Running head: COMMUNITY ASSESSMENT 1

Psychological Considerations of Stanislaus County

Danielle Antolak and Madison Kewkow
California State University, Stanislaus














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Psychological Considerations of Stanislaus County
Communities rely on multiple factors working together to make them successful and
prosperous. These factors include: biological, sociological, psychological, spiritual, and social
aspects, and with discord between any two aspects, the community can crumble and be
unproductive and stagnant. The psychological aspect of a community, although often
overlooked, is one of the most important factors in its success. The well-being, happiness, and
contentment of its residents ensure a thriving, productive, blossoming community. One such
community is Stanislaus County, a rural, agricultural county in Northern California. The
countys psychological well-being will be examined in this paper, including future prospects of
the community, crime rate, unemployment rates, communication networks for the residents, and
interactions of groups within the county.
Future Prospects for the Community
Future prospects within a community, gives insight into the psychological climate and
health within Stanislaus County. When a community is productive and growing, citizens will be
more likely to address issues within the community. If a community is in decline or stagnant,
apathy towards the problems within that environment is more likely to develop, negatively
impacting the psychological health within the community. Job rates and employment, as well as
future building projects, and the treatment of the mentally ill are all good indicators of future
prospects for the community and the influence it has on the psychological health within
Stanislaus County.
Employment rates are a good indicator of the health of the economy and whether or not
future prospects within that economy indicate growth or decline. In 2000, it was calculated that
there were 322,469 people ages 16 and over that were eligible for work. Of those individuals
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eligible to work, 197,448 people had entered the workforce, and unemployment rate among those
that had entered the work force 22,992 or 7.1% (United States [US] Census Bureau, 2000). In
2011, it was found that there were 382,119 people age 16 and over eligible for work. Of those
individuals eligible for work, 240,373 people were considered a part of the labor force. The
unemployment rate in 2011 in Stanislaus County was 9%, or 34,207 people out of work (US
Census Bureau, 2007-2011b). This decline of employment rates between 2000 and 2011 shows a
trend of economic decline in Stanislaus County.
Future building projects within a community are also a good indicator of economic
development and future prospects within that community. According to the Stanislaus County
Department of Planning and Community Development (2013), there are 20 projects within
Stanislaus County that are within the active phase of planning. A county wide agricultural update
will be made to improve food safety and replace outdated agricultural water systems. Gallo
wines will be updating and improving their glass factory to make it more environmentally
friendly. There will be a new solar facility built within Stanislaus County as well as a new mine.
The projects listed above, in combination with many other projects in the active phase of
planning indicate growth of the economy and a source for many new jobs within Stanislaus
County (Stanislaus Department of Planning and Community Development, 2013). These future
building projects indicate that while unemployment rates are up, the economy is still continuing
to grow and future prospects for the citizens of Stanislaus County will improve the psychological
health of the community.
The future prospects for the care of mental health disorders directly influences the
psychological climate of the community in regards to the stigma placed upon mentally ill
individuals. The more treatment becomes available, the more accepted mental illness will
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become, which will ultimately lead to better and more available mental health care for those who
need it. In the fiscal year of 2004 to 2005, behavioral health within Stanislaus County had a
budget of approximately $71 million and served 12,783 patients (Stanislaus County Behavioral
Health and Recovery Services, 2011). By the 2010 to 2011 fiscal year the mental health budget
decreased to $42 million and served 9,214 clients. Despite budget cuts between 2004 and 2011,
behavioral health programs within Stanislaus County continue to have extremely high success
rates. Within the Childrens and Transitional Age Youth System behavioral health care in 2011,
5,216 clients were served with success rates falling between 82% and 100%. Within the Adult
System of Care for behavioral health in Stanislaus County, 4,957 clients were served. Of these
adult clients, there was a 93% decrease in the number of homeless days, 85% reduction in the
number of hospitalizations and a 93% reduction in the number of incarcerations (Stanislaus
County Behavioral Health and Recovery Services, 2011). Despite budget cuts, the effectiveness
of behavioral health programs has continued to be consistent. Good mental health care for those
who need it only further contributes to the future prospects for Stanislaus County.
Significant Events in Community History
Stanislaus County has faced some rather significant events in its history, making it well
known to surrounding communities, states and even the nation. One rather significant event was
the murder of Laci Peterson and her unborn son and the eventual arrest and conviction of her
husband Scott Peterson. On Christmas Eve in 2002, Laci Peterson, a resident of Modesto went
missing and her and her late term fetal sons bodies were found in April 2003 decomposing in
the San Francisco Bay near Berkeley. The case made national headlines both during the initial
search for her, at the discovery of their bodies and during her husbands trial and eventual
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conviction of first-degree murder. This trial put Modesto and Stanislaus County on the map,
although sadly not in a good way.
