Community Health Needs Assessment
Transcription
Community Health Needs Assessment
2013 Community Health Needs Assessment Kaiser Foundation Hospital – DOWNEY License #5930000078 To provide feedback about this Community Health Needs Assessment, email [email protected]. Author Melissa Biel, DPA, RN [email protected] Acknowledgements Director, Public Affairs and Brand Communications Elizabeth D. Trombley, MPH Community Benefit Manager Sheri D. Bathurst A number of organizations and agencies contributed time and resources to assist with the conduct of this needs assessment. We acknowledge the participation of individuals from the following organizations and agencies: Bellflower Unified School District California Center for Public Health Advocacy Cerritos College Student Health Services City of South Gate Sports Center Crystal Stairs Downey Unified School District, TLC Family Resource Center Family Health Care Centers of Greater Los Angeles (FHCCGLA) INMED Partnerships for Children Kaiser Permanente Watts Counseling & Learning Center Los Angeles County Department of Public Health SPA 7 Community Health Services Montebello/Commerce YMCA Norwalk La Mirada Unified School District, Health on Wheels Pathways Volunteer Hospice South Central Family Health Center Whittier Rio Hondo AIDS Project (WRHAP) Worksite Wellness LA 1 Table of Contents I. Executive Summary............................................................................................................................. 5 II. Introduction and Background .............................................................................................................. 8 a. Purpose of the community health needs assessment report ............................................................. 8 b. About Kaiser Permanente ................................................................................................................ 8 c. About Kaiser Permanente Community Benefit ............................................................................... 9 d. Kaiser Permanente’s approach to the community health needs assessment .................................... 9 III. Community Served ........................................................................................................................ 12 a. Kaiser Permanente’s definition of community served by hospital facility .................................... 12 b. Description and map of community served by hospital facility .................................................... 12 Socioeconomic Profile ....................................................................................................................... 14 Population .......................................................................................................................................... 14 Race/Ethnicity ................................................................................................................................... 16 Language ........................................................................................................................................... 17 Poverty ............................................................................................................................................... 18 Unemployment .................................................................................................................................. 21 Homelessness..................................................................................................................................... 22 Educational Attainment ..................................................................................................................... 22 Fourth Grade Reading Proficiency .................................................................................................... 23 Crime and Violence ........................................................................................................................... 24 Access to Health Care........................................................................................................................ 25 Health Insurance Coverage ................................................................................................................ 25 Sources of Care .................................................................................................................................. 27 Access to Primary Care Community Clinics ..................................................................................... 28 Health Professional Shortage Areas, Access to Primary Care Physicians ........................................ 29 Barriers to Care .................................................................................................................................. 29 Delayed Care ..................................................................................................................................... 30 Dental Care ........................................................................................................................................ 30 Chronic Disease Prevalence and Incidence ....................................................................................... 31 Hospitalization Rates ......................................................................................................................... 31 2 Diabetes ............................................................................................................................................. 31 Heart Disease ..................................................................................................................................... 32 High Blood Pressure .......................................................................................................................... 32 Cancer ................................................................................................................................................ 32 Asthma ............................................................................................................................................... 33 Overweight and Obesity .................................................................................................................... 33 IV. Who Was Involved in the Assessment........................................................................................... 36 V. Process and Methods Used to Conduct the CHNA ........................................................................... 37 a. Secondary data ............................................................................................................................... 37 b. Community Input ........................................................................................................................... 38 c. Data limitations and information gaps ........................................................................................... 44 VI. Identification and Prioritization of Community’s Health Needs ................................................... 45 a. Identifying community health needs .............................................................................................. 45 b. Process and criteria used for prioritization of the health needs ..................................................... 46 c. Prioritized description of community health needs ....................................................................... 47 VII. Community Assets and Resources Available to Respond to the Needs of the Community .......... 58 Appendix A – Data Sources .................................................................................................................. 61 Appendix B – Healthy People 2020 Benchmark Comparisons ............................................................ 66 Appendix C – Interview Questions ....................................................................................................... 68 Appendix D – Focus Group Questions ................................................................................................. 71 Appendix E – Interview Report ............................................................................................................ 74 Appendix F – Focus Group Report ....................................................................................................... 87 Appendix G – Health Need Profiles ...................................................................................................... 95 Health Need Profile: Access to Care ................................................................................................ 96 Health Need Profile: Asthma ............................................................................................................ 98 Health Need Profile: Cardiovascular Disease ................................................................................ 100 Health Need Profile: Dental Health ................................................................................................ 102 Health Need Profile: Diabetes ........................................................................................................ 104 Health Need Profile: Mental Health ............................................................................................... 106 Health Need Profile: Nutrition and Health Eating.......................................................................... 108 Health Need Profile: Overweight and Obesity ............................................................................... 110 3 Health Need Profile: Physical Activity .......................................................................................... 112 Health Need Profile: Preventive Care ............................................................................................ 114 Health Need Profile: Sexually Transmitted Diseases (STDs) ........................................................ 116 Health Need Profile: Teen Birth ..................................................................................................... 118 Health Need Profile: Youth Safety and Community Violence....................................................... 120 Appendix H – Supplemental Health Data ........................................................................................... 122 Overall Health.................................................................................................................................. 123 Health Outcomes ............................................................................................................................. 123 Health Behaviors ............................................................................................................................. 128 Physical Environment ...................................................................................................................... 132 Clinical Care .................................................................................................................................... 135 Socioeconomic Factors .................................................................................................................... 139 4 I. Executive Summary The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their tax-exempt status under section 501(c)(3) of the Internal Revenue Code. One such requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a community health needs assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low-income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance and transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report was conducted in compliance with these new federal requirements. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. Secondary data were collected from a variety of local, county, and state sources to present demographics, mortality, morbidity, health behaviors, clinical care, social and economic factors, and physical environment. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of approximately 100 indicators in the data platform that help illustrate the health of a community. Additional data sets were included to supplement the minimum required data sets. These data were selected from local sources that were not offered on the common indicators database, and were identified from known and reliable sources of publically available data. Data collection was conducted at the most local level possible for the hospital’s primary service area given the availability of the data. When applicable, these data sets are presented in the context of state data, framing the scope of an issue as it relates to the broader community. The report includes benchmark comparison data that measures KFH – Downey service area data findings with Healthy People 2020 objectives. Healthy People 2020 objectives were selected as a benchmark as this national initiative seeks to improve the public’s health by providing measurable objectives and goals that are applicable at national, state, and local levels. For the primary data collection, information and opinions were gathered directly from persons who represent the broad interests of the community served by the hospital. Seventeen telephone 5 interviews with community stakeholders and four focus groups with 33 area residents were completed from August through October, 2012. The stakeholders and stakeholder groups were known to the Medical Center staff as those with special knowledge or expertise in public health; individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations; or regional, State or local health or other departments or agencies that have “current data or other information relevant to the health needs of the community served by the hospital facility.” They were selected to cover a range of communities within the service area, represent different age groups, and racial/ethnic populations. For the purposes of the CHNA, Kaiser Permanente defines a health need as a poor health outcome and its associated health driver(s), or a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. The health needs were identified from issues supported by primary and secondary data sources gathered for the Community Health Needs Assessment. Each health need was confirmed by more than one indicator or data source (i.e., the health need was suggested by more than one source of secondary or primary data). Health needs were selected from secondary data sources that were at levels below county level (e.g. zip code, place or Service Planning Area (SPA) level data). County level secondary data sources were not used for identifying health needs. Furthermore, the health needs were based on the size of the problem (relative portion of population afflicted by the problem); or the seriousness of the problem (impact at individual, family, and community levels). The health needs identified in the KFH – Downey service area included: Health Outcomes Asthma Cardiovascular disease Diabetes Overweight and obesity STDs Teen births Clinical Drivers Access to care Dental health Mental health Preventive health care (screening and prevention) Behavioral Drivers Nutrition/healthy eating 6 Physical activity Environmental Drivers Youth safety and community violence Priority setting is an important step in the community benefit planning process. The IRS regulations indicate that the Community Health Needs Assessment must provide a prioritized description of the community health needs identified through the CHNA, and include a description of the process and criteria used in prioritizing the health needs. For the prioritization process, KFH – Downey hosted a community forum on January 4, 2013 in Downey and another in Bellflower on January 8, 2013. The forums engaged 37 community leaders in public health, government agencies, schools, and nonprofit organizations that serve the medically underserved, low-income, minority and chronic disease populations in the community. These individuals had current data or other information relevant to the health needs of the community served by the hospital facility. A review of the Community Health Needs Assessment findings with the identified health needs was presented at the community forums. The forum participants engaged in a priority setting process using the Relative Worth method. The Relative Worth method is a ranking strategy where each participant assigns a fixed number of points to health needs based on the size of the problem; or seriousness of the problem. This process resulted in the health needs being ranked in the following order of priority: Health Needs as Identified by Community 1. Youth safety/community violence 1. Mental health 3. Overweight/obesity 4. Access to care 5. Diabetes 6. Physical activity 7. Preventive health 7. Nutrition/healthy eating 9. Dental health 9. Cardiovascular disease 9. Teen births 9. STDs 13. Asthma 7 II. Introduction and Background a. Purpose of the community health needs assessment report Kaiser Permanente is dedicated to enhancing the health of the communities it serves. The findings from this CHNA report will serve as a foundation for understanding the health needs found in the community and will inform the Implementation Strategy for Kaiser Foundation Hospitals as part of their Community Benefit planning. This report complies with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a Community Health Needs Assessment at least once every three years. The required Implementation Strategy is set forth in a separate written document. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52 regarding conducting the CHNA for the hospital facility. b. About Kaiser Permanente Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are: Prepaid health plans, which spread the cost to make it more affordable A focus on preventing illness and disease as much as on caring for the sick An organized coordinated system that puts as many services as possible under one roof—all connected by an electronic medical record Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than 9 million members in nine states and the District of Columbia. Our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. 8 c. About Kaiser Permanente Community Benefit For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we recognize that good health extends beyond the doctor’s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Health, requires equity and social and economic well-being. Like our approach to medicine, our work in the community takes a prevention-focused, evidence-based approach. We go beyond traditional corporate philanthropy or grant making to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we’ve focused our investments in three areas—Health Access, Healthy Communities, and Health Knowledge—to address critical health issues in our communities. For many years, we have worked side-by-side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we have conducted Community Health Needs Assessments to better understand each community’s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long-term, sustainable change—and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. d. Kaiser Permanente’s approach to the community health needs assessment About the new federal requirements Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations—this includes minority groups, low-income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy with the organization’s annual Form 990. SB 697 and California’s history with past assessments For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA 9 every three years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process that will continue to comply with SB 697 and that also meets the new federal CHNA requirements. Kaiser Permanente’s CHNA framework and process Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis, to the identification of prioritized needs and the development of an implementation strategy, the intent was to develop a rigorous process that would yield meaningful results. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. More information about the CHNA platform can be found at http://www.CHNA.org/kp/. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of approximately 100 indicators in the data platform that, when looked at together, help 10 illustrate the health of a community. California data sources were used whenever possible. When California data sources were not available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA data platform, and in some cases other local sources, each Kaiser Permanente hospital collected primary data through key informant interviews, focus groups, or surveys. They asked local public health experts, community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once all the community health needs were identified, they were prioritized based on a set of criteria. This process resulted in a complete list of prioritized community health needs. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will examine the prioritized list of health needs and develop an Implementation Strategy for those health needs it will address. These strategies will build on Kaiser Permanente’s assets and resources, as well as evidence-based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. 11 III. Community Served a. Kaiser Permanente’s definition of community served by hospital facility Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations. b. Description and map of community served by hospital facility The Kaiser Foundation Hospital (KFH) – Downey service area is presented below by community, zip code and Service Planning Area (SPA). KFH – Downey Medical Center Service Area City Zip Code Artesia 90701 Bell 90201 Bellflower 90706 Bell Gardens 90201 Cerritos 90703 Commerce 90040 Compton 90221,90222 Cudahy 90201 Downey 90240,90241,90242 Hawaiian Gardens 90716 Huntington Park 90255 Lakewood 90712,90713,90715 North Long Beach 90805,90808 Lynwood 90262 Maywood 90270 Norwalk 90650 Paramount 90723 Pico Rivera 90660 Santa Fe Springs 90670 South East Los Angeles 90001,90002,90003,90059 South Gate 90280 Vernon 90058 Whittier 90601,90602,90603,90604, 90605, 60606 12 SPA SPA 7 SPA 7 SPA 7 SPA 7 SPA 7 SPA 7 SPA 6 SPA 7 SPA 7 SPA 7 SPA 7 SPA 7 SPA 8 SPA 6 SPA 7 SPA 7 SPA 6 SPA 7 SPA 7 SPA 6 SPA 7 SPA 7 SPA 7 13 A description of the community served by KFH – Downey is provided in the following data narrative and tables. Given the available data sources, KFH – Downey information were presented as representing the entirety of the service area; the individual cities/places that make up the service area; or Service Planning Areas 6 and 7, portions of which are served by KFH Downey. Information is detailed in the following sections: Socioeconomic Profile, Access to Health Care, and Chronic Disease Prevalence and Incidence. Socioeconomic Profile Population The population of the KFH – Downey service area is 1,581,222. The service area is 169.5 square miles and has a high population density of 9,331.5 persons per square mile. Total Population Population Total population Total Land Area (square miles) Population Density (per square mile) Service Area 1,581,222 169.5 9331.5 California 36,637,288 155,779.2 235.2 Source: U.S. Census Bureau, American Community Survey, 2006-2010 From 2000 to 2010, the population increased by 3.1%. This was a slower rate of growth than experienced statewide. Change in Total Population 2000-2010 Population Total population 2000 Total population 2010 Change in population 2000-2010 Service Area 1,544,037 1,592,578 3.1% California 33,871,648 37,253,956 10.0% Source: U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1 Of the area population, 49.1% are male and 50.9% are female. Population by Gender Gender Male Female Service Area 49.1% 50.9% California 49.7% 50.3% Source: U.S. Census Bureau, American Community Survey, 2006-2010 Children and youth, ages 0-17, make up 30.6% of the population; 61.1% are adults, ages 18-64; and 8.3% of the population are seniors, ages 65 and over. 14 Population by Age Age Groups 0-4 5-17 18-24 25-34 35-44 45-54 55-64 65 and older Service Area 8.0% 22.6% 11.3% 14.5% 14.4% 12.3% 8.6% 8.3% California 6.9% 18.5% 10.4% 14.3% 14.4% 14.1% 10.3% 11.1% Source: U.S. Census Bureau, American Community Survey, 2006-2010 When the service area is examined by community, South East Los Angeles has the largest percentage of youth, ages 0-17. Cerritos has the highest percentage of residents 65 and older (17.7%). Median age ranges from 27 years old in Cudahy to 44 years old in Cerritos. Population by Youth, Ages 0-17, Seniors, Ages 65+, and Median Age Geographic Area Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Long Beach - 90805 Long Beach - 90808 Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East/LA - 90001 South East/LA - 90002 South East/LA - 90003 South East/LA - 90059 South Gate Vernon Youth (Ages 0-17) Seniors (Ages 65+) 22.5% 32.1% 28.4% 34.1% 20.4% 29.8% 33.1% 35.0% 26.8% 32.1% 31.8% 24.4% 31.5% 22.2% 33.0% 32.6% 27.6% 32.7% 26.7% 26.4% 34.9% 36.2% 35.6% 36.4% 31.1% 18.8% 13.6% 6.8% 8.5% 5.3% 17.7% 10.6% 7.3% 5.2% 10.3% 7.9% 6.5% 11.3% 6.4% 14.0% 5.3% 6.1% 9.9% 6.3% 12.2% 13.4% 5.4% 5.6% 5.2% 6.0% 7.1% 12.6% 15 Median Age 38.2 28.9 31.9 27.3 44.0 31.2 28.0 27.0 33.3 28.4 28.9 37.5 No Data No Data 27.8 27.9 32.5 28.6 34.0 35.3 No Data No Data No Data No Data 29.4 36.5 Whittier 25.4% 11.7% 34.9 Service Area California 30.6% 25.4% 8.3% 11.1% No Data 35.2 Source: U.S. Census Bureau, 2010 Race/Ethnicity In the KFH – Downey service area, the majority of the population is Hispanic/Latino (70.1%); 11.5% of the residents are White; 9.7% are African American; 6.9% are Asian; and 1.8% are American Indian/Alaskan Native or other race/ethnicity. There are a number of communities where over 90% of the population is Hispanic/Latino. These communities are: Bell, Bell Gardens, Commerce, Cudahy, Huntington Park, Maywood, Pico Rivera, and South Gate. Long Beach (90808), Vernon and Lakewood have the highest percentage of Whites. Watts (South East Los Angeles 90059) and Compton have large percentages of African Americans. Cerritos and Artesia have a high percentage of Asians. Race/Ethnicity Geographic Area Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Long Beach - 90805 Long Beach - 90808 Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East/LA 90001 South East/LA 90002 35.8% 93.1% 52.3% 95.7% 12.0% 94.5% 65.0% 96.0% 70.7% 77.2% 97.1% 30.1% 55.8% 20.2% 86.6% 97.4% 70.1% 78.6% 91.2% 81.0% 21.3% 4.9% 19.5% 2.7% 16.6% 3.1% 0.8% 2.1% 17.7% 7.3% 1.6% 40.9% 9.1% 63.8% 2.2% 1.8% 12.3% 5.6% 5.2% 11.9% 3.3% 0.6% 13.5% 0.5% 6.7% 0.5% 32.1% 0.8% 3.4% 3.4% 0.4% 8.3% 19.9% 3.4% 9.7% 0.2% 3.9% 11.1% 0.6% 1.9% 36.9% 0.6% 11.4% 0.5% 61.5% 1.0% 0.2% 0.5% 6.7% 10.5% 0.6% 16.0% 10.5% 8.0% 0.6% 0.2% 11.7% 2.8% 2.3% 3.8% American Indian/ Alaskan 0.2% 0.2% 0.3% 0.2% 0.1% 0.4% 0.2% 0.2% 0.2% 0.3% 0% 0.3% 0.2% 0.2% 0.1% 0.1% 0.3% 0.2% 0.2% 0.4% 88.5% 0.6% 10.3% 0.2% 0.1% 0.3% 73.4% 0.6% 24.8% 0.2% 0.1% 0.9% Hispanic White African American 16 Asian Other 2.5% 0.6% 3.0% 0.4% 3.1% 0.5% 1.7% 0.4% 1.3% 1.3% 0.3% 4.4% 4.5% 4.4% 0.8% 0.3% 1.7% 1.7% 0.5% 1.0% South East/LA 90003 South East/LA 90059 South Gate Vernon Whittier Service Area California 74.5% 0.7% 23.7% 0.2% 0.1% 0.8% 64.1% 0.9% 33.5% 0.2% 0.2% 1.1% 94.8% 42.9% 65.7% 3.4% 51.8% 28.3% 0.6% 3.6% 0.9% 0.7% 1.7% 3.5% 0.1% 0% 0.3% 0.4% 0% 1.3% 70.1% 37.6% 11.5% 40.1% 9.7% 5.8% 6.9% 12.8% 0.2% 0.4% 1.6% 3.3% Source: U.S. Census Bureau, 2010 Language As expected, languages spoken in the home mirror the racial/ethnic make-up of the service area communities. Spanish is spoken in the home among the largely Hispanic/Latino service area population. In Lakewood and Whittier over half the population speaks English only in the home. Cerritos and Artesia have high rates of Asian language speakers. Language Spoken at Home Geographic Area* English Only Spanish Asian Indo-European Other Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South Gate Vernon Whittier 36.9% 10.9% 45.9% 6.6% 38.7% 20.8% 39.9% 9.2% 32.4% 26.2% 5.9% 66.3% 19.8% 8.1% 33.3% 24.8% 28.3% 46.9% 11.5% 21.1% 56.6% 22.5% 86.4% 40.7% 92.2% 7.7% 77.7% 59.3% 89.6% 57.8% 63.7% 93.2% 17.6% 79.3% 91.1% 53.1% 71.3% 69.3% 51.0% 87.3% 73.4% 39.4% 25.3% 0.4% 10.4% 0.5% 44.8% 1.3% 0.7% 0.4% 6.7% 9.1% 0.6% 13.1% 0.4% 0.6% 10.7% 2.4% 1.5% 1.6% 0.8% 5.5% 1.8% 15.1% 0.3% 1.7% 0.3% 7.4% 0.2% 0.1% 0.7% 2.2% 0.6% 0.3% 2.5% 0.3% 0.2% 2.6% 0.7% 0.7% 0.2% 0.4% 0% 2.0% 0.2% 2.0% 1.3% 0.4% 1.4% 0% 0% 0.1% 0.9% 0.4% 0% 0.5% 0.2% 0% 0.3% 0.8% 0.2% 0.3% 0% 0% 0.2% California 57.0% 28.5% 9.4% 4.3% 0.8% Source: U.S. Census Bureau, American Community Survey, Five-Year Estimates, 2005-2009 + 2006-2010; Healthy City *Data available by city, therefore, zip code only areas in the KFH – Downey service area are not listed. 17 Limited English proficiency reports the percentage of the population ages 5 and older who speak a language other than English at home and speak English less than "very well." In the KFH – Downey service area, 31.7% of the population has limited English proficiency. This rate is higher than the state rate of 19.9%. Limited English Proficiency Service Area California 31.7% 19.9% Source: U.S. Census Bureau, American Community Survey, 2006-2010 Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2010, the federal poverty level for one person was $10,830 and for a family of four $22,050. Among the residents in the KFH – Downey service area, 17.1% are at or below 100% of the federal poverty level (FPL) and 43.1% are at 200% or below FPL. These rates of poverty are higher than found in the state. Poverty Levels, All Residents <100% FPL <200% FPL Service Area Number Percent 267,182 17.1% 673,983 43.1% California 13.7% 32.8% Source: U.S. Census Bureau, American Community Survey , 2006-2010 Poverty Rate (<100% FPL), Percentage of Total Population, by Tract Over 40.0% 30.1 - 40.0% 20.1 - 30.0% 10.1 - 20.0% Under 10.1% Source: American Community Survey, 2006-2010 A view of children in poverty by Service Planning Area (SPA) indicates that over half (57.6%) of children in SPA 6 live in poverty and 28.7% of children in SPA 7 are <100% FPL. In SPA 6, 82.2% of children are categorized as low-income (<200% FPL). And in SPA 7 51.8% of children under age 18 are low-income. These rates of poverty are higher than the state. 18 Children in Poverty, Ages 0-17 SPA 6 0-99% FPL 100-199% FPL 200-299% FPL 300% FPL and above SPA 7 57.6% 24.6% 11.3% 6.5% California 28.7% 23.1% 15.6% 32.6% 23.0% 20.2% 14.0% 42.8% Source: California Health Interview Survey, 2009 Poverty rates by city paint an important picture of the population within the KFH – Downey service area. From 5.2% of the population in Lakewood to 24.3% of the population in Cudahy live at or below 100% of the Federal Poverty Level. Children under 18 experience high rates of poverty. In fact, a number of communities have over one-quarter of the children living in poverty. Female headed households with children are especially vulnerable, experiencing very high rates of poverty. Bell Gardens, Cudahy, Hawaiian Gardens, Huntington Park, Lynwood and Maywood all have rates of poverty over 40% among female head of households with children. Poverty Rate for Population, Children under 18, and Female Head of Household with Children under 18 Years Old Geographic Area* Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South Gate Vernon Whittier Poverty Rate Children in Poverty (Under 18 Years) 9.3% 22.6% 13.1% 22.7% 6.1% 13.8% 22.8% 24.3% 10.0% 15.8% 24.0% 5.2% 20.1% 22.5% 11.1% 19.2% 11.0% 8.9% 18.5% 9.4% 9.1% 20.4% 28.8% 18.8% 31.7% 7.4% 18.3% 31.8% 32.3% 14.6% 24.9% 33.7% 7.5% 28.6% 30.7% 15.3% 25.0% 15.7% 13.1% 26.2% 0% 12.4% 19 Female Head of Household with Children in Poverty 37.4% 39.5% 22.9% 49.0% 26.7% 34.0% 34.5% 45.0% 20.4% 43.4% 43.9% 15.6% 45.6% 45.4% 21.4% 33.9% 34.6% 16.8% 39.3% 0% 23.1% Service Area 17.1% No Data No Data California 13.7% 19.1% 32.8% Source: U.S. Census Bureau, American Community Survey, 2006-2010 *Data available by city, therefore, zip code only areas in the KFH – Downey service area are not listed. The percentage of students eligible for the free and reduced price meal program is one indicator of socioeconomic status. In the KFH – Downey service area, three-fourths (74.7%) of the student population are eligible for the free and reduced price meal program, indicating a high level of low-income families. This rate is higher than the state rate of 55.6%. Free and Reduced Price Lunch Eligibility Service Area Number Public school students eligible for free or reduced price lunches 226,744 Percent 74.7% California 55.6% Source: U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Public School Universe File, 2009-2010 Percentage of Students Eligible for Free or Reduced Price Lunch, by School Over 80.0% 60.1 - 80.0% 40.1 - 60.0% 20.1 - 40.0% Under 20.1% Not Reported Source: National Center for Education Statistics, 2010-2011 Residents in SPA 6 have higher rates of participation in government-sponsored public programs compared to residents in SPA 7. In SPA 6, 40.1% of residents cannot afford food and 29.1% utilize food stamps. In SPA 7, 35.8% of residents cannot afford food and 9.9% utilize food stamps. This indicates a considerable percentage of residents who may qualify for food stamps but do not access this resource. WIC benefits are more readily accessed and 76.8% of eligible adults in SPA 6 and 56.6% in SPA 7 use WIC. Among qualified children in SPA 6, 70.5% access WIC and 67% in SPA 7 access WIC. Among SPA 6 residents, 13.8% are TANF/ CalWorks recipients and 4.3% are TANF/CalWorks recipients in SPA 7. 