Los Angeles CountyHealth Survey

Office of Health Assessment and Epidemiology

Los Angeles County

Department of Health Services

Presented By

Gigi A. Mathew DrPH, CPHQ

Mission of the Office of Health Assessment and Epidemiology

• To ensure the availability of high quality and

comprehensive health data on the Los Angeles

County population and to facilitate its use for

public health assessment, policy development,

program planning and evaluation.

Role of Health Surveys Population health data increasingly used to drive public

health decision-making and community health improvement efforts.

Most local health jurisdictions lack important health data: chronic disease prevalence functional status and other measures of health-related

quality of life health behaviors access to health services

To address gaps in local health data, LA County Department of Health Services inaugurated the Los Angeles County Health Survey in 1997.

Key Analysis Objectives

To obtain reliable population estimates for selected health indicators by various demographics including sex, race/ethnicity (the 4 largest groups), and Service Planning Area (8 regions in the county).

To identify disparities across population sub-groups.

To track temporal trends.

To compare with state and national data and with national health objectives.

Methodology

• Population-based, random-digit-dialed telephone

survey of Los Angeles County residents

• Representative of Adults and Children in Los

Angeles County

• Conducted in 1997; 1999-2000; 2002-2003;

and 2005

Components and Sample Size1997 1999-2000 2002-2003 2005

Adult (n=8,004)

Adult (n=8,354)

Adult

(n=8,167)

Adult

(n= 8,648)

Child (n=2,363)

Child (n=6,016)

Child

(n=5,995)

Child

(n=6,032)

Tobacco Policy (n=519)

Tobacco Policy (n=481)

Elder health (n=1160)

Low-income Survey (n=1898)

8 Sub-samples (n~1,000 each)Bio-terrorism (2)

Tobacco Policy (2)

Health Dept./ Antibiotic Use

Food-borne Illness

Young Children & Families

Alcohol Policy

8 Sub-samples (n~1,000 each)Bio-terrorism (2)

Tobacco Policy (2)

Health Dept./ Antibiotic Use

Food-borne Illness

Young Children & Families

Alcohol Policy

Adult Component Content

Demographic Characteristics Chronic Disease Prevalence

Arthritis Cardiovascular Disease Diabetes Asthma / Chronic Respiratory Condition

Functional Status and Other Measures of Health-Related Quality of Life

Health Status Mental Health

Adult Component Content Health Behaviors

Tobacco Use Alcohol Use Physical Activity Sexual Practices and HIV Testing

Access to Health Services Health Insurance Ease of obtaining medical care Regular Source of Care Barriers to Accessing Health Care

Food Insecurity and Public Aid Assistance Medical Examinations and Vaccinations

Mammogram Colorectal Screening Flu

Child Component Content

• Demographics (child & parent)

• Child Health

• SHCNs, asthma, ETS, parent-perceived health status

• Child Health Insurance & Access to Care

• Status/type, gaps in coverage, difficulty accessing care, RSC, ER

use, LAC-DHS use

• Child Routines

• TV viewing, read to child*, tells stories to child*, play music/sing

songs with child*, bed times*, meal times*

*asked of parents with children aged 0-5 yrs.

Prenatal to Postpartum*

• HIV testing; breastfeeding, hospital practices post partum; infant

sleep position

Parent Behaviors/Risks/Perceptions

• Parental aggravation/stress*, ease of finding someone to talk to

about raising child*, safe park/playground accessible,

neighborhood belonging, cigarette use, mental health risk

Childcare*

• Type(s), difficulty obtaining child care, reasons why no child care

used

Child Component Content

*asked of parents with children aged 0-5 yrs.

Languages of Interviews

Language• English• Spanish• Cantonese• Mandarin• Korean• Vietnamese• Armenian

Child 3521 (59%)2246 (37%)48 (<1%)34 (<1%)

132 (<2%)41 (<1%)10 (<1%)

Adult

6455 (72%)

1802 (23%)

64 (1%)

82 (1%)

189 (3%)

40 (<1%)

16 (<1%)

