.Ellis@mountnittany.org.

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Mount Nittany Health 2022 CHNA 4 2022 CHNA Executive Summary Mount Nittany Health Service Area For purposes of the CHNA, MNH defined its service area as Centre County, Pennsylvania, the residence for the majority of Mount Nittany Medical Center patients. Consistent with the 2019 CHNA, MNH aligned the CHNA process with the seven planning regions defined by the Centre County Planning and Community Development Office, shown in the map below. The regions are comprised of 35 municipalities, representing diverse urban and rural communities. Centre County Planning Regions Photo source: Centre County Planning & Community Development The Centre and Nittany Valley Regions, which include the boroughs of State College and Bellefonte, are home to nearly 78% of the Centre County population. State College Borough comprises 26% of the county population and is the largest designated borough in Pennsylvania and one of the densest cities of its population size in the nation. The Centre Region is home to Mount Nittany Medical Center and the Pennsylvania State University, the top employers for the county. The Historic Borough of Bellefonte, located approximately 20 minutes northeast of State College, is the county seat of government. Other regions of Centre County are primarily rural and include state forestlands, Amish farmland, and small municipalities ranging in population size from less than 250 to approximately 4,000. The health and social needs of residents in each region vary widely and are a primary consideration for the CHNA.

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Mount Nittany Health 2022 CHNA 5 CHNA Leadership The 2022 CHNA was overseen by a Steering Committee of representatives from MNH, in partnership with a community Advisory Council comprised of representatives from 36 organizations across Centre County. The Advisory Council was led be an executive committee of community agency and MNH representatives. Mount Nittany Health contracted a public health consultant to assist in all phases of the CHNA, including project management, data collection and analysis, and report writing. MNH CHNA Planning Committee Tom Charles, Executive Vice President, System Development and Chief Strategy Officer Nena Ellis, Director of Brand and Community Engagement Jeannine Lozier, Manager Community Engagement Advisory Council Executive Committee Tiffany Cabibbo, Executive Vice President, Mount Nittany Health Natalie Corman, Human Services Administrator, Centre County Government Molly Kunkle, Executive Director, Centre Foundation Leanne Lenz, Executive Director, Centre County United Way Consultant Catherine Birdsey, MPH, CHES CHNA Methodology The 2022 CHNA was conducted from August 2021 to May 2022. Quantitative and qualitative methods, representing both primary and secondary research, were used to illustrate and compare health and social trends and disparities across Centre County. The following research methods were used to determine community health needs: CHNA Study Methods  Statistical analysis of health and socioeconomic data indicators; a full listing of data references is included in Appendix A  Electronic survey of key stakeholders, including experts in public health and individuals representing medically underserved, low-income, and minority populations; a list of key stakeholders and their respective organizations is included in Appendix B  A review of Mount Nittany Medical Center utilization data to analyze how consumers are accessing care and where gaps in service exist  Electronic MNH provider engagement survey to better understand and respond to the impact of social determinants of health on patient health outcomes and assess systemwide Diversity, Equity, and Inclusion initiatives  A Partner Forum with community agency representatives to garner insight on existing health improvement efforts and opportunities for partnership

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Mount Nittany Health 2022 CHNA 6 Community Engagement Community engagement was an integral part of the 2022 CHNA. The CHNA Advisory Council guided the research process and provided ongoing feedback to inform findings and priority health needs. Mount Nittany Health thanks the following individuals for serving on the Advisory Council! 2022 CHNA Advisory Council Members Lydia Abdullah, Community Member Scott Mitchell, YMCA of Centre County Anne Ard, Centre Safe Deb Nardone, ClearWater Conservancy Kim Bahnsen, Nurse-Family Partnership / UPMC Home Healthcare Central PA Andrew Naugle, Centre Care Zach Barton, Leadership Centre County Eric Norenberg, Centre Region Council of Government Allayn Beck, State College Food Bank Louwana Oliva, Centre Area Transportation Authority Christine Bishop, Youth Service Bureau (YSB) David Ostrich, Congregation Brit Shalom Cathleen Brown, CentrePeace Cindy Pasquinelli, Strawberry Fields Inc. Randy Brown, State College Area School District Brandy Reiter, Senator Jake Corman Simon Corby, Mount Nittany Health Foundation Pratiti Roy, Penn State College of Medicine Natalie Corman, Centre County Government Renae Schunk, St. Paul's United Methodist Church & Wesley Foundation E. Carol Eicher, Community Diversity Group Derek Sherman, CATA - Centre Area Transportation Authority May Eicher, Community Diversity Group Kimberly Snively, Center for Community Resources Crisis Intervention Denise Feger, Crossroads Counseling Inc. Denise Sticha, Centre County Library and Historical Museum Jessica Foster, PA Health Access Network Tiffany Treese, Pyramid Healthcare, Inc William Hayes, Kish Bank Robin Weagley, The Meadows Psychiatric Center Cheryl Johnson, PICCC Cheryl White, Centre Volunteers in Medicine Molly Kunkle, Centre Foundation Amy Wilson, Mid-State Literacy Council, Inc. Leanne Lenz, Centre County United Way Matt Wise, Senator Jake Corman Olivia Luzier, James E. Van Zandt Altoona VA Medical Center Kelly Wolgast, Penn State Denise McCann, Centre Helps Akshata Yalvigi, Penn State College of Medicine Trish Meek, Centre Regional Planning Agency Cynthia Zerbe, Centre Area Transportation Authority The CHNA solicited and received input from individuals who represent the broad interests of the community, including underserved, low-income, and minority populations. These individuals provided wide perspectives on health trends, shared lived experiences among underserved populations, insights into service delivery gaps, and recommendations to advance community health. Opportunities for providing input included a Key Stakeholder Survey completed by 148 community representatives and a Partner Forum attended by 72 representatives of Centre County health and social service agencies.

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Mount Nittany Health 2022 CHNA 7 As part of the 2022 CHNA, MNH also sought to engage different groups of individuals, including people of different ages, races and ethnicities, abilities and disabilities, genders, religions, cultures, gender and sexual orientations. Future assessments will be enriched by continuing to increase engagement and involvement from the BIPOC and LGBTQ+ communities. Summary of Findings Centre County is a uniquely diverse community, representing both urban and rural geographies that encompass a national and international university student population and growing Amish population. Consistent with the state and nation, Centre County has an increasingly diverse racial and ethnic makeup, although 88% of the population identifies as White. Pennsylvania State University (PSU) students and staff continue to have a significant impact on Centre County demographics, including the median age and overall diversity. Nearly 1 in 4 Centre County residents is aged 18 to 24 compared to a statewide of 9%. Benner, Ferguson, Patton, and State College, the municipalities surrounding State College, have the most racial diversity within the county. Centre County residents benefit from longer, healthier lives overall. Average life expectancy increased from prior needs assessments and continues to exceed the statewide average, at 83 years versus 78.4 years. Centre County’s positive health outcomes are due in large part to positive social determinants of health. The county overall fares better than the state and nation on most socioeconomic indicators. The median household income increased from the 2019 CHNA, and the countywide percentage of residents and children living in poverty declined. Nearly half of residents have attained a bachelor’s degree and more residents have health insurance when compared to the state and nation. While Centre County overall is a healthier place to live, positive health outcomes are not shared across all communities, and differences are largely rooted in socioeconomic differences and racial disparities. Individuals living in rural Centre County communities, particularly in the western Moshannon Valley and Mountaintop regions, continue to report higher poverty, lower educational attainment, and overall life expectancy that is as much as five years less than other portions of the county. The Moshannon Valley and Mountaintop regions are home to a more diverse, non-White population. Minority residents have historically experienced inequitable socioeconomic opportunities and disparate health outcomes. Across Centre County, one-quarter to one-third of individuals of color live in poverty compared to less than 1 in 5 White residents. Statewide, Black residents live an average of 4 years less than White residents. Socioeconomic risk factors that contribute to negative health outcomes were exacerbated by the COVID-19 pandemic. Of note, unemployment nearly doubled in 2020 and child food insecurity was projected to have increased 40%. Partner Forum participants shared that COVID-19 widened economic disparities among residents. While some families did better due to stimulus payments and lower household costs, others experienced severe hardship due to job loss and rising inflation.

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Mount Nittany Health 2022 CHNA 8 Chronic conditions continue to be the leading cause of death and disability for Centre County residents, and the top reason for healthcare utilization. Heart disease is the leading cause of death, followed by cancer. Stroke, chronic lower respiratory disease, and diabetes are also among the top seven causes of death for residents. Centre County death rates due to chronic conditions have declined since prior assessments and are lower than state and national benchmarks, although risk factors remain prevalent. Approximately 27% of Centre County adults have obesity, a lower proportion that the state (33%), but an increase from prior years. Approximately 18.5% of adults are estimated to use tobacco, a slightly higher proportion than the state overall (17.9%). Older adults are among the most likely to experience chronic conditions and have overall higher healthcare spending due to increased utilization of services. Approximately 71.9% of Centre County older adult Medicare beneficiaries have two or more chronic conditions, a slight increase from the 2019 CHNA (71.2%). Nearly 18% of Centre County older adult Medicare beneficiaries have six or more chronic conditions, a similar proportion as the state and nation overall. The health needs of rural communities, particularly related to chronic disease, are amplified by declining population and an aging demographic. While the county population overall is growing, growth is largely centered in the Centre and Nittany Valley regions. The population in the western portion of the county declined by as much as 8%-14% since 2010. At the same time, the countywide proportion of seniors increased, and a higher proportion of seniors live in rural communities. These factors reinforce both increasing demand and challenges for providing healthcare services outside the Centre and Nittany Valley regions. Challenges to providing rural healthcare are demonstrated in a higher rate of emergency department (ED) utilization among older adult Medicare beneficiaries relative to the state and nation. Behavioral health is also a growing community need for Centre County. It was identified as the most pressing concern for residents and the top missing community resource by Key Stakeholder Survey participants. Partner Forum participants shared that pandemic-related factors, including school interruptions and loss of social emotional learning, isolation, and economic stress, exacerbated behavioral health concerns. Behavioral health is often measured by downstream outcomes, such as self-reported poor mental health and suicide. Centre County adults report an average of nearly five poor mental health days per month, a 50% increase from the 2016 CHNA report of three days. Centre County has historically averaged about 15 suicide deaths per year. While the rate of death due to suicide is lower than the state and nation, it increased 30% between 2013-2015 and 2015-2017 and has been stagnant since then. Preliminary data for 2022 indicate a potentially higher-than-average number of suicide deaths, with six suicide deaths occurring in January and February, including one death among a youth under age 18. Centre County youth are among the most likely to experience behavioral health concerns. Nearly 30% of Centre County youth report feeling consistently sad or depressed and 7% attempted suicide. These findings were largely unchanged from prior years. An analysis of MNH ED utilization data found that anxiety, depression, and unspecified mood disorders were the top diagnoses among behavioral health-

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Mount Nittany Health 2022 CHNA 9 related visits, and consistent with prior CHNA findings, youth and young adults comprised about one-third to one-half of visits for these conditions. Behavioral health conditions can have a wide range of causes, but are often connected with upstream social risk factors, such as adverse childhood experiences and socioeconomic disadvantages. The impact of these risk factors is demonstrated in behavioral health outcomes for youth enrolled in State College Area School District (SCASD) versus rural county school districts. Historically, approximately 35% of students in rural areas reported feeling consistently sad or depressed compared to 23% of SCASD students; 8% of rural students had attempted suicide compared to 6% of SCASD students. Despite increasing behavioral health needs, Centre County has a deficit of behavioral health providers. The Centre County behavioral health provider rate increased over the past five years but remains lower than state and national rates. Feedback from Key Stakeholder Survey participants identified service delivery gaps that span the spectrum of care, including inpatient and outpatient services, pediatric services, Medicare providers, partial hospitalization, prescribing psychiatrists, and case management. Substance use disorder has historically been identified as a Centre County community need. While this need persists, it has generally improved in recent years. As of 2019, Centre County had a lower rate of hospitalization for all reported substances compared to the state. This finding is consistent with an overall small number of drug overdose deaths in Centre County, even during pandemic years. Alcohol use disorder also declined and is on par with the state. Mount Nittany Health will continue to support the efforts of agency partners in meeting the substance use disorder needs of residents, but guided by 2022 CHNA, including feedback from community partners, the system will prioritize resources and planning to address growing behavioral health needs. Centre County community agencies, including MNH, have made significant progress in responding to the identified health and social needs. These efforts have included mobile outreach services, new access points for behavioral health service delivery, initiatives to address social determinants of health barriers, and cross-agency programming for chronic disease prevention and management. The 2022-2025 Implementation Plan developed by MNH in response to identified community health priorities will build upon these efforts, leveraging new and existing community partnerships for collective impact. Community Health Priorities To work toward health equity, it is imperative to prioritize resources and activities toward the most pressing and cross-cutting health needs within the community. Priorities were determined by the MNH CHNA Planning Committee considering research findings and feedback from community stakeholders. The 2022 CHNA consistently identified Behavioral Health and Chronic Disease as the most significant health needs for Centre County residents. Underlying these needs were the cross-cutting issues of social determinants of health and rural disparities in access to care and overall health and wellness. In

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Mount Nittany Health 2022 CHNA 10 developing the 2022-2025 Implementation Plan, MNH sought to prioritize strategies that address these underlying issues to promote an upstream, preventive approach to community health improvement. 2022-2025 Implementation Plan Guiding Goal and Health Priorities Guiding Goal: Promote social, physical, and economic environments that aim to eliminate health disparities and achieve the full potential for health and well-being. The CHNA also identified community needs related to substance use disorder and affordable housing. Mount Nittany Health recognizes the growing need for affordable housing in Centre County and will continue to support collective response efforts by the community, including promoting awareness and advocacy. Mount Nittany Health will also continue to work with its clinical practices and community partners to identify and respond to housing insecurity among patient populations. The CHNA report is available to the public at https://www.mountnittany.org/about-us/community-health-needs-assessment. A full summary of CHNA research findings follows. Behavioral Health Chronic DiseaseAddressing rural disparities and social determinants of health

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Mount Nittany Health 2022 CHNA 12 Secondary Data Profile Background Secondary data, including demographic, socioeconomic, and public health indicators, were analyzed for Centre County to measure key data trends and priority health issues identified in the 2019 CHNA, and to assess emerging health needs. Data were compared to Pennsylvania (PA) and United States (US) benchmarks and Healthy People 2030 (HP2030) goals, as available, to assess areas of strength and opportunity. Healthy People 2030 is a US Department of Health and Human Services health promotion and disease prevention initiative that sets science-based, 10-year national objectives for improving the health of all Americans. All reported demographic and socioeconomic data were provided by the US Census Bureau, American Community Survey, unless otherwise noted. Public health data were analyzed for a number of health issues, including access to care, health behaviors and outcomes, chronic disease prevalence and mortality, mental health and substance use disorder, and maternal and child health. Data were compiled from secondary sources including the Pennsylvania Department of Health, the Centers for Disease Control and Prevention (CDC), the Behavioral Risk Factor Surveillance System (BRFSS), and the University of Wisconsin County Health Rankings & Roadmaps program, among other sources. A comprehensive list of data sources can be found in Appendix A. Age-adjusted rates are referenced throughout the report to depict a comparable burden of disease among residents. Age-adjusted rates are summary measures adjusted for differences in age distributions so that data from one year to another, or between one geographic area and another, can be compared as if the communities reflected the same age distribution. The BRFSS is a telephone survey of residents age 18 or over conducted nationally by states as required by the CDC. A consistent survey tool is used across the US to assess health risk behaviors, prevalence of chronic health conditions, access to care, preventive health measures, among other health indicators. BRFSS data indicators are referenced throughout the public health data analysis.

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Mount Nittany Health 2022 CHNA 13 Centre County Population Statistics Demographics The primary service area for MNH encompasses all of Centre County. The county is comprised of seven regions and 35 boroughs (boro) and townships (twp). Nearly 60% of Centre County residents live in the Centre Region, with the highest population count in State College Boro (42,275). The Nittany Valley Region is the second most populous region, home to approximately 18% of the county population. Nearly one-third of Nittany Valley Region residents live in Benner Twp. The Centre County total population is growing at a consistent rate as the state overall, and slower than the nation. The population increased 2.7% from the 2010 to 2020 Census, compared to a nationwide increase of 7.4%. Most recent population counts for Centre County municipalities indicate that all municipalities within the Centre and Nittany Valley regions experienced population growth, but growth was higher in the Nittany Valley, particularly Benner Twp (+49.9%) and Marion Twp (+26.3%). Nearly half (16) of the municipalities experienced population decline. Notably, the population declined in all municipalities within the Lower and Upper Bald Eagle regions. Centre County’s population continues to be greatly impacted by Pennsylvania State University (PSU) students and staff. The county has a significantly lower median age than both the state and nation. Nearly 1 in 4 Centre County residents is age 18 to 24 compared to 9% statewide and nationally. While Centre County has an overall younger population, consistent with the state and nation, it is an aging community with an increasing proportion of residents age 65 or over. Older adults are more likely to live in rural areas of the county, including areas of declining population. This trend will continue to challenge health and social service providers to meet the needs of older adults and deliver timely, accessible care. 2020 Total Population Centre County Pennsylvania United States Total Population 158,172 13,002,700 331,449,281 Percent Change Since 2010 +2.7% +2.4% +7.4% Source: US Census Bureau, Decennial Census

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Mount Nittany Health 2022 CHNA 14 2015-2019 Total Population by Municipality Red = Declining population; Green = Higher population growth than the state and nation Total Population Percent Change Since 2010 Centre County Municipalities Benner Twp 9,273 +49.9% Marion Twp 1,546 +26.3% Harris Twp 5,770 +18.4% Miles Twp 2,288 +15.4% Haines Twp 1,796 +14.8% Ferguson Twp 19,390 +9.6% Snow Shoe Boro 835 +9.2% Centre Hall Boro 1,373 +8.5% College Twp 10,102 +6.1% Walker Twp 4,700 +6.0% Spring Twp 7,838 +4.9% Burnside Twp 459 +4.6% Halfmoon Twp 2,782 +4.3% Patton Twp 15,828 +3.4% Penn Twp 1,220 +3.3% Potter Twp 3,588 +2.0% Bellefonte Boro 6,282 +1.5% State College Boro 42,275 +0.6% Rush Twp 4,018 +0.2% Curtin Twp 615 -0.5% Snow Shoe Twp 1,724 -1.3% Philipsburg Boro 2,719 -1.8% Huston Twp 1,333 -2.0% Port Matilda Boro 593 -2.1% Boggs Twp 2,918 -2.2% Gregg Twp 2,346 -2.5% Taylor Twp 829 -2.8% Liberty Twp 2,045 -3.4% Union Twp 1,333 -3.6% Howard Boro 683 -5.1% Worth Twp 776 -5.8% Howard Twp 896 -7.1% Milesburg Boro 976 -13.1% Unionville Boro 242 -16.8% Millheim Boro 569 -37.1% Source: US Census Bureau, American Community Survey

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Mount Nittany Health 2022 CHNA 15 Centre County has a lower median age than the state and nation, primarily due to a high proportion of college age students or Generation (Gen) Z. The county overall has a low proportion of youth under age 18 (15%) compared to the state (21%) and nation (23%). This finding is consistent with an overall lower and declining birth rate compared to the state. Other age group proportions are generally consistent with the state and/or nation. 2015-2019 Population by Age Gen Z/ Gen C Gen Z Millennial Millennial/ Gen X Gen X Boomers Boomers/ Silent Median Age Under 18 years 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65 years and over Centre County 15.0% 23.9% 14.1% 10.7% 11.2% 11.4% 13.8% 32.3 Pennsylvania 20.8% 9.2% 13.1% 11.7% 13.2% 14.1% 17.8% 40.8 United States 22.6% 9.4% 13.9% 12.6% 13.0% 12.9% 15.6% 38.1 Source: US Census Bureau, American Community Survey The following maps illustrate the proportion of youth and older adult populations by Centre County zip code. The youth population age 0-17 comprises less than 20% of the total population in most zip codes. A higher proportion of youth live in the Penns Valley Region, as well as zip code 16870, Port Matilda. Higher youth concentration in the Penns Valley Region is likely impacted by Amish families, which typically average five or more children. 2015-2019 Youth Population Age 0-17 by Zip Code

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Mount Nittany Health 2022 CHNA 16 2015-2019 Older Adult Population Age 65 or Over by Zip Code The Amish are a prominent population group in Centre County. From 2017 to 2020, the estimated Amish population grew from 3,110 to 3,317 or 6.7%, a higher growth rate than the overall county population. Estimated Amish Population Settlements 2017 2020 % Change Centre County: Aaronsburg, Brush Valley / Rebersburg, Penns Valley, Nittany Valley / Howard* 3,110 3,317 6.7% Pennsylvania 74,251 81,499 9.8% Source: Elizabethtown College, Young Center for Anabaptist and Pietist Studies *The Nittany Valley/Howard settlement includes portions of both Centre and Clinton counties. The PA population as a whole is less racially diverse than the population nationwide. Residents of Centre County are less racially diverse than the state, excluding a higher proportion of Asian residents. Across Centre County, approximately 88% of residents identify as White compared to 80.5% statewide and 72.5% nationally. Greater population diversity is seen in portions of the Centre and Nittany Valley regions. Notably, approximately 1 in 10 residents in Ferguson, Patton, and State College identify as Asian, and 1 in 5 residents in Benner Twp identify as Black or African American.

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Mount Nittany Health 2022 CHNA 17 While the Centre County population is less diverse, consistent with the 2019 CHNA, diversity is slowly increasing. From the 2010 Census, the White population as a percentage of the total population declined nearly one percentage point. Marginal growth was seen among the Asian (0.6%) and Latinx (0.2%) populations. 2015-2019 Population by Race and Ethnicity Municipalities with notable racial and ethnic diversity are also shown White Asian Black or African American Some Other Race Two or More Races Latinx origin (any race) Centre County 87.6% 6.1% 3.8% 2.5% 1.8% 2.9% Benner Twp 72.3% 0.1% 21.8% 5.8% 2.6% 8.3% Ferguson Twp 75.8% 15.5% 4.7% 4.0% 3.1% 3.7% Patton Twp 83.6% 9.3% 5.2% 1.9% 1.5% 3.5% State College Boro 82.4% 10.9% 3.9% 2.8% 2.3% 4.2% Pennsylvania 80.5% 3.4% 11.2% 4.9% 2.5% 7.3% United States 72.5% 5.5% 12.7% 9.3% 3.3% 18.0% Source: US Census Bureau, American Community Survey Centre County Trended Change in Population by Race and Ethnicity White Asian Black or African American Latinx origin (any race) 2011-2015 88.4% 5.5% 3.8% 2.7% 2012-2016 88.0% 5.8% 3.8% 2.8% 2013-2017 87.8% 6.0% 4.0% 2.8% 2014-2018 87.5% 6.3% 4.0% 2.9% 2015-2019 87.6% 6.1% 3.8% 2.9% Net Change 2011-2015 to 2015-2019 -0.8% 0.6% 0.0% 0.2% Source: US Census Bureau, American Community Survey Minority (non-White) populations are largely concentrated in the Centre and Nittany Valley regions, impacted by the presence of PSU. A higher proportion of minority populations also live in the Moshannon Valley Region. The Moshannon Valley was home to a correctional institution through March 2021, which likely impacted local demographics. Nationwide, people of color, particularly Black and Latinx, are disproportionately incarcerated.

