Research ReportsWhy Don't Hospitals Prioritize Substance Abuse in Their Community Benefit Programming?Franz, Berkeley PhD; Skinner, Daniel PhD; Kelleher, Kelly MD, MPHAuthor Information Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio (Dr Franz); Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Dr Skinner); and Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio (Dr Kelleher). Correspondence: Berkeley Franz, PhD, Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Grosvenor 311, Athens, OH 45701 (firstname.lastname@example.org). The authors acknowledge help from Lisa Forster, Primary Care Research Initiatives, Ohio University, Heritage College of Osteopathic Medicine, in creating infographics.The authors declare no conflicts of interest. Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue 1 - p 62-68 doi: 10.1097/PHH.0000000000000716 Buy Metrics Abstract The goal of this study was to understand whether Appalachian Ohio hospitals prioritized substance abuse in their IRS-mandated community health needs assessments (CHNAs) and if not, what factors were important in this decision. Analysis of CHNA reports from all 28 hospitals in the region supplemented interview data from in-depth phone interviews, with 17 participants tasked with overseeing CHNAs at 21 hospitals. The CHNA reports show that hospitals in this region prioritize substance abuse and mental health less often than access to care and obesity. Interviews suggest 4 reasons: lack of resources, risk aversion, concern about hospital expertise, and stigma related to substance abuse. Hospitals are playing a larger role in public health as a result of CHNA requirements but resist taking on challenging problems such as substance abuse. The report concludes by summarizing concrete steps to ensure that community benefit efforts address pressing health problems. The implications of this study are manifest in concrete recommendations for encouraging hospitals to address pressing health problems in their community benefit efforts. © 2019 Wolters Kluwer Health, Inc. All rights reserved.