Community Health
NEEDS ASSESSMENT 2022
2 Ventura County Community Health Needs Assessment 2022 SECTION 1
Community Health Needs Assessment (CHNA)
at a Glance 4
SECTION 2
Frameworks Contributing to the Community
Health Needs Assessment Process
2.1 The California Healthy Places Index 7
2.2 Eco-Social Life Course Model 7
2.3 Healthy People 2030 8
SECTION 3
Introduction
3.1 CHNA Purpose 9
3.2 Ventura County Community Health Improvement Collaborative (VCCHIC) 9
3.3 Mission 9
3.4 Service Area 10
3.5 Collaborative Structure 10
3.6 Distribution of CHNA Report 10
3.7 Evaluation of Progress since Prior CHNA 11
3.8 Priority Health Needs from Preceding CHNA 11
3.9 Acknowledgements 11
3.10 Report Authors 11
SECTION 4
Profile of Ventura County
4.1 Demographic Profile 12
4.1.1 Population 12
4.1.2 Age 13
4.1.3 Race and Ethnicity 14
4.1.4 Language Spoken at Home 15
4.1.5 Education 15
4.1.6 Income 16
4.1.7 Employment 17
4.2 Social Determinants of Health 18
4.2.1 Poverty 19
4.2.2 Food Insecurity 21
4.2.3 T ransportation 21
4.2.4 Housing 23
4.3 Clinical Profile: Hospitalization and Emergency Room Utilization Rates 23
4.4 Life Expectancy in Ventura County, 2019-21 27
4.5 Mortality and Y ears of Life Lost (Premature Death), 2019-2021 28
4.5.1 Premature Deaths from Cancer 31
4.5.2 Premature Deaths from Diseases of the Heart 32
4.5.3 Premature Deaths from Accidents (Unintentional Injuries) 32
4.5.4 Drug-Induced Premature Deaths 33
4.5.5 Premature Deaths due to Covid-19 33
4.5.6 Premature Deaths due to Suicide 34
4.5.7 Average Y ears of Life Lost per Premature Death 34 SECTION 5
Disparities
5.1 Health Equity Index 35
5.2 Food Insecurity Index 36
5.3 Mental Health Index 36
5.4 Index of Disparity 37
SECTION 6
Primary Data Collection
6.1 Community Survey Key Findings 39
6.1.1 Demographics of Survey Responders 39
6.1.2 Overall Survey Results 39
6.2 Focus Group Discussion Findings 44
SECTION 7
Identification of Significant Health Needs
7 .1 Criteria for Significant Health Needs 45
7 .2 Significant Health Needs 45
SECTION 8
Data Synthesis
8.1 Overlapping Evidence of Need 47
8.2 Venn Diagram 47
SECTION 9
Prioritization
9.1 Process 48
Contents
3 Ventura County Community Health Needs Assessment 2022 SECTION 10
Prioritized Significant Health Needs
10.1 Addressing Mental Health and Substance Abuse Across the Lifespan 50 Overview 50
Mental Health 50
Adverse Childhood Experiences 51
Health and Wellness for Older Adults 55
10.2 Prevention of Chronic Conditions by Promoting Healthy Lifestyles 56 Overview 56
Cancer 56
Diabetes 57
Heart Disease & Stroke 57
Nutrition & Healthy Eating 58
Physical Activity 59
Weight Status 60
10.3 Advancing Equitable Access to Healthcare 61
Overview 61
SECTION 11
COVID-19 Impacts Snapshot
11.1 Introduction 62
11.2 Pandemic Overview 62
11.3 COVID-19 Cases and Deaths in Ventura County 62
11.4 Ventura County Unemployment Rates 63
11.5 Ventura County Vaccination Rates 64
11.6 Ventura County Community Feedback 64
Mental Health and Stress 65
Mental Health and Health Care Access 66
SECTION 12
Community Resources to Address Priority Health
Issues 67
SECTION 13
Conclusion 68
APPENDIX A. Ventura County’s Impact Report:
Evaluation since Prior CHNA 69
APPENDIX B. Secondary Data Methodology 71
Secondary Data Sources 71
Ventura County 71
Secondary Data Sources & Analysis 71
Secondary Data Scoring 71
Index of Disparity 72
Health Equity Index 72
How is the index value calculated? 72
What do the ranks and colors mean? 72
Mental Health Index 73
How is the index value calculated? 73
What do the ranks and colors mean? 73
Data Considerations 73
Race or Ethinic and Special Population Groupings 73
Zip Codes and Zip Code T abulation Areas 83
Secondary Data Scoring 83
Comparison to a Distribution of County Values: Within State and Nation 74 Comparison to Values: State, National, and T argets 74 T rend over Time 74
Missing Values 74
Indicator Scoring 74
T opic Scoring 75
Data Scoring Results 76
APPENDIX C. Primary Data Methodology 98
Primary Data Methods & Analysis 98
Community Survey 98
Focus Groups and Focus Group Profiles 98
Ventura County Focus Group Discussion Questions 98
APPENDIX D. Prioritization Activity 100
APPENDIX E: Community Resources 101
References 102
Contents
4Ventura County Community Health Needs Assessment 2022
Community Health Needs Asessment (CHNA) at a Glance
5 Ventura County Community Health Needs Assessment 2022 Community Health Needs Asessment (CHNA) at a Glance
6 Ventura County Community Health Needs Assessment 2022 Community Health Needs Asessment (CHNA) at a Glance
7Ventura County Community Health Needs Assessment 2022
The Ventura County Community Health Improvement Collaborative (VCCHIC) assessment process was based upon established public health frameworks that guide goal setting for all stakeholders engaged in the task of building healthy communities. These guiding frameworks are discussed below.
2.1 The California Healthy Places Index
Neighborhood-by-neighborhood, the California Healthy Places Index (HPI) maps data on social conditions that drive health — like education, job opportunities, clean air and water, and other indicators that are positively associated with life expectancy at birth. Community leaders, policymakers, academics and other stakeholders use the HPI to compare the health and well-being of communities, identify health ineq- uities and quantify the factors that shape health. (The Public Health Institute, 2022)
2.2 Eco-Social Life Course Model
The California Department of Public Health (CDPH) uses the Eco-Social Life Course Model shown in Figure 1 (California Department of Public Health, 2022) as the pub- lic health approach to health assessment and improvement planning. The model focuses on the following principles that contribute to overall health and wellness:
• Ecological-social (“eco-social”)
• Life course and inter-generational
• Equity, antiracism and health equity
• Prevention, especially primary prevention
CDPH has prioritized the following health issues in their 2022 State Health Assess- ment.
• COVID Readiness and Recovery
• Children and Y outh Behavioral Health
• Climate Change
FIGURE 1: ECO-SOCIAL LIFE COURSE MODEL
Frameworks Contributing to the Community Health
Needs Assessment Process
8Ventura County Community Health Needs Assessment 2022
2.3 Healthy People 2030
The Healthy People 2030 foundational principles include:
• The health and well-being of all people and communities is essential to a thriving, equitable society .
• Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental and social health dimensions. • Investing to achieve the full potential for health and well-being for all provides valuable benefits to society .
• Achieving health and well-being requires eliminating health disparities, achieving health equity and attaining health literacy .
• Healthy physical, social and economic environments strengthen the potential to achieve health and well-being.
• Promoting and achieving health and well-being nationwide is a shared respon - sibility that is distributed across the national, state, tribal and community levels, including the public, private and not-for-profit sectors. • vWorking to attain the full potential for the health and well-being of the population is a component of decision-making and policy formulation across all sectors (U.S.
Department of Health and Human Services, 2021).
Frameworks Contributing to the Community Health
Needs Assessment Process
9Ventura County Community Health Needs Assessment 2022
3.1 CHNA Purpose
The Community Health Needs Assessment (CHNA) is conducted and published every three years or as per Internal Revenue Service (IRS), the Health Resources and Services Administration’s (HRSA) Health Center Compliance Manual, Section 330 of the Public Health Service Act, and Public Health Accreditation Board (PHAB) requirements.
This report includes a description of:
• The community demographics and population served;
• The process and methods used to obtained, analyze and synthesize primary and secondary data;
• The significant health needs in the community, taking into account the needs of uninsured, low-income, and marginalized groups; • The process and criteria used in identifying certain health needs as significant community needs.
VCCHIC will work to develop implementation strategies, to be included in each member organization’s individual Community Health Improvement Plans (CHIP)/ Implementation Strategies (IS), that align with CHNA identified health priorities and focus on achieving health equity . T ogether, these agencies will support health advocacy, education, prevention and partnerships that extend the care continuum for medically underserved and vulnerable populations.
3.2 Ventura County Community Health Improvement Collaborative (VCCHIC)
VCCHIC is a formal, charter-bound partnership of seven health agencies that came together in June 2018 to participate in the development of a joint CHNA exercise and report. The agencies that constitute VCCHIC are given below:
• Adventist Health Simi Valley
• Camarillo Health Care District
• Clinicas Del Camino Real, Inc.
• Community Memorial Health System
• Gold Coast Health Plan
• St. John’s Regional Medical Center, Dignity Health
• Ventura County Health Care Agency Community Health Center • Ventura County Public Health
FIGURE 2: LOCATION OF VCCHIC PARTNERS WITHIN VENTURA COUNTY Source: Google Map on Health Matters in Ventura County
3.3 Mission
The mission of VCCHIC is to build partnerships to improve population health outcomes in Ventura County . These partnerships are necessary to accomplish the shared vision of working collaboratively to develop strategies based upon the identified health priorities from the community health needs assessment. This will result in a collective approach to addressing population health and benefit the communities in which we serve.
Introduction
10Ventura County Community Health Needs Assessment 2022
3.4 Service Area
With the purpose of jointly addressing health challenges of residents and serving communities with impactful solutions that leverage shared resources and coordi- nate care, the eight health agencies that make up VCCHIC have come together in defining their service area as the County of Ventura.
FIGURE3: ZIP CODE TABULATED AREAS WITHIN VENTURA COUNTY Source: Esri
3.5 Collaborative Structure
VCCHIC is the decision-making entity for the 2022 Community Health Needs Assessment and is chaired by the Epidemiologist at Ventura County Public Health.
Primary representatives for the founding members of the collaborative include:
• Erin Slack, MPH, Ventura County Public Health – Epidemiologist, Maternal, Child, and Adolescent Health Programs
• George West, JD, St. John’s Regional Medical Center and St. John’s Pleasant Valley Hospital, Dignity Health System – Service Area Vice President, Mission Integration • Kathryn Stiles, Adventist Health Simi Valley – Director of Community Integration • Lizeth Barretto, Ventura County Health Care Agency Community Health Center – Ambulatory Care Administrator
• Lynette Harvey, Camarillo Health Care District – Clinical Services Director • Pauline Preciado, Gold Coast Health Plan – Executive Director of Equity and Population Health
• Rachel Cox, MPH, Clinicas Del Camino Real, Inc. – Operations Manager • Will Garand, Community Memorial Health System – Vice President, Planning & Managed Care
3.6 Distribution of CHNA report
T o meet the requirements of the IRS regulations 501(r) for charitable hospitals, hospitals are required to make the Community Health Needs Assessment (CHNA) and Implementation Strategy (IS) available publicly through print copies and on the internet. Public comment is also solicited and documented. In keeping with these regulations, VCCHIC partners made the 2019 CHNA report available to community members to read online and in paper format. No written comments had been received at the time this report was written.
Adventist Health Simi Valley
2019 CHNA:
• https://www.adventisthealth.org/documents/
community-benefit/2019-chna/SimiValley_2019_
CommunityHealthNeedsAssessment.pdf
2019 Implementation Plan:
• https://www.adventisthealth.org/documents/
community-benefit/2020-chis/Simi-Valley_2020_
CommunityHealthImplementationStrategy .pdf
Introduction
11Ventura County Community Health Needs Assessment 2022 Community Memorial Health System
2019 CHNA and Implementation Strategy:
• https://www.cmhshealth.org/about/community-health-needs- assessment/
St. John’s Regional Medical Center, Dignity Health
2019 CHNA and Implementation Strategy:
• https://www.dignityhealth.org/central-coast/locations/ stjohnsregional/about-us/community-benefit
3.7 Evaluation of Progress since Prior CHNA
The CHNA process should be viewed as a three-year cycle (Figure 4). An important part of that cycle is revisiting the progress made on priority topics from previous CHNAs. By reviewing the actions taken to address priority areas and evaluating the impact of these actions in the community, an organization can better focus and target its efforts during the next CHNA cycle.
FIGURE 4: CHNA PROCESS
3 Y ear Cycle
3.8 Priority Health Needs from Preceding CHNA
VCCHIC’s priority health areas for the 2019 CHNA cycle were:
• Improve Access to Health Services
• Address Social Needs
• Improve Health and Wellness for Older Adults
• Reduce the Burden of Chronic Disease
• Reduce the Impact of Behavioral Health Issues
A detailed impact report outlining the goals, objectives and status of each strategy is provided in Appendix A.
3.9 Acknowledgements
VCCHIC commissioned Conduent Healthy Communities Institute (HCI) to conduct its 2022 Community Health Needs Assessment. HCI works with clients across the nation to drive community health outcomes by assessing needs, developing focused strategies, identifying appropriate intervention programs, establishing monitoring systems and implementing performance evaluation processes. T o learn more about Conduent Healthy Communities Institute, please visit https:// www.conduent.com/community-health/.
3.10 Report Authors
Report author from VCCHIC:
Erin Slack, MPH, Epidemiologist, Ventura County Public Health Aruni Ganewatte, MS, Community Service Coordinator, Ventura County Public Health
Report authors from Conduent HCI:
Sharri Morley, MPH, Public Health Consultant
Cushanta Horton, MPH, Epidemiologist
Margaret Mysz, MPH, Epidemiologist
Introduction
12Ventura County Community Health Needs Assessment 2022 Located in Southern California, Ventura County has a land area of 1,843.1 square miles which encompasses 10 cities, 23 census-designated places, and 15 other unincorporated communities. In 2022, Ventura County’s population had a median age of 39.3 and a median household income of $101,407 . Additionally, 50.5% of the population is female, 5.7% are below five years of age, 22.1% are below 18 years and 17 .3% are 65 years and above and 38.6% of the people in Ventura County speak a non-English language at home. (Claritas Pop-Facts, 2022) The homeownership rate is 59.4%, households with an internet subscription is
89.8%, and among county residents, 5.8% have veteran status and 21.3% are foreign born (American Community Survey, 2016-2020). In 2021, the percent of households with a computer is 89.6% (Claritas Consumer Profiles, 2021).
4.1 Demographic Profile
The following section explores the demographic profile of Ventura County . Demo- graphics are an integral part of describing the community and its population and are critical to forming further insights into the health needs of the community to best plan for improvement. All Ventura County residents should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background. Unfortunately, some population groups don’t have the same opportunities to be as healthy as others; these groups may experience more inequities and thus require different approaches and supports to health improvement (National Academies Press, 2008).
All demographic estimates are sourced from the U.S. Census Bureau’s (a) 2019 pop- ulation estimates or (b) 2016-2020 American Community Survey (ACS), or (c) 2022 Claritas Pop-Facts® , unless otherwise indicated. The Pop-Facts data set provides current year (2022) estimates using the 2010 Census and incorporation of newly available ACS data. Periods of measurement and sources for the data discussed are given in these sections if they are not mentioned elsewhere in the tables and figures enclosed within the report. For more information on the demographics in Ventura County, please visit https://www.healthmattersinvc.org/demographicdata
4.1.1 Population
According to 2022 Claritas Pop-Facts, Ventura County has a population of 842,465 and is the 13th largest county in terms of population. Figure 5 illustrates the popu- lation size in Ventura County by zip code. The most populated zip codes are 93033 (Oxnard), 93065 (Simi Valley), 93030 (Oxnard), and 93063 (Simi Valley) with pop- ulation totals of 82,273; 74,289; 60,815; and 55,685.
FIGURE 5: POPULATION BY ZIP CODE, 2022
Source: Claritas Pop-Facts
Profile of Ventura County
13Ventura County Community Health Needs Assessment 2022 T able 1 presents the U.S. Census Bureau population estimates in Ventura County by year for 2016, 2017, 2018 and 2019. Ventura County experienced a slight pop- ulation decrease in the four-year time period with a growth rate of -0.34%. This is less than that of California (0.77%) and the US growth rate (1.59%).
TABLE 1: TOTAL POPULATION: PAST FOUR YEARS, 2016-2019
T otal Population
2016 2017 2018 2019 Percent Change
2016-2019
Ventura
County 848,921 850,802 850,967 846,006 -0.34
California 39,209,127 39,399,349 39,557,045 39,512,223 0.77 United
States 323,071,342 325,147,121 327,167,434 328,239,523 1.59 Source: U.S. Census Bureau
4.1.2 Age
Distribution of age impacts the health care needs of a population. Economic means, work status and entitlement program eligibility are based on age which can affect an individual’s ability to access preventive health care services (Office of Disease Prevention and Health Promotion, 2014) . Figure 6 shows the Ventura County population by age as compared to the age distribution for the state of California.
Overall, Ventura County’s age distribution is similar to California. Notably, Ventura has a lower percentage of its population between 25-34 and 35-44 years of age compared to California. However, the percentage of the population aged 45 and above is slightly greater in Ventura than in California.
FIGURE 6: POPULATION BY AGE, 2022
Source: Claritas Pop-Facts
Profile of Ventura County
14Ventura County Community Health Needs Assessment 2022
4.1.3 Race/Ethnicity
The race and ethnicity composition of a population is important in planning for future community needs, particularly for schools, businesses, community centers, health care and childcare. Race and ethnicity data are also useful for identifying and understanding disparities in housing, employment, income and poverty .
Figure 7 shows the ethnicity of residents in Ventura County as compared to Cali - fornia. In Ventura County, 44.66% of residents identify as Hispanic/Latino (of any race) and 55.34% identify as Non-Hispanic/Latino.
FIGURE 7: VENTURA COUNTY POPULATION BY ETHNICITY , 2022 Source: Claritas Pop-Facts
Figure 8 shows the racial composition of Ventura County and California. Compared to California, Ventura County has a larger White population (65.13%) and smaller Black or African American and Asian populations (2.07% and 7 .62%, respectively).
FIGURE 8: VENTURA COUNTY POPULATION BY RACE, 2022
Source: Claritas Pop-Facts
T able 2 presents a closer examination of population trends over a span of four years.
Overall, Ventura County has experienced a slight increase in share of residents identifying as American Indian/Alaska Native, Asian, Black or African American, and T wo or More Races and Hispanic/Latino from 2016 to 2019. Meanwhile, there is a slight decrease in residents identifying as Native Hawaiian/Pacific Islander, and White in the past four years.
TABLE 2: POPULATION BY RACE OR ETHNICITY: PAST FOUR YEARS Ventura County
2016 2017 2018 2019
American Indian and Alaska Native 1.84% 1.85% 1.87% 1.86% Asian 7 .63% 7 .76% 7 .87% 7 .88%
Black or African American 2.27% 2.33% 2.38% 2.39%
Native Hawaiian and Other Pacific Islander 0.29% 0.29% 0.29% 0.28% T wo or More Races 3.38% 3.44% 3.49% 3.51%
White 84.59% 84.33% 84.10% 84.05%
Hispanic 42.47% 42.72% 43.02% 43.24%
Source: U.S. Census Bureau
Profile of Ventura County
15Ventura County Community Health Needs Assessment 2022
4.1.4 Language Spoken at Home
Figure 9 shows the percent of the population that speaks a language other than English at home, comparing the values for Ventura County with the California state value. In Ventura County, 61.39% of the population aged five and older speak only English while 38.61% of the population speak a language other than English at home, with the most common non-English language being Spanish (30.29%).
This measurement indicates where there may be language or cultural barriers to accessing health care.
FIGURE 9: POPULATION AGE 5+ LANGUAGE SPOKEN AT HOME, 2022 Source: Claritas Pop-Facts
4.1.5 Education
Education is an important indicator for health and wellbeing across the lifespan.
Education can lead to improved health by increasing health knowledge, providing better job opportunities and higher income, and improving social and psycho - logical factors linked to health. People with higher levels of education are likely to live longer, to experience better health outcomes, and practice health-promoting behaviors. (Egerter S, 2011)
Figure 10 displays the educational attainment for population age 25+ in Ventura County . All levels of educational attainment are similar between Ventura County and California state values. Notably, Ventura County has a lower percentage of the population with Some High School with No Diploma (5.29%) than the California (7 .30%). Ventura County has a higher percentage of the population with an Asso- ciate Degree (9.37%) than California (7 .87%).
FIGURE 10: EDUCATIONAL ATTAINMENT BY PEOPLE 25+, 2022
Source: Claritas Pop-Facts
Profile of Ventura County
16Ventura County Community Health Needs Assessment 2022 Figure 11 depicts the Population Age 25+ With Less Than High School Graduation at the granular zip code level, with darker green regions indicating a greater per - centage of individuals with less than a high school graduation. In this map, the areas with the highest percent and number of individuals without a high school degree are 93033 (39.46%; 19,479), 93060 (32.32%; 6,831), 93030 (27 .98%; 10,630), and 93015 (23.29%; 2,771).
FIGURE 11: POPULATION AGE 25+ WITH LESS THAN HIGH SCHOOL GRADUATION, 2022 Source: Claritas Pop-Facts
4.1.6. Income
Income has been shown to be strongly associated with morbidity and mortality, influencing health through various clinical, behavioral, social, and environmental factors. Those with greater wealth are more likely to have higher life expectancy and reduced risk of a range of health conditions including heart disease, diabetes, obesity, and stroke. Poor health can also contribute to reduced income by limiting one’s ability to work. (Khullar, 2018)
Figure 12 shows the Median Household Income for Ventura County and California.
Ventura has a median household income above the state value and the national values. Ventura County has an estimated median household income of approxi - mately $101,407, which was $11,926 higher than the median household income of California ($89,481) and $36,413 higher than the national value of $64,994 (American Community Survey 2016-2020) .
FIGURE 12: MEDIAN HOUSEHOLD INCOME, 2022
Source: Claritas Pop-Facts
Profile of Ventura County
17Ventura County Community Health Needs Assessment 2022 Figure 13 shows Median Household Income by race and ethnicity for Ventura County . Six out of eight racial and ethnic groups in Ventura County have higher median household incomes in comparison to the overall California state value.
The Asian population has the highest median household income at $132,689. Not only is this the highest, it also represents the greatest difference from the overall Ventura County value. Hispanic/Latino populations ($82,328) and those who have identified as Some Other Race ($84,531) have median incomes below the median household incomes of Ventura County and California.
FIGURE 13: MEDIAN HOUSEHOLD INCOME BY RACE OR ETHNICITY , 2022 Source: Claritas Pop-Facts
Per the five-year estimates from the 2016-2020 American Community Survey, the median household income was $89,274 for 2-person households, $116,087 for 4-person households, $107,340 for 6-person households, and $109,693 for 7+ person households. Looking at Figure 14, the regions with the darker shades of blue indicate zip codes with higher median household incomes, while the lighter shades indicate lower median household incomes. The zip code with the highest median household income in Ventura County is 91377 ($143,136), while the zip code with the lowest median household income is 93042 ($50,000).
FIGURE 14: MEDIAN HOUSEHOLD INCOME BY ZIP CODE, 2022
Source: Claritas Pop-Facts
4.1.7 Employment
A community’s employment rate is a key indicator of the local economy . An individu- al’s type and level of employment impacts access to health care, work environment, and health behaviors and outcomes. Stable employment can help provide benefits and conditions for maintaining good health. In contrast, poor or unstable work and working conditions are linked to poor physical and mental health outcomes. (U.S.
Department of Health and Human Services, 2021)
T ype of employment and working conditions can also have significant impacts on health. Work-related stress, injury, and exposure to harmful chemicals are examples of ways employment can lead to poorer health (U.S. Department of Health and Hu- Profile of Ventura County
18Ventura County Community Health Needs Assessment 2022 man Services, 2021). T able 3 lists the industries that employ the civilian population 16 years of age and over in Ventura County . Most of the employed population work in educational services, health care and social assistance (19.82%) followed by pro- fessional, scientific, and management, and administrative and waste management services (12.71%) and retail trade (10.02%). Additionally, 9.69% of civilians are in the arts, entertainment, recreation and accommodation and food services indus- try, and 9.56% are in the manufacturing industry . The smallest percent of civilian employed population are in the information industry (2.44%).
TABLE 3: INDUSTRY OF WORK FOR THE CIVILIAN EMPLOYED POPULATION 16 YEARS AND OVER Occupation Number Percent
Agriculture, forestry, fishing and hunting, and mining 21,092 5.13 Construction 25,178 6.12
Manufacturing 39,322 9.56
Wholesale trade 11,989 9.56
Retail trade 41,209 10.02
T ransportation and warehousing, and utilities 14,613 3.55 Information 10,019 2.44
Finance and insurance, and real estate and rental and leasing 29,977 7 .29 Professional, scientific, and management, and administrative and waste management services 52,279 12.71
Educational services, and health care and social assistance 81,509 19.82 Arts, entertainment, and recreation, and accommodation and food services 39,851 9.69
Other services, except public administration 22,078 5.37 Public administration 22,179 5.39
T otal: 411,295
Source: American Community Survey 2016-2020
Figure 15 depicts the percent of civilians, 16 years of age and older, who are un - employed as a percent of the civilian labor force. With the start of the COVID-19 Pandemic in March 2020, Ventura County’s unemployment rate increased to 13.9%.
This unemployment rate has decreased over time to 5%, with unemployment rates reaching close to pre-pandemic rates (3.9%).
FIGURE 15: UNEMPLOYED WORKERS IN CIVILIAN LABOR FORCE, APRIL 2017 - OCTOBER 2018 Source: U.S. Bureau of Labor Statistics
4.2 Social Determinants of Health
Healthy People 2030 defines social determinants of health as conditions in which people are born, grow, live, work, and age that affect a wide range of health out- comes and risks. The social determinants of health partly explain why some people are healthier than others, and generally why some people are not as healthy as they could be. Resources that address the social determinants of health and improve quality of life can have a significant impact on population health outcomes (Office of Disease Prevention and Health Promotion, 2014). Examples of these resources include access to education, good paying jobs, public safety, affordable housing, availability of healthy foods, and local emergency and health services.
Understanding the different social determinants in a service area can lead to poten- tial programs and services that work to improve disparities within that community .
Programs that address the social determinants such as targeted outreach to people living alone, translation services for people with limited English proficiency, and universal job training for entry level positions can help to improve the overall health of the community . This section explores the social and economic determinants of health in Ventura County . These social determinants and other factors help build the context of the service area to allow for better understanding of the results of both primary and secondary data.