A second major event in the countys history was the building and construction of the
only four-year university in the county, Stanislaus State University in Turlock. The University
offers undergraduate and graduate degrees in over sixty fields of study. When the University
opened in 1957, it was the first institute of higher education in the county to offer four-year
collegiate degrees. The University is primarily a commuter campus, servicing members of
Stanislaus, San Joaquin and Merced counties mainly. If not for the University, students wishing
to attain higher education degrees would be forced to move away to attend other Universitys,
which is not feasible for everyone.
Another very significant event in the communitys history was the economic crash that
occurred in 2008. Prior to 2008, banks had been giving out variable interest loans to people who
barely qualified for loans or were giving out loans that over extended the homeowners each
month with their mortgage payments. The interest started out low but at any time could increase
causing the homeowners mortgage payments to increase. As more and more people received
these loans, the value of homes in the United States skyrocketed making the market primarily a
sellers market. However, the interest on the loans continued to increase until the homeowners
could no longer pay their mortgage each month. The value of homes began to deteriorate and
people owed more on their home than what it was worth, making them upside down on their
mortgage payments. Thousands of homeowners then filed for bankruptcy and lost their home to
foreclosure, thus ruining the economic boom that had been occurring. With the crash of the
housing market, people were left without a home; many lost their job and thus struggled to
survive. Stanislaus County was hit particularly hard in the crash, showing some of the highest
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foreclosure rates in the state according to the Department of Housing and Community
Development (2012). The effects of the economic and housing market crash are still being felt
to this day, and hopefully within a few years the county can regain its employment and housing
rate it had prior to the crash.
The formation of gangs Stanislaus County has also been a significant event and problem
that has occurred. There are two primary gangs in the county, the Nortenos and the Surenos.
The Nortenos arose from the Nuestra Family while the Surenos arose from the Mexican Mafia.
While gangs of all ethnicities populate the county, 85% of all gangs in the county are of Hispanic
origin (Stafford, 2010). The Nortenos primarily dominate the county, especially rough areas of
Modesto such as the West Side and East Modesto region, which includes the particularly rough
Airport neighborhood (Stafford, 2010). The neighborhood is dominated by the Norteno gang
and is vastly a Hispanic district in Modesto. It is one of the roughest areas to live in with gang
violence and murders occurring frequently in the area (M. Reis, personal communication, 2013).
A drive thru of the area showed that most residents consider it unsafe and place bars on their
windows and extra locks on their doors for more protection. Sadly, children are not able to play
in the parks or in their yards due to the constant threat of violence that is primarily gang related.
Unfortunately, gang members show no remorse if a child or innocent person is injured or killed
by them so residents of the neighborhood live in constant fear of a traumatic event happening
(M. Reis, personal communication, 2013).
Compared with the Airport neighborhood, another area of Modesto known for its gang
violence is the Paradise neighborhood in West Modesto. While Hispanic gangs dominate the
Airport neighborhood, Asian gangs dominate the Paradise neighborhood. According to police
officer M. Reis (personal communication, 2013), the Paradise neighborhood is slightly safer
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compared with the Airport neighborhood as far as gang violence goes. Modesto High School
and an elementary school are located in the area and students are often seen walking to and from
school, something that does not frequently happen in the Airport neighborhood. Driving
through, it was noted that residents still do lock up their houses securely, live behind barred
windows and locked fences, as they do in the Airport neighborhood. Murders and violence are
still common, although it is more contained to gang members and the public is often left alone
(M. Reis, personal communication, 2013).
Interaction of Groups within the Community
The psychological climate within a community is influenced heavily by how the
population subgroups within that community interact. Accord between subgroups in a
community lends itself to a productive and psychologically healthy environment. Tension and
distrust between groups creates an unproductive environment in which health and psychological
problems are more difficult to address. The assessment of crimes, especially hate crimes, and the
assessment of predominate languages spoken is a good indicator of the interaction between
subgroups within a community.
Hate crimes, or crimes against an individual based on their ethnicity, sexual orientation,
gender, etc., is an indicator of tension amidst sub-groups within a community. Between 2010 and
2011, hate crime decreased 4.2% in California (California Department of Justice, 2011).
