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Cedars-Sinai Medical CenterCommunity Health Needs Assessment

2016

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Table of Contents

Introduction .................................................................................................................................5

Background and Purpose .....................................................................................................5

Service Area ........................................................................................................................6

Project Oversight .................................................................................................................8

Consultant............................................................................................................................8

Methods ......................................................................................................................................9

Secondary Data Collection ...................................................................................................9

Primary Data Collection .......................................................................................................9

Information Gaps ...............................................................................................................11

Public Comment.................................................................................................................11

Identification of Significant Health Needs ..................................................................................12

Review of Primary and Secondary Data .............................................................................12

Significant Health Needs ....................................................................................................12

Resources to Address Significant Needs ...........................................................................12

Priority Health Needs ................................................................................................................13

Impact Evaluation ..............................................................................................................14

Community Demographics ........................................................................................................16

Population ..........................................................................................................................16

Race/Ethnicity ....................................................................................................................18

Language ...........................................................................................................................18

Social and Economic Factors ....................................................................................................21

Social and Economic Factors Ranking ...............................................................................21

Poverty ..............................................................................................................................21

Households ........................................................................................................................24

Free or Reduced Price Meals.............................................................................................24

Public Program Participation ..............................................................................................25

Unemployment ...................................................................................................................25

Educational Attainment ......................................................................................................26

Community Input – Social and Economic Factors ..............................................................27

Homelessness ...................................................................................................................27

Community Input – Housing and Homelessness ................................................................29

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Crime and Violence ............................................................................................................30

Community Input – Community Safety ...............................................................................31

Health Care Access ..................................................................................................................33

Health Insurance Coverage ...............................................................................................33

Sources of Care .................................................................................................................35

Barriers to Care..................................................................................................................37

Access to Primary Care Community Health Centers ..........................................................37

Delayed Care .....................................................................................................................38

Community Input – Access to Care ....................................................................................39

Dental Care........................................................................................................................41

Community Input – Dental Care .........................................................................................41

Birth Characteristics ..................................................................................................................43

Births .................................................................................................................................43

Teen Birth Rate ..................................................................................................................43

Prenatal Care .....................................................................................................................44

Low Birth Weight ................................................................................................................46

Infant Mortality ...................................................................................................................48

Breastfeeding .....................................................................................................................48

Mortality/Leading Causes of Death ...........................................................................................49

Leading Causes of Premature Death .................................................................................49

Leading Causes of Death ...................................................................................................49

Heart Disease Mortality ......................................................................................................51

Cancer Mortality .................................................................................................................53

Stroke Mortality ..................................................................................................................55

Respiratory (Lung) Disease Mortality .................................................................................57

Pneumonia Mortality ..........................................................................................................59

Chronic Disease ........................................................................................................................61

Health Status .....................................................................................................................61

Disability ............................................................................................................................61

Asthma ..............................................................................................................................61

Diabetes ............................................................................................................................62

Heart Disease ....................................................................................................................63

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High Blood Pressure ..........................................................................................................63

Cancer ...............................................................................................................................64

HIV/AIDS ...........................................................................................................................64

Sexually Transmitted Diseases ..........................................................................................65

Teen Sexual History ...........................................................................................................65

Hospitalization and ER Rates for Ambulatory Care Sensitive Conditions ...........................66

Community Input – Chronic Disease ..................................................................................67

Health Behaviors .......................................................................................................................69

Health Behaviors Ranking ..................................................................................................69

Overweight and Obesity .....................................................................................................69

Fast Food...........................................................................................................................70

Soda Consumption ............................................................................................................71

Fruit Consumption ..............................................................................................................71

Access to Fresh Produce ...................................................................................................71

Physical Activity .................................................................................................................71

Community Input – Overweight and Obesity ......................................................................72

Mental Health and Substance Abuse ........................................................................................73

Mental Health .....................................................................................................................73

Community Input – Mental Health ......................................................................................74

Tobacco/Alcohol/Drug Use ................................................................................................75

Cigarette Smoking .............................................................................................................75

Alcohol and Drug Use ........................................................................................................75

Community Input – Substance Abuse ................................................................................76

Preventive Practices .................................................................................................................78

Flu and Pneumonia Vaccines.............................................................................................78

Immunization of Children ...................................................................................................78

Mammograms ....................................................................................................................79

Pap Smears .......................................................................................................................79

Colorectal Cancer Screening .............................................................................................79

Community Input – Preventive Practices ............................................................................80

Community Input .......................................................................................................................82

Additional Comments or Concerns .....................................................................................82

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Attachment 1 – Community Stakeholder Interviewees ..............................................................84

Attachment 2 – Community Resources .....................................................................................86

Attachment 3 – Impact Evaluation .............................................................................................90

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Introduction

Background and Purpose

Since its beginning in 1902, Cedars-Sinai has continually set new standards in quality

and innovation in patient care, research, teaching and community service. Located in

Los Angeles, Cedars-Sinai is one of the largest nonprofit academic medical centers in

the U.S. with 886 licensed beds, 2,100 physicians, 2,800 nurses and thousands of other

health care professionals and staff. Clinical programs range from primary care for

preventing, diagnosing and treating common conditions to specialized treatments for

rare, complex and advanced illnesses. In addition, Cedars-Sinai serves the community

through its Medical Network, which includes the highly rated Cedars-Sinai Medical

Group and Cedars-Sinai Health Associates.

Cedars-Sinai has consistently been named one of America’s Best Hospitals by U.S.

News & World Report, has received the National Research Corporation’s Consumer

Choice Award 18 years in a row for providing the highest quality medical care in Los

Angeles, and has the longest running Magnet designation for nursing excellence in

California. Cedars-Sinai is a leader in the clinical care and research of heart disease,

cancer and brain disorders, among other areas. Pioneering research achievements

include using cardiac stem cells to repair damaged hearts, developing minimally

invasive surgical techniques and discovering new types of drugs to target cancer more

precisely. Most notably, Cedars-Sinai demonstrates a longstanding commitment to

strengthening the Los Angeles community through wide-ranging programs that improve

the health of its most vulnerable residents.

Cedars-Sinai has undertaken a Community Health Needs Assessment (CHNA) as

required by state and federal law. California’s Senate Bill 697 and the Patient

Protection and Affordable Care Act through the IRS section 501(r)(3) regulations direct

tax-exempt hospitals to conduct a Community Health Needs Assessment and develop

an Implementation Strategy every three years.

The Community Health Needs Assessment is a primary tool used by Cedars-Sinai to

determine its community benefit plan, which outlines how it will give back to the

community in the form of health care and other community services to address unmet

community health needs. This assessment incorporates primary and secondary data

that focus on the health and social needs of the Community Benefit Service Area.

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Service Area

Cedars-Sinai is located at 8700 Beverly Boulevard, Los Angeles, California 90048. The

Community Benefit service area includes large portions of Service Planning Areas

SPAs) 4 (Metro), 5 (West) and 6 (South), and smaller portions of SPA 8 (South Bay) in

Los Angeles County. The Community Benefit service area includes 52 zip codes,

representing 25 cities or neighborhoods. To determine the Community Benefit Service

Area, Cedars-Sinai takes into account the zip codes of inpatients discharged from the

hospital; the current understanding of community need based on the most recent

Community Health Needs Assessment; and long-standing community programs and

partnerships. The Cedars-Sinai Community Benefit Service Area is presented below by

community, zip code and Service Planning Area (SPA).

Cedars-Sinai Community Benefit Service Area

Geographic Area Zip Code SPA

Baldwin Hills 90008 SPA 6

Beverly Hills 90210, 90211, 90212 SPA 5

Brentwood/Westwood 90024 SPA 5

Central LA 90013, 90014, 90015, 90017 SPA 4

Century City 90067 SPA 5

Crenshaw 90016, 90018 SPA 6

Culver City 90230, 90232 SPA 5

Downtown LA 90010, 90021, 90071, 90079 SPA 4

Fairfax/Mid-City 90019, 90036 SPA 4

Hollywood 90028, 90038 SPA 4

Inglewood 90301, 90302, 90303, 90305 SPA 8

Hyde Park 90043 SPA 6

L.A./Coliseum & MLK Blvd 90011 SPA 6

L.A./MLK & Hobart 90062 SPA 6

Ladera Heights 90056 SPA 5

Lennox 90304 SPA 8

South Central LA 90001, 90002, 90003, 90044, 90047 SPA 6

South Los Angeles 90059 SPA 6

University 90037, 90089 SPA 6

USC 90007 SPA 6

West Hollywood 90046, 90048, 90069 SPA 4

West LA/Palms 90034 SPA 5

West LA/Rancho 90025, 90035, 90064 SPA 5

Wilshire/Koreatown 90004, 90005, 90020 SPA 4 & 6

Wilshire 90006, 90057 SPA 4

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Map of the Community Benefit Service Area

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Project Oversight

The Community Health Needs Assessment process was overseen by:

Cindy Levey, MPH

Associate Director, Community Benefit Systems and Planning

Cedars-Sinai

Consultant

Biel Consulting, Inc. conducted the Community Health Needs Assessment. Biel

Consulting, Inc. is an independent consulting firm that works with hospitals, clinics and

community-based nonprofit organizations. Dr. Melissa Biel conducted the Cedars-Sinai

Community Health Needs Assessment. She was joined by Sevanne Sarkis, JD, MHA,

MEd, and Denise Flanagan, BA. Biel Consulting, Inc. has extensive experience

conducting hospital Community Health Needs Assessments and working with hospitals

on developing, implementing, and evaluating community benefit programs.

www.bielconsulting.com

http://www.bielconsulting.com/

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Methods

Secondary Data Collection

Secondary data were collected from a variety of local, county, and state sources to

present community demographics, social and economic factors, health care access,

birth characteristics, leading causes of death, chronic disease, health behaviors, mental

health and substance abuse and preventive practices. Analyses were conducted at the

most local level possible for the Community Benefit Service Area, given the availability

of the data. For the purposes of this Needs Assessment, when examining data by SPA,

the SPA 4, 5, and 6 geographic areas are presented.

Sources of data include Nielsen Claritas, accessed through the Healthy Communities

Institute, the U.S. Census American Community Survey, the California Health Interview

Survey, the California Department of Public Health, the California Employment

Development Department, the Los Angeles County Health Survey, the Los Angeles

Homeless Services Authority, the Uniform Data System, the National Cancer Institute,

the California Department of Education, and others. When pertinent, these data sets

are presented in the context of Los Angeles County and California State, framing the

scope of an issue as it relates to the broader community.

Secondary data for the Community Benefit Service Area were collected and

documented in data tables with narrative explanation. The tables present the data

indicator, the geographic area represented, the data measurement (e.g. rate, number,

or percent), county and state comparisons (when available), the data source, data year

and an electronic link to the data source. Analysis of secondary data included an

examination and reporting of health disparities for some health indicators. The report

includes benchmark comparison data that measures Cedars-Sinai data findings as

compared to Healthy People 2020 objectives. Healthy People 2020 objectives are a

national initiative to improve the public’s health by providing measurable objectives and

goals that are applicable at national, state, and local levels.

Primary Data Collection

Targeted interviews were used to gather information and opinions from persons who

represent the broad interests of the community served by the hospital. Given shared

service areas, Cedars-Sinai partnered with UCLA Health, Kaiser Foundation Hospital –

West Los Angeles and Providence St. John’s Health Center to conduct the interviews.

Thirty-six (36) interviews were completed from September through November, 2015.

For the interviews, community stakeholders identified by Cedars-Sinai, in partnership

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with UCLA Health, Kaiser Foundation Hospital – West Los Angeles and Providence St.

John’s Health Center, were contacted and asked to participate in the needs

assessment. Interviewees included individuals who are leaders and representatives of

medically underserved, low-income, and minority populations, or local health or other

departments or agencies that have “current data or other information relevant to the

health needs of the community served by the hospital facility.” Input was obtained from

Los Angeles County Department of Public Health officials.

The identified stakeholders were invited by email to participate in a one hour phone

interview. Appointments for the interviews were made on dates and times convenient to

the stakeholders. At the beginning of each interview, the purpose of the interview in the

context of the assessment was explained, the stakeholders were assured their

responses would remain confidential, and consent to proceed was given. A list of the

stakeholder interview respondents, their titles and organizations can be found in

Attachment 1.

Initially, significant health needs were identified through a review of the secondary

health data collected and analyzed prior to the interviews. These data were then used

to help guide the interviews. The needs assessment interviews were structured to

obtain greater depth and richness of information and build on the secondary data

review. During the interviews, participants were asked to identify the major health

issues in the community, and socioeconomic, behavioral, environmental or clinical

factors contributing to poor health. They were asked to share their perspectives on the

issues, challenges and barriers relative to the significant health needs, and identify

resources to address these health needs, such as services, programs and/or

community efforts. The interviews focused on these significant health needs:

Access to care

Asthma

Cancer

Community safety

Dental care

Diabetes

Heart disease

HIV/AIDS

Homelessness/housing

Mental health

Overweight and obesity

Preventive practices

Substance abuse

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Interview participants were asked to provide additional comments to share with Cedars-

Sinai. Analysis of the primary data occurred through a process that compared and

combined responses to identify themes. All responses to each question were examined

together and concepts and themes were then summarized to reflect the respondents’

experiences and opinions. The results of the primary data collection were reviewed in

conjunction with the secondary data. Primary data findings were used to corroborate

the secondary data-defined health needs, serving as a confirming data source. The

responses are included in the following Community Health Needs Assessment

chapters.

Information Gaps

Information gaps that impact the ability to assess health needs were identified.

Specifically, cancer incidence rates are not available at a rate more local than Los

Angeles County. Some of the secondary data are not always collected on a regular

basis, meaning that some data are several years old. Specifically, the results of the

most recent Los Angeles County Health Survey (a population based telephone survey

that provides information concerning the health of Los Angeles County residents) were

not yet available during the conduct of this CHNA.

Public Comment

In compliance with IRS regulations 501(r) for charitable hospitals, a hospital Community

Health Needs Assessment (CHNA) and Implementation Strategy are to be made widely

available to the public and public comment is to be solicited. In compliance with these

regulations, the previous Cedars-Sinai Community Health Needs Assessment and

Implementation Strategy were made widely available to the public on the website

http://www.cedars-sinai.edu/Community-Benefit/Community-Needs-

Assessment/index.aspx. Public comment was requested on these reports. To date, no

written comments have been received.

http://www.cedars-sinai.edu/Community-Benefit/Community-Needs-Assessment/index.aspx

http://www.cedars-sinai.edu/Community-Benefit/Community-Needs-Assessment/index.aspx

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Identification of Significant Health Needs

Review of Primary and Secondary Data

Health needs were identified from secondary data using the size of the problem (relative

portion of population afflicted by the problem) and the seriousness of the problem

(impact at individual, family, and community levels). To determine size or seriousness

of the problem, the health need indicators identified in the secondary data were

measured against benchmark data, specifically county rates, state rates and/or Healthy

People 2020 objectives. Indicators related to the health needs that performed poorly

against one or more of these benchmarks met this criterion to be considered a health

need.

The analysis of secondary data yielded a preliminary list of significant health needs,

which then informed primary data collection. The primary data collection process was

designed to validate secondary data findings, identify additional community issues,

solicit information on disparities among subpopulations, ascertain community assets to

address needs and discover gaps in resources.

Significant Health Needs

The following significant health needs were determined:

Access to care

Asthma

Cancer

Community safety

Dental care

Diabetes

Heart disease

HIV/AIDS

Homelessness/housing

Mental health

Overweight and obesity

Preventive practices

Substance abuse

Resources to Address Significant Needs

Through the interview process, community stakeholders identified community resources

to address the significant health needs. The identified community resources are

presented in Attachment 2.

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Priority Health Needs

The identified significant health needs were prioritized with input from the community.

Interviews with community stakeholders were used to gather input on the significant

health needs. The following criteria were used to prioritize the health needs:

The perceived severity of a health issue or health factor/driver as it affects the

health and lives of those in the community;

The level of importance the hospital should place on addressing the issue.

The stakeholder interviewees was asked to rank each of the significant health need on

a scale of 1 to 5 for severity (where 1 was least severe and 5 was most severe), and on

a scale of 1 to 5 for importance (where 1 was not important and 5 is very important to

address). The total score for each health need was divided by the total number of

interviewees who responded to the questions, resulting in an overall average for each

health need.

Not all survey respondents answered every question, therefore, the ratings were

calculated based on respondents only and not on the entire sample size. The

calculations of the community stakeholder survey resulted in the following prioritization

of the significant health needs. When ranked by importance, access to care, diabetes,

heart disease, substance abuse, overweight/obesity, preventive practices, mental health

and cancer received a score of 4.0 or higher, indicating an issue was considered

important or very important.

Significant Health Needs Ranked by Importance Score

Significant Health Needs Importance

(Total Possible Score of 5)

Severity


Access to care 4.7 4.4

Diabetes 4.3 4.0

Heart disease 4.3 3.9

Substance abuse 4.2 4.1

Overweight/obesity 4.2 3.9

Preventive practices 4.2 4.1

Mental health 4.2 4.3

Cancer 4.2 3.6

Homelessness 3.7 4.4

HIV/AIDS 3.6 3.3

Dental care 3.4 3.8

Asthma 3.4 3.0

Community safety 3.2 3.8

When the health needs were ranked by severity, access to care, homelessness, mental

health, substance abuse, preventive practices, and diabetes received a score of 4.0 or

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higher, indicating a health need was considered severe or very severe.

Significant Health Needs Ranked by Severity Score

Significant Health Needs Severity


Importance


Access to care 4.4 4.7

Homelessness 4.4 3.7

Mental health 4.3 4.2

Substance abuse 4.1 4.2

Preventive practices 4.1 4.2

Diabetes 4.0 4.3

Heart disease 3.9 4.3

Overweight/obesity 3.9 4.2

Dental care 3.8 3.4

Community safety 3.8 3.2

Cancer 3.6 4.2

HIV/AIDS 3.3 3.6

Asthma 3.0 3.4

Calculations totaling severity and importance scores from the community stakeholder

interviews resulted in the following prioritization of the significant health needs:

Significant Health Needs Priority Ranking


Access to care 4.5

Substance abuse 4.2

Mental health 4.2

Diabetes 4.2

Preventive practices 4.2

Overweight/obesity 4.1

Heart disease 4.1

Homelessness 4.0

Cancer 3.9

Dental care 3.6

Community safety 3.5

HIV/AIDS 3.5

Asthma 3.2

Community input on these health needs is detailed throughout the CHNA report.

Impact Evaluation

In 2013, Cedars-Sinai conducted their previous Community Health Needs Assessment

(CHNA). Significant health needs were identified from issues supported by primary and

secondary data sources gathered for the Community Health Needs Assessment. In

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developing the hospital’s Implementation Strategy associated with the 2013 CHNA,

Cedars-Sinai chose to address access to care (primary care and specialty care), mental

health, preventive care, cardiovascular disease, diabetes, cancer, and

overweight/obesity through a commitment of community benefit programs and

resources. The evaluation of the impact of actions the hospital used to address these

significant health needs can be found in Attachment 3.

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Community Demographics

Population

The population of the Cedars-Sinai Community Benefit Service Area is 1,827,324.

From 2010 to 2015, the population increased by 3.4%, slightly higher than the rate

experienced countywide.

Change in Total Population 2010-2015

Population Cedars-Sinai Service Area Los Angeles County

Total Population 2015 1,827,324 10,136,509

Change in Population 2010-2015 3.4% 3.2% Source: Healthy Communities institute/Claritas, 2015.

Of the area population, 49.7% are male and 50.3% are female.

