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Untitled - Kings County


									Acknowledgements                           i
A Message from the Health Officer          ii
Kings County Department of Public Health
             Mission Statement             iii
Highlight on Calories                      iv

COUNTY DEMOGRAPHICS                        1

BIRTHS                                     11

DEATHS & INJURY                            21

MORBIDITY                                  29



      REPORTABLE DISEASES                  61

DISASTER PREPAREDNESS                      79

REFERENCES                                 85

INDEX                                      89
For your time and contributions to this edition of the Kings
County Community Health Status Report, the Kings County
Department of Public Health thanks and acknowledges:

Michelle Bieber, MPH, RD
Leanne Brown, BSN, MBA
Sabrina Bustamante
Elizabeth Gazarek, MPA
Pat Harder, MSN
Nancy Hitchcock, SPHN, RN, BSN
Michael Mac Lean, M.D.
Kathy Mittleider, RN, BSN
Perry Rickard
Brenda Simpson, RN, BSN
Keith Winkler, REHS
Annie Wong, M.D., AAHIVS
Carol Williams, MS, RD
The Kings County Department of Public Health is pleased to present Kings County Community Health Status
Report 2008-2009. The document is the result of a joint effort within the department. We wanted to share with
the community our view of the most common health issues affecting the people of Kings County. We
recognize that there are other less common health issues affecting people in the county, and any omissions
shouldn’t be seen as our discounting these conditions. We felt that we needed to limit the size of the
document. We decided to limit each subject to one page. We hope this will encourage people to read the total
document. There are many things that influence the health of people in our county.

Each subject page begins with a description of the issue. In some cases it may not be clear why the subject is
considered a health matter. An example would be poverty. Public health has long recognized that social
factors have large influences on health and disease. For example, teen pregnancy, low educational
achievement and high unemployment are all associated with poverty. This in turn is highly associated with
many adverse health outcomes. Diabetes is a good example of a disease that disproportionately affects low
income people. There are many others. Each subject attempts to provide some quantitative measure of the
issue. How many people in the county are affected? How does Kings County compare with other counties?
The quality of Kings County specific data is quite variable. We have, for example, better data for births and
deaths than we have for chronic conditions such as obesity, high blood pressure or arthritis. In this report we
have provided the best data available. In those cases where we have no reliable Kings County specific data
we’ve made estimates based on national data.

Likely, health is one of those things we tend to undervalue until it’s gone. Unhealthy lifestyle choices cause
most of the premature death and disability in Kings County. Lifestyle changes are difficult. We have to
sacrifice today with the hope that we’ll be rewarded in the future with better health. Most subjects contain a
section with recommendations regarding things you can do as an individual to maintain your health.
Ultimately, we all need to take responsibility for our individual health. In this report we can’t provide you with
everything you need to make the necessary changes. Lifestyle changes involve getting more knowledge and
implementing your plan for making the necessary changes. You need, for example, to know what a healthy
diet is. You then need to figure out how to substitute the healthy choices for your current ones. You may need
to shop more often, learn new styles of cooking and brown bag your lunch more often. You’ll likely have to
plan your meals more carefully than you do now.

Currently, the healthy choice is often the hard choice. There are many environmental factors that make the
healthy choices harder. Our communities aren’t designed to encourage incorporating exercise into your daily
activities. It may not be safe for your child to walk to school. It may simply be too long a walk. The healthy
fast food options are often limited and often unappealing. Your co-workers may bring in unhealthy treats
regularly. There are numerous examples of how our environment contributes to an unhealthy lifestyle.
Recognizing the tension between individual freedom and a nanny society, there are things we can do
collectively to facilitate all of us having an environment that encourages a healthy lifestyle.

We hope the report will serve as a resource for Kings County to help people address their personal health
concerns. We also hope that it will serve as a basis for a dialogue with the community to improve the health of
Kings County residents.

                  Sincerely, Michael Mac Lean, M.D., M.S., Health Officer
           Kings County Department of Public Health

Our mission is to promote the physical, mental, social, and environmental health
                        of the people of Kings County.
                      “All that really counts is
The kind of diet doesn’t matter, scientists say.

cutting calories and sticking with it.” according to a recent federal
study that followed people for two years. Some previous studies have found that low carbohydrate diets like
Atkins work better than a traditional low-fat diet, but the new research found that the key to losing weight boiled

down to a basic rule —  calories in, calories out. Limiting the calories you consume
and burning off more calories with exercise is key.

A restricted calorie diet gives people greater food choices than other diets that may restrict the types of food
you eat, making the diet less monotonous. You just need to focus on how much you are eating. The trick is
finding a healthy diet that is tasty and that people will stick with over time.

“How many calories should I be eating a day?” This, of course, varies greatly from person to person. It
depends not only on your weight but also your height; the taller you are the more you burn because you have
more lean body tissue and this lean tissue (muscle) uses more energy than fat. It depends on whether you are
male or female; men typically have more muscle mass, so they burn more calories. It depends how old you are
because after a certain age (around 35) we start burning fewer calories and that number continues to decrease
gradually as we continue to age. Finally, it greatly depends on your activity level because if you get a lot of
exercise you naturally are burning a lot more calories.

 Here’s a quick and convenient way to estimate of how many calories you need. Multiply your weight by 15 to
  get the number of calories you need per day to maintain your weight. If you weight 150 pounds and you are
  happy with this weight, you need (15 x 150) approximately 2250 calories a day to maintain it. This is a very
 general starting point, because from these numbers we don’t know whether you are male or female, active or
                                sedentary, young or older. It’s just an estimate.

                                                                                   STAYING AT
             YOUR                                     15                              YOUR

Play around with the range of 10 to 15 times your weight. If you weigh 160 pounds, look at the numbers from
1600 (160 x 10) to 2400 calories (160 x 15). You could probably lose a pound a week by limiting your calorie
intake to 1600 calories, and you would probably maintain your weight if you ate 2400 calories a day.
Remember if you are middle-aged, female, less than 5’4”, and not very active you will need to keep your
calories in the lower part of this range to lose, and maybe even to maintain your weight.
  If you would like to lose weight, multiply your present weight by 10. If you weigh 180 pounds and you would
      like to weigh less, a good estimate is for you to eat (10 x 180) 1800 calories a day. Again, it certainly
    depends on how active you are, how tall you are, and whether you are male or female (a man could lose
                  weight faster on this calorie level than a woman), but it’s a good place to start.

                                                    10                                 A
                                                                                  LITTLE LESS

If you are very overweight (say, 50% or more) you should multiply the weight you would like to be by 15 to find
a good starting calorie level. People who are nearly 100 pounds overweight are carrying that extra weight as
fat tissue, which does not burn nearly the calories of our muscles, organs, and other lean tissue. So a 250
pound woman may aim for (170 x 15) 2550 calories to start losing weight if her goal is to weigh 170 pounds. It
sounds like a very high calorie level for weight loss to occur, but people who are this heavy are usually eating
more than 2500 calories a day! Therefore, reducing your intake to less than you usually eat will result in weight
loss. You do not have to start with a 1200 calorie diet and starve yourself to lose weight. It’s okay to lose one
or two pounds a week. Eat a little less; take your time with weight loss. Make it permanent!

                                                    When you don't have printed calorie information
                                                   available on food labels or restaurant menus, the
                                                  do-it-yourself approach can be good enough. The
                                                      U.S. Department of Agriculture maintains a
                                                               database of food calories at
                                          This is
                                                   the source of information for most other print and
                                                 online calorie counters. A popular, low-cost calorie-
                                                       tracking tool, My Food Diary is available at
                                           Another option: Pocket
                                                   paperback calorie counters are a good option for
                                                  basic foods. But they can go quickly out of date for
                                                  brand-name items. Now that calorie counting and
                                                   tracking tools -- and information about the calorie
                                                 content of foods -- is so widely available, it's easier
                                                                to be a calorie accountant.
                      This chapter reviews the Demographics of Kings County that affect
                      Health Status. Formed in 1893 from part of Tulare County, Kings
                      County is a land of agriculture, farming, and military.

                      Much of the information in this chapter comes from the 2000 United
                      States Census.

                      Chapter Highlights:

                                In 2000, Armona had the highest percentage of owner-
                                occupied housing in the county.
                                Del Monte is the county’s largest employer, but only during
                                tomato season.
                                The current estimate for the 2010 population of Kings
                                County is 164,535.

In this chapter:

Population...………………………      3
Income…………………………….          4
Poverty……….……………………         4
School Lunches………………….      5
Housing……………………………          6
Level of Education……………….   7
Large Employers….……………...   8
Unemployment.…………………..      9

The population of Kings County:                                                            By City:
                             Population Growth                 Current Estimate,                                                                    County population
                                                                   164,535                                   50,000                                                                                   160,000
  180,000                                                                                                    45,000                                                                                   140,000
  160,000                                            129,800                                                 40,000
  140,000                                                                                                    35,000

                                                                  2002 estimate, 154,617
                                                                                                             30,000                                                                                   100,000

  100,000                         73,738                                                                     25,000                                                                                   80,000
   80,000                                                                                                    20,000                                                                                   60,000
   60,000                                                                                                    15,000
   40,000                                                                                                    10,000
                                                                                                              5,000                                                                                   20,000
      -                                                                                                                0                                                                              0
                                                                                                                                     1990                 2003                   2004      2005
                1960     1970     1980      1990      2000     2010 est
                                                                                                         Kings Co                101,469                 137,278              141,586     145,110
                                                                                                         Avenal                      9,575               15,417                16,216     16,214
                                                                                                         Corcoran                13,360                  21,239                22,162     22,561
The population of Kings County has grown on
                                                                                                         Hanford                 30,897                  43,600                44,850     46,350
average 30% each decade over each of the last 4
                                                                                                         Lemoore                 13,622                  21,208                21,944     22,579
decades. The estimate for 2010 has increased by                                                                                  34,015                  35,814                36,414     37,406
10,000 over 2002’s estimate for 2010.

Legal immigration into Kings County: 2000-2006                                             By Age and Gender:
                 2000        538                                                             Kings County
                 2001        461                                                                                                                Kings County Population 2000
                 2002        673
                 2003        463                                                             80-84            MALE

                 2004        599                                                             70-74

                 2005        461                                                             60-64

                 2006        450                                                             50-54
Source: U.S. Citizenship and Immigration Services &
the California Department of Finance, Demographic
Research Unit.                                                                               30-34


In the years between 1995-2000, 32,618 people                                                10-14

moved into Kings County from other California                                                00-04
counties and out of state. 22,951 people moved




out of Kings County during that same time period
for a net domestic migration (gain) of 9,803 people.                                       The bulges in the pyramid may be attributed to the
Additionally, 7,291 people came in from a foreign                                          children of baby-boomers (age 30-40) and their
country.                                                                                   children (age 0-19). The heavy male side of the
                                                                                           population could be attributed to the prison
            Migration in Central Valley 1995-2000
   120,000                                                                                 populations in Corcoran and Avenal.
   100,000                                                     Inflow

                                                               Outflow                     Websites:
                                                                                           • California State Department of Finance:

                                                                                           Source for Migration: They Moved and Went Where:
                                                                                           California’s Migration Flow, 1995-2000; California State
                   Fresno          Kern            Kings         Madera
                                                                                           Department of Finance, Demographic Research Unit.

What is it, why is it important to Kings                                  Percentage of families and people whose income in
County:                                                                   the past 12 months is below the Poverty Level:
Wikipedia defines poverty as the deprivation of                                        dark = below poverty level, light = above poverty level
common necessities that determine the quality of                             100%
life, including food, clothing, shelter, and safe                             80%
drinking water, and may also include deprivation of                           70%
opportunities to learn, to obtain better employment                           60%
to escape poverty, and/or to enjoy the respect of                             40%
fellow citizens.                                                              30%
How are we doing in Kings County                                               0%

compared to other counties:
                                                                                        2000     2006   2000    2006    2000    2006   2000      2006
                                                                           age group
                                                                                               0-5          5-17           18-64           64+
From 2000 to 2006:
  • Poverty in Ages 5-17 increased 5%
  • All other ages saw approximately 1% increase
                                                                          Individual Primary Prevention:
2005 – Kings County was ranked #47 in California                            Education
for poverty with 24% of persons for those under                             Economic Development
age 18 living in poverty.                                                   Access to Health Care
The State’s level is 17.7% of persons for those
under age 18 living in poverty.                                             Websites:
                                                                          • California Department of Public Health –
Key findings/tables:                                                      • Health Status County Profiles 2008
Kings County’s per capita personal income is below              
that of other South Valley Counties and well below                        08.pdf
that of the state.                                                        • HHS Poverty Guidelines – 2008
                                                                 and search for “Poverty Guidelines”

                                      Per Capita Personal Income for Some Valley Counties


       $35,000          Fresno






                 1994          1995   1996     1997     1998     1999     2000      2001         2002      2003        2004

What is it, why is it important to the                   Benefits of National School Lunch
health status of Kings County?                           Program:
The Free-Reduced Price Meal (FRPM) is a                  • For children, the National School Lunch Program
program in schools, to provide food for students           provides a nutritious meal that contains one-third
from low-income families.                                  of the recommended dietary allowance of
The      percentage        on     Ed-Data (www.ed-         necessary nutrients. is based on the number of students       • For parents, the program offers a convenient
eligible for FRPM programs divided by enrollment           method of providing a nutritionally balanced lunch
from the CBEDS data collection.                            at the lowest possible price.
Statistics are split in to 3 categories:                 • For schools, the program enhances children's
       • Eligible = family meets economic criteria         learning abilities by contributing to their physical
       • Enrolled = family has met criteria &              and mental well being. Studies have shown that
          student is signed up                             children whose nutritional needs are met have
       • Participation = student actually receiving        fewer attendance and discipline problems and are
          FRPM                                             more attentive in class.
                                                         Source: California Department of Education

How are we doing in Kings County?
                                                         Websites for more information:
The Delta View, Lakeside, and Reef Sunset school
districts have the highest percentage of their           • California Department of Education:
students receiving free or reduced meals.        
                                                         • California Department of Education – DataQuest:
Key Findings:
                                                         • Kings County Office of Education:
Counts of students Enrolled in the FRPM by School
                                                         • US Census Bureau:
District for 2005-2008 school years:
                                                         • US Census Bureau, American Community







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Source: California Department of Education, Data Quest

Why is it important to the health                                                    Key Findings:
status of Kings County?                                                                                             Age of Home Owners
Home-ownership and renting data provide                                                90.0%
important information about the region’s economy.                                      80.0%
Higher levels of home ownership suggest that a                                         70.0%
greater number of individuals and families enjoy
sufficient wealth or income to purchase a home.                                        40.0%
There is also a contrast between urban and rural                                       20.0%
areas. Urban areas attract younger people more                                         10.0%
likely to rent as well as newcomers also more likely                                    0.0%
to rent before they buy, both of which may reflect a                                                Under        25 to        35 to         45 to             55 to     65 to         75 and
                                                                                         age         25           34           44            54                64        74            over
vibrant economy. Also, lower levels of home
ownership may suggest that the region’s wealth is                                    The percentage of people owning homes under the
more concentrated in the hands of a few.                                             age of 35 increased from the 1990 census to the
                                                                                     2000 census.
Home ownership also has important sociological
implications, as home owners typically are more
invested in their communities, working to make
                                                                                       Average Household Size, Kings County, Census
them safe, clean and livable.
                                                                                        5                        4.66
                                                                                                4.13                              4.33
From University of North Carolina – Charlotte Regional                                4.5
Indicators Project                                                                      4            3.47                    3.56
                                                                                           3.26                        3.06            3.18
                                                                                      3.5                  2.93
How are we doing in Kings County?                                                     2.5
Kings County Home Ownership Percentage was                                              2
55.9% in 2000, up from 52.9% in 1990.                                                   1







                                                                                                                                                                                       Kings Co
          Home Ownership Percentage, Kings County,
                       Census 2000



                                                                                     For More information
                                                                                     • US Census Bureau:




                                                                          Kings Co

In 2000, Armona had the highest percentage of
owner-occupied homes in the county. Only Avenal
is below the Total County percentage.

                                                                                                           Drop-out Rates:
What is it, why is it important to Kings
                                                                                                                        High School Dropout rates as a percentage of the
County:                                                                                                                    enrollment by School District for 12th grade
Educational attainment, according to the Census
Bureau, is the highest grade or degree completed.                                                                  10.00%
Prior to 1992, educational attainment was defined                                                                   8.00%
as years of completed schooling.                                                                                    6.00%
Level of education and educational attainment are                                                                   2.00%
important to Kings County, as higher education
                                                                                                                                 2003-04        2004-05             2005-06
improves the opportunities for a better quality of
                                                                                                                         Corcoran             Hanford                 KCOE
                                                                                                                                      Lemoore                  Reef-Sunset              Kings Co
How are we doing in Kings County
                                                                                                           Kings County drop-out rate is just above the
compared to California?                                                                                    State’s; there appears to be some fluctuation in the
                                                                                                           rates of individual school districts.
                                                  Kings Co                       California
 No High School                                                                                            Earnings:
                                                     30.1%                           19.9%
 High School Diploma                                 30.0%                           23.2%                                                         Earnings by Education
 Some College/
                                                     27.5%                           27.9%
 Associates Degree                                                                                                              200.0
                                                                                                            Relative Earnings

 Bachelor’s Degree or
                                                     12.4%                           29.0%                                      150.0
 Key findings/tables:
Educational Attainment:
        Kings County Population over age 25, by highest
                                                                                                                                           Not a High  High       Some       Bachelor   Advanced
                 grade or degree completed:                                                                                                 School    School     College      Degree     Degree
                                                                                                                                           Graduate Graduate
60.0%                                                                                                      Black line is US Median Earnings

                                                                                                           Individual Primary Prevention:
 0.0%                                                                                                                           •         Applying for financial aid for both 2 and 4
                al                                                   L              rd
                                                                                                                                          year college degrees.
              en           an         rd         an       re
     rm    Av         rc
                                                       oo      N           ra
                                                                                tf o
                                                                                                                                •         Engaging students in the learning process
    A                o        H            t
                                                    Le                   St              Ki
                   C                    Ke                                                                                      •         Engaging students in extra-curricular
   Less than 12th, no diploma                       High school grad (incl GED)                                                           activities
   Some College, Associate deg                      Bachelor's or higher

                                                                                                           Websites for more info:
Kettleman City and Stratford have a higher                                                                 • California Department of Education:
percentage of the population over 25 years old                                                     
without a High School Diploma than other cities and                                                        • Kings County Office of Education:
towns in Kings County.                                                                             
                                                                                                           • US Census Bureau:

Why is it important to the health                  Key Findings:
status of Kings County?                                      Work Status of past 12 months: Weeks
Large employers create many opportunities for:              worked by population age 16-64 in Kings
   • Employment in Kings County
                                                                         County 2006
   • Bringing money into the county                  35.00%
   • Jobs for the residents                          30.00%
How are we doing in Kings County?                    20.00%
As of 2006, Large Employers include…
 Avenal State Prison            1300 employees                Worked     Worked     Worked     Worked Worked 1   Did not
 Paramount Farms                600 employees                 50 to 52   40 to 49   27 to 39   14 to 26 to 13     work
                                                               weeks      weeks      weeks      weeks   weeks
 Reef-Sunset School District    306 employees
                                                   Source: U.S. Census Bureau, 2006 American
                                                   Community Survey
 Corcoran State Prison            1500 employees
 CSATF & SP @ Corcoran            1400 employees
                                                   The chart above tells us that about 25% of the
 Corcoran Unified School Dist     389 employees
                                                   working population of Kings County did not work a
 J.G. Boswell Company             375 employees
                                                   full year in 2006. This would likely include the 1500
       Farming                     225
                                                   Del Monte employees that only work during tomato
       Cotton/Safflower oil        150
                                                   season and other seasonal employees. Another
                                                   32% of the working population did not work at all
                                                   during 2006.
 Del Monte                      1937 employees
      Full time                   437
                                                   According to the American Community Survey
      During Tomato Season       1500
                                                   2006, Kings County Residents:
 Kings County                   1041 employees
                                                      • Work in Kings County: 78.6%
 Adventist Health               857 employees
 Hanford Elementary School Dist 520 employees         • Carpool: 19.7%
 Exopac, Inc.                   306 employees         • Mean travel time to work: 19.6 minutes
 Marquez Bros                   306 employees                 o But 3.9% travel 60 + minutes to work
 Central Valley Meat Co.        270 employees         • Are:
 ConAgra Foods                  250 employees                 o Local Government workers: 5,166
 Warmerdam Packing              250 employees                 o State Government workers: 4,866
 KWRA                       55-200 employees                  o Federal Government Workers: 2,841

 Lemoore:                                          For More information:
 NAS – Lemoore                  1400 Civilians          Websites:
 The Palace Casino              800 employees
                                                   • Kings County Economic Development
 Leprino Foods                  670 employees
 SK Foods                       350 employees
                                                   • US Census Bureau:
      Full time                   50
                                                   • US Census Bureau, American Community
      Seasonal                    300
 Communication Services for the Deaf
                                250 employees

                                                                                2007 Unemployment Rate by
What is it, why is it important to Kings                                       City/Town, County, State, & US
County:                                                                       30.0%
Unemployment is the state in which a person is
without work, available to work, and currently
seeking work.                                                                 20.0%
Kings County’s Unemployment Rate grows during
the winter months, when there are no crops to                                 15.0%

maintain, and decreases in the early spring,                                  10.0%
through the growing season, highlighting the
significance of Seasonal Crops to our county’s                                5.0%
economy.                                                                      0.0%

                                                                                           St ty
                                                                                        St en

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                                                                                  Ki Ar n

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                                                                                   ttl Ave



                                                                                   ni fo
              Kings County Unemployment 2000-2007 by month







                                                                         • Economic Development Department:
   7                                                                     • California Department of Food & Agriculture
            Jan Feb Mar Apr May Jun      Jul Aug Sep Oct Nov Dec
                        2000      2001          2002     2003            The unemployment rate in Kings County has been
                        2004      2005          2006     2007
                                                                         steadily dropping since 1992, with the exception of
How are we doing in Kings County                                         2001-02.
compared to other counties?
                                                           Unemployment Rates                                      Tulare Co
    20                                                                                                             Fresno Co
                                                                                                                   Kern Co
                                                                                                                   Kings Co
    16                                                                                                             CA








              1990    1991     1992      1993     1994   1995   1996   1997   1998    1999   2000   2001   2002   2006   2007

Data not available for all counties for 2003-2005 from EDD. Rates are lowest in July, August, and September.

This chapter examines the Health Status of childbearing women
and their infants in Kings County. Topics covered include the
importance of preconception and prenatal care and how they affect
birth outcomes.

Information is based on local data where available, and on State
and National data, where local data are not available.

Chapter Highlights:

      Kings County’s birth rates are higher than the State as a
      In 2005, nearly ½ of the teen births in Kings County were to
      women age 19. Over ¼ of the teen births were to women
      age 18.
      85% of Women with positive pregnancy tests gave a history
      of not planning the pregnancy.