Between 2002 and 2011, the number of hate crimes based on ethnicity decreased from 1,036 to
587, or 43.3%. Between 2002 and 2011, the number of hate crimes based on religion decreased
from 239 to 201, or 15.0%. Between 2002 and 2011, the number of hate crimes based on sexual
orientation decreased from 366 to 244, or 33.3% (California Department of Justice, 2011). The
decrease in hate crimes throughout California and Stanislaus County in particular indicates that
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tension between subgroups within the population is decreasing, improving psychological
wellbeing of the community.
The predominate language spoken within a community often draws lines and dictates the
interactions between subgroups within communities. In Stanislaus County, it is estimated that
59.5% of the population speaks only English, 40% of the population speaks a language other
than English, and 30% of those people speak only Spanish (US Census Bureau, 2007-2011a). In
Stanislaus County there are an estimated 167,860 households, 49,160 of which have no one 14
years or older within the household that speak English very well (US Census Bureau, 2011). It
is clear through these statistics that there is a language divide within Stanislaus County impeding
the communication of its citizens.
Protective Services within Stanislaus County
The psychological climate within a community is widely dictated by the level of safety
perceived by the individuals and families that reside there. The adequacy of protective services
such as law enforcement and fire safety personnel is directly proportional to the feeling of safety
and security within the community. Inadequate levels of emergency services contribute to a
stressful and hostile climate within the community and can lead to poor psychological health.
According to the 2012 to 2013 proposed Modesto city budget, the Mayor stated, It is clear that
public safety comprises two-thirds of the budget with the Police Department being the largest
department within the General Fund. Public safety is our number one priority, but there are also
other essential and quality of life services that need to be provided in complement to public
safety. The City will spend approximately $72 million in fiscal year (FY)12-13 to provide public
safety services to our community (p.4). While the importance of protective services is
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emphasized in city planning within Stanislaus County, there has been a clear decline in funding
in recent years.
The police departments within Stanislaus County play an indispensible role in
maintaining the psychological health of the citizens that reside there. From 2008 to 2009, the
proposed Modesto city budget for the police department was $51,735,277, in combination with
various grants and safety funds created a total budget of $55,138,745 for the fiscal year of 2008
to 2009 (City of Modesto, 2012b). The total police department budget for the fiscal year 2011 to
2012 was $51,286,057. This dramatic decrease in police department funding between 2007 and
2012 can largely be attributed to decreased city revenues in combination with loss of operational
grants, the loss of the traffic safety fund and dramatic decrease of all other safety funds. From the
fiscal year 08-09 to 11-12, the police department budget was decreased by $3,852,688 or
6.98%. This dramatic decrease in police funding contributed to increased emergency response
times and fewer police available to the citizens of Stanislaus County (City of Modesto, 2012b).
Another emergency service that citizens of Stanislaus County depend on is the fire
department. The sense of safety that the presence of fire safety personnel instills within the
community is essential for psychological health. In the fiscal year 2008 to 2009, the total budget
for the Modesto city fire department was $25,857,899. By the fiscal year 2011 to 2012 the
budget decreased to $25,106,361 (City of Modesto, 2012a). Between 2008 and 2012, the
allocated budget for the Modesto city fire department decreased by $751,538 or 2.9%. While
fiscal cuts were not as severe within the fire department budget as within the law enforcement
sector, a decrease of 2.9% in the annual budget causes loss of employees and a decrease in the
adequacy of emergency services within Stanislaus County (City of Modesto, 2012a).
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Crime rates in a community influence psychological health within the community
because they directly influence the feeling of safety and security of the residents living there. In
2005, Stanislaus County had a rate of 602.9 per 100,000 population of violent crimes committed
(California Department of Justice, 2007). Crime level decreased by 2006 to a rate of 588.5 per
100,000 people. This equals a 0.8% decrease in violent crime rates between 2005 and 2006
(California Department of Justice, 2007). Between 2005 and 2010, the number of homicides in
Stanislaus County decreased from 30 per year to 29 per year. In 2005, there was a recorded
number or 2,258 cases of aggravated assault and 4,836 cases of burglary in Stanislaus County
(California Department of Justice, 2007). In 2010, there were 1,741 recorded cases of aggravated
assault and 5,400 cases of burglary (California Department of Justice, 2010). The decrease of
aggravated assault cases corresponds with the decrease in the rate of violent crimes within
Stanislaus, but an increase in burglary cases between 2005 and 2010 indicates that people within
Stanislaus County may be feeling financially insecure.