20 Public Program Participation Not Able to Afford Food (<200%FPL) Food Stamp Recipients WIC Usage among Qualified Adults WIC Usage among Qualified Children (Ages 6 and Under) TANF/CalWorks Recipients SPA 6 40.1% 29.1% 76.8% SPA 7 35.8% 9.9% 56.6% California 40.4% 13.4% 46.4% 70.5% 13.8% 67.0% 4.3% 48.7% 6.2% Source: California Health Interview Survey, 2009 Unemployment The unemployment rate of KFH – Downey service area cities shows a diverse range. There are six cities with unemployment rates below the county and state rates: Artesia, Cerritos, Downey, Lakewood, Vernon and Whittier. However, the majority of the service area communities have high rates of unemployment. Commerce (22.8%) and Compton (20.6%) have the highest rates of unemployment in the service area. Unemployment Rate, 2011 Average Geographic Area* Unemployment Rate Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South Gate Vernon South Whittier Whittier 8.9% 16.2% 12.5% 19.3% 6.8% 22.8% 20.6% 17.0% 9.9% 13.8% 18.2% 8.0% 19.2% 17.7% 13.0% 17.8% 11.5% 10.3% 15.6% 0% 10.8% 8.8% Los Angeles County California 12.3% 11.7% Source: California Employment Development Department, Labor Market Information * Data available by city, therefore, zip code only areas in the KFH – Downey service area are not listed. 21 Homelessness According to the 2011 Los Angeles Homeless Services Authority count, SPA 6 had an annualized estimate of 8,735 homeless individuals and SPA 7 had 4,759 homeless individuals. In SPA 6, 64% are individuals and 35% of the homeless are families. SPA 7 has more single adults, 81% of the homeless, and fewer homeless families, 19%. Homeless SPA 6 Total Homeless Single Adults Family Members Unaccompanied Minors (<18) SPA 7 8,735 64% 35% 2% 4,759 81% 19% <1% Los Angeles County 45,422 79% 20% 1% Source: Los Angeles Homeless Service Authority, 2011 Greater Los Angeles Homeless Count Report Among the homeless population, approximately one-fourth are chronically homeless. In SPA 6, 32% experience substance abuse and 35% have mental illness. In SPA 7, 36% experience substance abuse and 27% suffer from mental illness. SPA 7 has more homeless veterans (18%) than SPA 6 (12%). In SPA 6, 10% of the homeless population was a victim of domestic violence and 12% of SPA 7 homeless was a domestic violence survivor. Homeless Subpopulations SPA 6 Chronically Homeless Substance Abuse Mentally Ill Veterans Survivors of Domestic Violence SPA 7 24% 32% 35% 12% 10% 23% 36% 27% 18% 12% Los Angeles County 24% 34% 33% 18% 10% Source: Los Angeles Homeless Service Authority, 2011 Greater Los Angeles Homeless Count Report Educational Attainment Among adults, ages 25 and older, in the KFH – Downey service area, over one-third of the population (35.6%) have no high school diploma. Population, 25 Years and Older, with No High School Diploma Service Area California 35.6% 19.3% Source: U.S. Census Bureau, American Community Survey, 2006-2010 When educational attainment is examined by SPA, 22.4% of SPA 6 adults and 45.1% of SPA 7 adults have obtained education beyond a high school diploma. 22 Adult Educational Attainment SPA 6 Grades 1-11 High School graduate Some college Vocational school Associate’s degree Bachelor’s degree Graduate degree Other SPA 7 44.8% 32.8% 8.3% 1.7% 1.6% 5.0% 3.9% 1.9% California 25.4% 29.5% 18.2% 1.9% 6.8% 11.6% 5.8% 0.7% 15.6% 26.0% 14.5% 2.7% 6.5% 20.6% 13.3% 0.8% Source: California Health Interview Survey, 2009 The high school graduation rate from among schools in the KFH – Downey service area is 75.9%. This is lower than the state graduation rate and also lower than the Healthy People 2020 objective, which is a high school graduation rate of 82.4%. High School Graduation Rate Service Area California Total enrollment 71,161 Average Freshman Enrollment 19,482 Diplomas Issued 14,796 On-Time Graduation Rate 75.9% 82.3% Source: U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Local Education Agency (School District) Universe Survey Dropout and Completion Data, 2008-2009 Percentage of Total Population (Age 25 and over) with No High School Diploma, by Tract Over 40.0% 30.1 - 40.0% 20.1 - 30.0% 10.1 - 20.0% Under 10.1% Source: American Community Survey, 2006-2010 Fourth Grade Reading Proficiency Fourth grade students in schools in the KFH – Downey service area were tested through the standardized STAR test. Results of the English Language component of the test, 39.2% of the 23 students tested below the “proficient” level. The Healthy People 2020 objective is that 36.3% or fewer students are not proficient in reading. The KFH – Downey indicator has a higher rate of not proficient students on the English Language standardized test. 4th Grade Reading Proficiency Service Area Number Children in grade 4 whose reading skills tested below the "proficient" level for the English Language Arts portion of the California STAR test California Percent 7,321 39.2% 35.6% Source: California Department of Education, Student Testing Reports, 2011 Crime and Violence Violent crimes include homicide, rape, robbery and assault. Compton (547.4), Commerce (436.7) and Hawaiian Gardens (427.9) have the highest rate of arrests for violent crimes per 100,000 persons in the KFH – Downey service area. Adult Violent Crimes Arrests, 2010, per 100,000 Persons Geographic Area* Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South Gate Whittier California Number Rate 14 97 213 81 30 56 528 81 168 61 229 134 237 73 228 104 133 42 237 199 87,808 84.6 273.4 278.0 192.5 61.2 436.7 547.4 340.3 150.3 427.9 394.1 167.4 339.7 266.5 216.0 192.2 211.3 258.9 251.1 233.2 235.7 Source: California Department of Justice, Office of the Attorney General, 2010;U.S. Census Bureau,2010 * Data available by city, therefore, zip code only areas in the KFH – Downey service area are not listed. Whittier, Compton and Bellflower have the highest number of domestic violence calls in the service area. While Whittier has a large number of domestic violence calls, the majority of the calls were for incidents without a weapon. 24 Domestic Violence Calls, 2010 Geographic Area* Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South Gate Vernon Whittier California Without Weapon Total 31 101 531 93 64 51 584 85 433 85 196 309 177 91 243 301 264 164 263 5 903 166,361 8 19 177 67 18 6 56 31 392 28 189 93 4 46 23 104 40 126 213 3 637 100,496 With Weapon 23 82 354 26 46 45 528 54 41 57 7 219 173 45 220 197 224 36 50 2 266 65,865 Source: California Department of Justice, Office of the Attorney General, 2010 * Data available by city, therefore, zip code only areas in the KFH – Downey service area are not listed. 14.2% of adults in SPA 6 indicated they had experienced physical or sexual violence by an intimate partner since the age of 18, and 4% had been the victims of intimate partner violence in the past year. In SPA 7, 13.1% had experienced violence since the age of 18, and 1.8% had been the victims of intimate partner violence in the past year. Experienced Physical or Sexual Violence SPA 6 By Intimate Partner Since Age 18 By Intimate Partner in Past Year SPA 7 14.2% 4.0% 13.1% 1.8% California 14.8% 3.5% Source: California Health Interview Survey, 2009 Access to Health Care Health Insurance Coverage In the KFH – Downey service area, 23.4% of the population has Medi-Cal coverage. This is higher than the state rate of 18.1%. Over one-quarter of the population (26.0%) are uninsured, which translates to 74% who have health insurance. This is less than the Healthy People 2020 objective of 100% health insurance coverage. 25 Medi-Cal and Uninsured Medi-Cal Coverage Uninsured Service Area Number Percent 393,907 23.4% 405,600 26.0% California 18.1% 17.9% Source: U.S. Census Bureau, American Community Survey, 2008-2010 Percent Uninsured Population Over 25.0% 18.1 - 25.0% 12.1 - 18.0% 6.1 - 12.0% Under 6.1% Source: American Community Survey, 2008-2010 A look at insurance coverage by SPA shows that in SPA 6 22.1% have employment-based insurance and 35.3% are covered by Medi-Cal. In SPA 7 44.6% of residents have employmentbased insurance and 18.2% are covered by Medi-Cal. Insurance Coverage SPA 6 Medi-Cal Healthy Families Medicare Only Medi-Cal/Medicare Medicare & Others Other Public Employment Based Private Purchase No Insurance SPA 7 35.3% 2.7% 1.0% 5.7% 2.4% 0.8% 22.1% 3.6% 26.4% California 18.2% 2.4% 0.8% 3.2% 6.2% 0.8% 44.6% 2.9% 20.8% 14.0% 2.0% 1.1% 2.8% 7.7% 2.6% 49.6% 5.7% 14.5% Source: California Health Interview Survey, 2009 When insurance coverage by SPA is examined by age groups, adults, ages 18-64, have the highest rate of uninsured. Coverage for children is primarily through Medi-Cal and employment-based insurance. Seniors have low rates of uninsured and high rates of Medicare coverage. The Healthy People 2020 objective for children and adults is 100% health insurance coverage. 26 Insurance Coverage by Age Group Ages 0-17 Medi-Cal Healthy Families Medicare Only Medi-Cal/Medicare Medicare & Others Other Public Employment Based Private Purchase No Insurance SPA 6 62.3% 7.5% Ages 18-64 SPA 7 37.0% 8.3% 20.3% 1.8% 7.5% SPA 6 24.2% 0.3% 0.7% 3.2% 1.1% 25.2% 5.1% 40.1% 41.8% 3.2% 9.7% Ages 65+ SPA 7 12.6% 0.2% 0.3% 1.3% 0.2% 1.2% 52.4% 3.1% 28.7% SPA 6 4.7% SPA 7 49.0% 30.4% 25.6% 65.0% 5.7% 1.5% 3.4% 1.1% Source: California Health Interview Survey, 2009 Sources of Care Residents who have a medical home and access to a primary care provider improve continuity of care and decrease unnecessary ER visits. Among the residents in SPA 6 and SPA 7, over 90% of children and youth have a usual source of care. Among adults, in SPA 6, 68.7% have a usual source of care, and 77.5% of adults in SPA 7 have a source of care. 86.3% of seniors in SPA 6 have a usual source of care and 95.4% of seniors in SPA 7 have a source of care. 85.8% of state residents have a usual source of care. Usual Source of Care Ages 0-17 Usual source of care SPA 6 91.7% SPA 7 90.5% Ages 18-64 SPA 6 68.7% Ages 65+ SPA 7 77.5% SPA 6 86.3% SPA 7 95.4% Source: California Health Interview Survey, 2009 The source of care for 42.2% of SPA 6 and 56.3% of SPA 7 is a doctor’s office, HMO, or Kaiser. Clinics and community hospitals are the source of care for 30.4% of those in SPA 6 and 25.2% in SPA 7. Sources of Care SPA 6 Dr. Office/HMO/Kaiser Community clinic/Government clinic/ Community hospital ER/Urgent Care Other No source of care Source: California Health Interview Survey, 2009 27 SPA 7 California 42.2% 56.3% 61.2% 30.4% 25.2% 22.7% 3.4% 1.6% 22.4% 0.5% 0.9% 17.1% 1.1% 0.8% 14.2% 20.9% of residents in SPA 6 and 18% of residents in SPA 7 visited an ER over the period of a year. In SPA 6, seniors visit the ER at the highest rates (24%) and in SPA 7 children and youth visit the ER at the highest rates (26.9%). In SPA 6 low-income residents and those living in poverty visit the ER at higher rates than found in the state. Use of Emergency Room Visited ER in last 12 months SPA 6 20.9% SPA 7 18.0% California 17.6% 0-17 years old 18-64 years old 65 and older 16.8% 22.8% 24.0% 26.9% 13.9% 19.4% 18.0% 17.2% 19.2% <100% of poverty level <200% of poverty level 24.8% 23.4% 15.3% 16.9% 21.7% 19.7% Source: California Health Interview Survey, 2009 Access to Primary Care Community Clinics Community clinics provide primary care (including medical, dental and mental health services) for uninsured and medically underserved populations. Using ZCTA (ZIP Code Tabulation Area) data for the KFH – Downey Medical Center service area and information from the Uniform Data System (UDS)1, 43.2% of the population in the service area is categorized as low-income (200% of Federal Poverty Level) and 17.1% of the population are living in poverty. There are a number of Section 330 funded grantees (Federally Qualified Health Centers – FQHCs) located the service area, including: The Children’s Clinic, AltaMed Health Services, Family Health Care Centers of Greater Los Angeles, JWCH Institute, St. John’s Well Child & Family Center, Central City Community Clinic, Watts Healthcare Corporation, and South Central Family Health Center. Even with Section 330 funded Community Health Centers (CHC) serving the area, there are a significant number of low-income residents who are not served by one of these clinic providers. The FQHCs have a total of 103,344 patients in the service area, which equates to 15.2% penetration among low-income patients and 6.5% penetration among the total population. From 2009-2011 the CHC providers added 15,790 patients for an 18% increase in patients served by Community Health Centers in the service area. However, there remain 577,147 low-income residents, approximately 84.8% of the population at or below 200% FPL that are not served by a Section 330-funded grantee. 1 The UDS is an annual reporting requirement for grantees of HRSA primary care programs: • Community Health Center, Section 330 (e) • Migrant Health Center, Section 330 (g) • Health Care for the Homeless, Section 330 (h) • Public Housing Primary Care, Section 330 (i) 28 Low-Income Patients Served and Not Served by FQHCs Low-Income Population 680,491 Patients served by Section 330 Grantees In Service Area 103,344 Low-Income Not Served Penetration among LowIncome Patients Penetration of Total Population Number Percent 15.2% 6.5% 577,147 84.8% Source: UDS Mapper, 2011 15% of the population in the KFH – Downey service area lives in a Health Professional Shortage Area (HPSA), compared to 13.8% of the population of California who lives in a HPSA. There are 13 health care facilities in the KFH – Downey service area designated as HPSAs, defined as having shortages of primary medical care, dental or mental health providers. Health Professional Shortage Areas, Access to Primary Care Physicians Total Facilities 13 Primary Care 4 Mental Health Care Dental Care 4 5 Primary Care Physicians Number Rate 1,795 113.1 Source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File, 2012 Professional Shortage Area Facilities, by Type Primary Care Dental Care Mental Health Source: Health Resources and Services Administration, 2012 Barriers to Care Adults in SPA 6 and SPA 7 experience a number of barriers to accessing care, including: cost of care, lack of a medical home, language barriers, and lack of transportation. 29 Barriers to Accessing Health Care 28.8% 18.6% 10.9% 18.7% 38.8% 24.0% 11.8% 4.4% 13.6% 27.2% Los Angeles County 22.3% 11.8% 5.9% 12.1% 27.3% 18.7% 14.5% 15.1% 12.5% 6.9% 7.4% SPA 6 Adults Unable to Afford Dental Care in the Past Year Adults Unable to Afford Medical Care in the Past Year Adults Unable to Afford Mental Health Care in the Past Year Adults Unable to Afford Prescription Medication in the Past Year Adults Who Reported Difficulty Accessing Medical Care Adults Who Reported Difficulty Talking to a Doctor because of a Language Barrier in the Past Year Adults Who Reported Transportation Problems Prevented Obtainment of Medical Care SPA 7 Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey 2007 Delayed Care Among residents of SPA 6, 9.1% delayed or did not get medical care and 7.0% delayed or did not obtain prescription medications when needed. In SPA 7, 9.3% of residents delayed care and 6.3% delayed obtaining prescription medications. Delayed Care Delayed or didn’t get medical care in past 12 months Delayed or didn’t get prescription meds in past 12 months SPA 6 9.1% 7.0% SPA 7 9.3% 6.3% California 12.5% 8.2% Source: California Health Interview Survey, 2009 Dental Care 15.7% of children in SPA 6 and 10.2% in SPA 7 had never been to a dentist. SPA 6 data indicate that there were no teens who had never been to the dentist. But in SPA 7 3.7% of teens had not been to a dentist. For households that delayed dental care for children and teens, not being able to afford the care or having no dental insurance coverage was the main reason 12% of children and 75.3% of teens in SPA 6 had not visited the dentist in the past year. 15.7% of children and 10.8% of teens in SPA 7 delayed a dental visit because of cost or no insurance coverage. Delay of Dental Care among Children and Teens Children Never Been to the Dentist Main Reason Children Did Not Visit Dentist in Past Year– Could Not Afford it/Had No Insurance Teens Never Been to the Dentist Main Reason Teens Did Not Visit Dentist in Past Year – Could Not Afford it/Had No Insurance Source: California Health Interview Survey, 2009 30 SPA 6 15.7% SPA 7 10.2% California 11.6% 12.0% 15.7% 10.4% 0% 3.7% 1.2% 75.3% 10.8% 30.6% Chronic Disease Prevalence and Incidence Hospitalization Rates In the KFH – Downey service area, the hospitalization rate for adult asthma is 9.7 per 1,000 persons hospitalized; for youth asthma it is 19.9 per 1,000 hospitalizations. The hospitalization rate for adult diabetes is 13.2 per 1,000 persons hospitalized; for youth diabetes it is 13.2 per 1,000 hospitalizations. For HIV hospitalizations the rate was averaged over two years and is 1.8 per 1,000 hospitalizations. The hospitalization rates for asthma, diabetes and HIV in the KFH – Downey service area exceed the state hospitalization rates for these conditions. Hospitalization Rates per 1,000 Persons Hospitalized Service Area Number Asthma Hospitalizations Adults Asthma Hospitalizations Youth Diabetes Hospitalizations Adults Diabetes Hospitalizations Youth HIV Hospitalizations (2010-2011) California Rate 1,342 561 1,817 176 303 9.7 19.9 13.2 6.3 1.8 7.7 19.2 9.7 4.8 1.7 Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010+2011 Diabetes Diabetes is a growing concern in the community. 15.8% of adults in SPA 6 and 12.7% in SPA 7 have been diagnosed with diabetes. For adults with diabetes, 67% in SPA 6 and 60% in SPA 7 are very confident they can control their diabetes, and 70% in SPA 6 and 82.5% in SPA 7 have a diabetes management care plan. However, over half of the diabetics in SPA 6 (48.8%) have not had a foot exam, and 17.4% have never had an HgA1c test. In SPA 7, 21.6% of diabetics have not had a foot exam, and 5.2% have never had an HgA1c test. Adult Diabetes SPA 6 Diagnosed Pre/Borderline Diabetic Diagnosed with Diabetes Very confident to Control Diabetes Somewhat confident Not confident Takes oral hypoglycemic medications Has a diabetic management care plan Has never had a foot exam Never heard of the HgA1c test Never had the HgA1c test SPA 7 California 7.9% 6.6% 8.0% 15.8% 12.7% 8.5% 67.0% 60.0% 58.6% 18.8% 14.2% 33.3% 6.7% 32.6% 8.8% 54.5% 77.2% 77.0% 70.0% 82.5% 78.0% 51.2% 21.6% 72.2% 6.8% 17.4% 17.4% 5.2% 14.5% 10.6% Source: California Health Interview Survey, 2009 31 Heart Disease For adults in SPA 6, 5% have been diagnosed with heart disease, and in SPA 7, 6.2% have been diagnosed with heart disease. Among these adults, in SPA 6 36.3% are very confident they can manage their conditions, and 51.7% have a management care plan developed by a health care professional. SPA 7 adults with heart disease indicate more confidence in controlling their condition (60.8%), and 76.1% have a care management plan. Adult Heart Disease SPA 6 Diagnosed with heart disease SPA 7 California 5.0% 6.2% 5.9% Very Confident to Control Condition Somewhat Confident to Control Condition Not Confident to Control Condition 36.3% 60.8% 28.1% 58.5% 32.3% 44.4% 19.3% 11.1% 9.2% Has a management care plan 51.7% 76.1% 70.9% Source: California Health Interview Survey, 2009 High Blood Pressure A co-morbidity factor for diabetes and heart disease is hypertension (high blood pressure). In SPA 6, 34.1% of adults have been diagnosed with high blood pressure. Of these, 63.4% are on medication for their blood pressure. In SPA 7, 26% of adults have been diagnosed with high blood pressure and 65.5% are on medication. High Blood Pressure SPA 6 Diagnosed with High Blood Pressure Takes Medication for High Blood Pressure 34.1% SPA 7 26.0% California 26.2% 63.4% 65.5% 70.2% Source: California Health Interview Survey, 2009 Cancer Cancer incidence rates are available at the county level. In Los Angeles County, the cervical cancer rate (9.8 per 100,000 persons) and the colorectal cancer rate (45.1per 100,000 persons) exceed the state rates for these cancers. Breast cancer (117.8), prostate cancer (142.8) and lung cancer (45.6) occur at rates less than the state rates for these types of cancer. Cancer Incidence, per 100,000 Persons Breast Cancer Cervical Cancer Colon and Rectum Cancer Prostate Cancer Lung Cancer Los Angeles County 117.8 9.8 45.1 142.8 45.6 California 123.2 8.3 43.7 146.5 52.4 Source: The Centers for Disease Control and Prevention, National Cancer Institute, State Cancer Profiles, 2005-2009 32 Asthma The population diagnosed with asthma in SPA 6 is 13.5% and in SPA 7 is 11.5%. 68.2% of asthmatics in SPA 6 and 43% in SPA 7 take medication to control their symptoms. Among youth in SPA 6, 15.7% have been diagnosed with asthma and 16.2% of youth in SPA 7 have been diagnosed with asthma. In SPA 6, 80.5% of asthmatics are very confident that they can control and manage their asthma. 52.7% of asthmatics in SPA 7 are very confident they can control and manage their asthma. Asthma Diagnosed with Asthma, Total Population Diagnosed with Asthma, 0-17 Years Old ER Visit in Past Year Due to Asthma, Total Population ER Visit in Past Year Due to Asthma, 0-17 Years Old Takes Daily Medication to Control Asthma, Total Population Takes Daily Medication to Control Asthma, 0-17 Years Old Very Confident to Control and Manage Asthma Confident to Control and Manage Asthma Not Confident to Control and Manage Asthma SPA 6 13.5% 15.7% SPA 7 11.5% 16.2% California 13.7% 14.2% 10.4% 7.0% 10.3% 24.3% 9.2% 13.7% 68.2% 43.0% 42.1% 65.2% 47.4% 38.1% 80.5% 14.5% 52.7% 40.8% 6.5% 76.9% 14.8% 3.3% 5.0% Source: California Health Interview Survey, 2009 Overweight and Obesity In SPAs 6 and 7, over one-third of the adult population is overweight. 18.8% of teens in SPA 7 and 11.3% in SPA 6 are overweight. And 15.2% of children in SPA 7 and 11.8% in SPA 6 are overweight. Overweight Adult Teen Child SPA 6 38.4% 11.3% 11.8% SPA 7 34.0% 18.8% 15.2% California 33.6% 16.7% 11.5% Source: California Health Interview Survey, 2009 When adult obesity levels were tracked over time, a 9% increase in obesity is seen in SPA 6, and a 10.3% increase in obesity is seen in SPA 7 from 2005 to 2011. In 2011, 32.7% of adults in SPA 6 and 30.1% of adults in SPA 7 were obese, higher than the county rate of 23.6%. 33 Adult Obesity 2005 Service Planning Area 6 Service Planning Area 7 Los Angeles County 30.0% 27.3% 20.9% 2007 2011 35.4% 26.6% 22.2% 32.7% 30.1% 23.6% Change 2005-2011 9.0% 10.3% 12.9% Source: LA County Department of Public Health, 2012 Los Angeles County Department of Public Health has collected data on adult and childhood obesity prevalence and established rankings to compare obesity levels across localities in Los Angeles County. In the hospital service area, over one-third of the adult population is obese in Compton, Lynwood, Paramount and South East Los Angeles. Commerce, Hawaiian Gardens, and West Whittier/Los Nietos have the highest rates of obesity among youth. Adult and Youth Obesity Rates and Rankings Prevalence of Adult Obesity Percent^ Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East L.A. Council District 9 South Gate South Whittier West Whittier/Los Nietos Rank of Adult Obesity* (ranked 1-127) 20.9% 29.4% 25.2% 29.4% 12.4% 30.2% 39.1% 29.5% 24.3% 27.0% 29.3% 21.2% 37.8% 30.1% 27.2% 35.5% 30.9% 29.4% 36.7% 53 99 74 99 13 109 125 104 69 83 97 54 123 107 86 121 112 99 122 25.5% 29.0% 23.4% 29.4% 15.2% 31.3% 29.0% 29.2% 21.2% 33.4% 30.3% 20.9% 27.7% 28.7% 26.0% 27.3% 25.9% 24.1% 29.5% Rank of Childhood Obesity * (ranked 1-119) 70 97 64 104 30 112 97 101 51 117 107 49 86 94 75 81 73 66 105 30.1% 28.0% 29.4% 107 91 99 30.7% 29.0% 31.1% 109 97 111 34 Prevalence of Childhood Obesity Percent+ Whittier 23.6% 65 23.4% 64 Los Angeles County 23.9% NA 23.0% N/A Source: L.A. County Department of Public Health, 2011 ^BMI of 30kg or above; +BMI for age > or equal to 95th percentile *Places were ranked from lowest to highest rates of obesity with 1 indicating the lowest rate of obesity. There are fewer rankings for children since some localities were not presented due to small student group sizes. Obese Youth Students in 'At High Risk' Body Composition Zones, by Elementary School District Over 40.0% 30.1 - 40.0% 20.1 - 30.0% 10.1 - 20.0% Under 10.1% Source: California Department of Education, 2011 35 IV. Who Was Involved in the Assessment Melissa Biel of Biel Consulting conducted the community health needs assessment. Biel Consulting is an independent consulting firm that works with hospitals, clinics and communitybased nonprofit organizations. Dr. Biel has over 10 years of experience in the field of community benefit, which includes work on hospital Community Health Needs Assessments. Dr. Biel may be contacted at [email protected] or 562-496-2462. 36 V. Process and Methods Used to Conduct the CHNA a. Secondary data Secondary data were collected from a variety of local, county, and state sources to present demographics, mortality, morbidity, health behaviors, clinical care, social and economic factors, and physical environment. These data categories are based on the Mobilizing Action Toward Community Health (MATCH) framework, which describes the elements of health and the relationships to each other. In order to ensure consistency across the organization, Kaiser Permanente identified a minimum set of required indicators for each of the data categories to be used by all Kaiser Permanente Regions for the Community Health Needs Assessments. Kaiser Permanente partnered with the Center for Applied Research and Environmental Systems (CARES) at the University of Missouri to provide the common indicators through a web-based data platform specific to the KFH – Downey service area. The secondary data for this report was obtained from the Kaiser Permanente CHNA data platform from October 2012 through February 2013. The data platform is undergoing continual enhancements and certain data indicators may have been updated since the data were obtained for this report. As such, the most updated data may not be reflected in the 37 tables, graphs, and/or maps provided in this report. For the most recent data and/or additional health data indicators, please visit CHNA.org/kp. Additional data sets were included to supplement the minimum required data sets. These data were selected from local sources that were not offered on the common indicators database. The data sets were accessed electronically and the data for the KFH – Downey service area collected and documented in data tables. The tables present the data indicator, the geographical area represented, the data measurement (e.g. rate, number, percent), and the data source and year. The Kaiser Permanente common indicator data were calculated to obtain unique service area rates. In most cases, the service area values represent the aggregate of all data for geographies (zip codes, counties, tracts, etc.), which fall within the service area boundary. When one or more geographic boundaries were not entirely encompassed by a service area, the measure was aggregated proportionally. The options for weighting “small area estimations” were based upon total area, total population, and demographic-group population. The specific methodology for how service area rates were calculated for each indicator can be found on the CHNA.org/kp website. When the data were not available at a level that represented the specific service area (in the case of Service Planning Areas – SPAs), the data were not totaled to represent the service area and were presented for the geographic area represented. When applicable, these data sets are presented in the context of state data, framing the scope of an issue as it relates to the broader community. Analysis of secondary data included an examination and reporting of health disparities for some health indicators. Sources of data for this report are listed in Appendix A. Health needs from secondary data sources were identified using two criteria: the size of the problem (relative portion of population afflicted by the problem) and the seriousness of the problem (impact at individual, family, and community levels). To determine size or seriousness of the problem, the health need indicators identified in the secondary data were measured against benchmark data, specifically California state rates or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against these benchmarks were considered to have met the size or seriousness criteria. The report includes benchmark comparison data that measures KFH – Downey community data findings with Healthy People 2020 objectives (Appendix B). Healthy People 2020 objectives were selected as a useful benchmark as they are nationally recognized and seek to improve the public’s health by providing measurable objectives and goals that are applicable at national, state, and local levels. b. Community Input Information and opinions were gathered directly from persons who represented the broad interests of the community served by the Hospital. Seventeen telephone interviews with 38 community stakeholders and four focus groups with 33 area residents were completed from August through October, 2012. For the interviews, community stakeholders were identified by the KFH – Downey Community Benefit department staff. The stakeholders were known to the Medical Center staff as those with special knowledge or expertise in public health; individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations; or regional, State or local health or other departments or agencies that have “current data or other information relevant to the health needs of the community served by the hospital facility.” They were selected to cover a wide range of communities within the service area, represent different age groups, and racial/ethnic populations that included: Low-income families, predominantly Latino and African American Immigrant families, particularly Latino families “Hard to Reach” populations – largely undocumented Uninsured and underinsured individuals and families Teen parents People living with HIV/AIDS Lesbian, Gay, Bisexual and Transgender (LGBT) populations School-age children/youth College students Veterans People experiencing bereavement Communities of Watts (and surrounding areas), Montebello/Commerce, City of South Gate, Norwalk La Mirada Unified School District, Bellflower Unified School District Residents of SPA 6 and 7 The services provided by the participating organizations included: Mental health services (school-based services, individual and family counseling, groups, domestic violence services) Health care services (provided by FQHCs, schools and community college) – including physical exams, case management, chronic disease care, immunizations, sick care Public health services Social services (including food, housing, employment) Hospice/bereavement services Services for older adults (including home-delivered meals) Child care and babysitting Case management