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Mount Nittany Health 2022 CHNA 18 2015-2019 Minority (non-White) Population by Zip Code Consistent with an overall younger and healthier population, fewer Centre County residents experience disability compared to PA and the US. Approximately 9% of the total population and 28% of older adults report a disability, a lower proportion than the state (14%, 34%) and nation (13%, 34.5%). Among older adults, the most prevalent disabilities include walking and hearing. 2015-2019 Population by Disability Status Centre County Pennsylvania United States Total population 9.2% 14.0% 12.6% Under 18 years 4.3% 5.4% 4.2% 65+ years 28.0% 33.6% 34.5% Ambulatory (walking) 16.2% 21.0% 21.9% Hearing 12.4% 13.9% 14.3% Independent living 10.9% 14.1% 14.2% Cognitive 5.4% 8.0% 8.6% Vision 4.1% 5.6% 6.3% Source: US Census Bureau, American Community Survey

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Mount Nittany Health 2022 CHNA 19 Socioeconomics Centre County continues to be a more affluent area in comparison to other PA communities and the nation. The median household income increased from the 2016 and 2019 CHNAs, and the percentage of residents living in poverty declined. While a higher proportion of Centre County residents are reported to live in poverty than the state and nation, this indicator is inflated by university students who report little or no income. Child poverty is a more accurate measure of economic stability for Centre County. The percentage of Centre County children living in poverty declined from the 2019 CHNA (14%) and is reported at 10.7% compared to state and national averages of approximately 18%. Note, these data reflect pre-COVID-19 findings, and likely do not demonstrate economic hardship experienced by individuals and families during the pandemic. Unemployment and food insecurity data for 2020 and 2021 provide insight into the impact of the pandemic on the local economy and residents. COVID-19 had a significant impact on unemployment rates across the nation. Near the onset of the pandemic in April 2020, the Centre County unemployment rate was 9.7%, nearly four times higher than the April 2019 rate of 2.6%. While unemployment has since declined, reaching 5.5% as of July 2021, pandemic-level rates will likely have a lasting economic and social impact on the community. Food insecurity is defined as not having reliable access to a sufficient amount of nutritious, affordable food. Food insecurity is associated with lower household income and poverty, as well as poorer overall health status. Similar to unemployment rates, COVID-19 had a profound impact on food insecurity, particularly among children. From 2019 to 2020, the percentage of food insecure children was projected to increase from 9.6% to 13.3%. Consistent with Centre County’s overall economic strength, food insecurity levels were lower, both before and during the pandemic, than the state and nation. Economic Indicators Centre County Pennsylvania United States Income and Poverty (2015-2019) Median household income $60,403 $61,744 $62,843 All people in poverty 18.2%1 12.4% 13.4% White 16.4%1 9.7% 11.1% Asian 38.6%1 13.9% 10.9% Black 31.9%1 26.0% 23.0% Latinx, any race 28.2%1 28.1% 19.6% Children in poverty 10.7% 17.6% 18.5% Older adults in poverty 4.4% 8.1% 9.3% Households with SNAP2 Benefits 6.8% 13.3% 11.7% Unemployment July 2021 (most recent available) 5.5% 6.7% 5.7% 2020 average 5.8% 9.1% 8.1% 2019 average 3.4% 4.5% 3.7% Source: US Census Bureau, American Community Survey & US Bureau of Labor Statistics 1Percentages are likely skewed by PSU students. 2Supplemental Nutrition Assistance Program.

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Mount Nittany Health 2022 CHNA 20 Food Insecurity Centre County Pennsylvania United States All Residents 2021 (projected) 10.1% 12.0% 12.9% 2020 (projected) 11.4% 13.8% 13.9% 2019 9.3% 10.6% 10.9% 2018 8.8% 10.9% 11.5% Children 2021 (projected) 10.6% 16.8% 17.9% 2020 (projected) 13.3% 20.4% 19.9% 2019 9.6% 14.6% 14.6% 2018 10.9% 15.1% 15.2% Source: Feeding America Economic Trends by CHNA Centre County 2016 CHNA 2019 CHNA 2022 CHNA Median household income $50,633 $54,407 $60,403 All people in poverty 20.9% 19.1% 18.2% Children in poverty 15.1% 13.6% 10.7% Food insecure children 19.0% 15.0% 10.9% Households with SNAP Benefits 6.7% 6.8% 6.8% Source: US Census Bureau, 2011-2013, 2012-2016, 2015-2019 Compared to PA and the US, Centre Country adults are generally very well educated. The proportion of adults who have completed a bachelor’s degree or graduate or professional degree far exceeds both the national and statewide benchmarks. Fewer than 6% of residents have not finished high school, less than half the national average. 2015-2019 Population (Age 25 or Over) by Educational Attainment Centre County Pennsylvania United States Less than high school diploma 5.7% 9.5% 12.0% High school graduate (includes equivalency) 29.4% 34.7% 27.0% Some college or associate’s degree 19.5% 24.4% 28.9% Bachelor’s degree 23.7% 19.0% 19.8% Graduate or professional degree 21.8% 12.4% 12.4% Source: US Census Bureau, American Community Survey Penn State’s University Park campus enrolls approximately 46,000 undergraduate and 14,000 graduate students, who comprise a significant portion of the Centre County population. In 2021, the university conducted a Food and Housing Needs Survey to better understand and respond to the prevalence and

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Mount Nittany Health 2022 CHNA 21 nature of student needs in the areas of food and housing security. The survey was emailed to a random sample of undergraduate and graduate/professional students and generated 2,051 responses. The survey confirmed that a need exists among students on the University Park campus, with 24.1% of respondents indicating they have some trouble securing food daily and 16.8% indicating they have some trouble securing adequate housing. Results show heightened impacts among respondents who self-identified as members of an underrepresented minority group, international students, students who have disabilities, or students who self-identified as sexually diverse or gender diverse. Socioeconomic Inequities Centre County overall has a strong socioeconomic composition, but it is not shared equally by all residents. Racial and ethnic disparities exist countywide, although findings should be interpreted with caution due to low population counts and the impact of PSU students. Most notably, poverty among non-White residents is approximately double or more than poverty among White residents. Black residents are also less likely to attain higher education, with approximately 26% completing a bachelor’s degree compared to 44% of White residents and 84% of Asian residents. The percentage of Black residents completing a bachelor’s degree declined from the 2019 CHNA. Socioeconomic Disparity Trends by Race and Ethnicity and CHNA Centre County 2019 CHNA 2022 CHNA Poverty Asian 39.0% 38.6% Black 35.5% 31.9% White 17.4% 16.4% Latinx (any race) 26.7% 28.2% Bachelor’s degree or higher Asian 72.5% 83.6% Black 33.0% 25.7% White 41.4% 44.3% Latinx (any race) 38.4% 41.5% Source: US Census Bureau, 2012-2016, 2015-2019 Similarly, wide differences in poverty and educational attainment exist across geographic areas within Centre County. Individuals living on the outskirts of the county, including portions of the Penns Valley, Moshannon Valley, and Mountaintop regions report higher poverty and lower educational attainment. Notable demographic trends within these areas contribute to these findings. Penns Valley is home to a prominent Amish population, which typically embraces a plain lifestyle and is less likely to seek higher education. Consistent with historic inequities among people of color, areas of the Moshannon Valley and Mountaintop regions that report lower socioeconomic status are home to a more diverse, non-White population.

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Mount Nittany Health 2022 CHNA 23 Housing Pennsylvania’s housing stock is older and generally more affordable than the nation’s housing stock. Centre County differs from statewide trends with overall newer and more expensive housing. Despite these differences, fewer Centre County homeowners are considered housing cost burdened compared to the state. Home ownership within the county increased from the 2016 and 2019 CHNAs, while the percentage of cost burdened homeowners declined. Many PSU students rent housing in and around State College, contributing to a high percentage of reported renters and rent cost burden countywide. When considered by age group, rent cost burden is high among college age students, but lower than the state and nation for adults age 35 or older. While fewer permanent Centre County residents are considered housing cost burdened, it is a growing concern within State College and the surrounding communities. Median home values exceed $300,000 in the areas of Lemont and Boalsburg and nearly one-quarter of homeowners in these areas are housing cost burdened. The Moshannon Valley and Penns Valley regions also have higher housing cost burden despite lower overall median home values. 2015-2019 Housing Indicators Centre County Pennsylvania United States Renters 38.5% 31.1% 36.0% Median monthly rent $1,000 $938 $1,062 Cost burdened1, householder age 15-24 72.6% 55.3% 55.2% Cost burdened1, householder age 25-34 45.0% 37.9% 41.8% Cost burdened1, householder age 35-64 38.3% 42.0% 44.0% Cost burdened1, householder age 65+ 48.6% 51.8% 54.2% Owners 61.5%1 68.9% 64.0% Median home value $234,900 $180,200 $217,500 Cost burdened1 21.6% 25.0% 27.8% Housing built before 1980 53.0% 69.6% 53.6% Source: US Census Bureau, American Community Survey 1Defined as spending 30% or more of household income on rent or mortgage expenses. Housing Indicator Trends by CHNA Centre County 2016 CHNA 2019 CHNA 2022 CHNA Renter-Occupied 39.9% 39.0% 38.5% Median Monthly Rent $876 $930 $1,000 Cost burdened, all renters 61.3% 56.8% 57.1% Owner-Occupied 60.1% 61.0% 61.5% Median Home Value $191,400 $206,000 $217,500 Cost burdened 25.8% 24.1% 21.6% Source: US Census Bureau, 2011-2013, 2012-2016, 2015-2019

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Mount Nittany Health 2022 CHNA 25 More than 90% of Centre County households have a computer device (e.g., desktop/laptop, smartphone), a higher percentage than the state and nation. A similar percentage of households have broadband internet (82%) as the state and nation. Digital access is higher within the Centre and Nittany Valley regions, likely impacted by PSU students and staff and other socioeconomic indicators. Within select zip codes in the Penns Valley and Moshannon Valley regions, fewer than 50% of households have broadband internet access. 2015-2019 Households by Digital Access Centre County PA US With a computer device (1+) 91.4% 88.0% 90.3% Desktop/laptop 85.2% 76.4% 77.8% Smartphone 79.1% 75.0% 79.9% With an internet subscription 82.5% 82.1% 83.0% Broadband 82.1% 81.5% 82.7% Source: US Census Bureau, American Community Survey 2015-2019 Households with any Broadband Internet by Zip Code

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Mount Nittany Health 2022 CHNA 27 Social Determinants of Health: The connection between our communities and our health Social determinants of health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health risks and outcomes. Healthy People 2030, the CDC’s national benchmark for health, recognizes SDoH as central to its framework, naming “social and physical environments that promote good health for all” as one of the four overarching goals for the decade. Healthy People 2030 outlines five key areas of SDoH: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. The mix of ingredients that influence each person’s overall health profile include individual behaviors, clinical care, environmental factors, and social circumstance. While health improvement efforts have historically targeted health behaviors and clinical care, as this graph shows, 50% of every person’s health profile is determined by a combination of socioeconomic factors and physical environment. Therefore, the portions of our communities that have positive socioeconomic factors and a health-promoting physical environment tend to be healthier than those who have negative socioeconomic factors and a poor physical environment. This difference results in disparity. Health inequities refer to the systematic differences in opportunities that population groups have to achieve optimal health, which lead to unfair and avoidable differences in health outcomes. Without addressing inequities and supporting initiatives aimed at providing a healthy start, access to opportunity for improvement, and a tangible pathway to a better life, interventions focused only on individual behavior change often do not have enough social and environmental soil to take root and create lasting

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Mount Nittany Health 2022 CHNA 28 positive change. By addressing inequities in our communities, we can more effectively work towards a healthier community for all people now and in the future. Tools for Identifying Disparity The following data visualizations illustrate the potential for health disparities and inequities at the community-level based on social determinants of health barriers. A description of each data visualization tool is provided below:  Area Deprivation Index (ADI): The ADI provides a census block group measure of socioeconomic disadvantage based on income, education, employment, and housing quality. ADI scores are displayed at the block group level on a scale from 1 (least disadvantaged) to 10 (most disadvantaged). A block group is a subdivision of a census tract and typically contains between 250 and 550 housing units.  Community Need Index (CNI): The CNI scores zip codes on a scale of 1.0 to 5.0, with 1.0 indicating a zip code with the least need and 5.0 indicating a zip code with the most need compared to the US national average of 3.0. The CNI is a zip code-based index of community need calculated nationwide, regarding healthcare. The CNI is weights, indexes and scores zip codes by socioeconomic barriers, including income, culture, education, insurance, and housing. Centre County Area Deprivation Index

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Mount Nittany Health 2022 CHNA 29 Centre County Community Need Index Centre County Community Need Index, 2019 vs. 2022 CHNA 2022 CHNA 2019 CHNA Trend 16866, Philipsburg 3.6 3.4 16801, State College 3.2 3.0 16803, State College 3.0 2.8 16820, Aaronsburg 2.4 2.6 16882, Woodward 2.4 2.6 16823, Bellefonte 2.4 2.4 -- 16845, Karthaus 2.4 2.2 16854, Millheim 2.4 2.0 16852, Madisonburg 2.2 2.0 16827, Boalsburg 2.2 2.0 16872, Rebersburg 2.2 2.0 16829, Clarence 2.2 1.4 16875, Spring Mills 2.0 2.0 -- 16859, Moshannon 2.0 2.0 -- 16874, Snow Shoe 2.0 1.6 16864, Orviston 1.8 2.0 16828, Centre Hall 1.8 1.8 -- 16841, Howard 1.8 1.6 16865, Pennsylvania Furnace 1.6 1.4 16844, Julian 1.6 1.2 16832, Coburn 1.4 2.2 16870, Port Matilda 1.2 1.2 -- Highest Need Lowest Need

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Mount Nittany Health 2022 CHNA 30 The weighted average CNI score for Centre County is 2.7 out of 5. The CNI score indicates moderate overall community need, but an increase from the 2019 CHNA score of 2.5. Across the county, CNI scores increased in 13 out of 22 reported zip codes, with the largest increase (0.8 points) in zip code 16829, Clarence, located in the Mountaintop Region. Centre County zip code-level CNI scores range from 1.2 (Port Matilda) to 3.6 (Philipsburg). While these differences are indicative of socioeconomic disparities, it is worth noting that Philipsburg is the only area to score in a higher need category. This finding is consistent with the county’s overall socioeconomic strength. Area Deprivation Index scores correlate with the CNI scores, demonstrating disadvantage in Philipsburg, and to a lesser degree in the Mountaintop Region. Of note, the southwest portion of Bellefonte, zip code 16823, has a maximum ADI score of 10, indicating the most disadvantaged. This finding should continue to be explored to better understand socioeconomic differences and potential inequities. 2015-2019 Social Determinants of Health by Geography* Population in Poverty Children in Poverty Primary Language Other Than English Less than HS Diploma Without Health Insurance CNI Score 16866, Philipsburg 14.8% 18.7% 14.0% 17.8% 4.9% 3.6 16801, State College** 33.6% 12.8% 15.8% 2.6% 3.9% 3.2 16803, State College** 23.4% 10.9% 21.9% 1.9% 4.7% 3.0 16820, Aaronsburg*** 10.0% 12.2% 32.7% 26.9% 37.5% 2.4 16823, Bellefonte 5.7% 6.6% 5.8% 8.4% 4.7% 2.4 16845, Karthaus 10.2% 20.7% 1.1% 15.5% 3.0% 2.4 16854, Millheim 6.7% 0.0% 5.4% 7.0% 7.8% 2.4 16882, Woodward*** 15.4% 13.4% 7.7% 15.4% 10.6% 2.4 16827, Boalsburg 6.3% 8.8% 9.2% 0.5% 1.3% 2.2 16829, Clarence 14.2% 25.0% 0.5% 11.5% 1.9% 2.2 16852, Madisonburg*** 12.1% 26.3% 19.4% 9.8% 11.8% 2.2 16872, Rebersburg*** 19.0% 31.2% 54.6% 39.1% 55.5% 2.2 16859, Moshannon 5.1% 0.0% 2.5% 9.5% 3.7% 2.0 16874, Snow Shoe 8.3% 10.4% 2.1% 10.0% 2.1% 2.0 16875, Spring Mills 9.5% 8.6% 8.1% 7.9% 11.7% 2.0 16828, Centre Hall 7.8% 10.2% 1.8% 3.2% 5.6% 1.8 16841, Howard 8.8% 20.0% 7.6% 9.5% 10.5% 1.8 16844, Julian 8.7% 13.9% 2.6% 6.7% 5.5% 1.6 16865, Pennsylvania Furnace 6.4% 0.9% 1.1% 3.8% 5.9% 1.6 16832, Coburn*** 3.0% 0.0% 20.0% 14.4% 23.2% 1.4 16870, Port Matilda 3.3% 1.8% 3.3% 4.7% 2.4% 1.2 Pennsylvania 12.4% 17.6% 11.4% 9.5% 5.7% NA United States 13.4% 18.5% 21.6% 12.0% 8.8% NA Source: US Census Bureau, American Community Survey *Data are not available for zip code 16864, Orviston. **Data are likely impacted by PSU students. ***Data are likely impacted by the Amish population.

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Mount Nittany Health 2022 CHNA 31 Comparing health indicators with population statistics demonstrates the adverse impact of social determinants on populations that historically and continually experience inequities. While Centre County is a less racially and ethnically diverse community overall, areas with more socioeconomic barriers, notably Philipsburg and Bellefonte, are among the most diverse populations in the county. In this way we can begin to see how inequities perpetuate persistent disparities in health and social outcomes. 2015-2019 Population by Prominent Racial and Ethnic Groups In order of most diverse communities White Black or African American Asian Two or More Races Latinx origin (any race) 16803, State College** 76.2% 5.6% 15.3% 2.4% 3.8% 16801, State College** 84.2% 3.4% 9.3% 2.5% 3.7% 16866, Philipsburg 88.4% 7.2% 1.7% 2.4% 9.4% 16823, Bellefonte 89.6% 7.7% 0.3% 1.4% 3.3% 16827, Boalsburg 91.8% 1.0% 1.8% 1.0% 2.6% 16845, Karthaus 92.3% 7.1% 0.0% 0.6% 3.0% 16865, Pennsylvania Furnace 92.3% 5.3% 0.0% 0.2% 0.0% 16859, Moshannon 93.5% 0.0% 0.0% 0.0% 6.5% 16832, Coburn 96.0% 0.6% 0.2% 3.2% 4.2% 16882, Woodward 96.4% 0.0% 2.1% 1.6% 11.6% 16875, Spring Mills 96.8% 0.9% 0.0% 2.2% 2.3% 16870, Port Matilda 96.8% 0.1% 2.1% 0.9% 1.3% 16854, Millheim 97.2% 0.0% 0.0% 2.8% 0.7% 16820, Aaronsburg 98.3% 0.0% 0.3% 1.4% 0.1% 16874, Snow Shoe 98.4% 0.0% 0.7% 0.9% 0.0% 16841, Howard 98.5% 0.2% 0.1% 1.1% 0.3% 16844, Julian 98.7% 0.3% 0.1% 0.9% 0.1% 16852, Madisonburg 98.8% 0.0% 0.0% 1.2% 1.2% 16828, Centre Hall 99.1% 0.9% 0.0% 0.0% 0.2% 16872, Rebersburg 99.6% 0.0% 0.4% 0.0% 0.6% 16829, Clarence 100.0% 0.0% 0.0% 0.0% 0.0% Pennsylvania 80.5% 11.2% 3.4% 2.5% 7.3% United States 72.5% 5.5% 12.7% 3.3% 18.0% Source: US Census Bureau, American Community Survey Life expectancy is another measure of the impact of social determinants of health. Centre County residents overall continue to benefit from longer, healthier lives. Average life expectancy is higher than the state and increasing. At the community-level, differences in life expectancy are consistent with existing socioeconomic barriers. Moshannon Valley and Mountaintop regions, including Philipsburg, have lower average resident life expectancy of 77.1-79.5 years compared to 81.7 years or higher in other regions. Portions of downtown Bellefonte report the lowest average life expectancy in the county at 73.5 years, although this finding should be further explored as it does not align with areas of socioeconomic disadvantage.

