CAP17Health

© 2011 Applied Survey Research 67

HealthSnapshotofSantaCruzCounty..................68

HealthCommunityGoals.............................................68

AccesstoHealthCare...............................................69

LowIncomeHealthCare..............................................71

HealthInsurance........................................................73

EndofLifeWishes(LivingWillorAdvanceDirective)............................................................................75

Births....................................................................................76

TeenBirths........................................................................76

AdequatePrenatalCare...............................................77

BirthWeight......................................................................79

Breastfeeding....................................................................79

ImmunizationLevels.....................................................81

DentalCare........................................................................82

MentalHealth...................................................................83

PhysicalHealth................................................................84

PhysicalActivity..............................................................84

FruitandVegetableConsumption...........................85

Obesity...........................................................................86

Diabetes..............................................................................87

AlcoholUse.......................................................................89

AvailabilityofAlcohol..................................................89

AcceptanceofAdultAlcoholProvision.................90

CommunityAcceptanceofMarijuanaUse...........90

TobaccoUse......................................................................92

MethamphetamineAdmissions...............................92

PrescriptionDrugUse..................................................93

SubstanceUsebyStudents........................................93

UnintentionalInjuries..................................................95

IntentionalInjuries........................................................95

ReportedCommunicableDiseases.........................96

AIDS......................................................................................96

Suicides...............................................................................97

LeadingCausesofDeath.............................................98

Health Santa Cruz County Community Assessment Project, Year 17, 2011

68 © 2011 Applied Survey Research

HEALTH SNAPSHOT OF SANTA CRUZ COUNTY

INDICATORS MEASUREMENT DATA OVERALL

TREND RECENT TREND

HEALTH INSURANCE Percent of CAP survey respondents who reported having health insurance 80.3%

IMMUNIZATION LEVELS Percent of kindergarten entrants with all required immunizations 82.5%

PHYSICAL HEALTH Percent of CAP survey respondents who indicated that their general health is “good,” “very good,” or “excellent”

82.9% NA NA

OBESITY Percent of CAP survey respondents who are overweight or obese 57.1%

ALCOHOL USE Percent of CAP survey respondents who engaged in binge drinking 12.9%

Indicates data moving in a positive direction; Indicates data moving in a negative direction; Increasing (Upward) trend; Declining (Downward) trend;

Inconclusive; variable; no clear trend; NA Not applicable or data unavailable.

HEALTH COMMUNITY GOALS

GOAL: By the year 2015, access to primary care will improve as measured by:

95% of Santa Cruz County residents will report having a regular source of health care; Less than 10% will report the emergency department as one of their regular sources of health care; and No significant difference between the percent of Caucasian and Latino residents reporting a regular source of

health care.

GOAL: By the year 2015, 98% of Santa Cruz County children 0 to 17 will have comprehensive health care coverage as measured by the CAP Survey.

» Community Hero: Araceli Castillo, Salud Para La Gente » Community Hero: Leslie Conner, Santa Cruz Women’s Health Center

GOAL: By the year 2015, the prevalence of childhood obesity in Santa Cruz County will decrease as measured by:

% of children under 5 years who are overweight or obese will decrease from 15% to 12%, and % of children 5 to 19 years who are overweight or obese will decrease from 26% to 21%.

» Community Hero: Danny Keith, Second Harvest Food Bank

Santa Cruz County Community Assessment Project, Year 17, 2011 Health


ACCESS TO HEALTH CARE Individualswithoutadependablesourceofcarereportedmoredifficultiesobtainingneededcare,receivingfewerpreventivehealthservices,weremorelikelytowaittogettreatmentuntiltheirconditionisworse,andweremorelikelytorequirehospitalization.22

Ninety‐one percent of Caucasian CAP survey respondents reported having a regular source ofhealth care in 2011, as compared to only 68% of Latinos, a statistically significant difference.CaucasianrespondentsweresignificantlymorelikelythanLatinorespondentstogotoaprivatepractice,theemergencyroom,orurgentcareclinicsfortheirregularsourceofhealthcarewhileLatino respondents were significantly more likely than Caucasian respondents to go tocommunityclinicsfortheirregularsourceofhealthcare.Inaddition,13%ofLatinorespondentsneededhealthcarebutwereunabletoreceiveit,thetopreasonbeingthatitwastooexpensive.

Do you have a regular source of health care? (Respondents answering “Yes”) By Ethnicity

Overall N: 2000=656; 2001=706; 2002=684; 2003=702; 2005=705; 2007=709; 2009=854, 2011=719; Caucasian N: 2000=444; 2001=493; 2002=478; 2003=491; 2005=493; 2007=495; 2009=596, 2011=503; Latino N: 2000=142; 2001=159; 2002=154; 2003=157; 2005=159; 2007=160; 2009=192, 2011=162 Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Caucasian respondents were significantly more likely than Latino respondents to have a regular source of health care.

If you have a regular source of health care, where do you go? By Ethnicity RESPONSE 2009 2011 RESPONSE 2009 2011 Private Practice 82.3% 81.2% Community Clinics 15.8% 17.0%

Caucasian 89.0% 88.1%* Caucasian 9.0% 9.2%* Latino 52.7% 50.0%* Latino 46.2% 48.2%*

Urgent Care Clinics 28.4% 29.0% Out of County 13.9% 13.2% Caucasian 27.3% 33.1%* Caucasian 15.3% 13.9% Latino 34.0% 13.5%* Latino 9.8% 12.1%

Emergency Room 26.8% 23.9% Other 0.5% 0.4% Caucasian 29.0% 26.5%* Caucasian 0.5% 0.1% Latino 19.0% 14.7%* Latino 0.0% 0%

Alternative Care Practices 16.1% 14.1% Caucasian 17.6% 14.9% Latino 9.6% 8.5%

Overall 2009: 725 respondents offering 1,334 responses, 2011: 606 respondents offering 1084 responses ; Caucasian 2009: 531 respondents offering 999 responses, 2011: 4 respondents offering 844 responses ; Latino 2009: 134 respondents offering 230 responses, 2011: 110 respondents offering 161 responses. Source: Applied Survey Research (2011). 2009-2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Response options were redefined in 2009 and are therefore not comparable to previous years. Note: This was a multiple response question so percentages do not add up to 100%. *Significance testing: Caucasian respondents were significantly more likely than Latino respondents to go to a private practice, the emergency room, or urgent care clinics for their regular source of health care; Latino respondents were significantly more likely than Caucasian respondents to go to community clinics for their regular source of health care.

22United States Department of Health and Human Services, Agency for Healthcare Research and Quality. (2011). National Healthcare Disparities and Quality Report. Retrieved January 14, 2011; and Billings, J., J.D., Bidman, A.B., M.D., Grumbach, K., M.D., et al. (1995). Preventable Hospitalizations and Access to Health Care. JAMA 274(4): 305-311.

87.0% 85.5%83.8%

84.6% 86.5% 91.0%85.1% 85.2%

89.6%86.3% 88.4%

85.6% 86.9%91.0%

89.5% 91.4%*

79.6%81.9%

70.6%

80.8%84.4%

93.6%

69.9% 67.9%*60%

80%

100%

2000 2001 2002 2003 2005 2007 2009 2011

Overall

Caucasian

Latino



If you DON’T have a regular source of health care, where do you go? By Ethnicity RESPONSE 2011 RESPONSE 2011

Community Clinics 47.0% Emergency Room 27.0% Caucasian 32.1%* Caucasian 23.4% Latino 60.8%* Latino 28.1%

Private Practice 35.2% Alternative Care Practices 7.1% Caucasian 39.4% Caucasian 8.6% Latino 29.7% Latino 2.7%

Urgent Care Clinics 33.6% Out of County 4.5% Caucasian 45.8%* Caucasian 4.1% Latino 24.7%* Latino 4.6%

Overall 2011: 94 respondents offering 145 responses; Caucasian 2011: 40 respondents offering 61 responses; Latino 2011: 45 respondents offering 68 responses. Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Survey question was not asked in 2009. *Significance testing: For those without a regular source of health care, Latino respondents were significantly more likely than Caucasian respondents to go to community clinics, while Caucasian respondents were significantly more likely than Latino respondents to go to urgent care clinics.

Have you needed health care in the past year and been unable to receive it? (Respondents answering “Yes”) By Ethnicity

Overall N: 2000=658; 2001=706; 2002=684; 2003=703; 2005=698; 2007=707; 2009=852: 2011=716; Caucasian N: 2000=445; 2001=493; 2002=478; 2003=491; 2005=494; 2007=494; 2009=595; 2011=500; Latino N: 2000=142; 2001=159; 2002=154; 2003=158; 2005=150; 2007=160; 2009=191: 2011=162 Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Latino respondents were significantly more likely than Caucasian respondents to go without necessary health care needs.

If you needed health care and were unable to receive it, why couldn’t you receive it? RESPONSE 2009 2011 RESPONSE 2009 2011

Too Expensive 29.8% 35.2% Couldn’t Afford The Premium 2.3% 1.5% Caucasian 32.9% 33.1% Caucasian 4.0% 0.0% Latino 29.9% 40.5% Latino 0.0% 0.0%

No Insurance 29.5% 29.8% Couldn’t Afford The Premium 2.3% 1.5%

Caucasian 21.8% 33.1% Caucasian 4.0% 0.0%

Latino 38.8% 32.8% Latino 0.0% 0.0%

Couldn’t Afford Co-Pay 9.2% 3.6% Other 9.9% 17.3%

Caucasian 9.4% 3.6% Caucasian 12.4% 15.3%

Latino 3.0% 0.0% Latino 8.0% 21.6%

Medi-Cal/ MediCruz Problems 8.5% 5.4% Total Respondents 82 55

Caucasian 2.4% 4.6% Caucasian 48 28

Latino 20.4% 0.0% Latino 27 21

Source: Applied Survey Research (2011). 2009-2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Response options were redefined in 2009 and are therefore not comparable to previous years.

17.2%

10.1% 10.7%12.1% 10.9%

7.1%9.7%

7.7%14.6%

6.6%8.5%

10.0%8.6%

5.4%8.1%

5.6%*

21.1% 21.9%

15.9%18.3% 18.0%

13.7% 14.2% 13.0%*

0%

5%

10%

15%

20%

25%

2000 2001 2002 2003 2005 2007 2009 2011

Overall

Caucasian

Latino



LOW INCOME HEALTH CARE CentralCaliforniaAlliance forHealth (theAlliance) is a locallygovernednon‐profithealthplanthatservesover200,000membersinSantaCruz,MontereyandMercedcounties.Theirprogramsinclude Medi‐Cal and the Healthy Families Program (a federally and state‐funded insuranceprogram for low‐income children). Over the past decade, the number of Alliance Medi‐Calmembers inSantaCruzCounty increasedconsiderably from21,968 in2001to33,743 in2011.OverhalfofwhomwereLatino/Hispanicand living inSouthCounty. InSantaCruzCounty, thenumberof children enrolled in theHealthy FamiliesProgram increasedby143%over the lastdecade,withabout6,840childrencoveredbyHealthyFamiliesin2011.

Medi-Cal Members Enrolled in the Alliance, Santa Cruz County, By Primary Care Provider TYPE OF PRIMARY CARE PROVIDER 2001 2003 2005 2007 2008 2009 2010 2011

01-11 % CHANGE

Clinic 8,243 9,503 10,534 11,468 11,956 12,717 14,582 13,160 59.7%

Private Practice 11,136 13,230 13,631 14,308 14,356 14,929 15,178 10,798 -3.0%

Administrative Members (Not Linked)

2,589 3,329 3,822 3,877 3,675 3,769 3,801 9,785 277.9%

Total Alliance Medi-Cal Members

21,968 26,062 27,987 29,646 29,987 31,415 33,561 33,743 53.6%

Source: Central California Alliance for Health. (June 2011). Medi-Cal Members Enrolled in the Alliance, 2001-2011. Personal Correspondence with Program Representative. Note: Central California Alliance for Health changed their patient designation in 2011. The number of administrative members increased due to this change.