for teen mothers Nutrition education 39 STD/HIV and teen pregnancy prevention education Health education and outreach/enrollment (including worksite-based services) Services for high school students, including educational support, scholarship programs, leadership development, summer youth employment program Community-based gym providing fitness classes and equipment The identified stakeholders were contacted by phone and asked to participate in the needs assessment. The phone calls were followed up with an email invitation that repeated the interview details. At the beginning of each interview, the purpose of the interview in the context of the assessment was explained, the stakeholders were assured their responses would remain confidential, and consent to proceed was given. The interview questions can be found in Appendix C. A list of the key stakeholder interview respondents, their titles, organizations and leadership roles are listed in the tables below. In addition to the stakeholder interviews, four focus groups were conducted with area residents who were clients of community organizations in the KFH – Downey service area. The focus group participants were selected as representing medically underserved, low-income, minority and/or chronic disease populations. Four community organizations were asked to invite program clients to a focus group held at their agency sites. An information sheet was made available to explain the focus group details. An agency contact was also available to answer any questions. At the beginning of each focus group, the purpose of the focus group and the community assessment were explained, the participants were assured their responses would remain confidential, and consent to proceed was given. Two focus groups were conducted in Spanish with a bilingual facilitator. Participant groups included: Young mothers at INMED Partnerships for Children - MotherNet Program HIV Clients at Whittier Rio Hondo AIDS Program (WHRAP) Adult ESL class participants at Bellflower Unified School District Patients from Family Health Care Centers of Greater Los Angeles (FHCCGLA) Focus group participants were provided with gift cards as a thank you for their input. The focus group questions can be found in Appendix D. The focus groups are detailed below. Individuals with special knowledge of or expertise in public health Name Title Affiliation Description of (Last, public health First, knowledge/expertise Academic Distinction) 40 Date of Consult Type of consult 1. Lastra, Lindsay Health Educator Los Angeles County Department of Public Health SPA 7 Community Health Services Community health 9/21/12 Interview Individuals consulted from Federal, tribal, regional, State or local health departments or other departments or agencies with current data or other relevant information Name Title Affiliation Type of Date of Type of (Last, First, Department Consult consult Academic Distinction) 1. Flores, Local California Center 9/21/12 Interview Jeanette Policy for Public Health Specialist Advocacy 2. Lastra, Health Los Angeles SPA 7 9/21/12 Interview Lindsay Educator County Community Department of Health Services Public Health Leaders, representatives, or members of medically underserved persons, low-income persons, minority populations and populations with chronic disease needs Leader / Rep. Description of What group(s) do they Date of Type of Name (Last, leadership, represent? (medically Consult consult First) representative, or underserved, lowOR member role income, minority Member population, population Type/# with chronic disease) 1. Aguilar, Felix, Chief Medical medically underserved, 9/25/12 Interview MD Officer, South low-income, minority Central Family population, population Health Center with chronic disease 2. Aguirre, Community Benefit medically underserved, 9/19/12 Interview Maria Manager, Kaiser low-income, minority Permanente Watts population Counseling & Learning Center 3. Banagas, Community Services medically underserved, 8/28/12 Interview Renett Coordinator, Caring low-income, minority Connections, population 41 4. Duran, Antoinette 5. Franco, Marilyn 6. Lawrence, Marilyn 7. Markel, James 8. Mendia, Liz 9. Montgomery, Nancy 10. Pardo, Luis 11. Perez, Luz 12. Saum, Alan 13. Shanahan, Joey 14. Skovgard, Cindy 15. Torres, Veronica Bellflower Unified School District Program Director for Youth Development, Montebello/Commerc e YMCA Case Manager, Family Health Care Centers of Greater Los Angeles Program Manager Children’s Health & Wellness, Crystal Chairs Fitness Coordinator, City of South Gage Sports Center Executive Director, Whittier Rio Hondo AIDS Project Student Health Services and Veteran Services, Cerritos College Executive Director, Worksite Wellness LA Program Coordinator, TLC Family Resource Center, Downey Unified School District Volunteer, Pathways Volunteer Hospice Director, INMED Partnerships for Children Executive Director, Pathways Volunteer Hospice Coordinator, Health on Wheels, Norwalk- medically underserved, low-income, minority population 9/11/12 Interview medically underserved, low-income, minority population, population with chronic disease medically underserved, low-income, minority population 9/28/12 Interview 9/18/12 Interview medically underserved, low-income, minority population medically underserved, low-income population with chronic disease medically underserved, low-income, minority populations 9/13/12 Interview 9/7/12 Interview 9/25/12 Interview medically underserved, low-income, minority population medically underserved, low-income, minority population 8/28/12 Interview 9/18/12 Interview medically underserved, low-income, minority population medically underserved, low-income, minority population, population medically underserved, low-income, minority population, population with chronic disease medically underserved, low-income, minority 8/27/12 Interview 9/7/12 Interview 9/13/12 Interview 10/5/12 Interview 42 16. 10 young mothers 17. 10 residents with AIDS 18. 14 parents 19. 9 patients La Mirada Unified School District INMED Mother Net Program participants Whittier Rio Hondo AIDS Program participants Bellflower Unified School District Adult ESL Program Family Health Care Centers of Greater Los Angeles patients population, population medically underserved, low-income, minority population, population medically underserved, low-income population with chronic disease medically underserved, low-income, minority population medically underserved, low-income, minority population, population with chronic disease 9/27/12 Focus Group 10/16/12 Focus Group 10/18/12 Focus Group conducted in Spanish Focus Group conducted in Spanish 10/17/12 Interview participants were asked to share their perspectives on a number of topics related to existing areas of priority health needs in the KFH – Downey service area. Questions that related to the following topics: Biggest issues or concerns facing the community Challenges people face in obtaining health care and/or social services Barriers to care for chronic disease prevention and treatment, Preventive measures used to manage chronic disease and services/resources used for care and education Services needed for at-risk youth Services available and needed to address overweight and obesity Other notes and comments Summary responses to these questions were documented in a report. The summary report from the interviews can be found in Appendix E. The focus group participants were asked to share their perspectives related to various topics within the following areas: Community Issues and Health Concerns Access to Care Healthy Lifestyles At-Risk Youth General/Other Summary responses to these questions were documented in a report. The summary report from the focus groups can be found in Appendix F. 43 Analysis of the primary data occurred through a process where responses were compared and combined to determine meaning and identify themes. Where applicable, responses that differed among the respondent groups were noted. Respondents were asked to identify issues in relation to their perceived size and seriousness in a community. This was accomplished by asking them to identify the “biggest” community health concerns. All the responses to each question were examined together and concepts and themes were then summarized to reflect the respondents’ experiences and opinions. c. Data limitations and information gaps The Kaiser Permanente common data set includes a robust set of nearly 100 secondary data indicators that when taken together enable an examination of the broad health needs faced by a community. However, there are some limitations with regard to this data, as is true with any secondary data available. Some data were only available at a county level, making an assessment of health needs at a neighborhood level challenging. For example, cancer incidence rates are not available at a rate more local than Los Angeles County. Moreover, disaggregated data around age, ethnicity, race, and gender are not available for all data indicators, which limited the ability to examine disparities of health issues within the community. Lastly, data were not always available or collected on a yearly basis, meaning that some data were several years old. For example, the results of the most recent 2011 Los Angeles County Health Survey (a population based telephone survey that provides information concerning the health of Los Angeles County residents) were not yet available during the conduct of this CHNA. 44 VI. Identification and Prioritization of Community’s Health Needs a. Identifying community health needs For the purposes of the CHNA, Kaiser Permanente defines a health need as a poor health outcome and its associated health driver(s), or a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. Health needs were identified from data and information gathered from both primary and secondary data sources. Health needs from these data sources were identified using two criteria: the size of the problem (relative portion of population afflicted by the problem) and the seriousness of the problem (impact at individual, family, and community levels). To determine size or seriousness of problem, the health need indicators identified in the secondary data were measured against benchmark data, specifically California state rates or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against these benchmarks were considered to have met the size or seriousness criteria. Additionally, primary data sources were asked to identify community and health issues based on the perceived size or seriousness of a problem. For example, focus group and interview respondents were asked to consider the size and seriousness of a health need by identifying and discussing the biggest health issues and concerns in the community. In summary, health needs were identified based on the following criteria: Complied with the Kaiser Permanente definition of a health need; Was confirmed by more than one indicator or data source; Only secondary data sources at levels below county level were used; and Size or seriousness of the problem: the health need indicators identified in the secondary data exceeded California benchmarks or Healthy People 2020 objectives; for primary data, the indicators were identified as issues or concerns by interview or focus group participants. The health needs identified in the KFH – Downey service area included: Health Outcomes Asthma Cardiovascular disease Diabetes Overweight and obesity STDs 45 Teen births Clinical Drivers Access to care Dental health Mental health Preventive health care (screening and prevention) Behavioral Drivers Nutrition/healthy eating Physical activity Environmental Drivers Youth safety and community violence b. Process and criteria used for prioritization of the health needs Priority setting is an important step in the community benefit planning process. The IRS regulations indicate that the Community Health Needs Assessment must provide a prioritized description of the community health needs identified through the CHNA, and include a description of the process and criteria used in prioritizing the health needs. KFH – Downey hosted a community forum on January 4, 2013 in Downey and another in Bellflower on January 8, 2013 to prioritize the identified health needs. The forums engaged 37 community leaders in public health, government agencies, schools, and nonprofit organizations that serve the medically underserved, low-income, minority and chronic disease populations in the community. These individuals have current data or other information relevant to the health needs of the community served by the hospital facility. A review of the Community Health Needs Assessment findings with the identified health needs was presented at the community forums. Priority Setting Process The forum attendees were engaged in a process to prioritize the health needs using the Relative Worth method. The Relative Worth method is a ranking strategy where each participant received a fixed number of points; in this case 100 points (5 dots equaled 100 points, where each dot was worth 20 points). Instructions were given, and the criteria for assigning points were explained. The points were assigned to health needs based on the size of the problem (relative portion of population afflicted by the problem); or seriousness of the problem (impact at individual, family, and community levels). This iterative methodology built on the identification of health needs based on the criteria of size and seriousness. The points could be distributed among the health needs to be prioritized in a number of ways: 46 Give all points to a single, very important item Distribute points evenly among all items (if none is larger or more serious than another) Distribute some points to some items, no points to other items In the tabulation, items were ranked in priority order according to the total points the group assigned. Points were totaled among the two community forum groups. The entire list of health needs was prioritized based on number of points given. Participants engaged in a group discussion about the priority areas. Participants were asked to discuss the following questions for the high priority areas: 1. For this issue, what is going well? What works in the community to address this issue? 2. What groups/organizations are already focused on this issue? 3. What/who is missing? Where are the gaps? What are the barriers? 4. What is the level of community readiness to effectively implement and support programs to address this priority need? 5. Identify collaborative opportunities to address this issue. The participants were also asked to explain their thinking behind the lower rankings for some of the health needs. They indicated that many of the health needs were interrelated and impacted on each other. So by addressing a particular health need, for example overweight and obesity, community heath planners would have to address healthy eating and physical activity. Therefore, more points were given to overweight and obesity as a health need as it encompasses the health needs of healthy eating and physical activity. The information gathered from the community forums will be used for decision making in creation of the Implementation Strategy. c. Prioritized description of community health needs The health needs were ranked in the following order of priority: Health Need Youth safety/community violence Mental health Overweight/obesity Access to care Diabetes Physical activity Preventive health Nutrition/healthy eating Dental health Cardiovascular disease 47 Points 500 500 480 460 240 200 120 120 60 60 Teen births STDs Asthma 60 60 20 The following issue statements provide a summary of each of the health needs presented in priority order. Sources cited can be found in Appendix A. Youth Safety/Community Violence Community violence is pervasive, especially in lower-income urban areas. Socioeconomics and crime interconnect and contribute to community violence. High rates of crime and violence impact on families’ feelings of safety and tend to reduce community interaction and outside physical activities (National Center for Children Exposed to Violence). Homicide - In the KFH – Downey service area the rate of homicide is 13.1 per 100,000 persons (age-adjusted, averaged over three years, 2008-2010) (California Department of Health, 2008-2010). Experienced Physical or Sexual Violence - 14.2% of adults in SPA 6 indicated they had experienced physical or sexual violence by an intimate partner since the age of 18. In SPA 7, 13.1% had experienced violence since the age of 18. In California the rate was 14.8% (California Health Interview Survey, 2009). Domestic Violence - Whittier, Compton and Bellflower had the highest number of domestic violence calls in 2010 in the KFH – Downey service area (California Department of Justice, 2010). Motor Vehicle Accident - In the KFH – Downey service area the rate of death from motor vehicle crash is 9.2 per 100,000 persons. In California the rate is 8.2. The Healthy People 2020 objective is 12.4. The rate of pedestrian deaths from motor vehicle crashes is 1.8 per 100,000 persons. This rate is higher than the California rate (0.8) and above the Healthy People 2020 objective (1.3) (California Department of Public Health, 2008-2010). A key driver for safety and violence is education. Lack of educational attainment is an associated risk factor for violence and crime in communities. Among adults, ages 25 and older, in the KFH – Downey service area, over one-third of the population (35.6%) have no high school diploma. This is compared to 19.3% of residents in California who do not have a high school diploma (American Community Survey, 2006-2010). Communities negatively impacted by violence include Compton (547.4), Commerce (436.7) and Hawaiian Gardens (427.9), which have the highest rate of arrests among adults for violent crimes per 100,000 persons in the KFH – Downey service area. Bell, Bellflower, Cudahy, Huntington Park and Lynwood also have high rates of violent crimes (California Department of Justice, 2010). A community resident identified the impact not feeling safe in a community has on a decrease in physical activity, “Safety is one barrier that limits the ability of parents to send their kids out to play; people don’t go out after dark, and there is a concern about gangs.” 48 Mental Health Mental illness is a common cause of disability. Untreated disorders may leave individuals atrisk for substance abuse, self-destructive behavior, and suicide. Additionally, mental health disorders can have a serious impact on physical health and are associated with the prevalence, progression and outcome of chronic diseases (Healthy People 2020). Adults – In SPA 6, 14.8% of adults had serious psychological distress, compared to 6.5% of adults in California (California Health Interview Survey, 2009). Teens – 26.4% of teens in SPA 6 and 16.7% of teens in SPA 7 needed help for emotional issues/substance abuse (California Health Interview Survey, 2009). In SPA 6 10.9% of adults reported needing mental health care but not being able to afford to access it. This is in comparison to 5.9% of adults in LA County who could not afford mental health care (Los Angeles County Health Survey, 2007). A key driver for mental illness is excessive alcohol use. Binge drinking is defined as consuming a certain amount of alcohol within a set period of time. For males this is five or more drinks per occasion and for females it is four or more drinks per occasion. Among adults, 25.2% in SPA 6 and 30.2% in SPA 7 had engaged in binge drinking in the past year (California Health Interview Survey, 2009). Teens are a significant subpopulation impacted by depression. In KFH – Downey -area school districts, 32.2%-43.6% of 7th grade females expressed depression-related feelings. This is higher than the state rate of 30.8% (California Healthy Kids Survey, 2008-2010). Poor mental health can influence rates of suicide. In the KFH – Downey service area the rate of death by suicide is 6.4 per 100,000 persons (age-adjusted, averaged over three years, 2008-2010) (California Department of Public Health, 2008-2010). Overweight/Obesity Being overweight or obese affects a wide range of health issues and are major risk factors for diabetes, cardiovascular disease, and other chronic diseases. Overweight – Over one-third of adults in the KFH – Downey service area are overweight. Among teens, 11.3% in SPA 6 and 18.8% in SPA 7 are overweight. 11.8% of children in SPA 6 and 15.2% in SPA 7 are overweight (California Health Interview Survey, 2009). Obesity – When adult obesity levels were tracked over time, a 9% increase in obesity is seen in SPA 6, and a 10.3% increase in obesity is seen in SPA 7 from 2005 to 2011. In 2011, 32.7% of adults in SPA 6 and 30.1% of adults in SPA 7 were obese, higher than the County rate of 23.6% (Los Angeles County Department of Public Health, 2012). Unhealthy eating has been found to be a risk factor for overweight and obesity. Diets High in Fat: 21.9% of the residents in SPA 6 consume fast food 3-4 times a week. In SPA 7, over one-third (33.5%) of the residents eat fast food 3-4 times a week. The state rate is 19.6% (California Health Interview Survey, 2009). 49 Soda Consumption: In comparison to the 14.7% rate of soda consumption in California, children and teens consume much higher rates of soda / sweetened drinks in SPA 6 (21.7%) and SPA 7 (23.5%) (California Health Interview Survey, 2009). Obesity prevalence increases among residents experiencing economic hardship. The percentage of students eligible for the free and reduced price meal program is one indicator of socioeconomic status. In the KFH – Downey service area, three-fourths (74.7%) of the student population are eligible for the free and reduced price meal program, indicating a high level of low-income families. This rate is higher than the state rate of 55.6% (National Center for Education Statistics, 2010-2011). Obesity co-morbidities are some of the leading causes of premature death in the service area. Heart disease is the #1 cause of premature death (death before age 75) in SPA 7 and the #2 cause of premature death in SPA 6. Among females, diabetes is the #3 cause of premature death in SPA 7 (LA County Dept. of Public Health, 2011). Obesity also increases rates of diabetes. 15.8% of adults in SPA 6 and 12.7% in SPA 7 have been diagnosed with diabetes. These are higher rates than found in California (8.5%) (California Health Interview Survey, 2009). Access to Care Access to comprehensive, quality health care services is important for health equity and for increasing the quality of a healthy life. Health care access is a key requirement for early detection of illnesses, chronic disease management and reduction of Emergency Room usage. In the KFH – Downey service area, 26% of residents are uninsured. In California the rate of uninsured is 17.9% (American Community Survey, 2008-2010). Insurance Coverage – In the KFH – Downey Service Area, 74% of residents have health insurance, which can include Medi-Cal, employer-based insurance and other public and private coverage (American Community Survey, 2008-2010). Health Professional Shortage Area (HPSA) – 15% of the KFH – Downey service area population live in a HPSA (which includes shortages of medical, dental, and mental health providers) compared to 13.8% of the state population (Health Resources and Services Administration, 2012). Residents who have a medical home have access to a primary care provider. Among the residents in the KFH – Downey Service Area, over 90% of children and youth have a usual source of care. Among adults, in SPA 6, 68.7% have a usual source of care, and 77.5% of adults in SPA 7 have a source of care. And, 86.3% of seniors in SPA 6 and 95.4% of seniors in SPA 7 have a usual source of care (California Health Interview Survey, 2009). Low-income populations face increased barriers to accessing health care; 43.1% of the population in the service area is categorized as low-income and 17.1% are living in poverty. In 2010, the poverty level income for a family of four was $22,050 (American Community Survey, 20062010). 50 Access to care enhances prevention of disease and disability. In SPA 6, 28.2% of adults rate their health as fair or poor and 20.1% of SPA 7 adults feel they are in fair or poor health. 15.2% of Californians rate themselves as being or fair or poor health (California Health Interview Survey, 2009). Diabetes Diabetes is the fifth leading cause of death in Los Angeles County. Living with uncontrolled diabetes can lead to severe health consequences that include heart disease, stroke and kidney failure. Diabetes is a costly chronic condition that can lead to disability, loss of productivity and premature death (Los Angeles County Department of Public Health, 2012). 15.8% of adults in SPA 6 and 12.7% in SPA 7 have been diagnosed with diabetes, compared to the state rate of 8.5% (California Health Interview Survey, 2009). A known risk factor for diabetes is overweight and obesity. In SPAs 6 and 7, over one-third of the adult population is overweight; 18.8% of teens in SPA 7 and 11.3% in SPA 6 are overweight. And 15.2% of children in SPA 7 and 11.8% in SPA 6 are overweight (California Health Interview Survey, 2009). Diabetes and the associated risk factors are found to be higher among the following populations (Los Angeles County Department of Public Health, 2012): Diabetes increases with age, adults ages 65+ have the highest rates of diabetes Latinos and African Americans have the highest prevalence of diabetes Diabetes prevalence increases among adults living below the Federal Poverty Level Individuals with diabetes commonly have hypertension. In SPA 6, 34.1% of adults have been diagnosed with high blood pressure. Of these, 63.4% are on medication for their blood pressure. In SPA 7, 26% of adults have been diagnosed with high blood pressure and 65.5% are on medication (California Health Interview Survey, 2009). Physical Activity According to Healthy People 2020, more than 80% of adults and adolescents in the U.S. do not meet the guidelines for aerobic and/or muscle-strengthening activities. Regular physical activity can improve physical and mental health, and quality of life, regardless of the presence of a chronic disease or disability. Personal, social, economic, and environmental factors all play a role in physical activity levels. Physical activity plays a key role in levels of overweight and obesity, and in the development and management of chronic diseases. Adult Physical Activity – In the KFH – Downey Service Area, 78.8% in SPA 6 and 81.4% in SPA 7 walked for transportation, fun or exercise, compared to 77.2% of adults in the state (California Health Interview Survey, 2009). Child Physical Activity – 15.2% of children in SPA 6 and 17% in SPA 7 were sedentary during the week, which is higher than the state rate of 11.8% (California Health Interview Survey, 2009). 51 Teen Physical Activity – 14.4% of teens in SPA 6 and 14.1% in SPA 7 were sedentary during the week, less than the state rate of 16.2% (California Health Interview Survey, 2009). Park and recreation facility access has a positive relationship with physical activity in a community. In the KFH – Downey service area, 68.3% of the population lives within half a mile of a park. The rate of individuals that live near a recreation facility is 4.4 per 100,000 persons; this is lower than the state rate of 8.9 per 100,000 persons (U.S. Census Bureau, 2009+2010). Higher incomes and educational attainment is positively associated with adult physical activity levels; 43.1% of the population in the service area is categorized as low-income (200% Federal Poverty Level or below). Additionally, 35.6% of individuals over 25 in the KFH – Downey service area do not have a high school diploma in comparison to the 19.3% in California (American Community Survey, 2006-2010). Lack of physical fitness is associated with many diseases. Heart disease is the #1 cause of premature death (death before age 75) in SPA 7 and the #2 cause of premature death in SPA 6. Among females, diabetes is the #3 cause of premature death in SPA 7 (Los Angeles County Department of Public Health, 2011). Preventive Care Health care preventive services include cancer and chronic disease screening and scheduled vaccines and immunizations. Preventive care reduces death and disability and improves health. These services prevent and detect illnesses and diseases—from flu to cancer—in earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and medical care costs for individuals and the community (Healthy People 2020). Mammograms: The Healthy People 2020 objective for mammograms is 81.1% of women 40+ years have a mammogram in the past two years. In SPA 6, 72% of women, age 40+, have had a mammogram, and 77% of women in SPA 7 have had a mammogram, which falls short of the Healthy People 2020 objective (Los Angeles County Department of Public Health, 2007). Pap Smears: The Healthy People 2020 objective for Pap smears is 93% of women have a Pap smear in the past three years. In SPA 6, 88.3% of women have had a Pap smear in the past three years, and 85% of women in SPA 7 have had a Pap smear in that time period (Los Angeles County Department of Public Health, 2007). Colorectal Cancer Screening: In SPA 6, 67.1% of adults have had the recommended screening for colorectal cancer. In SPA 7, the rate of compliance is 71.1%, which exceeds the Healthy People 2020 objective for colorectal cancer screening of 70.5%. Of adults advised to obtain screening, 57.9% in SPA 6 and 59.2% in SPA 7 were compliant at the time of the recommendation (California Health Interview Survey, 2009). Residents who have a medical home are able to access preventive care services. Among the residents in the KFH – Downey service area, over 90% of children and youth have a usual 52 source of care. 68.7% of adults in SPA 6, and 77.5% of adults in SPA 7 have a usual source of care. And, 86.3% of seniors and 95.4% of seniors in SPA 7 have a source of care. 85.8% of state residents have a usual source of care (California Health Interview Survey, 2009). Low-income populations face barriers obtaining preventive care: 43.1% of the population in the service area is categorized as low-income, compared to 32.8% in the state (American Community Survey, 2006-2010). Adequate preventive care may reduce unnecessary hospitalizations. The KFH – Downey service area has higher hospitalization rates (per 1,000 people hospitalized) than the state for adult asthma (KFH – Downey 9.7, state 7.7); youth asthma (KFH – Downey 19.9, state 19.2), adult diabetes (KFH – Downey 13.2, state 9.7), youth diabetes (KFH – Downey 6.3, state 4.8) and HIV (KFH – Downey 1.8, state 1.7) (OSHPD, 2010+2011). Nutrition and Healthy Eating Healthy eating and nutrition programs promote a healthy body weight and help to maintain chronic disease risk. A goal for good nutrition among vulnerable populations is to eliminate hunger, and increase access to nutrient dense, healthy food (Healthy People 2020). Fast Food Access: KFH – Downey area residents have an access rate of 64.4 fast food restaurants per 100,000 persons; this is less than the state rate of 69.4. Fast Food Consumption – Residents in SPA 6 (21.9%) and SPA 7 (33.5%) consume more fast food than California residents (19.6%) (California Health Interview Survey, 2009). Food Desert: A food desert is defined as a low-income census tract where a substantial percentage of residents have limited access to a supermarket or large grocery store. Only 1.5% of the population in the service area lives in a designated food desert as compared to the California rate of 5.7% (U.S. Department of Agriculture, 2009). Poverty affects access to healthy food. In the KFH – Downey service area, 43.1% of residents are low-income (200% or below Federal Poverty Level) (American Community Survey, 20062010). Poor nutrition and lack of healthy eating can add to the problem of overweight. In the KFH – Downey service area over one-third of the adult population is overweight (34%38.4%), higher than the state rate (33.6%) (California Health Interview Survey, 2009). Dental Low-income individuals, particularly children and minorities, are more likely to have poor oral health. Poor oral health can be both a result of certain health conditions and a cause of poor health (Healthy People 2020). The KFH – Downey service area shows higher rates of adults unable to afford dental care in comparison to LA County. SPA 6 has a higher number of children who have never been to the dentist compared with children in California. 