Service Planning Areas and Health Districts

Antelope Valley

Foothill

San Fernando

West

East Valley

West Valley

Pomona

Harbor

Whitt ier

Torrance

El Monte

Glendale

Long Beach

Central Alhambra

Bellflower

Inglewood

East LASouth-west

SanAntonio

Compton

North-east

Pasadena

South

Hollywood/Wilshire

South-east

SPA 1

SPA 2

SPA 3

SPA 8

SPA 5

SPA 7

SPA 4

SPA 6

Spas2002.shp

SPA 1 - Antelope Valley

SPA 2 - San Fernando

SPA 3 - San Gabriel

SPA 4 - Metro

SPA 5 - West

SPA 6 - South

SPA 7 - East

SPA 8 - South Bay

Service Planning Areas (SPA)

1) Chronic Disease1) Chronic Disease

• DiabetesDiabetes

• ObesityObesity

2) Health Behavior2) Health Behavior

• SmokingSmoking

Data Examples Adult Health

5%

12%

6%

14%

7%6%

8%7%

14%

3%

6%

14%

12%

3%

11%

17%

7%

2%

12%

18%19%

3%

18%18%

0%

10%

20%

30%

Overall 18+ 30-39 40-49 50-59 60-64 65+

1997 1999 2002 2005

Diabetes Trends by Age Groups, Diabetes Trends by Age Groups, 1997-20051997-2005

PrevalencePrevalence†† of Diabetes Among Adults in of Diabetes Among Adults in Los Angeles County, by Race/Ethnicity, 2005Los Angeles County, by Race/Ethnicity, 2005

7.1%

12.2%

11.9%

5.6%

0%

5%

10%

15%

20%

25%

Latino White African-American Asian/PacificIslander

† Age-adjusted to 2000 US population

Prevalence of Diabetes by Body Mass Index‡, 2005

15.6%

7.9%

4.1%

0%

5%

10%

15%

20%

25%

Obese Overweight Normal

‡Weight status is based on Body Mass Index (BMI) calculated from self-reported weight and height.

According to NHLBI clinical guidelines, a BMI < 18.5 is underweight, a BMI > 18.5 and < 25 is normal

weight, a BMI > 25 and < 30 is overweight, and a BMI > 30 is obese. [

25%29%

4%

22%

17%12%

7%

24%

20%

15%

5%

17%

30%

6%

17%

28%

0%

10%

20%

30%

40%

50%

White Latino African American Asian/PacificIslander

1997 1999 2002 2005

Prevalence of Obesity Among Prevalence of Obesity Among Adults (Adults (>>18 years old) by Race/Ethnicity, 18 years old) by Race/Ethnicity,

Los Angeles County, 1997-2005Los Angeles County, 1997-2005

Prevalence of Obesity Among Adults by Prevalence of Obesity Among Adults by Service Planning Area, Los Angeles County, 2005Service Planning Area, Los Angeles County, 2005

27.3%30.0%

14.1%

19.1%

17.0%

24.4%

21.0%20.0%

0%

10%

20%

30%

40%

AntelopeValley

SanFernando

San Gabriel Metro West South East South Bay

LA County20.9%

14.6%15.2%

18.1%18.2% 18.0%19.7%

22.1%22.2%

11.4%11.1%14.2%14.3%

0%

10%

20%

30%

1997 1999 2002 2005

Prevalence of Cigarette Smoking Among Prevalence of Cigarette Smoking Among Adults (Adults (>>18 years old), Los Angeles County, 18 years old), Los Angeles County,

1997-20051997-2005

Male

County

Female

Percent of Male Cigarette Smokers by Race/Ethnicity, Percent of Male Cigarette Smokers by Race/Ethnicity, 1997-20051997-2005

23%22%22%23%

22%22%23%22% 23%21%

18%19%20%

27%

17%17%

0%

10%

20%

30%

40%

Latino White African American Asian/Pacific Islander

1997 1999 2002 2005

Percent of Female Cigarette Smokers by Percent of Female Cigarette Smokers by Race/Ethnicity, 1997-2005Race/Ethnicity, 1997-2005

10%

21%20%

9%

18%

9%

19%

9%7%

20%

15%

7% 8%

23%

14%

7%

0%

10%

20%

30%

40%

Latina White African American Asian/PacificIslander

1997 1999 2002 2005

1)1) Childhood AsthmaChildhood Asthma

2)2) Children with Special Health Care NeedsChildren with Special Health Care Needs