Population by Gender

Gender Cedars-Sinai Service Area Los Angeles County

Male 49.7% 49.3%

Female 50.3% 50.7% Source: Healthy Communities Institute/Claritas, 2015.

Children and youth, ages 0-17, make up 23% of the population; 66.3% are adults, ages

18-64; and 10.7% of the population are seniors, 65 and over. The median age in the

Community Benefit Service Area is 34.2, lower than the County's median age of 36.0.

Population by Age

Age Ranges Cedars-Sinai Service Area Los Angeles County

0 – 4 6.5% 6.4%

5 – 9 6.5% 6.4%

10 – 14 6.1% 6.4%

15 – 17 3.9% 4.2%

18 – 20 4.6% 4.3%

21 – 24 6.3% 5.9%

25 – 34 17.6% 15.1%

35 – 44 15.0% 14.1%

45 – 54 12.9% 13.7%

55 – 64 10.1% 11.4%

65 – 74 6.0% 7.0%

75 – 84 3.2% 3.6%

85+ 1.5% 1.7%

2015 Median Age 34.2 36.0 Source: Healthy Communities Institute/Claritas, 2015.

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When the Community Benefit Service Area is examined by zip code, Inglewood, South

Central Los Angeles and South Los Angeles have the largest percentage of youth, ages

0-17. Century City has the highest percentage of residents 65 and older (53.4%).

Population by Youth, Ages 0-17, and Seniors, Ages 65+

Geographic Area Zip Code Youth

Ages 0 – 17 Seniors

Ages 65+

Baldwin Hills 90008 21.9% 16.5%

Beverly Hills 90210 18.5% 24.8%

Beverly Hills 90211 16.8% 17.1%

Beverly Hills 90212 15.8% 17.6%

Brentwood/Westwood 90024 8.5% 12.8%

Central LA 90013 4.2% 14.4%

Central LA 90014 4.3% 13.0%

Central LA 90015 22.0% 9.5%

Central LA 90017 24.6% 7.9%

Century City 90067 6.5% 53.4%

Crenshaw 90016 24.5% 11.4%

Crenshaw 90018 25.2% 11.4%

Culver City 90230 20.9% 15.7%

Culver City 90232 17.6% 14.5%

Downtown LA 90010 N/A N/A

Downtown LA 90021 11.6% 8.4%



Fairfax/Mid-City 90019 21.2% 12.2%

Fairfax/Mid-City 90036 17.4% 10.0%

Hollywood 90028 10.3% 11.4%

Hollywood 90038 18.7% 9.2%

Hyde Park 90043 22.6% 15.2%

Inglewood 90301 25.5% 10.3%

Inglewood 90302 25.4% 9.6%

Inglewood 90303 28.2% 10.0%

Inglewood 90305 19.0% 18.8%

L.A./Coliseum & MLK Blvd. 90011 32.8% 5.3%

L.A./MLK & Hobart 90062 26.5% 9.9%

Ladera Heights 90056 15.9% 24.8%

Lennox 90304 30.4% 6.6%

South Central LA 90001 32.9% 6.3%





South Los Angeles 90059 33.4% 6.6%

University 90037 29.2% 6.9%

University 90089 5.8% 0.1%

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Geographic Area Zip Code Youth

Ages 0 – 17 Seniors

Ages 65+

USC 90007 18.3% 6.8%

West Hollywood 90046 8.7% 15.4%



West LA/Palms 90034 17.4% 9.5%

West LA/Rancho 90025 13.3% 12.8%

West LA/Rancho 90035 20.4% 15.2%

West LA/Rancho 90064 19.7% 17.3%

Wilshire 90006 24.5% 9.5%

Wilshire 90057 23.8% 9.8%

Wilshire/Koreatown 90004 21.1% 10.3%



Cedars-Sinai Service Area 23.0% 10.7%

Los Angeles County 23.3% 12.2% Source: Healthy Communities Institute/Claritas, 2015.

Race/Ethnicity

In the Cedars-Sinai Community Benefit Service Area, 49.6% of the population is

Hispanic/Latino; 19.7% of the residents are White; 18% are African American; 10.1%

are Asian; and 2.7% are American Indian/Alaskan Native or other race/ethnicity. This is

a lower percentage of Whites and Asians, and a higher percentage of Blacks, than

found at the county level.

Race/Ethnicity

Race/Ethnicity Cedars-Sinai Service Area Los Angeles County

Hispanic/Latino 49.6% 48.8%

White 19.7% 26.4%

Black/African American 18.0% 8.0%

Asian 10.1% 14.0%

American Indian/Alaska Native 0.2% 0.2%

Native Hawaiian/Pacific Islander 0.1% 0.2%

Other 2.4% 2.4% Source: Healthy Communities Institute/Claritas, 2015.

Language

The languages spoken at home by area residents mirror the racial/ethnic make-up of

the Cedars-Sinai Community Benefit Service Area communities. English is spoken in

the home among 39.3% of the population. Spanish is spoken at home among 46.1% of

the population; 7.9% of the population speak an Asian language; and 5.3% of the

population speaks an Indo-European language at home.

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Language Spoken at Home, Population 5 Years and Older

Languages Cedars-Sinai Service Area Los Angeles County

Speaks Only English 39.3% 42.9%

Speaks Spanish 46.1% 39.6%

Speaks Asian/Pacific Islander Language 7.9% 10.9%

Speak Indo-European Language 5.3% 5.6%

Speaks Other Language 1.5% 1.1% Source: Healthy Communities Institute/Claritas, 2015.

When communities in SPAs 4, 5, and 6 are examined by language spoken in the home,

a number of communities have high percentages of Spanish speakers including: Central

Los Angeles, L.A./Coliseum, South Central Los Angeles, University, and Wilshire.

Neighborhoods with a high percentage of Asian language speakers include: Brentwood/

Westwood, Central Los Angeles, Fairfax, Wilshire and University (90089). Beverly Hills,

Brentwood/Westwood, Century City, Hollywood, West Hollywood and West Los Angeles

have higher rates of residents who speak Indo-European languages at home.

Language Spoken at Home by Zip Code

Geographic Area Zip

Code English Spanish

Asian/Pacific Islander

Indo European

Baldwin Hills 90008 73.6% 20.7% 1.5% 1.9%

Beverly Hills 90210 52.4% 6.6% 3.1% 34.3%

Beverly Hills 90211 48.2% 3.3% 6.9% 35.8%

Beverly Hills 90212 57.1% 6.0% 5.4% 28.4%

Brentwood/Westwood 90024 54.6% 8.6% 18.0% 15.5%

Central LA 90013 65.5% 13.9% 16.8% 3.2%

Central LA 90014 67.2% 16.8% 12.0% 3.3%

Central LA 90015 20.1% 64.8% 11.9% 2.6%

Central LA 90017 18.4% 66.2% 13.5% 1.6%

Century City 90067 67.2% 5.2% 8.1% 16.5%

Crenshaw 90016 45.0% 50.2% 1.7% 1.1%

Crenshaw 90018 38.4% 56.3% 2.5% 1.0%

Culver City 90230 55.6% 29.2% 7.7% 5.5%

Culver City 90232 58.7% 24.0% 7.6% 7.2%

Downtown LA 90010 N/A N/A N/A N/A

Downtown LA 90021 50.2% 38.9% 9.4% 1.1%



Fairfax/Mid-City 90019 39.3% 42.7% 14.2% 2.2%

Fairfax/Mid-City 90036 64.3% 8.2% 13.9% 9.5%

Hollywood 90028 44.9% 32.8% 5.5% 15.8%

Hollywood 90038 28.6% 53.9% 6.3% 10.2%

Hyde Park 90043 68.2% 26.8% 0.9% 2.2%

Inglewood 90301 40.6% 55.1% 1.2% 1.3%

Inglewood 90302 53.9% 41.6% 1.5% 1.2%

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Geographic Area Zip

Code English Spanish

Asian/Pacific Islander

Indo European

Inglewood 90303 38.9% 58.0% 1.9% 0.6%

Inglewood 90305 87.7% 8.0% 1.5% 1.3%

L.A./Coliseum & MLK 90011 10.7% 88.3% 0.7% 0.2%

L.A./MLK & Hobart 90062 39.1% 59.2% 1.0% 0.5%

Ladera Heights 90056 88.2% 6.7% 1.3% 0.5%

Lennox 90304 14.7% 83.7% 0.9% 0.2%

South Central LA 90001 13.4% 86.3% 0.2% 0.1%

South Central LA 90002 29.3% 70.0% 0.3% 0.3%

South Central LA 90003 27.8% 71.4% 0.2% 0.3%

South Central LA 90044 40.4% 57.9% 0.8% 0.5%

South Central LA 90047 67.2% 30.6% 0.7% 0.5%

South Los Angeles 90059 39.1% 60.1% 0.3% 0.3%

University 90037 23.6% 75.1% 0.6% 0.5%

University 90089 59.1% 5.7% 24.2% 6.3%

USC 90007 33.5% 49.2% 11.8% 4.2%

West Hollywood 90046 58.9% 9.9% 4.4% 23.4%

West Hollywood 90048 62.8% 7.1% 5.4% 19.5%

West Hollywood 90069 72.5% 8.9% 2.1% 14.6%

West LA/Palms 90034 48.8% 25.4% 12.0% 10.3%

West LA/Rancho 90025 56.1% 15.4% 11.0% 16.5%

West LA/Rancho 90035 58.8% 11.8% 5.2% 14.7%

West LA/Rancho 90064 62.0% 11.3% 12.2% 11.6%

Wilshire 90006 9.5% 71.5% 17.8% 0.7%

Wilshire 90057 12.0% 66.7% 19.4% 1.0%

Wilshire/Koreatown 90004 25.1% 48.1% 23.2% 3.2%



Cedars-Sinai Service Area 39.3% 46.1% 7.9% 5.3%

Los Angeles County 42.9% 39.6% 10.9% 5.6% Source: Healthy Communities Institute/Claritas, 2015.

21

Social and Economic Factors

Social and Economic Factors Ranking

Through the County Health Rankings database, social and economic indicators are

examined as a contributor to the health of a county’s residents. California’s 58 counties

are ranked according to social and economic factors with 1 being the county with the

best factors to 58 for that county with the poorest factors. This ranking examines high

school graduation rates, unemployment, children in poverty, social support, and others.

Los Angeles County is ranked as 42, in the bottom half of all California counties

according to social and economic factors—its lowest ranking in 4 years.

Social and Economic Factors Ranking

Geographic Area County Ranking (out of 58)

Los Angeles County 42

Source: County Health Rankings, 2015. www.countyhealthrankings.org

Poverty

Poverty thresholds are used for calculating all official poverty population statistics. They

are updated each year by the Census Bureau. For 2014 (the most recent year for

available data), the federal poverty level (FPL) for one person was an annual income of

$11,670 and for a family of four was $23,850.

Among the residents represented in the Cedars-Sinai Community Benefit Service Area,

SPA 6 has the highest poverty rates: 34.2% are at or below 100% of the federal poverty

level (FPL) and 69.7% are at 200% or below FPL. In SPA 4, 27.1% are at or below

100% FPL and 57.4% below 200% FPL; while in SPA 5 2.2% are at or below 100% FPL

and 15% below 200% FPL. Rates of poverty in SPA 4 and SPA 6 are higher than found

in the county.

Poverty Level

Poverty Level SPA 4 SPA 5 SPA 6 Los Angeles County

<100% FPL 27.1% 2.2% 34.2% 21.0%

<200% FPL 57.4% 15.0% 69.7% 45.1% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

A view of children in poverty by Service Planning Area (SPA) indicates that 44.1% of

children in SPA 6 live below the FPL, with 36.7% of children in SPA 4 also at poverty

level. In SPA 6, 76.9% of children are categorized as low-income (<200% FPL), while

68.4% of children in SPA 4 and 4.3% of children in SPA 5 are low-income.

http://www.countyhealthrankings.org/

http://ask.chis.ucla.edu/

22

Children in Poverty, Ages 0-17

Poverty Level SPA 4 SPA 5 SPA 6 Los Angeles County

0-99% FPL 36.7% 0.0%* 44.1% 27.2%

100-199% FPL 31.7% 4.3% 32.8% 25.2%

200-299% FPL 6.6% 9.0% 14.4% 14.5%

300% FPL and above 25.0% 86.7% 8.7% 33.1% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/ * = statistically unstable due to sample size

According to the 2014 California Health Interview Survey, 51.9% of adult residents of

SPA 4 and 46.1% of SPA 6 adults living below 200% of the Federal Poverty Level

reported food insecurity. This was higher than both the state average of 38.4%, and the

county level of 39.5%. 6.4% of low-income adults in SPA 5 are food insecure.

Food Insecurity, Adults below 200% of Poverty

Geographic Area Percent

SPA 4 51.9%

SPA 5 6.4%*

SPA 6 46.1%

Los Angeles County 39.5%

California 38.4% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/

* = statistically unstable due to sample size

Families in poverty paint an important picture of the population within the Cedars-Sinai

Community Benefit Service Area. Almost one-quarter (24%) of families in the

Community Benefit Service Area live in poverty. When examined by zip code,

community poverty rates are high among families in Central Los Angeles,

L.A./Coliseum, South Central Los Angeles, South Los Angeles, University, USC, and

Wilshire neighborhoods.

Families in Poverty by Zip Code (<100% FPL)

Geographic Area Zip Code Percent

Baldwin Hills 90008 23.5%

Beverly Hills 90210 7.0%



Brentwood/Westwood 90024 6.3%

Central LA 90013 9.7%




Century City 90067 6.2%

Crenshaw 90016 20.1%



23

Geographic Area Zip Code Percent


Culver City 90230 10.3%


Downtown LA 90010 N/A

Downtown LA 90021 28.6%



Fairfax/Mid-City 90019 21.1%


Hollywood 90028 23.6%


Hyde Park 90043 19.8%

Inglewood 90301 21.2%




L.A./Coliseum & MLK Blvd. 90011 43.7%

L.A./MLK & Hobart 90062 26.5%

Ladera Heights 90056 4.2%

Lennox 90304 28.9%

South Central LA 90001 32.7%





South Los Angeles 90059 36.2%

University 90037 40.2%

University * 90089 50.0%

USC 90007 37.2%

West Hollywood 90046 9.6%



West LA/Palms 90034 11.3%

West LA/Rancho 90025 6.5%



Wilshire 90006 32.1%


Wilshire/Koreatown 90004 21.4%



Cedars-Sinai Service Area 24.0%


Source: Healthy Communities Institute/Claritas, 2015.

* While the 90089 zip code has a population of 1,618, only 6 family units were identified, making this an unstable statistic.

24

Households

In the Cedars-Sinai Community Benefit Service Area there are 651,344 households and

704,249 housing units. Over the last decade, households grew by 4%. Housing units

(3.8%) grew at approximately the same rate. These rates of growth in the Community

Benefit Service Area are higher than the county growth in households and housing

units.

Households and Housing Units, 2015 and Growth Rate, 2010-2015

Households Cedars-Sinai Service Area Los Angeles County

Number Percent Growth Number Percent Growth

Households 651,344 4.0% 3,348.931 3.3%

Housing Units 704,249 3.8% 3,558,007 3.3% Source: Healthy Communities Institute/Claritas, 2015.

The median household income in the Community Benefit Service Area is $43,878 and

the average household income is $63,878. These rates are lower than the county rates.

Household Income

Household Income Cedars-Sinai Service Area Los Angeles County

Median Household Income $43,878 $54,514

Average Household Income $63,878 $78,309 Source: Healthy Communities Institute/Claritas, 2015.

Free or Reduced Price Meals

The percentage of students eligible for the free or reduced price meal program is one

indicator of socioeconomic status. Among Los Angeles Unified School District schools,

over three-fourths (75.6%) of the student population are eligible for the free or reduced

price meal program, indicating a high level of low-income families. In the Inglewood

Unified School District 78.3% of students qualify for the program. 90% of Lennox

School District students are eligible for the free or reduced price meal program. These

rates are higher than county and state rates.

Free or Reduced Price Meals Eligibility

School District Percent Eligible Students

Lennox School District 90.0%

Inglewood Unified School District 78.3%

Los Angeles Unified School District 75.6%

Culver City Unified School District 34.4%

Beverly Hills Unified School District 6.7%


California 58.6% Source: California Department of Education, 2014-2015. http://data1.cde.ca.gov/dataquest/

http://nces.ed.gov/ccd/pubschuniv.asp

http://data1.cde.ca.gov/dataquest/

25

Public Program Participation

Residents in SPA 6 have higher rates of participation in government sponsored public

programs compared to residents in SPA 4 and SPA 5. In SPA 4, 51.9% of residents

below 200% of the FPL cannot afford food and 17.4% utilize food stamps. In SPA 6,

46.1% of residents below 200% FPL cannot afford food and 26.6% utilize food stamps.

These rates indicate a considerable percentage of residents who may qualify for food

stamps but do not access this resource. WIC benefits are more readily accessed.

Among children in SPA 4, 36.9% access WIC, and in SPA 6 67.1% access WIC

benefits. SPA 5 respondents did not report accessing WIC for their children. Among

SPA 6 residents, 16% are TANF/CalWorks recipients; 5.6% of SPA 4 residents and

2.3% of SPA 5 residents are TANF/CalWorks recipients.

Public Program Participation

Public Programs SPA 4 SPA 5 SPA 6 Los Angeles

County

Not Able to Afford Food (<200%FPL) 51.9% 6.4% 46.1% 39.5%

Food Stamp Recipients (<300% FPL) 17.4% 3.0% 26.6% 18.7%

WIC Usage Among Children, 6 Years & Under 36.9% 0.0% 67.1% 50.8%

TANF/CalWorks Recipients 5.6% 2.3% 16.0% 10.6% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Unemployment

The unemployment rates of Cedars-Sinai Community Benefit Service Area cities show a

diverse range from 6.1% in Culver City to 10.8% in Huntington Park and Inglewood.

Los Angeles city has an unemployment rate of 8.7%.

Unemployment Rate, 2014 Average

Source: California Employment Development Department, Labor Market Information; http://www.labormarketinfo.edd.ca.gov/data/unemployment-and-labor-force.html - HIST * Data available by city, therefore, zip code-only areas in the Cedars-Sinai service area are not listed.

Geographic Area* Percent

Beverly Hills 7.9%

Culver City 6.1%

Huntington Park 10.8%

Inglewood 10.8%

Ladera Heights 8.0%

Lennox 8.3%

Los Angeles 8.7%

West Hollywood 6.9%


California 7.5%


http://www.labormarketinfo.edd.ca.gov/data/unemployment-and-labor-force.html#HIST

26

Educational Attainment

Among adults, ages 25 and older, 29.1% of adults lack a high school diploma; this is

higher than the county rate of 23.2%. 19.2% of Community Benefit Service Area adults

are high school graduates and 34.1% are college graduates. In Los Angeles County

20.6% of residents are high school graduates and 36.5% are college graduates.

Educational Attainment of Adults, 25 Years and Older

Educational Attainment Cedars-Sinai Service Area Los Angeles County

Less than 9th Grade 17.7% 13.5%

Some High School, No Diploma 11.4% 9.7%

High School Graduate 19.2% 20.6%

Some College, No Degree 17.6% 19.7%

Associate Degree 5.2% 6.8%

Bachelor Degree 19.0% 19.5%

Master’s Degree 6.0% 6.6%

Professional School Degree 2.7% 2.4%

Doctorate degree 1.2% 1.2% Source: Healthy Communities Institute/Claritas, 2015.