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Mount Nittany Health 2022 CHNA 33 COVID-19 Impact on Communities COVID-19 is the name of the disease caused by the SARS-CoV-2 virus. "CO" stands for corona, "VI" for virus, and "D" for disease. The number "19" refers to the year 2019 when the first case of COVID-19 was identified. Some refer to COVID-19 as simply “COVID.” COVID infection is typically measured by case incidence, which looks at the number of daily new cases per 100,000 to get an accurate estimate of COVID in a community. When calculating case incidence, an important part of understanding how COVID is affecting certain communities is to analyze the demographics of the community. The COVID pandemic has highlighted health disparities along racial, ethnic, and economic lines in the United States:  Black and Latinx people are much more likely than others to be infected with COVID and to die from the disease.  Although data is still sparse, early findings indicate Indigenous people and other people of color are also infected at much higher rates. As of April 11, 2022, Centre County had 31,286 confirmed COVID-19 cases and 348 related deaths. Pennsylvania overall had 2,313,103 confirmed cases and 44,442 deaths. The Centre County case rate per 100,000 residents was similar to the statewide rate, but the death rate was lower, potentially indicating either milder disease cases and/or better access to early and appropriate care. Centre County cases were largely concentrated in more populous regions, including the Centre and Nittany Valley regions, as well as the Moshannon Valley Region. COVID-19 Cases and Deaths (as of April 11, 2022) Centre County Pennsylvania Total Cases 18,522 2,791,018 Confirmed 31,286 2,313,103 Probable 3,959 477,915 Cases per 100,000 21,704.6 21,801.4 Total Deaths 348 44,442 Deaths per 100,000 214.3 347.1 Source: Pennsylvania Department of Health

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Mount Nittany Health 2022 CHNA 35 In Centre County, a total of 109,265 people or 69.9% of residents had received at least one vaccine dose as of April 8, 2022. Centre County ranked 20 out of 67 counties in PA for the percentage of residents with at least one vaccine dose. Centre County has a slightly lower percentage of residents vaccinated than the state (excluding Philadelphia County). COVID-19 Vaccination (as of April 8, 2022) Centre County Pennsylvania Total People Vaccinated 109,265 8,850,705 Fully vaccinated 95,042 7,338,879 Percent fully vaccinated 60.8% 62.9% Partially vaccinated 14,223 1,511,826 Percent partially vaccinated 9.1% 10.7% Percent of all people with at least one vaccine dose** 69.9% 73.6% Source: Pennsylvania Department of Health ** The Pennsylvania percentage excludes Philadelphia County. The CDC has prioritized vaccine equity, defined as preferential access and administration to those who have been most affected by COVID-19, including racial and ethnic minorities. Wide disparities in vaccine coverage exist across racial and ethnic groups in PA, primarily affecting Black/African American and Native American residents. These disparities are due in part to health inequities and barriers, such as vaccination site locations, transportation and other planning and access issues, and lack of information. Centre County differed from the state with generally higher vaccination rates among non-White residents and lower vaccination among White residents. Centre County has been successful in administering vaccines to older adults, averaging 99.9% vaccination among adults aged 70 or older as of April 8, 2022. In comparison to the state, Centre County had lower vaccination rates for adolescent and young adult age groups aged 15-24. Of note, only 34.4% of youth aged 15-19 had been vaccinated compared to a statewide average of 58.6%. The 15–24-year-old age cohort represents nearly 27% of the county population. Residents with At Least One COVID-19 Vaccine Dose by Race and Ethnicity All Residents White Black or African American Asian / Pacific Islander Native American Latinx (any race) Centre County 69.9% 53.1% 60.5% 59.0% 67.0% 59.7% Pennsylvania 73.6% 59.6% 51.9% 57.3% 30.7% 64.2% Source: Pennsylvania Department of Health, April 8, 2022

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Mount Nittany Health 2022 CHNA 37 Statistical Health Data Analysis Healthcare Access The Centre County uninsured population declined over much of the last decade, before stagnating in recent years. The current uninsured population is consistent with the state, lower than the nation, and meets the HP2030 goal of 92.1% insured residents. When considered by age group, Centre County has fewer uninsured adults age 19 or over, but more uninsured youth. The majority of uninsured youth reside in the Penns Valley Region, likely due in part to the Amish population that is less likely to participate in insurance programs. Source: US Census Bureau, American Community Survey Source: US Census Bureau, American Community Survey 6.6%6.6%5.9%5.5%5.6%8.8%8.0%7.1%6.2%5.7%13.0%11.7%10.5%9.4%8.8%0.0%2.0%4.0%6.0%8.0%10.0%12.0%14.0%16.0%2011-2015 2012-2016 2013-2017 2014-2018 2015-2019Total Uninsured PopulationCentre County PA USUnder 6years6-18 years19-25years26-44years45-64years65 years oroverCentre County7.6% 6.1% 6.8% 7.8% 4.9% 0.4%PA4.6% 4.2% 9.5% 9.5% 5.6% 0.4%US4.1% 5.5% 14.7% 14.8% 9.3% 0.8%0.0%5.0%10.0%15.0%20.0%2015-2019 Uninsured Population by Age

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Mount Nittany Health 2022 CHNA 38 2015-2019 Uninsured Youth (Age 0-17) Population by Zip Code Uninsured rates among Black and Latinx residents declined statewide and nationally, but continue to be disproportionately higher compared to Whites. Centre County differs from the state and nation with a similar proportion of uninsured residents across racial and ethnic groups. County-level results should be interpreted with caution due to small population counts. Source: US Census Bureau, American Community Survey 6.7%6.8%4.9%10.1%7.5%4.9%7.9%5.1%5.7%18.2%12.9%7.0%0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%USPACentreCounty2015-2019 Uninsured Population by Race and EthnicityAsian Black White Latinx (any race)

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Mount Nittany Health 2022 CHNA 39 Employer-based insurance continues to be the majority coverage type among Centre County residents, and coverage increased from the 2019 CHNA. The percentage of Medicaid insured residents also nearly doubled from the 2019 CHNA from 5.9% to 10.5%. Source: US Census Bureau, American Community Survey With few exceptions, the Centre County primary care provider rate has been largely stable over the past five years, mirroring the national provider rate. Providers are largely concentrated in the Centre and Nittany Valley regions. Consistent with prior CHNA cycles, the northern and western portions of the county, including the Moshannon Valley, Mountaintop, Lower Bald Eagle, and Upper Bald Eagle regions are primary care Health Professional Shortage Areas (HPSAs). Centre County has fewer dentists than the state and nation, and the entire county is a designated dental HPSA for low-income residents. Rural populations, particularly in the Moshannon Valley, Mountaintop, and Penns Valley regions, experience greater difficulty in accessing dental care, with fewer than 62% of adults reporting a recent dental visit compared to 72% or more of adults in the Centre Region. Note: Providers are identified based on their preferred business mailing address. Primary, dental, and mental health provider rates do not take into account providers that serve multiple counties or satellite clinics. Employer-basedDirect-purchaseMedicare Medicaid TRICAREVA HealthCareCentre County67.8% 18.1% 15.1% 10.5% 2.1% 1.6%PA59.6% 15.5% 19.6% 19.5% 1.4% 2.1%US55.2% 13.6% 17.3% 20.2% 2.7% 2.3%0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%2015-2019 Insured Population by Coverage Types (alone or in combination)

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Mount Nittany Health 2022 CHNA 43 Health Risk Factors and Chronic Disease Centre County adults are generally healthier than their peers statewide and nationally, but poor physical and mental health day averages increased from prior CHNAs. The average number of poor mental health days per month increased from 3.0 to 4.6 from the 2016 to 2022 CHNAs. Consistent with an increase in poor physical health days, physical inactivity also increased. Source: Centers for Disease Control and Prevention, 2004-2010, 2006-2012, 2016, 2018 Source: Centers for Disease Control and Prevention *State data are reported as a percentage of adults age 18+ for comparison purposes only. 3.33.03.84.63.43.13.53.83.63.64.34.73.53.53.94.02.03.04.05.02013 CHNA 2016 CHNA 2019 CHNA 2022 CHNAAge-Adjusted Average Poor Physical and Mental Health Days in Past 30 Days (Adults)Centre County Poor Mental Health Days Centre County Poor Physical Health DaysPA Poor Mental Health Days PA Poor Physical Health Days16.0%16.7%17.8%18.0%17.9%26.9%21.5%23.9%23.0%24.4%10.0%15.0%20.0%25.0%30.0%2015 2016 2017 2018 2019Age-Adjusted Adult (Age 20+) Physical InactivityCentre County PA

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Mount Nittany Health 2022 CHNA 44 Adult smoking increased sharply in Centre County from 2016 to 2017, bringing it in line with the nation. In 2018, a change in methodology occurred providing age-adjusted smoking rates. According to 2018 age-adjusted data, 18.5% of Centre County adults smoke, a higher percentage than both the state (17.9%) and nation (15.9%). Source: Centers for Disease Control and Prevention 2018 Age-Adjusted Adults (Age 18+) Who Are Current Smokers Centre County Pennsylvania United States 18.5% 17.9% 15.9% Source: Centers for Disease Control and Prevention Fewer Centre County adults have obesity or diabetes compared to the state and nation, but prevalence increased in recent years. About 27% of adults had obesity in 2019 compared to 24% in 2017; 8.2% of adults had diabetes in 2019 compared to 6.4% in 2016. Further analysis of obesity and diabetes prevalence at the zip code-level reveals disparities across Centre County. PLACES, a data collaboration between the CDC, Robert Wood Johnson Foundation, and CDC Foundation, provides 2018 obesity and diabetes estimates for adults age 18 or over at the zip code-level. According to PLACES findings, and consistent with other reported health and socioeconomic disparities, obesity and diabetes prevalence are higher in rural portions of the county. In the Moshannon Valley, including Philipsburg, adult obesity and diabetes are reported as 35.2% and 12.1% respectively. 17.9%17.7%14.6%17.0%19.9%18.1%18.0%18.7%18.1%17.5%17.1%17.1%10.0%15.0%20.0%25.0%2014 2015 2016 2017Adults (Age 18+) Who Are Current Smokers (crude percentage)Centre County PA US

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Mount Nittany Health 2022 CHNA 45 Source: Centers for Disease Control and Prevention, US Diabetes Surveillance System & BRFSS *State and national data are reported as a percentage of adults age 18+ for comparison purposes only. Source: Centers for Disease Control and Prevention, US Diabetes Surveillance System & BRFSS *State and national data are reported as a percentage of adults age 18+ for comparison purposes only. 27.2%24.4%24.0%24.4%26.9%29.2%29.5%30.8%30.5%32.8%29.8%30.0%31.2%31.0%32.1%15.0%20.0%25.0%30.0%35.0%2015 2016 2017 2018 2019Age-Adjusted Adult (Age 20+) ObesityCentre County PA US7.3%6.4%7.8%8.2%8.2%8.8%9.6%9.0%9.9%9.2%9.1%9.5%9.4%9.8%9.4%4.0%6.0%8.0%10.0%12.0%2015 2016 2017 2018 2019Age-Adjusted Adult (Age 20+) Diabetes PrevalenceCentre County PA US

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Mount Nittany Health 2022 CHNA 47 Heart disease and cancer continue to be the leading causes of death across the US, but death rates are declining. Centre County has lower rates of death due to heart disease and cancer, as well as other leading chronic diseases, compared to the state, nation, and HP2030 goals. While racial and ethnic death data are not available for Centre County, state and national trends indicate Black residents have disproportionately higher death rates. Leading Chronic Disease Causes of Death, Age-Adjusted Death Rates per 100,000 Green = Lower rate of death than the state and nation Centre County Pennsylvania United States HP2030 Goal Heart Disease Trend Decreasing Decreasing Decreasing 2019 139.0 172.9 161.5 NA 2018 156.5 176.1 163.6 2017 154.2 176.0 165.0 2016 145.0 176.2 165.5 2015 155.7 177.8 168.5 Cancer Trend Decreasing Decreasing Decreasing 2019 116.8 153.5 146.2 122.7 2018 114.2 156.6 149.1 2017 121.6 161.0 152.5 2016 124.4 164.7 155.8 2015 135.7 167.2 158.5 Chronic Lower Respiratory Disease* Trend Stagnant Decreasing Decreasing 2017-2019 25.3 35.4 39.6 NA 2016-2018 24.9 36.3 40.4 2015-2017 26.1 37.3 41.0 2014-2016 24.7 37.3 40.9 Stroke* Trend Decreasing Decreasing Stagnant 2017-2019 26.8 35.7 37.2 33.4 2016-2018 31.1 36.2 37.3 2015-2017 32.9 37.4 37.5 2014-2016 33.2 37.5 37.2 Diabetes* Trend Stagnant Decreasing Increasing 2017-2019 10.0 20.5 21.5 NA 2016-2018 10.9 20.5 21.3 2015-2017 9.6 21.1 21.2 2014-2015 9.7 21.5 21.1 Source: Centers for Disease Control and Prevention *Death rates are shown as a 3-year aggregate due to lower death counts.

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Mount Nittany Health 2022 CHNA 49 The following graphs depict cancer incidence and death rates for four of the most common types of cancer: Breast (female), colorectal, lung, and prostate. Centre County has a lower overall incidence of cancer, as well as lower incidence of colorectal, lung, and prostate cancers. The county has a higher incidence of female breast cancer, but a lower death rate when compared to the state and nation. This finding is indicative of positive screening practices for early detection and treatment. Centre County meets or nearly meets HP2030 cancer death rate goals for each of the four types. Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention, *US cancer incidence data is reported for 2013-2017 (most recent available). Source: Centers for Disease Control and Prevention All Cancers Breast (female) ColorectalLung andbronchusProstateCentre County419.2 145.8 34.1 45.0 97.4PA466.2 131.4 39.9 62.2 101.8US448.7 125.9 38.4 58.3 104.501002003004005002014-2018* Cancer Incidence per Age-Adjusted 100,000 PopulationBreast (female) Colorectal Lung and bronchus ProstateCentre County16.1 11.5 26.9 13.3PA21.1 14.8 40.8 18.5US20.1 13.9 38.4 18.9HP203015.3 8.9 25.1 16.9010203040502014-2018 Cancer Death per Age-Adjusted 100,000 Population

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Mount Nittany Health 2022 CHNA 50 Aging Population Consistent with the state and nation, Centre County is an aging population with an increasing proportion of residents age 65 or over. Older adults in Centre County are generally healthier than their peers statewide and nationally, benefiting from overall stronger socioeconomic status and social supports. Approximately 4.4% of Centre County older adults live in poverty compared to 8.1% across PA and 9.3% across the US. Centre County older adults are less likely to experience disability and/or multiple chronic conditions compared to PA and the US. Approximately 71.9% of Centre County older adult Medicare beneficiaries have two or more chronic conditions (comorbidities), a slight increase from the 2019 CHNA (71.2%). The percentage of Centre County older adult Medicare beneficiaries with comorbidities is comparable to the state and nation, although beneficiaries are more likely to have two or three conditions and less likely to have six or more conditions. 2018 Chronic Condition Comorbidities among Medicare Beneficiaries 65 Years or Over Centre County Pennsylvania United States 2 to 3 Conditions 31.7% 31.0% 29.4% 4 to 5 Conditions 22.9% 24.1% 22.8% 6 or More Conditions 17.3% 18.7% 18.2% Source: Centers for Medicare & Medicaid Services Older adults spend more money on healthcare than any other age group, and spending increases with a higher reported number of chronic conditions. Centre County older adult Medicare beneficiaries with six or more chronic conditions average more than $27,000 in annual Medicare expenses, a slightly lower amount than the state and nation. 2018 Per Capita Standardized Spending* for Medicare Beneficiaries Age 65 Years or Over Centre County Pennsylvania United States 0 to 1 Condition $1,981 $1,930 $1,944 2 to 3 Conditions $5,557 $5,183 $5,502 4 to 5 Conditions $10,605 $10,124 $10,509 6 or More Conditions $27,534 $28,954 $29,045 Source: Centers for Medicare & Medicaid Services *Standardized spending takes into account payment factors that are unrelated to the care provided (e.g. geographic variation in Medicare payment amounts). There is opportunity in Centre County to better manage older adult health in the primary care setting to avoid emergency department (ED) visits. Centre County older adult Medicare beneficiaries have a higher rate of ED visits than the state and nation, regardless of the number of diagnosed chronic conditions.

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Mount Nittany Health 2022 CHNA 51 2018 ED Visits per 1,000 Medicare Beneficiaries Age 65 Years or Over Centre County Pennsylvania United States 0 to 1 Condition 130.7 117.0 122.6 2 to 3 Conditions 330.0 285.1 318.4 4 to 5 Conditions 681.8 578.7 621.1 6 or More conditions 1,738.2 1,666.8 1,719.1 Source: Centers for Medicare & Medicaid Services Centre County older adult Medicare beneficiaries generally have a lower or similar prevalence of chronic conditions as beneficiaries across the state and nation, with the exception of asthma, cancer, chronic kidney disease, and depression. The prevalence of these conditions exceeds state and national averages. 2018 Chronic Condition Prevalence among Medicare Beneficiaries Age 65 Years or Over Green = Lower burden of disease than state and national benchmarks; Red = Higher burden of disease than state and national benchmarks Centre County Pennsylvania United States Alzheimer’s Disease 11.3% 11.8% 11.9% Arthritis 35.5% 36.6% 34.6% Asthma 6.1% 4.8% 4.5% Cancer 10.7% 10.1% 9.3% Chronic Kidney Disease 27.2% 25.4% 24.9% COPD 10.5% 10.9% 11.4% Depression 17.5% 16.5% 16.0% Diabetes 24.0% 26.2% 27.1% Heart Failure 13.2% 14.2% 14.6% High Cholesterol 53.0% 56.2% 50.5% Hypertension 58.6% 61.9% 59.8% Ischemic Heart Disease 24.7% 29.3% 28.6% Stroke 3.3% 4.5% 3.9% Source: Centers for Medicare & Medicaid Services The Centre County Alzheimer’s disease death rate among individuals age 65 or over increased markedly from 2014-2016 to 2017-2019, rising nearly 80 points. Some of the increase may be due to the reclassification of Alzheimer’s disease as the primary cause of death. Death certificates for individuals with Alzheimer’s disease often list acute conditions (e.g., pneumonia, heart failure) as the primary cause of death rather than Alzheimer’s. Alzheimer’s disease death rates should continue to be monitored in Centre County to assess actual increases in the number of deaths.

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Mount Nittany Health 2022 CHNA 52 Source: Centers for Disease Control and Prevention As older adults age, they are at risk for isolation due to physical limitations and decreasing social circles. One indicator of isolation is the percentage of older adults who live alone. The percentage of older adults living alone increased statewide and nationally with a higher percentage in PA versus the US. While Centre County older adults are less likely to live alone than their peers statewide and nationally, the percentage is on the rise. Source: US Census Bureau, American Community Survey 148.6147.2188.5189.5224.1166.8177.4184.2180.8175.6206.1221.3233.0233.2229.3100.0150.0200.0250.02013-2015 2014-2016 2015-2017 2016-2018 2017-2019Alzheimer's Disease Death Rate among Older Adults Age 65+ per 100,000Centre County PA US8.7%8.7%8.9%9.2%9.9%12.0%12.2%12.3%12.6%12.8%10.1%10.4%10.5%10.7%11.0%6.0%8.0%10.0%12.0%14.0%2011-2015 2012-2016 2013-2017 2014-2018 2015-2019Older Adults Age 65+ Living AloneCentre County PA US

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Mount Nittany Health 2022 CHNA 53 Youth Health Vaping and e-cigarette use, particularly among youth, is contributing to an increase in traditional cigarette use. While Centre County youth are less likely to vape or use e-cigarettes compared to their peers statewide, the percentage increased more than four percentage points from 2017 to 2019. Historically, vaping and e-cigarette use has been higher among rural school district youth compared to State College Area School District youth. Youth obesity is increasing statewide. Centre County has lower youth obesity than PA overall, but obesity among middle and high school students increased more than two percentage points over the past five years. Nearly 1 in 5 Centre County students in grades 7-12 is obese. Youth Tobacco Use within Past 30 Days (Grades 6, 8, 10, 12) Green = Lower percentage than the state; Red = Higher percentage than the state Centre County Overall State College Area School District Rural County School Districts Pennsylvania Cigarette use 2019 2.5% 0.8% NA 3.5% 2017 4.5% 3.0% 5.9% 5.6% 2015 5.2% 3.3% 7.2% 6.4% Vaping / E-cigarette use 2019 14.4% 9.5% NA 19.0% 2017 10.2% 9.9% 10.6% 16.3% 2015 12.1% 9.6% 14.5% 15.5% Source: Pennsylvania Commission on Crime and Delinquency Youth Obesity by School Year Green = Lower percentage than the state Centre County Pennsylvania Grades K-6 2017-2018 12.9% 16.8% 2016-2017 14.6% 16.4% 2015-2016 13.8% 16.7% 2014-2015 13.7% 16.5% 2013-2014 13.7% 16.3% Grades 7-12 2017-2018 17.0% 19.5% 2016-2017 17.9% 18.9% 2015-2016 16.9% 19.1% 2014-2015 15.7% 18.6% 2013-2014 14.8% 18.2% Source: Pennsylvania Department of Health

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Mount Nittany Health 2022 CHNA 54 Despite increasing health risk factors, Centre County youth continue to have a lower prevalence of chronic disease when compared to their peers statewide. The percentage of youth with diagnosed asthma is slowing decreasing and nearly four percentage points lower than the statewide average. Fewer than 10 students countywide have a type II diabetes diagnosis. Youth Chronic Disease Prevalence by School Year Green = Lower percentage than the state Centre County Pennsylvania Asthma 2017-2018 7.5% 11.3% 2016-2017 7.8% 11.9% 2015-2016 7.9% 12.1% Type II Diabetes 2017-2018 0.06% (n=9) 0.06% 2016-2017 0.05% (n=7) 0.08% 2015-2016 0.06% (n=9) 0.06% Source: Pennsylvania Department of Health Centre County youth report better mental health and lower substance use than youth statewide. The percentage of youth who reported feeling sad or depressed most days has generally been stable, while use of substances like alcohol has declined. It is still of note that more than one-quarter of youth feel consistently sad or depressed and nearly 7% have attempted suicide. Historically, youth in rural school districts have reported poorer mental health than youth in the State College Area School District. Youth Behavioral Health Measures (Grades 6, 8, 10, 12) Green = Lower percentage than the state Centre County Overall State College Area School District Rural County School Districts Pennsylvania Sad or Depressed Most Days in the Past Year 2019 28.4% 23.6% NA 38.0% 2017 29.3% 23.6% 35.0% 38.1% 2015 29.2% 23.2% 35.4% 38.3% Attempted Suicide 2019 6.7% 4.4% NA 9.7% 2017 7.0% 5.9% 8.4% 10.0% 2015 6.5% 5.6% 7.6% 9.5% Source: Pennsylvania Commission on Crime and Delinquency

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Mount Nittany Health 2022 CHNA 55 Youth Substance Use Disorder within the Past 30 Days (Grades 6, 8, 10, 12) Green = Lower percentage than the state Centre County Overall State College Area School District Rural County School Districts Pennsylvania Alcohol Use 2019 12.9% 9.6% NA 16.8% 2017 14.9% 13.4% 16.3% 17.9% 2015 15.0% 14.5% 15.5% 18.2% Marijuana Use 2019 5.9% 4.8% NA 9.6% 2017 7.6% 7.6% 7.6% 9.7% 2015 6.0% 6.2% 5.9% 9.4% Source: Pennsylvania Commission on Crime and Delinquency Behavioral Health and Substance Use Disorder Across the state in 2018, there were 113,704 hospital stays for mental disorders for a rate of 88.8 per 10,000 residents. Centre County overall had a lower hospitalization rate than the state at 60.4 per 10,000, but mental distress should be evaluated on a community-by-community basis, as statewide hospitalization rates were approximately three times higher in areas of high poverty and low educational attainment. Statewide, the top diagnosis among individuals treated for a mental disorder was depression (44%), followed by schizophrenia (20.7%) and bipolar (20.2%). The majority of patients were between the ages of 18 to 44 (50.8%). 2018 Hospitalizations for Mental Disorders per 10,000 Residents Statewide Rate: 88.8 per 10,000 Residents Source: Pennsylvania Health Care Cost Containment Council (PHC4)