Percent of Enrolled Medi-Cal Members in the Alliance, Santa Cruz County, By Ethnicity

ETHNICITY 2001 2003 2005 2007 2008 2009 2010 2011 01-11

NET CHANGE

Caucasian 40% 37% 36% 34% 33% 32% 32% 32% -8.0

Hispanic 45% 51% 56% 58% 59% 59% 59% 58% 13.0

Other 15% 12% 8% 8% 8% 9% 9% 8% -7.0


21,968 26,062 27,987 29,646 29,987 31,415 33,561 33,743 -

Source: Central California Alliance for Health. (June 2011). Medi-Cal Members Enrolled in the Alliance, 2001-2011. Personal Correspondence with Program Representative.

Percent of Enrolled Medi-Cal Members in the Alliance, Santa Cruz County, By Region

AREA OF ORIGIN 2001 2003 2005 2007 2008 2009 2010 2011 01-11

NET CHANGE

South County1 47% 53% 44% 44% 56% 56% 55% 56% 9.0

North County2 50% 44% 53% 55% 43% 43% 44% 43% -7.0

Out of County 3% 3% 3% 1% 1% 1% 1% 1% -2.0


21,968 26,062 27,987 29,646 29,987 31,415 33,561 33,743 -

Source: Central California Alliance for Health. (June 2011). Medi-Cal Members Enrolled in the Alliance, 2001-2011. Personal Correspondence with Program Representative. 1 CCAH defines South County as including the areas of Freedom and Watsonville. 2 CCAH defines North County as including the areas of Santa Cruz, Scotts Valley, Davenport, Felton, Ben Lomond, Boulder Creek, Brookdale, Aptos, Capitola, and Soquel.



Percent of Respondents Who Said They Were Covered by Medi-Cal

Source: UCLA Center for Health Policy Research. (2011). 2001-2009 California Health Interview Survey. Note: Data presented are the most recent available.

HEALTHY FAMILIES Number of Children Enrolled in Healthy Families, Santa Cruz County

Source: Managed Risk Medical Insurance Board. (2011). 2001-2011 Healthy Families Program Current Enrollment.

Number of Children Enrolled in Healthy Families

REGION MAY 2001 MAY 2003 MAY 2005 MAY 2007 MAY 2008 MAY 2009 MAY 2010 MAY 2011 01-11

% CHANGE

Santa Cruz County 2,814 4,276 4,681 5,284 5,789 6,413 6,531 6,838 143.0%

California 432,004 658,203 743,638 814,547 872,553 919,542 877,617 870,970 101.6%


Children Enrolled in Healthy Families by Ethnicity

ETHNICITY MAY 2001

MAY 2003

MAY 2005

MAY 2007

MAY 2008

MAY 2009

MAY 2010

MAY 2011

01-11 NET CHANGE

Alaska Native/Native American Indian

0.3% 0.4% 0.4% 0.2% 0.2% 0.1% 0.0% 0.1% -0.2

Asian/Pacific Islander 1.4% 1.8% 1.8% 1.8% 1.8% 1.6% 1.7% 1.2% -0.2

Black/African American 0.6% 0.7% 0.5% 0.3% 0.3% 0.2% 0.1% 0.1% -0.5

Hispanic 75.6% 70.7% 70.1% 71.0% 69.3% 67.2% 62.8% 57.2% -18.4

White 11.7% 14.8% 12.2% 11.0% 11.2% 10.2% 9.1% 9.8% -1.9

Other/Unknown 10.5% 11.7% 14.9% 15.7% 17.2% 20.7% 26.3% 31.5% 21.0

Santa Cruz County Total 2,814 4,276 4,681 5,284 5,789 6,413 6,531 6,838 -


9.1% 13.9% 12.6%17.2% 14.1%

11.6%16.9% 16.7% 15.7% 16.9%

0%

20%

40%

60%

2001 2003 2005 2007 2009

Santa Cruz County

California

2,814

4,276 4,6815,284

5,7896,413 6,531 6,838

0

2,000

4,000

6,000

8,000

May 2001 May 2003 May 2005 May 2007 May 2008 May 2009 May 2010 May 2011



Geographic Distribution of Children Enrolled in Healthy Families, Santa Cruz County

ZIP CODE MAY 2001

AUG. 2003

MAY 2005

MAY 2007

MAY 2008

MAY 2009

MAY 2010

MAY 2011

01-11 NET CHANGE

95003 — Aptos/La Selva Beach

2.2% 2.2% 3.3% 3.0% 3.6% 3.7% 3.6% 3.8% 1.6

95005 — Ben Lomond 0.8% 1.0% 1.4% 1.3% 1.3% 1.2% 1.2% 1.4% 0.6

95006 — Boulder Creek 0.8% 1.6% 1.6% 1.0% 1.0% 1.1% 1.2% 1.3% 0.5

95010 — Capitola 1.2% 1.7% 2.4% 2.6% 2.8% 2.6% 2.6% 2.6% 1.4

95018 — Felton/Lompico 0.5% 1.0% 1.2% 1.2% 1.1% 1.2% 1.4% 1.5% 1.0

95019 — Freedom 6.1% 6.6% 7.2% 7.1% 7.0% 7.4% 7.2% 6.5% 0.4

95060 — Santa Cruz 8.1% 6.7% 7.6% 6.7% 7.1% 6.8% 7.3% 7.6% -0.5

95062 — Santa Cruz/Live Oak

8.0% 9.6% 11.1% 11.2% 11.3% 10.8% 10.5% 10.5% 2.5

95064 — UC Santa Cruz 0.4% 0.3% 0.2% 0.1% 0.2% 0.3% 0.3% 0.3% -0.1

95065 — Santa Cruz 1.5% 1.4% 1.7% 1.8% 1.6% 1.5% 1.6% 1.9% 0.4

95066 — Scotts Valley 1.3% 1.7% 1.4% 1.4% 1.7% 1.8% 1.9% 2.1% 0.8

95073 — Soquel 1.3% 1.8% 2.2% 2.4% 2.2% 2.3% 2.1% 2.4% 1.1

95076 — Watsonville 66.3% 63.2% 57.7% 59.4% 58.3% 58.6% 58.1% 57.1% -9.2

7 Other ZIP Codes 1.5% 1.3% 0.9% 0.8% 0.8% 0.7% 1.0% 0.9% -0.6

Total Enrollment

(Selected ZIP Codes) 3,184 4,931 4,566 5,263 5,778 6,391 6,533 6,842 -


HEALTH INSURANCE WhilethepercentageofCAPsurveyrespondentsindicatingthattheyhavehealthinsuranceincreasedinSantaCruzCountybetween2000and2007,thepercentageofrespondentswithhealthinsurancedecreasedfrom89%in2007to80%in2011.Fifty‐onepercent(51%)ofLatinoCAPrespondentshadhealthinsurancecomparedto90%ofCaucasianrespondentsin2011.

Do you currently have health insurance? (Respondents answering “Yes”)

Overall N: 2000=652; 2001=706; 2002=684; 2003=702; 2005=709; 2007=710; 2009=849, 2011=719; Caucasian N: 2000=441; 2001=493; 2002=478; 2003=491; 2005=496; 2007=496; 2009=595, 2011=501; Latino N: 2000=140; 2001=159; 2002=154; 2003=157; 2005=159; 2007=159; 2009=191, 2011=162 Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Caucasian respondents were significantly more likely than Latino respondents to have health insurance.

83.1% 84.0% 85.2%81.1%

83.6%88.8%

80.4% 80.3%

90.7% 88.6% 89.8% 88.8% 88.7%91.8%

88.9% 89.5%*

59.3%

68.2%71.8%

58.1%

68.8%

78.0%

52.6% 51.0%*

40%

60%

80%

100%

2000 2001 2002 2003 2005 2007 2009 2011

Overall CaucasianLatino



Does your health insurance cover...? (Respondents answering “Yes”) TYPE OF COVERAGE 2000 2001 2002 2003 2005 2007 2009 2011

00-09 NET CHANGE

Prescriptions 91.5% 79.4% 84.9% 83.3% 80.4% 89.3% 90.0% 88.6% -2.9 Dependents 68.6% 56.7% 60.0% 64.6% 61.7% 47.7% 52.4% 66.0% -2.6 Mental Health1 NA NA NA NA 82.0% 81.8% 61.1% 82.3% NA

Prescriptions N: 2000=540; 2001=593; 2002=582; 2003=569; 2005=576; 2007=616; 2009=682; 2011=556; Dependents N: 2000=516; 2001=552; 2002=550; 2003=523; 2005=534; 2007=624; 2009=652; 2011=396; Mental Health N: 2005=434; 2007=472; 2009=682; 2011=380. Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey. 1 The question regarding mental health insurance coverage was added in 2005.

Percent of Respondents Who Said They Had Delayed Getting, or Didn’t Get, Medical Care

REGION 2007 2009 07-09

NET CHANGE

Santa Cruz County 17.8% 15.7% -2.1

California 13.4% 12.5% -0.9

Source: UCLA Center for Health Policy Research (2011). 2007-2009 California Health Interview Survey. Note: Data presented are the most recent available.

Percent of Respondents Aged 65 and Older Who Said They Were Covered by MediCare and Medi-Cal, or MediCare and a Supplemental Policy

COVERAGE/REGION 2003 2005 2007 2009 03-09 NET CHANGE

MediCare & Medi-Cal Coverage Santa Cruz County 12.0%^ 14.7%^ 15.5%^ 14.7%^ 2.7 California 20.3% 20.0% 18.6% 18.6% -1.7 MediCare Coverage & a Supplemental Policy Santa Cruz County 78.7% 71.5% 68.1% 75.9% -2.8 California 68.2% 67.8% 68.9% 71.6% 3.4

Source: UCLA Center for Health Policy Research (2011). 2003-2009 California Health Interview Survey. Note: Data presented are the most recent available. ^ Statistically unstable due to a low number of respondents.

Healthy Kids Program Enrollment

PROGRAM ENROLLMENT 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 06-11

% CHANGE

Program Enrollment Medi-Cal 186 175 378 907 1,590 754.8% Healthy Families 2,293 2,476 2,907 3,443 3,673 60.2% Healthy Kids 2,000 1,926 2,107 1,825 1,498 -25.1% Waitlist 227 370 193 224 125 -44.9% Total Enrollment1 4,479 4,577 5,392 6,180 6,886 -53.7% Unduplicated Program Enrollment Medi-Cal 185 165 307 874 1,522 722.7% Healthy Families 2,249 2,422 2,777 3,321 3,520 56.5% Healthy Kids 1,936 1,823 1,882 1,778 1,471 -24.0% Total Enrollment1 4,370 4,418 5,022 5,978 6,513 49.0%

Source: Healthy Kids of Santa Cruz County (Personal Correspondence with Program Representative, June 2011). Note: Healthy Kids instated the Newborn Enrollment Project conducing Med-Cal enrollments for all new babies at the three county hospitals. 1 Total enrollment includes number of children enrolled on the Healthy Kids waiting list as well as adults who applied for Medi-Cal.