High school graduation rates are determined by taking the number of graduates for the

school year divided by the number of freshman enrolled four years earlier. The high

school graduation rate for LAUSD (70.2%) and Inglewood Unified School District

(72.4%) are lower that the county (77.9%), and state (81%) rates. These districts do not

meet the Healthy People 2020 objective of 82.4% high school graduation rate. The

Lennox School District has a high school graduation rate of 95%. The Lennox School

District has a high school graduation rate of 95%, while Beverly Hills Unified has a

92.6% rate and Culver City Unified has an 89.5% graduation rate. These three districts

meet the HP2020 objective.

High School Graduation Rates, 2013-2014

School District High School Graduation Rate







California 81.0%

Source: California Department of Education, 2015. http://dq.cde.ca.gov/dataquest/.

http://dq.cde.ca.gov/dataquest/

27

Community Input – Social and Economic Factors

Stakeholder interviews identified the most important socioeconomic, behavioral,

environmental and clinical factors contributing to poor health in the community.

Following are their comments, quotes and opinions:

Access to transportation and affordable housing is crucial in lower-income

communities.

Stress and trauma are associated with socioeconomically disadvantaged

neighborhoods. Whether from not having enough money to pay for basic needs or

being around others who are stressed, stress is a driver of toxic environments.

The saying “zip code is more important that genetic code” is very clear. The

environment contributes to issues of poverty and desperation in an area that doesn’t

have integrated health and wellness services.

Poverty is huge issue for people. Lack of health care access drives a lot of

disparities.

Lack of education or quality education, discrimination, homelessness,

unemployment, and immigration status.

Factors impacting our communities include everything from education to income

inequalities to lack of fresh food and green spaces. Transportation is always a

challenge for low-income individuals. Many are uninsured and most are

undocumented as well.

The shortage of affordable housing is extreme. We are experiencing a demographic

shift, even the middle class is moving into homelessness.

People worry about diabetes and hypertension connected to an inadequate income

to purchase food that is nutritious.

The number of undocumented in the community is low but these individuals are

lower income and many are monolingual speakers. They are very neglected

because it is so hard for them to get services.

How much money a person has is driven by education and job readiness and

access opportunities.

There is a lack of adequate nutrition as a result of people having to make choices

between buying food and medicine or paying rent.

Homelessness

Every two years, the Los Angeles Homeless Services Authority (LAHSA) conducts the

Greater Los Angeles Homeless Count to determine how many individuals are homeless

on a given day. Data from this survey show an increase in homelessness from 2013 to

2015. In 2015, SPA 4 had an annualized estimate of 11,681 homeless individuals, SPA

5 had 4,276 homeless individuals, and SPA 6 had 7,513 homeless. In SPA 4, 85.2%

are individuals and 14.1% of the homeless are families. In SPA 5, 83.3% of the

28

homeless are single adults and 16.6% are families. In SPA 6, 77.5% of the homeless

are single adults and 21.2% are families. The percent of unsheltered homeless has

increased from 2013 to 2015, and the percentage of homeless families and

unaccompanied minors has decreased since 2013.

Homeless Population*, 2013-2015 Homeless Count Comparison

Homeless SPA 4 SPA 5 SPA 6

Los Angeles County

2013 2015 2013 2015 2013 2015 2013 2015

Total Homeless 10,472 11,681 3,667 4,276 7,045 7,513 35,524 41,174

Sheltered 41.4% 34.2% 41.3% 30.0% 33.9% 23.9% 36.4% 29.7%

Unsheltered 58.6% 65.7% 58.7% 70.0% 66.1% 76.1% 63.6% 70.3%

Individual Adults 82.1% 85.2% 80.0% 83.3% 77.4% 77.5% 78.9% 81.1%

Family Members 15.0% 14.1% 17.6% 16.6% 21.5% 21.2% 18.8% 18.2%

Unaccompanied Minors (<18) 2.9% <1% 2.3% <1% 1.1% 1.3% 2.3% <1% Source: Los Angeles Homeless Service Authority, 2013 & 2015 Greater Los Angeles Homeless Count.

www.lahsa.org/homelesscount_results

*These data represent the homeless counts from the LA County Continuum of Care, which does not include Glendale, Long Beach

and Pasadena homeless counts.

Among the homeless population, 31.4% in SPA 4, 43% in SPA 5 and 29.3% in SPA 6

are chronically homeless. The rates of chronic homelessness have increased from

2013 to 2015. The homeless in SPA 5 have high rates of mental illness (40.9%). SPA

5 also had the highest area rates of homeless veterans (20.8%). There is a notable

increase from 2013 to 2015 in the homeless population with a domestic violence

experience.

Homelessness Subpopulations*

Homeless Subpopulations SPA 4 SPA 5 SPA 6

Los Angeles County

2013 2015 2013 2015 2013 2015 2013 2015

Chronically Homeless 22.3% 31.4% 22.4% 43.0% 25.9% 29.3% 24.5% 34.4%

Substance Abuse 30.3% 24.3% 30.1% 26.8% 30.6% 17.1% 31.2% 25.2%

Mentally Illness 28.3% 29.2% 28.1% 40.9% 26.9% 25.2% 28.0% 29.8%

Veterans 11.6% 10.6% 11.5% 20.8% 10.7% 6.3% 11.3% 9.8%

Domestic Violence Experience 9.2% 22.5% 9.2% 27.0% 8.4% 16.6% 1.0% 21.4%

Physical Disability 18.4% 17.4% 18.3% 25.2% 16.8% 17.9% 8.9% 19.8%

Persons with HIV/AIDS 1.0% 3.2% 1.0% 1.8% 0.9% 1.3% 0.6% 0.2%

Source: Los Angeles Homeless Service Authority, 2013 & 2015 Greater Los Angeles Homeless Count.

www.lahsa.org/homelesscount_results

*These data represent the homeless counts from the LA County Continuum of Care, which does not include Glendale, Long Beach

and Pasadena homeless counts.

http://www.lahsa.org/homelesscount_results

http://www.lahsa.org/homelesscount_results

29

Community Input – Housing and Homelessness

Stakeholder interviews identified the following issues, challenges and barriers related to

housing and homelessness. Following are their comments, quotes and opinions:

Homelessness is getting worse. It revolves around joblessness and inner city issues

with education and crime.

Our shelters are full and struggling. We have additional challenges in getting people

off the streets. We have seen a shift to bring services to people on the street and

integrate mental health teams to stabilize people on the street and get them to

where they can consider options that may be available. But still there are very

limited housing and beds in shelters.

LAUSD has 7,000 homeless students that we know of. They move all the time and it

is hard to track them. We know that many of the undocumented are in L.A. living on

the edge. Also many LAUSD kids live in overcrowded housing. We see asthma,

child abuse, stress from that many families all living together.

Homelessness has gotten worse in SPA 4. We are working with the Los Angeles

County Healthy Neighborhoods collaboration with mental health, care providers, and

Department of Public Health to ensure care is coordinated in Hollywood Wilshire and

skid row. We are seeing promising results and all organizations that are involved

are committed to coordinating care.

The lack of affordable housing is getting worse. Because it is so hard to maintain

stable housing people can’t get off the streets. There are some really good efforts

for a Coordinated Entry System with LA Housing Services Authority, working to

consolidate resources so people can go to one place for eligibility of services.

20% of people with substance abuse problems are homeless at the time they are

admitted for services. Programs help them stop abuse, but when they are

discharged it is hard for them to find stable housing. They don’t have money and the

Section 8 housing wait list is so long that they go back on the streets. Even if they

can qualify for general relief, they only get $220 a month, which won’t pay for rent.

In some areas it seems like homelessness has gotten better, but that may be

because the homeless have been pushed to other areas. With the chronic

homeless, physical and mental state of mind is not what it should be and a number

of collaboratives are dealing with this. There are not enough shelters and housing.

Housing and homelessness is such a big issue. We get a lot of calls from families

who are already living in cars, another person’s home, etc.

Housing is the number one issue that people identify as a barrier. For the

chronically mentally ill it is very difficult to get them to accept services. There are

movements in LA and nationally to place the homeless in a livable situation and then

provide supportive wraparound services. It has helped but there are more homeless

than we can house. People who have lost jobs now live in cars or couch surf. They

30

would be amenable to support if they could get it. This is a systemic issue.

Lack of housing is a huge problem. Korean seniors have a high rate of living in

poverty. When little Tokyo opened low-income housing, hundreds of people signed

up for each space. And seniors were being taken advantage of. They were paying

people to move them to the front of the line for housing. People were so desperate

they squandered all their savings.

We don’t have affordable housing so people are cash strapped. Rental costs are

too expensive. People are concerned about getting the rent paid more than

accessing fresh food and going to the dentist. Instability of housing occurs if people

are barely making ends meet, and they move around a lot. This causes stress,

worry, anxiety and depression, particularly among kids. When kids move around in

an unstable housing environment, they have disrupted social and peer networks,

lower possibility of coming to school every day; and increased absenteeism. The

MacArthur Foundation showed that long-term health issues can be traced back to

lack of housing stability as a child. Also quality of housing is hugely impactful on

health. Mold, rodents, roaches can trigger asthma and other conditions; it is

unsanitary. Many old homes have paint issues, lead exposure, and many other

issues.

Crime and Violence

Violent crimes include homicide, rape, robbery and assault. Crime statistics indicate

that Community Benefit Service Area cities, with the exception of Beverly Hills, have

higher rates of violent crime than the county or state. West Hollywood had the highest

rate of violent crime (966.5 per 100,000 persons) and the highest rate of property

crimes (4,695.3 per 100,000 persons). Culver City also has high rates of property

crimes (4,452.5 per 100,000 persons).

Violent Crimes Rates and Property Crime Rates, per 100,000 Persons, 2012

Geographic Area Property Crime Rates Violent Crime Rates

Beverly Hills 3,117.3 256.7

Culver City 4,452.5 452.8

Huntington Park 3,244.8 631.4

Inglewood 2,397.6 699.6

Los Angeles 2,269.1 481.1

West Hollywood 4,695.3 966.5

Los Angeles County* 2,327.1 446.4

California 2,758.7 423.1 Source: U.S Department of Justice, FBI, Uniform Crime Reporting Statistics, 2012. www.bjs.gov/ucrdata/index.cfm

* = https://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012/tables/6tabledatadecpdf

http://www.bjs.gov/ucrdata/index.cfm

https://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012/tables/6tabledatadecpdf

31

Calls for domestic violence are categorized as with our without a weapon. The

domestic violence calls in the Community Benefit Service Area were primarily with

weapons, which include firearms, knives and other weapons. The with weapon call rate

(76.9%) in the Community Benefit Service Area was higher than county and state rates.

Domestic Violence Calls, 2014

Geographic Area Total Without Weapon With Weapon

Beverly Hills 114 47.4% 52.6%

Culver City 16 56.3% 43.7%

Huntington Park 193 92.7% 7.3%

Inglewood 475 76.8% 23.2%

Los Angeles 19,533 22.6% 77.4%

Los Angeles County Sheriff's Dept. 3,389 13.7% 86.3%

Los Angeles Transit Service 109 2.8% 97.2%

UCLA 62 83.9% 16.1%


Cedars-Sinai Service Area 24,029 23.1% 76.9%

Los Angeles County 39,145 34.5% 65.5%

California 158,547 60.9% 39.1% Source: California Department of Justice, Office of the Attorney General, 2014. https://oag.ca.gov/crime/cjsc/stats/domestic-violence

* Data available by city, therefore, zip code-only areas in the service area are not listed.

Community Input – Community Safety


community safety. Following are their comments, quotes and opinions:

The high incidence of crime due to a high rate of poverty.

In Southeast LA, there is a lot of human trafficking and prostitution. The predator

environment is not new. This is primarily adults preying on children. There are

some neighborhoods where this is quite a problem.

One defining characteristic of community safety is alleyways. In alleyways there is

gang activity and nooks in alleyways and yards don’t have cameras. One

opportunity is to green the alleyways and make them more accessible with anti-gang

initiatives.

Access to safe parks and/or public areas has gotten worse; we need more green

areas on the west side.

Homicide is a significant challenge particularly among black men. There are issues

of equitable health due to latent gang issues that percolate in a community. There

are significant levels of injury among children and women with family violence and

domestic violence. There are a lot of negative health impacts for everyone involved.

Violence is a major driver of what’s happening in our community. When you lose

someone to violence it can shake what you feel about all systems – the police,

https://oag.ca.gov/crime/cjsc/stats/domestic-violence

32

government, and schools.

With Prop 47, penalties for some crimes have been lowered to misdemeanors. With

early prison release there is a rise in violence. We have insufficient resources to

help former prisoners re-enter and rehabilitate and get marketable skills and

housing.

In the LA area, green open space is very limited for healthy activities. Specifically,

neighborhoods like Pico Union and South Central really lack resources and

opportunities to increase safety in their populations.

33

Health Care Access

Health Insurance Coverage

Health insurance coverage is a key component to accessing health care. The Healthy

People 2020 goal is for 100% insurance coverage for all population groups. University

90089 has 97.3% coverage and Wilshire 90057 has 53.8% coverage.

Health Insurance Coverage

Geographic Area Zip Code Percent Insured

Baldwin Hills 90008 80.2%




Brentwood/Westwood 90024 93.9%





Century City 90067 94.1%













Hyde Park 90043 79.2%





L.A./Coliseum & MLK Blvd. 90011 61.8%

L.A./MLK & Hobart 90062 67.3%

Ladera Heights 90056 92.7%

Lennox 90304 65.5%






34

Geographic Area Zip Code Percent Insured

South Los Angeles 90059 71.7%



USC 90007 78.7%




West LA/Palms 90034 80.2%









Cedars-Sinai Service Area 72.9%


California 83.3%

Source: U.S. Census Bureau, American Community Survey, 2010-2014, S2701. http://factfinder.census.gov

When insurance coverage is examined by SPA, 92.6% of SPA 5 residents have health

insurance, compared to 84% in SPA 6 and 78% in SPA 4.

Insurance Coverage

Insurance Coverage SPA 4 SPA 5 SPA 6 Los Angeles

County

Insured 78.0% 92.6% 84.0% 86.7%

Uninsured 22.0% 7.4% 16.0% 13.3%

Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

24.8% of the population in SPA 4, 5.2% in SPA 5, and 48.5% in SPA 6 had Medi-Cal

coverage. In SPA 4, 29.5% have employment-based insurance. Over half the

population had employment-based insurance in SPA 5 (54%). In SPA 6, 19% of the

population has employment-based insurance.


35

Insurance Coverage

Insurance Coverage SPA 4 SPA 5 SPA 6 Los Angeles

County

Medi-Cal 24.8% 5.2% 48.5% 24.4%

Medicare Only 2.8% 0.5% 0.4% 1.4%

Medi-Cal/Medicare 8.2% 2.4% 5.9% 3.7%

Medicare & Others 5.7% 16.5% 4.2% 7.4%

Other Public 1.1% 0.9% 0.2% 0.8%

Employment Based 29.5% 54.0% 19.0% 41.5%

Private Purchase 5.9% 13.1% 5.9% 7.4%

No Insurance 22.0% 7.4% 16.0% 13.3%


When insurance coverage by SPA was examined by age groups, adults, ages 18-64,

had the highest rate of uninsured. Coverage for children was primarily through Medi-

Cal and employment-based insurance. Seniors had low rates of uninsured and high

rates of Medicare coverage. SPA 4 had the highest rates of uninsured among adults

and seniors, and SPA 5 the highest among children. The Healthy People 2020

objective is 100% health insurance coverage for children and adults.

Insurance Coverage by Age Group

Insurance Coverage Ages 0-17 Ages 18-64 Ages 65+

SPA 4 SPA 5 SPA 6 SPA 4 SPA 5 SPA 6 SPA 4 SPA 5 SPA 6

Medi-Cal 60.8% 7.6% 76.8% 23.2% 6.2% 41.0% 0.7% 0.0% 1.3%

Medicare Only N/A N/A N/A N/A N/A N/A 16.3% 2.4% 4.6%

Medi-Cal/Medicare N/A N/A N/A 1.6% 0.0% 3.2% 41.9% 12.0% 45.4%

Medicare & Others N/A N/A N/A N/A N/A N/A 33.4% 83.6% 48.3%

Other Public 7.7% 0.0% 0.0% 0.0% 1.4% 0.3% 0.0% 0.0% 0.0%

Employment Based 23.4% 72.8% 18.3% 37.8% 65.2% 22.0% 1.0% 2.0% 0.0%

Private Purchase 2.1% 11.1% 3.7% 8.1% 17.6% 7.8% 0.3% 0.0% 0.0%

No Insurance 6.0% 8.6% 1.2% 29.3% 9.4% 25.5% 6.4% 0.0% 0.0%


Sources of Care

Residents who have a medical home and access to a primary care provider improve

continuity of care and decrease unnecessary ER visits. 96.5% of children in SPA 4 and

100% in SPA 5 have a usual source of care. In SPA 6, 85.6% of children and youth

have a usual source of care. Among adults, the lowest rates are seen in SPA 4, where

69.7% of adults have a usual source of care. In SPA 5, 86.3% of adults and 86% in

SPA 6, have a usual source of care. 100% of seniors in SPA 5 have a usual source of

care, while 93.4% in SPA 6 and 89.4% of SPA 4 seniors have a usual source of care.



36

Usual Source of Care

Source of Care Ages 0-17 Ages 18-64 Ages 65+

SPA 4 SPA 5 SPA 6 SPA 4 SPA 5 SPA 6 SPA 4 SPA 5 SPA 6

Usual Source of

Care 96.5% 100% 85.6% 69.7% 86.3% 86.0% 89.4% 100% 93.4%


When access to care through a usual source of care is examined by race/ethnicity,

Asians are the least likely to have a usual source of care. Residents in SPA 5 are more

likely to have a usual source of care than residents in SPA 4 and SPA 6.

Usual Source of Care by Race/Ethnicity

Race/Ethnicity SPA 4 SPA 5 SPA 6 Los Angeles

County

African American 98.7% 100% 84.5% 89.1%

Asian 72.2% 81.0% 64.4% 82.5%

Latino 73.8% 92.1% 87.5% 79.2%

White 88.1% 94.5% 100% 91.8% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

A doctor’s office, HMO, or Kaiser is the usual source of care for 43.7% of SPA 4

residents, 71.3% of SPA 5, and 38.9% of SPA 6 residents. Clinics and community

hospitals are the source of care for 32.5% in SPA 4, 15.2% in SPA 5 and 41.5% of

residents in SPA 6. The ER is a source of care for a small percentage of area

residents, though it is highest in SPA 6 (6.2%).

Sources of Care

Source of Care SPA 4 SPA 5 SPA 6 Los Angeles

County

Dr. Office/HMO/Kaiser 43.7% 71.3% 38.9% 57.6%

Community Clinic/Government Clinic/ Community Hospital

32.5% 15.2% 41.5% 23.6%

ER/Urgent Care 0.6% 2.1% 6.2% 1.7%

Other 0.1% 2.5% 0.0% 0.9%

No Source of Care 23.1% 8.9% 13.5% 16.2% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

14.5% of residents in SPA 4, 17.9% of SPA 5 residents and 24.3% of residents in SPA

6 visited an ER over the period of a year. In SPA 5, youth visited the ER at the highest

rates (28.3%). In SPA 4 (16.6%) and SPA 6 (28.5%), adults 18-64, visit the ER at the

highest rates. In SPA 5 and SPA 6 low-income residents visit the ER at higher rates.

SPA 4 and SPA 6 residents living in poverty visit the ER at higher rates than found in

the county.