Profile of Ventura County
19Ventura County Community Health Needs Assessment 2022
4.2.1 Poverty
In 2022, the federal poverty level was $27,750 for a family of four (U.S. Depart - ment of Health and Human Services, 2022). Federal assistance programs, such as Head Start, the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program, the Low-Income Home Energy Assistance Program and the Children’s Health Insurance Program, use the guidelines (or percentage multiples of the guidelines — for instance, 125 percent or 185 percent of the guidelines) in determining eligibility .
As shown in Figure 16, Ventura County has lower rates of poverty compared to the state and national poverty rates. Ventura County has a poverty rate of 8.9%, while state and national rates of poverty are 12.6% and 12.8%, respectively .
FIGURE 16: PEOPLE LIVING BELOW POVERTY LEVEL, 2016-2020 Source: American Community Survey
The United Way of California has created an estimate of the minimum income re - quired to meet basic needs for a given household type in a specific community . This threshold of affordability is referred to as the Real Cost Measure (RCM). The RCM builds a bare-bones budget that reflects constrained yet reasonable choices for essential expenses: housing, food, transportation, health care, taxes and childcare.
According to United Way’s report “Struggling to Stay Afloat” , one in three households in California, over 3.3 million families—including those with income well above the federal poverty level—struggle every month to meet basic needs. The United Way of California estimates that an income of at least $77,493 is required to meet the basic needs for a family of four (two adults, one infant, one school age child), in Ventura County; this figure is $75,740 for California (United Way of California, 2018). This is nearly three times the federal poverty level for a family of four. In Ventura Coun- ty, 72% of residents with education levels below high school, 64% of households headed by single females, 49% of Hispanic households and 52% of foreign born, non-citizen households are living below the RCM. By the same estimates, a family of four would need to hold more than three full time, minimum-wage jobs to achieve economic security .
According to Figure 17 the Percentage of People Living Below Poverty Level in Ventura County has a downward trend, similar to the state and national trends. However, the overall percentage of Ventura County’s population living below poverty level across all four four-year periods is less than the state and national values. In the 2013-2017 time period, Ventura County had a poverty rate of 10.3%, which dropped for the 2014-2018 time period to 9.6% and has remained stable in 2015-2019 to 2016-2020 time periods with 8.9%. In comparison, the poverty rate in Ventura County is almost four percentage points less than both state and national values.
FIGURE 17: PEOPLE LIVING BELOW POVERTY LEVEL
Source: American Community Survey
Profile of Ventura County
20Ventura County Community Health Needs Assessment 2022 Figure 18 depicts the Percentage of People Living Below Poverty Level disaggregat- ed by sub-county geographies. The dark blue regions indicate zip codes with the highest levels of poverty in the county while lighter shades represent lower rates of poverty . The Ventura County zip codes with the largest proportion percentage of the population living below poverty level are 93060 (15.0%) and 93033 (15.0%), followed by 93001 (14.2%).
FIGURE 18: PEOPLE LIVING BELOW POVERTY LEVEL, 2016-2020 Source: American Community Survey
Examining the context of poverty more deeply, Figure 19 shows the Percentage of People Living Below Poverty Level by race and ethnicity in comparison to state and national values. All race and ethnic groups in Ventura County, except American Indian/Alaska Native, have lower percentages of people living in poverty compared to state and national levels. The race or ethnic group in Ventura County with the greatest percentage of its population living in poverty is the American Indian/ Alaska Native population with 22.7% while the Native Hawaiian/Pacific Islander population has the lowest percentage with 3%.
FIGURE 19: PEOPLE LIVING BELOW POVERTY LEVEL BY RACE OR ETHNICITY , 2016-2020 Source: American Community Survey 2016-2020
According to the American Community Survey, for the 2016-2020 period, 12.2% of children in Ventura County were living below the federal poverty level. This is lower than the percentage of children living below the poverty level in California (16.8%) and the United States (17 .5%). Examining this by race, American Indian/ Alaska Native children and Hispanic/Latino children had the highest disparity, with 43.3% of American Indian/Alaska Native children living in poverty . The next highest populations are those identifying as Some Other Race (20%) and Hispanic or Latino (17 .1%).
Profile of Ventura County
21Ventura County Community Health Needs Assessment 2022 In terms of geographic area, 93060 had the greatest percentage of people under the age of 18 living below the federal poverty level (25.1%). The zip codes 93033 (23.9%), 93040 (22.4%), and 93001 (19.8%) were also among the worst regions in Ventura County .
For the 2016-2020 period, 7 .7% of individuals aged 65 and over were living below the federal poverty level in Ventura County . This is lower than the California (10.3%) and the United States values (9.3%). Examining by race or ethnicity, only Native Hawaiian/Pacific Islander and White (Non-Hispanic) populations (4.4% and 6.2%, respectively) were below the overall value for Ventura County . Meanwhile, those who identify as American Indian or Alaska Native (18.9%), T wo or More Races (12.4%), and Hispanic or Latino (11.6%), had significantly worse rates than the overall value.
Examining rates broken up by zip code, the highest proportion of individuals aged 65 and over living below poverty was in 93030 (14.4%) and 93036 (12.7%), making them among the worst regions in Ventura County .
The Gini index measures income distribution among the residents of a specified geography . A value of zero indicates perfect equality of income (all households having equal income) and a value of one indicates perfect inequality (one household having all the income). A value of 0.5 indicates an uneven distribution of income.
The Gini index for Ventura County is 0.447 (American Community Survey, 2016- 2020), indicating there may be some uneven distribution of outcomes. A low income affects housing stability, food access, healthcare spending, healthcare access and the health status of residents. These disparities correspond with race or ethnicity, languages spoken at home, foreign-born status and female-headed households among other factors. It is likely that these income related disparities are contributing to the poor health outcomes in the county (Khullar, 2018).
4.2.2 Food Insecurity
Food insecurity is defined as the disruption of food intake or eating patterns because of lack of money and other resources. Food insecurity, and the resulting hunger, is associated with disability, lack of adequate employment and racial and ethnic dis- parities (Coleman-Jensen A, 2017). It leads to the intake of nutritionally-deficient, high calorie foods that cause obesity, diabetes, heart disease, high blood pressure, and hyperlipidemia. Food assistance programs, such as the National School Lunch Program; the Women, Infants, and Children (WIC) program; and SNAP address food insecurity in vulnerable populations by delivering food benefits. Food Insecurity is discussed in greater detail in SECTION 7: Identification of Significant Health Needs.
Figure 20 describes the percent of the population in Ventura County that has ex - perienced food insecurity, compared to state and national rates. Given a change in methodology for the 2018 time period, values for 2018 should not be compared to previous time periods. However, there is a slight decrease in food insecurity rates between 2018 and 2019 time periods for all three populations. Ventura County has a lower food insecurity rate in 2019 (7 .8%) compared to the state (10.2) and the nation (10.9).
FIGURE 20: FOOD INSECURITY RATE, 2016-2019
Source: Feeding America
4.2.3 T ransportation
Public transportation offers mobility, particularly to people without cars. T ransit can help bridge the spatial divide between people and jobs, services and training opportunities. Public transportation also reduces fuel consumption, minimizes air pollution and relieves traffic congestion (Shapiro RJ, 2002). Active travel, such as walking to public transportation or walking and cycling to work can be a good way to increase physical activity throughout the day ( (Rissel C, 2012).
Figure 21 shows the Percent of Workers Who Drive Alone to Work by zip code. The darkest shaded regions on the map indicate zip codes with the highest proportion percentage of workers who drive alone to work. Within Ventura County, the area with the largest percentage of individuals that drove alone to work is zip code 93010 Profile of Ventura County
22Ventura County Community Health Needs Assessment 2022 at 82.63%. This is followed by 93035 at 82.16%, 91377 at 81.17% and 93021 at
81.02%. Driving alone to work can have long lasting impacts on health, affecting aspects such as active living, pollution, and accidents due to vehicle collisions.
FIGURE 21: WORKERS WHO DRIVE ALONE TO WORK, 2022
Source: Claritas Pop-Facts
With regards to Households without a Vehicle (Figure 22), a total of 4.29% of house- holds in Ventura County do not have a car. The map below depicts the Percentage of Households without a Vehicle by zip code. Areas shaded in darkest green indicate zip codes with the highest percentage of households without a vehicle. The zip code with the highest proportion percentage of households without a car is 93001 (7 .21%), 93030 (6.72%), 93003 (6.21%). This is followed by 93060 (6.24%), 93004 (5.97%), and 93015 (5.23%). Residents in these locations may be more likely to experience difficulties accessing services in Ventura County .
FIGURE 22: HOUSEHOLDS WITHOUT A VEHICLE, 2022
Source: Claritas Pop-Facts
Profile of Ventura County
23Ventura County Community Health Needs Assessment 2022
4.2.4 Housing
High costs of homeownership with a mortgage can strain both homeowners and the local housing market. With a limited income, paying a high rent may not leave enough money for other expenses such as food, transportation, and medical services. Moreover, high rent reduces the proportion of income a household can allocate to savings each month.
Figure 23 shows Renters Spending 30% or More of Household Income on Rent in Ventura County . Overall, 58.8% of individuals in Ventura County spend 30% or more of their household income on rent for the 2016-2020 period. This is greater than the California value of 54.2% and the United States value of 49.1%. The map shows 2016-2020 period in which the zip codes with the darkest shade of blue are the ones with the most renters spending 30% or more of income on rent. The highest percentages come from 93065 and 93041 with values at 65.7% and 62.4%, respectively .
FIGURE 23: RENTERS SPENDING 30% OR MORE OF HOUSEHOLD INCOME ON RENT , 2016-2020 Source: American Community Survey
Profile of Ventura County
4.6 Clinical Profile: Hospitalization and Emergency Room Utilization Rates
According to the Centers for Disease Control and Prevention, 16.6% of adults in Ventura County do not have health insurance and may not be receiving routine check-ups, access to primary prevention services and may be more likely to utilize the emergency room to access health care. Collected through the California De - partment of Health Care Access and Information (HCAI), the tables below identify Hospitalization and Emergency Room Utilization rates for the 2018-2020 three- year period in Ventura County . T able 4 provides the Ventura County value as well as the zip code with the highest emergency room visit rate or hospitalization rate for each indicator. T able 5 displays the number of hospitalization and emergency room utilization indicators by zip code with the highest rate. Based on the tables below, Oak View (93022) is the most heavily impacted, with high rates appearing in 10 of the indicators. The topics include indicators related to Asthma, Diabetes, Heart Disease, Infectious Diseases, and Mental Health. The second most heavily impacted is 93030 with 9 indicators and 93060 with 7 indicators. 24Ventura County Community Health Needs Assessment 2022 TABLE 4: HOSPITALIZATION AND EMERGENCY ROOM UTILIZATION INDICATORS BY ZIP CODE, 2018-2020 Hospitalization and Emergency Room Utilization Indicators by Zip Code Health Indicator Units Ventura County Value Zip Code Value Age-Adjusted ER Rate due to Adolescent Alcohol Use ER visits/ 10,000 population population aged 10-17 years 35.2 93012 31.9 Age-Adjusted Hospitalization Rate due to Adolescent Alcohol Use hospitalizations/ 10,000 population aged 10-17 years 4.1 — — Age-Adjusted ER Rate due to Adult Alcohol Use ER visits/ 10,000 population 18+ years 39.6 93022 66.2 Age-Adjusted Hospitalization Rate due to Adult Alcohol Use hospitalizations/ 10,000 population 18+ years 15.2 93022 17. 1 Age-Adjusted ER Rate due to Opioid Use ER visits/ 10,000 population aged 18+ years 7. 4 93022 17. 1 Age-Adjusted Hospitalization Rate due to Opioid Use hospitalizations/ 10,000 population 18+ years 3.1 93063 6.6 Age-Adjusted ER Rate due to Substance Use ER visits/ 10,000 population 18+ years 19.0 93022 38.7 Age-Adjusted Hospitalization Rate due to Substance Use hospitalizations/ 10,000 population 18+ years 4.9 91361 8.3 Age-Adjusted ER Rate due to Diabetes ER visits/ 10,000 population under 18 years 19.3 93030 42.8 Age-Adjusted Hospitalization Rate due to Diabetes hospitalizations/ 10,000 population 18+ years 15.0 93060 2 7. 6 Age-Adjusted ER Rate due to Long-T erm Complications of Diabetes ER visits/ 10,000 population 18+ years 3.7 93022 13.9 Age-Adjusted Hospitalization Rate due to Long-T erm Complications of Diabetes hospitalizations/ 10,000 population 18+ years 7. 3 93060 14.8 Age-Adjusted ER Rate due to Short-T erm Complications of Diabetes ER visits/ 10,000 population 18+ years 0.6 93065 1.0 Age-Adjusted Hospitalization Rate due to Short-T erm Complications of Diabetes hospitalizations/ 10,000 population 18+ years 5.2 93060 9.7 Age-Adjusted ER Rate due to T ype 2 Diabetes ER visits/ 10,000 population 18+ years 16.8 93030 41.1 Age-Adjusted Hospitalization Rate due to T ype 2 Diabetes hospitalizations/ 10,000 population 18+ years 11.4 93060 21.8 Age-Adjusted ER Rate due to Uncontrolled Diabetes ER visits/ 10,000 population 18+ years 13.7 93030 31.7 Age-Adjusted Hospitalization Rate due to Uncontrolled Diabetes hospitalizations/ 10,000 population 18+ years 2.4 93065 3.6 Age-Adjusted ER Rate due to Heart Failure ER visits/ 10,000 population 18+ years 6.3 93065 9.7 Age-Adjusted Hospitalization Rate due to Heart Failure hospitalizations/ 10,000 population 18+ years 23.9 93033 40.9 Age-Adjusted ER Rate due to Hypertension ER visits/ 10,000 population 18+ years 24.0 93030 38.6 Age-Adjusted Hospitalization Rate due to Hypertension hospitalizations/ 10,000 population 18+ years 3.3 93030 5.7 Age-Adjusted ER Rate due to Community Acquired Pneumonia ER visits/ 10,000 population 18+ years 16.3 93030 2 7. 3 Age-Adjusted Hospitalization Rate due to Community Acquired Pneumonia hospitalizations/ 10,000 population 18+ years 8.6 93063 13.7 Profile of Ventura County
25Ventura County Community Health Needs Assessment 2022 Hospitalization and Emergency Room Utilization Indicators by Zip Code Health Indicator Units Ventura County Value Zip Code Value Age-Adjusted ER Rate due to Hepatitis ER visits/ 10,000 population 18+ years 0.6 93060 1.8 Age-Adjusted Hospitalization Rate due to Hepatitis hospitalizations/ 10,000 population 18+ years 1.0 91360 1.5 Age-Adjusted ER Rate due to Immunization-Preventable Pneumonia and Influenza ER visits/ 10,000 population 18+ years 21.3 93022 45.7 Age-Adjusted Hospitalization Rate due to Immunization-Preventable Pneumonia and Influenza hospitalizations/ 10,000 population 18+ years 2.3 93063 3.5 Age-Adjusted ER Rate due to Adolescent Suicide and Intentional Self-Inflicted Injury ER visits/ 10,000 population aged 10-17 years 72.9 93012 229.7 Age-Adjusted Hospitalization Rate due to Adolescent Suicide and Intentional Self-Inflicted Injury hospitalizations/ 10,000 population aged 10-17 years 7. 5 93012 15.7 Age-Adjusted ER Rate due to Adult Mental Health ER visits/ 10,000 population 18+ years 69.6 93030 111.6 Age-Adjusted Hospitalization Rate due to Adult Mental Health hospitalizations/ 10,000 population 18+ years 22.0 93040 45.6 Age-Adjusted ER Rate due to Adult Suicide and Intentional Self-Inflicted Injury ER visits/ 10,000 population 18+ years 30.1 93030 55.2 Age-Adjusted Hospitalization Rate due to Adult Suicide and Intentional Self- Inflicted Injury hospitalizations/ 10,000 population 18+ years 13.9 93001 26.0 Age-Adjusted ER Rate due to Pediatric Mental Health ER visits/ 10,000 population aged 10-17 25.9 91360 35.0 Age-Adjusted Hospitalization Rate due to Pediatric Mental Health hospitalizations/ 10,000 population aged 10-17 7. 3 93003 16.0 Age-Adjusted ER Rate due to Dental Problems ER visits/ 10,000 population 26.5 93022 5 7. 0 Age-Adjusted ER Rate due to Dehydration ER visits/ 10,000 population 18+ years 11.9 93010 25.3 Age-Adjusted Hospitalization Rate due to Dehydration hospitalizations/ 10,000 population 18+ years 8.7 93065 13.2 Age-Adjusted ER Rate due to Urinary T ract Infections ER visits/ 10,000 population 18+ years 72.9 93030 122.5 Age-Adjusted Hospitalization Rate due to Urinary T ract Infections hospitalizations/ 10,000 population 18+ years 8.9 93065 13.8 Age-Adjusted ER Rate due to Adult Asthma ER visits/ 10,000 population 18+ years 14.3 93022 35.1 Age-Adjusted Hospitalization Rate due to Adult Asthma hospitalizations/ 10,000 population 18+ years 2.0 93060 4.9 Age-Adjusted ER Rate due to Pediatric Asthma ER visits/ 10,000 population aged 10-17 years 48.3 93041 34.4 Age-Adjusted Hospitalization Rate due to Pediatric Asthma hospitalizations/ 10,000 population aged 10-17 years 4.9 93003 5.0 Age-Adjusted ER Rate due to Asthma ER visits/ 10,000 population 23.0 93022 34.3 Age-Adjusted Hospitalization Rate due to Asthma hospitalizations/ 10,000 population 2.7 93060 4.5 Profile of Ventura County
26Ventura County Community Health Needs Assessment 2022 Hospitalization and Emergency Room Utilization Indicators by Zip Code Health Indicator Units Ventura County Value Zip Code Value Age-Adjusted ER Rate due to COPD ER visits/ 10,000 population 18+ years 9.8 93023 14.3 Age-Adjusted Hospitalization Rate due to COPD hospitalizations/ 10,000 population 18+ years 6.9 93063 13.8 Age-Adjusted ER Rate due to Unintentional Falls ER visits/ 10,000 population 18+ years 165.6 93023 212.9 Age-Adjusted Hospitalization Rate due to Unintentional Falls hospitalizations/ 10,000 population 18+ years 42.0 91360 54.5 Hospitalization Rate due to Hip Fractures Among Females 65+ hospitalizations/ 100,000 females 65+ years 242.4 93022 718.6 Hospitalization Rate due to Hip Fractures Among Males 65+ hospitalizations/ 100,000 males 65+ years 107 .2 93041 428.0 Source: California Department of Health Care Access and Information (HCAI) TABLE 5: NUMBER OF HOSPITALIZATION INDICATORS BY ZIP CODE WITH HIGHEST RATE, 2018-2020 Number of Hospitalization Indicators by Zip Code with Highest Rate Zip Code Hospitalization Indicator Count
93022 (Oak View) 10
93030 (Oxnard) 9
93060 (Santa Paula) 7
93065 (Simi Valley) 5
93063 (Simi Valley) 4
91360 (Thousand Oaks) 3
93012 (Camarillo) 3
93003 (Ventura) 2
93023 (Ojai) 2
93041 (Port Hueneme) 2
91361 (Thousand Oaks/Westlake) 1
93001 (Ventura) 1
93010 (Camarillo) 1
93033 (Oxnard) 1
93040 (Piru) 1
Source: California Office of Statewide Health Planning and Development Profile of Ventura County
27Ventura County Community Health Needs Assessment 2022
4.7 Life Expectancy in Ventura County, 2019-2021
Life expectancy is a measure of a population’s longevity and overall health. Amer- icans born today can expect to live 77 years while Ventura County residents born today can expect to live 81.3 years, 4.3 years longer than the United States average (Murphy, Kochanek, Xu, & Arias, December 2021). Females in Ventura County can expect to live an average of 4.9 years longer than their male counterparts (83.8 years versus 78.9 years). Figure 24 shows that Asians (Non-Hispanic) living in Ventura County enjoy the longest life expectancy of any race and ethnic group, followed by Hispanics, Whites (Non-Hispanic), and then African Americans (Non-Hispanic); this disparity in life expectancy at birth by race or ethnic group is statistically sig - nificant (confidence intervals do not overlap) in Ventura County and is consistent with national life expectancy trends.
Better mortality outcomes in the Hispanic population nationally, as compared to Whites (Non-Hispanic) and Black or African Americans (Non-Hispanic), have been attributed to the healthy migrant effect, which hypothesizes that Hispanics who immigrate can do so because of their better health. Culturally, the Hispanic family structure, lifestyle behaviors and social support networks may be considered a protective factor against the effects of low socioeconomic status in this population (Kochanek, Murphy, Xu, & T ejada-Vera, 2016).
FIGURE 24: LIFE EXPECTANCY BY RACE OR ETHNICITY FOR VENTURA COUNTY , 2019-2021
65.0 7 0.0 75.0 8 0.0 85.0 9 0.0 95.0
Asian (N H)
Black (NH)
Hispanic (Any Race)
White (NH)
Asian (N H)
Black (NH)
Hispanic (Any Race)
White (NH)
Asian (N H)
Black (NH)
Hispanic (Any Race)
White (NH)
Overall Female Male
Life Expectancy by Race/Ethnicity for Ventura County, 2019-2021 Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022
Profile of Ventura County
Disparities in life expectancy also exist by geographic area. Figure 25 shows that place matters when it comes to better health and mortality outcomes. Residents in Thousand Oaks/Westlake (91361) had the highest life expectancy in the county at
90.5 years (93.5 years for females and 87 .4 years for males). Residents of Santa Paula (93060) had the lowest life expectancy in the county at 78.6 years (82.0 years for females and 75.5 years for males). This is an 11.9-year difference in life expectancy between these two zip codes.
In the United States, lower income is associated with lower life expectancy; there is a 14.6-year difference in the life expectancy between the richest 1% and the poor- est 1% of Americans; even among the poorest individuals, there are geographic differences in life expectancy (Chetty R, 2016). For example, lower income individ- uals from different zip codes may have different life expectancy depending on the prevalence of smoking or other high-risk behaviors. There were twelve zip codes in Ventura County that had a lower life expectancy than the overall county average.
In general, zip codes with residents that benefit from higher socioeconomic status have a higher life expectancy than those residents with lower socioeconomic status..
FIGURE 25: LIFE EXPECTANCY BY ZIP CODE, 2019-2021
78.64352347
78.87597198
79.04788383
79.47938021
80.30394632
80.39161622
80.63010757
80.75628281
80.77108268
80.95144398
80.96834866
81.15015312
81.44364468
81.39357524
81.77357549
82.01529062
82.11244252
82.1372481
83.61410452
83.9648511
83.99791037
84.79174751
86.14127222
90.4549211
50 55 60 65 70 75 80 85 90 95
93060 - Santa Paula
93 03 6 - Ox nard
93 03 3 - Ox nard
93 03 0 - Ox nard
93041 - Port Hueneme
93022 - Oak View
93065 - Simi Valley
93015 - Fillmore
93063 - Simi Va lley (Santa Susana)
93 00 4 - Ventura
93 00 1 - Ventura
93 00 3 - Ventura
Ven tura C ounty
93 03 5 - Ox nard
93 01 0 - C amarillo
93021 - Moorpark
93 02 3 - Ojai
91360 - Tho usand Oaks
91320 - Tho usand Oaks/Newb ury Park
93 06 6 - Somis
93 01 2 - C amarillo
91362 - Tho usand Oaks/Westlake
91377 - Oak Park
91361 - Tho usand Oaks/Westlake
Life Expectancy by Zip Code, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022
28Ventura County Community Health Needs Assessment 2022
4.8 Mortality and Y ears of Life Lost (Premature Death) Mortality trends help drive public policy and health priorities; this has been espe- cially true during the past few years in response to the COVID-19 pandemic. The 10 leading causes of death in Ventura County for the 2019-2021 three-year period were diseases of the Heart, Cancer, Alzheimer’s Disease, Accidents, COVID-19, Stroke, Chronic Lower Respiratory Disease, Drug-Induced Deaths, Diabetes, and Chronic Liver Disease and Cirrhosis. Diseases of the Heart and Cancer were the Leading Causes of Death in Ventura County, California, and the United States. T o analyze statistically valid rates for comparison purposes by race or ethnicity, it is necessary to include three years of data. However, considering 2020 data for Ven- tura County, COVID-19 would be the sixth leading cause of death as compared to third leading cause of death in the United States and fourth in California in 2020.
For 2021, COVID-19 would surpass accidents and Alzheimer’s disease to become the third leading cause of death in Ventura County .
TABLE 6: LEADING CAUSES OF DEATH, 2019-2021 (VC) AND 2020 (CA AND US) Leading Causes of Death, 2015-17 (VC and CA) and 2016 (US) Rank Ventura County (2019-2020) California (2020) United States (2020) 1 Diseases of the Heart Diseases of the Heart Diseases of the Heart 2 All Cancers All Cancers All Cancers
3 Alzheimer’s Disease Injuries COVID-19
4 Accidents (Unintentional
Injuries) COVID -19 Accidents (Unintentional
Injuries)
5 COVID-19 Alzheimer’s Disease Cerebrovascular Disease
(Stroke)
6 Cerebrovascular Disease
(Stroke)
Cerebrovascular Disease
(Stroke)
Chronic Lower
Respiratory Disease
7 Chronic Lower
Respiratory Disease
Chronic Lower
Respiratory Disease Alzheimer’s Disease
8 Drug-Induced Deaths Drug-Induced Deaths Diabetes
9 Diabetes Chronic Kidney Diseases Influenza-Pneumonia
10 Chronic Kidney Disease
and Cirrhosis Diabetes Kidney Disease
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, April 2019 for Ventura County. California Community Burden of Disease Engine (2020 for California). National Vital Statistics Reports, Mortality in the United States, 2020, United States
Profile of Ventura County
In the United States, the All-Cause Mortality Rate for the total population increased by 16.8% from 2019 to 2020 (from 715.2 per 100,000 standard population to 835.4) (Murphy, Kochanek, Xu, & Arias, December 2021). Ventura County also experienced a statistically significant increase in the All-Cause Mortality Rate since the previous assessment period. T able 7 shows the Age-Adjusted Death Rate for the top 10 Leading Causes of Death from 2019-2021 as compared to the rate for the previous assessment period in 2015-17 . There was a statistically significant increase in the Age-Adjusted Death Rate for Accidents, Drug-Induced Deaths, and Chronic Liver Disease and Cirrhosis. There was a statistically significant decrease in the rate of Death Due to Cancer and Chronic Lower Respiratory Disease; it will be important to monitor these trends over time to see if this is in fact a real decrease because both were common co-morbidities listed on the death certificate for those residents who passed due to COVID-19.
