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IMPACT MONTEREY

COUNTYSecondary Data Report:

HEALTH

Ignacio A. Navarro Ph.D.Kim Judson Dr.PH.Institute for Community Collaborative StudiesCalifornia State University Monterey Bay

Introduction

Impact Monterey County

Community Stakeholders & Partners

Public

Health Community

Advocacy

Groups

CSUMB/ICCS

Researchers

Transportation

Faith

Community

Health &

Medical Groups

Social

Services

Media

Colleges &

Universities

City

Planners

Public

Safety

Parks &

Recreation

Elected Officials

Employers &

Business

LeadersEarly Care &

Education

Providers

K-12 Schools

Arts

Community

Behavioral

Health

Community

Health

Clinics

Hospitals

Tribal Leaders

Nonprofit

Organizations

Community

Leaders

2

Foundations

Collective Impact Relationships

3

Monterey County

Residents

Community Stakeholder

Groups

Impact MC Steering Committee

Data, Research & Analysis

Team

ICCS

Researchers

Data, Research & Analysis Team Organizations

4

• Cal State University Monterey Bay

• Community Foundation for Monterey County

• Community Volunteer

• CTB-McGraw Hill

• First 5 Monterey

• Grower-Shipper Association of Central CA

• Head Start Monterey County

• Monterey County Board of Supervisors’ representative

• Monterey County Department of Social Services

• Monterey County Health Department

• Middlebury Institute of International Studies at Monterey

• Naval Postgraduate School

• United Way of Monterey County

Data Analysis & Research Pre-Planning Phase

5

Oct2013-Jan2014

Collection & initial analysis of secondary data to identify themes for Aspirations Survey question development

Feb-June 2014

Selection of

indicators by

DataTeam for

analysis &

development of

Aspirations

Survey

questions

July-Dec 2014 Collection of Aspirations Survey data & analysis of selected indicators (available secondary data)

Jan-Apr 2015

Presentation of

secondary data

analysis &

Aspirations

Survey findings

Apr – May 2015 Final

report: “What are

residents’ aspirations

to improve life (for

education, health &

income) in Monterey

County?

Data Research & Analysis Team Oversight

Impact Monterey County Cycle

6

ICCS Final Report of Findings

Engage Community

around Findings

Community Goal Setting: Data

informs planning to develop Impact

Activities

Establish shared metrics (indicators,

measurement & approach)

Establish process to learn and

improve

Collect data, track results, evaluate

and report progress

Reflect and adapt and decide next

steps

Purpose of the Secondary Data Analysis

7

• What the secondary data analysis report does:

related to indicators selected by IMC Data

Research & Analysis Team

– Provides assessment of indicators as a

from population studies for analysis of primary

data (Aspirations Survey)

– Provides a from which IMC Stakeholders can

for each area of

interest – Education, Income, Health

Purpose of the Secondary Data Analysis

8

• What the secondary data analysis report do:

– Does not provide analysis of a of

indicators.

– Does not provide for all

indicators as this varies depending upon the availability of

data sets in Fall 2013 – Spring 2014.

– Does not that

delivers services related to Impact Monterey County’s areas

of interest (Education, Health or Income)

Secondary data presentation

HEALTH

9

• Third area of three – Education, Income, Health

• Review of HLTH indicators and what lies behind them, i.e., demographic dimensions*

• Analysis provides context for future discussions about which indicators to focus on for collective impact efforts

• * Health data sets did not include sub-county geographic distribution.

IMPACT MONTEREY COUNTYSecondary Data Report


Health

10

Background

11

Health Indicators selected based upon:

– Existing California Health Interview Survey (CHIS)* data and MCHD Community Health Assessment and other Monterey County reports

– Most significant differences compared with state and US data**

– Initial selections determined with IMC Data Committee (DC) for Aspirations Survey

– Final selections by DC with feedback from IMC Steering Committee (SC)

(Note: Health data was not available on a sub-county, i.e., district or zip code level for this report.)

*The California Health Interview Survey (CHIS) is the largest state health survey in the nation. Data for this study came from the 2011-12 CHIS survey of 512 adults (>18 years old) in Monterey County using a telephone survey employing a dual-frame random-digit-dial technique (both landline and cellular sampling frames). Note: Data is Pre-Affordable Care Act http://healthpolicy.ucla.edu/chis/Pages/default.aspx** For slides where data is available and applicable, boxes are included with comparison statistics for Monterey County (MC),California (CA), United States (US), Monterey County Health Department Community Health Improvement Plan (CHIP target), and U.S. Department of Health and Human Services Healthy People 2020 (2020 target).

BackgroundDemographic Variables: (Vary depending upon dataset)

• Ethnicity – CHIS & MCHD Dataset

• Latino

• White (non-Latino: NL)

• African American (NL)

• American -Indian/Alaska Native (NL)

• Asian (NL)

• Native Hawaiian/Pacific Islander (NL)

• Two or More Races (NL)

– MCHD via CHIS Dataset

• Latino

• White

• Other

• Gender – CHIS & MCHD datasets

• Male

• Female

• Income Levels*– CHIS Dataset

• 0-99% FPL*

• 100-199% FPL

• 200-299% FPL

• 300% FPL

– MCHD via CHIS Dataset

• INC <=138% FPL

• 138%<INC<=400% FPL

• INC>400% FPL

12*Federal Poverty Level (FPL) – A measure of income level issued annually by the Department of Health and Human Services and used to determine eligibility for certain programs and benefits. The Affordable Care Act has established three FPL thresholds used for calculating eligibility for Medicaid (MediCal) and other subsidized health insurance. Please see Appendix for FPL Income Guidelines. https://www.healthcare.gov/glossary/federal-poverty-level-FPL.

https://www.healthcare.gov/glossary/federal-poverty-level-FPL

BackgroundDemographic Variables: (Vary depending upon dataset)

• Age (varies by indicator)– CHIS dataset

• Child (0-11)

• Adolescent (12-17)

• Adult (18-64)

• Senior (65+)

– MCHD via CHIS dataset

• 19-29 years

• 30-49 years

• 50-64 years

• 65+ years

• Immigration Status – MCHD/CHIS dataset

• U.S. Born citizen

• Naturalized citizen

• Non-citizen (LPR/VISA & Undocumented)