37

Use of Emergency Room

Use of ER SPA 4 SPA 5 SPA 6 Los Angeles

County

Visited ER in Last 12 Months 14.5% 17.9% 24.3% 16.6%

0-17 Years Old 6.4% 28.3% 16.8% 19.7%

18-64 Years Old 16.6% 17.3% 28.5% 15.7%

65 and Older 12.8% 11.5% 20.5% 15.5%

<100% of Poverty Level 21.9% 7.7% 20.5% 17.7%

<200% of Poverty Level 15.1% 9.6% 22.0% 16.7% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Barriers to Care

Adults in the Community Benefit Service Area experience a number of barriers to

accessing care, including cost of care and lack of a medical home. Adults in SPAs 4

and 6 had higher rates of being unable to afford care.

Barriers to Accessing Health Care

Barriers to Access SPA 4 SPA 5 SPA 6 Los Angeles

County

Adults Unable to Afford Dental Care in the Past Year

37.6% 19.4% 35.0% 30.3%

Adults Unable to Afford Medical Care in the Past Year

17.7% 12.2% 18.7% 16.0%

Adults Unable to Afford Mental Health Care in the Past Year

6.0% 6.5% 6.8% 6.1%

Adults Unable to Afford Prescription Medication in the Past Year

15.3% 9.8% 18.8% 15.4%

Adults Who Reported Difficulty Accessing Medical Care

38.0% 17.0% 44.6% 31.7%

Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Los Angeles County Health Survey 2011. http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm

Access to Primary Care Community Health Centers Community Health Centers provide primary care (including medical, dental and mental

health services) for uninsured and medically underserved populations. Using ZCTA

(Zip Code Tabulation Area) data for the Cedars-Sinai Community Benefit Service Area

and information from the Uniform Data System (UDS)1, 52.2% of the population in the

Community Benefit Service Area is categorized as low-income (200% of Federal

Poverty Level) and 27.1% of the population are living in poverty.

There are 30 Section 330 funded grantees (Federally Qualified Health Centers –

FQHCs and FQHC Look-Alikes) serving the Community Benefit Service Area, including:

1 The UDS is an annual reporting requirement for grantees of HRSA primary care programs:

• Community Health Center, Section 330 (e) • Migrant Health Center, Section 330 (g) • Health Care for the Homeless, Section 330 (h)

• Public Housing Primary Care, Section 330 (i)


http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm

38

Venice Family Clinic, Saban Community Clinic, Los Angeles Christian Health Centers,

JWCH Institute, and AltaMed Health Services.2

Even with Community Health Centers serving the area, there are a significant number of

low-income residents who are not served by one of these clinic providers. The FQHCs

and Look-Alikes have a total of 278,868 patients in the Community Benefit Service

Area, which equates to 30.1% penetration among low-income patients and 15.7%

penetration among the total population. From 2012-2014 the clinic providers added

27,022 patients for a 10.7% increase in patients served by Community Health Centers.

However, there remain 646,187 low-income residents, approximately 70% of the

population at or below 200% FPL that are not served by a Community Health Center.

Low-Income Patients Served and Not Served by FQHCs and Look-Alikes

Low-Income

Population

Patients served

by Section 330

Grantees

In Service Area

Penetration

among Low-

Income Patients

Penetration of

Total

Population

Low-Income Not

Served

Number Percent

925,055 278,868 30.1% 15.7% 646,187 69.9% Source: UDS Mapper, 2014. http://www.udsmapper.org

Delayed Care

Residents of SPA 5 delayed or did not get medical care (14.4%) when needed at higher

rates than in SPA 4 (11.9%) or SPA 6 (10.7%), but showed the lowest rate of delay and

unfilled prescriptions (4.4%). In SPA 4, 7% delayed obtaining prescription medications.

Among SPA 6 residents 8.8% delayed access to medications.

Delayed Care

Delayed Care and Prescriptions SPA 4 SPA 5 SPA 6 Los

Angeles County

California

Delayed or Didn’t Get Medical Care In Past 12 Months 11.9% 14.4% 10.7% 11.7% 11.3%

Delayed or Didn’t Get Prescription Meds In Past 12 Months 7.0% 4.4% 8.8% 7.9% 8.7%


2 The Community Health Centers serving the Cedars-Sinai Community Benefit Service Area also include: APLA Health and

Wellness, Arroyo Vista Family Health Foundation, Asian Pacific Health Care Venture, Benevolence Industries Incorporated, Central

City Community Health Center, Inc., Central Neighborhood Health Foundation, Clinica Msr. Oscar A. Romero, Eisner Pediatric and Family Medical Center, Korean Health, Education, Information and Research Center, Mission City Community Network, Inc., Northeast Community Clinic, Inc., Northeast Valley Health Corporation, QueensCare Health Centers, Santa Clara Valley Health and

Hospital System, South Bay Family Healthcare Center, South Central Family Health Center, St. Anthony Medical Centers, St. John's Well Child & Family Center, T.H.E. Clinic, Inc., The Achievable Foundation, The Los Angeles Gay and Lesbian Community Services Center, Universal Community Health Center, University Muslim Medical Association, Inc., Watts Healthcare Corporation, and

Westside Family Health Center.

http://www.udsmapper.org/


39

Community Input – Access to Care


access to care. Following are their comments, quotes and opinions:

Covered CA has done an amazing job. Healthy Way LA has opened up to help the

uninsured in Los Angeles. But now people need to know how to get care, how to

use insurance and get appointments. The health system is typically open 8-5, M-F,

we need more weekend clinics. Also access to medication is really important.

There are some fundamental issues around health access equity. There are not a

lot of Medi-Cal providers in our communities. We don’t have enough places to

access care. There are numerous barriers that include, distrust of the system and

people don’t have transportation or childcare. These are systemic reasons that we

can address as a society to increase access to care and preventive services.

There is a lot of confusion with the Affordable Care Act (ACA) and access to

immunizations because kids now need to go to their assigned doctors and not the

local free clinic. In Malibu they don’t have doctors who take Medi-Cal. There are

many undocumented people in the community and to get care they need to get to

Santa Monica or go to Agoura Hills.

With the passage of the ACA many people are now eligible for care who were not

before. In the last couple of years access has gotten better. Now the access issues

have shifted from access to navigation of the system. We have a lot of people who

need complete support in getting enrolled, and staying in the system. Case

managers and navigators are critical to the process.

SPA 6 is an area where there are profound issues and gaps in care. Accessing

primary care and medications have been a major problem for years. ACA has

worked but there is still a lack of insurance for the undocumented.

We are seeing low-income African American and Hispanic families who cannot

afford the health insurance copayments. There are a number of people not eligible

for Medi-Cal or Covered CA programs because they are undocumented or

homeless. Other populations that have trouble accessing care are seniors,

veterans, young parents and youth.

Language is a big issue, access to insurance has helped but there are still barriers

to care because there so many languages spoken and the undocumented still have

issues with access to care. There are increasing numbers of people seen in

community clinics and FQHCs.

Access to care is very serious, particularly with persons who are uninsured and

undocumented. Especially within limited English populations. It is especially difficult

to access specialty care. For primary care it is a bit better with community and

county clinics. The number of uninsured has decreased but people don’t know how

to use their benefits. Even though they have My Health LA there is fear and a lack

40

of knowledge on how to access care. But accessing specialty care is really tough,

and it has gotten worse in the past couple of years for multiple reasons. The low

reimbursement rates are unattractive to those who serve that population. Also the

need to address cultural and linguistic issues to engage people in specialty care

makes it even harder.

Access is always an issue for the population we serve. A lot of low-income and

uninsured residents are being seen at community clinics or through the county

system. We struggle with access. There are just not enough doctors or space, and

waiting times can be long. Primary care providers are open and willing to accept

Medi-Cal and the uninsured. The issue is beyond primary care to accessing

specialty care for this population. To get care a person needs to get referred into the

county hospital. Having to get transportation to services is a barrier to accessing

care.

Health access has gotten more confusing in the last couple years. They can sign up

for health insurance but it is more difficult to navigate the system. People who are

challenged intellectually or emotionally or have limited English find it very confusing.

Homebound people and the frail find it very hard to access care. Care availability

has increased with insurance but also has increased the number of people who are

waiting for the doctor. We need an ability to connect back to community providers

so people have access to community providers once they are not in the hospital.

We need recognition that services are needed beyond hospital stays. If we help

people stabilize in the community it will help health outcomes and reduce

readmissions.

Overall I think access to care will improve. It seems to be on the initial tip of starting

to improve with the ACA. I think more people have access as they enroll in

insurance. The access challenges will start to be addressed with more people

insured. Will people know how to use it, maximize it? That is yet to be seen. We

need a level of literacy around health benefits.

41

Dental Care

11.3% of children in SPA 4 and SPA 5 had never been to a dentist. 12.7% of children in

SPA 6 had never been to the dentist. SPA 5 and SPA 6 data indicate there were no

teens who had never been to the dentist. In SPA 4 9.3% of teens had not been to a

dentist.

Delay of Dental Care among Children and Teens

Dental Care SPA 4 SPA 5 SPA 6 Los Angeles

County

Children Never Been to the Dentist 11.3% 11.3% 12.7% 16.0% Children Been to Dentist Less Than 6 Months to 2 Years 88.4% 98.1% 86.9% 83.8%

Teens Never Been to the Dentist 9.3% 0.0% 0.0%* 2.1%

Teens Been to Dentist Less Than 6 Months to 2 Years 90.7% 100% 98.4% 94.7% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/ * = statistically unstable due to sample size

Adults in SPA 5 are more likely to have dental insurance and to be able to afford dental

care. 38.9% of adults in SPA 4 have dental insurance and 37.1% of SPA 6 adults have

dental insurance.

Adult Dental Care

Dental Care SPA 4 SPA 5 SPA 6 Los Angeles

County

Adults Who Have Dental Insurance that Pays for Some or All of Their Routine Dental Care

38.9% 60.6% 37.1% 48.2%

Adults Who Reported Their Last Visit to a Dentist Was Less Than 12 Months Ago

52.1% 72.2% 44.5% 55.8%

Adults Unable to Obtain Dental Care Because They Could Not Afford It

37.6% 19.4% 35.0% 30.3%

Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2011. www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm

Community Input – Dental Care


dental care. Following are their comments, quotes and opinions:

Dental care is one of the top community health needs. We need dentists to take

Medi-Cal rates. There are too few dentists caring for the underserved because

reimbursement rates are so low.

Populations who are impacted and needing dental care are low-income adults,

chronically homeless, substance abusers, veterans, and kids.

Access to dental care has gotten worse. The ACA does not cover adult care.

Companies come around and offer to pull rotten teeth. But what is the follow up?

Oral health screening is a huge issue. When we conduct screenings we find

extraordinary amounts of oral disease: 7% of students have abscesses and 50%

need to see a dentist.



42

The need for dental care is great. We need more clinics and free dental care for

kids. It is a real problem. We find clinics but it is hard to get an appointment

because the need is so great.

Dental problems affect kids and result in missed school days. They have subclinical

diseases that play out in pain and suffering that gets in the way of their ability to

learn. Lack of dental care is a low level issue that is so prevalent that it is a major

issue. But it doesn’t rise to the level of awareness of other issues like asthma.

Dental disease goes undetected until it is a very big problem. There are not enough

dentists who will care for low-income populations.

Dental care is extremely lacking. When we coordinate big events to try and get

services to veterans, dental care is priority one. We partner with USC dental mobile

school. At our events we ensure we have the mobile van.

There is never enough dental care. This is a large need among seniors. Access is

little better now with Denti-Cal but many conditions are still not covered.

People prioritize other things as being more important than their teeth. They don’t

mind having a cavity. It’s really about prevention and education that poor oral health

can lead to infections and portals to other diseases. Kids don’t have a lot of dental

insurance. When we have the big free health service events like Care Harbor, we

always see that the dental lines are ridiculously long.

Dental care is very expensive. All we can provide are discounts to some dental

offices. When we organize health fairs we try to do free screenings.

43

Birth Characteristics

Births

In 2013, there were 24,450 births in the Community Benefit Service Area. Teen Birth Rate

In 2013, teen births occurred at a rate of 8.2% of total births. This rate is higher than

the teen birth rate found in the state (6.2%) and county (6.3%). The highest rates of

teen births were found in Downtown L.A. (90021) (16.7%), South Central Los Angeles

(10.7%-13.7%), South Los Angeles (13%), University (12.3%), and L.A./Coliseum

neighborhoods (12.1%). However, when examining geographic areas with a small

occurrence it is important to use caution when drawing conclusions from data as small

occurrences may result in high rates.

Births to Teenage Mothers (Under Age 20)

Geographical Area Zip Codes Births to Teen

Mothers Live Births*

Percent Teen Births

Baldwin Hills 90008 45 423 10.6%

Beverly Hills 90210 0 174 0.0%



Brentwood/Westwood 90024 1 294 0.3%

Central LA 90013 2 64 3.1%

Central LA 90014 0 33 0.0%

Central LA 90015 24 258 9.3%

Central LA 90017 40 390 10.3%

Century City 90067 1 23 4.3%

Crenshaw 90016 48 664 7.2%

Crenshaw 90018 49 624 7.9%

Culver City 90230 7 361 1.9%

Culver City 90232 2 174 1.1%

Downtown LA 90010 1 24 4.2%

Downtown LA 90021 4 24 16.7%

Downtown LA 90071 0 0 0.0%

Downtown LA 90079 0 0 0.0%

Fairfax/Mid-City 90019 43 759 5.7%


Hollywood 90028 13 187 7.0%

Hollywood 90038 20 297 6.7%

Hyde Park 90043 41 539 7.6%

Inglewood 90301 34 511 6.7%

Inglewood 90302 21 435 4.8%

Inglewood 90303 28 347 8.1%

44

Births to Teenage Mothers (Under Age 20)

Geographical Area Zip Codes Births to Teen

Mothers Live Births*

Percent Teen Births

Inglewood 90305 9 143 6.3%

L.A./Coliseum & MLK Blvd. 90011 242 1,994 12.1%

L.A./MLK & Hobart 90062 35 480 7.3%

Ladera Heights 90056 4 60 6.7%

Lennox 90304 46 462 10.0%

South Central LA 90001 148 1,137 13.0%

South Central LA 90002 129 1,045 12.3%

South Central LA 90003 196 1,430 13.7%

South Central LA 90044 173 1,567 11.0%

South Central LA 90047 68 634 10.7%

South Los Angeles 90059 101 779 13.0%

University 90037 143 1,160 12.3%

University 90089 0 0 0.0%

USC 90007 39 388 10.1%

West Hollywood 90046 0 330 0.0%



West LA/Palms 90034 11 694 1.6%

West LA/Rancho 90025 2 509 0.4%

West LA/Rancho 90035 4 519 0.8%

West LA/Rancho 90064 0 298 0.0%

Wilshire 90006 75 790 9.5%

Wilshire 90057 57 740 7.7%

Wilshire/Koreatown 90004 51 768 6.6%



Cedars-Sinai Service Area 2,011 24,450 8.2%

Los Angeles County 8,147 128,512 6.3%

California 30,814 494,332 6.2% Source: California Department of Public Health, Open Data Portal, 2013. https://cdph.data.ca.gov/browse?category=Demographics *Births in which the age of the mother is unknown are not included in the tabulation.

Prenatal Care

Pregnant women in the Community Benefit Service Area entered prenatal care in the

first trimester at a rate of 81.1%. This rate of on-time entry into prenatal care translates

to 18.9% of women entering prenatal care late or not at all. This rate of early entry into

prenatal care is lower than the LA County rate of 84.9% and the state rate of 83.6%, but

does meet the Healthy People 2020 objective of 78% of women entering prenatal care

in the first trimester. Baldwin Hills (90008), Central Los Angeles, Crenshaw, Hyde Park

and Ladera Ranch, had the lowest rates of early prenatal care. Brentwood, Beverly

Hills and West Hollywood (90048) had the highest rates of first trimester prenatal care.

https://cdph.data.ca.gov/browse?category=Demographics

45

On-Time Entry into Prenatal Care (In First Trimester)

Geographical Area Zip Codes On-Time

Prenatal Care Live Births* Percent

Baldwin Hills 90008 294 395 74.4%

Beverly Hills 90210 123 130 94.6%

Beverly Hills 90211 58 61 95.1%

Beverly Hills 90212 72 76 94.7%


Central LA 90013 49 62 79.0%

Central LA 90014 28 31 90.3%

Central LA 90015 184 250 73.6%

Central LA 90017 312 383 81.5%

Century City 90067 13 16 81.3%

Crenshaw 90016 501 612 81.9%

Crenshaw 90018 440 586 75.1%

Culver City 90230 303 344 88.1%

Culver City 90232 150 164 91.5%

Downtown LA 90010 17 22 77.3%

Downtown LA 90021 19 22 86.4%

Downtown LA 90071 0 0 N/A

Downtown LA 90079 0 0 N/A

Fairfax/Mid-City 90019 582 702 82.9%

Fairfax/Mid-City 90036 384 418 91.9%

Hollywood 90028 145 176 82.4%

Hollywood 90038 226 286 79.0%

Hyde Park 90043 378 502 75.3%

Inglewood 90301 384 495 77.6%

Inglewood 90302 336 416 80.8%

Inglewood 90303 268 336 79.8%

Inglewood 90305 106 134 79.1%

L.A./Coliseum & MLK Blvd. 90011 1,509 1,923 78.5%

L.A./MLK & Hobart 90062 357 458 77.9%


Lennox 90304 362 455 79.6%

South Central LA 90001 900 1,106 81.4%

South Central LA 90002 838 1,023 81.9%

South Central LA 90003 1,097 1,399 78.4%

South Central LA 90044 1,163 1,531 76.0%

South Central LA 90047 475 612 77.6%


University 90037 868 1,134 76.5%

University 90089 0 0 N/A

USC 90007 283 372 76.1%

West Hollywood 90046 246 281 87.5%

West Hollywood 90048 193 199 97.0%

West Hollywood 90069 101 109 92.7%

West LA/Palms 90034 572 642 89.1%

46

On-Time Entry into Prenatal Care (In First Trimester)

Geographical Area Zip Codes On-Time

Prenatal Care Live Births* Percent

West LA/Rancho 90025 429 461 93.1%

West LA/Rancho 90035 375 402 93.3%

West LA/Rancho 90064 250 267 93.6%

Wilshire 90006 624 771 80.9%

Wilshire 90057 594 729 81.5%






California 406,080 485,583 83.6% Source: California Department of Public Health, Open Data Portal, 2013; https://cdph.data.ca.gov/browse?category=Demographics *Births in which the first month of prenatal care is unknown are not included in the tabulation.

Low Birth Weight

Low birth weight is a negative birth indicator. Babies born at a low birth weight are at

higher risk for disease, disability and possibly death. For this measurement, a lower

rate is a better indicator. The Community Benefit Service Area rate of low birth weight

babies is 7.8% (77.5 per 1,000 live births). This is higher than the county rate (7%) and

the state rate (6.8%). The Community Benefit Service Area meets the Healthy People

2020 objective of 7.8% of births being low birth weight. When examined by community,

a number of neighborhoods have a rate that exceeds the Healthy People 2020

objective. Crenshaw and South Los Angeles have high rates of low-birth-weight babies.

When examining geographic areas with a small occurrence it is important to use caution

when drawing conclusions from data as small occurrences may result in high rates.