                           In this chapter:

                           Planned Pregnancy……………... 13
                           Pre-Conception Care……………. 14
                           Birth Defects……………………… 14
                           Prenatal Care……………………. 15
                           Births……………………………… 16
                           Teen Births……………………….. 17
                           Breastfeeding……………………. 18
                           Infant Mortality…………………… 19
                           SIDS………………………………. 20

What is it?                                                            Individual Primary Prevention/
Spacing your children for the benefit of the                           Deterring Activities
offspring, health of the mother, minimize impact on                    Educational information regarding the importance
personal finances of the family, and to provide                        of planned pregnancies and early initiation of
other siblings with maximum parental support                           prenatal care is provided to women in a variety of
                                                                       venues such as:
Why is it important to the health                                         • Migrant parents groups
status of Kings County?                                                   • Classes at various providers throughout the
    •     Financial impact in terms of the number of                          County
          women that are using Medi-Cal to subsidize                      • Parents groups at the Family Resource
          the pregnancy.                                                      Centers
    •     Potential reduction in the number of                            • Women who receive care through Kings
          maternal deaths.                                                    County Department of Public Health –
    •     Reduction in the number of terminations.                            Reproductive Health Clinic
    •     Potential reduction in child abuse.
                                                                       For More information
How are we doing in Kings County?                                           Contact for related programs:
         The proportion of births occurring within 24 months of a
                                                                        • Reproductive Health Clinic (559) 582-2795 for
                               previous birth                             appointment
                                                                        • Medical providers offering reproductive health
  18.0                                                                    care:
  16.0                                                                    • Central Valley Family Health
  14.0                                                                    • Family HealthCare Network
  12.0                                                                    • Women’s Health & Pregnancy Care Medical
  10.0                                                                       Center
                                                                          • Valley Family Health
         1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006      • Health Valley Medical Group
                                                                          • Kings Community Health Center
                    California age 12-19       Kings age 12-19            • Avenal Community Health Center
                    California age 15-44       Kings age 15-44          • Family Resource Centers:
                                                                             o Armona – 585-7291
                                                                             o Corcoran – 992-5880
                                                                             o Hanford North – 583-6939
Key Findings:                               Percentage of Positive           o Hanford – Home Garden – 584-4822
                                           Pregnanacy Tests where            o Kettleman City – 386-1693
85% of Women with                          Pregnancy was Planned
                                                                             o Lemoore Family Connection – 924-6407
Positive Pregnancy
Tests gave a history                            15%                           Websites:
of not planning the                                                    • California Department of Public Health:
Blue on chart is                                                       default.aspx
Not Planning.                                                
                                                                       • CDC – Preconception Care:
                                                                       • March of Dimes – Preconception:

What is it?                                                                                                                           Individual Primary Prevention/
Preconception care is defined as the care provided                                                                                    Deterring Activities
to women in the planning of future pregnancies.                                                                                       General counseling and education provided to
These interventions aim at identifying the                                                                                            women at the Department of Public Health during
biomedical, behavioral, and social risks that may                                                                                     pregnancy and contraceptive counseling
impact the outcome of the pregnancy. The goals of                                                                                     Specific referral for genetic counseling for women
preconception care are:                                                                                                               that provide a history of medical conditions which
   • To identify reducible or reversible risks                                                                                        may adversely affect the pregnancy.
   • Provide information to the woman and her
       partner about future reproduction                                                                                              5 steps from the CDC to get ready for a Healthy
   • To maximize the health of the offspring and                                                                                      Pregnancy:
       the woman.                                                                                                                        1. Take folic acid every day for at least 3
                                                                                                                                             months before getting pregnant to help
Why is it important to the health                                                                                                            prevent birth defects.
status of Kings County?                                                                                                                  2. Stop smoking and drinking alcohol.
                                                                                                                                         3. If you have a medical condition, be sure it is
The concern in Kings County is related to adverse
                                                                                                                                             under control.        Also be sure your
pregnancy outcomes and complications which
                                                                                                                                             vaccinations are up to date.
impact the overall health of women including
                                                                                                                                         4. Talk to a health care professional about any
maternal deaths. The possibility of premature
                                                                                                                                             over-the-counter        and     prescription
births, low birth weight babies, and birth defects
                                                                                                                                             medications you are taking.
can create a financial burden not only on the family,
                                                                                                                                         5. Avoid contact with toxic substances or
but also on society.
                                                                                                                                             materials that could cause infection at work
                                                                                                                                             or home.
How are we doing in Kings County?
Approximately 85% of pregnancies are unintended                                                                                       For More information
in Kings County.      Based on the California
Department of Public Health, County Health Status                                                                                          Contact for related programs:
Profiles, 2008, in unplanned pregnancies, there                                                                                        • Reproductive Health Clinic (559) 582-2795 for
was an incidence of 6.6% low birth weight infants                                                                                        appointment
from 2004-2006.                                                                                                                        • Medical providers offering reproductive health
Key Findings:
                                                                                                                                      • March of Dimes:,
              Rate of Births with Inadequate Prenatal                                                                       
                            Care by Year                                                                                              • California Department of Public Health –
        6.8                                                                                                                           Maternal, Child, and Adolescent Health Program
        6.4                                                                                                                           • CDC:

        5.6                                                                                                       California
                   95        96        97        98        99        00        01        02        03        04        05        06
              19        19        19        19        19        20        20        20        20        20        20        20

Inadequate Prenatal Care:                                     Late Entry into Prenatal Care:
Adequacy of prenatal care is based on the Kotelchuck          Late or no prenatal care is the percentage of births
Index or Adequacy of Prenatal Care Utilization Index,         that occurred to mothers who reported receiving
using two elements obtained from the birth certificate        prenatal care only in the third trimester of their
data.                                                         pregnancy, or reported receiving no prenatal care
    1. When prenatal care began                               on their child’s birth certificate.
    2. Number of visits between initiation and delivery
Inadequate prenatal care is when less than 50% of the         How are we doing in Kings County?
expected visits are received.                                 Trends indicate that late or no prenatal care has
                                                              increased over the past 12 years, from 5.5% in
Why is it important to the health status                      1995 to 8.2% in 2006. During the years of 1997
of Kings County?                                              through 2000, the percentages decreased as low
Prenatal care is necessary to prevent complications           as 2.8. Kings County is significantly higher than the
and decrease the incidence of maternal and prenatal           State percentages of 4.5 in 1995 to 2.8 in 2006.
mortality.                                                                  Rate of Births with Late or No Prenatal
                                                                                         Care by Year
How are we doing in Kings County?                                     8.0
The trends over the past 12 years indicate an increase                7.0            Kings
in inadequate prenatal care going from a rate of 17.0 in       Rate   6.0

1995 to 19.3 in 2006. During the years of 1997                        5.0

through 2000, Kings County had rates ranging from 9.5                 4.0

to 13.2, and then it started to increase.                             3.0

These rates are significantly higher than the State rates             2.0

ranging from 13.7 to 9.0 over the 12 year time frame





















(1995 – 2006).
                                                              Individual Primary Prevention/
           Rate of Births with Inadequate Prenatal            Deterring Activities
                         Care by Year                         Factors that increase chance of late or no prenatal
        20.0              California                          care include:
        18.0              Kings                                  • Low Income or educational level
        16.0                                                     • Young maternal age/teen pregnancy

                                                                 • Race or ethnicity
        10.0                                                     • High number of previous births, maternal
         8.0                                                          substance abuse
         6.0                                                     • Lack of health insurance/lack of obstetric
             95 996 997 998 999 000 001 002 003 004 005 006           providers
           19   1   1   1   1   2   2   2   2   2   2   2

                                                              For More information
Individual Primary Prevention/Deterring
                                                                   Contact for related programs:
                                                              Public Health Nurses: 584-1401 for information
Referral to Medi-Cal (Presumptive Eligibility while           Maternal Child Adolescent Health Program
application in progress) and AIM insurance for low-                  582-3211 x 2586
income pregnant women.
There is no reason for a woman to not get prenatal            • California Department of Public Health – MCAH
care, as there are many resources for prenatal care in
Kings County that may be accessed through the phone           • March of Dimes:
numbers listed on this page.                        

                                                                                                     Births by Race/Ethnicity of Mother & City of
What is it?                                                                                                          Residence
Births include all live births born to women.                                            100%
Why is it important to the health                                                         70%
status of Kings County?                                                                   50%
Births are significant to Kings County in the impact                                      40%
on the population growth within the County.                                               20%
How are we doing in Kings County?

Over the past 12 years, the birth rate for women


                                                                                                                                                o re







                                                                                                                         n fo

                                                                                                                                                       tf o
                                                                                                                 r co

                                                                                                                                                                          l ifo
                                                                                                                                  t tle

aged 15-44 years in Kings County has remained




consistently higher than the State rates.
                                                                                                Amer Indian         African-Am            Hispanic          White         All Other
         Births to mother age 15-44 by Race/Ethnicity
        140                                                                            Individual Primary Prevention/
        100                                                                            Deterring Activities

         80                                                                             • Residents can seek reproductive health care,
         40                                                                               birth control, from many medical offices – for
         20                                                                               low cost or free.
          0                                                                             • Plan pregnancies for better health of both mom
                                                                                          and baby.























                 CA White                                     Kings White
                                                                                        • Preconception health care before you get
                 CA Hispanic                                  Kings Hispanic              pregnant is important to the health of the baby.
                                                                                        • See a doctor as soon as you know that you are
                                                                                          pregnant. Prenatal care is important to the
Key Findings:                                                                             health of both mom and baby.
                                  Age of Mother
  100%                                                                                 For More information
   80%                                                                                      Contact for related programs:
   70%                                                                                  • Reproductive Health Clinic (559) 582-2795 for
   60%                                                                                    appointment
   50%                                                                                  • Public Health Nurse information and referral
   40%                                                                                    (559) 584-1401
                                                                                        • Medical providers offering reproductive health
                                                                            35+                  Websites:
                                                                                       California Department of Public Health –




                                                                                         • Vital Statistics Query System:











                                                                            Under 20





The majority of births in Kings County are to                                            • Statewide Birth Statistical Data Tables:
mothers below the age of 30.                                                 
In most cities in Kings County, births to Hispanic                                       • Birth and Death Profiles by ZIP Code:
mothers make up more than half of all births, which                          
is reflective of the population of each city.                                          athProfilebyZIPCode.aspx

What is it?                                                            Birth Rates for ages 15-19 by race/ethnicity
Teen Births are those live births born to young women
age 19 and younger. More specifically defined as:
births to adolescents age 15 to 19.                                                                                     100.0

Why is it important to the health status
of Kings County?

Teen births are significant to Kings County due to the                                                                  40.0

impact of finances, difficulty being teen parents,                                                                      20.0
increased uneducated and less productive tax payer
base, and poorer outcomes for children of teen                                                                          0.0
                                                                2000    2001     2002    2003    2004   2005     2006
                                                                           Asian/PI       African/Am    Latina

How are we doing in Kings County?
                                                                           White/Other    2+ Races      Total

The birth rates for teen girls aged 10-14 years has
decreased from 1.9/1000 live births to 0.6/1000 live        Individual Primary
births since 1995. Teen births from 15-19 year olds
have decreased from 98.5/1000 in 1995 to 64.1/1000
                                                            Prevention/Deterring Activities
in 2006. Even though the trends are decreasing, the         Prevention is the key to reducing the number of
rates remain significantly higher than the State rates.     teen pregnancies
                                                              • Talk to your adolescent children about their
                                                                sexual activity and health.
Key Findings:
                                                              • Insist that children complete high school and
In 2006, 13.4% of all live births in Kings County were to       attend college or a trade school.
young women age 15 to 19. Those births break down
                                                              • Preconception health care and planned
by age as follows:
                                                                pregnancy are important to the health of both
                                                                mom and baby.
         Births to Mothers Age 15-19 by Single Year           • Talk to your children about drug and alcohol
                                                                use and the impact of decreased inhibitions,
                          4%                                    control, and sound decision-making when under
                                                                the influence.

                                                            For More information
                                                      15         Contact for related programs
                                                      16    Kings County Department of Public Health –
             160 ,                 19%
                                                      17     Reproductive Health Clinics: 559-582-2795 for
             44%                                            appointment
                                                            Medical Providers offering FPACT services

                           25%                              • California Department of Public Health –
                                                              Teen Pregnancy Prevention:
                                                            • Family PACT:
                                                            • CDC – Healthy Youth:
What is it?                                                            Individual Primary Prevention/
Breastfeeding data is obtained from Hospital data                      Deterring Activities
as in-hospital breastfeeding as indicated on the                       Benefits for Baby:
Newborn Screening Test Form.               The data is                  • Antibodies in breast milk protect baby from
collected as “any breastfeeding” (also using                              illness
formula) and “exclusive breastfeeding” (no formula)
                                                                        • Decreased likelihood for allergies and dental
since birth, and is collected in the first 24-48 hours.
                                                                        • Appropriate jaw, teeth, and speech
Why is it important to the health                                         development
status of Kings County?                                                Benefits for Mother:
Breastfeeding is important for many reasons                             • Reduced rates of breast & ovarian cancer
including: infant immunity, weight, bonding.                            • Time saved
                                                                        • Can still feed baby when supplies of food and
How are we doing in Kings County?                                         water are not available
In Kings County for 2007, the rate of “any                             Benefits for Employers:
breastfeeding”      is   74.1%     and      “exclusive                  • Breastfed babies are healthier babies,
breastfeeding” is 25.4%.                                                  mothers miss less work for doctor visits
California rates for “any breastfeeding is 86.6% and                   Benefits for Environment:
for “exclusive breastfeeding” is 42.7%.                                 • No excess packaging or processing
                                                                        • Encourage Community level acceptance of
The breakdown for Kings County by race/ethnicity                          breastfeeding by enabling baby-friendly areas
for any breastfeeding is as follows:                                      at businesses, community buildings, and
    • African American – 67.2%                                            recreational areas.
    • Asian – 85.2%
    • Multiple Race – 71.9%                                            For More information
    • White – 79.6%                                                         Contact for related programs:
    • Hispanic – 72.8%                                                  • WIC Program – (559) 582-0180
                                                                        • Hospital Breastfeeding Program –
Key Findings:                                                             (559) 583-2215
                                                                        • LaLeche League - (559) 583-0703
            Any Breastfeeding by Race/Ethnicity 2004-2007

                                                                       • California Department of Public Health –
   80                                                                  Maternal, Child, and Adolescent Health
                                                                       Breastfeeding Program:
   40                                                                  • LaLeche League USA:
                                                                       • LaLeche Leage International:
    0                                                                  • LaLeche League Hanford:
           2004            2005           2006              2007
                                                                       • Adventist Health –
        California         KINGS            Healthy People Objective   Hanford Community Hospital &
                                                                       Central Valley General Hospital

What is it?                                                             Rate of Fetal Deaths by Year
Fetal deaths are defined as deaths of babies 20           7.0
weeks or more gestation.                                  6.5
Infant deaths are babies less than one year of age.

Fetal and infant deaths can be caused by a variety        5.0

of causes including:                                      4.5                        California    Local
    • Lack of access to health care                       4.0
    • Accidental,                                         3.5
    • Intentional, and                                    3.0
    • Congenital incapability with life                         1995-   1997-    1999-    2001-    2003-   2005-
                                                                1996    1998     2000     2002     2004    2006

Why is it important to the health
status of Kings County?                                 Individual Primary Prevention/
Gaps in health service systems exist that can best
be identified and addressed through systematic
                                                        Deterring Activities
reviews of individual cases of fetal and infant death   Active prevention is the key to decreasing infant
at the community level.                                 mortality.
Once these gaps in service systems are resolved          • Preconception and prenatal care from a
and the causes of fetal and infant deaths are               medical provider are important.
addressed, the services for all families improve and     • Do not use tobacco, alcohol, or drugs before,
the entire community benefits.                              during, or after pregnancy.
                                                         • Follow SIDS prevention guidelines of placing
How are we doing in Kings County?                           infant on back to sleep on a firm mattress.
                                                         • Always use car seats that are properly installed
Trends over the past 12 years indicate an increase
                                                            into car.
in fetal deaths from 3.4/1000 births in 1995-1996 to
5.5/1000 births in 2005-2006.
                                                        For More information
Infant death rates have decreased from 8.9/1000              Contact for related programs:
births in 1995-1996 to 6.1/1000 in 2005-2006.            • Reproductive Health Clinic (559) 582-2795
                                                         • Public Health Nurse information and referral
These rates are not significantly different from the       (559) 584-1401
State rates.                                             • Healthy Families/Healthy Kids (559) 584-1401

Key Findings:                                                   Websites:
               Infant Death Rate 1995-2006              • California Department of Public Health –
        14                                              • Fetal and Infant Mortality Review (FIMR)
        12                                                 Program:
         8                                              • CDC – Maternal and Infant Health:

               Kings Co                                 lth/index.htm
         2     California

           95 96 97 98 99 00 01 02 03 04 05 06
         19 19 19 19 19 20 20 20 20 20 20 20

What is it?                                                               Statewide SIDS Rates by Race/Ethnicity
Sudden Infant Death Syndrome (SIDS) is the                          200
sudden death of an infant under 1 year of age
which remains unexplained after a thorough case                     150
investigation, including performance of a complete
autopsy, examination of the death scene, and
review of clinical history.                                          50

Currently, there is no known way to prevent SIDS,                     0
but there are things that parents and caregivers can                        2000     2001      2002      2003    2004
do to reduce the risk of SIDS death.
                                                                          White             African-Am     Asian/PI
                                                                          Hispanic          2+ race
Why is it important to the health
status of Kings County?                                           The Statewide 2004 SIDS rates for African-
Citizens need to be educated to reduce the risk of                Americans (non-Hispanic) were more than twice the
SIDS deaths.                                                      White (non-Hispanic) SIDS rates and more than
                                                                  triple the Hispanic SIDS rates.
How are we doing in Kings County?
For the years 2002-2004, there were 3 SIDS                        Individual Primary Prevention/
deaths in Kings County, out of 7,225 total births.                Deterring Activities
That is equal to 0.04% of the total births; the                      1. Always place your baby on his/her BACK to
statewide percentage is 0.03%.                                          sleep, even for naps.
                                                                     2. Never allow smoking around your baby.
Key Findings:                                                        3. Place your baby on a firm, flat surface to
                                                                     4. Remove all soft things such as loose
            # SIDS Deaths in Kings County 1995-2006                     bedding, pillows, and stuffed toys from the
  7                                                                     sleep area.
                                                                     5. Never place your baby on a sofa, waterbed,
                                                                        soft chair, pillow, or bean bag.
  5                                                                  6. Take special precautions when your baby is
  4                                                                     in bed with you.
  3                                                                  7. Make sure your baby doesn’t get too hot.
                                                                     8. Keep your baby’s face and head uncovered
                                                                        during sleep.
  1                                                                  9. Share this information with everyone who
  0                                                                     cares for your baby.





                                                                  For More information





                                                                       Contact for related programs:
For the years 1995-2006, there have been 12 SIDS                   Kings County Department of Public Health –
Deaths in Kings County.                                            ask for the SIDS Coordinator: 584-1401
                                                                  • California SIDS Program:
                                                                  • National Institute of Health:
                                                                  • CDC:

Deaths and Injuries take a toll on the emotional and financial as
well as general health of a community. Many injuries can be
avoided, if safe choices are consistently made.

Chapter Highlights:

      Tobacco use contributes to 30% of all cancer deaths.
      Although Coronary Artery Disease is the leading cause of
      death in Kings County, Unintentional Injury and Accidents
      cause the greatest number of Potential Years of Life Lost.
      A single car accident involving fatalities of 3 18-year olds
      would lead to 171 Potential Years of Life Lost.

                           In this chapter:

                           Causes of Death…………………. 23
                           Intentional Injuries..……………… 24
                           Unintentional Injuries..…………... 25
                           Cancer……………..……………… 26
                           Suicide……………………………. 27

                                                             The average age for 15-24 is 19.5 years
What is it?
                                                             75 years – 19.5 years = 55.5 years
Deaths may      include   accidents,    homicide,   or       55.5 years x 11.33 deaths =
suicide.                                                               629 Potential Years of Life Lost

Why is it important to the health                            Contact for related programs:
status of Kings County?                                           Websites:
Premature death creates Potential Years Life Lost,
                                                             • California Department of Public Health:
or PYLL. PYLL represents the total years NOT
lived by an individual who died prematurely. One
way to measure the impact deaths on a community
is to measure the PYLL.

How are we doing in Kings County?                                               Death Rates for Top 10 Causes of Death, 2004
Current life expectancy      in   Kings    County   is                  120.0
approximately 80 years.                                                 100.0

Key Findings:                                                            40.0
Small numbers in some of the less common causes                           0.0

                                                                                                                                                                  MOTOR VEHICLE

                                                                                                                                                                                                                    FEMALE BREAST
                                                                                 CORONARY HEART



                                                                                                                                                    LUNG CANCER

                                                                                                                                                                                  COLON CANCER
of death fail to show the complete impact of those


deaths on a community.


To simplify, assuming a 75 year life-span, we can
calculate the PYLL. In Unintentional Injuries &
Accidents, the largest age group affected is age 15-
24 with an average of 11.33 deaths for 2004.