53 Adult Access – In SPA 6, 28.8% of adults and 24% of adults in SPA 7 were unable to afford dental care in the past year, which is higher than the L.A. County rate of 22.4% (California Health Interview Survey, 2009). Children (Ages 3-11) Access – 15.7% of children in SPA 6 and 10.2% in SPA 7 have never been to the dentist (California Health Interview Survey, 2009). High consumption of soda and sugar sweetened beverages is a known cause of dental caries (American Dental Association). In comparison to California (14.7%), children and teens consume much higher rates of soda (two or more sodas or sweetened drinks per day) in SPA 6 (21.7%) and SPA 7 (23.5%) (California Health Interview Survey, 2009). Hispanic and African American populations are at higher risk for poor oral health and not obtaining routine dental care. In the KFH – Downey service area, 70.1% of the population is Hispanic and 9.7% is African American (U.S. Census Bureau, 2010). Gum disease has been linked to premature birth and low birth weight babies. The KFH – Downey service area rate of low birth weight babies is 6.9%, which is slightly higher than the California rate of 6.8% (California Department of Public Health, 2010). Cardiovascular Disease Cardiovascular disease includes conditions that impact the heart and vascular system. Conditions may include heart disease, stroke, high blood cholesterol and high blood pressure. Cardiovascular disease is a significant contribution to death and disease in the KFH – Downey service area. A number of factors influence the development and management of cardiovascular disease: overweight/obesity, physical inactivity, and diets high in sugar and fat (Healthy People 2020). Heart Disease – 5% of adults in SPA 6 and 6.2% in SPA 7 have been diagnosed with heart disease. Among Whites in SPA 6, over one-third of the population (39.3%) has heart disease (California Health Interview Survey, 2009). Premature Death – Heart disease is the #1 cause of premature death (before age 75) in SPA 7 and the #2 cause of premature death in SPA 6 (Los Angeles County Department of Public Health, 2011). Mortality Rates – Rates of death for heart disease (147.4) and stroke (40.9) in the service area exceed the Healthy People 2020 objectives (100.8 and 33.8) (California Department of Public Health, 2008-2010). Smoking is a known risk factor for cardiovascular disease. Bellflower (15.7%), Compton (15.9%), Lynwood (16.5%), and South East Los Angeles (18.7%) have the highest rates of smoking in the service area. These rates exceed the Healthy People 2020 objective for smoking of 12% (Los Angeles County Department of Public Health, Cigarette Smoking in Los Angeles County, 2010). 54 Cardiovascular disease and the associated risk factors are found to be higher in the communities of: Bellflower Compton Hawaiian Gardens Huntington Park Lynwood Maywood Paramount South East LA South Gate West Whittier A comorbidity factor for heart disease is hypertension. In SPA 6, 34.1% of adults have been diagnosed with high blood pressure, and 63.4% are on medication for their blood pressure. In SPA 7, 26% of adults have been diagnosed with high blood pressure, and 65.5% are on medication (California Health Interview Survey, 2009). Teen Births Teen parents have unique needs for social, economic, and health support services. Teenage pregnancies may pose risks for the teen mothers and result in poor health outcomes for their children. The teen birth rate in the KFH – Downey service area was 11.8% of live births in 2010, an increase from 11.3% in 2009. The rate of teen births in California in 2010 was 8.5% (California Department of Public Health, 2010). Teen Sexual History – 5.4% of teens in SPA 6 and 5.7% of teens in SPA 7 had their first sexual encounter when they were less than 15 years old; 7.3% of teens in California had their first sexual encounter before the age of 15 (California Health Interview Survey, 2009). Teenage mothers are at high risk for late prenatal care, low birth weight births, and related health risks to the baby. The KFH – Downey service area rate of low birth weight babies is 6.9%, which is slightly higher than the California rate of 6.8% (California Department of Public Health, 2010). In the KFH – Downey service area, Bell/Bell Gardens (13%), Compton (16.1%), Hawaiian Gardens (15.2%), Southeast Los Angeles (15.3%-18.2%) and Vernon (19.7%) have high rates of teen births. Artesia (4.4%), Cerritos (2.1%), Downey (6.9%), and Long Beach 90808 (2.8%) have the lowest rates of teen births (California Department of Public Health, 2010). Sexually Transmitted Diseases (STD) STDs have been identified as a health need in the KFH – Downey service area. SPA 6 has high rates of Chlamydia, Gonorrhea, Early Latent Syphilis and HIV/AIDS, while SPA 7 has 55 lower rates of STDs than L.A. County as a whole. Community focus groups commented on the social stigma associated with discussing sex and intimacy, which Healthy People 2020 notes is the most important social factor contributing to the spread of STDs. Rates of HIV in the KFH – Downey service area have decreased from 2010 to 2011. In SPA 6 the HIV rate in 2011 was 16 (per 100,000 persons), and in SPA 7 it was 9. This is compared to the state rate of 13 (Los Angeles County Department of Public Health, 2011). The rate of Chlamydia in SPA 6 is 969.6 per 100,000 persons and in SPA 7 it is 406.3. In comparison the rate of Chlamydia in LA County is 455.1. Alcohol use can lead to risky sexual behaviors. 23.5% of teens in SPA 6 had drunk alcohol and 31.8% of teens in SPA 7 had drunk alcohol. These rates are lower than the state rate of 33.4% of teens drinking alcohol (California Health Interview Survey, 2009). Binge drinking among adults in SPA 6 was 25.2% and in SPA 7, 30.2%. The Healthy People 2020 objective for binge drinking is 23.4% (California Health Interview Survey, 2009). STDs are more likely to occur in low-income populations. In the KFH – Downey service area, 43.1% of the population is at 200% or below FPL. 32.8% of the state population is low-income (American Community Survey, 2006-2010). Asthma Asthma is a chronic disease that with preventive treatment can prevent symptoms and attacks and enable individuals who have asthma to lead active lives. Asthma episodes can range in severity from mild to life threatening. Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath (Healthy People 2020). The total population diagnosed with asthma in SPA 6 is 13.5% and in SPA 7 is 11.5%, the state rate of asthma prevalence is 13.7%. Among youth, ages 0-17, 15.7% in SPA 6 and 16.2% in SPA 7 have been diagnosed with asthma, which are both higher than the state rate of 14.2% (California Health Interview Survey, 2009). Smoking is a risk factor for asthma. Being a smoker, exposure to secondhand smoke, or having a mother who smoked during pregnancy have been shown to increase the chances of developing asthma. A number of communities in the KFH – Downey service area have high rates of cigarette smoking. Bellflower (15.7%), Compton (15.9%), Lynwood (16.5%), and South East Los Angeles (18.7%) have the highest rates of smoking in the service area. These rates exceed the Healthy People 2020 objective for smoking of 12% (Los Angeles County Department of Public Health, 2010). Families who live in communities with poor air quality have higher rates of asthma. Air quality measures the particulate matter levels above the National Ambient Air Quality 56 Standard (35 micrograms per cubic meter, per year) calculated using data collected by monitoring stations. In the KFH – Downey service area, the average daily ambient particulate matter was lower than the national standard but higher than found in the state (16 vs. 14.3). However, emissions standards were exceeded 14.9 days per year; compared to the state, which exceeded emission standards 15.4 days in a year (Centers for Disease Control and Prevention, 2008). Health Profiles for each of the health needs were developed to outline the scope of the health need in the context of the hospital service area. Health Need Profiles may be found in Appendix G. Additional community data not contained in the Health Need Profiles can be found in Appendix H – Supplemental Health Data. 57 VII. Community Assets and Resources Available to Respond to the Identified Health Needs of the Community Health Care Facilities Hospitals Coast Plaza Doctors Hospital Downey Regional Medical Center KFH – Downey Medical Center Los Angeles Community Hospital of Norwalk PIH Health St. Francis Medical Center Tri-City Regional Medical Center Whittier Hospital Medical Center Clinics AltaMed Medical and Dental Group American Indian Healing Center Family Health Care Center of Greater Los Angeles Health First Medical JWCH Institute, Inc. Los Angeles County Department of Health Services Los Angeles County Department of Public Health, Whittier Health Center Northeast Community Clinic – Community Medical Alliance South Central Family Health Center St. Francis Medical Center – Downey Community Clinic St. John’s Well Child & Family Center The Children’s Clinic Dental Care AIDS Project Los Angeles AltaMed Medical and Dental Group Assistance League of Whittier Children’s Dental Health Clinic Los Angeles County Department of Health Services St. John’s Well Child & Family Center Watts Healthcare Corporation Mental Health 58 Aspiranet Community Family Guidance Center ENKI, East LA Mental Health Helpline Youth Counseling, Inc. INMED Partnerships for Children Intercommunity Counseling Center of Whittier Kaiser Permanente, Watts Counseling and Learning Center Los Angeles County Department of Mental Health Pacific Clinics, El Camino The Whole Child Other Community Resources A partial list of resources within the community that are available to meet identified community health needs is listed below. Community resources are also identified in the reports from the community stakeholder interviews and focus groups, which can be found in Appendices E and F. Additional resources can be accessed at: www.211la.org www.healthycity.org/c/service School Districts ABC Unified School District Bellflower Unified School District Compton Unified School District Downey Unified School District East Whittier City Elementary School District El Rancho Unified School District Little Lake City Elementary School District Long Beach Unified School District Los Angeles Unified School District Los Nietos Elementary School District Lowell Joint Elementary School District Montebello Unified School District Norwalk-La Mirada Unified School District Paramount Unified School District South Whittier Elementary School District Whittier City Elementary School District Whittier Union High School District Community Organizations Activate Whittier Barbara J. Riley Community and Senior Center 59 Boys and Girls Club of Whittier California Center for Equality and Justice Catholic Charities Family Resource Center Children’s Network International City of Santa Fe Springs, Gus Velasco Neighborhood Center City of South Gate Sports Center Crystal Stairs Gangs Out of Downey (GOOD) Helpline Youth Counseling, Inc. INMED Partnerships for Children Interfaith Food Center Kaiser Downey Certified Farmer’s Market L.A. Care Health Plan Family Resource Center Montebello/Commerce YMCA Mother’s Nutritional Center Neighborhood Outreach Council Norwalk Certified Farmer’s Market Pathways Volunteer Hospice Plaza de la Raza Child Development Services, Inc. Salvation Army - Bellflower, Compton, Huntington Park and Whittier Salvation Army Bell Shelter Soledad Enrichment Action, Inc. South Asian Network Southeast Family Resource Center South Gate Certified Farmer’s Market St. Mathias Episcopal Church The Easter’s Nest Child Development Center Whittier First Day Whittier Rio Hondo AIDS Project Worksite Wellness LA YMCA of Greater Whittier 60 Appendix A – Data Sources 61 American Dental Association. Retrieved from http://wwwmouthhealthy.org. California Department of Alcoholic Beverage Control. (April 2012) Active License File. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.abc.ca.gov/datport/DataExport.html California Department of Education. (2011) Fitnessgram Physical Fitness Testing Results. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cde.ca.gov/ta/tg/pf/ California Department of Education. (2011) Student Testing Reports. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://nces.ed.gov/nationsreportcard/reading/achieveall.asp California Department of Education. (2012). California Healthy Kids Survey, 2008-20100. Retrieved from http://chks.wested.org/indicators California Department of Justice, Office of the Attorney General. (2010) Criminal Justice Profiles. Retrieved from http://oag.ca.gov/crime/cjsc/criminal-justice-profiles California Department of Public Health. (2008-2010) Death Statistical Master File. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdph.ca.gov/data/dataresources/requests/Pages/VitalStatisticsBirthDeathFetalDea thMarriageData.aspx California Department of Public Health. (2010) Birth Profiles by ZIP Code. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdph.ca.gov/data/statistics/Pages/BirthProfilesbyZIPCode.aspx California Department of Public Health. (2011) In-Hospital Breastfeeding Initiation Data. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdph.ca.gov/data/statistics/Pages/InHospitalBreastfeedingInitiationData.aspx California Employment Development Department. (2011) Labor Market Information. Retrieved from http://www.labormarketinfo.edd.ca.gov/ California Health Interview Survey (CHIS). (2007) California Health Interview Survey. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://healthpolicy.ucla.edu/chis/Pages/default.aspx California Health Interview Survey (CHIS). (2009) California Health Interview Survey. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://healthpolicy.ucla.edu/chis/Pages/default.aspx California Office of Statewide Health, Planning and Development (OSHPD). (2010-2011) Patient Discharge Data. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.oshpd.ca.gov/HID/Products/PatDischargeData/PublicDataSet/index.html 62 Centers for Disease Control and Prevention. (2003-2009) Behavioral Risk Factor Surveillance System. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdc.gov/brfss/ Centers for Disease Control and Prevention. (2003-2009) National Vital Statistics System. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdc.gov/nchs/nvss.htm Centers for Disease Control and Prevention. (2004-2010) Behavioral Risk Factor Surveillance System. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdc.gov/brfss/ Centers for Disease Control and Prevention, and the National Cancer Institute. (2005-2009) State Cancer Profiles. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://statecancerprofiles.cancer.gov/ Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdc.gov/brfss/ Centers for Disease Control and Prevention. (2008) National Environmental Public Health Tracking Network. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://ephtracking.cdc.gov/showIndicatorsData.action Centers for Disease Control and Prevention. (2009) National Diabetes Surveillance System. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://apps.nccd.cdc.gov/DDTSTRS/ Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2008) HIV prevalence. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdc.gov/nchhstp/ Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2009) Chlamydia Incidence. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.cdc.gov/nchhstp/ Dartmouth Atlas of Healthcare. (2003-2007) Selected Measures of Primary Care Access and Quality. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.dartmouthatlas.org/tools/downloads.aspx Los Angeles County Department of Public Health, Division of HIV and STD Programs. (2011) Annual HIV Surveillance Report. Retrieved from http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/2011_Annual%20HIV%20Surveillanc e%20Report.pdf Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (2007) Los Angeles County Health Survey. Retrieved from http://www.publichealth.lacounty.gov/ha/hasurveyintro.htm 63 Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (2010) Cigarette Smoking in Los Angeles County: Local Data to Inform Tobacco Policy. A Cities and Communities Health Report. Retrieved from http://www.publichealth.lacounty.gov/statrpt.htm Los Angeles County Department of Public Health. Office of Health Assessment and Epidemiology. (2011) Mortality in Los Angeles County 2008 Leading Causes of Death and Premature Death with Trends for 1999-2008. Retrieved from http://www.publichealth.lacounty.gov/statrpt.htm Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (2011) Obesity and Related Mortality in Los Angeles County: A Cities and Communities Health Report. Retrieved from http://www.publichealth.lacounty.gov/statrpt.htm Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (2012) Trends in Diabetes: Time for Action. Retrieved from http://www.publichealth.lacounty.gov/statrpt.htm Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (2012) Trends in Obesity: Adult Obesity Continues to Rise. Retrieved from http://www.publichealth.lacounty.gov/statrpt.htm Los Angeles County Department of Public Health, Sexually Transmitted Disease Program. (2010). Sexually Transmitted Disease Morbidity Report. Retrieved from http://publichealth.lacounty.gov/std/docs/annualreport_2010_v2.pdf Los Angeles Homeless Service Authority. (2011) Greater Los Angeles Homeless Count Report. Retrieved from http://www.lahsa.org/homelessness_data/default.asp National Center for Children Exposed to Violence. Retrieved from http://www.nccev.org/index.html Nielsen Claritas SiteReports. (2011) Consumer Buying Power. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.claritas.com/sitereports/demographic-reports.jsp The University of Wisconsin, Population Health Institute. (2012) County Health Rankings. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.countyhealthrankings.org/ UDS Mapper. (2011). Retrieved from http://www.udsmapper.org/index.cfm U.S. Bureau of Labor Statistics. (July 2012) Local Area Unemployment Statistics. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.bls.gov/lau/ U.S. Census Bureau. (2000) 2000 Census of Population and Housing, Summary File 1. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/main/www/cen2000.html 64 U.S. Census Bureau. (2005-2009) 2005-2009 American Community Survey 5-Year Estimates. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/acs/www/data_documentation/2010_release/ U.S. Census Bureau. (2006-2010) 2006-2010 American Community Survey 5-Year Estimates. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/acs/www/data_documentation/2010_release/ U.S. Census Bureau. (2008-2010) 2008-2010 American Community Survey 3-Year Estimates. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/acs/www/data_documentation/2010_release/. U.S. Census Bureau. (2009) Small Area Income and Poverty Estimates (SAIPE). Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/did/www/saipe/data/model/index.html U.S. Census Bureau. (2009) ZIP Code Business Patterns. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/econ/cbp/ U.S. Census Bureau. (2010) 2010 Census of Population and Housing, Summary File 1. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/2010census/data/ U.S. Census Bureau. (2010) 2010 Census of Population and Housing. Summary File 1 Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/2010census/data/ ; Esri's USA Parks layer (compilation of Esri, National Park Service, and TomTom source data), 2012. Retrieved from http://www.chna.org/KP/About.aspx. U.S. Census Bureau. (2010) County Business Patterns. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.census.gov/econ/cbp/ U.S. Department of Agriculture. (2009) Food Desert Locator. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://www.ers.usda.gov/dataproducts/food-desert-locator.aspx U.S. Department of Education, National Center for Education Statistics (NCES). (2008-09 and 2010-11) Common Core of Data, Public School Universe Survey Data. Retrieved from http://www.chna.org/KP/About.aspx. Original source: http://nces.ed.gov/ccd/pubschuniv.asp U.S. Department of Health and Human Services. (2012) Healthy People 2020. Retrieved from: http://www.healthypeople.gov/2020/default.aspx U.S. Department of Health Resources and Services Administration. (2012) Health Professional Shortage Area. Retrieved from http://www.chna.org/KP/About.aspx Walk Score. (2012) Community Walkability. Retrieved from www.walkscore.com 65 Appendix B – Healthy People 2020 Benchmark Comparisons 66 Where data were available, health and social indicators in the KFH – Downey service area were compared to Healthy People 2020 objectives. The bolded items are indicators that do not meet established objectives; non-bolded items meet or exceed benchmarks. Service Area Data High School Graduation Rate 75.9% Child health insurance rate SPA 6-92.5%; SPA 7-90.3% Adult health insurance rate SPA 6-59.9%; SPA 7-71.3% Heart disease deaths 147.4 per 100,000 Cancer deaths 159.2 per 100,000 Stroke deaths 40.9 per 100,000 Suicides 6.4 per 100,000 Homicides 13.1 per 100,000 Motor Vehicle Crash Deaths 9.2 per 100,000 Early prenatal care 85.7% of women Low birth weight infants 6.9% of live births Breastfeeding (any) 94.0% Adults with an ongoing source of care SPA 6-68.7%; SPA 7-77.5% Adults delay in obtaining medical care SPA 6-9.1%; SPA 7-9.3% Adults delay in obtaining prescription medications SPA 6-7.0%; SPA 7-6.3% Youth obese 15.2%-33.4% Adult obese 12.4%-39.1% Adults engaging in binge drinking SPA 6-25.2%; SPA 7-30.2% Cigarette smoking by adults 9.8%-18.7% Senior flu vaccine SPA 6-42.9%; SPA 7-68.2% Adults 50+ colorectal cancer screening SPA 6-67.1%; SPA 7-71.1% Adult women who have had a Pap smear SPA 6-88.3%; SPA 7-85% Women over 50 who have had a mammogram SPA 6-72%; SPA 7-77% Healthy People 2020 Objectives High School Graduation Rate 82.4% Child health insurance rate 100% Adult health insurance rate 100% Heart disease deaths 100.8 per 100,000 Cancer deaths 160.6 per 100,000 Stroke deaths 33.8 per 100,000 Suicides 10.2 per 100,000 Homicides 5.5 per 100,000 Motor Vehicle Crash Deaths 12.4 per 100,000 Early and adequate prenatal care 77.6% of women Low birth weight infants 7.8% of live births Breastfeeding (any) 81.9% Adults with an ongoing source of care 89.4% Adults delay in obtaining medical care 4.2% Adults delay in obtaining prescription medications 2.8% Youth obese 14.6% Adult obese 30.6% Adults engaging in binge drinking 24.3% Cigarette smoking by adults 12% Senior flu vaccine 90% Adults 50+ colorectal cancer screening 70.5% Adult women who have had a Pap smear 93% Women who have had a mammogram 81.1% 67 Appendix C – Interview Questions 68 KFH – Downey Medical Center is conducting a community health needs assessment. The information that is gathered here will provide the hospital with useful information to determine priority needs in the community. Participation in the interview is voluntary and you have the right to not answer questions. Or if you feel the question is beyond your scope or area of expertise feel free to let me know that as well. Your name and organizational affiliation will be listed in the needs assessment. But I want to assure you that the information you provide will be kept confidential and your responses will not be linked to you personally. The interview will last approximately one hour. By agreeing to go ahead with the interview, you are indicating your consent. 1. For the needs assessment, we are interested in gathering in-depth information on health needs of residents who share one or more of these characteristics: are typically underserved face health disparities face barriers to health care services suffer from heart disease, diabetes or other chronic diseases experience overweight and obesity interact with at-risk youth To begin, please outline which of these population groups you work with or serve, and the services and programs your organization/agency provides them. 2. In your opinion, what are some of the biggest issues or concerns facing the people served by your agency/in your community? 3. Please discuss the challenges that the people who are served by your agency have in obtaining health care and/or social services? 4. We know that many people in the area suffer from chronic health conditions such as diabetes and heart disease. a. What barriers do people face in getting treatment for their chronic diseases (care may be treatment by a specialist, routine screening, costs of medications, transportation, etc.)? 69 b. In caring for their conditions, what do people do to prevent the disease from getting worse or to keep complications from occurring? What preventive measures do they make use of? c. What resources do people access to care for their chronic diseases? d. If you are aware that people do not access services at all what are the reasons? 5. An area of focus for the hospital is addressing the needs of at-risk youth. What services do you feel are needed in the community to serve the needs of at-risk youth? 6. Overweight and obesity are pervasive problems among area residents. a. What services/programs/community efforts are you aware of that are working to address overweight and obesity? b. In your opinion, what else needs to be done to reduce the incidence of overweight and obesity? c. Is your organization involved in any obesity prevention programs? If yes, what are the programs? d. Is your organization interested in partnering to support obesity prevention efforts? Your responses have been very helpful. Before we finish I want to ask you if you have any other comments or concerns you want to share with KFH – Downey? Thank you for your time. 70 Appendix D – Focus Group Questions 71 The information that is gathered here today will provide the hospital with useful information to help guide them as they consider priorities for services and programs that benefit the community. Whatever you say during this focus group session will remain confidential. Your name will not be associated with any comments that are made. Your participation in this group is entirely voluntary. You may get up and leave at any time. I will be available after the group to answer any questions that you may have about the process or procedures associated with this focus group. There are no expectations about what is going to be said here today. There are no right or wrong answers. Please feel free to express your opinions on the topics we discuss. 1. What would you say are the biggest issues facing your community? Specifically, what are the biggest health concerns in the community? Access to Care 2. How important to you is it to be able to access health care for you or your family? a. With all the things requiring your time and money, is health care a priority item? (If the response is no, find out what becomes before health in terms of money and time) 3. Where do you and your family members go to access health care? Where is the place where you go for physical exams, check-ups, immunizations, treatment for illnesses (Emergency Room, community clinic or county clinic, urgent care, doctor’s office, other)? a. When do you tend to get health care – only when you are sick or also for routine preventive services? b. What gets in the way of obtaining care? 4. In the past year, have you had health insurance coverage? If no, what barriers have you faced in obtaining health insurance? Healthy Lifestyle 5. Do you feel that you are a healthy weight? Do you consider your children to be within a healthy weight range? a. If no, why not? b. If yes, what are you/they doing to be healthy? 72 6. Are there changes you would like to make to be healthy? If yes, what kinds of changes? a. Is your family doing anything to incorporate physical activity into your week? b. Are fresh fruits and vegetables a regular part of your family's diet? If not, why not (cost, short shelf life, kids don't like them)? Chronic Disease 7. What does the term chronic disease mean to you? 8. Do you know people with a health condition such as cancer, diabetes or heart disease? In thinking about you or a family member who has one of these conditions: a. Has your doctor talked to you/them about the condition and how to treat it? b. What are some of the reasons why people may not follow through with treatment for their conditions? 9. Do you have a trusted source where you get information on diseases such as cancer, diabetes or heart disease? At-Risk Youth 10. There are times when teens and young adults engage in high risk behaviors, things like drinking, drugs, and having unprotected sex. What types of support need to be in the community to prevent these? Where should these services be offered (school, church, teen center, other)? 11. Do you know of a child or teen who has needed mental health services in the past year? a. Were they able to get care? Before I dismiss the focus group I want to ask you if you have any other comments or concerns you want to share? Thank you for your time and your willingness to share your thoughts and opinions. Your responses have been very helpful. 