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Mount Nittany Health 2022 CHNA 56 2018 Mental Disorders Hospitalizations per 10,000 by Socioeconomic Factors Pennsylvania Poverty Rate Areas of high poverty (>25% of population) 163.3 Areas of low poverty (≤5% of population) 53.0 Education Areas of low education (≤10% with a bachelor’s degree) 159.4 Areas of higher education (≥40% with a bachelor’s degree) 58.4 Race/Ethnicity Black, Non-Hispanic 154.0 White, Non-Hispanic 81.7 Hispanic/Latinx 67.9 Source: Pennsylvania Health Care Cost Containment Council (PHC4) 2018 Mental Disorders Hospital Stay Characteristics Pennsylvania (Total Hospital Stays: 113,704) Treatment Setting Acute care hospital 56.4% Psychiatric hospital 43.6% Average Length of Stay Acute care hospital 8.6 days Psychiatric hospital 12.3 days Type of Mental Disorder Depression 44.0% Schizophrenia 20.7% Bipolar 20.2% Other (conduct, anxiety, somatic, miscellaneous) 7.3% Suicidal 4.2% Trauma (adjustment, post-traumatic stress and dissociative disorders) 3.6% Patient Age Under 18 years 14.8% 18-44 years 50.8% 45-64 years 27.2% 65-74 years 4.7% 75 years or over 2.6% Source: Pennsylvania Health Care Cost Containment Council (PHC4) Deaths due to suicide and mental and behavioral disorders are indicators of mental distress and access to care barriers. The Centre County suicide death rate per 100,000 increased from 8.7 in 2013-2015 to 11.4 in 2015-2017. The suicide death rate has since stabilized, remaining lower than the state and

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Mount Nittany Health 2022 CHNA 57 nation and meeting the HP2030 goal of 12.8. The mental and behavioral disorders death rate declined and remains lower than state and national rates. Source: Centers for Disease Control and Prevention Source: Centers for Disease Control and Prevention *Mental and behavioral disorders span a wide range of disorders, including disorders due to psychoactive substance use, anxiety, Schizophrenia and other delusional disorders, and mood or personality disorders. Statewide substance use disorder hospitalizations declined from 2017 to 2019 for all reported substances except amphetamine. The amphetamine hospitalization rate increased 62.6% across PA. As of 2019, Centre County had a lower rate of hospitalization for all reported substances compared to the 8.710.511.410.911.213.614.014.614.914.612.913.213.613.914.112.851015202013-2015 2014-2016 2015-2017 2016-2018 2017-2019Age-Adjusted Suicide Death per 100,000Centre County PA US HP203027.228.027.424.825.043.637.242.642.9 42.940.142.735.234.433.9203040502013-2015 2014-2016 2015-2017 2016-2018 2017-2019Age-Adjusted Mental & Behavioral Disorders Death per 100,000Centre County PA US

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Mount Nittany Health 2022 CHNA 58 state. This finding is consistent with an overall small number of drug overdose deaths in Centre County, even during pandemic years. Source: Pennsylvania Health Care Cost Containment Council (PHC4) 2019 Centre County Substance Use Disorder Hospitalizations by Substance Alcohol Opioid Cocaine Amphetamine Hospitalizations 451 99 17 56 Hospitalizations rate per 100,000 316.0 69.4 11.9 39.2 Source: Pennsylvania Health Care Cost Containment Council (PHC4) Pennsylvania tracks maternal stays with opioid use and newborn stays with neonatal abstinence syndrome (NAS) as indicators of opioid use prevalence and community impact. Maternal stays include residents aged 12-55 years. NAS is defined as an array of withdrawal symptoms that develop soon after birth in newborns exposed to addictive drugs while in the mother’s womb. From 2017 to 2019, the statewide hospitalization rates for maternal stays with opioid use and newborn stays with NAS declined 2% and 12% respectively. Centre County hospitalization rates for maternal and newborn stays were approximately half the statewide rates. 2019 Maternal Opioid Use and Neonatal Abstinence Syndrome (NAS) Centre County Pennsylvania Maternal hospital stays NA 2,565 Rate per 1,000 maternal stays 7.7 19.1 NAS hospital stays NA 1,610 Rate per 1,000 newborn stays 7.0 12.9 Source: Pennsylvania Health Care Cost Containment Council (PHC4) 571.4571.3568.4313.5297.3293.2166.9173.8164.139.251.363.701002003004005006002017 2018 2019Statewide Substance Use Disorder Hospitalizations by Substance per 100,000Alcohol Opioid Cocaine Amphetamine

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Mount Nittany Health 2022 CHNA 59 Consistent with other communities across the nation, Centre County’s 2019 success in tackling the opioid crisis was disrupted by the COVID-19 pandemic. Anecdotal evidence suggests the pandemic escalated the opioid crisis due to increased mental distress and healthcare access barriers for addiction support. Overdose deaths in Centre County have been variable since 2016, doubling from 2019 to 2020 and showing a deep decline in 2021. When analyzed by demographic characteristics, Centre County overdose deaths are evenly distributed among men and women and occur almost exclusively among White residents. While all age groups are affected, the highest number of deaths occur among young adults age 25-34. Source: OverdoseFreePA 2020-2021 Centre County Overdose Death Demographics 2020-2021 Gender Female 37% Male 63% Race Asian 0% Black 7% White 93% Other 0% Latinx 0% Age 0-17 0% 18-24 11% 25-34 37% 35-44 26% 45-54 15% 55+ 11% Source: OverdoseFreePA 2011198141305101520252016 2017 2018 2019 2020 2021Centre County Overdose Deaths

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Mount Nittany Health 2022 CHNA 60 The percentage of Centre County adults who reported excessive drinking decreased from 2017 to 2018 and is comparable to the statewide average. Consistent with the state and nation, approximately 1 in 4 driving deaths in Centre County are due to alcohol impairment. Source: Centers for Disease Control and Prevention & National Highway Safety Administration Consistent with prior years of CHNA data, approximately 76% of Penn State University students report alcohol use. Among alcohol users, 41% are moderate drinkers and 6% are heavy drinkers. Mount Nittany Medical Center sees a high volume of alcohol-related visits by Penn State students, although visits declined in recent school years. Penn State University Students Self-Reported Drinking Behavior Source: Penn State Student Affairs, The Partnership – Campus and Community United Against Dangerous Drinking

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Mount Nittany Health 2022 CHNA 61 Penn State Student Alcohol-Related Visits to Mount Nittany Medical Center 2015-16 2016-17 2017-18 2018-19 2019-20 651 711 691 570 537 Source: Penn State Student Affairs, The Partnership – Campus and Community United Against Dangerous Drinking Centre County has historically had a higher rate of crime offenses related to substance use compared to the state, particularly for alcohol. Consistent with a reported decline in Mount Nittany Medical Center medical visits due to alcohol, the annual number of alcohol-related violations declined in recent school years. Of note, the decline in violations was largely seen in the student population, while violations among non-students increased. Annual Number of All Alcohol-Related Violations (Public Drunkenness, Liquor Law Citations and DUI Arrests) Source: Penn State Student Affairs, The Partnership – Campus and Community United Against Dangerous Drinking

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Mount Nittany Health 2022 CHNA 62 Maternal and Child Health The total birth rate continued to decline statewide and in Centre County. Centre County has historically had a lower birth rate than the state. Consistent with countywide demographics, the majority (85%) of births in Centre County in 2019 were to White mothers. The percentage of births to Asian and Black mothers declined from the 2019 CHNA; births to Latina mothers increased approximately one percentage point. Centre County has fewer teenage births than the state overall. In 2019, 1.7% of births in the county were to teens, less than half the statewide percentage of 3.9%. Total Births Green = Lower percentage than the state Centre County Pennsylvania Birth Rate per 1,000 Trend Decreasing Decreasing 2019 14.1 20.6 2018 15.2 20.8 2017 15.2 21.1 2016 15.8 21.4 2015 16.7 21.5 2019 Births by Race and Ethnicity Total 1,173 135,677 Asian 8.0% 4.6% Black 1.1% 13.9% White 85.3% 70.1% Latinx 3.5% 11.6% Births to Teens Trend Variable Decreasing 2019 1.7% 3.9% 2018 2.1% 4.1% 2017 1.2% 4.3% 2016 1.4% 4.6% 2015 2.7% 5.1% Source: Pennsylvania Department of Health

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Mount Nittany Health 2022 CHNA 63 The percentage of Centre County pregnant women receiving first trimester prenatal care is consistent with the percentage reported at the time of the 2019 CHNA. Centre County has a higher percentage of women receiving early prenatal care compared to the state, but it does not meet the HP2030 goal of 80.5%. Contrary to state and national trends, White mothers in Centre County are less likely to receive early prenatal care compared to minority racial and ethnic groups, although findings should be interpreted with caution due to low population counts. Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention *In 2016, the US universally adopted the 2003 US Certificate of Live Birth, providing national indicators. 2019 Prenatal Care in the First Trimester by Race and Ethnicity Green = Higher percentage than state and national benchmarks; Red = Lower percentage than state and national benchmarks Total Births Asian Black White Latina Centre County 76.4% 78.1% 81.2% 76.2% 78.6% Pennsylvania 74.2% 72.5% 63.8% 77.4% 65.6% United States 77.6% 82.1% 67.6% 82.8% 72.1% HP2030 Goal 80.5% -- -- -- -- Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention 75.5%76.4%78.4%76.2%76.4%71.8%73.8%73.4%73.9%74.2%77.1%77.3%77.5%77.6%60.0%65.0%70.0%75.0%80.0%85.0%2015 2016 2017 2018 2019Prental Care in the First TrimesterCentre County PA US

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Mount Nittany Health 2022 CHNA 64 Fewer Centre County babies are born with low birth weight and/or preterm when compared to the state and nation. The county meets the preterm birth HP2030 goal. The low birth weight percentage declined from 2017 to 2019, while the preterm birth percentage has been variable. Centre County data are not reported for non-White women due to low counts. Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention 6.5%5.4%7.1%5.8%5.4%8.2%8.5%8.5%8.1%8.2%8.3%8.3%8.3%2.0%4.0%6.0%8.0%10.0%2015 2016 2017 2018 2019Low Birth WeightCentre County PA US7.5%6.7%7.9%6.8%8.0%9.4%9.3%9.4%9.5%9.9%9.6%9.9%9.9%10.0%10.2%4.0%6.0%8.0%10.0%12.0%2015 2016 2017 2018 2019Preterm BirthsCentre County PA US

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Mount Nittany Health 2022 CHNA 65 2019 Low Birth Weight and Preterm Births by Race and Ethnicity Green = Lower percentage than state and national benchmarks Total Births Asian Black White Latinx Low Birth Weight Centre County 5.4% NA NA 5.3% NA Pennsylvania 8.5% 8.8% 14.4% 7.0% 9.1% United States 8.3% 8.7% 14.2% 6.9% 7.6% Preterm Births Centre County 8.0% NA NA 8.1% NA Pennsylvania 9.9% 8.3% 13.8% 9.1% 10.5% United States 10.2% 8.7% 14.4% 9.3% 10.0% HP2030 Goal 9.4% -- -- -- -- Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention Nearly 90% of Centre County mothers breastfeed, exceeding state and national benchmarks. Within Centre County, White mothers are the least likely to breastfeed in comparison to other racial and ethnic groups, however, all reported demographics are more likely to breastfeed when compared to their peers statewide and nationally. Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention *In 2016, the US universally adopted the 2003 US Certificate of Live Birth, providing national indicators. 87.8%88.8%89.6%88.8%89.4%79.7%81.1%81.8%81.9%82.0%83.1%83.4%83.5%83.6%70.0%80.0%90.0%100.0%2015 2016 2017 2018 2019Breastfeeding at Discharge from HospitalCentre County PA US

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Mount Nittany Health 2022 CHNA 66 2019 Breastfeeding at Discharge from Hospital by Race and Ethnicity Green = Higher percentage than state and national benchmarks Total Births Asian Black White Latinx Centre County 89.4% 95.9% 97.1% 88.4% 100% Pennsylvania 82.0% 90.7% 76.5% 82.6% 81.7% United States 83.6% 90.1% 73.1% 85.0% 87.0% HP2030 Goal NA -- -- -- -- Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention More women smoke during pregnancy in PA than the nation overall, but the percentage is declining. Within Centre County, approximately 8% of women report smoking during pregnancy compared to 6% nationally. Consistent with the 2019 CHNA, a similar percentage of Black, White, and Latina pregnant women in Centre County report smoking. Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention *In 2016, the US universally adopted the 2003 US Certificate of Live Birth, providing national indicators. 2019 Mothers Who Do Not Smoke during Pregnancy by Race and Ethnicity Green = Higher percentage than state and national benchmarks; Red = Lower percentage than state and national benchmarks Total Births Asian Black White Latina Centre County 92.2% 100% 91.2% 91.7% 92.9% Pennsylvania 90.5% 99.2% 92.5% 89.1% 94.9% United States 94.0% 99.6% 95.2% 91.2% 98.5% HP2030 Goal 95.7% -- -- -- -- Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention 90.3%92.9%93.4%91.4%92.2%87.5%88.5%88.9%89.6%90.5%92.8%93.1%93.5%94.0%80.0%85.0%90.0%95.0%100.0%2015 2016 2017 2018 2019Mothers Who Do Not Smoke during PregnancyCentre County PA US

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Mount Nittany Health 2022 CHNA 67 Centre County saw a significant decline in infant deaths from 2007-2009 to 2013-2015. The infant death rate has since stabilized and remains lower than the state and nation and meets the HP2030 goal of 5.0 per 1,000 live births. Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention Across the state and nation, there are wide maternal and child health disparities, particularly affecting Black and Latina mothers. Of grave concern, as a national average, Black mothers are more than 2.5 times as likely as White and/or Latina mothers to die due to pregnancy-related causes. Reportable racial and ethnic differences in maternal and child health outcomes are limited within Centre County due to low birth counts among minority populations. When available, data indicate that Black and Latina mothers in Centre County generally fare better than both White mothers in Centre County and their peers statewide and nationally. This finding is contrary to 2019 CHNA findings and should continue to be monitored. 2018 Maternal Deaths* per 100,000 Live Births Total Deaths Total Death Rate Black Death Rate White Death Rate Latina Death Rate Pennsylvania 19 14.0 NA NA NA United States 658 17.4 37.1 14.7 11.8 HP2030 Goal -- 15.7 -- -- -- Source: Pennsylvania Department of Health & Centers for Disease Control and Prevention *Maternal deaths include deaths of women while pregnant or within 42 days of termination of pregnancy, from any cause related to pregnancy or its management. 4.72.93.23.03.96.66.36.16.16.15.95.95.95.85.70.02.04.06.08.010.02012-2014 2013-2015 2014-2016 2015-2017 2016-2018Infant Death per 1,000 Live BirthsCentre County PA US

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Mount Nittany Health 2022 CHNA 68 Key Stakeholder Survey Background An online Key Stakeholder Survey was conducted with Centre County community representatives to solicit information about local health needs and opportunities for improvement. Community representatives included healthcare and social service providers; public health experts; civic, social, and faith-based organizations; policy makers and elected officials; and others representing diverse community populations. A total of 148 individuals responded to the survey. A list of the represented community organizations and the participants’ respective titles, as provided, is included in Appendix B. Key stakeholder’s names are withheld for confidentiality. Key stakeholders were asked to indicate any specific regions of Centre County or populations that their organization serves, as applicable. Three-quarters of key stakeholders served all geographic regions of Centre County. Similarly, 71.6% of stakeholders served all population across the county. Nearly 20% of key stakeholders primarily served the Centre Region. Less than 10% of stakeholders served a specific population within Centre County; low-income/poor individuals or families were the most commonly served specific population group. Centre County Regions Served by Key Stakeholder Survey Participants Number of Participants Percent of Total Not applicable – serve all of Centre County 111 75.0% Centre Region 28 18.9% Nittany Valley Region 14 9.5% Penns Valley Region 13 8.8% Moshannon Valley Region 12 8.1% Lower Bald Eagle Valley Region 11 7.4% Upper Bald Eagle Valley Region 9 6.1% Mountaintop Region 8 5.4%

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Mount Nittany Health 2022 CHNA 69 Primary Populations Served by Key Stakeholder Survey Participants Number of Participants Percent of Total No specific focus-serve all populations 106 71.6% Other* 18 12.2% Low Income/Poor individuals or families 14 9.5% Young adults (19-24) 11 7.4% Older adults/Elderly 10 6.8% African American/Black 9 6.1% Religious community 9 6.1% Disabled/Differently abled (mental and physical) 7 4.7% Children (age 0-11) 6 4.1% Adolescents (age 12-18) 6 4.1% Homeless individuals or families 6 4.1% Asian/South Asian 2 1.4% LGBTQ+ Community 2 1.4% Uninsured/Underinsured individuals or families 2 1.4% American Indian/Alaska Native 1 0.7% Pacific Islander/Native Hawaiian 1 0.7% Hispanic/Latinx 1 0.7% Immigrant/Refugee populations 1 0.7% *Responses included all populations age 0-22, all populations age 18+, early learning program enrollees, employers and community organizations, incarcerated individuals (n=2), Jewish community, K-12 students, low literate adults and adults with limited English, pregnant mothers and mothers of children under 2 years, survivors of domestic violence and sexual assault (n=5), and veterans. Key stakeholders were asked a series of questions about perceived health priorities, perspectives on emerging health trends, including COVID-19, and recommendations to advance community health and well-being strategies. A summary of their responses follows.

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Mount Nittany Health 2022 CHNA 70 Survey Findings Health and Quality of Life Thinking about the people their organization serves, key stakeholders were asked to describe the overall health and well-being of individuals and the most pressing concerns affecting them. Key stakeholders selected up to five pressing concerns from a wide-ranging list of health and social issues. An option to “write in” any issue not included on the list was provided. Key stakeholders’ description of the overall health and well-being of the people their organization serves indicated common perceptions of opportunity for improvement. Approximately 47% of stakeholders described overall health and well-being as “average” and 33.8% described it as “below average” or “poor.” When asked if the health and quality of life of the people their organization serves improved, stayed the same, or declined over the past three years, 48.7% of key stakeholders indicated it had declined. Only 6.1% or nine key stakeholders indicated that health and quality of life improved over the past three years. The top concerns identified by key stakeholders as affecting the people their organization serves indicated consistent issues related to mental health and social determinants of health (SDoH). The largest proportion of key stakeholders (51.4%) selected mental health conditions as a top five most pressing concern. Approximately 33.8% of key stakeholders also selected stress (e.g., work, family, school, etc.). Key SDoH barriers identified by stakeholders included economic stability (46.6%), affordable and quality housing (36.5%), ability to afford healthcare (29.1%), and lack of transportation (29.1%). 2.7%12.8%46.6%31.1%2.7%4.1%Excellent AboveaverageAverage Below average Poor Don'tknow/Notsure0.0%10.0%20.0%30.0%40.0%50.0%I would describe the overall health and well-being of the people my organization serves as:

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Mount Nittany Health 2022 CHNA 71 In your opinion, what are the top five most pressing concerns affecting the population(s) that your organization serves? Top Key Stakeholder Selections. Number of Participants Percent of Total Mental health conditions 76 51.4% Economic stability (employment, poverty, cost of living) 69 46.6% Housing (affordable, quality) 54 36.5% Stress (work, family, school, etc.) 50 33.8% Ability to afford healthcare 43 29.1% Lack of transportation 43 29.1% Overweight/Obesity 38 25.7% Older adult health concerns 32 21.6% Substance use disorder 30 20.3% Limited healthcare providers or appointments available 27 18.2% Diabetes 24 16.2% Food insecurity 20 13.5% Heart disease and stroke 18 12.2% Cancers 16 10.8% Other* 16 10.8% *Responses included COVID-19 (n=4), affordable childcare (n=2), older adult health (ageism, dementia/Alzheimer’s disease/Parkinson’s disease) (n=2), incarceration, information literacy, adverse childhood experiences, injuries requiring surgery, rural transportation, reliable/affordable internet access, orthopedic issues, and post-acute care. Recognizing the unique urban and rural communities across Centre County, key stakeholders were asked if the health needs of individuals living in the Centre Region differ from the health needs of individuals living outside the Centre Region. Responses reflected diverse perspectives, with 37.8% of stakeholders “agreeing” or “strongly agreeing,” 38.5% “neither agreeing nor disagreeing,” and 12.8% “disagreeing” or “strongly disagreeing.” Key stakeholders that perceived a difference in health status largely identified SDoH, particularly transportation and income, as the root causes of these differences. Select verbatim comments by key stakeholders are included below.  “Affordable housing is moving farther and farther out from the Centre Region where employment, healthcare etc. is mostly centered. The county transportation partially serves the need, but hours are limited. CATA serves some areas but access and funding for access causes issues in growth. New funding models place efficiency goals on service - serving more rural or less dense populations outside the core are costly and inefficient - balancing need against these goals.”  “Individuals living outside of the Centre Region have less transportation options and more limits on the time they can use the MA (Medicare) van due to location. They also have less resources for food as many of the outlying food banks do not have the same resources that the Centre Region Food Bank offers.”

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Mount Nittany Health 2022 CHNA 72  “Our clients who live outside of the Centre region have difficulty with access to transportation for medical appointments. Transportation services do exist for clients with MA (Medicare) but can be difficult to use, especially with an infant. Access to safe areas to walk are limited for many of these clients, so exercise can be challenging, as well as access to grocery stores (vs Dollar Store or convenience store foods). Access to mental health services is more limited due to transportation concerns as well as access to broadband internet for virtual appointments. Connecting in community for support from other parents is also very challenging.”  “Overall, I feel the individuals living in the Centre region tend to have higher socioeconomic status, higher education, which helps with routine use of well visits and follow ups.” Other key stakeholders shared that common health concerns affect all populations within Centre County.  “Domestic violence is not discriminatory and occurs between people of any social class, any race, religion, sexual orientation, and all age groups.”  “There are pockets of populations in both the Central Region and elsewhere that have a higher rate of inequality in access to and affordability of healthcare coverage and receiving healthcare services.”  “With the exception of the student population, our health needs are similar to those of other mid/lower income communities in Pennsylvania. The university skews income data in regards to socio-economic status and tax brackets for Centre County.” In a follow-up question, key stakeholders were asked to rate the quality of the SDoH within the community their organization serves, focusing on the five key domains identified by Healthy People 2030: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Ratings were provided using a scale of (1) “very poor” to (5) “excellent.” The mean score for each SDoH domain is listed in the table below in rank order, followed by a graph showing the scoring frequency. Mean scores were between 3.00 and 3.59, with most respondents rating the listed areas as “fair” or “good.” Consistent with the 2019 Key Stakeholder Survey results, education was seen as the strongest community SDoH, with 15.6% of stakeholders rating it as “excellent” and 36.3% rating it as “good.” Economic stability was seen as the weakest SDoH, with 5.2% rating it as “very poor” and 25.9% rating it as “poor.” Approximately 65.2% (n=88) of stakeholders stated that their organization currently screens or assesses the people their organization serves for the needs related to SDoH. Among these individuals, 29.6% use a formal screening process (e.g., standard screening tool or process), while 35.6% informally screen or assess individuals through observation or conversation.