3)3) Breastfeeding Breastfeeding

Data Examples Child Health

Prevalence of Asthma by Child’s Race/Ethnicity Prevalence of Asthma by Child’s Race/Ethnicity ((17 years old), Los Angeles County, 200517 years old), Los Angeles County, 2005

8.3%

18.3%

8.3%7.3%8.8%

0%

5%

10%

15%

20%

25%

LA County Latino White African-American

Asian/PacificIslander

Activity Limitation and Emergency Room Visits by Income, Children with Asthma

(17 years old17 years old), 2005

50%

34%28%

19%

53%

26%

0%

10%

20%

30%

40%

50%

60%

Activity Limitation ER Use

< 100% FPL

100-199% FPL

>200% FPL

Percent of Children (17 years old17 years old) with Special Health Care Needs (SHCNs) by

Race/Ethnicity, 2005

15.8% 14.3%

19.3%22.5%

9.6%

0.0%

25.0%

L.A. County Latino White AfricanAmerican

Asian/PacificIslander

Percent of Children (17 years old17 years old) with Special Health Care Needs (SHCNs) by

Age Group, 2005

15.8%14.3%

19.3%

0.0%

25.0%

0-5 Years 6-11 Years 12-17 Years

Prevalence of Breastfeeding Initiation by Child Race/Ethnicity, 1994-2005

63% 68%

60%

82% 84%79% 78%

83%90%

82%92%

79%

92%91%90%

0%

20%

40%

60%

80%

100%

LA County Latina White African-American

Asian/PacificIslander

1994-1999 1998-2003 2001-2005

Prevalence of Breastfeeding 6 Months or Longer by Child Race/Ethnicity, 1994-2005

40%

50%

27%25%23%

42%50%

36%

62%

51% 49%

41%

61%57% 59%

0%

20%

40%

60%

80%

100%

LA County Latina White African-American

Asian/PacificIslander

1994-1999 1998-2003 2001-2005

Prevalence of Breastfeeding 12 Months or Longer by Child

Race/Ethnicity,1994-2005

17%20% 19%

*6%*11%

19% 18%14%

36%

30%29% 29%

35%33% 35%

0%

10%

20%

30%

40%

50%

LA County Latina White African-American

Asian/Pacific-Islander

1994-1999 1998-2003 2001-2005

* Estimate based on small sample size

Percent of Latina Mothers Who Initiated Breastfeeding and Breastfed at Least 6 Months by Birthplace,

2001-2005

84.1%92.5%

42.4%

63.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

U.S. born Latinas Non-U.S. born Latinas

Initiated breastfeeding Breastfed at least 6 months

Limitations of Survey

• Self-reported data

• Non-telephone households not included in the sampling frame

• Questionnaire content limited by time constraints

• Does not represent those living in group quarters (e.g. nursing homes and college dormitories)

Users of the Data,Los Angeles County Health Survey

• LAC Department of Health Services

• Governmental organizations (local, county, & state)

• Non-profit health foundations

• Community-based organizations (health centers, hospitals, human services, providers, health-interested organizations)

• Policymakers (advocacy groups)

• Researchers

• Private health care organizations

• Academic health and health policy professionals

Uses of the Data

• LAC-DHS Evaluation and Program Planning

– Ambulatory care planning

– Medi-Cal and Healthy Families outreach and enrollment

targets

– Public health emergency response preparedness

– HIV counseling and testing

• Health services planning (e.g., Kaiser Kids)• Community Health Assessment (e.g., SB 697)• School Readiness Indicators

• Public Education• Advocacy (e.g., food security)• Funding proposals/grant applications

Dissemination of Results

• Health Briefs and Fact Sheets (L.A. Health)

• Comprehensive Reports for county as a whole

(e.g., Health Trends) and 8 Service Planning Areas

(e.g., Key Health Indicators)

• Custom data requests and reports

• On the Web (www.lapublichealth.org/ha)

• Press Releases and Press Conferences

• Presentations

Dissemination of Results

• DHS Newsletters (e.g., The Public’s Health mailed

to 30,000 LA Co. Physicians)

• Reports produced by other organizations

(e.g., Children’s Planning Council, United Way,

First 5 LA)

• Newsletters disseminated by other organizations

(e.g., advocacy groups)

• Peer-reviewed journal publications

For additional information, call the

Office of Health Assessment and Epidemiology

at (213) 240-7785

or

Go to our website:

www.lapublichealth.org/ha