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San Diego

County, CA

Community Health Needs


Assessment
Marissa Cruz B.S., MPH (C)
Abigail Lopez B.S., MPH (C)

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The Table of Contents

The Community Defined.......3

o Geographical region map.4

Methods.......5

Key Indicators....6

o Demographic....6

o Social....7

o Physical....8

o Healthcare....9

o Behavior...9

Recommendations....10

County Resources...11-12

References........13-14

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The Community Defined

San Diego County is the second largest county in the United States with a total

population of 3,223,096 persons. Among the total population in the county of San Diego, by

gender, there are 50.23% male and 49.77% female. Based on research conducted by Community

Common quantitative data, the majority of the San Diego County population are Non-Hispanic

(67.08%) while 32.92% are Hispanic. San Diego County is a diverse community from different

levels of socioeconomic backgrounds to various community health needs. San Diego Countys

Community Health Needs Assessment conducted from Community Commons data, tools, and

mapping has provided resources to help prioritized actions to identify social determinants of

health coupled with health behaviors. Additionally, San Diegos high population of veterans can

lead to various areas of negative social determinants. Furthermore, to deepen our understanding

of trending characteristics of expressed needs are the following: housing cost burden, uninsured,

food access, and health behaviors of attempts to quit smoking. The geographical regions are best

seen in Figure 1.

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Figure 1

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Methods

The website CHNA.org was utilized for county reports for the purpose of analysis. Key

indicators were chosen by going on the CHNA.org website and clicking on run an indicator

report for the county of San Diego. The data categories included demographics, social and

economic factors, physical environment, clinical care, health behaviors, and health outcomes.

Indicators were chosen based on indicators that revealed to be in the red zone. In addition, a

PubMed and Google search was conducted using terms such as cultural competence, San

Diego County, housing burden and high blood pressure to provide further information. All

articles and websites were assessed for validity and chosen based on relevance to the topic.

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Key Indicators

Demographics: Total Population and Veteran Population

The Total Population indicator was chosen to gain an overall view of the demographics

(age and race/ethnicity) from the general public residing in San Diego County. It is essential to

have a general idea of the intended population to tailor programs to best fit the needs of the

community. San Diego County has a large population of youth (ages 5-17) and most of the

residents self-identify as White. From a public health standpoint, age can help determine the age-

appropriate materials that would be needed to be successful in meeting the goals and objectives

of the program. On the other hand, race/ethnicity can provide the necessary information to ensure

cultural competence. Existing literature related to program development emphasizes the

importance of cultural competence in providing quality care (Purnell, 2005).

The second indicator chosen was " Veteran Population." San Diego County has a 9.66%

veteran population compared to 6.1% from California and 8.32% from the entire nation. Since

many veterans reside in San Diego County, it is essential that we consider all types of

populations when determining the health needs of the community.

Figure 2

San Diego County,CA Population by Age Groups


Number of People

600,000

400,000

200,000

0
Age 0-4 Age 5-17 Age 18- Age 25- Age 35- Age 45- Age 55- Age 65+
24 34 44 54 64
Age Groups

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Social: Housing Cost Burden (30%) and Insurance (uninsured children)

The "Housing Cost Burden" data indicator provided information that reflects housing

affordability. The report showed that San Diego County has 44.7% cost-burdened households,

which is greater than that of California (43.86%) and significantly greater than the national

average (33.93%). Housing affordability is a social determinant of health that can either

negatively or positively impact health outcomes. A growing body of literature related to housing

shows the impact that unaffordable housing has on mental health (Mason et al., 2013). Thus

explaining the importance in having housing programs that help people of various economic

backgrounds to provide housing stability.

Figure 3

Image from Community Commons, CHNA website

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The second indicator chosen for further analysis was "Insurance (uninsured children)."

The reason was to gain insight into the population's access to healthcare. As stated on the CHNA

website, lack of insurance is a determining factor for health status. In turn, not having adequate

access to care can contribute to poor health outcomes. The report for this indicator showed that

3.6% of people under 19 are uninsured, which is slightly greater than the state average of 3.55%.

Lack of insurance can also result in emergency department crowding, which can reduce the

overall quality of care (Barish, Mcgauly, &Arnold, 2012).

Physical: Food Access-Fast food restaurants

The Food Access-Fast food restaurants indicator was important to assess in order to

evaluate the populations exposure to unhealthy food options since physical environment has

shown to influence dietary choices. Having access to quality food is needed to sustain a healthy

community. Based on the available data, San Diego County has a 86.68 fast food restaurant rate

(per 100,000 population), which is significantly higher than California (78.64) and the United

States (74.6) as a whole. The high rates of fast food establishments raises a concern about

healthy food access, however, further analysis is needed to determine the extent to which it

impacts dietary choices.

Figure 4

Fast Food Restaurants Rate Per 100, 000 Population

United States

California

San Diego County

68 70 72 74 76 78 80 82 84 86 88

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Healthcare: High Blood Pressure Management

When analyzing the data indicators related to healthcare for San Diego county, data

showed that many residents with high blood pressure are poorly managing their condition. In

San Diego County, 31.3% of adults are not taking high blood pressure medication when needed,

which is greater than the California and United State average of 30.3% and 21.7% respectively.

As stated on the American Heart Association website, high blood pressure is a silent killer that

if left untreated can result in severe negative health outcomes such as heart attack and stroke.

Thus, important to take preventative measures to reduce the risk of such outcomes.