  Top 10 Causes of death by            Average                             Top 10 Causes of Death by Potential
      number of deaths                  deaths RANK       PYLL                      Years Life Lost
 CORONARY HEART DISEASE                 138.7       1     1732            UNINTENTIONAL INJURIES (ACCIDENTS)
 RESPIRATORY DISEASE                      53.3      2     1105                                                     MOTOR VEHICLE CRASHES
 UNINTENTIONAL INJURIES                   50.7      3      643                                                    CORONARY HEART DISEASE
 DISEASE (STROKE)                         48.0      4      473                                        SUICIDE
 DIABETES                                 47.3      5      393                                      DIABETES
 LUNG CANCER                              43.7      6      336             CHRONIC LIVER DISEASE & CIRRHOSIS
 MOTOR VEHICLE CRASHES                    28.7      7      318                         DRUG-INDUCED DEATHS
 COLORECTAL (COLON)                                                            CHRONIC LOWER RESPIRATORY
 CANCER                                   17.3      8      296                                       DISEASE
 AND CIRRHOSIS                            16.3       9     264                                                                                                       HOMICIDE
 FEMALE BREAST CANCER                     13.3      10     253                                                                                                    LUNG CANCER
   •   Death before age 75; 2004 averages
   •   PYLL – Potential Years of Life Lost due to Premature Death
   •   Created based upon information from Center of Health Statistics, Vital Statistics Query System
   •   Diabetes deaths & Deaths due to Motor Vehicle Crashes may be a subset of some other type of death

What is it?
Intentional injury data is obtained from hospital
                                                        Key Findings:
admissions data. The rate is calculated from the        Intentional Injury death rates as reported by the
number of hospital admissions due to intentional        California Department of Public Health are
injuries per 100,000 persons (ages 0-24) in a           unreliable due to small numbers and a large
calendar year.                                          standard error. With that in mind, Kings County did
Intentional injuries may include:                       not meet the Healthy People 2010 Objectives in
    • Self-inflicted injuries – including Suicide       Suicide, Homicide, or Firearms Deaths, but had a
                                                        lower rate in all three, than the State as a whole.
    • Assault - including Homicide
    • Other types of injury including legal
        intervention (law enforcement) and War          Individual Primary Prevention/
The charts below come from EPIC's fatal injury          Deterring Activities:
which gets data from California Death Statistical       Factors that put a person at greater risk include:
Master File. Data about hospitalized nonfatal              • age
injuries comes from the Office of Statewide Health         • race/ethnicity
Planning and Development (OSHPD) patient                   • geographic location
discharge data.                                            • mental health problems
                                                           • social or behavioral problems
Why is it important to the health                          • history of incident with law
status of Kings County?                                    • aggressive behavior
This is important to Kings County due to the               • attention deficits
financial impact on the health care system and the         • exposure to violence
financial, social, and emotional impact on families        • lack of community assets
and individuals.        Also impacted are law              • involvement in gangs
enforcement, and the cost of that system.                  • lack of social networks
                                                           • substance abuse
How are we doing in Kings County?
 Non-Fatal          2003           2004         2005    Contact for related programs:
 All Injuries       626            581          671     Kings County Behavioral Health
 Intentional         97            120          132            (559) 582-3211 x 2376
 Kings Co          15.5%          20.7%        19.7%
 Fresno Co         16.5%          18.9%        18.5%    Websites:
Of those non-fatal intentional injuries:                • Kings County Behavioral Health
    • 5.5% Self-inflicted                     
    • 6.8% Assault                                      • Drowning Prevention:
    • 6.3% Other Intents including legal      
         intervention and war                           ingPrevention.aspx
 Fatal              2003           2004         2005
 All Injuries        74             68           69     • Poison:
 Intentional         24             23           16
 Kings Co          32.4%          33.8%        23.2%    • Suicide:
 Fresno Co         30.6%          30.9%        33.7%
Of those fatal intentional injuries:                    • EPICenter California Injury Online:
    • 17.5% Self-inflicted                    
    • 7.6% Homicide                                     .htm#summaries
    • 4.7% Other Intents                                • CA Vital Statistics Death Statistical Master File:
Source: California Department of Public Health, Vital
Statistics Death Statistical Master File
What is it?
Unintentional injuries include the following types of   Fatal un-intentional injuries ranked as follows:
injuries:                                                  1. Motor Vehicle Accidents – 56.8%
    • Burns                                                2. Poisoning – 14.2%
    • Cuts                                                 3. Falls – 6.8%
    • Drowning                                             4. Drowning – 4.7%
    • Falls                                                5. Suffocation – 4.1%
    • Firearms
    • Machinery                                         Individual Primary Prevention/
    • Motor vehicle accidents                           Deterring Activities
    • Bicycle                                           Motor Vehicle:
    • Pedestrian                                            • Use seat belts or car seats correctly
    • Other types of transportation                         • Do not engage in risky driving behavior
    • Natural/Environmental                                    (aggressive driving, speeding, etc.)
    • Overexertion                                          • Inexperience of younger drivers
    • Poisoning                                             • Be aware of poor road/driving conditions
    • Struck by object                                      • Avoid driving when drowsy or distracted
    • Suffocation                                           • Substance abuse & driving don’t mix
    • Other                                             Poison:
                                                            • Use & Store products safely
Why is it important to the health                           • Dispose of products properly
status of Kings County?                                 Falls:
Unintentional injuries are important to Kings County        • Reduce in-home hazards
due to the financial impact on the health care              • Improve lighting, make repairs
system as well as the financial, social, and                • Exercise regularly
emotional impact on families and individuals. Also,         • Review prescriptions with pharmacist
there is an impact to law enforcement and the cost          • Have eye exams
of that system.                                         Drowning:
                                                            • Adult supervision
How are we doing in Kings County?                           • Safety barriers
In the 2008 County Health Status Profiles, there            • Be aware in natural water settings
was an average of 50.7 deaths due to Unintentional          • Make appropriate boating choices
Injuries for Kings County for 2004-2006. Kings              • Substance abuse & water don’t mix
County ranks #27 in the State for death due to              • Always swim with a buddy
Unintentional Injury.
                                                        For More information:
Key Findings:                                                Websites:
Kings County’s death rate for unintentional injuries    • Motor Vehicles:
is lower than all other Valley counties.                •
For 2003-2005 in Kings County, non-fatal                  wningPrevention.aspx
unintentional injuries were ranked as follows:          • Poison:
    1. Falls – 45.3%                            
    2. Motor Vehicle Accidents – 23.7%                  • Falls:
    3. Other transportation accidents – 4.1%

What is it?                                                                                       For this period, cancer deaths have fallen for lung
Cancer is the second leading cause of death in                                                    (34%); breast (29%); colon (31%); and prostate
Kings County. About one hundred and fifty Kings                                                   (31%). However, cancer deaths from liver (56%)
county residents die of cancer every year. About a                                                and melanoma (16%) have increased. Compared
quarter of these deaths are due to lung cancer.                                                   with the State, tobacco use continues to be
Colon cancer, breast cancer, prostate cancer, and                                                 significantly higher in Kings County adults and
cancer of the pancreas each cause about 7% of the                                                 adolescents.
cancer deaths.

About 85% of the lung cancer deaths can be
                                                                                                  Individual Primary Prevention/
attributed to tobacco smoking. Tobacco use also                                                   Deterring Activities:
contributes to deaths caused by mouth, throat,                                                    Tobacco use clearly is the leading preventable
esophagus, bladder, and pancreas cancers.                                                         cause of cancer in Kings County. Even long term,
Overall, about 30% of the cancer deaths are related                                               heavy smokers will decrease their risk of cancer If
to tobacco use. Another 30% of cancer related                                                     they stop smoking.
deaths are likely due to obesity and a high fat diet.
                                                                                                  Avoidance of obesity and a high fat diet likely will
There are many factors that have been identified as                                               also reduce the risk of cancer.
causing cancer:
   • Chemicals               • Genes                                                              About 70% of cervical cancer can now be
   • Viruses                 • Radiation                                                          prevented with a vaccine. Preteen girls should be
The underlying cause of most cancer deaths is                                                     vaccinated against the human papilloma virus.
usually unknown.
                                                                                                  Cancer survival is frequently related to early
Why is it important to the health                                                                 detection.       Routine cancer screening is
                                                                                                  recommended for breast, cervical, prostate, skin
status of Kings County?                                                                           and colon cancer. The screening schedules are
Cancer remains the 2nd leading cause of death in                                                  based on risk due to age, gender, personal/family
Kings County.                                                                                     history, and other factors.     Individuals should
                                                                                                  consult with their health care providers or check
Key Findings:                                                                                     with the American Cancer Society to determine
            Cancer Deaths Attributed to Smoking in California, 1999
                                                                                                  what screenings are recommended. Likely, some
   100%                                                                                           of the decrease in cancer deaths observed is due
      80%                                                                                         to earlier diagnoses and treatment.
      40%                                                                                         Contact for related programs:
      20%                                                                                         • California Department of Public Health –
      0%                                                                                              Cancer Detection Section:







             lip, oral



                                                                                                      Cancer Prevention and Nutrition Section:
                 Deaths Attributed to Smoking              Deaths Unrelated to Smoking  
                                                                                                  • CDC:
How are we doing in Kings County?                                                         
Cancer deaths in California are decreasing.                                                       • American Cancer Society:
For the period from 1988 to 2006, all cancer deaths
in women have fallen 17%. In men, they have
fallen 23%.

What is it?                                            Be aware of the warning signs:
Suicide occurs when a person ends their life. It is       • Someone threatening to hurt or kill
the 11th leading cause of death among Americans.             themselves, or talking of wanting to hurt or
More people survive suicide attempts than actually           kill themselves
die.                                                      • Someone looking for means to kill
                                                             themselves by seeking access to firearms,
Why is it important to the health                            available pills, or other means
status of Kings County?                                   • Someone talking or writing about death,
Suicide affects the health of the community, as              dying, or suicide, when these actions are
family and friends of people who commit suicide              out of the ordinary for this person
may feel shock, anger, guilt, and depression. The         • Hopelessness
medical costs and lost wages associated with              • Rage, uncontrolled anger, seeking revenge
suicide also take their toll on the community.            • Acting reckless or engaging in risky
                                                             activities, seemingly without thinking
How are we doing in Kings County?                         • Feeling trapped – like there’s no way out
In 2006, Kings County saw 7 suicides between the          • Increased alcohol or drug use
ages 15 – 84 years of age. In 5 of those 7 deaths,        • Withdrawing from friends, family, or society
147.5 Potential Years of Life were Lost.                  • Anxiety, agitation, unable to sleep or
                                                             sleeping all the time
 Age      #       Average    75 minus     PYLL            • Dramatic mood changes
                             average                      • No reason for living, no sense of purpose in
 15-24    1      19.5        75-19.5      55.5               life
 25-34    1      29.5        75-2935      45.5
 45-54    1      49.5        75-49.5      25.5         Contact for related programs:
 55-64    1      59.5        75-59.5      15.5         Kings County Behavioral Health
 65-74    1      69.5        75-69.5      5.5                 (559) 582-3211 x 2376
 75-84    2      *           *            *            National Suicide Hotline: 1-800-273-TALK
                             TOTAL        147.5
* We do not calculate those over age 75 as the life-   Websites:
expectancy for Kings County is age 80.                 • Kings County Behavioral Health
Individual Primary Prevention/                         • CDC:
Deterring Activities:                          
According to the Centers for Disease Control and       • National Suicide Hotline:
Prevention, men are 4 times more likely than   
women to die from suicide, however, WHO reports        • National Institute for Mental Health:
that 3 times more women than men report        
attempting suicide. Suicide rates are high among       • Substance Abuse & Mental Health Services:
young people and those over age 65.            
                                                       • Suicide Prevention Resource Center:
Be aware of risk factors for suicide which include:
   • Previous suicide attempt(s)
   • History of depression or other mental illness
   • Alcohol or drug abuse
   • Family history of suicide or violence
   • Physical illness
   • Feeling alone

American Heritage Medical Dictionary defines morbidity as:
         the incidence or prevalence of a disease.
This includes those diseases that may affect quality of life or one’s
ability to perform daily activities.

This chapter examines the Health Status of morbidities in Kings
County. Topics covered include Asthma, Arthritis, and Diabetes.

Chapter Highlights:

       Osteoarthritis is more common in people who do manual
       Having diabetes doubles your risk for death due to heart
       disease or stroke.
       Uncontrolled blood pressure also causes Alzheimer-like
       mental decline.

                            In this chapter:

                            Alzheimer’s.………………………              31
                            Arthritis……...…………………….            32
                            Asthma……………………………                  33
                            Cardiovascular Disease………...       34
                            Diabetes…………….…………….               35
                            Hypertension……………………..             36
                            Metabolic Syndrome…………….           37
                            Stroke.…………………………….                38

What is it?                                            10 Warning Signs of Alzheimer’s
Memory loss that disrupts everyday life is not a       1. Memory Loss. Forgetting recently        What's normal?
normal part of aging. It is a symptom of dementia,     learned information is one of the most    Forgetting names or
a gradual and progressive decline in memory,           common early signs of dementia.              appointments
thinking, and reasoning skills. The most common                                                     occasionally.
cause of dementia is Alzheimer’s disease, a            2. Difficulty performing familiar tasks. What’s Normal?
disorder that results in the loss of brain cells.      People with dementia often find it hard     Occasionally
                                                       to plan or complete everyday tasks.      forgetting why you
Why is it important to the health                      Individuals may lose track of the steps came into a room or
                                                       involved in preparing a meal.           what you planned to
status of Kings County?                                                                                 say.
Knowledge of this disease is important to the health   3. Problems with language. People          What's normal?
of Kings County residents because early and            with Alzheimer’s disease often forget     Sometimes having
accurate diagnosis of Alzheimer’s disease or other     simple words or substitute unusual        trouble finding the
dementias is an important step to getting the right    words, making their speech or writing         right word.
treatment, care, and support.                          hard to understand.
                                                       4. Disorientation to time and place.       What's normal?
How are we doing in Kings County?                      People with Alzheimer’s can become         Forgetting the day
                                                       lost in their own neighbor-hood, forget      of the week or
Kings County has many services for individuals and
                                                       where they are, and not know how to         where you were
families with dementia. There are adult day care       get back home.                                    going.
centers and support groups that can refer a family
                                                       5. Poor or decreased judgment.            What's normal?
to many needed services available in the Central
                                                       Those with Alzheimer’s may dress              Making a
Valley.                                                inappropriately. They may show poor        questionable or
                                                       judgment, like giving away large sums of debatable decision
Individual Primary Prevention/                         money to telemarketers.                   from time to time.
Deterring Activities:                                  6. Problems with abstract thinking.        What's normal?
Make brain-healthy life choices:                       Someone with Alzheimer’s disease may          Finding it
                                                       have unusual difficulty performing          challenging to
    • Stay mentally active                             complex mental tasks, like forgetting         balance a
    • Remain socially active                           what numbers are for and how they            checkbook.
    • Stay physically active                           should be used.
    • Adapt a brain-healthy diet to include:           7. Misplacing things. A person with         What's normal?
             o Low fat                                 Alzheimer’s disease may put things in      Misplacing keys or
             o Low cholesterol                         unusual places: an iron in the freezer or a wallet temporarily.
             o Dark vegetables & Fruits                a wristwatch in the sugar bowl.
A diet rich in dark vegetables and fruits containing   8. Changes in mood or behavior.          What's normal?
antioxidants may protect brain cells.                  Someone with Alzheimer’s disease may Occasionally feeling
                                                       show rapid mood swings – from calm to     sad or moody.
For More Information:                                  tears to anger – for no apparent reason.
 • Alzheimer’s Association: 1-800-272-3900             9. Changes in personality. The              What's normal?
                                                       personalities of people with dementia          People’s
 • Valley Caregiver Resource Center:
                                                       can change dramatically. They may           personalities do
          o (559) 224-9194                             become extremely confused,                 change somewhat
 • Alzheimer’s & Memory Center: (559) 227-4810         suspicious, fearful or dependent on a          with age.
 • Kings County Commission on Aging:                   family member.
          o (559) 582-3211 x 2828                      10. Loss of initiative. A person with       What's normal?
Websites:                                              Alzheimer’s disease may become very        Sometimes feeling
• Alzheimer’s Association:                 passive, sitting in front of the TV for     weary of work or
                                                       hours, sleeping more than usual or not     social obligations.
                                                       wanting to do usual activities.

What is it?                                                  Osteoarthritis probably can’t be prevented, but the
Arthritis is a painful condition affecting the joints        disability associated with it can be prevented.
and connective tissues. While it is not a major                  • Avoidance of injury and overuse will help to
cause of death, arthritis is the leading cause of                     prevent disabling osteoarthritis.
disability in the United States. About 10% of
                                                                 • Proper use of occupational and sports
arthritis is caused by an inflammatory process in
                                                                      equipment will lessen the risk of injury.
the joint. Examples of this form of arthritis are
                                                                 • Athletes can lessen their risk of injury
rheumatoid arthritis and gout. The most common
                                                                      through proper training.
form of arthritis is due to wear and tear on the
                                                                 • Laborers can lessen their risk by modifying
joints. This kind of arthritis is called osteoarthritis or
                                                                      their work to avoid unnecessary stress on
degenerative arthritis.
                                                                      their joints.
                                                                 • The maintenance of good body weight will
Why is it important to the health                                     prevent mobility disability due to arthritis.
status of Kings County?
The older you get, the more likely you are to have
arthritis. Over half the people age 65 and over                   Annual Arthritis Burden in
have arthritis. Osteoarthritis is more likely to occur               the United States
in a joint that has been injured or overused.
                                                                    •   46 million adults with self-
Osteoarthritis is more common in people who do
manual labor.                                                           reported, doctor-diagnosed
Increased body weight is a major risk factor for                    •   Nearly 19 million people with
osteoarthritis affecting mobility. For every pound of
                                                                        activity limitations
weight gain, there is an added 3 pounds of weight
on the knees, and 6 pounds of weight on the hip                     •   $128 billion in total costs
joints.                                                             •   $81 billion in medical costs
                                                                    •   36 million outpatient visits
How are we doing in Kings County?                                   •   750,000 hospitalizations
We estimate that about a quarter of all adults in
                                                                    •   9,500 deaths
Kings County have doctor-diagnosed arthritis
                                                             Source: National Center for Chronic Disease Prevention
(based on state estimates from the CDC). We                  and Health Promotion
estimate that about half of these had symptoms
lasting more than one month during the past year.
                                                             Websites For More Information:
Arthritis diagnoses and symptoms are about 25%               • California Department of Public Health –
more common in Kings County than in the State as               California Arthritis Partnership Program:
a whole. Inflammatory arthritis likely isn’t more  
common in Kings County.            The increase in           spx
osteoarthritis in Kings County is probably due to the        • CDC:
increased rate of obesity and somewhat less due to 
the number of people engaged in manual labor.                m

Individual Primary Prevention/
Deterring Activities
Inflammatory arthritis usually can’t be prevented,
but can be treated. The treatment of inflammatory
arthritis is in general, more medically complex than
the treatment of osteoarthritis.
What is it?                                             • Good nutrition and control of chronic diseases
Asthma is a disease that affects your lungs. It           also will help tremendously in managing asthma
causes    repeated    episodes    of   wheezing,          or allergies.
breathlessness, chest tightness, and nighttime or       • Don’t ignore asthma or allergy symptoms.
early morning coughing. Asthma can be controlled          Consult with a health care provider as soon as
by taking medicine and avoiding the triggers that         they appear.
cause an attack.                                        • Use asthma medications as prescribed to
                                                          prevent a flare-up and cause an emergency
                                                          room visit.
Why is it important to the health
                                                        • Check the air quality daily, even if you don’t
status of Kings County?                                   have asthma or allergies. Long periods of
Asthma prevalence has been increasing in recent           exposure outside when the air quality is
years.                                                    moderate to unhealthy can be harmful to
Air quality has a great impact to asthma and allergy      anyone. Air Quality Flags are posted at the
sufferers due to pollution and geographic location        Kings County Department of Public Health in
                                                          Hanford and at several schools throughout the
How are we doing in Kings County?                         county.
According to 2005 data from the California Health       • Pay attention to the pollen count for the day in
Interview Survey, the prevalence rate of asthma in        the local newspaper, especially during weather
Kings County among children 17 and under is               changes or the first sign of blooming plants in
24.7% - the second highest in the state.                  the spring.
                                                        • Watch for the origin of asthma triggers in the
Since September 2007, the Kings County                    home.
Department of Public Health has adopted the Air         • For school age children, provide the teacher
Quality Flag Program, to raise awareness and              and school nurse with the provider’s signed
inform the community about the daily air quality.         action plan so that the specific treatment
Staff raises the flag according to the daily              regimen will be followed there as well.
information from the San Joaquin Valley Air
Pollution District.                                    For More information:
                                                            Contact for related programs:
Individual Primary Prevention/                         Kings County Asthma Coalition: (559) 584-1411
Deterring Activities                                   Adventist Health (559) 583-2254 Bill Legere
 • Early recognition of triggers                              Websites:
 • Observe the Kings County Department of              • Kings County Asthma Coalition:
   Public Health Flag Program                
 • Observe the Kings County Schools Flag               • American Lung Association:
   Program                                             • American Lung Association of California:
 • Meet with your health care provider at least
   once a year to assess the severity of your          • National Heart Lung and Blood Institute:
   asthma and allergy symptoms. The ability to
   follow the provider’s treatment regimen and         • California Breathing:
   recommendations will be elemental to achieve          Kings Co Profile:
   and maintain asthma and allergy control.  
 • Education and environmental control are as          • CDC – Agency for Toxic Substances & Disease
   important as the treatment. The ability to            Registry:
   recognize indoor and outdoor triggers and           • American Academy of Pediatrics:
   learning as much as possible about the      
   condition, will be a gateway to long-term
                                                       • Environmental Protection Agency:
What is it?                                             Key Findings:
Heart Disease or Cardiac Disease is the number              HEART ATTACK WARNING SIGNS
one cause of death in the United States. Coronary       Chest discomfort           Most heart attacks
artery disease is the form that causes heart attacks.                              involve discomfort in the
Over many years, the coronary arteries become                                      center of the chest that
narrowed due to a build up of fatty material in the                                lasts more than a few
blood vessels feeding the heart muscle. Clots form                                 minutes, or that goes
in the narrowed area, closing off the vessel. Heart                                away and comes back.
muscle fed by the vessels then dies. Some people                                   It can feel like
die soon after their heart attack. Others can                                      uncomfortable pressure,
survive for years with or without disability due to                                squeezing, fullness, or
exercise pain or diminished exercise capacity.                                     pain.
About one in five deaths in the United States is due
                                                        Discomfort in other        Symptoms can include
to coronary artery disease.
                                                        areas of the upper         pain or discomfort in one
                                                        body                       or both arms, the back,
Heart failure is the term used when the heart no
                                                                                   neck, jaw, or stomach.
longer functions as an efficient pump to supply the
                                                        Shortness of breath        With or without chest
body’s needs. Heart failure is becoming more
common in the United States. It’s estimated that
there are half a million new cases a year. Heart        Other signs                May include: breaking
failure is noted on 12% of all death certificates.                                 out in a cold sweat,
Coronary artery disease and high blood pressure                                    nausea, or
are each major causes of heart failure. It’s likely                                lightheadedness
also, that marked obesity causes heart failure.
                                                        Individual Primary Prevention/
Why is it important to the health                       Deterring Activities
status of Kings County?                                 Most heart disease is a consequence of lifestyle
African Americans are disproportionately affected       choices. The most effective means of limiting the
by heart disease. Their risk of dying of any disease    risk for heart disease is to maintain a healthy
of the heart and blood vessels is increased about       lifestyle throughout your life. The risk of having
40%.                                                    symptoms of heart disease when young is low, but
                                                        the earlier the adoption of a healthy lifestyle, the
The risk factors for coronary heart disease are:        better. Middle age individuals should know their
   • High Blood Pressure                                risk factors for heart disease. Those risk factors
   • High Cholesterol                                   identified should be corrected with improved diet,
   • Smoking                                            exercise, and medications, when diet and exercise
                                                        fail to correct the problem.
   • Diabetes
   • Physical Inactivity
                                                        Early treatment in the course of a heart attack can
   • Family History
                                                        decrease the amount of damage done to the heart.
                                                        Know the symptoms of heart disease, and seek
How are we doing in Kings County?                       immediate medical attention should you experience
Around 140 Kings County residents die every year        the symptoms.
from coronary artery disease. Our death rate due
to coronary artery disease is slightly worse than the   Websites For More Information:
state average, and is slightly short of attaining the
                                                        • American Heart Association:
Year 2010 Objective.
                                                        • CDC:

What is it?                                              How are we doing in Kings County?
Diabetes is a group of diseases marked by high           Obesity is twice as common in Kings County as in
levels of blood glucose, also called blood sugar,        the Bay Area. Type 2 diabetes is likely more
resulting from defects in insulin production, insulin    common in Kings County compared with the state
action, or both. Diabetes can lead to serious            average. Diabetes related deaths in the six south
complications and premature death, but people with       valley counties are one and a half times that of the
diabetes can take steps to control the disease and       state average.
lower the risk of complications.                                         Deaths Due to Diabetes 2003-2005