13

Communicable Diseases

Nutrition, Physical Activity, and Obesity

Behavioral Health

Overview of

Health

Indicators

Maternal, Infant, and Child Health

Injury and Violence

Chronic Diseases

Overweight/Obese adults and adolescents

Suicides ~ Drug-related deaths ~ Teens & adults

reporting binge drinking in past month

Blood Pressure ~ Heart Disease ~

Diabetes

Access to Health Services

Health Status

Usual source of care/MD Visits

Health Insurance ~Cost of care

Language Barriers

Online Health Information

Unintentional Injury Mortality rates ~

Homicides ~ Domestic Violence

Prenatal Care ~ Teen Pregnancy (Births)

Newly reported HIV/AIDS cases ~ Pertussis infection

rates

14

Access to Health Services• Indicators:

1. Health status

2. Usual source of care

3. Emergency Room visits

4. Doctor visits

5. Health insurance

6. Language Barriers

7. Online Health Information

• Data Sources:– California Health Interview Survey (CHIS), 2010-2012

– HealthyPeople.gov, 2014

– Monterey County Health Department Community Health Improvement Plan (CHIP), 2014

16


17

22.0%

28.0%

14.6%

43.1%

33.2%

30.3%

16.3%

12.7%

18.5%

34.9%

50.1%

32.1%

29.7%

24.7%

10.6%

35.9%

23.3%

12.4%

38.7%

10.7%

26.9%

32.6%

36.3%

18.1%

10.2%

22.9%

11.3%

10.4%

14.5%

32.8%

5.4%

3.6%

12.7%

2.8%

11.8%

7.6%

0% 50% 100%

Latino

White (non-latino)

African American (non-latino)

American-Indian/Alaska Native (non-latino)

Asian (non-latino)

U.S. Born

Naturalized

Non-citizen

RA

CE/

ETH

NIC

ITY

IMM

IGR

ATI

ON

Resident health status by Immigration status and Race/ethnicity, CHIS 2011-12

Excellent Very good Good Fair Poor

CA USMC 2020 TargetCHIP Target


27.618

14.3

^ Usual Source of Care - Is there a place that you usually go to when you are sick or need advice about your health?* LPR/VISA= Legal Permanent Residents/VISA recipient* *Undocumented Calculated by ICCS, not CHIS. Methodology in final report

27.6%22.4%19.7%31.6%

52.7% 48.8%23% 18.1%

11.3%

43.6%29.6%

14.0%

39.6%19.6%

20.7%

0%

50%

100%

Mo

nte

rey

Co

un

ty

US

Bo

rn

Nat

ura

lized

LPR

/VIS

A*

Un

do

cum

ente

d*

*

19

-29

yea

rs

30

-49

yea

rs

50

-64

yea

rs

65

+ y

ears

INC

<=

13

8%

FP

L

13

8%

<IN

C<

=40

0%

FP

L

INC

>40

0%

FP

L

Lati

no

Wh

ite

Oth

er

IMMIGRATION AGE POVERTY LEVEL RACE/ETHNICITY

No usual source of care^ by Immigration Status, Age, Race/Ethnicity and Poverty, CHIS 2011-12

13.6 55


19

(Note: Although there are no Kaiser facilities is MC, CHIS data is including Kaiser/HMO)Data less than 2% were not highlighted in graph.* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report*** Other= Some other place or Complementary and Alternative Medicine

59.3%73.9%

32.3%33.3%

47.3%46.6%

44.8%73.1%

78.3%38.3%

61.9%67.3%

35.7%74.2%

64.3%

38.4%23.4%

64.8%66.7%

52.1%52.8%

49.7%26.1%

20.9%56.2%

36.5%31.3%

63.7%20.8%

35.7%

2.9%2.1%

3.7%

3.8%

3%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

IC

ITY

MD Office/Kaiser/HMO Health Center/Gov't or Hosp Clinic ER Other***

For those with a usual source of care, kind of place by Immigration Status, Age, Race/Ethnicity and Poverty, CHIS 2011-12


20^ Usual Source of Care - Is there a place that you usually go to when you are sick or need advice about your health?(Note: Although there are no Kaiser facilities in MC, CHIS data includes Kaiser/HMO)

14.1%

19%

42.5%

7.6%

10.1%

20%

24.3%

11.5%

85.9%

81%

57.5%

92.4%

89.9%

80%

75.7%

88.5%

0% 50% 100%

MD Office/Kaiser/HMO

Health Center/Gov't or Hosp. Clinic

Some Other Place

No Usual Source of Care

Uninsured

Medicare & Others

Medicaid/Healthy Families

Private/Employment

USU

AL

SOU

RC

E O

FC

AR

EIN

SUR

AN

CE

TYP

E

Monterey County: Ever visited emergency room for own health in past 12 months, by Usual Source of Care^ and

Insurance Type, CHIS 2011-12

YES NO


21

Data (for 7-12 times) collected in CHIS, but no MC respondents in sample fell into these categories.Data less than 2% were not highlighted in graph.* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

87.7%86.1%

80.4%100%

95.4%100%

95.8%70.2%

84.2%96.2%

86.1%82.1%

99.0%76.6%

98.3%

10.6%

11.4%

19.6%

4.6%

4.2%

25.3%

13.6

3.8

13.9%

13.4%

20.1%

2.5%

4.6%2.2%

4.5%

3.4%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Number of times visited ER in past year by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

0-2 times 3-6 times 13+ times


55.3/32.3/4.522


Data (for 7-12 times) collected in CHIS, but no MC respondents in sample fell into these categories.Data less than 2% were not highlighted in graph.* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

57.6/30.2/4.2

55.3%49.8%51.5%

68.7%71.2%

77.7%61.2%

36.5%30%

66.4%50.7%51.4%

62.2%50.8%

50.9%

32.3%34%

39.5%25.1%

22.7%15%

32.2%39.7%

53.7%25.1%

36.7%33.5%

28.1%32.8%38.8%

4.5%5.7%4.3%3.5%1.2%2.6%2.3%

8.8%6%

5.2%5.9%3.6%

6.2%3.2%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Number of doctor visits by, Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12 0-2 times 3-6 times 13+ times

NA NANA


24.7 17.723


* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

NA

24.7%18.1%

10.5%

44.2%52.5%

35.7% 30.2%18.7%

2.7%

45%

23.6%10.8%

36.1%

19.4% 14.1%

0%

50%

100%

Mo

nte

rey

Co

un

ty

US

Bo

rn

Nat

ura

lized

LPR

/VIS

A*

Un

do

cum

ente

d**

19

-29

yea

rs

30

-49

yea

rs

50

-64

yea

rs

65

+ ye

ars

INC

<=

13

8%

FP

L

13

8%

<IN

C<=

40

0%

FP

L

INC

>40

0%

FP

L

Lati

no

Wh

ite

Oth

er

IMMIGRATION AGE POVERTY LEVEL RACE/ETHNICITY

Zero doctor visits in past year by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

NANA

.