TABLE 7: COMPARISON OF AGE-ADJUSTED DEATH RATES FOR VENTURA COUNTY Causes of Death 2015-17 2019-2021
All-Cause Mortality 602.6 625.4
Diseases of the Heart 142.0 137 .6
All Cancers 142.1 125.2
Alzheimer’s Disease 43.8 43.7
Accidents (Unintentional Injuries) 32.6 43.0
COVID-19 N/A 37. 3
Cerebrovascular Disease (Stroke) 38.2 35.7
Chronic Lower Respiratory Disease 32.0 26.7
Drug-Induced Deaths 14.0 23.7
Diabetes 19.6 21.8
Chronic Liver Disease and Cirrhosis 11.2 14.9
Statistically Significant Increase
Statistically Significant Decrease
No Statistically Significant Difference
Source: Vital Records Business Intelligence System
(deaths 2019-2021) and Claritas Pop-Facts (2020),
analysis by Ventura County Public Health, March 2022.
29Ventura County Community Health Needs Assessment 2022 Outside of the pandemic years, the Leading Causes of Death usually do not change significantly from year to year and tend not to shape emerging public health policy .
Although the Leading Causes of Death are often related to behaviors such as lack of physical activity, poor nutrition, and tobacco and/or alcohol use, the social de- terminants of health such as income, education and access to affordable and safe housing play a huge role in health and wellness and should be considered when implementing public health policy to address mortality trends (Sillies, 2009).
Therefore, this assessment takes another approach to analyzing the mortality data by looking at YLL. The Leading Causes of Death show how the aging population is dying, while YLL analysis shows how young people are dying, which moves the focus to prevention. The World Health Organization (WHO) has calculated a standard expected YLL that changes based upon the age at a person’s death (Department of Health Statistics and Information Systems, 2013). For example, if someone died within the first year of life, their YLL would be 91.94 years. However, if someone made it to 92 years, then their YLL would be 6.55 years. The WHO standard expected YLL assumes the first person could have lived to be 91.94 years old, and the second could have lived to be 98.55 years (since he or she was already 92).
There were 19,446 deaths in Ventura County from 2019-2021 and each death was assigned a YLL based upon age at death. This data was used to calculate the Age-Adjusted YLL rate per 100,000 population per year, YLL per Y ear and Average YLL per Death for Ventura County residents. A premature death occurs when some- one does not reach their achievable life expectancy; there were 126,352 YLL Due to Premature Death Per Y ear in Ventura County (73,965 YLL for males and 52,387 YLL for females). The Age-Adjusted YLL rate Per 100,000 population Per year was 12,939 for All Causes of Death (16,120 for males and 9,950 for females). On average, there were 19.5 YLL Per Death from 2019-2021 among Ventura County residents (21.9 years for males and 16.9 years for females).
Figure 26 shows the Leading Causes of Premature Death in Ventura County based upon the Age-Adjusted YLL rate per 100,000 population per year. Cancer and Cor- onary Heart Disease still have the top spots in terms of premature death because they accounted for 43.1% of all deaths from 2019-2021. Accidental Deaths ranked third for Premature Deaths, up from fourth in terms of Leading Causes of Death.
Drug-Induced Deaths were the fourth Leading Cause of Premature death, up from eighth. Suicide was the ninth Leading Cause of Premature Death, up from twelfth.
Alzheimer’s Disease dropped from third in terms of Leading Causes of Death to the tenth Leading Cause of Premature Death.
FIGURE 26: AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021 0 5 00 10 00 15 00 20 00 25 00 30 00
Alzheimer’s Disease (3)
Suicide (12)
D iabete s (9)
Cerebrovascular Disease (Stroke) (6)
Chronic Liver Disease and Cirrhosis (7)
COVID- 19 ( 5)
Dru g- In duced Deaths ( 8)
Accidents (Unin tentio nal Injuries) (4)
Diseases of the Heart (1)
All Cancers (2)
Age-Adjusted Years of Life Lost Rate per 100,000 population per year, 2019- 21 Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022
*Rates highlighted in green improved and highlighted in orange worsened from previous assessment period using data from 2015-17 .
T able 8 shows the Leading Causes of Premature Death for males and females based upon the Age-Adjusted YLL rate Per 100,000 population Per year from 2019-2021.
The top five leading causes of premature death are the same for both males and females, however, men are more likely to die a premature death due to suicide, dia- betes or motor vehicle traffic crashes and females are more likely to die a premature death due to breast cancer, Alzheimer’s disease and lung cancer.
Profile of Ventura County
2683.1
2027 .0
1858.2
1183.0
768.4
523.1
508.0
442.3
419.3
413.0
30Ventura County Community Health Needs Assessment 2022 TABLE 8: LEADING CAUSES OF PREMATURE DEATH BY GENDER, 2019-2021 Rank Ventura County Male Female
1 All Cancers All Cancers All Cancers
2 Diseases of the Heart Diseases of the Heart Diseases of the Heart 3 Accidents (Unintentional
Injuries)
Accidents (Unintentional
Injuries)
Accidents (Unintentional
Injuries)
4 Drug-Induced Deaths Drug-Induced Deaths Drug-Induced Deaths 5 COVID-19 COVID-19 COVID-19
6 Chronic Liver Disease and
Cirrhosis
Chronic Liver Disease and
Cirrhosis Breast Cancer
7 Cerebrovascular Disease
(Stroke) Suicide Alzheimer’s Disease
8 Diabetes Cerebrovascular Disease
(Stroke)
Cerebrovascular Disease
(Stroke)
9 Suicide Motor Vehicle T raffic
Crashes
Chronic Liver Disease and
Cirrhosis
10 Alzheimer’s Disease Diabetes Lung Cancer
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
T able 9 shows the leading causes of premature death by race or ethnicity based upon the Age-Adjusted YLL rate Per 100,000 Population Per year from 2019-2021 The top three leading causes of premature death are the same for all race or ethnic groups, which include cancers, accidents and diseases of the heart, only the rank order differs. COVID-19 was the fourth leading cause of premature death for both Hispanics and Asians (Non-Hispanic) while the fourth leading cause of premature deaths for Whites (Non-Hispanic) and Blacks (Non-Hispanic) was drug-induced.
TABLE 9: LEADING CAUSES OF PREMATURE DEATH BY RACE OR ETHNICITY , 2019-2021 Rank Hispanic/Latino White
Non-Hispanic
Asian
Non-Hispanic
Black
Non-Hispanic
1 All Cancers All Cancers All Cancers All Cancers
2 Accidents
(Unintentional
Injuries)
Accidents
(Unintentional
Injuries)
Diseases of the
Heart
Diseases of the
Heart
3 Diseases of the
Heart
Diseases of the
Heart
Accidents
(Unintentional
Injuries)
Accidents
(Unintentional
Injuries)
4 COVID-19 Drug-Induced
Deaths COVID-19 Drug-Induced
Deaths
5 Drug-Induced
Deaths
Chronic Liver
Disease and
Cirrhosis
Cerebrovascular
Disease (Stroke)
Cerebrovascular
Disease (Stroke)
6 Diabetes Suicide Diabetes Suicide
7 Cerebrovascular
Disease (Stroke) Alzheimer’s Disease Drug-Induced
Deaths Alzheimer’s Disease
8 Chronic Liver
Disease and
Cirrhosis
Chronic Lower
Respiratory Disease
Motor Vehicle
T raffic Crashes Diabetes
9 Motor Vehicle T raffic
Crashes
Cerebrovascular
Disease (Stroke) Alzheimer’s Disease COVID-19
10 Alzheimer’s Disease COVID-19
Chronic Liver
Disease and
Cirrhosis
Chronic Lower
Respiratory Disease
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
Profile of Ventura County
31Ventura County Community Health Needs Assessment 2022
4.8.1 Premature Deaths from Cancer
Cancer was the Leading Cause of both Death and Premature Death in Ventura County from 2019-2021. Figure 27 shows the Age-Adjusted YLL rate Per 100,000 population Per year from All Cancers combined. Males had a higher rate of Premature death from Cancer than females. Black or African American (Non-Hispanic) experienced the highest Premature Death rate due to Cancer of any race or ethnic group, followed by Whites (Non-Hispanic), Hispanics and then Asians (Non-Hispanic).
Males lost an average of 21 years due to All Cancers compared to 21.1 years for females. Hispanics had the highest Average YLL Per Death from All Cancers (25.5 years) followed by Black or African Americans (Non-Hispanic) (24.3 years), Asians (Non-Hispanic) (22.2 years) and then Whites (Non-Hispanic) (19.4 years). On average, there were 21.1 YLL Per Death from Cancer for all race or ethnic groups combined.
FIGURE 27: ALL CANCERS - AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021
0 5 00 10 00 15 00 20 00 25 00 3 00 0 3 50 0 40 00
White
AfAm/Black
Asian
Hisp/Lat
Female
Male
Ven tura C ounty
All Cancers - Age-Adjusted Years of Life Lost Rate
per 100,000 population per year, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
Figure 28 shows the Age-Adjusted YLL rate Per 100,000 population Per year by type of cancer. Female Breast Cancer had the highest Premature Death rate and resulted in an average of 22.4 years of life lost Per death. Lung Cancer had the second highest Premature Death rate and resulted in an average of 19.2 YLL Per Death.
FIGURE 28: CANCER - AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021
62.0 137.1
151.8
172.5
204.8
254.2
271.4
371.7
476.1
0 50 1 00 1 50 2 00 2 50 3 00 3 50 4 00 4 50 5 00
Kid ney Canc er (C64)
L iver Ca nc e r ( C2 2 )
Brain Cancer (C71)
Ovari an Ca nc e r ( C5 6 )
Pancr eati c Cancer (C25)
Colorectal Cancer (C18-21) (C 26.0)
Prostate Cancer (C61)
L u ng Ca nc e r ( C3 4)
Female Breast Cancer (C50)
All Cancers - Age-Adjusted Years of Life Lost Rate
per 100,000 population per year, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
*Codes next to the type of cancer refer to the ICD-10 code Profile of Ventura County
32Ventura County Community Health Needs Assessment 2022
4.8.2 Premature Deaths from Diseases of the Heart
Diseases of the Heart were the Leading Cause of Death and second Leading Cause of Premature Death in Ventura County from 2019-2021. Figure 29 shows the Age-Ad- justed YLL rate Per 100,000 Population Per Y ear from Diseases of the Heart. Males had a higher rate of Premature Death from Diseases of the Heart than females. Black or African Americans (Non-Hispanic) experienced the highest Premature Death rate of any race or ethnic group followed Whites (Non-Hispanic), Hispanics and then Asians (Non-Hispanic). Males lost an average of 16.8 years due to Heart Disease compared to 11.9 years for females. Black or African Americans (Non-Hispanic) (18.8 years) had the highest average YLL Per Death from Heart Disease followed by Hispanics (17 .5 years), Asians (Non-Hispanic) (15.7 years) and then Whites (Non-Hispanic) (13.5 years). On average, there were 14.3 YLL Per Death from Heart Disease.
FIGURE 29: CORONARY HEART DISEASE - AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021
0 5 00 10 00 15 00 20 00 25 00 3 00 0
White
AfAm/Black
Asian
Hisp/Lat
Female
Male
Ven tura C ounty
Diseases of the Heart - Age-Adjusted Years of Life Lost Rate per 100,000 population per year, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
4.8.3 Premature Deaths from Accidents (Unintentional Injuries) Deaths Due to Accidents (unintentional injuries) were the third Leading Cause of Premature Death, up from fourth as a Leading Cause of Death. Figure 30 shows that males were more likely than females to die a premature death due to an accident (unintentional injury); males lost an average of 43.1 years Per death while females lost an average of 33.7 years Per death. Whites (Non-Hispanics) had higher rates of Premature Death Due to an Accident (Unintentional Injury) than other race or ethnic groups; Hispanics lost an average of 48.3 years Per death compared to
38.3 years for Blacks or African Americans (Non-Hispanic), 36.1 years for Whites (Non-Hispanic), 28.2 years for Asians (Non-Hispanic). On average, there were 40.1 YLL Per Death from Accidents for all race or ethnic groups combined.
FIGURE 30: ACCIDENTS- AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021
0 5 00 10 00 15 00 20 00 25 00 3 00 0
White
AfAm/Black
Asian
Hisp/Lat
Female
Male
Ven tura C ounty
Accidents - Age-Adjusted Years of Life Lost Rate
per 100,000 population per year, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
Profile of Ventura County
33Ventura County Community Health Needs Assessment 2022
4.8.4 Drug-Induced Premature Deaths
Drug-Induced Deaths were the eighth Leading Cause of Death but fourth Leading Cause of Premature Death from 2019-2021. Figure 31 shows the Age-Adjusted YLL rate Per 100,000 population Per Y ear Due to Drug Induced Deaths. Males had a higher rate of Premature Death from Drug-Induced Deaths than females; males lost an average of 49.0 years Due to Drug-Induced Deaths compared to 44.6 years for females. Whites (Non-Hispanic) experienced the highest Premature Death rate of any race or ethnic group followed by Black or African Americans (Non-Hispanic), Hispanics, and then Asians (Non-Hispanic). Hispanics had the highest average YLL Per death from drugs (51.0 years) followed Black or African Americans (Non-Hispanic) (48.0 years), Whites (Non-Hispanic) (46.1 years), and then Asians (Non-Hispanic) (41.3 years). On average, there were 47 .7 YLL Per Death from drugs for all race or ethnic groups combined.
FIGURE 31: DRUG-INDUCED- AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021
0 2 00 4 00 6 00 8 00 1 00 0 1 20 0 1 40 0 1 60 0 1 80 0 White
AfAm/Black
Asian
Hisp/Lat
Female
Male
Ven tura C ounty
Drug-Induced - Age-Adjusted Years of Life Lost Rate
per 100,000 population per year, 2019-21
Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
4.8.5 Premature Deaths due to COVID-19
COVID-19 was the fifth Leading Cause of Death and Premature Death in Ventura County from 2019-2021. Figure 32 shows the Age-Adjusted YLL rate Per 100,000 population Per Y ear from COVID-19. Males had a higher rate of Premature Death from COVID-19 than females; males lost an average of 22.1 years due to COVID-19 compared to 17 .2 years for females. Hispanics experienced the highest premature death rate of any race or ethnic group followed by Asians (Non-Hispanic), Black or African Americans (Non-Hispanic), and then Whites (Non-Hispanic). Black or African Americans (Non-Hispanic) had the highest average YLL Per Death from COVID-19 (24.9 years) followed Hispanics (23.6 years), Asians (Non-Hispanic) (18.8 years), and Whites (Non-Hispanic) (15.8 years). On average, there were 20.1 YLL Per Death from COVID-19 for all race or ethnic groups combined.
FIGURE 32: COVID-19 - AVERAGE YEARS OF LIFE LOST PER DEATH, 2019-2021 0 2 00 4 00 6 00 8 00 1 00 0 1 20 0 1 40 0 1 60 0 1 80 0 White
AfAm/Black
Asian
Hisp/Lat
Female
Male
Ven tura C ounty
COVID-19 - Age-Adjusted Years of Life Lost Rate
per 100,000 population per year, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022
Profile of Ventura County
34Ventura County Community Health Needs Assessment 2022
4.8.6 Premature Deaths due to Suicide
Suicides were the twelfth Leading Cause of Death but ninth Leading Cause of Premature Death from 2019-2021. Figure 33 shows the Age-Adjusted YLL rate Per 100,000 Population Per Y ear Due to Suicide. Males had a higher rate of Premature Death from Suicide deaths than females; males lost an average of 40.4 years due to Suicide deaths compared to 40.0 years for females. Whites (Non-Hispanic) ex - perienced the highest Premature Death rate of any race or ethnic group followed by Asians (Non-Hispanic), and then Hispanics. Hispanics had the highest Average YLL Per Death from Suicide (57 .9 years) followed Asians (Non-Hispanic) (45.2 years) and then Whites (Non-Hispanic) (34.1 years). On average, there were 40.3 YLL Per Death from Suicide for all race or ethnic groups combined.
FIGURE 33: SUICIDE - AGE-ADJUSTED YEARS OF LIFE LOST RATE PER 100,000 POPULATION PER YEAR, 2019-2021
0 1 00 2 00 3 00 4 00 5 00 6 00 7 00
White
Asian
Hisp/Lat
Female
Male
Ven tura C ounty
Suicide - Age-Adjusted Years of Life Lost Rate
per 100,000 population per year, 2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022.
4.8.7 Average Y ears of Life Lost per Premature Death
Figure 34 shows the top ten causes of Premature Death in terms of the Average YLL Per Death in Ventura County . Homicide has the highest Average YLL Per Death at
56.0 years, which increases to 58.1 years for Hispanics. Drug-Induced Deaths have the second highest Average YLL Per Death at 47 .7 years, followed by Motor Vehicle T raffic Crashes at 47 .4 years, Firearm-Related Deaths at 43.0 years, Suicide at 40.3 years and Accidents (Unintentional Injuries) at 40.1 years.
These preventable causes of death describe how the younger population is dying in Ventura County . Although access to health care may play a role in a small pro - portion of these deaths in terms of access to behavioral health services for those addicted to substances or suffering from mental health issues, in large part, these deaths are related to conditions influenced by the social determinants of health such as safe neighborhoods, educational opportunities, poverty status and the built environment. T o create a healthy Ventura County, it is imperative to expand the public health focus to include prevention as well as providing access to health services with an emphasis on addressing social determinants of health.
FIGURE 34: AVERAGE YEARS LIFE LOST PER DEATH, 2019-2021
28.9 30.5
32.9 36.7
40.1 40.3
43 47.4
47.7 56
0 10 20 30 40 50 60
Brain Cancer ( 152)
Obesity, unspecified (32)
Chr onic Liver D isease an d C irrh osis (449)
Alcohol Dependence (47)
Accidents (Unintentional Injuries) (1,141)
Suicide ( 265)
Firearm-Related Deaths (151)
Motor Vehicle Tra ffic Crashes (199)
Drug-Induced Deaths (595)
Homi cide (7 4)
Average Years Life Lost Per Death,
2019-21
Source: Vital Records Business Intelligence System (deaths 2019-2021) and Claritas Pop-Facts (2020), analysis by Ventura County Public Health, March 2022. *The number by the cause of death refers to the number of deaths that occurred from 2019-2021.
Profile of Ventura County
35Ventura County Community Health Needs Assessment 2022 According to the Centers for Disease Control and Prevention, health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged popula- tions. Those disparities that are systematic and avoidable and therefore, considered unjust or unfair, are considered health inequities. VCCHIC wants to lessen the disparities by focusing on achieving health equity . “Health equity” means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives.
5.1 Health Equity Index
All communities can be described by various social and economic factors that are well known to be strong determinants of health outcomes, as discussed in Sec - tion 4 of this report. Healthy Communities Institute developed the Health Equity Index (formerly, SocioNeeds ®Index) to easily compare multiple socioeconomic factors across geographies. This index incorporates estimates for six different social and economic determinants of health — income, poverty, unemployment, occupation, educational attainment, and linguistic barriers — that are associated with poor health outcomes including preventable hospitalizations and premature death. Within Ventura County, zip codes are ranked based on their index value to identify the relative levels of need. Those geographic areas with the highest values (from 0-100) are estimated to have the highest socioeconomic need which can be correlated with preventable hospitalizations and premature death (Healthy Com- munities Institute, 2019).
Figure 35 shows that Oxnard (93030, 93033 and 93036), Santa Paula (93060), and Fillmore (93015) are the areas within the county that have the highest socio - economic needs. In general, the areas of the county with higher socioeconomic needs (highlighted above) have a lower average life expectancy than the Ventura County average of 81.4 years. Conversely, those areas with lower socioeconomic needs such as Oak Park (93777) and Thousand Oaks/Westlake (91361 and 91362) have life expectancies of 84+ years.
FIGURE 35: HEALTH EQUITY INDEX, VENTURA COUNTY , 2021
Source: Health Matters in Ventura County
Disparities
36Ventura County Community Health Needs Assessment 2022
5.2 Food Insecurity Index
Conduent’s Food Insecurity Index (FII) estimates areas of low food accessibility correlated with social and economic hardship. In this index, zip codes are ranked based on their value to identify the relative levels of need, as illustrated by the map in Figure 36. According to the 2021 FII for Ventura County, the following zip codes have the highest level of food insecurity (as indicated by the darkest shades of green):
93033, 93043, 93041, and 93030. See Appendix A for a detailed FII methodology .
FIGURE 36: FOOD INSECURITY INDEX, VENTURA COUNTY , 2021 Source: Health Matters in Ventura County
5.3 Mental Health Index
Conduent’s Mental Health Index (MHI) is a measure of socioeconomic and health factors correlated with self-reported poor mental health. Based on the MHI, in 2021, zip codes are ranked based on their index value to identify the relative levels of need, as illustrated by the map in Figure 37 . The following zip codes are estimated to have the highest need (as indicated by the darkest shades of purple): 93003, 93023, 91360, and 93001. See Appendix A for more detailed MHI methodology .
FIGURE 37: MENTAL HEALTH INDEX, VENTURA COUNTY , 2021
Source: Health Matters in Ventura County
Disparities
37Ventura County Community Health Needs Assessment 2022
5.4 Index of Disparity
Critical components in assessing the needs of a community are identifying bar - riers and disparities in health care. Additionally, the identification of barriers and disparities will help inform and focus strategies for Ventura County to address the prioritized health needs. Healthy Communities Institute uses the Index of Disparity, which is a tool used to summarize disparities across groups within a population, across all indicators.
T able 10 identifies secondary data health indicators with race or ethnic disparities in Ventura County . T able 10 lists the indicators with the greatest, significant race or ethnic disparities and highlights the groups that were impacted. T able 11 displays the number of significant health indicators for each race or ethnic group. Hispanic/ Latino populations had the greatest impact, with disparities in 18 indicators. This is followed by the Black/African American population with 17 indicators and the White population with 14 indicators.
Upon further examination, the Black/African American population is predominately experiencing disparities related to asthma, diabetes, and substance abuse. Among the significant health indicators, Black/African American populations experience the highest rates of Age-Adjusted Emergency Room (ER) visits due to Asthma, with 44.5 ER visits per 10,000 population. This is in comparison to the Ventura County rate of 23.0 ER visits per 10,000 population. The Black/African American population 18+ has the highest rate of Age-Adjusted ER visits due to Adult Suicide and Intentional Self-inflicted Injury, with a rate of 60.5 ER visits per 10,000 popula- tion. This is in comparison to the Ventura County rate of 30.1 ER visits per 10,0000 population. The Hispanic/Latino population is experiencing disparities in diabetes and obesity . Among the significant health indicators, Hispanic/Latino populations experience the highest rates of Age-Adjusted Hospitalization Rate due to Long- T erm Complications of Diabetes, with a rate of 12.0 hospitalizations per 10,000 population. This is compared to the Ventura County rate of 7 .3 hospitalizations per 10,000. Additionally, 48.4% of the Hispanic/Latino adult population is considered obese, compared to the average of 25.6% of adults in Ventura County . The White population is predominately experiencing higher rates of substance use ER visits and hospitalizations. Among the significant health indicators, White populations experience a higher rate of Age-Adjusted Emergency Department (ED) visits due to Heroin Overdose (26.0 ED visits per 100,000 residents) compared to Ventura County overall (11.5 ED visits per 100,000 residents).
Disparities
38Ventura County Community Health Needs Assessment 2022 Disparities
TABLE 10: INDICATORS WITH SIGNIFICANT RACE OR ETHNIC DISPARITIES, 2016-2020 Disparities by Race or Ethnicity
Health Indicator Population Experiencing Disparities
Children Living Below Poverty Level American Indian/Alaska Native (43.3%), Hispanic/Latino (17 .1%), Other Race (20.0%) Families Living Below Poverty Level American Indian/Alaska Native (17 .4%), Hispanic/Latino (10.0%), Other Race (10.7%) People 65+ Living Below Poverty Level Hispanic/Latino (11.6%), T wo or More Races (12.4%) People Living Below Poverty Level American Indian/Alaska Native (22.7%), Hispanic/Latino (12.0%), Other Race (13.4%) People 25+ with a Bachelor’s Degree or Higher American Indian/Alaska Native (13.6%), Native Hawaiian/Pacific Islander (16.1%), Other Race (14.1%), T wo or More Races (24.1%)
Juvenile Arrest Rate Black or African American (41.3), Hispanic/Latino (11.4) Adult Arrest Rate Black or African American (135.2), Hispanic/Latino (55.7) Deaths in Custody White (0.2)
Substantiated Child Abuse Rate Hispanic/Latino (6.2)
Age-Adjusted ED Visit Rate due to Heroin Overdose White (26.0) Babies with Very Low Birth Weight Asian (1.5%), White (1.3%) Adults Who Are Obese Hispanic/Latino (48.4%)
Age-Adjusted ER Rate due to Asthma Black/African American (44.5) Age-Adjusted ER Rate due to Adult Asthma Black/African American (40.8) Age-Adjusted ER Rate due to COPD Black/African American (22.3), White (11.2) Age-Adjusted Hospitalization Rate due to Substance Use Black/African American (8.9), White (6.1) Age-Adjusted Hospitalization Rate due to Opioid Use Black/African American (5.9) Age-Adjusted ER Rate due to Diabetes Black/African American (32.8), White (21.7), Hispanic/Latino (29.8) Age-Adjusted Hospitalization Rate due to Diabetes Black/African American (27 .7), White (16.3), Hispanic/Latino (20.8) Age-Adjusted Hospitalization Rate due to Long-T erm Complications of Diabetes Hispanic/Latino (12.0) Age-Adjusted Hospitalization Rate due to Short-T erm Complications of Diabetes Black/African American (9.7), White (6.2) Age-Adjusted Hospitalization Rate due to Uncontrolled Diabetes Black/African American (5.4), Hispanic/Latino (3.5) Age-Adjusted ER Rate due to Uncontrolled Diabetes Black/African American (24.5), White (15.2), Hispanic/Latino (21.1) Age-Adjusted Hospitalization Rate due to T ype 2 Diabetes Black/African American (20.3), Hispanic/Latino (18.3) Age-Adjusted ER Rate due to T ype 2 Diabetes Black/African American (29.4), White (18.3), Hispanic/Latino (27 .9) Age-Adjusted Hospitalization Rate due to Hypertension Black/African American (7 .9), Hispanic/Latino (4.4) Age-Adjusted Hospitalization Rate due to Adult Mental Health Black/African American (47 .2), White (26.9) Age-Adjusted ER Rate due to Adult Suicide and Intentional Self-inflicted Injury Black/African American (60.5), White (38.4) Hospitalization Rate due to Hip Fractures Among Females 65+ Hispanic/Latino (407 .7), White (607 .4) Hospitalization Rate due to Hip Fractures Among Males 65+ Hispanic/Latino (224.1), White (305.1) Sources: American Community Survey (2016-2020); California Health Interview Survey (2018-2020); Child Welfare Dynamic Reporting System (2020); California Department of Justice (2020); California Opioid Overdose Surveillance Dashboard (2020); California Department of Public Health (2016-2018), California Department of Health Care Access and Information (2018-2020) TABLE 8: SUBGROUPS WITH
MOST DISPARITIES, 2016-
2020
Subgroups with Most
Disparities
Race or
Ethnicity
Group
Health
Indicator
Count
Hispanic/
Latino 18
Black/African
American 17
White 14
American
Indian/Alaska
Native 4
Other 4
T wo or More
Races 2
Asian 1
Native
Hawaiian/
Pacific
Islander 1
39Ventura County Community Health Needs Assessment 2022
6.1 Community Survey Key Findings
The 2022 Community Health Assessment Survey was designed and disseminated by VCCHIC. Furthermore, VCCHIC participated in a Centers for Disease Control and Prevention health equity pilot which required that they include survey questions on racial trauma and discrimination. A total of 3,066 responses were collected. This was a convenience sample, which means results may be vulnerable to selection bias; however, the results are applicable to the population of Ventura County .
