Community Health Needs Assessment 2016
Table of Contents Introduction ...... 5 Background and Purpose ...... 5 Service Area ...... 5 Project Oversight ...... 7 Author ...... 7 Methods ...... 8 Secondary Data Collection ...... 8 Primary Data Collection ...... 8 Information Gaps ...... 9 Public Comment...... 10 Identification of Significant Health Needs ...... 11 Review of Primary and Secondary Data ...... 11 Significant Health Needs ...... 11 Resources to Address Significant Needs ...... 11 Priority Health Needs ...... 12 Impact Evaluation ...... 13 Community Demographics ...... 14 Population ...... 14 Race/Ethnicity ...... 15 Language ...... 16 Social and Economic Factors ...... 17 Social and Economic Factors Ranking ...... 17 Poverty ...... 17 Households ...... 18 Households by Type ...... 19 Free or Reduced Price Meals...... 19 Public Program Participation ...... 20 Unemployment ...... 20 Educational Attainment ...... 21 Homelessness ...... 21 Crime and Violence ...... 22
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Community Input – Social and Economic Factors ...... 23 Health Care Access ...... 25 Health Insurance Coverage ...... 25 Sources of Care ...... 26 Barriers to Care...... 28 Access to Primary Care Community Health Centers ...... 28 Delayed Care ...... 29 Community Input – Access to Care ...... 29 Dental Care ...... 31 Community Input – Dental Care ...... 31 Birth Characteristics ...... 33 Births ...... 33 Teen Birth Rate ...... 33 Prenatal Care ...... 33 Low Birth Weight ...... 34 Infant Mortality ...... 35 Breastfeeding ...... 35 Mortality/Leading Causes of Death ...... 36 Leading Causes of Premature Death ...... 36 Leading Causes of Death ...... 36 Cancer Mortality ...... 37 Heart Disease Mortality ...... 38 Stroke Mortality ...... 39 Respiratory (Lung) Disease Mortality ...... 40 Diabetes ...... 42 Chronic Disease ...... 44 Health Status ...... 44 Disability ...... 44 Asthma ...... 44 Community Input – Asthma ...... 45 Diabetes ...... 45 Community Input – Diabetes ...... 46
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Heart Disease ...... 47 High Blood Pressure ...... 47 Community Input – Heart Disease ...... 48 Cancer ...... 48 Community Input – Cancer ...... 49 HIV/AIDS ...... 49 Sexually Transmitted Diseases ...... 50 Teen Sexual History ...... 50 Hospitalization and ER Rates ...... 50 Health Behaviors ...... 52 Health Behaviors Ranking ...... 52 Overweight and Obesity ...... 52 Fast Food...... 53 Soda Consumption ...... 54 Fruit Consumption ...... 54 Access to Fresh Produce ...... 54 Physical Activity ...... 54 Community Input – Overweight and Obesity ...... 55 Mental Health and Substance Abuse ...... 57 Mental Health ...... 57 Community Input – Mental Health ...... 58 Tobacco/Alcohol/Drug Use ...... 60 Cigarette Smoking ...... 60 Alcohol and Drug Use ...... 60 Community Input – Substance Abuse ...... 61 Preventive Practices ...... 63 Flu and Pneumonia Vaccines ...... 63 Immunization of Children ...... 63 Mammograms ...... 64 Pap Smears ...... 64 Community Input – Preventive Practices ...... 64 Attachment 1. Community Interviewees ...... 66
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Attachment 2. Community Resources ...... 67 Attachment 3. Impact Evaluation ...... 70
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Introduction
Background and Purpose Henry Mayo Newhall Hospital (Henry Mayo) is a 238-bed nonprofit hospital that serves the Santa Clarita Valley in Los Angeles County, California. The mission of the hospital is to improve the health of our community through compassion and excellence in health care services. Founded in 1975, Henry Mayo is a fully accredited, acute care hospital facility and level II trauma center that provides inpatient and outpatient services. Services include a nationally recognized Advanced Primary Stroke Center, the Sheila R. Veloz Breast Imaging Center, a behavioral health unit, outpatient wound care, maternity, cancer and comprehensive cardiovascular care.
Henry Mayo has seen the Santa Clarita Valley experience tremendous growth and an aging population. As a result, the need for expanded health care services has dramatically increased. To grow with the community, the hospital has embarked on a major long-term planning project which includes the construction of a new inpatient hospital building that will add up to 120 new beds, new medical office buildings designed to support hospital programs and services, a new central plant, new parking structures and a life-saving helipad. Recent improvements include the complete renovation and expansion of the intensive care unit (ICU), the current construction of a neonatal intensive care unit (NICU), and a new operating room. In the last five years, the hospital also expanded and updated its entire emergency and imaging departments, adding new and replacement technologies to improve the quality of your care.
Henry Mayo Newhall Hospital has undertaken a Community Health Needs Assessment (CHNA) required by state and federal law. California Senate Bill 697 and the Patient Protection and Affordable Care Act IRS section 501(r)(3) direct tax exempt hospitals to conduct a Community Health Needs Assessment and develop an Implementation Strategy every three years. The Community Health Needs Assessment is a primary tool used by the hospital to determine its community benefit plan, which outlines how it will give back to the community in the form of health care and other community services to address unmet community health needs. This assessment incorporates components of primary data collection and secondary data analysis that focus on the health and social needs of the service area.
Service Area Henry Mayo Newhall Hospital is located at 23845 McBean Parkway, Valencia, California 91355. The service area includes portions of Service Planning Area (SPA) 2 (San Fernando) in Los Angeles County.
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The hospital service area includes 10 zip codes, representing 9 cities or communities. To determine the service area, Henry Mayo Newhall Hospital takes into account the zip codes of inpatients discharged from the hospital. The Henry Mayo Hospital service area is presented below. Newhall zip code 91322 is not yet tracked by any of the data- reporting sites, such as the Census bureau, or L.A County or California Departments of Health; therefore this zip code is omitted in the following report, and all data are based on the remaining 9 zip codes.
Henry Mayo Newhall Hospital Service Area Geographic Area Zip Code SPA/County Agua Dulce / Saugus 91350, 91390 SPA 2, Los Angeles County Canyon Country 91351, 91387 SPA 2, Los Angeles County Castaic / Val Verde 91384 SPA 2, Los Angeles County Newhall 91321, 91322 SPA 2, Los Angeles County Santa Clarita 91354 SPA 2, Los Angeles County Stevenson Ranch 91381 SPA 2, Los Angeles County Valencia 91355 SPA 2, Los Angeles County
Source: HealthyCity.org
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Project Oversight The Community Health Needs Assessment process was overseen by: Patrick J. Moody Director, Marketing, Public and Community Relations Henry Mayo Newhall Hospital
Author Biel Consulting, Inc. conducted the Community Health Needs Assessment. Biel Consulting, Inc. is an independent consulting firm that works with hospitals, clinics and community-based nonprofit organizations. Melissa Biel, DPA, RN conducted the Community Health Needs Assessment. She was joined by Sevanne Sarkis, JD, MHA, MEd and Denise Flanagan, BA. Biel Consulting, Inc. has extensive experience conducting hospital Community Health Needs Assessments and working with hospitals to develop, implement, and evaluate community benefit programs. www.bielconsulting.com
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Methods
Secondary Data Collection Secondary data were collected from a variety of local, county, and state sources to present community demographics, social and economic factors, health care access, birth characteristics, leading causes of death, chronic disease, health behaviors, mental health and substance abuse, and preventive practices. These data are presented in the context of Los Angeles County and California State, framing the scope of an issue as it relates to the broader community.
Sources of data include the U.S. Census American Community Survey, Los Angeles County Department of Public Health, California Health Interview Survey, California Department of Public Health, California Employment Development Department, the California Cancer Registry, County Health Rankings, Los Angeles Homeless Services Authority, the California Department of Education, and others. When pertinent, these data sets are presented in the context of California State.
Secondary data for the hospital service area were collected and documented in data tables with narrative explanation. The tables present the data indicator, the geographic area represented, the data measurement (e.g. rate, number, or percent), county and state comparisons (when available), the data source, data year and an electronic link to the data source. Analysis of secondary data included an examination and reporting of health disparities for some health indicators. The report includes benchmark comparison data that measures Henry Mayo’s community data findings with Healthy People 2020 objectives. Healthy People 2020 objectives are a national initiative to improve the public’s health by providing measurable objectives and goals that are applicable at national, state, and local levels.
Primary Data Collection Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by the hospital. Twenty-two interviews were completed from June through September, 2016. For the interviews, community stakeholders identified by Henry Mayo were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, and minority 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.
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The identified stakeholders were invited by email to participate in a one hour phone interview. Appointments for the interviews were made on dates and times convenient to the stakeholders. 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. A list of the stakeholder interview respondents, their titles and organizations can be found in Attachment 1.
Initially, significant health needs were identified through a review of the secondary health data collected and analyzed prior to the interviews. These data were then used to help guide the interviews. The needs assessment interviews were structured to obtain greater depth and richness of information and build on the secondary data review. During the interviews, participants were asked to identify the major health issues in the community, and socioeconomic, behavioral, environmental or clinical factors contributing to poor health. They were asked to share their perspectives on the issues, challenges and barriers relative to the significant health needs, and identify potential resources to address these health needs, such as services, programs and/or community efforts. The interviews focused on these significant health needs: Access to health care Cancer Cardiovascular disease Diabetes Mental health Overweight/obesity Preventive practices (screenings, vaccines) Substance abuse (alcohol, drugs, tobacco)
Analysis of the primary data occurred through a process that compared and combined responses to identify themes. All responses to each question were examined together and concepts and themes were then summarized to reflect the respondents’ experiences and opinions. The results of the primary data collection were reviewed in conjunction with the secondary data. Primary data findings were used to corroborate the secondary data-defined health needs, serving as a confirming data source. The responses are included in the following Community Health Needs Assessment chapters.
Information Gaps Information gaps that impact the ability to assess health needs were identified. Some of the secondary data are not always collected on a regular basis, meaning that some data
9 Henry Mayo Hospital – Community Health Needs Assessment are several years old. Primary data collection and the prioritization process were also subject to limitations. Themes identified during interviews were likely subject to the experience of individuals selected to provide input. The final prioritized list of significant health needs is also subject to the affiliation and experience of the individuals who participated in the prioritization process.
Public Comment In compliance with IRS regulations 501(r) for charitable hospitals, a hospital Community Health Needs Assessment (CHNA) and Implementation Strategy are to be made widely available to the public and public comment is to be solicited. In compliance with these regulations, the previous hospital Community Health Needs Assessment and Implementation Strategy were made widely available to the public on the website http://www.henrymayo.com/our-community/our-community. Public comment was requested on these reports. To date, no written comments have been received.
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Identification of Significant Health Needs
Review of Primary and Secondary Data The analysis of secondary data yielded a preliminary list of significant health needs, which then informed primary data collection. The primary data collection process helped to validate secondary data findings, identify additional community issues, solicit information on disparities among subpopulations, and ascertain community assets to address needs.
Health needs were identified from secondary data using 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 county rates, state rates and/or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against one or more of these benchmarks met this criterion to be considered a health need.
The analysis of secondary data yielded a preliminary list of significant health needs, which then informed primary data collection. The primary data collection process was designed to validate secondary data findings, identify additional community issues, solicit information on disparities among subpopulations, ascertain community assets to address needs and discover gaps in resources.
Significant Health Needs The following significant health needs were determined: Access to health care Asthma Cancer Dental Care Diabetes Heart disease Mental health Overweight/obesity Preventive practices (screenings, vaccines) Substance abuse (alcohol, drugs, tobacco)
Resources to Address Significant Needs Through the interview process, community stakeholders identified potential community resources to address the identified health needs. These are presented in Attachment 2.
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Priority Health Needs
The identified significant health needs were prioritized with input from the community. Interviews with community stakeholders were used to gather input on the identified health needs. The following criteria were used to prioritize the health needs: The perceived severity of a health issue or health factor/driver as it affects the health and lives of those in the community; The level of importance the hospital should place on addressing the issue. Calculations totaling severity and importance scores from the community stakeholder interviews resulted in the following prioritization of the significant health needs:
Each of the stakeholder interviewees was sent a link to an electronic survey (Survey Monkey) in advance of the interview. The stakeholders were asked to rank each identified health need. The percentage of responses were noted as those that identified the need as having severe or very severe impact on the community, had worsened over time, and had a shortage or absence of resources available in the community. Not all survey respondents answered every question, therefore, the response percentages were calculated based on respondents only and not on the entire sample size. Mental health, substance abuse, and overweight and obesity had the highest scores in the survey. Diabetes also had a high ranking for worsening over time; and access to care, heart disease and cancer also rated high on insufficient resources available to address the need.
Severe and Very Severe Insufficient or Significant Health Worsened Over Impact on the Absence of Needs Time Community Resources Access to health care 46.2% 22.2% 58.3% Asthma 20.0% 0% 25.0% Cancer 70.0% 30.0% 55.6% Dental Care 11.1% 14.3% 0% Diabetes 42.9% 62.5% 44.4% Heart disease 71.4% 28.6% 57.1% Mental health 100% 72.7% 100% Overweight/obesity 54.5% 62.5% 66.7% Preventive practices 30.0% 0% 20.0% Substance abuse 84.6% 72.7% 72.7%
The interviewees were asked to rank order the health needs according to highest level of importance in the community. The total score for each significant health need (possible score of 4) was divided by the total number of responses for which data were provided, resulting in an overall average for each health need. Mental health, access to care and substance abuse were ranked as the top three priority needs in the service area. The calculations of the community input resulted in the following prioritization of
12 Henry Mayo Hospital – Community Health Needs Assessment the significant health needs:
Significant Health Needs Priority Ranking (Total Possible Score of 4) Mental health 4.00 Access to health care 3.86 Substance abuse (alcohol, drugs, tobacco) 3.85 Heart disease 3.69 Overweight/obesity 3.64 Cancer 3.62 Diabetes 3.57 Preventive practices (screenings, vaccines) 3.46 Asthma 3.42 Dental Care 3.29
Impact Evaluation In 2013 Henry Mayo conducted their previous Community Health Needs Assessment (CHNA). Significant health needs were identified from issues supported by primary and secondary data sources gathered for the Community Health Needs Assessment. In developing the Implementation Strategy associated with the 2013 CHNA, Henry Mayo chose to address access to care, cardiovascular disease, and diabetes. The evaluation of the impact of actions the hospital used to address these significant health needs can be found in Attachment 3.