Percent of Children Ages 0-17 Currently Insured

REGION/AGE GROUP 2001 2003 2005 2007 2009 01-09

NET CHANGE

Santa Cruz County - Children 0-17 Years 93.3% 96.2% 97.4% 97.9% 92.1% -1.2

Children 0-4 Years 93.0% 100.0% 95.6% 100.0% 92.1% -0.9

Children 5-11 Years 89.7% 93.2% 98.1% 97.4% 99.1% 9.4

Children 12-14 Years 98.3% 97.3% 100.0% 100.0% 89.9% -8.4

Children 15-17 Years 96.7% 97.6% 95.2% 93.3% NA NA

California – Children 0-17 Years 90.6% 92.9% 93.6% 94.3% 95.1% 4.5

Children 0-4 Years 93.4% 95.7% 94.4% 96.0% 96.4% 3.0

Children 5-11 Years 90.5% 93.1% 94.0% 94.2% 95.4% 4.9

Children 12-14 Years 88.7% 91.4% 92.9% 92.8% 93.4% 4.7

Children 15-17 Years 88.5% 89.8% 92.1% 93.7% 94.0% 5.5

Source: UCLA Center for Health Policy Research (2011). 2001-2009 California Health Interview Survey. Note: Data presented are the most recent available.

How many of your children have health insurance? - 2011 AGE GROUP NONE AT LEAST ONE

Children 0 – 5 years old 5.8% 94.2%


Children 0-5 N: 2011=110; Children 6-17 N: 2011=173 Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Survey question not asked in 2009.

END OF LIFE WISHES (LIVING WILL OR ADVANCE DIRECTIVE) Endof lifewishesare instructionsgivenby individualsspecifyingwhatactionsshouldbetakenfor their health in the event they are no longer able tomake decisions. In 2011, 40% of CAPsurvey respondents had their end‐of‐life wishes in a written document. However, only 8% ofLatinoshadalivingwillcomparedto51%ofCaucasians.

Do you have your end-of-life wishes for medical treatment in a written document? (Respondents answering “Yes”) By Ethnicity

Overall N: 2007=697; 2009=852; 2011=722; Caucasian N: 2007=488; 2009=595; 2011=504; Latino N: 2007=158; 2009=192: 2011=162 Source: Applied Survey Research (2011). 2007-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Caucasian respondents were significantly more likely than Latino respondents to have their end-of-life wishes for medical treatment in a written document.

43.5%40.8% 40.0%

47.6% 51.5% 51.0%*

29.9%7.9% 7.6%*

0%

20%

40%

60%

80%

100%

2007 2009 2011

Overall

Caucasian

Latino



BIRTHS The number of births to Santa Cruz County residents decreased 12%over the past five years,from3,591birthsin2006to3,170in2010.AnincreasingnumberofcountybirthshavebeenpaidforbyMedi‐Cal,with55%ofcountybirthspaidforbyMedi‐Cal.

Number of Births - Santa Cruz County Residents (All Ages) DELIVERY LOCATION 2006 2007 2008 2009 2010 06-10 % CHANGE

Dominican Hospital 1,046 1,112 1,017 932 861 -17.7%

Sutter Maternity & Surgery Center 826 853 829 871 845 2.3%

Watsonville Community Hospital 1,462 1,326 1,453 1,236 1,213 -17.0%

Out of County 186 209 192 193 195 4.8%

Non-Hospital 71 70 53 58 56 -21.1%

Santa Cruz County Total 3,591 3,570 3,544 3,290 3,170 -11.7%

Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data

Percent of Deliveries Funded by Medi-Cal - Santa Cruz Residents (All Ages) DELIVERY LOCATION 2006 2007 2008 2009 2010 06-10 NET CHANGE

Dominican Hospital 38.5% 40.8% 40.3% 43.0% 45.3% 6.8

Sutter Maternity & Surgery Center 25.1% 24.6% 30.7% 30.1% 31.3% 6.2

Watsonville Community Hospital 78.9% 79.1% 77.4% 79.5% 85.4% 6.5

Santa Cruz County Total 50.2% 49.6% 51.4% 51.4% 54.5% 4.3

Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data

TEEN BIRTHS Teen parents and their children are often at greater risk for experiencing short and long‐termhealth,economic,social,andacademicchallengescomparedtoparentswhohavechildrenlaterinlife.23 The birth rate among teens ages 15‐19 in Santa Cruz County fell from32.9 per 1,000 in2006 to 30.2 per 1,000 in 2010. Births to Latina mothers (225) were much higher than toCaucasianmothers(27),makingup87%oftotalteenbirthsin2010.

Birth Rate per 1,000 Teens (Ages 15-19)

Source: County of Santa Cruz, Public Health Department. Births, (July 2011).Unpublished Data Note: Birth rates per 1,000 teens ages 15-19 include only births to mothers who were residents of Santa Cruz County. 1 2010 California data was not available.

23Klein,J.D.,&theCommitteeonAdolescence.(2005).Adolescentpregnancy:Currenttrendsandissues.Pediatrics,116(1),281‐286.

32.9 32.5 33.6 36.130.2

38.2 37.1 35.2 32.1

0

20

40

60

2006 2007 2008 2009 2010¹

Santa Cruz County

California



Number and Percent of Births to Teens (Ages 19 and Under), Santa Cruz County Residents

INDICATOR 2006 2007 2008 2009 2010 06-10

% CHANGE

Number of Births to Teens 310 301 304 319 258 -16.8%

Number of Births, All Ages 3,591 3,570 3,526 3,290 3,170 -11.7%

Percent of Births to Teens, Santa Cruz County 8.6% 8.4% 8.6% 9.7% 8.1% -

Percent of Births to Teens, California 9.5% 9.5% 9.5% 9.2% NA -

Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data.

Number of Births to Teens (Ages 19 and Under) by Location, Santa Cruz County Residents

DELIVERY LOCATION 2006 2007 2008 2009 2010 06-10

% CHANGE

Dominican Hospital 41 60 51 61 57 39.0%

Sutter Maternity & Surgery Center 42 32 36 51 26 -38.1%

Watsonville Community Hospital 219 198 207 195 166 24.2%

Out of County 7 11 10 10 8 ^

Non-Hospital 1 0 0 2 1 ^

Total Number of Births to Teens 310 301 304 319 258 -16.8%

Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.

Number of Births to Teens (Ages 19 and Under) by Age of Mother, Santa Cruz County Residents

AGE GROUP 2006 2007 2008 2009 2010 06-10

% CHANGE

Under 15 Years 6 4 2 5 1 ^

15-17 Years 109 103 99 114 88 -19.3%

18-19 Years 195 194 203 200 169 -13.3%


Source: County of Santa Cruz, Public Health Department. Births, (July 2011). Unpublished Data. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.

Number of Births to Teens (Ages 19 and Under) by Ethnicity of Mother, Santa Cruz County Residents

ETHNICITY 2006 2007 2008 2009 2010 06-10

% CHANGE

African American 1 1 5 8 1 ^

Asian 1 0 1 1 0 ^

Caucasian 30 33 28 32 27 -10.0%

Hispanic/Latina 274 264 267 273 225 -17.9%

Other/Unknown 3 2 2 1 2 ^


Source: County of Santa Cruz, Public Health Department. Births, (July 2011). Unpublished Data. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.



ADEQUATE PRENATAL CARE Access to andutilization of prenatal care services canbe crucial in protecting the health of anexpectingmotheraswellasherunbornchild.BasedontheKotelchuckIndex,24thestandardforadequateprenatalcarebasedonhealthindicators,almostone‐third(32%)ofallteenbirthshadlessthanadequateprenatalcarein2010,comparedto19%ofallbirthswithlessthanadequatecare.

Percent of Births with Less Than Adequate Care (Kotelchuck Index), Santa Cruz County


Percent of Births with Less Than Adequate Care (Kotelchuck Index)


NET CHANGE

Dominican Hospital 14% 16% 15% 15% 14% 0.0

Sutter Maternity & Surgery Center 11% 11% 12% 11% 13% 2.0

Watsonville Community Hospital 22% 31% 32% 24% 24% 2.0

Out of County 18% 16% 24% 24% 27% 9.0

Non-Hospital 14% 16% 13% 16% 11% -3.0

Santa Cruz County 17% 20% 22% 18% 19% 2.0


Percent of Births to Teens (Ages 19 and Younger) with Less than Adequate Care (Kotelchuck Index)


NET CHANGE

Dominican Hospital 22% 24% 25% 27% 18% -4.0

Sutter Maternity & Surgery Center 24% 10% 17% 22% 21% -3.0

Watsonville Community Hospital 32% 46% 42% 35% 38% 6.0

Santa Cruz County 30% 38% 35% 32% 32% 2.0


24PleaseseeAppendixIIfordefinitionof“KotelchuckIndex.”

17.0% 20.0% 22.0% 18.0% 19.0%

30.0%38.0% 35.0% 32.0% 32.0%

0%

20%

40%

60%

80%

100%

2006 2007 2008 2009 2010

Percent of All Births

Percent of Births to Teens (Ages 19 and Younger)



BIRTH WEIGHT Large percentages of babies born at lowbirthweight in a communitymay indicate a need forimproving the health of pregnant mothers through prenatal care services and reducingenvironmental stressors.25 In SantaCruzCounty, the percentage of all births born at lowbirthweight was 5.7% in 2010, down from 6.5% in 2009. The percentage of low births weightdeliveries to teenmothers remainedhigher than in the general population except in2006and2010.

Percent of Births with Babies Born at Low Birth Weight1, Santa Cruz County

Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data. 1 Babies born weighing less than 2,500 grams.

Percent of Low Birth Weight Deliveries, All Births


NET CHANGE

Dominican Hospital 7.0% 8.9% 9.3% 10.6% 9.1% 2.1

Sutter Maternity & Surgery Center 2.2% 1.5% 1.4% 1.4% 0.9% -1.3

Watsonville Community Hospital 4.7% 3.7% 5.6% 4.3% 4.3% -0.4

Out of County 19.4% 21.5% 17.7% 34.0% 22.6% 3.2

Non-Hospital 0.0% 1.4% 3.8% 0.0% 0.0% NA

Santa Cruz County 5.5% 5.8% 6.3% 6.5% 5.7% 0.2

California 6.8% 6.9% 6.8% 6.8% NA NA

Source: Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data.

Number and Percent of Low Birth Weight Deliveries, Births to Teens (Ages 15-19)

BIRTH WEIGHT 2006 2007 2008 2009 2010 00-10

% CHANGE

Under 1500 Grams (2.5 lbs.) 3 4 2 5 3 ^

1500 - 2499 Grams (5.5 lbs.) 11 17 19 20 11 ^

2500 Grams & Over (Normal) 296 280 283 294 244 -17.6%

Santa Cruz County Teen Births 310 301 304 319 258 -16.8%

Percent Low Birth Weight 4.5% 7.0% 6.9% 7.8% 5.4% -

Source: County of Santa Cruz, Public Health Department. (July 2011). Unpublished Data. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.

25CommunityHealthNetwork.(2011).High‐RiskNewborn—LowBirthweight.RetrievedJanuary4,2011fromhttp://www.ecommunity.com/health/index.aspx?pageid=P02382.