73 Appendix E – Interview Report 74 Biggest Issues or Concerns in the Community Community issues and concerns that were identified included both issues that cut across all population groups as well as some issues of greater concern within specific communities or sub-populations. The broader, community-wide issues most frequently mentioned included: The downturn in the economy and related impacts o Lack of jobs/unemployment (noted particularly among veterans, college students, recently released inmates, and youth of color) o Lack of health insurance o Poverty/lack of income o Inadequate affordable housing o High stress levels o Food insecurity Lack of information about how to access health care, including general questions about what services or coverage programs people are eligible for and/or where to go to access available services Lack of health education regarding healthy food choices and nutrition Lack of mental health services for low-income and underserved populations Transportation concerns, particularly noted for lower-income people, students, veterans, and teen parents Obesity among children and adults. While this was identified as a community-wide issue, it was identified as a particular concern among children and youth within the school districts and at community centers, and among college students Safety issues, including the physical environment (bad sidewalks and lack of bike lanes), domestic violence, and community violence/gang activity Some population-specific issues identified through the interviews included the following: Seniors – An overall concern for seniors is their ability to maintain their independence and to remain safely in their homes. Some specific issues identified were access to health care and understanding what health care services they are eligible for; high-cost of in-home supportive services; transportation for basic needs, including medical services and groceries; spike in dementia and Alzheimer’s, which in turn increases safety concerns; and nutrition Immigrant Populations – Language barriers and related anxieties to accessing services; fear of deportation; generally “toxic and inhospitable environment” College Students – Lack of income or access to income; severe obesity; lack of access to food (“often students do not eat for days”), which has led the college to start a food bank on campus; severe obesity; high blood pressure; mental health issues related to stress, poor coping skills and depression; and large population with Sexually Transmitted Infections (STIs), including Chlamydia and Gonorrhea 75 Veterans – High stress levels; not prepared for re-entry into civilian life and lack of support/assistance for this transition; homelessness; long wait time for benefits to take effect; need for mental health and medical services; and jobs Children and Youth – Obesity (often the “primary diagnosis” at school-based health centers), coupled with lack of resources for nutritional counseling or physical activity; psychosocial and mental health needs coupled with lack of family counseling or parent education resources; academic assistance/tutoring needs; basic needs, such as food and clothing; and need for medical/health care services Gay Youth and Transgender Populations – Very underserved populations at risk for homelessness and suicide, and with significant needs for mental health services Several specific health/behavioral health issues were identified including: Chronic diseases – diabetes, asthma, high cholesterol, high blood pressure Overweight and obesity Sexually Transmitted Infections Tobacco use among youth Breastfeeding Finally, “other” issues/concerns identified included: Lack of financial literacy Lack of appropriate role models and social supports for adults or children to cope with death and grief Need for better emergency preparedness and development of “community resiliency;” ability of communities to “bounce back” after major disasters Need to educate cities to create healthier environmental policies and educate communities to advocate for change Challenges in Obtaining Health Care and Other Health/Social Services Interview participants were asked to identify the kinds of problems or challenges that the people in their community and/or are served by their agency face in obtaining health care and/or social services. The most frequently reported barriers were: Lack of financial resources and cost of services, including the following related barriers: o Lack of health insurance due to ineligibility, inability to afford insurance, not covered by employer or unemployed o Inability to pay for care, labs and/or medications, even when offered at a lower-cost (e.g., at college-based student health center) o Families working multiple jobs and unable to schedule/attend medical appointments for themselves or their families, especially when services are not available in the evenings and on weekends. “If they miss a day of work, they will not get paid.” 76 o Health costs and co-pays compete with other family needs and priorities, such as housing, food and work. One interviewee said, “health care is not a priority for them when they are just trying to get through the day and pick-up extra shifts.” Transportation to services, identified by numerous interviewees. One interviewee said, “Teen mothers rely on bus tokens, but they end up cancelling appointments because they can’t get there.” Lack of knowledge about the importance of preventive care and a tendency to obtain services only when sick. One interviewee said, “By the time they come in for services their issue has exploded; they do not have the resources, time, energy or education to address their issues earlier on.” Several related issues included: o Home remedies are often used, which may or may not be helpful o Lack of awareness that obesity is a health problem or that diabetes can be present without symptoms o Trend among some parents to sign waivers for their children’s immunizations as a way to “save time or for convenience so that their kids can enter school,” without awareness of or concern about the potential health impacts o Parents do not understand the value of regular physicals for their children and/or do not have the time or see it as a priority, and so will miss important conditions that should be addressed, such as vision problems Insufficient capacity at primary care clinics, and general lack of primary care resources. One clinic representative said, “We turn away 30-50 patients per day and ask them to come back.” Another clinic talked about people coming to them with severe problems resulting from unmanaged chronic diseases. While this is due in part to lack of knowledge about prevention, it is also in part due to lack of affordable health care facilities within the communities. It was noted that several new clinics have recently opened (e.g., Downey Family Medical Center through Family Health Care Centers of Greater L.A.); however, the community is not yet fully aware of and utilizing these newer resources Although there are insufficient resources for affordable health care in the community, there is also a lack of knowledge about the lower-cost services that are available, such as community clinics and county services. And, there are concerns about how to access available services: what the costs will be, what kind of documentation will be requested, and whether they will be eligible for any coverage programs Lack of affordable mental health services for uninsured due to insufficient capacity at county mental health services and lack of other, affordable community resources. Also, lack of Spanishspeaking mental health providers Immigration and cultural barriers o The undocumented are not eligible for services from the Los Angeles County Healthy Way LA program, and there is a concern that they will not have access under Health Care Reform 77 o Language barriers and lack of culturally sensitive services can result in people feeling “culturally and linguistically isolated.” There is a lack of services that are “friendly” to people from different cultures, or who speak other languages o Fears among undocumented that “if they fill out any kind of form, someone will come and deport them and their families” or that if they get free services, it will be “held against them when they try to become legal.” Lack of trust of agencies and institutions among lower-income and immigrant populations, including historical experience of getting the “run around” or being turned away from services as well as experience over time with programs and services disappearing when grant funding ends Barriers among the LGBT and HIV positive communities, which can affect their willingness to seek services, include “stigma, discrimination, internalized shame, denial, and other emotional issues.” Many also remain “closeted” and do not disclose their HIV status, gender change, or sexual orientation to their medical provider Other barriers o Difficulty in navigating through health care systems, and for seniors in understanding Medicare o Need a place for families to troubleshoot problems with access o Lack of childcare, particularly for teen mothers o Difficulty obtaining services from DPSS due to long lines and social workers that have lost their compassion for the people they serve and the hardships they face o General dearth of social services and difficulty in making good referrals that will serve client needs o Lack of affordable dental care and vision services. Difficulty accessing affordable dental care has been exacerbated by the termination of the Denti-Cal program o Veteran’s benefits take months to start o Insufficient drug and alcohol services in the community o Feeling safe to access services, given large presence of gangs in the area Chronic Health Conditions: Barriers to Prevention, Treatment and Management A number of barriers to care, treatment and management of chronic health conditions were reported Lack of health insurance Cost/Fear of cost Transportation to services Lack of orientation to prevention services resulting in missed opportunities for early detection and delays in seeking care until medical situations are acute or emergent Lack of connection to a primary care provider or knowledge of how to access primary care for ongoing chronic disease/case management Time constraints and economic barriers Fears associated with immigration status Language barriers 78 In addition, some additional barriers were identified that are more specifically associated with chronic disease prevention, management and treatment Difficulty accessing and paying for medications. It was noted that there are a limited number of the larger pharmacies in the area, a by-product of the extent of poverty in the community. The cost of medications can be prohibitive, and people have to prioritize between the medications and other basic needs Compliance with medical regimens, partly due to cost and access to medications, but also a result of denial and other psychosocial barriers Difficulty accessing specialty care services at Los Angeles County Department of Health Services (provider of safety-net specialty care services) o Long wait times for referrals to be approved and for appointments (especially difficult for a transient population) o Travel distance to these services at LAC+USC Medical Center or Harbor UCLA, given the closure of the MLK Hospital Difficulty in making healthy lifestyle changes due in part to lack of options/opportunities for physical activity and lack of access to affordable fresh fruits and vegetables. A need for more nutritional counseling and education was also identified, as was the availability of culturally appropriate options (Zumba or walking associated with a park community center, where people are connected) Structure of the health care system in the community promotes episodic care, as “most providers in the area are urgent care or walk-in clinics for episodic care, which is responsive to the consumer behavior of only going to the doctor when sick.” Need to overcome social impediments to HIV testing, and to establish community norms and more accessible HIV testing in the community; where “kits could be purchased at the 99 Cent store, and testing was as routine as pregnancy testing.” What People Do to Prevent/Manage Chronic Health Conditions Several interview participants said that many people do not do anything to help prevent/manage their chronic health condition(s) until their condition becomes “serious or acute.” As noted, many people do not seek preventive care and so may be unaware that they are in poor health or at-risk for chronic disease until there is a health event that results in a visit to the emergency room or a hospitalization. One interviewee at a school-based health clinic reported that she does not see families engage in any kind of prevention and that even where there are kids in the family with diabetes, they do not go to the doctor. It was also noted, however, that once people get some kind of health coverage and establish a relationship with an affordable primary care provider, they become “proactive versus reactive, see a doctor, and follow through on recommendations.” Interview participants said that people “look for a variety of things they can do” and “make an effort.” The kinds of activities that people are doing to prevent/manage chronic health conditions were reported 79 Engaging in exercise, including walking, swimming and cycling. Zumba, in particular, was noted by several interviewees as a form of exercise that people (especially women) really like, and that participants are very encouraged when they see the benefits, such as weight loss and improved feelings of wellbeing Diet changes, when possible Attend classes or counseling sessions with a nutritionist, when possible. (Individual and group meetings with a dietician were thought to be significantly more effective at producing behavior changes than are flyers and presentations) Find social support from families and friends - noted particularly among the HIV positive community A number of barriers to engaging in healthy behaviors that prevent and manage chronic disease were also identified Living in a “food desert,” where access to affordable fresh fruits and vegetables is extremely limited Markets showcase cookies, candy and other unhealthy foods at the front of the store, and at eye level of children, and put fruit and water in the back of the store Preference for using home remedies, due to fear and mistrust of Western medicine Lack of knowledge/education regarding the connection between nutrition, physical activity, and chronic disease Health Care Services, Education Programs and Materials People Use to Help them Care For or Learn More about Their Chronic Diseases People access information/education via many different approaches and settings Community clinics, community-based health providers, and social service agencies2 Family and friends Local health fairs Free/low-cost exercise opportunities in the community Farmer’s Markets (particularly at KFH – Downey , where healthy cooking classes are offered and there is the ability to double WIC and other vouchers up to $10) Educational lectures/classes Consultations with a nutritionist or dietician Private doctors AIDS Drug Assistance Program (ADAP) for people with HIV Interestingly, it was noted that there is not a lot of engagement with churches in the area. 2 Agencies that were identified included: South Central Family Health Center, Family Health Care Centers of Greater LA, Bellflower Health Center, Cerritos College Student Health Center, WRHAP, JWCH Institute in Bell Gardens, Alta-Med in Pico Rivera, AIDS Healthcare Foundation in El Monte, Worksite Wellness LA, City of South Gate Sports Center, Health on Wheels at Norwalk La Mirada Unified School District 80 Services Needed for At-Risk Youth Interview participants were asked what services they felt were needed in the community to better serve the needs of at-risk youth. As part of the response to this question, many people identified the issues they feel youth are facing and the risky behaviors in which they are engaging A “downward cycle in their homes and neighborhoods” Alcohol, tobacco and drug use Unsafe sexual practices, resulting in STIs, HIV and unplanned pregnancies Absence of education/knowledge about STIs, HIV and teen pregnancy prevention Unhealthy nutrition resulting in obesity, due to foods with a lot of sugar, inexpensive fast foods, and high-fat food provided via food banks Depression, high levels of stress, and poor coping skills Post-Traumatic Stress Disorder (PTSD) resulting from the violence they are witnessing in their homes and communities Violence and gang activity Poor basic academic skills, such as reading, writing and math LGBT/Queer questioning youth are at-risk of homelessness (as well as many of the other issues listed above) Lack of available/supportive parents Unsupervised time after school and in some cases into the evening Lack of access to health care While some school and community-based programs that offer support to youth through after-school programs and education were identified (Pathways Volunteer Hospice, Kaiser Permanente Watts Counseling & Learning Center), much is still needed. Suggestions of services to help address the needs of at-risk youth included: Asking the youth directly what services they feel are needed, as they can speak best for themselves Empowering youth to make choices to take control of their lives Outreach Counseling/mental health services are much needed and not sufficiently available Health education provided by trusted sources (health care providers) on safe sex, HIV/STI and pregnancy prevention, and other topics Prevention and treatment for drug and alcohol use Access to physical exams to facilitate eligibility for youth sports Support of health and wellness initiatives in schools related to healthy eating, sugar beverages Nutrition education/training After-school programs to engage youth and keep them busy in positive ways – to avoid violence, gang activity and school drop-outs Tutoring and academic assistance to remediate basic skills and keep youth in school 81 Mentoring and role modeling for young men Training for staff who serve LGBT/Queer questioning populations to improve cultural competency and awareness Opportunities for youth to see what they could do and become, including college tours, job shadowing, and exposure to the arts Parenting classes Services Available to Address Overweight and Obesity The interview participants identified a number of services, programs and community efforts offered by both their own organizations and other organizations in the community that are working to address overweight and obesity, including nutrition education/programs, physical activity programs, and policy work to improve access to healthier foods and physical activity. Programs/services offered by the organizations that participated in the interviews are listed below. All these organizations were enthusiastic about the idea of participating in additional partnerships to support obesity prevention Programs at Ted Watkins Park, the newly re-opened County Park, including walking, aquatics program for seniors, a monthly 5k around the park hosted by Kaiser Permanente Watts Counseling & Learning Center, and a weekly table with information about healthy eating and water intake, also hosted by the Watts Counseling & Learning Center.= Watts Counseling & Learning Center and Crystal Stairs are using the Weight of the Nation video series to “re-energize people, because much of the urgency is gone” Yoga class offered weekly for pre-school children and nutrition classes, offered at Montebello/Commerce YMCA (funded by KFH – Downey ) Nutrition classes and counseling for patients offered by South Central Family Health Center California Center for Public Health Advocacy (CCPHA) is working with elected officials and cities to promote breastfeeding locations in city buildings as well as to provide technical assistance for healthy vending machine choices. CCPHA also trains people to advocate on their own behalf on health issues INMED offers Zumba classes three days per week Worksite Wellness LA is working with Community Health Councils on a program to reduce food deserts in the area by encouraging business owners to have healthier food choices in vending machines and in stores Cerritos College if offering Pound by Pound, funded by Kaiser Permanente Bellflower, to promote physical activity and weight loss. The program uses a format similar to the “Biggest Loser” and is available to all students and staff at no charge. It includes Zumba classes four times per week and access to a dietician to help with nutritional planning and weight loss City of South Gate offers a community gym at very low-cost to city residents to promote physical activity via walking, swimming, fitness center, basketball and other activities. The City also offers three trails that are well used for walking 82 Programs and policy work at Unified School Districts (USDs) o Bellflower USD: Policy change to improve nutrition in the cafeteria and require that children bring healthier foods to school o Downey USD: Healthy Lifestyles program for chronic disease management offered with support from Kaiser Permanente o Norwalk La Mirada USD Health on Wheels: Offers nutritional counseling and screenings for cholesterol and diabetes. Would like to offer more nutritional counseling. Also has a wellness program that has promoted access to healthier foods in the cafeteria and the reduction of access to unhealthy foods and sodas Activate Whittier, a collaborative that includes LA County Department of Public Health (SPA 7), Whittier YMCA, and others to promote healthy eating and physical activity. Activities include working with the schools to improve nutrition and to bring back physical education, as well as working on a labeling system for foods sold at corner stores, to facilitate healthy choices Other Los Angeles County Department of Public Health programs, including Champions for Change, Safe Routes to Schools, promoting healthy vending options, and promoting bicycle use and bike-ability Other programs/services available in the community were identified WIC programs provide nutrition education and breastfeeding support Corner Store Conversion program to get healthier food options in corner stores and move tobacco, candy and alcohol to the back of the store Zumba classes offered at churches Cooking demonstrations and supermarket workshops Food Revolution program offered at schools Restaurant programs to publish the calories of their menu items on the menus. Farmer’s Markets Investment by Los Angeles Police Department to start a football league and other positive programs at local housing projects Green Dot, a Charter School in the area, is supporting a track league at Locke High School, where they are located Green Dot also started a Walk and Watch program to promote Safe Routes to Schools and walking opportunities for parents around the school site, along with health education A number of barriers to success for these programs were also identified Programs are not always sustainable and disappear after a time because of funding changes or for other reasons. This makes it difficult for the community to rely on programs and trust that they will continue to help them over time. Also creates difficulty for the organizations to sustain programs of value 83 Ted Watkins County Park, which recently re-opened and is being used to promote exercise in the community, is accessible for people in the “right” gang territory, but off limits for those who are not In general, community safety was identified as a barrier to accessing resources. One interviewee said, “Safety is one barrier that limits the ability of parents to send their kids out to play; people don’t go out after dark, and there is a concern about gangs.” Challenges to success of the Healthy Lifestyles program include determining a time of day that will work for people to attend and the tendency of many people to not get engaged in their health until something is obviously wrong The track league organized by Green Dot Charter School at Locke High School is need of running suits for boys and sports bras for girls Additional Services Needed to Further Address Overweight and Obesity Suggestions for additional programs/services/community efforts that are needed to further reduce the incidence of overweight and obesity included: Schools to serve as a location for obesity prevention efforts o Increasing physical education/physical activity o Providing nutrition information to parents, particularly parents of young children o Providing nutrition education in the classroom via guest speakers such as nurse practitioners and physicians o Establishing nutrition and low-calorie meal standards in their cafeterias o Establishing school gardens in elementary schools and using them to teach students “where food comes from and how to grow their own food” Policies and built environment improvements needed to create more opportunities for physical activity and healthy eating o One interviewee said, “There are a number of vacant lots in South Central that were burned out during the riots in the 1960s and 1990s. They are eyesores and it could be possible to convert some of these into pocket parks and community gardens. There are many vacant lots strewn with garbage and debris and the area needs more green space and parks” o Improve the physical infrastructure (fix sidewalks, create bike lanes) to make physical activity safer o Reduce junk food available in stores and improve the quality of healthier, fresh foods o Assure public transportation will take people to places for physical activity and to markets that offer affordable, healthy foods o Create green space and opportunities for physical activity in communities that have not traditionally done this (South Whittier, Pico Rivera, Norwalk). Worksites to offer fitness classes and nutrition information Health care clinics/providers to provide good prenatal care that includes information on nutrition, as well as to promote breastfeeding until at least six months 84 Broad-based, community education on how to make their lifestyles healthier Engage the community and train community members to serve as advocates for their own health and for changes to make their communities safer and healthier Include and actively engage whole families in strategies to reduce obesity and learning skills that will make them healthier (e.g., cooking classes). One interviewee said, “Pamphlets are not enough; people learn by doing.” Another said, “This is a family problem and the whole family needs to buy in, not just the kids, or it doesn’t work.” Sensitivity to cultural differences in food preferences, etc. is also important Food banks to offer healthy food preparation classes for clients Restaurants to offer reasonable portion sizes and make food healthier Kaiser Permanente to re-introduce its swimming pool initiative, which was so popular with families Reduce costs/improve affordability of afterschool sports and team activities Improve coordination among programs and replicate programs that are working. One interviewee said, “Sharing information means sharing information with competitors, which is hard for agencies, but important for overall goals of safety and health” Challenges relative to reducing overweight and obesity were identified Television Fast food Cost of healthier, fresh food Neighborhood safety relative to outdoor physical activity Focus within schools on test scores, which has led to a reduced focus on health No way to influence food trucks to serve healthier foods Comments/Other Participants were given an opportunity to share any final thoughts or comments. A number of organizations expressed appreciation for their partnership with KFH – Downey Medical Center, including the grant funding the Medical Center provides and the support provided with educational materials and diabetes prevention. Comments also included interest in a stronger partnership with KFH – Downey by some organizations as well as suggestions for how KFH – Downey could help to address needs/fill gaps in the community Bringing together organizations to improve coordination and knowledge of what is being offered in the community, and also to help reduce competition and build a spirit of collaboration. Periodic convening of community agencies for networking and information sharing was recommended by several interviewees. One person said, “It is important that we are all aware of the other programs funded by KFH – Downey in order to coordinate with them to best serve the community.” Another said, “It would be great if we could all come together to make a bigger impact.” 85 Assisting local service providers in developing educational and promotional pieces that they could post on You-Tube, Facebook, and Spanish-language television Having a greater presence on community college campuses where they are the primary insurer to conduct health fairs, provide health information and education, share information about classes offered to the community Engaging more in partnerships to address obesity prevention A final, general comment that was made by one interviewee was that “it’s important to create programs that really involve people and where there’s accountability and ownership.” There is “no sense of ownership for the community, or of people working together to build something.” Overall, the participants expressed appreciation about being included in the Community Health Needs Assessment and the opportunity to share about their client population or to talk about their organization’s mission. There is much interest among the interviewees for a copy of the final Assessment document and to learn about the Medical Center’s priorities. 86 Appendix F – Focus Group Report 87 Community Issues and Health Concerns The “biggest issues facing the community” were identified to include: Economy and unemployment, with several people mentioning recent layoffs Transportation, noted especially by the HIV group relative to accessing medical and social services, and the young mothers relative to getting to school. Problems included cost, few bus lines and infrequent schedules Drugs in the schools and parks, and open drug dealing on the streets Graffiti Thefts and robberies, including car thefts and robberies on the street and in homes Bullying in the schools Lack of funding to support schools and education Services for seniors, including fitness classes and opportunities to “get out of the house, with assistance from caregivers” High cost of basic needs, such as food (including milk), gas and rent. One mother shared that she is one of seven people living in a two-bedroom apartment The biggest health concerns in the community were identified as: Cost of health care and health insurance, along with cost of dental care and vision care. The Spanish-speaking participants said they did not obtain dental or vision services due to cost, unless it was absolutely necessary Lack of health insurance/coverage for many, and lack of affordable health care clinics to serve uninsured, low-income people Cost of medications Decrease in benefits among those with insurance, including increased costs for services and medications No hospital or Emergency Room in the area after closure of MLK The HIV participants discussed difficulty in accessing emergency services, related to the cost of the services and their fear of receiving a bill. These participants reported that there is no access to affordable services after hours or when the local AIDS Healthcare Foundation clinic at WHRAP is not open, if they should experience a medical crisis. Access to Care Value of Care Relative to Other Family Priorities All of the focus group participants reported that access to health care and “staying healthy” is extremely important to them, and they are concerned about the cost of care and of health insurance as barriers to access. Participants did not directly address the issue of health care as a priority for them relative to their time or to other financial priorities, or that they might need to choose between paying for health care versus other basic needs for their families such as food and clothing. 