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Community Demographics
Population The population of the Henry Mayo Newhall Hospital service area is 276,958.
Population, 5-Year Estimates, 2010-2014 Zip Code Population Agua Dulce/Saugus 91390 19,691 Canyon Country 91351 32,433 Canyon Country 91387 42,518 Castaic/ Val Verde 91384 28,949 Newhall 91321 34,576 Santa Clarita 91354 29,034 Saugus 91350 35,826 Stevenson Ranch 91381 20,296 Valencia 91355 33,635 Henry Mayo Service Area 276,958 Los Angeles County 9,974,203 Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP05.http://factfinder.census.gov
Of the area population, 51.0%% are male and 49.0% are female.
Population by Gender Henry Mayo Service Area Los Angeles County Male 51.0% 49.3% Female 49.0% 50.7% Source: U.S. Census Bureau, 2010-2014 American Community Survey, 5-year estimates, DP05.http://factfinder.census.gov
Children and youth, ages 0-17, make up 26.8% of the population; 63.9% are adults, ages 18-64; and 9.3% of the population are seniors, 65 and over. The median age in the service area is 36.2, higher than the county's median age of 35.3.
Population by Age Henry Mayo Service Area Los Angeles County 0 – 4 6.0% 6.5% 5 – 9 7.3% 6.3% 10 – 14 8.3% 6.5% 15 – 17 5.1% 4.2% 18 – 20 4.5% 4.5% 21 – 24 5.0% 6.2% 25 – 34 12.3% 15.3% 35 – 44 14.8% 14.2% 45 – 54 16.3% 13.8% 55 – 64 11.0% 10.9%
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Henry Mayo Service Area Los Angeles County 65 – 74 5.8% 6.3% 75 – 84 2.4% 3.6% 85+ 1.2% 1.7% Median Age 36.2 35.3 Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP05.http://factfinder.census.gov
When the service area is examined by zip code, Stevenson Ranch has the largest percentage of youth, ages 0-17 (32%). Newhall has the highest percentage of residents 65 and older (13%), followed by Valencia (12.7%).
Population by Youth, Ages 0-17, and Seniors, Ages 65+ Youth Seniors Zip Code Ages 0 – 17 Ages 65+ Agua Dulce/Saugus 91390 27.1% 9.7% Canyon Country 91351 26.5% 8.9% Canyon Country 91387 28.5% 8.1% Castaic/ Val Verde 91384 22.7% 5.2% Newhall 91321 26.2% 13.0% Santa Clarita 91354 28.8% 8.8% Saugus 91350 27.3% 9.1% Stevenson Ranch 91381 32.0% 7.3% Valencia 91355 23.2% 12.7% Henry Mayo Service Area 26.8% 9.3% Los Angeles County 23.5% 11.6% Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP05.http://factfinder.census.gov
Race/Ethnicity In the Henry Mayo Hospital service area, 50.8% of the population is White; 30.4% is Hispanic/Latino; 10.6% of the residents are Asian; 3.4% are Black/African American; 0.1% are American Indian/Alaskan Native; 0.1% are Native Hawaiian/Pacific Islander; and 4.6% are another race or multiple race/ethnicity. This is a much higher percentage of Whites and a lower percentage of other races/ethnicities (other than ‘other/multiple’) than found at the county level.
Race/Ethnicity Henry Mayo Service Area Los Angeles County White 50.8% 27.3% Hispanic/Latino 30.4% 48.1% Asian 10.6% 13.8% Black/African American 3.4% 8.0% American Indian/Alaska Native 0.1% 0.2% Native Hawaiian/Pacific Islander 0.1% 0.2% Other / Multiple 4.6% 2.4% Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP05.http://factfinder.census.gov
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Language English is spoken at home by the majority (69.5%) of service area residents. Spanish is spoken in the home among 19.1% of the population, while 6.6% of the population speaks an Asian language; and 4.8% of the population speaks another language at home. This is a much higher percentage of English-speakers, and a lower percentage of Spanish, Asian, and other Indo-European-language speakers than found at the county level.
Language Spoken at Home, Population 5 Years and Older Henry Mayo Service Area Los Angeles County Speaks Only English 69.5% 43.3% Speaks Spanish 19.1% 39.4% Speaks Asian/Pacific Islander Language 6.6% 10.8% Speak Other Indo-European Language 3.2% 5.4% Speaks Other Language 1.6% 1.1% Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP02.http://factfinder.census.gov
When communities in the service area are examined by zip code, the areas with the highest concentrations of English-only speakers are Agua Dulce/Saugus and Valencia. The highest concentration of Spanish-speakers is found in Newhall and Canyon Country (91351 zip code).
Language Spoken at Home by Zip Code Zip Asian/Pacific Other Indo English Spanish Code Islander European Agua Dulce/Saugus 91390 80.0% 13.1% 2.6% 3.1% Canyon Country 91351 62.1% 29.0% 5.3% 2.5% Canyon Country 91387 64.1% 22.1% 7.6% 3.4% Castaic/ Val Verde 91384 66.5% 26.4% 4.7% 2.1% Newhall 91321 57.8% 33.8% 4.4% 2.8% Santa Clarita 91354 74.5% 7.8% 11.1% 4.3% Saugus 91350 75.0% 14.7% 5.6% 2.9% Stevenson Ranch 91381 72.7% 6.5% 12.4% 6.6% Valencia 91355 79.0% 10.3% 6.7% 2.4% Henry Mayo Service Area 69.4% 19.1% 6.6% 3.2% Los Angeles County 43.2% 39.4% 10.8% 5.4% Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP02.http://factfinder.census.gov
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Social and Economic Factors
Social and Economic Factors Ranking Through the County Health Rankings database, social and economic indicators are examined as a contributor to the health of a county’s residents. California’s 58 counties are ranked according to social and economic factors with 1 being the county with the best factors to 58 for the county with the poorest factors. This ranking examines high school graduation rates, unemployment, children in poverty, social support, and others. Los Angeles County is ranked as 42, in the bottom half of all California counties according to social and economic factors.
Social and Economic Factors Ranking County Ranking (out of 58) Los Angeles County 42 Source: County Health Rankings, 2015. www.countyhealthrankings.org
Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2014, the federal poverty level (FPL) for one person was an annual income of $11,670 and for a family of four was $23,850. The hospital service area has a much lower rate of poverty than Los Angeles County or the state, with 8.7% of the population at or below 100% of the federal poverty level (FPL) compared to 18.4% for the county and 16.4% for California. The service area population at or below 200% FPL (low income) is 20.7%, which is lower than Los Angeles County (40.9%) and the state (36.4%).
Poverty Level Henry Mayo Service Area Los Angeles County California <100% FPL 8.7% 18.4% 16.4% <200% FPL 20.7% 40.9% 36.4% Source: U.S. Census Bureau, American Community Survey, 2010-2014, S1701. http://factfinder.census.gov
A view of poverty by zip code shows that the highest rate of poverty among children (24.5%) and seniors (10.6%) is found in Newhall (24.5%). Valencia has the second- highest rate of poverty among seniors (9.9%) and the lowest rate of poverty among children (1.6%) in the service area. Compared to the county and state, the service area overall has much lower rates of poverty among children and seniors.
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Poverty Levels of Individuals, Children under Age 18, and Seniors 65+ ZCTA Individuals Children Seniors Agua Dulce/Saugus 91390 5.6% 5.7% 0.8% Canyon Country 91351 12.9% 19.0% 5.0% Canyon Country 91387 10.6% 16.0% 5.5% Castaic/ Val Verde 91384 9.5% 12.3% 3.0% Newhall 91321 16.1% 24.5% 10.6% Santa Clarita 91354 4.3% 3.5% 2.7% Saugus 91350 5.1% 5.2% 4.4% Stevenson Ranch 91381 4.1% 3.0% 3.4% Valencia 91355 6.2% 1.6% 9.9% Henry Mayo Service Area 8.7% 10.9% 6.0% Los Angeles County 18.4% 26.0% 13.4% California 16.4% 22.7% 10.2% Source: U.S. Census Bureau, American Community Survey, 2010-2014, S1701. http://factfinder.census.gov
According to the 2014 California Health Interview Survey, 25.3% of adult residents of SPA 2 living below 200% of the Federal Poverty Level reported food insecurity. While this represents more than a quarter of the low-income population, it is well below both the state average of 38.4%, and the county level of 39.5%.
Food Insecurity, Adults below 200% of Poverty Percent SPA 2* 25.3% Los Angeles County 39.5% California 38.4% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/ * = statistically unstable due to sample size
Households In the hospital service area there are 87,638 households and 91,170 housing units. The median household income is $89,668 and the average (mean) household income is $106,350. These are higher than Los Angeles County’s median and mean household income.
Household Income Henry Mayo Service Area Los Angeles County Median Household Income $89,668 $55,870 Average Household Income $106,350 $82,109 Source: U.S. Census Bureau, 2010-2014 American Community Survey, 5-year estimates, DP03. http://factfinder.census.gov
When looked at by zip code, the median household income ranges quite widely, from $57,654 in Newhall 91321 to $114,608 in Stevenson Ranch.
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Median Household Income ZCTA Households Median Income Agua Dulce/Saugus 91390 6,243 $105,659 Canyon Country 91351 10,139 $70,858 Canyon Country 91387 13,441 $82,076 Castaic/ Val Verde 91384 6,908 $102,273 Newhall 91321 11,022 $57,654 Santa Clarita 91354 9,570 $111,098 Saugus 91350 11,114 $97,921 Stevenson Ranch 91381 6,527 $114,608 Valencia 91355 12,674 $89,596 Henry Mayo Service Area 87,638 $89,668 Los Angeles County 3,242,391 $55,870 California 12,617,280 $61,489 Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP03.http://factfinder.census.gov
Households by Type When households are examined by type, the service area has a higher percent of family households with children under 18 years old (40.1% of all households), and a lower percent of female as head of household with children (7% of all households), and seniors 65+ living alone (6.6% of all households), when compared to the county and state.
Households by Type Family Female Head of Total Seniors, 65+, Households with Household with own Households Living Alone Children under 18 Children under 18 Number Percent Percent Percent Henry Mayo Service Area 87,638 40.1% 7.0% 6.6% Los Angeles County 3,242,391 31.3% 7.8% 8.1% California 12,617,280 32.4% 7.1% 8.6% Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP02. http://factfinder.census.gov
Free or Reduced Price Meals The percentage of students eligible for the free or reduced price meal program is one indicator of socioeconomic status. In the Los Angeles Unified School Districts, over 75% of the student population is eligible for the free or reduced price meal program, indicating a high level of low-income families. This rate is higher than county and state rates. Castaic Union, William S. Hart Union and Saugus Union School Districts have fewer than a third of their students who are eligible for the program.
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Free or Reduced Price Meals Eligibility Percent Eligible Students Acton Agua Dulce School District 40.6% Castaic Union School District 29.7% Los Angeles Unified School District 75.6% Newhall School District 39.7% Saugus Union School District 21.2% Sulphur Springs School District 52.1% William S. Hart Union High School District 27.4% Los Angeles County 66.5% California 58.6% Source: California Department of Education, 2014-2015. http://data1.cde.ca.gov/dataquest/
Public Program Participation Residents in SPA 2 have lower rates of participation in the WIC and Food Stamp government sponsored public programs as compared to county residents. In SPA 2, 40.1% of residents below 200% of the FPL indicated they could not afford food, and 14.9% utilize food stamps. These rates indicate a percentage of residents who may qualify for food stamps but do not access this resource. WIC benefits are more readily accessed. Among children in SPA 2, 47% access WIC benefits and, 3.1% are TANF/CalWorks recipients, which is lower than state and county rates.
Public Program Participation Los Angeles SPA 2 California County Not Able to Afford Food (<200%FPL) 40.1% 42.8% 41.9% Food Stamp Recipients (<300% FPL) 14.9% 16.7% 17.4% WIC Usage Among Children, 6 Years & Under 47.0% 53.3% 45.6% TANF/CalWorks Recipients 3.1% 7.4% 7.1% Source: California Health Interview Survey, 2012-2014. http://ask.chis.ucla.edu/
Unemployment Many of the service area communities are not tracked by the California Employment Development Department. Santa Clarita has 6.1% unemployment and Val Verde has12.9% unemployment.
Unemployment Rate, 2015 Average Percent Santa Clarita 6.1% Val Verde 12.9% Los Angeles County 6.7% California 6.2% Source: California Employment Development Department, Labor Market Information, 2015; Unemployment data is not tracked in all service area cities. http://www.labormarketinfo.edd.ca.gov/data/labor-force-and-unemployment-for-cities-and-census-areas.html
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Educational Attainment Among service area adults, ages 25 and older, 10.9% lack a high school diploma; this is less than half of the county rate of 23.2%. 45.4% of service area adults are high school graduates and 43.7% are college graduates. In Los Angeles County, 40% of residents are high school graduates and 36.7% are college graduates.