6.1.1 Demographics of Survey Respondents
VCCHIC members went to great lengths to collect surveys from socially marginalized populations. Demographics of survey respondents are as follows:
• All age groups were represented in the survey - 0-17 (5%), 18-24 (11%), 25-34 (18%), 35-44 (22%), 45-54 (16%), 55-64 (14%), and 65+ (14%) • Gender Identity – Female/Woman (77%), Male/Man (20%), Another Gender Identity or Prefer Not to Answer (3%)
• Household Income – 25% of respondents had a household income less than $30K per year
• Race or ethnicity – 63% of respondents were Hispanic/Latino (4% Indigenous from Mexico, Central or South America), 30% Non-Hispanic White, 4% Non-Hispanic Asian, 1% Non-Hispanic Black, 1% Non-Hispanic American Indian or Alaska Native, 1% another race or ethnicity • Marital Status – Married (48%), Not Married/Single (33%), Domestic Partner (9%)
• Education – Less than high school graduate (11%), high school graduate or GED (13%)
• Language – Spanish (23%), English (72%), Mixtec (2%); 16% of surveys were completed in Spanish
• Military – Currently serve or served in the past (4%) • Physical or Mental Disability - 12%
• Insurance – Medi-Cal (18%), No insurance (7%), Cash Pay (6%) • Industry/Business – Agriculture (5%), Construction (1%), Education (6%), Food Service or Retail (5%), Government (30%), Healthcare (39%), T echnology (2%)
6.1.2 Overall Survey Results
Survey responses of what makes a healthy community can be seen in Figure 38.
Access to health care was the number one response for survey participants and has remained a consistent response from the 2016 needs assessment. The top five responses to the survey question about what residents consider to be components of a healthy community include- affordable housing, low crime/safe neighborhoods, good schools, good jobs and healthy economy . Additionally, the top five responses demonstrate that residents view affordable housing, low crime, good schools, and economic opportunities as means of improving overall health in the community .
Access to health care was most important to residents 18-24 years old (83%), res- idents with a household income between $30-39K (81%), residents identifying as another gender identify rather than female/woman or male/man (up to 100%), residents of Hispanic or Latino ethnicity (79%), and residents with a high school diploma or GED (83.4%).
Primary Data Collection
40Ventura County Community Health Needs Assessment 2022 FIGURE 38: RESPONSES TO “WHAT DO YOU THINK MAKES A HEALTHY COMMUNITY?”
0.22 0.25
0.26 0.27
0.28 0.28
0.36 0.37
0.42 0.44
0.44 0.47
0.53 0.56
0.77 0 0 .1 0 .2 0 .3 0 .4 0 .5 0 .6 0 .7 0 .8 0 .9
Lo w level of ch ild abu se
Strong family life
Parks and recreation
Access to transportation
Excellent rac e relat ion s
Good place to raise ch ildren
Safe places to exercise (e.g. walk, ride a bicycle, or ride a horse) Hea lthy behaviors a nd lifestyles
Clean environment
Access to organizations which provide community services (e.g. food banks, shelters, screenings, free vaccinations etc.) Good jobs and healthy economy
Good schools
Low crime / safe neighborhoods
Affordable housing
Access to health care (e.g., having a regular doctor, insurance coverage) What do you think makes a Healthy Community?
In 2016, mental health ranked fourth for the most important health problem but rose to first place in both 2019 and 2022. Figure 39 shows the top responses for the most important health problems within the community . The top five health priorities include: Mental Health, Cancer, Aging Complications, Diabetes, and Heart Disease and Stroke. The community health survey was distributed during the COVID-19 pandemic. Despite this, COVID-19 was not ranked as one of the top five health topics by survey respondents.
Mental Health was identified most by residents 45-54 years old (79%), residents with a household income more than $150K (84%), residents identifying as another gender identify rather than female/woman or male/man (up to 100%), residents of Non-Hispanic or Latino ethnicity (83%), and residents with a doctoral degree (91%).
Primary Data Collection
41Ventura County Community Health Needs Assessment 2022 FIGURE 39: MOST IMPORTANT HEALTH PROBLEMS FOR SURVEY PARTICIPANTS
0.14 0.17
0.2 0.22
0.24 0.24
0.25 0.29
0.3 0.32
0.33 0.39
0.41 0.49
0.73 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Motor vehicle crash injuries
Rap e/sexual assau lt
Infectious Diseases (e.g. non-COVID-19 such as hepatitis, TB, etc.) Caregiver stress
Multiple chronic conditions
Suicid e
High blood pressure
COVID -19
Domestic Violence
Chi ld abus e / neg lect
Heart disease and stroke
Diabetes
Aging complications (e.g. dementia, falls, social isolation etc.) Canc ers
Mental health problems (e.g. trauma, depression, bipolar etc.) What are the most important health problems?
Figure 40 shows the top risky behaviors survey respondents identified. There have been no significant changes in the arrangement of health topics from 2016-2022.
Drug Abuse, Alcohol Abuse, being Overweight/Obese, Poor Eating Habits, and Racism are consistent risky health behaviors that are affecting residents living in Ventura County .
Drug Abuse was identified as a risky behavior most by residents 45-54 years old (81%), residents with a household income more than $150K (79%), residents iden- tifying as gender non-binary, gender non-conforming (77%), residents of Hispanic or Latino ethnicity (75%), and residents with some college but no degree (78%).
FIGURE 40: RISKY BEHAVIORS RANKED IN THE COMMUNITY
0.05 0.11
0.12 0.2
0.2 0.23
0.25 0.33
0.35 0.35
0.38 0.46
0.59 0.7
0.74 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Other - please specify
Not using seat belts / child safety seats
Unsafe sex
Lack of adequate sleep
Lack of family planning (e.g. not using birth control)
Not getting “shots� to prevent disease
Dropping out of school
Tobacco/e-cigarette use
Lack of exercise
Prescription Drug Abuse
Racism
Po or eat in g habits
Being overweight/obese
Alcohol abuse
Drug abuse
Figure 41 shows survey responses of what issues should be addressed. The top five areas that need to be addressed include cost of healthcare services, poor housing conditions or lack of housing, environmental exposures, lack of good paying jobs, and lack of options for childcare services or lack of support for childcare. Address- ing high healthcare costs was most important to residents 55-64 years old (74%), residents with a household income between $80-89K (82%), residents identifying as another gender identify (83.3%), residents of Non-Hispanic or Latino ethnicity (79%), and residents with an associate degree (75%).
Primary Data Collection
42Ventura County Community Health Needs Assessment 2022 FIGURE 41: WHAT RESIDENTS WOULD LIKE TO SEE ADDRESSED IN COMMUNITY
0.17 0.2
0.2 0.21
0.21 0.21
0.22 0.23
0.29 0.32
0.32 0.4
0.4 0.47
0.68 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Homicide
Lack of educational opportunities
Natural disasters (e.g. wildfires, tsunamis, earthquakes, etc.) Lack of information to make correct health decisions
Lack of transportation for medical needs
Firearm-related injuries
Lack of skills to use technology to communicate, access virtual school, or work remotely from home Lack of free early childhood education for families in need Lack of safe places to exercise (e.g. walk, ride a bicycle, or ride a horse) Lack of sufficient food or healthy food options
Lack of options for childcare services/lack of childcare support Lack of good paying jobs
Environmental Exposures (e.g. pesticides, smoke etc.)
Poor housing conditions or lack of housing
High healthcare costs (e.g. insurance, co-pays, prescriptions) Providing Care to a Family Member or Friend
Research has shown that the health and wellness of someone who provides regular care for a chronically ill, disabled, or elderly family member, is negatively impacted (Caregiver Burden, 2022). Respondents were asked whether or not they provided regular care to a family member or friend. Figure 42 shows almost 30% of respon- dents indicated they did provide this type of assistance. T able 12 shows most were providing care to a person 65 years or older.
FIGURE 42: PROVIDING REGULAR CARE TO A FAMIL Y MEMBER OR FRIEND (N=2,950)
29.53%
62.17%
8.31%
Do you provide assistance?
Yes No Prefer not to answer
TABLE 12: WHO IS PROVIDED ASSISTANCE?
Centers for Disease Control and Prevention (CDC) Health Equity Pilot Questions on T rauma and Discrimination
VCCHIC was one of seven participating sites in a national health equity pilot to identify gaps between what is currently being measured and what can be mea - sured while considering additional data collection methods for identifying root causes and key drivers of structural inequalities (Centers for Disease Control and Prevention, 2022). As a result of participation in this pilot, the following questions were integrated into the health assessment survey .
• In your day-to-day life, how often have any of the following things happened to you?
> Follow-up: What do you think is the main reason for these experiences? Y ou may select more than one option.
• Have you ever experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior in any of the following situations because of your race, ethnicity, or color?
Figure 43 shows that residents are most likely to experience being treated with less courtesy or respect than other people, people acting as if they are not smart, and receiving poorer service than other people at restaurants or stores. Residents indicated that they believe the main reason these experiences happen is because of their gender (30%), their ancestry or national origin (21.5%), and their race (13.4%); sexual orientation (0.2%) and religion (1.2%) were least likely to be selected as reasons for these experiences.
Primary Data Collection
43Ventura County Community Health Needs Assessment 2022 FIGURE 43: PEOPLE TREATING YOU DIFFERENTL Y? (N=2,545)
Figure 44 shows where residents are most likely to feel they have experienced discrimination based upon their race, ethnicity, or color. Residents indicated that they are most likely to experience discrimination on the street or in a public setting, getting service at a store or restaurant, at work and at school.
Residents who were more likely to indicate that they were experiencing discrimi - nation on the street or in a public setting included residents 25-34 years old (49%), residents with a household income between $70-79K (50%), residents identifying as gender non-binary, gender non-conforming (46%), residents of Black or African American race (57%).
Primary Data Collection
44Ventura County Community Health Needs Assessment 2022 FIGURE 44: DISCRIMINATION DUE TO RACE, ETHNICITY , OR COLOR? (N=2,537)
6.2 Focus Group Discussion Findings
One of the key objectives of this assessment was to engage the community, including socially marginalized populations, and other stakeholders to share their perceptions on the health needs for Ventura County residents. Throughout the month of February 2022, VCCHIC members facilitated more than fifteen focus groups. Focus group participants included persons from the black community, monolingual Hispanic or Latino Spanish speakers, older adults, LGBTQIA+ persons, students, and those accessing mental health and substance use treatment services among others. In collaboration with California State Channel Islands University and Pacifica High Primary Data Collection
School in Oxnard, CA, VCCHIC was also able to receive input from local high school and college students about the issues impacting them.
Figures 45 and 46 outline the key themes from the Community and Stakeholder Focus Groups. Similar to the primary data collected through the survey, focus group participants were concerned with mental health across the lifespan, access to healthcare and substance use issues. Additional impacts exacerbated by the COVID-19 pandemic included social isolation, learning loss, cultural issues, and challenges in the household environments. Quotes from focus group discussions can be found in Section 10 in the corresponding prioritized health need. 45Ventura County Community Health Needs Assessment 2022 FIGURE 45: KEY THEMES FROM COMMUNITY AND STAKEHOLDER FOCUS GROUPS FIGURE 46: KEY THEMES FROM FOCUS GROUPS – PACIFICA HIGH SCHOOL AND CALIFORNIA STATE
CHANNEL ISLANDS STUDENT
Primary Data Collection
46Ventura County Community Health Needs Assessment 2022 Secondary data used in this assessment consisted of community health indicators, while primary data consisted of focus group discussions, and a community survey .
Findings from these data sources as well as from Life Expectancy and Y ears of Life Lost analysis were combined to identify the significant health needs for Ventura County . 7 .1 Criteria for Significant Health Needs
Health needs were determined to be significant if they met certain criteria in at least one of the three data sources: included in the top ten highest scoring health needs based on secondary data analysis, frequency by which the topic was discussed within/across focus groups, identification as a priority issue by 25% or more of survey respondents and determined to be a significant health need based on Life Expectancy and Y ears of Life Lost analysis results. Figure 47 summarizes these criteria.
FIGURE 47: VISUAL OF DATA SYNTHESIS APPROACH
7 .2 Significant Health Needs
Based on the criteria shown in Figure 48, fifteen needs emerged as significant.
Figure 48 shows those significant health needs, listed in alphabetical order, that were included for prioritization based on the findings of all forms of data collected for VCCHIC CHNA.
FIGURE 48: SIGNIFICANT HEALTH NEEDS
Identification of Significant Health Needs
47Ventura County Community Health Needs Assessment 2022 T o gain a comprehensive understanding of the significant health needs, the findings from all four data sources were analyzed for areas of overlap.
8.1 Overlapping Evidence of Need
T able 13 outlines the 15 significant health needs (in alphabetical order) alongside the corresponding data sets that identified the need as significant. Secondary data identified nine needs as significant, focus group participants identified seven topic areas of greater need, the community survey identified 15 needs as significant and life expectancy analysis identified eight needs as significant.
TABLE 13: OVERLAPPING EVIDENCE OF NEED
Health/Quality of Life Category Data Source(s)
Access to Health Care Secondary Data, Community Survey, Focus Groups Adolescent Health Secondary Data, Community Survey, Focus Groups Alcohol & Drug Use Secondary Data, Community Survey, Focus Groups Cancers Community Survey, Life Expectancy
COVID-19 Community Survey, Life Expectancy
Diabetes Community Survey, Life Expectancy
Education Community Survey, Focus Groups
Heart Disease & Stroke Secondary Data, Community Survey, Life Expectancy Mental Health Community Survey, Focus Groups, Life Expectancy Nutrition and Healthy Eating Secondary Data, Community Survey Older Adults Secondary Data, Community Survey, Focus Groups, Life Expectancy
Physical Activity Secondary Data, Community Survey
Prevention & Safety Secondary Data, Community Survey, Focus Groups, Life Expectancy
Weight Status Secondary Data, Community Survey
Respiratory Diseases Community Survey, Life Expectancy
8.2 Venn Diagram
The Venn Diagram in Figure 49 demonstrates the overlay of data from secondary, primary (focus groups and community survey) and life expectancy sources to define the prioritized health needs.
FIGURE 49. DATA SYNTHESIS RESULTS
Data Synthesis
48Ventura County Community Health Needs Assessment 2022 VCCHIC convened a meeting of collaborative founding members to participate in a presentation of data facilitated by HCI to target activities that address pressing health needs. An additional meeting was convened to allow participants to com - plete an online scoring survey . Participants ranked each health need based on a set of criteria. The process was conducted virtually to maintain social distancing and safety guidelines related to the COVID-19 pandemic.
After reviewing the scoring results and supporting evidence the founding members identified three priority areas to be considered for subsequent implementation planning. Figure 50 illustrates how prioritization exercise participants use their knowledge and subject matter experience in light of prioritization criteria to pri - oritize the significant health needs identified during the data synthesis process.
FIGURE 50: CONSIDERATIONS FOR PRIORITIZATION
9.1 Process
VCCHIC founding members attended a secondary and primary data presentation and virtual prioritization activity on April 19 and 26 of 2022. There was a total of 14 individuals representing local hospital systems, the health department, communi- ty-based organizations, and nonprofits.
During the April 19th meeting, the group reviewed and discussed the results of HCI’s primary and secondary data as well as life expectancy and years of life lost analyses. Synthesis of these data lead to the significant health needs introduced to the group. In the April 26th meeting, the group revisited the significant health needs with a robust discussion and determined to roll all but two of them into seven over- arching health topics. COVID-19 and Respiratory Diseases were the non-prioritized health topics for the 2022 community health assessment. The group determined that COVID-19 would be described in its own dedicated section. Further, the group determined that Respiratory Diseases had so few areas of overlap between the four analyses conducted and limited ability to combine with another significant health need as to warrant elimination.
Following the discussion, participants were provided with a survey link to assign a score to each health topic based on the prioritization criteria. The group agreed that root causes, disparities, and social determinants of health would be considered for all prioritized health topics resulting from the online prioritization activity .
The criteria for prioritization included:
1. Magnitude of the Issue
a. How many people in the community are or will be impacted? b. How does the identified need impact health and quality of life? c. Has the need changed over time?
2. Ability to Impact
a. Can actionable and measurable goals be defined to address the health need? Are those goals achievable in a reasonable time frame? b. Do collaborative partners have the expertise or resources to address the identified health need?
c. Can the need be addressed in collaboration with community partners? Are organizations already addressing the health issue?
Participants assigned a score of 1-3 to each health topic and criterion, with a higher score indicating a greater likelihood for that topic to be prioritized. For example, participants assigned a score of 1-3 to each topic based on whether the magnitude was (1) least concerning, (2) somewhat concerning or (3) most concerning. Along a similar line, participants assigned a score of 1-3 to each topic based on (1) least ability to impact (2) some ability to impact or (3) most ability to impact. In addition to considering the data presented by HCI in the presentation and on the prioritization cheat sheet, participants were encouraged to use their Prioritization
49Ventura County Community Health Needs Assessment 2022 own judgment and knowledge of the community in considering how well a health topic met the criteria.
Completion of the online exercise resulted in a numerical score for each health topic and criterion. Numerical scores for the two criteria were equally weighted and averaged to produce an aggregate score and overall ranking for each health topic. The aggregate ranking can be seen in Figure 51 below. For those topics with identical scores, the health needs are listed in alphabetical order.
FIGURE 51: AGGREGATE RESULTS OF ONLINE PRIORITIZATION ACTIVITY 28 30
31 31
31.5 32
33 24 26 28 30 32 34
Substance Use
Health and Wellness for Older Adults
Adverse C hildhoo d Experiences (Su bstance Use, Adolescent H ealth , E d ucati on , H o us in g Over cr ow di ng)
Mental Hea lth
Healthy Lifestyle and Prevention (Nutrition and Healthy Eati ng, Physical Activity , Weight Status)
Preventio n of C hronic Co ndition s (C an cers, Diab etes, Heart Disease & Stroke)
Equitable Access to Health Services
Overall Health Topics Ranking (N=13)
On May 3, 2022 VCCHIC founding members convened a final working group ses- sion to review the aggregate results for the online prioritization activity . After some discussion, they further combined significant health needs into three prioritized health topics for subsequent implementation planning by VCCHIC partners. These three health priorities are:
• Addressing Mental Health and Substance Abuse Across the Lifespan • Prevention of Chronic Conditions by Promoting Healthy Lifestyles • Advancing Equitable Access to Healthcare
Figure 52 shows the sub-topics included in each of the three prioritized health needs and their relationships with associated topics. Addressing Mental Health and Substance Use Across the Lifespan, for example, has two subtopics — Adverse Childhood Experiences, which includes Adolescent Health, Substance Use, Housing Overcrowding and Education; and Health and Wellness for Older Adults. Similarly, Prevention of Chronic Conditions by Promoting Healthy Lifestyles includes chronic disease related sub-topics like Diabetes, Cancer, Weight Status, Physical Activity, Heart Disease and Stroke and Nutrition and Healthy Eating. Advancing Equitable Access to Healthcare stands alone as a topic without associated subtopics FIGURE 52: PRIORITIZED SIGNIFICANT HEALTH NEEDS
Many of the selected health needs are consistent with the priority areas that emerged from the previous CHNA process. VCCHIC plans to build upon efforts that emerged from its previous CHNA process, collaborating with other facilities and community partners, to address the three priority health needs.
A deeper dive into the primary and secondary data for each of these priority health topics is provided in the next section of the report. This information highlights how each topic became a high priority health need for the Ventura County Community Improvement Health Collaborative.
Prioritization
50Ventura County Community Health Needs Assessment 2022 The following section provides a detailed description of each prioritized health need.
An overview is provided for each health topic, followed by a table highlighting the poorest performing indicators and a description of key themes that emerged from primary data. The three prioritized health needs are presented in alphabetical order.
10.1 Addressing Mental Health and Substance Abuse Across the Lifespan
Overview
Mental Health and Substance Use Across the Lifespan consists of two related sub- topics: Adverse Childhood Experiences and Health and Wellness for Older Adults.
The founding members of VCCHIC determined that based on their collective expe- rience in mental health supported by extensive research and hospital-based care in the community, that four of the identified significant health needs were directly and indelibly impacted by childhood trauma. The group posited that by developing upstream implementation strategies targeted at addressing childhood experiences they could have a downstream impact on Substance Abuse, Adolescent Health, Education and some Housing issues (The Center on the Developing Child, 2022).
Mental Health
Secondary Data
From the secondary data scoring results, Mental Health & Mental Disorders scored low, with a score of 1.26. Further analysis was done to identify specific indicators of concern. Those indicators with high data scores (scoring at or above the threshold of 1.70) were categorized as indicators of concern and are listed in T able 14 below.
See Appendix B for the full list of indicators categorized within this topic, including the source from which each indicator was derived.
TABLE 14. DATA SCORING RESULTS FOR MENTAL HEALTH AND MENTAL DISORDERS * For more updated hospitalization rates, please see Section 4.6 From the secondary data results, there are several indicators within this topic that raise concern for Ventura County . The worst performing indicators are Alzheimer’s Disease or Dementia in the Medicare Population and Depression in the Medicare Population. These indicators measure the percentage of adults in the Medicare population that have been diagnosed with Alzheimer’s or Dementia or Depression, respectively . Ventura County’s values of 10.3% and 17 .2% rank within the worst quartile for all California Counties. Further, Depression within the Medicare Pop- ulation has increased significantly over recent years. The percent of Adults with Likely Serious Psychological Distress in Ventura County is higher than the state (11.4% vs. 12.6%, respectively) and has been increasing significantly over time.
Prioritized Significant Health Needs
Prioritized Significant Health Needs
51Ventura County Community Health Needs Assessment 2022 Primary Data
Mental health problems (trauma, depression, bipolar) were ranked the most im - portant health problem for both the general (74%) and student (82%) populations.
Additionally, Suicide was the most important health problem for just under a third (32%) of students surveyed. Mental health issues across the lifespan—for children, adolescents, adults, and older adults—were discussed extensively among focus group participants. Student focus groups further mentioned a loss or a change in social skills due to pandemic-related isolation, while community and stakeholder focus groups focused on the social isolation of homebound older adults who avoided social situations for fear they might result in contracting COVID-19.
Life Expectancy
Suicide ranked the seventh Leading Cause of Premature Death for males in the 2019-2021 period and ninth overall for Ventura County (T able 8). Suicide also ranked the sixth Leading Cause of Premature Death for White (Non-Hispanics) (T able 9) with Whites leading all other race or ethnic groups in the Age-Adjusted YLL with 534.6 years lost. Males outpace females in Age-Adjusted YLL with 617 .3 years lost (Figure 33).
Adverse Childhood Experiences
As shown through survey and focus group data described in previous sections, Ventura County residents have experienced increased stress about their finances, housing situation, and employment. Further, residents have been concerned about their overall mental and physical health, and in some cases, increased their use of harmful substances during the pandemic.
This type of stress in a family environment can lead to abuse and neglect but even witnessing parental conflict, mental illness, or substance abuse as a child can have negative long-term impacts on learning, behavior, and health. Adverse childhood experiences (ACEs) can create toxic levels of stress that may affect brain development and lead to increased risk for smoking, alcoholism, depression, heart disease, and other health issues (Adverse Childhood Experiences, 2022). During the COVID-19 pandemic, a study of college-aged adults found that a higher level of ACEs was associated with higher levels of depression in adults but that having a stable caregiver, stable home routine, etc. as a child was associated with lower levels of depression (Doom, 2021).
T able 15 shows the percentage of adults with and without Adverse Childhood Expe- riences (ACEs) before age 18, by presence of children in the household and number of ACEs. Among Ventura County adults ages 18 and older living in households with children in 2011-2017, 18% were exposed to four or more ACEs which puts them at higher risk of exposing their own children to ACEs.
TABLE 15: PREVALENCE OF ADVERSE CHILDHOOD EXPERIENCES (ADULT RETROSPECTIVE): 2011-2017 Ventura County Percent
Number of ACEs Households
with Children
Households
without Children
All Households
1–3 ACEs 47% 46% 46%
4 or more ACEs 18% 15% 17%
Data Source: As cited on kidsdata.org, UC Davis Violence Prevention Research Program, tabulation of data from the California Behavioral Risk Factor Surveillance System and American Community Survey (Apr. 2020).
Prioritized Significant Health Needs
52Ventura County Community Health Needs Assessment 2022 Substance Abuse (Alcohol & Drug Use)
Secondary Data
From the secondary data scoring results, Substance Use had the highest data score of all topic areas, with a score of 1.71. Further analysis was done to identify specific indicators of concern. Those indicators with high data scores (scoring at or above the threshold of 1.70) were categorized as indicators of concern and are listed in T able 16 below. See Appendix B for the full list of indicators categorized within this topic, including the source from which each indicator was derived.
TABLE 16. DATA SCORING RESULTS FOR ALCOHOL & DRUG USE
From the secondary data results, there are several indicators within this topic that are cause for concern. The worst performing indicator is Alcohol-Impaired Driving Deaths, which measures the percentage of motor vehicle crash deaths with alcohol involvement. The value for Ventura County, 35%, is higher than the state value (28.7%) and the U.S. Value (27%). Further, the county has not met the Healthy People 2030 target of 28.3%. Age-adjusted death rates due to all opioid overdose (17 .1) per 100,000 residents is higher than the state rate (13.5). Most indicators of concern within this topic area have seen statistically significant increases over time; Alcohol Impaired Driving Deaths and Liquor Store Density are exceptions, with Ventura County seeing a non-statistically significant decrease in these indi - cator values over time.
Primary Data
Alcohol & Drug Use were
ranked the top risky be -
haviors by both general
and student survey respon-
dents, with 79% of student
respondents identifying
Alcohol Use as the most important risky behavior in the community . Additionally, 36% of general respondents and 31% of student respondents declared prescription drug use an important risky behavior. Substance use was mentioned in multiple focus group discussions throughout the county . One focus group mentioned that substance use had seemed to increase, and that normalization of use was notably higher. Other focus group members indicated that alcohol and drug use could be seen in increasingly younger children, particularly girls, and that peer pressure created an enticement toward substance use. They further noted that creating an open dialogue on campuses about the associated risks of substance use could help address the problem.