88 Where People Access Preventive and Primary Care Participants were asked where they and their family members go to access health care, including physical exams, immunizations, or treatment for an illness Participants in the FHCCGLA group all said they use that clinic for their preventive and primary care The ESL students and young mothers primarily access care at community clinics and county clinics, though two ESL students reported using hospitals (St. Francis Medical Center and Harbor-UCLA Medical Center) Most of the children of the participants had some kind of coverage (Medi-Cal or Healthy Families), and so would access care accordingly The WHRAP focus group participants use the AIDS Healthcare Foundation (AHF) clinic that is offered at a WHRAP site in Whittier two days per week for their primary care services, screenings, most HIV medical care, medications, and referrals for specialty care. All participants reported that they use the AHF clinic on a regular and consistent basis, and obtain routine care and screenings as well as other medical services and medications for their HIV Use of Health Care Services for Preventive/Routine Care versus Sick Care The ESL participants and young mothers reported that they primarily access only sick care, but will get a check-up as needed for a job or for school; however, a couple of the young mothers said they also get annual physicals Participants in the FHCCGLA group said that in addition to sick care, they all use the clinic regularly for preventive care, check-ups and chronic disease management As noted above, the HIV participants reported using the AHF clinic at WHRAP regularly for preventive care and primary care, as well as for sick care. They have relationships with the physicians there; as one participant said, “The physicians at AHF keep me on track for routine care and screenings and the other medical services I need” Barriers to Accessing Health Coverage and Health Care Participants in all the groups had a mix of health care coverage, including no insurance, Medi-Cal, Medicare, Kaiser Permanente (though spouses’ work) and Positive Healthcare (managed care plan through AHF). Cost was identified as the biggest barrier to obtaining health insurance for those with no insurance or with Medi-Cal. Barriers to obtaining health care were identified: Cost of care is a barrier, especially for follow-up or specialty care services. One woman shared that her mammogram showed a problem, but she had to wait to obtain follow-up tests until she could borrow the money Cost and lack of coverage for dental care and vision care were identified as barriers in all the focus groups. The WHARP clients reported that some basic dental services were available 89 through AIDS Project Los Angeles, but they had to pay out-of-pocket for any kind of specialty procedure or periodontal work The WHRAP clients also reported difficulty accessing health services on the five days per week (and evenings) when the AHF clinic is not operating at the WHRAP site. If they need services on those days, they have no access to care unless they “travel to a place where another AHF clinic is being held, or go to the Emergency Room.” As noted above, access to emergency services is very difficult due to cost, and “fear about being stuck with a bill they cannot pay” Specialty care was also identified as difficult to access by a number of the participants, either because they had to wait for approval by their provider or wait for an appointment in the county system Changes in health plans/coverage are confusing and take time to understand The WHRAP focus group was asked about difficulty they had accessing supportive services and what would make it easier for them to obtain care. Their responses to the question regarding supportive services that are difficult to access included: Affordable housing. Several of the participants had been approved for Section 8 housing, which they all saw as very positive, but it has meant they have had to move out of the area to East L.A. or other areas where the Section 8 housing was available to them. This has resulted in a need to travel to/from the Whittier area for services and/or to visit family and friends (one woman said she was born and raised in Whittier but is now living in East L.A.) using an unreliable and infrequent public transportation system, or to pay for gas Mental health services have been cut back at WHRAP due to budget cuts and are sorely needed. There are few to no affordable mental health services available WHRAP clients shared the following strategies that would make it easier for them to obtain care: Use of a TAP card to access MTA services in Los Angeles County Availability of multiple services in a “one-stop shop” location More resources for mental health to reduce waits and increase access More information for individuals about insurance benefits for their own plans, including what they are eligible for, at what locations, and the costs Healthy Lifestyles Healthy Weight Participants in the ESL, INMED and FHCCGLA focus groups were asked whether they feel they and their children are at a healthy weight None of the 14 women in the ESL group felt they were at a healthy weight and only one of the eight women in the FHCCGLA group felt she was at a healthy weight. Of the young mothers, seven of the ten felt they were at a healthy weight About half the ESL group but none of the FHCCGLA group felt their children were at a healthy weight, though all the young mothers said their children are at a healthy weight 90 According to the participants, factors that contribute to unhealthy weight among their children include: Poor eating habits, including drinks with too much sugar and consuming too much food Lack of physical activity Mothers don’t know how to plan meals to help them be healthier Access to unhealthy food on the streets and in school, which can sabotage family efforts for healthier eating Lifestyle Behaviors: Healthy Eating and Physical Activity All participants said there are lifestyle changes they would like to make to be healthier Exercising more (the impact of exercise on stress and depression was acknowledged by the young mothers) Learning how to cook healthier Eating healthier (“not so many chips and red bull!”) Portion control Eat more balanced meals, and at regular times Eating a healthy breakfast in the morning Efforts participants identified that they have made to incorporate physical activity into their lives Walking, trail walking (in Whittier), cycling and going to the gym Exercise classes at the park Use of free exercise equipment at park in Commerce (not available at parks in Bell Gardens) Lifting weights at school Soccer on the weekends Aztec dancing Efforts that have been made related to healthier eating Eating more fresh fruits and vegetables, though “it’s a battle to get children to eat vegetables” (they prefer fruit, which is sweet) Reducing carbohydrates and sugar Counting calories Eating more chicken and vegetables, and less red meat Portion control Avoiding processed foods Barriers to making healthy lifestyle changes were identified Lack of motivation; laziness Tired after working all day Healthier food and organic food is more expensive 91 Difficult when not everyone in the household/family wants to eat healthier Taste of healthy foods and vegetables not as appealing, especially for children Lack of knowledge regarding how to cook vegetables in a way that will be appealing for children Feeling discouraged by current weight, and embarrassed to go to the gym Parks have started to charge for exercise classes, which has severely limited the ability of many people to participate Young mothers feel there is no time for breakfast given what they need to do in the mornings to get themselves and their babies ready for the day Chronic Disease When asked what the term chronic disease “means to them” respondents described chronic disease as a long-term illness that needs constant attention. Examples they provided included diabetes, high blood pressure, high cholesterol, asthma and depression. Almost all focus group participants said they know someone with a chronic disease, such as heart disease, diabetes, high cholesterol, and high blood pressure. All participants in the WHRAP focus group were HIV, so were personally contending with a chronic disease. All focus group participants felt that their doctor (or the doctor of the family member with the chronic disease) did a good job of explaining how to treat their chronic disease. The WHRAP clients, in particular, receive treatment from physicians who specialize in HIV and include a considerable amount of education along with direct services. Reasons why people may not follow through on the recommended treatment for their conditions included: Fear of their illness Lack of insurance Cost Difficulty adhering to complicated drug and treatment regimens Difficulty accessing specialty care, as recommended for treatment Participants identified “trusted sources” where they get information on their chronic diseases WHRAP clients get their information from the AHF clinic at WHRAP and from other WHRAP staff Community clinic Media sources, including internet, radio and television Health fairs Classes at school YMCA health clinic held at shopping mall 92 At-Risk Youth A context for the questions on at-risk youth was established by the focus group facilitator, who reminded participants that “there are times when teens and young adults engage in high-risk behaviors, like drinking, drugs and having unprotected sex.” Participants were then asked what is needed to help teens and young adults decrease unplanned pregnancies and prevent STIs and HIV. Responses included: Foster communication between parents and teens by teaching parents how to talk to their kids about sex, including how to overcome their own embarrassment More sex/health education is needed in the schools, to start with kids at a younger age to include: o What is HIV? How is it spread? How can it be prevented? o Importance of using condoms for STI and HIV prevention, even when a good form of birth control is in place. o Education about birth control options, including pros and cons o Consequences of behaviors o What it’s like to parent and to have a baby Parents need to serve as role models for their kids relative to alcohol consumption Education for girls that they don’t have to have a boyfriend and engage in sexual activity, despite the images they see on television and what is promoted within rap music Support needed in the community to help with prevention was identified Opportunities for teens to share experiences openly and support each other More activities for youth to engage in that are positive, and that will help to prevent gang activity or to delay sexual activity Information available at the community clinics In regard to mental health services, most participants knew of children or youth who needed mental health services, but few were able to access that care. Several of the participants at INMED had received mental health services through a program at their school. While some felt that the services had helped them to connect more to their feelings, others felt that the therapists wanted them to forget the horrific traumas several of them had witnessed, which they said they could not do. One participant said, “Not all people want to change” Participants in the WHRAP group said that mental health services had been cut way back at WHRAP due to funding cuts, and the services are sorely missed. They would like to have more access to a counselor and not have to wait a long time for services, or be unable to get an appointment Additional Notes and Comments At the close of each focus group, participants were given an opportunity to share any additional comments, concerns or suggestions. These comments included some concerns and needs Need for anger management classes in the community 93 Need for job training in the community Concern that some programs in the community have been cut back since attendance is low; people need to take advantage of the programs that are available Concern about general apathy in the community 94 Appendix G – Health Need Profiles 95 Health Need Profile: Access to Care Access to comprehensive, quality health care services is important for health equity and for increasing the quality of a healthy life. Health care access is a key requirement for early detection of illnesses, chronic disease management and reduction of Emergency Room usage. In the KFH – Downey service area, 26% of residents are uninsured. In California the rate of uninsured is 17.9% (American Community Survey, 2008-2010). Population Uninsured SNAPSHOT Insurance Coverage – In the Kaiser Permanente KFH Downey Service Area, 74% of residents have health insurance, which can include Medi-Cal, employer-based insurance and other public and private coverage (American Community Survey, Over 25.0% 18.1 - 25.1% 12.1 - 18.0% 6.1 - 12.0% 2008-2020). Health Professional Shortage Area (HPSA) – 15% of the KFH - Downey service area population live in a HPSA (which includes shortages of medical, dental, and mental health providers) compared to 13.8% of the state population Under 6.0% Population Receiving Medi-Cal (Health Resources Services Administration, 2012). Over 25.0% Income Disparity – Lowincome populations face increased barriers to accessing health care; 43.1% of the population in the service area is categorized as low-income and 17.1% are living in poverty. In 2010, the poverty level income for a family of four was $22,050 (American Community Survey, 2006-2010). 18.1 - 25.1% 12.1 - 18.0% 6.1 - 12.0% Under 6.0% Source: American Community Survey, 2008-2010 96 Barriers to Accessing Health Care 18.6% 18.7% 38.8% 11.8% 13.6% 27.2% Los Angeles County 11.8% 12.1% 27.3% 18.7% 14.5% 15.1% 12.5% 6.9% 7.4% SPA 6 Adults Unable to Afford Medical Care in the Past Year Adults Unable to Afford Prescription Medication in the Past Year Adults Who Reported Difficulty Accessing Medical Care Adults Who Reported Difficulty Talking to a Doctor because of a Language Barrier in the Past Year Adults Who Reported Transportation Problems Prevented Obtainment of Medical Care SPA 7 Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007 Associated Factors Usual Source of Care - Residents who have a medical home have access to a primary care provider. Among the residents in the Service Area, over 90% of children and youth have a usual source of care. Among adults, in SPA 6, 68.7% have a usual source of care, and 77.5% of adults in SPA 7 have a source of care. And, 86.3% of seniors in SPA 6 and 95.4% of seniors in SPA 7 have a usual source of care (California Health Interview Survey, 2009). Delayed Care - Without health insurance and/or a usual source of care, residents may delay accessing needed health care and obtaining prescriptions. In SPA 6, 9.1% of residents delayed accessing needed medical care and 7% delayed getting prescriptions. In SPA 7, 9.3% of residents delayed accessing needed medical care and 6.3% delayed getting prescriptions. In California 12.5% residents delayed medical care and 8.2% delayed getting prescriptions (California Health Interview Survey, 2009). ER and Hospital Use - Regular care reduces unnecessary ER visits and hospitalizations. 20.9% of residents in SPA 6 and 18% of residents in SPA 7 visited an ER over the period of a year. In California this rate is 17.6% (CHIS, 2009). Residents in the service area have higher hospitalization rates for diabetes, asthma (for adults and children), and HIV than found in the state (OSHPD, 2010). Health Status - Access to care enhances prevention of disease and disability. In SPA 6, 28.2% of adults rate their health as fair or poor and 20.1% of SPA 7 adults feel they are in fair or poor health. 15.2% of Californians rate themselves as being or fair or poor health (California Health Interview Survey, 2009). Community Assets Central City Community Clinic Crystal Stairs Family Health Care Centers of Greater Los Angeles JWCH Institute South Central Family Health Center St. John’s Well Child & Family Center The Children’s Clinic Watts Healthcare Corporation Community Input There is a lack of information about how to access health care, including services, locations or coverage programs and eligibility Immigrant Populations – Language barriers and related anxieties to accessing services; fear of deportation; generally “toxic and inhospitable environment” We are experiencing insufficient capacity at primary care clinics, and general lack of primary care resources. 97 Health Need Profile: Asthma Asthma is a chronic disease that with preventive treatment can prevent symptoms and attacks and enable individuals who have asthma to lead active lives. Asthma episodes can range in severity from mild to life threatening. Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath (Healthy People 2020). Youth Asthma Hospital Discharge Rates (per 1,000 Hospitalizations), by ZCTA SNAPSHOT Prevalence – The total population diagnosed with asthma in SPA 6 is 13.5% and in SPA 7 is 11.5%, the state rate of asthma prevalence is 13.7%. Among youth, ages 0-17, 15.7% in SPA 6 and 16.2% in SPA 7 have been diagnosed with asthma, which are both higher than the state rate of 14.2% (California Health Interview Survey, 2009). Hospitalization Rates – Rates of hospitalizations for asthma among youth in the KFH - Downey Service Area are 19.9 per 1,000 hospitalizations, this is higher than the California rate of 19.2. The hospitalization rate for asthma among adults is 9.7 per 1,000, which is higher than the state rate of 7.7 (OSHPD, 2010). Over 30.0 20.1 - 30.0 10.1 - 20.0 5.1 - 10.0 Under 5.1 Source: OSHPD, 2010 Asthma Diagnosed with Asthma, Total Population Diagnosed with Asthma, 0-17 Years Old ER Visit in Past Year Due to Asthma, Total Population ER Visit in Past Year Due to Asthma, 0-17 Years Old Takes Daily Medication to Control Asthma, Total Population Takes Daily Medication to Control Asthma, 0-17 Years Old Very Confident to Control and Manage Asthma Confident to Control and Manage Asthma Not Confident to Control and Manage Asthma SPA 6 13.5% 15.7% SPA 7 11.5% 16.2% California 13.7% 14.2% 10.4% 7.0% 10.3% 24.3% 9.2% 13.7% 68.2% 43.0% 42.1% 65.2% 47.4% 38.1% 80.5% 14.5% 52.7% 40.8% 6.5% 76.9% 14.8% 3.3% 5.0% Source: California Health Interview Survey, 2009 98 Risk Factors Smoking - Being a smoker, exposure to secondhand smoke or having a mother who smoked during pregnancy have been shown to increase the chances of developing asthma. A number of communities in the service area have high rates of cigarette smoking. Bellflower (15.7%), Compton (15.9%), Lynwood (16.5%), and South East Los Angeles (18.7%) have the highest rates of smoking in the service area. These rates exceed the Healthy People 2020 objective for smoking of 12% (Los Angeles County Department of Public Health, 2010). Overweight/Obesity - In SPAs 6 and 7, over one-third of the adult population is overweight; 18.8% of teens in SPA 7 and 11.3% in SPA 6 are overweight. And 15.2% of children in SPA 7 and 11.8% in SPA 6 are overweight (CHIS, 2009). Low Birth Weight - The KFH – Downey service area rate of low birth weight babies is 6.9%. This is higher than the state rate of 6.8%, and lower than the Healthy People 2020 objective of 7.8% of low birth weight births (California Department of Public Health, 2010). Air Quality - Air quality measures the particulate matter levels above the National Ambient Air Quality Standard (35 micrograms per cubic meter, per year) calculated using data collected by monitoring stations. In the service area, the average daily ambient particulate matter was lower than the national standard but higher than found in the state (16 vs. 14.3). However, emissions standards were exceeded 14.9 days per year; compared to the state, which exceeded emission standards 15.4 days in a year (Centers for Disease Control and Prevention, 2008). Community Assets Community assets are resources to meet the identified health need. Family Health Care Center of Greater Los Angeles JWCH Institute, Inc. Los Angeles County Department of Health Services Los Angeles County Department of Public Health, Whittier Health Center Northeast Community Clinic – Community Medical Alliance South Central Family Health Center St. Francis Medical Center – Downey Community Clinic St. John’s Well Child & Family Center The Children’s Clinic Watts Healthcare Corporation 99 Community Input One of the biggest concerns identified in the community was chronic diseases, which include diabetes, asthma, high cholesterol, and high blood pressure. The structure of the health care system in the community promotes episodic care, as “most providers in the area are urgent care or walk-in clinics for episodic care, which is responsive to the consumer behavior of only going to the doctor when sick.” Health Need Profile: Cardiovascular Disease Cardiovascular disease includes conditions that impact the heart and vascular system. Conditions may include heart disease, stroke, high blood cholesterol and high blood pressure. Cardiovascular disease is a significant contribution to death and disease in the KFH – Downey service area. A number of factors influence the development and management of cardiovascular disease: overweight/obesity, physical inactivity, and diets high in sugar and fat (Healthy People 2020). Mortality Rates per 100,000 persons, Age-Adjusted, 2008-2010 Service Area California Healthy People 2020 Heart Disease 147.4 131.3 100.8 Stroke 40.9 39.5 33.8 SNAPSHOT Premature Death – Heart disease is the #1 cause of premature death (before age 75) in SPA 7 and the #2 cause of premature death in SPA 6 Source: California Department of Public Health, 2010 A map of the KFH – Downey Medical Center service area shows the heart disease death rate. Heart Disease Death Rate (Per 100,000 Pop.), 2008-2010 Over 200.0 (Los Angeles County Dept. of Public Health, 2011). 160.1 - 200.0 Mortality Rates – Rates of death for heart disease (147.4) and stroke (40.9) in the service area exceed the Healthy People 2020 objectives (100.8 and 33.8) (California Department of 120.1 - 160.0 80.1 - 120.0 Under 80.1 Source: California Department of Public Health, 2008-2010 Public Health, 2008-2010). Heart Disease – 5% of adults in SPA 6 and 6.2% in SPA 7 have been diagnosed with heart disease. Among Whites in SPA 6, over one-third of the population (39.3%) has heart disease (California Health Interview Survey, 2009). High Blood Pressure – A comorbidity factor for heart disease is hypertension. In SPA 6, 34.1% of adults have been diagnosed with high blood pressure. In SPA 7, 26% of adults have been diagnosed with high blood pressure (California Health Interview Survey, 2009). Communities Most Impacted Cardiovascular disease and the associated risk factors are found to be higher in the communities of: Bellflower Compton Hawaiian Gardens Huntington Park Lynwood Maywood Paramount South East LA South Gate West Whittier 100 Risk Factors Smoking - Bellflower (15.7%), Compton (15.9%), Lynwood (16.5%), and South East Los Angeles (18.7%) have the highest rates of smoking in the service area. These rates exceed the Healthy People 2020 objective for smoking of 12% (Los Angeles County Department of Public Health, Cigarette Smoking in Los Angeles County, 2010). Overweight/Obesity - In SPAs 6 and 7, over one-third of the adult population is overweight; 18.8% of teens in SPA 7 and 11.3% in SPA 6 are overweight. And 15.2% of children in SPA 7 and 11.8% in SPA 6 are overweight (California Health Interview Survey, 2009). Physical Inactivity - 15.2% of children in SPA 6 and 17% in SPA 7 are sedentary. Among adults, 78.8% in SPA 6 and 81.4% in SPA 7 walked for transportation, fun or exercise (California Health Interview Survey, 2009). Diets High in Fat - 21.9% of the residents in SPA 6 consume fast food 3-4 times a week. In SPA 7, over onethird (33.5%) of the residents eat fast food 3-4 times a week (California Health Interview Survey, 2009). Excessive Alcohol Use - Binge drinking is defined as consuming a certain amount of alcohol within a set period of time. For males this is five or more drinks per occasion and for females it is four or more drinks per occasion. Among adults, 25.2% in SPA 6 and 30.2% in SPA 7 had engaged in binge drinking in the past year (California Health Interview Survey, 2009). Community Input One of the biggest concerns identified in the community was chronic diseases, which include diabetes, asthma, high cholesterol, and high blood pressure. Community Assets Community assets are resources within the community to meet the identified health need. American Indian Healing Center Family Health Care Center of Greater Los Angeles JWCH Institute, Inc. Los Angeles County Department of Health Services Los Angeles County Department of Public Health, Whittier Health Center Northeast Community Clinic – Community Medical Alliance South Central Family Health Center St. Francis Medical Center – Downey Community Clinic St. John’s Well Child & Family Center The Children’s Clinic “People have difficulty in making healthy lifestyle changes, which may be due in part to lack of options and opportunities for physical activity and lack of access to affordable fresh fruits and vegetables.” In reference to managing chronic diseases, people have difficulty accessing and paying for medications. It was noted that there are a limited number of the larger pharmacies in the area, a by-product of the extent of poverty in the community. The cost of medications can be prohibitive, and people have to prioritize between the medications and other basic needs. 101 Health Need Profile: Dental Health Low-income individuals, particularly children and minorities, are more likely to have poor oral health. Poor oral health can be both a result of certain health conditions and a cause of poor health (Healthy People 2020). The KFH – Downey service area shows higher rates of adults unable to afford dental care in comparison to LA County. SPA 6 has a higher number of children who have never been to the dentist compared with children in California. SNAPSHOT Adult Access – In SPA 6, 28.8% of adults and 24% of adults in SPA 7 were unable to afford dental care in the past year, which is higher than the L.A. County rate of 22.4% (California Health Interview Survey, 2009). Children (Ages 3-11) Access – 15.7% of children in SPA 6 and 10.2% in SPA 7 have never been to the dentist (California High consumption of soda and sugar sweetened beverages is a known cause of dental caries (American Dental Association). Areas with high rates of soda expenditures are shown below. Soda Expenditures (Percent of Total Expenditures per Household), by Tract Health Interview Survey 2009). Ethnicity Disparity – Hispanic and African American populations are at higher risk for poor oral health and not obtaining routine dental care. In the KFH - Downey service area, 70.1% of the population is Hispanic and 9.7% is African American (U.S. Census, 2010). Health Professional Shortage Area (HPSA) – 15% of the KFH - Downey service area population live in a HPSA, which includes a shortage of dental providers. 13.8% of residents in the state live in a HPSA (Health Resources and Services Administration, 2012). Top 80th Percentile (Highest Expenditures) 60th - 80th Percentile 40th - 60th Percentile 20th - 40th Percentile Bottom 20th Percentile (Lowest Expenditures) Source: Nielsen SiteReports, 2011 Barriers to Accessing Dental Care SPA 6 Adults Unable to Afford Dental Care in the Past Year 28.8% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey, 2007 102 SPA 7 24.0% Los Angeles County 22.3% Dental care is the one of the most prevalent health care needs for children in the U.S. Low-income children are more likely to have dental issues and less likely to have regular dental care. Delay of Dental Care among Children and Teens Children Never Been to the Dentist Main Reason Children Did Not Visit Dentist in Past Year– Could Not Afford it/Had No Insurance Teens Never Been to the Dentist Main Reason Teens Did Not Visit Dentist in Past Year – Could Not Afford it/Had No Insurance SPA 6 15.7% SPA 7 10.2% California 11.6% 12.0% 15.7% 10.4% 0% 3.7% 1.2% 75.3% 10.8% 30.6% Source: California Health Interview Survey, 2009 Associated Factors Diabetes - Persons with diabetes are at an increased risk for infection in the gums and bone. Rates of diabetes are higher in SPA 6 (15.8%) and SPA 7 (12.7%) than the state (8.5%) (California Health Interview Survey, 2009). HIV/AIDS - Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS. The HIV rate for SPA 6 in 2010/2011 was 16 cases per 100,000 persons and for SPA 7 it was 9 cases per 100,000 persons. This was compared to the state rate of 13 cases (County of Los Angeles, Public Health, 2011) Cardiovascular disease - Research suggests that heart disease, arterial disease and stroke may be linked to oral bacteria / gum disease. The service area mortality rate per 100,000 persons is higher than California for both heart disease (147.4 vs. 131.3) and stroke (40.9 vs. 39.5) (California Department of Public Health, 2008-2010). Premature Birth / Low Birth Weight - Gum disease has been linked to premature birth and low birth weight babies. The service area rate of low birth weight babies is 6.9%, which is slightly higher than the California rate of 6.8% (California Department of Public Health, 2010). Community Assets Community Input Community assets are resources within the community to meet the identified health need. Assistance League of Whittier Children’s Dental Health Clinic Los Angeles County Department of Health Services South Central Family Health Center St. John’s Well Child & Family Center Watts Healthcare Corporation Cost and lack of coverage for dental care were identified as barriers in all focus groups. Difficulty accessing affordable dental care has been exacerbated by the termination of adult Denti-Cal services. Spanish-speaking participants said they did not obtain dental services due to cost, unless it was absolutely necessary. Poor eating habits including consumption of too much sugar was noted by focus groups as a community problem. 103 Health Need Profile: Diabetes Diabetes is the fifth leading cause of death in Los Angeles County. Living with uncontrolled diabetes can lead to severe health consequences that include heart disease, stroke and kidney failure. Diabetes is a costly chronic condition that can lead to disability, loss of productivity and premature death (LA County Department of Public Health, 2012). SNAPSHOT Premature Death – Among females, diabetes is the third leading cause of premature death in SPA 7, behind heart disease and breast cancer (Los Diabetes Discharge Rate (Per 1,000 Hospitalizations) for Youth, by ZCTA Over 15.0 Angeles County Department of Public Health, 2011). 11.1 - 15.0 7.1 - 11.0 Hospitalization Rates – Rates of hospitalizations for diabetes in the KFH - Downey service area are higher than California for adults (13.2 vs. 9.7) and youth (6.3 vs. 4.8) 3.1 - 7.0 Under 3.1 Source: OSHPD, 2010 (OSHPD, 2010). Prevalence – 15.8% of adults in SPA 6 and 12.7% in SPA 7 have been diagnosed with diabetes, compared to the state rate of 8.5% (California Health Interview Survey, 2009). Adult Diabetes SPA 6 Takes oral hypoglycemic medications Has a diabetic management care plan Has never had a foot exam Never heard of the HgA1c test Never had the HgA1c test SPA 7 54.5% 70.0% 51.2% 6.8% 17.4% 77.2% 82.5% 21.6% 17.4% 5.2% California 77.0% 78.0% 72.2% 14.5% 10.6% Source: California Health Interview Survey, 2009 Diabetes Disparities Diabetes and the associated risk factors are found to be higher among the following populations (LA County Department of Public Health, 2012): Diabetes increases with age, adults ages 65+ have the highest rates of diabetes Latinos and African Americans have the highest prevalence of diabetes Diabetes prevalence increases among adults living below the Federal Poverty Level Source: LA County Department of Public Health, 2012 104 Risk Factors Overweight/Obesity - In SPAs 6 and 7, over one-third of the adult population is overweight; 18.8% of teens in SPA 7 and 11.3% in SPA 6 are overweight. And 15.2% of children in SPA 7 and 11.8% in SPA 6 are overweight (California Health Interview Survey, 2009). Fast Food and Soda Consumption - Poor nutrition and increased consumption of foods high in fat and sugar can contribute to diabetes. In SPA 6, 21.9% of the residents consume fast food 3-4 times a week. In SPA 7, over one-third (33.5%) of the residents eat fast food 3-4 times a week. Soda consumption can also contribute to overweight and obesity. In SPA 6, 21.7% of children and teens consume two or more soda or sweetened drinks a day. 23.5% of children and teens in SPA 7 consume two or more soda or sweetened drinks a day. This rate is higher than the state rate of 14.7% (California Health Interview Survey, 2009). High Blood Pressure - In SPA 6, 34.1% of adults have been diagnosed with high blood pressure. Of these, 63.4% are on medication for their blood pressure. In SPA 7, 26% of adults have been diagnosed with high blood pressure and 65.5% are on medication (California Health Interview Survey, 2009). Physical Inactivity- 15.2% of children in SPA 6 and 17% in SPA 7 are sedentary. Among adults, 78.8% in SPA 6 and 81.4% in SPA 7 walked for transportation, fun or exercise (California Health Interview Survey S, 2009). Smoking – One of the negative health effects of smoking is an increased risk of diabetes. Bellflower (15.7%), Compton (15.9%), Lynwood (16.5%), and South East Los Angeles (18.7%) have the highest rates of smoking in the service area. These rates exceed the Healthy People 2020 objective for smoking of 12% (Los Angeles County Department of Public Health, 2010). Community Assets Community assets are resources within the community to meet the identified health need. Family Health Care Center of Greater Los Angeles JWCH Institute, Inc. LA County Department of Health Services Los Angeles County Department of Public Health, Whittier Health Center Northeast Community Clinic – Community Medical Alliance South Central Family Health Center St. Francis Medical Center – Downey Community Clinic St. John’s Well Child & Family Center The Children’s Clinic Watts Healthcare Corporation 105 Community Input A stakeholder at a school-based health clinic reported that she does not see families engage in any kind of prevention. “Even where there are kids in the family with diabetes, they do not go to the doctor.” Fortunately, once people get some kind of health coverage and establish a relationship with an affordable primary care provider, they become “proactive versus reactive, see a doctor, and follow through on recommendations.” Health Need Profile: Mental Health Mental illness is a common cause of disability. Untreated disorders may leave individuals at-risk for substance abuse, self-destructive behavior, and suicide. Additionally, mental health disorders can have a serious impact on physical health and are associated with the prevalence, progression and outcome of chronic diseases (Healthy People 2020). SNAPSHOT Adults – In SPA 6, 14.8% of adults had serious psychological distress, compared to 6.5% of adults in California (California Health Interview Survey, 2009). Teens – 26.4% of teens in SPA 6 and 16.7% of teens in SPA 7 needed help for emotional issues/substance abuse (California Health Interview Survey 2009). Health Professional Shortage Area (HPSA) – 15% of the KFH Downey service area population lives in a HPSA, which includes a shortage of mental health providers. In California, 13.8% of the population lives in a HPSA (Health Resources and Services Administration, 2012). Accessibility – In SPA 6 10.9% of adults reported needing mental health care but not being able to afford to access it. This is in comparison to 5.9% of adults in LA County who could not afford mental health care (Los Angeles County Health Survey, 2007). Feelings of Depression Among Teens – In KFH - Downey-area school districts, 32.2%-43.6% of 7th grade females expressed depression-related feelings. This is higher than the state rate of 30.8% The table below indicates that SPA 6 has higher rates of mental health issues in comparison to the state. Overall, the service area had a notable percentage of individuals who sought or needed mental health services and did not receive treatment. Risk Factors and Complications Mental Health Indicators Adults who had Serious Psychological Distress During Past Year Adults who Needed Help for Emotional-Mental and/or Alcohol-Drug Issues in Past Year Teens who Needed Help for Emotional-Mental and/or Alcohol-Drug Issues in Past Year Adults who Saw a Health Care Provider for Emotional/Mental Health and/or Alcohol-Drug Issues in Past Year Teens Received Psychological/ Emotional Counseling in Past year Has Taken Prescription Medicine for Emotional/Mental Health Issue in Past Year Sought/Needed Help but Did Not Receive Treatment Source: California Health Interview Survey 2009 (California Healthy Kids Survey, 2008-2010). 