Low Birth Weight (Under 2,500 g)

Geographical Area Zip Codes Low Birth Weight Live Births* Percent

Baldwin Hills 90008 37 423 8.7%





Central LA 90013 4 64 6.3%

Central LA 90014 1 33 3.0%

Central LA 90015 22 258 8.5%

Central LA 90017 26 390 6.7%

Century City 90067 0 23 0.0%

Crenshaw 90016 53 664 8.0%

Crenshaw 90018 69 624 11.1%

Culver City 90230 22 361 6.1%

Culver City 90232 10 174 5.7%


47

Low Birth Weight (Under 2,500 g)

Geographical Area Zip Codes Low Birth Weight Live Births* Percent

Downtown LA 90010 0 24 0.0%

Downtown LA 90021 0 24 0.0%

Downtown LA 90071 0 0 0.0%

Downtown LA 90079 0 0 0.0%



Hollywood 90028 10 187 5.3%

Hollywood 90038 21 297 7.1%

Hyde Park 90043 53 539 9.8%

Inglewood 90301 35 511 6.8%

Inglewood 90302 35 435 8.0%

Inglewood 90303 27 347 7.8%

Inglewood 90305 14 143 9.8%

L.A./Coliseum & MLK Blvd. 90011 149 1,994 7.5%

L.A./MLK & Hobart 90062 45 480 9.4%


Lennox 90304 35 462 7.6%

South Central LA 90001 77 1,137 6.8%

South Central LA 90002 97 1,045 9.3%

South Central LA 90003 128 1,430 9.0%

South Central LA 90044 146 1,567 9.3%

South Central LA 90047 56 634 8.8%


University 90037 102 1,160 8.8%

University 90089 0 0 0.0%

USC 90007 29 388 7.5%



West Hollywood 90069 16 132 12.1%

West LA/Palms 90034 43 694 6.2%

West LA/Rancho 90025 30 509 5.9%

West LA/Rancho 90035 22 519 4.2%

West LA/Rancho 90064 22 298 7.4%

Wilshire 90006 45 790 5.7%

Wilshire 90057 58 740 7.8%






California 33,798 494,365 6.8% Source: California Department of Public Health, Open Data Portal, 2013; https://cdph.data.ca.gov/browse?category=Demographics *Births in which the weight of the newborn is unknown are not included in the tabulation.


48

Infant Mortality

The infant (less than one year of age) mortality rate in in the Community Benefit Service

Area was 5.4 deaths per 1,000 live births, which is higher than the county rate (4.3) and

the state rate (4.5 deaths per 1,000 live births). The infant death rate is less than the

Healthy People 2020 objective of 6.0 deaths per 1,000 births.

Infant Mortality Rate, 2012 Geographical Area Infant Deaths Live Births Death Rate

Cedars-Sinai Service Area 138 25,343 5.4 Los Angeles County 567 131,697 4.3

California 2,247 503,788 4.5 Source: California Department of Public Health, 2012. http://www.cdph.ca.gov/data/Pages/default.aspx;

http://www.cdph.ca.gov/programs/mcah/Documents/MO-MCAH-InfantMortalitybyCounty2012_Jan2014.pdf

Breastfeeding

Breastfeeding has been proven to have considerable benefits to baby and mother. The

California Department of Public Health (CDPH) highly recommends babies be fed only

breast milk for the first six months of life. Data on breastfeeding are collected by

hospitals on the Newborn Screening Test Form. Breastfeeding rates at Cedars-Sinai

Medical Center indicate 96.1% of new mothers use some breastfeeding and 72.3% use

breastfeeding exclusively. These rates are better than the average rate among

hospitals in the county and state.

In-Hospital Breastfeeding

Geographic Area Any Breastfeeding Exclusive Breastfeeding

Number Percent Number Percent

Cedars-Sinai Medical Center 5,848 96.1% 4,397 72.3%

Los Angeles County 109,455 92.8% 62,955 53.3%

California 396,602 92.9% 275,706 64.6% Source: California Department of Public Health, Breastfeeding Hospital of Occurrence, 2013 https://www.cdph.ca.gov/data/statistics/Documents/MO-MCAH-HospitalTotalsReport2013.pdf

http://www.cdph.ca.gov/data/Pages/default.aspx

http://www.cdph.ca.gov/programs/mcah/Documents/MO-MCAH-InfantMortalitybyCounty2012_Jan2014.pdf

https://www.cdph.ca.gov/data/statistics/Documents/MO-MCAH-HospitalTotalsReport2013.pdf

49

Mortality/Leading Causes of Death

Leading Causes of Premature Death

In Los Angeles County, 42% of people in 2012 died before they reached age 75, with

deaths prior to 75 years of age determined by the Los Angeles County Department of

Public Health to be premature. In SPA 4 and SPA 5, coronary heart disease was the

leading cause of premature death. In SPA 6, homicide was the leading cause of

premature death.

Leading Cause of Premature Death, Service Planning Areas 4, 5, 6, 2012

SPA 4 SPA 5 SPA 6

1. Coronary Heart Disease 1. Coronary Heart Disease 1. Homicide

2. Homicide 2. Suicide 2. Coronary Heart Disease

3. Drug Overdose 3. Drug Overdose 3. Motor Vehicle Crash

4. Liver Disease 4. Liver Disease 4. Liver Disease

5. Suicide 5. Lung Cancer 5. Diabetes Source: LA County Department of Public Health, Mortality in Los Angeles County, 2014.

http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt12.pdf

Leading Causes of Death

Heart disease, cancer, and stroke are the top three leading causes of death in the

Community Benefit Service Area. When compared to the county and state, the

Community Benefit Service Area has higher death rates for the top three causes of death.

Respiratory disease is the fourth leading cause of death and pneumonia is the fifth

leading cause of death.

These leading causes of death are age-adjusted death rates. Age adjusting eliminates

the bias of age in the makeup of the populations being compared. When comparing

across geographic areas, age-adjusting is typically used to control for the influence that

different population age distributions might have on health event rates. When

examining geographic areas with a small population, such as zip codes, it is important

to use caution when drawing conclusions from data; small occurrence of a health

problem may result in a high rate.

http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt12.pdf

50

Leading Causes of Death, Age-Adjusted Rate per 100,000 Persons, 5-Year, 2009-2013

Causes of Death

Cedars-Sinai Service Area Los Angeles

County California

Healthy People

2020 Objective

Average

Annual Deaths Rate Rate Rate Rate

Diseases of the Heart 2,824 207.3 169.3 158.4 103.4

Cancer 2,333 172.1 148.9 152.9 161.4

Stroke 536 39.3 35.4 36.6 34.8

Chronic Lower Respiratory Disease/ Chronic Obstructive Pulmonary Disease

401 29.8 31.8 36.2 No Objective

Pneumonia 388 28.5 22.3 20.3 No Objective

Source: California Department of Public Health, Public Health Statistical Master Files 2009-2013, Age-adjustment using U.S.

2010 Decennial Census SF1. http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx

Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC.

Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed.

The overall mortality rate for all causes of death in the Community Benefit Service Area

is 697.6 per 100,000 persons. This is higher than the county rate (614.9 per 100,000

persons) and the state (640.5 per 100,000 persons).

Age-Adjusted Death Rate per 100,000 Persons, 5-Year Average Total, 2009-2013*

Geographic Area Average Annual Deaths Rate

Cedars-Sinai Service Area 9,676 697.6 Los Angeles County 58,321 614.9

California 239,521 640.5 Source: California Department of Public Health, Public Health Statistical Master Files 2009-2013, Age-adjustment using U.S.

2010 Decennial Census SF1. http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx


Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed.

*When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing

conclusions from data; small occurrence of a health problem may result in a high rate.

http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx


51

Heart Disease Mortality

The Community Benefit Service Area has a high rate of death due to heart disease at

207.3 per 100,000 persons, which is higher than the county and state rates, and

exceeds the Healthy People 2020 objective of 103.4 deaths per 100,000 persons.

South Central Los Angeles (90003) has the highest rate of death due to heart disease

(308.1).

Heart Disease, Age-Adjusted Death Rate per 100,000 Persons, 5-Year Average, 2009-

2013*

Geographic Area Zip Code Average Annual Deaths Rate

Baldwin Hills 90008 92 241.9

Beverly Hills 90210 50 112.1



Brentwood/Westwood 90024 73 125.1

Central LA 90013 29 229.1

Central LA 90014 27 295.4

Central LA 90015 18 162.7

Central LA 90017 24 183.2

Century City 90067 13 106.9

Crenshaw 90016 94 250.3

Crenshaw 90018 110 261.5

Culver City 90230 61 169.9

Culver City 90232 30 164.9

Downtown LA 90010 3 87.3



Downtown LA 90079** 0 0.0

Fairfax/Mid-City 90019 110 190.8


Hollywood 90028 54 234.2

Hollywood 90038 31 181.7

Hyde Park 90043 122 263.2

Inglewood 90301 60 236.9

Inglewood 90302 41 234.7

Inglewood 90303 37 252.5

Inglewood 90305 41 223.5

L.A./Coliseum & MLK Blvd. 90011 88 230.6

L.A./MLK & Hobart 90062 59 258.7

Ladera Heights 90056 25 183.8

Lennox 90304 20 184.1

South Central LA 90001 62 238.5





South Los Angeles 90059 57 276.8

52


University 90037 81 251.2

University 90089*** N/A N/A

USC 90007 36 182.7

West Hollywood 90046 111 180.6



West LA/Palms 90034 69 187.8

West LA/Rancho 90025 62 146.5



Wilshire 90006 67 186.6

Wilshire 90057 68 207.4

Wilshire/Koreatown 90004 69 176.7


Wilshire/Koreatown 90020 36 169.7 Cedars-Sinai Service Area 2,824 207.3

Los Angeles County 16,100 169.3

California 59,458 158.4 Source: California Department of Public Health, Public Health Statistical Master Files 2009-2013, Age-adjustment

using U.S. 2010 Decennial Census SF1. http://www.cdph.ca.gov/data/statistics/Pages/DeathProfilesbyZIPCode.aspx


Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period

were suppressed.

*When examining geographic areas with a small population, such as zip codes, it is important to use caution when

drawing conclusions from data; small occurrence of a health problem may result in a high rate.

** Zip Code 90079 has a residential population of zero.

*** Zip Code 90089 is a unique zip code assigned to the University of Southern California. No death data is

available for this zip code.


53

Cancer Mortality

The age-adjusted death rate for all cancers in the Community Benefit Service Area is

172.1 per 100,000 persons, which is higher than the county (148.9), state (152.9) and

Healthy People 2020 (161.4) rates. South Central Los Angeles (90003) has the highest

rate of death due to cancer (238.8).

All Cancers, Age-Adjusted Death Rate per 100,000 Persons, 5-Year Average, 2009-2013*







Central LA 90013 18 138.0

Central LA 90014 10 108.5

Central LA 90015 16 137.7

Central LA 90017 19 133.5


Crenshaw 90016 74 195.1

Crenshaw 90018 86 209.9

Culver City 90230 56 159.6

Culver City 90232 25 158.9







Hollywood 90028 38 166.0

Hollywood 90038 26 142.5

Hyde Park 90043 106 227.3

Inglewood 90301 46 175.3

Inglewood 90302 40 204.1

Inglewood 90303 32 195.4

Inglewood 90305 39 212.3


L.A./MLK & Hobart 90062 50 209.1


Lennox 90304 22 156.8







54




USC 90007 24 117.9




West LA/Palms 90034 59 156.6




Wilshire 90006 55 139.5

Wilshire 90057 46 142.3




Cedars-Sinai Service Area 2,333 172.1


California 56,857 152.9

Source: California Department of Public Health, Public Health Statistical Master Files 2009-2013, Age-adjustment




were suppressed.







55

Stroke Mortality

The age-adjusted death rate for stroke in the Community Benefit Service Area is 39.3

per 100,000 persons, which is higher than the county (35.4), state (36.6) and Healthy

People 2020 (34.8) rates. Los Angeles (90062) has the highest rate of death due to

stroke (67.8).

Cerebrovascular Disease (Stroke), Age-Adjusted Death Rate per 100,000 Persons, 5-Year

Average, 2009-2013*







Central LA 90013 5 42.5

Central LA 90014 3 27.4

Central LA 90015 4 32.8

Central LA 90017 4 35.1


Crenshaw 90016 19 50.9

Crenshaw 90018 17 39.1

Culver City 90230 13 36.4








Hollywood 90028 10 42.9

Hollywood 90038 6 34.3

Hyde Park 90043 22 48.0

Inglewood 90301 11 42.6

Inglewood 90302 9 47.3




L.A./MLK & Hobart 90062 16 67.8


Lennox 90304 5 39.9






56





USC 90007 6 32.5




West LA/Palms 90034 10 26.3




Wilshire 90006 14 37.4

Wilshire 90057 12 36.4




Cedars-Sinai Service Area 536 39.3






were suppressed.







57

Respiratory (Lung) Disease Mortality

Chronic Lower Respiratory Disease and Chronic Obstructive Pulmonary Disease

include emphysema and bronchitis. The age-adjusted death rate for respiratory disease

in the Community Benefit Service Area is 29.8 per 100,000 persons, which is lower than

the county (31.8) and state rates (36.2). South Central Los Angeles (90003) has the

highest rate of death due to lung disease (52.9).

Chronic Lower Respiratory/Chronic Obstructive Pulmonary Disease, Age-Adjusted Death

Rate per 100,000 Persons, 5-Year Average, 2009-2013*







Central LA 90013 4 32.6

Central LA 90014 3 27.6

Central LA 90015 2 21.1

Central LA 90017 2 14.5


Crenshaw 90016 13 33.7

Crenshaw 90018 13 31.0











Hyde Park 90043 19 40.0

Inglewood 90301 10 41.0





L.A./MLK & Hobart 90062 8 33.3


Lennox 90304 3 26.3







58




USC 90007 5 26.7








Wilshire 90006 10 26.7

Wilshire 90057 10 32.8



Wilshire/Koreatown 90020 4 19.7 Cedars-Sinai Service Area 401 29.8






were suppressed.







59

Pneumonia Mortality

The age-adjusted death rate for pneumonia in the Community Benefit Service Area is

28.5 per 100,000 persons, which is higher than the county (22.3) and state (20.3) rates.

South Los Angeles (90059) has the highest rate of death due to pneumonia (50.5).

Pneumonia, Age-Adjusted Death Rate per 100,000 Persons, 5-Year Average, 2009-2013*







Central LA 90013 2 20.0

Central LA 90014 2 22.8

Central LA 90015 3 27.9

Central LA 90017 4 35.6


Crenshaw 90016 11 30.9

Crenshaw 90018 17 39.6











Hyde Park 90043 15 33.1






L.A./MLK & Hobart 90062 8 36.4


Lennox 90304 3 35.1









USC 90007 7 32.8

60









Wilshire 90006 13 38.0

Wilshire 90057 13 37.9



Wilshire/Koreatown 90020 6 34.3 Cedars-Sinai Service Area 388 28.5






were suppressed.







61

Chronic Disease

Health Status

Among the residents in SPA 4, 30.2% rate themselves as being in fair or poor health. In

SPA 5, 9.8%, and in SPA 6, 27.3% of residents indicate they have fair or poor health

status. The level of fair or poor health increases among seniors. In SPA 4, 45.8% of

seniors have a self-rated fair or poor health status. 19.3% of seniors in SPA 5 and

44.1% of seniors in SPA 6 consider themselves to be in fair/poor health.

Health Status, Fair or Poor Health

Health Status by Age SPA 4 SPA 5 SPA 6 Los Angeles

County

Fair or Poor Health 30.2% 9.8% 27.3% 19.3%

18-64 Years Old 30.6% 9.4% 34.0% 22.0%

65+ Years Old 45.8% 19.3% 44.1% 31.4% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Disability

In the Community Benefit Service Area, 26.3% of adults in SPA 4, 25.5% in SPA 5 and

39.4% of adults in SPA 6 had a physical, mental or emotional disability. The rate of

disability in the county is 28.6%. Disabled persons in SPA 6 (45.2%) were far less likely

to report having health insurance than disabled persons in SPA 4 (73.8%) and SPA 5

(91.5%).

Population with a Disability

Disability SPA 4 SPA 5 SPA 6 Los Angeles

County

Adults with a Disability 26.3% 25.5% 39.4% 28.6%

Disabled Persons with Health Insurance 73.8% 91.5% 45.2% 72.5% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/

Asthma

The population diagnosed with asthma in SPA 4 is 11.7%, in SPA 5 7% of the

population has asthma, and in SPA 6 6.8% has asthma. Among those with asthma,

56.9% in SPA 4, 28.6% in SPA 5 and 39.8% in SPA 6 take medication to control their

symptoms. Among youth in SPA 4, 10.6% have been diagnosed with asthma, 7.8% of

youth in SPA 5 and 9.5% of youth in SPA 6 have been diagnosed with asthma.



62

Asthma

Asthma SPA 4 SPA 5 SPA 6 Los Angeles

County

Diagnosed with Asthma, Total Population 11.7% 7.0% 6.8% 11.4%

Diagnosed with Asthma, 0-17 Years Old 10.6% 7.8% 9.5% 10.5%

ER Visit in Past Year Due to Asthma, Total Population

3.3% 0.0% 3.4% 4.7%

ER Visit in Past Year Due to Asthma, 0-17 Years Old

0.0% 0.0% 0.0% 2.4%

Takes Daily Medication to Control Asthma, Total Population

56.9% 28.6% 39.8% 41.0%

Takes Daily Medication to Control Asthma, 0-17 Years Old

0.0% 0.0% 3.8% 27.7%


Diabetes

Diabetes is a growing concern in the community. 14.7% of adults in SPA 6, 8.4% in

SPA 4, and 4% in SPA 5 reported they have been diagnosed with diabetes. For adults

with diabetes, 69.6% in SPA 5 and 77.7% in SPA 6 were very confident they can control

their diabetes; however only 23.3% of respondents in SPA 4 felt very confident.

Adult Diabetes

Diabetes SPA 4 SPA 5 SPA 6 Los Angeles

County

Diagnosed Pre/Borderline Diabetic 8.4% 4.0% 12.0% 8.8%

Diagnosed with Diabetes 11.1% 4.6% 14.7% 10.0%

Very Confident to Control Diabetes 23.3% 69.6% 77.7% 56.9%

Somewhat Confident 45.8% 14.7% 19.0% 33.7%

Not Confident 30.9% 15.7% 3.3% 9.3% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Rates of diabetes reported by African American (26.6%) and Asian (16.4%) residents of

Service Planning Areas 4, 5 and 6 were higher than rates for those groups at county

and state levels. Rates reported by Latinos (8.4%) and Whites (5.7%) were lower.

Adult Diabetes by Race/Ethnicity

Race/Ethnicity SPA 4, SPA 5, SPA 6 Los Angeles County California

African American 26.6% 16.9% 12.4%

Asian 16.4% 10.0% 9.4%

Latino 8.4% 11.0% 10.0%

White 5.7% 7.1% 7.7%

Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/




63

Heart Disease For adults in SPA 4, 2.4% have been diagnosed with heart disease, 4.8% of SPA 5

adults and 8.6% of SPA 6 adults have been diagnosed with heart disease. Among

these adults, 66.7% in SPA 5 and 62.4% in SPA 6 are very confident they can manage

their condition. In SPA 4, 29.4% are very confident they can manage their condition.

Adult Heart Disease

Heart Disease SPA 4 SPA 5 SPA 6 Los Angeles

County

Diagnosed with Heart Disease 2.4% 4.8% 8.6% 5.7%

Very Confident to Control Condition 29.4% 66.7% 62.4% 53.5%

Somewhat Confident to Control Condition 53.2% 30.7% 33.3% 36.0%

Not Confident to Control Condition 17.4% 2.6% 4.2% 10.4%

Has a Management Care Plan 61.5% 89.8% 51.8% 55.5% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/

SPAs 4, 5 and 6 show higher rates of heart disease among African Americans (9.7%)

than were reported at the county (7.1%) or state (5.2%) level; rates were lower for the

other three racial groups detailed.