5.5%5.8% 6.3% 6.5%

5.7%4.5%

7.0% 6.9% 7.8%

5.4%

0%

5%

10%

2006 2007 2008 2009 2010

Percent of All Births

Percent of Births to Teens (Ages 15-19)



BREASTFEEDING AccordingtotheAmericanAcademyofPediatrics(AAP),breastfeedinghasbeenshowntohaveanumberofhealthadvantagesforinfants,mothers,families,andsociety.Thereisstrongevidencethat children who are breastfed experience a decreased incidence of infectious disease, adecreased rateof Sudden InfantDeathSyndrome (SIDS), andenhanced cognitivedevelopment.Greater social benefits include decreased annual health care costs, decreased parentalabsenteeism fromwork, and a decreased environmental burden. Because of such benefits, theAAPrecommendsthatinfantsshouldbeexclusivelybreastfedforatleastsixmonthsafterbirth.26

In2010,alargemajorityofSantaCruzCountymothersengagedinanyin‐hospitalbreastfeeding(98%),muchhigherthanCaliforniaoverall(91%).Latinamothershadmuchlowerpercentagesofexclusivein‐hospitalbreastfeeding(64%),comparedtoCaucasian(93%)in2010.

Percent of Any In-Hospital Breastfeeding - 2010

Source: California Department of Public Health (2011). 2008-2011 California In-Hospital Breastfeeding Statistics as Indicated on the Newborn Screening Test Form. Note: 2010 data presented cannot be compared to data published in prior years due to recent revisions to the NBS data collection tool (NBS Form) as well as changes in their data analysis methodology.

Percent of In-Hospital Breastfeeding DELIVERY LOCATION 2010

Dominican Hospital

Any Breastfeeding 98.6%

Exclusive Breastfeeding 91.0%

Sutter Maternity & Surgery Center



Watsonville Community Hospital



Santa Cruz County



California


Exclusive Breastfeeding 56.8% Source: California Department of Public Health (2011). 2008-2010 California In-Hospital Breastfeeding Statistics as Indicated on the Newborn Screening Test Form. Note: 2010 data presented cannot be compared to data published in prior years due to recent revisions to the NBS data collection tool (NBS Form) as well as changes in their data analysis methodology.

26AmericanAcademyofPediatrics,BreastfeedingandtheUseofHumanMilk,retrievedJanuary14,2011.http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496

98.1% 90.8%

0%

20%

40%

60%

80%

100%

Santa Cruz County California



Percent of In-Hospital Breastfeeding by Ethnicity, Santa Cruz County ETHNICITY 2010 ETHNICITY 2010

Asian White

Any Breastfeeding 100% Any Breastfeeding 98.7%

Exclusive Breastfeeding 80.9% Exclusive Breastfeeding 93.1%

Hispanic/Latina Multiple Race

Any Breastfeeding 97.8% Any Breastfeeding 98.6%

Exclusive Breastfeeding 63.9% Exclusive Breastfeeding 88.9% Source: California Department of Public Health (2011). 2008-2010 California In-Hospital Breastfeeding Statistics as Indicated on the Newborn Screening Test Form. Note: 2010 data presented cannot be compared to data published in prior years (2004-2008, or 2009) due to recent revisions to the NBS data collection tool (NBS Form) as well as changes in their data analysis methodology. Note: Percents were not calculated for ethnicities with fewer than 20 events.

IMMUNIZATION LEVELS Thepercentofchildcarecenterandkindergartenentrantswhohadallrequiredimmunizations27decreased from 2000 to 2010. The percentages of Santa Cruz County child care center andkindergarten entrants with all required immunizations continue to be lower than those ofCalifornia.

Percent of Child Care Center and Kindergarten Entrants with All Required Immunizations, Santa Cruz County

Source: California Department of Health Services, Immunization Branch (2011). 2000-2010 Kindergarten Assessment Results. California Department of Health Services, Immunization Branch (2011). 2000-2010 Child Care Assessment Results.

Immunization Levels of Child Care Center Entrants1

CHILD CARE CENTER ENTRANTS 2000 2002 2004 2006 2007 2008 2009 2010 00-10

NET CHANGE

Number of Children 3,095 3,101 3,343 3,263 3,582 3,516 4,576 3,348 253.0

Number of Child Care Centers 70 75 75 77 84 79 85 89 19.0

Percent with Permanent Medical Exemptions

0.2% 0.7% 0.7% 0.4% 0.1% 0.2% 0.1% 0.3% 0.1

Percent with Personal Belief Exemptions 2.1% 4.6% 4.4% 3.1% 4.0% 5.4% 4.8% 7.0% 4.9

Percent Needing One or More Immunizations (Conditional Entrants)

7.5% 11.5% 6.9% 8.2% 7.3% 9.3% 9.2% 11.3% 3.8

Santa Cruz County – Percent with All Required Immunizations

92.4% 88.5% 88.0% 88.4% 88.5% 85.1% 85.9% 81.4% -11.0

California – Percent with All Required Immunizations

94.1% 94.3% 93.7% 93.6% 93.5% 92.9% 91.9% 90.6% -3.5

Source: California Department of Health Services, Immunization Branch (2011). 2000-2010 Child Care Assessment Results. Note: As of July 2001, one dose of Varicella (Chickenpox) vaccine or physician-documented disease and/or immunity is required for entry into child care and Kindergarten. 1 Includes children ages 2 years to 4 years, 11 months.

27PleaseseeAppendixIIfordefinitionof“RequiredImmunizations.”

92.4% 88.5% 88.0% 88.4% 88.5% 85.3% 85.9%

81.4%90.1% 87.8% 87.0% 86.8% 84.0% 85.1% 83.1%

82.5%

60%

80%

100%

2000 2002 2004 2006 2007 2008 2009 2010

Child Care Center Entrants

Kindergarten Entrants



Immunization Levels of Kindergarten Entrants1

KINDERGARTEN ENTRANTS 2000 2002 2004 2006 2007 2008 2009 2010 00-10

NET CHANGE

Number of Students 3,359 3,351 3,063 3,309 3,281 2,941 3,371 3,452 -

Number of Schools 59 62 57 65 66 58 63 64 -

Percent with Permanent Medical Exemptions

0.2% 0.4% 0.3% 0.5% 0.7% 0.5% 0.3% 0.1% -0.1

Percent with Personal Belief Exemptions 3.4% 5.4% 4.6% 7.6% 6.3% 7.3% 6.5% 9.8% 6.4

Percent Needing One or More Immunizations (Conditional Entrants)

6.3% 6.5% 8.1% 5.1% 8.9% 6.9% 10.2% 7.6% 1.3

Santa Cruz County – Percent with All Required Immunizations

90.1% 87.8% 87.0% 86.8% 84.0% 85.3% 83.1% 82.5% -7.6

California – Percent with All Required Immunizations

92.2% 92.3% 92.9% 92.7% 92.1% 91.7% 91.1% 90.7% -1.5

Source: California Department of Health Services, Immunization Branch (2011). 2000-2010 Kindergarten Assessment Results. Note: As of July 2001, one dose of Varicella (Chickenpox) vaccine or physician-documented disease and/or immunity is required for entry into child care and Kindergarten. 1 Includes children ages 4 years to 6 years, 11 months.

DENTAL CARE Since2003thepercentageofCAPsurveyrespondentswithdentalinsurancedecreasedfrom72%in2003to57%in2011.AlthoughthemajorityofCAPsurveyrespondents(87%)reportedbeingable to get dental care they needed in the past year, Caucasian respondents (90%) weresignificantlymorelikelythanLatinorespondents(77%)toreceivedentalcarewhentheyneededit.

Does your health insurance cover dental care?

RESPONSE 2003 2005 2007 2009 2011 03-11 NET CHANGE

Yes 71.6% 64.8% 66.5% 62.4% 57.1% -14.5

No 28.4% 35.2% 33.5% 36.6% 42.9% 14.5

Total Respondents 568 589 628 682 571 -

Source: Applied Survey Research (2011). 2003-2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Percentages may not add up to 100% due to respondents answering “Don’t Know.” Note: Question reworded in 2007 from “Do you also have additional health insurance coverage for dental care?”

How many of your children have dental insurance? - 2011 AGE GROUP NONE AT LEAST ONE



Children 0-5 N: 2011=107; Children 6-17 N: 2011=169 Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Survey question not asked in 2009.

Have you needed dental care in the past year and been unable to receive it? (Respondents answering “Yes”) - 2011

N: Overall=717; Caucasian=504; Latino=159. Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Latino respondents were significantly more likely than Caucasian respondents in the past year to have been unable to receive dental care when needed.

13.2% 9.6%*23.5%*

0%

20%

40%

Overall Caucasian Latino



If you needed dental care and were unable to receive it, why couldn’t you receive it? RESPONSE 2009 2011

Too Expensive 42.4% 41.1%

No Insurance 30.5% 26.4%

Insurance Wouldn’t Cover It 13.9% 12.5%

Couldn’t Afford Co-Pay 4.6% 10.0%

Couldn’t Afford Premiums 2.6% 7.9%

Other 6.0% 2.2%

Total Respondents 127 93 Source: Applied Survey Research (2011). 2009-2011 Santa Cruz County Community Assessment Project, Telephone Survey.

MENTAL HEALTH Whenaskedabouttheirmentalhealth,LatinoCAPsurveyrespondents(26%)weresignificantlymorelikelythanCaucasianrespondents(9%)tofeelsosadorhopelessalmosteverydayfortwoweeksormoreinarowduringthepast12monthsthattheystoppeddoingsomeusualactivities.

During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? (Respondents answering “Yes”) By Ethnicity - 2011

N: Overall=720; Caucasian=504 Latino=161. Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Latino respondents were significantly more likely than Caucasian respondents to feel so sad or hopeless almost every day for two weeks or more in a row during the past 12 months that they stopped doing some usual activities.

Percent of Adult Respondents (Ages 18 and Older) Who Indicated that, in the Past 12 Months, They Had …

EVENT/REGION 2007 2009

Needed to See a Professional for Problems with Their Emotional/Mental Health or Alcohol/Drug Use Santa Cruz County 19.7% 13.1% California 16.5% 14.3%

Seen a Health Care Provider for Problems with Their Emotional/Mental Health or Alcohol/Drug Use Santa Cruz County 16.3% 11.2% California 12.4% 10.9%

Taken Prescription Medication for Their Mental Health or Emotional Problems Almost Daily for Two Weeks or More Santa Cruz County 9.2% 10.0% California 10.0% 9.7%

Source: UCLA Center for Health Policy Research (2011). 2007-2009.California Health Interview Survey. Note: Data presented are the most recent data available.

13.5%9.3%*

26.4%*

0%

20%

40%




PHYSICAL HEALTH 1in3(30%)LatinoCAPsurveyrespondentsin2011indicatedthatingeneraltheiroverallhealthwas “fair” or “poor” compared to 14% of Caucasian respondents, a statistically significantdifference.Forthosewhoseincomewaslessthan$35,000peryear,30%ofsurveyrespondentsindicatedtheirhealthwas“fair”or“poor”,comparedtoonly6%ofsurveyrespondentsearning$65,500ormoreperyear,astatisticallysignificantdifference.

How would you describe, in general, your overall health? - 2011

N: Overall=719; Caucasian=501; Latino=162 Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Significantly more Caucasian respondents than Latino respondents had excellent or very good overall health compared to Latino respondents. And significantly more Latino Respondents than Caucasian respondents reported their overall health was fair or poor.

PHYSICAL ACTIVITY Physical activity is an important factor in achieving and maintaining good health. The CDCrecommends30minutesofmoderate‐intensityphysical activity, fiveormore timesaweek foradults,and60minutesormoreeachdayforchildren.21

How many days per week do you engage in physical activity, such as brisk walking or gardening, for a combined total of 30 minutes or more? (Respondents answering “At Least One Day a Week”) By Income Level

Overall N: 2001=705; 2002=684; 2003=699; 2005=706; 2007=711; 2009=848, 2011=720; $34,999 or less N: 2001=257; 2002=280; 2003=311; 2005=267; 2007=176; 2009=164, 2011=276; $35,000 to $65,499 N: 2001=173; 2002=158; 2003=164; 2005=130; 2007=157; 2009=195, 2011=136; $65,500 or more N: 2001=210; 2002=195; 2003=172; 2005=242; 2007=311; 2009=218, 2011=247 Source: Applied Survey Research (2011). 2001-2011 Santa Cruz County Community Assessment Project, Telephone Survey.

21CentersforDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,NutritionandPhysicalActivity.(2010).TheImportanceofPhysicalActivity.Retrieved2010fromhttp://www.cdc.gov.

17.2%

24.6%*

22.9%*

22.3%

37.9%*

34.1%*

30.4%

23.6%

25.7%

23.3%

10.4%*

13.1%*

6.9%

3.5%*

4.1%*

0% 20% 40% 60% 80% 100%

Latino

Caucasian

OverallExcellentVery GoodGoodFairPoor

89.8%

88.9%91.2%

89.1%

92.8%91.1%

91.3%

86.9%

84.4%

87.0% 86.5% 86.7%

83.0%

86.2%

87.1%

91.6% 95.2%

91.8%

90.5%

87.6%

93.4%

96.0%95.1% 95.9%

93.1%

96.0% 95.4%94.3%

80%

90%

100%

2001 2002 2003 2005 2007 2009 2011

Overall

$34,999 or less

$35,000 to $65,499

$65,500 or more



Percentage of Students Achieving Physical Fitness Goals in At Least 5 Out of 6 Fitness Areas by Grade

GRADE 2001/02 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 01-10

NET CHANGE

Santa Cruz County

5th Grade 51.7% 55.1% 52.7% 53.9% 55.0% 54.6% 53.0% 54.0% 2.3

7th Grade 52.6% 61.3% 62.2% 63.3% 60.7% 64.2% 63.4% 57.2% 4.6

9th Grade 60.1% 55.8% 63.6% 65.3% 62.6% 66.7% 67.6% 63.1% 3.0

California 5th Grade 48.0% 51.0% 50.8% 52.0% 53.3% 55.1% 55.9% 55.4% 7.4

7th Grade 52.2% 55.4% 55.4% 55.7% 57.1% 59.3% 60.7% 61.8% 9.6

9th Grade 48.0% 52.2% 53.0% 53.8% 56.6% 62.7% 64.8% 66.1% 18.1

Source: California Department of Education. (2011). 2001-2010 Physical Fitness Testing Statewide Research Files. Note: The Fitness Areas include Aerobic Capacity, Body Composition, Abdominal Strength, Trunk Extensor Strength, Upper Body Strength, and Flexibility.

FRUIT AND VEGETABLE CONSUMPTION Fruits and vegetables provide vitamins,minerals, fiber and other nutrients important to goodhealth.Dietsrichinfruitsandvegetablesmayhelpreducetheriskofchronicdiseaseandcancer.Over half (56%) of CAP survey respondents reported eating 5 or more servings of fruits andvegetables a day. Fifty‐three percent (53%) of Caucasian respondents (lower than previousyears),and64%ofLatinorespondents(higher thanpreviousyears)reportedeating5ormoreservingsoffruitsandvegetablesaday.

Do you eat 5 or more servings of fruits and vegetables a day? (Respondents answering “Yes”) By Ethnicity

Overall N: 2005=703; 2007=699; 2009=842, 2011=711; Caucasian N: 2005=492; 2007=486; 2009=592, 2011=494; Latino N: 2005=159; 2007=160; 2009=187, 2011=162 Source: Applied Survey Research (2011). 2005-2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: A serving is 1 medium apple or a cereal bowl full of salad. Fresh, frozen, canned, 100% juice or dried fruits or vegetables all count. *Significance testing: Latino respondents were significantly more likely than Caucasian respondents to eat 5 or more servings of fruits and vegetables a day.

Thinking about physical activity and nutrition, do you know what the 5210 campaign1 stands for? RESPONSE 2009 2011

Yes 3.6% 2.1%

No 96.4% 97.9%

Total Respondents 849 722

Source: Applied Survey Research (2011). 2009-2011 Santa Cruz County Community Assessment Project, Telephone Survey. 1 Please see Appendix II for definition of “5210 Campaign”.

61.1%55.3% 57.1% 55.7%58.0% 56.7% 59.1%

52.8%*

70.5%

48.9% 50.8%

64.4%*

40%

60%

80%

2005 2007 2009 2011

Overall

Caucasian

Latino



How many times in the past 7 days did you eat fast food? (Respondents answering at least once) - 2011

Overall N: 2011=717; Caucasian N: 2011=500; Latino N:2011=161 Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: Survey question was not asked in 2009.

OBESITY BasedontheBodyMassIndex,thepercentageofCAPsurveyrespondentswhoareoverweightorobese increased from 50% in 2007 to 57% in 2011. Latinos had higher percentages ofoverweight/obesity(70%)ascomparedtoCaucasians(54%)in2011.Moreover,in2008,SantaCruz County ranked 40th (1 being the best) out of California’s 66 counties and healthjurisdictions22 foroverweightchildrenaged less than fiveyears.Over two‐thirdsof students in5th,7th,and9thgradeinSantaCruzCountyschoolswereconsideredathealthyweightin2010.

Foradults,overweightisdefinedasaBodyMassIndex(BMI)of25.0orgreater.TheformulaforcalculatingtheBMIofadultsis:

WeightinPoundsBMI=(Heightininches)x(Heightininches)x703

Overweight and Obese Adult Respondents in Santa Cruz County (Based on BMI) By Ethnicity

Overall N: 2007=673; 2009=792, 2011=650; Caucasian N: 2007=473; 2009=570, 2011=470; Latino N: 2007=152; 2009=161, 2011=132 Source: Applied Survey Research (2011). 2007-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Latino respondents were significantly more likely than Caucasian respondents to be obese.

22Thehealthjurisdictionsinclude:CityofBerkeley,Pasadena,LongBeach,LosAngelesNorth,LosAngelesSouth,LosAngelesWestandLosAngelesEast,andLosAngelesOther.

38.8% 32.7%

57.6%

0%

20%

40%

60%

80%

100%


50.3%

55.8%57.1%

49.3% 50.3% 54.3%*

51.9%

71.6% 69.7%*

0%

20%

40%

60%

80%

100%

2007 2009 2011

Overall

Caucasian

Latino

)(



Percent of Low-Income Children Under 5 Years and Ages 5-19 Who Are Obese (≥95th Percentile), Santa Cruz County

Source: Center for Disease Control (2011). 2000-2009 Pediatric Nutrition Surveillance. Growth Indicators by Race/Ethnicity and Age. Note: The data are collected from participants in the Child Health and Disability Prevention Program, which serves Medi-Cal recipients and children/youth with family incomes up to 200% of the federal poverty level (FPL). These data on overweight/obesity capture approximately 22% of low-income (up to 200% FPL) children in California.

Percent of Low-Income Children Who Are Obese (≥95th Percentile)

AGE GROUP/REGION 2000 2002 2004 2005 2006 2007 2008 2009 00-09

NET CHANGE

Children Under 5 Years

Santa Cruz County 15.2% 16.2% 13.2% 13.5% 15.6% 15.2% 15.0% 13.5% -1.7

California 16.1% 16.2% 16.3% 15.9% 15.4% 15.5% 15.5% 15.7% -0.4

Children 5-19 Years Santa Cruz County 23.2% 24.3% 23.1% 23.8% 22.3% 23.0% 25.9% 24.4% 1.2

California 19.7% 20.8% 22.4% 22.7% 23.1% 23.1% 22.8% 23.1% 3.4

Source: Center for Disease Control (2011). 2000-2009 Pediatric Nutrition Surveillance. Growth Indicators by Race/Ethnicity and Age. Note: The data are collected from participants in the Child Health and Disability Prevention Program, which serves Medi-Cal recipients and children/youth with family incomes up to 200% of the federal poverty level (FPL). These data on overweight/obesity capture approximately 22% of low-income (up to 200% FPL) children in California.

Students at a Healthy Weight,1 by Grade Level

GRADE LEVEL/REGION 2006 2007 2008 2009 2010 06-10 NET CHANGE

5th Grade


California 67.4% 67.9% 68.4% 68.4% 68.5% 1.1

7th Grade


California 67.0% 67.7% 68.4% 68.7% 68.8% 1.8

9th Grade Santa Cruz County 74.2% 72.0% 72.1% 73.2% 71.9% -2.3

California 68.0% 68.7% 69.7% 69.8% 71.3% 3.3

Source: Lucile Packard Foundation for Children’s Health. (2011). Kidsdata.org. 1 Please see Appendix II for definition of “Healthy Weight”.

15.2% 16.2%13.2% 13.5% 15.6% 15.2% 15.0% 13.5%

23.2% 24.3% 23.1% 23.8% 22.3% 23.0%25.9% 24.4%

0%

20%

40%

2000 2002 2004 2005 2006 2007 2008 2009

Under 5 Years

Ages 5-19



DIABETES Diabetesaffects25.8millionpeopleofallages in theUS,about8%of theUSpopulation. It isamajorcauseofheartdiseaseandstrokeandistheseventhleadingcauseofdeathinthenation.23InSantaCruzCounty,thepercentageofCAPsurveyrespondentswhoreportedthatadoctorhadtoldthemthattheyhaddiabetesorpre‐diabetes(otherthanduringpregnancy) increasedfrom10%in2007to12%in2011.

Other than during pregnancy, has a doctor ever told you that you have diabetes or pre-diabetes? (Respondents answering “Yes”)

Over all N: 2007=700; 2009=849, 2011=716 Latino N: 2007= 159: 2009= 593:2011= 162: Caucasian N: 2007= 159: 2009=191: 2011= 498. Source: Applied Survey Research (2011). 2007-2011 Santa Cruz County Community Assessment Project, Telephone Survey.

If a doctor has told you that you have diabetes or pre-diabetes, were you told it was:

N: 2007=64; 2009=98, 2011=82 Source: Applied Survey Research (2011). 2007-2011 Santa Cruz County Community Assessment Project, Telephone Survey.

Percent of Adult Respondents (Ages 18 and Older) Who Have Ever Been Diagnosed with Diabetes

REGION 2003 2005 2007 2009 03-09

NET CHANGE

Santa Cruz County 4.1% 3.5% 7.3%^ 4.3% 0.2California 6.6% 7.0% 7.8% 8.5% 1.9

Source: UCLA Center for Health Policy Research (2011). 2003-2009 California Health Interview Survey. Note: Data presented are the most recent available. ^ Statistically unstable due to a low number of respondents.

Adult Respondents (Ages 18 and Older) with Diabetes, By Type

TYPE/REGION 2003 2005 2007 2009 03-09

NET CHANGE

Type 1 Santa Cruz County 13.2%^ 30.8%^ 9.9%^ 14.7%^ 1.5 California 15.7% 17.4% 12.9% 14.9% -0.8

Type 2 Santa Cruz County 86.8% 69.2% 90.1% 82.3% -4.5 California 84.3% 82.6% 87.1% 82.8% -1.5

Source: UCLA Center for Health Policy Research (2011). 2003-2009 California Health Interview Survey. Note: Data presented are the most recent available. ^Statistically unstable due to a low number of respondents.

23USDepartmentofHealthandHumanServices.NationalDiabetesInformationClearinghouse(NDIC).(2011).NationalDiabetesStatistics.RetrievedSeptember2011fromwww.diabetes.niddk.nih.gov.