Behavior: Tobacco Usage-Quit Attempts

Health behaviors significantly impact health outcomes. Based on the available indicators

shown on the CHNA report for the county of San Diego, the quit attempts for tobacco usage and

the walking or biking to school were the only indicators considered to be in the red zone. The

indicator chosen out of the two was "Tobacco Usage-Quit Attempts" to get an idea as to how

many people within San Diego County relapse and default back to using tobacco and what

races/ethnicities to target when developing smoking cessation programs. It is also essential to

analyze since tobacco use is linked to cancers (ex. Lung cancer) and cardiovascular diseases. For

this reason, developing smoking cessation efforts is needed to reduce the risk of such severe

diseases. Based on the sample population of smokers over the age of 18, 55% self-reported that

they attempted to quit within the past year, but were unsuccessful in the long run. The report also

indicated that racial and ethnic minorities, such as Blacks (non-Hispanic) and Hispanics/Latinos

are more likely to struggle when attempting to quit smoking.

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Recommendations

Transitioning from rigorous military lifestyle to civilian life can be difficult. As

previously indicated, San Diego County has a large veteran population. Thus, essential to

developing programs that can help make that transition run smoothly. One example would be a

one-stop design program tailored to the veteran population that can provide assistance with

housing, food, psychological counseling to address PTSD, and support groups to provide

emotional support. The one-stop program design can help increase access to such services due to

convenience.

Housing burden affects many in San Diego County. Financial programs can help low-

income family households suffering from housing burden to increase their financial stability.

Also, the county of San Diego has high rates of uninsured children (under 19 years old). Being

uninsured is a problem since the majority of the population is between the ages of 5-17 years old.

When dealing with the youth, it is essential that the parents also get involved. Having community

leaders or community health workers provide education about health care navigation, and health

care access can help increase insurance coverage among youth.

Access to healthy food options is also a problem in San Diego County, due to the vast

amount of fast food establishments, especially going towards the coastline. A solution to this

issue is to advocate for a larger selection of healthier options on the menu at fast food locations.

Also, require all fast food and restaurant establishment to have the nutrition information on all

their food and drinks to increase consciousness. To have a higher success rate of quitting

smoking among adults, a policy that eliminates smoking in public areas can help change social

norms that promote a smoke-free environment and support those trying to quit.

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County Resources

The following resources were found on the San Diego County website:

Veteran Population

The VASH Program (Veterans Affairs Supportive Housing): is a joint program between

U.S. Department of Housing and Urban Development and the U.S. Department of

Veteran Affairs to alleviate homelessness among veterans in San Diego. They also offer

VA case management and support services to all veterans

Courage to Call: is a hotline that San Diego County funds a 24/7. This program is for

veterans transitioning to civilian life, and suffering from PTSD. Their number 2-1-1 or go

to the website 211SanDiego.org/Courage-to-Call

Housing Cost Burden

San Diego Housing Commission (SDHC): is San Diego largest rental program that is

federally funded by Section 8 Housing Choice Voucher (HCV). Assisting low-income

families and homeless veterans of San Diego

Housing Opportunities for Person with AIDS (HOPWA): Alleviates rent burden by

providing rental assistance to people living with HIV or AIDS.

Access to Healthy Food Options

Certified Farmers Market: are located seven days a week throughout San Diego County

to provide thriving community members with access to healthy food

http://www.sandiegocounty.gov/content/dam/sdc/awm/docs/CFMAZ2017Sep.pdf

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Websites for food recourses to find food banks in San Diego:

http://sandiegofoodbank.org/get-help/need-food-zip-code-search/

http://feedingamericasd.org/need-help

Quit Smoking

San Diego County Tobacco Control Coalition: Free telephone support for San Diegans

who are attempting to quit and need counseling English 1-800-NO-BUTTS or visit

www.californiasmokershelpline.org

Nicotine Anonymous (NA) Holds weekly meetings at several locations. Call the San

Diego County NA Hotline at 619-682-7092 for the most current information.

http://www.nicotine-anonymous.org/

Uninsured Youth

Healthy San Diego: is a program in San Diego that provided health services, enrolls, and

educates on how to choose a health plan and doctor. For more information, please call

619-515-6584 for more details about HSD

San Diego County Medical Services (CMS): funds services through a network of

community health centers, private physicians, and hospitals for adults who are uninsured

in the San Diego County. For more information, please call 1-800-587-8118

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References

American Heart Association. (n.d.). The facts about High Blood Pressure. Retrieved October 25,

2017, from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/Getthe

FactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure_UCM_002050

_Article.jsp

Baris, R.A., Mcgauly, P.L., & Arnold, T.C. (2012). Emergency Room Crowding: A Marker of

Hospital Health. Transactions of the American Clinical and Climatological Association,

123, 304-311.

Community Commons. (n.d.). Community Health Needs Assessment (CHNA) Report.

County of San Diego HHSA. (2010). Quit smoking recourses report. Retrieved from

http://www.sandiegocounty.gov/hhsa/programs/phs/documents/San_Diego_

TCRP_Quit_Smoking_Help_Resources.pdf

County Medical Services (CMS). (n.d.). Retrieved October 28, 2017, from http://san

diegocounty.gov/content/sdc/hhsa/programs/ssp/county_medical_services.html

Mason, K. E., Baker, E., Blakely, T., & Bentley, R. J. (2013). Housing affordability and mental

health: Does the relationship differ for renters and home purchasers? Social Science &

Medicine,94, 91-97. doi:10.1016/j.socscimed.2013.06.023

Purnell, L. (2005). The Purnell Model for Cultural Competence. Journal of Multicultural Nursing

& Health.

San Diego Housing Commission. (n.d.). Retrieved October 21, 2017, from http://www.sdhc.org/

Rental Assistance (n.d.). Retrieved October 15, 2017, from http://www.sandiegocounty.

gov/ content/sdc/sdhcd/rental-assistance/overview.html

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Veteran Services. (n.d) Retrieved October 20, 2017, from http://www.sandiegocounty.

gov/content/sdc/hhsa/programs/ais/veterans_services.html

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