Why is it important to the health                                60

status of Kings County?
                                                                 50                                         Fresno

Diabetes is a common condition that’s responsible                                                           Kings
                                                                 30                                         Merced
for significant death and disability in Kings County.                                                       Tulare
Likely, there are more than 11,000 people in Kings                                                          California
County with diabetes. Having diabetes doubles
your risk for death due to heart disease or stroke.                   2003         2004          2005
Diabetes is the leading cause of blindness in
adults. 40% of all kidney failure is due to diabetes.
Half of all amputations are the result of diabetes-      Individual Primary Prevention/
related diseases.
                                                         Deterring Activities:
Type 1 diabetes accounts for around 5% of all            Individuals can control their risk for type 2 diabetes
cases.    Type 1 diabetes generally occurs in            and its complications. Regardless of other risks for
children, doesn’t run in families, is unrelated to       diabetes, individuals can prevent or delay by
gender, and is unrelated to lifestyle. We don’t yet      decades, the onset of diabetes by adopting a
know how to prevent type 1 diabetes.                     healthy lifestyle consisting of a healthy diet and
                                                         regular exercise. Most people don’t understand the
By far, the most common form is type 2 diabetes          power of this recommendation. The more risk there
(85%-90%). The risk for diabetes increases with          is for diabetes, the more benefit derives from
age, with the risk rising rapidly after age 45. On the   adopting a healthy lifestyle. In families with a
other hand, type 2 diabetes in children has              history of type 2 diabetes, parents should model
increased dramatically over the last 2 decades.          and teach their children a healthy lifestyle that
Type 2 diabetes is more likely in persons with a         maintains a healthy weight.
family history of type 2 diabetes.           Hispanic-
Americans and African-Americans have at least a          Websites for More Information:
two-fold increased risk for type 2 diabetes.             • California Department of Public Health –
Females are somewhat more at risk than males.             California Diabetes Program:
Women who had diabetes with a pregnancy are at 
increased risk for type 2 diabetes.            
                                                         • California Diabetes and Pregnancy Program:
The most important risk factor for type 2 diabetes is
obesity. Being 15% overweight results in a five-fold     • CDC:
increase for the risk for type 2 diabetes. Type 2        • Central California Regional Obesity Prevention
diabetes is becoming more common in both adults            Program (CCROPP):
and children. The rise in diabetes cases has     
paralleled the rise in obesity.                            CROPP/index.shtml
                                                         • American Diabetes Association:

What is it?                                            Individual Primary Prevention/
Hypertension is high blood pressure. High blood        Deterring Activities
pressure has been called the silent killer. People     The recommended frequency of blood pressure
with high blood pressure have no symptoms. They        checks is dependent on age, race, family history,
don’t feel any better once their blood pressure is     and previous readings. Adults with blood pressures
controlled.                                            greater than 120/80 should have their blood
                                                       pressure checked at least annually.          Blood
Why is it important to the health                      pressure increases with:
status of Kings County?                                   • Weight gain
High blood pressure is a major cause of early heart       • Physical inactivity
disease, stroke, and kidney disease. Uncontrolled         • High salt intake
blood pressure also causes Alzheimer-like mental
decline. While the blood pressure is silent, the       Many people are at risk for developing high blood
diseases it causes are not. Sometimes, people are      pressure because of high sodium intake. Sodium
first diagnosed with high blood pressure after         shows up in many places in our diet. 40% of table
they’ve had a heart attack or a stroke.                salt is sodium. The National Institute of Health
                                                       recommends we limit our intake of sodium to less
There are some other diseases that cause high          than 2400 mg per day. (One teaspoon of salt
blood pressure. Most of the time, no direct cause is   contains 2000 mg of sodium)           The average
found.                                                 American diet is very high in sodium. Much of the
                                                       excess salt is found in processed foods. Until
African-Americans are more likely to have high         processed food producers lower the content of salt
blood pressure. African-Americans with high blood      in their products, we should limit our consumption
pressure tend to have strokes earlier, and their       of processed foods. We need to begin checking
strokes are more disabling.                            labels for sodium content and decreasing our use
                                                       of added salt.
How are we doing in Kings County?
                                                       If you are diagnosed with high blood pressure,
We have no data on blood pressure in Kings
                                                       make certain you stay on your medications and
County. High blood pressure is very common.
                                                       have regular follow-ups.       The goal of blood
                                                       pressure treatment is to prevent the diseases
Blood pressure tends to go up with age.
                                                       associated with high blood pressure. There is
                            % of population with
                                                       ample evidence that control of high blood pressure
          Age               high blood pressure
                                                       is effective in preventing the early onset of blood
     Under age 40                    7%                pressure related medical conditions.
      Age 40 – 60                   30%
      Over age 60                   65%
                                                       For More information:
In the United States, we have made very little              Websites:
progress in addressing high blood pressure. Only       • California Department of Public Health –
about a third of those with high blood pressure
have their blood pressure under control.               oodPressure.aspx
                                                       • CDC:
                                                       • National Heart, Lung, and Blood Institute:
                                                       • National High Blood Pressure Education Program:
                                                       • American Heart Association:
                                                            It is known that insulin resistance is usually present
What is it?                                                 for years before the onset of frank diabetes. Not all
Metabolic Syndrome is a term used to describe a             people with insulin resistance develop diabetes, but
clustering of abnormalities that in turn increase the       all persons with type 2 diabetes likely had high
risk for both diabetes and heart disease. In                insulin levels and insulin resistance before they
metabolic syndrome, both the blood pressure and             developed frank diabetes. (Insulin resistance can
blood sugar are on the high side. Blood cholesterol         be measured in scientific laboratories, but it’s a test
and triglycerides are usually also elevated. The            that is available in the clinical setting.)
body develops a low level of chronic inflammation.
The term syndrome recognizes that these
abnormalities tend to be grouped in the same
                                                            How are we doing in Kings County?
person. When the metabolic syndrome is present,             It’s well recognized that risk factors for type 2
the risk for type 2 diabetes is increased five times.       diabetes and heart disease are often clustered in
The risk for heart disease is increased two times.          the same person. The metabolic syndrome hasn’t
                                                            been universally recognized as a distinct disease.
                                                            There is no data on the occurrence of this
Why is it important to the health                           syndrome in Kings County.         Obesity is more
status of Kings County?                                     common in Kings County than in the State.
Metabolic syndrome probably reflects the                    Because obesity, especially abdominal obesity, is
resistance of the body to insulin.           Body fat,      thought to cause metabolic syndrome, it’s likely that
especially that fat accumulated in the abdomen,             this condition is common in Kings County, and may
increases the body’s resistance to its own insulin.         be present in 20% of the adult population.
Persons with metabolic syndrome usually have
very high insulin levels. It’s thought that these high      Individual Primary Prevention/
insulin levels play a part in creating the cluster of
findings in metabolic syndrome.
                                                            Deterring Activities:

 Targets and Goals                          Recommendations
 Abdominal Obesity                        Consistently encourage weight maintenance/reduction through
 Goal: Reduce body weight by 7%-10%       appropriate balance of physical activity, caloric intake, and formal
 during first year. Continue weight loss  behavioral programs when indicated to maintain/achieve waist
 thereafter to extent possible with goal  circumference of <40 inches in men and <35 inches in women.
 to ultimately achieve desirable weight   Aim initially at slow reduction of ~ 7%-10% from baseline weight.
 (BMI <25kg/m2)                           Even small amounts of weight loss are associated with significant
                                          health benefits
Physical Inactivity                       In patients with established CVD, assess risk with detailed
Goal: regular moderate-intensity          physical activity history and/or exercise test, to guide prescription.
physical activity; at least 30 minutes of Encourage 30-60 minutes moderate-intensity aerobic activity (brisk
continuous/intermittent (preferably 60    walking) preferably daily, supplemented by increase in daily
minutes) 5 days/week, but preferably      lifestyle activities (pedometer step tracking, walking breaks at
daily                                     work, gardening, and household work). Higher exercise times
                                          achieved by accumulating exercise throughout day. Encourage
                                          resistance training 2 days/week. High-Risk patients should be
                                          medically supervised (recent acute coronary syndrome or
                                          revascularization, CHF).
High Fat/High Sugar Diet                  Recommendations: saturated fat <7% of total calories; reduce
Goal: Reduce intakes of saturated fat,    trans fat; dietary cholesterol <200 mg/day; total fat 25%-35% of
trans fat, and cholesterol                total calories. Most dietary fat should be unsaturated, simple
                                          sugars should be limited.
Websites: AHA:                         NHLBI:

What is it?                                              Key Findings
A stroke occurs when brain cells are destroyed due       If you think someone may be having a stroke, act
to a blood vessel problem. The loss of brain cells is    F.A.S.T. and do this simple test:
permanent; they don’t grow back. The stroke
occurs because the blood vessels are blocked or

                                                                      ACT F.A.S.T.
burst. The results of the stroke are dependent on
the amount of brain damage. If the damage is quite
extensive, the stroke is fatal.
                                                                     ASK THE PERSON TO SMILE.
Why is it important to the health                                    DOES ONE SIDE OF THE FACE DROOP?
status of Kings County?                                              ASK THE PERSON TO RAISE BOTH ARMS.
Stroke is the third leading cause of death in the        ARMS        DOES ONE ARM DRIFT DOWNWARD?
United States. Lesser degrees of damage can
result in permanent disabilities including the                       ASK THE PERSON TO REPEAT A SIMPLE
inability to use an arm, walk, speak, or understand                  SENTENCE.
language. Two out of three non-fatal strokes result      SPEECH      ARE THE WORDS SLURRED? CAN HE/SHE
in permanent disability, with many of the survivors                  REPEAT THE SENTENCE CORRECTLY?
being unable to care for themselves.
                                                                     IF THE PERSON SHOWS ANY OF THESE
                                                                     SYMPTOMS, TIME IS IMPORTANT.
African-Americans have twice the risk of having a
stroke. They have strokes earlier in life and have                   CALL 911 OR GET TO THE HOSPITAL FAST.
more severe strokes with both more deaths and                        BRAIN CELLS ARE DYING.
more disability following the stroke.

Untreated high blood pressure is a major risk factor     Individual Primary Prevention/
for stroke. Other powerful risk factors are:
                                                         Deterring Activities
    • Smoking
                                                         The early control of stroke risk factors is the best
    • High cholesterol
                                                         way to prevent stroke.      High blood pressure,
    • Diabetes                                           smoking, high cholesterol, diabetes, and certain
    • Some kinds of heart disease                        heart disease are the treatable risk factors for
                                                         stroke. Know your risk factors for stroke, and work
The outcome of a stroke in progress can be               with your medical care provider to minimize your
improved with early medical treatment.     Early         risk for stroke.
medical treatment will limit the amount of brain
damage suffered.                                         Prevention of stroke is the best way to avoid the
                                                         burden of stroke. If you begin having a stroke,
How are we doing in Kings County?                        getting early medical treatment is essential. Know
Around fifty (50) Kings County residents die every       the signs of early stroke, and call 911.
year due to a stroke. The death rate in Kings
County is slightly worse than the state average and      For More information:
is slightly short of the Year 2010 Objective. We
don’t know how many people in Kings County have               Websites:
disability due to stroke. In the United States, stroke   • National Stroke Association:
is the leading cause of major disability.                • California Department of Public Health:
                                                         • American Stroke Association:
                                                         • CDC:

Risk factors come from a variety of sources including genetics,
personal lifestyle choices, and the environment around you.

Information is this chapter is designed to provide education and
resources to more information about these issues.

Chapter Highlights:

      Current estimates of obesity show that in California, 22.6%
      of the adult population is obese.
      Children & Adolescents should engage in at least 60 minutes
      of physical activity on most, preferably all, days of the week.
      The National Highway Traffic Safety Administration (NHTSA)
      estimates that child restraints are 71% effective in reducing
      fatality among infants.

                           In this chapter:

                           Access to Health Care...………… 41
                           Alcohol Use………………………. 42
                           Diet & Nutrition…………………… 43
                           Drug Use..................................... 44
                           Obesity…………………………… 45
                           Physical Activity…………………. 46
                           Retail Food Sales……………….. 47
                           Seat Belts & Child Safety Seats.. 48
                           Tobacco Use…………………….. 49

What is it?                                                    Medi-Cal Beneficiaries in the Central Valley,
Access to Health Care is the ability to obtain a               2004-2008:
Health Care Service when you need it.
                                                                                                         % of population that are Medi-Cal
                                                                                                             Beneficiaries, 2004-2008
Why is it important to the health                                                                    Kings          California           Fresno           Kern          Tulare

status of Kings County?                                             40.0%
The rising cost of living, gas, lack of jobs, and other             35.0%
personal problems facing our community are
challenges we are frequently concerned about.                       30.0%
Because of the very nature of some of our                           25.0%
communities and the jobs available, the winter cold
and summer drought affects the outcomes of our                      20.0%
communities’ ability to be able to access available                 15.0%
health care. Income for many is very uncertain and                                                      2004           2005              2006          2007         2008
just providing for the essentials of everyday life may
become overwhelming. Going to a health care                    Kings County has a lower percentage of the
provider in a non-emergency situation or for follow-           population as Medi-Cal beneficiaries than other
up treatment will become secondary or non-                     Valley Counties.
                                                                                               Medi-Cal Beneficiaries by Age & Gender, Kings
Distance to and from providers, cost of gas along                                                           County, April 2008
with transportation that can be unreliable, will                                           6,000
                                                                 Number of Beneficiaries

become larger barriers as time goes on and                                                                                                                          Female
economic hardships increase.                                                                                                                                        Male

How are we doing in Kings County?                                                          3,000
          2005 Health Insurance Coverage Status




















                                           Percent Insured



50                                         Percent Uninsured
                                                               As children, more males are enrolled in Medi-Cal,
                                                               but adults are predominately female.
10                                                             Barriers to access include:
 0                                                                                         •    Income
     Fresno Co   Kern Co   Kings Co   Tulare Co   California                               •    Insurance – cost or lack of
                                                                                           •    Distrust
From the US Census Bureau, Small Area Health                                               •    Language Issues
Insurance Estimates, 2005                                                                  •    Transportation

In 2005, 19.6% of Kings County residents were                  For More information:
                                                               • California Department of Health Care Services –

What is it?
Excessive alcohol use is the 3rd leading lifestyle-
related cause of death for the nation.

Alcohol is found in beer, wine coolers, malt liquor,                6         12

wine, and distilled spirits or liquor. The Dietary                  4
Guidelines for Americans recommends that if you                     2
drink alcoholic beverages, do so in moderation                      0
which is no more than 1 drink per day for women                            beer     wine        hard liquor
and 2 drinks per day for men.                           1 serving of alcohol equals:
                                                             1 ounce = 8 ounces                = 12 ounces
Binge Drinking:                                            Hard Liquor        Wine                 Beer
   Women, 4 or more drinks during a single
   occasion                                             All 3 contain about the same amount of pure
   Men, 5 or more drinks during a single occasion       alcohol and all have the same effect on your body
Heavy Drinking:                                         and mind.
   Women, more than 1 drink per day on average          There are no statistics available for Alcohol Use in
   Men, more than 2 drinks per day on average           Kings County.
Excessive drinking includes heavy drinking, binge
drinking, or both
                                                        Individual Primary Prevention/
                                                        Deterring Activities:
Health risks from binge drinking include:               Follow the Dietary Guidelines for Americans.
   • Unintentional injuries-traffic injuries, falls,
     drowning, burns, and firearm injuries              Don’t drink:
   • Violence                                              • When you are pregnant or trying to become
   • Risky sexual behaviors                                    pregnant
   • If pregnant: miscarriage, stillbirth, and a           • When you are taking prescription drugs or
     combination of physical and mental birth                  over the counter medications that may
     defects                                                   cause harmful reactions when mixed with
   • Alcohol poisoning                                         alcohol
                                                           • If you are under the age of 21
Health risks from long-term excessive alcohol use:         • If you are recovering from alcoholism or
   • Neurological problems including dementia,                 unable to control the amount you drink
     stroke, and neuropathy                                • If you are suffering from a medical condition
   • Cardiovascular problems including myocardial              that may be worsened by alcohol
     infarction, cardiomyopathy, atrial fibrillation,      • When driving, planning to drive, or
     and hypertension                                          participating in other activities requiring skill,
   • Psychiatric problems including depression,                coordination, and alertness
     suicidality, and anxiety
   • Social problems including unemployment, lost       For More information:
     productivity, and family problems                       Contact for related programs:
   • Cancer of the mouth, throat, esophagus, liver,     National Drug & Alcohol Treatment Referral
     prostate, and breast (in women).                   Routing Service available at: 1-800-662-HELP for
   • Liver diseases including: hepatitis, cirrhosis,    information about treatment programs in your area.
     and can worsen Hepatitis C virus
   • Other gastrointestinal problems including
     pancreatitis and gastritis                         CDC:
What is a “Healthy Diet”?                               • Get the most nutrition out of your calories.
                                                          - Choose the most nutritionally rich foods you
The Dietary Guidelines describe a healthy diet as
                                                            can from each food group each day—those
one that:
                                                            packed with vitamins, minerals, fiber, and other
 • Emphasizes fruits, vegetables, whole grains,             nutrients but lower in calories. Pick fruits,
     and fat-free or low-fat milk and milk products
                                                            vegetables, whole grains, and fat-free or low-fat
 • Includes lean meats, poultry, fish, beans,               milk products more often.
     eggs, and nuts
                                                        • NUTRITION: To know the facts, use the label.
 • Is low in saturated fats, trans fats, cholesterol,     - Most packaged foods have a Nutrition Facts
     salt (sodium), and added sugars                        label. For a healthier you, use this tool to make
                                                            smart food choices quickly and easily.
Eating a healthy diet is linked to maintaining a
                                                        • Play it safe with food.
healthy body weight to minimize risk of several
                                                          - Know how to prepare, handle, and store food
chronic diseases and conditions. With many meals            safely to keep you and your family safe.
being eaten away from home, the American diet
consists of far too many calories, excess saturated     • About alcohol.
and trans fats, cholesterol, sodium, and sugar.           - If you choose to drink alcohol, do so in
Many factors influence what one chooses to eat,             moderation. More information on the Alcohol
including: culture, preference, taste, availability,        page.
and convenience.       We also know that most
Americans do not eat nearly enough fruits and           Follow My guidelines:
vegetables.                                              • Learn what to eat from each food group.
                                                         • Focus on how much you eat. Watch your
                                                            portion sizes!
Individual Primary Prevention/
                                                         • Choose “nutrient-dense” forms of foods. These
Deterring Activities                                        foods are packed with nutrients, but low in
Refer to and follow the Dietary Guidelines for              “extras” that just add calories.
Americans.                                               • Get moving! Physical activity can help you
• Feel better today. Stay healthy for tomorrow.             reach and keep a healthier weight.
  - Eating right and being physically active aren't      • Follow your progress by tracking your food
    just a "diet" or a "program"—they are keys to a         intake and physical activity. Check your weight
    healthy lifestyle. With healthful habits, you may       weekly.
    reduce your risk of many chronic diseases and
    increase your chances for a longer life.
• Make smart choices from every food group.
  - The best way to give your body the balanced
    nutrition it needs is by eating a variety of
    nutrient-packed foods every day. Just be sure
    to stay within your daily calorie needs.
• Mix up your choices within each food group.
  - Focus on Fruits, Vary your Veggies, Get your
    Calcium-rich foods, Make half your grains           Websites for More information:
    whole, Go lean with Protein, Know the limits on     Department of Health & Human Services & USDA -
    fats, salt, and sugars                    
• Find your balance between food and physical           nt/html/brochure.htm
  activity.                                             USDA – My
  - If you eat 100 more food calories a day than
    you burn, you'll gain about 1 pound in a month.     CDC -
    To lose weight, it's important to reduce calories   NIH – National Heart, Lung, and Blood Institute –
    and increase physical activity.           
                                                        FDA -
                                                                        Potential Years Life Lost due to Drug Induced
What is it?                                                                          Deaths in 2002-2004
Drug Addiction is a chronic, often relapsing brain                           150
disease that causes compulsive drug-seeking and                              135
use despite harmful consequences to the individual

who is addicted and to those around them.                                     90
Drug Addiction is a brain disease because the                                 45
abuse of drugs leads to changes in the structure                              30
and function of the brain.                                                     0
                                                                              Age 15-24   25-34   35-44   45-54   55-64
Why is it important to the health                           Average # Deaths       1.67    1      1.33     4       2
status of Kings County?                                     Potential Years Life   92.7   45.5    47.2    102      31
Drug abuse and addiction are a major burden to              Lost
society. Estimates of the total overall costs of            Average Age at         19.5   29.5    39.5    49.5    59.5
substance abuse in the United States – Including            Death
health- and crime-related costs as well as losses in
productivity – exceed half a trillion dollars annually.
                                                          Individual Primary Prevention/
This does not fully describe the breadth of
                                                          Deterring Activities:
deleterious public health – and safety –
                                                          Similar to other chronic, relapsing diseases, such
implications, which include family disintegration,
                                                          as diabetes, asthma, or heart disease, drug
loss of employment, failure in school, domestic
                                                          addiction can be managed successfully.
violence, child abuse, and other crimes.
                                                          Prevention is the key:
It is important to note that drug abuse does not only
occur with illegal drugs, but prescription drugs may         • Prevention programs that involve families,
also be abused.                                                 schools, communities, and the media are
                                                                effective in reducing drug abuse.
How are we doing in Kings County?                            •    When youths perceive drug abuse as
In the time period for 2002-2004, there was an                    harmful, they reduce their drug taking.
average of 11 drug-induced deaths per year.
Although drug-induced deaths was not in the top-10
causes of death (Female Breast Cancer was #10             For More information
with average of 13.3 deaths per year), it was in the           Contact for related programs:
top-10 for Potential Years Life Lost (PYLL). Drug-        National Drug & Alcohol Treatment Referral
induced deaths were #7 in terms of PYLL for Kings         Routing Service available at: 1-800-662-HELP for
County at 318.4 years for those 11 deaths.                information about treatment programs in your area.
Age at death ranged from 15-64, with the majority         National Institute on Drug Abuse -
in the 45-54 age-range at 4, contributing to 102
Potential Years Life Lost, while in the 15-24 age-
range the average was 1.67, contributing 92.6
Potential Years Life Lost.                                For help with prevention:

                                                          For help with Treatment:

What is it?                                             BMI Chart for Adults:
Obesity is a weight range that is greater than what
is considered healthy for a given height. It is
measured by body mass index (BMI). The BMI is
an estimate of body fat. An adult who has a BMI of
30 or higher is considered obese. BMI is also
measured for children over two and plotted on a
growth chart to determine if she is overweight or
  • Overweight and obesity result from an energy
    imbalance. This involves eating too many
    calories and not getting enough physical
  • Body weight is the result of genes, metabolism,
    behavior,     environment,      culture,    and
    socioeconomic status.
  • Behavior and environment play a large role in       Source:
    causing people to be overweight and obese.
    These are the greatest areas for prevention and               2005 BMI from California Health
    treatment actions.                                                  Interview Survey