24

About 1/3 of respondents sought an appointment with a doctor in 2-days in past year, except LPR/VISA @ 13.7%.* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

7.5%5.4%

12.1%20.6%

9.2%9%

5.7%8.9%

6.1%

13.7%

8.2%7.3%7.3%

15%13.2%

31%

7.9%14%21.7%

10.8%12.8%

28.3%14.5%

9.4%11%

13.3%21%

16.4%17.5%

9.5%

25.8%9.7%

12.7%16%

31.6%2.9%

15.9%22.8%

13.2%19.0%

15%

61.1%63.9%

47.5%79.4%

57.1%67.2%

59.9%64.2%

49.5%56.1%55.9%

66.6%67.6%

60.4%56.7%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

STA

TUS

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

How often respondent got an appointment in 2 days in past year by Immigration, Age, Poverty Level, Race/Ethnicity, CHIS 2011-12

Never Sometimes Usually Always

.


25

^ Usual Source of Care - Is there a place that you usually go to when you are sick or need advice about your health?(Note: Although there are no Kaiser facilities is MC, CHIS data is including Kaiser/HMO)

6.0%

4.1%

14.6%

42.7%

4.2%

13.4%

2.5%

7.3%

15.2%

17.6%

5.6%

4.9%

17%

12.9%

41.1%

9.5%

18.5%

8.2%

35.2%

6.2%

26.7%

16%

15.4%

60.3%

70.2%

79.8%

17.2%

72.6%

47%

40.4%

67.8%



Some Other Place


Uninsured

Medicare & Others


Private/Employment

USU

AL

SOU

RC

E O

FC

AR

EIN

SUR

AN

CE

How often respondent got an appointment in 2 days in past year by Usual Source of Care^ and Insurance Type, CHIS 2011-12

Never Sometimes Usually Always


21.3 16.836.8

Over 65 not included due to MediCare coverageCounty, State, and US stats based on Uninsured All and part year & excludes 65+ years* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

26


23.5%15.6%

12.8%26.0%

54.8%27%

25.8%15.9%

38.8%26.3%

6.8%30.3%

13.1%24.5%

13.3%12%

11.2%23.3%

13.2%21.8%

10.6%6%

12.8%24.5%

15.5%12.9%

9.9%

63.2%72.4%76%

50.7%32.1%

51.2%63.7%

78.1%

48.3%49.2%

91.5%54.2%

73.9%65.6%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

IC

ITY

Insurance status in past 12 months by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

Uninsured All Year Uninsured Part Year Insured All Year

00


27

23.8%

3.2%

13.2%

1.7%

7.8%

45.1%

3.5%

1.7%

0% 50%

Uninsured

Medicare & Medicaid

Medicare & Others

Medicare Only

Medicaid

Employment Based

Privately Purchased

Healthy Families/Other Public

Monterey County: Type of current health insurance coverage (18+ years) CHIS 2011-12


28Data less than 2% were not highlighted in graph* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report.

23.8%15.1%

19.6%26.0%

58.0%34.0%31.2%

17.7%

41.0%29.8%

5.4%36.4%

10.7%23.9%

13.2%18.6%11.8%

3%

79.0%5.5

10.8%21.0%

25.5%10.7%

7.8%4.6%

6.6%34.3%

5.4%14.1%

10.7%

18.8%7.5%

13.9%

7.8%

45.1%49.7%

47.9%34.5%31.6%

45.1%51.3%

67.3%

24.3%43.1%

62.2%40.9%

48.0%47.3%

10.2%7%

13.3%12.0%14.1%

5.2%

6.7%6.8%

12.8%18.8%

10.4%8.7%

11.4%6%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Uninsured Medicare & Others Medicaid Employment-Based Other

Top 4: Type of current health coverage (18-64 years), by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12


29

0.2%

0.5%

0.6%

1.4%

2.0%

2.3%

2.4%

2.9%

3.0%

7.0%

14.8%

26.2%

36.6%

0% 50%

Thought was Insured

No Need- General

Other

Health Insurance Was Canceled/Was Dropped

Can Get Healthcare For Free/Pay For Own

Procrastination/Hans't Taken Steps To Get

Don't Know Where Or How to Get Insurance

Don't Believe in Insurance

Not Eligible Due To Health Or Other Problem

Can't Qualify For Public Program Coverage

Not Eligible Due To Citizenship/Immigration Status

Not Eligible Due To Working Status

Can't Afford/Too Expensive

Monterey County: Reason for being uninsured (all year/part year) in past 12 months, CHIS 2011-12

Data less than 4% were not highlighted in graph.Over 65 not included due to MediCare coverage* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report


30

36.6%43%

55.3%31.7%

24.8%19.2%

48.8%59.4%

31.6%38.9%

48.3%24.0%

53.7%50.5%

26.2%32.9%

39.8%46.8%

4.7%30.8%

20.8%25.2%

14.1%36.6%

23.7%27%

33.9%16.4%

14.8%

43.6%

21.4%

11.3%

25.2%

8.5%

25.2%

7%

11.4%

4.2%

5.4%

11.8%

10.3%

10.2%

6.8

10.7%

6.7%

4.4%

12.4%

9.6%

4.9%

10.6%

19%

13.8%

12.6%

8.1%

15%

9.4%

17.7%

12.5%

6.1%

18.4%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Can't Afford/Too Expensive Not Eligible Due To Working Status

Not Eligible Due To Citizenship/Immigration Status Can't Qualify For Public Program Coverage

Not Eligible Due To Health Or Other Problem Other

Top 5 reasons for uninsured (all & part year) in past 12 months, by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

Language Barriers in Monterey County

• 55.4% of Monterey County residents were identified to be

of Hispanic or Latino origin (US Census, 2010).

