Community Health Assessment of Nogales, AZCindy Cho, PharmD Candidate Class of 2019

University of Arizona College of Pharmacy

Background and IntroductionObjective•  The purpose of this community health assessment is to identify and

evaluate the health needs of the community in Nogales, AZ.

Community DescriptionGeography and History•  Nogales, AZ is located just cross the Mexican-American border from its “twin city”: Nogales, Sonora, Mexico.•  With the Gadsden Purchase in 1854, the border between Arizona and Mexico were defined, bisecting Nogales, AZ and Nogales, Mexico.

Nogales Today•  Nogales is the largest port of entry for produce in the US. 4 billion

pounds of fruits and vegetables are transported across the Mexican-American border each year.

•  Many of the stores along the historic Morley Avenue, founded in the early 1900s, are run by descendants of the pioneer merchants. Today, Nogales, AZ is a major port of entry into Mexico.

Pictures  of  Morley  Avenue  in  the  1900s  vs.  present  day.  The  buildings  that  once  used  to  be  hotels  Nogales  in  the  1900s  have  not  been  renovated  and  s>ll  stand  today.    

Demographics•  Population estimate (July 1, 2015): 20,252 people•  Race/Ethnicity:

Table 1: Race Distribution

•  Education: Nogales as 8 elementary schools, 2 middle schools, 2 high schools, and 1 community college.

Table 2: High School Education and Beyond

MethodsThe community health assessment was conducted between June 2016 to July 2016. Information about Nogales, AZ was obtained through:•  Windshield surveys•  Interviews with community members and healthcare providers in a

local community health center•  City and country health reports accessed online•  US Census Bureau reports accessed online

Employment:•  Most citizens in Nogales have lower median household income,

higher rates of poverty, and higher rates of unemployment compared to the average person living in Arizona. Table 3: Median income, Poverty Levels, and Unemployment Rates

Access to Healthcare: •  Because of its close proximity to the Mexican-American border,

Nogales, Arizona is home to undocumented immigrants coming from Nogales, Sonora, Mexico. These undocumented immigrants may not be able to have insurance. Because of the relatively high employment rate and poverty levels, the citizens of Nogales may not be able to afford insurance either.

Table 4: Percentage of People Without Insurance

Healthcare Facilities:•  1 community health center•  1 hospital (49 beds)•  4 community pharmacies

Available Health Services:Some of the many health services provided by the Mariposa Community Health Center are:•  Mental Health Services•  Immunizations•  Maternal and Child Health•  STD/HIV Prevention and Control•  Tuberculosis Prevention and Control•  Diabetes Control•  Diet and Exercise•  Home visits for medication reconciliation

 

Results

Community Health Concerns and Potential Causes

Priority of Health Concerns Ranked by Community Members1.  Diabetes2.  High Blood Pressure3.  Obesity/ sedentary lifestyle4.  Skin Cancer/Cancer in general5.  Asthma6.  Behavioral Health

Potential Causes of Health Concerns•  Community/family beliefs•  Insufficient health education (for older adults)•  Lack of exercise•  Inadequate access to transportation •  Inadequate number of healthcare providers, possibly due to negative

media coverage of the border town as well as difficulty to retain healthcare providers in a rural area

•  Early education on nutrition and disease state•  Follow up calls for nutrition classes and changing lifestyle•  More funding for transportation to clinics/hospitals •  Need more physicians, nurses, dentists, and behavioral health

specialists•  More jobs to boost economy•  Improve “walkability” with better sidewalks and bike paths•  Advertising Resources and Community events like 5k runs

Intervention Opportunities

References  

Morbidity and Mortality:•  The top five causes of mortality in the Santa Cruz County are due to

coronary heart disease, Alzheimer’s disease, unintentional injuries, cancer, and stroke.

Table 5: Morbidity and Mortality in Santa Cruz County

Suicide:•  For the Santa Cruz County in general, suicide has caused an

average of 37.7 deaths between the years of 2011 and 2013.

Substance Abuse:•  Overall, people in Santa Cruz County have higher rates of alcohol

and tobacco use compared to state and national average.Table 6: Percentage of Substance Abuse

Teen Pregnancy: •  59 out of 1000 females ages 15-19 are pregnant in the Santa Cruz

County. This is less than the state average (62.0 for Arizona), but 13.2 higher than the national average.

Table 7: Teen Birth Rates

Crime:•  There is a lower crime index in Nogales compared to the national

average. Figure 1: Crime Index

Results

1.  Nogales History. https://www.nogalesaz.gov/Nogales-History 2.  Nogales Arizona, A Gateway To Old Mexico. http://www.arizona-leisure.com/nogales-arizona.html 3.  Population estimates, July 1, 2015, (V2015) http://www.census.gov/quickfacts/dashboard/

PST045215/0449640 4.  Nogales, Arizona Population 2016, 2015 - SuburbanStats.org. https://suburbanstats.org/.../arizona/how-

many-people-live-in-nogales5.  American FactFinder - Results – Census. factfinder.census.gov/.../jsf/pages/productview.xhtml?src=bkmk6.  Nogales Housing Authority. www.nogalesaz.gov/Nogales-Housing-Authority 7.  SANTA CRUZ COUNTY'S HEALTH STATUS PROFILE FOR 2015. http://www.santacruzhealth.org/Portals/

7/Pdfs/Reports/2015SantaCruzHealthStatus.pdf8.  BLS Data Viewer. http://beta.bls.gov/dataViewer/view/timeseries/LAUMC043570000000003 9.  Nogales, Arizona - City-Data.com. www.city-data.com/city/Nogales-Arizona.html 10. AZ Report Cards - Accelerating Student Achievement https://azreportcards.com/ReportCard?

school=5165&district=-1 11. Behavioral Health Patterns in Nogales, Arizona - GeoStat.org. http://www.geostat.org/data/nogales-az/

behavior12. Crime in Nogales, Arizona (AZ): murders ... - City-Data.com. www.city-data.com/crime/crime-Nogales-

Arizona.html

Acknowledgements  I would like to thank the Nogales community and healthcare providers at the Mariposa Community Health Center who participated in the key informant interviews and helped me complete this project.

For more information, please contact:Cindy Cho: cho@pharmacy.arizona.edu