Adult Heart Disease by Race/Ethnicity



Asian 4.9% 6.3% 5.6%

Latino 2.8% 3.9% 4.0%

White 7.5% 8.0% 8.1%


High Blood Pressure

A co-morbidity factor for diabetes and heart disease is hypertension (high blood

pressure). In SPA 4, 28.6% of adults reported having been diagnosed with high blood

pressure. In SPA 5, 26.8% of adults have high BP and in SPA 6, 35.7% of adults have

been diagnosed with high blood pressure. Of these, 66.2% in SPA 4, 60.6% in SPA 5

and 55.5% in SPA 6 reported taking medication for their high blood pressure.

High Blood Pressure

Blood Pressure SPA 4 SPA 5 SPA 6 Los Angeles

County

Diagnosed with High Blood Pressure 28.6% 26.8% 35.7% 27.3%

Takes Medication for High Blood Pressure 66.2% 60.6% 55.5% 67.2% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/




64

In SPAs 4, 5 and 6 African Americans have the highest rates of hypertension, with well

over half (59.6%) saying they have high blood pressure; this is higher than the rates

reported for L.A. County and California. Asians (28.9%) and Whites (34.7%) also

reported slightly higher rates, with Latinos reporting slightly lower rates (21.3%) than

county and state levels.

Adult High Blood Pressure by Race/Ethnicity



Asian 28.9% 24.4% 23.3%

Latino 21.3% 23.1% 24.0%

White 34.7% 30.6% 31.8%


Cancer

Cancer incidence rates are available at the county level. In Los Angeles County, cancer

levels are lower overall, than at the state level; however, the colorectal cancer rate (41.3

per 100,000 persons), uterine cancers, (25.1 per 100,000), ovarian cancer, (12.5 per

100,000) and thyroid cancer (12.5 per 100,000 persons) exceed the state rates.

Cancer Incidence, Age-Adjusted, per 100,000 Persons, 2008-2012

Cancer Los Angeles County California

Cancer, All Sites 405.6 424.9

Prostate (males) 122.0 126.9

Breast (female) 116.9 122.1

Lung & Bronchus 41.6 47.9

Colon & Rectum 41.3 40.0

In Situ Breast (female) 25.5 29.1

Uterine ** (females) 25.1 24.1

Non-Hodgkin Lymphoma 18.4 18.8

Urinary Bladder 16.7 18.5

Kidney and Renal Pelvis 13.6 14.3

Leukemia * 12.3 12.5

Ovary (females) 12.5 12.1

Thyroid 12.5 12.0 Source: The Centers for Disease Control and Prevention, National Cancer Institute, State Cancer Profiles, 2008-2012

http://www.cancer-rates.info/ca/ * = Myeloid & Monocytic + Lymphocytic + "Other" Leukemias ** = Uterus, NOS + Corpus Uteri

HIV/AIDS

In 2013, 442 cases of HIV/AIDS were diagnosed in SPA 4 for a rate of 39 per 100,000

persons, 51 cases were diagnosed in SPA 5 (8 per 100,000 persons), and 159 cases of

HIV/AIDS were diagnosed in SPA 6 for a rate of 16 per 100,000 persons. The rate of

HIV/AIDS diagnosed in 2013 has decreased from 2012. However, rates of diagnosis of


http://www.cancer-rates.info/ca/

65

HIV/AIDS are higher in SPA 4 and SPA 6 than found in the county.

Rates of new diagnoses are highest among males, young adults 20-29, and

Blacks/African Americans. 83% of the new cases were reportedly via male-to-male

sexual contact, 10% via heterosexual sex, and 6% were cases where IV drug use was

implicated.

HIV/AIDS Diagnoses, Number and Rate per 100,000 Persons, 2012 – 2013

Geographic Area 2012 2013

Number Rate Number Rate

SPA 4 646 58 442 39

SPA 5 96 15 51 8

SPA 6 223 22 159 16

Los Angeles County 1,911 19 1,268 13

Source: County of Los Angeles, Public Health, 2013 Annual HIV Surveillance Report http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/2013AnnualSurveillanceReport.pdf

Sexually Transmitted Diseases

In the Community Benefit Service Area, SPA 6 has the highest area rate of Chlamydia

(968 per 100,000 persons), with particularly high rates in the South and Southwest

health districts within the SPA. SPA 4 has the highest area rates of Gonorrhea (271.8),

primary and secondary syphilis (30) and early latent syphilis (52.5). Females have the

highest rates of Chlamydia. Young adults, ages 20-24, have the highest rates of

Chlamydia and Gonorrhea, and residents ages 25-29 have the highest syphilis rates.

Blacks/African Americans have the highest rates of the listed sexually transmitted

infection.

STD Cases, Rate per 100,000 Persons, 2012

STD SPA 4 SPA 5 SPA 6 Los Angeles

County

Chlamydia 628.8 316.5 968.0 521.3

Gonorrhea 271.8 90.6 233.0 122.9

Primary & Secondary Syphilis 30.0 7.7 12.0 9.4

Early Latent Syphilis 52.5 11.1 17.2 13.7 Source: County of Los Angeles, Public Health, Sexually Transmitted Disease Morbidity Report, 2012. http://publichealth.lacounty.gov/dhsp/Reports/STD/STDMorbidityReport2012.pdf

Teen Sexual History

68.2% of area teens reported that they had never had sex; this was a lower rate of

abstinence than seen at the county (78.4%) or state levels (82.9%). A larger

percentage of those teens had their first encounter before the age of 15 than seen at

the county (twice as many) or state levels (three times as many). Of those youth who

had sex, only 6.8% had been tested for an STD, which is lower than the rates of testing

reported at the county (36.7%) and state (31.7%) levels.

http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/2013AnnualSurveillanceReport.pdf

http://publichealth.lacounty.gov/dhsp/Reports/STD/STDMorbidityReport2012.pdf

66

Teen Sexual History

Sexual History SPA 4, SPA 5,

SPA 6 Los Angeles

County California

Never Had Sex 68.2% 78.4% 82.9%

First Encounter Under 15 Years Old 23.7% 10.7% 7.6%

First Encounter Over 15 Years Old 8.1% 10.9% 9.5%

If Had Sex, Tested for STD in Past Year 6.8% 36.7% 31.7% Source: California Health Interview Survey, 2012. http://ask.chis.ucla.edu/

Hospitalization and ER Rates for Ambulatory Care Sensitive Conditions

Ambulatory care sensitive (ACS) conditions are defined as “those conditions resulting in

hospital admissions that with improved high quality outpatient care could otherwise

have been avoided, resulting in lower cost to the hospital and better quality of life for the

patient” (AHRQ, 2004). In the Cedars-Sinai Community Benefit Service Area, the top

three ACS conditions resulting in hospitalization are congestive heart failure, diabetes

and COPD. When compared to hospitalization rates in L.A. County, most Cedars-Sinai

rates for hospitalizations exceed the county rates for the ACS conditions.

Hospitalization Rates for Ambulatory Care Sensitive Conditions, per 10,000 Persons

ACS Conditions Cedars-Sinai Service Area Los Angeles County

Congestive Heart Failure 39.1 29.3

Diabetes 25.9 20.5

COPD 20.1 15.3

Bacterial Pneumonia 18.9 19.1

Urinary Tract Infection 18.7 16.2

Long-Term Complications of Diabetes 16.6 13.4

Dehydration 13.3 11.4

Adult Asthma 12.7 8.7

Short-Term Complications of Diabetes 6.6 5.2

Immunization-Preventable Pneumonia &

Influenza 65+ 5.1 4.0

Immunization-Preventable Pneumonia &

Influenza 1.3 1.1

Source: Healthy Communities Institute, California Office of Statewide Health Planning and Development, 2011-2013.

A look at the ER rates for the ACS conditions indicates that urinary tract infections

(UTI), adult asthma and diabetes are the top three conditions presenting at the ER. As

was the case with hospitalizations, the rates of ER admission at Cedars-Sinai are

somewhat higher than other hospitals in L.A. County. Except for pneumonia, all other

conditions see higher ER usage when compared to L.A. County.


67

Emergency Room Rates for Ambulatory Care Sensitive Conditions, per 10,000 Persons

ACS Conditions Cedars-Sinai Service Area Los Angeles County

Urinary Tract Infections 72.0 71.7

Adult Asthma 33.8 29.8

Diabetes 28.2 24.5

Dehydration 14.0 12.6

Long-Term Complications of Diabetes 13.4 12.2

Bacterial Pneumonia 12.1 12.6

COPD 11.6 9.9

Congestive Heart Failure 8.3 6.3

Uncontrolled Diabetes 2.6 2.1

Short-Term Complications of Diabetes 0.6 0.5 Source: Healthy Communities Institute, California Office of Statewide Health Planning and Development, 2011-2013.

Community Input – Chronic Disease


chronic disease. Following are their comments, quotes and opinions:

We try to build a network in the community where people can safely walk and we

can focus on prevention and health lifestyles.

Things need to change on the policy level to address substandard housing that

impacts asthma.

In regard to asthma, we have to do a better job of outreach and health education at

earlier ages in schools.

Asthma is particularly challenging. In our school district as we have 10-13% of kids

with asthma on any given campus, most of the time they are undiagnosed. A lot of

collaboration is needed for kids and families to get connected to manage asthma in

home and school environments. Diabetes Type 1 is also extremely challenging in

the schools. We have to help coordinate care with insulin.

A huge part of what we do is chronic disease management. HIV is at the top of our

list. We have around 5,000 primary care clients and 3,000 of them have HIV.

The number of people testing positive for HIV/AIDS is declining. And those moving

from HIV to AIDS are greatly reduced with medication compliance. However, with

HIV, the fastest growing incidence rates are among the young African American and

Latino populations.

Diabetes and heart disease are getting worse as more people are overweight and

are developing pre-diabetes.

Risk factors for chronic disease are due to behaviors and it is hard to change

behaviors. We do education with individuals or groups and we see that it is not

enough to push to make changes. Now we are working on policy system changes

so the healthy choice is the easy choice. This has worked with changing the policies

on smoking. Anti-smoking laws have decreased smoking and we see this can

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improve health.

Chronic diseases continue to be serious problems but there is greater public

awareness of them. Appropriate cultural and linguistic prevention and lifestyle

messages are key.

The diabetes rate is growing fast in Asian Pacific Islander populations. They can

have lower BMIs compared to other groups and still be at high risk for diabetes.

They don’t have high rates of obesity, but they do have high rates of diabetes.

Hypertension is also a big issue in this population.

There are exceptionally high rates of chronic disease in south LA. HIV rates in

minorities are extraordinarily high compared to other groups. Significant rates of

STDs in south LA (Chlamydia and Gonorrhea), and these STDs are pathways to the

spread of HIV.

Unsafe communities provide barriers to address these health issues. Fear of

violence can make it challenging to walk around the neighborhood and exercise. If

residents don’t have access to fresh quality food like the corner store and farmer’s

markets, there isn’t access. We can’t count on people to drive in a car outside of

their neighborhoods to go to a good grocery store. A lot of people rely on public

transportation.

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Health Behaviors

Health Behaviors Ranking

The County Health Rankings database examines healthy behaviors and ranks counties

according to health behavior data. California’s 58 counties are ranked from 1

(healthiest) to 58 (least healthy) based on a number of indicators that include: adult

smoking, obesity, physical inactivity, excessive drinking, sexually transmitted infections,

and others. A ranking of 17 puts Los Angeles County in the top 50% of California

counties for health behaviors.

Health Behaviors Ranking

Geographic Area County Ranking (out of 58)

Los Angeles County 17

Source: County Health Rankings, 2015. www.countyhealthrankings.org

Overweight and Obesity

37.1% of adults in SPA 4, 5 and 6 are overweight. 9.5% of teens are overweight and

12.4% of children are overweight.

Overweight

Age Group SPA 4, SPA 5, SPA 6 Los Angeles County California

Adult (18+ Years) 37.1% 36.2% 35.5%

Teen (Ages 12-17) 9.5% 14.4% 16.3%

Child (Under 12) 12.4% 11.5% 13.6% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

The Healthy People 2020 objectives for obesity are 30.5% of adults aged 20 and over,

and 16.1% of teens. Teens in the area SPAs are at or above this target. Adults in SPA

6 also do not meet the goal, with 39.1% reporting obesity. SPA 4 is slightly better than

the goal, at 29.3% obesity, while SPA 5 is well below, at 14.8%.

Obesity

Age Group SPA 4 SPA 5 SPA 6 Los Angeles County

Adult (Ages 20+ Years) 29.3% 14.8% 39.1% 27.2%

Teen (Ages 12-17 Years) 24.4% 16.7% 21.9% 14.9% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Adult overweight and obesity by race and ethnicity indicate over three-quarters of the

adult population among African-Americans are overweight or obese. Latinos also have

rates of overweight and obesity. Asians tend to have lower rates of overweight and

obese except in SPA 6, where Whites show a lower rate. SPA 6 shows the highest

rates of overweight and obesity among all races/ethnicities except Whites.

http://www.countyhealthrankings.org/



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Adults, 20+ Years of Age, Overweight and Obesity by Race/Ethnicity

Race/Ethnicity SPA 4 SPA 5 SPA 6 Los Angeles

County

African American 75.6% 79.8% 84.8% 83.5%

Asian 49.7% 38.6% 59.6% 41.1%

Latino 73.1% 69.3% 75.2% 72.6%

White 65.6% 54.1% 41.2% 60.8% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

The physical fitness test (PFT) for students in California schools is the FitnessGram®.

One of the components of the PFT is measurement of body composition (measured by

skinfold measurement, BMI, or bioelectric impedance). Children who do not meet the

“Healthy Fitness Zone” criteria for body composition are categorized as needing

improvement or at high risk (overweight/obese).

In area school districts, over half of 5th grade students tested as needing improvement

or at health risk from body composition. Among 9th graders the rates were improved.

Only the rates for Beverly Hills Unified and Culver City Unified were below state and

county averages.

5th and 9th Graders, Body Composition, Needs Improvement + Health Risk

School District Fifth Grade Ninth Grade

Beverly Hills Unified School District 28.8% 26.1%

Culver City Unified School District 33.6% 22.6%

Inglewood Unified School District 55.2% 50.4%

Lennox School District 51.9% 45.6%

Los Angeles Unified School District 50.1% 44.4%

Los Angeles County 44.6% 38.6%

California 40.5% 35.8%

Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, 2013-2014.

http://data1.cde.ca.gov/dataquest/page2.asp?Level=District&submit1=Submit&Subject=FitTest

Fast Food

Adults, ages 18-64, consume fast food at higher rates than children, 0-17. SPA 6 has

higher rates of fast food consumption among both age groups when compared to SPA 4

and SPA 5, and the county. 28.6% of adults and 19.3% of children in SPA 6 consume

fast food 3 or more times a week.


http://data1.cde.ca.gov/dataquest/page2.asp?Level=District&submit1=Submit&Subject=FitTest

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Fast Food Consumption, 3 or More Times a Week

Fast Food Consumption SPA 4 SPA 5 SPA 6 Los Angeles

County

Adult, Aged 18-64, Fast Food Consumption 19.0% 23.0% 28.6% 25.5%

Children and Youth, 0-17 Years of Age, Fast Food Consumption

16.7% 4.0% 19.3% 15.1%

Source: California Health Interview Survey, 201.; http://ask.chis.ucla.edu/

Soda Consumption

The percentage of adults who consume seven or more sodas in a week is higher in

SPA 6 (16.8%) than in SPA 4 (9.9%), SPA 5 (9.6%), or the county (10.2%).

Adults Average Weekly Soda Consumption; 7 or more

Soda Consumption SPA 4 SPA 5 SPA 6 Los Angeles

County

Adult Soda Consumption 9.9% 9.6% 16.8% 10.2% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Fruit Consumption

Children in SPA 5 (81%) are more likely to eat two or more servings of fruit a day than

in SPA 4 (67.4%) or SPA 6 (76.3%). Teens are less likely to eat two or more servings

of fruit a day than children.

Consumption of Fruit, Two or More Servings a Day, Children and Teens

Age Group SPA 4 SPA 5 SPA 6 Los Angeles

County

Children 67.4% 81.0% 76.3% 63.4%

Teens 41.6% 61.3% 38.2% 43.6% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

Access to Fresh Produce

Among adults, 18 years and older, 90% in SPA 4, 95.8% in SPA 5, and 77.9% in SPA 6 indicated that accessing fresh produce (fruits and vegetables) was somewhat or very easy. Adults who Reported Accessing Fresh Produce was Very or Somewhat Easy

Age Group SPA 4 SPA 5 SPA 6 Los Angeles

County

Adults, 18+ Years Old 90.0% 95.8% 77.9% 89.7% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2011.

www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm

Physical Activity

4.4% of area children and teens spend over five hours in sedentary activities after

school on a typical weekday, and 6% spend over 8 hours a day on sedentary activities

on weekend days. In contrast, a larger percentage of SPA teens (15.3%) were reported





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to spend no days during the week being physically active for at least one hour. 64.6%

of teens had been to a park, playground or open space in the past month.

Physical Activity

Physical Activity SPA 4, SPA 5,

SPA 6 Los Angeles

County California

5+ Hours Spent On Sedentary Activities After School On a Typical Weekday - Children and Teens 4.4% 9.3% 10.2%

8+ Hours Spent On Sedentary Activities On a Typical Weekend Day - Children and Teens 6.0% 8.9% 7.2%

Teens No Physical Activity in a Typical Week 15.3% 11.9% 8.6%

Teens Visited Park/Playground/Open Space in Past Month 64.6% 62.1% 69.2%


Community Input – Overweight and Obesity


overweight and obesity. Following are their comments, quotes and opinions:

In some schools, 70% of kids fail the fitness test, speed coordination, balance, etc.

Of that 70%, 30% fail every section. They aren’t moving around, they are obese.

We must have a campus approach to healthy, active living.

Overweight/obesity is one of our biggest challenges. We have obesity prevention

programs right and left, some are more effective. There are a lot of groups working

on it but it has gotten worse in the past few years.

A lack of access due to high cost of healthy foods has added to the problem ove

overweight and obesity.

Overweight and obesity are highly prevalent in this community. We are a food

desert with no high quality restaurants. It is hard to get fresh fruit and vegetables.

Obesity is a result. We are also challenged to find outlets for exercise. Park space

is limited here. We have a ‘Perfect storm’ for overweight and obesity.

Visibility and public awareness is growing on this issue. The Department of Public

Health is taking it seriously. Good prevention programs will pay dividends in the

future.

We have poor nutritional quality, inadequate diet, limited time, energy, and space for

recreation. Sedentary lifestyle is a huge contributor, people on computers video

games, etc. We have opportunities to reframe the conversation – drink more water,

schools have healthy options at the front of the counter, rezoning fast food

restaurants and getting grocery stores where they are needed.


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Mental Health and Substance Abuse

Mental Health

Among adults, 9.6% in SPA 4, 9.0% in SPA 5, and 8.2% in SPA 6 experienced serious

psychological distress in the past year. 21.9% of adults needed help for mental health

and/or alcohol and problems in SPA 4, 20% in SPA 5, and 15% of adults in SPA 6.

12% of adults in SPA 4 saw a health care provider for their mental health and/or alcohol

and drug issues in the past year; in SPA 5 it was 19.7% and in SPA 6 10.9%.

11.2% of adults in SPA 4, 10.1% in SPA 5, and 8% in SPA 6 had taken a prescription

medication for at least two weeks for an emotional or mental health issue in the past

year. Well over half the adults in SPA 4 (60.7%), over a third in SPA 5 (37%), and

45.6% of adults in SPA 6 who needed help for an emotional or mental health problem

did not receive treatment. The Healthy People 2020 objective is for 64.6% of adults

with a mental disorder to receive treatment, which equates to 35.4% who do not receive

treatment.