• More than 50% of households in Monterey County are

reported to speak a language other than English at home,

compared with 43% for California (US Census, 2010).

• Close to half of Monterey County residents speak English

‘not very well’ or ‘not at all’ (44.1%) compared with 35.2%

for California (CHIS, 2012)

3131



32

^ For those who visited a doctor in past 12-months* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

3.7%

2.1%

4.1%

3.2%

10.9%

0.6%

8.4%

2.5%

1.9%

4.1%

6.1%

1.2%

3.9%

2.8%

4.8%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Reported hard time understanding doctor during last visit, by Immigration, Age, Poverty Level,

Race/ethnicity, CHIS 2011-12^

80.9%61.3%100%100%83.6%

100%37.1%60.4%77.3%87.0%59.4%74.2%69.8%100%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

IC

ITY

Of those reporting hard time understanding doctor during last visit (n=9,042): Hard Time Understanding Doctor Because of Language Spoken, by Immigration,

Age, Poverty Level, Race/ethnicity, CHIS 2011-12^

0%


33

13.3%3.5%

12.8%39.5%

56%

24.3%17.5%

21.5%13.3%

25.2%0.8%

13.8%2.3%

18.5%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

STA

TUS

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Reported needing someone else to help understand doctor, by Immigration, Age, Poverty Level,

Race/ethnicity, CHIS 2011-12


0%


34

13.7%

11.4%

15.3%

11.6%

27.5%

6.9%

12.3%

0% 50%



Some Other Place


Uninsured

Medicare & Others


Private/Employment

USU

AL

SOU

RC

E O

FC

AR

EIN

SUR

AN

CE

Reported needing someone else to help understand doctor, by Usual Source of Care and Insurance Type, CHIS 2011-12

0%


35

No data available for age 19-29 years.Data less than 3% were not highlighted in graph.* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

3.3%

9.8%

16.2%

4.4%

8.2%

41.2%100%

46.8%19.0%

26.8%

38.2%19.9%

76.1%19.7%

49.1%

57.9%100%

13.8%

46.9%

36.2%81%

52.6%

51.8%63.9%

10.5%53.1%

46.5%

31.2%

72.1%

6.2%

20.6%

10%

27.2%

10.9%

7.2%

13.5%

100%

6%

Monterey CountyUS Born

NaturalizedLPR/VISA*

Undocumented**19-29 years30-49 years50-64 years

65+ yearsINC <=138% FPL

138%<INC<=400% FPLINC>400% FPL

LatinoWhiteOther

IMM

IGR

ATI

ON

STA

TUS

AG

EP

OV

ERT

Y LE

VEL

RA

CE/

ETH

NIC

ITY

Who helped you understand doctor during last visit, by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

Minor Child (Under age 18) Adult Family Member or Frield of MineMedical Staff Including Nurses / Docs Prof. Interpreter (Person/Phone)Other (Patients, Someone Else)


36


75.9%87.5%

68%63.2%

51.2%88.9%

79.3%69.2%

55%62%

71.4%90.4%

70%84.6%

71.9%

24.1%12.5%

32%36.8%

48.8%11.1%

20.7%30.8%

45%38%

28.6%9.6%

30%15.4%

28.1%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

STA

TUS

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Ever used the internet, by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

Yes No


37

62.2%71.3%

54.2%63.3%

18.1%54.4%

65.7%76.0%

50.8%51.1%

59.7%69.5%

42.3%73.2%73.6%

37.8%28.7%

45.8%36.7%

81.9%45.6%

34.3%24%

49.2%48.9%

40.3%30.5%

57.7%26.8%26.4%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

STA

TUS

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Used internet to find medical information in past 12 months, by Immigration, Age, Poverty Level,

Race/ethnicity, CHIS 2011-12 Yes No



38

Data less than 3% not highlighted in graph* LPR/VISA= Legal Permanent Residents/VISA recipient**Undocumented Calculated by ICCS, not CHIS. Methodology in final report

67.6%75.9%

70.2%55.6%

22.2%60.1%

71.1%78.1%

61.3%42.6%

61.2%84.9%

48.4%80.6%

74.1%

18.7%15.4%

18.9%27.3%

32.2%20.9%

21.3%12%

17.3%23.1%

26.9%10.3%

26.0%12.6%

18.3%

11.9%7%

6.8%17.1%

45.5%19.1%

7.6%5.3%

14.6%34.%1

8%3.8%

24.7%3.9%6.5%

4%

4.66.8%

4%

0% 50% 100%

Monterey County

US Born

Naturalized

LPR/VISA*

Undocumented**

19-29 years

30-49 years

50-64 years

65+ years

INC <=138% FPL

138%<INC<=400% FPL

INC>400% FPL

Latino

White

Other

IMM

IGR

ATI

ON

STA

TUS

AG

EP

OV

ERTY

LEV

ELR

AC

E/ET

HN

ICIT

Y

Very Confident Somewhat Confident Not Too Confident Not At All Confident

Confidence completing an application online, by Immigration, Age, Poverty Level, Race/ethnicity, CHIS 2011-12

Access to Health Services ~ Moving Forward

39

• Establish a systematic approach to data collection, analysis and

reporting.

• Select (and prioritize) important variables that contribute to

improved health outcomes to study on a periodic basis.

• Partner with Central Coast Alliance for Health to collaborate

on (MediCal) provider and patient data analysis directed at

improving the system’s ability to address selected population

health issues.

• Conduct periodic data collection of all health care service

providers throughout the County and explore contributions to

improvements in health status.