Why is it important to the health                                                    30.0 or higher          0 - 18.49
status of Kings County?
                                                                                        (Obese)            (Underweight)
                                                                                          30%                   2%
Adapted from U.S. Surgeon General’s Call to
Action to Prevent and Decrease Overweight and                         25.0 - 29.99
Obesity, 2001:                                                           34%
This rate of obesity raises concern because of its                                          18.5 - 24.99
implications for the health of Americans. Obesity                                              34%
increases the risk of many diseases and health
conditions. These include:
  • Hypertension (high blood pressure)
  • Osteoarthritis (a degeneration of cartilage and     Individual Primary Prevention/
    its underlying bone within a joint)
  • Dyslipidemia (for example, high total cholesterol   Deterring Activities:
    or high levels of triglycerides)                       • Talk to your doctor about what treatment
  • Type 2 diabetes                                          option would be best for you.
  • Coronary heart disease                                 • Refer to and follow the Dietary Guidelines for
  • Stroke                                                   Americans.
  • Gallbladder disease                                    • Take advantage of the opportunity to buy
  • Sleep apnea and respiratory problems                     fresh locally grown vegetables and fruit at
                                                             your Farmer’s Market or farm stand.
  • Some cancers (endometrial, breast, and colon)

Obesity rates have been rising in the United States     For More information
for over 30 years. Current estimates of obesity              Websites:
show that in California, 22.6% of the adult             - CDC:
population is obese.                                    - The Obesity Society:
Rates of overweight and obesity have also gone up       - California Obesity Prevention Initiative:
for children and adolescents.                           -
                                                               minutes of moderate- to vigorous-intensity
Why is it important to the health                              activity on most days of the week while not
status of Kings County?                                        exceeding caloric intake requirements.
Getting enough physical activity is important to            • To sustain weight loss in adulthood:
maintaining a healthy body weight and has been                 participate in at least 60 to 90 minutes of
shown to reduce the risk of certain chronic                    daily moderate-intensity physical activity
diseases, including high blood pressure, stroke,               while not exceeding caloric intake
coronary artery disease, type 2 diabetes, colon                requirements. Some people make need to
cancer, and osteoporosis.                                      consult with a healthcare provider before
                                                               participating in this level of activity.
In 2002, 25 percent of adult Americans did not              • Achieve physical fitness by including
participate in any leisure time physical activities in         cardiovascular training, stretching exercises
the past month (9), and in 2003, 38 percent of                 for flexibility, and resistance exercises or
students in grades 9-12 viewed television 3 or more            calisthenics for muscle strength and
hours per day (10) – (Dietary Guidelines for                   endurance.
Americans).                                              Key recommendations for Specific Population
For children and adolescents, regular physical              • Children & Adolescents: engage in at least
activity has beneficial effects on the following               60 minutes of physical activity on most,
aspects of health: (source: CDC)                               preferably all, days of the week.
    • Weight                                                • Pregnant Women: in the absence of
    • Muscular strength                                        medical       or    obstetric     complications,
    • Cardiorespiratory (aerobic) fitness                      incorporate 30 minutes or more of
    • Bone       mass      (through  weight-bearing            moderate-intensity physical activity on most,
        physical activities)                                   if not all, days of the week. Avoid activities
    • Blood pressure (for hypertensive youth)                  with a high risk of falling or abdominal
    • Anxiety and stress                                       trauma.
    • Self-esteem                                           • Breastfeeding Women: be aware that
                                                               neither acute nor regular exercise adversely
Individual Primary Prevention/                                 affects the mother’s ability to successfully
Deterring Activities:                                       • Older Adults: participate in regular physical
Key recommendations from the Dietary Guidelines                activity tor educe functional declines
for Americans:                                                 associated with aging and to achieve the
    • Engage in regular physical activity and                  other benefits of physical activity identified
       reduce sedentary activities to promote                  for all adults.
       health, psychological well-being, and a
       healthy body weight                               For More information
    • To reduce the risk of chronic disease in
       adulthood: engage in at least 30 minutes of            Contact for related programs:
       moderate-intensity physical activity, above       Local parks and recreation facilities
       usual activity, at work or home on most           Local Gym
       days of the week.                                        Websites:
    • For most people, greater health benefits can       CDC:
       be obtained by engaging in physical activity
       of more vigorous intensity or longer              Dietary Guidelines:
    • To help manage body weight and prevent
       gradual, unhealthy body weight gain in
       adulthood: engage in approximately 60
                                                         Utilize Farmer’s Markets, Nutrition-on-the-Go, and
Why is it important to the health                        Commodities give-a-ways when available
status of Kings County?
Maintaining a healthy weight to minimize the risk of     For More information
chronic diseases such as diabetes and heart
disease requires access to healthy food. Grocery
stores and other retail outlets that sell healthy food   • California Center for Public Health Advocacy:
must be readily accessible to people where they  
live and work. The composition of retail food
outlets in an area may be described as the “food         Distribution of Retail Food Outlets in
environment”. A recent study by the California           Neighboring Counties:
Center for Public Health Advocacy analyzed retail        The Center for Public Health Policy report on the
food outlets in cities and counties with populations     retail food environment sampled cities and counties
greater than 250,000. Their findings showed there        with a population above 250,000, which included
are more opportunities to buy unhealthy than             Fresno and Tulare Counties but not Kings.
healthy food by a ratio of 4:1 in many places.           However, Kings County may look similar to Fresno
                                                         or Tulare.
The retail food environment is also important
because about half of the money spent on food is                             Fresno – 5.34
for meals purchased away from home.
Unfortunately, most of the food sold in retail outlets
is high in calories, fat, and simple carbohydrates,
such as high fructose corn syrup. While a direct
relationship between meals eaten away from home
and obesity has not been proven, the overall quality
of the diet is worse when more meals are eaten
away from home.

A recent study of Kids Meals sold at fast food
outlets showed the vast majority of the meals
analyzed were too high in the recommended
amount of 430 calories (93%), sodium (86%), and
saturated fat (45%). Some of the meals reached
                                                                             Tulare – 4.42
900-1000 calories per meal. Because the nutrient
content of the meals is not included on the menu
board, or any place else where it is readily
accessible, parents are not aware of the potential
damage these meals may be doing to their child’s
health. (Center for Science in the Public Interest)

Individual Primary Prevention/
Deterring Activities:
Get information about the calorie, fat, and sodium
content of foods you and your family eat in fast food
restaurants by asking for it or checking the website.

Prepare and eat meals at home, and bring food
from home to eat at lunch.                               Source: California Center for Public Health Advocacy,
                                                         “The Food Landscape in California Cities and Counties”
                                                         • Check the safety rating at
                                                           when you are planning to purchase a new or
Why is it important to the health
                                                           used car
status of Kings County?
The lack of use of Seat Belts and/or Child Safety       Key Findings:
Seats leads to the unintentional injury or death
among children and adults.                              In Kings County most accidents where Safety
                                                        Equipment was not used were either on
In California, unintentional injuries are the leading   Unincorporated State Highways or County Roads.
cause of death and hospitalization among children
under age 16. Motor vehicle occupant injuries are
among the top five causes of both death and                    % of Injuries where Safety Equipment Not
hospitalization among children under age 16. The               Used in Injury Accidents in Kings County,
National Highway Traffic Safety Administration             25%                   2006
(NHTSA) estimates that child restraints are 71%            20%
effective in reducing fatality among infants and 54%
effective among children aged one to four in
passenger cars. It is estimated that during the past       10%
30 years, approximately 8,325 children’s lives have         5%
been saved by the use of child restraints, according        0%
to the NHTSA website.                                            Corcoran   Hanford   Lemoore    Uninc.    County
                                                                                                Highways   Roads
25 states, the District of Columbia, and Puerto Rico
have seat belt laws, and all 50 states as well as DC
and Puerto Rico have laws requiring that children       For More information:
be restrained in motor vehicles. Child safety seats          Contact:
and booster seats save lives. They offer the best       Kings County Department of Public Health –
protection for children in the event of a crash.         Child Passenger Safety Seat Program
How are we doing in Kings County?                                Websites:
The Department of Public Health offers a class to       • California Department of Public Health:
expectant parents on the proper use of child safety
seats and boosters. Participants pay $20.00 and         -VOSP.aspx
receive a voucher for $60.00 toward the purchase        • National Highway and Traffic Safety
of a car seat.                                            Administration:
                                                        • Information about vehicle safety ratings:
Certified Child Passenger Safety Technicians offer
periodic Safety Seat Inspections free of charge to      • California Highway Patrol:
the public.                                             • Injury Prevention Web:
Individual Primary Prevention/
Deterring Activities
 • Attend a class on the proper use of seat belts,
   child safety seats, and boosters
 • Go to a safety seat check-up when it is offered
   in your community
 • Make sure that when children are passengers
   in a car, they are correctly secured in the
   restraint recommended for required by law for
   their age and size
                                                             • Contact the Smoker’s Helpline for advice
Why is it important to the health
                                                               about quitting
status of Kings County?
Tobacco use is the number one preventable cause           Bans on smoking in public places and raising the
of death and disease in California.        Despite        cost of cigarettes have been effective in lowering
significant gains in the last 20 years, 4 million         smoking rates. California laws also ban smoking in
Californians still smoke and youth smoking has            playgrounds, in day care facilities, or in cars with
increased for the first time in a decade (American        children under the age of 18.
Lung Association).
- Smoking is a major risk factor for:                     Key Findings:
    • Coronary Heart Disease
    • Stroke                                                25
                                                                 Adult Smoking Prevalance, Kings County & California

    • Lung and other types of Cancer                        20
- Smoking during pregnancy increases risk for:
    • Premature birth
    • Low birth weight
    • Infant death
                                                                 KC   CA    KC      CA    KC    CA      KC     CA   KC   CA
It is estimated that in the United States, 438,000
                                                                  1990        1996          1999         2002         2005
deaths each year are caused by diseases related to
smoking. Millions of Americans have at least one             Current Smoker Total        Daily Smoker        Occasional Smoker
serious illness related to smoking including:
                                                          Daily & Occasional Smokers add up to total for
     • Emphysema
     • Chronic Obstructive Pulmonary Disease
     • Bronchitis
                                                          For More information:
     • Smoking makes asthma & pneumonia worse.
                                                               Contact for related programs:
The children of parents who smoke:                        Kings County Department of Public Health –
   • have more problems with asthma                        Tobacco Control Program: 1-800-649-5399
   • get colds & ear infections more often                        Websites:
   • have a higher risk of dying from Sudden              • American Heart Association: 1-800-AHA-USA-1
     Infant Death Syndrome (SIDS) in infants                (1-800-242-8721)
   • are more likely to become smokers                    • American Stroke Association: 1-888-4 STROKE
Individual Primary Prevention/                            • American Lung Association 1-800-LUNG-USA
Deterring Activities                                        (1-800-586-4872)
The nicotine in cigarettes is highly addictive and        • Centers for Disease Control & Prevention (CDC)
makes it difficult to stop smoking. There are a   
number of methods for quitting smoking which may          • National Cancer Institute 1-800-4-CANCER
be used separately or combined, such as:                    (1-800-422-6237)
   • Attend a smoking cessation class                     • Nicotine Anonymous
   • Talk with your physician about nicotine                1-877-TRY-NICA (1-877-879-6422)
     replacement      products      or     prescription   • California Smoker’s Helpline
     medications that may help you quit smoking             1-800-NO-BUTTS (1-800-662-8887)
     to decide if one of them is right for you:   
         Nicotine patch, gum, or lozenges                 • California Department of Public Health –
         Zyban                                              California Tobacco Control Program
                                                          • Tobacco Free California
This chapter examines the Health Status of the Environment in
Kings County. Topics covered include Air and Water Quality as
well as Land Use Planning.

Chapter Highlights:

      2004-2006, Kings County’s # Days with Ozone greater than
      the National Standard was lower than that in Fresno, Kern, &
      Tulare Counties.
      The Health Department inspects 542 fixed facilities
      (restaurants, bars, markets, bakeries, and school cafeterias)
      1-4 times each year.
      It is now illegal to dispose of home-generated syringes and
      other medical “sharps” in the trash.

                          In this chapter:

                          Air Quality…………………………             53
                          Food Safety……………………….             54
                          Hazardous Materials…………….         55
                          Land Use Planning………………           56
                          Lead Poisoning…….…………….           57
                          Solid Waste Management ...……      58
                          Toxic Chemicals………………….           59
                          Water………………………………                 60

What is it?
The US Environmental Protection Agency (EPA)           The San Joaquin Valley Air District’s 2007 Ozone
has adopted federal primary air quality standards.     Plan sets a deadline of 2024 to attain the ozone
Primary standards are intended to protect human        standard. Its Draft 2008 PM2.5 Plan projects
health and have been set for several air pollutants.   attainment for that standard by 2015.
Air pollution in excess of those standards is
unhealthy, especially for sensitive groups such as     Key Findings:
people with lung disease, including asthma, as well
as children, seniors, and people who exercise
outdoors. California has set state standards which              # Days Ozone Greater than 8-hour National
are stricter than those set by the US-EPA.                                     Standard

The San Joaquin Valley has a long-standing
problem with two air pollutants: ground-level ozone
and fine particulate matter (PM). Federal and state
health-related standards have been set for ozone                                                  Tulare Co
and two types of PM – particles smaller than 10          2005
                                                                                                  Kings Co
micrometers (PM10) and 2/5 micrometers (PM2.5).                                                   Kern Co
                                                         2004                                     Fresno Co
Why is it important to the health
                                                                0             10             20               30
status of Kings County?
Short-term exposure to ozone adversely affects
lung function and may cause some or all of these       Individual Primary Prevention/
temporary respiratory symptoms:
                                                       Deterring Activities
    • Cough
                                                       Go to the San Joaquin Valley Air Pollution Control
    • Pain on deep inspiration
                                                       District’s Healthy Air Living website for ideas that
    • Shortness of breath
                                                       include using electric lawn tools, biking, carpooling,
                                                       or using public transportation and not using a
Fine particles can penetrate deep into the lungs
                                                       charcoal BBQ:
and lead to a variety of adverse health effects.
Short-term exposures to people with lung disease
can contribute to asthma attacks and acute
bronchitis and may also result in increase             For More information
susceptibility to lung infections. In people with           Contact for related programs
heart disease, short-term exposures have been          San Joaquin Valley Air Pollution Control District
linked to heart attacks and arrhythmias. Long-term     (559) 230-6000
exposures to PM have been linked to reduced lung                Websites:
function and the development of chronic bronchitis.
                                                       • US EPA:
                                                       • California Air Resources Board:
How are we doing in Kings County?                      • San Joaquin Valley Air Pollution Control District
Kings County is classified as “non-attainment” for     
the health-based federal 8-hour standard for ozone     • Air Now – Air Quality Guide for Ozone:
and for fine particulate matter (PM2.5). “Non-         
attainment” is the failure to meet the National Air
                                                       • Operation Clean Air, Inc. – The San Joaquin
Quality Standards. Based on recent air monitoring
                                                         Valley Initiative:
data, the EPA re-designated the entire San Joaquin
                                                       • Central Valley Air Quality Coalition:
Valley Air Basin as “attainment” for PM10 in 2008.

What is it?                                            Individual Primary Prevention/
The provision of food and beverage for human           Deterring Activities:
consumption has an inherent potential for food         Food handling safety risks at home are           more
borne illness transmission. In 1999 the Federal        common than most people think. The four          easy
Centers for Disease Control and Prevention (CDC)       lessons of CLEAN, SEPARATE, COOK,                AND
estimated that approximately 76 million Americans      CHILL can help prevent harmful bacteria          from
become ill, 325,000 are hospitalized, and 5,000 die    making your family sick.
each year due to food borne illness. Improper
temperature control of potentially hazardous foods     CLEAN: Wash hands with warm water and soap
causes the majority of food borne illnesses while      before and after handling food. Wash cutting
other major risk factors identified by CDC include     boards, dishes, utensils, and counter tops with hot
inadequate cooking, poor food handler hygiene,         soapy water before and after preparing each food
contaminated equipment or food, and foods from         item. Rinse fruits and vegetables under running
unsafe sources.                                        water, including those with skins and rinds that are
                                                       not eaten.
Why is it important to the health
status of Kings County?                                SEPARATE: Don’t cross-contaminate. Keep raw
                                                       meat and its juices apart from other food items in
Consumers in Kings County have the right to
                                                       your grocery cart. Use one cutting board for raw
expect that food they buy is safe, pure,
                                                       meat, poultry and seafood and another for salads
unadulterated, and properly represented, and that
                                                       and ready-to-eat food. Store raw meat so juices
retail food facilities are clean and sanitary. They
                                                       can't drip on other foods
also have a right to know the results of inspections
made of those facilities.
                                                       COOK: Use a food thermometer — you can't tell if
                                                       food is cooked safely by how it looks. Food is
How are we doing in Kings County?                      safely cooked when it reaches a high enough
Food safety standards for retail food businesses       internal temperature to kill the harmful bacteria that
are established by the California Retail Food Code.    causes illness. Refer to the temperature chart at
Primary responsibility for enforcement rests with
local health agencies. However, food production
and wholesale distribution are regulated by federal    CHILL leftovers and takeout foods within 2 hours.
and state agencies.                                    Keep the fridge at 40 °F or below and use an
                                                       appliance thermometer. Thaw meat, poultry, and
The Health Department inspects 576 fixed facilities    seafood in the fridge, not on the counter, and don't
(restaurants, bars, markets, bakeries, and school      overstuff the fridge.
cafeterias), 162 food vending vehicles, 49 produce
stands, 67 temporary food facilities, and 10 vending
machine sites. Routine inspections are scheduled       Websites for More information
anywhere from one to four times a year based on a      Division of Environmental Health Services:
risk assessment of each operation.           
                                                       US Food & Drug Administration’s “Bad Bug Book”:
Summary of 2007-2008 fiscal year routine               www.cfsan.fda.gob/%Emow/intro.html
inspection results:                                    Fight BAC! – Keep Food Safe from bacteria:
 Type of                     Needs           
 Facility        Passed Improvement Failed             CLEAN.SEPARATE.COOK.CHILL – home food
 Restaurants      71.6%      26.0%       2.4%          safety tips:
 Markets          64.5%      33.8%       1.7%

What is it?                                             Individual Primary Prevention/
Any solid, liquid, or gas that can harm people, other   Deterring Activities:
living organisms, property, or the environment             •   Take household hazardous wastes like old
                                                               paint cans, batteries, fluorescent lights,
Why is it important to the health                              pesticides, cleaning chemicals and mercury
                                                               thermometers to household hazardous
status of Kings County?
                                                               waste collection days operated by the Kings
Because of the nature and volume of chemicals                  Waste and Recycling Authority (KWRA).
handled at a variety of facilities, some operations
                                                           •   Take used motor oil to KWRA or to other
may represent a threat to public health and safety if
                                                               collection points such as auto parts stores
chemicals are released into the environment.
                                                               for recycling.
Information on the location, type, quantity, and
                                                           •   Do not put electronic waste such as old
health risks of the hazardous materials handled,
                                                               TVs, computers or cell phones in the trash.
used, stored, or disposed in the county needs to be
                                                               KWRA will also accept electronic waste.
available to firefighters, environmental health
                                                               Sometimes working electronic products can
officers, EMS personnel, health care providers,
                                                               be donated to nonprofit organizations.
regulatory agencies, and other interested persons,
                                                           •   Consider reducing your purchase of
including area residents. It is also important that
                                                               products       that   contain     hazardous
such facilities implement measures to prevent
                                                               ingredients.     Learn about the use of
releases and to respond to chemical emergencies
                                                               alternative methods or products without
                                                               hazardous ingredients.
Some hazardous liquids, particularly motor fuels,
are stored in underground tanks. It has repeatedly         •   Do not flush unused drugs down the drain.
been demonstrated that underground storage tanks               See
and piping may leak, thus causing environmental                for disposal options.
damage. Leaks occur due to factors which include
corrosion of steel tanks, structural flaws, and         For More information
improper installation of underground tanks and
piping. Leaking underground storage tanks may
                                                             Contact for related programs
cause significant contamination of soil and             Kings County Department of Public Health: Division
groundwater thereby threatening the safety of           of Environmental Health Services: (559) 584-1411
drinking water supplies.                                       Webpages
                                                        Kings County Department of Public Health: Division
Surveillance and education of facilities that           of Environmental Health Services:
generate hazardous wastes and the enforcement of
applicable regulations are needed to ensure that        US Environmental Protection Agency Green
hazardous wastes are stored, treated, transported,      Purchasing recommendations:
and disposed in a safe manner.                
How are we doing in Kings County?                       Waste Oil Collection Centers in Kings County:
Effective July 1, 1996, the Kings County health
Department was approved by the Secretary of the         ecenters.htm
California Environmental Protection Agency to be a      Department of Toxic Substances Control –
Certified Unified Program Agency (CUPA) as              Managing Hazardous Wastes:
provided in the California Health and Safety Code.
CUPA approval makes the Health Department               California Office of Emergency Services
responsible for administering a unified hazardous
materials    management      regulatory   program
throughout Kings County.

What is it?
The way that a community is planned and laid out
                                                      Individual Opportunities for Action:
can have a direct impact on the health of its            •   Attend and participate in the regular public
residents. Where and how schools, offices, stores,           meetings    of    your     local   Planning
parks, and community services are located, and               Commission, and give your input into how
constructed in relation to housing can impact our            your community is planned.
physical health, air quality, water resources, and
general quality of life.                                 •   Contact elected officials and other decision
                                                             makers in your community regarding land
                                                             use and planning actions, to share your
Why is it important to the health
                                                             ideas and concerns.
status of Kings County?
Communities must plan carefully so that they grow
in a way that minimizes impacts to the natural        For More information
environment, while providing ample opportunity for         Contact for related programs
their residents to maintain healthy lifestyles by     Kings County Department of Public Health: Division
promoting easy access to necessary services,             of Environmental Health Services: (559) 584-
nutritious food, recreation, physical activity, and      1411
social interaction. These “smart growth” principles   Kings County Community Development Agency:
are key to developing healthy, environmentally           (559) 582-3211 x 2370
sustainable communities.
How are we doing in Kings County?                     Kings County Environmental Health Services:
Kings County has begun to implement these   
principles of healthy and sustainable growth in its   Kings County Community Development Agency:
planning activities. The Community Development
Agency now works closely with the Department of       Central California Regional Obesity Prevention
Public Health to insure that human and                Project:
environmental health impacts are considered 
throughout the planning process, both in              ROPP/index.shtml
community-wide plans and in individual projects.      Smart Growth Online:
Through a partnership with Fresno State’s Central     Active Living by Design:
California Regional Obesity Prevention Program,
Health Department staff regularly meet with city
and county planners to maintain a dialog between
the two groups, keeping the link between
community planning and community health at the
focus of planning decisions.

In addition, staff from the Department of Public
Health’s Environmental Health Services Division
(EHS), review every proposed community plan and
every proposed development project in the county.
EHS comments focus on insuring the plan or
project complies with applicable health and
environmental regulation, while maximizing the
public health benefits and minimizing the
environmental impacts to the community.