Another protective service within a community that contributes to psychological health
through a sense of safety and security is the presence of medical insurance. Between 2001 and
2003 in Stanislaus County, percentages of adults who had health insurance decreased from
87.1% to 82.6% (Stanislaus County Health Services Agency, 2008). However, from 2003 to
2005 the percentage of adult insured rose from 82.6% to 86.9%. Of those adults insured within
Stanislaus County, a significant portion of those individuals qualify for Medi-Cal. Between 2003
and 2005 the number of adults covered by Medi-Cal rose from 17.2% to 17.7% which is
significant because only low income families and children are eligible for that insurance. Trend
of overall percentage of adults insured is rising since 2003, as well as the percentage of adults
that are insured by Medi-Cal (Stanislaus County Health Services Agency, 2008).
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Communication Network
There are a variety of communication networks the members of Stanislaus County use to
stay connected to one another and to the rest of the world. Most cities in the county have a
newspaper that is often delivered to the homes of the residents once or multiple times a week.
The countys largest newspaper, the Modesto Bee is accessible to all residents of the county and
is printed everyday. The Modesto Bee keeps residents of the county informed on events and
news happening locally, in the state, nationally and around the world. Residents of the county
are also able to log onto the Modesto Bee or their local newspaper website to catch up on daily
news and events if they do not subscribe to the paper.
The Internet is also a large communication network many members of the residents
utilize. At the tip of their fingers, residents of the county have millions of websites accessible to
them if they pay for Internet access in their home. Facebook and other social media sites keep
residents connected to each other as well as to people who live in different cities, states and
countries. If residents do not have Internet access in their home due to cost, all public libraries in
the county have computers and printers available for the residents to use to catch up on news,
pay bills, email friends and family, etc.
The major news stations that service Stanislaus County are KCRA News 3 and ABC
News 10. These television news stations run in the morning, afternoon and evening and televise
news and events occurring primarily in the valley and surrounding counties, with some small
clips of state and national news. The news is televised on basic cable so residents do not need an
upgraded cable package to view the local news.
Sources of Stress in the Community
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The residents of Stanislaus County face a variety of stressors in their daily life, which
negatively impacts their psychological well-being. According to Martinez (2013), the
unemployment rate in Stanislaus County for February 2013 was 14.9%, compared with the
unemployment rate of California in February 2013, which was 9.7%. Thus, there are
approximately five percent more people without a job in the county compared with the state,
causing more stress for the residents who do not have a job to pay their bills or mortgage.
A second source of stress in the community is the high foreclosure rate. Not only do
people struggle to pay their mortgage, some people are unable to, and end up losing their house
to the bank, which is incredibly stressful. According to the Department of Housing and
Community Development (2012), Stanislaus County had some of the highest foreclosure rates in
the nation. 10,700 homes were lost to foreclosure between 2007 and 2008, which is almost nine
percent of all homes and condominiums in the county. For the residents, knowing your home is
due to be foreclosed because of inability to pay the mortgage payment would be an immense
stressor in ones life. Having to find a place to live quickly, possibly living with family or
friends, or not having anywhere at all to go would be incredibly taxing and traumatic.
A third stressor for the residents of the county is the long commuting hours many
residents drive every day to work, mostly to the Bay Area. Homes are much cheaper in the
valley compared with the Bay Area and so many people buy a home in Stanislaus County and
then find a higher paying job in the Bay Area as the valley pays much less compared with the
Bay Area. The residents who do this are then stuck with a long commute every day to work.
Commutes often average one hour or more and can easily be two to two and a half hours if there
is an accident on the freeway. Thus, in addition to working eight hours per day, the residents
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drive two to three hours roundtrip making their working days extremely long and tiring, adding
stress to their and their families lives.
Another potential stressor for the residents of Stanislaus County is the lack of top medical
facilities to treat serious illness or disease. The county has two major hospitals, Memorial
Medical Center and Doctors Medical Center, both located in Modesto. While these are
excellent hospitals, they are not level one trauma centers and lack the resources of top magnet
hospitals, such as Stanford Hospital or the University of California at San Francisco Medical
Center. For residents who do not live in Modesto, the nearest hospital may be thirty to forty-five
minutes away, which can be quite the stressor when one is in an acute medical situation. The
county also lacks a pediatric hospital, which is a major stressor for families with ill children who
need to be hospitalized. The closest childrens hospitals are over an hour away in Oakland,
Madera, San Francisco, Palo Alto and Davis. Commuting to and from those cities for
appointments or hospitals stays or arranging housing in those cities can be major sources of
stress for parents of ill children.