9.7%

12.2% 11.8%

9.1%12.6%

11.7%

12.3%12.2%

10.7%

0%

5%

10%

15%

2007 2009 2011

Overall

Caucasian

Latino

46.1%

59.4% 62.4%53.9%

40.6% 37.6%0%

20%40%60%80%

2007 2009 2011

Diabetes

Pre-Diabetes



ALCOHOL USE In2009,52%ofAmericansage12andolderhadusedalcoholatleastonceinthe30dayspriortobeing surveyed and 24% had engaged in binge drinking (5 ormore drinks within 2 hours).24Thirteen percent (13%) of CAP survey respondents engaged in binge drinking “one or moretimes”inthepast30daysin2011.

Considering all types of alcoholic beverages, during the past 30 days about how many times did you have 5 or more drinks on an occasion? An occasion is considered about 2 hours. (Respondents answering “One or more times”)

N: 2005=705; 2007=707; 2009=848, 2011=719 Source: Applied Survey Research (2011). 2005-2011 Santa Cruz County Community Assessment Project, Telephone Survey.

AVAILABILITY OF ALCOHOL The number of retail alcohol outlets25 has been demonstrated to significantly correlate withassaultrates,orhighercrime.26Overthepastdecade,thenumberofretailalcoholoutletsinSantaCruzCountyandCaliforniaremainedvirtuallythesame.However,SantaCruzCountyconsistentlyhadahigherrateofretailalcoholoutletsin2010(around2.5per1,000)thanCalifornia(around1.9per1,000).

Number of Retail Alcohol Outlets1

INDICATOR APRIL

2001 APRIL

2003 JUNE 2005

JUNE 2006

JUNE 2007

JUNE 2008

JUNE 2009

JUNE 2010

01-10 % CHANGE

Retail Alcohol Outlets – Santa Cruz County

641 633 634 634 631 638 647 689 7.5%

Retail Alcohol Outlets – California 71,216 66,9922 68,072 68,953 69,891 70,813 71,087 71,599 0.5% Outlets per 1,000 People - Santa Cruz County

2.4 2.4 2.4 2.4 2.4 2.4 2.4 2.5 -

Outlets per 1,000 People - California 2.0 1.9 1.8 1.9 1.9 1.9 1.9 1.9 - Source: California Department of Alcoholic Beverage Control (2011). 2001-2011 Alcoholic Beverage Licenses Report. California Department of Finance (2011). 2001-2011 E-1: City/County Population Estimates with Annual Percent Change. 1Includes both on-sale and off-sale outlets. 2 As of 2003, a more accurate calculation of total California wholesale and retail alcohol outlets was performed, and this accounts for the apparent reduction in the total number of California outlets.

Retail Alcohol Outlets, by City - 2010 INDICATOR UNINCORPORATED CAPITOLA SANTA CRUZ WATSONVILLE SCOTTS VALLEY Number of Retail Outlets 240 59 245 104 40 Outlets per 1,000 People 1.7 5.8 4.1 2.0 3.4 Percentage of County Retail Outlets 34.8% 8.6% 35.6% 15.1% 5.8%

Source: California Department of Alcoholic Beverage Control (2011). 2011 Alcoholic Beverage Licenses Report. California Department of Finance (2011). 2011 E-1: City/County Population Estimates with Annual Percent Change.

24U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration,OfficeofAppliedStudies.(2010).Resultsfromthe2009NationalSurveyonDrugUseandHealth:VolumeI.SummaryofNationalFindings.RetrievedNovember2011fromhttp://oas.samhsa.gov/nsduh/2k9nsduh/2k9resultsp.pdf.25PleaseseeAppendixIIfordefinitionof“RetailAlcoholOutlets.”26Gruenewaldetal.(1995).Ecologicalmodelsofalcoholoutletsandviolentassaults:crimepotentialsandgeospatialanalysis.SocietyfortheStudyofAddiction,2006.

16.7%10.7% 12.2%

12.9%

0%

10%

20%

2005 2007 2009 2011



How much of an impact has drug and alcohol abuse had in your neighborhood? (Respondents answering “Big Impact”) By Region - 2011

N: Overall=680 North County=259; South County=215; SLV=210. Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey.

ACCEPTANCE OF ADULT ALCOHOL PROVISION One in five CAP survey respondents (21%) reported feeling that it is “very” or “somewhat”acceptable foradults toprovidealcohol tounderageyouth in theirhome.Twenty‐fourpercent(24%)ofCaucasian survey respondents felt it is “very”or “somewhat” acceptable foradults toprovidealcoholtounderageyouthintheirhomecomparedtoonly11%ofLatinorespondents,astatisticallysignificantdifference.

How acceptable do you think it is for adults to provide alcohol to underage youth in their home? (Respondents answering “Very acceptable” or “Somewhat acceptable”) By Ethnicity

2009 N: Overall=700; Caucasian= 582; Latino=187. 2011 N: Overall=700; Caucasian= 482; Latino=162 Source: Applied Survey Research (2011). 2009-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Latino respondents were significantly more likely than Caucasian respondents to think that it is unacceptable for adults to provide alcohol to underage youth in their home.

COMMUNITY ACCEPTANCE OF MARIJUANA USE Overall, thepercentageofCAPsurveyrespondentswhoreported feeling thatmarijuanause forrecreationalornon‐medicinaluseis“acceptable”decreasedfrom55%in2003to50%in2011.Significantly more Caucasian respondents found it acceptable to use marijuana than Latinorespondents, andsignificantlymoreSanLorenzoValley respondents found it acceptable tousemarijuanathaninSouthCountyrespondents.

14.4% 11.5%17.5% 16.5%

0%

20%

40%

60%

80%

100%

Overall North County South County SLV

20.4% 21.2%

22.1% 24.0%*

13.5% 11.4%*0%

20%

40%

2009 2011

Overall

Caucasian

Latino



How acceptable do you find the use of marijuana for recreational or non-medicinal use? (Respondents answering “Very Acceptable” or “Somewhat Acceptable”)

Overall N: 2000=657; 2001=700; 2002=681; 2003=693; 2005=680; 2007=688; 2009=833, 2011=690 Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey. Note: “Very” was added to the response option “Very acceptable” in 2011.

How acceptable do you find the use of marijuana for recreational or non-medicinal use? (Respondents answering “Very Acceptable” or “Somewhat Acceptable”) by Ethnicity

2009 N: Overall=700; Caucasian= 582; Latino=187. 2011 N: Overall=690; Caucasian= 479; Latino=159 Source: Applied Survey Research (2011). 2009-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: Caucasian respondents were significantly more likely than Latino respondents to think that it is very or somewhat acceptable for recreational or non-medicinal use of marijuana. Note: “Very” was added to the response option “Very acceptable” in 2011.

How acceptable do you find the use of marijuana for recreational or non-medicinal use? (Respondents answering “Very Acceptable”) by Region

REGION 2000 2001 2002 2003 2005 2007 2009 2011 00-11

NET CHANGE

North County 29.8% 35.0% 30.4% 44.6% 31.5% 17.0% 16.0% 15.8%* -14.0

South County 13.3% 16.5% 16.1% 16.8% 25.8% 13.7% 8.7% 7.0%* -6.3

San Lorenzo Valley 23.2% 37.9% 34.7% 38.7% 35.2% 29.7% 16.4% 24.7%* 1.5

North County N: 2000=346; 2001=202; 2002=232; 2003=233; 2005=229; 2007=228; 2009=334, 2011=257; South County N: 2000=195; 2001=288; 2002=226; 2003=239; 2005=231; 2007=237; 2009=281, 2011=225; SLV N: 2000=112; 2001=210; 2002=222; 2003=221; 2005=218; 2007=227; 2009=217, 2011=209 Source: Applied Survey Research (2011). 2000-2011 Santa Cruz County Community Assessment Project, Telephone Survey. *Significance testing: San Lorenzo Valley respondents were significantly more likely than North and South County respondents to find the use of marijuana for recreational or non-medicinal use acceptable in 2011. Note: “Very” was added to the response option “Very acceptable” in 2011.

24.8% 22.0% 23.5% 21.6% 23.4% 26.5% 31.2% 36.6%

23.7% 28.3% 25.6% 33.5% 29.2% 17.5% 13.3%13.3%

0%

20%

40%

60%

80%

100%

2000 2001 2002 2003 2005 2007 2009 2011

Very Acceptable

Somewhat Acceptable

44.5%49.9%

52.8%59.9%*

20.2% 20.3%*0%

20%

40%

60%

80%

2009 2011

OverallCaucasianLatino

48.5% 50.3% 49.1% 55.1% 52.6%

44.0% 44.5% 49.9%



TOBACCO USE Overall,thepercentageofSantaCruzCounty11thgradestudentswhohavesmokedcigarettesinthelast30daysdecreasedfrom19%in2000/01to14%in2008/09.9thand11thgradestudentsusingsmokelesstobaccointhelast30daysincreasedto6%inthecounty,greaterthanCaliforniaat4%in2008/09.

Percent of Students Who Reported Using Cigarettes in the Last 30 Days, By Grade SANTA CRUZ COUNTY 2000/01 2002/03 2004/05 2006/07 2008/09 00-09 NET CHANGE

7th Grade 6% 5% 5% 4% 6% 0.0

9th Grade 13% 9% 11% 10% 12% -1.0

11th Grade 19% 11% 18% 14% 14% -5.0

CALIFORNIA1 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 03-10 NET CHANGE

7th Grade 4% 4% 4% 5% 5% 5% 1.0

9th Grade 9% 9% 9% 9% 9% 10% 1.0

11th Grade 13% 14% 13% 14% 13% 13% 0.0

Source: West Ed for California Department of Education (2011). 2000-2010 California Healthy Kids Survey, Santa Cruz County. Note: Data are weighted. Data presented are the most recent available. 1 Data for previous years in California are not available, as the survey instrument has changed.

Percent of Students Who Reported Using Smokeless Tobacco in the Last 30 Days, By Grade SANTA CRUZ COUNTY 2000/01 2004/05 2006/07 2008/09 00-09 NET CHANGE

7th Grade NA 2% 2% 3% -

9th Grade 3% 4% 4% 6% 3

11th Grade 3% 4% 5% 6% 3

CALIFORNIA1 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 03-10 NET CHANGE

7th Grade 2% 2% 2% 3% 3% 3% 1.0

9th Grade 2% 2% 3% 3% 4% 4% 2.0

11th Grade 3% 3% 3% 4% 4% 4% 1.0

Source: West Ed for California Department of Education (2011). 2000-2010 California Healthy Kids Survey, Santa Cruz County. Note: Data are weighted. Data presented are the most recent available. 1 Data for previous years in California are not available, as the survey instrument has changed.

METHAMPHETAMINE ADMISSIONS Whenaskedabouthowbigofan impactmethamphetamineusehashad in theirneighborhood,thepercentageofCAPsurveyrespondentswhobelievedmethamphetamineusehadhada “bigimpact”or“somewhatofanimpact”increasedfrom31%in2009to35%in2011.Yet,2009/10methamphetamine treatment admissions decreased from theprevious year in both SantaCruzCountyandstatewide.



How big of an impact has methamphetamine use had in your neighborhood? (Respondents answering “A Big Impact” or “Somewhat”) By Region

2009 N: Overall=853; North County=340; South County=289; SLV=223; 2011 N: Overall=639; North County=245; South County=198; SLV=206. Source: Santa Cruz County Community Assessment Project, Telephone Survey, 2011. *Significance testing: SLV respondents were significantly more likely to report methamphetamine use having a big or somewhat big impact in their neighborhood compared to South County respondents.