Chronic Disease

• Indicator:– Blood Pressure

– Heart Disease

– Diabetes

Data Source:

– California Health Interview Survey (CHIS), 2010-2012


– Monterey County Health Department Community Health Improvement Plan (CHIP), 2014

41


Chronic Disease: High Blood Pressure

27.2 29

30.4% 25.9%

0%

50%

100%

Male Female

Blood pressure: Ever diagnosed with high blood pressure by

Gender, CHIS 2011-12

24.1%32.9%

21.2%*

64.9%*

34.3%*

-

19.6%*

0.0%

50.0%

100.0%

Blood pressure: Ever diagnosed with high blood pressure by Race/ethnicity, CHIS 2011-12

- (hyphen) Estimate is less than 500 people* Statistically unstable, interpret with caution

4228.1 NANA


Chronic Disease: High Blood Pressure

-11.7%

38.0%

58.7%66.9%*

0%

50%

100%

Adult 18-24 years

Adult 25-39 years

Adult 40-64 years

Senior 65-79 years

Senior 80+years

Blood pressure: Ever diagnosed with high blood pressure by ‘adult’ age, CHIS 2011-12

4327.228.1


NA29NA


Chronic Disease: Heart Disease

5.0%*11.6%

- -3.8%* - -

0%

50%

Heart disease: Ever diagnosed with heart disease by

Race/ethnicity, CHIS 2011-12

3.0%*8.2%

15.7%

35.5%

0%

50%

Adult 18-24

Adult 25-39

Adult 40-64

Senior 65-79

Heart disease: Ever diagnosed with heart

disease by Age , CHIS 2011-12

6.344

7.5


NA

7.1%

12.5%

4.6%

0%

50%

U.S. Borncitizen

Naturalizedcitizen

Non-citizen

Heart disease: Ever diagnosed with heart

disease by Immigration Status, CHIS 2011-12

NAImprove baseline


Chronic Disease: Diabetes

9.8% 8.7%- -

19.0%*

- -0.0%

50.0%

100.0%

Diabetes: Ever diagnosed with diabetes by Race/ethnicity, CHIS 2011-12

8.4

- (hyphen) = Estimate is less than 500 people* Statistically unstable, interpret with caution

459.7 NA

6.5%

18.0%*11.1%*

0%

50%

100%

U.S. Borncitizen

Naturalizedcitizen

Non-citizen

Diabetes: Ever diagnosed with diabetesby Immigration Status, CHIS 2011-12

NA7.2/1,000


Chronic Disease: Diabetes

8.4

- - 7.3%* 14.7%0%

50%

100%

Child (0-11) Adolescent (12-17) Adult (18-64) Senior (65+)

Diabetes: Ever diagnosed with diabetes by Age, CHIS 2011-12

Type I diabetes

11%Type II

diabetes89%

Type of diabetes: Type I or Type I, CHIS 2011-12


469.7 NA NA7.2/1,000

Injury and Violence

• Indicators:

– Unintentional Injury Mortality rates*

– Homicides

• Data Source:



– Monterey County Health Department:

• Community Health Assessment, 2013

• Community Health Improvement Plan (CHIP), 2014

48

* Deaths caused by injuries where there is no evidence of predetermined intent, e.g., car accidents , suffocation, poisoning., and falls.


Injury and Violence

30.5

29.4

0

5

10

15

20

25

30

35

40

45

50

Rat

e p

er

10

0,0

00

Age-adjusted Unintentional Mortality rate per 100,000 by Race/ethnicity, MCHD 1999-2010

Asian/Pacific Islander (nH) Black (nH)

Hispanic/Latino, any race Multiple/Other races (nH)

White (nH) Monterey County

10

15

20

25

30

35

40

45

50

Age-adjusted unintentional mortality rates per 100,00 by gender, MCHD 2013

Male Female

26.9 40.4

Source: California Department of Public Health, statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit.

4929.4 36.4Improve baseline


Injury and Violence

Graph Source: Monterey County Health Department 2013 Community Assessment* Statistically unstable, some data years suppressed to preserve confidentiality, e.g. 99-01, 00-02, 02-03, 06-10.** Statistically unstable, interpret with caution

26.950

29.4

30.529.4

0

10

20

30

40

50

60

70

80

90

100

rate

pe

r 1

00

,00

0

Unintentional mortality rate per 100,000 by Age, MCHD 1999-2010

<1 year *

1 to 14 years**

15 to 24 years

25 to 44 years

45 to 64 years

65+ years

Monterey County

40.4 36.4Improve baseline


Injury and Violence

10.2 6.1

Graph Source: Monterey County Health Department 2013 Community AssessmentData for 1to 14 years is suppressed to preserve confidentiality* Statistically unstable, interpret with caution

515.3

5.110.2

0

25

50

2005-07 2006-08 2007-09 2008-10R

ate

pe

r 1

00

,00

0

Age-adjusted homicide rate per 100,000 by Race/ethnicity, MCHD

2005-2010

Asian/Pacific Islander (nH) * Black (nH)*

Hispanic/Latino, any race* Multiple/Other races (nH)*

White (nH) * Monterey County

5.110.2

0

25

50

2005-07 2006-08 2007-09 2008-10

Rat

e p

er

10

0,0

00

Homicide rates per 100,000 by Age, MCHD 2005-2010

1 to 14 years* 15 to 24 years*

25 to 44 years 45 to 64 years

Monterey County

5.55.5

CA USMC 2020 TargetMC Target

Injury and Violence

52

Domestic Violence (CHIS, 2009)

9.0%

18.4%

0%

50%

Male Female

Ever experienced physical or sexual violence by an intimate partner since age 18 by gender,

CHIS 2009

14.4% 15.5%

- -8.1%

- -0%

50%

Ever experienced physical or sexual violence by an intimate partner since age 18 by Race/ethnicity, CHIS 2009


15.6%

7.8%

13.9%

0%

50%

U.S. Borncitizen

Naturalizedcitizen

Non-citizen

Ever experienced physical or sexual violence by an intimate partner

since age 18 by Immigration Status, CHIS 2009

1.9 NA3.5 NANA

Maternal, Infant and Children

54

• Indicator:

– Prenatal Care

– Teen Pregnancy (Births)

• Data Source:







78.4

74.6

50

60

70

80

90

100

2005-07 2006-08 2007-09 2008-10

Rat

e p

er

10

0

Entry into prenatal care in first trimester per 100 population by mother’s age, MCHD 2005-2010

17 years and less 18 to 24 years

25 to 34 years 35+ years

Monterey County

78.4

74.6

50

60

70

80

90

100

2005-07 2006-08 2007-09 2008-10R

ate

pe

r 1

00

Entry into prenatal care in first trimester per 100 population by mother’s race/ethnicity, MCHD 2005-2010




83.5 per 100 70.8%

Source: California Department of Public Health, Health Information and Research Section, Birth Statistical Master File 1999-2010; statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit.