Extent of Mental Illness in the Community
Mental health problems include depression, anxiety disorders and psychotic disorders
such as schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. Access to
quality mental health care is often difficult for those suffering from mental illness, especially for
those of low socioeconomic status. Sadly, private insurance companies and government funded
insurances, such as Medi-Cal and Medi-Care are often more restrictive in their covering of
mental health services compared with that of physical health issues, according to the Health
Assessment Survey (HAS). Data from the HAS of Stanislaus County showed that in the past 12
months, 69.6% of citizens did not feel sad or hopeless every day for two weeks or more in a row
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causing them to stop usual activities, compared with 30.4% who did (2008). In Stanislaus
County, 20.5% of citizens needed help for emotional or mental problems in 2005, compared with
14.6% of residents in 2001. In 2005, 3.8% of Stanislaus County residents sought mental health
treatment, compared with 5.5% of residents in 2001. According to the HAS, 43.3% of residents
were not able to receive mental health treatment if needed, while 56.7% of residents were able
to. Common reasons cited for not receiving treatment included: lack of insurance, inability to
pay, did not know where to go, uncomfortable asking for help, transportation issues, lack of
services available and inconvenient doctors office hours (HAS, 2008).
Mortality Rate
The mortality rate indicates the number of deaths that have occurred in a certain
community, and according to Tong and Hutchins, between the years of 2005 and 2009, 18,054
residents of Stanislaus County passed away, an average of just over 3,600 people per year
(2011). 9,112 males died (50.55) compared with 8,942 females (49.5%). As expected, the
mortality rate increases with age, with the lowest percentage of deaths occurring in the youngest
population. There were 342 children between the ages of zero and nine that died, accounting for
1.9% of all deaths in Stanislaus County. 146 citizens between the ages of 10 and 19 died,
accounting for 0.8% of all deaths. 314 people aged 20 to 29 passed away, accounting for 1.7%
of deaths and 445 people aged 30 to 39 died, accounting for 2.5% of deaths in the county. 1,106
citizens aged 40 to 49 died, which was 6.1% of the overall mortality rate and 1,948 people aged
50 to 59 died, accounting for 10.8% of the mortality rate. There were 2,507 citizens aged 60 to
69 that passed away, which is 13.9% of the overall mortality rate. 3,741 citizens aged 70 to 79
died, accounting for 20.7% of all deaths. The most deaths occurred in the 80 to 89 year old
population, with 5,104 citizens dying, accounting for 28.3% of the deaths. 2,277 people aged 90
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to 99 passed away, accounting for 12.6% of deaths and 124 people who lived to be 100 or older
passed away, accounting for 0.7% of all deaths (Tong & Hutchins, 2011).
The deaths were further broken down by ethnicity and sex, and according to Tong and
Hutchins, of the males who passed away, 87% were due to natural causes, while 9% were due to
unintentional injury and 4% were due to intentional injury (2011). Of the females who passed
away, 93% were due to natural causes, 5% died from unintentional injuries and 1% died from
intentional injuries. Breaking it down further, of the Latino population that died, 83% were due
to natural causes, 11% died from unintentional injuries and 5% died from intentional injuries.
91% of non-Latinos died from natural causes, 6% from unintentional injuries, and 2% from
intentional injuries. 90% of whites died from natural causes, 7% died of unintentional injuries
and 2% died from intentional injuries. 86% of blacks died from natural causes, 9% from
unintentional injuries and 3% from intentional injuries. 91% of Asian/Pacific Islanders died
from natural causes, 6% from unintentional injuries and 3% died from intentional injuries. Of
the people of unknown race, 91% died from natural causes, 13% died from unintentional injuries
and 5% died from intentional injuries (Tong & Hutchins, 2011).
A much higher percentage of young citizens died from injuries, compared with older
populations. Of citizens aged zero to 17, 67.9% died from natural causes, 21.3% died from
unintentional injuries and 7.7% died from intentional injuries (Tong & Hutchins, 2011) . Of
citizens aged 18 to 44, 44.3% died from natural causes, 33.8% died from unintentional injuries
and 17.6% died from intentional injuries. Of citizens aged 45 to 64, 84.7% died from natural
causes, while 10.4% died from unintentional injuries, and 3.5% died from intentional injuries.
96.6% of citizens aged 65 and older died from natural causes, while 3.0% died from
unintentional injuries, and 0.3% died from intentional injuries (Tong & Hutchins, 2011).
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The manner of death was also influenced by the geography of the residents. Residents of
West Modesto and the West Side had the highest proportion of residents die from unintentional
injuries, at 10.4% and 10.5%, respectively. Residents of West Modesto, the South Central region
(Ceres, Keyes) and the East Central region (East Central Modesto and the Airport neighborhood)
had the highest proportion of deaths from intentional injuries at 3.8% for West Modesto, 2.9%
for the South Central region and 2.8% for the East Central region (Tong & Hutchins, 2011).