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Mount Nittany Health 2022 CHNA 73 Ranking of Social Determinants of Health in Descending Order by Mean Score Mean Score Education (e.g., high school graduation, enrollment in higher education, language and literacy, early childhood education and development) 3.59 Neighborhood and Built Environment (e.g., access to healthy foods, quality of housing, crime and violence, environmental conditions, transportation) 3.30 Health and Healthcare (e.g., access to healthcare, access to primary care, health literacy) 3.29 Social and Community Context (e.g., sense of community, civic participation, perceptions of discrimination and equity, incarceration/institutionalization) 3.11 Economic Stability (e.g., poverty, employment, food security, housing stability) 3.00 Healthcare delivery shifted during the COVID-19 pandemic, with more patient encounters conducted via telehealth (e.g., virtual video or phone appointments). Approximately 69.6% of key stakeholders indicated that the people their organization serves accessed telehealth services in the past three years. Key stakeholders were asked to share barriers to providing or accessing telehealth among their client base to help inform delivery improvements. Key stakeholder responses largely spoke to a lack of electronic devices or reliable high-speed internet, lack of digital literacy particularly affecting older adults, and perceptions of lower quality of care. Note: Lack of reliable high-speed internet addressed both availability and affordability. Select verbatim comments by stakeholders are included below.  “A vast majority of the people we serve outside of our immediate "hub" area are of the older population that still do not carry internet or have access to computers or cell phones. Many also do not have family to assist them with education in using these electronics even if they did have access.” 5.2%2.2%0.8%3.0%0.7%25.9%23.7%16.5%20.9%8.2%34.1%33.3%39.1%26.1%37.0%28.9%34.1%30.8%38.1%36.3%3.7%2.2%7.5%9.0%15.6%0.0% 20.0% 40.0% 60.0% 80.0% 100.0%Economic StabiltySocial and Community ContextHealth and HealthcareNeighborhood andBuilt EnvironmentEducationQuality of Community Social Determinants of Health Very poor Poor Fair Good Excellent

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Mount Nittany Health 2022 CHNA 74  “Biggest barriers to telehealth are clients not being able afford cable/wifi and not having a computer to access the services. They could use free wifi at other places (library, coffee shops, etc.) but it would not be very confidential.”  “Difficulties with technology and internet capabilities have hindered using telehealth (video visits). Primarily our people use telephone visits and like using the phone for these services when possible.”  “Internet tends to be a lot of the problems for patients along with not knowing how to operate their camera or general IT issues for the older generation that they do not know how to fix while on the call with the providers.”  “Lack of digital literacy, lack of trust in being checked outside the physical presence of the service provider, not knowing whether or not their health insurance would cover it.”  “Our organization provides telehealth visits based on client needs and desires. The ability of clients to use this service is limited due to lack of access to high-speed internet, either because it is not available, or they can't afford it. Even telephone visits can be challenging in areas with poor cellular service.”  “Patients report that virtual appointments for mental health concerns are not as beneficial as in person.”  “The rural parts of Centre County don't have broadband so it would be difficult or impossible to access telehealth.” COVID-19 Insights and Perspectives Nearly all key stakeholders (88.3%) “agreed” or “strongly agreed” that the COVID-19 pandemic had a negative impact on the health and well-being of the people their organization serves. Only three stakeholders “disagreed” that it had a negative impact and no stakeholders “strongly disagreed.” Thinking about the people their organization serves, key stakeholders were asked to rate their level of agreement with a variety of statements about COVID-19, including availability of testing, vaccination, and reliable information; susceptibility to misinformation; and likeliness to follow recommended safety protocols. Their responses are shown in the graph on the following page. While the majority of key stakeholders “agreed” or “strongly agreed” that testing, vaccination, and reliable information were available to the people their organization serves and that individuals wore recommended personal protective equipment (PPE), it is worth noting that 35%-45% of stakeholders did not agree with these statements. Also of note is that 55.5% of stakeholders “agreed” or “strongly agreed” that individuals were susceptible to misinformation about COVID-19. When asked about community groups that influenced the likeliness of individuals to follow COVID-19 safety protocols, family members were the most commonly identified group, followed by healthcare leaders and elected officials and political leadership. However, of note, nearly 10% of stakeholders

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Mount Nittany Health 2022 CHNA 75 “disagreed” or “strongly disagreed” that healthcare providers influenced likeliness to follow COVID-19 safety protocols. Key stakeholders were asked to identify the most likely sources of COVID-19 information for the people their organization serves. Key stakeholders rank ordered up to three responses with #1 the most likely source for information. An option to “write in” any source not included on the list was provided. Key stakeholder responses reflected wide use of diverse COVID-19 information sources. Social media was perceived as the top source of information, with 19.2% of stakeholders selecting it as the #1 source and 55.6% selecting it as a top three source. Friends and family were also a top source of information, along with national and local new sources/media. While 18.3% of stakeholders identified the CDC as a #1 source for information, only 31% identified it as a top three source. Similarly, only 24.5% of stakeholders identified the Pennsylvania Department of Health as a top three source for information. These findings, when considered with other COVID-19 insights and perspectives, indicate opportunity to promote reliable and trustworthy sources of health information, and to ensure consistent and accurate reporting across information channels. 1.6%0.8%1.6%3.9%0.8%7.8%3.1%11.7%14.8%15.0%8.6%6.2%3.1%5.5%19.5%18.0%28.9%16.4%18.1%22.7%19.4%21.1%9.4%42.2%41.4%19.5%34.4%35.4%34.4%45.0%37.5%44.5%15.6%21.9%10.9%16.4%21.3%21.1%10.1%15.6%21.1%0.0% 20.0% 40.0% 60.0% 80.0% 100.0%Were influenced by healthcare leaders to follow COVID-19safety protocols.Were influenced by family members to follow COVID-19safety protocols.Were influenced by religious leaders to follow COVID-19safety protocols.Were influenced by elected officials and politicalleadership to follow COVID-19 safety protocols.Wore recommended personal protective equipment toprotect themselves and others.Were susceptible to misinformation about COVID-19.Received reliable and culturally-/linguistically-appropriateinformation about the pandemic and how to stay safe.Received COVID-19 vaccination.Received COVID-19 testing when they needed it.COVID-19 Insights and Perspectives: The people my organization serves...Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

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Mount Nittany Health 2022 CHNA 76 Where were the people your organization serves most likely to get information about COVID-19? Percent Selecting as #1 Source Percent Selecting within Top 3 Sources Social media 19.2% 55.6% Centers for Disease Control and Prevention (CDC) 18.3% 31.0% Friends/Family 18.3% 49.7% National news source/media 18.3% 42.9% Local news source/media 10.8% 35.4% Pennsylvania Department of Health 4.2% 24.5% Mount Nittany Health 3.3% 16.9% Other* 3.3% 7.6% Other healthcare providers (e.g., primary care providers, other local health systems) 1.7% 16.1% Political leadership 1.7% 8.5% Social/Civic organizations 0.8% 2.5% Health insurance providers 0.0% 0.9% Church/Religious leaders 0.0% 8.5% *Responses included key stakeholder organizations, case workers, and Centre County Correctional Facility. Community Resources to Impact Health Key stakeholders were asked to identify missing resources in the community that would help residents optimize their health. Stakeholders rank ordered up to three free-form responses with #1 as the top missing resource. The graph on the following page summarizes identified missing resources by category and number of mentions by key stakeholders. Access to care was the top identified missing resource category by key stakeholders, and within access to care, behavioral healthcare was the top identified service gap. Stakeholders identified a broad list of missing behavioral healthcare services, including inpatient and outpatient mental healthcare, pediatric mental healthcare, Medicare providers, drug and alcohol rehab, Bridge Programs, prescribing psychiatrists, and case management. Key stakeholders also identified the need for more local providers for both primary and specialty care. Stakeholders cited the need for more appointment availability with primary care providers and expanded specialty care services, including bariatric, cardiology, diabetes, geriatrics, interventional radiology, neurology, palliative care, and pediatrics. Note: no specialty services were identified by more than one stakeholder. The need for affordable healthcare, including dental care, and free or reduced cost services were also commonly identified by key stakeholders. Transportation was the second top identified missing resource by key stakeholders. While transportation needs were cited for all of Centre County, stakeholders largely prioritized need within rural communities and areas outside the Centre Region.

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Mount Nittany Health 2022 CHNA 77 Identified community education and outreach opportunities addressed the need for accurate and consistent health information that reflects appropriate literacy levels and is available both digitally and in print. Print materials were considered important for older adults and individuals without internet. Key stakeholders were asked how community organizations, including MNH, can better serve underrepresented populations (Black, indigenous, immigrant/undocumented, people of color, LGBTQ+, and others) to achieve health and social equity. Stakeholders were invited to provide free-form comments about the topics. Select verbatim comments are included below.  “A campaign that visually shows underrepresented populations. Something similar to PSU's You Belong Here campaign.”  “Adjust care practices to address cultural differences and to reckon with long-held misunderstandings about health of historically excluded populations.”  “By going out into the community where the underrepresented populations are; going to them, through the agencies/businesses/religious communities that serve them.”  “Earmark funding to be spent locally on initiatives that decrease the negative impact of social determinants of health.” 4712142133101132691441Internet accessEconomic opportunity/supportHealthy food access (available/affordable)Community education & outreachHousing (quality/affordable)TransportationAccess to health care0 20 40 60 80 100 120Top Missing Community Resources by Number of Key Stakeholder MentionsKey Informants Selecting as a Top Missing Resource (#1 Ranking)Key Informants Selecting as a Missing Resource (Any Ranking)

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Mount Nittany Health 2022 CHNA 78  “Educate employees about inequities, hidden biases, and providing sensitive care. Assure all employees are treating clients with dignity and respect. In our program, we see firsthand how different clients are treated differently when seeking the same healthcare or assistance. This not only includes underrepresented populations, but also very young clients as well as lower-resource or less educated clients.”  “Have an intentional and ongoing action plan in regard to employee training, organizational culture-building and culture-keeping, and maintenance and improvements to facilities. Pay attention to the needs of all patients and visitors and listen to people's feedback and suggestions.”  “I would prefer not focus on inequities, but focus on inclusion in all we do moving forward. Create awareness of microaggressions and design strategies with representatives of underrepresented populations on the planning teams and subcommittees.”  “Many of our systems are coded to prevent certain identities from even being recorded. Better computer interface and documentation would be a big step. All staff needs to be better educated on diversity issues and better trained to interact with the public even, and especially, when individuals do not share their identities.”  “Marginalized groups will respond to facilities that have those groups represented on staff/boards. Public forum participation and opportunities to hear from those populations directly.”  “Translate documents into different languages, have information available in workplaces and other spaces where underrepresented populations are likely to be present, actually reach out to the populations mentioned (don't wait for them to come to you), ensure safety and acceptance when these populations reach out, have more people with similar backgrounds available to help.”  “We can do a better job of educating our staff regarding biases and racism. Many staff members have very little understanding or acknowledgement of biases and how they play a part in the delivery of healthcare. Additionally, we can continue to strive to represent all populations within our own health system staff.” Lastly, stakeholders were asked for recommendations on how MNH can better collaborate with their organization and others to improve the health and well-being of residents. Recommendations were provided as free-form comments. Select verbatim comments are included below by overarching theme. Access to Healthcare  “Better communication and collaboration for high - need clients.”  “Better connection/linkage to social supports/services and care.”  “Better ways to inform communities of existing health and well-being care options.”  “Continue to hire providers of color.”  “Improved access to telehealth and other telemedicine options. Better use of tech.”  “Increase outpatient Mental Health providers- one stop shop for appointments.”  “Mobile Health vans so every population can be served.”

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Mount Nittany Health 2022 CHNA 79  “More drug and alcohol counseling for individuals while incarcerated.”  “More training for physicians and nursing on aging adults and cognition/dementia.”  “Offer satellite testing or vaccination services at our location.”  “Patient transportation offerings.”  “Refer pregnant clients to Nurse - Family Partnership program.”  “Suicide prevention efforts focused at the clinical level.”  “Use strategies where people come to clinic and receive an array of medical services - dr., nurse, labs, nutrition, mental health, similar to Dialysis clinic - treat people holistically with a case management approach.” Community Outreach  “Collaboration on education and outreach.”  “Come out into the community for events.”  “Encourage staff to increase their involvement in local government, school boards, civic organizations, and volunteer engagements.”  “Have and provide us information about free clinics/screenings.”  “Highlight Mount Nittany Health's commitment to community - social media, local radio, Centre County printed news, etc.”  “Information fairs/activities in the community, throughout the county.”  “Include more community events where people talk about their needs and barriers.”  “Mount Nittany did an excellent job with their vaccine clinics. Use similar strategies for other needs.”  “Promoting our services.”  “Push out health information that is written for people with low information literacy.”  “Regularly keep us informed of the challenges experienced and ways you are addressing them.”  “We miss the Community Partnership for Health opportunity that linked Mount Nittany with community groups.” Other  “Allow space for innovative thinking, problem solving, and collaboration with organizations that serve at risk populations.”  “Be up-to-date on the latest domestic violence/sexual assault scientific literature.”  “Continue the grant partnership - very valuable!”  “Having a yearly meeting on how we can partner around serving the homeless.”  “Help find funding for new and innovative collaborations and programs.”  “Partner with school districts, county government, and local social service organizations to do community outreach or make referrals to services that impact social determinants of health.”  “Promote affordable housing initiatives, especially outside Centre Region.”  “Share resources - contribute funding to local initiatives that impact social determinants of health.”

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Mount Nittany Health 2022 CHNA 80 Mount Nittany Medical Center Utilization Data Background As part of the 2022 CHNA, Mount Nittany Medical Center utilization data were analyzed to assess patient trends related to key community health needs, including chronic disease prevalence, management and behavioral health. The data were analyzed by zip code and payer type, as available, and correlated with public health and socioeconomic measures to identify utilization patterns among high-risk populations and to improve patient outcomes. It is important to consider public health data with utilization data as each year much of the population will not have contact with any of the medical center’ departments. Therefore, their health concerns are not measured by health provider data. Utilization data were analyzed for calendar years 2019 and 2020, and the first and second quarters of 2021 (Q1 - Q2 2021). Data were analyzed across the inpatient (IP), outpatient (OP), and emergency department (ED) settings. Nationally, healthcare use decreased in spring 2020 due to delayed or avoided medical care because of concerns about COVID-19 and cancellations of elective care. The cancellation of elective care was taken to increase hospital capacity for the care of individuals affected by COVID-19 and to mitigate community spread of the virus. Healthcare use rebounded in the latter part of 2020 as in-person care resumed for hospital and lab services and COVID-19 testing became more widely available. However, overall healthcare utilization was lower in 2020 than in prior years. Recognizing the impact of COVID-19 on healthcare, Mount Nittany Medical Center utilization data were analyzed for the period before and during the pandemic. Utilization patterns related to key health issues, including ambulatory care sensitive* and behavioral health conditions, were trended annually to demonstrate changes in demand for services and to predict patient needs moving forward. *Ambulatory care is care provided on an outpatient basis and includes diagnosis, observation, treatment, etc. Ambulatory care sensitive conditions are conditions that if effectively managed in an outpatient setting, should not be the primary reason for a hospital visit. Ambulatory care sensitive utilization trends can identify access to care barriers and inform the need for community health management resources. The following is a full analysis of Mount Nittany Medical Center utilization data as it relates to the 2022 CHNA. Utilization Data Key Findings Chronic Condition Prevalence Chronic conditions are among the most common health problems affecting Americans. According to the CDC, “Six in ten Americans live with at least one chronic disease, like heart disease, cancer, or diabetes. These and other chronic diseases are the leading causes of death and disability in the US, and they are also a leading driver of healthcare costs.”

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Mount Nittany Health 2022 CHNA 81 The following table illustrates the top zip codes of residence for Mount Nittany Medical Center patients who are managing a chronic condition. Patients from these zip codes accounted for 50% or more of all visits with a chronic condition listed on the patient record. Data were analyzed across nine chronic conditions: Asthma, behavioral health (BH), cancer, chronic obstructive pulmonary disorder (COPD), congestive heart failure (CHF), coronary artery disease (CAD), diabetes, hypertension (HTN), and substance use disorder (SUD). Note: The condition may not be the primary reason for the visit or the primary diagnosis. Recognizing the relationship between social determinants of health and health status, socioeconomic measures are shown for the top zip codes for chronic condition prevalence to assess their potential impact on healthcare utilization. At the time of the 2016 CHNA, only three zip codes were identified as driving 50% or more of visits with a chronic condition listed on the patient record: 16801, 16803, and 16823. These zip codes comprise the majority of the Centre County population, which will influence prevalence rates. Since the 2019 CHNA, other zip codes, spanning more rural portions of the county, have also been identified as top areas of patient origin. Notably, zip codes 16866, Philipsburg and 17044, Lewistown represent an increasing proportion of patients who are managing a chronic condition. While this finding may suggest overall higher patient volumes from these areas, it is worth noting that both zip codes have the highest Community Need Index (CNI) score in their respective county, indicating higher overall socioeconomic need. Among Philipsburg and Lewistown patient visits, the largest increases in chronic disease prevalence were seen for behavioral health, diabetes, and/or coronary artery disease. At the time of the 2019 CHNA, patients from Philipsburg zip code 16866 accounted for 4.6% of all visits with a behavioral health diagnosis listed on the patient record. This proportion increased to 5.5% for the current analysis. Similarly, at the time of the 2019 CHNA, patients from Lewistown zip code 17044 accounted for 3.6% of all visits with a coronary artery disease diagnosis and 4.7% of all visits with a diabetes diagnosis listed on the patient record. These proportion increased to 4.6% and 6.4%, respectively, for the current analysis. Zip Codes Accounting for 50% or More of Chronic Condition Prevalence Across Inpatient, Outpatient, and Emergency Department Settings, 2019 – Q2 2021 Zip Code Asthma BH Cancer COPD CHF CAD Diabetes HTN SUD 16823, Bellefonte 19.4% 19.6% 14.6% 23.2% 23.4% 20.1% 20.2% 16.9% 20.3% 16801, State College 14.4% 16.4% 15.7% 10.3% 15.7% 12.5% 11.6% 12.4% 12.7% 16803, State College 9.2% 9.5% 10.2% 5.2% 7.7% 6.7% 6.4% 7.2% 6.3% 16866, Philipsburg 5.3% 5.5% 3.9% 5.7% 6.5% 6.0% 4.5% 4.5% 5.6% 16828, Centre Hall -- -- -- 4.0% -- 4.0% 3.9% 4.1% 2.6% 17044, Lewistown* -- -- -- -- -- 4.6% 6.4% 5.6% -- 16870, Port Matilda 3.9% -- 3.7% 3.2% -- -- -- -- 3.0% 16827, Boalsburg -- -- 3.1% -- -- -- -- -- -- Sum of above zip codes 52.2% 51.0% 51.2% 51.6% 53.3% 53.9% 53.0% 50.7% 50.5% *Lewistown is located in Mifflin County. All other zip codes are located in Centre County.