Methamphetamine Treatment Admissions

AREA FY

2001/02 FY

2003/04 FY

2004/05 FY

2005/06 FY

2006/07 FY

2007/08 FY

2008/09 FY

2009/10 01-10

% CHANGE

Santa Cruz County 361 445 631 771 775 600 524 363 0.6%

California 61,038 73,128 79,088 70,077 79,769 69,174 61,663 49,268 -19.3%

Source: California Department of Alcohol and Drug Programs, Office of Applied Research and Analysis, 2011. Note: This table presents the number of annual admissions for which methamphetamine was the primary drug of abuse.

PRESCRIPTION DRUG USE In 2011, 2% of CAP survey respondents reported using a prescription medication without aprescription. Therewere no significant differences between income, gender, race/ethnicity, orregion.

During the past 30 days, on how many days have you taken prescription medication without a prescription?

RESPONSE 2011

None 97.8%

1 1.1%

2 0.4%

3 0.2%

4 0.1%

6 0.2%

30 0.1% N:720 Source: Applied Survey Research (2011). 2011 Santa Cruz County Community Assessment Project, Telephone Survey.

SUBSTANCE USE BY STUDENTS AlcoholuseamongSantaCruzCounty11thgradestudentsdecreasedoverthepasttenyearsfrom51%in2000/01to41%in2008/09.However,theuseofmarijuana,cocaine,methamphetamine,inhalants,andpsychedelicswentupfor9thgradersbetween2000/01and2008/09.

30.9% 25.9%33.0%

43.0%34.5% 33.8% 30.9%*

46.0%*

0%

20%

40%

60%

80%

100%

Overall North County South County SLV

2009

2011



Percent of 11th Grade Students Who Reported Using Alcohol1 or Marijuana in the Past 30 Days, Santa Cruz County

Source: West Ed for California Department of Education (2011). 2000-2009 California Healthy Kids Survey, Santa Cruz County. Note: Data are weighted. 1 Alcohol use refers to at least one drink.

Self-Reported Drug and Alcohol Use Among Youth in the Past 30 Days, Santa Cruz County

SUBSTANCE 2000/

01 2002/

03 2004/

05 2006/

07 2008/

09 00-09 NET CHANGE

Alcohol1

7th Grade 18% 13% 16% 15% 18% 0.0

9th Grade 39% 31% 33% 33% 34% -5.0

11th Grade 51% 46% 47% 44% 41% -10.0

Marijuana

7th Grade 7% 6% 6% 7% 10% 3.0

9th Grade 22% 19% 18% 20% 26% 4.0

11th Grade 32% 25% 29% 26% 30% -2.0

Cocaine

7th Grade2 NA NA NA NA NA NA

9th Grade 4% 3% 3% 3% 6% 2.0

11th Grade 6% 4% 5% 4% 5% -1.0

SUBSTANCE 2000/

01 2002/

03 2004/

05 2006/

07 2008/

09 00-09 NET CHANGE

Methamphetamines/Amphetamines


9th Grade 3% 3% 4% 2% 4% 1.0

11th Grade 3% 3% 3% 2% 3% 0.0

Inhalants

7th Grade 4% 5% 3% 5% 8% 4.0

9th Grade 5% 5% 5% 5% 8% 3.0

11th Grade 4% 3% 3% 3% 4% 0.0

Psychedelics (Includes Ecstasy, LSD, or other psychedelics)


9th Grade 4% 4% 3% 3% 8% 4.0

11th Grade 5% 3% 3% 3% 7% 2.0

Source: West Ed for California Department of Education (2011). 2000-2009 California Healthy Kids Survey, Santa Cruz County. Note: Data are weighted. Data presented are the most recent available. 1 Alcohol use refers to at least one drink. 2 Questions regarding use of Methamphetamines and Psychedelics were not asked of 7th middle school students.

Self-Reported Drug and Alcohol Use Among Youth in the Past 30 Days, California

SUBSTANCE 2003/

05 2004/

06 2005/

07 2006/

08 2007/

09 2008/

10 03-10 NET CHANGE

Alcohol1 7th Grade 13% 13% 13% 14% 15% 14% 1.0 9th Grade 27% 28% 27% 26% 27% 25% -2.0 11th Grade 37% 37% 37% 37% 36% 34% -3.0

Marijuana 7th Grade 4% 4% 4% 5% 6% 6% 2.0 9th Grade 12% 12% 12% 12% 13% 15% 3.0 11th Grade 16% 16% 16% 18% 19% 20% 4.0

Cocaine 7th Grade2 NA NA NA NA NA NA NA 9th Grade 2% 2% 2% 3% 3% 3% 1.0 11th Grade 2% 3% 3% 3% 3% 3% 1.0

SUBSTANCE 2003/

05 2004/

06 2005/

07 2006/

08 2007/

09 2008/

10 03-10 NET CHANGE

Methamphetamines/Amphetamines 7th Grade2 NA NA NA NA NA NA NA 9th Grade 2% 2% 2% 3% 3% 3% 1.0 11th Grade 2% 2% 2% 3% 3% 3% 1.0

Inhalants 7th Grade 4% 5% 6% 6% 6% 6% 2.0 9th Grade 4% 5% 5% 5% 6% 6% 2.0 11th Grade 3% 3% 3% 4% 4% 5% 2.0

Psychedelics (Includes Ecstasy, LSD, or other psychedelics) 7th Grade2 NA NA NA NA NA NA NA 9th Grade 2% 2% 2% 4% 4% 5% 3.0 11th Grade 2% 2% 2% 5% 5% 6% 4.0

Source: West Ed for California Department of Education (2011). 2003-2010 California Healthy Kids Survey, Santa Cruz County. Note: Data are weighted. Data presented are the most recent available. 1 Alcohol use refers to at least one drink. 2 Questions regarding use of Methamphetamines and Psychedelics were not asked of 7th middle school students.

51% 46% 47% 44% 41%

32% 25% 29% 26% 30%

0%

20%

40%

60%

2000/01 2002/03 2004/05 2006/07 2008/09

Alcohol UseMarijuana Use



UNINTENTIONAL INJURIES TherateofnonfatalunintentionalinjuriesinSantaCruzCountydecreasedbetween2001(2.5per1,000)and2009(2.1per1,000).Totalunintentionalinjuriesinthecountyweredown17%from2001to2009.Therewasadecreaseinfallsandmotorvehicleinjuriesbetween2001and2009.

Unintentional Non-Fatal Injuries (Ages 0-20) by Age Group AGE GROUP 2001 2003 2005 2006 2007 2008 2009 01-09 % CHANGE

Under 1 Year 10 6 11 9 8 5 10 ^

1- 4 Years 25 27 29 28 27 30 33 32.0% 5-12 Years 53 31 34 31 32 35 22 -58.5% 13-15 Years 30 22 32 19 26 20 15 ^ 16-20 Years 70 55 68 67 66 55 65 -7.1% Santa Cruz County Total Ages 0-20 188 141 174 154 159 145 145 -22.9% Rate per 1,000 – Santa Cruz County 2.5 2.0 2.4 2.2 2.2 2.0 2.1 - Rate per 1,000 – California 2.8 2.7 2.4 2.3 2.1 2.0 2.0 -

Source: California Office of Statewide Health Planning & Development. (2011). 2001-2009 Inpatient Discharge Data. State of California, Department of Finance (2011). 2001-2009 Race/Ethnic Population with Age and Sex Detail. Note: Data presented are the most recent available. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.

Unintentional Non-Fatal Injuries (Ages 0-20), Santa Cruz County CAUSE OF INJURY 2001 2003 2005 2006 2007 2008 2009 01-09 % CHANGE

Falls 64 52 53 42 52 38 37 -42.2% Motor Vehicle Traffic 47 29 35 41 37 31 34 -27.7% Poisoning 16 16 16 10 10 11 19 ^ Struck by Object 10 6 8 10 11 11 12 ^ Firearms 0 0 0 1 1 1 1 NA

Source: California Office of Statewide Health Planning & Development. (2011). 2001-2009 Inpatient Discharge Data.State of California, Department of Finance (2011). 2001-2009 Race/Ethnic Population with Age and Sex Detail. Note: Data presented are the most recent available. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.

INTENTIONAL INJURIES Therewere47intentionalnon‐fatalinjuriesforages0‐20in2001,decreasingto35in2009.

Number of Intentional Non-Fatal Injuries (Ages 0-20) AGE GROUP 2001 2003 2005 2006 2007 2008 2009 01-09 % CHANGE

Under 1 0 0 1 1 0 1 0 NA

1 to 4 0 0 0 0 0 0 0 NA

5 to 12 3 1 0 2 0 0 1 ^

13 to 15 10 6 2 6 8 5 6 ^

16 to 20 34 27 29 27 37 35 28 -17.6%

Santa Cruz County Total (Ages 0-20) 47 34 32 36 45 41 35 -25.5%

Rate per 1,000 – Santa Cruz County 0.6 0.5 0.4 0.5 0.6 0.6 0.5 -

Rate per 1,000 – California 0.7 0.6 0.6 0.6 0.6 0.6 0.5 -

Source: California Office of Statewide Health Planning & Development. (2011). 2001-2009 Inpatient Discharge Data. State of California, Department of Finance (2011) 2001-2009 Race/Ethnic Population with Age and Sex Detail. Note: Data presented are the most recent available. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.



Number of Intentional Non-Fatal Injuries for Persons (Ages 0-20), Santa Cruz County CAUSE OF INJURY 2001 2003 2005 2006 2007 2008 2009

Self-Inflicted 33 21 13 18 26 13 17

Cut/Pierce 3 2 1 0 3 2 3

Poisoning 30 18 12 18 19 9 12

Other (Jump) 0 1 0 0 4 0 1

Hanging/Suffocation 0 0 0 0 0 2 1

Assault 14 13 19 18 19 28 18

Blunt Object 0 1 2 2 2 1 0

Cut/ Pierce 10 10 12 9 13 16 11

Fight, Unarmed 2 1 1 0 2 3 1

Firearm 2 1 2 4 2 3 5

Other (Abuse & Neglect) 0 0 2 3 0 5 1

Total 47 34 32 36 45 41 35

Source: California Office of Statewide Health Planning & Development. (2011). 2001-2009 Inpatient Discharge Data. Note: Intentional injuries include intentional self-harm/suicide and assault/homicide injuries. Note: Data presented are the most recent available.

REPORTED COMMUNICABLE DISEASES Communicable diseases are an indicator of a community’s overall health and are largelypreventableand/ortreatable.Overthepastdecade,themostcommonlyreportedcommunicabledisease in SantaCruzCountywasChlamydia,which increased26% from2000.GonorrheaandWhoopingCoughwerealsoupfrom2000/02to2008/10(35%and47%,respectively).

Reported Cases of Communicable Diseases, Three Year Averages, Santa Cruz County

DISEASE 2000/02 2002/04 2004/06 2005/07 2006/08 2007/09 2008/10 00-10

% CHANGE

Chlamydia 547 566 598 621 647 657 690 26.1%

Gonorrhea 40 58 86 89 72 68 54 35.0%

Hepatitis A1 15 10 3 2 2 2 1 ^

Hepatitis B (Acute)1 5 3 3 3 3 2 1 ^

Lyme Disease 6 5 5 5 5 4 5 ^

Measles1 2 0 0 0 0 0 0 NA

Pertussis (Whooping Cough)1

30 47 42 33 25 20 44 46.7%

Salmonellosis 44 43 37 35 45 52 49 11.4%

Shigellosis 18 27 23 20 11 8 6 ^

Syphilis (Infections) 1 8 7 5 4 6 9 ^

Tuberculosis (Active) 6 8 9 9 9 8 7 ^

Source: Santa Cruz County Health Services Agency (2011). 2000-2010 Communicable Disease Morbidity Comparisons. 1 Vaccine-preventable. ^ Percent change is not calculated for numbers less than 20, as small numbers are unstable and can be misinterpreted.