106 SPA 6 SPA 7 California 14.8% 5.5% 6.5% 13.2% 11.9% 14.3% 26.4% 16.7% 12.9% 7.6% 8.6% 10.9% 4.3% 7.7% 9.5% 7.9% 7.8% 9.7% 56.4% 45.7% 44.5% Associated Factors Homeless - Mental health issues are prevalent among the homeless population: Mental Illness: In SPA 6, 35% of the homeless have mental illness; 27% of the homeless in SPA 7 have mental illness. Substance Abuse: Among the homeless, 32% in SPA 6 and 32% in SPA 7 are substance abusers (2011 Greater Los Angeles Homeless Count Report). Experienced Physical or Sexual Violence 14.2% of adults in SPA 6 indicated they had experienced physical or sexual violence by an intimate partner since the age of 18, and 4% had been the victims of intimate partner violence in the past year. In SPA 7, 13.1% had experienced violence since the age of 18, and 1.8% had been the victims of intimate partner violence in the past year. In the state, 14.8% of adults had experienced physical or sexual violence by an intimate partner since the age of 18, and 3.5% had been the victims of intimate partner violence in the past year (California Health Interview Survey, 2009) Suicide - In the KFH – Downey service area the rate of death by suicide is 6.4 per 100,000 persons (age-adjusted, averaged over three years, 2008-2010). This compares favorably to the Healthy People 2020 objective of 10.2 (California Department of Public Health, 2008-2010). Excessive Alcohol Use - Binge drinking is defined as consuming a certain amount of alcohol within a set period of time. For males this is five or more drinks per occasion and for females it is four or more drinks per occasion. Among adults, 25.2% in SPA 6 and 30.2% in SPA 7 had engaged in binge drinking in the past year. This is lower than the state rate of 31.3% (California Health Interview Survey, 2009). Community Assets Community assets are resources to meet the identified health need. Aspiranet Community Family Guidance Center Family Health Care Centers of Greater Los Angeles Gang Alternatives Program (GAP) Helpline Youth Counseling, Inc. INMED Partnerships for Children Intercommunity Counseling Center of Whittier Pathways Volunteer Hospice South Central Family Health Center The Whole Child Community Input A lack of psychosocial and mental health services was noted for many populations, including: children/family/parent education, the uninsured, veterans, and college students GLBT youth– “Very underserved, at risk for homelessness and suicide. Youth need to be empowered to take control of their lives” There is a “lack of Spanish-speaking therapists.” 107 Health Need Profile: Nutrition and Healthy Eating Healthy eating and nutrition programs promote a healthy body weight and help to maintain chronic disease risk. A goal for good nutrition among vulnerable populations is to eliminate hunger, and increase access to nutrient dense, healthy food (Healthy People 2020). SNAPSHOT Overweight – In the KFH Downey service area over onethird of the adult population is overweight (34%-38.4%), higher than the state rate (33.6%) Fast Food Access: KFH – Downey area residents have an access rate of 64.4 fast food restaurants per 100,000 persons; this is less than the state rate of 69.4. Fast Food Restaurant Rate (Per 100,000 Pop.), by ZCTA (California Health Interview Survey, 2009). Premature Death – Heart disease is the #1 cause of premature death (death before age 75) in SPA 7 and the #2 cause in SPA 6. Among adult females, diabetes is the #3 cause of premature death in SPA 7 (Los Angeles County Department of Public Health, 2011). Fast Food Consumption – Residents in SPA 6 (21.9%) and SPA 7 (33.5%) consume more fast food than California residents (19.6%) (California Health Interview Over 100.0 80.1 - 100.0 Survey, 2009). 60.1 - 80.0 Economic Disparity – Poverty affects access to healthy food. In the KFH - Downey service area, 43.1% of residents are lowincome (200% or below Federal Poverty Level) (American Community 40.1 - 60.0 Under 40.0 Source: US Census ZIP Code Business Patterns, 2009 Survey, 2006-2010). Fast Food Consumption, 3-4 Times a Week SPA 6 Total Population Ages 0-17 Ages 18-64 Ages 65+ SPA 7 21.9% 16.4% 27.9% 7.5% Source: California Health Interview Survey, 2009 108 33.5% 22.1% 40.3% 17.6% California 19.6% 17.0% 22.6% 7.7% Associated Factors Soda Consumption: In comparison to state rates (14.7%), children and teens consume much higher rates of soda (two or more sodas or sweetened drinks per day) in SPA 6 (21.7%) and SPA 7 (23.5%) (California Health Interview Survey, 2009). Fresh Fruits and Vegetables: In SPA 6 and SPA 7 over half of the children consume five fruits and vegetables in a day. This is a higher rate than found in the state. Fresh fruit and vegetable consumption decreases considerably among teens. Only 8.9% of teens in SPA 6 and 31.4% in SPA 7 consume the recommended portions, in comparison to 19.9% in the state (California Health Interview Survey, 2009). Food Desert: A food desert is defined as a low-income census tract where a substantial percentage of residents have limited access to a supermarket or large grocery store. Only 1.5% of the population in the service area lives in a designated food desert as compared to the California rate of 5.7% (U.S. Department of Agriculture, 2009). Community Assets Community assets are resources to meet the identified health need. Activate Hawaiian Gardens Activate Whittier Certified Farmer’s Markets Downey YMCA Family Health Care Centers of Greater Los Angeles Healthy Downey Los Angeles County Department of Public Health Mother’s Nutritional Center South Central Family Health Center WIC programs Community Input When asked what could be done to improve healthy eating and reduce overweight and obesity in the service area, focus group and interview respondents’ suggestions included: Reduce junk food and increase lower cost healthy food in stores. Need greater/more convenient accessibility of programs, farmers markets for working families Provide good prenatal care that includes information on nutrition, as well as promoting breastfeeding until at least six months Encourage food banks to offer less high fat food and healthy food preparation classes for clients “There are a number of vacant lots in South Central that were burned out during the riots in the 1960s and 1990s. They are eyesores and it could be possible to convert some of these into pocket parks and community gardens. Among college students there is severe obesity; lack of access to food (“often students do not eat for days”), which has led one college to start a food bank on campus. 109 Health Need Profile: Overweight and Obesity Being overweight or obese affects a wide range of health issues and are major risk factors for diabetes, cardiovascular disease, and other chronic diseases. SNAPSHOT Premature Death – Obesity comorbidities are some of the leading causes of premature death in the service area. Heart disease is the #1 cause of premature death (death before age 75) in SPA 7 and the #2 cause of premature death in SPA 6. Among females, diabetes is the #3 cause of premature death in SPA 7 Overweight Over one-third of adults in the KFH – Downey service area are overweight. Among teens, 11.3% in SPA 6 and 18.8% in SPA 7 are overweight. 11.8% of children in SPA 6 and 15.2% in SPA 7 are overweight (California Health Interview Survey, 2009). Obesity When adult obesity levels were tracked over time, a 9% increase in obesity is seen in SPA 6, and a 10.3% increase in obesity is seen in SPA 7 from 2005 to 2011. In 2011, 32.7% of adults in SPA 6 and 30.1% of adults in SPA 7 were obese, higher than the County rate of 23.6%. (Los Angeles County Dept. of Public Health, 2011). Diabetes – 15.8% of adults in SPA 6 and 12.7% in SPA 7 have been diagnosed with diabetes. These are higher rates than found in California (8.5%) (California Health Interview Survey,2009). Adult Obesity 2005 SPA 6 SPA 7 LA County 30.0% 27.3% 20.9% 2007 35.4% 26.6% 22.2% Change 20052011 32.7% 9.0% 30.1% 10.3% 23.6% 12.9% 2011 Source: Los Angeles County Department of Public Health, 2012 Hospitalization Rates – Rates of hospitalizations for diabetes in the KFH - Downey Service Area (13.2 for adults and 6.3 for children are higher than in California (9.7 for adults and 4.8 for youth) (OSHPD, 2010). Risk Factors Diets High in Fat - 21.9% of the residents in SPA 6 consume fast food 3-4 times a week. In SPA 7, over one-third (33.5%) of the residents eat fast food 3-4 times a week. The state rate is 19.6% (California Health Interview Survey, 2009). Soda Consumption - In comparison to the 14.7% rate of soda consumption in California, children and teens consume much higher rates of soda / sweetened drinks in SPA 6 (21.7%) and SPA 7 (23.5%) (California Health Interview Survey, 2009). Fresh Fruits and Vegetables - In SPA 6 and SPA 7 over half of the children consume five fruits and vegetables in a day. Consumption decreases considerably among teens. Only 8.9% of teens in SPA 6 and 31.4% in SPA 7 consume the recommended portions, in comparison to the 19.9% rate in the state (California Health Interview Survey, 2009). Physical Inactivity - 15.2% of children in SPA 6 and 17% in SPA 7 are sedentary; 11.8% of children in the state are inactive. Among adults, 78.8% in SPA 6 and 81.4% in SPA 7 walked for transportation, fun or exercise; this rate is 77.2% in the state (California Health Interview Survey 2009). 110 Disparities Obesity prevalence increases among residents experiencing economic hardship. The percentage of students eligible for the free and reduced price meal program is one indicator of socioeconomic status. In the KFH – Downey service area, three-fourths (74.7%) of the student population are eligible for the free and reduced price meal program, indicating a high level of low-income families. This rate is higher than the state rate of 55.6% (National Center for Education Statistics, 2010-2011). Percentage of Students Eligible for Free or Reduced Price Lunch, by School Over 80.0% 60.1 - 80.0% 40.1 - 60.0% 20.1 - 40.0% Under 20.1% Not Reported Source: National Center for Education Statistics, 2010-2011 Community Assets Community assets are resources to meet the identified health need. Activate Hawaiian Gardens Activate Whittier Certified Farmer’s Markets Downey YMCA Family Health Care Centers of Greater Los Angeles Healthy Downey Los Angeles County Department of Public Health Mother’s Nutritional Center South Central Family Health Center WIC programs Community Input The Problem Obesity is often the “primary diagnosis” at schoolbased health centers; Obstacles include lack of resources for nutritional counseling or physical activity. There is severe obesity among the college student population. Among patients, lack of awareness that obesity is a health problem or that diabetes can be present without symptoms. Suggestions Reduce junk food and increase lower cost healthy food in stores. Need greater/more convenient accessibility of programs, farmers markets for working families. Food banks are encouraged to offer less high fat food and healthy food preparation classes for clients. 111 Health Need Profile: Physical Activity According to Healthy People 2020, more than 80% of adults and adolescents in the U.S. do not meet the guidelines for aerobic and/or muscle-strengthening activities. Regular physical activity can improve physical and mental health, and quality of life, regardless of the presence of a chronic disease or disability. Personal, social, economic, and environmental factors all play a role in physical activity levels. Physical activity plays a key role in levels of overweight and obesity, and in the development and management of chronic diseases. Park and Recreation Facility Access SNAPSHOT Adult Physical Activity – In the KFH - Downey Service Area, 78.8% in SPA 6 and 81.4% in SPA 7 walked for transportation, fun or exercise (California Health Interview Survey, 2009). In the KFH - Downey service area, 68.3% of the population lives within half a mile of a park. The rate of individuals that live near a recreation facility is 4.4 per 100,000 persons; this is lower than the state rate of 8.9 per 100,000 persons (U.S. Census, 2009+2010). Percent of Students Not In Aerobic Healthy Fitness Zone, By Elementary School District Over 54.0% Child Physical Activity – 15.2% of children in SPA 6 and 17% in SPA 7 were sedentary during the week 42.1 - 54.0% (California Health Interview Survey, 2009). 30.1 - 42.0% Teen Physical Activity – 14.4% of teens in SPA 6 and 14.1% in SPA 7 were sedentary during the week 18.1 - 30.0% Under 18.1% (California Health Interview Survey, 2009). Health Consequences: Lack of physical fitness is associated with many diseases. Heart disease is the #1 cause of premature death (death before age 75) in SPA 7 and the #2 cause of premature death in SPA 6. Among females, diabetes is the #3 cause of premature death in SPA 7 (Los Angeles County Department of Public Health, 2011) Income/Education Disparity – Higher incomes and educational attainment is positively associated with adult physical activity levels; 43.1% of the population in the service area is categorized as low-income (200% Federal Poverty Level or below). Additionally, 35.6% of individuals over 25 in KFH - Downey service area do not have a high school diploma in comparison to the 19.3% in California (American Community Survey, 2006-2010). Source: California Department of Education, 2011 Factors that Affect Physical Activity Levels According to Healthy People 2020, the following factors are positively associated with adult physical activity – Postsecondary education Higher income Enjoyment of exercise Expectation of benefits Belief in ability to exercise (self-efficacy) History of activity in adulthood Social support from peers, family, or spouse Access to and satisfaction with facilities Enjoyable scenery Safe neighborhoods 112 Physical Activity SPA 6 Engaged in Vigorous Physical Activity 3 Days/Week – Child No Physical Activity/Week – Child No Physical Activity/Week – Teen Teens Take PE Class Walked/Biked/Skated to School Youth Visited Park/Playground/Open Space Adults Walked for Transportation, Fun or Exercise SPA 7 California 61.5% 64.2% 67.1% 15.2% 14.4% 73.9% 64.4% 74.1% 78.8% 17.0% 14.1% 80.1% 49.5% 79.5% 81.4% 11.8% 16.2% 65.9% 43.0% 79.4% 77.2% Source: California Health Interview Survey, 2009 Community Walkability Geographical Area* Walk Score WalkScore.com is a website that issues a ranking to over 2,500 cities in the United States. Many locations are sampled within each city and an overall score is issued for the walkability of that city. WalkScore.com has established the range of scores: 0-24: Car Dependent (Almost all errands require a car) 25-49: Car Dependent (A few amenities within walking distance) 50-69: Somewhat Walkable (Some amenities within walking distance) 70-89: Very Walkable (Most errands can be accomplished on foot) 90-100: Walker's Paradise (Daily errands do not require a car) Communities in the service area are scored as somewhat walkable and very walkable. Artesia Bell/Bell Gardens Bellflower* Cerritos Commerce Compton Cudahy Downey* Hawaiian Gardens Huntington Park Lakewood Lynwood* Maywood Norwalk* Paramount Pico Rivera Santa Fe Springs South Gate Vernon Whittier* Los Angeles County 74 67 63 60 71 54 67 58 82 74 61 57 68 62 64 55 75 61 52 62 66 Community Input Barriers to making physical activity changes: Lack of motivation, laziness Tired after working all day Feeling discouraged by current weight, and embarrassed to go to the gym Parks have started to charge for exercise classes, which has severely limited the ability of many people to participate Safety is one barrier that limits the ability of parents to send their kids out to play; people don’t go out after dark, and there is a concern about gangs. *Communities with Kaiser Permanente Medical Office Buildings Community Assets Community assets are resources to meet the identified health need. Activate Whittier Boys & Girls Clubs City of South Gate Community Gym Gang Alternatives Program (GAP) Parks and recreation facilities Whittier Greenway Trail YMCA 113 Health Need Profile: Preventive Care Health care preventive services include cancer and chronic disease screening and scheduled vaccines and immunizations. Preventive care reduces death and disability and improves health. These services prevent and detect illnesses and diseases—from flu to cancer—in earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and medical care costs for individuals and the community (Healthy People 2020). SNAPSHOT ER Visits – Preventive health care can avert health issues from spiraling into more serious conditions, resulting in fewer ER visits or hospitalizations. 20.9% of residents in SPA 6 and 18% of residents in SPA 7 visited an ER over a period of a year, compared to 17.6% Californians who went to an ER (California Health Interview Survey, 2009). Hospitalization – Adequate preventive care may reduce unnecessary hospitalizations. The KFH - Downey service area has higher hospitalization rates (per 1,000 people hospitalized) than the state for adult asthma (KFH Downey 9.7, state 7.7); youth asthma (KFH - Downey 19.9, state 19.2), adult diabetes (KFH Downey 13.2, state 9.7), youth diabetes (KFH - Downey 6.3, state 4.8) and HIV (KFH - Downey 1.8, state 1.7) (OSHPD, 2010 +2011). Preventive Health Care Services Mammograms - The Healthy People 2020 objective for mammograms is 81.1% of women 40+ years have a mammogram in the past two years. In SPA 6, 72% of women, age 40+, have had a mammogram, and 77% of women in SPA 7 have had a mammogram, which falls short of the Healthy People 2020 objective (Los Angeles County Department of Public Health, 2007). Pap Smears - The Healthy People 2020 objective for Pap smears is 93% of women have a Pap smear in the past three years. In SPA 6, 88.3% of women have had a Pap smear in the past three years, and 85% of women in SPA 7 have had a Pap smear in that time period (Los Angeles County Department of Public Health, 2007). Colorectal Cancer Screening - In SPA 6, 67.1% of adults have had the recommended screening for colorectal cancer. In SPA 7, the rate of compliance is 71.1%, which exceeds the Healthy People 2020 objective for colorectal cancer screening of 70.5%. Of adults advised to obtain screening, 57.9% in SPA 6 and 59.2% in SPA 7 were compliant at the time of the recommendation (California Health Interview Survey, 2009). Vaccines and Flu Shots - Seniors tend to receive flu vaccines at higher rates than adults or youth. Among seniors, 42.9% in SPA 6 and 68.2% in SPA 7 had received a flu shot. Adults received flu shots at a lower rate – 25.3% in SPA 6 and 23.7% in SPA 7. 42.3% of children in SPA 6 received a flu shot, and 38.8% of children in SPA 7 received a flu vaccine (California Health Interview Survey, 2009). Over half the seniors in SPA 6 (51.1%) and SPA 7 (56.6%) had obtained a pneumonia vaccine (Los Angeles County Department of Public Health, 2007). These rates do not meet the Healthy People 2020 objectives, which recommend 90% of seniors receive recommend flu shots and pneumonia vaccines, and 80% of adults and youth receive recommended flu shots. 114 Associated Factors that Influence Obtaining Preventive Care Usual Source of Care - Residents who have a medical home are able to access preventive care services. Among the residents in the KFH - Downey service area, over 90% of children and youth have a usual source of care. 68.7% of adults in SPA 6, and 77.5% of adults in SPA 7 have a usual source of care. And, 86.3% of seniors and 95.4% of seniors in SPA 7 have a source of care. 85.8% of state residents have a usual source of care (California Health Interview Survey, 2009). Health Professional Shortage Area (HPSA) - 15% of the KFH - Downey service area population lives in a HPSA (which includes medical, dental and mental health services), compared to 13.8% of the population in the state living in a HPSA (Health Resources and Services Administration, 2010). Insurance Coverage - In the KFH - Downey service area, 74% have health insurance, which can include MediCal, employer-based insurance and other public and private coverage; in comparison, 82% of Californians have health insurance (American Community Survey, 2006-2010). Income Disparity - Low-income populations face barriers obtaining preventive care: 43.1% of the population in the service area is categorized as low-income, compared to 32.8% in the state (American Community Survey, 2006-2010). Community Assets Community assets are resources within the community to meet the identified health need. Family Health Care Center of Greater Los Angeles JWCH Institute, Inc. Community Input Los Angeles County Department of Health There is a lack of knowledge about the importance Services of preventive care and a tendency to obtain Northeast Community Clinic – Community services only when sick. Medical Alliance South Central Family Health Center “By the time they come in for services their issue St. Francis Medical Center – Downey has exploded; they do not have the resources, time, Community Clinic energy or education to address their issues earlier St. John’s Well Child & Family Center on.” The Children’s Clinic “Parents do not understand the value of regular Watts Healthcare Corporation physicals for their children and/or do not have the time or see it as a priority, and so will miss important conditions that should be addressed, such as vision problems.” A lack of orientation to prevention services resulting in missed opportunities for early detection and delays in seeking care until medical situations are acute or emergent. 115 Health Need Profile: Sexually Transmitted Diseases (STDs) STDs have been identified as a health need in the KFH – Downey service area. SPA 6 has high rates of Chlamydia, Gonorrhea, Early Latent Syphilis and HIV/AIDS, while SPA 7 has lower rates of STDs than L.A County as a whole. Community focus groups commented on the social stigma associated with discussing sex and intimacy, which Healthy People 2020 notes is the most important social factor contributing to the spread of STDs. SNAPSHOT HIV Hospitalization Rate (per 1,000 Hospitalizations), by ZIP Code HIV Hospitalization – The rate of adult hospitalization for HIV per 1,000 hospitalizations is 1.8. This is slightly higher than the state rate of HIV hospitalization of 1.7 (OSHPD, 2010-2011). Teen STD Testing – Among sexually active teens, 54% in SPA 6 had been tested for an STD and 7% in SPA 7 had been tested for an STD. 31.9% of sexually active teens in the state had been tested for an STD (California Health Over 3.00 2.01 - 3.00 1.01 - 2.00 Under 1.01 No Hospitalizations Source: OSHPD, 2010-2011 Interview Survey, 2009). Economic Disparity – STDs are more likely to occur in low-income populations. In the KFH - Downey service area, 43.1% of the population is at 200% or below FPL. 32.8% of the state population is low-income (American Rates of HIV in the KFH – Downey service area have decreased from 2010 to 2011. In SPA 6 the HIV rate in 2011 was 16 (per 100,000 persons), and in SPA 7 it was 9. This is compared to the state rate of 13 (County of Los Angeles, Public Health, 2011). Community Survey, 2006-2010). Ethnicity Disparity Hispanic and African American populations are at higher risk for STDs (Healthy People 2020). In the service area, 70.1% of the population is Hispanic and 9.7% African American (U.S. Census, 2010). Rate of STDs The rate of Chlamydia in SPA 6 is 969.6 per 100,000 persons and in SPA 7 it is 406.3. In comparison the rate of Chlamydia in LA County is 455.1. STD Cases, Rate per 100,000 Persons, 2010 Chlamydia Gonorrhea Primary and Secondary Syphilis Early Latent Syphilis SPA 6 969.6 225.7 5.9 10.3 SPA 7 406.3 52.4 4.4 6.0 Los Angeles County 455.1 96.8 6.5 9.2 Source: County of Los Angeles, Public Health, Sexually Transmitted Disease Morbidity Report, 2010 116 Risk Factors Alcohol Use - 23.5% of teens in SPA 6, and 31.8% of teens in SPA 7 have had an alcohol drink. These rates are lower than the state rate of 33.4% of teens drinking alcohol (California Health Interview Survey, 2009). Binge drinking among adults in SPA 6 was 25.2% and in SPA 7, 30.2%. The Healthy People 2020 objective for binge drinking is 23.4% (California Health Interview Survey, 2009). Drug Use - Among teens in the KFH – Downey service area, 16% have tried drugs and 13.2% used marijuana in the past year. These rates are higher than found among teens in California where 13.5% tried drugs and 8.8% used marijuana (California Health Interview Survey, 2009). Community Assets Community assets are resources within the community to meet the identified health need. Community Input More sex/health education is needed in the schools, and it needs to start with kids at a younger age. Cerritos College Family Health Care Center of Greater Los Angeles INMED JWCH Institute, Inc. Los Angeles County Department of Health Services Northeast Community Clinic – Community Medical Alliance South Central Family Health Center St. Francis Medical Center – Downey Community Clinic St. John’s Well Child & Family Center The Children’s Clinic Education to foster communication between parents/teens is needed regarding sex and alcohol use. Girls need to be educated that they don’t have to have a boyfriend and engage in sexual activity, despite the images they see on television and what is promoted within rap music. There are barriers among the LGBT and HIV positive communities, which can affect their willingness to seek services, include “stigma, discrimination, internalized shame, denial, and other issues.” There is a need to overcome social impediments to HIV testing where “kits could be purchased at the 99 Cent store, and testing is as routine as pregnancy testing.” 117 Health Need Profile: Teen Birth Teen parents have unique needs for social, economic, and health support services. Teenage pregnancies may pose risks for the teen mothers and result in poor health outcomes for their children. The teen birth rate in the KFH – Downey service area was 11.8% of live births in 2010, an increase from 11.3% in 2009. The rate of teen births in California in 2010 was 8.5% (CDPH, 2010). Rate of Births to Women under Age 20 (Per 1,000 Births), by ZCTA SNAPSHOT Over 125.0 Teen Sexual History – 5.4% of teens in SPA 6 and 5.7% of teens in SPA 7 had their first sexual encounter when they were less than 15 years old; 7.3% of teens in California had their first sexual encounter before the age of 15 (California 100.1 - 125.0 75.1 - 100.0 50.1 - 75.0 Under 50.1 Source: California Department of Public Health, 2010 Health Interview Survey, 2009). Low Birth Weight – Teenage mothers are at high risk for late prenatal care, low birth weight births, and related health risks to the baby. The KFH - Downey service area rate of low birth weight babies is 6.9%, which is slightly higher than the California rate of 6.8% (California Department of Geographic Focus of Teen Births In the KFH - Downey service area, Bell/Bell Gardens (13%), Compton (16.1%), Hawaiian Gardens (15.2%), Southeast Los Angeles (15.3%-18.2%) and Vernon (19.7%) have high rates of teen births. Artesia (4.4%), Cerritos (2.1%), Downey (6.9%), and Long Beach 90808 (2.8%) have the lowest rates of teen births (California Department of Public Health,, 2010). Public Health, 2010). Prenatal Care – 85.7% of pregnant women in the KFH Downey service area entered prenatal care within the first trimester. The area rate of early entry into prenatal care exceeds the Healthy People 2020 objective of 78% of women entering prenatal care in the first trimester (California Department of Public Health, 2010). Births to Teenage Mothers (Under Age 20) 2009/2010 Comparison Geographical Area Percent of Births 2009 Service Area California 11.3% 9.2% Source: California Department of Public Health, 2009 + 2010 118 Percent of Births 2010 11.8% 8.5% Over half (58.2%) of teenage mothers in the KFH – Downey service area are of Hispanic/Latino ethnicity. Ethnicity of Teenage Mothers Geographical Area Service Area California Hispanic/Latino 58.2% 65.4% Source: California Department of Public Health, 2010 Community Assets Community assets are resources within the community to meet the identified health need. Family Health Care Center of Greater Los Angeles JWCH Institute, Inc. INMED Partnerships for Children Los Angeles County Department of Health Services Mother’s Nutritional Center Northeast Community Clinic – Community Medical Alliance South Central Family Health Center St. Francis Medical Center – Downey Community Clinic St. John’s Well Child & Family Center The Children’s Clinic Community Input More sex/health education is needed in the schools, to start with kids at a younger age. Education should include birth control options, as well as consequences of behavior and what it’s like to parent and have a baby. What is needed is education to foster communication between parents and teens by teaching parents how to talk to their kids about sex, including how to overcome their own embarrassment. Girls need to know that they don’t have to have a boyfriend or engage in sexual activity, despite the images they see on television and what is promoted within rap music. Focus groups also noted that the following related social services were needed: Opportunities for teens to share experiences and support each other. More activities for youth to engage in that are positive, and that will help to delay sexual activity. 