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Mount Nittany Health 2022 CHNA 82 Social Determinants of Health Indicators by Zip Code Population in Poverty Children in Poverty Less than HS Diploma No Health Insurance CNI Score 16823, Bellefonte 5.7% 6.6% 8.4% 4.7% 2.4 16801, State College* 33.6% 12.8% 2.6% 3.9% 3.2 16803, State College* 23.4% 10.9% 1.9% 4.7% 3.0 16866, Philipsburg 14.8% 18.7% 17.8% 4.9% 3.6 16828, Centre Hall 7.8% 10.2% 3.2% 5.6% 1.8 17044, Lewistown 15.1% 25.0% 10.4% 4.4% 3.2 16870, Port Matilda 3.3% 1.8% 4.7% 2.4% 1.2 16827, Boalsburg 6.3% 8.8% 0.5% 1.3% 2.2 *Data are likely impacted by PSU students. Ambulatory Care Sensitive (ACS) Conditions Ambulatory care is care provided on an outpatient basis and includes diagnosis, observation, treatment, etc. Ambulatory care sensitive conditions are conditions that if effectively managed in an outpatient setting, should not be the primary reason for a hospital visit. Ambulatory care sensitive utilization trends can identify access to care barriers and inform the need for community health management resources. The following graphs depict the top five ACS conditions based on prevalence within Mount Nittany Medical Center IP and ED settings. The conditions represent the primary diagnosis or reason for the hospital visit. Ambulatory care sensitive conditions comprised a small proportion of overall IP and ED visits to Mount Nittany Medical Center. In 2019, the top five ACS conditions accounted for 6.9% of all IP visits and 3.7% of all ED visits. Consistent with past CHNA findings, behavioral health was the most prevalent condition in IP and ED settings. Substance use disorder was the second most prevalent condition in the ED. 2.8%1.1%1.0%0.7%1.4%2.4%1.2%1.0%0.9%0.7%2.5%1.2%1.1%1.0%0.9%0.0%0.5%1.0%1.5%2.0%2.5%3.0%Behavioral Health Diabetes Cancer Substance UseDisorderCOPDTop Five Ambulatory Care Sensitive Conditions as a Percentage of Total Inpatient Visits2019 2020 Q1-Q2 2021

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Mount Nittany Health 2022 CHNA 83 The proportion of ED visits due to a behavioral health concern increased from 1.4% in 2019 to 2.1% in 2020, but these findings represent a decrease in utilization from prior CHNAs. At the time of the 2016 and 2019 CHNAs, behavioral health conditions accounted for 2.4% and 2.7% of all ED visits, respectively. Substance use disorder-related ED visits also declined, accounting for approximately 2% of ED visits at the time of the 2016 and 2019 CHNAs and 1.3% of ED visits in 2019 and 2020. Consistent with the decline in the proportion of ED visits due to behavioral health and substance use disorders, the number of visits also declined, even before the pandemic. Additional declines in 2020 were likely due in part to the impact of COVID-19 on overall healthcare services. It is worth noting that the number and proportion of IP visits due to substance use disorder increased from prior CHNAs, although they account for approximately 1% of all visits. Substance use disorders accounted for 0.5% of IP visits at the time of the 2019 CHNA and 0.9% of IP visits in 2020; the number of substance use disorder-related IP visits increased from 81 to 138 during the same time period. 1.4%1.3%0.4%0.4%0.3%2.1%1.3%0.5%0.5%0.3%2.2%1.4%0.7%0.4%0.4%0.0%0.5%1.0%1.5%2.0%2.5%Behavioral Health Substance UseDisorderHypertension Asthma DiabetesTop Five Ambulatory Care Sensitive Conditions as a Percentage of Total Emergency Department Visits2019 2020 Q1-Q2 2021

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Mount Nittany Health 2022 CHNA 84 Behavioral Health and Substance Use Disorder Patient Trends The following table depicts behavioral health-related ED visits by patient age for the top three primary diagnoses: anxiety, depression, and unspecified mood disorders. These diagnoses accounted for 76.8% of all behavioral health-related ED visits occurring from 2019 to Q2 2021. Consistent with prior CHNA findings, youth and young adults comprised about half of all depression and unspecified mood disorder-related visits and one-third of anxiety-related visits. An annual analysis of the top two behavioral health diagnoses in the ED, anxiety and depression, illuminates unique trends among both youth and older adults. While the total number of ED visits due to anxiety and depression declined from 2017 to 2020, the number of visits among youth under age 18 increased slightly. Notably, there were 57 ED visits among youth for depression in 2020, accounting for 27.4% of all depression visits. Among older adults aged 65 or over, the number of visits due to anxiety increased by nearly 50% from 2017 to 2019, although visits declined in 2020. The decline in visits in 2020 is likely due in part to the pandemic and fear of seeking services at the hospital. This trend should continue to be monitored and explored for unmet care needs among older adults. Behavioral Health Emergency Department Visits (Primary Diagnosis) by Top 3 Diagnoses and Patient Age, 2019 – Q2 2021 Anxiety Depression Unspecified Mood Disorder Count Percent Count Percent Count Percent Under 18 years 49 6.0% 116 23.2% 95 29.8% 18 – 24 years 249 30.4% 174 34.8% 76 23.8% 25 – 34 years 202 24.6% 86 17.2% 61 19.1% 35 – 44 years 101 12.3% 40 8.0% 27 8.5% 45 – 54 years 55 6.7% 33 6.6% 23 7.2% 55 – 64 years 62 7.6% 22 4.4% 19 6.0% 65 years or over 102 12.4% 29 5.8% 18 5.6% Total Visits 820 500 319 506473356189146988380145081116138751023819505295020040060080010001200140016002017 2019 2020 Q1-Q2 2021Behavioral Health and Substance Use Disorder Visit Trends in the Emergency Department and Inpatient Setting Behavioral Health IP Visits Behavioral Health ED VisitsSubstance Use Disorder IP Visits Substance Use Disorder ED Visits

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Mount Nittany Health 2022 CHNA 85 Anxiety-Related Emergency Department Visits (Primary Diagnosis) by Patient Age, Trended 2017 – 2020 2017 2019 2020 Count Percent Count Percent Count Percent Under 18 years 15 3.7% 21 6.3% 20 6.3% 18 – 24 years 131 32.1% 94 28.3% 91 28.6% 25 – 34 years 101 24.8% 81 24.4% 85 26.7% 35 – 44 years 47 11.5% 43 13.0% 34 10.7% 45 – 54 years 33 8.1% 19 5.7% 24 7.5% 55 – 64 years 45 11.0% 23 6.9% 30 9.4% 65 years or over 36 8.8% 51 15.4% 34 10.7% Total Visits 408 332 318 Depression-Related Emergency Department Visits (Primary Diagnosis) by Patient Age, Trended 2017 – 2020 2017 2019 2020 Count Percent Count Percent Count Percent Under 18 years 47 10.9% 38 19.5% 57 27.4% 18 – 24 years 177 41.1% 73 8.3% 66 8.2% 25 – 34 years 69 16.0% 27 3.1% 35 4.4% 35 – 44 years 34 7.9% 21 2.4% 12 1.5% 45 – 54 years 47 10.9% 9 1.0% 18 2.2% 55 – 64 years 44 10.2% 8 0.9% 11 1.4% 65 years or over 13 3.1% 19 2.2% 9 1.1% Total Visits 431 195 208 The following table depicts ED visits due to substance use disorder by primary substance (drug or alcohol) and patient age. Alcohol-related visits accounted for 88.4% of the total ED visits due to substance use disorder occurring from 2019 to Q2 2021. Consistent with prior CHNA findings, approximately 66% of alcohol-related visits occurred among patients aged 18 to 24, while 69% of drug-related visits occurred among patients aged 25 or over.

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Mount Nittany Health 2022 CHNA 86 Substance Use Disorder Emergency Department Visits (Primary Diagnosis) by Primary Substance and Patient Age, 2019 – Q2 2021 Alcohol-Related Visits Drug-Related Visits Count Percent Count Percent Under 18 years 16 1.1% 6 3.2% 18 – 24 years 945 66.0% 52 27.8% 25 – 34 years 144 10.1% 54 28.9% 35 – 44 years 115 8.0% 49 26.2% 45 – 54 years 105 7.3% 13 7.0% 55 – 64 years 87 6.1% 7 3.7% 65 years or over 20 1.4% 6 3.2% Total Visits 1,432 187 Among alcohol-related visits, the number of visits by youth under age 18 declined, even before the pandemic. This finding is consistent with public health data that showed declining alcohol use among youth countywide. The number of drug-related ED visits was stable or declined from 2019 to 2020 for all age groups except 25–34-year-olds. The number of drug-related ED visits among adults aged 25-34 nearly doubled from 2019 to 2020 and was consistent with 2017 findings. Alcohol-Related Emergency Department Visits (Primary Diagnosis) by Patient Age, Trended 2017 – 2020 2017 2019 2020 Count Percent Count Percent Count Percent Under 18 years 23 2.5% 4 0.5% 7 1.6% 18 – 24 years 627 68.5% 535 70.4% 266 61.3% 25 – 34 years 93 10.2% 64 8.4% 46 10.6% 35 – 44 years 50 5.5% 50 6.6% 42 9.7% 45 – 54 years 73 8.0% 62 8.2% 27 6.2% 55 – 64 years 32 3.5% 31 4.1% 40 9.2% 65 years or over 17 1.9% 14 1.9% 6 1.4% Total Visits 915 760 434

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Mount Nittany Health 2022 CHNA 87 Drug-Related Emergency Department Visits (Primary Diagnosis) by Patient Age, Trended 2017 – 2020 2017 2019 2020 Count Percent Count Percent Count Percent Under 18 years 4 3.7% 4 6.0% 2 2.8% 18 – 24 years 39 36.1% 20 29.9% 21 29.6% 25 – 34 years 28 25.9% 15 22.4% 26 36.6% 35 – 44 years 17 15.7% 19 28.4% 13 18.3% 45 – 54 years 10 9.3% 4 6.0% 5 7.0% 55 – 64 years 7 6.5% 3 4.5% 3 4.2% 65 years or over 3 2.8% 2 3.0% 1 1.4% Total Visits 108 67 71 Behavioral Health and Substance Use Disorder Comorbidities Behavioral health and substance use disorders can also present as comorbidities, particularly among patients with chronic conditions. Behavioral health comorbidities were present for nearly 30% of IP visits due to a select primary chronic condition diagnosis and nearly 20% of ED visits. Substance use disorder comorbidities were present for a similar percentage (20%-22%) of IP and ED visits due to a primary chronic condition diagnosis. Behavioral Health and Substance Use Disorder Secondary Diagnoses (Comorbidities) among Inpatient and Emergency Department Visits due to a Chronic Condition*, 2019 – Q2 2021 Behavioral Health Comorbidities Substance Use Disorder Comorbidities Count Percent Count Percent Inpatient Setting 594 29.7% 392 19.6% Emergency Department Setting 353 19.3% 403 22.0% *Chronic conditions included Asthma, Cancer, COPD, CHF, CAD, Diabetes, and Hypertension. Chronic conditions can be more difficult to manage if a patient has a behavioral health and/or substance use disorder comorbidity. The following charts examine the prevalence of comorbidities among IP and ED visits due to select chronic conditions. Note: the chronic condition was the primary diagnosis or reason for the visit, while behavioral health and substance use disorder diagnoses were secondary conditions. Within the IP and ED settings, visits due to a primary diagnosis of COPD or diabetes were among the most likely to have a behavioral health and/or substance use disorder comorbidity. Notably, approximately 40% of IP visits due to COPD or diabetes had a behavioral health comorbidity, and 37% of visits due to COPD had a substance use disorder comorbidity. In the ED setting, approximately 20% of visits due to COPD or diabetes had a behavioral health comorbidity, and 44% of visits due to COPD had a substance use disorder comorbidity. These findings are consistent with national healthcare trends.

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Mount Nittany Health 2022 CHNA 88 Behavioral health and substance use disorders also often present together. Among IP and ED visits due to a behavioral health diagnosis, approximately 40-50% of visits had a co-occurring substance use disorder. Within the IP setting, nearly 62% of visits due to a substance use disorder had a co-occurring behavioral health disorder. Readmission Rates The following tables show 30-day all-cause readmission rates by age and zip code. Readmissions include admission to Mount Nittany Medical Center for any reason within 30 days of the initial visit. Nearly 66% of readmissions were among patients aged 65 or older, and 40% were among patients aged 75 or older. The majority of readmissions occurred among patients residing in four zip codes: 16823, 16801, 16803, 30.6%100.0%20.0%43.2%30.4%17.1%36.9%23.8%61.7%13.9%46.4%12.8%37.4%11.0%12.1%21.2%14.3%100.0%0.0%20.0%40.0%60.0%80.0%100.0%120.0%Behavioral Health and Substance Use Disorder Diagnoses Among IP Visits due to a Primary Chronic Condition Diagnosis, 2019 - Q2 2021Behavioral Health Substance Use Disorder16.4%100.0%11.8%21.1%26.9%14.3%19.7%20.1%17.7%20.4%36.8%8.8%44.1%6.4%0.0%23.2%14.1%100.0%0.0%20.0%40.0%60.0%80.0%100.0%120.0%Behavioral Health and Substance Use Disorder Diagnoses Among ED Visits due to a Primary Chronic Condition Diagnosis, 2019 - Q2 2021Behavioral Health Substance Use Disorder

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Mount Nittany Health 2022 CHNA 89 and 16866. Note: while patients from zip code 16866, Philipsburg accounted for 7.6% of all readmissions, they had one of the highest readmission rates across Centre County at nearly 10%. 30-Day Readmissions by Patient Age, 2019 – Q2 2021 Number of Readmissions Percent of Total Readmissions Under 18 years 69 2.3% 18 – 24 years 47 1.6% 25 – 34 years 109 3.7% 35 – 44 years 135 4.6% 45 – 54 years 222 7.5% 55 – 64 years 427 14.5% 65 – 74 years 752 25.5% 75 years or over 1,186 40.2% Patient Zip Codes of Origin with Highest 30-Day Readmissions, 2019 – Q2 2021 Admissions Readmissions Readmission Rate Percent of Total Readmissions 16823, Bellefonte 7,483 689 9.2% 23.4% 16801, State College 5,174 421 8.1% 14.3% 16803, State College 3,064 234 7.6% 7.9% 16866, Philipsburg 2,265 223 9.8% 7.6% The following table calculates 30-day all-cause readmission rates among patients admitted to Mount Nittany Medical Center for a chronic condition (primary diagnosis). The inpatient readmission rate for the medical center was highest among patients with congestive heart failure (13.4%), followed by chronic obstructive pulmonary disorder (11.4%) and cancer (11.1%). Readmissions by Chronic Condition as Primary Diagnosis, 2019 – Q2 2021 Admissions 30-Day Readmissions 30-Day Readmission Rate Congestive heart failure 5,580 745 13.4% Chronic obstructive pulmonary disorder 4,438 507 11.4% Cancer 1,519 169 11.1% Coronary artery disease 7,158 677 9.5% Diabetes 8,146 729 8.9% Behavioral health 11,534 955 8.3% Substance use disorder 6,242 429 6.9% Hypertension 11,688 588 5.0% Asthma 2,838 123 4.3% Research findings from the utilization data analysis were compared to secondary public health and socioeconomic findings to compare healthcare and community trends, identify high-risk populations, and assess contributing social determinants of health factors.

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Mount Nittany Health 2022 CHNA 90 Partner Forum Summary Background As part of the CHNA, Mount Nittany Health hosted a virtual Partner Forum on Tuesday, March 1, 2022. A total of 72 people attended representing Mount Nittany Health, health and social service agencies, senior services, local government, and civic organizations. The objective of the forum was to share data from the CHNA and garner feedback on community health priorities, as well as opportunities for collaboration among partner agencies. Research from the CHNA was presented at the session. Small group dialogue was facilitated to discuss research findings, existing resources and initiatives to address priority areas, the impact of COVID-19 on communities and services, and new or innovative opportunities for cross-sector collaboration. Small Group Discussion Following the presentation of the CHNA research, participants were asked to reflect on the findings to share takeaways and key insights for addressing priority needs. A common discussion guide was used to facilitate conversation and capture participant feedback. Participants were instructed through a two-part facilitation that asked the following questions: Applying Lessons from COVID-19 1. What are striking findings from the CHNA research? Have these findings changed with COVID? 2. What challenges brought about by COVID will take our community the longest time to recover from? 3. What COVID responses/reactions within our community brought about new ways of doing things that will continue to benefit individuals and families? 2022 CHNA Partner Forum Agenda  Welcome and Opening Remarks  2022 CHNA Overview and Research Findings  Centre County Community Updates (Centre County Foundation, Centre County Government, Centre County United Way)  Small Group Facilitated Breakout Discussion  Conclusion

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Mount Nittany Health 2022 CHNA 91 Measuring Impact 1. What stands out to you as a significant accomplishment in recent years that has most impacted the community? 2. What does it take to get to the next level? Where do you see opportunity to grow your offerings and/or expand? Who are your partners today, and who would you like to partner with in the future? 3. What are opportunities to foster community and clinical linkages to reduce health and social inequities? How is your organization working to foster community equity? What has been successful? Key Themes Applying Lessons from COVID-19 1. What are striking findings from the CHNA research? Have these findings changed with COVID?  COVID exacerbated mental health concerns across all ages due to isolation, economic stress, and limited-service availability during the pandemic; preliminary findings for 2022 suggest the county could see more suicide deaths this year than in prior years  Disparities in life expectancy and related health outcomes are prevalent in rural communities, and are largely rooted in social determinants of health differences (e.g., poverty, food insecurity)  Transportation continues to be a challenge, particularly in rural communities, and may have been exacerbated by higher demand for access to community resources during the pandemic  Approximately 45% of county households were considered ALICE (asset-limited, income-constrained, employed) before the pandemic; this proportion likely grew with job loss and other economic pressures experienced by individuals (Consider updating the CHNA data annually to measure the ongoing impact of COVID-19)  Despite COVID, Centre County saw improvements in many measures of health and social well-being and continues to be one of the healthiest counties in the state 2. What challenges brought about by COVID will take our community the longest time to recover from?  Adjusting back to normal life; people have adapted an isolated lifestyle, contributing to lower attendance and engagement in community events  Affordable housing was an emerging issue before COVID; the pandemic exacerbated this issue, continuing to push affordable housing farther outside the Centre Region  COVID widened economic disparities; some families did better due to stimulus payments and lower household costs, while others, particularly in the service industry, experienced severe hardship as a result of job loss and now rising inflation  Delayed care practices in 2020 and 2021 have contributed to both high demand for healthcare services in 2022 and higher acuity patients, during a time of unprecedented staffing shortages o Clinical staffing shortages have contributed to long patient wait lists and/or no available specialty appointments, particularly for behavioral healthcare  Increasing reliance on virtual services has highlighted disparities in internet and technology access, as well as technological expertise, particularly among older adults

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Mount Nittany Health 2022 CHNA 92  Isolation and the shift to virtual care and services may create an unintentional barrier to reporting and/or identifying issues at home (e.g., abuse or neglect)  Loss of academic and social emotional learning among youth is anticipated to have long-term negative impacts  Political polarization during the pandemic created mistrust and animosity for healthcare providers and other reliable sources of health information  Rising inflation has contributed to higher agency operating costs, depleted revenues  Social service staffing shortages have limited service capacity and created longer wait times; these shortages are anticipated to be a long-term issue requiring smaller/leaner operations  The pandemic contributed to more anxiety, depression, and other mental health concerns, particularly among youth and older adults; additionally, the pandemic forced some individuals to prioritize caring for their families versus themselves, potentially exacerbating health needs and delaying their early detection  Other impacts of COVID, including “long-COVID” disease symptoms, obesity due to diet and physical activity lifestyle changes during the pandemic, and food shortages or scarcity 3. What COVID responses/reactions within our community brought about new ways of doing things that will continue to benefit individuals and families?  Advancements in telehealth and expedited use across healthcare and social service agencies o Community agencies will likely continue telehealth services as a way of expanding access to care, creating flexibility for attending activities and events, and addressing persistent access barriers like transportation and childcare o Some agencies (e.g., Veterans Affairs) have started providing computer devices and technology support to clients  Development of new, virtual interactive programs by community agencies that allow them to offer relevant material in real-time (e.g., Mental Health First Aid)  Ability to leverage Zoom and other conferencing applications to gather for social events  Greater acknowledgement and appreciation among health and social service providers  Greater awareness and use of community social service resources  New convenience options, such as grocery store food delivery  New federal funding for emergency social services have allowed more people to be served by community agencies during the pandemic, but providers are concerned about what happens to these individuals when funding is no longer available; financial support for housing and childcare were specifically identified by participants  Remote work options have expanded applicant pools to fill labor shortages and have created more flexible work schedules for better work-life balance  The YMCA’s approach of “going to where they are” for food distribution is a model for increasing access to other services across the county

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Mount Nittany Health 2022 CHNA 93 Measuring Impact 1. What stands out to you as a significant accomplishment in recent years that has most impacted the community?  Based on prior data trends, Centre County anticipated fewer overdose-related deaths and other measures of addiction in 2021; this trend held true even with the pandemic  Centre County has been successful in lowering incarceration rates by approximately 50% over the past six years; some of this success is attributed to the county’s Behavioral Health Diversionary Initiative to identify individuals with serious mental illnesses who are involved with the criminal justice system and redirect them to mental health treatment systems  Centre Helps has provided valuable assistance to individuals in crisis or struggling to make ends meet by helping them navigate the local safety net  COVID vaccine clinics successfully provided countywide vaccination options  Greater community awareness of behavioral health concerns and investment in services by Centre County Government, including a new crisis center offering 24-hour phone and mobile services o A 24/7 walk-in crisis center was added at 2100 East College Avenue o Mobile crisis services were expanded to be responsive to the needs of school districts and law enforcement; the county is also seeking funding for a crisis residential center  Growth of CATAGO! services in Bellefonte has improved transportation options with on-demand, curb-to-curb, shared ride shuttles  Outdoor recreation facilities saw higher use during the pandemic, and the community has invested in organizations that promote outdoor healthy lifestyles (e.g., Harvest Fields Community Trails, Happy Valley Adventure Bureau, ClearWater Conservancy)  New indoor recreation opportunities (e.g., C3 sports, Nittany Valley Sports Centre)  Out of the Cold purchased a new building to help shelter individuals experiencing homelessness  The Centre County United Way Hamer Foundation Community Disaster Fund provided financial support during the pandemic to assist families in meeting basic needs (e.g., housing, food, utilities, medical bills, childcare); about 600 families have received financial assistance  The community saw an uptick in “Asian hate” as a result of the pandemic; agencies are pursuing mechanisms to discuss, identify, and increase reporting of these occurrences  The COVID pandemic fostered community connectedness, including looking out for neighbors, especially the elderly or infirmed 2. What does it take to get to the next level? Where do you see opportunity to grow your offerings and/or expand? Who are your partners today, and who would you like to partner with in the future?  A countywide assessment of industry wages to measure cost of living disparities and racial inequities  Centre Helps serves as a local call center for the National Suicide Prevention Lifeline and this summer, will begin receiving all local calls to the Lifeline; while this approach will provide better response to resident calls, Centre Helps is anticipating high call volumes due to COVID and the Lifeline is currently staffed by volunteers – additional funding and support is being explored  Collective planning and action among community leaders is needed to impact economic and health outcomes, and develop creative solutions for persistent issues like behavioral health

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Mount Nittany Health 2022 CHNA 94  Consistent with physical health strategies, community partners need to explore opportunities to promote mental wellness, while providing comprehensive services for mental illness  Embedded case managers at both primary care practices and social service agencies to help navigate the safety net system and conduct home visits as needed  Expanded local acute care services; more partnerships with Mount Nittany Health to promote programs like Centre Moves and enhance wrap-around services for patient populations (e.g., pregnant people)  Leveraging social and religious organizations to disseminate information and services  Mobile or satellite health and social services to better meet the needs of rural communities  Opportunities like the Partner Forum to share data, learn about existing community resources, and network with other providers  Partnership with Penn State University to develop a pipeline for diverse, minority applicants at the medical center  Standards of care and engagement for all populations, particularly those currently marginalized, so that efforts can shift from reactive to proactive  Support for statewide and federal initiatives to improve internet connectivity in rural areas  The county has been largely successful in meeting food-related needs for residents, but requires additional support for housing-related needs, including affordable housing inventory and case managers to assist individuals in accessing short-term shelter and long-term stabilized housing  “The death of George Floyd represents a DEI tipping point moment” for our communities; awareness has been raised that all population groups, ethnicities, etc. need to be supported and we need to take advantage of this opportunity 3. What are opportunities to foster community and clinical linkages to reduce health and social inequities? How is your organization working to foster community equity? What has been successful?  Continue efforts to destigmatize issues like homelessness and mental health through community education and conversation  Create more opportunities for community agencies to share and promote available resources, and foster a collective community approach versus individual planning in silos or sectors  Expand connection groups for pregnant people and new parents  Explore multi-faceted and cross-organizational solutions to address transportation needs, particularly in rural communities  Explore opportunities for collaboration between hospitals and community-based organizations to both increase affordable housing inventory (e.g., hospital as developer) and provide healthcare services within community shelters  Explore opportunities to include mental health professionals in police response to individuals in psychiatric or substance use crises  Explore partnership opportunities with PSU’s Health Services and Student Affairs  Replicate Patton Township’s efforts to assess affordable housing needs and present actionable recommendations to expand and maintain inventory  Streamline referrals between health and social service agencies to better meet the holistic needs of residents, centralize resources, and decrease response time for crisis situations  Use new virtual technologies to assist in navigating resources between community agencies

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Mount Nittany Health 2022 CHNA 95 Provider Engagement Survey Background An online Provider Engagement Survey was conducted with healthcare providers, leadership, and staff employed by Mount Nittany Health (MNH). The survey was conducted to support MNH’s ongoing efforts to improve access to care, reduce health disparities, and develop collaborative action planning to address the underlying social determinants of health (SDoH) that perpetuate disparate health outcomes. A total of 86 individuals responded to the survey. Participant demographics were included as optional questions to ensure confidentiality and are provided as available. More than half of survey participants worked at Mount Nittany Medical Center, while other participants worked across MNH primary and outpatient care sites. The largest proportion of participants identified as nurses, physicians, or physician assistants (22%-24%). The most represented age group was 35-44 (36%), followed by 45-54 (24%). Approximately 66% of participants identified as female and 24% as male. Primary Work Setting of Survey Participants (as provided) Number of Participants Percent of Total Mount Nittany Medical Center 29 58.0% Mount Nittany Health - Park Avenue 10 20.0% Mount Nittany Health - Bellefonte 6 12.0% Other* 6 12.0% Mount Nittany Health - Boalsburg 5 10.0% Mount Nittany Health - Blue Course Drive 3 6.0% Mount Nittany Health - Green Tech Drive 3 6.0% Mount Nittany Health - Mifflin County 3 6.0% Mount Nittany Health - Penns Valley 2 4.0% Mount Nittany Health - Philipsburg 2 4.0% Cardiovascular Pavilion 1 2.0% Mount Nittany Health Surgical Center 1 2.0% *Responses included emergency department, pediatrics, reconstructive & cosmetic surgery, multiple sites.

