Community Health Needs Assessment

Transcription

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
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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
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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
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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
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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
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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
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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.
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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
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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.
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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%
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%
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 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%
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%
*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%
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%
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%
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%
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
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%
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%
Percent Uninsured Population
Over 25.0%
18.1 - 25.0%
12.1 - 18.0%
6.1 - 12.0%
Under 6.1%
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%
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%
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%
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
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%
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%
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
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%
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%
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%
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
0-17 Years Old
Takes Daily Medication to Control Asthma,
Total Population
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%
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%
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
Health Center
with chronic disease
2.
Aguirre,
Community Benefit
9/19/12
Interview
Maria
Manager, Kaiser
Permanente Watts
population
Counseling &
Learning Center
3.
Banagas,
Community Services medically underserved,
8/28/12
Interview
Renett
Coordinator, Caring
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-
population
9/11/12
Interview
population
9/28/12
Interview
9/18/12
Interview
population
low-income population
populations
9/13/12
Interview
9/7/12
Interview
9/25/12
Interview
population
population
8/28/12
Interview
9/18/12
Interview
population
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
low-income population
population
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
Diabetes
STDs
45
Teen births
Clinical Drivers
Access to care
Dental health
Mental health
Preventive health care (screening and prevention)
Behavioral Drivers
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
Dental health
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%
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).
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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
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%
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
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
Watts Healthcare Corporation
Mental Health
58
Aspiranet
Community Family Guidance Center
ENKI, East LA Mental Health
Helpline Youth Counseling, Inc.
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
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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.
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
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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.
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.cdph.ca.gov/data/statistics/Pages/BirthProfilesbyZIPCode.aspx
California Department of Public Health. (2011) In-Hospital Breastfeeding Initiation Data.
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.
http://healthpolicy.ucla.edu/chis/Pages/default.aspx
California Health Interview Survey (CHIS). (2009) California Health Interview Survey.
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.
http://www.cdc.gov/nchs/nvss.htm
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. (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.
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
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
Epidemiology. (2011) Obesity and Related Mortality in Los Angeles County: A Cities and
Communities Health Report. Retrieved from
Epidemiology. (2012) Trends in Diabetes: Time for Action. Retrieved from
Epidemiology. (2012) Trends in Obesity: Adult Obesity Continues to Rise. Retrieved from
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.claritas.com/sitereports/demographic-reports.jsp
The University of Wisconsin, Population Health Institute. (2012) County Health Rankings.
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
http://www.census.gov/main/www/cen2000.html
64
U.S. Census Bureau. (2005-2009) 2005-2009 American Community Survey 5-Year Estimates.
http://www.census.gov/acs/www/data_documentation/2010_release/
http://www.census.gov/acs/www/data_documentation/2010_release/
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.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
http://www.census.gov/2010census/data/
U.S. Census Bureau. (2010) 2010 Census of Population and Housing. Summary File 1 Retrieved
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
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
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%
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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.)?
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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.
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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?
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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.
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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
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.”
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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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
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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
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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%
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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
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
Total Population
0-17 Years Old
Total Population
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%
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).
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
Services
 Los Angeles County Department of Public
Health, Whittier Health Center
 Northeast Community Clinic –
Community Medical Alliance
Community 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
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%
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
Services
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
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
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%
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
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
Community Assets
Community assets are resources within the community to
meet the identified health need.
 LA County Department of Health Services
 Los Angeles County Department of Public Health,
Whittier Health Center
 Northeast Community Clinic – Community Medical
Alliance
 St. Francis Medical Center – Downey Community
Clinic
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
 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
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
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%
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
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
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%
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
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
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%
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%
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%
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
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
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.
Community Input
There is a lack of knowledge about the importance
Services
of preventive care and a tendency to obtain
services only when sick.
Medical Alliance
“By the time they come in for services their issue
has exploded; they do not have the resources, time,
Community Clinic
energy or education to address their issues earlier
on.”
“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.”
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
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
Angeles
 INMED
Services
Medical Alliance
Community 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).
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
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%
Community Assets
Community assets are resources within the community to meet the identified health need.
Angeles
 INMED Partnerships for Children
Services
 Mother’s Nutritional Center
Medical Alliance
Community 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
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%
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
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%
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%
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%
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%
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%
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%
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%
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%
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
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 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
*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
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 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
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%
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%
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%
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%
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%
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.
Geographical Area
Births to Teen
Mothers
Artesia
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 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
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
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
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%
140

Community Health Needs Assessment

Transcription

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