Mental Health Indicators, Adults

Mental Health Indicators SPA 4 SPA 5 SPA 6 Los Angeles

County

Adults who had Serious Psychological Distress During Past Year

9.4% 9.0% 8.2% 9.6%

Adults who Needed Help for Emotional-Mental and/or Alcohol-Drug Issues in Past Year

21.9% 20.0% 15.0% 18.0%

Adults who Saw a Health Care Provider for Emotional/Mental Health and/or Alcohol-Drug Issues in Past Year

12.0% 19.7% 10.9% 13.0%

Has Taken Prescription Medicine for Emotional/Mental Health Issue in Past Year

11.2% 10.1% 8.0% 9.2%

Sought/Needed Help but Did Not Receive Treatment

60.7% 37.0% 45.6% 43.2%


Among teens, 19.3% needed help for emotional or mental health problems, which was

lower than the county (22.4%) or state (23.2%) rates. Frequent mental distress was

reported during the past month by 6.8% of area teens, which was lower than the county

level (7.3%) but higher than for the state (5.8%).


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Mental Health Indicators, Teens

Mental Health Indicators SPA 4, SPA 5,

SPA 6 Los Angeles

County California

Teens Who Needed Help for Emotional or Mental Health Problems in Past Year

19.3% 22.4% 23.2%

Teens Who Had Frequent Mental Distress During the Past Month

6.8% 7.3% 5.8%


Community Input – Mental Health


mental health. Following are their comments, quotes and opinions:

Private practice for mental health care is nonexistent. Many patients have Medi-Cal,

but in this environment it is virtually impossible to find a practitioner.

There is a stigma associated with mental health problems. Parent education, home

visiting programs and more focus on intergenerational support are needed.

There are two issues with mental health. One is stigma, which is different among

cultures. We need to help people talk about mental illness and seek treatment. The

second issue is workforce. If more people started seeking care, are there care

resources available for them?

Proposition 63 has infused funding, allowed the system to try innovative approaches,

and raised the expertise of the workforce. We are seeing changes with ACA health

plans as moderate health issues are now getting reimbursed. Before it used to be

only severe conditions could receive treatment. So there is now more early

intervention.

This is a public policy issue. Funds are from the mental health services act and

recovery is based on volunteer engagement. It is voluntary, not mandatory. We

cannot force people to get treatment.

I’m seeing an uptick in the number of vets self-disclosing mental health issues.

There is not a lack of stigma, but it has been minimized. It is now appropriate for

them to say they have an issue. Five years ago people would be cautious to say

that.

There is a lack of resources to help people with mental illness. The jail population

suffers the most as there is very little care in the facilities and we lack reentry

programs.

Some doctors are not sensitive to those with mental health problems so they are not

getting the level of care they need.


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Tobacco/Alcohol/Drug Use

Cigarette Smoking

The 2014 California Health Interview Survey indicated that in SPA 4, 11.1% of adults

smoke cigarettes, 7.8% of adults in SPA 5 and 12.8% of SPA 6 adults are current

smokers. The Healthy People 2020 objective for cigarette smoking among adults is

12%.

Cigarette Smoking, Adults

Smoking SPA 4 SPA 5 SPA 6 Los Angeles

County

Current Smoker 11.1% 7.8% 12.8% 10.8%

Former Smoker 22.6% 22.9% 26.1% 22.4%

Never Smoked 66.2% 69.2% 61.1% 66.8% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu

Among teens in SPA 4, 3.8% smoke cigarettes and 4.7% have smoked an electronic

(vaporizer) cigarette. 4.4% of SPA 5 teens and 3.2% of SPA 6 teens indicated they had

smoked an e-cigarette.

Smoking, Teens

Smoking SPA 4 SPA 5 SPA 6 Los Angeles

County

Current Cigarette Smoker 3.8% None 1.4% 2.3%

Ever Smoked an e-Cigarette 4.7% 4.4% 3.2% 11.3% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu

Alcohol and Drug Use

Binge drinking is defined as consuming a certain amount of alcohol within a set period

of time. For males this is five or more drinks per occasion and for females it is four or

more drinks per occasion. Among adults, 31.1% in SPA 4, 41.4% in SPA 5, and 31.9%

in SPA 6 had engaged in binge drinking in the past year. SPA 5 showed higher levels

of binge drinking than found in the county (31.5%).

Binge Drinking, Adults

Binge Drinking SPA 4 SPA 5 SPA 6 Los Angeles County

Adult Binge Drinking Past Year 31.1% 41.4% 31.9% 31.5% Source: California Health Interview Survey, 2014; http://ask.chis.ucla.edu/

Fewer teens in area SPAs reported having tried alcohol (15.2%) than at the county

(19.1%) or state (22.5%) levels. However, far more (24%) reported having tried illegal

drugs than having tried alcohol, and levels were significantly higher than county (14.7%)

and state (12.4%) levels. More teens have also used marijuana in the past year




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(10.3%) than L.A. County (9.4%) or California teens (8.6%).

Teen Alcohol and Illegal Drug Use

Alcohol and Illegal Drug Use SPA 4, SPA 5,

SPA 6 Los Angeles

County California

Teen Ever Had an Alcoholic Drink 15.2% 19.1% 22.5%

Ever Tried Illegal Drugs, Including Marijuana, Cocaine, Sniffing Glue Or Others*

24.0% 14.7% 12.4%

Use of Marijuana in Past Year* 10.3% 9.4% 8.6% Source: California Health Interview Survey, 2014 & 2012 (*); http://ask.chis.ucla.edu/

Community Input – Substance Abuse


substance abuse. Following are their comments, quotes and opinions:

Substance abuse is a big issue right next to mental health. There are major impacts

in secondary and even middle school students. There is a lack of providers on the

treatment side. A lot of treatment is geared toward adults, like 12 step programs,

which are not right for kids. We need to push the envelope to get more prevention

programs. The system is set up to address treatment and conditions once they are

significant enough. We need to get in front of it.

Substance abuse is rampant; not enough is being done. The number of Green

stores is so high; access is easy and in your face. LA County care isn’t great when

someone is addicted to heroin or meth. For alcohol and pot there is not enough

education and access to counseling.

While not exclusive to the Gay community, they are impacted by use of crystal meth.

Crystal meth is still the drug of choice, then alcohol and then pot.

As people become more acculturated we see substance abuse rise. First

generations are so focused on working, but kids get into it. We see this in the

Korean community. The first generation works hard and kids are unsupervised.

They are influenced by American culture and lots of drug and alcohol abuse. When

immigrants come here, their education isn’t accepted, their status at home culture

isn’t accepted and family culture goes upside down – kids can navigate through

society quicker so they outpace the parents.

There is not enough funding for substance abuse and not enough integration with

mental health.

There are really not a lot of services available. There is a lack of short-term

residential treatment. The provider community recognizes it and it has gotten better

but funding has not kept up.

The recognition of substance abuse as an issue is increasing, and the availability to

get reimbursed for treatment is increasing. But with some substances we are seeing

an increase in abuse.


77

In SPA 5 prescription drug overdose and managing medications is a huge issue.

Especially among higher income individuals and white males. There are significant

rates of overdoses and suicide in this middle to upper class group.

A person can buy pot on every corner and can buy a card to get a medical marijuana

prescription for $5.00. More people are mixing drugs and alcohol. Substance abuse

is hitting younger populations with easy access to drugs and alcohol.

In the Hollywood area we have a lot of dispensaries, which has made drugs more

easily available. This is a problem with the homeless as they have mental health

and substance abuse issues.

In the past, it was common for Latino women not to be seen drinking. Now it is

socially acceptable. This can evolve into abuse.

Those with a drug addiction or binge drinking can open themselves up to risky

behaviors, which can result in STDs or driving under the influence.

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Preventive Practices

Flu and Pneumonia Vaccines

Residents of SPA 5 are more likely to get flu shots, in every age group, than in SPA 4,

SPA 6, or the county. Seniors tend to receive flu vaccines at higher rates than adults or

children; however, only SPA 5 seniors met the 70% Healthy People 2020 goal, which

applies to all age groups.

Among area seniors, 58.5% in SPA 6, 62.5% in SPA 4, and 72.8% in SPA 5 had

received a flu shot. Adults received flu shots at the lowest rate – 34.2% in SPA 4,

34.5% in SPA 6, and 43.4% in SPA 5. Among children 6 months to 17 years of age,

52.2% of children in SPA 4, 57.4% in SPA 6 and 62.1% in SPA 5 received a flu shot.

Flu Vaccine

Flu Vaccine SPA 4 SPA 5 SPA 6 Los Angeles

County

Received Flu Vaccine, 65+ Years Old 62.5% 72.8% 58.5% 69.7%

Received Flu Vaccine, 18-64 34.2% 43.4% 34.5% 32.5%

Received Flu Vaccine, 6 Months-17 Years Old 52.2% 62.1% 57.4% 47.8% Source: California Health Interview Survey, 2014. http://ask.chis.ucla.edu/

The Healthy People 2020 objective is for 90% of seniors to obtain a pneumonia vaccine.

The seniors in SPA 4 (61%), SPA 5 (64.1%) and SPA 6 (53.9%) had obtained a

pneumonia vaccine, which does not meet the Healthy People 2020 objective.

Pneumonia Vaccine, Adults 65+

Pneumonia Vaccine SPA 4 SPA 5 SPA 6 Los Angeles

County

Adults 65+, Had a Pneumonia Vaccine 61.0% 64.1% 53.9% 61.3% Source: Los Angeles County Health Survey, 2011. http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm

Immunization of Children

Among area schools, rates of compliance with childhood immunizations upon entry into

kindergarten are below the state average (90.4%), with the exceptions of the Lennox

School District and the Culver City Unified School District, which show high rates of

compliance (96.7% and 94.1%, respectively). At 78.9%, LAUSD is below the county

level of 86%. Only 77.4% of children have the required immunizations in the Beverly

Hills Unified school district.



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Up-to-Date Immunization Rates of Children Entering Kindergarten, 2014-2015

School District Immunization Rate







California 90.4% Source: California Department of Public Health, Immunization Branch, 2014-2015. https://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx

Mammograms

The Healthy People 2020 objective for mammograms is that 81.1% of women 50-74

years to have a mammogram in the past two years. In SPA 4, 75.5% of women in the

target demographic have had a mammogram. 82.5% in SPA 5 and 82.8% of women 50-

74 in SPA 6 have had mammograms.

Pap Smears

The Healthy People 2020 objective for Pap smears in the past three years is 93% of 21-

65 year olds to be screened. In SPA 4, 82% of women have had a Pap smear. In SPA

5, 83.5% of women, and in SPA 6, 87.4% of women 21-65 have had a Pap smear in the

past three years.

Women Mammograms and Pap Smears

Mammograms and Pap Smears SPA 4 SPA 5 SPA 6 Los Angeles

County

Women 50-74 Years, Had a Mammogram in Past Two Years

75.5% 82.5% 82.8% 79.8%

Women 21-65; Pap Smear in Past Three Years 82.0% 83.5% 87.4% 82.8% Source: Los Angeles County Health Survey, 2011. http://www.publichealth.lacounty.gov/ha/LACHSDataTopics2011.htm

Colorectal Cancer Screening

The Healthy People 2020 objective for colorectal cancer screening is 70.5% of 50-75

year olds to be screened. SPA 4 (72.7%) and SPA 5 (78.5%) exceed this screening

objective. With 66.9% of targeted adults obtaining colorectal screening, SPA 6 has a

rate less than the Healthy People 2020 objective. Of adults advised to obtain

screening, 64.5% in SPA 4, 72.3% in SPA 5 and 57.8% in SPA 6 were compliant at the

time of the recommendation.

https://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx


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Colorectal Cancer Screening, Adults 50 to 75 years old

Colorectal Cancer Screening SPA 4 SPA 5 SPA 6 Los Angeles

County

Screening Sigmoidoscopy, Colonoscopy or Fecal Occult Blood Test 72.7% 78.5% 66.9% 74.0%

Compliant with Screening at Time of Recommendation 64.5% 72.3% 57.8% 65.3%


Community Input – Preventive Practices


preventive practices. Following are their comments, quotes and opinions:

Build healthy neighborhoods is the best thing we can do. Communities that are

stronger and more successful get more services and funding. A strong sense of

community feeds into health of community.

It is essential that payment for health needs shifts toward prevention. Fee for service

has been a downfall. ACA should move us into providing more preventive care and

helping people stay healthy.

Schools are places where we can do more. We have a responsibility to see where

medical care stops and educational and wellness systems start. Schools are great

places to do more early screenings and interventions.

Waiting for people to come to us for care doesn’t work; instead we go out to

community centers, churches, etc. If there is an identified complication we give

them a referral to various agencies to get services. We want to create an

opportunity where it’s a neutral location and reduce the stigma; it’s baby steps to

treatment.

It is very important to be proactive about screenings based on evidence-based best

practices. Clinics have the ability to flag consumers when they need screenings.

We are deficient in primary and secondary preventions. People put off seeking care

and when they do access care, their disease is advanced. We have to admit them

to a hospital for something that should have been detected long ago. Poor diet,

exercise, and cigarette smoking is high in the African American population so there

is more cancer and COPD in this community. It’s a major focus here, but need more

resources. If we had resources we could make a lot of progress.

Hepatitis B is the biggest challenge with the Asian population. There are so many

subgroups in the community and many are not English proficient. There is a need to

target and identify them within their cultural enclaves. It’s hard but worth the effort

because cancer may be preventable.

The challenge is with habits. It takes so long to break them. Many low-income

people believe being a little overweight is healthy. That concept has passed from

generation to generation. But a chubby kid doesn’t equal health. Poverty and a lack


81

of access to healthy choices impacts health.

Increased numbers of people are getting care because they are now insured.

Community clinics and really big insurers like Kaiser are doing more outreach

services.

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Community Input

In addition to offering input on the significant health needs in the communities served by

Cedars-Sinai, the community stakeholders were asked what health or social services

were most difficult to access or are missing in the community. Their responses

included:

Dental services

Mental health services

Access to care (insurance coverage, medical homes, homeless care, culturally

competent, linguistically accessible)

Substance abuse services (counseling, treatment, residential treatment, LGBT

competent, integrated with mental health)

Specialty care (orthopedics, gastroenterology, cardiology, oncology, psychiatry and

dermatology)

Transportation

Permanent supportive housing, affordable housing

Vision care (low-cost glasses, optometrists)

Legal services

Cancer treatment

Healthy communities to include urban gardens, green space, and protected areas

Additional Comments or Concerns

Finally, interview participants were asked if they had any other comments or concerns

they wanted to share with Cedars-Sinai. Their responses included:

Hospitals play a pivotal role in capturing patients at their sickest. It's important for

hospitals to collaborate with health plans to help coordinate transitions.

As all the changes are taking place in coverage, we need to have a coordinated

effort of all players in delivery systems. This has been hard. Who is going to step

up to coordinate? Who are the new partners and working relations and how does

money get distributed? How does power get shared? How do you work together to

share information?

I would like to see that we work with existing programs. We have the programs but

we don’t have finances to expand the services.

Hospitals can take a more active role in community engagement.

Clinics are being asked to do a large amount of things as a non-profit to accomplish

the goals set forth by ACA. It’s more work with less resources.

It is important for organizations to work together on policy issues to address priority

needs.

There is a lot of potential but we need stronger networking. We work with certain

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groups and we all do work in the same geographic areas serving the same people.

If a large organization worked with the groups together and passed uniform

messages to our populations, and included businesses, this would be a great

opportunity.

We need an overall countywide plan that involves everybody. Currently, it is

fragmented. The California Endowment is trying to take the lead in certain

neighborhoods but there is no true leader to bring everyone to the same table. It’s a

missed opportunity. Hospitals try and include as many people as they can, and

clinics try to work though their systems, but no one is stepping up to take leadership

of this. There is a vacuum. The restructured County health system may change this

when they reorganize.

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Attachment 1 – Community Stakeholder Interviewees

Community input was obtained from public health professionals and representatives

from organizations that represent medically underserved, low-income, and/or minority

populations.

Name Title Organization

Elaine Batchlor, MD, MPH CEO Martin Luther King, Jr. Community Hospital

Christopher Brown Director of Health and Mental Health Services

Los Angeles LGBT Center

Richard Bruckner Director LA County Department of Regional Planning

Jeff Bujer Executive Director Saban Clinic

Stephanie Caldwell Chief of Staff LA County Department of Public Health

Maria Calleros Director Safety Net Initiatives LA Care Health Plan

David Carlisle, MD, PhD President and CEO Charles R. Drew University of Medicine and Science

Connie Chung Supervising Regional Planner LA County Department of Regional Planning

Maureen Cyr Supervisor LA County Department of Mental Health

Lucia Diaz Director Mar Vista Family Center

Elizabeth Forer, MSW, MPH CEO Venice Family Clinic

David Giugni Manager, Social Services City of West Hollywood

Pina Hernandez Outreach Manager PHFE WIC Program

Alison Herrmann, PhD Assistant Director UCLA Kaiser Permanente Center for Health Equity

Michael Hochman, MD Health Deputy Office of LA County Supervisor, 2

nd

Mark Ridley-Thomas

Connie Chung Joe, JD Executive Director Korean American Family Services

Jan King, MD, MPH SPA 5 and SPA 6 Area Health Officer

LA County Department of Public Health

Veronica Lewis, MPA Division Director Homeless Outreach Program Integrated Care System

Tod Lipka CEO Step Up on Second

John Maceri CEO Ocean Park Community Center/OPCC

Ivan Mason, MPA Executive Director U.S. Veterans Initiative

Salya Mohamedy Assistant Deputy Office of LA County Supervisor, 2

nd

Mark Ridley-Thomas

Cristin Mondy, RN, MSN, MPH

SPA 3 and SPA 4 Area Health Officer

LA County Department of Public Health

D’Ann Morris Deputy Neighborhood Officer Los Angeles Urban League

Lyn Morris, MFT Senior Vice President of Clinical Operations

Didi Hirsch Mental Health Services

Maryjane Puffer, BSN, MPA Executive Director LA Trust for Children’s Health

Jennifer Ralls Director of Community Outreach and Impact

Para Los Niños

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Vivian Sauer, LCSW Director of Quality Management and Program Development

Jewish Family Services of Los Angeles

Barbara J. Shields Executive Director Team HEAL

Elan Shultz Head Deputy LA County Supervisor, 3

rd District

Office of Supervisor Sheila Kuehl

Wayne Sugita Interim Executive Director Substance Abuse Prevention and Control, LA County Department of Public Health

Karla Torres Program Director Mexican Consulate

Kimberly Uyeda, MD, MPH Assistant Director Los Angeles Unified School District

Nina Vaccaro, MPH Executive Director Southside Coalition of Community Clinics

Rosemary Veniegas, PhD Program Officer California Community Foundation

Jacquelyn Wilcoxen District Chief LA County Department of Mental Health

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Attachment 2 – Community Resources

Cedars-Sinai solicited community input through key stakeholder interviews to identify

resources potentially available to address the significant health needs. These identified

resources are listed in the table below. This is not a comprehensive list of all available

resources. For additional resources refer to Think Health LA at www.thinkhealthla.org

and 211 LA County at https://www.211la.org/.