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Mount Nittany Health 2022 CHNA 96 Role of Survey Participants (as provided) Number of Participants Percent of Total Nurse 12 24.0% Other* 12 24.0% Physician 11 22.0% Physician associate (assistant) 6 12.0% Case manager 5 10.0% Behavioral health provider 4 8.0% Nurse practitioner 1 2.0% Medical assistant 1 2.0% Social worker 1 2.0% *Responses included management, registrar, allied health professional, caregiver, faith-based organization. Age Group of Survey Participants (as provided) Number of Participants Percent 18-24 years 1 2.0% 25-34 years 6 12.0% 35-44 years 18 36.0% 45-54 years 12 24.0% 55-64 years 7 14.0% 65 years or more 1 2.0% Prefer not to answer 5 10.0% Survey participants were asked a series of questions about access to care and social services, perspectives on the impact of COVID-19 and SDoH on patient outcomes, and opportunities to promote health and well-being and inclusive care environments. A summary of their responses follows. Survey Findings Social Determinants of Health Impact Thinking about the people their care site serves, survey participants were asked to rate the impact of SDoH and COVID-19 on health outcomes and perceptions of SDoH training needs. Ratings were provided using a scale of (1) “strongly disagree” to (5) “strongly agree,” with an option for “not applicable (NA).” Nearly 63% of survey participants “agreed” or “strongly agreed” that SDoH negatively impacted the health of patients and their families, and nearly 85% “agreed” or “strongly agreed” that COVID-19 negatively impacted patients by exacerbating SDoH needs. Less than 40% of participants “agreed” or “strongly agreed” that their care site had the right amount of training and resources to address SDoH.

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Mount Nittany Health 2022 CHNA 97 Survey participants were asked to rate their level of comfort in identifying and discussing SDoH with patients. Participant responses indicated varying perceptions, with slightly more than half stating they are “comfortable” or “very comfortable,” one-quarter stating they were “neither uncomfortable nor comfortable,” and 1 in 10 stating they were “uncomfortable” or “very uncomfortable.” Please rate the following statements: Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree NA The SDoH negatively impact the health of the patients and families my care site serves. 2.3% 17.4% 15.1% 33.7% 29.1% 2.3% The COVID-19 pandemic has had a negative impact on my care site’s patients because it exacerbated various SDoH. 1.2% 7.1% 5.9% 54.1% 30.6% 1.2% My care site has the right amount of training and resources to address patient/family needs related to SDoH. 4.7% 38.4% 18.6% 31.4% 5.8% 1.2% Please rate your level of comfort in performing the following tasks related to SDoH: Very Uncomfortable Uncomfortable Neither Uncomfortable nor Comfortable Comfortable Very Comfortable NA Identifying SDoH that impact optimal healthcare for patients. 1.2% 9.4% 28.2% 43.5% 15.3% 2.4% Discussing SDoH that impact health during your patients’ office visits. 1.2% 11.8% 22.4% 45.9% 9.4% 9.4% Approximately 55% of survey participants indicated that their care site actively screens patients for SDoH, including home life, food security, housing, etc. When SDoH needs are identified among patient populations, the most common care site response was to refer them to community-based or other external resources for assistance and/or use patient navigators, case managers, social workers, or other staff to assist them. Nearly 10% of participants indicated that their care site does not address SDoH needs and 16.5% were unsure of their care site’s response. Awareness of available SDoH resources and the process for referring patients to them varied widely among survey participants. A nearly equal proportion of participants were aware of both available SDoH resources and the referral process for them (31.0%) or neither of these factors (27.4%).

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Mount Nittany Health 2022 CHNA 98 *Other responses by survey participants:  “As a case manager I am directly involved with the SDoH issues. We are currently lacking resources and time to manage all the social issues for these folks.”  “Attempt to get transportation or change workflows to accommodate certain patient transportation issues.”  “Based on individual case.”  “I know we have provided Crisis information and have a LGBT friendly therapist.”  “UBER assistance for students.” If you identify SDoH needs among your patients, are you aware of available resources and the process for referring patients to them? Percent I am aware of both available resources to address SDoH needs and the process for referring patients to them. 31.0% I am aware of available resources to address SDoH needs, but not the process for referring patients to them. 26.2% I am not aware of available resources to address SDoH needs, but I am aware of the process for referring patients to them. 15.5% I am not aware of either available resources to address SDoH needs or the process for referring patients to them. 27.4% Thinking about SDoH, survey participants were asked to identify the top three needed social services for patients. Participants rank ordered up to three free-form responses with #1 as the top needed service. The following table summarizes identified needs by category and number of mentions by participants. 5.9%9.4%9.4%16.5%38.8%55.3%60.0%61.2%Other*Provide food, clothing, or other assistance at care siteNoneNot sureRecord SDoH data in electronic health recordsScreen patients about their home life, food security,housing, etc.Use patient navigators, case managers, social workers, orother staff to help patients with SDoH needsRefer patients to community-based or other externalresources for assistance0.0% 20.0% 40.0% 60.0% 80.0%How does your care site currently address SDoH? Check all that apply.

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Mount Nittany Health 2022 CHNA 99 It is worth noting that while survey participants were asked to identify the top three needed social services for patients, the top identified need was mental health services, including counseling, outpatient care, and psychiatry. Related to social needs, transportation was the top identified gap. Other top identified service gaps were economic stability and senior and caregiver support, with a focus on in-home care, adult day care, and long-term care options. Identified economic stability needs spanned both career and wage opportunities and financial assistance programs to meet basic needs, such as affordable, nutritious food. What are the top social services or external community factors that would help improve SDoH for patients? Rank order up to three responses. #1 Social Service Gap Top 3 Social Service Gap Number of Mentions Number of Mentions Mental health services (counseling, outpatient, psychiatry) 14 27 Transportation 8 23 Senior/Caregiver support (in-home care, adult day care, long-term care) 7 12 Economic stability (job opportunities, financial assistance) 6 16 Case managers/social workers 5 5 Housing (affordable, safe, shelter options) 4 9 Healthcare cost assistance (medications, copays/deductibles) 3 9 Dental care (affordable, uninsured care) 1 4 Diversity, Equity, and Inclusion (training, diversity in staff) 1 4 Survey participants were asked to share suggestions that will help address patient SDoH needs. Select verbatim comments are included below. Common themes among participants included the need for awareness of available community social services and referral practices, onsite case management to support patients in navigating health and social services, more available mental health services, and enhanced partnerships between both clinical providers (e.g., primary care and behavioral health) and clinical and social service providers to co-locate and/or coordinate care.  “A lot of what we do for our patients has been streamlined to be done electronically. While this is very helpful and many have adapted to this, a large portion of our patient population does not have access to a computer or may not have family or friends that can help them do things on the computer. This can make patients very anxious and upset, thinking they are unable to get certain care.”  “Case management to help with connection and identification of problems, possibly help with resolution.”  “Collaboration between primary care & mental health services including psychiatric care & counseling services.”  “Conduct town halls open to the public on a regular basis to get community input. Look at ways to co-house with community partners providing supportive services such as mental health and job training - for a one-stop shop.”

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Mount Nittany Health 2022 CHNA 100  “Expanding access to primary care services on nights and weekends.”  “For patients that go by other names/genders than given at birth, we have to go into a patient’s chart and only then see if there's a different identity. I think we should be able to have this put in patients’ charts to be seen on the schedule and chart.”  “Have a homelessness coordinator that can assist the homeless in our community that visit our offices. This coordinator can have access to transportation to get the patients to and from appointments. Find places for them to stay if needed. Have resources for food and clothing or supplies for kids. Have connections to resources in the community to assist a family that may need these resources in the future.”  “I believe there is a need for outpatient case management. We need more home health services and caregivers. I'd like to see more mobile psych for patients that don't drive or won't get themselves to appointments.”  “It would be great to receive education from our community partners, to know exactly what they offer and how we can refer to them. Especially Office of Aging and Centre Co. Base Service Unit.”  “MNH and the community are in dire need of more mental health/counseling services as well as inpatient/addition support facilities.”  “Open forum as the community demographics change. Diverse representation in administration. Hiring of more minority/underrepresented races in positions where they have a real opportunity to enhance care and make positive changes.”  “Provide paid family leave so that employees can care for their children or other family members without stressing about lost pay.”  “The hospital must address improving transportation upon discharge from the hospital. Suggestions include a complimentary shuttle van with handicap accessibility. This often holds up discharges and increases length of stay and risk for the patient.”  “There used to be a social service person in the MNPG practice. As pt.'s are acutely ill in the hospital and we cannot address all of their social issues nor "fix" them it would be great to have a person or persons in the physician practices that we could call upon to let them know what we have started as far as referrals to community resources so that these things can be followed up on. This would also be a great role for a transitional care nurse in the physician practices.” Care Management Survey participants were asked to rate their level of agreement in how effectively their care site manages patient health and social needs and perceived benefit of enhanced care management and care coordination services. Ratings were provided using a scale of (1) “strongly disagree” to (5) “strongly agree,” with an option for “not applicable (NA).” The majority of survey participants “agreed” or “strongly agreed” that their care site effectively manages the clinical needs of patients. Participants had differing opinions on their care site’s effectiveness in managing social needs and coordinating care and services between Mount Nittany

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Mount Nittany Health 2022 CHNA 101 Medical Center and Mount Nittany Health primary care sites. Approximately 42%-50% of participants “agreed” or “strongly agreed” with these statements, while 17%-21% “disagreed” or “strongly disagreed.” Consistent with this finding, nearly three-quarters of participants “agreed” or “strongly agreed” that their care site would benefit from care management services. Please rate the following statements: Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree NA My care site effectively manages the clinical needs of patients. 0.0% 4.6% 16.7% 50.0% 25.8% 3.0% My care site effectively manages the social needs of patients. 1.5% 19.7% 27.3% 47.0% 3.0% 1.5% My care site would benefit from care management services. 0.0% 1.5% 13.6% 43.9% 30.3% 10.6% There is good coordination of care and services between Mount Nittany Medical Center and Mount Nittany Health primary care sites. 4.6% 12.1% 36.4% 36.4% 6.1% 4.6% Survey participants were asked to describe their ideal scenario for providing care management services at their care site. Select verbatim comments are included below. Common themes among participants included the need for dedicated case management staff, particularly for individuals seen in the ED and patients with chronic disease and/or behavioral health concerns; culturally competent and welcoming care settings for diverse patient populations; and enhanced communication and coordination of patient needs and services across clinical and community providers.  “Case management in the ED is diligent in attempting to schedule necessary outpatient f/up appointments for patients being discharged. For the mental health population this is challenging because there are not enough outpatient providers to fulfill the need. It is difficult for ED CM to provide continued f/up to be sure patient is successful in following through with scheduled appointments, as this falls within the parameters of an outpatient CM.”  “Case manager in office available to meet with patients with identified psychosocial needs. Referral could be initiated by provider or by patient themselves.”  “Completion of medication reconciliation for ALL patients.”  “Dedicated staff persons to do follow up phone calls for patients with chronic conditions visiting the ED to ensure they are taking their medications and following through with follow up visits and treatment plan to prevent return visits. Cannot rely on ED nurses in a care assignment to be able to make a thorough follow up call.”  “Having information for homeless shelters, women’s services, etc. I’d like to have "Safe space" signs for LGBTQ+ community.”

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Mount Nittany Health 2022 CHNA 102  “I think the needs of certain demographics are met at a higher rate than other demographics that are unrepresentative/misunderstood because we don’t have the right people to effectively assess the needs of diverse backgrounds/ needs.”  “Increased communication between our care management staff, so that both are aware when mutual clientele seek services of the other. Sharing of records, making referrals when services are needed of the other, opportunity to share updated information on resources that are available through our offices.”  “More case managers at all times for the ER. One case manager for psych patients and one case manager for medical patients at all times.”  “Patients have an alert that pops up identifying any barriers to their health like transportation, language, hearing, assistance needed, etc. and a plan is laid out for when the patient arrives prior to them coming through the door.”  “The primary focus of case management at MNMC is two-fold - utilization management and discharge planning. With providing both of these services it can be difficult to address all the social issues of our community. The caseloads can be between 15-20 patients most days. It can be difficult to provide "full service" as a result. As mentioned earlier having a resource person in the physician offices would be very helpful.”  “We have been using Rebecca Burkholder from the hospital for a pilot here in the DM office. She has been amazing. Having a devoted in-house care manager here is needed and would help us to better provide excellent care to many patients. We providers are wearing many hats here including case manager and social worker and it’s really difficult b/c we don't have the time or training to best help the patients in this way. An in-house case worker to work exclusively with our diabetes patients would be incredibly useful and a valuable resource.” Thinking about chronic disease care and management, survey participants were asked to identify the top three needed services to improve patient outcomes. Participants rank ordered up to three free-form responses with #1 as the top needed service. The following table summarizes identified needs by category and number of mentions by participants. The top identified service needed to improve chronic disease care and management was case management. Participants identified the need for case management in both primary and acute care settings and to assist with coordinating referrals, conducting patient and discharge follow-up, and providing social service assistance. Other top identified needs included medication reconciliation, mental health services, and education and hands-on coaching to promote healthy lifestyles and disease management.

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Mount Nittany Health 2022 CHNA 103 If you were to improve chronic disease care and management for your patient population, what are the top 3 things that you would need in your care setting? Rank order up to three responses. #1 Service Need Top 3 Service Need Number of Mentions Number of Mentions Case management 7 19 Medication reconciliation 4 4 Mental health services (counseling, psychiatric, walk-in care) 4 6 Healthy lifestyle and disease management education, coaching 3 7 Additional clinical staffing 1 3 Home healthcare 1 2 Screening/Needs assessment 1 2 More time with patients 1 1 Medication payment assistance 0 4 Community resource awareness 0 2 As follow up to this question, survey participants were asked to think specifically about diabetes care and management and to identify the top three needed services to improve diabetic patient outcomes. Participants rank ordered up to three free-form responses with #1 as the top needed service. The following table summarizes identified needs by category and number of mentions by participants. The top identified service needed to improve diabetes care and management was education and support. Participants identified the need for Diabetes Self-Management Education, in-office educators, and community programming. Other top identified needs included dietician support and dietary guidance (e.g., nutrition counseling, cooking classes, guided shopping) and medication cost assistance, including insurance coverage checks to ensure prescribed medications are covered by health plans. If you were to improve chronic disease care and management for your patient population, what are the top 3 things that you would need in your care setting? Rank order up to three responses. #1 Service Need Top 3 Service Need Number of Mentions Number of Mentions Diabetes education and support 9 22 Medication cost assistance 4 5 Dietician support/dietary guidance 2 6 Endocrinology access 2 4 Diabetes-specific case management 2 5 Care supply assistance (e.g., glucometers, test strips) 1 2 Digital care monitoring 0 2 Diversity, Equity, and Inclusion Diversity, equity, and inclusion (DEI) describes policies and programs that promote the representation and participation of different groups of individuals, including people of different ages, races and ethnicities, abilities and disabilities, genders, religions, cultures, and sexual orientations. Mount Nittany Health is assessing system wide training and resource needs to help improve DEI policies and programs.

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Mount Nittany Health 2022 CHNA 104 Approximately 88% of survey participants “agreed” or “strongly agreed” that it is valuable to examine and discuss the impacts of DEI on healthcare delivery and outcomes. Participants were asked to rate their current understanding of DEI and competency level in applying DEI practices in the healthcare setting. Ratings were provided using a scale of (1) “novice” to (5) “expert.” Participant responses indicated consistent perceptions of opportunity for DEI training and resources. No participant considered themselves an “expert” in DEI or applying DEI practices in the healthcare setting; approximately one-third considered themselves “proficient.” A lower proportion of participants (17%-21%) considered themselves “proficient” in ability to train others on DEI policies and programs or medical knowledge of health challenges that disproportionately affect vulnerable populations. Please rate your competency level related to Diversity, Equity, and Inclusion Novice Beginner Competent Proficient Expert Clear understanding of DEI and the difference between each term 0.0% 26.3% 40.4% 33.3% 0.0% Ability to train others on DEI policies and programs 26.3% 24.6% 31.6% 17.5% 0.0% Ability to apply DEI practices in the healthcare setting 10.5% 17.5% 40.4% 31.6% 0.0% Medical knowledge of health challenges that disproportionately affect vulnerable populations (e.g., metastatic breast cancer among women of color, mental health and substance use disorder among LGBTQ+ or non-binary youth) 8.8% 26.3% 42.1% 21.1% 1.8% Lastly, survey participants were provided with a list of DEI-related trainings and asked to indicate the trainings they have already received and/or that they think should be offered to MNH employees. Participants were mostly likely to have received cultural awareness and belonging and/or unconscious and implicit bias trainings. Approximately 60% or more of survey participants thought that all of the listed trainings should be offered to MNH employees, with the top recommendations of unconscious and implicit bias and antiracism trainings. Diversity, Equity, and Inclusion Training among MNH Employees I have received this training I think this training should be offered to MNH employees Neither Unconscious and implicit bias 33.9% 73.2% 10.7% Antiracism 26.3% 70.2% 12.3% LGBTQ+ gender identity and affirming 26.3% 68.4% 15.8% Addressing micro aggressions 21.1% 64.9% 21.1% Cultural awareness and belonging 40.4% 63.2% 10.5% Stereotyping 31.6% 63.2% 15.8% The meaning of DEI 28.6% 62.5% 17.9% Inclusive workspace training 29.8% 61.4% 17.5%

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Mount Nittany Health 2022 CHNA 105 Evaluation of Health Impact: 2019-2022 Community Health Improvement Plan Progress In 2019, Mount Nittany Health (MNH) completed a CHNA and developed a supporting three-year Implementation Plan for community health improvement. The Implementation Plan outlined our strategies for measurable impact on identified priority health needs, including behavioral health and substance use disorders and chronic disease. Within six months of the release of the 2019 Implementation Plan, the COVID-19 pandemic shifted the priorities of our community and MNH adapted our work to respond to the emergent needs of residents. The following sections outline our work to impact the 2019 CHNA priority health areas and respond to COVID-19 in our communities. Community Investment Mount Nittany Health is committed to creating healthier people and a stronger, thriving community. Through our expanded grant program, registered local and regional community organizations may apply for grants to help advance their missions in and around Centre County. The grant program aims to address the most pressing health issues facing our region, as identified by the CHNA, and improve quality of life across Centre County by supporting effective outcome-based projects and leveraging sustainable funding to empower positive solutions. COVID-19 Response Beginning in February 2020, MNH began preparations to care for our community for what is now known as the COVID-19 pandemic. Response to COVID-19 diverted significant health system and community resources as we worked to collectively address one of the worst public health crises in modern history. Mount Nittany Health became the community's trusted health advisor for COVID-19, providing not just care for those who became ill but relevant and factual information to help community members protect themselves, loved ones, and neighbors. We also proudly served as the first and leading COVID-19 vaccination provider during the early stages of vaccine distribution when supplies were limited. Mount Nittany Health provided over 51,000 vaccinations, cared for nearly 2,300 COVID patients, and conducted over 91,000 COVID tests. We developed a host of tools and campaigns to educate our community at large, including targeted marketing campaigns, videos, social media posts, and dedicated web pages. Behavioral Health and Substance Use Disorder 2019 Implementation Plan Goal: Improve overall well-being of residents by increasing access to care and encouraging resiliency, wellness, and self-management of behavioral health and/or substance use disorders.

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Mount Nittany Health 2022 CHNA 106 Increasing Awareness and Promoting Evidence-Based Strategies Mount Nittany Health supported diverse community initiatives to increase awareness of behavioral health and substance use disorder signs and symptoms, reduce stigma, promote available services across Centre County, and develop messaging and programs that promote integrated physical and behavioral wellbeing. These initiatives included the following: Red Folder Project Mount Nittany Health partnered with the Jana Marie Foundation and Suicide Prevention Task Force to provide 2,500 'Red Folders' to serve as quick reference guides to Centre County behavioral health resources. The folders were distributed to community gatekeepers, including faith-based leaders, school staff, and others. The folders included tips for how to approach someone who may be in distress and connect the individual with an appropriate resource. Question, Persuade, Refer; Mental Health First Aid; and Youth Mental Health First Aid Mount Nittany Health partnered with the Jana Mare Foundation to provide Adult and Youth Mental Health First Aid (MHFA) and Question, Persuade, Refer (QPR) suicide prevention training. These are reoccurring programs that MNH has funded for several years. Collectively, the program aims to teach participants how to identify, understand, and respond to signs of mental illness. Community members trained in QPR and MHFA:  71 Community members Trained in Mental Health First Aid  22 Community members in Youth Mental Health First Aid  60 Community members Trained in Question Persuade Refer  1 additional trainer certified in Youth Mental Health First Aid Community Based Education Mount Nittany Health partnered with community organizations to develop messaging programs that promote integrated physical and behavioral well-being and prevention and self-management tactics. Messages were disseminated through MNH communication channels, as well as community partner agencies. Shared information included the importance of behavioral health and wellness, available resources including crisis intervention support, and practical tips to well-being. Centred Outdoors Mount Nittany Health partnered with Clearwater Conservancy to offer Centered Outdoors and the Prescription PARx program. Centred Outdoors is designed to engage people in the natural world through guided, family-friendly outings. The PARx program allows physicians and other clinicians to prescribe time outdoors, encouraging patients to engage in more physical activity. The program provides a low barrier of entry for individuals of all physical fitness and skill levels to spend time hiking and being active.