Educational Attainment of Adults, 25 Years and Older Henry Mayo Service Area Los Angeles County Less than 9th Grade 4.4% 13.6% Some High School, No Diploma 6.5% 9.6% High School Graduate 18.9% 20.6% Some College, No Degree 26.5% 19.5% Associate Degree 9.8% 6.8% Bachelor Degree 23.1% 19.5% Graduate or Professional Degree 10.8% 10.4% Source: U.S. Census Bureau, American Community Survey, 2010-2014, DP02. http://factfinder.census.gov
High school graduation rates are determined by taking the number of graduates for the school year divided by the number of freshman enrolled four years earlier. The high school graduation rate for LAUSD (70.2%) is lower that the county (77.9%), and state (81%) rates, and does not meet the Healthy People 2020 objective of a 82.4% high school graduation rate. Acton / Agua Dulce and William S. Hart Union school districts have graduation rates that are higher than the county and state, and that exceed the Healthy People 2020 objective.
High School Graduation Rates, 2013-2014 High School Graduation Rate Acton Agua Dulce School District 86.7% Los Angeles Unified School District 70.2% William S. Hart Union High School District 95.3% Los Angeles County 77.9% California 81.0% Source: California Department of Education, 2013-2014. http://dq.cde.ca.gov/dataquest/.
Homelessness Every two years, the Los Angeles Homeless Services Authority (LAHSA) conducts the Greater Los Angeles Homeless Count to determine how many individuals are homeless on a given day. Data from this survey show an increase in homelessness from 2013 to 2015. In 2015, SPA 2 had 5,216 homeless persons, 78.2% of whom were single adults and 21% were families. The percent of unsheltered homeless has risen in SPA 2; the percentage of unaccompanied minors has decreased since 2013.
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Homeless Population, 2013-2015 Homeless Count Comparison SPA 2 Los Angeles County
2013 2015 2013 2015 Total Homeless 4,836 5,216 39,463 44,359 Sheltered 28.3% 26.6% 36.3% 30.1% Unsheltered 71.7% 73.4% 63.7% 69.9% Individual Adults 77.9% 78.2% 78.9% 81.1% Family Members 20.9% 21.0% 18.8% 18.2% Unaccompanied Minors (<18) 1.2% 0.8% 2.3% <1% Source: Los Angeles Homeless Services Authority, 2013 & 2015 Greater Los Angeles Homeless Count. http://www.lahsa.org/homeless-count/results
Among the homeless population, 37.8% in SPA 2 are chronically homeless. The rates of chronic homelessness have increased from 2013 to 2015. The homeless in SPA 2 have high rates of mental illness (40.2%), which was an increase from 2013 (28.6%). There is a notable increase from 2013 to 2015 in the homeless population with a domestic violence experience.
Homelessness Subpopulations SPA 2 Los Angeles County
2013 2015 2013 2015 Chronically Homeless 22.6% 37.8% 24.5% 34.4% Substance Abuse 33.3% 26.9% 31.2% 25.2% Mental Illness 28.6% 40.2% 28.0% 29.8% Veterans 11.1% 11.3% 11.3% 9.8% Domestic Violence Experience 8.6% 23.9% 1.0% 21.4% Physical Disability N/A 21.0% 8.9% 19.8% Persons with HIV/AIDS 0.9% 1.7% 0.6% 0.2% Source: Los Angeles Homeless Services Authority, 2013 & 2015 Greater Los Angeles Homeless Count. www.lahsa.org/homelesscount_results
Crime and Violence Violent crimes include homicide, rape, robbery and assault. Santa Clarita is the only service area city for which crime statistics are available; it has a lower rate of violent crime and property crime than the county or state.
Violent Crimes Rates and Property Crime Rates, per 100,000 Persons, 2012 Property Crime Rates Violent Crime Rates Santa Clarita 1,529.7 190.8 Los Angeles County* 2,327.1 446.4 California 2,758.7 423.1 Source: U.S Department of Justice, FBI, Uniform Crime Reporting Statistics, 2012. www.bjs.gov/ucrdata/index.cfm * = https://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012/tables/6tabledatadecpdf
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Calls for domestic violence are categorized as occurring with or without a weapon. The domestic violence calls in Santa Clarita were primarily with weapons. The with weapon call rate for Santa Clarita (76.6%) and the L.A. County Sheriff’s Office (who respond to calls in the unincorporated areas) were higher than the county rate.
Domestic Violence Calls, 2014 Total Without Weapon With Weapon Santa Clarita 518 23.4% 76.6% L.A. County Sheriff’s Dept. 3,389 13.7% 86.3% Los Angeles County 39,145 34.5% 65.5% California 158,547 60.9% 39.1% Source: California Department of Justice, Office of the Attorney General, 2014. https://oag.ca.gov/crime/cjsc/stats/domestic-violence
Community Input – Social and Economic Factors Stakeholder interviews identified the most important socioeconomic, behavioral, environmental and clinical factors contributing to poor health in the community: There is a large influx of homeless individuals who have nowhere to go and there are very few resources for them in the Santa Clarita Valley. We have a growing homeless population and many of them have multiple health issues that bring them to our ED. Those are infection, diabetes, mental health issues. The homeless situation is increasing. We have frequent flyers and patients who don’t want to follow-up on their own care. We do have a homeless coalition that just started in the last 6 months. There are a couple of shelters around but they do not provide year-round service, only in the winter. Homelessness is an interesting issue in Santa Clarita. The city has really avoided wanting to embrace the issue. They tried to not provide a permanent facility. The homeless have their own network, they know how to operate, where facilities are and how to work the system and the city doesn’t want people settling here. Access to healthy foods in some areas. Healthy food costs more. We have poverty in a community that is viewed as very affluent. It makes it difficult to acknowledge that it exists and it is impacting care and services in this community. We have a fairly significant population of homeless or housing insecure. As a community we are openly beginning to acknowledge this fact. No supportive housing options, no resources to address it. Very conservative environment. So when you talk about the undocumented, it’s not openly discussed. It is at a crisis level before there are access services. When we do provide those services, there is small amount of money for undocumented care, so it’s an underserved population in the community. Samuel Dixon (community clinic) has more clients to serve than they have the capacity to serve.
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We have a Latino community in Newhall and lower-income areas going into Canyon Country where there is a lack of healthy living. A lot of people work in other parts of LA versus working here in the Santa Clarita Valley so we have to be on the roads a lot more. It’s also a lot hotter out here. If English is not your first language, you may have fear and lack of education. In some cultures, people don’t do certain things; they just don’t know and haven’t been taught anything different. It’s hard for people to find a job out here and stay out here due to the high price of property and rentals, and it’s getting worse and worse. Soon people will be living very far out of town to work here. Our community likes to believe things don’t happen here. We have to really wake people up that it happens at every level in this valley. We have stigmas against things we don’t want in our Valley like homelessness: we only have a homeless shelter that is open for three months a year. Impoverished, poor, and undocumented, don’t have access to care. They struggle to survive day-to-day so their health needs get pushed to the side until it can’t be ignored anymore. Homelessness has increased incredibly in the Santa Clarita Valley. Unlike downtown LA, we don’t have Skid Row but we have the Wash and a lot of homeless people live there. Temperatures and temperature ranges are different here. Its bitter cold and very hot: extremes here. People suffer with no place to live. What is a little different from LA is that the homeless aren’t as visible here, they are couch surfing, living at a friend’s house, etc.; they are invisible. Not an encampment. High rents are becoming a real huge issue out here. People can’t find living arrangements they can afford. So we are seeing an uptick in homelessness. Low level of education, no high school diploma, language can be a barrier as well. Lack of resources in our community is also a significant barrier. Socioeconomic level for a segment of the population that is at poverty level such as day laborers and uninsured. Our community has this sense that we are affluent. And I think there is a certain pressure to keep up or be perceived as being part of the so-called affluent class. We are a fishbowl. Not a lot of diversity or access to different types of communities, so we are an internal, self-absorbed type of community. And coming off the downfall of the economy, so many people in the Santa Clarita Valley lost their homes. People are maxed out. Not enough money to eat is a big issue. We have seniors who will choose not to buy their medications because otherwise they won’t have enough money to cover rent.
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Health Care Access
Health Insurance Coverage Health insurance coverage is a key component to accessing health care. The Healthy People 2020 goal is for 100% insurance coverage. While none of the zip codes in the service area meet that goal, some come closer than others. As a whole, the service area has a higher rate of insurance coverage (88.4%) than the county (79.1%) or the state (83.3%). The highest rate of coverage is found in Santa Clarita (93.4%) and the lowest in Newhall 91321 (80%).
Health Insurance Coverage by Zip Code Zip Code Percent Agua Dulce/Saugus 91390 92.4% Canyon Country 91351 82.2% Canyon Country 91387 86.9% Castaic/ Val Verde 91384 90.2% Newhall 91321 80.0% Santa Clarita 91354 93.4% Saugus 91350 90.5% Stevenson Ranch 91381 92.2% Valencia 91355 92.5% Henry Mayo Service Area 88.4% Los Angeles County 79.1% California 83.3% Source: U.S. Census Bureau, American Community Survey, 2010-2014, S2701.http://factfinder.census.gov
In SPA 2, 88.1% of the population is insured, which is higher than the county rate.
Insurance Coverage SPA 2 Los Angeles County California Insured 88.1% 86.7% 88.1% Uninsured 11.9% 13.3% 11.9% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
SPA 2 has a lower percentage of Medi-Cal coverage (20.8%), and a higher percentage of employment-based insurance (46.8%), and privately purchased insurance (9.2%) than the county or state.
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Insurance Coverage SPA 2 Los Angeles County California Medi-Cal 20.8% 24.4% 22.5% Medicare Only 1.7% 1.4% 1.4% Medi-Cal/Medicare 1.6% 3.7% 3.0% Medicare & Others 7.9% 7.4% 9.0% Other Public 0.1% 0.8% 1.0% Employment Based 46.8% 41.5% 44.8% Private Purchase 9.2% 7.4% 6.4% No Insurance 11.9% 13.3% 11.9% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
When insurance coverage for SPA 2 was examined by age groups, adults, ages 18-64, had the highest rate of uninsured. Coverage for children was primarily through employment-based insurance and Medi-Cal. Seniors have high rates of Medicare coverage.
Insurance Coverage by Age Group Ages 0-17 Ages 18-64 Ages 65+ Los Angeles Los Angeles Los Angeles SPA 2 SPA 2 SPA 2 County County County Medi-Cal 40.0% 45.5% 16.7% 21.0% 1.6% 1.8% Medicare Only N/A N/A 0.1% 0.1% 14.4% 10.9% Medi-Cal/Medicare N/A N/A 0.5% 1.4% 11.5% 23.5% Medicare & Others N/A N/A 0.0% 0.2% 70.6% 60.0% Other Public 0.2% 0.8% 0.0% 0.9% 0.0% 0.6% Employment Based 50.1% 44.4% 53.5% 48.0% 0.8% 1.4% Private Purchase 9.6% 4.9% 10.5% 9.7% 1.1% 0.3% No Insurance 0.0% 4.4% 18.6% 18.8% 0.0% 1.6% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
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. Children and seniors are more likely to have a usual source of care in SPA 2 than adults 18-64. 87.3% of SPA 2 children and 73.9% of adults have a usual source of care, which are both slightly lower than county levels; 96.7% of seniors have a source of care, which is higher than the county level.
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Usual Source of Care Ages 0-17 Ages 18-64 Ages 65+ Los Angeles Los Angeles Los Angeles SPA 2 SPA 2 SPA 2 County County County Usual Source of Care 87.3% 90.3% 73.9% 79.9% 96.7% 92.3% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
When access to care through a usual source of care is examined by race/ethnicity, Latinos are the least likely to have a usual source of care, followed by African Americans, then Asians; Whites are the most-likely to have a usual source of care.
Usual Source of Care by Race/Ethnicity SPA 2 Los Angeles County California African American 79.5% 85.6% 86.2% Asian 81.8% 81.8% 85.0% Latino 77.8% 80.8% 81.7% White 89.8% 90.7% 91.0% Source: California Health Interview Survey, 2012-2014. http://ask.chis.ucla.edu/
A doctor’s office, HMO, or Kaiser is the usual source of care for 61.3% of SPA 2 residents; clinics and community hospitals are the source of care for 16.4%. The ER is a source of care for a small percentage of area residents (1%).
Sources of Care SPA 2 Los Angeles County California Dr. Office/HMO/Kaiser 61.3% 57.6% 60.7% Community Clinic/Government Clinic/ 16.4% 23.6% 23.0% Community Hospital ER/Urgent Care 1.0% 1.7% 1.4% Other 1.1% 0.9% 0.7% No Source of Care 20.2% 16.2% 14.2% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
17.2% of residents in SPA 2 visited an ER over the period of a year, which was lower than the state and county levels (18%). In SPA 2, youth visited the ER at the highest rates (23.6%), followed by seniors 65 and over (20.9%), both of which were higher than county and state rates. SPA 2 residents living in poverty (lower than 100% FPL) visit the ER at lower rates (12.5%) than found in the county or state/
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Use of Emergency Room SPA 2 Los Angeles County California Visited ER in Last 12 Months 17.2% 18.0% 18.0% 0-17 Years Old 23.6% 21.4% 19.5% 18-64 Years Old 13.7% 16.6% 17.3% 65 and Older 20.9% 18.5% 18.9% <100% of Poverty Level 12.5% 19.2% 21.7% <200% of Poverty Level 20.0% 18.9% 20.0% Source: California Health Interview Survey, 2013-2014. http://ask.chis.ucla.edu/
Barriers to Care Adults in SPA 2 experience a number of barriers to accessing care, including cost of care and prescriptions. Adults in SPA 2 reported higher rates of being unable to afford care than those of the county, with the exception of dental care.