What is it?                                             Individual Primary Prevention/
   •   Childhood lead poisoning is one of the most      Deterring Activities
       common      and    preventable    childhood      Ways to protect children:
       environmental health problems in California.       • Always wash hands before eating
       Young children are especially at risk              • Eat healthy meals and snacks high in iron,
       because their hand to mouth behavior,                  calcium, and vitamin C
       rapidly developing nervous systems, and
                                                          • Clean the home regularly with a wet mop
       increased capacity to absorb lead. Lead is
                                                              and damp cloths
       a heavy metal and a neuro-toxin. Once it is
                                                          • Be aware of peeling or chipping paint
       in the environment, it stays there until it is
                                                              around the house
       removed. Many lead burdened children are
       asymptomatic.                                      • Do not use home remedies
                                                          • Have the children screened for blood lead
Lead can be found in:                                         levels at ages 12 and 24 months
   • Lead paint in houses built before 1978
   • Home remedies from Mexico, South East              For More information
      Asia, or India                                         Contact for related programs:
   • Ceramics from Mexico                               Child Health and Disability Prevention at:
   • Imported candies from Mexico                       (559) 584-1401 ext 2619
   • Various toys & jewelry made in China                      Websites:
                                                        • Environmental Protection Agency:
Why is it important to the health               
status of Kings County?                                 • California Department of Public Health:
Complications of elevated blood lead levels include:
  • Diminished intelligence                             /CLPPBChildrenAtRisk.aspx
  • Impaired neuro-behavioral development               • CDC:
  • Deficits in attention                               • CDC Lead Recalls:
  • Increased aggression                        
  • Hyperactivity
  • Sleep disturbance
  • Anemia

How are we doing in Kings County?
Children are screened for elevated lead levels
during a routine health assessment at 12 an 24
months of age. In Kings County we identify about
5-10 elevated blood lead levels every year. We
provide follow-up and health education to families.
Most of elevated blood levels in Kings County have
come from exposure to imported items from

What is it and why is it important to
the health status of Kings County?
The improper management of municipal solid waste              Services to ensure that they comply with state
(trash) can quickly lead to significant community             regulations and permit conditions that protect
nuisances and even health concerns. Odors, flies,             environmental quality and public health.
mosquitoes, rodents, conditions of blight, and water
contamination are just some of the problems that              Individual Primary Prevention/
can result if trash is not contained, removed, and
disposed of in a timely and effective manner.
                                                              Deterring Activities:
                                                              People are strongly encouraged to continue to
Illegal dumping is also an ongoing problem that               increase their use of curbside recycling and other
impacts communities and innocent property owners              easy (and profitable) recycling options, such as
by decreasing property values, increasing                     community buy-back centers.
expenses, and impacting quality of life. Improper
disposal of used syringes from home medical use               Despite the availability of a variety of free or low
can result in puncture wounds and infection in solid          cost options for waste removal, such as free
waste workers.                                                community clean up days, illegal dumping remains
                                                              an ongoing and significant problem in the county. It
Inadequate community recycling measures can                   is important to properly dispose of waste to prevent
result in useful products being wasted by disposal            the creation of unsightly conditions and hazards to
in a landfill, filling up the landfill sooner, resulting in   health and the environment. Natural areas such as
the need to build more landfill space. A shift                the Kings River are not places to dump trash.
towards viewing trash as a resource to be                     Residents are urged to report illegal dumping to law
exploited, rather than a waste to be disposed of is           enforcement agencies or to the Health Department’
beginning to occur in California.                             Division of Environmental Health Services.

                                                              Because of the risk of injury to solid waste workers,
How are we doing in Kings County?                             it is now illegal to dispose of home-generated
Kings County residents and businesses generated               syringes and other medical “sharps” in the trash.
over 150,000 tons of solid waste in 2007. Through             Approved sharps containers are available free to
recycling, composting, and other means, the county            the public from KWRA or from the Department’s
currently keeps almost half of its wastes from going          EHS Division. These can be dropped off free of
to landfills.                                                 charge at KWRA or any Household Hazardous
                                                              Waste collection event in the county.
There are two active municipal solid waste landfill
sites in Kings County, one in Avenal and one
southwest of Kettleman city. Before being land                For More information
filled, however, most solid waste in the county first              Contact for related programs:
goes to the Kings Waste & Recycling Authority                 Kings County Department of Public Health –
(KWRA) material recovery facility in Hanford.                  Environmental Health Services Division
There, the recyclable material in the trash is                 (559) 5841-1411
removed, sorted, and eventually sold for                      KWRA: (559) 583-8829
reprocessing and reuse as a valuable commodity.
Green materials such as yard trimmings are also                      Websites:
segregated for further processing for beneficial use,         Kings County Environmental Health Services:
such as composting for soil amendments. There is
currently one active compost facility located near            California Integrated Waste Management Board:
Avenal. All solid waste facilities in the county are
permitted and inspected by the Health                         US Environmental Protection Agency (USEPA):
Department’s Division of Environmental Health       

What is it and why is it important to                  Individual Primary Prevention/
the health status of Kings County?                     Deterring Activities:
Toxic chemicals may cause cancer, birth defects,          •   Consider reducing your purchase of
neurological problems, and other adverse health               products     that    contain hazardous
effects if excessive exposures occur. Residents               ingredients.   Learn about the use of
are exposed to toxic chemicals in consumer                    alternative methods or products without
products, housing, workplaces, air, water, and soil.          hazardous ingredients.

A large hazardous waste treatment, storage, and           •   Learn about Green Chemistry, which is
disposal facility is located in Kings County. Large           chemicals and chemical processes that
volumes of hazardous materials are also                       reduce or eliminate negative impacts on the
transported through the county by highway and                 environment by using chemicals that are
railroad.                                                     less toxic, don’t persist in the environment
                                                              and are safer to use.
There were 5.7 million pounds of pesticides applied
in Kings County in 2005, according to data from the    For More information
California Department of Pesticide Regulation.
                                                            Contact for related programs:
                                                       Kings County Department of Public Health –
How are we doing in Kings County?
                                                        Environmental Health Services Division
The Kings County Department of Public Health has
                                                        (559) 5841-1411
been approved by the Secretary of the California
                                                       Kings County Agricultural Commissioner
Environmental Protection Agency to be a Certified
                                                        (559) 582-3211 x 2833
Unified Program Agency (CUPA). CUPA approval
made the Health Department’s Division of
Environmental Health Services responsible for                 Websites:
administering a unified hazardous materials            • Kings County Department of Public Health –
management regulatory program throughout the           Hazardous Materials and Wastes Website:
county. This program includes enforcement of laws
and regulations applicable to underground storage
tanks, aboveground petroleum storage tanks,            • Kings County Agricultural Commissioner
hazardous materials management, the prevention
of accidental releases, and hazardous waste            x.html
generators, including those that conduct waste
treatment operations onsite.                           • The U.S. EPA’s Green Chemistry website:
There were a total of 36 releases of hazardous
materials reported to the Health Department by the     • California Environmental Health Tracking
California Office of Emergency Services during           Program:

Pesticide use is regulated by the Kings County         • California Department of Pesticide Regulation
Agricultural Commissioner with oversight from the
California Department of Pesticide Regulation.

What is it and why is it important to                   Individual Primary Prevention/
the health status of Kings County?                      Deterring Activities:
                                                           •   Community water systems with 15 or more
Drinking water is essential to human life. However,            connections as well as systems that serve
water can also be a vehicle for disease                        25 or more of the same individuals for at
transmission. Waterborne microbial diseases such               least 6 months out of the year must provide
as cholera remain a significant cause of morbidity             an annual report to water users describing
and mortality in many developing countries.                    what contaminants have been found during
Chemical contaminants such as arsenic in drinking              the most recent tests. These “Consumer
water contribute to cancers and other diseases,                Confidence Reports” are to be distributed
including acute illnesses.                                     no later than July 1st and cover the period
                                                               that ends December 31st of the prior year.
How are we doing in Kings County?                              Consumers are encouraged to read these
                                                               annual reports and to call the Kings County
The United States is considered to have one of the
                                                               Department of Public Health with any
safest water supplies in the world. However, water
quality varies depending on the source of the water
and the treatment, or lack of, that it receives.           •   Individuals in Kings County that obtain their
                                                               water from private wells should consider
Groundwater is the primary source of drinking
water in Kings County with the exception of the city           testing their water for at least coliform
of Avenal, NAS Lemoore and a few small systems                 bacteria, arsenic and nitrates. Drinking
                                                               water with elevated nitrate levels should be
that use surface water from the California
                                                               avoided by pregnant women and children
                                                               under the age of 2 years. Water testing
Public water systems are regulated by both federal             laboratories can be found in the yellow
and California state law. There are over 40 small              pages of the phonebook.
water systems that are regulated by the Kings
County Department of Public Health. Larger              For More information
systems having 200 connections or more are                   Contact for related programs:
overseen by the California Department of Public         Kings County Department of Public Health –
Health. Drinking water from private wells is not         Environmental Health Services Division
required to be tested for water quality.                 (559) 5841-1411

Contaminants that have been found during routine
sampling of local public water systems in Kings
County include coliform bacteria, arsenic, nitrates,       •  Kings County Environmental Health
and uranium.       Arsenic, a naturally occurring             Drinking Water website
contaminant, is present at some level in most of the
county’s groundwater sources. Some of the public         htm
water systems in the county fail to meet the arsenic
standard. According to the Consumer Confidence             • US Environmental Protection Agency –
Report issued by the city of Hanford in 2008, the            information for private wells
city’s drinking water contains naturally-occurring
arsenic in excess of the allowable level. The city is
implementing a program to abandon high arsenic            • City of Hanford – water system information
concentration wells and find new water sources
with lower arsenic concentrations. The city of          %20Water%20Division.htm
Corcoran has added a water treatment facility to
remove arsenic.

                                           This chapter reviews Communicable and Reportable Diseases and
                                           their impact on the Health Status of Kings County.

                                           Communicable diseases means illnesses due to infectious agents
                                           or their toxic products, which may be transmitted from a reservoir to
                                           a susceptible host either directly as from an infected person or
                                           animal or indirectly through the agency of an intermediate plant or
                                           animal host, vector, or the inanimate environment. (Code of Federal

                                           Reportable Diseases are specified diseases and conditions which
                                           are mandated by State laws and regulations to be reported by
                                           healthcare providers and laboratories to the local health officer.

                                           Chapter Highlights:

                                                 The Kings County Department of Public Health gives about
                                                 1,900 flu shots annually.
                                                 Chlamydia is the most common Sexually Transmitted
                                                 Disease in Kings County.
                                                 Many parents do not realize that some childhood vaccines
                                                 wear off over time and many are unaware of the new
In this chapter:
                                                 vaccines now recommended for preteens.
Immunizations – Infant…… 63
Immunizations – Preteen… 64
Immunizations – Adult……. 65
Influenza…………………… 66
Valley Fever.……………… 67
West Nile Virus…………… 68
Hepatitis C.......................... 69
HPV………………………… 70
STD………………………… 71
HIV/AIDS…………………… 72
Chlamydia….……………… 74
Gonorrhea…..……………... 75
Syphilis..…………………… 76
Tuberculosis………………. 77

What is it?                                             An example of the effectiveness of vaccines can be
After safe drinking water, immunization has been        demonstrated by the following table. In the early
called the most important public health intervention    1980s, it was estimated that about 20,000 cases of
in history. It has saved millions of lives over the     Hib Disease (bacterial meningitis) occurred
years and prevented hundreds of millions of cases       annually in the United States. The incidence of
of disease.                                             invasive Hib Disease began to fall dramatically in
                                                        the late 1980s, coincident with licensure of Hib
                                                        vaccines and has declined by > 99% compared to
Why is it important to the health                       the pre-vaccine era.
status of Kings County?
The current recommended immunization schedule
for children ages 0 – 6 years can protect against 15
diseases. Except for tetanus, these diseases are
all contagious.       The routine recommended
schedule for these vaccines is from birth to 15
months of age.         Some vaccines are only
recommended for older children along with booster
dose of some other vaccines.

How we are doing in Kings County:
Two goals of the immunization program include:
   1. 95% of children who enter Kindergarten are
      up-to-date on all required immunizations
   2. By the end of 2009, 90% of all two-year olds
      will be up-to-date.
                                                        This same pattern of decrease in incidence is seen
Kings County has met the first goal with almost         in polio, tetanus, mumps, and other diseases as
97% of all children entering Kindergarten being up-     related to the introduction of the vaccine.
to-date on all required immunizations.
Kings County is at about 85% for the second goal        For More information:
of having all two-year olds up-to-date on all                Contact for related programs:
immunizations.                                          Kings County Department of Public Health –
                                                        Immunization Program at 584-1401 or toll free at
As fears regarding vaccine safety arise among the       1-800-649-5399 and ask for IZs
public, there has been an increase in the incidence
of vaccine-preventable diseases among children                 Websites:
throughout California and the world. This is            • CDC:,
especially true for measles and pertussis       
(whooping cough).                                       • Immunization Action Coalition:
Individual Primary Prevention/                          • National Network for Immunization Information:
Deterring Activities                                    • Allied Vaccine Group:
Parents should take their children for routine health   • Vaccine Information:
assessments and have their children up-to-date  
with all required and recommended immunizations.
                                                        • Vaccinate Your Baby:

What is it?                                             •   The incidence of Human Papillomavirus is
Immunizations are a safe and effective way to help          very high – approximately 20 million
preteens stay healthy by protecting them from               infections are reported in the United States.
serious diseases.     Complications from vaccine
preventable diseases can be devastating to           Individual Primary Prevention/
children and their families. Many parents do not     Deterring Activities
realize that some childhood vaccines wear off over   Parents are encouraged to take their preteen
time and many are unaware of the new vaccines        children for a well child check up at their private
now recommended for preteens.            Preteens    provider or clinic. They should bring their yellow
generally do not receive preventable healthcare      immunization cards and the provider will assess
and only visit the doctor when they are sick.        what vaccines are needed.
Consequently, the estimated overall vaccination
rate among pre-teens is very low, approximately      The Health Department encourages school-based
30% in California.                                   clinics for the middle schools.
                                                     The Health Department also has Immunization
Why is it important to the health                    clinics throughout the county. Call for the schedule.
status of Kings County?
The federal Centers for Disease Control &            For More information:
Prevention (CDC) recommend the following                  Contact for related programs:
immunizations for preteens:                          Kings County Department of Public Health –
   • New tetanus booster (Tdap). This vaccine        Immunization Program at 584-1404 ext 4523
      protects against tetanus, diphtheria, and
      pertussis (whooping cough).                           Websites:
   • Meningococcal conjugate vaccine (MCV).          • CDC:,
      This vaccine protects against invasive,
      meningococcal disease, a serious illness       • Immunization Action Coalition:
      that can cause meningitis.             
   • Chickenpox vaccine. A second dose of            • National Network for Immunization Information:
      varicella is now recommended for all   
      children over 4 years of age who have not
      had the disease.                               The below schedule indicates the recommended
   • Human Papillomavirus (HPV) vaccine. This        ages for routine administration of currently licensed
      three shot series is now recommended for       childhood vaccines, as of December 1, 2007, for
      girls between 9-26 years of age to prevent     children aged 7 through 18 years.
      70% of the cervical cancer in adulthood.       Additional     information     is    available     at

What is it?
The Advisory Committee on Immunization
                                                       Individual Primary Prevention/
Practices   (ACIP)     annually    reviews   the       Deterring Activities:
recommended Adult Immunization Schedule to             The Kings County Department of Public Health
ensure that the schedule reflects current              offers adult and travel immunizations at the Health
recommendations for listed vaccines.                   Department every month. At this point, the clinic is
Thus, the schedule can change from year to year.       cash only as the Department does not have the
The     schedule     can     be      viewed   at:      ability to bill for the service. Some of the adult .              vaccines are available at private and public clinics
                                                       under Medi-Cal
Why is it important to the health
                                                       Those travelling to foreign countries may also
status of Kings County?                                require vaccinations prior to travelling. The CDC
As of October 2007, there were 10 vaccines that        suggests that you visit your doctor 4-6 weeks
would prevent 14 diseases:                             before travel for those vaccines. The CDC divides
   • Tdap:                                             travel vaccines into three categories:
       * Tetanus * Diphtheria * Pertussis *                • Routine – see website at top of page
   • Human Papillomavirus (HPV)                            • Recommended – these may depend on
   Approximately 80% of people who are sexually                your destination, season travelling, and
   active will acquire a Human Papillomavirus at               other criteria
   some point in their lifetime. It is a common            • Required - The only vaccine required by
   problem in Kings County.                                    International Health Regulations is yellow
   • MMR                                                       fever vaccination for travel to certain
       * Measles * Mumps * Rubella *                           countries in sub-Saharan Africa and tropical
   • Influenza                                                 South America. Meningococcal vaccination
   • Pneumococcal                                              is required by the government of Saudi
   • Hepatitis A                                               Arabia for annual travel during the Hajj.
   • Hepatitis B                                       For more information on travel vaccines see the
   • Meningococcal                                     CDC travel website listed below.
   The incidence of meningococcal disease may
   not be very high among teens and adults, but        For More information:
   the consequences or long-term effects from the
   disease can be devastating with 10% resulting            Contact for related programs:
   in death.                                           Kings County Department of Public Health
   • Varicella                                            Immunization Clinic (559) 584-1401 ext 4523
   • Zoster (shingles)                                               For vaccination
   Incidence increases over time and rises to 50%             Websites:
   by 85 years of age.                                 • CDC:
How are we doing in Kings County?                      • National Foundation for Infectious Diseases:
Kings County does very well in getting the influenza
vaccine out to the senior population every year
through drive-through flu clinics and open clinic
time at County Clinics. The rate of protection
among the other vaccines is very low.

The incidence of pertussis is hard to determine, as
most adults do not seek medical care, but can be
contagious to young infants.
What is it?                                             Who should get a flu shot?
Influenza, commonly called the flu, is caused by an     It is recommended by the CDC that the following
influenza virus, which infects the respiratory tract    groups get the flu shot each fall:
(nose, throat, lungs). Unlike many other viral               • Adults 50 and over
respiratory infections, the flu can cause severe             • Children aged 6 months up to their 19th
illness and life-threatening complications in many               birthday
people.     Symptoms of the flu include fever,               • Pregnant Women
headache, extreme tiredness, dry cough, sore                 • Nursing Home Residents
throat, runny nose, and muscle aches.                        • Health Care Workers
                                                             • Individuals with a chronic health condition
Although the term “stomach flu” is sometimes used                including:
to describe vomiting, nausea, and diarrhea, these                    o Pulmonary disorders including
illnesses are caused by other viruses, bacteria, or                      asthma
parasites, and are rarely related to influenza.                      o Cardiovascular disorders
                                                                     o Diabetes
Why is it important to the health                                    o Renal dysfunction
status of Kings County?                                      • People who live with, or care for an adult
In the United States, the peak of flu season occurs              over 50, a child under 6 months, or anyone
anywhere from late November through March.                       with a chronic health condition
Approximately 36,000 Americans die and over
200,000 are hospitalized every year from                Individual Primary Prevention/
complications of flu. Influenza is contagious and is    Deterring Activities
spread by coughing, sneezing, and nasal                 To stop the spread of influenza, you should take
secretions.                                             the following precautions:
                                                            • Stay at home when sick
Influenza vaccine can prevent influenza. Because
                                                            • Cough or sneeze into your elbow or a tissue
influenza viruses are always changing, influenza
vaccines are updated every year and an annual flu           • Wash your hands with soap and warm
shot is recommended.                                             water or use an alcohol-based hand
                                                            • Eat a balanced diet, drink plenty of water,
How are we doing in Kings County?                                get adequate rest and exercise
Flu season peaks in Kings County between
December and January every year. As in most
communities throughout California, Kings County
                                                        For More information:
sees an increase in hospital admissions and                  Contact for related programs:
mortality related to influenza. Much of our targeted    Kings County Department of Public Health
population, mainly seniors, remains unvaccinated                Immunization Clinic (559) 584-1401
every year. Influenza vaccination is available at the                  For vaccination
Health Department clinics, private health care          Private Healthcare Providers
providers, and many local pharmacies                           Websites:
                                                        • California Department of Public Health:
                                                        • CDC:
                                                        • Flu clinic locator:

What is it?
Valley Fever
Valley Fever is a fungal disease of variable
severity. The fungus grows in the soil in limited
areas of the United States, Mexico, and Argentina.
The fungus is more likely to be found in soil that
hasn’t been farmed or irrigated. People become
infected when they inhale spores released by the
fungus. The spores can be carried on the wind
long distances.

Likely, less than half of the people infected with the
fungus have symptoms. Most with symptoms have
an influenza-like illness with fever, chills, cough,     In California and in Kings County, the number of
muscle aches, and other symptoms. A chest film           cases increased every year from 2000 through
will usually show a pneumonia.             Even with     2006.
treatment, this condition causes prolonged illness.

Why is it important to the health
status of Kings County?
The average duration of illness is 70 days. 75% of
these people will miss work because of the illness.
They miss on average about a month of work. In
less than 2% of cases, the disease produces an
overwhelming pneumonia or spreads widely
throughout the body. Certain groups are at higher
risk of having complicated Valley Fever. Age over
65 years, pregnancy, African-American race, and
impaired immunity, all increase the risk for             Individual Primary Prevention/
complicated Valley Fever. It’s estimated that less       Deterring Activities
than 1% of people infected with the fungus die of        At the present time, there are no known measures
Valley Fever.                                            that individuals in Kings County can take to prevent
                                                         Valley Fever. Some progress is being made
How are we doing in Kings County?                        toward the development of a vaccine. As only a
In California, the disease is most common in Kern        limited number of Americans are at risk for Valley
County. Kings, Tulare, and San Luis Obispo               Fever, vaccine development hasn’t been viewed by
Counties all have rates less than half that of Kern      private industry as commercially viable. The work
County. The disease is reported from other areas         to date has been funded primarily by the federal
of the state, but much less frequently. Outbreaks of     government and the State of California. Kings
the disease are known to occur at irregular              County residents should advocate for continued
intervals. No one knows why these occur.                 public funding for vaccine development.