53Ventura County Community Health Needs Assessment 2022 Adolescent Health
Secondary Data
From the secondary data scoring results, Adolescent Health had the fourth highest data score of all topic areas, with a score of 1.55. Further analysis was done to identify specific indicators of concern. Those indicators with high data scores (scoring at or above the threshold of 1.70) were categorized as indicators of concern and are listed in T able 17 below. See Appendix B for the full list of indicators categorized within this topic, including the source from which each indicator was derived.
TABLE 17 . DATA SCORING RESULTS FOR ADOLESCENT HEALTH
Prioritized Significant Health Needs
From the secondary data results, there are several indicators within this topic that raise concern for Ventura County . The worst performing indicator is Children and T eens Who Engage in Regular Physical Activity, which measures the percentage of physically active people aged 0-18 in the community . The value for Ventura County,
11.2%, is lower than the state value (16.5%). Understandably, the percentage of teens that are Overweight or Obese (67 .2%) is nearly double the California State Value (38.2%). 7th Grade Students who are Physically Fit has decreased, although non-significantly, over time while 9th Grade Students Who are at a Healthy Weight or Underweight has increased non-significantly over the same period of time.
Primary Data
Community feedback from the survey showed that more than half (56%) of respon- dents ranked poor eating habits and being overweight or obese (51%) as important risky behaviors and were voted as the top #3 and #4 ranked risk behaviors overall.
Alcohol and drug use are also areas of grave concern related to adolescent health with focus group respondents indicating increasingly earlier use of alcohol and drugs among children and teens.
The direct impacts of the COVID-19 pandemic on the adolescent population are difficult to ascertain. Thirty-eight percent of general community survey respondents reported that their child or children’s mental health was worse after COVID-19 than before while 14% reported it was better. Focus groups comprised of adolescents centered around the challenges of virtual learning, and expectations to develop adult-level time man- agement skills in order to maintain academic standards. Students found it difficult to get help from educators who pre-recorded class sessions or felt too embarrassed to ask questions during live sessions. One focus group participant described the juxta- position between the dramatically more lenient and permissive attitudes of educators in the virtual school environment and those expectations once students returned to in-person learning. Further, adolescent focus group members shared that social isolation, increased responsibilities at home to care for younger siblings, and toxic household environments put pressure on already existing mental health challenges.
Prioritized Significant Health Needs
54Ventura County Community Health Needs Assessment 2022 Education
Primary Data
Although the data score for education in Ventura County (1.21) failed to reach the 1.5 threshold required for elevation as a significant health need through the secondary data analysis, it is worth noting that in Ventura County there are 23.7 students per teacher while the national ratio is 16.3. Further, high-school graduation rates in the 2020-2021 period in Ventura County (83.3%) fell below Healthy People 2030 goals (90.7%). Focus group members pointed to learning loss during the pandemic as a key issue. T wenty-five percent of student community survey respondents voted lack of free early childhood education for families in need as an issue they would most like to see addressed in the community .
Lack of health resources education came up in both focus group discussions and community survey results. Thirty-one percent of survey respondents indicated the issue they would most like to see addressed in the community was information on how to make correct health decisions. A lack of knowledge of available resources related to addressing health needs was also a topic of conversation in focus groups.
Housing
Primary Data
Affordable housing ranked among Ventura County residents surveyed as the sec- ond most important attribute of a healthy community followed immediately by low crime/safe neighborhoods. Further, approximately half of residents surveyed indicated that poor housing conditions or lack of housing were the issue they would most like to see addressed in the community .
Prioritized Significant Health Needs
55Ventura County Community Health Needs Assessment 2022 Health and Wellness for Older Adults
Secondary Data
Older adult health and wellness is threatened by chronic diseases and an associated lack of healthy behaviors exacerbated by mental health challenges. Older adults in the county have a higher rate of Rheumatoid Arthritis or Osteoarthritis (34.5%) in the Medicare population as compared with the state rate (31.2%). In the same population, rates of Asthma (6%), Atrial Fibrillation (8.4%), Hyperlipidemia (48.5%), Hypertension (55.4%) and Stroke (3.9%) are all higher in Ventura County than in the state of California.
The Older Adult population in Ventura County falls behind the state values and short of Healthy People 2030 objectives relating to some healthy behaviors, par - ticularly preventative care. Data shows that only 64.8% of Adults 65+ in Ventura County have received an influenza vaccine as compared with 69.3% in the state.
Men 65+ in Ventura have a lower rate of receiving preventative services (30.1%) as compared with their national counterparts (32.4%) while women in Ventura County (36%) considerably outpace other women in the nation in receiving recommended preventative services (28.4%). Colon cancer screenings (67 .2%), though marginally better than national rates (66.4%) still fall short of HP 2030 goals (74.4%).
Mental health related indicators also show cause for concern in older adults in Ventura County . Although Alzheimer’s Disease and Dementia in the Medicare pop- ulation in Ventura (10.3%) are comparable to state (10.5%) and national (10.8%) rates, depression in Ventura (17 .2%) is a full percentage point higher than in the state (16.2%). The isolation of people 65+ described in focus group discussions as well as the community survey may provide a partial explanation for the mental health disorders demonstrated in the secondary data. In the most recent (2016- 2020) American Communities Survey (ACS) data 28,318 people 65+ (21.5% of the population) were counted as living alone while 9,961 (7 .7%) live below the poverty line. The latter rate is significantly lower than the state (10.3%) and national (9.3%) poverty rates for people over 65 years old.
TABLE 18. DATA SCORING RESULTS FOR OLDER ADULTS
Prioritized Significant Health Needs
56Ventura County Community Health Needs Assessment 2022 Primary Data
Forty-one percent of general community survey respondents voted aging com - plications like dementia, falls and social isolation to be the most important health problems in the community . Just under 30% of those surveyed in the community provide regular care to a family member or friend. More than half of those, provide care to an older adult. Nearly 30% care for an older adult with a disability and just under 15% care for an older adult with dementia. Community and stakeholder fo- cus group participants noted social isolation as a fundamental issue among older adults in Ventura County .
10.2 Prevention of Chronic Conditions by Promoting Healthy Lifestyles
Overview
Prevention of Chronic Conditions by Promoting Healthy Lifestyles consists of six related health sub-topics: Cancer; Diabetes; Heart Disease & Stroke; Nutrition & Healthy Eating; Physical Activity; and Weight Status. Cancer and Diabetes were identified as significant health needs in both the community survey and life expec- tancy analysis. Heart Disease & Stroke was identified as a significant health need in secondary data, the community survey as well as the life expectancy analysis while Nutrition & Healthy Eating, Physical Activity and Weight Status were each identified by secondary data and the Community Survey results (see Data Synthesis, T able X and Figure X).
Cancer
Secondary Data
Though secondary data scoring for cancer (1.33) in Ventura County fell short of the
1.5 threshold, a few indicators are worthy of attention. Prostate Cancer Incidence per 100,000 males is higher in Ventura County (103.4) than California (92.3). Oral Cavity and Pharynx Cancer Incidence follows a similar trend while the Age-Adjusted Death Rate due to Colorectal Cancer per 100,000 population in Ventura County (13.1) is both higher than the state rate (12.2) and falls dramatically short of the HP 2030 goals (8.9). Finally, the Breast Cancer Incidence Rate per 100,000 females is higher in Ventura County (129. 2) than both the state (121.8) and national (126.8) rates.
Primary Data
In both the general and student populations, nearly half of survey respondents indicated cancers to be the most important health problem in the community .
Approximately 40% of both general and student populations voted environmental exposures like pesticides and smoke as a problem they would like to see addressed in the community .
Life Expectancy
All Cancers in Ventura County follow both state and national trends, ranking second as a leading cause of death and the leading cause of premature death in the 2019- 2021 time-period (T able 6). Encouragingly, the All-Cause Age-Adjusted Death Rate for All Cancers (T able 7) has significantly decreased in 2019-2021 (125.2) over the previous period (142.1).
Prioritized Significant Health Needs
57Ventura County Community Health Needs Assessment 2022 Diabetes
Primary Data
The community survey showed similar trends between general and student re - spondents concerning diabetes and related health behaviors. Approximately 40% of survey respondents in both groups ranked diabetes the most important health problem in the community . Similarly, poor eating habits was declared the most important risky behavior in the community by 47% of general survey respondents and 56% of students surveyed. Lack of exercise came to the top for 36% of respon- dents in both groups. Lack of sufficient food or healthy food options was what 32% of general and 46% of student survey respondents wanted most to see addressed in the community . Nearly one-third of the general survey respondents wanted to see a lack of safe places to exercise (walk, ride a bike or ride a horse) addressed.
Life Expectancy
Though the Age-Adjusted Death Rate has not seen a statistically significant increase in 2019-2021 (21.8) over the previous period (19.6) (T able 7), diabetes rose in the rankings to be the ninth Leading Cause of Premature Death in Ventura County during the 2019-2021 time period (T able 6). Further, the Age-Adjusted YLL Rate Per 100,000 population for Diabetes is 442.3 years (Figure 26). Diabetes is the eighth Leading Cause of Premature Death overall for Ventura County (T able 8), the sixth Leading Cause of Premature Death for both Asian and Hispanic/Latino populations and eighth for Black or African American populations (T able 9).
Heart Disease & Stroke
Secondary Data
Results of the secondary data analysis show several warning indicators of interest including the Age-Adjusted Death Rate due to Stroke earning the top score (2.21) with 39 deaths per 100,000 population. The rate is higher than both the California (36.9) and U.S. (37 .3) and falls well above the HP 2030 goal (33.4). Percentages of the Medicare population who have been diagnosed with Atrial Fibrillation (8.4%) and Hyperlipidemia (48.5%) in Ventura County are among the worst in the state and these percentages have been increasing significantly over time.
Prioritized Significant Health Needs
58Ventura County Community Health Needs Assessment 2022 TABLE 19. DATA SCORING RESULTS FOR HEART DISEASE & STROKE Primary Data
Approximately a third of all survey respondents voted heart disease and stroke the most important health problem in the community . High blood pressure was voted most important by a quarter of all respondents. Health behaviors like lack of exercise (36%) and being overweight or obese (59%) were viewed by the general population as the most important risk behaviors in the community . Similarly, lack of sufficient or healthy food options (32%) and safe places to exercise (30%) were issues respondents wanted most to see addressed in the community .
Life Expectancy
Diseases of the Heart earned the top ranking in analysis of Leading Causes of Death (T able 6) and second Leading Cause of Premature Death for the 2019-2021 time period (T able 8). Though a few seats lower, Stroke made the top ten list ranking as the sixth Leading Cause of Death (T able 6) and seventh Leading Cause of Premature Death (T able 8) in the 2019-2021 period.
Nutrition & Healthy Eating
Secondary Data
Secondary data results for Ventura County related to Nutrition and Healthy Eating demonstrate some concerning trends. Adults who consume sugary drinks in Ventura (14.1%) is higher than the state (11%) while Child and T een Fruit Consumption is lower at the county level (63.1%) than the state (64.3%) level.
TABLE 20. DATA SCORING RESULTS FOR NUTRITION &HEALTHY EATING Primary Data
Health behaviors and lifestyles was a key defining feature of a healthy community for 38% of general survey respondents and more than half (52%) of students sur - veyed. Consistent with this focus, approximately half of all general Ventura County residents (47%) surveyed and 56% of students voted poor eating habits the most important risky health behavior in the community . Access to community organiza- tions that provide food security to families (food banks) was an important feature of a healthy community for 43% of general survey respondents and 58% of students.
Prioritized Significant Health Needs
59Ventura County Community Health Needs Assessment 2022 Physical Activity
Secondary Data
A total of ten warning indicators (indicators with a score of 1.5 or above) related to physical activity resulted from secondary data analysis. The highest scoring indicators and associated trends are shown in T able 21. The Percent of Workers who Walk to Work is lower in Ventura County (1.6) than in either the state (2.5) or the U.S. (2.6) and percentages have decreased significantly over time. Children and T eens who Engage in Regular Physical Activity in Ventura County (11.6%) is also dramatically lower than the state rate (16.5%). The percentage of 7th Grade Students who are Physically Fit (64.4%) is higher than the state (61%) but has decreased non-significantly over time.
TABLE 21. DATA SCORING RESULTS FOR PHYSICAL ACTIVITY
Primary Data
Physical activity and safe places to exercise was a recurrent theme throughout community survey responses. Ventura County residents surveyed ranked healthy behaviors and lifestyles a key feature of a healthy community in both the general (38%) and student (52%) populations. Parks and recreation areas were important as a defining feature of a healthy community to more than a quarter of residents surveyed. While being overweight/obese (59%) and lack of exercise (36%) were among the most important risky behaviors in the community, 30% of residents wanted to see the lack of safe places to exercise addressed through the community health needs assessment.
Prioritized Significant Health Needs
60Ventura County Community Health Needs Assessment 2022 Weight Status
Secondary Data
Secondary data results related to weight status for teens in Ventura County is of notable concern with 67 .2% of teens who are overweight or obese as compared with the state rate of 38.2%. This percentage is ranked among the worst compared to other California counties. The percentages of 9th Grade Students (64.1%) and fifth Grade Students (59.2%) who are at a Healthy Weight or Underweight in Ventura County are slightly higher than those for the state (62.2% and 58.7%, respectively).
However, these indicators have seen a non-significant increase over recent time periods.
TABLE 22. DATA SCORING RESULTS FOR WEIGHT STATUS
Primary Data
Physical Activity and Nutrition and Healthy Eating, described in independent sections, relate closely with weight status in the qualitative data collected through the community survey . As also described in those sections, healthy behaviors and lifestyles was a top definition of a healthy community for 38% of the general popu- lation and 52% of students. In isolation, weight status or obesity scored high with Ventura County residents as the most important risky behavior in the community for the general population (59%) as well as students (51%).
Prioritized Significant Health Needs
61Ventura County Community Health Needs Assessment 2022
10.3 Advancing Equitable Access to Healthcare
Overview
Advancing Equitable Access to Healthcare was identified as a significant health need through three data sources, the community survey, focus groups and secondary data (see Data Synthesis, T able 13 and Figure 49).
Secondary Data
Historical challenges related to healthcare access and quality continue to demon- strate in secondary data analysis results as warning indicators. Adults (ages 18-64) with Health Insurance in Ventura County (86.6%) falls below state values (89.8%).
Perhaps associated to the lack of health insurance coverage is the low rate of adults who have had a Routine Check-up (68.4%) as compared to the U.S. rate (76.6%).
Further, adults who delayed receiving care or had difficulty in obtaining care was higher in Ventura County (24.3%) than in California (19.6%). Of further concern, the Non-Physician Primary Care Provider Rate in Ventura County (45.9 provid - ers/100,000 pop) is much lower than the state average (67 .5 providers/100,000 pop), although Ventura County has seen a significant increase in this rate over recent years.
TABLE 23. DATA SCORING RESULTS FOR ACCESS TO HEALTHCARE Primary Data
Access to healthcare was top of mind for community respondents with 76% of the general population and 89% of students ranking it the top attribute of a healthy community . Access to organizations that provide community services (58%) and transportation (36%) were more of a defining characteristic of a healthy community for students than general residents. Both groups, however, determined healthcare costs (insurance, copays and prescriptions) to be the top health concern they would most like to see addressed in the community . Finally, almost one-third of students voted lack of information to make correct health decisions the issue they would most like to see addressed in the community .
62Ventura County Community Health Needs Assessment 2022 Introduction
At the time that VCCHIC began its collaborative CHNA process, Ventura County and the state of California were in a period of the novel coronavirus (COVID-19) pandemic that is hoped to be in its final phases. The process for conducting the assessment remained fundamentally the same as that conducted in 2019 with the exception of some adjustments made during the primary data collection to ensure the health and safety of those participating.
Pandemic Overview
On March 13, 2020, a U.S. national emergency was declared over the novel coro- navirus outbreak first reported in the Wuhan Province of China in December 2019.
Officially named COVID-19 by the World Health Organization (WHO) in February, WHO declared COVID-19 a pandemic on March 11, 2020. Later that month, stay- at-home orders were placed by the California Governor and unemployment rates soared as companies were impacted and began mass layoffs.
COVID-19 Cases and Deaths in Ventura County
The COVID-19 pandemic impacts to communities with less favorable societal and living conditions has highlighted many of the existing health inequities within Ventura County . The State of California, as part of the California for All plan, and its commitment to health equity, identifies the most disproportionately impacted communities through the Healthy Places Index. The Healthy Places Index (HPI) maps data on health-related social conditions, and are divided into quartiles, with Quartile 1 (HPI 1) having less healthy conditions, and Quartile 4 having more healthy conditions. Figure 53 shows the positivity rates for COVID-19 in Ventura County across the various HPI groups. Unfortunately, HPI quartile 1 (having less healthy conditions) throughout the pandemic had the highest positivity rates. It is also important to note that during our largest surges (January 2021 and January 2022), the positivity rates for HPI 1 were considerably higher than the other quartiles.
FIGURE 53: 30 DAY COVID POSITIVITY RATES ACROSS HEALTHY PLACES INDEX GROUPS Source: Ventura County Public Health Communicable Disease Program In addition to positivity rates being disproportionately higher among HPI 1, deaths are significantly higher as well, as shown in Figure 2. The mortality rate (per 100k) is nearly double for HPI 1, compared to HPI 4, with HPI 4 having the healthiest condi- tions. Both the positivity rate and the mortality rates for HPI 1 can be attributed to factors such as access to healthcare. Individuals who have access to a primary care physician on a regular basis will likely have common comorbidity conditions as it relates to COVID-19 deaths under control, such as T ype II diabetes, and obesity . In addition to access to healthcare, transportation plays a crucial role in healthy com- munities as well. Those who rely on public transportation will have a more difficult time seeking care the medical facility is too far, or if the hours of public transportation make it an inconvenience to go see a doctor. Many individuals who are a part of the lower HPI quartiles also may not have benefits such as sick leave, or paid leave, that will allow them to stay home and rest of they are not feeling well, or able to go see a doctor, without the risk of a reduced paycheck. These conditions not only pose a higher risk of infection of COVID-19, but lead to COVID-19 related deaths as well.
COVID-19 Impacts Snapshot
COVID-19 Impacts Snapshot
63Ventura County Community Health Needs Assessment 2022 FIGURE 54: VENTURA COUNTY COVID-19 DEATH RATE PER 100K
Source: Ventura County Public Health Communicable Disease Program COVID-19 rates by age group showed that the 25-34 age group had the highest rate of COVID-19 followed by the 15-24 age group. The 75-84 age group had the lowest rate. Figure 55 depicts COVID-19 case rates per 100K, by age group:
FIGURE 55: VENTURA COUNTY COVID-19 CASE RATE PER 100K BY AGE GROUP Source: Ventura County Public Health Communicable Disease Program COVID-19 was the fifth leading cause of death (T able 6) and of premature death (T able 8) in Ventura County for 2019-2021. For current cases and deaths due to COVID-19 visit the Ventura County Public Health website Health Matters in Ventura County (https://www.healthmattersinvc.org/), the California COVID-19 dashboard (https://covid19.ca.gov/) or the Ventura County Recovers website (https://www. venturacountyrecovers.org/).
Ventura County Unemployment Rates
Unemployment rates rose between March and April 2020 for Ventura County when stay-at-home orders were first announced. Illustrated in Figure 54 below, as counties began slowly reopening some businesses in late-2020, the unemployment rate gradually began to go down. As of late 2021, unemployment rates have stabilized but still exceed pre-pandemic rates. When unemployment rates rise, there is a potential impact on health insurance coverage and healthcare access if jobs are lost include employer-sponsored healthcare.
FIGURE 54: UNEMPLOYED WORKERS IN CIVILIAN LABOR FORCE, DEC 2019-OCT 2021
COVID-19 Impacts Snapshot
64Ventura County Community Health Needs Assessment 2022 Ventura County Vaccination Rates
Vaccinations were available to select groups of individuals starting in December 2020 and became more widely available to all adults in early 2021. Figure 55 shows the percent of persons eligible for the COVID-19 vaccinations who are fully vacci- nated by zip code. Despite availability of vaccinations, new cases, hospitalizations, and deaths continue to occur throughout Ventura County, California, the U.S., and worldwide. Upon completion of this report in June 2022, the pandemic was consid- ered a health crisis across the United States and in most countries.
FIGURE 55: PERSONS FULL Y VACCINATED AGAINST COVID-19 BY ZIP CODE Source: California Department of Public Health
Ventura County Community Feedback
In collaboration with Ventura County Behavioral Health, VCCHIC added several questions to the community survey to assess the impact of the pandemic on re - lationships, mental health, physical health, and sources of stress for residents in Ventura County . Figure 56 below shows how residents responded when asked about how they feel now compared to before COVID-19 regarding their children’s mental and physical health, employment/work, their finances, their housing, their overall mental and physical health, and their relationships with partners, family, and friends.
FIGURE 56: COMPARED TO BEFORE COVID-19, PLEASE TELL US HOW YOU FEEL TODAY ABOUT YOUR… (N=2,577)
COVID-19 Impacts Snapshot
65Ventura County Community Health Needs Assessment 2022 Mental Health and Stress
Survey respondents who indicated a decline in mental health since the onset of the COVID-19 pandemic included residents 18-24 years old (43%), residents with a household income between $100-149K (48%), residents identifying as gender non-binary, gender non-conforming or another gender category (50%), residents of Asian race (45%). Six percent of respondents indicated they had suicidal thoughts and of those, 9% had made a suicide attempt. Unfortunately, only 39% of those respondents that had attempted suicide sought medical attention afterwards which indicates that most individuals may not be receiving necessary prevention resources to ensure that another attempt is not made.
Figure 57 shows how residents responded when asked about their consumption of substances including marijuana, alcohol, drugs, prescription drugs, and other tobacco related products including vaping. Since the onset of the COVID-19 pan- demic residents were more likely to have an increased consumption of alcohol, marijuana, and tobacco products or misuse prescription medication Residents who indicated increased consumption of alcohol included residents 45- 54 years old (18%), residents with a household income of $150K or more (23%), residents identifying as gender non-binary, gender non-conforming (19%), residents of Black or African American race (24%).
FIGURE 57: COMPARED TO BEFORE COVID-19, PLEASE TELL US HOW MUCH MORE OR LESS YOU CONSUME… (N=2,576)
Figure 58 shows survey respondents’ level of stress in relation to children’s mental and physical health, employment/work, their finances, housing, mental and physical health, and relationships with partners, family, and friends. Residents were more likely to experience high levels of stress related to their employment/work, overall mental health, and financial situation.
Residents who indicated high stress levels related to their employment/work in - cluded residents 35-44 years old (26%), residents with a household income between $90-99K (28%), residents identifying as gender non-binary, gender non-conforming (42%), residents of Black or African American race (41%).
FIGURE 58: PLEASE TELL US HOW MUCH STRESS YOU HAVE RELATED TO YOUR… (N=2,528)
66Ventura County Community Health Needs Assessment 2022 Mental Health and Health Care Access
Residents were asked whether or not they or a close family member were able to access needed mental health or other health care services in the last 12 months.
Figures 59 and 60 show that 50% of residents needed mental health services and 47% of residents needed other health care services; 46% of residents who needed both mental health and other health care services were not able to access them during the pandemic.
The most common reasons for not accessing needed mental health and other health care services were:
Mental Health Services
• Cost – too expensive/can’t pay
• Limited access or was closed due to COVID-19
• Did not feel cared for, respected, or understood
Other Health Services
• Limited access or was closed due to COVID-19
• Cost – too expensive/can’t pay
• Timing of services was not convenient for me
FIGURE 59 AND 60: MENTAL HEALTH AND OTHER HEALTH CARE SERVICE AVAILABILITY IN PAST 12 MONTHS
COVID-19 Impacts Snapshot
67Ventura County Community Health Needs Assessment 2022 VCPH has partnered with 211 Ventura
County to connect residents to health in-
formation, social services, and referrals
through their comprehensive resource da-
tabase. This resource inventory is available
publicly to all constituents of VCCHIC and
their partners. The community resources
are searchable by topic area such as hous-
ing, food, income and expenses, trans -
portation, education or by target popu -
lation such a children and family, youth,
and seniors. Therefore, VCCHIC has made
a direct link to all of the resources avail -
able through 211 Ventura County on the
Health Matters in Ventura County website
and can be found at the url https://www.
healthmattersinvc.org/211resources. The
resource library will be updated regularly
as 211 Ventura County updates their da-
tabase. Links to the 211 Ventura County
social need topics can also be accessed
through Appendix D in this report.
Community Resources to Address Priority Health Issues
68Ventura County Community Health Needs Assessment 2022 The preceding community health needs
assessment (CHNA) describes barriers to
health faced by the community, throwing
into focus its priority health issues and
providing information necessary to all
levels of stakeholders to build upon each
other’s work in a coordinated, collabo -
rative manner. VCCHIC has established
clear priorities based on the results of this
community health assessment to improve
health outcomes for the residents of Ven-
tura County . Over the next year, VCCHIC
organizations will work together on the
development of strategies to address the
priorities outlined in the report. In col -
laboration with community stakeholders
and residents, VCCHIC hopes to realize its
vision of becoming the healthiest county
in the nation by 2030.
Conclusion
69Ventura County Community Health Needs Assessment 2022 Significant Health
Need Identified in
Preceding CHNA
Planned Activities to Address Health Needs
Identified in Preceding Implementation
Strategy
Was Activity
Implemented
(Y es/No)
Results, Impact & Data Sources
Improve Access to
Health Services
From 2019 to 2022, VCCHIC will build a
Community Information Exchange (CIE) which
can be adopted by participating hospitals and
other community-based organizations (CBO)
to increase intra- and inter-agency referrals and
tracking of high risk/high need clients.
Y es –
In Progress
VCCHIC started the CIE workgroup to begin working on this project in January 2020. Unfortunately, due to COVID-19, the work of the collaborative was put on hold to respond to the pandemic. In March 2021, Ventura County Public Health (founding member of VCCHIC) was able to secure $4.8M in start-up funding for this proj- ect. As a result, the planning process for the CIE quickly took hold. Outcomes for the project thus far include:
• Established a charter for the project signed off by founding and supporting members of the collaborative. • Established 15-member governance board including hospitals, FQHCs, public health, CBOs, social services agencies, and other providers in the community to oversee the planning for the CIE. • Contracted with Public Health Institute to oversee governance and planning activities. • Contracted with Interface/211 to engage CBOs and social services agencies from beginning to ensure their voice is included in planning.
• Contracted with technology consultant, Intrepid Ascent, to facilitate the process to develop the technologi- cal requirements for the request for proposals to develop the CIE technology infrastructure.