Barriers to Access
SPA 2 Los Angeles County Adults Unable to Afford Dental Care in the Past Year 29.8% 30.3% Adults Unable to Afford Medical Care in the Past Year 16.8% 16.0% Adults Unable to Afford Mental Health Care in the Past Year 7.2% 6.1% Adults Unable to Afford Prescription Medication in Past Year 15.8% 15.4% Adults Who Reported Difficulty Accessing Medical Care 28.9% 31.7% Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey 2011. http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm
Access to Primary Care Community Health Centers Community Health Centers 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 hospital service area and information from the Uniform Data System (UDS)1, 20.7% of the population in the service area is categorized as low-income (200% of Federal Poverty Level) and 8.5% of the population are living in poverty.
There are a number of Section 330 funded grantees (Federally Qualified Health Centers – FQHCs and FQHC Look-Alikes) serving the service area, including: Antelope Valley Community Clinic, Northeast Valley Health Corp., Samuel Dixon Family Health Centers, Inc., El Proyecto del Barrio, Inc., Mission City Community Network, Inc., Comprehensive Community Health Centers, Inc., and Center for Family Health and Education, Inc.
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 Henry Mayo Hospital – Community Health Needs Assessment
Even with Community Health Centers serving the area, there are a significant number of low-income residents who are not served by one of these clinic providers. The FQHCs and Look-Alikes have a total of 17,877 patients in the service area, which equates to 32.3% penetration among low-income patients and 6.5% penetration among the total population. From 2012-2014 the clinic providers added 2,459 patients; a 15.9% increase in patients served by Community Health Centers. However, there remain 37,487 low-income residents, approximately 67.7% of the population at or below 200% FPL, that are not served by a Community Health Center.
Low-Income Patients Served and Not Served by FQHCs and Look-Alikes Patients served Low-Income Not Penetration Penetration of Low-Income by Section 330 Served among Low- Total Population Grantees Income Patients Population Number Percent In Service Area 55,364 17,877 32.3% 6.5% 37,487 67.7% Source: UDS Mapper, 2014. http://www.udsmapper.org
Delayed Care Residents of SPA 2 delayed or did not get medical care (12.2%) when needed at a slightly higher rate than the county or state and also showed a higher rate of delayed and unfilled prescriptions (9.8%).
Delayed Care Los Angeles SPA 2 California County Delayed or Didn’t Get Medical Care In Past 12 Months 12.2% 11.7% 11.3% Delayed / Didn’t Get Prescription Meds In Past 12 Months 9.8% 7.9% 8.7% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Community Input – Access to Care Stakeholder interviews identified the following issues, challenges and barriers related to access to health care: Lack of transportation is a barrier to care. People may not be familiar with the bus system, prefer to get a ride from friends. Currently there are not enough primary care physicians. As the Santa Clarita Valley has grown, I don’t know that our general medicine has kept pace with services needed out here. We don’t have the infrastructure in place. It’s hard to connect – you have to be savvy to find resources if someone isn’t leading you along the way. Not having insurance or coverage and fear of being identified in a system that may act adversely toward them. Cultural and language barriers. In our
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community, for the Latino population, language may be a barrier. Fairly unique situation in Santa Clarita Valley; transportation is an issue for our clients, so they tend not to get care. Some clients are not insured or are afraid and don’t know how to access care. They then show up in crisis in ED to access care that way. Health insurance is one of the big issues. It’s expensive to live here; housing consumes a larger and larger portion of people’s income. One of the big issues we are struggling with is homelessness. Up to 100 students at the Canyon Community College are homeless. They have health issues, and because they don’t have health insurance and don’t know where to access services, the college has set up an education service. There are only two FQHCs in the area. There is limited adult access to care for lower-income adults because not enough Medi-Cal and specialty care providers. Some may believe the problem is access to care but it’s really that people are not aware of what is available to them. People are struggling to keep their jobs and to keep their insurance. They may not realize they qualify for some kind of assistance. Almost all of my patients have to travel outside of the Valley for specialty care. The IPA my clinic is affiliated with, Healthcare LA IPA, can’t seem to contract with any specialist providers out here. They refuse to take Medi-Cal rates. Even if we offer Medicare and Medicare plus rates but they won’t accept the patients. If you want to call yourself a community, all providers have to step up to the plate and serve all of those in the community. For access to care the shelter does a great job but still a lot of people have needs outside of the shelter. Biggest challenge here is people who only have Medi-Cal as their primary insurance and the limited number of doctors who take insurance, The wait time for care is significant. We are the only hospital in this area. This is a limitation in the community. We are also the only ER in the area. Have people that are unable to receive benefits because of immigration. We have a lot of people who aren’t citizens. Access to care can be financial; the co- pays and deductibles are so high. Even though we’re a smaller community, if a person does not have a car or money for transportation, it can be difficult to get to the doctor. The undocumented are cash pay and go to community healers sometimes that works, sometimes it doesn’t. The number of seniors is increasing in our community. In certain ethnic communities, there is an understanding that they will take care of elderly. Out here they are very isolated. See high number of ER medical visits from seniors
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trying to do things on their own and then they fall. If someone is low-income, uninsured and undocumented there are significant barriers to receive care, especially mental health and dental care. Often the wait for services in town is 30 – 45 days or more and often someone needs to meet with a specialist right away. In many ways, to actually use the service, due to the need and demand, it takes time to get access to the services. Many seniors don’t have transportation and are dependent on public transportation, which is not always reliable. They need to depend on a friend or family, but they don’t want to be a burden.
Dental Care 17.4% of children in SPA 2 have never been to a dentist. These percentages are lower than county and state levels.
Delay of Dental Care among Children and Teens, 2013-2014 Los Angeles SPA 2 California County Children Never Been to the Dentist 17.4% 18.1% 17.7% Children Been to Dentist Less Than 6 Months to 2 Years 82.6% 80.9% 81.2% Teens Never Been to the Dentist 0.0% 2.6% 2.1% Teens Been to Dentist Less Than 6 Months to 2 Years 96.7% 94.9% 94.8% Source: California Health Interview Survey, 2013-2014. http://ask.chis.ucla.edu/ * = statistically unstable due to sample size
Adults in SPA 2 are more likely to have dental insurance (51%) and less likely to be unable to afford dental care (29.8%) compared to Los Angeles County (48.2% and 30.3% respectively). A slightly higher percentage of adults in SPA 2 had been to the dentist in the past year (67.3%) compared to the county (64.8%).
Adult Dental Care SPA 2 Los Angeles County Adults Who Have Dental Insurance that Pays for 51.0% 48.2% Some or All of Their Routine Dental Care Adults Unable to Obtain Dental Care Because They 29.8% 30.3% Could Not Afford It Adults Who Reported Their Last Visit to a Dentist 67.3% 64.8% Was Less Than 12 Months Ago * Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2011. www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm * = Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Community Input – Dental Care Stakeholder interviews identified the following issues, challenges and barriers related to access to dental care: The cost of dental care is exorbitant. Dental with co-pays gets expensive.
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Dental care is a great need. There is only one small dental clinic in Canyon Country. People often do not know when to bring their children to the dentist. We see a lot of children with tooth decay related to longer term bottle use. Even milk has sugar in it, when they go to bed with a bottle the milk sits on those teeth and eats away at them. Teeth get rotten when using drugs. There are a lot of dentists and most of them participate in multiple dental programs. These dentists serve the insured. I am just not sure how many take Medi-Cal patients. Seniors don’t get dental care coverage on Medicare and it’s very expensive for them. We have seniors here who haven’t gone to the dentist in 10-15 years. They can’t afford it or don’t want to spend money on it as they are living on fixed incomes. The issues are finances and finding a dentist who will take someone who is low- income. Also, getting a person to get themselves to the dentist. There is a lot of destruction with teeth over time with alcohol and drugs. People may be cautious about going to the dentist as they see some have charged unnecessary services. Dentists will often do pro bono cosmetic work as a result of domestic battery. But for those with poor dental care, like the meth addict, or those who have not had treatment for a while, there isn’t a lot of free or affordable services. Need more dentists willing to work with our population, there aren’t many. A challenge for our patients is transportation. Many don’t have vehicles, so they rely on public transportation, and can’t always afford the public transportation. Even with a grant for additional dental care there are no grants for transportation so they don’t go. Plethora of dentists and specialists and periodontists. Huge amount of well- respected specialties in the valley. But very few dentists will accept Medi-Cal. Seniors don’t tend to have dental insurance. There are some free services, but most are in LA so you have to be able to get there. People with missing teeth have a hard time eating and chewing food. It leads to nutrition issue. Children are covered by aid programs, but a lot of people are not covered or are hesitant. People with lower budgets need to have options.
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Birth Characteristics
Births In 2012, there were 2,937 births in the hospital service area
Teen Birth Rate In 2012, teen births in the service area occurred at a rate of 2.9% of total births. This rate is lower than the teen birth rate found in the state (6.2%) and county (6.3%). The highest rates of teen births were found in Canyon Country (91351) and Newhall, which were both still below county and state rates. It is important to remember, when examining geographic areas with a small occurrence, to use caution when drawing conclusions from data as small occurrences may result in high rates.
Births to Teenage Mothers (Under Age 20) Births to Teen Percent Teen Zip Codes Live Births** Mothers Births Agua Dulce/Saugus 91390 3 146 2.1% Canyon Country 91351 20 400 5.0% Canyon Country 91387 18 551 3.3% Castaic/ Val Verde 91384 3 258 1.2% Newhall 91321 19 445 4.3% Santa Clarita 91354 4 294 1.4% Saugus 91350 8 366 2.2% Stevenson Ranch 91381 2 153 1.3% Valencia 91355 8 324 2.5% Henry Mayo Service Area 85 2,937 2.9% Los Angeles County * 8,147 128,512 6.3% California * 30,814 494,332 6.2% Source: California Department of Public Health, 2012; https://www.cdph.ca.gov/data/statistics/Pages/BirthProfilesbyZIPCode.aspx * Source: California Department of Public Health, Open Data Portal, 2013; including 2012 data to allow for same-year comparisons.https://cdph.data.ca.gov/browse?category=Demographics **Births in which the age of the mother is unknown are not included in the tabulation.
Prenatal Care Pregnant women in the service area entered prenatal care in the first trimester at a rate of 87.9%. This rate of early entry into prenatal care is higher than the LA County rate of 84.9% and the state rate of 83.6%, as well as meeting the Healthy People 2020 objective of 78% of women entering prenatal care in the first trimester. Newhall 91321 (84.1%) had the lowest rates of early prenatal care, and Santa Clarita had the highest (92.1%).
On-Time Entry into Prenatal Care (In First Trimester) On-Time Zip Codes Live Births** Percent Prenatal Care Agua Dulce/Saugus 91390 127 143 88.8%
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On-Time Zip Codes Live Births** Percent Prenatal Care Canyon Country 91351 341 399 85.5% Canyon Country 91387 476 544 87.5% Castaic/ Val Verde 91384 226 256 88.3% Newhall 91321 370 440 84.1% Santa Clarita 91354 267 290 92.1% Saugus 91350 332 364 91.2% Stevenson Ranch 91381 136 152 89.5% Valencia 91355 283 321 88.2% Henry Mayo Service Area 2,558 2,909 87.9% Los Angeles County * 105,257 124,010 84.9% California * 406,080 485,583 83.6% Source: California Department of Public Health, 2012; https://www.cdph.ca.gov/data/statistics/Pages/BirthProfilesbyZIPCode.aspx * Source: California Department of Public Health, Open Data Portal, 2013; including 2012 data to allow for same-year comparisons.https://cdph.data.ca.gov/browse?category=Demographics. **Births in which the age of the mother is unknown are not included in the tabulation.
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. In the area, the rate of low birth weight babies is 6.9% (69.1 per 1,000 live births). The service area meets the Healthy People 2020 objective of 7.8% of births being low birth weight. When examined by zip code, four neighborhoods have a rate that exceeds the Healthy People 2020 objective: Stevenson Ranch, Newhall, Valencia (91355) and Saugus. When examining geographic areas with a small occurrence it is important to use caution when drawing conclusions from data as small occurrences may result in high rates.
Low Birth Weight (Under 2,500 g) Zip Codes Low Birth Weight Live Births** Percent Agua Dulce/Saugus 91390 10 146 6.8% Canyon Country 91351 17 400 4.3% Canyon Country 91387 34 551 6.2% Castaic/ Val Verde 91384 13 258 5.0% Newhall 91321 37 445 8.3% Santa Clarita 91354 18 294 6.1% Saugus 91350 30 366 8.2% Stevenson Ranch 91381 17 153 11.1% Valencia 91355 27 324 8.3% Henry Mayo Service Area 203 2,937 6.9% Los Angeles County * 9,058 128,519 7.0% California * 33,798 494,365 6.8% Source: California Department of Public Health, 2012; https://www.cdph.ca.gov/data/statistics/Pages/BirthProfilesbyZIPCode.aspx * Source: California Department of Public Health, Open Data Portal, 2013; including 2012 data to allow for same-year comparisons.https://cdph.data.ca.gov/browse?category=Demographics. **Births in which the age of the mother is unknown are not included in the tabulation.
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Infant Mortality The infant (less than one year of age) mortality rate in in the service area was 3.8 deaths per 1,000 live births, which is lower than the county rate (4.3) and the state rate (4.5 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 births.