The overall leading cause of death in Stanislaus County from 2005 to 2009 was diseases
of the heart, with 28.6% of all citizens dying from this (Tong & Hutchins, 2011). The rate of
women dying from diseases of the heart to men dying from heart diseases was pretty much
equal, at 28.4% of women compared with 28.3% of men. The second leading cause of the death
in the county was cancer, accounting for 21.3% of all deaths in the county. 21.2% of women and
21.1% of men died of cancer. Unintentional injuries were the third leading cause of death, with
6.2% of the population dying from them. More men died from unintentional injuries than
women, at 7.6% and 3.8%, respectively. 5.8% of citizens died from stroke, and more women
died of a stroke than men, at 7.1% for women and 4.5% for men. 3.6% of citizens died from
Alzheimers disease and more women again died from this disease, at 6.1%, compared with men
at 2.9%. Diabetes claimed the life of 3.0% of the population, and an equal percentage of women
and men died from this disease as well, at exactly 3.0% for both groups. 2.9% of people died
from pneumonia or influenza, 2.9% of women, and 2.5% of men. According to Tong &
Hutchins, the last seven leading causes of death claimed the life of less than 2% of the population
each and were: chronic liver disease, suicide, essential hypertension and hypertensive renal
disease, nephritis, nephritic syndrome and nephrosis, homicide, septicemia and Parkinsons
disease (2011).
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Morbidity
Morbidity refers to all non-fatal health events, such as illnesses or diseases.
Hypertension, or elevated blood pressure, is a major risk factor for heart disease and the
percentage of adults in Stanislaus County ever diagnosed with hypertension has continued to
increase over the years (Tong & Hutchins, 2011). In 2005, 23.1% of citizens of the county had
been diagnosed with hypertension at least once in their life; the rate rose to 32.6% in 2007 and
slightly declined to 30.7% in 2009. The prevalence of women and men diagnosed with
hypertension remained pretty similar, except in 2007 when the rate of men diagnosed far
exceeded women at 40.7% compared to 25.1%. Asians had the lowest rate of hypertension at
20.7%, Whites had the next lowest rate at 32.8%, American Indians/Alaskans had the next
highest rate of hypertension at 49.1% and African Americans had the highest rate in the county
at 71.0%. Latinos had a lower rate of hypertension compared with non-Latinos, at 24.9% for
Latinos compared with 34.9% of non-Latinos (Tong & Hutchins, 2011).
Twelve percent of the population of the county had been diagnosed at least once in their
lifetime with heart disease, the leading cause of death in the county according to Tong and
Hutchins (2011). The percentage of people having been diagnosed at least once with heart
disease has declined from 2005 to 2009, with 6.7% of the population having heart disease in
2005, 5.2% in 2007 and 5.0% in 2009. The percentage of men with heart disease has been
higher than the percentage of women in history, however in 2009 those numbers reversed and
women had a higher percentage of heart disease at 5.8% compared to 4.2% of men. Native
Hawaiian, American Indian, Alaska Natives had higher rates of heart disease, compared with
Whites, Blacks and Asians. A higher percentage of non-Latinos (11.9%) than Latinos (8.3%)
had ever been diagnosed with heart disease (Tong & Hutchins, 2011).
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Diabetes, a major cause of heart disease, stroke, kidney disease and many other health
problems, affected 9.4% of the population in 2005, 7.7% of the population in 2007 and 7.6% of
the population in 2009, according to Tong and Hutchins (2011). In 2005, the percentage of
adults with Type I diabetes was 20.1%, compared with 79.9% of all diabetics being Type II. The
rate of Type II diabetes rose in 2007, with 87.6% of all diabetics being Type II, while 12.4%
were Type I. In 2009, 61.4% of all diabetics were Type II, 32.4% were Type I and 6.2% were
other (combination of Type I and Type II diabetes). Data from 2003 and 2005 shows that the
percentage of males diagnosed with diabetes was almost twice that of women, at 8.3% of males
compared with 4.3% of women. However, in 2007 and 2009, the percentage of females with
diabetes had surpassed men, at 8.0% of females compared with 7.3% of males. Blacks had the
highest rate of diabetes in the county at 12.6%, 11.8% of Latinos had diabetes, 8.4% of Asian-
Americans were affected by the disease and 7.1% of non-Latino Whites had the disease (Tong &
Hutchins, 2011).