Address Social
Needs
From 2019 to 2022, VCCHIC will reduce food
insecurity by 2% from baseline (7 .6% to 7 .4% for
county and 15.4% to 15.1% of children in 2017)
by screening for food insecurity at provider
practices and hospitals to connect
high need/high risk clients to federal/state/
local food access programs and food resources
for their unmet needs.
No Pilot projects were started with Community Memorial Health System and Ventura County Health Care Agency Ambulatory Clinics to administer food insecurity screening in the clinical environments and make referrals to Ventura County Public to for enrollment in CalFRESH and/or WIC.
Unfortunately, the projects were suspended due to the COVID-19 pandemic because of the adoption of mostly telehealth appointments early in the pandemic.
APPENDIX A.
Ventura County’s Impact Report: Evaluation since Prior CHNA
70Ventura County Community Health Needs Assessment 2022 Improve Health
and Wellness for
Older Adults
From 2019-2022, VCCHIC will implement a
Community Based Care T ransition Program per
Section 3026 of the Affordable Care Act to sup-
port medically fragile 65+ year adults and their
caregivers after an acute care hospitalization to
reduce hospital re-admissions and improve the
provision of value-based services.
Y es —
In Progress
• 2 hospitals have implemented Caregiver Navigator Program and have dedicated professional staff dedicated to Caregivers. (Dignity, Community Memorial Health System) • 1 hospital (Simi Adventist) has an RN who follows up with Caregivers and provides some resources. • Between the two hospitals 318 Caregivers have been served impacting over 636 family members and 318 patients. (I am confirming exact numbers. CMHS has served 184 caregivers and Dignity has served 134 caregivers.
• Early data shows that depression and anxiety have decreased after meeting with a Navigator and resilience has been stable.
• VCCHIC member started a Caregiver Roundtable/Coalition and met to identify all caregiving issues in our county . We plan to meet quarterly and to continue identifying strategies to improving caregiving resources in our county .
• VCCHIC members helped spearhead a monthly series for Health and Wellness Seminars with VCAAA that can be accessed by Caregivers for free that address topics with experts including Legal Services, In-Home Care, Caregiver Resources, Long term Care Ombudsman, Alzheimer’s diseases, Neurological services and more.
• As of March 2022, we have a total of 141 baseline assessments and 37 post-assessments.
Participants are asked: In the past 6 months, how many times have you visited the: Emergency room (ER)? Inpatient Hospitalization?
Baseline — At the start of the Caregiver Post-Assessment — 6 Months later (n=141) (n=37)
Mean (Average) Minimum Maximum Mean (Average) Minimum Maximum Care Recipient
ER 0.37 0 2 0.06 0 2
Inpatient
Hospitalization 0.49 0 5 0.21 0 2
Caregiver
ER 0.22 0 5 0.06 0 1
Inpatient
Hospitalization 0.33 0 7 0.06 0 1
Significant Health
Need Identified in
Preceding CHNA
Planned Activities to Address Health Needs
Identified in Preceding Implementation
Strategy
Was Activity
Implemented
(Y es/No)
Results, Impact & Data Sources
Reduce the
Burden of Chronic
Disease
These prioritized health needs were not selected because VCCHIC has identified other community stakeholders that are currently leading interventions to address these health needs in the county, including Ventura County Behavioral Health. Further, the prioritized strategies that have been chosen are upstream strategies that target root causes of the poor health outcomes that affect vulnerable populations in the county such as food insecurity . These strategies need to be implemented county-wide through collaborative and collateral action and require all the partners to engage in extensive sharing of technology and data in a HIPAA compliant manner. Given the wide scope of the selected strategies, VCCHIC partnership will need to focus its resources and expertise on the selected priorities to demonstrate impact. That focus will require concerted efforts and time and leave VCCHIC with no resources to take on the remaining priorities in this iteration of the joint CHIS.
Reduce the Im-
pact of Behavioral
Health Issues
APPENDIX A.
Ventura County’s Impact Report: Evaluation since Prior CHNA 71Ventura County Community Health Needs Assessment 2022 T wo types of data were used in this assessment: primary and secondary data. Pri- mary data are data that have been collected for the purposes of this community assessment. Primary data were obtained through a community survey, focus groups and key informant interviews.
Secondary data are health indicator data that have already been collected by public sources such as government health departments. Each type of data was analyzed using a unique methodology . Findings were organized by health topics and then synthesized for a comprehensive overview of the health needs in the VCCHIC Service Area.
Secondary Data Sources
The main source for the secondary data, or data that have been previously collected, is the community indicator database maintained by Conduent Healthy Communities Institute. The following is a list of both local and national sources used in Ventura County’s Community Health Needs Assessment:
Ventura County
• American Community Survey
• American Lung Association
• California Department of Education
• California Department of Health Care Access and Information • California Department of Justice
• California Department of Public Health
• California Department of Public Health, Immunization Branch • California Department of Public Health, STD Control Branch • California Health Interview Survey
• California Health Interview Survey, Neighborhood Edition • California Healthy Kids Survey
• California Opioid Overdose Surveillance Dashboard
• California Secretary of State
• California State Highway Patrol
• CDC - PLACES
• Centers for Disease Control and Prevention
• Centers for Medicare & Medicaid Services
• Child Welfare Dynamic Report System
• Claritas Pop-Facts
• Claritas Consumer Profiles
• Controlled Substance Utilization Review and Evaluation System • County Health Rankings
• Feeding America
• Healthy Communities Institute
• Lucile Packard Foundation for Children’s Health
• National Cancer Institute
• National Center for Education Statistics
• National Environmental Public Health T racking Network • U.S. Bureau of Labor Statistics
• U.S. Census - County Business Patterns
• U.S. Department of Agriculture - Food Environment Atlas • U.S. Environmental Protection Agency
• United For ALICE
Secondary Data Sources & Analysis
Secondary data used for this assessment were collected and analyzed from HCI’s community indicator database. This database, maintained by researchers and analysts at HCI, includes over 241 community indicators from at least 32 state and national data sources. HCI carefully evaluates sources based on the following three criteria: the source has a validated methodology for data collection and analysis; the source has scheduled, regular publication of findings; and the source has data values for small geographic areas or populations.
Secondary Data Scoring
HCI’s Data Scoring T ool (Figure 70) was used to systematically summarize multiple comparisons in order to rank indicators based on highest need. For each indicator, the community value was compared to a distribution of California and US counties, state and national values, Healthy People 2030, and significant trends were noted.
These comparison scores range from 0-3, where 0 indicates the best outcome and 3 APPENDIX B.
SECONDARY DATA METHODOLOGY
72Ventura County Community Health Needs Assessment 2022 the worst. Availability of each type of comparison varies by indicator and is dependent upon the data source, comparability with data collected for other communities and changes in methodology over time. The comparison scores were summarized for each indicator, and indicators were then grouped into topic areas for a systematic ranking of community health needs. APPENDIX B. Secondary Data Methodology FIGURE 70: SUMMARY OF TOPIC SCORING ANAL YSIS
Index of Disparity
An important part of the CHNA process is to identify health disparities, the needs of vulnerable populations and unmet health needs or gaps in services. There were several ways in which subpopulation disparities were examined in the Ventura County Service Area. For secondary data health indicators, the Index of Disparity tool was utilized to see if there were large, negative, and concerning differences in indicator values between each subgroup data value and the overall county value.
The Index of Disparity was run for the county, and the indicators with the highest race or ethnicity index value were found, with their associated subgroup with the negative disparity listed below in SECTION 5: Disparities.
Health Equity Index
Every community can be described by various social and economic factors that can contribute to disparities in health outcomes. Conduent HCI’s Health Equity Index (formerly SocioNeeds ® Index) considers validated indicators related to income, employment, education, and household environment to identify areas at highest risk for experiencing health inequities.
How is the index value calculated?
The national index value (from 0 to 100) is calculated for each zip code, census tract, and county in the U.S. Communities with the highest index values are estimated to have the highest socioeconomic needs correlated with preventable hospitalizations and premature death.
What do the ranks and colors mean?
Ranks and colors help to identify the relative level of need within a community or service area. The national index value for each location is compared to all other similar locations within the community area to assign a relative rank (from 1 to 5) locally . These ranks are used to color the map and chart for the Health Equity Index, with darker coloring associated with higher relative need.
Food Insecurity Index
Every community can be described by various health, social, and economic fac - tors that can contribute to disparities in outcomes and opportunities to thrive.
Conduent HCI’s Food Insecurity Index considers validated indicators related to income, household environment and well-being to identify areas at highest risk for experiencing food insecurity .
How is the index value calculated?
The national index value (from 0 to 100) is calculated for each zip code, census tract, and county in the U.S. Communities with the highest index values are estimated to have the highest food insecurity, which is correlated with household and community measures of food-related financial stress such as Medicaid and SNAP enrollment.
What do the ranks and colors mean?
Ranks and colors help to identify the relative level of need within a community or service area. The national index value for each location is compared to all other similar locations within the community area to assign a relative rank (from 1 to 5) locally . These ranks are used to color the map and chart for the Food Insecurity Index, with darker coloring associated with higher relative need.
APPENDIX B.
METHODOLOGY
73Ventura County Community Health Needs Assessment 2022 Mental Health Index
Every community can be described by various health, social, and economic factors that can contribute to disparities in mental health outcomes. Conduent HCI’s Men- tal Health Index considers validated indicators related to access to care, physical health status, transportation, employment and household environment to identify areas at highest risk for experiencing poor mental health.
How is the index value calculated?
The national index value (from 0 to 100) is calculated for each zip code, census tract, and county in the U.S. Communities with the highest index values are estimated to have the highest socioeconomic and health needs correlated with self-reported poor mental health.
What do the ranks and colors mean?
Ranks and colors help to identify the relative level of need within a community or service area. The national index value for each location is compared to all other similar locations within the community area to assign a relative rank (from 1 to 5) locally . These ranks are used to color the map and chart for the Mental Health Index, with darker coloring associated with higher relative need.
Data Considerations
Several limitations of data should be considered when reviewing the findings presented in this report. Although the topics by which data are organized cover a wide range of health and health-related areas, data availability varies by health topic. Some topics contain a robust set of secondary data indicators, while others may have a limited number of indicators or limited subpopulations covered by those specific indicators.
Data scores represent the relative community health need according to the secondary data for each topic and should not be considered a comprehensive result on their own. In addition, these scores reflect the secondary data results for the population as a whole and do not represent the health or socioeconomic need that is much greater for some subpopulations. Moreover, many of the secondary data indica - tors included in the findings are collected by survey, and though specific methods are used to best represent the population at large, these measures are subject to instability, especially for smaller populations. The Index of Disparity is also limited by data availability, where indicator data varies based on the population groups and service areas being analyzed.
APPENDIX B.
METHODOLOGY
Race or ethnic and Special Population Groupings
The secondary data presented in this report derive from multiple sources, which may present race and ethnicity data using dissimilar nomenclature. For consistency with data sources throughout the report, subpopulation data may use different terms to describe the same or similar groups of community members.
Zip Codes and Zip Code T abulation Areas
This report presents both Zip Code and Zip Code T abulation Area (ZCTA) data.
Zip Codes, which were created by the U.S. Postal Service to improve mail delivery service, are not reported in this assessment as they may change, include P .O. boxes or cover large unpopulated areas. This assessment cover ZCTAs or Zip Code T ab- ulation Areas which were created by the U.S. Census Bureau and are generalized representations of Zip Codes that have been assigned to census blocks.
Demographics for this report are sourced from the United States Census Bureau, which presents ZCTA estimates. T ables and figures in the Demographics section of this report reference Zip Codes in title (for purposes of familiarity) but show values of ZCTAs. Data from other sources are labeled as such.
74Ventura County Community Health Needs Assessment 2022
SECONDARY DATA SCORING
Data scoring is done in three stages:
Comparisons
• Quantitatively
score all
possible
comparisons
Indicators
• Summarize
comparison
scores for each
indicator
Topics
• Summarize
indicator scores
by topic area
For each indicator, in VCCHIC’s service area is assigned a score based on its com- parison to other communities, whether health targets have been met, and the trend of the indicator value over time. These comparison scores range from 0-3, where 0 indicates the best outcome and 3 the worst. Availability of each type of comparison varies by indicator and is dependent upon the data source, comparability with data collected for other communities and changes in methodology over time.
Indicators are categorized into topic areas and each topic area receives a score.
Indicators may be categorized in more than one topic area. T opic scores are deter- mined by the comparisons of all indicators within the topic.
APPENDIX B.
METHODOLOGY
Comparison to a Distribution of County Values: Within State and Nation For ease of interpretation and analysis, indicator data on the Community Dashboard is visually represented as a green-yellow-red gauge showing how the community is faring against a distribution of counties in the state or the United States. A distribu- tion is created by taking all county values within the state or nation, ordering them from low to high, and dividing them into three groups (green, yellow, red) based on their order. Indicators with the poorest comparisons (“in the red”) scored high, whereas indicators with good comparisons (“in the green”) scored low.
Comparison to Values: State, National, and T argets
Each county is compared to the state value, the national value, and target values.
T arget values include the nation-wide Healthy People 2030 (HP2030) goals. Healthy People 2030 goals are national objectives for improving the health of the nation set by the Department of Health and Human Services’ Healthy People Initiative.
For all value comparisons, the scoring depends on whether the county value is better or worse than the comparison value, as well as how close the county value is to the target value.
T rend over Time
The Mann-Kendall statistical test for trend was used to assess whether the county value is increasing over time or decreasing over time, and whether the trend is sta- tistically significant. The trend comparison uses the four most recent comparable values for the county, and statistical significance is determined at the 90% confi - dence level. For each indicator with values available for four time periods, scoring was determined by direction of the trend and statistical significance.
Missing Values
Indicator scores are calculated using the comparison scores, availability of which depends on the data source. If the comparison type is possible for an adequate proportion of indicators on the community dashboard, it will be included in the indicator score. After exclusion of comparison types with inadequate availability, all missing comparisons are substituted with a neutral score for the purposes of calculating the indicator’s weighted average. When information is unknown due to lack of comparable data, the neutral value assumes that the missing comparison score is neither good nor bad.
Indicator Scoring
Indicator scores are calculated as a weighted average of all included comparison scores. If none of the included comparison types are possible for an indicator, no score is calculated, and the indicator is excluded from the data scoring results. 75 Ventura County Community Health Needs Assessment 2022 T opic Scoring
IIndicator scores are averaged by topic area to calculate topic scores. Each indicator may be included in up to three topic areas if appropriate. Resulting scores range from 0-3, where a higher score indicates a greater level of need as evidenced by the data. A topic score is only calculated if it includes at least three indicators.
The health and quality of life topic areas are described as follows:
Data Scoring Results
The following tables list each indicator by topic area for VCCHIC’s service area.
Secondary data for this report are up to date as of April 19, 2022.
APPENDIX B.
METHODOLOGY
76 Ventura County Community Health Needs Assessment 2022
SCORE ADOLESCENT HEALTH UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.03 Children and T eens who Engage in Regular Physical Activity percent 11.2 16.5 2015-2016 10
2.03 T eens who are Overweight or Obese percent 67. 2 38.2 2015-2016 10
1.76 7th Grade Students who are Physically Fit percent 64.4 61 2018-2019 3
1.76 9th Grade Students who are at a Healthy Weight or
Underweight percent 64.1 62.2 2018-2019 3
1.76 T eens who have Ever Used Inhalants: 7th Graders percent 4 3.6 2017-2019 11
1.76 T eens who have Ever Used Recreational Prescription Drugs: 9th Graders percent 10 8.8 2017-2019 11
1.76 T eens who Use Alcohol or Drugs: 7th Graders percent 7. 8 7 2017-2019 11
1.76 T eens who Use Alcohol: 7th Graders percent 4.7 4.2 2017-2019 11
1.76 Y outh Depression percent 36 32 2017-2019 11
1.71 T eens who have Used Alcohol percent 35.9 23.3 2013-2014 9
1.68 Age-Adjusted ER Rate due to Adolescent Suicide and Intentional Self-inflicted Injury
ER visits/ 10,000 population
aged 10-17 50.3 40.3 2016-2018 African/American, White 4
1.65 Y outh Connectedness to School percent 43.3 2017-2019 11
1.59 T eens who Binge Drink: 11th Graders percent 8.2 8 2017-2019 11
1.59 T eens who have Ever Used Inhalants: 9th Graders percent 4 3.9 2017-2019 11
1.59 T eens who have Ever Used Recreational Prescription Drugs: 11th Graders percent 12 11.4 2017-2019 11
1.59 T eens who Smoke: 11th Graders percent 2.1 2 2017-2019 11
1.59 T eens who Smoke: 7th Graders percent 1.1 1 2017-2019 11
1.59 T eens who Use Alcohol or Drugs: 9th Graders percent 15.2 15 2017-2019 11
1.59 T eens who Use Alcohol: 11th Graders percent 16.8 16 2017-2019 11
1.59 T eens who Use Alcohol: 9th Graders percent 10 9.3 2017-2019 11
1.59 T eens who Use Marijuana: 9th Graders percent 10.3 10 2017-2019 11
1.59 Y outh Gang Membership percent 4.3 4.2 2017-2019 11
1.41 T eens who have Ever Used Inhalants: 11th Graders percent 3 3.2 2017-2019 11
1.41 T eens who Use Alcohol or Drugs: 11th Graders percent 23 23 2017-2019 11
1.41 T eens who Use Marijuana: 11th Graders percent 14.6 16 2017-2019 11
1.41 T eens who Use Marijuana: 7th Graders percent 4 4 2017-2019 11
1.24 T eens who Smoke: 9th Graders percent 1.5 2 2017-2019 11 APPENDIX B.
METHODOLOGY
77 Ventura County Community Health Needs Assessment 2022
0.97 Age-Adjusted Hospitalization Rate due to Adolescent Suicide and Intentional Self-inflicted Injury
hospitalizations/ 10,000
population aged 10-17 8.7 12.9 2016-2018 4
0.82 Children and T eens with Asthma percent 8.7 14.6 2015-2016 9
0.62 T een Birth Rate: 15-19 live births/ 1,000 females aged 15-19 13.4 14.2 18.8 2016-2018 6
SCORE ALCOHOL & DRUG USE UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.53 Alcohol-Impaired Driving Deaths percent of driving deaths with alcohol involvement 35 28.3 28.7 27 2015-2019 22
2.47 Age-Adjusted Death Rate due to Synthetic Opioid
Overdose (excluding Methadone) Rate per 100,000 residents 11.1 10 2020 12
2.24 Liquor Store Density stores/ 100,000 population 14.7 10.5 10.5 2019 30
2.18 Age-Adjusted Death Rate due to All Opioid Overdose Rate per 100,000 residents 17. 1 13.5 2020 12
2.18 Age-Adjusted Death Rate due to Heroin Overdose deaths/ 100,000 population 4 4.2 2.4 2020 12
2.18 Age-Adjusted Death Rate due to Prescription Opioid Overdose Rate per 100,000 residents 14.6 11.8 2020 12
2.12 Age-Adjusted ED Visit Rate due to Opioid Overdose
(excluding Heroin) Rate per 100,000 residents 29.9 29 2020 12
2.03 Age-Adjusted Hospitalization Rate due to Adolescent Alcohol Use
hospitalizations/ 10,000
population aged 10-17 3.4 2.6 2016-2018 4
2.03 Age-Adjusted Hospitalization Rate due to Adult
Alcohol Use
hospitalizations/ 10,000
population 18+ years 14.9 12.4 2016-2018 White 4
2.03 Age-Adjusted Hospitalization Rate due to Opioid Use hospitalizations/ 10,000 population 18+ years 3.5 2.5 2016-2018 White 4
2.03 Age-Adjusted Hospitalization Rate due to Substance Use
hospitalizations/ 10,000
population 18+ years 6.2 4.5 2016-2018 White 4
1.94 Death Rate due to Drug Poisoning deaths/ 100,000 population 16.4 13.8 21 2017-2019 22
1.85 Age-Adjusted ER Rate due to Adolescent Alcohol Use ER visits/ 10,000 population aged 10-17 19 11.3 2016-2018 White 4
1.82 Age-Adjusted Death Rate due to Drug Use deaths/ 100,000 population 15.6 13.1 2016-2018 6
1.82 Age-Adjusted ED Visit Rate due to All Drug Overdose Rate per 100,000 residents 133.7 130.7 2020 12
1.76 Adults who Binge Drink: Last 30 Days percent 17. 6 16.7 2019 15
1.76 T eens who have Ever Used Inhalants: 7th Graders percent 4 3.6 2017-2019 11
1.76 T eens who have Ever Used Recreational Prescription Drugs: 9th Graders percent 10 8.8 2017-2019 11
1.76 T eens who Use Alcohol or Drugs: 7th Graders percent 7. 8 7 2017-2019 11 APPENDIX B.
METHODOLOGY
78 Ventura County Community Health Needs Assessment 2022
1.76 T eens who Use Alcohol: 7th Graders percent 4.7 4.2 2017-2019 11
1.71 Age-Adjusted Hospitalization Rate due to Opioid
Overdose (excluding Heroin) Rate per 100,000 residents 9.2 7. 9 2020 12
1.71 T eens who have Used Alcohol percent 35.9 23.3 2013-2014 9
1.68 Age-Adjusted ER Rate due to Opioid Use ER visits/ 10,000 population 18+ years 7. 6 5.2 2016-2018 White 4
1.59 T eens who Binge Drink: 11th Graders percent 8.2 8 2017-2019 11
1.59 T eens who have Ever Used Inhalants: 9th Graders percent 4 3.9 2017-2019 11
1.59 T eens who have Ever Used Recreational Prescription Drugs: 11th Graders percent 12 11.4 2017-2019 11
1.59 T eens who Use Alcohol or Drugs: 9th Graders percent 15.2 15 2017-2019 11
1.59 T eens who Use Alcohol: 11th Graders percent 16.8 16 2017-2019 11
1.59 T eens who Use Alcohol: 9th Graders percent 10 9.3 2017-2019 11
1.59 T eens who Use Marijuana: 9th Graders percent 10.3 10 2017-2019 11
1.50 Age-Adjusted ER Rate due to Adult Alcohol Use ER visits/ 10,000 population 18+ years 44.8 41 2016-2018 White 4
1.41 Age-Adjusted ED Visit Rate due to Heroin Overdose Rate per 100,000 residents 11.5 9.8 2020 White 12
1.41 T eens who have Ever Used Inhalants: 11th Graders percent 3 3.2 2017-2019 11
1.41 T eens who Use Alcohol or Drugs: 11th Graders percent 23 23 2017-2019 11
1.41 T eens who Use Marijuana: 11th Graders percent 14.6 16 2017-2019 11
1.41 T eens who Use Marijuana: 7th Graders percent 4 4 2017-2019 11
1.35 Age-Adjusted Hospitalization Rate due to All Drug
Overdose Rate per 100,000 residents 46.1 50.4 2020 12
1.32 Age-Adjusted Drug and Opioid-Involved Overdose
Death Rate
Deaths per 100,000
population 17. 9 16.5 23.5 2018-2020 16
1.32 Age-Adjusted ER Rate due to Substance Use ER visits/ 10,000 population 18+ years 21.7 21.7 2016-2018 White 4
1.26 Opioid Prescription Patients percent 2.6 Q4 2021 21
1.26 Quarterly Opioid Prescription Rate prescriptions per 10,000 population 319.1 Q4 2021 21
0.97 Age-Adjusted Long Acting or Extended Release
Opioid Prescription Rate to Opioid Naive Residents per 100,000 population 1.5 1.7 2020 12
0.82 Age-Adjusted Hospitalization Rate due to Heroin
Overdose Rate per 100,000 residents 1 1.8 2020 12
APPENDIX B.
METHODOLOGY
79 Ventura County Community Health Needs Assessment 2022
SCORE CANCER UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.18 Prostate Cancer Incidence Rate cases/ 100,000 males 103.4 92.3 106.2 2014-2018 Black/African American 26
2.00 Oral Cavity and Pharynx Cancer Incidence Rate cases/ 100,000 population 12.1 10.2 11.9 2014-2018 White 26
1.68 Age-Adjusted Death Rate due to Colorectal Cancer deaths/ 100,000 population 13.1 8.9 12.2 2016-2018 6
1.59 Breast Cancer Incidence Rate cases/ 100,000 females 129.2 121.8 126.8 2014-2018 White 26
1.47 Age-Adjusted Death Rate due to Prostate Cancer deaths/ 100,000 males 19.5 16.9 19.7 2016-2018 6
1.47 Cervical Cancer Incidence Rate cases/ 100,000 females 7. 4 7. 3 7. 7 2014-2018 26
1.41 Mammogram in Past 2 Y ears: 50-74 percent 73.6 77 .1 74.8 2018 15
1.32 Age-Adjusted Death Rate due to Breast Cancer deaths/ 100,000 females 18.1 15.3 18.6 2016-2018 6
1.24 Cervical Cancer Screening: 21-65 Percent 84.1 84.3 84.7 2018 15
1.24 Colon Cancer Screening: Sigmoidoscopy Past 5 Y ears and FOBT Past 3 Y ears, Colonoscopy Past 10 Y ears, or
FOBT Past Y ear
percent 67. 2 74.4 66.4 2018 15
1.12 Colorectal Cancer Incidence Rate cases/ 100,000 population 34.4 34.8 38 2014-2018 26
1.06 Age-Adjusted Death Rate due to Cancer deaths/ 100,000 population 136.2 122.7 134.4 2016-2018 6
0.88 Adults with Cancer percent 6 7. 1 2019 15
0.71 Age-Adjusted Death Rate due to Lung Cancer deaths/ 100,000 population 24.4 25.1 25.8 2016-2018 6
0.65 Lung and Bronchus Cancer Incidence Rate cases/ 100,000 population 39.3 40.3 5 7. 3 2014-2018 White 26
SCORE CHILDREN’S HEALTH UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
1.76 Children with Health Insurance percent 95.9 96.4 94.3 2019 1
1.76 T eens who have Ever Used Inhalants: 7th Graders percent 4 3.6 2017-2019 11
1.76 T eens who have Ever Used Recreational Prescription Drugs: 9th Graders percent 10 8.8 2017-2019 11
1.68 Child and T een Fruit Consumption percent 63.1 64.3 2014-2015 9
1.65 5th Grade Students who are at a Healthy Weight or
Underweight percent 59.2 58.7 2018-2019 3
1.59 T eens who have Ever Used Inhalants: 9th Graders percent 4 3.9 2017-2019 11
1.59 T eens who have Ever Used Recreational Prescription Drugs: 11th Graders percent 12 11.4 2017-2019 11
1.50 Children with Low Access to a Grocery Store percent 4 2015 31
1.50 Food Insecure Children Likely Ineligible for Assistance percent 28 32 23 2019 23 APPENDIX B.
METHODOLOGY
80 Ventura County Community Health Needs Assessment 2022
1.47 Kindergartners with Required Immunizations percent 95.5 94.3 2019-2020 7
1.41 Children who Visited a Dentist percent 92.7 91.9 2017-2018 10
1.41 T eens who have Ever Used Inhalants: 11th Graders percent 3 3.2 2017-2019 11
1.32 Age-Adjusted Hospitalization Rate due to Pediatric Mental Health
hospitalizations/ 10,000
population under 18 years 16.6 19.5 2016-2018 White 4
1.32 Children with Influenza Vaccination percent 52.7 51 2015-2016 10
1.24 Children who are Overweight for Age percent 12.9 14.9 2017-2018 10
1.15 Age-Adjusted ER Rate due to Pediatric Asthma ER visits/ 10,000 population under 18 years 21.9 32.1 2016-2018 Black/African American, Hispanic, White 4
1.09 Substantiated Child Abuse Rate cases/ 1,000 children 4.7 8.7 6.8 2020 18
0.97 Age-Adjusted ER Rate due to Pediatric Mental Health ER visits/ 10,000 population under 18 years 26.1 33.4 2016-2018 Black/African American; White 4
0.97 Age-Adjusted Hospitalization Rate due to Pediatric Asthma
hospitalizations/ 10,000
population under 18 years 3.8 6.8 2016-2018 White 4
0.82 Children and T eens with Asthma percent 8.7 14.6 2015-2016 9
0.71 Projected Child Food Insecurity Rate percent 13.4 16.8 2021 23
0.44 Child Food Insecurity Rate percent 10.4 13.6 14.6 2019 23
SCORE COMMUNITY UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.53 Alcohol-Impaired Driving Deaths percent of driving deaths with alcohol involvement 35 28.3 28.7 27 2015-2019 22
2.35 Workers who Walk to Work percent 1.6 2.5 2.6 2016-2020 T wo or More Races 1
2.12 Workers Commuting by Public T ransportation percent 1 5.3 4.6 4.6 2016-2020 1
1.94 People 65+ Living Alone (Count) people 28318 2016-2020 1
1.91 Workers Commuting by Public T ransit percent 1.1 5 2022 19
1.88 Juvenile Arrest Rate arrests/ 1,000 population
aged 0-17 8.7 4.4 2019 5
1.85 Voter Engagement Percent of adults 62.2 65.6 2020 9
1.82 Bicycle-Involved Collision Rate collisions/ 100,000 population 30.4 28.9 2017 14
1.74 Drivers who Drive Alone to Work percent 79 73.8 2022 19
1.71 Adult Arrest Rate arrests/ 1,000 population
18+ 43 2 7. 1 2020 5
APPENDIX B.