Infant Mortality Rate, 2013 Infant Deaths Live Births Death Rate Henry Mayo Service Area 11 2,937 3.8 Los Angeles County 567 131,697 4.3 California 2,348 494,392 4.7 Source: California Department of Public Health, Vital Statistics Query System, 2013 http://informaticsportal.cdph.ca.gov/chsi/vsqs/; California Health and Human Services Data Portal, 2013 https://chhs.data.ca.gov/browse?category=Demographics * Infant Death Rate for the Henry Mayo Hospital Service Area is approximate. The number of Infant Deaths by zip code is available for 2013, while the number of live births by zip code is available up to 2012.
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 Henry Mayo Hospital indicate 93.7% of new mothers use some breastfeeding and 71.8% use breastfeeding exclusively. These rates are higher than the average rate among hospitals in the county and state.
In-Hospital Breastfeeding Any Breastfeeding Exclusive Breastfeeding
Number Percent Number Percent Henry Mayo Newhall Hospital 1,013 93.7% 776 71.8% Los Angeles County 109,455 92.8% 62,955 53.3% California 396,602 92.9% 275,706 64.6% Source: California Department of Public Health, Breastfeeding Hospital of Occurrence, 2013 https://www.cdph.ca.gov/data/statistics/Documents/MO-MCAH-HospitalTotalsReport2013.pdf
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Mortality/Leading Causes of Death
Leading Causes of Premature Death In Los Angeles County, 42% of people in 2012 died before they reached age 75, with deaths prior to 75 years of age determined by the Los Angeles County Department of Public Health to be premature. In SPA 2, coronary heart disease was the leading cause of premature death, suicide was second, and motor vehicle crash was third.
Leading Cause of Premature Death, 2012 SPA 2 Los Angeles county 1. Coronary Heart Disease 1. Coronary Heart Disease 2. Suicide 2. Homicide 3. Motor Vehicle Crash 3. Motor Vehicle Crash 4. Drug Overdose 4. Liver Disease/Cirrhosis 5. Lung Cancer 5. Suicide Source: LA County Department of Public Health, Mortality in Los Angeles County, 2015. http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt12.pdf
Leading Causes of Death The overall mortality rate for all causes of death in the service area is 418.8 per 100,000 persons. This is lower than the county rate (587.1 per 100,000 persons) and the state (632.5 per 100,000 persons).
Crude Death Rate per 100,000 Persons, 5-Year Average Total, 2008-2012 Average Annual Deaths Rate Henry Mayo Service Area 1,140 418.8 Los Angeles County 57,773 587.1 California 236,089 632.5 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx
Cancer and heart disease are the top two leading causes of death in the service area; stroke is the third, and respiratory disease is the fourth leading cause of death. The rate of death was lower in the service area for all listed causes of death, than in the county or state. The service area zip code with the highest rate of death for each of the top four causes, and for 6 of the 7 causes listed here, is Newhall 91321; for Alzheimer’s it has the second-highest rate.
When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Also, crude rates are subject to wide variation due to variations in median age from zip code to zip code, and from service area to county and state.
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Leading Causes of Death, Crude Rate per 100,000 Persons, 5-Year Average, 2008-2012 Henry Mayo Service Area Los Angeles County California Average Rate Rate Rate Annual Deaths Cancer 303 111.3 140.9 150.1 Diseases of the Heart 284 104.3 163.4 158.5 Stroke 69 25.3 33.5 36.2 Chronic Lower Respiratory Disease/ 64 23.5 29.7 35.0 Chronic Obstructive Pulmonary Disease Alzheimer’s disease 52 19.1 23.0 28.9 Pneumonia and Flu 24 8.8 21.0 16.5 Diabetes 23 8.4 21.2 19.8 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx
Cancer Mortality The crude death rate for all cancers in the service area is 111.3 per 100,000 persons, which is lower than the county (140.9) and state (150.1) rates. Newhall (91321) has the highest rate of death due to cancer (154.8).
All Cancers, Crude Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Zip Code Rate Median Age Annual Deaths Agua Dulce/Saugus 91390 26 130.7 40.0 Canyon Country 91351 41 127.8 36.0 Canyon Country 91387 37 92.1 34.1 Castaic/ Val Verde 91384 25 86.4 32.5 Newhall 91321 54 154.8 33.2 Santa Clarita 91354 25 88.1 37.3 Saugus 91350 39 114.9 35.5 Stevenson Ranch 91381 16 81.3 36.9 Valencia 91355 42 126.5 37.1 Henry Mayo Service Area 303 111.3 36.2 Los Angeles County 13,861 140.9 34.8 California 56,040 150.1 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Heart Disease Mortality The service area has a rate of death due to heart disease of 104.3 per 100,000 persons, which is lower than the county and state rates. Newhall 91321 has the highest rate of death due to heart disease (187.8).
Heart Disease, Crude Death Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Annual Zip Code Rate Median Age Deaths Agua Dulce/Saugus 91390 19 94.8 40.0 Canyon Country 91351 42 130.3 36.0 Canyon Country 91387 35 86.7 34.1 Castaic/ Val Verde 91384 24 83.0 32.5 Newhall 91321 66 187.8 33.2 Santa Clarita 91354 19 67.6 37.3 Saugus 91350 37 107.9 35.5 Stevenson Ranch 91381 13 65.1 36.9 Valencia 91355 45 136.7 37.1 Henry Mayo Service Area 284 104.3 36.2 Los Angeles County 16,074 163.4 34.8 California 59,177 158.5 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Stroke Mortality The crude death rate for stroke in the service area is 25.3 per 100,000 persons, which is lower than the county (33.5) and state (36.2) rates.
Cerebrovascular Disease (Stroke), Crude Death Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Annual Zip Code Rate Median Age Deaths Agua Dulce/Saugus 91390 4 21.9 40.0 Canyon Country 91351 8 26.3 36.0 Canyon Country 91387 7 16.8 34.1 Castaic/ Val Verde 91384 4 12.3 32.5 Newhall 91321 19 52.9 33.2 Santa Clarita 91354 5 17.6 37.3 Saugus 91350 8 24.5 35.5 Stevenson Ranch 91381 3 16.3 36.9 Valencia 91355 12 37.3 37.1 Henry Mayo Service Area 69 25.3 36.2 Los Angeles County 3,296 33.5 34.8 California 13,528 36.2 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Respiratory (Lung) Disease Mortality Chronic Lower Respiratory Disease and Chronic Obstructive Pulmonary Disease include emphysema and bronchitis. The crude death rate for respiratory disease in the service area is 23.5 per 100,000 persons, which is lower than the county (29.7) and state rates (35.0).
Chronic Lower Respiratory/Chronic Obstructive Pulmonary Disease, Crude Death Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Annual Zip Code Rate Median Age Deaths Agua Dulce/Saugus 91390 4 21.9 40.0 Canyon Country 91351 7 23.2 36.0 Canyon Country 91387 7 18.3 34.1 Castaic/ Val Verde 91384 5 16.5 32.5 Newhall 91321 15 41.5 33.2 Santa Clarita 91354 3 11.3 37.3 Saugus 91350 12 33.8 35.5 Stevenson Ranch 91381 3 17.3 36.9 Valencia 91355 9 26.5 37.1 Henry Mayo Service Area 64 23.5 36.2 Los Angeles County 2,927 29.7 34.8 California 13,080 35.0 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Alzheimer's Disease, Crude Death Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Zip Code Rate Median Age Annual Deaths Agua Dulce/Saugus 91390 3 17.0 40.0 Canyon Country 91351 7 23.2 36.0 Canyon Country 91387 4 10.4 34.1 Castaic/ Val Verde 91384 3 10.3 32.5 Newhall 91321 12 34.1 33.2 Santa Clarita 91354 5 17.6 37.3 Saugus 91350 5 15.7 35.5 Stevenson Ranch 91381 3 15.2 36.9 Valencia 91355 12 35.5 37.1 Henry Mayo Service Area 52 19.1 36.2 Los Angeles County 2,263 23.0 34.8 California 10,794 28.9 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012. http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Diabetes The crude death rate from diabetes in the service area is 8.4 per 100,000 persons, which is significantly lower than the county (21.2) and state rates (19.8).
Diabetes, Crude Death Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Annual Zip Code Rate Median Age Deaths Agua Dulce/Saugus 91390 2 11.0 40.0 Canyon Country 91351 5 15.7 36.0 Canyon Country 91387 6 15.4 34.1 Castaic/ Val Verde 91384 4 13.0 32.5 Newhall 91321 8 21.6 33.2 Santa Clarita 91354 4 13.4 37.3 Saugus 91350 4 12.2 35.5 Stevenson Ranch 91381 2 11.2 36.9 Valencia 91355 5 15.7 37.1 Henry Mayo Service Area 23 8.4 36.2 Los Angeles County 2,088 21.2 34.8 California 7,373 19.8 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Pneumonia and Influenza Mortality The crude death rate for pneumonia and flu in the service area is 8.8 per 100,000 persons, which is well below the county (21.0) and state (16.5) rates. Newhall 91321 has the highest rate from pneumonia/flu, with 18.2 deaths per 100,000 persons.
Pneumonia and Influenza, Crude Death Rate per 100,000 Persons, 5-Year Average, 2008-2012* Average Annual Zip Code Rate Median Age Deaths Agua Dulce/Saugus 91390 1 5.0 40.0 Canyon Country 91351 3 10.0 36.0 Canyon Country 91387 4 8.9 34.1 Castaic/ Val Verde 91384 2 6.9 32.5 Newhall 91321 6 18.2 33.2 Santa Clarita 91354 2 6.3 37.3 Saugus 91350 4 12.2 35.5 Stevenson Ranch 91381 1 7.1 36.9 Valencia 91355 4 10.8 37.1 Henry Mayo Service Area 24 8.8 36.2 Los Angeles County 2,067 21.0 34.8 California 6,154 16.5 35.2 Source: California Department of Public Health, Public Health Statistical Master Files 2008-2012, http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate.
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Chronic Disease
Health Status Among the residents in SPA 2, 11.5% rate themselves as being in fair or poor health. Rates of fair or poor health increases among seniors (32.9%); this is higher than the reported county and state rates.
Health Status, Fair or Poor Health SPA 2 Los Angeles County California Fair or Poor Health 11.5% 19.3% 17.0% 18-64 Years Old 10.8% 22.0% 19.3% 65+ Years Old 32.9% 31.4% 27.9% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Disability 28.1% of adults in SPA 2 have a physical, mental or emotional disability. Disabled persons were less likely to report having health insurance (80.8%) than disabled persons in the county (84.6%) and state (87.8%).
Population with a Disability SPA 2 Los Angeles County California Adults with a Disability 28.1% 28.6% 28.9% Disabled Persons with Health Insurance 80.8% 84.6% 87.8% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/
Asthma 12.9% of the population in SPA 2 is diagnosed with asthma. Among those with asthma, 44.2% take medication to control their symptoms. Among youth, 13.3% have been diagnosed with asthma, and 31.0% take medication to control their symptoms as compared to the county (44.4%) and state (41.7%).
Asthma SPA 2 Los Angeles County California Diagnosed with Asthma, Total Population 12.9% 12.1% 14.1% Diagnosed with Asthma, 0-17 Years Old 13.3% 12.4% 14.9% ER Visit in Past Year Due to Asthma, 11.7% 15.0% Total Population 11.8% ER Visit in Past Year Due to Asthma, 19.0% 23.5% 0-17 Years Old 18.2% Takes Daily Medication to Control Asthma, 44.2% 45.8% Total Population 44.6% Takes Daily Medication to Control Asthma, 31.0% 44.4% 0-17 Years Old 41.7% Source: California Health Interview Survey, 2012-2014. http://ask.chis.ucla.edu/
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Community Input – Asthma Stakeholder interviews identified the following issues, challenges and barriers related to asthma: It is a challenge to have some of the specialty products needed to help the asthmatic child, like hypoallergenic pillowcases. There are pest issues in the home like cockroaches. We have bad air in LA County. Air quality is sometimes not so good. Like the San Fernando Valley, there are lots of allergies here. Sometimes our patients can’t afford the medications and they let their inhalers lapse. Not having the resources to get it refilled. One of challenges is our patients’ education level. They only inform us when they are having breathing issues and are out of their inhaler for quite some time. Asthma can increase during fires and pollen in spring and fall. A lot of people are not aware how to treat it, they just shrug it off. It’s a treatable chronic disease. It’s education and environmental, we are in a valley here.
Diabetes Diabetes is a growing concern in most communities, but is lower in SPA 2 than the county and state. 5.8% of adults in SPA 2 reported they have been diagnosed with diabetes, versus 10% of the county population. For adults with diabetes, 74.5% in SPA 2 were very confident they can control their diabetes, which is higher than state and county levels.
Adult Diabetes SPA 2 Los Angeles County California Diagnosed Pre/Borderline Diabetic 6.3% 8.8% 10.5% Diagnosed with Diabetes 5.8% 10.0% 8.9% Very Confident to Control Diabetes 74.5% 56.9% 56.5% Somewhat Confident 22.4% 33.7% 34.7% Not Confident 3.0% 9.3% 8.8% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Rates of diabetes reported by ethnic groups in SPA 2 – Latino (7.8%), White (7%), Asian (6.7%) and African American (4.1%) – were lower than rates for those groups at county and state levels.