Asthma is an inflammatory airway disease with unknown causes. In 2005, 11.9% of the
population had been diagnosed at least once in their life with asthma, in 2007 the number rose to
14.0% and in 2009 the number skyrocketed to 21.8% (Tong & Hutchins, 2011). Females
(14.5%) suffer more frequently from asthma compared with males (10.8%). The lifetime
prevalence of asthma in the county was higher for non-Latinos than for Latinos. However, both
ethnic groups experienced a rise in the prevalence of the disease between 2003/2005 and
2007/2009 with a 78.4% increase in Latinos and a 26.7% increase in non-Latinos, according to
Tong and Hutchins (2011).
According to the California Department of Public Health (CDPH), Acquired
Immunodeficiency Syndrome (AIDS) is a deadly viral infection transmitted by bodily fluids
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(2013). Between the years of 2009 and 2011, there was an average of 19.0 people living with
AIDS in Stanislaus County. Chlamydia is a sexually transmitted disease and between the years
of 2009 and 2011, 1,822.7 people were affected with the disease, making it the most prevalent
STD in the county. Gonorrhea, another STD affected on average 70.7 females aged 15 to 44 and
66.3 males aged 15 to 44 in Stanislaus County between the years of 2009 and 2011.
Tuberculosis, a potentially deadly bacterial infection of the respiratory system affected on
average 15.0 people in the county between 2009 and 2011 (CDPH, 2013).
185,822 residents of Stanislaus County were hospitalized in California hospitals between
the years of 2008 and 2010, for an average of 61,941 hospitalizations per year (Tong &
Hutchins, 2011). Childbirth, pregnancy and the puerperium was the leading cause of
hospitalizations, accounting for 14.1%. Newborns and neonate conditions began in the perinatal
period accounted for the second leading cause of hospitalizations at 13.6%. Circulatory system
illness accounted for 13.0% of all hospitalizations, while respiratory system illness accounted for
9.2% of all hospitalizations. Digestive system illness accounted for 7.9% of all hospitalizations,
while musculoskeletal and connective tissue problems accounted for 7.2%. 5.2% of all
hospitalizations were due to mental disease and disorders while 4.9% were due to nervous
system disorders. Kidney and urinary tract diseases accounted for 3.6% of all hospitalizations
and endocrine, metabolic and nutritional illness rounded out the top ten reasons for
hospitalizations at 3.5% (Tong & Hutchins, 2011).
Stanislaus County is located within Californias Central Valley, whose economy is
largely agricultural based. In recent years unemployment rates have increased within Stanislaus
County. New building projects and potential jobs are on the rise with 20 projects currently being
approved by the Department of Planning and Development. Budgets for programs throughout the
COMMUNITY ASSESSMENT 20

county have been decreased, including the behavioral health budget, but despite this, the
effectiveness of these programs has been sustained. The history of Stanislaus County is
significant full of negative and positive events. The construction of California State University,
Stanislaus is a positive event, while the murder of Laci Peterson, the gang activity in the Airport
and Paradise neighborhoods and the dramatic rise in foreclosures are negative events within the
community. In recent years, tension between subgroups has decreased by the decrease in hate
crimes and crimes in general, while the language barrier has increased between solely English
and Spanish speaking individuals. The funding for protective services such as police and fire
departments has decreased, while crime rates within Stanislaus have simultaneously decreased.
Communication within Stanislaus County is facilitated by local newspapers, the use of the
internet, and by local news stations. Sources of stress within the community are the increasing
unemployment rates, high home foreclosure rates, the high number of individuals who commute
to work, and a lack of magnet facilities within the area to treat serious illness. The rate of mental
illness within the community is increasing while the number of people who seek, and have
access to, mental health care is decreasing. Mortality rates within the community have remained
unchanged over recent years and the leading cause remained diseases of the heart. Asthma, heart
disease, hypertension, and diabetes are all the leading causes of morbidity within Stanislaus
County.
One can see that Stanislaus County, while it has its positives, has many negatives as well.
Further research on the county should be done, especially regarding the psychological aspects of
the community, as the psychological well-being of a community is one of the most important
factors in its success. One could research the question, why is it that Stanislaus County had the
highest foreclosure rate in the nation, one of the highest unemployment rates in the state, a
COMMUNITY ASSESSMENT 21

prominent gang presence and insufficient medical and behavioral health centers despite its
adequate state and federal funding and protective services? Nurses in the county can play a large
role, especially in the promotion of the health of its residents. One potential psychological
nursing diagnosis could be a knowledge deficit of the residents related to diseases of the heart as
evidenced by heart diseases being the leading cause of death for both men and women in the
County, a lack of magnet medical centers, and a lack of cardiac specialists in the county. A
second nursing diagnosis could be a lack of resources for the residents of the community related
to mental health services as evidenced by one third of the population feeling sad or helpless in
the past twelve months (HAS, 2008), doctors behavioral health center being the only acute
mental health facility in the county, and 43% of those suffering from mental health feeling like
they could not access the resources and services they needed to get better (HAS, 2008).