State prison inmates in Kings County have a higher       Websites For More Information:
risk of getting Valley Fever than other residents.       • California Department of Public Health –
For the period 2000-2006, state prisoners were             Disease Investigation Section (DIS):
eight times more likely than the general population
to have the disease diagnosed.                           •

What is it?                                              collected in traps, and blood testing special
West Nile Virus (WNV) is a mosquito-borne disease        “sentinel flocks” of chickens.
that has long been common in Africa, the Middle
East, and Asia. Wild birds serve as the main             The Department of Public Health works closely with
source of virus for mosquitoes.        In 1999, it       the Kings Mosquito Abatement District and other
appeared in North America for the first time, in the     community partners through an ad-hoc committee
New York City area. It moved west over the next          to coordinate public education activities. The public
few years and was eventually detected in dead            information program has included the development
birds in Kings County in 2004.                           and distribution of a “Fight the Bite” flyer as well as
                                                         news media interviews and press releases.
From 1999 through 2007, 1,062 deaths have been
attributed to West Nile Virus nationwide.                Recommendations include:
                                                            • Drain standing water
Why is it important to the health                           • Limit outdoor activities at dusk and dawn
status of Kings County?                                     • Use insect repellents containing DEET,
The county had its first human cases in 2005.                 picaridin, or oil of lemon eucalyptus
Since then, 40 Kings County residents have been             • Dress in long sleeves and pants during
confirmed to have West Nile Virus infections and it           dawn and dusk, or in areas where
has caused or contributed to the deaths of four of            mosquitoes are active
them.                                                       • Doors and windows should be well-
Many survivors experienced severe neuroinvasive
disease such as meningitis or encephalitis. These        For More information
symptoms may last several weeks or longer, and
                                                              Contact for related programs:
the neurological effects may be permanent. A
more common milder form of the disease is called         Kings Mosquito Abatement District: (559) 584-3326
West Nile fever. People over the age of 50 are at               Websites:
particular risk of getting the severe neurovinvasive     • U.S. Centers for Disease Control and Prevention
form of the disease. There is no specific treatment        West Nile Virus website;
available for West Nile Virus infections, nor is there
a vaccine for humans.                                    • California Department of Public Health –
                                                           West Nile Virus
How are we doing in Kings County?                        • Kings Mosquito Abatement District website:
  Human West Nile Virus Cases in Kings County    
           Residents 2005-2007

                              2005   2006 2007
 WNV-Related Fatalities         3      0    1
 Total Human Infections        32      1    7
 Cases per 100,000            21.5    0.7  4.6

Individual Primary Prevention/
Deterring Activities
Mosquito control is carried out by the Kings
Mosquito Abatement District in most of the county.
The District also conducts surveillance for West
Nile Virus by testing dead birds, pooled mosquitoes

What is it?
                                                             •     People who received a blood product for
Hepatitis C is a liver disease caused by the                       clotting problems made before 1987
hepatitis C virus (HCV), which is found in the blood         •     Hemodialysis patients or persons who spent
of persons who have this infection. The infection is               many years on dialysis for kidney failure
spread by contact with blood or body secretions of           •     People who received body piercing or
an infected person, including:                                     tattoos done with non-sterile instruments
    • Injection of street drugs                              •     People with known exposures to the
    • Received blood transfusion from an infected                  hepatitis C virus, such as:
        donor                                                    o Healthcare workers injured by needlesticks
    • Accidental needlestick                                     o Recipients of blood or organs from a donor
    • Hepatitis C can be passed from mother to                     who tested positive for the hepatitis C virus
        baby during delivery                                 •     HIV-infected persons
    • Having sex with an infected person                     •     Children born to mothers infected with the
    • Sharing razors or toothbrushes that may                      hepatitis C virus
        have blood on them with an infected person
                                                          Key Findings:
Why is it important to the health
                                                                       Hepatits C Cases in Kings County
status of Kings County?
A person who has hepatitis C can still get other
types of viral hepatitis, such as hepatitis A or
hepatitis B.                                                 Community         398
Many people have some liver damage, but many
do not feel sick from the disease. Some persons
with liver damage due to hepatitis C may develop
cirrhosis of the liver and liver failure which may take     Incarcerated                 3740
many years to develop. Others have no long-term
                                                                           0     1000    2000      3000   4000
How are we doing in Kings County?
As of January 2008, Kings County Public Health
Nurses are contacting every person with a reported        Individual Primary Prevention/
case of Hepatitis C and offering health education         Deterring Activities
and resources to treat the disease. The reception            • See your doctor regularly
to this program has been positive.                           • Do not drink alcohol
                                                             • Tell your doctor about all medicines that you
Who is at risk for hepatitis C?                                are taking, even over-the-counter and herbal
Some people are at increased risk for hepatitis C,             medicines
including:                                                   • If you have liver damage from hepatitis C, you
    • Current injection drug users (currently the              should get vaccinated against hepatitis A.
      most common way hepatitis C virus is spread
      in the United States)                               Websites for More information:
    • Past injection drug users, including those who
                                                          • CDC:
      injected only one time or many years ago
    • Recipients of donated blood, blood products,
                                                          • California Department of Public Health:
      and organs (once a common means of
      transmission but now rare in the United
      States since blood screening became
      available in 1992)
What is it?                                                           Cancer Deaths in Kings County due to
                                                                      Male & Female Genital Cancers & Anal
Human Papillomavirus is the most common                                             Cancers
sexually transmitted infection in the US. It is a           12
small DNA virus that infects both men and women.            10
There are more than 100 types indentified. Most              6
HPV infections do not have symptoms and result in            4
no clinical disease.         Frequently it goes              0


















Why is it important to the health
                                                                     2002                 2003               2004            2005            2006

status of Kings County?
Studies have determined that HPV causes cervical          Individual Primary Prevention/
cancer, genital warts, and laryngeal papillomas. It       Deterring Activities
is also believed that HPV is responsible for 90% of       HPV vaccine is highly effective among females
anal cancers, 40% of vulvar, vaginal, or penile           without evidence of infection. This vaccine covers
cancers, and 12% of oral and pharyngeal cancers.          virus types known to cause genital warts and
There is a vaccine available that is licensed for girls   cervical cancer.           Advisory Committee of
ages 9 to 26 years of age.                                Immunization Practices (ACIP) experts recommend
                                                          that females aged 11-12 years get vaccinated. The
How are we doing in Kings County?                         series of 3 doses can begin as early as 9 years and
HPV infection is common among adolescents and             given up to 26 years of age. The vaccine has not
young adults. This is a non-reportable disease, so        been licensed for men.
county-wide data specific to Kings County is              Other prevention activities include:
unavailable. Based on studies, modeling estimates             • Abstaining from sexual contact
suggest that more than 80% of sexually active                 • Mutual monogamous relationships who are
women will have been infected by age 50. HPV is                   STD free
also common in men.                                           • Using latex condoms – correctly &
                                                                  consistently can reduce the risk of
Key Findings:                                                     developing HPV, but HPV can infect areas
According to the CDC:                                             not covered by a condom, so condoms may
 • Approximately 20 million Americans are                         not fully protect from HPV
   currently infected with HPV
 • At least 50% of sexually active men & women            For More information
   acquire genital HPV infection at some point in
                                                               Contact for related programs:
   their lives
                                                          Kings County Department of Public Health
 • About 1% of sexually active adults in the U.S.
                                                           Reproductive Health Clinic (559) 582-2795
   have genital warts at any one time
                                                                       For testing appointment
 • The American Cancer Society estimates related
                                                           Immunization Clinic (559) 584-1401 – For Vaccine
   to HPV for 2008:
   o 11,070 women will be diagnosed with cervical                 Websites:
     cancer in the U.S.                                   • California Department of Public Health:
   o 3,460 women diagnosed with vulvar cancer   
   o 2,210 women diagnosed with female genital            Papillomavirus(HPV).aspx
     cancers                                              • CDC:
   o 1,250 men diagnosed with male genital                • ASHA: National HPV & Cervical Cancer
     cancers                                                Prevention Resource Center:
   o 3,050 women and 2,020 men diagnosed with   
     anal cancer                                          • American Cancer Society:
What is it?                                                                             STDs include:
Sexually Transmitted Disease (STD) is serious,                                             •   Chlamydia
sometimes painful, and can cause a lot of damage.                                          •   Gonorrhea
Some STDs infect only your sexual and                                                      •   Hepatitis B
reproductive organs. Others (HIV, hepatitis B,                                             •   Herpes
syphilis) cause general body infections.                                                   •   HIV (Human Immunodeficiency Virus)
                                                                                           •   HPV (Human Papillomavirus)
Sometimes you can have an STD with no signs or                                             •   LGV (Lymphogranuloma Virus)
symptoms. Other times, the symptoms go away
                                                                                           •   MRSA (Methicillin-Resistant
without treatment. Either way, you still have the
                                                                                               Staphylococcus aureus)
STD. Many STDs can be cured. Others cannot be
                                                                                           •   PID (Pelvic Inflammatory Disease)
cured, but all STDs can and must be treated.
                                                                                           •   Syphilis
                                                                                           •   Trichomoniasis
Why is it important to the health
status of Kings County?                                                                 Individual Primary Prevention/
STD can increase the risk of complications at birth,
death, chronic pain, infertility, or multisystem                                        Deterring Activities
disease. In March of 2008, the CDC released a                                              • Abstaining from sexual contact
study estimating that one in four teenage girls have                                       • Mutual monogamous relationships who are
a Sexually Transmitted Disease.                                                                STD free
                                                                                           •   Talk to your partner about past partners and
In October of 2007, the Public Health Institute                                                about needle drug use. Don’t have sex with
released a report about the Hidden STD Epidemic                                                someone who you think may have an STD.
among California youth. In that report, it was                                             •   Using latex condoms or dental dams –
estimated that for Kings County in 2005, 5,884 new                                             correctly & consistently can reduce the risk
STD cases among 15-24-year olds would be                                                       of getting an STD.
reported, resulting in medical costs of $4 million.                                        •   It is the responsibility of both men and
                                                                                               women to carry and know how to correctly
                                                                                               use condoms.
                                                                                           •   If you notice a symptom that worries you,
How are we doing in Kings County?
                                                                                               stop having sex and get checked!!
There has been an increase in the number of
Chlamydia cases in Kings County. Chlamydia is
                                                                                           •   If you have an STD, your partner(s) must
                                                                                               get tested and treated too.
treatable, but can have long-term complications.
HIV, Herpes, and Warts – all are viruses, and you                                          •   If you have an STD, don’t have sex until
will have them for the rest of your life.                                                      your treatment is complete.

                      STDs in Kings County 2002-2006
                                                                                        For More information
         100                                                  500                            Contact for related programs:
                                                                      Chlamydia Rates

         80                                                   400                       Kings County Department of Public Health –
         60                                                   300                        Communicable Diseases (559) 584-1401

         40                                                   200                        Reproductive Health (559) 582-2795
         20                                                   100                              Websites:
           0                                                  0                         • CDC:
               2002      2003      2004   2005      2006
                                                                                        • California Department of Public Health:
           Pelvic Inflammatory Disease    Non-Gonococcal Urethritis
           Gonorrhea                      Chlamydia
                                                                                        • Find a clinic:
What is HIV?                                               How is HIV Spread?
Human: this virus can only infect human beings             Only in 3 ways
Immuno-deficiency: it harms the immune system by           B Body Fluids – Having sex (vaginal, oral, or anal)
    decreasing the body’s ability to fight off infection      with someone who has HIV in semen or vaginal
Virus: that reproduces itself by overtaking the               fluid.
    machinery of the human DNA                             B Blood
                                                              • Sharing needles with a drug user who has
You can be infected with HIV and do not know it.                   HIV
   Years can go by before you get sick.                       • Sharing needles for tattooing and body
You may look and feel fine for years and can still                 piercing can spread HIV
   pass HIV on to others.                                     • During pregnancy, childbirth from a mother
                                                                   with HIV
What is AIDS?                                                 • From a blood transfusion tainted with HIV,
AIDS stands for:                                                   which is almost zero in the US since 1985
         Acquired Immune Deficiency Syndrome               B Breastfeeding – from a mother with HIV
AIDS is the last stage of HIV disease where
unusual opportunistic infections may occur and can         How are we doing in Kings County?
be life-threatening.
                                                           Kings County Department of Public Health HIV
                                                           CARE program reports:
Why is it important to the health                          1. Most (70%) of all new HIV cases from 2006-
status of Kings County?                                       2008 were diagnosed LATE with advanced
•   Most new cases detected in the Kings HIV                  AIDS. This trend is why the new CDC HIV
    CARE Program are very late. (CARE –                       testing guideline is to voluntarily screen all
    Comprehensive AIDS Resources Emergency).                  people ages 13–64 at least once for HIV. An
• Although there is no cure, early diagnosis and              estimated 250,000 people in the US are
    treatment will delay the onset of AIDS and                infected with HIV and do not know it.
    extend lives.                                          2. Almost half (45%) of the total HIV cases are
• The modes of transmission in Kings County                   AIDS.
    CARE patients are primarily heterosexual or            3. Most (90%) new infections from 2006 – 2008
    bisexual; AIDS is not just a gay disease.                 are Latino (mainly Mexican).
• We can stop the spread of HIV epidemic with              4. Two-thirds of the HIV patients are Latino
    Free Confidential RAPID HIV Testing (30                   (mainly Mexican).
    minutes), prevention messages, awareness,              5. More women get HIV than ever before: 40% of
    and openness to talk about sex.                           the total HIV patients are female.
For Free Rapid HIV Confidential Testing:                   6. Half of the NEW infections in 2006 – 2008
Call Kings County Dept of Public Health 584-1401              occur among young people age 15 to 30, very
Program information available in Appendix.                    similar to worldwide statistics.
                                                           7. Most (95%) patients on HIV treatment have
                                                              Undetectable Viral Load.
HIV Is Preventable, know your ABC’s:
     A – Abstinence, no sex
                                                           Who should get tested?
     B – Be mutually faithful and know your
       partner’s HIV status                                Anyone who:
     C – Condoms – latex, with ONLY water-based               • has had unprotected sex
       lubricant                                              • has had more than one sex partner – EVER
     D – Drug-free to prevent poor decisions in               • has history of any sexually transmitted
       sharing needles and unsafe sex                            infection
     E – Enforce Pregnancy HIV testing to deliver             • is a man who has had sex with another man
       a safe baby                                            • has shared needles, tattooing, piercing

Case Management Services                                 •   ADAP – The AIDS Drug Assistance
                                                             Program is Federally funded through the
Case management is a critical component of                   CARE Act, as well as State funded. This
communicable disease control. Case managers                  program ensures HIV medications will be
ensure equal access to health care, coordinate               available for all clients.
resources to ensure favorable outcomes and               •   The Testing Voucher Program ensures
intervene in the transmission of infection through           access to viral load testing and resistance
behavior based education and counseling. Case                testing for low income patients.
management services are available to all
community residents with HIV and AIDS.                How is HIV not spread?
                                                         •   from shaking hands or hugging a person
AIDS Case Management available at                            with HIV/AIDS
the Kings County Department of                           •   from using a public telephone, drinking
                                                             fountain, restroom, swimming pool, or hot
Public Health:                                               tub
                                                         •   from sharing a drink/food/eating utensils
A continuum of services has been developed to            •   from being coughed or sneezed on by a
ensure all Kings County residents, regardless of             person with HIV/AIDS
ability to pay, have equal access to HIV related         •   from giving blood
care and treatment. Five programs are in place to
                                                         •   from a mosquito bite or from pets
enhance access and improve the delivery of quality
                                                      For More information:
   •   CARE – funds distributed under the Ryan             Contact for related programs:
       White Comprehensive AIDS Resources             Free Rapid HIV Confidential Testing
       Emergency (CARE) Act, Title II, and                   Mon – Fri, 8 – 4 at the
       supports core case management activities.      Kings County Department of Public Health –
       All clients are enrolled in the CARE            Communicable Disease (559) 584-1401
       Program, which ensures equal access to                Websites:
       support services and medical care.
                                                      • CDC:
   •   CMP – The Community Based Case
                                                      • Office of AIDS:
       Management Program, targets the patient
       with advanced AIDS disease or HIV
       infection complicated by concomitant health
       problems. Funding is a combination of          • AIDS.Gov:
       State and Federal monies.

   •   HOPWA – Housing Opportunities for
       Persons with AIDS, which is funded through
       Housing and Urban Development (HUD), is
       designed to provide resources and
       incentives for the development of strategies
       for meeting various types of housing needs.

What is it?                                                   Individual Primary Prevention/
Chlamydia is a common Sexually Transmitted                    Deterring Activities
Disease (STD) caused by a bacterium, which can
                                                                 • Abstaining from sexual contact
damage a woman’s reproductive organs.
Chlamydia can make women and possibly men                        • Mutual monogamous relationships who are
unable to have children. Chlamydia is transmitted                      STD free
during vaginal, anal, or oral sex.                               •     Using latex condoms – correctly &
                                                                       consistently can reduce the risk of getting
Why is it important to the health
                                                                 •     CDC recommends yearly testing for all
status of Kings County?                                                sexually active women age 25 or younger
It is important to promote awareness along with                  •     If you notice a symptom that worries you,
education for the citizens of Kings County.                            get checked!!
Chlamydia is a major cause of infertility.
                                                              Chlamydia is curable with antibiotic. Your health
How are we doing in Kings County?                             care provider will give you pills or liquid to take.
Chlamydia is the most common STD in Kings                     You have to take all the medicine because
County and the majority of those affected are                 Chlamydia might come back if you don’t. Ask your
young females.                                                health care provider when you can have sex after
                                                              treatment and tell your sex partner(s) your status.
Key Findings:                                                 Your partner must be treated too; otherwise he or
                                                              she could give Chlamydia to someone else, or back
Chlamydia –Rates – 2002-2006                                  to you.
       2002     2003     2004     2005     2006
Kings 376.5     424.9    432.0    436.7    337.2              For More information
CA     312.9    323.4    338.1    349.2    363.5                   Contact for related programs
Chlamydia – Rates for Females of selected age                      Webpage
groups – 2006
                                                              • CDC:
           15-19        15-24         15-44
Kings      2178.2       2582.7        1298.6                  • California Department of Public Health:
CA         2278.2       2529.5        1199.5
From “Sexually Transmitted Diseases in California, 2006
Annual Report”
   •   Rates are per 100,000 people.
       Female Chlamydia by Race/Ethnicity for Kings                     Male Chlamydia by Race/Ethnicity for Kings
                        County                                                          County
        0.9%      2.7%                                                     0.0%  0.9%
                                    American                                                        American
                                    Indian/Alaska Native                                            Indian/Alaska Native
           9.6%                                                              8.6%                    Asian/Pacific Islander
                                     Asian/Pacific Islander
                     13.1%                                                              18.8%

                                     Black/African-American                                          Black/African-American
        29.2%                                                        24.8%
                                     Latina/Hispanic                                                 Latina/Hispanic

                   54.1%             White                                                           White

                                     Other/Multi/Not                                                 Other/Multi/Not
                                     Specified                                                       Specified

What is it?                                                   Key Findings:
Gonorrhea is a Sexually Transmitted Disease                   Gonorrhea–Rates – 2002-2006
(STD). Anyone that is sexually active can get                        2002     2003     2004     2005      2006
gonorrhea; it is more common among teens and                  Kings 36.2      63.2     80.8     83.5      71.4
younger adults.                                               CA     69.7     71.4     83.5     92.2      90.2
Gonorrhea can easily grow in the reproductive                 Gonorrhea– Rates for select age groups, by
tract, including the cervix, in the mouth, throat,            Gender– 2006
eyes, and anus.                                                              15-24                  25-64
Gonorrhea can also be spread from mother to baby                      Females Males         Females Males
during delivery.                                              Kings     439.6      109.5       51.2       53.7
                                                              CA        376.0      229.4       55.0      112.5
Why is it important to the health                             From “Sexually Transmitted Diseases in California, 2006
status of Kings County?                                       Annual Report”
It is important to the health of Kings County                 spx
because having unprotected vaginal, anal, or oral             * Rates are per 100,000 people
sex puts you at risk of getting gonorrhea, or any
other STD.
                                                              Individual Primary Prevention/
It is also important to know that some men and                Deterring Activities
women may have no symptoms at all. Gonorrhea                     1. The safest way to avoid transmission of
can cause infertility, and may be life-threatening.                 gonorrhea is to abstain from sexual
                                                                    intercourse, or to be in a mutually-
How are we doing in Kings County?                                   monogamous relationship, where both
                                                                    persons are STD Free.
       Female Gonorrhea by Race/Ethnicity for Kings              2. Another method is when latex condoms are
                                                                    used correctly and consistently, they can
                                    Indian/Alaska Native            reduce the risk of transmitting gonorrhea.
                    12.8%            Asian/Pacific Islander      3. Get checked for gonorrhea and other STDs

       31.9%                         Latina/Hispanic          For More information:
                    53.2%            White
                                                              • CDC:
                                     Other/Multi/Not          • California Department of Public Health:
        Male Gonorrhea by Race/Ethnicity for Kings
                        County                                • AVERT – averting HIV & AIDS:
           0.0%   0.0%              American                  • Teen Source:
                                    Indian/Alaska Native      • The Well Project:
                                     Asian/Pacific Islander


                 44.7%               White


What is it?                                                 Late and Latent Stages:
Syphilis is a sexually transmitted disease caused           The latent (hidden) stage of syphilis begins when
by a type of bacteria called T. Pallidum. It can            primary and secondary symptoms disappear.
spread from person to person by physical contact            Without treatment, the infected person will continue
during vaginal, anal, or oral sex.                          to have syphilis even though there are no signs or
                                                            symptoms; infection remains in the body, and can
                                                            last for years.
Why is it important to the health
status of Kings County?                                     Individual Primary Prevention/
Knowledge about syphilis is important as it is highly
contagious, but the public should know that it is
                                                            Deterring Activities
treatable.                                                     •   Abstinence
                                                               •   Mutual Monogamy
If not treated, syphilis can cause brain damage,               •   Plan ahead & protect yourself with condoms
heart disease, and other long-term health                          & dental dams – 100% use
problems. A pregnant woman can pass syphilis to                •   If you are thinking about having sex with a
her baby which could cause permanent damage.                       new partner:
                                                                       o Talk about STDs
How are we doing in Kings County?                                      o Talk about your wish to have
                                                                           protected, safer sex
Kings County historically has low numbers, but
                                                                       o Suggest an STD check-up for both
lately, syphilis rates have been rising, even among
                                                                           of you before having sex
heterosexual partners. Syphilis is most common in
men having sex with men.
                                                            If you already have syphilis:
                                                                 • Your sex partner(s) must be examined and
Key Findings:                                                       treated. If not treated, they can give the
          Syphilis Cases in Kings County 2003-2007                  infection back to you, or infect others
                                                                 • Your syphilis blood test may stay positive
  7                                                                 (not normal) even after treatment. The
  6                                                                 Public Health Department can give you a
  5                                                                 card that shows proper treatment was given
  4                                                                 to cure your syphilis once your treatment is
  3                                                                 completed. You are no longer contagious
  2                                                                 once treatment is completed.
  1                                                              • You will need a repeat blood test one week
  0                                                                 after treatment, and then regularly during
      2003        2004         2005      2006        2007           the first year of your diagnosis treatment.
  Congenital             Early Latent
  Late Latent            Primary & Secondary
                                                            For More information
Primary Stage:
The primary stage of syphilis is usually marked by               Contact for related programs:
the appearance of a single sore (called a chancre),         Kings County Department of Public Health –
but there may be multiple sores. The time between            Communicable Disease Unit: (559) 584-1401
infection with syphilis and the start of the first                 Websites:
symptom can range from 10 to 90 days.                       • New York Online Access to Health:
Secondary Stage:                                    
Skin rash and mucous membrane lesions                       • American Social Health Association:
characterize the secondary stage. This stage        
typically starts with the development of a rash on
                                                            • CDC:
one or more areas of the body.
What is it?                                                                    Tuberculosis Cases by Age Group, Kings County,
Tuberculosis is caused by an unusual bacterium.                          12
Most people infected with the bacteria never                             11
develop the disease. While the disease can involve                       10
any body organ, it most commonly involves the

                                                            # of Cases
lungs. Tuberculosis is spread when a person with                          7
tuberculosis of the lungs coughs. Tuberculosis is                         6
only moderately contagious. Most people become                            4
infected only after prolonged exposure.                                   3
Why is it important to the health                                         0
status of Kings County?                                                         2007          2005         2002         2001         2000
Tuberculosis is a major problem in most of the                                0-4   5 to 14     15 to 24     25 to 44     45 to 65     65+
world. Worldwide, it’s estimated that there are
around two million deaths per year due to                  Most cases of tuberculosis in Kings County occur in
tuberculosis.   Tuberculosis is preventable and            the population over age 25.
curable.    Most nations lack the resources to
manage tuberculosis.                                       Individual Primary Prevention/
                                                           Deterring Activities
How are we doing in Kings County?
                                                           Most Kings County residents need have little
Active tuberculosis is not common in Kings County.
                                                           concern about tuberculosis. Residents who’ve
Only around seven cases of active disease are
                                                           lived in less developed areas of the world should
diagnosed per year.        Tuberculosis infection is
                                                           have a skin test to see if they are infected with the
infrequently acquired in Kings County. Probably
                                                           tuberculosis bacteria. Those found to be infected
less than ten people a year acquire tuberculosis
                                                           can be treated to prevent the later development of
infection while living in Kings County. Most of the
                                                           tuberculosis. The treatment takes nine months. It
Kings County residents infected with the
                                                           is important that the full treatment course be
tuberculosis bacteria acquired their infection
outside the United States. About 80% of the cases
of active tuberculosis were born outside the United
States.                                                    For More information
                                                           • California Department of Public Health:
        Tuberculosis Cases and Rates by Year,
              Kings County, 1998-2007                        /Tuberculosis.aspx
  18                                                       • CDC:
                                       # Cases
                                       Rate per 100,000
  14                                                         ntro1
       1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

The Kings County Department of Public Health Bioterrorism /
Disaster Preparedness Department is dedicated to ensuring the
safety and security of this community by building strong,
collaborative partnerships at the local and state levels as well as
between the public and private sectors.