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Adult Diabetes by Race/Ethnicity SPA 2 Los Angeles County California African American 4.1% 12.8% 10.9% Asian 6.7% 8.8% 8.0% Latino 7.8% 10.7% 10.3% White 7.0% 7.3% 7.2% Source: California Health Interview Survey, 2011-2014; http://ask.chis.ucla.edu/
Community Input – Diabetes Stakeholder interviews identified the following issues, challenges and barriers related to diabetes: More prevention education tied to obesity could be used to prevent the onset of diabetes. Impoverished population sees a lot of obesity and associated health effects like diabetes. We serve mainly Latino population and we have a large diabetic population. We need more classes and prevention in the schools. We see people who have multiple chronic diseases worry about how pay for medications and supplies. People still think eating sugar cause diabetes. There needs to be a lot more education around prevention. Alcohol exacerbates diabetes problems because of putting all that sugar into your body. The barrier in itself is the addiction. We need a diabetes educator and outpatient diabetes education follow-up. That might happen as we are opening a fitness center and it’s going to be for employees and the community. Some of our health groups and classes could involve diabetes. Currently diabetes education is insufficient. People don’t realize how bad diabetes is. They make poor food choices. Good food costs so much and a lot of programs don’t give out fresh fruit. People buy the unhealthy food because it is cheap. People with medical issues do not have consistent care for their illness if they are impoverished or do not have a place to live or food to eat. They focus on housing and food first and do not take care of their diabetes until it’s pretty serious and they end up in the hospital. They may not take their insulin or lost their insulin. People may run out of medications and won’t tell us. We find out when they come back in for appointment and their hemoglobin A1C levels are high. With limited funds they stretch their dollars when buying food, often not the most nutritious. Patients from our experience don’t seem to be motivated with educational workshops. Many people don’t know how to manage diabetes so they live on their own and struggle. They do not know how to do food preparation just for themselves.
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Heart Disease For adults in SPA 2, 4.9% have been diagnosed with heart disease. Among these adults, 57.8% are very confident they can manage their condition. They are less likely to report that they have a management care plan (58.2%) than county or state residents (66.6% and 72.2%, respectively).
Adult Heart Disease SPA 2 Los Angeles County California Diagnosed with Heart Disease 4.9% 5.3% 5.9% Very Confident to Control Condition 57.8% 51.7% 54.4% Somewhat Confident to Control Condition 37.8% 37.2% 35.6% Not Confident to Control Condition 4.4% 11.0% 10.0% Has a Management Care Plan 58.2% 66.6% 72.2% Source: California Health Interview Survey, 2012-2014; http://ask.chis.ucla.edu/
SPA 2 reported a higher rate of heart disease among Asians (7%) and Whites (6.8%).
Adult Heart Disease by Race/Ethnicity SPA 2 Los Angeles County California African American 1.4% 7.1% 5.2% Asian 7.0% 6.3% 5.6% Latino 2.3% 3.9% 4.0% White 6.8% 8.0% 8.1% Source: California Health Interview Survey, 2012-2014; http://ask.chis.ucla.edu/
High Blood Pressure A co-morbidity factor for diabetes and heart disease is hypertension (high blood pressure). In SPA 2, 20.5% of adults have been diagnosed with high blood pressure, which is lower than county and state levels. Of these, 64.2% reported taking medication for their high blood pressure, which is lower than county and state rates.
High Blood Pressure SPA 2 Los Angeles County California Diagnosed with High Blood Pressure 20.5% 27.3% 28.5% Takes Medication for High Blood Pressure 64.2% 67.2% 68.5% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
All racial / ethnic groups in SPA 2 report lower levels of high blood pressure than county and state rates. Among Whites, over one-quarter (24.7%) have been diagnosed with high blood pressure.
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Adult High Blood Pressure by Race/Ethnicity SPA 2 Los Angeles County California African American 17.3% 42.6% 39.2% Asian 17.1% 24.1% 21.6% Latino 20.0% 24.1% 24.4% White 25.7% 29.3% 30.5% Source: California Health Interview Survey, 2011-2014. http://ask.chis.ucla.edu/
Community Input – Heart Disease Stakeholder interviews identified the following issues, challenges and barriers related to heart disease: If someone has no medical insurance or no money, they cannot get into the doctor. Usually heart disease is one of many issues that they have when they come into my office. People have limited resources to pay to manage their conditions. They stop taking medications and can’t afford to refill. So many reasons for heart disease. To avoid cardiac arrest, you’d have to proactively know if you had any issues. Eating, exercise, smoking and drinking all contribute to heart disease. Heart disease is something that can be prevented or managed. People do not have to give up and be lethargic.
Cancer Cancer incidence rates are available at the county level. In Los Angeles County, cancer levels are lower overall, than at the state level; however, the colorectal cancer rate (39.5 per 100,000 persons), uterine cancers, (25.6 per 100,000), thyroid cancer (13.1 per 100,000) and ovarian cancer, (12.2 per 100,000) exceed the state rates.
Cancer Incidence, Age-Adjusted, per 100,000 Persons, 2009-2013 Los Angeles County California Cancer, All Sites 398.0 418.0 Breast (female) 116.5 121.7 Prostate (males) 114.2 119.0 Lung & Bronchus 40.0 46.6 Colon & Rectum 39.5 38.3 Uterine ** (females) 25.6 24.4 Non-Hodgkin Lymphoma 18.5 18.7 Urinary Bladder 16.4 18.2 In Situ Breast (female) 13.8 28.9 Melanoma of the Skin 13.3 21.1 Kidney and Renal Pelvis 13.3 14.3 Thyroid 13.1 12.3 Leukemia * 12.2 12.6
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Los Angeles County California Ovary (females) 12.2 11.9 Pancreas 11.4 11.6 Source: The Centers for Disease Control and Prevention, National Cancer Institute, State Cancer Profiles, 2009-2013 http://www.cancer-rates.info/ca/ * = Myeloid & Monocytic + Lymphocytic + "Other" Leukemias ** = Uterus, NOS + Corpus Uteri
Community Input – Cancer Stakeholder interviews identified the following issues, challenges and barriers related to cancer: Getting the right cancer treatment and dealing with insurance companies and getting approvals is tough. Everyone is affected by cancer. Medical insurance is very costly. Some people don’t want to talk about cancer. They don’t want anyone knowing they have it. There is still a stigma about it. People are fearful their employers are going to find out. They will get the care but they won’t get the emotional support they need if they are fearful of others knowing. We are seeing more people with colon cancer recently. They are younger demographically for colon cancer, traditionally we see this in older people. The American Cancer Society has 60-70 volunteer drivers for all of LA County. Not enough drivers especially if people have treatments 5 days a week. The taxi coupon can only be used once a month. This causes strain on the family and caregivers as well. Cancer is being caught too late. People are not being proactive in care. Even though many cancers are treatable and survivable.
HIV/AIDS In 2013, 246 cases of HIV/AIDS were diagnosed in SPA 2 for a rate of 11 per 100,000 persons. The rate of HIV/AIDS diagnosed in 2013 has decreased from 2011 and 2012, and rates of diagnosis of HIV/AIDS in SPA 2 are lower than county rates. Rates of new diagnoses are highest among males, young adults 20-29, and Blacks/African Americans. 83% of the new cases were reportedly via male-to-male sexual contact, 10% via heterosexual sex, and 7% were cases where IV drug use was implicated.
HIV/AIDS Diagnoses, Number and Rate per 100,000 Persons, 2011 – 2013 2011 2012 2013
Number Rate Number Rate Number Rate SPA 2 274 13 263 12 246 11 Los Angeles County 1,997 20 2,012 20 1,820 18 Source: County of Los Angeles, Public Health, 2014 Annual HIV / STD Surveillance Report http://publichealth.lacounty.gov/dhsp/Reports/HIV-STDsurveillanceReport2014.pdf
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Sexually Transmitted Diseases SPA 2 has lower rates of chlamydia, gonorrhea and early syphilis than the county rates. Females ages 20-24 have the highest rates of Chlamydia, males ages 20-29 have the highest rates of Gonorrhea, and males ages 25-34 have the highest syphilis rates. Blacks/African Americans have the highest rates of these STDs.
STD Cases, Rate per 100,000 Persons, 2014 SPA 2 Los Angeles County Chlamydia 377 551 Gonorrhea 86 154 Early Syphilis (Primary/ Secondary or Early Latent) 18 26 Source: County of Los Angeles, Public Health, 2014 Annual HIV / STD Surveillance Report http://publichealth.lacounty.gov/dhsp/Reports/HIV-STDsurveillanceReport2014.pdf
Teen Sexual History 82.4% of SPA 2 teens reported that they had never had sex. This is a higher rate of abstinence than the county (78.4%), but lower than state levels (82.9%). 4.6% of teens reported that they had their first encounter before the age of 15, while 13% said it was after the age of 15. Of those youth who had sex, 59.2% said they had been tested for an STD in the past 12 months, which is higher than the rates of testing reported at the county (36.7%) and state (31.7%) levels.
Teen Sexual History SPA 2 Los Angeles County California Never Had Sex 82.4% 78.4% 82.9% First Encounter Under 15 Years Old 4.6% 10.7% 7.6% First Encounter Over 15 Years Old 13.0% 10.9% 9.5% If Had Sex, Tested for STD in Past Year 59.2% 36.7% 31.7% Source: California Health Interview Survey, 2012. http://ask.chis.ucla.edu/
Hospitalization and ER Rates At Henry Mayo, the top five primary diagnoses resulting in hospitalization are circulatory system, pregnancy, digestive system, births, and mental disorder diagnoses.
Hospitalization Rates by Principal Diagnosis for Henry Mayo Newhall Hospital Henry Mayo Percent Circulatory System 11.6% All Pregnancies 10.9% Digestive System 10.7% Births 10.0% Mental Disorders 9.0% Injuries/Poisonings/Complications 7.9% Respiratory System 7.4% Genitourinary System 5.8%
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Henry Mayo Percent Infections 5.4% Musculoskeletal System 3.5% Source: Healthy Communities Institute, California Office of Statewide Health Planning and Development, 2015. http://report.oshpd.ca.gov/?DID=PID&RID=Facility_Summary_Report_Hospital_Inpatient
A look at the ER principal diagnoses indicates that ‘symptoms’ and injuries/poisonings/complications are the top two primary diagnoses presenting at the ER, followed by respiratory system.
Emergency Room Rates by Principal Diagnosis for Henry Mayo Newhall Hospital Henry Mayo Percent Symptoms 24.4% Injuries / Poisonings / Complications 17.8% Respiratory System 11.4% Injuries / Poisonings 5.9% Genitourinary System 5.4% Digestive System 5.0% Musculoskeletal System 4.9% Nervous System 4.8% Mental Disorders 3.3% Skin Disorders 3.1% Source: Healthy Communities Institute, California Office of Statewide Health Planning and Development, 2014. http://report.oshpd.ca.gov/?DID=PID&RID=Facility_Summary_Report_Emergency_Department
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Health Behaviors
Health Behaviors Ranking The County Health Rankings database examines healthy behaviors and ranks counties according to health behavior data. California’s 58 counties are ranked from 1 (healthiest) to 58 (least healthy) based on a number of indicators that include: adult smoking, obesity, physical inactivity, excessive drinking, sexually transmitted infections, and others. A ranking of 17 puts Los Angeles County in the top 50% of California counties for health behaviors.
Health Behaviors Ranking County Ranking (out of 58) Los Angeles County 17 Source: County Health Rankings, 2015. www.countyhealthrankings.org
Overweight and Obesity 35.2% of adults, 16.5% of teens, and 8% of children in SPA 2 are overweight. Area children and teens are less likely to be overweight than found among children in the county or state.
Overweight SPA 2 Los Angeles County California Adult (18+ Years) 35.2% 35.2% 35.4% Teen (Ages 12-17) 16.5% 19.2% 17.2% Child (Under 12) 8.0% 12.7% 12.5% Source: California Health Interview Survey, 2011-2014. http://ask.chis.ucla.edu/
The Healthy People 2020 objectives for obesity are 30.5% of adults aged 20 and over, and 16.1% of teens. SPA 2 is meeting these objectives, with 22.3% of adults and 12.3% of teens obese; these rates are lower than both county and state.
Obesity SPA 2 Los Angeles County California Adult (Ages 20+ Years) 22.3% 25.9% 25.8% Teen (Ages 12-17 Years) 12.3% 14.9% 14.9% Source: California Health Interview Survey, 2011-2014. http://ask.chis.ucla.edu/
Adult overweight and obesity by race and ethnicity in SPA 2 indicate high rates among African-Americans and Latinos. Asians have the lowest rates of overweight and obesity (37.8%). In all cases, SPA 2 shows lower rates of overweight and obesity than the county and state, with a slight exception among Whites, who are over the county level, but still lower than the state.
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Adults, 20+ Years of Age, Overweight and Obesity by Race / Ethnicity
SPA 2 Los Angeles County California
African American 61.1% 75.8% 74.2% Asian 37.8% 39.3% 40.6% Latino 66.2% 72.0% 73.5% White 55.3% 55.2% 58.1% Source: California Health Interview Survey, 2011-2014. http://ask.chis.ucla.edu/
The physical fitness test (PFT) for students in California schools is the FitnessGram®. One of the components of the PFT is measurement of body composition (measured by skinfold measurement, BMI, or bioelectric impedance). Children who do not meet the “Healthy Fitness Zone” criteria for body composition are categorized as needing improvement or at health risk (overweight/obese).
In the LAUSD, almost half (49.8%) of their 5th grade population tested as needing improvement or at health risk; this is above the county and state rates. Among 9th graders the rates were generally improved; however Los Angeles Unified School District (45.6%) continued to show a higher rate of unhealthy body composition than county and state rates.
5th and 9th Graders, Body Composition, Needs Improvement + Health Risk Fifth Grade Ninth Grade Acton Agua Dulce School District 29.7% 23.0% Castaic Union School District 34.2% N/A Los Angeles Unified School District 49.8% 45.6% Newhall School District 32.2% N/A Saugus Union School District 27.0% N/A Sulphur Springs School District 34.5% N/A William S. Hart Union High School District N/A 28.4% Los Angeles County 44.0% 39.0% California 40.3% 36.0% Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, 2014-2015. http://data1.cde.ca.gov/dataquest/page2.asp?Level=District&submit1=Submit&Subject=FitTest
Fast Food Adults, ages 18-64, consume fast food at higher rates than children, 0-17. SPA 2 has lower rates of fast food consumption among both adults and children when compared to the county and state; 23.8% of adults and 14.5% of children in SPA 2 consume fast food 3 or more times a week.