Within Stanislaus County, the psychological health of the population dictates the ability
of the community to cope with stress and improve community-wide health. By assessing the
future prospects of the community, significant events in community history, the interaction of
subgroups, protective services, communication networks, sources of stress within the
community, the extent of mental illness within the community, mortality, and morbidity rates
within the community, problems within Stanislaus County can be identified. By identifying
problems within the community, plans can be implemented to improve the health of the
population throughout all of Stanislaus County.




COMMUNITY ASSESSMENT 22

References
California Department of Housing and Community Development. (2012). Housing Element.
Retrieved from http://www.co.stanislaus.ca.us/planning/pl/gp/housing-element.pdf
California Department of Justice. (May 2007). Crimes, 2005-2006: Stanislaus County, C.A.
Retrieved April 4, 2013, from http://oag.ca.gov/crime
California Department of Justice. (2010). Crimes, 2010: Stanislaus County, C.A. Retrieved April
4, 2013, from http://oag.ca.gov/crime
California Department of Justice. (2011). Hate crime in california, Retrieved April 4, 2013 from
http://oag.ca.gov/sites/all/files/pdfs/cjsc/publications/hatecrimes/hc11/preface11.pdf
California Department of Public Health. (2013). County health status profiles. Retrieved from
http://www.cdph.ca.gov/pubsforms/Pubs/OHIRProfiles2013.pdf
City of Modesto. (2012). Fire department budget: Modesto, C.A. Retrieved April 2, 2013, from
http://www.modestogov.com/fin/budget/
City of Modesto. (2012). Police department budget: Modesto, C.A. Retrieved April 2, 2013,
from http://www.modestogov.com/fin/budget/
City of Modesto. (May 4, 2012). Proposed fiscal year 2013-13 budget for the city of modesto:
Modesto, C.A. Retrieved April 2, 2013, from http://www.modestogov.com/fin/budget/
Martinez, N., (2013, March 23). Modesto metropolitan statistical area. Retrieved from
California Department of Employment Development website:
http://www.calmis.ca.gov/file/lfmonth/mode$pds.pdf
Stafford, S. (2010, April 16). Valley gang membership, violence on the rise. Turlock Journal.
Retrieved April 13, 2013, from http://www.turlockjournal.com/archives/3687/
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Stanislaus County Behavioral Health and Recovery Services. (2011). Stanislaus county mental
health board annual report: Stanislaus County, C.A. Retrieved April 1, 2013 from
www.stancounty.com/BHRS/pdf/2011annualreport.pdf
Stanislaus County Department of Planning and Community Development. (2013). Active
planning projects: Stanislaus County, C.A. Retrieved April 4, 2013, from
http://www.stancounty.com/planning/
Stanislaus County Community Health Assessment. (2008). Mental health: Why is it important?
Retrieved from Stanislaus County Health Services Agency website:
http://www.schsa.org/PublicHealth/pdf/dataPublications/mental-health.pdf
Stanislaus County Health Services Agency. (2008). Stanislaus county community health
assessment: Stanislaus County, C.A. Retrieved April 2, 2013, from
http://www.hsahealth.org/PublicHealth/pdf/dataPublications/communityHealthAssessme
nt/2008%20CHA%20Full%20Report.pdf#page=48&zoom=auto,0,137
Tong, O., & Hutchins, S. (2011). Community health needs assessment of Stanislaus County.
Retrieved from Stanislaus County Health Services Agency website:
http://www.schsa.org/publichealth/pdf/dataPublications/2011-Stanislaus-County-Health-
Needs-Assessment-for-Memorial-Medical-Center-FullReport.pdf
U.S. Census Bureau. (2000). Profile of selected economic characteristics: Stanislaus County,
C.A. Retrieved April 1, 2013, from http://factfinder.census.gov.
U.S. Census Bureau. (2007-2011). Languages spoken at home: Stanislaus County, C.A.
Retrieved April 4, 2013, from http://factfinder.census.gov.
U.S. Census Bureau. (2007-2011). Selected economic characteristics: Stanislaus County, C.A.
Retrieved April 1, 2013, from http://factfinder.census.gov
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