METHODOLOGY
81 Ventura County Community Health Needs Assessment 2022
1.71 Social Associations membership associations/
10,000 population 6.1 5.9 9.3 2018 22
1.68 Workers who Drive Alone to Work percent 77 .7 72.1 74.9 2016-2020 1
1.65 Mean T ravel Time to Work minutes 26.9 29.8 26.9 2016-2020 1
1.65 Y outh Connectedness to School percent 43.3 2017-2019 11
1.59 Y outh Gang Membership percent 4.3 4.2 2017-2019 11
1.47 Solo Drivers with a Long Commute percent 34.5 42.2 37 2015-2019 22
1.38 Average Commute Time minutes 29 33 2022 19
1.35 Hate Crime Offenses offenses 15 2020 5
1.18 Voter T urnout: Presidential Election percent 85.9 80.7 2020 13
1.15 Deaths in Custody per 10,000 population 0.1 0.3 2020 5
1.15 Households with Wireless Phone Service percent 97. 6 97. 7 97 2020 20
1.09 Families Below Poverty percent 6.2 9.4 2022 19
1.09 Substantiated Child Abuse Rate cases/ 1,000 children 4.7 8.7 6.8 2020 18
0.97 Households with a Smartphone percent 84.8 84.1 81.9 2021 20
0.97 Households with No Car and Low Access to a Grocery Store percent 0.7 2015 31
0.94 Homeownership percent 59.4 51 56.9 2016-2020 1
0.94 People 65+ Living Alone percent 21.5 22.3 26.3 2016-2020 1
0.85 Age-Adjusted Death Rate due to Motor Vehicle T raffic Collisions deaths/ 100,000 population 8.7 10.1 9.8 11.5 2016-2018 6
0.71 Households with One or More T ypes of Computing
Devices percent 93.4 94.3 91.9 2016-2020 1
0.71 People 25+ with a Bachelor’s Degree or Higher percent 33.9 34.7 32.9 2016-2020 American Indian/Alaska
Native, Native Hawaiian/
Pacific Islander, Other,
T wo or More Races
1 0.53 Households with an Internet Subscription percent 89.8 89.1 85.5 2016-2020 1
0.53 Persons with an Internet Subscription percent 91.5 91.3 88.5 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 0.53 Violent Crime Rate crimes/ 100,000 population 200.4 437 2020 5
0.47 Children Living Below Poverty Level percent 12.2 16.8 17. 5 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 APPENDIX B.
METHODOLOGY
82 Ventura County Community Health Needs Assessment 2022
0.35 Per Capita Income dollars 39403 38576 35384 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Native Hawaiian/Pacific
Islander, Other, T wo or
More Races
1 0.35 Y outh not in School or Working percent 1 1.6 1.8 2016-2020 1
0.29 People Living Below Poverty Level percent 8.9 8 12.6 12.8 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 0.18 Single-Parent Households percent 18.2 22.4 25.3 2016-2020 1
0.00 Median Household Income dollars 89295 78672 64994 2016-2020 Hispanic/Latino, Other 1
SCORE DIABETES UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.12 Adults with Diabetes percent 11.1 10.5 2019-2020 9
1.38 Age-Adjusted Death Rate due to Diabetes deaths/ 100,000 population 19.3 21.2 21.3 2016-2018 6
1.32 Age-Adjusted Hospitalization Rate due to T ype 2
Diabetes
hospitalizations/ 10,000
population 18+ years 9.9 11.8 2016-2018 Hispanic, White 4
1.32 Age-Adjusted Hospitalization Rate due to
Uncontrolled Diabetes
hospitalizations/ 10,000
population 18+ years 2.6 3 2016-2018 Hispanic 4
1.18 Diabetes: Medicare Population percent 26.1 2 7. 2 27 2018 17
1.15 Age-Adjusted ER Rate due to Diabetes ER visits/ 10,000 population 18+ years 20.7 28.1 2016-2018 Black/African American, Hispanic, White 4
1.15 Age-Adjusted ER Rate due to T ype 2 Diabetes ER visits/ 10,000 population 18+ years 18.3 24.9 2016-2018 Black/African American, Hispanic, White 4
1.15 Age-Adjusted Hospitalization Rate due to Diabetes hospitalizations/ 10,000 population 18+ years 13.2 15.8 2016-2018 Hispanic, White 4
1.15 Age-Adjusted Hospitalization Rate due to Long-T erm Complications of Diabetes
hospitalizations/ 10,000
population 18+ years 6.8 8.3 2016-2018 Hispanic 4
1.15 Age-Adjusted Hospitalization Rate due to Short-T erm Complications of Diabetes
hospitalizations/ 10,000
population 18+ years 3.9 4.5 2016-2018 White 4
0.97 Age-Adjusted ER Rate due to Long-T erm
Complications of Diabetes
ER visits/ 10,000 population
18+ years 3.5 5.3 2016-2018 Black/African American, Hispanic 4
0.97 Age-Adjusted ER Rate due to Short-T erm
Complications of Diabetes
ER visits/ 10,000 population
18+ years 0.4 0.7 2016-2018 4
0.97 Age-Adjusted ER Rate due to Uncontrolled Diabetes ER visits/ 10,000 population 18+ years 13.1 17. 4 2016-2018 Black/African American, Hispanic, White 4
APPENDIX B.
METHODOLOGY
83 Ventura County Community Health Needs Assessment 2022
SCORE ECONOMY UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.53 Renters Spending 30% or More of Household Income
on Rent percent 58.8 54.2 49.1 2016-2020 1
1.94 People 65+ Living Below Poverty Level (Count) people 9961 2016-2020 1
1.76 Mortgaged Owners Spending 30% or More of
Household Income on Housing percent 37. 7 36.9 26.5 2019 1
1.59 Households with Student Loans Debt percent 11.2 11.7 11.1 2021 20
1.50 Food Insecure Children Likely Ineligible for Assistance percent 28 32 23 2019 23
1.41 Severe Housing Problems percent 23.3 26.4 18 2013-2017 22
1.35 Students Eligible for the Free Lunch Program percent 46.3 52.7 38.5 2020-2021 27
1.32 Households that are Asset Limited, Income
Constrained, Employed (ALICE) percent 34.1 35.2 2016 33
1.24 Households that Used Check Cashing, Cash Advance,
or Title Loan Shops percent 5.4 5.5 6 2021 20
1.24 Unemployed Workers in Civilian Labor Force percent 4.5 5.4 3.9 11/1/2021 29
1.15 Low-Income and Low Access to a Grocery Store percent 3.3 2015 31
1.09 Families Below Poverty with Children percent 4.3 6.9 2022 19
1.06 Households with a 401k Plan percent 44.3 42.3 39.2 2021 20
1.06 Size of Labor Force persons 412299 44501 29
0.97 Adults who Feel Overwhelmed by Financial Burdens percent 13.1 13.9 14.4 2021 20
0.97 Households that are Above the Asset Limited, Income Constrained, Employed (ALICE) Threshold percent 5 7. 4 51.6 2016 33
0.97 Households that are Below the Federal Poverty Level percent 8.5 13.2 2016 33
0.97 Households with a Savings Account percent 74 72.2 70.2 2021 20
0.94 Homeownership percent 59.4 51 56.9 2016-2020 1
0.94 People 65+ Living Below Poverty Level percent 7. 7 10.3 9.3 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 0.88 Overcrowded Households percent of households 6.2 8.2 2016-2020 1
0.71 Projected Child Food Insecurity Rate percent 13.4 16.8 2021 23
0.71 Projected Food Insecurity Rate percent 9.6 12.1 2021 23
0.47 Children Living Below Poverty Level percent 12.2 16.8 17. 5 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 APPENDIX B.
METHODOLOGY
84 Ventura County Community Health Needs Assessment 2022
0.47 Families Living Below Poverty Level percent 6.1 9 9.1 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 0.44 Child Food Insecurity Rate percent 10.4 13.6 14.6 2019 23
0.44 Food Insecurity Rate percent 7. 8 10.2 10.9 2019 23
0.35 People Living 200% Above Poverty Level percent 76.2 70.6 70.2 2016-2020 1
0.35 Per Capita Income dollars 39403 38576 35384 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Native Hawaiian/Pacific
Islander, Other, T wo or
More Races
1 0.35 Y outh not in School or Working percent 1 1.6 1.8 2016-2020 1
0.29 People Living Below Poverty Level percent 8.9 8 12.6 12.8 2016-2020 American Indian/Alaska
Native, Hispanic/Latino,
Other
1 0.29 Persons with Disability Living in Poverty (5-year) percent 17. 1 22.9 25.4 2016-2020 1
0.00 Median Household Income dollars 89295 78672 64994 2016-2020 Hispanic/Latino, Other 1
SCORE EDUCATION UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.38 Student-to-T eacher Ratio students/ teacher 23.7 22.6 16.3 2020-2021 27
1.82 High School Graduation percent 83.3 90.7 83.6 2020-2021 3
1.76 6th Grade Students Proficient in Math percent 31.6 30.8 2021 3
1.76 8th Grade Students Proficient in Math percent 31.1 30.8 2021 3
1.65 Y outh Connectedness to School percent 43.3 2017-2019 11
1.50 11th Grade Students Proficient in English/Language Arts percent 58.2 59.2 2021 3
1.44 Population Age 25+: Bachelor’s Degree percent 20.6 21.1 2021 19
1.32 7th Grade Students Proficient in English/Language
Arts percent 54.7 50 2021 3
1.32 7th Grade Students Proficient in Math percent 36.9 34.4 2021 3
1.18 11th Grade Students Proficient in Math percent 36 34.4 2021 3
1.00 4th Grade Students Proficient in Math percent 41.6 35.9 2021 3
1.00 6th Grade Students Proficient in English/Language
Arts percent 4 7. 9 43.6 2021 3
1.00 8th Grade Students Proficient in English/Language
Arts percent 52.4 4 7. 4 2021 3
APPENDIX B.
METHODOLOGY
85 Ventura County Community Health Needs Assessment 2022
0.82 3rd Grade Students Proficient in Math percent 45.8 39.7 2021 3
0.82 5th Grade Students Proficient in Math percent 34.4 30.1 2021 3
0.71 People 25+ with a Bachelor’s Degree or Higher percent 33.9 34.7 32.9 2016-2020 American Indian/Alaska
Native, Native Hawaiian/
Pacific Islander, Other,
T wo or More Races
1 0.53 3rd Grade Students Proficient in English/Language Arts percent 4 7. 1 39.8 2021 3
0.53 4th Grade Students Proficient in English/Language
Arts percent 48.3 41.5 2021 3
0.53 5th Grade Students Proficient in English/Language
Arts percent 52.7 46.5 2021 3
SCORE ENVIRONMENTAL HEALTH UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.56 Asthma: Medicare Population percent 6 5.3 5 2018 17
2.24 Liquor Store Density stores/ 100,000 population 14.7 10.5 10.5 2019 30
1.85 Farmers Market Density markets/ 1,000 population 0 2018 31
1.85 Fast Food Restaurant Density restaurants/ 1,000
population 0.7 2016 31
1.71 Adult Arrest Rate arrests/ 1,000 population
18+ 43 2 7. 1 2020 5
1.68 Annual Ozone Air Quality Grade F 2017-2019 2
1.65 Annual Particle Pollution Grade F 2017-2019 2
1.50 Children with Low Access to a Grocery Store percent 4 2015 31
1.50 Grocery Store Density stores/ 1,000 population 0.2 2016 31
1.50 People with Low Access to a Grocery Store percent 15.9 2015 31
1.50 WIC Certified Stores stores/ 1,000 population 0.1 2016 31
1.41 Severe Housing Problems percent 23.3 26.4 18 2013-2017 22
1.35 Number of Extreme Heat Events events 6 2019 28
1.35 Number of Extreme Precipitation Days days 19 2019 28
1.35 PBT Released pounds 2423 2020 32
1.35 Weeks of Moderate Drought or Worse weeks per year 5 2020 28
1.32 People 65+ with Low Access to a Grocery Store percent 2.1 2015 31
1.32 Recreation and Fitness Facilities facilities/ 1,000 population 0.1 2016 31
1.15 Age-Adjusted ER Rate due to Pediatric Asthma ER visits/ 10,000 population under 18 years 21.9 32.1 2016-2018 Black/African American, Hispanic, White 4
APPENDIX B.
METHODOLOGY
86 Ventura County Community Health Needs Assessment 2022
1.15 Low-Income and Low Access to a Grocery Store percent 3.3 2015 31
1.06 Number of Extreme Heat Days days 10 2019 28
0.97 Age-Adjusted ER Rate due to Adult Asthma ER visits/ 10,000 population 18+ years 11.5 16.8 2016-2018 Black/African American, White 4
0.97 Age-Adjusted ER Rate due to Asthma ER visits/ 10,000 population 14.2 20.8 2016-2018 Black/African American, White 4
0.97 Age-Adjusted Hospitalization Rate due to Adult
Asthma
hospitalizations/ 10,000
population 18+ years 2.1 2.8 2016-2018 4
0.97 Age-Adjusted Hospitalization Rate due to Asthma hospitalizations/ 10,000 population 2.5 3.8 2016-2018 White 4
0.97 Age-Adjusted Hospitalization Rate due to Pediatric Asthma
hospitalizations/ 10,000
population under 18 years 3.8 6.8 2016-2018 White 4
0.97 Households with No Car and Low Access to a Grocery Store percent 0.7 2015 31
0.88 Adults with Current Asthma percent 8.2 8.9 2019 15
0.88 Overcrowded Households percent of households 6.2 8.2 2016-2020 1
0.76 Food Environment Index 8.9 8.8 7. 8 2021 22
0.62 Access to Exercise Opportunities percent 97. 7 93.1 84 2020 22
0.56 Adults with Asthma percent 10.8 16.1 14.2 2020 9
SCORE HEALTH CARE ACCESS & QUALITY UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.29 Adults who have had a Routine Checkup percent 68.4 76.6 2019 15
2.29 Adults with Health Insurance: 18-64 percent 86.6 89.8 2018-2020 9
1.94 Adults without Health Insurance percent 16.6 13 2019 15
1.85 Non-Physician Primary Care Provider Rate providers/ 100,000 population 45.9 67. 5 2020 22
1.76 Adults Delayed or had Difficulty Obtaining Care percent 24.3 19.6 2017-2018 10
1.76 Children with Health Insurance percent 95.9 96.4 94.3 2019 1
1.53 People with a Usual Source of Health Care percent 86.9 87 2018-2020 Black/African American,
non-Hispanic, Native
Hawaiian/Pacific
Islander, non-Hispanic
9 1.50 Adults with Health Insurance (5-year): 19+ percent 87. 5 89.8 87. 7 2016-2020 1
1.41 Children who Visited a Dentist percent 92.7 91.9 2017-2018 10
1.29 People Delayed or had Difficulty Obtaining Care percent 12.9 3.3 14.1 2019-2020 9 APPENDIX B.
METHODOLOGY
87 Ventura County Community Health Needs Assessment 2022
1.15 Children and T eens Delayed or had Difficulty
Obtaining Care percent 6.9 7. 7 2015-2016 10
1.09 Primary Care Provider Rate providers/ 100,000
population 78.2 79.8 2018 22
0.88 Adults who Visited a Dentist percent 68 66.5 2018 15
0.82 Adults Needing and Receiving Behavioral Health Care Services percent 67 54.6 2019-2020 9
0.74 Dentist Rate dentists/ 100,000 population 92.8 87 2019 22
0.62 Mental Health Provider Rate providers/ 100,000
population 396.5 373.4 2020 22
SCORE HEART DISEASE & STROKE UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.21 Age-Adjusted Death Rate due to Cerebrovascular
Disease (Stroke) deaths/ 100,000 population 39 33.4 36.9 37. 3 2016-2018 6
2.18 Atrial Fibrillation: Medicare Population percent 8.4 7. 5 8.4 2018 17
2.18 Hyperlipidemia: Medicare Population percent 48.5 45.3 4 7. 7 2018 17
2.06 Stroke: Medicare Population percent 3.9 3.5 3.8 2018 17
1.94 Adults who Have T aken Medications for High Blood
Pressure percent 68.9 76.2 2019 15
1.94 Hypertension: Medicare Population percent 55.4 53 5 7. 2 2018 17
1.74 Adults with Heart Disease percent 6.9 6.8 2017-2018 10
1.68 Age-Adjusted Hospitalization Rate due to Heart
Attack
hospitalizations/ 10,000
population 35+ years 24.9 23.6 2014 28
1.68 Ischemic Heart Disease: Medicare Population percent 26.3 24.7 26.8 2018 17
1.41 Cholesterol T est History percent 86.3 87. 6 2019 15
1.32 Age-Adjusted Hospitalization Rate due to
Hypertension
hospitalizations/ 10,000
population 18+ years 2.7 3.5 2016-2018 Black/African American, Hispanic 4
1.24 High Cholesterol Prevalence: Adults 18+ percent 31.9 33.6 2019 15
1.21 Age-Adjusted Death Rate due to Coronary Heart
Disease deaths/ 100,000 population 82.3 71.1 85.1 92.7 2016-2018 6
1.18 Heart Failure: Medicare Population percent 13.1 13.9 14 2018 17
1.15 Age-Adjusted ER Rate due to Hypertension ER visits/ 10,000 population 18+ years 24 2 7. 7 2016-2018 Black/African American, Hispanic 4
1.15 Age-Adjusted Hospitalization Rate due to Heart
Failure
hospitalizations/ 10,000
population 18+ years 25.5 29.3 2016-2018 Black/African American, Hispanic 4
APPENDIX B.
METHODOLOGY
88 Ventura County Community Health Needs Assessment 2022
1.06 Age-Adjusted Death Rate due to Heart Attack deaths/ 100,000 population 35+ years 42.2 41 2019 28
0.97 Age-Adjusted ER Rate due to Heart Failure ER visits/ 10,000 population 18+ years 6.6 10.5 2016-2018 Black/African American 4
0.82 High Blood Pressure Prevalence percent 21.9 2 7. 7 25.1 2020 9
0.71 Adults who Experienced a Stroke percent 2.7 3.4 2019 15
0.71 Adults who Experienced Coronary Heart Disease percent 4.9 6.2 2019 15
SCORE IMMUNIZATIONS & INFECTIOUS DISEASES UNITS VENTURA COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
1.68 Adults 65+ with Influenza Vaccination percent 64.8 69.3 2015-2016 10
1.53 Persons Living and Diagnosed with HIV who are in
Care percent 74.4 75 2019 6
1.50 Age-Adjusted ER Rate due to Immunization-
Preventable Pneumonia and Influenza
ER visits/ 10,000 population
18+ years 17. 1 16.8 2016-2018 Hispanic, White 4
1.50 Age-Adjusted Hospitalization Rate due to Hepatitis hospitalizations/ 10,000 population 18+ years 1.1 1 2016-2018 4
1.47 Kindergartners with Required Immunizations percent 95.5 94.3 2019-2020 7
1.32 Age-Adjusted Hospitalization Rate due to Community Acquired Pneumonia
hospitalizations/ 10,000
population 18+ years 10.4 11.1 2016-2018 4
1.32 Age-Adjusted Hospitalization Rate due to
Immunization-Preventable Pneumonia and Influenza
hospitalizations/ 10,000
population 18+ years 2.1 2.1 2016-2018 4
1.32 Children with Influenza Vaccination percent 52.7 51 2015-2016 10
1.32 Chlamydia Incidence Rate cases/ 100,000 population 398.5 594.7 551 2019 8
1.29 Congenital Syphilis Incidence Rate cases/ 100,000 live births 45.3 21 99.9 2019 8
1.18 COVID-19 Daily Average Incidence Rate cases per 100,000 population 6 6.6 7. 7 4/1/2022 24
1.18 HIV Diagnosis Rate cases/ 100,000 population 5.3 11 2019 6
1.15 Age-Adjusted ER Rate due to Hepatitis ER visits/ 10,000 population 18+ years 0.7 0.7 2016-2018 4
1.15 Death Rate Among Persons with Diagnosed HIV
Infection deaths/ 100,000 population 1.9 4.8 2019 6
1.09 T uberculosis Incidence Rate cases/ 100,000 population 2.1 1.4 4.3 2020 6
1.03 Gonorrhea Incidence Rate cases/ 100,000 population 89.3 201.7 187 .8 2019 8
1.03 Syphilis Incidence Rate cases/ 100,000 population 9.1 20.6 11.9 2019 8
0.97 Adults who Agree Vaccine Benefits Outweigh
Possible Risks Percent 51.7 50.8 49.4 2021 20
APPENDIX B.
METHODOLOGY
89 Ventura County Community Health Needs Assessment 2022
0.97 Age-Adjusted ER Rate due to Community Acquired
Pneumonia
ER visits/ 10,000 population
18+ years 18 21.4 2016-2018 Black/African American, White 4
0.88 Overcrowded Households percent of households 6.2 8.2 2016-2020 1
0.82 COVID-19 Daily Average Case-Fatality Rate deaths per 100 cases 1.4 9.3 16 4/1/2022 24
0.56 Age-Adjusted Death Rate due to Influenza and
Pneumonia deaths/ 100,000 population 9 14.6 14.2 2016-2018 6
0.53 Persons Fully Vaccinated Against COVID-19 percent 71.6 3/25/2022 16
SCORE MATERNAL, FETAL & INFANT HEALTH UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
1.56 Any In-Hospital Breastfeeding percent 96.2 2019 6
1.50 WIC Certified Stores stores/ 1,000 population 0.1 2016 31
1.38 Babies with Very Low Birth Weight percent 1.2 1.2 1.4 2013 6
1.29 Congenital Syphilis Incidence Rate cases/ 100,000 live births 45.3 21 99.9 2019 8
1.26 In-Hospital Exclusive Breastfeeding percent 80.9 2019 Hispanic 6
1.18 Mothers who Breastfeed percent 96.4 94 2015-2017 6
1.18 Mothers who Received Early Prenatal Care percent 84.2 83.5 2015-2017 6
0.91 Infant Mortality Rate deaths/ 1,000 live births 3.9 5 3.9 5.8 2016-2018 6
0.62 T een Birth Rate: 15-19 live births/ 1,000 females aged 15-19 13.4 14.2 18.8 2016-2018 6
0.56 Babies with Low Birth Weight percent 5.8 6.9 8.2 2016-2018 6
0.53 Preterm Births percent 7. 4 9.4 8.7 2016 25
SCORE MENTAL HEALTH & MENTAL DISORDERS UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.12 Alzheimer’s Disease or Dementia: Medicare
Population percent 10.3 10.5 10.8 2018 17
2.12 Depression: Medicare Population percent 17. 2 16.2 18.4 2018 17
1.85 Age-Adjusted Hospitalization Rate due to Adult
Suicide and Intentional Self-inflicted Injury
hospitalizations/ 10,000
population 18+ years 14.7 13.6 2016-2018 White 4
1.76 Adults with Likely Serious Psychological Distress percent 11.4 12.6 2019-2020 9
1.76 Y outh Depression percent 36 32 2017-2019 11
1.68 Age-Adjusted ER Rate due to Adolescent Suicide and Intentional Self-inflicted Injury
ER visits/ 10,000 population
aged 10-17 50.3 40.3 2016-2018 Black/African American; White 4
APPENDIX B.