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Fast Food Consumption, 3 or More Times a Week Los Angeles SPA 2 California County Adult, Aged 18-64, Fast Food Consumption 23.8% 26.8% 23.9% Children and Youth, 0-17 Years of Age, 14.5% 16.4% 14.9% Fast Food Consumption Source: California Health Interview Survey, 2011-2014.; http://ask.chis.ucla.edu/
Soda Consumption The percentage of adults who consume seven or more sodas in a week is lower in SPA 2 (6.3%) than in the county (10.2%), or the state (10.1%).
Adults Average Weekly Soda Consumption; 7 or more SPA 2 Los Angeles County California Adult Soda Consumption 6.3% 10.2% 10.1% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Fruit Consumption 55.5% of teens in SPA 2 eat two or more servings of fruit a day. Among children, 54% consume two or more servings of fruit a day.
Consumption of Fruit, Two or More Servings a Day, Children and Teens SPA 2 Los Angeles County California Children, 0 – 11 54.0% 67.6% 69.8% Teens, 12 - 17 55.5% 54.9% 56.0% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Access to Fresh Produce Among adults, 18 years and older, 91.4% in SPA 2 indicated that they can find fresh produce (fruits and vegetables) in their neighborhood usually or always, which exceeds county and state rates.
Adults who Reported Always or Usually Finding Fresh Produce in Neighborhood SPA 2 Los Angeles County California Adults, 18+ Years Old 91.4% 85.5% 86.7% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Physical Activity Only 3.5% of children and teens in SPA 2 spent over five hours in sedentary activities after school on a typical weekday, as compared to county and state youth. This trend is continued when looking at how many spend over 8 hours a day on sedentary activities on weekend days (8.7% in SPA 2 versus 25.2% at the county and 22.8% at the state level). However, 9.3% of SPA 2 teens were reported to spend no days during the week
54 Henry Mayo Hospital – Community Health Needs Assessment being physically active for at least one hour. 66% of SPA 2 teens had been to a park, playground or open space in the past month.
Physical Activity Los Angeles SPA 2 California County 5+ Hours Spent On Sedentary Activities After School On a Typical Weekday - Children and Teens 3.5% 11.2% 11.4% 8+ Hours Spent On Sedentary Activities On a Typical Weekend Day - Children and Teens 8.7% 25.2% 22.8% Teens No Physical Activity in a Typical Week 9.3% 9.4% 8.6% Teens Visited Park/Playground/Open Space in Past Month 66.0% 69.9% 71.9% Source: California Health Interview Survey, 2013-2014; http://ask.chis.ucla.edu/
Community Input – Overweight and Obesity Stakeholder interviews identified the following issues, challenges and barriers related to overweight and obesity: In Santa Clarita, we promote a healthy environment, promote walking, biking, and sports for kids. There are plenty of parks and clean restrooms. We promote a healthy lifestyle. People need knowledge about and access to healthy food choices. It costs more to eat well. We provide Farmer’s market coupons for elderly and WIC participants to encourage people to try the Farmer’s market. We have three in the area. Newhall has a matching program. If a person spends $10 the market will give them another $10 in credit to purchase. I believe that the members of the surrounding community don’t have the means to purchase healthy foods, which are more expensive. The culture is another factor that affects the health of this largely Hispanic community. Their diet consists of high carbohydrates and high fat foods. The culture plays a significant role in the behavior of most individuals as well, where most females are home tending after the children, thereby limiting their ability to participate in outdoor physical activity. Language barriers and insecurity play another role. Most people are too afraid to get out of their community to explore recreational activities and seek out resources. Kids are being exposed to vendors that sell ice cream and popcorn in the local parks. We have one vendor who parks outside our building every day. Culturally, it is more acceptable to be a bit heavy as little kids. Not enough education about having a healthy lifestyle and not always good choices on restaurant menus. If you are gluten free for instance, it is very hard to eat out and find options. Obesity goes hand-in-hand with diabetes and heart disease. We want people to have healthy lifestyles but it is often too much work or too much money to have a
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healthy lifestyle. Folks who are homeless tend to have higher rates of obesity. They do not take care of themselves, do not eat right and come into the clinic morbidly obese. Overall we have a very active community. We have lot of community pools, city building tennis courts, lot of golf courses, paseos to walk around. This is a huge issue that needs to be addressed. People are eating out more. It is very simple to cook at home but home economics classes have fallen by the wayside in school. Adults who grew up eating out all the time need to realize they can eat healthy and delicious food at home.
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Mental Health and Substance Abuse
Mental Health Among adults, 10.7% in SPA 2 experienced serious psychological distress in the past year, which was higher than county and state levels. 14.2% needed help for mental health and/or alcohol and problems, and 11.2% of adults in SPA 2 saw a health care provider for their mental health and/or alcohol and drug issues in the past year.
8.5% of adults in SPA 2 had taken a prescription medication for at least two weeks for an emotional or mental health issue in the past year, which is lower than county and state levels. Well over a third of the adults in SPA 2 (39.1%) who needed help for an emotional or mental health problem did not receive treatment, which, while better than county and state rates, does not meet the Healthy People 2020 goal. The Healthy People 2020 objective is for 64.6% of adults with a mental disorder to receive treatment, which equates to 35.4% or fewer who do not receive treatment.
Mental Health Indicators, Adults Los Angeles SPA 2 California County Adults who had Serious Psychological Distress 10.7% 9.6% 7.7% During Past Year Adults who Needed Help for Emotional-Mental and/or 14.2% 18.0% 15.9% Alcohol-Drug Issues in Past Year Adults who Saw a Health Care Provider for Emotional/Mental Health and/or Alcohol-Drug Issues 11.2% 13.0% 12.0% in Past Year Has Taken Prescription Medicine for 8.5% 9.2% 10.1% Emotional/Mental Health Issue in Past Year Sought/Needed Help but Did Not Receive Treatment 39.1% 43.2% 43.4% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
Among teens, 18.3% in SPA 2 needed help for emotional or mental health problems, which is lower than the county (19.1%) and state (19.8%) rates. Frequent mental distress was reported during the past month by 6.3% of SPA 2 teens, compared to 4.9% of county and 4.2% of state teens.
Mental Health Indicators, Teens SPA 2 Los Angeles County California Teens Who Needed Help for Emotional 18.3% 19.1% 19.8% or Mental Health Problems in Past Year Teens Who Had Serious Psychological 6.3% 4.9% 4.2% Distress During the Past Month Source: California Health Interview Survey, 2011-2014. http://ask.chis.ucla.edu/
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Community Input – Mental Health Stakeholder interviews identified the following issues, challenges and barriers related to mental health:
The challenges are medication management and lack of psychiatric care. Often booked for months, often not want to take insurance, so cash based and insurance makes it difficult to treat them. Medication clinic with 24-hour psychiatric ability would be nice to have. People run out of medications and hit the EDs and that becomes their medication management strategy, which packs up the ED. There used to be a lot of mental health treatment options in the 1980s. All agencies could get treatment, no matter what. That all dried up, now we are starting to look at this again. If money becomes available again for treatment, it would be better for people to get into month-long treatment versus just getting sober and out in 3 days again. Serious mental health issue includes not wanting to acknowledge issues and that sets up barriers to care. Kids are a challenge. There is nowhere to hospitalize them when they are a threat to themselves or others. A lot of people with mental health issues haven’t come to the attention of anyone. How did they get to that level or level of stress and not get connected to any services? It’s a gap. We are seeing an increase in community suicides. Very high suicide rate. Unusually high to the point where we wonder what is going on out there? There may not be a fabric of networked mental health professionals or people that are trained to identify the type of mental health issues and resources to send people to get the resources and get over depression, etc. With mental health, it is easy to miss it. People need to be more aware of needs and resources. For the homeless there are not enough resources or we don’t actively try to reach out to them to help them. We don’t have a facility out here. To get care they need to leave the area and they need to be close to home – that is so disruptive. There are very few providers that will see our people. It is difficult for providers to diagnosis our people. They may have mental health issues as well as developmental issues, so it’s a challenge for providers. The whole system is overwhelmed by so many people with mental health issues. We have developmentally disabled with health needs and schizophrenia, so it may mask itself for a while. We have a behavioral health unit on our campus. But it’s the only one. Sometimes the people in the most need don’t have insurance. So one of the
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needs I see is to offer treatment and diagnosis to those who are in need, without insurance. When the Sherriff brings them to the ED, they need help right away. The lack of insurance can be a barrier. We are not that far from Los Angeles. For children with psychiatric needs it is very hard to get placement. In particular, a major problem is accessing mental health treatment for children, families and adolescents. When we have to hospitalize kids, there are no beds in our community. Sometimes it takes 8-10 hours to locate an adolescent bed. We send our children to Torrance or Bakersfield which doesn’t help the family at all. The families often have very little resources and trying to be involved in their treatment and being three hours away - that is virtually impossible. If someone is really in need, we reach out to Santa Clarita health and sometimes we can get someone in fast, sometimes we can’t. Mental health needs to be addressed. There are very few of us without some trauma. We make referrals to Santa Clarita Mental Health. Challenges are clients who don’t want to go. People who have severe mental health issues, it’s hard for them to want to go or to know that to go. We have people who don’t want to get connected because of the stigma. It takes encouragement to get people to connect. Not getting care will impact their ability to move on - they aren’t getting stable. It impacts them exploring employment and housing. When they get treatment it helps them function better. Primary doctors often refuse to prescribe antidepressant medications because they don’t want to contend with mental health issues. But these are basic antidepressants that a general MD can prescribe. For someone with depression or anxiety, it’s well within their scope for primary doctors but they don’t want to deal with mental health issues. We have one of highest suicide rates in all of LA County. For awhile it was at least every week we were getting a string of reports from the Sherriff department on deaths from suicide. This is an area that needs to be focused on. For the uninsured the wait time can be pretty long or they may not get the care, often the funds have been all used up. We need more agencies in our community specifically targeting low-income, uninsured. If someone needs psychotropic medications it is challenging to find a doctor who will work with that population. We don’t have long-term facilities or places to go for help. Go to ER and get assessed and maybe temporary holding but need to be outsourced to a place out of town to deal with mental health issues. There are no facilities here to manage that. Some people being over-treated and others not treated enough. People are afraid to seek help because they don’t want to be locked up if they are having violent or weird or suicidal thoughts.
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Tobacco/Alcohol/Drug Use
Cigarette Smoking In SPA 2, 12.5% of adults smoke cigarettes, while 24.3% are former smokers; these are higher than state and county rates. The Healthy People 2020 objective for cigarette smoking among adults is 12%.
Cigarette Smoking, Adults SPA 2 Los Angeles County California
Current Smoker 12.5% 11.7% 12.2% Former Smoker 24.3% 21.4% 22.8% Never Smoked 63.2% 66.8% 64.9% Source: California Health Interview Survey, 2013-2014. http://ask.chis.ucla.edu
Among teens in SPA 2, 4.4% indicated that they had smoked an e-cigarette; this is below county and state levels.
Smoking, Teens SPA 2 Los Angeles County California
Current Cigarette Smoker 0.0% 2.3% 2.1% Ever Smoked an e-Cigarette 4.4% 11.3% 10.3% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu
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, 30.3% in SPA 2 had engaged in binge drinking in the past year, which is a lower level of binge drinking than found in the county (31.5%) and state (32.6%).
Binge Drinking, Adults SPA 2 Los Angeles County California Adult Binge Drinking Past Year 30.3% 31.5% 32.6% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/
Slightly more SPA 2 teens (27.6%) reported having tried alcohol, as compared to the county (27.3%) and state (26.4%). Among SPA 2 teens 10% reported having tried illegal drugs and 6.3% used marijuana.
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Teen Alcohol and Illegal Drug Use Los Angeles SPA 2 California County Teen Ever Had an Alcoholic Drink 27.6% 27.3% 26.4% Ever Tried Illegal Drugs, Including Marijuana, 10.0% 15.2% 13.2% Cocaine, Sniffing Glue Or Others* Use of Marijuana in Past Year* 6.3% 10.2% 9.2% Source: California Health Interview Survey, 2011-2014 & 2011-2012 (*); http://ask.chis.ucla.edu/
Community Input – Substance Abuse Stakeholder interviews identified the following issues, challenges and barriers related to substance abuse: We are in the midst of an epidemic with opioids and it’s affecting all ages. We have so many drugs for pain management and they are so addictive, people can become physically dependent after a week. A lot more kids are drinking and there is a lack of parent involvement. Average parent spends less than 10 minutes a day with kids. Social media and peer pressure much higher today. More adolescents are vaping than ever before. It was meant to help keep you from smoking but now we see kids that are vaping who would have likely never smoked. It is something we need to pay attention to. Substance abuse is a significant problem in the Valley. It’s being addressed but it is certainly a crisis that isn’t being recognized. A fairly large percentage of the homeless population has addiction problems. We don’t have substance abuse services in our community. We say we are trying to provide services, but it’s kind of empty. There really aren’t services here; you have to leave Santa Clarita Valley for substance abuse care. Substance abuse is a public health crisis here. The police have an interdiction team off the 5 freeway and we get reports on the 5 corridor about drugs or money. We have individuals who are on drugs and living out on the street because their families can’t take them anymore because they are addicted to heroin. Family gave them many chances to get off drugs, gave them help and paid for rehab but the kids continue to steal cars and money, and then they are living on the street. Rehab services are far and few between. There are simply not enough and the drug epidemic is not going away anytime soon. Need more substance abuse resources. People are willing to ignore these “throwaways of society.” The only reason there is momentum on the homelessness issue is because it’s creeping onto middle America. When it’s so pervasive we have to do something, and now we are in crisis mode – why aren’t we addressing it? Teens in Valencia are using heroin.