5574.6 per 100 77.9%NA



29.4 40.256

Graph Source: Monterey County Health Department 2013 Community Assessment

52.5

11.2 12 9.3 9

29.8 32.2 35.6 39.2

79.775.4

71.566.2

22.2 22 20.2 21.316.3 17.4 17.5 18.2

57.2 56.1 54.852.5

0

50

100

2005-07 2006-08 2007-09 2008-10

2005-10 Birth rates to teen mothers (age 15 to 19) per 1,000 population by mother’s race/ethnicity, MCHD 2005-2010

Asian/Pacific Islander (nH) Black (nH) Hispanic/Latino, any race

Multiple/Other races (nH) White (nH) Monterey County

36.2Improve baseline

CA USMC 2020 TargetCHIP Target57


29.4 40.2

Graph Source: Monterey County Health Department 2013 Community Assessment

52.5

13 13.5 13.1 12.5

129.7

127.2120.7 111.6129.5

130.3 129.3125.6

24.6 24.4 24.6 24.7

0

50

100

150

2005-07 2006-08 2007-09 2008-10

2005-10 Birth rates per 1,000 population by mother’s age, MCHD 2005-2010

17 years and less 18 to 24 years 25 to 34 years 35+ years

36.2Improve baseline

Behavioral Health

59

• Indicators:– Drug-related Deaths

– Suicides

– Teens who reported binge* drinking in past month

– Adults who reported binge* drinking in past month

– Data Sources:



– Monterey County Health Department:• Community Health Assessment, 2013


• Binge drinking can be defined as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above.


Behavioral Health

9.6

0

5

10

15

20

25

rate

pe

r 1

00

,00

0



White (nH)* Monterey County

Age-adjusted accidental poisoning/ unintentional drug-related mortality rates per

100,000 by race/ethnicity, MCHD 2008-10

9.6

0

5

10

15

20

25

rate

pe

r 1

00

,00

0

Male Female Monterey County

Age-adjusted accidental poisoning/unintentional drug-related mortality rates per 100,000 by gender, MCHD

2008-10

8.7 13.2

Drug-related Deaths (Overdose)

Source: California Department of Public Health, statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit.* Data statistically unstable for this category


609.6 Baseline

(13.2)NA


Behavioral HealthSuicides

10.1

0

5

10

15

20

25

rate

pe

r 1

00

,00

0

Suicide rates per 100,000 by age, MCHD 1999-2010

15 to 24 years* 25 to 44 years 45 to 64 years 65+ years* Monterey County

14.0 11.3

Source: California Department of Public Health, statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit.* Statistically unstable, interpret with caution

6110.1 10.2NA


Behavioral HealthSuicides

14.0 11.3

7.110.1

0

5

10

15

20

25

rate

pe

r 1

00

,00

0

Age-adjusted suicide rates per 100,000 by race/ethnicity, MCHD 1999-2010

Asian/Pacific Islander (nH) * Black (nH)*

Hispanic/Latino, any race* Multiple/Other races (nH)*

White (nH)* Monterey County

7.1 10.1

0

5

10

15

20

25

rate

pe

r 1

00

,00

0

Age-adjusted suicide rates per 100,000 by gender, MCHD 1999-2010

Male Female Monterey County



6210.1 10.2NA


Teens who reported binge drinking in past month

3.6 9.5

Substance Abuse

YES4.4%NO

95.6%

Monterey County: Teens reported to binge drink in past month, CHIS

2011-12

-

10.0%

0%

25%

50%

Male Female

Axi

s Ti

tle

Teens reporting binge drinking in past month by Immigration Status, CHIS 2011-

12

634.4


4.90%* - -

0%

25%

50%

Teens reporting binge drinking in past month by Immigration Status, CHIS 2011-

12

8.6NA


Adults who reported binge drinking in past month

31.1 27.1

Substance Abuse

NO 65.9%

YES34.1%

Monterey County: Adults who binge drink in past year,

CHIS 2011-12

37.9% 35.2%

18.5%*

- 4.3%* -

50.8%*

0%

50%

100%

Adult binge drinking in past year by Race/ethnicity, CHIS 2011-12


6434.1 24.424.4


Adults who reported binge drinking in past month

Substance Abuse

NO 65.9%

YES34.1%

Monterey County: Adults who binge drink in past year,

CHIS 2011-12


46.5% 46.2%

18.5%*

15.6%

4.3%*

0%

50%

100%

Adult binge drinking in past year by age group, CHIS 2011-12

6531.1 27.134.1 24.424.4

Nutrition, Physical Activity,

and Obesity

67

• Indicators:

– Overweight/Obese adults and adolescents

– Data Sources:


– Healthypeople.org, 2014

– Monterey County Health Department Community

Health Improvement Plan (CHIP), 2014


6. Nutrition, Physical Activity, and Obesity

12.6 10.4 (ages 2-5)

6811.1

* Data not available due to estimate less than 500 people

88.9%88.9%

83.4%95.7%

85.6%98.2%

100.0%100.0%70.4%

100.0%86.1%86.5%

76.6%100.0%

11.1%11.1%

16.6%4.3%

14.4%

13.9%13.5%

23.4%

0% 50% 100%

Monterey County

U.S. Born citizen

Naturalized citizen*

Non-citizen*

Male

Female

Latino

White (non-latino)


American-Indian/Alaska Native (non-latino)

Asian (non-latino)

Native Hawaiian/Pacific Islander (non-latino)*

Two or More Races (non-latino)

0-99% FPL

100-199% FPL

200-299% FPL

300% FPL and above

IMM

IGR

ATI

ON

GEN

DER

RA

CE/

ETH

NIC

ITY

PO

VER

TYLE

VEL

Obesity: Children (0-12years) Overweight/Not Overweight for age (not factoring height), by Immigration, Gender, Race/ethnicity, and Poverty Level, CHIS 2011-12

Not overweight for age Overweight for age

9.4 (ages 2-5) NA



69

Data less than 2% not highlighted in graph* Statistically unstable, interpret with caution**At-Risk - greater probability of becoming overweight.*** Data not available due to estimate being less than 500 people

11.94.8 17.9 16.89.7 (at-risk & Ob.)