Chapter Highlights:

       During Extreme Heat: Wear appropriate clothing and
       sunscreen: choose lightweight, light-colored, loose-fitting
       In your Emergency Kit, you should have water, one gallon of
       water per person per day for at least three days, for drinking
       and sanitation.
       More than 500,000 people died from influenza in the United
       States in 1918. Approximately 262,725 Americans were
       killed, wounded, or reported missing during World War I from

                            In this chapter:

                            Extreme Heat….…………………. 81
                            Hazard Specific Emergencies….. 82
                            Pandemic Influenza....…………... 83
                            Personal Preparedness…………. 84
                            Household Preparedness………. 84

What is it?                                                     •   Wear appropriate clothing and sunscreen:
Heat kills by pushing the human body beyond its limits.             choose lightweight, light-colored, loose-
In extreme heat and high humidity, evaporation is                   fitting clothing. Sunburn affects your body’s
slowed and the body must work extra hard to maintain                ability to cool itself & causes a loss of body
a normal temperature. Most heat disorders occur                     fluids
because the victim has been overexposed to heat or              •   Pace yourself: if you are not accustomed to
has over-exercised for his or her age and physical                  working or exercising in a hot environment,
condition. Older adults, young children, and those who              start slowly and pick up the pace gradually
are sick or overweight are more likely to succumb to
                                                                •   Stay cool indoors: stay indoors and in an air
extreme heat. Conditions that can induce heat-related
                                                                    conditioned place if possible. If your home
illnesses include stagnant atmospheric conditions and
                                                                    does not have air conditioning, go to the
poor air quality.
                                                                    shopping mall or public library – even a few
                                                                    hours spent in air conditioning can help your
How to Prepare for Extreme Heat:                                    body stay cooler when you go back into the
   •   Have a supply of water on hand to prevent                    heat. Electric fans will not prevent heat-
       dehydration, as well as ample sunscreen to                   related illness above 90 degrees, taking a
       protect your skin against the sun’s harmful rays             cool shower or bath is a much better way to
   •   Install window air conditioners snugly; insulate if          cool off
       necessary                                                •   Use a buddy system – when working in the
   •   If you have an air conditioner, make sure that it            heat, monitor the condition of your co-
       works properly before the summer beings.                     workers and have someone do the same for
       Check air conditioning ducts for proper                      you
       insulation                                               •   Monitor those at high risk
   •   Install temporary window reflectors (for use                 o Infants and children up to 4 years of age
       between windows and drapes), such as                         o People 65 years of age or older
       aluminum foil-covered cardboard, to reflect heat             o People who are overweight
       back outside                                                 o People who work or exercise outside
   •   Weather-strip doors and cover windows that                   o People who are physically ill, especially
       receive morning or afternoon sun with drapes,                      with heart disease or high blood
       shades, awnings, or louvers. (Outdoor awnings                      pressure,    or    who     take   certain
       or louvers can reduce the heat that enters a                       medications such as for depression,
       home by up to 80%)                                                 insomnia, or poor circulation

What to Do During a Heat Emergency:                          Car Safety:
Kings County has drafted an Extreme Heat Response            During hot weather, intense heat can build up
Plan. Monitor weather conditions. Stay tuned to TV           quickly in a closed or nearly closed car. Children
and radio broadcasts for advisories and notices on how       and pets can die from heat stroke in a matter of
to escape the heat. The following tips can help you          minutes when left in a closed car. Never leave
during such an event:                                        children or pets in a parked car during periods of
                                                             intense summer heat.
    • Drink plenty of fluids: don’t wait until you are
       thirsty to drink
       o Warning – if your doctor generally limits the       For More information:
           amount of fluid you drink or has you on           Kings County Department of Public Health –
           water pills, ask how much you should drink         Bioterrorism / Disaster Preparedness Online:
           while the weather is hot                
    • Eat small, frequent meals: avoid high-protein

Chemical Emergencies:                                        atomic mushroom cloud. A dirty bomb works
A hazardous chemical is a toxic gas, liquid, or solid that   completely differently and cannot create a nuclear
can poison people and the environment. A chemical            blast. A dirty bomb spreads smaller amounts of
emergency occurs when a hazardous chemical is                radioactive material into the surrounding area for
released and the release has the potential for harming       the main purpose of frightening people and
people’s health.         Chemical releases can be            contaminating buildings or land.
unintentional, as in the case of an industrial accident,
or deliberate, as in the case of a terrorist attack.         The main danger from a dirty bomb is from the
                                                             explosion, which can cause serious injuries and
You may be exposed to a chemical in three ways:              property damage. The radioactive materials used in
   1. Breathing the chemical                                 a dirty bomb would probably not create enough
   2. Swallowing contaminated food, water, or                radiation exposure to immediately cause serious
      medication                                             illness, except to those people who are very close
   3. Touching the chemical, or coming into contact          to the blast site. However, the radioactive dust and
      with clothing or things that have touched the          smoke spread by the explosion could be dangerous
      chemical                                               if it is inhaled. Because people cannot see, smell,
                                                             feel, or taste radiation, you should take immediate
Remember – you may be exposed to chemicals even              steps to protect yourself and your loved ones.
though you may not be able to see or smell anything
                                                             Nuclear Blasts:
                                                             A nuclear blast is an explosion with intense light
Biological Emergencies:                                      and heat, a damaging pressure wave and
A biological attack is the deliberate release of germs or    widespread    radioactive    material  that   can
other biological substances that can make you sick.          contaminate the air, water and ground surfaces for
Many agents must be inhaled, enter through a cut in          miles around. The bombs dropped on Hiroshima
the skin, or be eaten to make you sick. Some                 and Nagasaki, Japan, at the end of World War II
biological agents, such as anthrax, do not cause             produced nuclear blasts.
contagious diseases. Others, like the smallpox virus,
can result in diseases that can be spread person-to-         The effects on a person from a nuclear blast will
person.                                                      depend on the size of the bomb and the distance
                                                             the person is from the explosion. However, a
Signs of a Biological Threat:                                nuclear blast would likely cause great destruction,
A biological attack may not be immediately obvious.          death, and injury, and have a wide area of impact.
While it is possible that you will see signs of a
biological attack, as was sometimes the case with the        In a nuclear blast, injury or death may occur as a
anthrax mailings, it is perhaps more likely that local       result of the blast itself or as a result of debris
health care workers will report a pattern of unusual         thrown from the blast.
illness or there will be a wave of sick people seeking
emergency medical attention. You will probably learn
of the danger though an emergency radio or TV
                                                             For More information:
broadcast.                                                   Kings County Department of Public Health –
                                                              Bioterrorism / Disaster Preparedness Online:
Radiological Emergencies:
A dirty bomb, or radiological dispersion device (RDD),
is a bomb that uses conventional explosives such as
dynamite to spread radioactive materials in the form of
powder or pellets. A dirty bomb is not the same as a
nuclear blast. A nuclear blast involves the splitting of
atoms and a huge release of energy that produces the
What is it?
A pandemic is a global disease outbreak. A flu              The “Asian Flu” of 1957-58 caused approximately
pandemic occurs when a new influenza virus emerges          70,000 deaths in the United States.
for which people have little or no immunity, and for                                From
which there is no vaccine. The disease spreads easily
                                                                 The virus came to the United States quietly,
person-to-person, causes serious illness, and can                  with a series of small outbreaks over the
sweep across the country and around the world in very           summer of 1957. When children went back to
short time.                                                      school in the fall, they spread the disease in
                                                                   classrooms and brought it home to their
Why is it important to the health status                        families. Infection rates were highest among
                                                                 school children, young adults, and pregnant
of Kings County?                                                 women in October 1957. Most influenza-and
Kings County’s health care community is already                 pneumonia-related deaths occurred between
stressed on a day-to-day basis, especially during               September 1957 and March 1958. The elderly
annual flu seasons; when the next pandemic strikes              had the highest rates of death. By December
Kings County will be forced to respond to the incident               1957, the worst seemed to be over.
as a community as the likeliness of outside resources
being brought in is slim to nothing. Our neighbors in all        However, during January and February 1958,
directions will likely be attempting to respond as well.         there was another wave of illness among the
                                                                  elderly. This is an example of the potential
                                                                 "second wave" of infections that can develop
Past Pandemic influenza outbreaks:                                during a pandemic. The disease infects one
From                                         group of people first, infections appear to
         By late September, influenza was present                  decrease and then infections increase in a
    throughout the West Coast. Within two weeks of                     different part of the population.
   the first reported outbreak in Massachusetts, over
         35,000 people throughout California, had
   contracted influenza. According to state officials,      1968-69, "Hong Kong flu," caused about 34,000
   influenza was most prevalent in the southern part        deaths in the United States. This virus was first
      of California but the death toll was high across      detected in Hong Kong in early 1968 and spread to
       the state. In early November, the number of          the United States later that year. This strain of
    reported cases peaked at over 115,000. Because          Influenza viruses still circulate today.
    officials were overwhelmed by the pandemic and
       unable to keep accurate records, the actual
    number of cases was probably much higher than           Individual Primary
         The disease peaked in the fall. Influenza          Prevention/Deterring Activities:
     remained prevalent throughout the state during
   the winter and spring of 1919. The disease did not       Kings County has established work groups which
        begin to disappear from the state until the         include local health care providers/facilities and
                      summer of 1919.                       community partners to assist in the planning efforts
                                                            for the citizens of Kings.
More than 500,000 people died from influenza in the
United States, and up to 50 million people may have         For More information:
died worldwide during the 1918 pandemic.                    • California Department of Public Health –
Approximately 262,725 Americans were killed,                  Be Prepared California:
wounded, or reported missing during World War I and 
nearly 30.5 million worldwide from July 1914-Nov 1918.      • CDC – Emergency Preparedness &
                         From:          Response:

Emergency Supplies                                           Additional Items to Consider Adding
                                                             to an Emergency Supply Kit:
All Americans should have some basic supplies on
hand in order to survive for at least three days if an       •   Prescription medications and glasses
emergency occurs. Following is a listing of some basic       •   Infant formula and diapers
items that every emergency supply kit should include.        •   Pet food and extra water for your pet
However, it is important that individuals review this list   •   Important family documents such as copies of
and consider where they live and the unique needs of             insurance policies, identification, and bank
their family in order to create an emergency supply kit          account records in a waterproof, portable
that will meet these needs. Individuals should also              container.
consider having at least two emergency supply kits:          •   Cash or traveler’s checks and change
    • One full kit at home                                   •   Emergency reference material such as a first
    • One smaller, portable kit at their workplace, in           aid book or information from
        their vehicle, or other places they spend time.      •   Sleeping bag or warm blanket for each person.
                                                                 Consider additional bedding if you live in a cold-
Recommended Items to Include in a                                weather climate
Basic Emergency Supply Kit:                                  •   Complete change of clothing including a long-
                                                                 sleeved shirt, long pants, and sturdy shoes.
   •   Water, one gallon of water per person per day             Consider additional clothing if you live in a cold-
       for at least three days, for drinking and                 weather climate
       sanitation                                            •   Household chlorine bleach and medicine
   •   Food, at least a three-day supply of non-                 dropper – when diluted nine parts water to one
       perishable food                                           part bleach, bleach can be used as a
                                                                 disinfectant. Or, in an emergency, you can use
   •   Batter-powered or hand crank radio and a
                                                                 it to treat water by using 16 drops of regular
       NOAA Weather Radio with tone alert and extra
                                                                 household liquid bleach per gallon of water.
       batteries for both
                                                                 Do not use scented, color safe, or bleaches
   •   Flashlight and extra batteries
                                                                 with added cleaners!
   •   First aid Kit (
                                                             •   Matches in a waterproof container
   •   Whistle to signal for help
                                                             •   Feminine supplies and personal hygiene items
   •   Dust mask, to help filter contaminated air
                                                             •   Mess kits, paper cups, plates, plastic utensils,
   •   Plastic sheeting and duct tape to shelter-in-             and paper towels
                                                             •   Paper and pencil
   •   Moist towelettes, garbage bags, and plastic ties
                                                             •   Books, games, puzzles, or other activities for
       for personal sanitation’
   •   Wrench or pliers to turn off utilities
   •   Can opener for food (if kit contains canned
   •   Local maps

For More information:
Kings County Department of Public Health –
 Bioterrorism / Disaster Preparedness Online:

AIDS.Gov:                                California Department of Health Care Services, Medi-
Alzheimer’s Association,                     cal/pages/default.aspx

American Cancer Society,                  California Department of Public Health, 2006 Birth
                                                         Records. (2006). “California Birth Profiles by Zip
American Diabetes Association,
American Heart Association,
                                                         California Department of Public Health, Alzheimer
American Lung Association,               Disease,
California Air Resources Board, Air Quality Data         r%27sDiseaseProgram.aspx
                                                         California Department of Public Health, Arthritis
California Center for Public Health Advocacy, “The       Partnership Program,
Food Landscape in California Cities and Counties.”
                                                         California Department of Public Health, Birth Records,
                                                         “Live Births by Age of Mother (Detailed Under Age
California Department of Education – Dataquest
                                                         20), California Counties…, 2005.”
“District Information”,
California Department of Education – Dataquest
“Grade 12 Enrollment and Graduates”,
                                                         California Department of Public Health, Birth Records,
                                                         “Number and Percent of Live Births with Late or No
                                                         Prenatal Care, California Counties, 1996-2005.”
California Department of Finance, Economic     
Research Unit, “Per Capita Personal Income by            C-2006-0219.pdf
County, California, 1994 to 2004”                     California Department of Health Services, Birth,
                                                         Death, and Fetal Death Records, “Live Births, Deaths,
California Department of Finance, Demographic            Maternal Deaths, Fetal Deaths, and Infant Deaths by
Research Unit & U.S. Citizenship and Immigration         Age, California Counties,”
Services, “They Moved and Went Where?” California
Department of Public Health. (2008).                     APriorReports.aspx

California Department of Food & Agriculture,             “The Cost of Smoking in California, 1999,” California                                          Department of Health Services, December 2002.
California Department of Public Health, California        California Department of Public Health, County Health
Diabetes Program,                                         Status Profiles 2008.

California Department of Public Health, California        California Department of Public Health, “County
Tobacco Program,                                          Health Status Profiles” 2003, 2004, 2005, 2006, 2007
California Department of Public Health, Center for
Family Health, Genetic Disease Screening Program,         California Department of Public Health, Diseases and
Newborn Screening Data 2004 – 2007.                       Conditions, Hepatitis C,
California Department of Public Health, Center for        c.aspx
Family Health, Maternal, Child, and Adolescent
Health Program, Genetic Disease Screening                 California Department of Public Health, Disease
Program. (2004). Newborn Screening Data, 2004.            Investigation Section,
California Department of Public Health, Center for
Family Health, Maternal, Child, and Adolescent            California Department of Public Health, Epidemiology
Health Program, Genetic Disease Screening                 and Prevention for Injury Control (EPIC) Branch,
Program. (2005). Newborn Screening Data, 2005.            EPICenter California Injury Online

California Department of Public Health, Center for        California Department of Public Health, High Blood
Family Health, Maternal, Child, and Adolescent            Pressure,
Health Program, Genetic Disease Screening       
Program. (2006). Newborn Screening Data, 2006.            dPressure.aspx

California Department of Public Health, Center for        California Department of Public Health, Influenza,
Family Health, Maternal, Child, and Adolescent  
Health Program, Genetic Disease Screening                 uenza(Flu).aspx
Program. (2007). Newborn Screening Data, 2007.
                                                          California Department of Public Health, Lead
California Department of Public Health, Center for        Poisoning Prevention Branch,
Health Statistics, Vital Statistics Query System.
(2008),                                                   hildrenAtRisk.aspx
California Department of Public Health, Center for        California Department of Public Health, Office of
Health Statistics, Vital Statistics Query System, Birth   AIDS,
                                                          California Department of Public Health, Sexually
California Department of Public Health, Child             Transmitted Diseases Data, “Sexually Transmitted
Passenger Safety,                                         Diseases in California, 2006 Annual Report.” 
California Department of Public Health, Statewide          Centers for Disease Control and Prevention,
Birth Statistical Data Tables. (200x).                     Immunization schedules, ,
                                                           Centers for Disease Control and Prevention, Motor
California Department of Public Health, Tuberculosis,      Vehicles,
                                                           Centers for Disease Control and Prevention, Poison,
California Department of Public Health, Tuberculosis
Disease Data,      Centers for Disease Control and Prevention,
osisDiseaseData.aspx                                       Preconception Care,
California Department of Public Health, Vital Statistics
Death Statistical Master File                              Centers for Disease Control and Prevention, PreTeen                Vaccinations,

California Department of Public Health, West Nile          Centers for Disease Control and Prevention, Suicide
Virus,                                 Prevention, “Understanding Suicide Fact Sheet.”
California Highway Patrol, Statewide Integrated
Traffic Records System (SWITRS),                                      Centers for Disease Control & Prevention (CDC),
California Integrated Waste Management Board,
                                                           City of Hanford – Water System Information,
California SIDS Program, “SIDS in California,”             %20Water%20Division.htm
                                                           Community Health Status Report, Kings County 2001-
Centers for Disease Control and Prevention, BMI
Chart for Adults,
                                                           C-Stats, County and Statewide Archive of Tobacco
Centers for Disease Control and Prevention,                Statistics,
                                                           CUPA, Cal-EPA Unified Program,
Centers for Disease Control and Prevention, Falls,

Centers for Disease Control and Prevention, HIV,           Department of Health & Human Services & USDA,      
Centers for Disease Control and Prevention, HPV,                                  Dietary Guidelines,
Economic Development Department,                        National Institute on Drug Abuse,                    

Environmental Protection Agency,       National Stroke Association,

Immunization goals provided by Kings County
                                                        Office of the Surgeon General, “US Surgeon
Department of Public Health Immunization Staff
                                                        General’s Call to Action to Prevent and Decrease
                                                        Overweight and Obesity, 2001.”
 “Increase in Coccidioidomycosis California, 2000-
2006” presentation by CDPH Infectious Diseases
                                                        Public Health Institute, “Hidden Epidemic Among
                                                        California Youth.”
Kings County Agricultural Commissioner,

                                                        Review of patient charts from Family Planning
Kings County Asthma Coalition,                          Division of Kings County Department of Public Health
                                                        San Joaquin Valley Air Pollution Control District,
Kings County Department of Public Health, Division of
Environmental Health Services,
                                                        Smart Growth Online,
Kings County Department of Public Health, Food
Safety,                                                 UCLA California Health Interview Study, 2005,

                                                        US Census Bureau, 2006 American Community
Kings County Department of Public Health,
                                                        Survey – Economic Profile,
Hazardous Materials and Wastes Website,
                                                        US Census Bureau, Census 2000 Summary File 1
                                                        and Summary File 3,
Kings County Economic Development Corporation,                                        US Census Bureau, “Earnings by Occupation and
Kings County Planning Agency,
                                                        USDA My,
La Leche League International,

National Center for Chronic Disease Prevention and      US EPA,
Health Promotion,
                                                        Weekly Morbidity Report, sorted by place of report
National Heart Lung and Blood Institute,
A                                F
AIDS                     72,73   Food Safety                 54
Air Quality                 53
Alcohol use                 42   G
Alzheimer’s                 31   Genital Warts               70
Arthritis                   32   Gonorrhea                   75
Asthma                      33
B                                Hazardous Materials          55
Birth Control               13   Health Care – Access to      41
Births                   11,16   Heart Disease                34
Breastfeeding               18   Hepatitis C                  69
                                 HIV                       72,73
C                                Household Preparedness       84
Calories                   iii   Housing                      6
Cancer                     26    HPV                          70
Cardiovascular Disease     34    Hypertension                 36
Chlamydia                  74
Coccidioidomycosis         67    I
Car Seats                  48    Immunizations – Infants     63
                                 Immunizations – Preteen     64
D                                Immunizations – Adult       65
Deaths                     23    Income                      4
Diabetes                   35    Infant Mortality            19
Diet                       43    Influenza                   66
Disaster Preparedness      79    Injuries Intentional        24
Drug Use                   44    Injuries Unintentional      25

E                                J
Education, Level of        7
Emergencies,                     K
     Hazard Specific       82
Extreme Heat               81
L                                  Suicide           27
Land Use Planning             56   Syphilis          76
Large Employers               8
Lead Poisoning                57   T
                                   Teen Births       17
M                                  Tobacco Use       49
Metabolic Syndrome            37   Toxic Chemicals   59
                                   Tuberculosis      77

Nutrition                     43
                                   Unemployment      9

Obesity                       45
                                   Valley Fever      67

Pandemic Influenza            83
                                   Water             60
Personal Preparedness         84
                                   West Nile Virus   68
Physical Activity             46
Planned Pregnancy             13
Population                    3
Poverty                       4
Pre-Conception Health Care    14
Prenatal Care – Inadequate    15   Y
Prenatal Care – Late Entry    15
Prevention of Birth Defects   14   Z


Retail Food Sales             47

School Lunches                5
Solid Waste Management        58
Seat Belts                    48
Sexually Transmitted
      Diseases                71
SIDS                          20
Stroke                        38

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