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This is a middle class suburban community. We need to create resources and public policy around this. We need to step in and create a solution. Among teenagers there is a lot of heroin, meth, and opiate addiction that people don’t talk about. We have only one outpatient facility and no resident facilities. To get care you will have to drive to Tarzana in the San Fernando Valley. We need to look at more providers and residential treatment providers in the Santa Clarita Valley. We have clients that are substance users and it’s a challenge to get them to follow-up with services and support that can be provided to them. Many don’t seek services and it is hard to get them into rehab programs. There is a high percentage of young people who are abusing illegal substances. They are taking their parents medications. There is a big push to try to intervene with youth and adolescents to divert them from beginning to use. Ongoing steadily increasing problem. For such a small community there is an alarming rate of these types of issues. We don’t have a detox center that is affordable or rehab that is affordable. We have one that is for people who are wealthy. They pay several thousand a month to stay in a beautiful home with a pool and a resident advisor and get linked back into the community. We need more substance abuse resources in general. Similar to mental health services, it is challenging to find service providers that will specifically target underserved populations. Drugs and alcohol are a definite problem in our schools. For several years now we are seeing heroin and prescription drugs use. Alcohol is pretty common but that is a norm in most communities. There is a huge problem with abusing pain medications and meth. People are seeking to numb some kind of pain they don’t realize that this is part of life. People do struggle. See more issues with substance abuse and depression with seniors. A lot of them are on pain medications. There are no programs to take Medi-Cal or the indigent for substance abuse and we have no ability to detox them which is typical done in a hospital bed. For adults they go to Tarzana, about 45 minutes away and adolescents go to the Tarzana in Antelope Valley, about an hour away.
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Preventive Practices
Flu and Pneumonia Vaccines Among area seniors, 89.1% in SPA 2 had received a flu shot. Seniors tend to receive flu vaccines at much higher rates than adults or children, and SPA 2 seniors meet the 70% Healthy People 2020 goal. Adults received flu shots at the lowest rate (28.3%), which was below state and county rates. Among children 6 months to 17 years of age, 48.4% received a flu shot.
Flu Vaccine Los Angeles SPA 2 California County Received Flu Vaccine, 65+ Years Old 89.1% 69.7% 72.7% Received Flu Vaccine, 18-64 28.3% 32.5% 37.4% Received Flu Vaccine, 6 Months-17 Years Old 48.4% 47.8% 53.7% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/
The Healthy People 2020 objective is for 90% of seniors to obtain a pneumonia vaccine. 65% of seniors in SPA 2 reported having obtained a pneumonia vaccine, which, while slightly higher than the 62% in county rate, does not meet the Healthy People 2020 objective.
Pneumonia Vaccine, Adults 65+ SPA 2 Los Angeles County Adults 65+, Had a Pneumonia Vaccine 65.0% 62.0% Source: Los Angeles County Health Survey, 2015. http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm
Immunization of Children Among three of the seven area school districts, rates of compliance with childhood immunizations upon entry into kindergarten are above state (92.9%) and county (91.4%) averages. Castaic Union School District has the highest rate, at 96.1%, and LAUSD has the lowest (85.6%), with the exception of William S. Hart Union High School District, which has only one school with a Kindergarten: Santa Clarita Valley International School, with a compliance rate of only 74.7%.
Up-to-Date Immunization Rates of Children Entering Kindergarten, 2015-2016 Immunization Percent Acton Agua Dulce School District 87.1% Castaic Union School District 96.1% Los Angeles Unified School District 85.6% Newhall School District 93.3% Saugus Union School District 90.1%
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Immunization Percent Sulphur Springs School District 95.1% William S. Hart Union High School District (Santa 74.7% Clarita Valley International School) Los Angeles County 91.4% California 92.9% Source: California Department of Public Health, Immunization Branch, 2015-2016. https://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx
Mammograms The Healthy People 2020 objective for mammograms is that 81.1% of women 50-74 years to have a mammogram in the past two years. In SPA 2, 77.9% of women in the target demographic have had a mammogram, which is just slightly more than the county rate of 77.3% of women aged 50-74.
Pap Smears The Healthy People 2020 objective for Pap smears in the past three years is 93% of 21- 65 year olds to be screened. In SPA 2, 88.2% of women have had a Pap smear in the past three years, which is higher than the county level of 84.4%.
Women Mammograms and Pap Smears Los Angeles SPA 2 County Women 50-74 Years, Had a Mammogram in Past Two Years 77.9% 77.3% Women 21-65; Pap Smear in Past Three Years 88.2% 84.4% Source: Los Angeles County Health Survey, 2015. http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2015.htm
Community Input – Preventive Practices Stakeholder interviews identified the following issues, challenges and barriers related to preventive practices: For substance abusers, they don’t access preventive care and don’t realize they even have an issue. I don’t know how much clients actually particulate in all those free preventive screenings. We are so discrete in what we do in Santa Clarita Valley; there are still silos versus collaborating better within our own community. Back to school immunizations fairs, screenings for health and diseases, I don’t see these resources out there anymore. We don’t have a health department in Santa Clarita Valley. Pacoima health center is the closest public service. Vaccinations revolve around the school year when kids need to enroll. Then parents will get it done. Don’t see vaccine issue as a big issue in our community. Proactive is a philosophy and a lifestyle and it requires insurance. If a person has
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access and insurance, it helps, but you also need to embrace a personal philosophy to access the services. People need to understand and be aware of preventive services. Doctors need to do a better job integrating all body systems. Quite a few issues can be caught by a thorough examination and treatment.
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Attachment 1. Community Interviewees Community input was obtained from public health professionals, representatives from organizations that represent medically underserved, low-income, or minority populations, and community residents.
Name Title Organization President and Chief Dr. Joan Aschoff Child and Family Center Executive Officer Marguerite Berg Manager of Client Services Bridge to Home Jill Lawson Bondy Immediate Past President Circle of Hope Chris Bratzel Residential Administrator LARC Ranch Human Services Supervisor Julie Calderon Newhall Community Center at City of Santa Clarita Los Angeles County Department of Pei-lin Chen Epidemiology Analyst Public Health Domestic Violence Center of Santa Linda Davies Executive Director Clarita Valley Stephanie English Community Services Liaison LA County Fire Department Christine Goulet WIC Administrator WIC County of Los Angeles Department of Mental Health Clinic Dr. Michelle Majors Mental Health Program Manager II Santa Clarita Valley Mental Health Alcoholics Anonymous Santa Clarita Valley Central Office Joann Melton Manager Alcoholics Anonymous David Zapata Boys and Girls Club of Santa Clarita Chief Executive Officer Menchaca Valley Director of Supportive SuzAnn Nelson Santa Clarita Valley Senior Center Services Health and Wellness Natalie Newton Santa Clarita Valley Senior Center Coordinator Teresa “Missy” Chief Operations Officer Northeast Valley Health Corporation Nitescu Frank Oviedo Assistant City Manager City of Santa Clarita Henry Mayo Newhall Hospital Social Kim Pointer Director Case Management Services Community Services Jeanine Prado City of Santa Clarita Administrator Henry Mayo Newhall Hospital Cary Quashen Executive Director Behavioral Health Unit Samuel Dixon Family Health Center, Philip Solomon Chief Executive Officer Inc. Kathy Sturkey Executive Director LARC Ranch Tyger White President Santa Clarita Valley Interfaith Council
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Attachment 2. Community Resources Community resources to potentially address the identified significant health needs are listed below. This is not a comprehensive list of all available resources. For additional resources refer to Think Health LA at www.thinkhealthla.org and 211 LA County at https://www.211la.org/.
Access to Care ACTION Family Counseling Bridge to Home Child and Family Center Circle of Hope Domestic Violence Center Henry Mayo Newhall Hospital Hope of the Valley Housing for Health LA County Department of Public Health LARC transportation Northeast Valley Health Corporation Providence Holy Cross Samuel Dixon Family Health Center Santa Clarita Valley Homeless Coalition Valley Care Community Consortium
Asthma Northeast Valley Health Corporation Breathe Easy Program Samuel Dixon Family Health Center
Cancer American Cancer Society Circle of Hope
Dental Care Bridge to Home Northeast Valley Health Corporation Samuel Dixon Family Health Center USC Dental School
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Diabetes American Diabetes Association Bridge to Home Henry Mayo Newhall Hospital Northeast Valley Health Corporation Samuel Dixon Family Health Center UCLA WIC
Heart Disease American Heart Association Bridge to Home Henry Mayo Newhall Hospital Northeast Valley Health Corporation Samuel Dixon Family Health Center
Mental Health
Bridge to Home Child and Family Center County of Los Angeles Department of Mental Health, Santa Clarita Valley Mental Health Northeast Valley Health Corporation Samuel Dixon Family Health Center Sheriff’s Department Tarzana Treatment Center
Overweight and Obesity
Boys and Girls Club of Santa Clarita Valley Bridge to Home City of Santa Clarita, Healthy Santa Clarita Farmer’s Markets Northeast Valley Health Corporation Samuel Dixon Family Health Center WIC
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Preventive Practices
Medical Mission Adventures Northeast Valley Health Corporation Samuel Dixon Family Health Center WIC
Substance Abuse
Alcoholics Anonymous/Narcotics Anonymous ACTION Family Counseling Action Network Henry Mayo Newhall Hospital Behavioral Health Unit Light of Hope National Council on Aging Salvation Army Santa Clarita Valley Youth Project Schools and school districts Sheriff’s Department
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Attachment 3. Impact Evaluation Henry Mayo Newhall Hospital developed and approved an Implementation Strategy to address significant health needs identified in the 2013 Community Health Needs Assessment. The Implementation Strategy addressed the following health needs through a commitment of community benefit programs and resources: access to care, cardiovascular disease, and diabetes. To accomplish the Implementation Strategy, goals were established that indicated the expected changes in the health needs as a result of community programs and activities. The following section outlines the impact made on the selected significant health needs since the completion of the 2013 CHNA.
Access to Care The Sheila R. Veloz Breast Imaging Center provides breast cancer screenings and diagnostic tests to women regardless of their ability to pay. Through the Circle of Hope, we offered referrals for financial and emotional assistance to uninsured and underinsured breast cancer patients. The breast imaging center also served uninsured and underinsured individuals over the age of 40 through the hospital’s Foundation and takes part in the state-subsidized program for women over 40 years of age. In addition, a grant from the Susan G. Komen for the Cure Foundation subsidized mammograms for symptomatic women and men who were age 40 and under. Henry Mayo provided available financial assistance to qualified patients. In FY13, FY 14 and FY15, Henry Mayo contributed over $30 million in charity care for patients who did not have health care coverage.
Cardiovascular Disease The hospital offered quarterly Care for Your Heart health screenings, which included cholesterol and glucose tests, blood pressure monitoring, height and weight analysis, body fat and BMI measurement, oxygen saturation and carbon monoxide measurement, and heart risk assessments. Henry Mayo nurses shared information about warning signs, symptoms of stroke and the importance of a healthy diet and exercise to reduce risk factors at the Care for Your Heart health screenings. Spanish language materials and translators were available. Since 2013, over 2,000 area residents took advantage of these free screenings. CPR classes were offered in partnership with Superior Life Support. Approved by the American Heart Association, the Family & Friends CPR program is designed to educate participants on how to recognize and care for an adult or child who is choking and how to perform CPR. In the past three years, 265 persons received CPR training. Community health education was offered at various senior centers and health
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fairs on topics related to heart health, nutrition, warning signs of strokes and other related topics. Henry Mayo hosted a monthly stroke support group, which yielded an average of 10 attendees per session. Carotid artery screenings were provided at quarterly health fairs, which reached over 800 persons in 2015. These screenings were also offered at the Annual Senior Years Expo, where 222 persons were screened in 2015 The hospital implemented a sponsorship of American Heart Association community awareness programs and events and participated in the 2015 Heart Walk. 85 people visited the hospital booth and received education on nutrition and cardiac risk factors. Henry Mayo partnered with the Santa Clarita Valley Senior Center to provide stroke education to seniors. Over 50 seniors received this education. At the Santa Clarita Valley Celebrate Life Festival, 125 persons received carotid artery screening and 47 persons received stroke education. In March 2014, Henry Mayo participated in the Summerhill Villa Health Fair, where 37 people visited our booth and were educated about the signs and symptoms of stroke.
Diabetes The hospital provided community health education on topics related to diabetes management, nutrition, prevention and other related topics. Henry Mayo promoted healthy lifestyles and health care services available in the community through participation in Health and Wellness Fairs. 106 persons received blood glucose screenings at the Santa Clarita Valley Celebrate Life Festival. The hospital partnered with community organizations to address diabetes self- management. Henry Mayo sponsored American Diabetes Association community awareness events. Smoking is a known contributor to diabetes. The hospital provided 57 persons with smoking cessation screening and information on strategies to stop smoking. Henry Mayo participated annually in the Diabetes Walk, where Henry Mayo nurses provided 68 glucose screenings and 15 foot exams, and 70 families received health information on diabetes prevention. In FY15, Henry Mayo participated in the Val Verde Health Fair and Back to school event where staff and a nutritionist were present to educate kids about eating healthy and reducing sugar intake. Kids volunteered to take an exercise pledge. We reached 32 participants.
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