Significant Health Needs Community Resources

Access to care Westside Family Health Center, Venice Family Clinic, Saban Community

Clinic, LA Christian Health Center, T.H.E. Clinic, Eisner Pediatric &

Family Medical Center, Clinica Oscar Romero, QueensCare Family

Clinics, St. John’s Well Child & Family Center, Watts Healthcare

Corporation, Northeast Community Clinic, Korean Health Education

Information and Research Center, JWCH Institute, South Bay Family

Healthcare Center, school-based health centers, school wellness centers,

Healthy Way LA, primary care providers, Team HEAL, Simms Mann

Clinic, Jewish Family Services, Didi Hirsch Mental Health Services,

Supportive Services for Veterans Families, Cedars-Sinai’s COACH for

Kids mobile medical units, Ocean Park Community Center (OPCC), Los

Angeles LGBT Center, Mexican Consulate Window for Health,

Paratransit programs, The Mobile Clinic Project at UCLA, To Help

Everyone Clinic, Inc., Watts Health Center: Crenshaw Community Health

Center

Cancer Southern Los Angeles Patient Navigation Wellness Center, Cedars-Sinai,

UCLA Health, Saban Clinic, Kaiser Permanente, Marina Del Rey

Hospital, Brotman Medical Center, county hospital, Venice Family Clinic,

LGBT Health Alliance, Every Woman Counts, Cancer Support

Community Benjamin Center, American Cancer Society, primary care

providers, Los Angeles County Department of Public Health Office of

Women’s Health, Cancer Legal Resource Center (CLRC), Los Angeles

breast Cancer Alliance, Breast Cancer Solutions, WeSpark

Chronic disease (asthma,

diabetes, heart disease,

HIV/AIDS)

Breath Mobile, Venice Family Clinic, primary care physicians, Westside

Family Health Center, UCLA Health, Alzheimer’s Association, Common

Ground, Saban Clinic, Homeless Access Center, county clinics, hospitals,

American Diabetes Association, churches, First Ladies Club, schools and

school districts, HIVLA.org, Jeffrey Goodman Clinic, Los Angeles County

Department of Public Health, AIDS Project Los Angeles, BREATHE

California of Los Angeles County, Disability Rights Legal Center,

Esperanza Community Housing Corporation Healthy Breathing Project,

The Asthma Coalition of Los Angeles County, The City of Los Angeles

Department on Disability, YMCA Diabetes Prevention Program

http://www.thinkhealthla.org/

https://www.211la.org/

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Community safety Libraries, schools and school districts, faith institutions, law enforcement,

Department of Transportation, parks, shelters and day centers, Safe

Routes to School program, gang intervention programs, Para Los Niños

Family Support Centers, Korean Community Center, Neighborhood

Councils, First 5 LA Best Start, Summer Night Lights program, Los

Angeles LGBT Center, Homeboy Enterprises, Salvation Army, Parks after

Dark, 1736 Family Crisis Center, City of Los Angeles Anonymous Gun

Buyback, LAUSD’s Joint-Use Development Bond Program, Los Angeles

County Department of Children and Family Services, Los Angeles School

Police Department, National Sheriff’s Association, Southern California

Crossroads, The Children’s Institute, Inc., The Good Shepherd Shelter,

The Injury & Violence Prevention Program (IVPP) of the Los Angeles

County Department of Public Health, The Los Angeles Police

Department’s Neighborhood Watch Program Violence Prevention

Coalition of Greater Los Angeles, Vista Del Mar Child and Family

Services: Home Safe

Dental care WIC, Venice Family Clinic, private dentists, schools – screening and

varnish programs, UCLA Health Dental clinic, county hospital, USC

Dental program, St. John’s Well Child and Family Center, Saban Clinic,

free health clinics, Southside Coalition of Community Clinics, Eisner

Pediatric & Family Medical Center, LAUSD Oral Health Initiative, Los

Angeles Christian Health Center, Clinica Oscar Romero, QueensCare

Health Centers, The LA Trust, Cedars-Sinai’s COACH for Kids mobile

medical units – pediatric dental education, screening and referral

Homelessness Ocean Park Community Center (OPCC), Providence St. John’s Health

Center, HOPICS, United Way, PATH, Santa Monica, UCLA Family

Medicine and nursing staff homeless clinics, Los Angeles LGBT Center,

Veterans Administration, West Hollywood Housing Development, Mar

Vista Housing, Los Angeles Homeless Services Authority, LA County

Department of Public Health, Department of Mental Health, homeless

access center, St. Joseph’s Center, My Friend’s Place, Safe Place for

Youth, Daniel’s Places, Step Up on Second, Center for Justice and Social

Compassion, Mid-Wilshire Homeless Collaborative, 1736 Family Crisis

Center, Alliance for Housing and Healing, Chrysalis, Homeless Health

Care, JWCH Institute, Inc., Lamp Community, Los Angeles Mission,

Shelter Partnership, Inc., The Good Shepherd Shelter, Union Rescue

Mission, United Way-Greater Los Angeles, Weingart Center, Homeless

Outreach Program Integrated Care System (HOPICS), People Assisting

the Homeless (PATH)

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Mental health LA County Department of Mental Health, community clinics, Didi Hirsch

Mental Health Services, Para Los Niños, Providence St. John’s Health

Center, Santa Monica, My Health LA, L.A. County mental health clinics,

law enforcement, NAMI, Los Angeles LGBT Center, UCLA Nathanson

Family Resilience Center, VA, Resnick Neuropsychiatric Hospital at

UCLA, St. Joseph’s Center, Ocean Park Community Center (OPCC),

schools and school districts, Step Up on Second, Aviva Family &

Children's Services, Exodus Recovery wellness center, JWCH Institute,

Inc., Los Angeles County Wellness and Client Run Centers, Los Angeles

County: Veterans and Loved Ones Recovery (VALOR) Program,

Magnolia Place Family Center Children's Bureau, Shields for Families,

Inc., Vista Del Mar Child & Family Services, Alcott Center for Mental

Health Services, Amanecer Community Counseling Center, West Central

Family Mental Health Center, Children’s Institute, Didi Hirsch Mental

Health Services, Jewish Family Services of Los Angeles, Korean

American Family Services, Southern California Counseling Center, The

Maple Counseling Center

Overweight and obesity LA County Department of Public Health, Cedars-Sinai’s Healthy Habits

program, community clinics, primary care providers, Team HEAL, Mar

Vista Family Center, American Diabetes Association, UCLA Family

Center, policy work in communities, schools and school districts,

community-based coalitions and collaboratives, Mexican Consulate,

farmer’s markets, REACH, breakfast in the classroom, Fit for Life, Kaiser,

American Heart Association, Jump Rope for Heart Event, Beyond the

Bell, Black Women for Wellness, California WIC Association, Champions

for Change, Choose Health LA, Community Market Conversion (CMC),

Dairy Council of California, First 5 LA, Food Policy Roundtable Coalition,

Gasol Foundation, LA’s BEST, Magnolia Place Family Center Children's

Bureau, Network for Healthy California, School Wellness Committees,

Summer Food Services Program, The Coalition for an Active South LA,

The LA Trust, YMCA

Preventive practices Nonprofit social service agencies, churches, schools and school districts,

community clinics, LA County Department of Public Health, Cedars-

Sinai’s COACH for Kids mobile medical units, primary care providers,

libraries, Vaccines for Children (VFC), Los Angeles LGBT Center, high

school wellness centers, promotoras, policy work in communities, St.

Joseph’s Center, Cedars-Sinai, UCLA Family Clinic, Kaiser Permanente,

My Friend’s Place, Safe Place for Youth, promotoras, Team HEAL,

Magnolia Place Family Center Children's Bureau, The LA Trust

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Substance abuse Didi Hirsch Mental Health Services, Mar Vista Family Center, LA County

Department of Public Health, LA County Department of Mental Health,

AA programs, law enforcement, schools and school districts, CLARE

Foundation, community-based substance abuse treatment providers,

Bienestar, Venice Family Clinic, Providence St. John’s Health Center,

Santa Monica, Resnick Neuropsychiatric Hospital at UCLA, Los Angeles

LGBT Center, Saban Clinic, Tarzana Treatment Center, City of Los

Angeles Needle Exchange, JWCH Institute, Inc., LA County Department

of Public Health’s Substance Abuse Prevention and Control (SAPC)

program, Law enforcement and corrections, Los Angeles Overdose

Prevention Task Force, Shields for Families, Inc., Substance abuse

counselors, The Los Angeles Centers for Alcohol and Drug Abuse (L.A.

CADA), The Los Angeles County Prescription Drug Abuse Medical Task

Force, Beit T’Shuvah

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Attachment 3 – Impact Evaluation

Cedars-Sinai developed and approved an Implementation Strategy to address

significant health needs identified in the 2013 Community Health Needs Assessment.

The Implementation Strategy addressed the following health needs through a

commitment of community benefit programs and resources.

Priority Geography

Health needs were prioritized by areas of highest need in Cedars-Sinai’s Community

Benefit Service Area, with a particular focus on Service Planning Areas 4 and 6, these

planning areas include diverse, low-income communities with more uninsured adults

and children and greater health challenges than in other parts of Los Angeles. High-

need populations closer to Cedars-Sinai were also addressed.

Priority Health Needs

Access to Care: Selected Community Benefit efforts focused on increasing and

supporting access to essential health care services for the underserved through direct

programs and partnerships with local community-based organizations. Programs,

partnerships and strategies addressed the following access-to-care priority health

needs:

• Primary care

• Specialty care

• Mental health

• Preventive care

Chronic Disease: Community Benefit efforts also focused on the prevention of key

chronic health conditions and their underlying risk factors. Programs, partnerships and

strategies addressed the following priority health needs related to chronic disease:

• Cardiovascular disease

• Diabetes

• Cancer

• Overweight/obesity: healthy food choices and physical activity

• Preventive care

• Health education

Impact

Strategies to address the priority health needs were identified and impact measures

tracked. The following sections outline the impact made on the selected significant

health needs for FY14 (July 1, 2013 – June 30, 2014) and FY15 (July 1, 2014 – June

30, 2015). At the time of this report, impact data for FY16 were not fully available and

are not included.

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Access to Care Primary Care, Specialty Care, Mental Health Care, Preventive Care

COACH for Kids and Their Families® Community Outreach Assistance for Children's Health (COACH)

Cedars-Sinai operates two state-of-the-art mobile medical clinics staffed by an expert

team of bilingual registered nurses, nurse practitioners, social workers and health care

professionals. COACH preventive health care services include well-child and

immunization clinics for children, dental screenings and fluoride varnish for children,

BMI clinics for adults, nutrition and fitness education, and linkages to medical homes.

COACH serves communities in Downtown/Skid Row, Pico-Union/Central Los Angeles,

South Los Angeles, Watts, Compton, Inglewood, Lennox, Crenshaw/Mid-City, and

Hollywood/West Hollywood. Health care services are provided at elementary, middle,

and high schools, community-based agencies, family homeless shelters and public

housing developments. COACH collaborates with more than 200 public and private

community organizations.

Impact

In FY14 and FY15, COACH provided more than 61,000 encounters. The

following services were provided:

Coach Services Encounters

Medical Visits 8,416 Case Management Visits 1,824 Dental Visits 6,024 Mental Health Visits 5,166 Health Education Visits 30,391 Nutrition Visits 9,732 Total 61,553

Safety Net Clinics

Ambulatory Care Clinic

The general internal medicine clinic in the Cedars-Sinai Ambulatory Care Center

provided outpatient services to the adult population. This care included screening,

preventive health measures, and management of diabetes and cardiovascular disease.

Attending physicians and medical residents cared for patients in a primary care setting,

using the resources of the Medical Center, including imaging, pharmacy and laboratory

services.

Saban Community Clinic

Cedars-Sinai physicians provided adolescent and adult patients access to primary care

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at the Saban Community Clinic for pregnancy and other medical conditions and

ancillary services, i.e., lab and x-ray. Cedars-Sinai provided supervisorial clinical staff

and medical and specialty residents for six primary and specialty clinics every week,

financially supported Saban Community Clinic’s Medical Director in the provision of

primary care to Saban Community Clinic patients, and providing funding for

infrastructure needs.

Venice Family Clinic

Cedars-Sinai provided internal medicine residents for provision of primary care to

uninsured and underinsured Venice Family Clinic patients, as well as specialized lab

services to support quality care for Venice Family Clinic patients. Additionally, Cedars-

Sinai actively participates in the Venice Family Clinic Westside Access Stakeholder

collaborative, which seeks to garner regional expertise to increase access to care for

homeless and low income populations on the west side of Los Angeles County.

Impact

In FY14 and FY15, Cedars-Sinai support of safety net clinics provided 37,963

patient encounters for primary care and specialty care services. Cedars-Sinai

medical residents provided care at Saban Community Clinic, Venice Family

Clinic, L.A. Christian Health Center and Clinica Oscar Romero.

Cedars-Sinai Community Clinic Initiative: Strengthening L.A.’s Safety Net Cedars-Sinai recognizes the critical role of partnerships in promoting access to high-

quality care for underserved populations. The medical center is building multi-

dimensional partnerships that include significant investments to strengthen the safety

clinic network across Los Angeles, as well as individual capacity-building grants to

clinics.

Impact

In FY15, Cedars-Sinai provided three grants totaling over $1.9M to develop

programs promoting leadership and effectiveness at federally qualified health

centers (FQHCs) and FQHC look-alikes. Each program addressed a different

set of challenges facing community clinics, including developing the next

generation of leaders, furthering a culture of quality, and promoting financial

acumen and preparation for payment reform. Over 32 clinics have participated in

the programs, and 23 have engaged in significant year-long programs focused

on performance improvement projects and in-depth financial benchmarking.

Providing Access to Health Care

Cedars-Sinai is one of the largest providers of Medi-Cal services among non-

government hospitals in California. The hospital provides available financial assistance

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to qualified patients.

Impact

In FY14 and FY15, Cedars-Sinai provided $138 million to pay for the unfunded

cost of caring for Medi-Cal patients, as well as $65 million in traditional charity

care for indigent patients who did not have health care coverage.

Psychological Trauma Center (PTC) – Share and Care

Since 1981, Cedars-Sinai’s school-based mental health programs help victims of

trauma, filling crucial needs for prevention, therapy, crisis intervention, and training that

would otherwise be unmet. Programs and trainings - for children, teachers and school

principals - run by licensed mental health practitioners, enhance an at-risk child's ability

to learn in the classroom, change destructive behaviors and envision a brighter and

happier future. The PTC’s Share and Care program focuses on a series of art-therapy

12-week group curricula that support a therapeutic environment to improve students’

ability to concentrate on their lessons. The therapy groups focus on trauma, loss and

grief, self-esteem, bullying, socialization, anger management, divorce, shyness,

students with an incarcerated parent, and substance abuse.

Impact

The following information outlines the impact of the actions that were undertaken

on the selected significant health needs.

Provided mental health services to over 1,800 students in 29 schools in 122

classrooms (20 Elementary Schools, 6 Middle Schools and 2 High Schools)

Total children’s therapy groups facilitated: 6,447.

Total encounters with children, teachers and parents: 56,652.

Total contacts: children individually and in therapy groups: 15,376; children

in classrooms: 2,549; teachers: 6,274; parents: 4,848

Developed a new program component and trained 120 teachers.

Provided education for 525 teachers at the Los Angeles Unified School

District’s New Teacher Summits.

Conducted education session for 75 Charter School teachers.

Expanded to 2 new elementary schools.

Continued parent trainings with a focus on positive parenting, positive

communication, substance abuse awareness and bullying: 155 parent

training groups with 2,153 parent contacts made in those trainings.

School principal trainings were offered monthly at the 29 partner schools.

Community Mental Health Grants

The Community Mental Health Grant program focuses grants on the mental health

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needs of vulnerable populations—particularly the uninsured, underinsured, and

uninsurable.

Impact

In FY14 and FY15 $1,336,750 in grants were awarded to 21 organizations

providing direct services to marginalized community members facing significant

economic barriers as well as, in many cases, comorbidities. The vast majority of

grantees serve vulnerable populations in Los Angeles County Service Planning

Areas (SPAs) 4 and 6. Cedars-Sinai further refined its giving criteria to

emphasize organizations serving underinsured and uninsured clients. In FY14

and FY15, there were 11,365 individuals served.

TeenLine – Suicide Prevention Hotline

TeenLine, a Cedars-Sinai supported organization that is housed on the Medical

Center’s premises, provides crisis intervention and prevention, peer counseling and

referrals for adolescents ages 12 to 19. The teen-to-teen program helps young people

cope in times of trauma and stress by offering advice and referrals. TeenLine's

outreach services provided education to schools and adolescent-serving agencies. The

Teen Line hotline, answered by intensively trained high school students, is open daily

and receives calls from teens across the nation.

Impact

In FY14 and FY15, the TeenLine responded to 23,128 calls to the suicide hotline.

Chronic Disease

Healthy Habits

Cedars-Sinai’s Healthy Habits programs provide nutrition education and obesity

prevention by helping children and families learn about healthy eating and physical

activity with a wide range of education, capacity building and technical assistance

programs run by trained health educators, reaching elementary and middle school

students, parents of preschool children, and families in underserved communities.

Impact

Expanded Healthy Habits for Kids and Healthy Habits for Families to sixteen

elementary schools.

Taught program lessons/workshops for a total of 71,627 participant

encounters, including 7,668 elementary students and 351 middle school

students through Healthy Habits programs in schools.

Reached near 800 parents from schools and preschools through Healthy

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Habits Parent Workshops.

Implemented Healthy Habits for Families adult health education at ten

schools with over 1,700 encounters.

Provided free workouts through Exercise in the Park program to over 610

individuals.

Facilitated 6 Grocery Store Tour programs to 83 individual participants.

Facilitated Healthy Habits for Teachers training for 189 teachers in 5

schools.

In partnership with the American Heart Association, provided Hands-Only

CPR Training to over 620 parents, teachers and school staff.

As a result of Healthy Habits:

84% of elementary students are eating more fruits.

75% of elementary students are eating more vegetables.

78% of elementary students are eating less junk food.

77% of elementary students are drinking fewer sugary drinks.

85% of parents reported that their child made a healthy snack at home.

Over half of third grade students engage daily in at least 60 minutes of

physical activity.

Over 75% of teachers incorporate physical activity during school day.

88% of second grade families do regular physical activity together.

Support Groups

Cedars-Sinai provides comprehensive support groups that focus on assisting with life's

changes and adjustments.

Programs and Activities

Aphasia support group

Big Voices Group

Bridging the Gap

Diabetes support group

Weight Loss Surgery support

Good Beginnings Parent NICU support group

Heart transplant support group

Mechanical circulatory device support group

Multi-organ transplant relaxation and support group

Neuroendocrine tumor support group

One Stroke Ahead support group

Think Tank cognitive rehabilitation support

Yes I Can support group

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Impact

In FY14 and FY15, Cedars-Sinai provided more than 7,400 participant

encounters.

Programs for Adults

Cedars-Sinai is committed to improving the number of quality life years for adults and

seniors in our community. The hospital provided adult-focused community programs,

screenings, educational and self-help programs, health fairs, immunization clinics and

exercise programs. These programs occur in underserved communities, churches,

synagogues, neighborhood community centers as well as at the Medical Center.


Cardiovascular disease, diabetes, hypertension and related preventive programs and services

Influenza and pneumococcal immunization programs

Health promotion and prevention programs for seniors

Health information handouts for seniors

Physical exercise programs for seniors

Health fairs

Impact


encounters.

Cancer Services

Cedars-Sinai makes cancer education, support and resources services available to the

community.


Cancer exercise

Cancer survivorship services

Kidney cancer support group

Physical fitness/cancer survivorship

Sarcoma cancer support group

Stress reduction

Yoga restorative and strengthening support group

Impact


encounters.