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Mount Nittany Health 2022 CHNA 107 Youth Service Bureau Street Outreach Program The Street Outreach Program serves youth ages 5-17 in outlying, rural areas across the county. Many of these youth face adversities due to poverty, poor family relationships or parental supervision, lack of access to transportation, violence, and/or drug and alcohol issues in the family. The program builds critical mentorship connections, with the goal that participants will be able to name at least one adult they can turn to for help and demonstrate protective factors for avoiding drug and alcohol use. Program outcomes:  96% of youth were able to name at least one adult they can turn to for help (Goal: 90%)  97% of youth reported improved relationships with peers and family (Goal: 85%)  97% of youth demonstrated increased ability to make good decisions (Goal: 90%)  97% of youth demonstrated increased social and emotional competence (Goal: 90%) Increasing Access to Services and Improving Care Coordination Mount Nittany Health sought to improve patient outcomes related to behavioral health and substance use disorder through evidence-based and patient-centered care practices, case management services, screening and referral standards, and partnership with community-based providers. Strawberry Fields, Inc. (SFI) In partnership with SFI, MNH provided funding assistance for blended case management services and the purchase of the Wiley Treatment Planner. Funding support for blended case management services enabled SFI to assist with consumers' transportation needs for physical and behavioral health follow-up appointments, both reducing no-show appointments and improving follow-through for recommended care. The Wiley Treatment Planner provides over 1,000 evidence-based interventions for 31 presenting diagnoses and serves as a mobile management tool for better care coordination across providers. Centre County Mental Health Task Force Mount Nittany Health is an active collaborator within the Centre County Mental Health Task Force to identify and implement improvements in the delivery of crisis services and transitions of care. Per the recommendation of the Task Force, MNH created the Behavioral Health Interdisciplinary Committee to oversee mental health crisis patient response within the ED and other hospital settings. The committee is comprised of the ED lead physician, the behavioral health psychiatrist, the ED manager, the behavioral health manager, and the lead behavioral health case manager. Mount Nittany Health plans to identify a consulting liaison as an advisor on the promotion of inclusive and culturally responsive care settings. The charge to the Behavioral Health Interdisciplinary Committee includes:  Identify and adopt inclusive and evidence-based practices to enhance positive patient outcomes  Enhance two-way communication with families  Conduct internal clinical case reviews and data collection to seek opportunities to improve practice  Explore evidence-based processes, technologies (i.e., telemedicine), and protocols  Identify and review data to assess the effectiveness of the ED's mental health crisis response system

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Mount Nittany Health 2022 CHNA 108  Assess ongoing education and professional development needs to include, but not limited to, mental health crisis diagnosis and response, crisis intervention and de-escalation, cultural sensitivity, implicit bias, inclusivity, special populations, substance use disorder, serious mental illness (SMI), HIPAA applications, and 302 regulations/decisions  Review policies and procedures, e.g., develop a consistent intake process and HIPAA compliant feedback loop for patients brought to the ED by law enforcement and their family members  Review and implement applicable recommendations in the PA General Assembly's Joint State Government Commission Report, released in July 2020 Mount Nittany Health ED Psychiatric Liaison Program A Psychiatric Liaison position was created in the ED in 2016 to streamline processes and enhance the accuracy of care delivery strategies for patients with behavioral health disorders. Services were expanded to 24/7 coverage in 2018 as a result of reported improved patient care outcomes, including consistent and quality psychiatric assessments; coordinated care, referrals, and appointments within the MNH system and with community-based partners; decreased wait time in transition from the ED to the next level of care; and improved patient and provider satisfaction. Chronic Disease 2019 Implementation Plan Goal: Reduce risk factors for chronic disease and improve management of chronic disease conditions. Promoting Healthy Lifestyles and Addressing Social Determinants of Health Barriers Mount Nittany Health sought to promote healthy lifestyles for Centre County residents by providing financial and technical support to organizations engaging residents in their health; supporting and sponsoring free or low-cost initiatives targeting at-risk communities; leveraging MNH providers to provide chronic disease community education; and assessing opportunities to provide mobile preventive health services in partnership with community agencies. Centre Volunteers in Medicine (CVIM) Mount Nittany Health is proud to be CVIM's lead healthcare partner. As a partner, MNH provided sustained support for CVIM’s operations to meet the healthcare needs of the uninsured. Since 2019, MNH has provided: $815,000 in cash contributions; $969,175 in-kind healthcare services; and other supporting services such as Information Technology, at-cost pharmaceuticals, and volunteer physicians. Since CVIM's inception in 2003, Mount Nittany Health has proudly invested $7 million in direct financial and in-kind services. Mid-State Literacy Mount Nittany Health was a funding partner for the Literacy for Life: Chronic Disease Prevention and Management program. This program included relevant education at accessible reading levels, emphasizing heart disease, cancer, diabetes, and obesity. Additional tutoring services targeted low-

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Mount Nittany Health 2022 CHNA 109 income and ethnically diverse populations and were provided in small groups and one-on-one instruction across Centre County. The program demonstrated success in increasing chronic disease knowledge, including ability to follow prescription label and aftercare instructions, and improving English listening comprehension and speaking ability among adults with limited English language skills. YMCA Anti-Hunger Programs Mount Nittany Health was a funding partner for YMCA anti-hunger programs, providing $25,000 in support for the Travelin’ Table and Backpack Program. The Travelin’ Table is a mobile bus bringing nutritious meals and other important resources to sustain healthy physical and mental growth directly to those who need them. It is equipped with a full kitchen to support distribution of healthy meals, healthcare education and screenings, and educational supplies and sports equipment to combat summer learning loss and encourage exercise. The Backpack Program serves students across Centre County. Students enrolled in the program receive a backpack full of food each Friday (or the last day of school for the week) during the school year. The program served 965 students in seven school districts in 2021, providing a total of 33,681 bags. Open Streets Bellefonte On May 18, 2019, MNH hosted the inaugural Open Streets Bellefonte event. The four-hour event drew more than 1,000 people to the borough’s downtown for health-centered activities. The event created ‘paved parks’ on High and Allegheny Streets that provided activity hubs for all ages and fitness levels, from dancing to yoga to aerobics to hula-hooping. Sponsored in part by Northwest Bank, the day also featured wellness-themed educational activities and brought community members together. Due to the COVID-19 pandemic, a virtual Open Streets event was hosted in 2020. As part of the 2020 event, MNH distributed 300 activity bags and designed an adventure hunt and virtual 5k. Mount Nittany Health Fit for Play Mount Nittany Health Fit for Play is the system’s physical therapy and sports medicine specialty provider. Inspired to find new ways to care for the community during the pandemic, Mount Nittany Health Fit for Play began offering virtual exercise classes to local assisted living facilities to support the health and wellness of residents. The 30-minute classes were free and included a variety of upper body, lower body, and core exercises to get the heart rate up, as well as to improve circulation, range of motion, strength, and cardiovascular health. Centre Moves Centre Moves is a community coalition with the vision that all Centre County residents will adopt healthy habits. Centre Moves programs, supported by MNH, included the Fit Families Challenge, a community-wide physical activity challenge; Push the Pedal, a community-wide biking challenge; and Community Garden Program, offering a seed swap and community garden information and workshops. Centre Moves was not active in the latter portion of 2021 or 2022 as coalition members diverted resources to addressing pandemic-related concerns.

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Mount Nittany Health 2022 CHNA 110 Mount Nittany Health Provider Education Mount Nittany Health providers regularly served as subject matter experts to provide chronic disease community education. Providers were featured as part of the following community partner communications: Health Break, Healthy Weight over the Holiday Campaign, social media, and newsletters. Improving Care Coordination for Individuals with a Chronic Condition Mount Nittany Health sought to improve chronic disease care coordination through dedicated care coordinator programs, expanded palliative care, integrated care models, and social determinants of health screening and response practices. Technology Investment and Patient Care Pilot Program Mount Nittany Health has made a major investment in care management technology to improve patient outcomes, particularly for those individuals managing a chronic disease. This technology focuses on improving population health by addressing gaps in care, improving patient engagement, and focusing on quality measures. Mount Nittany Physician Group recently piloted a program using this technology with strong results. The program focused on securing routine screenings, vaccinations, and in-office procedures to provide holistic care for patients managing a chronic disease; enhanced patient-clinician interactions; and increased adherence to care plans. The pilot program and technology are actively being evaluated for operationalization and wide distribution across Mount Nittany Physician Group offices. Mount Nittany Physician Group Care Coordinator Program The Care Coordinator Program was implemented in 2016 to improve care outcomes for patients with comorbidities and in need of intensive case management services, and to help them reach their highest health potential. The program provides appointment management, medication reconciliation, and linkages to community and medical resources. Oncology Patient Navigation and Oncology Breast Navigation Programs These programs are available to MNH cancer patients and their family members and are designed to remove social barriers to care and improve health outcomes. As part of the program, MNH employs a Breast Care Center patient care coordinator. Program Utilization:  2019 – 501 Patients, 1479 Interventions  2020 – 426 Patients, 1685 Interventions  2021 – 488 Patients, 1763 Interventions Lung Nodule Program Mount Nittany Medical Center has been designated as a Screening Center of Excellence by Go2 Foundation for Lung Cancer and UPMC Health Plan for its ongoing commitment to responsible lung

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Mount Nittany Health 2022 CHNA 111 cancer screening. From 2019 to 2021, the screening center detected eight lung cancer diagnoses among patients. Screenings are offered as part of the Lung Nodule Program, dedicated to improving quality of life by providing early detection of lung cancer; best practices in lung nodule care; avoidance of surgical procedures; and thorough follow-up care based on evidence-based treatment recommendations. Program Statistics:  2019 – 125 Baseline Exams, 158 Annual Exams (87% return rate)  2020 – 124 Baseline Exams, 188 Annual Exams (83% return rate)  2021 – 202 Baseline Exams, 239 Annual Exams (78% return rate) Mount Nittany Health Palliative Care Services To improve the lives of patients in our community who are dealing with serious chronic illnesses, MNH launched a palliative care program. The new program, available on both an inpatient and outpatient basis, prioritizes symptom management, emotional and spiritual support, help with daily activities, and help with healthcare decision making for patients. Mount Nittany Health Heart Failure Program The heart failure program at MNH is designed to help patients understand their disease process and better manage it through lifestyle changes and medication. The multi-disciplinary care approach focuses on meeting the patient's entire spectrum of care needs and improved healthcare outcomes. In 2019, the program enrolled 145 patients and 62% of patients had zero hospital admissions for any cause. In 2020, the program enrolled 192 patients and 82% patients had zero hospital admissions for heart failure. In 2021, the program enrolled 125 new patients and had active enrollment by 226 patients. Among active patients, 61% had zero hospital admissions for any cause and 91% had zero heart failure admissions. Mount Nittany Health Diabetes Programming Mount Nittany Health offers a number of programs to teach patients, caregivers, and clinicians how to best deal with diabetes. The Life with Diabetes Education Series and individual sessions with certified diabetes educators help people with diabetes comfortably manage their disease. Group classes cover all aspects of learning to manage diabetes, including what diabetes is, understanding medications, monitoring and treatment practices, healthy eating, and weight loss strategies. Our Commitment to the Community Mount Nittany Health is dedicated to improving quality of life for residents of Centre County. Responding to the health needs of our community is central to our mission: Healthier People. Stronger Community. We will continue to invest in the health of our community through collaboration with community partners and residents, and as outlined in our 2022-2025 Implementation

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Mount Nittany Health 2022 CHNA 113 Appendix A: Public Health Secondary Data References Center for Applied Research and Engagement Systems. (2021). Map room. Retrieved from https://careshq.org/map-rooms/ Centers for Disease Control and Prevention. (n.d.). BRFSS prevalence & trends data. Retrieved from http://www.cdc.gov/brfss/brfssprevalence/index.html Centers for Disease Control and Prevention. (2019). Diabetes data and statistics. Retrieved from https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html Centers for Disease Control and Prevention. (2020). CDC wonder. Retrieved from http://wonder.cdc.gov/ Centers for Disease Control and Prevention. (2020). National environmental public health tracking network. Retrieved from https://ephtracking.cdc.gov/ Centers for Disease Control and Prevention. (2021). National vital statistics system. Retrieved from https://www.cdc.gov/nchs/nvss/index.htm Centers for Medicare & Medicaid Services. (2021). Chronic conditions. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and Reports/Chronic-Conditions/CC_Main.html County Health Rankings & Roadmaps. (2021). Pennsylvania. Retrieved from http://www.countyhealthrankings.org/ Dignity Health. (2021). Community need index. Retrieved from http://cni.dignityhealth.org/ Feeding America. (2021). Food insecurity in the United States. Retrieved from https://map.feedingamerica.org/ OverdoseFreePA. (n.d.). View county death data. Retrieved from https://www.overdosefreepa.pitt.edu/ Pennsylvania Commission on Crime and Delinquency. (2019). Pennsylvania youth survey (PAYS). Retrieved from https://www.https://www.pccd.pa.gov/Juvenile-Justice/Pages/PAYS-County-Reports.aspx Pennsylvania Department of Health. (n.d.). COVID-19 data for Pennsylvania. Retrieved from https://www.health.pa.gov/topics/disease/coronavirus/Pages/Cases.aspx Pennsylvania Department of Health. (n.d.). Enterprise data dissemination informatics exchange (EDDIE). Retrieved from https://www.phaim1.health.pa.gov/EDD/ Pennsylvania Department of Health. (n.d.). School health statistics. Retrieved from https://www.health.pa.gov/topics/school/Pages/Statistics.aspx

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Mount Nittany Health 2022 CHNA 114 Pennsylvania Health Care Cost Containment Council. (n.d.) Public reports – research briefs. Retrieved from http://www.phc4.org/reports/researchbriefs/ Pennsylvania State University Student Affairs. (n.d.). The partnership - campus & community united against dangerous drinking annual assessment report 2019-2020. Retrieved from https://sites.psu.edu/thepartnership/annual-reports/ United States Bureau of Labor Statistics. (2021). Local area unemployment statistics. Retrieved from https://www.bls.gov/lau/ United States Census Bureau. (n.d.). American Community Survey. Retrieved from http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml United States Department of Health and Human Services. (2010). Healthy people 2030. Retrieved from https://health.gov/healthypeople/objectives-and-data/browse-objectives

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Mount Nittany Health 2022 CHNA 115 Appendix B: Key Stakeholder Survey Participants  Boggs Township, Secretary/Treasurer  Catholic Charities, Emergency Financial Caseworker  Center for Alternatives in Community Justice, Executive Director  Central Pennsylvania Community Action, Family Service Coordinator  Centre Area Transportation Authority, Assistant ADA & On-Demand Operations Manager  Centre Area Transportation Authority, ADA & On Demand Operations Manager  Centre Area Transportation Authority, Administration  Centre Area Transportation Authority, Executive Director  Centre County Drug and Alcohol, Drug and Alcohol Program Administrator  Centre County Library & Historical Museum, Administrative Director  Centre County Library and Historical Museum, Assistant Branch Manager  Centre County Library and Historical Museum, Executive Director  Centre County MH/ID EI D&A, Human Services Administrator  Centre County MH/ID/EI-D&A, Assistant Administrator  Centre County Youth Service Bureau, CEO  Centre County Youth Service Bureau, Program Director Parenting Plus and DeClutter  Centre Emergency Medical Associates, Physician  Centre Helps, Basic Needs Case Manager  Centre Helps, Executive Director  Centre Safe - Child Access Center, Visitation & Exchange Advocate  Centre Safe, Counselor/Advocate  Centre Safe, Director of Finance  Centre Safe, Director of Programs and Services  Centre Safe, Executive Director  Centre Safe, Housing Advocate  Centre Safe, Legal Director  Centre Safe, Paralegal  Centre Safe, Prevention Educator  Centre Safe, Prevention Educator  Centre Safe, Triage Advocate  Centre Volunteers in Medicine, Executive Director  CentrePeace, Inc., Executive Director  Church, Leader  Congregation Brit Shalom, Rabbi  Early Learning Resource Center Region 8/Child Development and Family Council of Centre County, Inc., Executive Administrator  Food Bank, Volunteer  Food Bank of the State College Area, Operations Manager  Foxdale Village, Director of Health Services  Housing Transitions, Executive Director  Leadership Centre County, Executive Director  MidPenn Legal Services, Regional Manager

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Mount Nittany Health 2022 CHNA 116  Mid-State Literacy Council, Inc., Executive Director  Miles Township Fire Co. Ladies Auxillary, Secretary  Mount Nittany Health, Director  Mount Nittany Health, EVP PCS CNO  Mount Nittany Health, Manager  Mount Nittany Health, Manager  Mount Nittany Health, Manager  Mount Nittany Health, Manager  Mount Nittany Health, Manager, Program & Service Development  Mount Nittany Health, MD  Mount Nittany Health, RN  Mount Nittany Health, RN  Mount Nittany Medical Center, Assistant  Mount Nittany Medical Center, Clinical Coordinator  Mount Nittany Medical Center, Director  Mount Nittany Medical Center, Director  Mount Nittany Medical Center, House Supervisor  Mount Nittany Medical Center, Manager  Mount Nittany Medical Center, Nursing Supervisor  Mount Nittany Medical Center, Oncology Patient Navigator  Mount Nittany Medical Center, Physician  Mount Nittany Medical Center, Registered Nurse  Mount Nittany Medical Center, RN  Mount Nittany Medical Center, RN  Mount Nittany Medical Center, Supervisor  Mount Nittany Physician Group, COO  Mount Nittany Physician Group, Clinical Coordinator  Mount Nittany Physician Group, Practice Manager  Mount Nittany Physician Group, Practice Manager  Mount Nittany Physician Group, RN  Nurse - Family Partnership / UPMC HHC Central PA, Supervisor, Centre County  Out of the Cold: Centre County, Program Manager  Patton Township, Township Manager  Penn State College of Medicine, 4th-year Medical Student  Penn State Millennium Scholars, Assistant Program Director  Penn State University, Sustainable Food Systems Program  Penns Valley Community Church, Pastor  Private Industry Council of the Central Corridor, Director  Senator Jake Corman, Executive Assistant  St. Paul's United Methodist Church & Wesley Foundation, Director of Community & Congregational Care  State College Area School District, Finance and Operations Director  State College Community Land Trust, Executive Director  State College Food Bank, Board President

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Mount Nittany Health 2022 CHNA 117  State College Food Bank, Director and Volunteer  State College Food Bank, Executive Director  State College Food Bank, Vice President  Strawberry Fields, Inc, Director Program Operations  Strawberry Fields, Inc, Employee  Strawberry Fields, Inc, supervisor Blended Case Management  Unity Church of Jesus Christ, General Body member  Unity Church of Jesus Christ, Lay Leader  Unity Church of Jesus Christ, Leadership Team  Unity Church of Jesus Christ, Member  Unity Church of Jesus Christ, Member  Unity Church of Jesus Christ, Member  Unity Church of Jesus Christ, Member  Unity Church of Jesus Christ , Safety/Security/Team leader  YMCA of Centre County, CEO  YMCA of Centre County - Penns Valley Branch, Director

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Mount Nittany Health 2022 CHNA 118 Appendix C: Partner Forum Participants  Amanda Pighetti-Marshall, Mount Nittany Medical Center  Amy Trithart, Mount Nittany Health  Amy Wilson, Mid-State Literacy Council, Inc.  Ann Walker, ELRC 8/Child Development and Family Council of Centre County, Inc.  Anna Kochersperger, State College Community Land Trust  Anne Ard, Centre Safe  Annie Smith, Strawberry Fields, Inc.  Ashley Kader, Mount Nittany Medical Center  Ashley Mekis, Mount Nittany Medical Center  Ashley Shuey, Mount Nittany Physician Group Blue Course Drive IM  Brandy Reiter, Senator Jake Corman  Carol Eicher, Community Diversity Group  Cheryl White, Centre Volunteers in Medicine  Christine Bishop, Youth Service Bureau  Courtney Maholtz, Mount Nittany Medical Center  Cynthia Zerbe, Centre Area Transportation Authority  Deborah Nardone, ClearWater Conservancy  Denise McCann, Centre Helps  Doug Erickson, Patton Township  Dr. Deborah Smith, Retired from Penn State University  Emily Wolfe, Penn State University  Eric Norenberg, Centre Region Council of Governments  Erika Smith, The Arc of Centre County  Gay Dunne, Bellefonte Borough’s Environmental Advisory Board  Greg Scott, Chamber of Business and Industry of Centre County  Holly Oxendale, Tides, Inc.  Jacqueline Hahn, Mount Nittany Medical Center  Jay Hoover, Mount Nittany Medical Center  Jeannine Lozier, Mount Nittany Health  Jennifer Crane, Youth Service Bureau  Jennifer Scanlon, Mount Nittany Health  Jessy Foster, PA Health Access Network  Jim Prowant, Mount Nittany Physician Group  Joleen Hindman, FirstEnergy / Local Affairs  Jordan Taylor, Skills of Central PA  Kelly Wolgast, Penn State University  Kim Bahnsen, Nurse - Family Partnership / UPMC HHC Central PA  Leanne Lenz, Centre County United Way  Leslie Pillen, Penn State University  Louwana Oliva, Centre Area Transportation Authority  Madeline Sell, The Arc of Centre County  Mark Higgins, Centre County Government

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Mount Nittany Health 2022 CHNA 119  Matt Golemboski, Mount Nittany Health  Matt Wise, Senator Jake Corman  Melissa Bopp, Pennsylvania State University  Michael Pipe, Centre County Government  Molly Kunkel, Centre Foundation  Morgan Wasikonis, Housing Transitions  Naana Nti, Community Diversity Group  Nalini Krishnankutty, Penn State University  Natalie Corman, Centre County Government  Nena Ellis, Mount Nittany Health  Nicole Tice, SKILLS  Nina Campbell, Mount Nittany Medical Center  Paul Takac, College Township  Rebecca Burkholder, Mount Nittany Medical Center  Robin Weagley, The Meadows Psychiatric Center  Roger Greene, Mount Nittany Health - Organizational Development  Samantha Bittinger, Mount Nittany Physician Group  Scott Mitchell, YMCA of Centre County  Scott Specht, James E Van Zandt VA Medical Center  Shannon Hilliard, Mount Nittany Health  Stephanie Fost, Habitat for Humanity of Greater Centre County  Susan Seymour, VHA  Tamra Fatemi-Badi, WPSU  Tiffany Ricotta, CenClear  Tom Charles, Mount Nittany Health  Trish Meek, Centre Region Council of Governments