AIDS Acquired Immunodeficiency Syndrome (AIDS) is the final stage of Human immunodeficiencyvirus (HIV) infection.Peopleat this stageofHIVdiseasehavebadlydamaged immunesystems,which put them at risk for opportunistic infections. AIDS requires medical intervention andtreatment to prevent death. Newly diagnosed cases of AIDS have decreased, from 23 cases in2000to2in2010.

Newly Diagnosed Cases of AIDS ETHNICITY 2000 2002 2004 2006 2007 2008 2009 2010

African American 2 0 1 1 0 0 1 0 Asian/Pacific Islander 0 0 0 1 0 0 0 0 Caucasian 13 11 9 8 10 4 3 0 Hispanic 7 6 5 5 6 0 4 2 Native American 0 1 0 0 0 0 1 0 Other/Unknown 1 0 0 0 0 0 0 0

Santa Cruz County Total 23 18 15 14 16 4 9 2

Source: Santa Cruz County Health Services Agency Public Health Division (2011). 2000-2010 HIV /AIDS in Santa Cruz County. (Personal Correspondence with Program Representative, June 2011). Note: AIDS cases are attributed to the year in which the criteria for case definition were met, rather than to the year in which the disease was reported. Cases may thus be attributed retroactively, for example, to 1997 even if not reported until 2000. Updates are continual.

SUICIDES The suicide age‐adjusteddeath rate decreased slightly in SantaCruzCounty between2001/03(13per100,000)and2009(12per100,000),butdidnotmeettheHealthyPeople2020NationalObjectives27(10per100,000).

Suicide Age-Adjusted Death Rate per 100,000 Population, Three-Year Averages

AREA 2001/03 2003/05 2004/06 2005/07 2006/08 2007/09

HEALTHY PEOPLE 2020 NATIONAL

OBJECTIVE

01-09 NET CHANGE

Santa Cruz County 13.0 12.7 10.5 10.4 10.8 12.4 10.2

-0.6

California 9.5 9.2 9.0 9.0 9.4 9.6 0.1

Source: California Department of Public Health (2011). 2001-2009 County Health Status Profiles. Note: Data presented are the most recent available.

Number of Suicides AGE GROUP 2000 2002 2004 2006 2007 2008 2009 2010

Under 18 Years 1 0 1 1 1 0 0 1

18-29 Years 3 6 4 2 5 1 8 7

30-39 Years 5 2 3 4 6 2 4 3

40-49 Years 8 12 10 5 8 10 12 4

50-59 Years 6 7 5 2 14 12 7 9

60 Years & Older 11 9 10 10 6 6 5 16

Unknown 0 0 NA NA 0 0 0 0

Santa Cruz County Total 34 36 33 24 40 31 36 40

Source: 2000-2002 data: Santa Cruz County Coroner's Office, 2003-2010 data: Santa Cruz County Sheriff’s Office, 2011. (Personal Correspondence with Program Representative, June 2011). Note: Percentage change calculations are not included as calculations based on small number of cases are unstable and can be misinterpreted.

27PleaseseeAppendixIIfordefinitionof“HealthyPeople2020Objectives.”



LEADING CAUSES OF DEATH Monitoringthecausesofdeathisimportantforplanningpreventionactivitiesandhelpsinformboththepublicandhealthpractitionersabouthealthrisksandareasforprevention.Thetopfourleading causes of death were heart disease, cancer (especially lung cancer), stroke, andunintentionalinjuriesin2007/09.Drug‐relateddeathsinthecountywerehigherthanthestateandHealthPeople2020objectives.BreastcancerinthecountywasalsohigherthanthestateandHealthyPeople2020objectives, and according to the communityhealth guidewas an area forconcernincomparisontotheUSandsimilardemographic(peer)counties’deathrate.

DisparitieswereseenbetweenHispanicandCaucasiandeathrates, inwhichhigherdeathratesforHispanicresidentsoccurredindiseasesoftheliverandtype2diabetes.Caucasianshadhigherdeath rates for unintentional injuries and suicide. For youth ages 15‐24, the leading cause ofdeathoverthelastdecadewasunintentionalinjuries.

Age-Adjusted Death Rate per 100,000 Population by Cause of Death, Three-Year Averages

CAUSE OF DEATH 2000/02 2001/03 2003/05 2004/06 2005/07 2006/08 2007/09

HEALTHY PEOPLE 2020 NATIONAL

OBJECTIVE

00-09 NET CHANGE

Coronary Heart Disease Santa Cruz County 132.1 141.8 134.7 119.9 113.2 112.5 114.5

100.8 -17.6

California 186.0 175.9 162.6 154.0 145.2 137.1 128.0 -58.0 All Cancers Santa Cruz County 147.3 163.2 171.7 166.8 166.7 164.6 168.5

160.6 21.2

California 172.7 169.6 165.1 161.3 159.3 155.9 154.0 -18.7 Lung Cancer

Santa Cruz County 37.6 42.7 45.6 41.3 37.9 36.1 39.3 45.5

1.7 California 44.8 43.8 41.5 40.2 39.2 38.1 37.2 -7.6 Breast Cancer Santa Cruz County 19.9 22.0 27.1 26.5 26.92 28.0 25.8

20.6 5.9

California 24.1 23.4 22.7 22.1 21.7 21.2 21.2 -2.9 Stroke Santa Cruz County 45.5 48.5 48.8 42.1 38.1 35.9 38.9

33.8 -6.6

California 58.9 55.6 51.7 47.8 43.5 40.8 38.4 -20.5 Drug-Related Santa Cruz County 10.3 10.9 10.5 10.9 11.9 12.1 11.6

11.3 1.3

California 8.6 9.4 9.6 10.3 10.5 10.6 10.7 2.1 Unintentional Injuries Santa Cruz County 24.6 26.3 29.3 31.2 32.6 34.2 32.5

36.0 7.9

California 27.6 28.6 29.5 30.2 30.4 29.7 28.7 1.1 Suicide Santa Cruz County 12.0 13.0 12.7 10.5 10.4 10.8 12.4

10.2 0.4

California 9.5 9.5 9.2 9.0 9.0 9.4 9.6 0.1 Firearm-Related Santa Cruz County 7.8^ 7.2^ 5.7^ 5.3^ 5.3^ 5.4^ 5.9^

9.2 -1.9

California 9.5 9.6 9.4 9.2 8.9 8.5 8.2 -1.3 Homicide Santa Cruz County 3.1^ 3.3^ 2.8^ 3.0^ 2.6^ 2.8^ 2.2^

5.5 -0.9

California 6.5 6.7 6.7 6.8 6.6 6.3 5.8 -0.7 Motor Vehicle Crashes Santa Cruz County 9.5 11.0 10.2 9.7 9.9 10.4 9.5

12.4 0.0

California 11.1 12.0 11.7 11.9 11.1 10.3 9.2 -1.9 Deaths Due to All Causes

Santa Cruz County 659.5 709.4 699.8 670.5 671.7 669.8 686.8 None Set

27.3 California 745.0 729.0 716.7 697.5 683.5 666.4 647.2 -97.8

Source: California Department of Public Health (2011). 2000-2009 Death Statistical Master Files. Note: Data presented are the most recent available. ^ Death rate unreliable, relative standard of error is greater than or equal to 23%.



Age-Adjusted Death Rate per 100,000 Population by Selected Ethnicities, Santa Cruz County

CAUSE OF DEATH 2001 2003 2005 2006 2007 2008 2009 01-09

NET CHANGE

Cancer

White 174.1 173.7 189.2 174.9 194.9 176.4 195.2 21.1

Hispanic 94.6 148.3 111.5 98.0 104.9 140.4 128.6 34.0

Diseases of the Heart & Circulatory System

White 298.1 287.2 239.3 230.6 251.9 237.7 248.2 -49.9

Hispanic 182.9 207.6 171.7 208.8 192.0 208.4 189.6 6.7

Diseases of the Liver

White 11.4 11.9 11.9 16.7 10.0 17.9 14.9 3.5

Hispanic 18.0 22.8 21.7 17.6 22.4 24.8 21.2 3.2

Diabetes Mellitus (type 2)

White 15.6 12.1 15.1 13.8 15.9 19.3 17.8 2.2

Hispanic 32.9 17.5 55.1 25.7 13.2 32.1 32.5 -0.4

Pneumonia

White 20.6 23.1 24.8 14.2 16.0 9.1 15.6 -5.0

Hispanic 7.1 20.5 11.3 10.6 16.1 24.3 14.0 6.9

Emphysema

White 6.5 5.9 14.7 8.2 5.1 7.6 7.5 1.0

Hispanic 7.1 0.0 4.8 9.2 0.0 4.1 4.0 -3.1

HIV/AIDS

White 2.1 3.5 3.6 2.2 1.1 2.2 2.2 0.1

Hispanic 1.0 0.0 5.9 0.0 2.3 0.0 3.5 2.5

Unintentional Injuries

White 24.6 27.7 28.5 41.5 37.6 34.7 33.4 8.8

Hispanic 38.5 30.7 36.7 36.8 36.1 32.2 25.2 -13.3

Suicide

White 16.5 19.1 12.3 10.2 16.7 16.4 19.8 3.3

Hispanic 1.0 1.0 3.9 3.7 9.1 3.1 3.6 2.6

Homicide

White 4.0 1.9 2.2 2.6 2.3 2.5 0.7 -3.3

Hispanic 6.2 5.4 1.7 9.6 0.0 3.3 5.8 -0.4

Deaths Due to All Causes

White 766.1 762.8 730.6 703.7 746.9 717.0 773.0 6.9

Hispanic 523.2 560.9 527.3 554.8 476.1 614.8 578.0 54.8

Source: California Department of Public Health (2011). 2001-2009 County Health Status Profiles. Note: Data presented are the most recent available. Note: Age-adjusted death rates were calculated using the 2000 U.S. Standard Population.



Selected Leading Causes of Death by Age Group, Santa Cruz County CAUSE OF DEATH 2001 2003 2005 2006 2007 2008 2009

Children Under Age 1 Year

Conditions Originating in the Perinatal Period 30 34 33 35 38 40 58

Congenital Malformations & Chromosomal Abnormalities

5 3 3 6 4 3 2

Cancer 0 0 0 0 0 0 0

Diseases of the Heart & Circulatory System 0 1 0 0 0 0 1

Unintentional Injuries 0 1 1 0 1 1 0

Homicide 0 0 1 0 0 0 0

All Causes 13 15 14 15 19 8 8

Children Ages 1-4 Years


1 0 1 0 2 0 0

Cancer 0 0 0 0 0 0 0



Homicide 0 1 0 0 0 1 0

All Causes 2 2 1 1 4 3 0

Children Ages 5-14 Years


0 0 0 0 0 0 0

Cancer 1 0 0 1 1 0 3



Homicide 2 1 0 0 0 0 0

All Causes 7 5 2 5 3 5 4

Youth Ages 15-24 Years


0 0 0 0 1 0 0

Cancer 0 1 4 0 2 1 3



Homicide 3 2 1 1 0 2 4

All Causes 18 20 28 10 28 27 21

Source: California Department of Public Health (2011). 2001-2009 County Health Status Profiles. Death Statistical Data, Note: Data presented are the most recent available.

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