119 Health Need Profile: Youth Safety and Community Violence Community violence is pervasive, especially in lower-income urban areas. Socioeconomics and crime interconnect and contribute to community violence. High rates of crime and violence impact on families’ feelings of safety and tend to reduce community interaction and outside physical activities (National Center for Children Exposed to Violence). Violent Crime Violent crimes include homicide, rape and assault. Violent Crime Rate (per 100,000), by Police Jurisdiction SNAPSHOT Over 500 250.1 - 500 Homicide - In the KFH - Downey service area the rate of homicide is 13.1 per 100,000 persons (age-adjusted, averaged over three years, 2008-2010). This rate is more than double the California rate (5.2) and the Healthy People 2020 objective (5.5) (California 100.1 - 250 50.1 - 100 Under 50.1 Source: U.S. Federal Bureau of Investigation, Uniform Crime Reports, 2010 Department of Public Health,, 2008-2010). Experienced Physical or Sexual Violence - 14.2% of adults in SPA 6 indicated they had experienced physical or sexual violence by an intimate partner since the age of 18. In SPA 7, 13.1% had experienced violence since the age of 18. In California the rate was 14.8% (California Health Interview Survey, 2009). Domestic Violence - Whittier, Compton and Bellflower had the highest number of domestic violence calls in 2010 in the KFH - Downey service area (California Department of Justice, 2010). Compton (547.4), Commerce (436.7) and Hawaiian Gardens (427.9) have the highest rate of arrests among adults for violent crimes per 100,000 persons in the KP Downey service area. Bell, Bellflower, Cudahy, Huntington Park and Lynwood also have high rates of violent crimes (California Department. of Justice, 2010). Homicide, Death Rate (per 100,000), by ZCTA Over 25.0 Motor Vehicle Accident - In the KFH Downey service area the rate of death from motor vehicle crash is 9.2 per 100,000 persons. In California the rate is 8.2. The Healthy People 2020 objective is 12.4. The rate of pedestrian deaths from motor vehicle crashes is 1.8 per 100,000 persons. This rate is higher than the California rate (0.8) and above the Healthy People 2020 objective (1.3) 10.1 - 25.0 5.1 - 10.0 Under 5.1 No Deaths Source: California Department of Public Health, 2008-2010 (California Department of Public Health,, 2008-2010). 120 Associated Factors Youth Population – In the service area, 41.9% of the population is made up of youth and young adults, ages 024. In comparison 35.8% of the population in California is 0-24 (American Community Survey, 2006-2010). Poverty – In 2010, the federal poverty level for one person was $10,830 and for a family of four $22,050 (Census, 2010). Among the residents in the service area, 17.1% are at or below 100% of the federal poverty level (FPL) and 43.1% are at 200% or below FPL. These rates of poverty are higher than found in the state (13.7% and 32.8%) (American Community Survey, 2006-2010). Low-Income and Poverty Level Children – Incomes of 200% or below Federal Poverty Level are classified as low-income. In SPA 6, 82.2% of children, and in SPA 7 51.8% of children are categorized as low-income (CHIS, 2009). Cudahy (24.3%) and Huntington Park (24%) have the highest percentage of children living in poverty in the service area, in comparison to state rates of 19.1% (American Community Survey, 2006-2010). Families with Single Parent Head of Households – Female headed households with children are especially vulnerable, experiencing very high rates of poverty. Bell Gardens, Cudahy, Hawaiian Gardens, Huntington Park, Lynwood and Maywood all have rates of poverty over 40% among female head of households with children. In California the rate is 32.8% (American Community Survey, 2006-2010). Educational Attainment – Lack of educational attainment is an associated risk factor for violence and crime in communities. Among adults, ages 25 and older, in the KFH – Downey service area, over one-third of the population (35.6%) have no high school diploma. This is compared to 19.3% of residents in California who do not have a high school diploma (American Community Survey, 2006-2010). Community Assets Community assets are resources to meet the identified health need. Community Input Safety is one barrier that limits the ability of parents to send their kids out to play; people don’t go out after dark, and there is a concern about gangs. Boys & Girls Clubs California Center for Equality and Justice Gang Alternatives Program (GAP) Gangs Out of Downey (GOOD) Helpline Youth Counseling INMED Partnerships for Children The Whole Child YMCA Our community needs more activities for youth to engage in that are positive, and that will help to prevent gang activity. GLBT youth are “very underserved, at risk for homelessness and suicide. Youth need to be empowered to take control of life.” 121 Appendix H – Supplemental Health Data 122 Supplemental health data provides information on the health needs in the service area. The following data are presented according to the organization of data in CHNA.org/kp and the MATCH population framework. Overall Health Health Status Among the residents in SPA 6, 28.2% rate themselves as being in fair or poor health. The level of fair/poor health increases among adults to 32.2% and among seniors to 35.6%. In SPA 7, 20.1% of residents have a self-rated fair/poor health status. 21.8% of adults and 38.5% of seniors in SPA 7 consider themselves to be in fair/poor health. These rates of fair/poor health status are greater than found in the state. Health Status, Fair or Poor Health SPA 6 SPA 7 California Fair or Poor Health 28.2% 20.1% 15.2% 18-64 Years Old 65+ Years Old 32.2% 35.6% 21.8% 38.5% 16.8% 27.6% Source: California Health Interview Survey, 2009 Health Outcomes Disability In the KFH – Downey service area, 9.4% of the population has a physical, mental or emotional disability. The rate of disability in the state is 10%. Population with a Disability Service Area California 9.4% 10.0% Source: U.S. Census Bureau, 2008-2010 American Community Survey Infant Mortality The infant (less than one year of age) mortality rate in the KFH – Downey service area was 4.1 deaths per 1,000 live births. In comparison, the infant death rate in the state was slightly higher at 4.7 deaths per 1,000 live births. The infant death rate is less than the Healthy People 2020 objective of 6.0 deaths per 1,000 live births. Infant Mortality Rate Geographical Area Service Area California Infant Deaths 107 2,419 Live Births 25,889 511,825 Source: California Department of Public Health, 2010 123 Death Rate 4.1 4.7 Leading Causes of Premature Death In Los Angeles County, 44% of people in 2008 died before they reached age 75. With 75 years set as a cut-off date, everyone who dies younger than 75 is considered to have died prematurely. When premature death rates were examined for SPA 6 and SPA 7, the top three causes of premature death were: homicide, heart disease and motor vehicle crash. Leading Causes of Premature Death (before age 75) by Gender, SPA 6 and SPA 7 Male Female Overall SPA 6 SPA 7 SPA 6 SPA 7 SPA 6 SPA 7 #1 Cause Homicide Heart Disease Heart Disease Heart Disease Homicide Heart Disease #2 Cause Heart Disease Homicide Breast Cancer Breast Cancer Heart Disease Homicide #3 Cause Motor Vehicle Crash Motor Vehicle Crash Homicide Diabetes Motor Vehicle Crash Motor Vehicle Crash Source: L.A. County Department of Public Health, Office of Health Assessment and Epidemiology. Mortality in Los Angeles County 2008: Leading causes of death and premature death with trends for 1999-2008, 2011. Causes of premature death differ when examined by gender. Among males in SPA 6 and SPA 7 the leading causes of premature death were: homicide, coronary heart disease, and motor vehicle accident. Among females the top causes of premature death were: coronary heart disease, breast cancer, homicide, and diabetes. Mortality Rates The three leading causes of death in the KFH – Downey service area are cancer, heart disease and stroke. The mortality data were averaged over three years (2008-2010) and age-adjusted. The crude death rate is a ratio of the number of deaths to the entire population. Age-adjusted death rates eliminate the bias of age in the population being examined. When comparing death rates across geographic areas, age-adjusting typically controls for the influence that different population age distributions might have on health event rates. The age-adjusted cancer death rate is 159.2 per 100,000 persons. This rate is lower than the state rate for cancer mortality and is also lower than the Healthy People 2020 objective of 160.6 per 100,000 persons. The age-adjusted heart disease mortality rate in the service area is 147.4 per 100,000 persons, which exceeds the Healthy People 2020 objective of 100.8 deaths per 100,000 persons. The stroke death rate of 40.9 per 100,000 persons exceeds the state rate and the Healthy People 2020 objective of 33.8 per 100,000 persons. Other sources of death indicate the rate of suicide in the KFH – Downey service area is lower than the state rate and the Healthy People 2020 objective. Age-adjusted rates for homicide in the KFH – Downey service area exceed state rates and Healthy People 2020 objectives, as do deaths of pedestrians from motor vehicle crashes. 124 Mortality Rates, per 100,000 persons, Age-Adjusted, Three-Year Average, 2008-2010 Service Area Number Cancer Heart Disease Stroke Suicide Homicide Motor Vehicle Crash Pedestrian Motor Vehicle Crash California Crude Rate 2,227 2,097 533 128 120 115 25 140.7 132.5 33.7 8.1 7.6 7.3 1.6 HP 2020 Age-Adjusted Rate 159.2 147.4 40.9 6.4 13.1 9.2 1.8 161.0 131.3 39.5 9.8 5.2 8.2 0.8 160.6 100.8 33.8 10.2 5.5 12.4 1.3 Source: California Department of Public Health, Death Statistical Master File, 2008-2010 Homicide, Death Rate (Per 100,000 Pop.), by ZCTA Over 25.0 10.1 - 25.0 5.1 - 10.0 Under 5.1 No Deaths Source: California Department of Public Health, 2008-2010 HIV/AIDS In 2011, 174 cases of HIV/AIDS were diagnosed in SPA 6 for a rate of 16 per 100,000 persons, and 128 cases of HIV/AIDS were diagnosed in SPA 7 for a rate of 9 per 100,000 persons. The rate of HIV/AIDS diagnosed in 2011 has decreased from 2010. Rates of diagnosis of HIV/AIDS are higher in SPA 6 than found in the county. HIV/AIDS Diagnoses, 2010 - 2011 SPA 6 SPA 7 Los Angeles County 2010 Number Rate 258 24 167 12 2,062 20 Source: County of Los Angeles, Public Health, 2011 Annual HIV Surveillance Report 125 2011 Number 174 128 1,340 Rate 16 9 13 Sexually Transmitted Diseases SPA 6 has high rates of Chlamydia (966.9 per 100,000 persons), Gonorrhea (225.7), and Early Latent Syphilis (10.3). Females have the highest rates of Chlamydia. Young adults, ages 20-24, and Blacks/African Americans have the highest rates of sexually transmitted infections. STD Cases, Rate per 100,000 Persons, 2010 Chlamydia Gonorrhea Primary & Secondary Syphilis Early Latent Syphilis SPA 6 969.6 225.7 5.9 10.3 SPA 7 406.3 52.4 4.4 6.0 Los Angeles County 455.1 96.8 6.5 9.2 Source: County of Los Angeles, Public Health, Sexually Transmitted Disease Morbidity Report, 2010 Mental Health Among adults, 14.8% in SPA 6 and 5.5% in SPA 7 experienced serious psychological distress in the past year. 13.2% of adults needed help for mental health problems in SPA 6, and 11.9% of adults in SPA 7 needed help for mental health problems. 26.4% of teens needed help for mental health problems in SPA 6, and 16.7% of teens in SPA 7 needed help for mental health problems. 7.6% of adults and 4.3% of teens in SPA 6 received help for their mental health issues. 8.6% of adults and 7.7% of teens in SPA 7 received counseling. 7.9% of adults in SPA 6 and 7.8% in SPA 7 have taken a prescription medication for an emotional or mental health issue in the past year. Over half the adults in SPA 6 (56.4%) and 45.7% of adults in SPA 7 who needed help for an emotional or mental health problem did not receive treatment. Mental Health Indicators SPA 6 Adults who had Serious Psychological Distress During Past Year Adults who Needed Help for Emotional-Mental and/or Alcohol-Drug Issues in Past Year Teens who Needed Help for Emotional-Mental and/or Alcohol-Drug Issues in Past Year Adults who Saw a Health Care Provider for Emotional/Mental Health and/or Alcohol-Drug Issues in Past Year Teens Received Psychological/ Emotional Counseling in Past year Has Taken Prescription Medicine for Emotional/Mental Health Issue in Past Year Sought/Needed Help but Did Not Receive Treatment SPA 7 California 14.8% 5.5% 6.5% 13.2% 11.9% 14.3% 26.4% 16.7% 12.9% 7.6% 8.6% 10.9% 4.3% 7.7% 9.5% 7.9% 7.8% 9.7% 56.4% 45.7% 44.5% Source: California Health Interview Survey, 2009 Depression is one of the most common emotional health problems among teens. The California Healthy Kids Survey reported on 7th graders’ feelings of depression (defined as feeling sad or hopeless every day 126 for at least two weeks to an extent they stopped doing some usual activities). In California, 30.8% of 7th grade females and 24.7% of 7th grade males indicated they experienced feeling sad or hopeless. Females reported depression-related feelings in greater percentages. In KFH – Downey -area school districts, female 7th graders reported feelings of depression at higher percentages than the state. South Whittier Elementary 7th graders had the highest percentage of depression-related feelings among both females and males. Feeling Sad or Hopeless, by School District, 7th Grade Students, by Gender, 2008-2010 District* ABC Unified Bellflower Unified Compton Unified Downey Unified East Whittier City Elementary El Rancho Unified Little Lake City Elementary Lowell Joint Montebello Unified Norwalk-La Mirada Unified Paramount Unified South Whittier Elementary Whittier City Elementary California Female Male 32.5% 33.7% 35.6% 36.0% 28.7% 33.8% 40.2% 32.2% 32.9% 32.8% 34.8% 43.6% 38.5% 30.8% Source: California Department of Education, California Healthy Kids Survey, 2008-2010 *No data were available for Los Nietos Elementary School District 127 26.7% 26.8% 21.4% 30.5% 20.7% 20.8% 24.4% 24.8% 25.9% 25.8% 26.9% 33.3% 23.9% 24.7% Health Behaviors Breastfeeding Breastfeeding has been proven to have considerable benefits to baby and mother. The California Department of Public Health (CDPH) highly recommends babies be fed only breast milk for the first six months of life. Data on breastfeeding are collected by hospitals on the Newborn Screening Test Form. Breastfeeding rates at KFH – Downey indicate 94% of new mothers use some breastfeeding and 74% use breastfeeding exclusively. These rates are better than found among hospitals in LA County and the state. In-Hospital Breastfeeding KFH – Downey Los Angeles County California Any Breastfeeding Number Percent 2,834 94.0% 109,686 90.9% 481,183 91.7% Exclusive Breastfeeding Number Percent 2,228 73.9% 56,478 46.8% 264,377 60.4% Source: California Department of Public Health, Breastfeeding Hospital of Occurrence, 2011 Teen Sexual History 90.4% of teens in SPA 6 indicated they had never had sex and 76.2% of teens in SPA 7 denied having sex. Of those youth who had sex, 54% in SPA 6 had been tested for an STD and 7% in SPA 7 had been tested for an STD. Teen Sexual History SPA 6 SPA 7 California Never Had Sex First Encounter Under 15 Years Old First Encounter Over 15 Years Old 90.4% 5.4% 4.2% 76.2% 5.7% 18.1% 80.7% 7.3% 12.0% If Had Sex, Tested for STD in Past Year 54.0% 7.0% 31.9% Source: California Health Interview Survey, 2009 Cigarette Smoking The percent of smokers by community is presented with rankings from lowest to highest according to smoking prevalence. A ranking of 1 is the lowest rate of smoking and a ranking of 127 is the highest. Cerritos (9.8%) and Commerce (9.9%) have the lowest rates and rankings of smoking. Bellflower (15.7%), Compton (15.9%), Lynwood (16.5%), and South East Los Angeles (18.7%) have the highest rates of smoking in the service area. 128 Cigarette Smoking Geographical Area* Artesia Bell Bellflower Bell Gardens Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East L.A. Council District 9 South Gate South Whittier West Whittier – Los Nietos Whittier Los Angeles County Percent of Smokers 13.2% 13.5% 15.7% 13.6% 9.8% 9.9% 15.9% 13.4% 12.3% 12.7% 14.2% 12.8% 16.5% 13.8% 14.5% 15.2% 12.7% 12.6% 18.7% 13.8% 13.0% 12.3% 11.3% 14.3% Rank (1-127) 78 80 102 82 20 22 104 79 54 62 89 68 109 84 91 97 62 61 121 84 74 54 40 NA Source: LA County Department of Public Health, Cigarette Smoking in Los Angeles County, 2010 *Data available by community, therefore, zip code only areas in the KFH – Downey service area are not listed. Expenditures for cigarettes, as a percentage of total household expenditures, indicate that the expenditure by household in the KFH – Downey service area is 1.07%, which is less than the California rate of 1.08% per household for tobacco expenditures. Alcohol and Drug Use Binge drinking is defined as consuming a certain amount of alcohol within a set period of time. For males this is five or more drinks per occasion and for females it is four or more drinks per occasion. Among adults, 25.2% in SPA 6 and 30.2% in SPA 7 had engaged in binge drinking in the past year. In SPA 7 5.5% of teens had engaged in binge drinking. No incidents of binge drinking among teens in SPA 6 were documented. However, 23.5% of teens in SPA 6 and 31.8% of teens in SPA 7 had indicated they had tried an alcoholic drink. These rates of alcohol consumption are lower than in the state. 129 Alcohol Consumption and Binge Drinking SPA 6 Adult Binge Drinking Past Year Teen Binge Drinking Past Month Teen Ever Had an Alcoholic Drink SPA 7 25.2% 0 23.5% California 30.2% 5.5% 31.8% 31.3% 5.8% 33.4% Source: California Health Interview Survey, 2009 16% of teens in SPA 7 have tried illegal drugs and 13.2% have used marijuana in the past year. No teens in SPA 6 documented the use of illegal drugs. Teen Illegal Drug Use SPA 6 Ever Tried Illegal Drugs Use of Marijuana in Past Year SPA 7 0 0 California 16.0% 13.2% 13.5% 8.8% Source: California Health Interview Survey, 2009 Fast Food 21.9% of the residents in SPA 6 consume fast food 3-4 times a week. In SPA 7, over one-third (33.5%) of the residents eat fast food 3-4 times a week. Adults, ages 18-64, consume fast food at higher rates than youth or seniors. SPA 7 has higher rates of fast food consumption among all age groups when compared to SPA 6 and the state. Fast Food Consumption, 3-4 Times a Week SPA 6 Total Population Ages 0-17 Ages 18-64 Ages 65+ SPA 7 21.9% 16.4% 27.9% 7.5% 33.5% 22.1% 40.3% 17.6% California 19.6% 17.0% 22.6% 7.7% Source: California Health Interview Survey, 2009 Soda Consumption In Service Planning Area 6, 21.7% of children and teens consume two or more soda or sweetened drinks a day. 23.5% of children and teens in SPA 7 consume two or more soda or sweetened drinks a day. This rate is higher than the state rate of 14.7%. Soda or Sweetened Drink Consumption, Two or More a Day SPA 6 Teens and Children SPA 7 21.7% 23.5% Source: California Health Interview Survey, 2009 130 California 14.7% Fresh Fruits and Vegetables In SPA 6 and SPA 7 over half of the children consume five fruits and vegetables in a day. This is a higher rate of fruit and vegetable consumption than found in the state. Fresh fruit and vegetable consumption decreases considerably among teens. Only 8.9% of teens in SPA 6 consume the recommended portions. In SPA 7, 31.4% of teens consume five or more fresh fruits and vegetable a day. Consumption of 5+ Fresh Fruits and Vegetables a Day SPA 6 Children Teens SPA 7 50.6% 8.9% California 53.6% 31.4% 48.4% 19.9% Source: California Health Interview Survey, 2009 In SPA 6, 61.5% of children engaged in vigorous physical activity at least three days a week. In SPA 7, 64.2% of children engaged in vigorous physical activity. And over 70% of youth visited a park, playground or open space. However, 15.2% of children in SPA 6 and 17% in SPA 7 were sedentary during the week. Among adults, 78.8% in SPA 6 and 81.4% in SPA 7 walked for transportation, fun or exercise. Physical Activity SPA 6 Engaged in Vigorous Physical Activity 3 Days/Week – Child No Physical Activity/Week – Child No Physical Activity/Week – Teen Teens Take PE Class Walked/Biked/Skated to School Youth Visited Park/Playground/Open Space Adults Walked for Transportation, Fun or Exercise SPA 7 California 61.5% 64.2% 67.1% 15.2% 14.4% 73.9% 64.4% 74.1% 17.0% 14.1% 80.1% 49.5% 79.5% 11.8% 16.2% 65.9% 43.0% 79.4% 78.8% 81.4% 77.2% Source: California Health Interview Survey, 2009 131 Physical Environment Liquor Store Access In the KFH – Downey service area there are 69.0 liquor stores per 100,000 persons. This is less than the state rate of 72.3 per 100,000 persons. Liquor Store Access, per 100,000 Persons Alcohol Retail Licenses Service Area Number Rate 1,100 69.0 California 72.3 Source: California Department of Alcoholic Beverage Control, Active License File, April 2012 Air Quality Air quality measures the particulate matter 2.5 levels above the National Ambient Air Quality Standard (35 micrograms per cubic meter) per year, calculated using data collected by monitoring stations. In the KFH – Downey service area, the average daily ambient particulate matter 2.5 was higher than found in the state. However, the number of days exceeding emissions standards was 14.9, which is less than the average number of days in the state of 15.4. In the service area, 4.1% of days exceeded emissions standards. Poor Air Quality, Particulate Matter Service Area California 16 14.9 4.1% Average Daily Ambient Particulate Matter 2.5 Number of Days Exceeding Emissions Standards Percentage of Days Exceeding Emissions Standards 14.3 15.4 4.2% Source: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, 2008 Fast Food Access KFH – Downey area residents have an access rate of 64.4 fast food restaurants per 100,000 persons; this is less than the state rate of 69.4. Fast Food Access, per 100,000 Persons Fast Food Restaurant Access Service Area Number Rate 1,026 64.4 California 69.4 Source: U.S. Census Bureau, ZIP Code Business Patterns, 2009 Food Desert A food desert is defined as a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store. Only 1.5% of the population in the service area lives in a designated food desert. 132 Food Deserts Population Living in Area Designated as Food Desert Service Area Number Percent 22,369 1.5% California 5.7% Source: U.S. Department of Agriculture, Food Desert Locator, 2009 Community Walkability WalkScore.com ranks over 2,500 cities in the United States (over 10,000 neighborhoods) with a walk score. The walk score for a location is determined by its access to amenities. Many locations are sampled within each city and an overall score is issued for the walkability of that city. A higher score indicates an area is more accessible to walking while a lower score indicates a more vehicle-dependent location. WalkScore.com has established the range of scores as follows: 0-24: Car Dependent (Almost all errands require a car) 25-49: Car Dependent (A few amenities within walking distance) 50-69: Somewhat Walkable (Some amenities within walking distance) 70-89: Very Walkable (Most errands can be accomplished on foot) 90-100: Walker's Paradise (Daily errands do not require a car) Walkability Geographical Area* Artesia Bell/Bell Gardens Bellflower Cerritos Commerce Compton Cudahy Downey Hawaiian Gardens Huntington Park Lakewood Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South Gate Vernon Whittier Los Angeles County Walk Score 74 67 63 60 71 54 67 58 82 74 61 57 68 62 64 55 75 61 52 62 66 Source: WalkScore.com, 2012 * Data available by city, therefore, zip code only areas in the KFH – Downey service area are not listed. 133 Based on this scoring method, most communities in the KFH – Downey service area are classified as “Somewhat Walkable.” Artesia, Commerce, Hawaiian Gardens, Huntington Park and Santa Fe Springs are rated as “Very Walkable.” Physical Activity 68.3% of the population in the KFH – Downey service area lives within one-half mile of a park. This exceeds the state rate of 58.6%. Park Access Population Living Within 1/2 Mile of Park Service Area Number Percent 1,087,304 68.3% California 58.6% Source: U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1 In the KFH – Downey service area there are 4.4 recreation facilities per 100,000 persons. While park access is greater in the service area than the state, the rate of access to recreation facilities is less than the state rate of 8.9 facilities per 100,000 persons. Recreation Facility Access, per 100,000 Persons Recreation and Fitness Facilities Service Area Number Rate 48 4.4 Source: U.S. Census Bureau, ZIP Code Business Patterns, 2009 134 California 8.9 Clinical Care Births In 2010, there were 25,889 births in the area. The majority of the births were to mothers who are Latino (79.8%). Prenatal Care Pregnant women in the service area entered prenatal care late - after the first trimester - at a rate of 142.9 per 1,000 live births. This rate of late entry into prenatal care translates to 85.7% of women entering prenatal care within the first trimester. The area rate of early entry into prenatal care exceeds the Healthy People 2020 objective of 78% of women entering prenatal care in the first trimester. Hawaiian Gardens has the highest rate of late entry into prenatal care at 244.5 per 1,000 live births (75.5% first trimester prenatal care). Long Beach 90808 (93.3%) and Lakewood (89.3%) have the highest rates of first trimester prenatal care. Late Entry into Prenatal Care (After First Trimester) Geographical Area Artesia Bell/ Bell Gardens/Cudahy Bellflower Cerritos Commerce Compton Downey Hawaiian Gardens Huntington Park Lakewood Long Beach - 90805 Long Beach - 90808 Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East/LA - 90001 South East/LA - 90002 South East/LA - 90003 South East/LA - 90059 South Gate Vernon Whittier Service Area California Late Prenatal Care 22 216 200 39 30 260 190 56 165 95 272 27 157 56 230 139 110 32 182 178 264 121 198 20 303 3,562 82,823 Live Births* 157 1,711 1,101 361 179 1,767 1,467 229 1,244 887 1,557 406 1,280 457 1,543 926 872 180 1,140 1,091 1,432 896 1,488 79 2,466 24,916 501,042 Rate per 1,000 Live Births 140.1 126.2 181.7 108.0 167.6 147.1 129.5 244.5 132.6 107.1 174.7 66.5 122.7 122.5 149.1 149.6 126.1 177.8 159.6 163.2 184.4 135.0 133.1 253.2 122.9 142.9 165.3 Source: California Department of Public Health, 2010 *Births in which the first month of prenatal care is unknown are not included in the tabulation. 135 Low Birth Weight Low birth weight is a negative birth indicator. Babies born at a low birth weight are at higher risk for disease, disability and possibly death. For this measurement, a lower rate is a better indicator. The KFH – Downey service area rate of low birth weight babies is 6.9% (69.0 per 1,000 live births). This is higher than the state rate of 6.8% (68.1 per 1,000 live births). Overall, the service area compares favorably to the Healthy People 2020 objective of 7.8% of births being low birth weight. However, when examined by community, a number of areas have a rate that exceeds the Healthy People 2020 objective. South East Los Angeles (8.1% - 10.4%) and Paramount (9%) have the highest rates of low birth weight births. Low Birth Weight (Under 2,500 g) Geographical Area Low Birth Weight Artesia Bell/ Bell Gardens/Cudahy Bellflower Cerritos Commerce Compton Downey Hawaiian Gardens Huntington Park Lakewood Long Beach - 90805 Long Beach - 90808 Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East/LA - 90001 South East/LA - 90002 South East/LA - 90003 South East/LA - 90059 South Gate Vernon Whittier Service Area California 12 89 91 30 12 152 87 12 65 43 129 29 102 25 104 86 49 6 97 103 135 97 89 3 140 1,787 34,846 Live Births 161 1,802 1,141 377 189 1,823 1,503 231 1,303 936 1,655 427 1,289 477 1,586 955 902 186 1,202 1,142 1,529 930 1,526 81 2,536 25,889 511,825 Source: California Department of Public Health, 2010 136 Rate per 1,000 Live Births 74.5 49.4 79.8 79.6 63.4 83.3 57.9 51.9 49.9 45.9 77.9 67.9 79.1 52.4 65.6 90.0 54.3 32.2 80.7 90.2 88.3 104.3 58.3 37.0 55.2 69.0 68.1 Percentage of Newborns with Low Birth Weight, by ZCTA Over 9.0% 7.1 - 9.0% 5.1 - 7.0% 3.1 - 5.0% Under 3.1% Source: California Department of Public Health, 2010 Flu and Pneumonia Vaccines Seniors tend to receive flu vaccines at higher rates than adults or youth. Among seniors, 42.9% in SPA 6 and 68.2% in SPA 7 had received a flu shot. Adults received flu shots at a lower rate – 25.3% in SPA 6 and 23.7% in SPA 7. 42.3% of children in SPA 6 received a flu shot, and of these, 45.9% received the vaccine at a community clinic. 38.8% of children in SPA 7 received a flu vaccine, and of these, 47.7% received the vaccine at a doctor’s office, Kaiser or HMO. Flu Vaccine SPA 6 SPA 7 California Received Flu Vaccine, 65+ Years Old Received Flu Vaccine, 18-64 Received Flu Vaccine, 0-17 Years Old 42.9% 25.3% 42.3% 68.2% 23.7% 38.8% 65.9% 29.4% 49.9% Child Received Vaccine at Dr. Office/ Kaiser/ HMO Child Received Vaccine at Community Clinic Child Received Vaccine at Hospital or ER Child Received Vaccine Some Other Place 31.5% 45.9% 16.2% 6.4% 47.7% 25.2% 5.7% 21.4% 47.1% 23.6% 7.1% 22.2% Source: California Health Interview Survey, 2009 Seniors are recommended to obtain a pneumonia vaccine. Over half the seniors in SPA 6 (51.1%) and SPA 7 (56.6%) had obtained a pneumonia vaccine. Pneumonia Vaccine, Adults 65+ SPA 6 Adults 65+, had a Pneumonia Vaccine 51.1% SPA 7 56.6% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007 137 Los Angeles County 60.5% Mammograms The Healthy People 2020 objective for mammograms is that 81.1% of women 40+ years have a mammogram in the past two years. In SPA 6, 72% of women, age 40+, have had a mammogram, and 77% of women in SPA 7 have had a mammogram. Pap Smears The Healthy People 2020 objective for Pap smears in the past three years is 93%. In SPA 6, 88.3% of women have had a Pap smear in the past three years, and 85% of women in SPA 7 have had a Pap smear in that time period. Women Mammograms and Pap Smears SPA 6 Women 40+ Years, had a Mammogram in Past Two Years Women had a Pap Smear in Past Three Years 72.0% 88.3% SPA 7 77.0% 85.0% Los Angeles County 73.7% 84.4% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007 Colorectal Cancer Screening In SPA 6, 67.1% of adults have had the recommended screening for colorectal cancer. In SPA 7, the rate of compliance is 71.1%, which exceeds the Healthy People 2020 objective for colorectal cancer screening of 70.5%. Of adults advised to obtain screening, 57.9% in SPA 6 and 59.2% in SPA 7 were compliant at the time of the recommendation. Colorectal Cancer Screening, Adults 50+ SPA 6 Screening Sigmoidoscopy, Colonoscopy or Fecal Occult Blood Test Compliant with Screening at Time of Recommendation SPA 7 California 67.1% 71.1% 78.0% 57.9% 59.2% 68.1% Source: California Health Interview Survey, 2009 138 Socioeconomic Factors Teen Birth Rate In 2010, teen births occurred at a rate of 117.7 per 1,000 births (or 11.8% of total births). This rate is higher than the teen birth rate found in the state. Compton, Hawaiian Gardens, Southeast Los Angeles and Vernon have high rates of teen births and Cerritos has the lowest rate of teen births. Births to Teenage Mothers (Under Age 20) Geographical Area Births to Teen Mothers Artesia Bell/ Bell Gardens/Cudahy Bellflower Cerritos Commerce Compton Downey Hawaiian Gardens Huntington Park Lakewood Long Beach - 90805 Long Beach - 90808 Lynwood Maywood Norwalk Paramount Pico Rivera Santa Fe Springs South East/LA - 90001 South East/LA - 90002 South East/LA - 90003 South East/LA - 90059 South Gate Vernon Whittier Service Area California 7 235 110 8 19 294 104 35 166 48 199 12 151 58 168 115 105 20 184 208 233 144 182 16 226 3,047 43,651 Live Births 161 1,802 1,141 377 189 1,823 1,503 231 1,303 936 1,655 427 1,289 477 1,586 955 902 186 1,202 1,142 1,529 930 1,526 81 2,536 25,889 511,825 Rate per 1,000 Live Births 43.5 130.4 96.4 21.2 100.5 161.3 69.2 151.5 127.4 51.3 120.2 28.1 117.1 121.6 105.9 120.4 116.4 107.5 153.1 182.1 152.8 154.8 119.2 197.5 89.1 117.7 85.3 Source: California Department of Public Health, 2010 When teen births in 2010 are compared to 2009 rates, there has been a slight increase in the percentage of teen births in the KFH – Downey service area from 11.3% to 11.8%. 139 Births to Teenage Mothers (Under Age 20) 2009/2010 Comparison Geographical Area Percent of Births 2009 Service Area California Percent of Births 2010 11.3% 9.2% 11.8% 8.5% Source: California Department of Public Health, 2009 + 2010 Rate of Births to Women under Age 20 (Per 1,000 Births), by ZCTA Over 125.0 100.1 - 125.0 75.1 - 100.0 50.1 - 75.0 Under 50.1 Source: California Department of Public Health, 2010 Over half (58.2%) of teenage mothers in the KFH – Downey service area are of Hispanic/Latino ethnicity. Ethnicity of Teenage Mothers Geographical Area Service Area California Hispanic/Latino 58.2% 65.4% Source: California Department of Public Health, 2010 140