5.4%

8.6%

4.8%

82.4%84.1%

65.8%88.1%

75.5%78.5%

86.5%

100.0%100.0%

87.9%62.7%

75.5%92.4%

10.3%8.0%

34.2%3.1%

19.1%14.3%

12.1%12.2%

24.5%

4.80%5.30%

8.80%

5.60%

19.70%

0% 50% 100%

Monterey County

U.S. Born citizen*

Naturalized citizen***

Non-citizen*

Male*

Female*

Latino

White (non-latino)*

African American (non-latino)***

American-Indian/Alaska Native (non-latino)***

Asian (non-latino)

Native Hawaiian/Pacific Islander (non-latino)

Two or More Races (non-latino)***

0-99% FPL*

100-199% FPL*

200-299% FPL*

300% FPL and above*

IMM

IGR

AT

ION

GEN

DE

RR

AC

E/ E

THN

ICIT

YP

OV

ERTY

Obesity: Teens (12-17 years) body mass index (4 levels), by Immigration, Gender, Race/ethnicity, and Poverty Level, CHIS 2011-12

Underweight (within lowest 5th percentile) Normal weight (5th up to 85th percentile)

At risk of overweight** (85th up to 95th percentile) Overweight/obese (highest 5th percentile)



33.9/ 22.6 NA / 33.9 70

37.2/25.1

Data less than 3% not highlighted in graph.* Data not available due to Estimate being less than 500 people

NA / 30.5 Improve baseline

3.2%

36.0%36.9%

31.6%37.0%

29.5%42.4%

29.8%41.4%

61.4%

40.2%

49.2%37.4%

23.7%30.9%

43.7%

37.2%37.7%

32.5%39.6%

45.9%28.6%

41.4%33.4%

11.2%

46.5%

26.0%48.6%32.7%

37.6%

25.1%23.8%

34.0%21.8%23.6%

26.6%26.7%24.3%21.4%

13.4%

50.8%34.3%

27.1%33.3%

17.3%

0% 50% 100%

Monterey County

U.S. Born citizen

Naturalized citizen

Non-citizen

Male

Female

Latino

White (non-latino)


American-Indian/Alaska Native (non-latino)*

Asian (non-latino)

Native Hawaiian/Pacific Islander (non-latino)*

Two or More Races (non-latino)

0-99% FPL

100-199% FPL

200-299% FPL

300% FPL and above

IMM

IGR

ATI

ON

GEN

DER

RA

CE/

ETH

NIC

ITY

PO

VER

TYLE

VEL

Obesity: Adult body mass index (4 levels), by Immigration, Gender, Race/ethnicity, and Poverty Level, CHIS 2011-12

Underweight( 0 - 18.49) Normal (18.5 - 24.99 ) Overweight (25.0 - 29.99) Obese (30.0 or higher)

Communicable Diseases• Indicators:

– Newly reported HIV/AIDS cases

– Pertussis

• Data Source:




72


Newly reported HIV/AIDS cases

Communicable Diseases

8.7 4.3 (HIV)

8.70

25

50

75

2005-07 2006-08 2007-09 2008-10 2009-11

Newly reported HIV/AIDS cases per 100,000 by age group, MCHD

2005-11

0 to 14 years* 15 to 24 years* 25 to 44 years

45 to 64 years 65+ years* Monterey County

8.70

25

50

75

2005-07 2006-08 2007-09 2008-10 2009-11

Newly reported HIV/AIDS cases per 100,000 by Race/ethnicity, MCHD

2005-11

Asian/Pacific Islander (nH)* Black (nH)*

Hispanic/Latino, any race Multiple/Other races (nH)*




73 4.6 per 100 (HIV)/ 13.8 per 100,000 (AIDS)

3.5 per100 (HIV)/ 12.4 per 100,000 (AIDS) NA


Pertussis infection rates

Communicable Disease

748.02

14.6

0

5

10

15

20

25

2005-07 2006-08 2007-09 2008-10 2009-11

0 to 14 years*

15 to 24 years*

25 to 44 years*

45 to 64 years*

65+ years*

Monterey County

Pertussis infection rates per 100,000 by age group, MCHD 2005-11



0

5

10

15

20

25

2005-07 2006-08 2007-09 2008-10 2009-11

Male* Female Monterey County

Pertussis infection rates per 100,000 by Gender, MCHD 2005-11

14.6 8.97 NANA


Pertussis infection rates

Communicable Disease

758.2


14.6

0

5

10

15

20

25

2005-07 2006-08 2007-09 2008-10 2009-11

Asian/Pacific Islander (nH)* Black (nH)* Hispanic/Latino, any race*

Multi-Race/Other (nH)* White (nH)* Monterey County

Pertussis infection rates per 100,000 by Race/ethnicity, MCHD 2005-11

14.6 8.97 NANA

General: Moving Forward

76

• Wide variation in health conditions across demographic groups.

• Monterey County Health Department systematically collects,

analyzes and makes available to the public, data on population

health issues across demographic groups (and where possible)

geographic regions and responds (with available funding)

• Central Coast Alliance for Health systematically collects and

analyzes medical provider data and works with providers to improve

the medical system’s capacity to address health problems.

• Health Information Systems (and use of Electronic Health Records

Systems) are beginning to allow more system-wide data sharing to

improve monitoring and tracking of selected health conditions by

demographic groups.

General Health: Moving Forward

77

• Determine which variables to explore on a sub-county level across demographic groups to determine which individual and community level health concerns are appropriate for this project.

• Continue to explore connections between income, education and health to better understand distribution of individual and community health problems across demographic groups.

• Engage medical, public health and social service providers in efforts to address health equity issues through cross-sector collaboration.