METHODOLOGY
90 Ventura County Community Health Needs Assessment 2022
1.68 Age-Adjusted ER Rate due to Adult Suicide and
Intentional Self-inflicted Injury
ER visits/ 10,000 population
18+ years 20.6 18.5 2016-2018 Black/African American, White 4
1.50 Age-Adjusted Hospitalization Rate due to Adult
Mental Health
hospitalizations/ 10,000
population 18+ years 33.7 38.4 2016-2018 White 4
1.32 Age-Adjusted Hospitalization Rate due to Pediatric Mental Health
hospitalizations/ 10,000
population under 18 years 16.6 19.5 2016-2018 White 4
0.97 Age-Adjusted ER Rate due to Adult Mental Health ER visits/ 10,000 population 18+ years 70.5 85.8 2016-2018 Black/African American, White 4
0.97 Age-Adjusted ER Rate due to Pediatric Mental Health ER visits/ 10,000 population under 18 years 26.1 33.4 2016-2018 Black/African American, White 4
0.97 Age-Adjusted Hospitalization Rate due to Adolescent Suicide and Intentional Self-inflicted Injury
hospitalizations/ 10,000
population aged 10-17 8.7 12.9 2016-2018 4
0.82 Adults Needing and Receiving Behavioral Health Care Services percent 67 54.6 2019-2020 9
0.71 Adults Ever Diagnosed with Depression percent 16 18.8 2019 15
0.71 Poor Mental Health: 14+ Days percent 11.5 13.6 2019 15
0.62 Age-Adjusted Death Rate due to Suicide deaths/ 100,000 population 10.5 12.8 10.6 13.9 2016-2018 6
0.62 Mental Health Provider Rate providers/ 100,000
population 396.5 373.4 2020 22
0.53 Adults Needing Help With Mental, Emotional or
Substance Abuse Problems percent 16 20.9 2020 9
SCORE NUTRITION & HEALTHY EATING UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
1.85 Adults who Drink Sugar-Sweetened Beverages percent 14.1 11 2015-2016 10
1.68 Child and T een Fruit Consumption percent 63.1 64.3 2014-2015 9
1.50 WIC Certified Stores stores/ 1,000 population 0.1 2016 31
1.32 Adults Who Frequently Used Quick Service
Restaurants: Past 30 Days Percent 39.9 40.3 41.2 2021 20
1.24 Adults who Frequently Cook Meals at Home Percent 35.2 35.1 34.4 2021 20
SCORE OLDER ADULTS UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.65 Rheumatoid Arthritis or Osteoarthritis: Medicare
Population percent 34.5 31.2 33.5 2018 17
2.56 Asthma: Medicare Population percent 6 5.3 5 2018 17
2.18 Atrial Fibrillation: Medicare Population percent 8.4 7. 5 8.4 2018 17 APPENDIX B.
METHODOLOGY
91 Ventura County Community Health Needs Assessment 2022
2.18 Hyperlipidemia: Medicare Population percent 48.5 45.3 4 7. 7 2018 17
2.12 Alzheimer’s Disease or Dementia: Medicare
Population percent 10.3 10.5 10.8 2018 17
2.12 Depression: Medicare Population percent 17. 2 16.2 18.4 2018 17
2.06 Stroke: Medicare Population percent 3.9 3.5 3.8 2018 17
2.03 Hospitalization Rate due to Hip Fractures Among
Females 65+
hospitalizations/ 100,000
females 65+ years 658.4 537 .1 2016-2018 4
1.94 Chronic Kidney Disease: Medicare Population percent 23.6 24.3 24.5 2018 17
1.94 Hypertension: Medicare Population percent 55.4 53 5 7. 2 2018 17
1.94 People 65+ Living Alone (Count) people 28318 2016-2020 1
1.94 People 65+ Living Below Poverty Level (Count) people 9961 2016-2020 1
1.68 Adults 65+ with Influenza Vaccination percent 64.8 69.3 2015-2016 10
1.68 Hospitalization Rate due to Hip Fractures Among
Males 65+
hospitalizations/ 100,000
males 65+ years 325.3 297 .3 2016-2018 4
1.68 Ischemic Heart Disease: Medicare Population percent 26.3 24.7 26.8 2018 17
1.59 Adults 65+ who Received Recommended Preventive
Services: Males percent 30.1 32.4 2018 15
1.32 People 65+ with Low Access to a Grocery Store percent 2.1 2015 31
1.24 Colon Cancer Screening: Sigmoidoscopy Past 5 Y ears and FOBT Past 3 Y ears, Colonoscopy Past 10 Y ears, or
FOBT Past Y ear
percent 67. 2 74.4 66.4 2018 15
1.18 Diabetes: Medicare Population percent 26.1 2 7. 2 27 2018 17
1.18 Heart Failure: Medicare Population percent 13.1 13.9 14 2018 17
1.00 Elder Index (Elderly Household Below Income
Threshold) percent 24.1 2 7. 7 2019-2020 9
0.94 People 65+ Living Alone percent 21.5 22.3 26.3 2016-2020 1
0.94 People 65+ Living Below Poverty Level percent 7. 7 10.3 9.3 2016-2020 Hispanic/Latino, T wo or More Races 1
0.76 COPD: Medicare Population percent 8.5 9.5 11.5 2018 17
0.71 Adults 65+ who Received Recommended Preventive
Services: Females percent 36 28.4 2018 15
0.71 Adults 65+ with T otal T ooth Loss percent 10.3 13.5 2018 15
0.71 Adults with Arthritis percent 18.5 25.1 2019 15
APPENDIX B.
METHODOLOGY
92 Ventura County Community Health Needs Assessment 2022
SCORE ORAL HEALTH UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.00 Oral Cavity and Pharynx Cancer Incidence Rate cases/ 100,000 population 12.1 10.2 11.9 2014-2018 White 26
1.41 Children who Visited a Dentist percent 92.7 91.9 2017-2018 10
0.97 Age-Adjusted ER Rate due to Dental Problems ER visits/ 10,000 population 26.3 35.4 2016-2018 Black/African American, White 4
0.88 Adults who Visited a Dentist percent 68 66.5 2018 15
0.74 Dentist Rate dentists/ 100,000 population 92.8 87 2019 22
0.71 Adults 65+ with T otal T ooth Loss percent 10.3 13.5 2018 15
SCORE OTHER CONDITIONS UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.65 Rheumatoid Arthritis or Osteoarthritis: Medicare
Population percent 34.5 31.2 33.5 2018 17
1.94 Chronic Kidney Disease: Medicare Population percent 23.6 24.3 24.5 2018 17
1.68 Age-Adjusted Hospitalization Rate due to Urinary
T ract Infections
hospitalizations/ 10,000
population 18+ years 10.3 9.6 2016-2018 Black/African American, Hispanic, White 4
1.50 Age-Adjusted ER Rate due to Dehydration ER visits/ 10,000 population 18+ years 14.2 13.5 2016-2018 White 4
1.32 Age-Adjusted Hospitalization Rate due to
Dehydration
hospitalizations/ 10,000
population 18+ years 9.3 9.7 2016-2018 4
1.15 Age-Adjusted ER Rate due to Urinary T ract Infections ER visits/ 10,000 population 18+ years 80.8 97. 8 2016-2018 Black/African American, Hispanic, White 4
0.88 Adults with Kidney Disease Percent of adults 2.8 3.1 2019 15
0.71 Adults with Arthritis percent 18.5 25.1 2019 15
SCORE PHYSICAL ACTIVITY UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.35 Workers who Walk to Work percent 1.6 2.5 2.6 2016-2020 T wo or More Races 1
2.03 Children and T eens who Engage in Regular Physical Activity percent 11.2 16.5 2015-2016 10
1.85 Farmers Market Density markets/ 1,000 population 0 2018 31
1.85 Fast Food Restaurant Density restaurants/ 1,000
population 0.7 2016 31
1.76 7th Grade Students who are Physically Fit percent 64.4 61 2018-2019 3
1.76 9th Grade Students who are at a Healthy Weight or
Underweight percent 64.1 62.2 2018-2019 3
APPENDIX B.
METHODOLOGY
93 Ventura County Community Health Needs Assessment 2022
1.68 Child and T een Fruit Consumption percent 63.1 64.3 2014-2015 9
1.50 Children with Low Access to a Grocery Store percent 4 2015 31
1.50 Grocery Store Density stores/ 1,000 population 0.2 2016 31
1.50 People with Low Access to a Grocery Store percent 15.9 2015 31
1.32 People 65+ with Low Access to a Grocery Store percent 2.1 2015 31
1.32 Recreation and Fitness Facilities facilities/ 1,000 population 0.1 2016 31
1.24 Adults who are Overweight or Obese percent 61.1 62 67. 1 2020 9
1.15 Low-Income and Low Access to a Grocery Store percent 3.3 2015 31
1.06 Adults who Follow a Regular Exercise Routine Percent 26.1 26.2 23.3 2021 20
1.03 Adults Who Are Obese percent 25.6 28.5 31.9 2020 Hispanic/Latino 9
0.97 Adults who Walk Regularly percent 44 38.9 2015-2016 10
0.97 Households with No Car and Low Access to a Grocery Store percent 0.7 2015 31
0.76 Food Environment Index 8.9 8.8 7. 8 2021 22
0.62 Access to Exercise Opportunities percent 97. 7 93.1 84 2020 22
SCORE PREVENTION & SAFETY UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.03 Age-Adjusted Hospitalization Rate due to
Unintentional Falls
hospitalizations/ 10,000
population 18+ years 42.4 37. 8 2016-2018 White 4
2.03 Hospitalization Rate due to Hip Fractures Among
Females 65+
hospitalizations/ 100,000
females 65+ years 658.4 537 .1 2016-2018 4
1.94 Death Rate due to Drug Poisoning deaths/ 100,000 population 16.4 13.8 21 2017-2019 22
1.68 Hospitalization Rate due to Hip Fractures Among
Males 65+
hospitalizations/ 100,000
males 65+ years 325.3 297 .3 2016-2018 4
1.50 Age-Adjusted Death Rate due to Unintentional
Injuries deaths/ 100,000 population 35.6 43.2 33 48.3 2016-2018 6
1.41 Severe Housing Problems percent 23.3 26.4 18 2013-2017 22
1.15 Age-Adjusted ER Rate due to Unintentional Falls ER visits/ 10,000 population 18+ years 176.8 184.7 2016-2018 White 4
APPENDIX B.
METHODOLOGY
94 Ventura County Community Health Needs Assessment 2022
SCORE RESPIRATORY DISEASES UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.56 Asthma: Medicare Population percent 6 5.3 5 2018 17
2.00 Adults who Smoke percent 8.7 5 6.7 2019-2020 9
1.68 Adults 65+ with Influenza Vaccination percent 64.8 69.3 2015-2016 10
1.59 T eens who Smoke: 11th Graders percent 2.1 2 2017-2019 11
1.59 T eens who Smoke: 7th Graders percent 1.1 1 2017-2019 11
1.50 Age-Adjusted ER Rate due to Immunization-
Preventable Pneumonia and Influenza
ER visits/ 10,000 population
18+ years 17. 1 16.8 2016-2018 Hispanic, White 4
1.32 Age-Adjusted Hospitalization Rate due to Community Acquired Pneumonia
hospitalizations/ 10,000
population 18+ years 10.4 11.1 2016-2018 4
1.32 Age-Adjusted Hospitalization Rate due to
Immunization-Preventable Pneumonia and Influenza
hospitalizations/ 10,000
population 18+ years 2.1 2.1 2016-2018 4
1.32 Children with Influenza Vaccination percent 52.7 51 2015-2016 10
1.24 T eens who Smoke: 9th Graders percent 1.5 2 2017-2019 11
1.18 COVID-19 Daily Average Incidence Rate cases per 100,000 population 6 6.6 7. 7 4/1/2022 24
1.15 Age-Adjusted ER Rate due to Pediatric Asthma ER visits/ 10,000 population under 18 years 21.9 32.1 2016-2018 Black/African American, Hispanic, White 4
1.09 T uberculosis Incidence Rate cases/ 100,000 population 2.1 1.4 4.3 2020 6
0.97 Adults Who Used Smokeless T obacco: Past 30 Days percent 1.3 1.2 2 2021 20
0.97 Age-Adjusted ER Rate due to Adult Asthma ER visits/ 10,000 population 18+ years 11.5 16.8 2016-2018 Black/African American, White 4
0.97 Age-Adjusted ER Rate due to Asthma ER visits/ 10,000 population 14.2 20.8 2016-2018 Black/African American, White 4
0.97 Age-Adjusted ER Rate due to Community Acquired
Pneumonia
ER visits/ 10,000 population
18+ years 18 21.4 2016-2018 Black/African American, White 4
0.97 Age-Adjusted ER Rate due to COPD ER visits/ 10,000 population 18+ years 11.5 17. 5 2016-2018 Black/African American, White 4
0.97 Age-Adjusted Hospitalization Rate due to Adult
Asthma
hospitalizations/ 10,000
population 18+ years 2.1 2.8 2016-2018 4
0.97 Age-Adjusted Hospitalization Rate due to Asthma hospitalizations/ 10,000 population 2.5 3.8 2016-2018 White 4
0.97 Age-Adjusted Hospitalization Rate due to COPD hospitalizations/ 10,000 population 18+ years 9.5 12.4 2016-2018 White 4
0.97 Age-Adjusted Hospitalization Rate due to Pediatric Asthma
hospitalizations/ 10,000
population under 18 years 3.8 6.8 2016-2018 White 4 APPENDIX B.
METHODOLOGY
95 Ventura County Community Health Needs Assessment 2022
0.88 Adults with Current Asthma percent 8.2 8.9 2019 15
0.82 Children and T eens with Asthma percent 8.7 14.6 2015-2016 9
0.82 COVID-19 Daily Average Case-Fatality Rate deaths per 100 cases 1.4 9.3 16 4/1/2022 24
0.79 Adults Who Used Electronic Cigarettes: Past 30 Days percent 3.6 3.7 4.1 2021 20
0.76 COPD: Medicare Population percent 8.5 9.5 11.5 2018 17
0.71 Adults with COPD Percent of adults 4.7 6.6 2019 15
0.71 Age-Adjusted Death Rate due to Lung Cancer deaths/ 100,000 population 24.4 25.1 25.8 2016-2018 6
0.65 Lung and Bronchus Cancer Incidence Rate cases/ 100,000 population 39.3 40.3 5 7. 3 2014-2018 White 26
0.56 Adults with Asthma percent 10.8 16.1 14.2 2020 9
0.56 Age-Adjusted Death Rate due to Influenza and
Pneumonia deaths/ 100,000 population 9 14.6 14.2 2016-2018 6
SCORE SEXUALL Y TRANSMITTED INFECTIONS UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
1.53 Persons Living and Diagnosed with HIV who are in
Care percent 74.4 75 2019 6
1.32 Chlamydia Incidence Rate cases/ 100,000 population 398.5 594.7 551 2019 8
1.29 Congenital Syphilis Incidence Rate cases/ 100,000 live births 45.3 21 99.9 2019 8
1.18 HIV Diagnosis Rate cases/ 100,000 population 5.3 11 2019 6
1.15 Death Rate Among Persons with Diagnosed HIV
Infection deaths/ 100,000 population 1.9 4.8 2019 6
1.03 Gonorrhea Incidence Rate cases/ 100,000 population 89.3 201.7 187 .8 2019 8
1.03 Syphilis Incidence Rate cases/ 100,000 population 9.1 20.6 11.9 2019 8
SCORE TOBACCO USE UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.00 Adults who Smoke percent 8.7 5 6.7 2019-2020 9
1.59 T eens who Smoke: 11th Graders percent 2.1 2 2017-2019 11
1.59 T eens who Smoke: 7th Graders percent 1.1 1 2017-2019 11
1.24 T eens who Smoke: 9th Graders percent 1.5 2 2017-2019 11
0.97 Adults Who Used Smokeless T obacco: Past 30 Days percent 1.3 1.2 2 2021 20
0.79 Adults Who Used Electronic Cigarettes: Past 30 Days percent 3.6 3.7 4.1 2021 20
APPENDIX B.
METHODOLOGY
96 Ventura County Community Health Needs Assessment 2022
SCORE WEIGHT STATUS UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
2.03 T eens who are Overweight or Obese percent 67. 2 38.2 2015-2016 10
1.76 9th Grade Students who are at a Healthy Weight or
Underweight percent 64.1 62.2 2018-2019 3
1.65 5th Grade Students who are at a Healthy Weight or
Underweight percent 59.2 58.7 2018-2019 3
1.41 Adults Happy with Weight Percent 21.8 22.1 21.4 2021 20
1.24 Adults who are Overweight or Obese percent 61.1 62 67. 1 2020 9
1.24 Children who are Overweight for Age percent 12.9 14.9 2017-2018 10
1.03 Adults Who Are Obese percent 25.6 28.5 31.9 2020 Hispanic/Latino 9
SCORE WELLNESS & LIFESTYLE UNITS VENTURA
COUNTY HP2030 California U.S. MEASUREMENT
PERIOD HIGH RACE DISPARITY* Source
1.88 Older Adult Self-Reported General Health
Assessment: Good or Better percent 64.2 72.1 2014 9
1.85 Adults who Drink Sugar-Sweetened Beverages percent 14.1 11 2015-2016 10
1.59 Child and T een Self-Reported General Health
Assessment: Good or Better percent 89.9 94.8 2013-2014 10
1.41 Adults Happy with Weight Percent 21.8 22.1 21.4 2021 20
1.32 Adults Who Frequently Used Quick Service
Restaurants: Past 30 Days Percent 39.9 40.3 41.2 2021 20
1.24 Adults who Frequently Cook Meals at Home Percent 35.2 35.1 34.4 2021 20
1.24 Self-Reported General Health Assessment: Poor or Fair percent 18.1 18.6 2019 15
1.18 Adult Self-Reported General Health Assessment:
Good or Better percent 82.6 82.6 2018-2019 9
1.06 Adults who Follow a Regular Exercise Routine Percent 26.1 26.2 23.3 2021 20
1.00 Self-Reported General Health Assessment: Good or
Better percent 91.5 87. 8 2020 9
0.97 Adults who Agree Vaccine Benefits Outweigh
Possible Risks Percent 51.7 50.8 49.4 2021 20
0.97 Insufficient Sleep percent 32.9 31.4 34.5 35 2018 22
0.82 High Blood Pressure Prevalence percent 21.9 2 7. 7 25.1 2020 9
0.79 Life Expectancy years 82.5 81.7 79.2 2017-2019 White 22
0.71 Poor Physical Health: 14+ Days percent 11.2 12.5 2019 15
1.59 Breast Cancer Incidence Rate cases/ 100,000 females 129.2 121.8 126.8 2014-2018 White 26 APPENDIX B.
METHODOLOGY
97 Ventura County Community Health Needs Assessment 2022
1.47 Cervical Cancer Incidence Rate cases/ 100,000 females 7. 4 7. 3 7. 7 2014-2018 26
1.41 Mammogram in Past 2 Y ears: 50-74 percent 73.6 77 .1 74.8 2018 15
1.32 Age-Adjusted Death Rate due to Breast Cancer deaths/ 100,000 females 18.1 15.3 18.6 2016-2018 6
1.24 Cervical Cancer Screening: 21-65 Percent 84.1 84.3 84.7 2018 15 APPENDIX B.
METHODOLOGY
98 Ventura County Community Health Needs Assessment 2022 Primary Data Methods & Analysis
Community input for VCCHIC was collected to expand upon the information gathered from the secondary data. The entire process was undertaken by VCCHIC membership. Primary data used in this assessment consisted of a community survey in English and Spanish, focus groups and stakeholder focus groups.
Community Survey
Since one of the most valuable ways to learn about the health of a community is by reaching out to the different constituents in the community, including residents, VCCHIC prioritized local participation for this community health needs assessment and improvement planning cycle. The full survey can be found via https://ven- turacoph.sjc1.qualtrics.com/jfe/form/SV_4MZNKxzWSQ3lY6G. The community survey was distributed online through Qualtrics from February 9th through March 30th of 2022. The survey was made available in both English and Spanish. Paper surveys were also made available and answers to the paper survey were entered into Qualtrics.
Focus Groups and Focus Group Profiles
Eighteen focus groups were conducted in February and March 2022. The groups were organized and facilitated by members of VCCHIC and partners from Califor- nia State Channel Islands University and Pacifica High School. Participants were recruited using multiple modes: direct recruitment by partner community-based organizations, email invitations, flyers, newspaper and social media postings. The following groups, who are more likely to be socially marginalized, were recruited for participation in the focus groups:
• Black or African American Community
• Hispanic or Latino, including monolingual Spanish speakers • Older Adults
• LGBTQIA+ Community
• High School Students
• Residents receiving services from the Behavioral Health Department APPENDIX C.
PRIMARY DATA METHODOLOGY
Each focus group included both a facilitator and a note taker from to capture the conversation verbatim. A list of the questions asked during the focus groups can be found in this Appendix. The focus group transcripts and notes were analyzed qualitatively so as to code the transcripts according to a list of major health and quality of life topics. Input from focus group participants is included in each relevant health need topic area detailed in SECTION 6: Primary Data Collection and SECTION 7: Identification of Significant Health Needs.
Ventura County Focus Group Discussion Questions
COVID-19 QUESTION
1. We know that COVID-19 has significantly impacted everyone’s lives. What have you seen as the biggest challenges in Ventura County during the pan- demic?
[Probe 1: Which groups of people are having the hardest time right now?] [Probe 2: How have you seen these challenges being addressed, if at all?] [Probe 3: What are some of the positives? What has worked?]
GENERAL HEALTH QUESTIONS
2. What is the top health related problem that residents are facing in your community that you would change or improve?
[Probe 1: Why do you think this is the most important health issue?]
3. What do you think is the cause of this problem in your community? [Probe 1: What would you do to address this problem? What is needed to address this problem?]
4. From the health issues and challenges we’ve just discussed, which do you think are the hardest to overcome?
[Probe: Are some of these issues more urgent or important than others? If so, why?]
99 Ventura County Community Health Needs Assessment 2022
5. Are there groups in your community that are facing particular health issues or challenges? Which groups are these?
[Probe: Are these health challenges different if the person is a particular age, or gender, race or ethnicity? Or lives in a certain part of the county for example?]
6. What do you think causes residents to be healthy or unhealthy in your community?
[Probe 1: What types of things influence their health, to make it better or worse?]
[Probe 2: What might prevent someone from accessing care for these health challenges? Examples could include lack of transportation, lack of health insurance coverage, doctor’s office hours, language or cultural barriers, etc.] 7 . What resources are available for residents in your community? [Probe 1: Are there specific community organizations or agencies that you see taking a strong leadership role for improving the health of particular groups in your community?]
[Probe 2: Do you see residents taking advantage of them? Why or why not?] APPENDIX C.
PRIMARY DATA METHODOLOGY
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The prioritization process is described in detail in Section 9 of this report. This Appendix contains a copy of the online prioritization activity .
Prioritization Activity: Ventura County Community Health Improvement Collaborative
Purpose: You have been invited to participate in a virtual prioritization activity. The purpose of this activity is to guide the VCCHIC decision on the "prioritized" health areas it will focus on for the next three years. We anticipate it will take 10 minutes to complete this exercise.
Recommendations: For optimal user experience, use a laptop or desktop computer. If you must use a tablet or cell phone, hold in landscape mode and scroll horizontally to ensure all questions are answered.
Handouts: We recommend you have the Prioritization Cheat Sheet available for easy reference.
Questions: Reach out to Sharri Morley at [email protected] for questions or help with technical issues.
Prioritization Activity
* 1. Assign a score to each health topic and criterion using the guidelines outlined below:
Criteria 1: Ability to Impact (the perceived likelihood for positive impact on each health issue)
Consider the following factors:
Can actionable and measurable goals be defined to address the health need? Are those goals achievable in a reasonable time frame?
Do collaborative partners have the expertise or resources to address the identified health need?
Can the need be addressed in collaboration with community partners? Are organizations already addressing the health issue?
Criteria 2: Scope and Severity (gauges the magnitude of each health issue) Consider the following factors:
How many people in the community are or will be impacted? How does the identified need impact health and quality of life? Has the need changed over time?
Ability to Impact Scope and Severity
Equitable
Access to
Health
Services
Adverse
Childhood
Experiences
(Substance
Use,
Adolescent
Health,
Education,
Housing
Overcrowding)
Substance Use
Prevention of
Chronic
Conditions
(Cancers,
Diabetes,
Heart Disease
& Stroke)
Mental
Health
Healthy
Lifestyle and
Prevention
(Nutrition and
Healthy
Eating,
Physical
Activity,
Weight Status)
Health and
Wellness for
Older Adults
Thank You!
Conduent Healthy Communities Institute will total the scores from all survey responses to develop a health needs list in rank order from the highest-scoring need to the lowest scoring need. VCCHIC will use these results to inform their decision on the “prioritized” health needs they will focus on over the next three years.
Thank you for participating in this prioritization activity and the Community Health Needs Assessment process! APPENDIX D.
PRIORITIZATION ACTIVITY
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A current lists of resources, can be found
on the Health Matters in Ventura County
website at https://www.healthmatters-
invc.org/211resources.
The list of community resources was de-
veloped through documentation of men-
tions by community input participants in
conjunction to those accessed through
the 2-1-1 website for Ventura County .
APPENDIX E.
COMMUNITY RESOURCES
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Chetty R, S. M. (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA, 1750-1766.
Coleman-Jensen A, R. M. (2017). Household food insecurity in the United States in 2016. United States Department of Agriculture.
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Egerter S, B. P .-N.-K. (2011). Education and Health: An examination of the many ways in which education can influence health, including how educational attainment affects health across generations and the social and economic advantages it represents. Robert Wood Johnson Foundation.
Healthy Communities Institute. (2016, June 20). Data Scoring T ool. Retrieved from Health Matters in Ventura County: www.healthmattersinvc.org Healthy Communities Institute. (2019). SocioNeeds Index. Retrieved from Health Matters in Ventura County: http://www.healthmattersinvc.org/ index.php?module=indicators&controller=index&action=socioneeds Khullar, D. C. (2018, October 1). Health, Income, and Poverty. Retrieved from Roberty Wood Johnson Foundation: https://www.rwjf.org/en/library/ research/2018/10/health--income-and-poverty-where-we-are-and- what-could-help.html
Murphy, S. L., Kochanek, K. D., Xu, J., & Arias, E. (December 2021). Mortality in the United States, 2020. National Center for Health Statistics.
National Academies Press. (2008). Appendix D, Community Approaches to Addressing Health Disparities. In Institute of Medicine (US) Roundtable on Health Disparities. Challenges and Successes in Reducing Health Disparities:
Workshop Summary. Washington DC: National Academies Press.
Office of Disease Prevention and Health Promotion. (2014). Healthy People 2020: Social Determinants of Health. Retrieved from Healthy People 2020:
https://www.healthypeople.gov/2020/topics-objectives/topic/social- determinants-of-health
Rissel C, C. N. (2012). Physical Activity Associated with Public T ransport Use—A Review and Modelling of Potential Benefits. International Journal of Environmental Research and Public Health, 2454 - 2478.
Shapiro RJ, H. K. (2002). Conserving energy and preserving the environment:
The role of public transportation. American Public T ransportation Association.
Sillies, M. (2009). The Casual Effect of Education on Health: Evidence from the United Kingdom. Economics of Education Review, 122-128.
The Center on the Developing Child. (2022). The Science of Adult Capabilities.
Retrieved from Developing Child: https://developingchild.harvard. edu/science/deep-dives/adult-capabilities/
The Public Health Institute. (2022). California Healthy Places Index. Oakland:
The Public Health Alliance of Southern California.
U.S Bureau of Labor Statistics. (2021, April 21). Education Pays. Retrieved from U.S Bureau of Labor Statistics: https://www.bls.gov/emp/chart- unemployment-earnings-education.htm
U.S. Department of Health and Human Services. (2021). Healthy People 2030.
Washington, DC: Office of Disease Prevention and Health Promotion.
World Health Organization. (2014). Social Determinants of Mental Health.
Geneva: WHO.
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