IMPACT MONTEREY COUNTYSecondary Data Report


Thank You

78

HEALTH APPENDIX

79

80

Person in family/household Poverty guideline

For families/households with more than 8 persons, add $4,160 for each additional person.

1 $11,770

2 15,930

3 20,090

4 24,250

5 28,410

6 32,570

7 36,730

8 40,890

2015 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF

COLUMBIA

Source: U.S. Department of Health & Human Services (2015). http://aspe.hhs.gov/poverty/15poverty.cfm

References

• California Department of Health Care Services. (October 2012). Finding California’s Medi-Cal population:

Challenges and methods in calculating Medi-Cal enrollment numbers. Sacramento, CA: Research and Analytic

Studies Branch.

• California Department of Education. (2013). Report to the governor and the legislation: 2011-12 California physical

fitness test report. Sacramento, CA.Assessment Development and Administration Division District,

School, and Innovation Branch.

• California Department of Public Health. (2015). STD: Sexually transmitted diseases in California 2013. Center for

Infectious Diseases, Division of Communicable Disease Control.

• California Department of Public Health. (2014). Unintentional Injury Death Data Trends for Years 2000-2010.

Office of Health Information and Research. Retrieved from

http://www.cdph.ca.gov/programs/ohir/Pages/UnInjury2010Total.aspx

• California Department of Public Health. (2013a). Chronic Hepatitis B and Hepatitis C Infections in California. Center

for Infectious Diseases.

• California Department of Public Health. (2013b). California addresses the national HIV/AIDS strategy goals and

objectives. Office of AIDS.

• California Department of Public Health. (2013c). Pertussis Report. Sacramento, CA. Immunizations Branch.

• California Department of Public Health. (2010a). Healthy California: Food safety. Sacramento, CA.

• California Department of Public Health. (2010b). Healthy California 2010: Focus Area 16-Maternal, Infant, and

Child Health. Sacramento, CA.

81

http://www.cdph.ca.gov/programs/ohir/Pages/UnInjury2010Total.aspx

References cont.

• California Department of Public Health. (2009a). General fertility rates, total fertility rates, and birth rates by age and

race/ethnicity group of mother. Sacramento, CA. Department of Finance, Race and Ethnic Populations

with Age and Sex Detail.

• California Department of Public Health. (2009b). Leading causes of death, death rates, age-adjusted death rates, and

percentage change by sex. Sacramento, CA. Department of Finance, Race and Ethnic Populations with Age

and Sex Detail.

• Centers for Disease Control & Prevention. (2012). Health,United States, 2012: With special feature on emergency care.

Sacramento, CA. U.S Department of Health and Human Services.

• Centers for Disease Control Prevention. (July 2010). Unintentional drug poisoning in the United States. Atlanta, GA.

National Viral Statistics System.

• Centers for Disease Control & Prevention. (2013). High blood pressure facts. Retrieved from

http://www.cdc.gov/bloodpressure/facts.htm

• City of Salinas. (2010). Salinas comprehensive strategy for community-wide violence reduction 2010-2012. Salinas; CA.

• Hamilton, B. E., Martin, J.A., Osterman, M.J., & Curtin, S. C. (May 2014). Births: Preliminary data for 2013.

National Vital Statistics Reports, 63(2), 2

• Hernandez, L.B. (2011). Monterey County birth outcomes. Monterey County Health Department. Salinas; CA

• Humphrey, A.,Lee, L., Green R. (2011). Aspirations for later life (Research report No 737). National Centre for Social

Research. Department for Work and Pensions.

• Health Indicators Warehouse. (2014). Health Indicators Warehouse: Indicator List. Retrieved from

http://healthindicators.gov/App_Resources/Documents/HIW_Indicator_List.pdf

82

http://www.cdc.gov/bloodpressure/facts.htm

http://healthindicators.gov/App_Resources/Documents/HIW_Indicator_List.pdf

References cont.

• Institute for Community Collaborative Studies. (June 2012). Phase I report: Preliminary profile of health care needs & safety net providers that serve residents of Monterey County. Seaside, CA, Judson, K. & Navarro, I.

• Kidsdata.org. (2013a). Kindergarteners with all required immunizations. Retrieved from http://www.kidsdata.org/topic/292/immunizations-kindergarteners/

• Kidsdata.org. (2013b). Reports of gang membership, by grade level. Retrieved from http://www.kidsdata.org/topic/668/gang-grade/table#fmt=950&loc=2,32 0&tf=65&ch=613,614,69,305,306,431&sortColumnId=0&sortType=asc

• Monterey County Health Department. (2014). 2014-2018 Community health improvement plan for Monterey County, California. Salinas, CA.

• Monterey County Health Department. (2011). Health Brief: Overweight and obesity in Monterey County. Salinas; CA

• Monterey County Health Department. (2011). Strategic plan 2011-2015. Salinas: CA.

• Monterey County Health Department. (2013). Monterey County 2013 Community health assessment. Salinas: CA.

• National Household Education Surveys Program. (2005). Before- and After-School Programs and Activities. Retrieved from: http://nces.ed.gov/nhes/pdf/aspa/2005_aspa.pdf

• University of California Los Angeles Center for Health Policy Research (2013). California Health Interview Survey: 2011-2012 Questionnaire. Regents of the University of California.

http://healthpolicy.ucla.edu/chis/Pages/default.aspx

• U.S. Department of Health and Human Services. (2013). Healthy People 2020. Retrieved from http://www.healthypeople.gov/

• National Center for HIV/AIDS, Virus Hepatitis, STD & TB Prevention. (2009). Viral Hepatitis Surveillance: United States. Atlanta, GA. Center for Disease Control.

• Sirna, M. (2012) Sonoma County Human Services Department Upstream Investments: Indicators of success 2012 update. Santa Rosa, CA. Sonoma County Human Services Department

83

http://www.kidsdata.org/topic/292/immunizations-kindergarteners/

http://www.kidsdata.org/topic/668/gang-grade/table#fmt=950&loc=2,32 0&tf=65&ch=613,614,69,305,306,431&sortColumnId=0&sortType=asc

http://nces.ed.gov/nhes/pdf/aspa/2005_aspa.pdf

http://healthpolicy.ucla.edu/chis/Pages/default.aspx

http://www.healthypeople.gov/